ABSTRACT
CONTEXT: An umbrella term, acquired dermal macular hyperpigmentation (ADMH), has been proposed to denote conditions including ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, and idiopathic macular eruptive pigmentation. AIMS: To classify the patients manifesting ADMH on the basis of histology. SETTINGS AND DESIGN: In this retrospective, cross-sectional study, histology specimens of patients of ADMH, who underwent skin biopsy in our institution from 1.1 2015 to 31.12.2017, were included after obtaining ethical clearance. MATERIALS AND METHODS: The histology specimens of patients of ADMH were reviewed by the pathologist and classified. Clinical features of individual patient were collected from previous records and the data analyzed. STATISTICAL ANALYSIS USED: Pearson's Chi-square test was used to determine significance of association between age of onset and duration of pigmentation with histology type. RESULTS: Three patterns of histology were identified in the study group (17 males and 13 females). Type 1: Basal cell degeneration and moderate to dense inflammation (12 patients, 40%), type 2: Significant pigment incontinence and sparse inflammation without basal cell degeneration, (12 patients, 40%), and type 3: sparse inflammation without basal cell degeneration or significant pigment incontinence (six patients, 20%). Statistically significant association was noted between age of onset of pigmentation and histology type (P value, 0.02). LIMITATIONS: Main limitation was the small sample size. CONCLUSIONS: Prospective studies evaluating the clinical progression and dermoscopy features and analyzing serial biopsies of ADMH patients may confirm whether the histology patterns observed represent different stages of same disease process or are different entities.
ABSTRACT
Objetivos: 1. Evaluar la immunohistoquimica de los granulomas de la lepra en las muestras de biopsias cutáneas de pacientes con lepra tuberculoide y lepromatosa, con respecto a la presencia y distribución de células T CD4+, CD8+ y CD28+, células CD 68+ y células CD1a+. 2. Evaluar los hallazgos inmunohistoquimicos observados en leprorreacciones. Metodología: Estudio descriptivo. Se seleccionaron para el estudio biopsias cutaneas, en las que se había diagnosticado clínica e histopatologicamente lepra entre el 1.8.2016 al 31.5.2017 en el Instituto Medico Gubernamental, Kozhikode. Se estudió la immunohistoquimica de las lesiones cutáneas en lepra y leprorreacciones, observando específicamente la distribución de células CD4/ CD8/ CD28/ CD68/ CD1a en la lepra en distintos escenarios. Resultados: En el estudio se incluyeron veintiséis casos tuberculoides y 14 lepromatosos. Todos los granulomas independientemente del tipo de enfermedad presentaron tinción positiva por CD4 y CD68. Dos de los 14 casos lepromatosos (14・3%), y 15/26 (57・7%) de las muestras tuberculoides presentaron expresion CD4 de moderada a fuerte. Se detectó negatividad CD28 en cuatro casos tuberculoides (15・4%) y en 10 lepromatosos (71・4%). La expresion CD4 moderada a fuerte se detectó en más del 70% de los T1R incremento mientras que en los demás grupos solo fue de 20%-50%. Más del 80% de las T1R estáticas e incremento presentaban positividad CD28, mayor de que el 30%-50% registrado en otros grupos. Conclusiones: Los resultados revelan que la inmunohistoquimica tiene un papel en aclarar los complejos procesos inmunológicos empleados en la lepra y las leprorreacciones
Objectives: 1. To study the immunohistochemistry of leprosy granulomas in the skin biopsy specimens of patients with tuberculoid and lepromatous leprosy, with respect to the presence and arrangement of CD4+, CD8+ and CD28+ T cells, CD 68+ cells and CD1a+ cells. 2. To study the immunohistochemistry findings observed in leprosy reactions. Design: Descriptive study. Skin biopsies in which the clinical and histopathological diagnosis of leprosy was reported between 1.8.2016 to 31.5.2017 in the Government Medical College, Kozhikode, were selected for the study. Immunohistochemistry of the skin lesions in leprosy and leprosy reactions was studied, looking specifically for the distribution of CD4/ CD8/ CD28/ CD68/ CD1a positive cells in leprosy at different scenarios. Results: Twenty-six tuberculoid and 14 lepromatous cases were included in the study. All granulomas irrespective of disease type showed positive staining for CD4 and CD68. Two of the 14 lepromatous leprosy cases (14・3%), and 15/26 (57・7%) tuberculoid specimens manifested moderate to strong CD4 expression. CD28 negativity was documented in four tuberculoid (15・4%) and 10 lepromatous cases (71・4%). Moderate to strong CD4 expression was noted in more than 70% of upgrading T1R while a similar finding was documented in only 20%-50% of other groups. More than 80% of static and upgrading T1R showed CD28 positivity, which was higher than the 30%-50% positivity recorded in other groups. Conclusions: The observations of the current study indicate a role for immunohistochemistry analysis in delineating the complex immunological processes involved in leprosy and leprosy reactions
