Lichenoid tissue reaction

Lichenoid tissue reaction (LTR) is characterised by epidermal basal cell damage which takes the form of liquefaction degeneration or cell death either apoptosis or necrosis with an associated cascade of histologic events in epidermis and dermis. LTR is found in clinical conditions with lichenoid poikilodermatous and pigmentary dermatoses. A selected group of fifty lichenoid and pigmentary dermatoses such as Lichen planus (LP) Discoid lupus erythematosus (DLE) Lichenoid melanodermatitis (LM) and Lichen nitidus (LN) were studied. In LP basal cell liquefaction degeneration was extensive in comparison to other disease with large number of Civatte bodies and colloid bodies. There were significant vasodilatation in upper dermis inside the massive band like infiltrate. PAS positive basement membrane was disrupted in reaction area. Hypergranulosis was conspicuous. Chronic DLE showed spotty lichenoid reaction in the form of basal cell liquefaction degeneration. Civatte bodies and colloid bodies were infrequent. Infiltrate was more focal but could be band like. Epidermal atrophy and thickening of PAS positive basement membrane were important differentiating features, LM or Melanodermatitis toxica revealed focal mild to moderate liquefaction degeneration of basal cells with atrophy of the epidermis. The infiltrate although band like was less dense with marked pigmentary incontinence in clumps and giant melanophages. Civatte bodies, colloid bodies were not found and vascular changes were less prominent. LN showed localised basal cell damage with claw like rete ridges clutching a dense infiltrate. The dermal infiltrate often showed multinucleated giant cell. Civatte bodies and colloid bodies were not present. In some cases of the overlap syndrome LP/LE a careful study of lichenoid tissue reaction could distinguish these two diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser abrasion for cosmetic and medical treatment of facial actinic damage

Previous studies have shown the carbon dioxide (CO2) laser to be effective in the treatment of actinic cheilitis. After CO2 laser abrasion, normal skin and marked cosmetic improvement of the lip were noted. In our study, twenty-three patients were treated with CO2 laser abrasions for cosmetic improvement of facial lines and actinic changes. Pre- and postoperative histopathologic examinations were made on two patients. Preoperative examination of specimens from actinically damaged skin showed atypical keratinocytes in the basal layer of the epidermis, with overlying dense compact orthokeratosis and parakeratosis. Abundant solar elastosis was seen in the papillary dermis. Postoperative histologic specimens showed a normal-appearing epidermis with fibrosis in the papillary dermis and minimal solar elastosis (about four weeks after laser treatment). At present, various modalities are available for the regeneration of the aged skin, including chemical peels and dermabrasion. Significantly fewer complications were noted with CO2 laser abrasion than with these methods. Thus, CO2 laser abrasion can be useful in the cosmetic and medical treatment of the aged skin. Marked clinical and histologic improvement has been demonstrated.     

拟诊Weary-Kindler综合征一例

患者男,51岁,全身红斑、角化、皮肤异色、肢端水疱7年余,并伴有皮肤萎缩、光敏感、并指、粘膜损害、甲破坏、眼睑内翻、掌趾角化、假阿洪病、龋齿。皮肤病理：表皮角化过度,表皮萎缩,基底细胞液化变性,可见胶样小体。可见一处皮下裂隙,真皮浅层可见大量游离色素和嗜色素细胞。拟诊：Weary-kindler综合征。     

Annular atrophic lichen planus

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.     

Apoptosis in lichen planus and several other dermatoses. Intra-epidermal cell death with filamentous degeneration.

In hyperplastic conditions of the skin, eosinophilic bodies are often observed in the epidermis and upper dermis. These have been named variously Civatte body of lichen planus and dyskeratotic cell of actinic keratosis. In the present studies, it was found that (i) these cells commonly contain whorls of distinct filaments (60-80 A), which may be attached to desmosomes; (ii) unlike keratinized cells, the cellular envelope was not thickened by the formation of the marginal band; (iii) the cytoplasm contains a large number of vacuoles; (iv) the nucleus is lost by condensation or diffuse disintegration; and (v) these cells could be dropped into the upper dermis and filamentous contents could be released to dermal phagocytes. From these observations it was concluded that Civatte bodies and other eosinophilic bodies of neoplastic and hyperplastic epidermis represent "filamentous degeneration" or premature keratinization of keratinocytes.     

Relationship between food intake and cutaneous solar elastosis adjacent to basal cell carcinoma

Background/Objective Studies suggest that diet may influence in skin ageing and skin appearance. However, the effect of diet in the elastotic changes of dermis, which is the main histological sign of ageing, has not been studied previously. The objective was to investigate if the dietary habits influence the dermal elastosis observed in BCCs. Materials and methods The 136 patients with facial BCCs, who underwent surgery, were interviewed to assess the consumption of fruit, vegetables, fat, red meat, coffee and tea. We reviewed 136 specimens of BCC to identify the presence of solar elastosis. We also analysed clinical variables such as gender, age, phototype and smoking. Results Severe solar elastosis was found in 22 patients (16%), middle reticular dermis in 37 (27 %) and 77 patients (57%) had abscence or light elastosis. Fat consumption was reported by most of participants from our sample, while fruit and tea consumption was less common. Intakes of fat, vegetables and coffee were not associated with the grade of elastosis whereas Vitamin E and C‐rich fruits and tea were correlated with less risk of elastosis. Smokers showed higher grades of elastosis than non‐smokers. Conclusion Our study provides evidence that the presence of dermal elastosis and cutaneous ageing may be influenced by the type of food intake: Vitamin E and C‐rich fruit and tea are positively associated with less elastosis.     

Are dark‐skinned people really protected from ultraviolet radiation?

Background. Premature ageing of the skin (photoageing) results from the action of ultraviolet radiation (UVR) on skin. One of the histopathological findings of photoageing is the presence of solar elastosis in the dermis. Skin pigmentation is protective against UVR. Aim. To evaluate the presence of solar elastosis in dark‐skinned people. Methods. Normal facial skin biopsies of 147 dark‐skinned and 140 light‐skinned people were examined histopathologically for solar elastosis. The degree of solar elastosis was graded on a five‐point scale by a panel of dermatopathologists blinded to patient demographics. Results. There were 112 of 140 (80%) light‐skinned and 50 of 147 (34%) dark‐skinned patients with high‐grade solar elastosis. In the dark‐skinned patient group, high‐grade solar elastosis was seen in 29 of 61 (47.5%) Hispanic and 5 of 49 (10.2%) African American subjects. Conclusions. Dark‐skinned people are not completely protected from the effects of UVR.     

Poikiloderma of Civatte: a clinical and epidemiological study

BACKGROUND: Although a common dermatosis, idiopathic poikiloderma of the face and neck has not been studied in depth for decades. OBJECTIVES: To reassess the clinical and epidemiological characteristics of poikiloderma of Civatte (PC). MATERIAL AND METHODS: Fifty consecutive patients with PC. Evaluation included history taking and physical examination. Epidemiological and clinical parameters were recorded and analysed. The literature from 1923 until today, was reviewed thoroughly. RESULTS: The frequency of PC among dermatologic patients was estimated to be 1.4%. There were 34 females (68%) and 16 males in the present study. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. The majority (88%) had skin phototype II or III. Among females, 26 were at their peri-menopausal stage, including three cases of iatrogenic menopause. Four patients reported that other blood-related family members also had PC. The v and the sides of the neck and the upper chest were most often affected in a symmetric distribution. The face (preauricular and parotid region) was involved in 19 patients (38%). The erythemato-telangiectatic clinical type predominated (58%), followed by the mixed (22%) and the pigmented type (20%). Almost half of the patients (46%) were symptomatic (itching, burning and 'flushing'). The mean duration from onset to diagnosis was 6.2 years according to the patients' report. The course was usually slowly progressive (82%) and irreversible. CONCLUSIONS: PC shows characteristic features, supporting the theory that it represents a distinct entity. It is rather common in Greece. Although menopausal women predominated in our cohort, men were not uncommonly affected and were diagnosed at an older age. Based on the predominating clinical feature, PC can be classified into three clinical forms. Symmetry and sparing of the anatomically shaded areas of the neck are highly characteristic for PC. Face involvement was not as common and as severe as it had been considered in the past. Recognition of clinical type is important for the selection of the most appropriate treatment, which, despite the advent of novel modalities, remains problematic.     

Lichen amyloidosus. Ultrastructure and pathogenesis

The ultrastructure of six cases of lichen amyloidosus was studied with special attention to epidermal keratinocytes and the role of tonofilaments as precursors of fibrils of amyloid. Through the process of apoptosis, keratinocytes undergo degeneration and become filamentous cells and then filamentous masses or Civatte bodies. These bodies then drop into the dermis through a damaged basement membrane. In the papillary dermis, islands of amyloid become closely associated with Civatte bodies. In some cases, conversion to straight nonbranching filaments, characteristic of fibrils of amyloid, was found within whorled, densely packed filamentous masses. The transformation into fibrils of amyloid was not observed in keratinocytes or Civatte bodies situated in the epidermis. This final step of conversion may be aided by dermal fibroblasts that are frequently lodged around deposits of amyloid.     

In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution

Please cite this paper as: In vivo reflectance confocal microscopy detects pigmentary changes in melasma at a cellular level resolution. Experimental Dermatology 2010; 19 : e228–e233. Abstract: Melasma is a frequent pigmentary disorder caused by abnormal melanin deposits in the skin. In vivo reflectance confocal microscopy (RCM) is a repetitive imaging tool that provides real‐time images of the skin at nearly histological resolution. As melanin is the strongest endogenous contrast in human skin, pigmentary disorders are the most suitable candidates for RCM examination but RCM features of melasma have never been reported. This study investigates the pilot use of RCM in melasma to provide a set of well‐described morphological criteria with histological correlations. RCM images were acquired from melasma skin and compared to adjacent control skin in 26 patients. Skin biopsies were obtained from eight patients. In the epidermis, RCM showed in all patients a significant increase in hyperrefractile cobblestoning cells. These cells corresponded to hyperpigmented basal keratinocytes in histology. In six patients, dendritic cells corresponding to activated melanocytes were also found in the epidermis. In the dermis, RCM identified in nine patients plump bright cells corresponding to melanophages. Interestingly, for a given patient, the topographic distribution of melanophages in melasma lesions was very heterogeneous. RCM also showed a significant increase in solar elastosis and blood vessels in the dermis. RCM is a non‐invasive technique that detects pigmentary changes in melasma at a cellular level resolution. Therefore, RCM provides an innovative way to classify melasma by pigment changes.     

Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of patients with severe depigmentation

BACKGROUND: Pulsed dye laser (PDL) treatment is widely used for poikiloderma of Civatte. Some adverse events in small numbers of patients have been reported. Guidelines for treatment of poikiloderma of Civatte do not exist. OBJECTIVE: To report the occurrence of persistent depigmentation as a late adverse event in a series of patients with poikiloderma of Civatte after treatment with PDL. METHODS: Eight patients (seven women and one man, mean age 48 years) with poikiloderma of Civatte were treated with PDL using a 585-nm wavelength and a fixed pulse duration of 450 micros. In all patients one or two test PDL patches were performed and reviewed after 3 months. All of the patients tolerated the testing without complications. Subsequent treatments were undertaken at intervals of 3 months. RESULTS: All patients were treated with fluences between 3.5 and 7 J/cm2, using a 7- or 10-mm spot size. All patients had a good result with respect to clearing of the vascular component. Nevertheless, six of them, treated with 5-7 J/cm2, reported severe depigmentation 4-11 months after treatment. Two patients treated with lower fluences (3.5-5.5 J/cm2) did not report this depigmentation. CONCLUSIONS: Great care is needed when PDL treatment is used for poikiloderma of Civatte. Pigment changes have been incidentally mentioned as late complications but have not been well documented as the late depigmentation has been in this series. It is advisable to use fluences as low as possible, and not exceeding an upper limit of 5 J/cm2, on a 10-mm spot size. More research is needed to define an optimal pulse duration.     

Kerosis and comedos without prominent elastosis in Favre-Racouchot disease

Favre-Racouchot disease often is reported to be characterized by the association of cysts and comedos with prominent solar elastosis. Our histological study of patients who rarely exposed themselves to solar irradiation revealed no association between these signs. We detected only the presence of kerosis, as well as closed and open comedos. There were no true cysts. Actinic damage to the epidermis was absent, and solar elastosis was moderate to discrete. Therefore, the characteristic follicular alterations in Favre-Racouchot disease appear to be independent of and not secondary to solar elastosis.     

Pseudoxanthoma elasticum: evaluation of diagnostic criteria based on molecular data

BACKGROUND: Pseudoxanthoma elasticum (PXE) is a genetic disorder due to mutations in the gene encoding the transmembrane transporter protein adenosine triphosphate binding cassette (ABC)-C6, resulting in calcification of elastic fibres in the skin, eyes and cardiovascular system. OBJECTIVES: To evaluate the diagnostic criteria for PXE based on molecular data. METHODS: Of 10 families with a positive history of PXE 142 subjects were investigated for clinical symptoms, histological findings and genetic haplotype analysis. RESULTS: Of these, 25 subjects were haplotypic homozygous for PXE and 23 had typical clinical and histopathological manifestations. Two of the 25 patients showed such marked solar elastosis and macular degeneration that PXE could not be confirmed clinically. Sixty-seven subjects were haplotypic heterozygous carriers and 50 were haplotypic homozygous unaffected. Of these 117 subjects, 116 showed no cutaneous or ophthalmological signs of PXE. In one of the 50 haplotypic homozygous unaffected patients important solar elastosis and scarring of the retina mimicked PXE lesions. Only four of the 67 haplotypic heterozygous carriers had biopsies of nonlesional skin; all were histopathologically normal. CONCLUSIONS: In our patients, PXE presents as an autosomal recessive genodermatosis. Correlation of haplotype and phenotype confirmed actual major diagnostic criteria. In patients with marked solar elastosis and/or severe macular degeneration clinical diagnosis can be impossible and molecular testing is needed to confirm the presence of PXE. To the best of our knowledge our large study compares for the first time clinical findings with molecular data.     

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte

BACKGROUND: Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE: To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS: Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS: Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS: Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.     

Penetration of lysophosphatidylcholine into the dermis.

The ability of Lysophosphatidylcholine (LPC) to penetrate into the dermis and its degradation were investigated in vivo using hairless rats. Phosphatidylcholine (PC) was used as a control. Radioactively labelled LPC and PC were applied on the surface of skin, and the radioactivities of the epidermis and dermis were measured at 8, 24, and 48 hours. The recoveries of radioactive materials of LPC and PC within the area of epidermis and dermis at 8 hours were 0.21% and 0.25%; at 24 hours, 0.68% and 0.31%; and at 48 hours, 0.42% and 0.92%. No radioactivity was detected in serum. The radioactive substances which had penetrated were identified as LPC, PC, diglycerides, and free fatty acids. It was also found that topical application of LPC did not change the structure of skin as seen by microscopical examination. These findings indicate that a small amount of LPC can penetrate without the damaging skin structure and is enzymatically degraded into several lipids. Since LPC has bactericidal and antiviral activity, this substance could be an useful agent for dermatological use.     

Favre–Racouchot syndrome concurrent with chronic granulomatous reaction

Favre–Racouchot syndrome (FRS) is a disorder consisting of solar elastosis with the presence of multiple cysts and open comedones. Although the exact mechanism of the condition is not known, FRS has been specifically connected to sun exposure, smoking and radiation exposure. The histological changes present in FRS reveal an atrophic epidermis and large masses of keratinous material, causing follicular plugging, as well as solar elastotic changes and possible basophilic degeneration of connective tissue. Herein, we report an unusual case of FRS concurrent with chronic granulomatous reaction and review relevant published works.     

Scanning electron microscope studies of solar elastosis

Scanning electron microscope findings of solar elastosis were compared with those of normal dermis in specimens digested by hyaluronidase and by autoclaving. Solar elastosis showed amorphous masses and broad fibres with irregular shapes and sizes in specimens digested by hyaluronidase, while it showed only fibrous structures in those after autoclaving. It is suggested that the origin of solar elastosis is elastic tissue.     

扁平苔藓的临床和病理表现

本文分析60例典型扁平苔藓的临床表现和组织病理像,发现两者存在着内在的联系,并显示胶样小体的形成可能是基底细胞退行变性的结果。     

Poikilodermatous changes on the forearms of a woman practicing aroma-therapy: extracervical poikiloderma of Civatte?

We report the case of a 48-year-old, Caucasian female who presented with slowly progressing asymptomatic poikilodermatous changes of the extensor aspects of the forearms. She also had typical Poikiloderma of Civatte on the V of the neck and erythemato-telangiectatic rosacea of the central face. The patient had been practicing aroma-therapy for many years. Histologic examination revealed findings consistent with PC. Patch-testing revealed positive reactions to Fragrance mix and Nickel sulphate. Based on clinical and histological findings, a diagnosis of extracervical PC was suggested. PC with extra-cervical or extra-facial involvement is rare. In addition, this case supports the theory that contact sensitization to fragrances may contribute to the development of PC.     

Expression of apoptotic, cell proliferation regulatory, and structural proteins in actinic keratosis and their association with dermal elastosis

BACKGROUND: Actinic keratosis (AK) is a premalignant lesion caused by ultraviolet (UV) radiation and characterized by epithelial and connective tissue alterations. However, little is known about the link between connective and UV-damaged epithelial tissues in AK. OBJECTIVE AND METHODS: To examine the potential relationship between connective tissue degeneration and molecular alterations in epithelial cells without evident morphologic changes, 30 cases of AK (8, grade I; 10, grade II; 12, grade III), divided into three grades according to the proportion of dermal elastosis (in grade I, up to 30% of collagen degeneration; in grade II, 30-60%; in grade III, more than 60%), were immunohistochemically analyzed for the expression of Ki67, p53, p63, bcl-2, E-cadherin, 34-betaE12, and CD99. RESULTS: The increase in the solar elastosis grade was associated with an increase in positive cell numbers for all analyzed markers. Basal expression predominated in the lesions with low and moderate levels of connective tissue degeneration, while a basal and suprabasal expression pattern was prevalent in the lesions with high degeneration. In grade I and II lesions, proliferation marker, Ki67, expression was found to be significantly associated with the proapoptotic marker p53, while in grade III lesions, its expression was correlated with the anti-apoptotic marker, bcl-2. CONCLUSIONS: These results demonstrate that the epithelial expression of apoptotic, cell proliferation, and structural proteins is augmented with the increase of the solar elastosis grade. Thus, the grade of solar elastosis could be a helpful morphologic marker in the assessment of neoplastic changes in sun-damaged skin.