Expression of the receptor for advanced glycation end products in acquired reactive perforating collagenosis.

BACKGROUND: Acquired reactive perforating collagenosis (ARPC) is a rare skin disorder characterized by transepidermal elimination of dermal collagen. There is little data regarding the pathogenesis of ARPC. The receptor for advanced glycation end products (RAGE) is a multiligand transmembrane receptor that plays an important role in inflammatory responses and may be involved in the pathogenesis of ARPC. AIM: To explore the expression of RAGE in ARPC. METHODS: Paraffin-embedded punch biopsy specimens of 41 patients with ARPC and of 11 healthy controls with normal skin were obtained from the Department Of Pathology. Clinical data of all patients were reviewed from the medical files. All specimens were stained immunohistochemically with antibody to RAGE (Anti-RAGE). The intensity of RAGE expression was assessed semi-quantitatively on epidermal cells, microvascular endothelium, dermal fibroblasts and inflammatory cells and graded as 0 (no staining), 1 (weak), 2 (moderate) and 3 (strong). The patients were divided into diabetic and nondiabetic groups for analysis. RESULTS: RAGE expression in microvascular endothelium, inflammatory cells and fibroblasts of patients with ARPC was more intense than normal tissues of healthy participants (P values are 0.005, 0.017 and P > 0.05). LIMITATIONS: Our method of assessment of RAGE expression was semi-quantitative. CONCLUSION: We observed an overexpression of RAGE in lesional samples of patients with ARPC which was independent of the presence of diabetes.

Case of suspected connective tissue disease presenting as chronic edema or swelling of face, neck, and upper trunk.

An adequate biopsy that includes the subcutaneous tissue is very helpful in the evaluation of patients with suspected connective tissue disease. However, the histologic features must often be correlated with the clinical features and other laboratory tests for a definitive diagnosis. An objective histologic diagnosis can usually be made in scleroderma, lupus erythematosus panniculitis, amyloidosis, and angioedema, and in diseases such as lepromatous leprosy and mycosis fungoids (which are sometimes confused with connective tissue diseases). Correlation with clinical features and, sometimes, other laboratory tests is often required to establish a diagnosis of scleredema, dermatomyositis, myxedema, and lichen myxedematosus. The features in cheilitis granulomatosa usually are not specific, but a biopsy is helpful to rule out other diseases.

The significance of the fluorescent treponemal antibody (FTA-ABS) test in collagen disorders and leprosy.

A test is described to distinguish the immunofluorescence seen on T. pallidum in syphilis from that due to antibodies against DNA. The method consists of comparing the results of the fluorescent treponemal antibody (FTA-ABS) test with the staining obtained with T. gondii and T. cruzi using an indirect fluorescent technique. The ability of a particular serum to stain other organisms, in addition to T. pallidum, at a significant titre indicates that the treponemal fluorescence is not specific, and the loss of this staining property when organisms are pretreated with deoxyribonuclease suggests that the common microbial antigen is DNA. The isolated treponemal fluorescence found in syphilis is unaffected by pretreatment of T. pallidum. When 123 sera from patients with collagen disorders were examined, non-specific bacterial fluorescence was observed in six sera, while in 95 sera from patients with lepromatous leprosy, a positive FTA-ABS reaction was obtained in 14. There was no accompanying immunofluorescence on other protozoa. Therefore the antibody reacting in the FTA-ABS test in leprosy is likely to be treponemal in origin. A mitochondrial antibody was found in seven out of the 15 sera from patients with lepromatous leprosy.