The Free Sign in morphea and other sclerosing disorders: A clue to the presence of early sclerosis?

Background The Floating Sign is a histopathologic clue to the diagnosis of autoimmune sclerosing skin disorders such as morphea and interstitial granulomatous dermatitis (IGD). On the other hand, the “free‐floating” sign has been associated with neoplasms, for example, dermatofibroma and interstitia...

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Bibliographic Details
Published in:Journal of cutaneous pathology 2024-01, Vol.51 (1), p.58-62
Main Authors: Ortega‐Springall, Maria Fernanda, Yang, Sarah, Mitra, Anupam, Fung, Maxwell A.
Format: Article
Language:English
Subjects:
collagen trapping
Dermatitis
floating sign
free sign
free‐floating sign
Graft-versus-host reaction
Immunoglobulin D
morphea
Mycosis
Mycosis fungoides
Scleroderma
Sclerosis
Skin diseases
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Summary:Background The Floating Sign is a histopathologic clue to the diagnosis of autoimmune sclerosing skin disorders such as morphea and interstitial granulomatous dermatitis (IGD). On the other hand, the “free‐floating” sign has been associated with neoplasms, for example, dermatofibroma and interstitial mycosis fungoides. Herein, we report the Free Sign in sclerosing skin disorders. Methods In a case‐control study, we applied detailed histopathologic definitions of Floating Sign and Free Sign to assess their presence in morphea, IGD, and other sclerosing disorders. Results Free Sign was present in most cases of morphea (46/55, 84%) and IGD (7/13, 54%) but not necrobiosis lipoidica (NL) (6/14, 42.8%) or sclerodermoid graft versus host disease (SGVHD) (2/7, 28.5%). The sensitivity and specificity of Free Sign for morphea versus other disorders was 84% and 56%, respectively. Floating Sign was not identified in most cases: NL (3/14, 21.4%), SGVHD (1/7, 14.2%), morphea (5/55, 9%), IGD (1/13, 7.7%). The diagnostic sensitivity of Floating Sign in morphea was 9%. Conclusions The Free Sign was present in most cases of morphea in our series and may represent a clue to the presence of evolving sclerosis. Free Sign may be seen in other sclerosing disorders. Technical artifact is a potential cause of a false‐positive Free Sign.
ISSN:0303-6987
1600-0560
DOI:10.1111/cup.14421