To the Editor:
This letter to the editor comes from a project one of us (J.G.) did exploring the true origin of a famous histological feature in an attempt to find the truth behind how it came to be Pautrier's namesake. We thought it might be of interest to the greater community to put all of the puzzle pieces into one document.
The story starts with Jean Ferdinand Darier who was a French pathologist born in Budapest, Hungary, and later became a dermatologist. He is regarded as one of the most influential figures in the history of French dermatology and is credited with discovering “minute cellular nests filled with lymphocytes” in 1887 that are diagnostic for mycosis fungoides.1 At first, they were called “Darier's epidermal nests” and later came to be known as “petits nids cellulaires,” as they are known in French.1–3
Lucien Marie Pautrier was born in 1876 and was only 11 years old when Darier made the discovery of the small collection of cells.2 Nevertheless, Pautrier went on to become a prominent French dermatologist with great contributions throughout the era of World War II. In 1922, the Rockefeller Institute invited Pautrier and 2 of his well-known colleagues, George Masson and Paul Bouin, to North America to give lectures.4 Pautrier himself had referred to “Darier's epidermal nests” as “petits nids cellulaires,” effectively separating Darier from his discovery.1–3
Separately, in 1926 during a meeting of the New York Society of Dermatology in the United States, it is noted that the term “Darier's epidermal nests” was used.3,4 However, that is one of the only times in the United States where Darier is associated with his discovery.
What follows these events has become quite controversial. Incorrectly, Dr. Louis H. Winer is credited with linking the American microabscess with Pautrier's work on the “petits nids cellulaires in 1946 at the 66th annual meeting of the American Dermatological Association.2 However, thanks to the work of another one of us (B.C.), Dr Cribier was able to locate a critical piece of information regarding a meeting in 1927 of the New York Society of Dermatology where Fred Wise gave a presentation on mycosis fungoides.4 Pautrier was in attendance during this meeting, and considering his extensive knowledge on the subject and his reference to these epidermal nests as mere “petits nids cellulaires,” a term which precluded Darier from being credited, it is posited that the members who attended the 1927 New York Society of Dermatology meeting are responsible for propagating the idea that Pautrier discovered them.3,4
Many years later in 1932, American dermatopathologists documented the small collection of cells as having a pattern that resembled a Munro abscess and this established it as a microabscess from the American perspective.2 We suspect that the dermatopathologists in 1932 were unaware of the New York Society of Dermatology's 1926 recognition of Darier's discovery because information at the time was not as easily communicated.
Once Pautrier gained credit in America in 1927, and US dermatopathologists in 1932 established the epidermal nests as a microabscess, the term “Pautrier's microabscess” became common place among the literature discussing mycosis fungoides. Although Dr. Winer is not the reason for this misattribution, American dermatologists and dermatopathologists at large remain responsible. We make that distinction because the term “Pautrier's microabscess” is not found in French publications, rather, it is only found in American publications and English translations of French research (Fig. 1).2,5
1. Bhat RM, Madhumita M. Pautrier's microabscess: an eponym by mistake. Indian J Dermatol Venereol Leprol. 2020;86:747.
2. Schmidt-Skrabs CC. Pautrier microabscesses (PA): a historical note. Am J Dermatopathol. 2000;22:555.
3. Pollack KE, Noland MMB. Darier Nests or Pautrier microabscesses: highlighting the confusion of a decade. Dermatol Online J. 2018;24:7.
4. Cribier BJ. The myth of Pautrier's microabscesses. J Am Acad Dermatol. 2003;48:796–797.
5. Steffen C. The man behind the eponym: lucien Marie Pautrier—pautrier's microabscess. Am J Dermatopathol. 2003;25:155–158.