四川省自贡市结节状疥疮的观察

本文报告四川省自贡市49例结节状疥疮的临末和组织学检查结果.1982年1~3月在皮肤科门诊3576个病人中,结节状疥疮占1.37%.病例仅发生于男性,年龄从13~61岁.多数结节数自2~15个,并不成簇,主要位于阴囊和阴茎.半数以上的病例,结节状疥疮在疥疮发生一周以上时形成. 49例患者的结节作了活检,在苏木素和伊红染色的连续切片中.有6例呈现疥蜿、卵或排泄物,其组织学变化均相同,即多形的、广泛的皮肤浸润.     

Immunoglobulin and complement deposits in the skin and circulating immune complexes in scabies

Sixteen patients with papulovesicular, 6 with nodular and one with a Norwegian scabies were studied. Direct immunofluorescence (IF) examination revealed C3 deposits in the skin lesions of 13 of the 18 patients. Among them were all 6 cases with nodular scabies. C3 was found mostly in dermal vessel walls and 3 of the patients also showed IgM and 2 IgA deposits at the same site. No circulating immune complexes were found, with a solid-phase C1q radioimmunoassay (RIA), but HSV- and RSV-RIA methods detected IgM antibodies of rheumatoid factor type in 5 of the 15 sera examined. These results suggest that local complement activation and perhaps also immune complex deposition may by important in the pathogenesis of the papular and nodular skin lesions of human scabies.     

成人朗格汉斯细胞组织细胞增生症1例

患者男,48岁,肛周皮肤增生性斑块半年。皮肤科情况:肛周见裙边样增生性斑块,边缘游离,表面光滑。皮损组织病理示:表皮基本正常,真皮乳头水肿,可见大量浆细胞浸润,中下层可见大量增生单个核细胞成结节状浸润,胞质丰富淡染,核椭圆形或肾形,部分可见核沟,并可见大量的嗜酸性粒细胞及淋巴细胞浸润。免疫组织化学示:CD1a(+)、S-100(+)、CD68(+),Ki-67(40%+)。诊断:朗格汉斯细胞组织细胞增生症。治疗:给予口服沙利度胺50 mg,2次/d治疗,3个月后肛周皮损明显消退。     

Inflammatory cells, IgA, C3, fibrin and fibronectin in skin lesions in dermatitis herpetiformis

Skin lesions were produced by application of 50% potassium iodide to twelve patients with dermatitis herpetiformis (DH). Perivascular cellular infiltrates were found to be characteristic of developing lesions. The cells were mainly round cells; α-naphthyl acetate esterase staining revealed that in 24-h lesions the mean percentage of T-lymphocytes was 43%, that of mononuclear phagocytes 6% and that of non-T/non-M cells (mainly B-lymphocytes), 44%. The percentage of the latter was highest (mean 81%) in 6-h specimens, suggesting that these cells are participating in the early stages of lesion formation. The infiltrating cells in dermal papillae and within subepidermal vesicles were predominantly polymorphonuclear leukocytes (mean 86%), with some mononuclear phagocytes and non-T/non-M cells. Immunofiuorescence examination confirmed that fibrin deposition is characteristic of the initial lesions of DH and showed that the same is true of fibronectin. Seven out of eight patients had fibronectin deposits in dermal papillae. IgA was found in all and Ci in most of the specimens and, with the exception of papillary vesicles and blister cavities, tbe intensity of IgA and C3 fluorescence showed no marked alterations during the development of lesions.     

T-cell subsets in acne rosacea lesions and the possible role of Demodex folliculorum

Skin biopsy specimens from 4 patients with typical acne rosacea lesions were examined for the presence of T-cell subsets using monoclonal antibodies. The infiltrates consisted chiefly of LEU-1 reactive T cells with a predominance of LEU-3a antibody positive helper-inducer T cells, while LEU-2a staining suppressor-cytotoxic T cells were scarce. These cells penetrated regularly into the follicular wall and the epidermis. The study showed that most T cells in the dermal granulomatous infiltrates around Demodex parts, which were displaced extrafollicularly, were helper-inducer T cells. The predominance of helper-inducer T-cell subsets in the dermal infiltrates of acne rosacea lesions in frequent association with Demodex supports the hypothesis that a cell-mediated immune response plays an important role in the pathogenesis of rosacea.     

The patch stage of mycosis fungoides. Criteria for histologic diagnosis

It has long been claimed that a specific histologic diagnosis of mycosis fungoides cannot be made in the premycotic" or "eczematous" (patch) stage of the disease. Indeed, the histologic features of the premycotic lesions were constantly said to be those of "chronic non-specific dermatitis." We studied 46 biopsy specimens of patch lesions from patients in whom mycosis fungoides was unequivocally established by clinical events (i.e., concurrence or later development of typical plaque and/or nodular lesions) and indubitable histologic findings. We divided patch lesions into early nonatrophic patches and late atrophic ones. The early patches are considered to be evolving lesions of mycosis fungoides, whereas late patches represent resolving plaques of the disease. On the basis of this study, we concluded that histologic diagnosis can be made with near certainty in patch lesions of the disease. We found that the critical feature for histologic diagnosis of early and late patch lesions of mycosis fungoides is the presence of an increased number of mononuclear cells distributed singly or in small collections within an epidermis devoid of spongiotic microvesiculation. Other important features are lacunae surrounding intraepidermal mononuclear cells which gives them the appearance of "haloed cells." A sparse infiltrate of mononuclear cells is present around the blood vessels of the superficial, and sometimes the deep, vascular plexus. Atypical mononuclear cells are not necessary for the diagnosis of early patch lesions of mycosis fungoides, but they are found commonly in late patch lesions. Late atrophic patches show a thinned epidermis, loss of the usual configuration between rete ridges and dermal papillae, and coarse collagen throughout a thickened papillary dermis.     

Histologic and Clinical Findings in Human Scabies

ABSTRACT: The epidermal histological finding, in the primary scabetic lesion are hyperkeratosis. Acanthosis, and spongiolic edema and vesiculation. The dermal changes consist of perivascular and diffuse cell infiltrates, mainly mononuclear ells, and sometimes eosinophilic granulocytes. The number of mast cells are slightly greater in primary scabetic lesions compared with secondary lesions and normal skin. Vasculitis is found in those cases showing tissue eosinophils. Severe dermatitis, and many mites. A nodular lesion shows perivascular infiltrates mainly containing histiocytes. some with atypical and hyper-chromatic nuclei and a few in mitosis, and some lymphocytes and cells with pyroninophilic cytoplasm. Secondary scabetic lesions show acanthosis and perivascular inflammatory cell infiltrates, mainly mononuclear cells, whereas clinically normal skin presents very slight perivascular and diffuse mononuclear cell infiltrates in half of the patients. Both the number at circulating eosinophilic granulocytes and serum IgE concentrations correlate with the severity of the skin reaction. Ten of 60 patients with scabies had markedly increased numbers of circulating eosinophilic granulocytes during scabies infestation. In most of the patients, however, the number of circulating eosinophils decreased after scabies treatment.     

Comparative histopathology of scabies versus nodular scabies

Comparative histopathology was studied in 25 cases of scabies versus 25 cases of nodular scabies which were selected from Dermato-Venereology out patients. Salient differences observed were that in scabies lifting of stratum corneum at places was seen in all 100% cases, spongiosis in 100%, spongiotic vesicles in 28%, burrows in 56%, mite in 40% and vasculitis in 28% whereas in nodular scabies acanthosis was seen in 100%, pseudo epitheliomatous hyperplasia in 8%, burrows in 48%, mite in 24% and vasculitis in 84%. In nodular scabies, dermal infiltrate in 32% cases was arranged as lymphoid follicles with admixture of plasma cells and eosinophils.     

In situ localization of IFN-gamma-positive cells in psoriatic lesional epidermis.

Interferon-gamma (IFN-gamma) is believed to be an important mediator in the cytokine cascade of psoriasis. Lesional T cells in the epidermis may play a role in psoriasis. We examined whether IFN-gamma-producing T cells were present in the epidermis of psoriasis in situ by immunohistochemical techniques. Mixtures of CD4+ T cells and CD8+ T cells were found to be present in the papillary dermis and the epidermis of the psoriatic lesions. CD8+ T cells seemed to be dominant in the epidermis. Considerable amounts of IFN-gamma-positive cells were detected in infiltrates of the papillary dermis. IFN-gamma-positive cells were found to be present in the epidermis. The pattern of IFN-gamma staining appeared to be a combination of intracellular staining in mononuclear lymphoid cells and extracellular deposition in the surrounding areas. The staining was considered to be highly specific because it could be completely blocked by preabsorption with recombinant IFN-gamma. Our data suggest that psoriatic epidermal T cells produce and secrete IFN-gamma within the lesion and that these T cells are involved in the pathogenesis of psoriasis.     

Characterization of cutaneous infiltrates in MRL/lpr mice monitored from onset to the full development of lupus erythematosus-like skin lesions.

The skin is a primary site injured in lupus erythematosus (LE), but it is still controversial whether the injury is due to cells of the mononuclear infiltrate and which immunocompetent cells play the major role in the development of cutaneous LE. To better characterize the role of immunocompetent cells, we performed an immunohistochemical examination of these cells in LE-like skin lesions in MRL/Mp-lpr/lpr (MRL/lpr) mice. Skin lesions in 60 female MRL/lpr mice were monitored from onset to full development. Skin specimens from each stage were stained for epidermal Ia+ Langerhans cells (Ia(+)-LC), for Thy-1+ dendritic epidermal cells (Thy-1+DEC), and for the phenotype of the mononuclear cell infiltrates. The numbers of Ia(+)-LC and Thy-1+DEC were decreased markedly in the skin lesions at the later stage. However, the numbers of Ia(+)-LC were increased significantly in the central portion of lesions at an early stage and in the peripheral portion of lesions later. L3T4+ cells were predominant, and the L3T4/Lyt-2 ratio was high in dermal infiltrates at an early stage. With advancing stage, the L3T4/Lyt-2 ratio gradually decreased in dermal infiltrates, whereas the Thy-1.2/Lyt-2 ratio in lymph nodes was reversed. L3T4+ cells were especially predominant in dermal infiltrates under the epidermis with increased numbers of Ia(+)-LC. This immunohistochemical analysis of a mouse model of cutaneous LE revealed changes in immunocompetent cell populations with the evolution of skin lesions, and we conclude that Ia(+)-LC and Thy-1+DEC, as well as L3T4+ and Lyt-2+ cells, may play pathogenic roles in the development of skin lesions.     

Pityriasis rosea (Gibert): abnormal distribution pattern of antigen presenting cells in situ

Pityriasis rosea is a skin disease which is obscure in its etiology and pathogenesis. We studied its immunopathology by immunophenotyping the inflammatory cells in situ using monoclonal antibodies that define leukocyte subsets. Findings as to T-cells and their major subsets did not reveal disease-specific data. Monocytes stained only rarely. Neither natural killer cells, B-cells nor plasma cells were ever found. An unexpected finding was the presence within the infiltrates and rarely within the epidermis of cells having the immunophenotype of interdigitating cells (RFD1+). Intense and dendritic staining with anti-T6 and anti-HLA-DR indicated Langerhans cells to be present in the dermal infiltrates, in between these infiltrates in the papillary dermis, and focally within the parakeratotic horny layer. This Langerhans' cell pattern provides evidence for dermal Langerhans cell compartmentalization and transepidermal Langerhans' cell elimination. Such a distribution indicates a change in Langerhans' cell migration processes in pityriasis rosea pathogenesis.     

Histopathologic features seen in Gianotti-Crosti syndrome secondary to Epstein-Barr virus

BACKGROUND: Gianotti-Crosti syndrome (GCS) or infantile papular acrodermatitis presents as a symmetric erythematous lichenoid papular and papulovesicular eruption of the face, extremities, and buttocks, usually occurring in young children. GCS has been associated with hepatitis B and enteroviruses, as well as Epstein-Barr virus (EBV) and, rarely, cytomegalovirus. OBJECTIVE: The purpose of this study was to use immunohistochemical studies to determine the pattern of the lymphoid infiltrate and evidence for viral antigens in cases of EBV-associated GCS. METHODS: Routine histologic and immunohistochemical stains were evaluated in 3 patients with typical GCS. All 3 patients showed serologic evidence of an acute EBV infection. The immunohistochemical studies included monoclonal antibodies for CD3, CD4, CD8, CD20, TIA, S-100 protein, KP-1, EBV latent membrane antigen-1, and EBV-encoded nuclear antigen-2. RESULTS: All biopsy specimens showed minimal epidermal spongiosis with marked papillary dermal edema. The associated inflammatory infiltrate showed a mixed mononuclear cell infiltrate with rare eosinophils. Immunohistochemical stains for latent membrane antigen-1 and EBV-encoded nuclear antigen-2 were negative for EBV. The majority of mononuclear cells showed membrane staining for CD3, 30% to 40% of the CD3 mononuclear cells showed positive staining for CD4, and 50% to 60% showed positive staining with CD8. TIA(+) cells appeared to correspond to the CD8(+) cells. CONCLUSION: Although papillary dermal edema has been reported within the spectrum of histologic findings in GCS, it was marked and a consistent finding in the 3 cases in which EBV was the most likely etiologic agent. The presence of large numbers of cytotoxic T cells in the inflammatory infiltrate may have accentuated this histologic finding and may be a relatively distinctive histologic finding with GCS associated with EBV.     

Post-kala-azar dermal leishmaniasis: a histopathological study

BACKGROUND: Post-kala-azar dermal leishmaniasis follows an attack of visceral leishmaniasis and is caused by the same organism, i.e. Leishmania donovani. METHODS: In the present study, biopsy specimens from hypopigmented macules, nodules or plaques of 25 patients clinically diagnosed as PKDL were evaluated for epidermal and dermal changes and for the presence or absence of Leishmania donovani bodies (LDBs). RESULTS: The hypopigmented macules showed a patchy perivascular and periappendageal infiltrate with no demonstrable LDBs in any of the biopsies. In the nodular and plaque lesions, the infiltrate was diffuse, beneath an atrophic epidermis (74%) and follicular plugging (95.6%) was seen in most biopsies. The infiltrate consisted of lymphocytes, histiocytes and plasma cells in decreasing order of presence. LDBs could be demonstrated in only 10 (43.5%) biopsy specimens from nodular and plaque lesions and were never numerous. CONCLUSIONS: Histopathological features of PKDL are elucidated and discussed.     

Atrophoderma (Pasini-Pierini)

A patient with atrophoderma (Pasini-Pierini) was studied. Microscopic examination showed small collections of mononuclear cells around dermal blood vessels. Electron microscopic study demonstrated macrophages and lymphocytes around vessels and between fibers in the dermis; the epidermis, dermis, collagen, and elastic fibers appeared normal. Monoclonal antibody studies of the cells in the perivascular infiltrate demonstrated cells reacting with anti-Leu-1 (pan-T-cell antibody), anti-Leu-3a (the helper/inducer T-cell antibody), and OKM 1 antibody-reacting cells (macrophages). Direct immunofluorescent studies showed IgM and C3 staining in the small blood vessels of the papillary dermis, scattered IgM cytoids at the basement membrane, and focal fibrinogen in the mid-dermis. Mononuclear cells in the perivascular infiltrate, similar in type and percentage concentration, have been demonstrated also in patients with anetoderma, another rare atrophic cutaneous disorder. Macrophages and T lymphocytes around papillary dermal blood vessels may play a role in the pathogenesis of atrophoderma and anetoderma.     

Immunophenotypical characterization of inflammatory cellular infiltrates in tinea.

In order to elucidate the still poorly understood pathogenetic pathways of acute tinea, the inflammatory cellular infiltrates in this infection were analyzed. Lesional punch biopsies were cryostat-sectioned and stained with monoclonal antibodies for immunophenotypization of T cells, B cells, macrophages and activation markers. For each antibody the positively stained inflammatory cells in the dermis and in the epidermis were quantified separately. Most of the dermal mononuclear cells in acute tinea were identified as T helper lymphocytes of the memory type. Furthermore, considerable amounts of Langerhans' cells and macrophages were found, but virtually no B cells. A high proportion of cells expressed markers of activation. Within the epidermis, accumulations of Langerhans' cells and LeuM5+ dendritic macrophages were detected near fungal element. In view of the otherwise rather similar cellular infiltrates in acute tinea and different non-infectious dermatoses, acute tinea may be particularly suitable to study the functional relationship of Langerhans cells and LeuM5+ macrophages.     

The role of CD4 and CD8 cytotoxic T lymphocytes in the formation of viral vesicles

BACKGROUND: Herpetic vesicles caused by herpes simplex virus and varicella zoster virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule formation. OBJECTIVES: To understand the histogenesis of umbilicated vesicles in herpetic vesicles and HV, we demonstrated the presence of the virus-associated molecules in the lesions, and the pathogenic role of cytotoxic T-lymphocyte (CTL) immune responses. METHODS: Phenotyping of infiltrating cells was carried out in biopsy specimens from herpes simplex, varicella, herpes zoster and HV, and compared with nonviral contact dermatitis. Viral antigens and Epstein-Barr virus-encoded small nuclear RNA (EBER) were detected by immunostaining and by in situ hybridization, respectively. Infiltrating CTLs expressing granzyme B and granulysin were determined by double immunostaining using confocal laser scanning microscopy. RESULTS: In all herpetic vesicles, the corresponding viral antigens were observed in the cytopathic keratinocytes, and infiltration of lymphoid cells was present in the upper dermis and around the vessels. In all HV lesions studied, EBER+ T cells made up 5-10% of the dermal infiltrates and the dermal infiltrates contained almost no CD56 cells. CTLs expressing granzyme B and granulysin were present in both herpetic and HV lesions, in which they made up 10-30% of the total dermal infiltrates, whereas they comprised less than 5% of the infiltrates of biopsy specimens from nonviral contact dermatitis. Confocal laser microscopic examination demonstrated that both CD4+ and CD8+ T cells expressed granzyme B and granulysin. CONCLUSIONS: CD4+ and/or CD8+ CTLs reactive to the virus-infected cells might be responsible for the histogenesis of herpetic and HV lesions characterized by umbilicated vesicles.     

HLA-DR antigen expression on keratinocytes in highly inflamed parts of psoriatic lesions

We have investigated the immunoperoxidase staining pattern in the epidermis and dermal infiltrates of highly inflamed portions of psoriatic lesions, selecting for biopsy early pinpoint lesions or margins of active plaque lesions. We found positive intercellular staining for HLA-DR antigens in localized areas of the epidermis in about half of the patients tested. In contrast, OKT6 antigen was found only on the dendritic cells in the epidermis and dermis in all cases. These findings support the hypothesis that an active cellular immune reaction involving the epidermis, possibly associated with the expression of HLA-DR antigens on keratinocytes, occurs in the highly inflamed areas of psoriatic lesions, particularly in early pinpoint lesions or at the edges of spreading plaque lesions.     

Fc epsilon R11/CD23 receptor distribution in patch test reactions to aeroallergens in atopic dermatitis.

There is increasing evidence that exposure to organic allergens may induce or exacerbate lesional skin in patients with atopic dermatitis. In this study, patients with atopic dermatitis were patch tested to 11 common organic allergens and to control chambers containing 0.4% phenol and 50% glycerin in 0.9% saline. In biopsies from positive patch test reactions, patch test control skin, lesional eczematous and non-lesional skin from atopic individuals, and normal skin from non-atopic volunteers, the presence and distribution of macrophages (RFD7+), dendritic cells (RFD1+), and Langerhans cells, and the expression of the low-affinity receptor for IgE (CD23) were investigated. In patch test reactions and lesional skin samples, inflammatory infiltrates of diffusely distributed macrophages (RFD7+), dendritic cells (RFD1+), T lymphocytes (RFTmix+), and Langerhans cells (CD1+) were seen, the latter being present in both the epidermis and the dermis. The numbers of Langerhans cells were reduced in the epidermis and increased in the dermis in patch test reactions and lesional skin compared to their controls. Double staining revealed a change in the distribution of CD23 antigen. In patch test control and non-lesional biopsies many macrophages and only a few Langerhans cells within the dermal infiltrates expressed this antigen. In patch test reaction and lesional skin samples, however, the proportion of CD23+ dermal Langerhans cells had increased compared to macrophages. Furthermore, in these latter samples an increased proportion of dermal CD1+ cells expressed the dendritic cell (RFD1+) marker. These results show that following antigen challenge there are marked similarities between the phenotype of the cellular infiltrate in patch test reaction and lesional skin biopsies, and also demonstrate a changing distribution of CD23 on antigen-presenting cells.     

Phenotypic characterization in situ of inflammatory cells in pityriasis (tinea) versicolor

The cellular response in pityriasis (tinea) versicolor lesions was analysed in situ with an immunohistochemical double staining technique combined with periodic acid-Schiff staining in frozen sections of skin biopsies from 9 patients. The proportions of B and T cells and subpopulations of T cells in the blood were normal as were the proliferative responses of blood mononuclear cells against various B- and T-cell mitogens and antigens. Fungi were observed in stratum corneum in all lesions, and there were moderate cell infiltrates in both epidermis and dermis as compared to biopsies from normal-looking skin. The majority of the infiltrating perivascular cells reacted with anti-Leu 1 antibodies (all mature peripheral T cells). Anti-Leu 2a reactive cells ('suppressor/cytotoxic' phenotype) were few and scattered, whereas anti-Leu 3a reactive cells ('helper/inducer' phenotype) dominated. This investigation demonstrates that pityriasis versicolor is not a simple overgrowth of the fungus in stratum corneum, but is accompanied by infiltrating immunocompetent cells in both epidermis and dermis.     

Immunohistochemical detection of interferon-gamma-producing cells in dermatophytosis

Skin lesions of dermatophytosis are thought to be a result of a T cell-dependent inflammatory response that is mediated by various cytokines. We examined whether IFN-gamma-positive cells (as expression of Th1 response) were present in the skin lesions of dermatophytosis in situ by immunohistochemical techniques. Mixtures of CD4-positive T cells and CD8-positive T cells were found to be present in the dermal infiltrates of the lesions. Considerable numbers of CD1a-positive cells were detected in the upper dermis and epidermis. A marked accumulation of CD68-positive cells was found in the upper dermis. IFN-gamma-positive cells were present in the upper dermis of the lesions. The pattern of IFN-gamma staining appeared to be intracellular in mononuclear lymphoid cells. The staining was considered to be highly specific because it could be completely blocked by preabsorption with recombinant IFN-gamma. Our data support the hypothesis that the skin lesions of dermatophytosis may be associated with a Th1 response. Th1 response, which is characterized by IFN-gamma release, is thought to be involved in the host defense against dermatophytes and to reflect cutaneous reaction in dermatophytosis.