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Histologic observations of coccoid forms suggestive of cell wall deficient bacteria in cutaneous and systemic lupus erythematosus.
The cutaneous lesions of seven consecutive patients with cutaneous lupus erythematosus (LE), two patients with systemic LE, and a patient with both dermatomyositis and cutaneous LE, were studied bacteriologically and microscopically for the presence of bacteria. The study was prompted by the previous reports of variably acid-fast and non-acid-fast bacteria in other collagen diseases, and also by recent reports confirming the presence of cell wall deficient (CWD) bacteria (staphylococci, streptococci, and corynebacteria) within the hematologic elements of both "normal" and diseased individuals. Staphylococcus epidermis was isolated from four cases. Propionibacterium acnes from two cases, and Corynebacterium sp. from one case. Three cases were bacteriologically negative. Basophilic- and eosinophilic-stained coccoid forms, suggestive of CWD bacteria, were identified in the microscopic sections of all the cases, as were non-acid-fast coccoid forms. Definite acid-fast coccoid forms were observed in vivo in two cases of cutaneous LE. The complex bacteriology of LE is discussed, as well as the possibility that variably acid-fast CWD microbes might be the long sought-after etiologic agent or agents in the production of LE.
Cheilitis and labial lesions of lupus in the French Indies.
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Tripterygium in dermatologic therapy.
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Complement deficiency and disease.
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Transplantation of hair bulbs and melanocytes into leukodermic scars.
In performing transplantations of hair into places scarred and depigmented by discoid lupus erythematosus, it was found that considerable repigmentation in addition to growth of viable hairs was achieved.
Repigmentation of stable leukoderma by autologous minigrafting.
The technique known as autologous minigrafting is reviewed. This procedure has proven useful and reliable for repigmenting diverse types of leukoderma. A few refinements of this technique are described. These refinements were used in six patients who were successfully repigmented. Causes of pigment loss in these cases included thermal burns, contact with monobenzyl ether of hydroquinone, chronic discoid lupus erythematosus, and segmental vitiligo.
Autologous fat transplantation. Long-term follow-up.
We present a clinical long-term follow-up of our autologous fat transplantation patients. Our study group consists of 43 patients followed over 3-48 months (mean 26 months). Cosmetic defects treated include linear morphea, expression lines, acne scars, discoid lupus erythematosus scars, and post-traumatic scarring. Postoperative complications were rare and short term. We conclude that autologous fat transplantation is a safe and effective procedure. Fat graft longevity is examined in relation to the cosmetic defect treated, the recipient site, and the donor site.
Neonatal lupus erythematosus: a review.
Neonatal lupus erythematosus is an uncommon type of lupus that in addition to cutaneous lesions may have systemic involvement. It is generally a benign condition unless complicated by complete heart block, which is irreversible and which carries a high mortality rate in the first year of life. Patients' mothers often show clinical and/or laboratory features of connective tissue diseases.
Cutaneous immunohistochemistry. The direct immunoperioxidase and immunoglobulin-enzyme bridge methods compared with the immunofluorescence method in dermatology.
Two immunohistochemical methods, using the enzyme horseradish peroxidase, the direct immunoperoxidase (DIP) and the immunoglobulin-enzyme bridge (IEB) method were applied on 129 skin specimens of 81 patients with lupus erythematosus, bullous pemphigoid, pemphigus vulgaris and rosacea. These methods were compared with each other and with the immunofluorescence (IF) method. The DIP method was preferred to the IEB method because of the greater contrast between the specific staining and the nonspecific staining of the former. The results obtained with both peroxidase methods were comparable with those of the IF method.
Immunoelectron microscopy of skin in lupus erythematosus.
A multistep immunocytochemical method, utilizing horeradish peroxidase as an immunological bound marker enzyme, was employed to demonstrate in vivo fixed immunoglobulins (IgG, IgM) in the skin of three patients with CDLE and three patients with SLE. The immunoglobulin deposits were confined to the uppermost strata of the dermis, i.e. the area just below the basal lamina. Small amounts of immunoglobulin were visible within the lamina lucida and the basal lamina. Only quantitative differences were observed between deposits of immunoglobulins in CDLE and SLE. I CDLE, the reaction product covered a wider area of the superficial dermis and extended deeper down into the dermis. IgG and IgM deposits exhibited an identical fine structural morphology.
Sulphhydryl crosslinking in cutaneous apoptosis: a review.
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Semiologic value of C1q and C4 cutaneous deposits. An immunofluorescent study.
One hundred twenty skin biopsies from patients with different skin diseases were found to be positive for C3 cutaneous staining by immunofluorescence study. By the direct immunofluorescence method, we looked for C1q and C4 and immunoglobulin deposits in all those biopsies. C1q and/or C4 were only found in dermatoses with a recognised humoral immunologic mechanism; in some cases C1q and/or C4 deposits were found in the absence of immunoglobulins. The results showed that identification of C1q and C4 is important in routine immunopathologic studies, and provide interesting data of diagnostic value.
Oral leukoplakia and other white lesions of the oral mucosa related to dermatological disorders.
"White lesions" of the oral mucosa often present problems of differential diagnosis, which are of primary importance when assessing precancerous changes in the mouth. The precancerous character of oral leukoplakia is well established, and the "high-risk" type: erosive-dysplastic leukoplakia of greater malignant potential, has been thoroughly investigated. Because of their possible association with oral carcinoma, some clinical types of oral lichen planus, namely, the atrophic erosive forms, indicate caution in their treatment and supervision. Epithelial dysplasia is often associated with candidiasis and discoid lupus erythematosus, but neither these, nor such other white lesions as white sponge naevus or morsicatio buccarum, are considered to be preneoplastic. All these white lesions may be clearly identified, differentiated, and circumscribed as clinico-pathological disease-entities, by clinical, histopathological and ultrastructural methods, thus facilitating early diagnosis, treatment and prevention of possible malignancy.
Collagen diseases.
Dermatomyositis and variants of lupus erythematosus share histopathologic features which include liquefaction degeneration of the epidermal basal zone, melanin pigment incontinence, and the presence of colloid bodies. The pattern of epidermal changes and dermal inflammation help establish the correct diagnosis. Immunofluorescence microscopy of skin biopsies is useful in confirming the diagnosis.
Outcome of facial rashes with non-specific histological features: a long-term follow-up of 64 cases.
Facial inflammatory dermatoses can be difficult to diagnose in their early stages; skin biopsy may help but often shows indeterminate features. The aims of our study were to identify patients presenting with a facial dermatosis requiring skin biopsy, in whom the initial histological features were classified as "non-specific", to determine the eventual diagnostic outcome, and to attempt to identify subtle early histologic features. We located 79 such cases with indeterminate histology from 45,000 dermatopathology reports 1972-1987. The original biopsies were assessed and scored using a check-list of 20 features and the patients' case-records up to 1992 were examined. Follow-up information was available in 64 cases and an eventual clinical diagnosis was made in 54 (84%) of these; the commonest diagnoses were rosacea (26%), chronic discoid lupus erythematosus (24%) and seborrheic or unclassified dermatitis (17%). Histological differences were seen in the original biopsies of these three diagnostic categories, although none was predictive. We conclude that clinical follow-up leads to the diagnosis of most facial rashes initially showing "non-specific" histology.
The immunofluorescent profile of dermatomyositis: a comparative study with lupus erythematosus.
We have demonstrated a role for microvascular injury mediated by the membrane attack complex of complement (C5b-9) in the genesis of cutaneous lesions of dermatomyositis (DM) (1). The purpose of this study is to revisit the immunofluorescent (IF) profile of DM, to further investigate the role of C5b-9 in the pathogenesis of cutaneous lesions, and to see if any features of the IF profile reliably distinguish DM from LE. Lesional skin biopsies from 24 patients with clinical findings characteristic of DM were received in formalin and in Michel's transport medium. Conventional light microscopy, and IF studies with antibodies monospecific for IgG, IgA, IgM, C3, fibrin and C5b-9 were performed. The control group comprised biopsies from 31 patients with well-documented LE. A positive lupus band test (LBT) correlated highly with a diagnosis of LE, with a sensitivity of 64.5% and a specificity of 95.6% (p=0.001). The LBT was most sensitive in the setting of DLE and SLE and was least sensitive in the setting of SCLE. The finding of vascular C5b-9 deposition correlated with a diagnosis of DM versus LE (p=0.001) although the false positive rate was 21.4%. The false negative rate was reduced when vascular C5b-9 was seen in the absence of antibodies to Ro, La, or RNP. While a negative LBT correlated with a diagnosis of DM (p=0.001), the specificity was only 64.5%. However, when it was seen in concert with C5b-9 along the DEJ, specificity was increased to 80.6% (p=0.001). The presence of C5b-9 in vessels and along the DEJ in concert with a negative LBT was predictive of DM (p=0.001) with a specificity of 93.5%, sensitivity of 78.3%, a false positive rate of 10% and a false negative rate of 14.7%. The combination of a negative LBT, vascular C5b-9 deposition and negative serology for Ro, La, and RNP was a predictor of DM versus LE with a sensitivity of 90.5%, a specificity of 96.8%, a false positive rate of 5% and a false negative rate of 6.2% (p=0.001). The IF profile of DM in lesional skin comprises a negative LBT, deposition of C5b-9 within vessels and along the DEJ, and variable keratinocyte decoration for IgG and C5b-9. The most statistically powerful predictor of DM is the combination of a negative LBT with vascular C5b-9 deposition and negative serology for antibodies to Ro, La, Sm, and RNP. Demonstration of a negative LBT in all but 1 case of DM suggests that the DEJ is not a primary site for antigen-antibody interaction. We postulate that the aforementioned IF findings reflect humorally mediated injury of endothelium and keratinocytes, effected by C5b-9.
Expression of matrix metalloproteinases (MMP-2, MMP-3, and MMP-9) and fibronectin in lichen planus.
BACKGROUND: Keratinocyte damage and lichenoid-interface reaction are the two major pathologic findings in lichen planus (LP). Matrix metalloproteinases (MMPs) are proteinases that participate in extracellular matrix (ECM) degradation and may play an important role in basal membrane (BM) damage in LP. Fibronectin (FN) mediates a variety of cellular interactions with ECM and plays important roles in cell adhesion, migration, growth and differentiation. OBJECTIVE: To determine MMP-2, MMP-3, MMP-9 and FN expressions in LP and discuss the possible associations. MATERIALS AND METHODS: Skin biopsy samples of 55 patients with LP and 11 normal skin were investigated. Five discoid lupus erythematosus (DLE) and 5 chronic dermatitis (CD) samples were also examined for comparison. Immunochemical stainings were performed for MMP-2, MMP-3, MMP-9 and fibronectin. RESULTS: Weak or absent expressions of MMP-2 and MMP-3 in epidermis; and dense MMP-9 expression in dermal inflammatory infiltrate cells were detected in LP. FN expression was lost in epidermal basal layer and papillary dermis. CONCLUSION: Loss of MMP-2, MMP-3 and FN in LP can be explained with the destruction of the epidermal basal layer. Similar expressions of MMP-2 and MMP-3 both in LP and DLE implied that these MMPs may be involved in the pathogenesis of interface dermatitis.