Dermatology Immunology

Context: Immunofluorescence (IF) is an immunological technique which is used for identifying antibodies against antigens that
are bound to tissues or those circulating in body fluids. This study is an attempt to evaluate the dermatological lesions such as
noninfectious vesiculobullous lesions, connective tissue disorders, vasculitis, and lichen planus using histopathology techniques
and direct IF (DIF) studies. Furthermore, an attempt was made to evaluate the diagnostic utility of the IF technique in our
hospital. Aims: (1) To determine the utility of IF in the diagnosis of skin lesions. (2) To correlate IF with histopathological fndings.
Settings and Design: A cross‑sectional, observational study. Subjects and Methods: The present study was conducted in the
Pathology Department, Coimbatore Medical College, Coimbatore, from August 2012 to August 2013. Fifty cases received during
the period were included in our study. Two skin biopsies for each case ‑ one in formalin for routine histopathological examination
and other in phosphate buffer solution for IF studies ‑ were received. Statistical Analysis Used: Fisher’s exact value, mean,
and coeffcient of mean were calculated. Results: The lesions were diagnosed by both light microscopy and IF study. Out of ffty
cases, 42 cases were positive with the IF technique and the overall sensitivity of IF was 84% in our study. When histopathological
and IF fndings were correlated, statistically signifcant two‑tailed P = 0.0130 was obtained. Both light microscopic fndings and
IF fndings complemented each other in our study. IF proved to be a necessary supplementary technique to both clinical and
histopathological examinations, especially in cases of diagnostic dilemmas. Conclusions: IF is a rapid diagnostic procedure.
IF was useful in early diagnosis, treatment, and monitoring of various disorders in our study. Positive and negative DIF had
prognostic signifcance in certain cases. Clinicopathological correlation along with DIF studies proved to be a powerful tool in
defnite diagnosis of the skin lesions

Background:  Lupus erythematosus (LE) is an autoimmune disease of unknown cause. Prevalence of oral involvement in patients with LE is uncertain but may vary from 9 to 45% in patients with systemic disease and from 3 to 20% in patients with chronic cutaneous involvement.Methods:  Incidence of oral lesions of LE and their clinical aspects were investigated. Their histopathologic features were analyzed, and the status of epithelial maturation was assessed through the expression patterns of cytokeratins.Results:  Twenty-six patients (from 188 examined) presented oral lesions of LE. Most of them were females (19) with systemic disease (11). Clinical aspects of these lesions varied, and lips and buccal mucosa were most affected. Histologically, lesions revealed lichenoid mucositis with perivascular infiltrate and thickening of basement. Cytokeratins profile showed hyperproliferative epithelium, with expression of CK5/6, and CK14 on all epithelial layers, CK16 on all suprabasal layers and CK10 on prickle cell layers only.Conclusions:  Oral lesions of LE show a variety of aspects, and their microscopic features are of a lichenoid mucositis with deep inflammatory infiltrate. Cytokeratins expression patterns are of hyperproliferative epithelium, and this phenomenon must be analyzed in relation to the inflammatory cytokines for a better understanding of the mechanisms of the disease.

Biopsy specimens of cutaneous discoid lesions of 71 patients with cutaneous lupus erythematosus (CLE) were studied. The material was examined by direct immunofluorescence (DIF) to establish positivity and morphologic patterns of immunoglobulins and complement deposits in the basement membrane zone (BMZ). A correlation between DIF results and thickening of the epidermis basement membrane (BM) stained by periodic acid-Schiff (PAS), obtained from 31 matched biopsy specimens, also is presented. Direct immunofluorescence had positive results in 66.20% of the 71 examinations and 70.97% of the matched examinations, whereas PAS showed BM thickening in 100% of the specimens. This observation stresses the importance of such histopathologic findings in the diagnosis of discoid lesions in CLE. There was no correlation between DIF patterns and PAS-stained BMZ thickening. These findings merit additional study. In conclusion, an accordance between PAS-stained BM thickening and immunoglobulin deposits has occurred in 70.97% of cases. This phenomenon does not depend on the presence of immunocomplexes, for it occurs even in cases in which immunocomplex deposits were not detected.

Lupus erythematosus (LE) is a chronic, complex autoimmune disease with confounding etiology and pathogenesis. The tremendous heterogeneity in patients necessitates the stratification of patients on a molecular basis. Molecular initiators of disease induction, and details of inflammatory pathways leading to local tissue damage remain unclarified. Cutaneous lesions develop in 80% of LE patients at some point and 10-40% patients with cutaneous LE (CLE) (mainly discoid=DLE) show transitions to systemic LE (SLE). The skin may also flare independently of the systemic disease and vice versa, while treatments might improve one or the other or both diseases. The genomic strategies used in our investigations are expected to help clarify relationship between the systemic and cutaneous disease.  Comparative analysis of CLE skin and blood transcriptional profiles illuminates a more comprehensive understanding of the coordination of disease mechanisms at play in CCLE across systemic and local environments.  Overall, our transcriptional studies indicate that there are both shared and specific genetic underpinnings relevant to SLE and CLE.  Detailed genetic and functional pathway analysis has the potential to identify disease specific markers for future diagnostic, prognostic and treatment choices in cutaneous lupus.  Our ultimate goal is to advance towards a comprehensive " road map " in cutaneous lupus for disease development, progression, and phenotypic expression that can be utilized to identify individuals at risk, model disease outcomes, and reveal novel therapeutic targets.  The examination of gene expression datasets in CCLE skin and blood in the context of clinical data and known pathways and processes provides the framework upon which therapeutic considerations may be proposed.  In the remaining unique 1407 DEG in CLE-skin and blood profiles, we discover an enrichment of several KEGG pathways and GO processes that highlight the skin as a major locale of activity.  KEGG pathways such as amino acid degradation, lysosome and proteasome related breakdown processes, fatty acid metabolism, chemokine signaling, regulation of actin cytoskeleton and ECM-receptor interaction that are most likely to be specific for the cutaneous disease.  The implication is that these pathways and processes are specific to CLE that may represent novel targets in future therapeutic choices. We examined DEGs and disrupted downstream processes within the 152 overlapping DEGs between CLE (skin and blood) and SLE in the context of the enriched KEGG pathway Systemic Lupus erythematosus. 5, 6

Pencilliosis is an infection caused by Penicillium marneffei, a dimorphic fungus and can cause systemic mycosis in human beings. It is endemic in Southeast Asia and China. The prevalence 1 of P marneffei infection has increased substantially during the past few years especially in the immunocompromised individuals. This increase has occurred exclusively among patients infected with HIV in endemic regions. It also occurs in eastern India where the disease was not known before and where bamboo groves abound. These groves are the habitat of bamboo rats 2 which are putative carriers of P marneffei . As yet no reservoir for the fungus has been defined even though the soil is believed to be the natural source. Pencilliosis occurs usually when the CD 4 count is less than 100/µL. The disease has now been reported among HIV-infected persons in Thailand, Myanmar (Burma), Vietnam, Cambodia, Malaysia, northeastern India, Hong Kong, Taiwan and Southern China. The first report from India was of four autochthonous cases of 3 disseminated P marneffei infection in HIV-infected patients from the State of Manipur in 1999. 4 We describe a case of pencilliosis from a non endemic state of India. This individual had

Lupus erythematosus: Clinical and histopathological study of oral manifestations and immunohistochemical profile of the inflammatory infiltrate Background: Lupus erythematosus (LE) is a multifactorial autoimmune disease, which may affect the oral mucosa in either its cutaneous and systemic forms, with varied prevalence. Methods: Forty-six patients with confirmed diagnosis of LE, presenting oral lesions were included in the study. Oral mucosal lesions were analyzed clinically, their histopathological features were investigated and inflammatory infiltrate constitution was assessed using immunohistochemistry against the following clusters of differentiation: CD3, CD4, CD8, CD20, CD68 and CD1a. Results: From 46 patients with specific LE oral lesions 34 were females (25 with cutaneous LE and nine with systemic LE) and 12 were males (11 with cutaneous LE and one with systemic LE). Clinical aspects of lesions varied, and lips and buccal mucosa were the most affected sites. Histologically, lesions revealed lichenoid mucositis with perivascular infiltrate and thickening of basement membrane. Inflammatory infiltrate was predominantly composed by T lymphocytes of the CD4 subtype, with a minor prevalence of B lymphocytes, isolated macrophages and rare Langerhans cells. Conclusions: Oral lesions of lupus erythematosus show a variety of clinical aspects and histologically consist of a lichenoid mucositis with deep inflammatory infiltrate, composed predominantly of T CD4 positive lymphocytes.

Abstract: Palmoplantar lichen planus is an uncommon dermatosis. We present a case of 38-year-old Caucasian
male with a history of pruritic, scaly lesions on the right plantar foot. Physical examination revealed whitish
plaques and numerous spiny hyperkeratotic papules and focal scaling. A biopsy demonstrated orthohyperkeratosis
and acanthosis of the epidermis. Immunohistochemical staining revealed positivity within the epidermis and/
or lichenoid infi ltrate with CD3, CD8, CD45, CD68, myeloid histiod antigen, BCL2, p27, p53, HLA-DPDQDR,
metallothionein and tissue inhibitor of metalloproteinases 1. The diagnosis of PPLP was thus confi rmed; this case
illustrates that PPLP should be considered in the differential diagnosis of uncommon foot dermatoses with a signifi
cant junctional infl ammatory component.