What Is the Auspitz Sign?
Auspitz sign is a distinctive mark seen when a skin plaque has been removed. Plaques (also called scales) are common in plaque psoriasis, but people with Darier′s disease and actinic keratosis may also have the Auspitz sign.
It looks like dots of blood, though the skin may not be broken and bleeding. Instead, the tiny blood vessels underneath the skin have ruptured and brought blood to the surface of the skin where you can see them.
The “Auspitz” name comes from Heinrich Auspitz, an Austrian dermatologist who lived in the mid-1800s and discovered the skin marking. Some people say he wasn’t the original observer, though, as other researchers had described the Auspitz sign before him. Still, Auspitz tends to get the credit for the discovery because his name was associated with it.
The Auspitz sign is one of the most well-known dermatologic structures. Though there’s published research on its existence, there’s not much on how to make it go away. Instead, trying to clear it up is done by treating the underlying condition, such as psoriasis.
Auspitz sign vs. Koebner phenomenon
The Auspitz sign may be confused with the Koebner phenomenon, but they’re not the same thing.
The Koebner phenomenon happens when new lesions appear on skin that’s already damaged from injury or burns. The phenomenon is most studied in people with psoriasis.
It’s commonly seen in people who develop psoriasis at a young age, those with psoriasis that’s not well-controlled, those who have undergone multiple treatments, and people who are stressed out. The Koebner phenomenon is more likely to happen in colder weather than in warmer temperatures.
Plaques from the Knoebner phenomenon can show up anywhere in your body, even if they’re not in areas where you usually have psoriasis plaques.
Some research shows that the phenomenon happens less frequently when you’re in remission from psoriasis. It can occur whether you have mild or severe psoriasis, too.
The Auspitz sign differs from the Koebner phenomenon, but it’s similar to the Auspitz sign in that the phenomenon can be used to help a doctor make an official psoriasis diagnosis.
Auspitz Sign Causes
When a psoriasis scale flakes off your skin or you remove it, you may notice an Auspitz sign.
The sign is caused by thinning in the inner layer of skin. Because the skin is so fragile, blood vessels break and cause the appearance of specks of blood.
Psoriasis isn’t the only condition that’s common in people with the Auspitz sign, so it’s not the only cause. The Auspitz sign is also seen in people with actinic keratosis or Darier’s disease.
Why does the Auspitz sign happen with psoriasis?
The skin under a psoriasis plaque is thin. The blood vessels may be more prone to break because of that. When the vessels break, they release specks of blood to the surface of the skin. You can see an Auspitz sign when a plaque flakes off or is removed.
Though removing plaques or scales can be beneficial, it’s important not to simply scrape them off. Doing so can open your skin up for infection or increase a flare. Instead, salicylic acid or lactic acid may help gently remove scales. (You may then notice an Auspitz sign.)
Auspitz Sign Symptoms
Psoriasis plaques can be reddish in appearance with thick skin that’s covered by silver or white scales. People with darker skin may have plaques that look brown, gray, or purple. Darker skin tones tend to have thicker plaques.
The Auspitz sign looks like small specks of blood underneath the skin. It may appear differently depending on your skin tone.
Auspitz Sign Diagnosis
Just because you see an Auspitz sign under a scale doesn’t mean you have psoriasis.
In one study on 234 patients, 41 of them with psoriasis had Auspitz sign and the rest didn’t.
If you have Darier′s disease and actinic keratosis, you may notice the marking.
Your doctor may use different methods to diagnose what’s causing the Auspitz sign.
Psoriasis
The Auspitz sign is common in people with psoriasis, but it doesn’t always mean that you have psoriasis. To see if you have psoriasis, your health care professional will look at your skin, nails, and scalp. The doctor may ask about your symptoms including joint issues, as well as details on any relatives with the disease. They may perform a skin biopsy, which involves removing a small piece of skin to examine it under a microscope.
Your provider may look for Auspitz sign, but it’s not the only factor that goes into a diagnosis.
Actinic keratosis
Ongoing sun exposure over time can cause this condition, which results in rough, scaly patches on the skin. Your doctor may diagnose it just by looking at your skin or perform a biopsy. They can also check for the Auspitz sign, as it is seen in people with actinic keratosis.
Darier’s disease
Darier’s disease is a skin disorder that causes wart-like marks on the body that can flare up like psoriasis. You may be able to see the Auspitz sign on your skin, as people with the disease can have it.
To diagnose this genetic disease, your doctor may use genetic testing or biopsy.
Auspitz Sign Treatment
Your doctor won’t recommend a separate treatment for the Auspitz sign. If a plaque is removed and your skin is bleeding, they may cover it and suggest topical substances to avoid an infection. Instead, the best way to treat it is to treat the underlying condition.
Psoriasis
A variety of treatments for psoriasis include:
- Putting creams and ointments directly on the skin
- Using light therapy (phototherapy)
- Oral or injectable medications
Actinic keratosis
Sometimes actinic keratosis goes away on its own, though it can come back if you’re in the sun a lot.
Your doctor may suggest:
- Applying a cream or gel on your skin in order to remove the spots
- Laser therapy
- Light therapy
- Scraping
- Freezing (cryotherapy)
Darier’s disease
To treat this rare yet chronic disease, your doctor may advise you to:
- Avoid warm temperatures and wear sunscreen
- Put on topical steroids or antiseptics to ease inflammation and stop bacterial growth
- Use oral or topical retinoids
Prognosis
The Auspitz sign is just one indicator that you may have psoriasis, actinic keratosis, or Darier’s disease. Your doctor will try to diagnose which condition you have instead of just treating the Auspitz sign.
If the cause of your Auspitz sign is psoriasis, for example, it’s important to know that psoriasis is a chronic condition that can come and go. Sometimes, psoriasis can calm down and clear up, but it can also flare up unpredictably. When you treat psoriasis, you can consider medications, but there are lifestyle changes that may help. Specifically, avoiding stress can protect you from a flare-up or ease symptoms if you do experience a flare.
If you treat the underlying health problem, it may help the speckles go away, at least temporarily, and potentially cause the speckling to dissipate.
Takeaways
Psoriasis is caused by abnormal growth of skin cells known as keratinocytes. The cells grow faster than the body can shed them, producing plaques or scales. If a plaque is removed, you may see speckled dots underneath the skin even if it’s not bleeding. This is known as the Auspitz sign.
Not everyone with psoriasis has it, and it can emerge in other conditions like actinic keratosis and Darier’s disease.
To try and get rid of the spots, you need to treat the underlying cause. Treatments are available for each related condition.
Auspitz Sign FAQs
What is the Auspitz sign?
The Auspitz sign is a skin marking that is common in psoriasis, and it may mean that you have psoriasis. People with Darier′s disease and actinic keratosis also may exhibit this skin marking, which appears when a plaque is removed.
The spot itself looks like dots of blood, though the skin may not be broken and bleeding. Instead, the tiny blood vessels underneath the skin break and bits of blood move to the surface of the skin where you can see it suspended under the skin’s surface.
What is the Auspitz sign mechanism of the disease?
Auspitz sign isn’t a mechanism of the disease. It’s a skin marking that’s often associated with psoriasis, though not everyone with psoriasis has the speckled marking. The mechanism behind psoriasis, specifically, is a genetic skin disease that affects the immune system, causing an overgrowth of cells.
What is the Auspitz sign of guttate psoriasis?
Guttate psoriasis is just one type of psoriasis. This form of psoriasis often occurs after an infection like strep throat. Most people recover completely from it, though it becomes chronic plaque psoriasis in about one-third of people. The Auspitz sign is often seen when a scale is removed in people with plaque psoriasis.
Why does bleeding occur in the Auspitz sign?
The Auspitz sign is characterized by small specks of blood that come to the surface of the skin but stay underneath it. In many cases, there’s no actual bleeding so long as the plaque is removed gently.
