Histological Patterns of Skin Lesions in Tuberous Sclerosis Complex: A Panorama
Round 1
Reviewer 1 Report
This review describes the histopathology of hypomelanotic lesions and various types of connective tissue nevi of tuberous sclerosis complex (TSC). The histopathological images of fibrous cephalic plaque that are not frequently biopsied and folliculocystic hamartoma, which is a new entity described in patients with TSC, are particularly interesting and instructive.
It is also novel that the authors pointed out the importance of concentric peri-follicular fibrosis in the adnexa. This review is easy to read and provides useful information in a compact format for many dermatologists. I would recommend this paper for acceptance after the minor points listed below.
- What is “Dermatology, Necker-Enfants Malades” in clinical pictures? They should be removed from the figures.
- Are the histopathological images biopsied from the cases in the clinical photographs?
- In hypomelanotic lesions, a significant decrease in the amount of melanin pigment in the epidermis is observed. I think that the image showing a decreased pigmentation will be helpful.
- mTor in page 3 should be mTOR.
- The labels should be placed in the figures. The length and width of the figures should be aligned.
Author Response
Thank you very much for your time and your positive and constructive comments.
- « Dermatology, Necker-Enfants Malades » means that pictures concern patients from the Dermatology department of the Necker-Enfants Malades Hospital. If you think it is not suitable in the pictures, we propose to remove it.
- Histopathological images are biopsied from the cases in the clinical photographs for fibrous cephalic plaque and folliculocystic hamartomas. Concerning the other cases, we unfortunately did not have clinical pictures for the biopsied cases.
- We did not find any biopsies or excision of hypomelanotic lesions related to STB in our data base (between 1997 and 2017). Hypomelanotic lesions are never biopsied in our hospital.
- Thanks for the remark about mTOR, which we have corrected.
- Thank you for the suggestion, we suppose that the editor will agree to answer to this request.
Reviewer 2 Report
I suggest to make the manuscript widely revised by an English language speaker, better if with medical/pathological expertise.
For example, sometimes the adjective "histological" has been used (in the title), but "histologic" has been used in the text.
Moreover:
Abstract, lane 11-12: "Dermatologic evaluation is critical...." revise the whole sentence in a more clear and better English (Dermatologic....dermatologic) sounds not good!
Page 2 lane 71 "and most common on the trunk" change with "most commonly on the trunk"
Page 3 lane 79 Electron microscopy demonstrates....
Page 3 lane 91 3.1. Angiofibromas (AF): re-write completely the paragraph with a more scientific clinical presentation (anyway do not use sentences as "3 to 4 years old" in English 3-year-old is better)
Page 4 lane 99: Omit the author's names and just refer to bibliography. I. e. "AF histology has been described in three main articles (9-11)."
Page 5, lane 125: "...the histologic description is close...." this sentence is too simple and not clear.
Page 7, lane 142 "...FCP described in the literature are similar...."
Author Response
Thank you very much for your time and constructive comments.
A correction with an English native corrector will be performed after the reviewing procedure, as the chief editor proposed to us.
Point 1. Abstract lane 11-12 : we have reworded the sentence and removed the redundancy of the word "dermatologic”.
Point 2. Page 3 Lane 79 : we also made the English correction.
Point 3. Page 3 lane 91, angiofibromas : we re-wrote the clinical presentation of AF.
Point 4. Page 4 lane 99 : authors' names have been removed, only the references remain.
Point 5. Page 5 lane 125 : “the histologic description is close…” : We have chosen to highlight the rare differences and the most recent available data. We did not want to be redundant by describing again the different components already described in AF paragraph. We added a sentence to explain that point in the manuscript. We hope that you will find it suitable.
Point 6. Page 7 lane 142 : “…FCP described in the literature…” : As with the UFs, we have chosen to highlight the differences and the most recent available data between FCP and UF rather than being redundant. We hope that you will also find it suitable.
