[Acrosyringium and follicular infundibulum: immunomorphologic aspects]. / Akrosyringium und Follikelinfundibulum: Immunmorphologische Aspekte.

Acrosyringium and infundibulum are epidermal structures with different morphology, but functional similarities regarding re-epithelialization, transport of antigens, and attraction of infiltrates. Immunomorphologically, the infundibula revealed an immunoreactivity of Langerhans cells and keratinocytes comparable with that of the interfollicular epidermis, whereas the acrosyringia reacted differently because of the permanent expression of MHC class II antigens and reduced Langerhans cells in the perisyringial region. Our findings suggest that these epidermal compartments differ with regard to their individual immunologic situations. While the mechanisms of epidermal immunity known from the interfollicular epidermis are possibly the same in the infundibula, we have to expect a basically different immunologic situation in the acrosyringia.

[Characterization of lymphocytic infiltrate cells in bullous pemphigoid and pemphigus vulgaris]. / Charakterisierung lymphozytärer Infiltratzellen bei bullösem Pemphigoid und Pemphigus vulgaris.

By means of monoclonal antibodies (mab) and alkaline phosphatase anti-alkaline-phosphatase (APAAP) technique, the distribution and characteristics of lymphocytic infiltrates were studied in biopsies from 15 patients with bullous pemphigoid (b.P.) and 5 patients with pemphigus vulgaris (P.v.). The biopsies were obtained from freshly developed blisters along with perilesional tissue. The lymphocytic infiltrates in b.P. as well as in P.v. were located in the area of the fresh lesions and consisted almost exclusively of T cells (CD3 positive lymphocytes). In b.P., the discrepancy between a decreased number of CD2 positive lymphocytes (10-20%) and markedly higher number of CD3 staining cells (50-60% of all infiltrate cells) was striking. The characterization of the T cell subpopulations in both dermatoses showed mainly T helper cell infiltrates (CD4), while only up to 10% of T suppressor cells (CD8) were detected. CD45R positive (CD4+/CD45R+: suppression inducing) as well as CD29-positive (CD4+CD29+: cells which provide help for antibody production) T-cell subpopulations were detected in both dermatoses particularly adjacent to blister in up to 10% of the cell infiltrates. Epidermal staining with CD29 mab in b.P. up to the stratum spinosum and in P.v. within intraepidermal blisters was detected. By means of CD19 and CD21 mab B lymphocytes were minimal. Perivascular individual cell staining occurred with CD7 CD16, CD56 and CD57 mab (K/NK cells) in b.P. as well as in P.v. patients. The predominance in T cell infiltrates, particularly T helper cells, suggests the role of cellular immune mechanism in the pathogenesis of these diseases, in b.P. the CD2 antigen (SE receptor) appears to be of particular importance.

[The value of serologic inflammatory parameters in the diagnosis of alopecia areata]. / Die Wertigkeit serologischer Entzündungsparameter in der Diagnostik der Alopecia areata.

Even recently, focal processes or inflammatory diseases have repeatedly been discussed as the possible causes of alopecia areata (AA) and corresponding diagnostic measures are still recommended. Therefore, we initially attempted to find definite indications of processes like these in AA patients by means of serologic parameters of inflammation and ESR as well as supplementary clinical focal diagnostics. The data obtained revealed increased titers of antistreptolysin in 2.9% and antistreptococcal DNase B in 25.7%, positive C-reactive protein in 8.6%, positive rheumatoid factor in 4.3%, and elevated ESR in 11.7% of the cases. After these data had carefully been compared to those in healthy persons, only the titer of antistreptococcal DNase B and the ESR were found to be increased. In the majority of the cases, these elevations correlated with concomitant bacterial infections detected by clinical focal diagnostics. Antistreptococcal DNase B titer and ESR seem to be the most appropriate of all our test parameters to provide some indications of a focal process or concomitant inflammatory diseases. The remaining parameters are not indicated in AA.

[Classification of HIV-associated acquired immunologic deficiency syndrome]. / Klassifizierung des HIV-assoziierten erworbenen Immundefektsyndroms.

Regarding the staging of HIV infection, there are several classification systems, but neither of them has universally been accepted. We tested a new staging system with 4 parameters: HIV antibodies, CD4/CD8 ratio, absolute count of CD4 + lymphocytes, and absolute count of leukocytes. This classification indicates a regular progression of immunodeficiency, 294 blood specimens were used for immunological staging. The correlation between the immunological staging and the severity of the disease proved the usefulness of this classification system.

[Epidermal reticular CD1 pattern]. / Das epidermale retikuläre CD1-Muster.

183 biopsies taken from various skin diseases as well as normal skin were studied in cryostat sections by means of the avidin-biotin complex immunoperoxidase technique, using monoclonal antibody anti-Leu 6, which is directed against the Langerhans cell antigen CD1. In 47 cases, we observed a reticular, pemphigus-like intercellular pattern. This pattern was neither correlated to individual skin diseases, nor to the quality or quantity of corial or epidermotropic infiltrates, nor to the HLA-DR expression of keratinocytes, nor to the count of Langerhans cells. There was, however, a correlation to the presence of Langerhans cells: This pattern was never observed in the aerosyringia or deep infundibula. We conclude, therefore, that the stained antigen has to be regarded as free CD1 derived from the Langerhans cell and diffusing into the keratinocytic intercellular spaces.

Two-color flow cytometry analysis in alopecia areata.

Since previous studies have shown that circulating T cytotoxic/suppressor cells and natural killer cells are reduced in alopecia areata (AA), we attempted to find further imbalances in mononuclear cells by double labeling with these and additional monoclonal antibodies. In all, the blood of 35 patients and 44 controls was examined using the combinations anti-Leu 3a/8, Leu 2a/8, Leu 2a/15, Leu 7/15 and Leu 7/11a. We found a highly significant reduction of the subpopulation Leu 2a+8+ (p less than 0.008). The results show that patients with AA have additional abnormalities of the circulating mononuclear cells, whereby the reduced Leu 2a+8+ subpopulation represents a new additional marker.

Differential expression of major histocompatibility complex class II antigens on human keratinocytes.

Skin biopsies from 136 patients with 30 different dermatoses and eight biopsies of normal skin were investigated with the avidin-biotin-peroxidase complex method with regard to the expression of major histocompatibility complex class II antigens human leukocyte antigen (HLA) HLA-DR, HLA-DQ, HLA-DP on keratinocytes. In normal skin the expression of these antigens was restricted to acrosyringia and Langerhans cells. In the dermatoses investigated HLA-DR was found in 51.5% (70 of 136), HLA-DQ in 24.3% (33 of 136), and HLA-DP in 20.5% (8 of 39). In 37 cases (27.2%) only HLA-DR could be detected, whereas in 33 cases (24.3%) HLA-DR was expressed jointly with HLA-DQ. Coexpression of HLA-DR and HLA-DQ was found especially often in cutaneous T cell lymphomas, skin tumors, and inflammatory dermatoses.

Anti-Leu 19 monoclonal antibody detects an antigen on autonomic nerves in human skin.

The monoclonal antibody anti-Leu 19 recognizes the NKH-1 antigen of active natural killer cells. In immunohistological preparations of the skin, the antibody reacts with cutaneous nerves and labels nerve fibers in the region of the sweat glands, the blood vessels and the hair arrector muscles. This staining pattern corresponds to the distribution of the autonomic sympathetic nervous system of the skin. On the other hand, anti-Leu 7 labels a myelin-associated glycoprotein which is to be found in the myelin sheath of sensory cutaneous nerves. The reactivity of neural structures of the skin can thus be differentiated. Anti-Leu 7 labels the myelinated sensory nervous system, whereas anti-Leu 19 seems to constitute a new marker for the autonomic nervous system of the skin.

[Type IV immunity in alopecia areata in a comparison of 2 test methods]. / Die Typ-IV-Immunität der Alopecia areata im Vergleich zweier Testmethoden.

69 patients with alopecia areata of different degree and duration were tested for cell-mediated immunity (DCH) by means of the Multitest system and other recall antigens. Our findings revealed a normergic status in most of the patients. In comparison with healthy controls, however, these patients showed decreased cell-mediated immunity, which was proved by a diminished score and a reduced number of positive reactions. There was no correlation between an anergic or hypoergic status on the one hand, and the degree or duration of the disease on the other.

Reaction of human keratinocytes with the monoclonal antibody anti-Leu-11: an immunohistologic study.

Biopsy specimens from skin of 99 patients with 26 different dermatoses and 17 specimens from normal skin were labeled with regard to the reactivity of keratinocytes with the monoclonal natural killer-associated antibody anti-Leu-11b by means of the avidin-biotin-peroxidase complex method. Reactivity occurred in 64.7% of the preparations from normal skin and in 84.8% of the preparations from diseased skin. The membranes of the subcorneal keratinocyte layers were labeled regularly. In some of the preparations cytoplasmic reactivity and labeling of the basement membrane zone occurred in addition. Most labeled preparations and the highest labeling intensities were shown in the skin tumors and in the infectious dermatoses. The biologic significance of this finding is discussed.

Reactivity of human keratinocytes with the antimonocytic monoclonal antibody anti-Leu M2.

Skin biopsies from 49 patients with 21 different dermatoses and biopsies of normal skin were investigated with regard to the reactivity of keratinocytes with the monoclonal antimonocytic antibody anti-Leu M2 using the avidin-biotin-peroxidase complex method. In all excisates, a cytoplasmic reaction of keratinocytes was seen which was regularly weaker in the basal layers of the epidermis than in the upper layers. Marked differences in the labelling intensity were shown between the individual dermatoses. Keratinocytes have now been shown to react with several monoclonal antibodies directed against monocytic antigens; therefore the functional significance of this should be discussed.

[Reactivity of conventional and immunologically standardized allergen extracts in the prick test]. / Reaktivität herkömmlicher und immunologisch standardisierter Allergenextrakte im Prick-Test.

In comparison with conventional allergen preparations immunologically characterized allergens were tested by skin-prick-tests for reactions. These results were compared with those of Rasttests.

[Clinical and immune-modulating effects of the treatment with unsaturated fatty acids in atopic dermatitis]. / Klinische und immunmodulatorische Effekte einer Behandlung mit ungesättigten Fettsäuren bei atopischer Dermatitis.

The metabolism of essential unsaturated fatty acids seems to show changes in patients with atopic dermatitis (AD). A defect or a deficiency of a Delta-6-Desaturase, which transforms cis-linoleic acid into gamma-linolenic-acid will be discussed. We examined the influence of a treatment with unsaturated fatty acids on clinical phenotype and the surface antigens of lymphocytes in peripheral blood. Prolonged recurrence free intervals as well as a faster ability to control relapse were established. Dysbalance in the lymphocytic system was able to be positively influenced. We found an increase of Leu 2 a-antigen carrying T-suppressor-lymphocytes and of the Leu 3+8+- antigen carrying subpopulation of T-helper-lymphocytes, which are responsible for activation of precursor T-suppressor cells into.

[Clinical and immunologic studies of the use of thymus polypeptide factor (thymostimulin) in chronic mucocutaneous candidiasis]. / Klinische und immunologische Beobachtungen während der Gabe von Thymuspolypeptidfaktor (Thymostimulin) bei chronischer mukokutaner Kandidose.

T-cell lymphocyte subpopulations were successfully converted by means of thymus polypeptide factor in a 17-year-old boy with chronic mucocutaneous candidiasis and combined immunodeficiency. It was demonstrated that the injections caused normalization of the peripheral T-lymphocytes subpopulations and a better state of general health. Normalization was due to a minimal increase in total peripheral T-lymphocytes and T-helper cells and a significant decrease in T-suppressor cells.

Simplified fixative medium for direct immunofluorescence in skin biopsies.

The main limitation for the use of direct immunofluorescence in skin biopsies was the necessity for frozen tissue. In 1973 Michel et al reported use of a liquid fixative, consisting of ammonium sulfate, N-ethyl-maleimide, magnesium sulfate, and potassium citrate, for handling skin biopsy specimens. The present study introduces a simplified liquid fixative medium consisting only of ammonium sulfate and saline. Comparisons of direct immunofluorescence findings in biopsy specimens transported in these two transport media and in fresh-frozen specimens revealed only minimal differences between the three different procedures.

[Mycotic mycetoma (eumycetoma) caused by Madurella mycetomi]. / Mykotisches Myzetom (Eumyzetom) durch Madurella mycetomi.

Mycotic mycetoma is a chronic, granulomatous and fistulous tropical disease caused by hyphomycetes of different families. A case caused by Madurella mycetomi is presented and the diagnostic and therapeutic possibilities discussed.

[Swimming pool granuloma--an atypical mycobacterial infection]. / Das Schwimmbadgranulom--eine atypische Mykobakteriose.

After an introduction on the problem of swimming pool or fish tank granulomas--chronic granulomatous skin infections with Mycobacterium marinum--we present two of our own cases. The disease is discussed and the signs and symptoms, histological changes, and therapeutic methodology presented.