The histology and immunopathology of vitiligo.

Twenty-nine Caucasoid patients with 'common' vitiligo were studied. The sera of these patients were tested for autoantibodies. Shave biopsies from uninvolved, marginal and involved areas were studied by DOPA method, direct immunofluorescence tests, indirect immunofluorescence complement fixation technique, Epon embedded tissue for light microscopy and by electron microscopy. All the patients had symmetrical vitiligo apart from one. About 50% of these patients had the onset of their vitiligo before the age of 20 years. The incidence of autoimmune disorders that are commonly associated with vitiligo seemed to be increased. These patients frequently had a positive family history of vitiligo and other autoimmune disorders. The organ specific autoantibodies were also increased in the sera of these patients. There was no significant deposition of immunoglobulins in all areas biopsied apart from the presence of cytoid (colloid/amyloid) bodies. However, in many patients, there was deposition of fibrin in the papillary dermis and at the dermo-epidermal junction of the marginal and involved areas. There was no complement fixing antibody to the melanocytes in the sera of all the patients tested.On light and electron microscopy, inflammatory changes were seen in the skin of these patients, mostly in the marginal areas. This consisted of spongiosis of the epidermis with a mononuclear cell infiltrate. Many of the intraepidermal lymphocytes were found in direct contact with melanocytes and Langerhans cells. The degree of mononuclear cell infiltrate of the dermis did not parallel that seen in the epidermis. Sometimes, there was a massive lymphocytic infiltrate in the epidermis, even forming Pautrier-like micro-abscess, but only a few lymphocytes in the upper dermis. It is suggested that the primary inflammatory reaction occurs in the epidermis where an antigen is present. Langerhans cells were found to be increased in the epidermis-of uninvolved areas of patients with vitiligo compared to that of normal controls. These cells were also increased in the involved depigmented areas. Some of these cells were seen to be in direct contact with lymphocytes. The melanocytes were markedly reduced in the marginal areas and only a few residual cells were found in the involved skin. The melanosomes had the tendency to be singly dispersed in the keratinocytes rather than in membrane bounded complexes. There was no obvious pathological changes in the cutaneous nerves. However, there appeared to be some evidence of regeneration of axons. In a third of the patients intra-epidermal nerves were found in the basal layer. Some of these nerves were adrenergic in type and observed occasionally in direct contact with a secretory melanocyte. Colloid/amyloid bodies were demonstrated in the papillary dermis, by a variety of techniques. They had the tendency to occur in the skin of patients with vitiliqo compared to that of normal controls. These colloid/amyloid bodies had many features that would suggest these bodies were derived from degenerating melanocytes. Three patients with occupational vitiligo due to paratertiary butyl phenol were studied. The findings were similar to that found in idiopathic vitiligo. The light microscopic ultrastructural and immunopathological findings in vitiligo do support the hypothesis that this condition is an 'autoimmune' disorder

“Acquired epidermodysplasia verruciformis” in kidney transplant patients

AbstractBackgroundEpidermodysplasia verruciformis (EV) is a well known inherited autosomal recessive skin disease associated with numerous early onset viral warts on the sun exposed parts of the body that usually progress into skin malignancies. Kidney transplant patients are also commonly associated with viral warts that might change into skin cancers.ObjectiveTo describe the clinical pictures of extensive viral warts with skin malignancies in kidney transplant patients in comparison with inherited (EV) features.Patients and methodsThis case controlled study that included 130 patients with kidney transplantation was done in kidney transplantation centers in Baghdad and Al-Karma Teaching Hospitals during December 2002 to September 2004. All recruited patients were receiving multiple immunosuppressive drugs like methyl prednisolone succinate, oral prednisolone, azathioprine and cyclosporine. History was taken from all patients including all the relevant points. These patients were divided into three groups according to the duration of kidney transplant: group A 1–10years, group B 11–20years and group C more than 20years. Biopsies were performed from the viral warts lesions and the associated tumors.Two hundred and sixty apparently healthy individuals, 206 males and 54 females had been examined as control cases for the presence of viral warts and tumors. These control cases had been taken randomly from general population in multiple regions in Baghdad.ResultsSixty-five patients out of 130 with kidney transplantation had viral warts. Their ages ranged from 20 to 71 (45.49±SD 10.82) years, 51 males and 14 females, while the duration of the warts ranged from 0.5 to 10 (3.74±SD 2.67) years. The distribution of patients with viral warts among the groups was as follows: group A 28 (43.1%), group B 30 (46.2%) and group C 7 (10.7%) cases. Viral warts were seen in 10 (3.8%) of the control group. There were statistically significant differences between patients and control cases (P value <0.001). Most of the viral warts in patients with kidney transplantation were multiple and of the verrucae vulgaris type. They were mainly located on the exposed areas of the body, mostly on the face and dorsa of hands.Skin malignancies were observed in 6 (9.2%) cases: five squamous cell carcinomas and one case of basal cell carcinoma. Squamous cell carcinoma was mainly located on the lower lips in 3 cases and 2 on the dorsa of hands, while basal cell carcinoma was observed on the nose. Two cases (7.1%) of squamous cell carcinoma were seen in group A, 2 (6.6%) in group B and 1 (14%) in group C. One case of basal cell carcinoma was noted in group B .No skin malignancy was observed in the control group.ConclusionKidney transplant patients have an increased susceptibility to infection with human papilloma virus and have served as a model for viral induced carcinogenesis. This collection of features deserves the term “acquired epidermodysplasia verruciformis”

Treatment of perniosis with oral tadalafil, pentoxifylline or prednisolone A therapeutic comparative study

Background: perniosis is a common dermatological problem. Different modalities of treatment are available with conflicting results and no single effective therapy is universally accepted. Objective: To evaluate the effectiveness of oral tadalafil and compare it with pentoxyfylline or prednisolone in treatment of perniosis Patients and methods: This was a therapeutic comparative trial conducted in the department of Dermatology, Baghdad Teaching hospital, Baghdad, Iraq between November 2011 and March 2014. Fifty eight patients with perniosis were enrolled in this study, and divided into 3 groups. Group (A) comprised 19 patients who received oral tadalafil (5 mg once daily); group (B) comprised 18 patients who received pentoxifylline tablet (400 mg three times daily) and group (C) included 21 patients who received prednisolone 15 mg twice daily. The treatment duration was 2 weeks. All patients did not receive any treatment before the study. A severity score was proposed taken in consideration the number of finger/ toes, type of lesion, coldness, cyanosis and itching Results: Forty seven patients completed the study. Their ages ranged from 13-43 with a mean ± SD of 22.38 ±6.99 years. Thirty three patients were females (70.21%) and 14 were males (29.79%). The percentage of improvement was 50.65, 44.16 and 31.51% for the groups A, B and C respectively. Conclusion: Tadalafil has a superior effect over pentoxyfylline. The latter has a better effect than prednisolone

Association of Higher Defensin β-4 Genomic Copy Numbers with Behçet’s Disease in Iraqi Patients

Objectives: Behçet’s disease (BD) is an immune-mediated small vessel systemic vasculitis. Human β-defensins are antimicrobial peptides associated with many inflammatory diseases and are encoded by the β-defensin family of multiple-copy genes. However, their role in BD necessitates further investigation. The aim of the present study was to investigate the possible association of BD in its various clinical forms with defensin β-4(DEFB4) genomic copy numbers. Methods: This case-control study was conducted from January to September 2011 and included 50 control subjects and 27 unrelated Iraqi BD patients registered at Baghdad Teaching Hospital, Bagdad, Iraq. Copy numbers of the DEFB4 gene were determined using the comparative cycle threshold method by duplex real-time polymerase chain reaction technology at the Department of Dermatology of Jena University Hospital, Jena, Germany. Results: DEFB4 genomic copy numbers were significantly higher in the BD group compared to the control group (P = 0.010). However, no statistically significant association was found between copy numbers and clinical variables within the BD group. Conclusion: The DEFB4 copy number polymorphism may be associated with BD; however, it is not associated with different clinical manifestations of the disease

Follicular vitiligo: the present clinical status

Vitiligo is a common autoimmune inflammatory disease where there is damage to the basal melanocytes of the epidermis. Hair follicles are the main reservoir of the melanocytes, and melanocytes stem cells, and these cells will supply the melanocytes for the basal layer of the epidermis when these cells are lost. But when these follicular melanocytes are damaged, this will cause follicular vitiligo either in a form gray/white hair or in form of follicular leukoderma. Although follicular vitiligo is not uncommon variant of vitiligo but rarely discussed and classified

Cupping (Hijama) in Skin diseases with positive Koebner’s Phenomenon: What is New?

Background: Cupping therapy is an ancient traditional and complementary medicine used in the treatment of a broad range of medical conditions. It is very popular in many countries, especially in China, Korea, and Japan. It is used in the Muslim world, as well as in North Africa, Eastern Europe and Latin America. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. Till now, there is no certain scientific base for using cupping in treating any medical problem especially skin diseases. Many skin diseases have tendency to appear at the site of injury or damage to the skin, the so called koebners phenomena. Our observation is that hijama induces skin diseases at the site of cupping in patients with skin dis-eases with koebner phenomenon. Objective: to present cases with koebner phenomenon after cupping with primary lesions seen at the site of cupping. Patients and method: a total of 24 male patients previously diagnosed with skin diseases; 16 with psoriasis, 6 with lichen planus, one patient with dermatitis herpetiformis, and one with seborrheic dermatitis. Results: All patients had stable skin diseases prior to cupping but new lesions appeared at the site of cupping around two weeks after the procedure. Conclusion: cupping should not be encouraged for skin diseases with positive koebner phenomenon commonly psoriasis and lichen planus and possibly contraindicated as till now there is no scientific basis for using this procedure

Panniculitis is a common unrecognized histopathological feature of cutaneous leishmaniasis

Background: Cutaneous leishmaniasis (CL) is a parasitic cutaneous infection caused by Leishmania parasite. The histopathology is usually granulomatous in nature. Aims: The aim of the present study is to elucidate the histology of CL and evaluate the presence and the frequency of panniculitis among the affected patients. Settings and Design: Case series interventional study. Materials and Methods: Thirty-five patients with CL were diagnosed clinically between December-2012 and May-2013. Diagnostic confirmation established by smears, culture, and polymerase chain reaction (PCR). The histopathological assessment was carried out to study the general pathology and to look for the presence of panniculitis. Statistical Analysis Used: Simple statistics utilized via SPSS version 16.0 (SPSS, Inc., Chicago, USA). Results: Eighteen women and 17 men with CL were enrolled in the present work with a mean duration of their disease was 3 months. The results of the diagnostic tests were as follow: The smear was positive in 21 (60%) of cases, Leishman-Donovan (LD) bodies were seen in 7 (20%) patients, culture was positive in 24 (68%), and PCR was positive in 32 (91.4%) patients. The epidermal changes included acanthosis, pseudoepitheliomatous hyperplasia, ulceration, focal spongiosis, and interface dermatitis while the dermal changes were dependent on the spectrum of the disease, so in the ulcerative lesions there was lymphohistiocytic infiltration with foci of plasma cells and sometimes aggregate of LD bodies, whereas in the dry lesions the pathology is mainly of epithelioid granuloma. Panniculitis was seen in 16 (46%) cases as a diffuse lymphohistiocytic infiltration of both the septum and lobules of the subcutaneous layer of the skin. Conclusion: Panniculitis is an important feature of CL that must be differentiated from other diseases that can simulate CL such as chronic skin infections, Discoid lupus erythematosus, and cutaneous lymphoma