Case Report OPEN ACCESS Autoreactivity to sweat glands and nerves in clinical scabies infection

Abstract Context: Skin changes in pregnancy can be categorized as 1) physiological/hormonal, 2) alterations in pre-existing skin diseases, or 3) represent development of new dermatoses, some of which may be pregnancy specific. Case Report: We describe a 19 years old female at 27 weeks gestation who presented with a rash on the face and breast, with intense pruritis. Hematoxylin and eosin demonstrated Scabies mites within the epidermis, with an intense perivascular infiltrate of lymphohistiocytic cells around the superficial dermal blood vessels. By direct immunofluorescence (DIF), human fibrinogen was also detected in the perivascular areas. DIF also revealed deposits of human IgG and complement C5-9/MAC deposits in the sweat glands, as well as in nerves surrounding the sweat glands subjacent to the mites. Overexpression of ezrin and junctional adhesion molecule antibodies close to the scabies infection sites were also seen. Conclusion: Given that the hallmark of clinical scabies is intense pruritus and that very limited information is available regarding the pathophysiology of this symptom, we suggest that the itching sensation may be exacerbated by nerves and eccrine sweat glands in close proximity to the sites of infection

Survivin, p53, MAC, Complement/C3, fibrinogen and HLA-ABC within hair follicles in central and centrifugal cicatricial alopecia

Abstract Context: Central centrifugal cicatricial alopecia (CCCA; originally entitled follicular degeneration syndrome, or hot comb alopecia) was first described in African American women utilizing hot combs and/or strong chemical hair care products. Case Report: A 67 year old African American female was evaluated for the presence of alopecic areas occurring on the scalp vertex, and spreading centrifugally. The alopecic lesions appeared as diffuse patches, including atrophic small areas surrounding individual hair follicles. Patients and Methods: Skin biopsies for hematoxylin and eosin examination, as well as for direct immunofluorescence and immunohistochemistry analyses were performed. Results: hematoxylin and eosin staining demonstrated histopathologic findings of premature desquamation of the inner root sheath and eccentric thinning of the follicular epithelium, supporting the diagnosis of CCCA. Direct immunofluorescence revealed strong depositions of Complement/C3, fibrinogen and kappa light chains around the hair follicles. Immunohistochemistry demonstrated increased expressions of HLA-ABC (as in African American patients with insulin independent diabetes mellitus). We also detected positive p53, bcl-2 and MAC staining in the hair follicle areas. Conclusions: Follicular degeneration syndrome may have an important immunological component previously not described, and multicolor immunofluorescence may be useful in establishing an early diagnosis