Reverse Sandwich sign
In the Reverse Sandwich Sign elongated mounds of parakeratosis that contain tiny globules of serum parallel the epidermis and are seen where these overlie an area of orthokeratosis. In conjunction with a mild lymphocytic upper perivascular infiltrate plus very slight spongiosis , it suggests guttate parapsoriasis (small plaque parapsoriasis).
The true sandwich sign refers to orthokeratosis over parakeratosis without serum globules in dermatophytosis which also has hyphae or yeasts between the two layers.
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