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2.
Indian J Dermatol Venereol Leprol ; 87(6): 778-786, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491679

RESUMO

BACKGROUND: Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely, it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center. OBJECTIVES: The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders. METHODS: Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. A three millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings. RESULTS: Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed "n" serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an "n" serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a "u" serrated pattern. Three patients with negative indirect immunofluorescence showed "u" serration on direct immunofluorescence while the rest showed "n" serration. LIMITATIONS: ELISA and immunoblotting could not be performed due to resource constraints. CONCLUSION: Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable.


Assuntos
Dermatopatias Vesiculobolhosas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Pré-Escolar , Feminino , Imunofluorescência , Humanos , Masculino , Microscopia de Fluorescência , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
6.
Int J Dermatol ; 53(6): 746-51, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24320966

RESUMO

OBJECTIVES: Most human immunodeficiency virus (HIV)-infected patients develop various skin diseases. These skin manifestations not only act as markers but also reflect the patient's underlying immune status. Investigating CD4 counts is costly and not always possible. Thus, the potential value to be gained by using skin manifestations as predictors of low CD4 counts and disease progression should be explored. The present study attempted to correlate the association of various cutaneous disorders found in HIV patients with CD4 and CD8 counts, the CD4 : CD8 ratio and stage of HIV infection. METHODS: This was a prospective study involving 61 patients who were HIV-positive and demonstrated skin lesions. Punch biopsies of skin were taken for histopathological diagnosis. CD4 and CD8 T cell counts were performed. RESULTS: The study sample included a majority of male patients, most of whom were aged 21-40 years. Pruritic papular dermatitis was the most common skin manifestation, followed by molluscum contagiosum, eosinophilic folliculitis, and Hansen's disease. Most of the lesions were associated with CD4 counts of <220/µl (n = 38). All skin lesions associated with HIV or acquired immune deficiency syndrome (AIDS) showed a CD4 : CD8 ratio of <0.50. CONCLUSIONS: The study findings demonstrate an inverse relationship between CD4 counts and the occurrence of skin lesions. The majority of lesions were associated with stage 3 or stage 4 infection. Thus, specific cutaneous manifestations can be considered as good clinical indicators for predicting underlying immune status in resource-poor countries.


Assuntos
Eosinofilia/patologia , Foliculite/patologia , Infecções por HIV/complicações , Molusco Contagioso/patologia , Infecções Oportunistas/patologia , Dermatopatias Vesiculobolhosas/patologia , Dermatopatias/patologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/imunologia , Adulto , Biópsia por Agulha , Contagem de Linfócito CD4 , Estudos de Coortes , Países em Desenvolvimento , Eosinofilia/complicações , Eosinofilia/imunologia , Feminino , Foliculite/complicações , Foliculite/imunologia , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Molusco Contagioso/complicações , Molusco Contagioso/imunologia , Infecções Oportunistas/complicações , Infecções Oportunistas/imunologia , Estudos Prospectivos , Prurido/complicações , Prurido/imunologia , Prurido/patologia , Índice de Gravidade de Doença , Dermatopatias/complicações , Dermatopatias/imunologia , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/imunologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-20657117

RESUMO

BACKGROUND: Colloid bodies (CB) in direct immunofluorescence (DIF) studies are usually found in interface dermatitis. Furthermore, CB can be found in various skin diseases and even in normal skin. AIM: To evaluate the diagnostic value of CB deposits in DIF studies. METHODS: From 1996-2007, data from 502 patients where DIF studies showed immunoreactants at CB were enrolled. The definite diagnoses of these patients were based on clinical, histopathological and immunofluorescent findings. The results of DIF studies were analyzed. RESULTS: Immunoreactants at CB were detected in 44.4%, 43.8%, 4.2%, 3.8%, and 2.2% of interface dermatitis, vasculitis, autoimmune vesiculobullous disease, panniculitis, and scleroderma/morphea, respectively. The most common immunoreactant deposit of all diseases was Immunoglobulin M (IgM). Brighter intensity and higher quantity of CB was detected frequently in the group with interface dermatitis. CONCLUSIONS: Immunoreactant deposits at CB alone can be found in various diseases but a strong intensity and high quantity favor the diagnosis of interface dermatitis. CB plus dermoepidermal junction (DEJ) deposits are more common in interface dermatitis than any other disease. Between lichen planus (LP) and discoid lupus erythematosus (DLE), CB alone is more common in LP; whereas, CB plus DEJ and superficial blood vessel (SBV) is more common in DLE. The most common pattern in both diseases is CB plus DEJ. The quantity and intensity of CB in LP is higher than in DLE.


Assuntos
Técnica Direta de Fluorescência para Anticorpo/métodos , Microscopia de Fluorescência/métodos , Dermatopatias/patologia , Pele/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Coloides , Dermatite/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paniculite/patologia , Esclerodermia Localizada/patologia , Dermatopatias Vesiculobolhosas/patologia , Vasculite/patologia , Adulto Jovem
8.
Indian J Lepr ; 81(4): 205-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20704077

RESUMO

An untreated case of BL presented with clinical features of type 2 reaction (T2R) confirmed by histopathology. The case was a 18-year-old female with borderline lepromatous leprosy who developed annular vesiculobullous eruptions oversome of the pre-existing plaques on arms and upper back along with fever and severe neuritis after a short course of ofloxacin intake prescribed for urinary tract infection. In addition to the above lesions, some of the existing lesions showed acute exacerbation characterized by erythema, oedema, tenderness and vesiculobullous eruption. This can be considered as an example of leprous exacerbation as described in older literature. T2Rs are common in lepromatous leprosy and not so uncommonly are observed in borderline lepromatous leprosy. The vesiculobullous and crusted lesions developing over the existing borderline plaques, some of them presenting in an annular pattern in T2R in the form of leprous exacerbation, have been reported rarely in the literature.


Assuntos
Eritema Nodoso/patologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/patologia , Dermatopatias Vesiculobolhosas/patologia , Adolescente , Clofazimina/administração & dosagem , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Eritema Nodoso/tratamento farmacológico , Feminino , Glucocorticoides/administração & dosagem , Humanos , Hansenostáticos/administração & dosagem , Hanseníase Dimorfa/complicações , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Virchowiana/tratamento farmacológico , Prednisolona/administração & dosagem , Recidiva , Pele/patologia , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-17675738

RESUMO

Bullae occurring in lesions of morphea are uncommon. The cause of bullae formation in morphea is multifactorial, although lymphatic obstruction from the sclerodermatous process is considered the likeliest cause. Bullous morphea may be confused clinically with lichen sclerosus et atrophicus since both diseases may cause bullae in sclerodermatous plaques. A 69-year-old woman presented with a history of generalized morphea diagnosed 9 years earlier; and a 1-month history of pruritic bullae on her inframammary folds, axillary regions, lower abdomen, upper extremities and inguinal folds. Physical examination revealed multiple erythematous erosions, hemorrhagic vesicles and eroded bullae with slight scale or crusts overlying hypopigmented, indurated, shiny plaques. Skin biopsy revealed prominent edema in the papillary dermis, resulting in bulla formation and thickening of collagen fibers within the dermis. Direct immunofluorescence was negative. According to histologic and clinical features, the diagnosis of bullous morphea was established.


Assuntos
Esclerodermia Localizada/patologia , Dermatopatias Vesiculobolhosas/patologia , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Fricção , Humanos , Esclerodermia Localizada/fisiopatologia , Dermatopatias Vesiculobolhosas/etiologia
11.
Lepr Rev ; 74(3): 275-8, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14577473

RESUMO

A middle-aged HIV infected man receiving treatment for pulmonary tuberculosis, presented with a febrile illness along with evanescent, erythematous nodular lesions all over the body. On examination, he had features suggestive of lepromatous leprosy with lesions of erythema nodosum leprosum. In addition, there were multiple small, circumscribed areas of slack skin, clinically and histopathologically suggestive of anetoderma. Both leprosy and HIV infection are known to give rise to lesions of anetoderma. Pathogenesis of anetoderma in these infectious conditions is discussed.


Assuntos
Infecções por HIV/complicações , Hanseníase Virchowiana/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Tuberculose Pulmonar/complicações , Adulto , Diagnóstico Diferencial , Humanos , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologia , Masculino , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/patologia
12.
Indian J Lepr ; 74(2): 145-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12708733

RESUMO

Erythema nodosum leprosum (ENL) classically presents as tender, erythematous nodules over the face, arms and legs. Severe ENL can become vesicular or bullous and break-down and is termed erythema necroticans (Jopling & McDougall, 1996) and is treated with corticosteroids. The causes of death in a majority of leprosy patients are the same as in the general population, with the exception of renal damage in lepromatous leprosy. There is possible increased mortality from side-effects of antileprosy drugs, steroids, or other drugs used in reactions, from toxaemia in severe reactions, and from asphyxia due to glottic oedema (Jopling & McDougall, 1996). We report here a case of erythema necroticans, the cause of death being septicaemia, secondary to skin ulcers and urinary tract infection, precipitated by corticosteroids.


Assuntos
Corticosteroides/efeitos adversos , Eritema Nodoso/patologia , Hanseníase Virchowiana/patologia , Dermatopatias Vesiculobolhosas/patologia , Corticosteroides/uso terapêutico , Anti-Infecciosos/uso terapêutico , Ciprofloxacina/uso terapêutico , Eritema Nodoso/tratamento farmacológico , Evolução Fatal , Humanos , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Dermatopatias Vesiculobolhosas/tratamento farmacológico
13.
Ann Dermatol Venereol ; 125(3): 188-90, 1998 Mar.
Artigo em Francês | MEDLINE | ID: mdl-9747246

RESUMO

BACKGROUND: Polar and borderline lepromatosis leprosy can be complicated by type 2 reactional states, including erythema nodosum leprosum. CASE REPORT: A 36-year-old man was treated for lepromatous leprosum. He consulted for recurrent erythema nodosum leprosum. Certain nodular lesions were bullous. Histopathology demonstrated major dermal edema causing bullous blisters. Treatment with thalidomide led to rapid regression. DISCUSSION: The bullous form of erythema nodosum leprosum is rarely described in the literature. It raises the diffential diagnosis with other bullous dermatoses, particularly Sweet's syndrome.


Assuntos
Eritema Nodoso/patologia , Hanseníase Virchowiana/patologia , Dermatopatias Vesiculobolhosas/patologia , Adulto , Diagnóstico Diferencial , Eritema Nodoso/complicações , Eritema Nodoso/tratamento farmacológico , Guiana Francesa , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Talidomida/uso terapêutico
15.
Clin Exp Dermatol ; 21(1): 67-71, 1996 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8689777

RESUMO

A 20-year-old lady presented with a 3-month history of an itchy eruption affecting her face and trunk. Erythematous annular plaques with follicular papules and pustules at the margins were present on her face consistent with Ofuji's disease. A perifollicular and perivascular eosinophil-rich infiltrate was seen histologically, with infiltration of the follicular epithelium by eosinophils and formation of eosinophilic microabscesses. An unusual feature was the presence of follicular mucinosis. Treatment with dapsone resulted in an improvement in the eruption after 2 weeks. Ofuji's eosinophilic pustular folliculitis is becoming increasingly frequently recognized, and may not be as rare as initial reports suggested. In 1965, Ise and Ofuji reported the case of a Japanese woman who had recurrent episodes of follicular pustules affecting her face and back accompanied by a peripheral eosinophilia. Following this, in 1970 Ofuji et al. reported three further cases and proposed the name eosinophilic pustular folliculitis. Although many of the early cases were in Japanese patients, reports of this disease affecting individuals from Europe and the United States have been increasing.


Assuntos
Eosinofilia/patologia , Foliculite/patologia , Dermatopatias Vesiculobolhosas/patologia , Adulto , Dapsona/uso terapêutico , Eosinofilia/tratamento farmacológico , Feminino , Foliculite/tratamento farmacológico , Humanos , Hansenostáticos/uso terapêutico , Dermatopatias Vesiculobolhosas/tratamento farmacológico
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