Correlation of dermal and blood eosinophilia with bullous pemphigoid disease severity.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease associated with immune response against BP-180 and BP-230. Peripheral blood eosinophilia and dermal infiltration of eosinophils are common findings in BP. OBJECTIVE: The aim of our study was to demonstrate a statistical correlation between dermal and peripheral blood eosinophilia, anti BP-180, and anti BP-230 IgG and clinical severity of BP. METHODS: A total of 27 patients with newly diagnosed BP were included. Severity of disease was assessed according to the bullous pemphigoid disease activity index (BPDAI). Anti-BP-180 and anti-BP-230 titers, peripheral blood eosinophilia, and dermal eosinophil infiltration and tissue inflammation severity were assessed for each patient. RESULTS: A significant correlation was found between the serum levels of anti-BP-180 and anti-BP-230, and dermal eosinophilia and tissue inflammation severity with objective and subjective BPDAI scores. In addition, there was a significant correlation between the percentage of peripheral blood eosinophils and subjective BPDAI scores and urticarial/eczematous lesions. Moreover, the mucosal component did not show any correlation with autoantibody levels and inflammation severities. CONCLUSION: Anti-BP-180 and anti-BP-230 levels, tissue inflammation severity, and dermal eosinophilia had a strong and significant correlation with BP severity. In addition, percentage of peripheral blood eosinophilia showed a correlation with subjective BPDAI scores.

Distinguishing immunohistochemical features of alopecia areata from androgenic alopecia.

BACKGROUND: Distinction between alopecia areata (AA) and androgenic alopecia (AGA) can be made according to clinical presentation and biopsy findings. However, it is sometimes difficult to differentiate them, especially when the diffuse pattern of both AA and AGA is in the differential diagnosis of hair loss in androgen-dependent areas. OBJECTIVES: To evaluate the characteristics of inflammatory cell infiltration using CD3, CD4, CD8, and CD20 antigens, in AA and AGA to find some consistent histological clues for distinguishing these two entities. METHODS: A retrospective analysis of patients with diagnosed AA (30 cases) and AGA (30 cases) was performed based on the clinical and histopathological criteria. We studied immunohistochemical findings for CD3, CD4, CD8, and CD20 in all selected cases. RESULTS: Immunohistochemical stains for CD4 and CD20 were not helpful in differentiating AA from AGA, but the inflammation density for AA was significantly (P-value = .025, .001) higher than AGA in CD3 (specificity= 86.7% and sensitivity= 96.7%) and CD8 (specificity= 50% and sensitivity=86.6%). Our findings revealed that intrafollicular CD3 (P-value = .017) and CD8 (P-value = Ë‚.001) infiltrations were significantly higher in AA samples in comparison with AGA. CONCLUSION: Characterization of CD3 and CD8 in IHC samples is helpful, especially when the density of CD3 and CD8 T cells are significant in more than 50% of the infiltrated cells and are located intrafolliculary. Moreover, the most specific and sensitive test for differentiating of AA from AGA is CD3.

Nail Changes in Early Mycosis Fungoides.

BACKGROUND: Mycosis fungoides (MF) has a wide range of clinical presentations and it has been reported rarely to involve the nail apparatus. OBJECTIVE: We intended to evaluate the frequency and characteristics of nail changes in patients with biopsy-proven MF. METHODS: A retrospective analysis of 60 patients with MF who were evaluated at our cancer center from 2013 to 2014 was performed to identify patients with nail changes. Histological examinations of the skin around the nail apparatus were obtained from 10 patients with periungual skin erythema and scaling. RESULTS: In 45 patients out of 60 cases, the skin around the nail apparatus was normal, and only in 5 patients of these 45 cases, nail changes were detected. These changes included leukonychia, longitudinal ridging, nail thickening, and opacity. In the remaining 15 patients, erythema and scaling was observed in periungual skin, and 13 of them demonstrated nail changes including longitudinal ridging, nail thickening, fragility of the nail plate, subungual hyperkeratosis, pigmented nail band, Beau's lines, onychomadesis, koilonychia, nail thinning, distal notching, subungual debris, leukonychia, and pitting. In biopsies of periungual skin, none of 10 cases revealed histological findings consistent with MF. CONCLUSIONS: Evidence of nail changes was observed in 18 cases (30%). The most common nail changes detected in MF patients included longitudinal ridging, nail thickening, nail fragility, and leukonychia.

Folliculotropic Mycosis Fungoides: Clinical and Histologic Features in Five Patients.

BACKGROUND: Alopecia can be a manifestation of mycosis fungoides (MF); however, the prevalence is unknown. AIMS: We sought to describe the clinicopathologic presentation of alopecia in patients with diagnosis of MF. METHODS: A retrospective analysis of patients with biopsy-proven MF, who were evaluated at our cancer center from 2002 to 2012, was performed to identify patients with alopecia. RESULTS: Five patients with alopecia were identified from reviewing of 157 patients with MF. The male:female ratio was 3:2, and the mean age of patients was 42.8 years. Two of these patients showed patchy hair loss on scalp which was clinically identical to alopecia areata. In remaining three patients, hair loss was seen in areas of MF lesions, and epidermal changes consisted of patch- and plaque-type lesions of MF, tumors, and follicular lesions (follicular MF) were also present. In two of these patients, lymphadenopathy without any visceral involvement was detected. CONCLUSIONS: Alopecia was observed in 5 (3.18%) patients with MF, which makes it a rare finding, which included alopecia areata-like patchy loss in 2 and alopecia within MF lesions in 3.