1
|
Whittington CP, Saleh JS, Bresler SC, Patel RM. Hypertrophic Lichen Planus: An Up-to-Date Review and Differential Diagnosis. Arch Pathol Lab Med 2024; 148:659-665. [PMID: 37327190 DOI: 10.5858/arpa.2022-0515-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT.— Hypertrophic lichen planus (HLP) is a variant of lichen planus that can be difficult to diagnose based on histopathologic features alone. Thus, patient clinical history and clinicopathologic correlation are essential considerations to make the correct diagnosis. OBJECTIVE.— To discuss the clinical and histologic presentation of HLP and provide a thorough review of commonly encountered mimickers in the differential diagnosis. DATA SOURCES.— Data were derived from a literature review, personal clinical and research experiences, and a review of cases in the archives of a tertiary care referral center. CONCLUSIONS.— In general, HLP involves the lower extremities and is characterized by thickened, scaly nodules and plaques that are often pruritic and chronic in nature. HLP affects both males and females and is most common in adults 50 to 75 years of age. Unlike conventional lichen planus, HLP tends to have eosinophils and classically displays a lymphocytic infiltrate most concentrated around the tips of rete ridges. The differential diagnosis for HLP is broad and encompasses numerous entities in many different categories, including premalignant and malignant neoplasms, reactive squamoproliferative tumors, benign epidermal neoplasms, connective tissue disease, autoimmune bullous disease, infection, and drug-related reactions. Therefore, a high index of suspicion must be maintained to avoid a misdiagnosis and potential inappropriate treatments.
Collapse
Affiliation(s)
- Carli P Whittington
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Jasmine S Saleh
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Scott C Bresler
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| | - Rajiv M Patel
- From the Departments of Pathology (Whittington, Saleh, Bresler, Patel) and Dermatology (Whittington, Saleh, Bresler, Patel), University of Michigan, Ann Arbor
- the Department of Cutaneous Pathology, WCP Laboratories Inc, Maryland Heights, Missouri (Patel)
| |
Collapse
|
2
|
Cassisa A, Cima L. Cutaneous vasculitis: insights into pathogenesis and histopathological features. Pathologica 2024; 116:119-133. [PMID: 38767544 PMCID: PMC11138767 DOI: 10.32074/1591-951x-985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024] Open
Abstract
The mechanisms underlying the onset and progression of vasculitis remain poorly understood. This condition is characterized by damage to the vascular wall, recruitment of inflammatory cells, and subsequent structural remodeling, which are hallmarks of vasculitis. The histopathological classification of vasculitis relies on the size of the affected vessel and the predominant type of inflammatory cell involved - neutrophils in acute cases, lymphocytes in chronic conditions, and histiocytes in granulomatous forms. Pathological changes progress in every context, and a single vasculitic pattern can be associated with various systemic conditions. Conversely, a single causative agent may lead to multiple distinct clinical and pathological manifestations of vasculitis. Moreover, many cases of vasculitis have no identifiable cause. A foundational understanding of the normal structure of the cutaneous vascular network is crucial. Similarly, identifying the cellular and molecular participants and their roles in forming the "dermal microvascular unit" is propedeutical. This review aims to elucidate the complex mechanisms involved in the initiation and progression of vasculitis, offering a comprehensive overview of its histopathological classification, underlying causes, and the significant role of the cutaneous vascular network and cellular dynamics. By integrating the latest insights from studies on NETosis and the implications of lymphocytic infiltration in autoimmune diseases, we seek to bridge gaps in current knowledge and highlight areas for future research. Our discussion extends to the clinical implications of vasculitis, emphasizing the importance of identifying etiological agents and understanding the diverse histopathological manifestations to improve diagnostic accuracy and treatment outcomes.
Collapse
Affiliation(s)
- Angelo Cassisa
- Department of Oncology, Section of Pathology, San Giovanni di Dio Hospital, USL Centro Toscana, Florence, Italy
| | - Luca Cima
- Department of Laboratory Medicine, Pathology Unit, Santa Chiara Hospital, Trento, Italy
| |
Collapse
|
3
|
DeBoisblanc CE, Nava VE, Chauhan S, Joseph J. Comorbid Ankylosing Spondylitis and Systemic Lupus Erythematosus: A Therapeutic Challenge. Cureus 2024; 16:e57080. [PMID: 38681357 PMCID: PMC11052660 DOI: 10.7759/cureus.57080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) are common rheumatologic ailments that cause multiorgan system disease. The incidence of lupus and AS in the same patient is rare and has seldom been described in the literature. Comorbid lupus and AS provide interesting diagnostic and therapeutic challenges. Here, we present a case of comorbid lupus and AS, discuss the diagnostic challenges in diagnosing these conditions, and put forth possible therapeutic interventions that may benefit similar patients.
Collapse
Affiliation(s)
| | - Victor E Nava
- Pathology, George Washington University, Washington, DC, USA
| | - Suman Chauhan
- Pathology, Veterans Affairs Medical Center, Washington, DC, USA
| | - Joyce Joseph
- Rheumatology, Veterans Affairs Medical Center, Washington, DC, USA
| |
Collapse
|
4
|
Dias de Oliveira NF, Santi CG, Maruta CW, Miyamoto D, Pereira NV, Sotto MN, da Silva LFF, Aoki V. Increased expression of in situ CD123 and reduced Toll-like receptor 7/9 signalling pathway suggest impaired activation of plasmacytoid dendritic cells in recurrent erythema multiforme. J Eur Acad Dermatol Venereol 2024. [PMID: 38407349 DOI: 10.1111/jdv.19919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Affiliation(s)
- N F Dias de Oliveira
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C G Santi
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C W Maruta
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - D Miyamoto
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - N V Pereira
- Laboratory of Medical Investigation-56, Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M N Sotto
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - L F F da Silva
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - V Aoki
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratory of Medical Investigation-56, Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
5
|
Zheremyan EA, Ustiugova AS, Karamushka NM, Uvarova AN, Stasevich EM, Bogolyubova AV, Kuprash DV, Korneev KV. Breg-Mediated Immunoregulation in the Skin. Int J Mol Sci 2024; 25:583. [PMID: 38203754 PMCID: PMC10778726 DOI: 10.3390/ijms25010583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Wound healing is a complex process involving a coordinated series of events aimed at restoring tissue integrity and function. Regulatory B cells (Bregs) are a subset of B lymphocytes that play an essential role in fine-tuning immune responses and maintaining immune homeostasis. Recent studies have suggested that Bregs are important players in cutaneous immunity. This review summarizes the current understanding of the role of Bregs in skin immunity in health and pathology, such as diabetes, psoriasis, systemic sclerosis, cutaneous lupus erythematosus, cutaneous hypersensitivity, pemphigus, and dermatomyositis. We discuss the mechanisms by which Bregs maintain tissue homeostasis in the wound microenvironment through the promotion of angiogenesis, suppression of effector cells, and induction of regulatory immune cells. We also mention the potential clinical applications of Bregs in promoting wound healing, such as the use of adoptive Breg transfer.
Collapse
Affiliation(s)
- Elina A. Zheremyan
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Alina S. Ustiugova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Nina M. Karamushka
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Aksinya N. Uvarova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Ekaterina M. Stasevich
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | | | - Dmitry V. Kuprash
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
- Faculty of Biology, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Kirill V. Korneev
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
- National Research Center for Hematology, 125167 Moscow, Russia
| |
Collapse
|
6
|
Wong J, Roy SF, McNiff JM, Xu ML. IRF8 in Conjunction With CD123 and CD20 to Distinguish Lupus Erythematosus Panniculitis From Subcutaneous Panniculitis-like T-Cell Lymphoma. Am J Surg Pathol 2023; 47:1425-1431. [PMID: 37767989 DOI: 10.1097/pas.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Distinguishing lupus erythematosus panniculitis (LEP) from subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a diagnostic challenge with important clinical implications. Immunohistochemical expression of interferon regulatory factor 8 (IRF8) has been shown to highlight cells with plasmacytoid dendritic cell differentiation. Considering that the presence of plasmacytoid dendritic cells highlighted by CD123 immunolabeling is a well-described feature that supports LEP over SPTCL, we hypothesized that IRF8 immunohistochemistry can be used as a diagnostic test to improve accuracy in differentiating LEP from SPTCL. In this study, we assessed the expression of IRF8, CD123, and CD20 in 35 cutaneous biopsies from 31 distinct patients, which included 22 cases of LEP and 13 cases of SPTCL. We found that clusters of IRF8-positive cells within the dermis, and away from subcutaneous fat, could discriminate LEP from SPTCL ( P =0.005). Similarly, CD123-positive clusters in any location were observed in LEP but absent in all cases of SPTCL. In addition, we found that dermal CD20-predominant lymphoid aggregates could help discriminate LEP from SPTCL ( P =0.022). As individual assays, IRF8, CD123, and CD20 were highly specific (100%, 100%, and 92%, respectively) though poorly sensitive (45%, 29%, and 50%, respectively). However, a panel combining IRF8, CD123, and CD20, with at least 1 positive marker was more accurate than any individual marker by receiver operating characteristic curve analysis. Our study provides a rationale for potentially including IRF8 as part of an immunohistochemical panel composed of other currently available markers used to differentiate LEP from SPTCL.
Collapse
Affiliation(s)
- Jahg Wong
- Department of Pathology, University of Montreal Hospital Center, University of Montreal Faculty of Medicine, Montreal, QC, Canada
| | | | - Jennifer M McNiff
- Departments of Dermatology
- Pathology, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT
| | - Mina L Xu
- Pathology, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT
| |
Collapse
|
7
|
Cho SK, Vazquez T, Werth VP. Litifilimab (BIIB059), a promising investigational drug for cutaneous lupus erythematosus. Expert Opin Investig Drugs 2023:1-9. [PMID: 37148249 DOI: 10.1080/13543784.2023.2212154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION There are no U.S. Food and Drug Administration (FDA) approved therapies for cutaneous lupus erythematosus (CLE). Litifilimab is a monoclonal antibody against BDCA2, a plasmacytoid dendritic cell specific antigen, currently under investigation for systemic lupus erythematosus (SLE) and CLE. The LILAC study, published in the New England Journal of Medicine, is a phase II randomized controlled trial for CLE which demonstrated superiority of Litifilimab over placebo using a skin directed outcome measure. AREAS COVERED This review identifies challenges that have hindered the development of any approved treatments for CLE, recent SLE trials that include skin disease data, and the pharmacological properties of litifilimab. We review the clinical efficacy and safety of litifilimab for both SLE and CLE in the phase I and II clinical trials. This review aims to highlight the need for more CLE specific clinical trials and examine the potential of litifilimab as the first FDA approved therapy for CLE. (Clinical trial registration: www.clinicaltrials.gov identifier is NCT02847598.). EXPERT OPINION Litifilimab demonstrated efficacy in a randomized phase II clinical trial as a standalone CLE trial using validated skin specific outcome measures, making it the first successful clinical trial for a CLE targeted therapy. If approved, litifilimab will be a pivotal change in the landscape of CLE management especially for severe and refractory disease.
Collapse
Affiliation(s)
- Sung Kyung Cho
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas Vazquez
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
8
|
Xu Q, Qiu Y, Lu Z, Yu H, Ling B, Li Y, Gu Y, Yao Z. Centrifugal lipodystrophy on a spectrum with lupus erythematosus panniculitis in children and efficacy and safety of hydroxychloroquine: A clinicopathological study. Dermatol Ther 2022; 35:e15825. [PMID: 36100983 DOI: 10.1111/dth.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to investigate the relationship between centrifugal lipodystrophy (CLD) and lupus erythematosus panniculitis (LEP), and the efficacy and safety of hydroxychloroquine (HCQ) for treating CLD in children. A total of 29 cases clinically diagnosed as CLD (n=24) and CLD/LEP overlap (n=5) were enrolled and all were confirmed by skin biopsies of CLD and LEP. The clinicopathological findings, clinical outcomes and prognosis with the treatment of HCQ between CLD and LEP were compared. All 29 cases (male: female=1:1.6; median age at onset: 3 years) had cutaneous lesions of centrifugally expanding lipoatrophy, of which five cases overlapped with LEP lesions presented as erythematous indurated plaque (n=2), subcutaneous nodules (n=2) and alopecia along Blaschko's lines (n=1). Antinuclear antibodies were found in six (25.0%) CLD and two (40.0%) overlapped patients (P=.597). Histopathologically, of the 24 cases of CLD, 14 (58.5%) exhibited subcutis loss or mild lobular inflammation. Ten (41.7%) cases displayed lobular panniculitis with moderate to dense lymphohistiocytic infiltrate and plasma cells, similar to the five cases of overlap. Small clusters of CD123 positive plasmacytoid dendritic cells were found in 62.5% (5/8) of CLD and 66.7% (2/3) of overlap cases (P>.99). HCQ (5 mg/kg/d) treatment showed improvement in 91.3% (21/23) of CLD and all overlap cases, including 4 cases unresponsive to previous oral glucocorticosteroid treatment. Our findings suggested that CLD and LEP represent a spectrum within the same disease. HCQ (5 mg/kg/d) was effective and safe for treating CLD (age>1.5 years), and early treatment and a regular long-term follow-up are essential. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Qianyue Xu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yangyang Qiu
- Department of Dermatology, Xiamen Branch, Zhongshan Hospital, Fudan University, Fujian, China
| | - Zhiyong Lu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Yu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Ling
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Gu
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
9
|
Furie RA, van Vollenhoven RF, Kalunian K, Navarra S, Romero-Diaz J, Werth VP, Huang X, Clark G, Carroll H, Meyers A, Musselli C, Barbey C, Franchimont N. Trial of Anti-BDCA2 Antibody Litifilimab for Systemic Lupus Erythematosus. N Engl J Med 2022; 387:894-904. [PMID: 36069871 DOI: 10.1056/nejmoa2118025] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antibody-binding of blood dendritic cell antigen 2 (BDCA2), which is expressed exclusively on plasmacytoid dendritic cells, suppresses the production of type I interferon that is involved in the pathogenesis of systemic lupus erythematosus (SLE). The safety and efficacy of subcutaneous litifilimab, a humanized monoclonal antibody that binds to BDCA2, in patients with SLE have not been extensively studied. METHODS We conducted a phase 2 trial of litifilimab involving participants with SLE. The initial trial design called for randomly assigning participants to receive litifilimab (at a dose of 50, 150, or 450 mg) or placebo administered subcutaneously at weeks 0, 2, 4, 8, 12, 16, and 20, with the primary end point of evaluating cutaneous lupus activity. The trial design was subsequently modified; adults with SLE, arthritis, and active skin disease were randomly assigned to receive either litifilimab at a dose of 450 mg or placebo. The revised primary end point was the change from baseline in the total number of active joints (defined as the sum of the swollen joints and the tender joints) at week 24. Secondary end points were changes in cutaneous and global disease activity. Safety was also assessed. RESULTS A total of 334 adults were assessed for eligibility, and 132 underwent randomization (64 were assigned to receive 450-mg litifilimab, 6 to receive 150-mg litifilimab, 6 to receive 50-mg litifilimab, and 56 to receive placebo). The primary analysis was conducted in the 102 participants who had received 450-mg litifilimab or placebo and had at least four tender and at least four swollen joints. The mean (±SD) baseline number of active joints was 19.0±8.4 in the litifilimab group and 21.6±8.5 in the placebo group. The least-squares mean (±SE) change from baseline to week 24 in the total number of active joints was -15.0±1.2 with litifilimab and -11.6±1.3 with placebo (mean difference, -3.4; 95% confidence interval, -6.7 to -0.2; P = 0.04). Most of the secondary end points did not support the results of the analysis of the primary end point. Receipt of litifilimab was associated with adverse events, including two cases of herpes zoster and one case of herpes keratitis. CONCLUSIONS In a phase 2 trial involving participants with SLE, litifilimab was associated with a greater reduction from baseline in the number of swollen and tender joints than placebo over a period of 24 weeks. Longer and larger trials are required to determine the safety and efficacy of litifilimab for the treatment of SLE. (Funded by Biogen; LILAC ClinicalTrials.gov number, NCT02847598.).
Collapse
Affiliation(s)
- Richard A Furie
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Ronald F van Vollenhoven
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Kenneth Kalunian
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Sandra Navarra
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Juanita Romero-Diaz
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Victoria P Werth
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Xiaobi Huang
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - George Clark
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Hua Carroll
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Adam Meyers
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Cristina Musselli
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Catherine Barbey
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| | - Nathalie Franchimont
- From Northwell Health, Great Neck, NY (R.A.F.); Amsterdam University Medical Centers, Amsterdam (R.F.V.); the University of California San Diego, La Jolla (K.K.); the University of Santo Tomas, Manila, Philippines (S.N.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City (J.R.-D.); the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (V.P.W.); Biogen, Cambridge, MA (X.H., G.C., H.C., A.M., C.M., N.F.); and Biogen, Baar, Switzerland (C.B.)
| |
Collapse
|
10
|
Magaña M, Castellanos G, Meurehg CC, Magaña-Mainero MR. Lupus Erythematosus Tumidus: Clinical and Pathological Features in a Series of 20 Patients. Am J Dermatopathol 2022; 44:469-477. [PMID: 35704910 DOI: 10.1097/dad.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to assess the clinicopathologic/immunophenotypical features in patients with lupus erythematosus tumidus (LET). METHODS All skin biopsies diagnosed as LET in 16 years were retrieved from our pathology laboratory. Clinical charts were reviewed and immunohistochemical markers were performed. Subpopulations of cells in the infiltrates were studied, as well as the number/distribution of plasmacytoid dendritic cells (PDC), which were compared with two control groups: normal skin and discoid lupus erythematosus. Direct immunofluorescence was performed when available. RESULTS We found 20 patients (11 men and 9 women; mean age 43.5 years); the mean evolution previous to diagnosis was 20.3 months. They all had erythematous, nonscarring urticarial-like plaques: 8 in the head region only, 8 in trunk/limbs only; both segments were affected in 2 patients; topography was unknown in 2. Except for 1 patient, no one developed systemic lupus erythematosus. A dense perivascular/periadnexal superficial-to-deep lymphocytic infiltrate and stromal mucin deposition were characterized histopathologically; interphase changes were absent. Immunophenotype supported an inflammatory profile. The differential count of CD123 + PDC in 10/20 cases of LET (n = 1180) was notably higher than 5 cases of discoid lupus erythematosus (n = 419) and 5 cases of normal skin (n = 38). No immune deposits were found in 2 cases. CONCLUSION LET is a rare, peculiar form of cutaneous lupus erythematosus that only exceptionally evolves to systemic lupus erythematosus . Its clinical-pathologic/immunophenotypical features are very characteristic. The amount of CD123 + PDC is a very helpful feature among the criteria for its diagnosis and seems to be relevant in its pathogenesis.
Collapse
Affiliation(s)
- Mario Magaña
- Centro de Dermatología & Dermatopatología, Mexico City, Mexico
- Chairman, Service of Dermatology, School of Medicine, Universidad Nacional Autónoma de México/Hospital General de México "Eduardo Liceaga" S. S., Mexico City, Mexico
| | - Guillermo Castellanos
- Service of Anatomic Pathology, Hospital de Especialidades "Bernardo Sepúlveda" Centro Médico Nacional Siglo XXI, IMSS, Mexico City, Mexico
| | | | | |
Collapse
|
11
|
Wu S, Smith CJ, Miedema JR, Googe PB. Updates in Inflammatory Dermatopathology. Semin Diagn Pathol 2022; 39:288-297. [DOI: 10.1053/j.semdp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
|
12
|
Shakshouk H, Deschaine MA, Wetter DA, Drage LA, Ernste FC, Gibson LE, Lehman JS. Do histopathological features correlate with systemic manifestations in dermatomyositis? Analysis of 42 skin biopsy specimens from 22 patients. J Cutan Pathol 2022; 49:442-447. [PMID: 35080246 DOI: 10.1111/cup.14203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding whether specific histopathologic features on skin biopsy are predictive of systemic associations in dermatomyositis would be useful to guide clinical screening. METHODS Via retrospective medical record search, clinical and laboratory findings of patients with dermatomyositis were documented. Existing skin biopsy slides were re-reviewed blindly. RESULTS Of all biopsy specimens (n=42), the most frequent histopathological finding was vacuolar interface dermatitis (95%). Other features included perivascular lymphocytic infiltrate (71%), increased dermal mucin (40%), vessel wall thickening (12%), follicular plugging (9.5%) and dermal sclerosis (7%). Neutrophilic infiltrate was observed in 3 biopsies from a patient with adualimumab-associated DM. Vasculitis was not observed. There was no statistically significant difference in the presence of any histopathological feature and that of various systemic manifestations [i.e. myopathy, interstitial lung disease (ILD) and malignancy]. However, we observed that dense lichenoid infiltrate rather than pauci-inflammatory changes correlated with severe itching (p < 0.001) Patients with MDA-5 antibodies were significantly more likely to have vasculopathy than those without (p=0.029*). CONCLUSIONS No dermatopathological feature was reliably predictive of myopathy, ILD or malignancy. This finding implies that regardless of histopathologic findings, patients should be screened for associated conditions, as clinically indicated.
Collapse
Affiliation(s)
| | - Maria A Deschaine
- Department of Dermatology, Florida State University, Tallahassee, FL, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
13
|
Tirumalae R, Krishnamurthy S, Inchara YK. Plasmacytoid Dendritic Cell marker (CD123) expression in scarring and non-scarring alopecia. J Cutan Aesthet Surg 2022; 15:179-182. [PMID: 35965907 PMCID: PMC9364453 DOI: 10.4103/jcas.jcas_126_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Classification of scarring alopecia poses a major problem, as there is considerable clinicopathologic overlap, particularly between lupus erythematosus (LE) and lichen planopilaris (LPP), especially in later stages. CD123 positive plasmacytoid dendritic cells (PDC) have been shown recently to be present in all forms of LE and are touted to be useful in differentiating LE from other scarring alopecias. Their distribution in non-scarring alopecia is not well documented. This is the first study that examines the PDC in both scarring and non-scarring alopecias.
Collapse
|
14
|
Maurelli M, Colato C, Gisondi P, Girolomoni G. Uncommon non-infectious annular dermatoses. Indian J Dermatol 2022; 67:313. [PMID: 36386081 PMCID: PMC9644792 DOI: 10.4103/ijd.ijd_743_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Several cutaneous diseases can present with annular lesions, making a distinction by physical appearance alone challenging. They can be distinguished into infectious and non-infectious, and common and uncommon annular dermatoses. Common non-infectious diseases include granuloma annulare, urticaria, and subacute lupus erythematosus. In addition, there are rare non-infectious non-neoplastic annular dermatoses whose nosographic attribution is established, including annually recurring erythema annulare centrifugum (EAC) and annular erythema in Sjögren syndrome and others whose nosographic positioning is still debated. They are neutrophilic figurate erythema, palpable migratory arciform erythema, eosinophilic annular erythema, and annular lichenoid dermatitis of youth. Their etiopathogenesis is largely unknown, although immune-mediated mechanisms are likely involved. It is difficult to establish if they are variants of reaction patterns or separate clinic-pathological entities. In fact, EAC and annually recurring EAC may represent different aspects of the same disease. Palpable migratory arciform erythema is hardly distinguishable from EAC deep type, Jessner-Kanof disease, and lupus tumidus. Neutrophilic figurate erythema and eosinophilic figurate erythema are clinically very similar and differing only in the relative proportion of eosinophils and neutrophils.
Collapse
|
15
|
Worm M, Zidane M, Eisert L, Fischer-Betz R, Foeldvari I, Günther C, Iking-Konert C, Kreuter A, Müller-Ladner U, Nast A, Ochsendorf F, Schneider M, Sticherling M, Tenbrock K, Wenzel J, Kuhn A. S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part 1: Classification, diagnosis, prevention, activity scores. J Dtsch Dermatol Ges 2021; 19:1236-1247. [PMID: 34390136 DOI: 10.1111/ddg.14492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Margitta Worm
- Department of Dermatology, Venereology and Allergology, Division of Allergology and Immunology Charité - Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - Miriam Zidane
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité - Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - Lisa Eisert
- Department of Dermatology and Venereology, Vivantes Klinikum Neukölln, Berlin
| | - Rebecca Fischer-Betz
- Clinic and Functional Division for Rheumatology, University Hospital Düsseldorf, Düsseldorf
| | - Ivan Foeldvari
- Hamburg Center for Pediatric and Adolescent Rheumatology, Hamburg
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus Dresden, and Technical University of Dresden, Dresden
| | - Christof Iking-Konert
- III. Medical Clinic and Polyclinic, Section Rheumatology, University Hospital Hambug-Eppendorf, Hamburg
| | - Alexander Kreuter
- Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, and University of Witten-Herdecke, Oberhausen
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Hospital GmbH, Bad Nauheim
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine Charité - Universitätsmedizin Berlin, corporate member of Free University of Berlin, Humboldt University of Berlin, and Berlin Institute of Health
| | - Falk Ochsendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main
| | - Matthias Schneider
- Clinic and Functional Division for Rheumatology, University Hospital Düsseldorf, Düsseldorf
| | | | - Klaus Tenbrock
- Department of Pediatrics and Adolescent Medicine, University Hospital RWTH Aachen, Aachen
| | - Jörg Wenzel
- Dermatological Department, University Hospital Bonn, Bonn
| | - Annegret Kuhn
- Medical Director, Hospital Passau, Passau, University of Münster, Münster, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, Niederlande
| |
Collapse
|
16
|
Worm M, Zidane M, Eisert L, Fischer-Betz R, Foeldvari I, Günther C, Iking-Konert C, Kreuter A, Müller-Ladner U, Nast A, Ochsendorf F, Schneider M, Sticherling M, Tenbrock K, Wenzel J, Kuhn A. S2k‐Leitlinie zur Diagnostik und Therapie des kutanen Lupus erythematodes – Teil 1: Klassifikation, Diagnostik, Prävention und Aktivitätsscores. J Dtsch Dermatol Ges 2021; 19:1236-1248. [PMID: 34390147 DOI: 10.1111/ddg.14492_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie, Abteilung für Allergologie und Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berliner Institut für Gesundheitsforschung, Berlin
| | - Miriam Zidane
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berliner Institut für Gesundheitsforschung, Berlin
| | - Lisa Eisert
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Rebecca Fischer-Betz
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | - Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg
| | - Claudia Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus Dresden und Technische Universität Dresden, Dresden
| | - Christof Iking-Konert
- III. Medizinische Klinik und Poliklinik, Sektion Rheumatologie, Universitätsklinikum Hambug-Eppendorf, Hamburg
| | - Alexander Kreuter
- Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Oberhausen Universität Witten-Herdecke, Witten-Herdecke
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik GmbH, Bad Nauheim
| | - Alexander Nast
- Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence Based Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, und Berliner Institut für Gesundheitsforschung, Berlin
| | - Falk Ochsendorf
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - Matthias Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
| | | | - Klaus Tenbrock
- Klinik für Kinder- und Jugendmedizin, Uniklinik RWTH Aachen, Aachen
| | - Jörg Wenzel
- Dermatologische Klinik, Universitätsklinikum Bonn, Bonn
| | - Annegret Kuhn
- Ärztliche Direktion, Klinikum Passau, Passau, Universität Münster, Münster, Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam, Niederlande
| |
Collapse
|
17
|
Chanprapaph K, Pomsoong C, Tankunakorn J, Eden C, Suchonwanit P, Rutnin S. Comparative Analyses of Clinical Features, Histopathology, and CD123 Immunohistochemistry of Oral Lupus Erythematosus, Lichen Planus, and Other Lichenoid Lesions. Dermatology 2021; 238:464-475. [PMID: 34515092 DOI: 10.1159/000517971] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral lupus erythematosus (OLE) and oral lichen planus (OLP) are among the common causes of oral lichenoid lesions (OLLs). The differential diagnosis among causes of OLLs, particularly between OLE and OLP, is challenging as they have significant clinical and histopathological overlap. OBJECTIVES To compare and summarize the clinical, histopathological, and direct immunofluorescence (DIF) findings between OLE, OLP, and other OLLs and to explore the diagnostic value of CD123 immunohistochemistry. METHODS A retrospective study on patients with OLE, OLP, and other OLLs was performed between January 2014 and December 2019. The baseline characteristics, the clinical, histopathological, and DIF features, as well as CD123 immunohistochemistry for plasmacytoid dendritic cells (PDCs) were statistically analyzed and compared between groups. RESULTS Of 70 patients, 12 had OLE, 39 had OLP, and 19 had other OLLs. Oral erosions/ulcers were the most common findings in all three groups. Red macules, telangiectases, and discoid plaques were more common in OLE patients, while OLP cases were typified by reticulated patches (p < 0.05). Additionally, white patches were found more often in other OLLs than in both OLE and OLP (p = 0.002). Histologically, mucosal atrophy, basal vacuolization, and perivascular infiltrate were observed in OLE, whereas OLP specimens possessed mucosal hyperplasia, hypergranulosis, and compact orthokeratosis (p < 0.05). Mucosal spongiosis was a histologic feature that favored other OLLs over OLE and OLP (p < 0.001). Data on DIF were nonspecific for all three conditions. For immunohistochemical staining, the median number of total CD123+ PDCs was observed to be higher in OLE than OLP in the mucosal-submucosal junction (MSJ) (p = 0.021), the superficial perivascular area (p = 0.026), and the superficial and deep perivascular areas (p = 0.001). Likewise, PDCs in clusters ≥2+ were seen in significantly higher numbers on OLE than OLP along the MSJ (p = 0.002), the superficial perivascular area (p < 0.001), as well as the superficial and deep perivascular areas (p = 0.011). CD123+ PDCs were found to be significantly more numerous in both OLE and OLP than other OLLs in all of the abovementioned areas (all p < 0.05). CONCLUSION While there are some differences in the clinicopathological features between OLE, OLP, as well as other OLLs, a significant overlap remains. The quantity and distribution pattern of CD123 immunohistochemical staining has a diagnostic implication in differentiating OLE from OLP and other OLLs.
Collapse
Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jutamas Tankunakorn
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chime Eden
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
18
|
Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
Collapse
Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
19
|
Bitar C, Chan MP. Connective Tissue Diseases in the Skin: Emerging Concepts and Updates on Molecular and Immune Drivers of Disease. Surg Pathol Clin 2021; 14:237-249. [PMID: 34023103 DOI: 10.1016/j.path.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cutaneous manifestations are common across the spectrum of autoimmune diseases. Connective tissue diseases manifesting in the skin are often difficult to classify and require integration of clinical, histopathologic, and serologic findings. This review focuses on the current understanding of the molecular and immune drivers involved in the pathogenesis of cutaneous lupus erythematosus, dermatomyositis, scleroderma/systemic sclerosis, and mixed connective tissue disease. Recent research advances have led to the emergence of new ancillary tools and useful diagnostic clues of which dermatopathologists should be aware to improve diagnostic accuracy for these diseases.
Collapse
Affiliation(s)
- Carole Bitar
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - May P Chan
- Department of Pathology, University of Michigan, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA.
| |
Collapse
|
20
|
Sugioka K, Hayashi A, Ichishi M, Sugimoto Y, Habe K, Yamanaka K. Three Cases of Lymphocytic Infiltration of the Eyelid. Dermatopathology (Basel) 2021; 8:124-129. [PMID: 34066876 PMCID: PMC8161816 DOI: 10.3390/dermatopathology8020018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/19/2023] Open
Abstract
Lymphocytic infiltration of the skin (LIS), first reported by Jessner and Kanof in 1953, is a disease of unknown etiology characterized by erythematous papules and plaques on the head, neck, and upper back and histopathological findings of a normal epidermis with underlying lymphocytic infiltration of the reticular dermis without mucin deposition. A 69-year-old man and a 21-year-old woman presented with edematous indurative erythema of the left upper eyelid. Lymphocytic infiltration of the dermis with CD4+ T cell predominance was noted on biopsy. A 68-year-old man presented with a four-year history of recurrent edematous indurative erythema of the right upper eyelid that extended up to the right cheek. Predominantly dermal infiltration of CD8+ T lymphocytes was found on biopsy. We treated all three patients with 8-16 mg of methylprednisolone daily, and the erythema and induration improved. CD4+ T cells were predominant in the acute phase (patients 1 and 2), whereas CD8+ T cells were predominant in the chronic phase (patient 3). CD8+ T cells may be involved in LIS recurrence. Lymphocytic infiltration of the eyelid may be associated with isolated circumscribed, edematous, indurative, colorless lesions that are responsive to daily low-to-middle doses of oral methylprednisolone.
Collapse
Affiliation(s)
- Kyoko Sugioka
- Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Mie 514-8507, Japan; (K.S.); (K.H.)
| | - Akinobu Hayashi
- Department of Oncologic Pathology, Graduate School of Medicine, Mie University, Tsu, Mie 514-8507, Japan; (A.H.); (M.I.)
| | - Masako Ichishi
- Department of Oncologic Pathology, Graduate School of Medicine, Mie University, Tsu, Mie 514-8507, Japan; (A.H.); (M.I.)
| | - Yasuko Sugimoto
- Department of Dermatology, Matsusaka City Hospital, Matsusaka, Mie 515-8544, Japan;
| | - Koji Habe
- Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Mie 514-8507, Japan; (K.S.); (K.H.)
| | - Keiichi Yamanaka
- Department of Dermatology, Graduate School of Medicine, Mie University, Tsu, Mie 514-8507, Japan; (K.S.); (K.H.)
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Skin injury is the most common clinical manifestation of SLE and is disfiguring, difficult to treat, and incompletely understood. We provide an overview of recently published articles covering the immunopathogenesis of skin injury in SLE. RECENT FINDINGS Skin of SLE has an inherent susceptibility to apoptosis, the cause of which may be multifactorial. Chronic IFN overexpression leads to barrier disruption, infiltration of inflammatory cells, cytokine production, and release of autoantigens and autoantibody production that result in skin injury. Ultraviolet light is the most important CLE trigger and amplifies this process leading to skin inflammation and potentially systemic disease flares. SUMMARY The pathogenesis of skin injury in CLE is complex but recent studies highlight the importance of mechanisms driving dysregulated epidermal cell death likely influenced by genetic risk factors, environmental triggers (UV light), and cytotoxic cells and cellular signaling.
Collapse
Affiliation(s)
- Grace A. Hile
- Department of Dermatology, University of Michigan, Ann Arbor, 48109, MI, USA
| | - J. Michelle Kahlenberg
- Department of Dermatology, University of Michigan, Ann Arbor, 48109, MI, USA
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| |
Collapse
|
22
|
Bardawil T, Khalil S, Kurban M, Abbas O. Diagnostic utility of plasmacytoid dendritic cells in dermatopathology. Indian J Dermatol Venereol Leprol 2021; 87:3-13. [PMID: 33580939 DOI: 10.25259/ijdvl_638_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/01/2020] [Indexed: 12/11/2022]
Abstract
Differentiating cutaneous diseases that mimic each other clinically and histopathologically can at times be a challenging task for the dermatopathologist. At the same time, differentiation of entities with overlapping features may be crucial for patient management. Although not seen in normal skin, plasmacytoid dendritic cells usually infiltrate the skin in several infectious, inflammatory/autoimmune and neoplastic entities. Plasmacytoid dendritic cells can be identified in tissue using specific markers such as CD123 and/or blood-derived dendritic cell antigen-2. Plasmacytoid dendritic cells are the most potent producers of type I interferons and their activity may therefore be assessed indirectly in tissue using human myxovirus resistance protein A, a surrogate marker for type I interferon production. In recent years, accumulating evidence has established the utility of evaluating for specific plasmacytoid dendritic cell-related parameters (plasmacytoid dendritic cell content, distribution and clustering and/ or human myxovirus resistance protein A expression) as a diagnostic tool in differentiating cutaneous diseases with overlapping features such as the alopecias, lupus and its mimics, and neoplastic entities. In this review, we provide an update on the current evidence on this topic and on the contexts where this can be a useful adjunct to reach the histopathological diagnosis.
Collapse
Affiliation(s)
- Tara Bardawil
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Khalil
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
23
|
Sohier P, Matar S, Meritet JF, Laurent-Roussel S, Dupin N, Aractingi S. Histopathologic Features of Chilblainlike Lesions Developing in the Setting of the Coronavirus Disease 2019 (COVID-19) Pandemic. Arch Pathol Lab Med 2021; 145:137-144. [PMID: 33501498 DOI: 10.5858/arpa.2020-0613-sa] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT.— During the coronavirus disease 2019 pandemic, several studies have described a distinctive cutaneous manifestation with a clinical picture resembling chilblains or chilblain lupus in young patients. OBJECTIVE.— To report the histopathologic description of a series of chilblainlike lesions appearing in the context of the severe acute respiratory syndrome coronavirus 2 epidemic. DESIGN.— The study included 13 patients with cutaneous acral lesions resembling chilblains occurring in the setting of suspected severe acute respiratory syndrome coronavirus 2 infection with available skin biopsy. RESULTS.— Two main histopathologic patterns were observed: a chilblainlike histopathologic pattern (10 of 13 cases; 77%) and a thrombotic vasculopathy pattern (3 of 13 cases; 23%). The chilblainlike histopathologic pattern featured a superficial and deep perivascular infiltrate of lymphocytes of varying intensity. This infiltrate was sometimes peri-eccrine and alterations of eccrine glands were present in most cases. Vacuolar alteration of the basal layer of the epidermis was found in a majority of patients. Lichenoid interface dermatitis was rarely present. The thrombotic vasculopathy pattern featured an absent or mild inflammatory infiltrate, multiple intraluminal fibrin thrombi, and ischemic epidermal necrosis. In both patterns, no true vasculitis was observed. No patient tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction, possibly because these lesions may represent late cutaneous manifestations of the disease or are associated with an early effective immune response. CONCLUSIONS.— The relationship of chilblainlike lesions to severe acute respiratory syndrome coronavirus 2 requires further investigations. Histopathologic features mimic chilblains, chilblain lupus, and, less frequently, a thrombotic vasculopathy. Response to viral infection might trigger diverse mechanisms leading to the 2 histopathologic patterns described.
Collapse
Affiliation(s)
- Pierre Sohier
- The Department of Pathology (Sohier, Laurent-Roussel), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France.,Université de Paris, Paris, France (Sohier, Dupin, Aractingi)
| | - Stéphanie Matar
- Department of Dermatology and Venereology (Matar, Dupin, Aractingi), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France
| | - Jean-François Meritet
- Department of the Laboratory of Virology (Meritet), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France
| | - Sara Laurent-Roussel
- The Department of Pathology (Sohier, Laurent-Roussel), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France.,Université de Paris, Paris, France (Sohier, Dupin, Aractingi)
| | - Nicolas Dupin
- Department of Dermatology and Venereology (Matar, Dupin, Aractingi), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France.,Université de Paris, Paris, France (Sohier, Dupin, Aractingi).,Cutaneous Biology Lab, Institut Cochin, INSERM U1016, UMR8104, Paris, France (Dupin, Aractingi)
| | - Selim Aractingi
- Department of Dermatology and Venereology (Matar, Dupin, Aractingi), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France.,Université de Paris, Paris, France (Sohier, Dupin, Aractingi).,Cutaneous Biology Lab, Institut Cochin, INSERM U1016, UMR8104, Paris, France (Dupin, Aractingi)
| |
Collapse
|
24
|
Psarras A, Alase A, Antanaviciute A, Carr IM, Md Yusof MY, Wittmann M, Emery P, Tsokos GC, Vital EM. Functionally impaired plasmacytoid dendritic cells and non-haematopoietic sources of type I interferon characterize human autoimmunity. Nat Commun 2020; 11:6149. [PMID: 33262343 PMCID: PMC7708979 DOI: 10.1038/s41467-020-19918-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/28/2020] [Indexed: 12/23/2022] Open
Abstract
Autoimmune connective tissue diseases arise in a stepwise fashion from asymptomatic preclinical autoimmunity. Type I interferons have a crucial role in the progression to established autoimmune diseases. The cellular source and regulation in disease initiation of these cytokines is not clear, but plasmacytoid dendritic cells have been thought to contribute to excessive type I interferon production. Here, we show that in preclinical autoimmunity and established systemic lupus erythematosus, plasmacytoid dendritic cells are not effector cells, have lost capacity for Toll-like-receptor-mediated cytokine production and do not induce T cell activation, independent of disease activity and the blood interferon signature. In addition, plasmacytoid dendritic cells have a transcriptional signature indicative of cellular stress and senescence accompanied by increased telomere erosion. In preclinical autoimmunity, we show a marked enrichment of an interferon signature in the skin without infiltrating immune cells, but with interferon-κ production by keratinocytes. In conclusion, non-hematopoietic cellular sources, rather than plasmacytoid dendritic cells, are responsible for interferon production prior to clinical autoimmunity.
Collapse
Affiliation(s)
- Antonios Psarras
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adewonuola Alase
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Ian M Carr
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Md Yuzaiful Md Yusof
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - George C Tsokos
- Division of Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
- National Institute for Health Research (NIHR), Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| |
Collapse
|
25
|
Plasmacytoid dendritic cells in dermatology. An Bras Dermatol 2020; 96:76-81. [PMID: 33342561 PMCID: PMC7838105 DOI: 10.1016/j.abd.2020.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Plasmacytoid dendritic cells are part of the dendritic cells family and are a relevant link between innate and adaptive immunity. They are the most potent producers of type 1 interferon, generating antiviral response, stimulating macrophages and dendritic cells and inducing activation and migration of natural killer cells. Plasmacytoid dendritic cells also exert a role as antigen-presenting cells, promote T-lymphocyte responses, immunoregulation, plasma cells differentiation and antibody secretion. Even though plasmacytoid dendritic cells are not usually present in normal skin, their presence is detected in healing processes, viral infections, and inflammatory, autoimmune, and neoplastic diseases. In recent years, the presence of plasmacytoid dendritic cells in several dermatological diseases has been described, enhancing their potential role in the pathogenesis of such conditions. Future studies on the role of plasmacytoid dendritic cells in dermatology may lead to new therapeutic targets.
Collapse
|
26
|
Saggini A, Kempf W, Kutzner H. Lichen planus follicularis tumidus: Immunotyping of the inflammatory infiltrate with focus on plasmacytoid dendritic cells. J Cutan Pathol 2020; 47:923-928. [PMID: 32458476 DOI: 10.1111/cup.13724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
Lichen planus follicularis tumidus (LPFT) is a rare clinicopathological variant of lichen planus (LP), clinically presenting with red-to-violaceous plaques studded with comedo-like lesions and keratin-filled milia-like cysts. Histopathologically, LPFT is characterized by cystically dilated follicular infundibula in the dermis, surrounded by a dense lichenoid lymphoid infiltrate with an associated interface reaction. We describe the clinicopathological features of an additional case of LPFT, focusing on the number and distribution of CD123(+) TCF4(+) plasmacytoid dendritic cells (pDCs). In our case, pDCs represented approximately 5% of the total inflammatory infiltrate, predominantly exhibiting a lichenoid distribution around the infundibula with no evidence of cluster formation, thus ruling out cutaneous lupus erythematosus. Our report is the first to describe the number and distribution of pDCs in LPFT. The results of our immunohistochemical analysis corroborate the notion that LPFT should be regarded as a rare variant of LP.
Collapse
Affiliation(s)
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zürich, Switzerland
| | | |
Collapse
|
27
|
Garelli CJ, Refat MA, Nanaware PP, Ramirez-Ortiz ZG, Rashighi M, Richmond JM. Current Insights in Cutaneous Lupus Erythematosus Immunopathogenesis. Front Immunol 2020; 11:1353. [PMID: 32714331 PMCID: PMC7343764 DOI: 10.3389/fimmu.2020.01353] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/27/2020] [Indexed: 12/25/2022] Open
Abstract
Cutaneous Lupus Erythematosus (CLE) is a clinically diverse group of autoimmune skin diseases with shared histological features of interface dermatitis and autoantibodies deposited at the dermal-epidermal junction. Various genetic and environmental triggers of CLE promote infiltration of T cells, B cells, neutrophils, antigen presenting cells, and NK cells into lesional skin. In this mini-review, we will discuss the clinical features of CLE, insights into CLE immunopathogenesis, and novel treatment approaches.
Collapse
Affiliation(s)
- Colton J. Garelli
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Maggi Ahmed Refat
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Padma P. Nanaware
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Zaida G. Ramirez-Ortiz
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jillian M. Richmond
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
| |
Collapse
|
28
|
Aslani FS, Sepaskhah M, Bagheri Z, Akbarzadeh-Jahromi M. Value of CD123 Immunohistochemistry and Elastic Staining in Differentiating Discoid Lupus Erythematosus from Lichen Planopilaris. Int J Trichology 2020; 12:62-67. [PMID: 32684677 PMCID: PMC7362963 DOI: 10.4103/ijt.ijt_32_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Differentiating scarring alopecia secondary to lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) has always been a challenge clinically and pathologically. Plasmacytoid dendritic cells (PDCs) have been reported in the cutaneous lupus erythematosus by CD123 immunostaining. This study assesses CD123 marker positivity and patterns of elastic fiber loss in scalp biopsy to differentiate DLE from LLP. Patients and Methods: Forty-three cases with clinical and pathological diagnosis of LPP and DLE were selected, and CD123 immunohistochemistry staining and elastic staining were performed on them. The presence of CD123-positive cells, clustering and distribution of cells, and patterns of elastic fibers loss in the dermis were evaluated. To analyze the data, the Chi-square test was used; moreover, the sensitivity and specificity of CD123 were calculated based on a diagnostic test for 2-by-2 tables. Results: Infiltration of PDC was seen in 90% of DLE cases. The presence of more than 10% and 20% PDC cells in inflammatory cells had 90% and 85% sensitivity and 34.7% and 91.3% specificity, respectively. PDC clusters more than 20 cells had 100% specificity for DLE. Location and patterns of PDC infiltration were not statistically significant (P = 0.378). The wedge-shaped loss of elastic fibers and the diffuse loss were the dominant patterns in LPP and DLE, respectively (P = 0.006). Conclusion: Our results suggested that CD123 along with elastic staining and histological features might be useful to diagnose challenging cases of lymphocytic scarring alopecia with clinical differential diagnosis of LPP and DLE.
Collapse
Affiliation(s)
- Fatemeh Sari Aslani
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Sepaskhah
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh-Jahromi
- Department of Pathology, Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
29
|
A clinical population pharmacokinetic/pharmacodynamic model for BIIB059, a monoclonal antibody for the treatment of systemic and cutaneous lupus erythematosus. J Pharmacokinet Pharmacodyn 2020; 47:255-266. [PMID: 32335844 DOI: 10.1007/s10928-020-09688-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
A population pharmacokinetic/pharmacodynamic (popPK/PD) model for BIIB059 (anti-blood dendritic cell antigen 2 [anti-BDCA2]), a humanized immunoglobulin G1 monoclonal antibody currently under development for the treatment of SLE and CLE, is presented. BIIB059 binds BDCA2, a plasmacytoid dendritic cell (pDC)-specific receptor that inhibits the production of IFN-I and other inflammatory mediators when ligated. Phase 1 PK and PD data of healthy adult volunteers (HV, n = 87) and SLE subjects (n = 22) were utilized for the development of the popPK/PD model. The data included single and multiple dosing of intravenous and subcutaneous BIIB059. BDCA2 internalization (PD marker) was measured for all subjects by monitoring reduction of BDCA2 on pDC cell surface and used for development of the popPD model. A two-compartment popPK model with linear plus non-linear elimination was found to best describe BIIB059 PK. BDCA2 levels were best captured using an indirect response model with stimulation of the elimination of BDCA2. Clearance in SLE subjects was 25% higher compared to HV (6.87 vs 5.52 mL/h). Bodyweight was identified as only other covariate on clearance and central volume. The estimates of EC50 and Emax were 0.35 μg/mL and 8.92, respectively. No difference in EC50 and Emax was observed between SLE and HV. The popPK/PD model described the data accurately, as evaluated by pcVPCs and bootstrap. The presented popPK/PD model for BIIB059 provides valuable insight into the dynamics and dose-response relationship of BIIB059 for the treatment of SLE and CLE and was used to guide dose selection for the Phase 2 clinical study (NCT02847598).
Collapse
|
30
|
Cohen L, Shah V, Chen PL, Messina J, Seminario-Vidal L. Cutaneous squamous cell carcinoma causing a rhinophymatous mass in a patient with clinically occult hypertrophic lupus erythematosus. Lupus 2020; 29:644-648. [PMID: 32202198 DOI: 10.1177/0961203320912838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypertrophic lupus erythematosus is a variant of discoid lupus erythematosus, which manifests as verrucous plaques and/or keratoacanthoma-like nodules on the face and arms. Diagnosis and treatment of hypertrophic lupus erythematosus can be challenging as it can resemble cutaneous squamous cell carcinoma clinically and histopathologically. Furthermore, cutaneous squamous cell carcinoma is a known complication of discoid lupus erythematosus. We present a diagnostically challenging case of a patient with a rapidly enlarging rhinophymatous mass and multiple keratoacanthoma-like lesions of the bilateral upper extremities whose work-up was initially equivocal. CD123 staining helped to elucidate a final diagnosis of cutaneous squamous cell carcinoma arising in a background of occult hypertrophic lupus erythematosus.
Collapse
Affiliation(s)
- Leah Cohen
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Vidhi Shah
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA
| | - Pei-Ling Chen
- Department of Pathology, Moffitt Cancer Center, Tampa, USA
| | - Jane Messina
- Department of Pathology, Moffitt Cancer Center, Tampa, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, USA
| |
Collapse
|
31
|
Chen SJT, Tse JY, Harms PW, Hristov AC, Chan MP. Utility of
CD
123 immunohistochemistry in differentiating lupus erythematosus from cutaneous T cell lymphoma. Histopathology 2019; 74:908-916. [DOI: 10.1111/his.13817] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 12/30/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Stephanie J T Chen
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Pathology University of Iowa Iowa City IA USA
| | - Julie Y Tse
- Department of Pathology Tufts Medical Center Boston MA USA
| | - Paul W Harms
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
| | - Alexandra C Hristov
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
| | - May P Chan
- Department of Pathology University of Michigan Ann Arbor MI USA
- Department of Dermatology University of Michigan Ann Arbor MI USA
| |
Collapse
|
32
|
Gardet A, Pellerin A, McCarl CA, Diwanji R, Wang W, Donaldson D, Franchimont N, Werth VP, Rabah D. Effect of in vivo Hydroxychloroquine and ex vivo Anti-BDCA2 mAb Treatment on pDC IFNα Production From Patients Affected With Cutaneous Lupus Erythematosus. Front Immunol 2019; 10:275. [PMID: 30846987 PMCID: PMC6394354 DOI: 10.3389/fimmu.2019.00275] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/31/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: Plasmacytoid dendritic cells (pDCs) are a major source of Type-I Interferon (IFN-I), a key driver in cutaneous lupus erythematosus (CLE). Currently evaluated in Phase II clinical trial, 24F4A (BIIB059) is an antibody targeting BDCA2, an inhibitory receptor expressed on pDCs. Given that Hydroxychloroquine (HCQ), a widely-used CLE therapy, and 24F4A are both able to inhibit pDC-derived IFN-I production; this study aimed to determine whether 24F4A would show an additional inhibitory effect on pDC response after ex vivo or in vivo treatment with HCQ. Methods: The effect of 24F4A on pDC-derived IFNα was measured from peripheral blood mononuclear cells (PBMC) either from healthy donors in presence or absence of HCQ or from CLE patients clinically exposed to various levels of HCQ. TLR7, TLR7/8, and TLR9 agonists (ssRNA, R848, and CpG-A) were used for pDC stimulation. Results: PDCs were the only producers of IFNα in response to CpG-A, R848, and ssRNA stimulation in PBMC cultures. CLE patients with higher levels of blood HCQ showed lower ex vivo pDC responses to CpG-A, but not R848 or ssRNA. In contrast, 24F4A reduced the amount of IFNα produced by pDCs from CLE patients in response to all TLR agonists, irrespective of the blood HCQ level. Conclusion: Our findings reveal that clinically-relevant HCQ concentrations partially inhibit the pDC response to TLR9 and weakly affect the response to TLR7/8 stimulation. 24F4A robustly inhibits pDC responses even in the presence of HCQ, highlighting its unique potential to disrupt pDC disease relevant biology, which could provide additional therapeutic benefit for CLE patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA, United States
| | | |
Collapse
|
33
|
Furie R, Werth VP, Merola JF, Stevenson L, Reynolds TL, Naik H, Wang W, Christmann R, Gardet A, Pellerin A, Hamann S, Auluck P, Barbey C, Gulati P, Rabah D, Franchimont N. Monoclonal antibody targeting BDCA2 ameliorates skin lesions in systemic lupus erythematosus. J Clin Invest 2019; 129:1359-1371. [PMID: 30645203 DOI: 10.1172/jci124466] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Plasmacytoid DCs (pDC) produce large amounts of type I IFN (IFN-I), cytokines convincingly linked to systemic lupus erythematosus (SLE) pathogenesis. BIIB059 is a humanized mAb that binds blood DC antigen 2 (BDCA2), a pDC-specific receptor that inhibits the production of IFN-I and other inflammatory mediators when ligated. A first-in-human study was conducted to assess safety, tolerability, and pharmacokinetic (PK) and pharmacodynamic (PD) effects of single BIIB059 doses in healthy volunteers (HV) and patients with SLE with active cutaneous disease as well as proof of biological activity and preliminary clinical response in the SLE cohort. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted in HV (n = 54) and patients with SLE (n = 12). All subjects were monitored for adverse events. Serum BIIB059 concentrations, BDCA2 levels on pDCs, and IFN-responsive biomarkers in whole blood and skin biopsies were measured. Skin disease activity was determined using the Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity (CLASI-A). RESULTS Single doses of BIIB059 were associated with favorable safety and PK profiles. BIIB059 administration led to BDCA2 internalization on pDCs, which correlated with circulating BIIB059 levels. BIIB059 administration in patients with SLE decreased expression of IFN response genes in blood, normalized MxA expression, reduced immune infiltrates in skin lesions, and decreased CLASI-A score. CONCLUSIONS Single doses of BIIB059 were associated with favorable safety and PK/PD profiles and robust target engagement and biological activity, supporting further development of BIIB059 in SLE. The data suggest that targeting pDCs may be beneficial for patients with SLE, especially those with cutaneous manifestations. TRIAL REGISTRATION ClinicalTrials.gov NCT02106897. FUNDING Biogen Inc.
Collapse
Affiliation(s)
- Richard Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Victoria P Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania and Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Tziotzios C, Lee JYW, Brier T, Saito R, Hsu CK, Bhargava K, Stefanato CM, Fenton DA, McGrath JA. Lichen planus and lichenoid dermatoses: Clinical overview and molecular basis. J Am Acad Dermatol 2019; 79:789-804. [PMID: 30318136 DOI: 10.1016/j.jaad.2018.02.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Deriving from the Greek word λειχήν for "tree moss" and the Latin word planus for "planar," lichen planus is a relatively uncommon and heterogeneous cutaneous disorder that typically develops in middle-aged adults. Despite the significant clinical burden associated with the disorder, little well-conducted molecular research has been undertaken, possibly because of heterogeneity impeding consistent and confident phenotyping. The multiple variants of lichenoid disease bear overlapping clinical and pathologic features despite manifesting as distinct clinical disorders. The first article in this 2-part continuing medical education series provides a comprehensive overview of the clinical and pathologic characteristics of cutaneous lichenoid dermatoses and links these manifestations to recent advances in our understanding of the underlying pathobiology of such diseases.
Collapse
Affiliation(s)
- Christos Tziotzios
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom.
| | - John Y W Lee
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Timothy Brier
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Ryo Saito
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Chao-Kai Hsu
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Kapil Bhargava
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Catherine M Stefanato
- Department of Dermatopathology, St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
| | - David A Fenton
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| |
Collapse
|
35
|
Roda Â, Travassos AR, Soares-de-Almeida L, Kutzner H. Lupus erythematosus mimicking mycosis fungoides: CD123 + plasmacytoid dendritic cells as a useful diagnostic clue. J Cutan Pathol 2018; 46:167-170. [PMID: 30430606 DOI: 10.1111/cup.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/20/2018] [Accepted: 10/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Ângela Roda
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal
| | - Ana Rita Travassos
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal
| | - Luís Soares-de-Almeida
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal.,Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Laboratório de Histopatologia Cutânea, Lisbon, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa, Portugal
| | - Heinz Kutzner
- Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa, Portugal.,Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
| |
Collapse
|
36
|
Subcutaneous Panniculitis-Like T-Cell Lymphoma Versus Lupus Erythematosus Panniculitis: Distinction by Means of the Periadipocytic Cell Proliferation Index. Am J Dermatopathol 2018; 40:567-574. [DOI: 10.1097/dad.0000000000001173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Wang ML, Chan MP. Comparative Analysis of Chilblain Lupus Erythematosus and Idiopathic Perniosis: Histopathologic Features and Immunohistochemistry for CD123 and CD30. Am J Dermatopathol 2018; 40:265-271. [DOI: 10.1097/dad.0000000000000945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Abstract
Inflammatory dermatoses encompass a variety of histologic patterns that affect different portions of the skin. In spongiotic, psoriasiform, lichenoid, pityriasiform, and blistering disorders, there are predominately epidermal and junctional activities with variable superficial dermal inflammation. Hypersensitivity reactions can show either epidermal or mostly dermal changes depending on whether the exposure of the exogenous allergen occurs through an external or internal route, respectively. Exceptions include erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis, where the etiology is often due to infection or ingested medications, but the histologic features are almost exclusively confined to the epidermis and dermoepidermal junction. Autoimmune disorders are unique in that lesions typically incorporate a mixture of epidermal and dermal inflammatory patterns with periadnexal inflammation, while the vast majority of vasculitis/vasculopathy and alopecia have changes limited to only the vessels and hair follicles, respectively. It is critical to recognize that a relatively limited number of histologic patterns are seen in a large array of clinical entities. Therefore, clinicopathologic correlation and careful examination of histologic details are of the utmost importance when evaluating skin biopsies for inflammatory disorders.
Collapse
Affiliation(s)
- Andy C Hsi
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Ilana S Rosman
- 1 Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.,2 Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
39
|
Abstract
Owing to the wide variety and complexity of inflammatory skin diseases, inflammatory dermatopathology can be a challenging topic for dermatopathologists and general surgical pathologists alike. Following a basic tissue reaction pattern approach, this article reviews the most common and important entities of each pattern, with emphasis on differential diagnosis, diagnostic pitfalls, and appropriate workup when indicated. A few dermatologic emergencies are also discussed.
Collapse
|
40
|
Saadeh D, Kurban M, Abbas O. Plasmacytoid dendritic cells and type I interferon in the immunological response against warts. Clin Exp Dermatol 2017; 42:857-862. [PMID: 28736973 DOI: 10.1111/ced.13187] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Plasmacytoid dendritic cells (pDCs) are the most potent producers of type I interferons (IFNs), and are involved in the pathogenesis of several cutaneous infectious (especially viral), inflammatory/autoimmune and neoplastic entities. Their role in the pathogenesis and regression of human papilloma virus (HPV)-induced skin lesions has not been well studied. AIM To investigate pDC occurrence and activity in HPV-induced skin lesions, including inflamed and uninflamed warts as well as epidermodysplasia verruciformis (EDV)-associated lesions. METHODS In total 20 inflamed and 20 uninflamed HPV-induced skin lesions (including 7 EDV lesions) were retrieved from our database, and the tissue was immunohistochemically tested for pDC occurrence and activity using anti-BDCA-2 and anti-MxA antibodies, respectively. RESULTS pDCs were present in all 20 inflamed warts and absent from all 20 uninflamed cases. MxA expression was also diffuse and strong in 75% (15/20) inflamed warts, but not in any of the uninflamed warts. CONCLUSIONS pDCs constitute a central component of the inflammatory host response in inflamed warts, possibly contributing to their regression through production of type I interferons.
Collapse
Affiliation(s)
- D Saadeh
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Kurban
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - O Abbas
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
41
|
Curto-Barredo L, López-Aventín D, Gómez-Martín I, Pujol RM. Recurrent pruritic papules on the elbows as a localized form of polymorphous light eruption. Clin Exp Dermatol 2017; 42:708-710. [PMID: 28543669 DOI: 10.1111/ced.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L Curto-Barredo
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - D López-Aventín
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - I Gómez-Martín
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - R M Pujol
- Department of Dermatology, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| |
Collapse
|
42
|
Abstract
The terms 'lichenoid' and 'interface' dermatitis are often used interchangeably to describe an inflammatory pattern characterized histologically by damage to the basal keratinocytes in the epidermis. The mechanism of cell damage of such cells is now best understood as apoptosis, or programmed cell death. This inflammatory pattern of dermatoses, is also accompanied frequently by a band of lymphocytes and histiocytes in the superficial dermis, that often obscures the dermal-epidermal junction, hence the term 'lichenoid'. A discussion of the more common lichenoid/interface dermatitides encountered in the routine clinical practice encompasses the following entities: lichen planus, lupus erythematosus, dermatomyositis, erythema multiforme, graft versus host disease, fixed drug reactions, and multiple others.
Collapse
Affiliation(s)
- Alejandro A Gru
- Department of Pathology & Dermatology, University of Virginia, Charlottesville, VA, Unitee States.
| | - Andrea L Salavaggione
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
43
|
Abstract
Lupus erythematosus (LE) is a multifactorial autoimmune disease with clinical manifestations of differing severity which may present with skin manifestations as primary sign of the disease (cutaneous lupus erythematosus, CLE) or as part of a disease spectrum (systemic lupus erythematosus, SLE). To date, no drugs are approved specifically for the treatment of CLE and only single agents have been applied in randomized controlled trials. Therefore, topical and systemic agents are used "off-label", primarily based on open-label studies, case series, retrospective analyses, and expert opinions. In contrast, several agents, such as hydroxychloroquine, chloroquine, cyclophosphamide, azathioprine, and belimumab, are approved for the treatment of SLE. Recent approaches in the understanding of the molecular pathogenesis of LE enabled the development of further new agents, which target molecules such as interleukin 6 (IL-6) and interferon (IFN). Only single trials, however, applied these new agents in patients with cutaneous involvement of the disease and/or included endpoints which evaluated the efficacy of these agents on skin manifestations. This article provides an updated review on new and recent approaches in the treatment of CLE.
Collapse
Affiliation(s)
- A Kuhn
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Germany Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany
| | - A Landmann
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany
| | - J Wenzel
- Department of Dermatology, University of Bonn, Germany
| |
Collapse
|
44
|
Kolivras A, Thompson C. Primary scalp alopecia: new histopathological tools, new concepts and a practical guide to diagnosis. J Cutan Pathol 2016; 44:53-69. [PMID: 27682637 DOI: 10.1111/cup.12822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/05/2016] [Accepted: 09/20/2016] [Indexed: 12/13/2022]
Abstract
The diagnosis of primary scalp alopecia remains one of the most challenging fields in dermatopathology. In this review, we would like to connect the established classification of primary alopecia into scarring (cicatricial) and non-scarring (non-cicatricial) with current concepts. We introduce a simplified pathway for the diagnosis of the most common causes of alopecia, including a discussion of tissue processing techniques and use of immunohistochemistry.
Collapse
Affiliation(s)
- Athanassios Kolivras
- Department of Dermatology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium.,Department of Dermatopathology, Saint-Pierre, Brugmann and Queen Fabiola Children's University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Curtis Thompson
- Department of Biomedical Engineering, Oregon Health Sciences University, Portland, OR, USA.,Department of Pathology, Oregon Health Sciences University, Portland, OR, USA.,Department of Dermatology, Oregon Health Sciences University, Portland, OR, USA
| |
Collapse
|
45
|
Karkouche R, Bernigaud C, Fontugne J, Zehou O, Bellaud G, N'Diaye M, Cherif K, Wolkenstein P, Chosidow O, Ortonne N, Ingen-Housz-Oro S. Cold-associated perniosis of the thighs histopathologically mimicking lupus. Six observations. J Eur Acad Dermatol Venereol 2016; 31:1029-1032. [DOI: 10.1111/jdv.13969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- R. Karkouche
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - C. Bernigaud
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - J. Fontugne
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - O. Zehou
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - G. Bellaud
- Service de maladies infectieuses; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M. N'Diaye
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - K. Cherif
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - P. Wolkenstein
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
| | - O. Chosidow
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
- Centre d'Investigation Clinique 1430, AP-HP; Créteil France
| | - N. Ortonne
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
| | - S. Ingen-Housz-Oro
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| |
Collapse
|
46
|
Cold-Associated Perniosis of the Thighs (“Equestrian-Type” Chilblain): A Reappraisal Based on a Clinicopathologic and Immunohistochemical Study of 6 Cases. Am J Dermatopathol 2016; 38:726-31. [DOI: 10.1097/dad.0000000000000477] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
47
|
Fening K, Parekh V, McKay K. CD123 immunohistochemistry for plasmacytoid dendritic cells is useful in the diagnosis of scarring alopecia. J Cutan Pathol 2016; 43:643-8. [DOI: 10.1111/cup.12725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/13/2015] [Accepted: 04/27/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Katherine Fening
- Division of Dermatopathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Viswas Parekh
- Department of Pathology; University of Alabama at Birmingham; Birmingham AL USA
| | - Kristopher McKay
- Division of Dermatopathology; University of Alabama at Birmingham; Birmingham AL USA
| |
Collapse
|
48
|
Kolivras A, Thompson C. Clusters of CD123+ plasmacytoid dendritic cells help distinguish lupus alopecia from lichen planopilaris. J Am Acad Dermatol 2016; 74:1267-9. [DOI: 10.1016/j.jaad.2015.12.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/25/2015] [Accepted: 12/29/2015] [Indexed: 01/05/2023]
|
49
|
Saadeh D, Kurban M, Abbas O. Update on the role of plasmacytoid dendritic cells in inflammatory/autoimmune skin diseases. Exp Dermatol 2016; 25:415-21. [PMID: 26837058 DOI: 10.1111/exd.12957] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/28/2022]
Abstract
Plasmacytoid dendritic cells (pDCs) represent a specialized dendritic cell population that exhibit plasma cell morphology, express CD4, CD123, blood-derived dendritic cell antigen-2 (BDCA-2) and Toll-like receptor (TLR)7 and TLR9 within endosomal compartments. When activated, pDCs are capable of producing large quantities of type I IFNs (mainly IFN-α/β), which provide antiviral resistance and link the innate and adaptive immunity. While generally lacking from normal skin, pDCs infiltrate the skin and appear to be involved in the pathogenesis of several inflammatory, infectious (especially viral) and neoplastic entities. In recent years, pDC role in inflammatory/autoimmune skin conditions has been extensively studied. Unlike type I IFN-mediated protective immunity that pDCs provide at the level of the skin by regulated sensing of microbial or self-nucleic acids upon skin damage, excessive sensing may elicit IFN-driven inflammatory/autoimmune diseases. In this review, focus will be on the role of pDCs in cutaneous inflammatory/autoimmune dermatoses.
Collapse
Affiliation(s)
- Dana Saadeh
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
50
|
Ingen-Housz-Oro S, Ortonne N. [Surface membrane markers (clusters of differentiation) used in dermatopathology (2): Inflammatory infiltrates]. Ann Dermatol Venereol 2016; 143:311-7. [PMID: 26988384 DOI: 10.1016/j.annder.2016.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 01/05/2016] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - N Ortonne
- Département de pathologie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| |
Collapse
|