The diagnostic use of monoclonal antibodies in a variety of dermatologic conditions.

Monoclonal antibodies have been used to characterize subpopulations of lymphocytes in a variety of dermatologic conditions by immunofluorescence and immunoperoxidase staining. Various clinical presentations of cutaneous T-cell lymphoma have been shown to be neoplastic expansions of helper T-lymphocytes. Immunoperoxidase studies using subset-specific monoclonal antibodies have allowed the differentiation of patients with cutaneous T-cell lymphoma from lymphocytoma cutis and B-cell lymphomas secondarily involving the epidermis. Increased numbers of OKT-6 positive Langerhans' cells in the dermal infiltrates of patients with cutaneous T-cell lymphoma may be another immunocytological marker of this disease. Studies done on circulating lymphocytes of patients with psoriasis and pemphigus vulgaris have shown normal ratios of T-cell subsets in patients with psoriasis and an expansion of the helper T-cell subset in an untreated patient with pemphigus. Immunofluorescence and immunoperoxidase techniques used in conjunction with highly specific monoclonal antibodies have been shown to be valuable for histopathologic study of dermatologic diseases.

Reactivity of Langerhans cells with hybridoma antibody.

Reactivity of a monoclonal antibody with human Langerhans cells was demonstrated by a double-labeling immunofluorescence technique. Ia-bearing cells of the epidermis (Langerhans cells) were reactive with this antibody both in frozen sections and in cell suspensions prepared from human epidermis. This monoclonal antibody was unreactive with non-Ia-bearing epidermal cells and with peripheral blood B cells, T cells, and monocytes but did not bind to 70% of intrathymic lymphocytes. These observations further distinguish Langerhans cells from classical monocytes. Furthermore, this monoclonal antibody is a highly specific marker for the in vivo identification and in vitro isolation of Langerhans cells.

Use of Orthoclone monoclonal antibodies in the study of selected dermatologic conditions.

Monoclonal antibodies recognizing human T cell differentiation antigens were used to study lymphocyte populations in three cutaneous diseases. Neoplastic lymphocytes from patients with varying phases of cutaneous T cell lymphoma (mycosis fungoides, Sezary syndrome and related presentations) were reactive with OKT1 and OKT3 (pan T cell reagents) and OKT4 (an antibody defining the functional "helper" T cell subset). The malignant cells lacked membrane antigens reactive with OKT5 and OKT8 (markers of "suppressor" T cells). The presence of an OKT1+, OKT3+, OKT4+, OKT5-, OKT8- phenotype on the neoplastic T lymphocytes of cutaneous T cell lymphoma (CTCL) supports the clinical impression that all phases of CTCL represent a single disease entity. A patient with pemphigus vulgaris, a disease of autoreactive, antiepidermal antibodies was shown to consistently have a marked expansion of the peripheral blood OKT4 reactive T lymphocyte population. These findings suggest that autoantibodies in pemphigus vulgaris may occur in the context of a profound OKT4/OKT5 immunoregulatory imbalance. Peripheral blood lymphocytes from patients ith extensive psoriasis vulgaris had a normal profile of reactivity with the OKT antibodies. In addition, OKT6 (marker of intrathymic T cells) has been shown to react with Ia+ dendritic cells in the epidermis suggesting that this antibody may recognize Langerhans' cells.

Primary cutaneous aspergillosis in six leukemic children.

We report a cluster of primary cutaneous aspergillosis in six children with hematologic malignancy. When first seen, they had hemorrhagic bullae caused by Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger at the sites of insertion of intravenous cannulas or where arm boards had been taped to the extremities. Rapid diagnosis of cutaneous aspergillosis was made by direct examination of the blister roof with potassium hydroxide before it progressed to a necrotic ulcer. Intravenous amphotericin was instituted promptly in five of six patients, and none died of disseminated aspergillosis. Epidemiologic investigation tracked the source of aspergillus to a storeroom with a false ceiling that had recently been repaired for a water leak.