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May 1993

From Basket Weave to Barrier: Unifying Concepts for the Pathogenesis of the Disorders of Cornification

Author Affiliations

Departments of Dermatology and Pediatrics University of California; Dermatology Service Department of Veterans Affairs Medical Center and Department of Dermatology University of California 4150 Clement St San Francisco, CA 94121

Arch Dermatol. 1993;129(5):626-629. doi:10.1001/archderm.1993.01680260096015

Although "normal basket-weave keratin pattern," in which hematoxylin-eosin—stained sections of the stratum corneum seem to float over the epidermis like a lofty cumulus over an otherwise perfect day, the normal stratum corneum is, in fact, the highly organized end product of the carefully orchestrated process of epidermal differentiation. It is an ever-renewing system, designed to keep the "good things in" and the "bad things out"; to dissipate in an orderly and invisible manner; and to inform the epidermal machinery below about its current status and requirements. Despite the general usefulness of comparing the stratum corneum to a brick wall (the "bricks and mortar" hypothesis), this oversimplified view no longer does justice to emerging information about the complexity of stratum corneum cellular and intercellular compartments.1 Moreover, this model does not encompass new information about homeostatic connections between the stratum corneum and the underlying, mother epidermis.2-4

The term cornification embraces the many components of the stratum corneum, including both

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