ABSTRACT: Palpable arciform migratory erythema (PAME) is characterized by large, elevated, reddish annular lesions localized on the upper trunk. As its infiltrate consists predominantly of dense infiltrates of CD4+ lymphocytes with polyclonal T-cell receptor (TCR) gene rearrangement, it has been grouped as a rare member of the T-cell pseudolymphomas.
We performed histology, immunophenotyping, and TCR-gamma gene rearrangement studies in an human immunodeficiency virus (HIV)-positive patient, CDC stage IIIB, who showed a clinically typical PAME.
While TCR-gamma gene rearrangement studies showed a polyclonal infiltrate confirming a pseudolymphoma, 85% of skin-infiltrating lymphocytes were CD8+ T cells.
PAME may also occur in HIV-positive patients with CD4+ deficiency. Our case demonstrates that regular CD4 counts and immunocompetence are not necessary for its pathogenesis.
Journal of Cutaneous Pathology 06/2004; 31(5):379-82. · 1.56 Impact Factor
ABSTRACT: Neutrophilic urticaria (NU) is a histologically defined entity, but its clinical and pathogenetic aspects are poorly understood. We investigated 22 NU patients whom we identified by examining 118 biopsies of weals. The patients comprised 11 of 20 with acute urticaria, nine of 49 with chronic urticaria, one of 10 with cold urticaria and one of 10 controls undergoing prick tests. Clinically, NU patients had a shorter mean duration of disease than other urticaria patients and significantly increased erythrocyte sedimentation rate and leucocytosis. Histologically, not only neutrophil counts, but to a lesser extent also eosinophil counts and mononuclear cell infiltrates were significantly increased in lesional skin of NU, and there was more marked vasodilatation and endothelial swelling. On immunohistochemistry, increased tumour necrosis factor alpha and interleukin (IL)-3 expression was noted, compared with other urticarias, whereas IL-8 expression was only minor. These data characterize NU as an acute phase urticarial reaction associated with an intense inflammatory infiltrate and marked upregulation of some mast cell-derived cytokines.
British Journal of Dermatology 03/1998; 138(2):248-53. · 3.67 Impact Factor
ABSTRACT: To identify possible special histopathologic features of different types of urticaria.
Hematoxylin-eosin- and toluidine blue-stained sections from biopsy specimens of all patients with urticaria seen from 1990 to 1993.
Inpatient and outpatient services of the Virchow Klinikum, Humboldt University, Berlin, Germany.
We studied spontaneous or induced wheals of 108 patients with acute, chronic, and physical urticaria who consented to an additional biopsy from uninvolved skin. The controls were 10 normal volunteers with wheals that tested positive on a prick test and who had contralateral normal skin.
Mast cell numbers in both lesional and nonlesional skin in the upper and lower dermis of biopsy specimens from patients and controls.
Blind evaluations of microscopic sections showed dermal edema and dilated lymphatic and vascular (P < .001 for all, Fisher exact test) capillaries almost exclusively in involved skin. The same held for inflammatory infiltrates, with significantly increased numbers of neutrophils and eosinophils in specimens from patients with acute urticaria and those with delayed pressure urticaria (P < .01 for each). Mast cell numbers were higher in the upper (P < .01) and lower dermis (P < .05) of lesional and uninvolved skin of all patients with urticaria, with a further increase (P < .01) in patients with disease of more than 10 weeks' duration. Edema and vascular changes were most prominent in the skin of patients with cold urticaria (P < .005) and mononuclear infiltrates were more pronounced in those with cold urticaria, chronic urticaria, and prick test-positive wheals (P < .05 for each) and in the lower dermis of patients with delayed pressure urticaria (P < .001).
In all types of urticaria, mechanisms must be operative that cause an increase of cutaneous mast cells. Distinctive pathological features can be identified in different types of urticaria, although these are not diagnostic.
Archives of Dermatology 01/1998; 134(1):41-6. · 3.89 Impact Factor
Journal of the American Academy of Dermatology 07/1994; 30(6):1023-4. · 3.99 Impact Factor