Liquefaction Degeneration Of Basal Cells Research Articles

Established Genital and Extragenital Lichen Sclerosus:A Clinicopathological Analysis

Objective To investigate the clinicopathological characteristics of established genital and extragenital lichen sclerosus(LS)and compare the differences between them. Method The clinicopathological data of 55 patients with established genital and extragenital LS diagnosed by pathological examination in the Department of Dermatology of Beijing Hospital were retrospectively analyzed. Results The 55 patients included 11 males and 44 females.Among them,38,15,and 2 patients had genital lesions,extragenital lesions,and both genital and extragenital lesions,respectively.Extragenital LS mainly involved the back(14.55%)and extremities(7.27%).Among the patients,28.30% were asymptomatic,and 73.58% and 24.53% felt itchy and painful,respectively.The asymptomatic patients had a higher proportion in extragenital cases(χ2=31.224,P=0.000),and the itchy symptom was more common in genital LS cases than in extragenital LS cases(χ2=39.073,P=0.000).Vulvar pain only appeared in the patients with genital LS.A total of 57 biopsy specimens from the 55 patients were reviewed,of which 40 were from genital lesions and 17 were from extragenital lesions.In addition to papillary dermal homogenization (100%),the common pathological changes include hyperkeratosis(98.25%),atrophy(50.88%),basal cell liquefaction degeneration (52.63%),dilated blood vessels(64.91%),a perivascular lymphocytic infiltrate(100%),histiocytic infiltrate(85.96%),and lichenoid inflammatory infiltrate(54.39%).Higher proportions of acanthosis (χ2=4.402,P=0.036),dilated blood vessels (χ2=9.330,P=0.002),and eosinophilic infiltrate (χ2=4.162,P=0.041) were observed in genital LS cases.A higher proportion of follicular plugging appeared in extragenital LS cases (χ2=5.076,P=0.024). Conclusion The established genital LS and extragenital LS showed some differences in clinical symptoms and pathological changes including acanthosis,dilated blood vessels,eosinophilic infiltrate,and follicular plugging.

Histopathological Grading of Oral Mucosal Chronic Graft-versus-Host Disease: Large Cohort Analysis.

Graft-versus-host disease (GVHD) can manifest as acute or chronic complications in patients after hematopoietic cell transplantation (HCT). Oral chronic GVHD (cGVHD) occurs in approximately 70% of HCT recipients and includes lichenoid-like mucosal reactions, restricted mouth opening, and salivary gland dysfunction. However, the underlying histopathological presentation remains to be validated in large cohorts. We characterized the histopathological features of oral mucosal cGVHD and devised a scoring model in a large patient cohort (n=112). Oral mucosal biopsy sections (n=303) with and without oral cGVHD were identified from archived and current HCT recipients with additional healthy controls. Histological screening was performed on hematoxylin and eosin-stained and periodic acid-Schiff-stained sections. A points-based grading tool (0 to 19, grade 0 to IV) was established based on intraepithelial lymphocytes and band-like inflammatory infiltrate, atrophic epithelium with basal cell liquefaction degeneration, including apoptosis, as well as separation of epithelium and pseudo-rete ridges. Validation involved 62 biopsy specimens, including post-HCT (n=47) and healthy (n=15) specimens. Remaining biopsy specimens (n=199) were blindly graded by 3 observers. Histological severity was correlated with clinical diagnostic and distinctive features, demonstrating a spectrum of individual patient severity, including frequent signs of subclinical GVHD in healthy mucosa. However, oral cGVHD presented with significantly higher (P < .001) scores compared with HCT controls, with moderate to high positive likelihood ratios for inflammatory infiltrate, exocytosis, and basal membrane alterations. The grade II-IV biopsy specimens demonstrated a histopathological diagnosis of active mucosal lichenoid-like cGVHD, highlighting the importance of correlating clinical presentation with the dynamic histopathological processes for improved patient stratification. In addition, this tool could be used for assessing treatments, pathological processes, and immune cellular content to provide further insight into this debilitating disease.

副银屑病81例临床及病理分析

Objective To analyze clinicopathological features of parapsoriasis. Methods Clinical and pathological data were collected from 81 patients with parapsoriasis in Department of Dermatology, Peking University First Hospital between January 2016 and May 2018, and analyzed retrospectively. Results Among the 81 patients with parapsoriasis, 44 were male and 37 were female, with age ranging from 6 to 77 years. Their disease course ranged from 7 days to 30 years, and the median disease course was 12 months. Moreover, 61 (75.3%) patients were aged less than 40 years, and 20 (24.7%) were aged 41 years and older. Of the 81 patients, 16 (19.8%) were diagnosed with small plaque parapsoriasis, 20 (24.7%) with large plaque parapsoriasis, 37 (45.7%) with pityriasis lichenoides chronica, and 8 (9.9%) with pityriasis lichenoides et varioliformis acuta. Additionally, distribution patterns of lesions included diffuse type in 65 cases (80.2%) , central type in 6 cases (7.4%) , and peripheral type in 10 cases (12.3%) . Histopathological examination of skin lesions revealed liquefaction degeneration of basal cells in 69 cases (85.2%) , migration of lymphocytes into the epidermis in 67 cases (82.7%) , focal parakeratosis in 42 cases (51.9%) , keratinocyte necrosis in 29 cases (35.8%) , extravasation of erythrocytes in 23 cases (28.4%) , epidermal spongiosis in 21 cases (25.9%) , and dermal perivascular focal infiltration in 61 cases (75.3%) . Conclusion Parapsoriasis has characteristic clinical and pathological manifestations, and a close combination of clinical manifestations with pathological features is necessary for its accurate diagnosis. Key words: Parapsoriasis; Pityriasis lichenoides

A case of necrolytic acral erythema

A 25-year-old female patient presented with itchy rashes on her feet for 10 years. Skin examination showed dark red plaques with clear boundaries, whose surfaces were covered with grey-brown scales, on the dorsum of toes and adjacent dorsum of the feet, the extensor aspect of the right ankle and the left Achilles tendon. Laboratory tests revealed that serum anti-hepatitis C virus (HCV) antibody was negative and HCV-RNA quantity was normal. Histopathological examination showed epidermal hyperkeratosis with parakeratosis, irregularly thickened spinous layer, scattered dyskeratotic cells and necrotic keratinocytes in the middle and upper spinous layer, focal liquefaction degeneration of basal cells, dilatation of small blood vessels in the superficial and middle dermis, and perivascular infiltration of a small number of lymphocytes. The patient was diagnosed with necrolytic acral erythema without hepatitis C. After 2-month treatment, the skin lesions completely regressed, and hyperpigmentation remained. Key words: Hepatitis C; Necrolytic migratory erythema; Necrolytic acral erythema

Clinical and pathological analysis of three cases of lichen planopilaris

Objective To investigate clinical and histopathological features of lichen planopilaris (LPP) . Methods The clinical and histopathological findings in 3 cases of LPP were analyzed. Results All the 3 patients were female, and their average age was 49 years. One patient presented with large-area patchy hair loss on the frontal, parietal and occipital region, and 2 patients presented with irregular patchy hair loss on the scalp and skin atrophy. Besides the hair loss, the eyebrows and axillary hairs also lost in 1 patient. Histopathological examination showed liquefaction degeneration of basal cells in the walls of hair follicles and infiltration of lymphocytes. Infiltration of a small number of lymphocytes was also observed around blood vessels and appendages. Conclusions LPP may only affect the scalp, or involve the other sites all over the body. LPP commonly manifests as patchy hair loss on the scalp and skin atrophy, and is pathologically characterized by liquefaction degeneration of basal cells in hair follicles and infiltration of lymphocytes. Key words: Lichen planus; Hair; Hair follicle; Alopecia

Pigmented Oral Lichen Planus: A Case Report

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lichen planus is a chronic muccocutaneous inflammatory disorder. Oral lichen planus (OLP) has certain specific characteristics in its clinical presentation, but can also be presented in forms resembling other diseases. This may introduce difficulty in the diagnostic process. It has been reported that OLP affects between 0.1 to 4% individuals, predominantly women and people over 40 years old. &lt;strong&gt;Case Report:&lt;/strong&gt; A 46-year-old woman complained of a non-healing ulcer present for 1.5 months. Intraorally, multiple white striae with prominent central areas of brownish hyperpigmentation were apparent on the right and left buccal mucosa, right and left buccal sulcus, and lateral and dorsum of the tongue. A biopsy was completed and the histopathology features confirmed the diagnosis of OLP. For the initial treatment, a topical corticosteroid was prescribed, followed by steroid mouthwash. Response to this treatment was positive. OLP has been frequently reported to affect women over the age of 40, with psychological stress as a primary predisposing factor. The clinical presentation is characteristic of Wickham’s striae with erosive areas. However, a biopsy and histopathological examination is mandatory to confirm the diagnosis. The clinical feature of pigmented OLP has been reported and confirmed by microscopic finding of band-like lymphocytic appearance which is the pathognomonic features of OLP, along with basal cell liquefaction degeneration, and melanin in continence at the lamina propria. &lt;strong&gt;Conclusion:&lt;/strong&gt; Pigmented OLP is a variant of erosive OLP. Anamnesis, clinical presentation, and histopathological examination confirm diagnosis.&lt;/p&gt;

Reflectance confocal microscopy characteristics of childhood hypopigmented lichen striatus

Objective To investigate reflectance confocal microscopy (RCM) characteristics of childhood hypopigmented lichen striatus. Methods RCM was performed to image skin lesions and perilesional normal skin in 11 children with hypopigmented lichen striatus. Then, confocal microscopic findings of the skin lesions were compared with pathological findings. Results Histopathological examination of the skin lesions showed mild intercellular and intracellular edema, thickening of prickle cell layer to different extent, local liquefaction degeneration of basal cells, and perivascular infiltration of plenty of lymphocytes and a few melanophages in the superficial dermis. RCM horizontal images showed multifocal liquefaction degeneration of basal cells, which caused indistinct dermo-epidermal junction, incomplete or unclear dermal papillary rings, infiltration of many highly refractive melanophages and slightly to moderately refractive inflammatory cells in papillary and superficial dermis. Conclusion RCM characteristics can serve as strong evidences for the diagnosis and differential diagnosis of childhood hypopigmented lichen striatus. Key words: Hypopigmentation; Microscopy, confocal; Pathologic processes; Lichen striatus albus

Clinicopathological analysis of nine cases of dermatomyositis with panniculitis as a skin manifestation

Objective To analyze clinical and pathological features of dermatomyositis with pan-niculitis as a skin manifestation. Methods Clinical data were collected from 9 cases of dermatomyositis with panniculitis as a skin manifestation in Department of Dermatology of Zhongshan Hospital affiliated to Fudan University from October 2012 to July 2016, and their clinical and pathological features were analyzed. Results Of the 9 cases, 6 were female and 3 were male, and the age ranged from 28 to 73 years. Panniculitis lesions of the 9 patients all manifested as painful indurated plaques or nodules on the buttock, thigh, waist, back, abdomen, upper extremities and cheeks. These lesions occurred before, after or simultaneously with the onset of characteristic skin and muscle lesions of dermatomyositis, especially preceded the onset of characteristic lesions of dermatomyositis by 30 years in 1 case. Histopathological examination of lesions showed liquefaction degeneration of basal cells, inflammatory infiltration of lymphocytes and plasma cells around blood vessels, in the fat lobules as well as between the lobules and septa in the dermis. The necrosis and calcification of lipocytes, lipomembranous changes, fibrinoid necrosis of damaged vessel walls and microvascular occlusion were observed in some cases. Because panniculitis preceded the onset of characteristic lesions of dermatomyositis, 2 patients were misdiagnosed with lupus panniculitis and morphea profunda for several times. Most patients had good response to systemic glucocorticoids combined with immunosuppressive agents, while the patients with lipomembranous fat necrosis had poor response to the combination therapy. Conclusions Panniculitis lesions of dermatomyositis are histologically characteristic, and may do not coincide with the onset of characteristic lesions of dermatomyositis. If panniculitis lesions precede characteristic lesions of dermatomyositis, patients will be easily misdiagnosed. Thus, persistent follow-up visit will be of great importance for the diagnosis. Key words: Dermatomyositis; Panniculitis; Antibodies, antinuclear; Glucocorticoids; Immuno-suppressive agents

Pigmented oral lichen planus: A case report

Background: Lichen planus is a chronic muccocutaneous inflammatory disorder. Oral lichen planus (OLP) has certain specific characteristics in its clinical presentation, but can also be presented in forms resembling other diseases. This may introduce difficulty in the diagnostic process. It has been reported that OLP affects between 0.1 to 4% individuals, predominantly women and people over 40 years old. Case Report: A 46-year-old woman complained of a non-healing ulcer present for 1.5 months. Intraorally, multiple white striae with prominent central areas of brownish hyperpigmentation were apparent on the right and left buccal mucosa, right and left buccal sulcus, and lateral and dorsum of the tongue. A biopsy was completed and the histopathology features confirmed the diagnosis of OLP. For the initial treatment, a topical corticosteroid was prescribed, followed by steroid mouthwash. Response to this treatment was positive. OLP has been frequently reported to affect women over the age of 40, with psychological stress as a primary predisposing factor. The clinical presentation is characteristic of Wickham’s striae with erosive areas. However, a biopsy and histopathological examination is mandatory to confirm the diagnosis. The clinical feature of pigmented OLP has been reported and confirmed by microscopic finding of band-like lymphocytic appearance which is the pathognomonic features of OLP, along with basal cell liquefaction degeneration, and melanin in continence at the lamina propria. Conclusion: Pigmented OLP is a variant of erosive OLP. Anamnesis, clinical presentation, and histopathological examination confirm diagnosis.

A retrospective study of oral lichen planus in paediatric population

Aim:Well documented cases of oral lichen planus, a cell mediated immune condition is infrequently reported in paediatric population. This study was undertaken to obtain epidemiological data retrospectively and also to explore the possibility of any association that might exist among the clinical and histopathological features in paediatric patients suffering from oral lichen planus.Subjects and Methods:A retrospective study was carried out on 22 patients, younger than 18 years with clinical and histopathological diagnosis of oral lichen planus over a period of 14 years. The clinical characteristics and histopathological features were observed. The statistical analysis of the data was performed using Statistical Analysis Software (SAS), Version 9.1.Results:Analysis of data of 22 patients revealed that the average age of patient is 15.18 years with equal male and female predilection. The most common site is buccal mucosa (50%) and most frequent clinical form is erosive (63.64%). Focusing on the histopathological findings, parakeratosis was found in 86.36% of the cases, acanthosis in 63.64% of cases, moderate basal cell degeneration was identified in 63.64% of cases and dense lymphocytic infiltration at juxtaepithelial connective tissue region was found in 59.09% of cases.Conclusions:Oral lichen planus in paediatric population is rare and appeared between 8 to 18 years of age. There is no significant gender predominance. The most common clinical form is erosive, manifesting mainly in buccal mucosa. Histopathological findings characteristic of oral lichen planus in paediatric patients include parakeratosis, acanthosis, liquefaction degeneration of basal cells and lymphocytic infiltration in the subepithelial layer.

Graft versus host disease after liver transplantation: A case report

In documenting clinical experience in the diagnosis and treatment of graft versus host disease (GVHD), we retrospectively analyzed data of one case that has developed GVHD after liver transplantation. This patient exhibited fever, skin rash, and diarrhea on day 9 after liver transplantation. His liver function was normal. Skin biopsy showed scattered keratinocytes accompanied by satellite-like lymphocyte infiltration and basal cell liquefaction degeneration. After carefully analyzing the complications, we took the strategy of decreasing the dose of tacrolimus. Thereafter, the patient's temperature decreased to normal, his skin rashes subsided, and his diarrhea was relieved. This case suggests that reducing the dosage of immunosuppressive agents can be an effective strategy for GVHD after liver transplantation.

Significance of liquefaction degeneration in oral lichen planus: a study of its relationship with apoptosis and cell cycle arrest markers

To assess the utility of liquefaction degeneration as a marker of apoptosis in oral lichen planus (OLP). TdT-mediated dUTP-biotin nick-end labelling (TUNEL) assay and immunohistochemical methods were used to detect p21 proteins and the active form of caspase 3 in 32 tissue samples of oral mucosa with OLP and 20 samples of normal oral mucosa. Liquefaction degeneration was moderate or intense in 27.5% (n=8) and slight in 72.4% (n=21) of OLP samples. There was low expression of apoptosis markers (TUNEL, active caspase 3 form), which was not significantly associated with liquefaction degeneration of the basal cell layer. Basal and suprabasal expression of p21 was significantly more frequent in samples with more intense liquefaction degeneration of basal cells (P<0.01). Our results demonstrate that liquefaction degeneration, as a morphological expression of T lymphocyte attack, does not unequivocally indicate apoptosis. Attacked basal cells more frequently respond with cell-cycle arrest or senescence than with apoptosis.

Sparfloxacin-induced photosensitivity and the occurrence of a lichenoid tissue reaction after prolonged exposure

Background: A new antibacterial quinolone, sparfloxacin (SPFX), frequently causes photosensitive dermatitis and sometimes induces a treatment-resistant lichenoid tissue reaction (LTR). Objective: We attempted to determine the factors that induce LTR in SPFX-induced photodermatitis. Methods: Thirteen patients with SPFX photosensitive dermatitis were studied clinically and histopathologically. Results: Six of the 13 patients had acute dermatitis with epidermal spongiosis and focal epidermal HLA-DR and intercellular adhesion molecule–1 (ICAM-1) expression with CD4 + cell infiltration. The other seven displayed LTR with basal cell liquefaction degeneration and diffuse epidermal HLA-DR and ICAM-1 expression associated with CD8 + cells. The seven patients with LTR were exposed to UV and SPFX for more than 2 weeks after the appearance of their initial eruption, whereas the six patients with acute dermatitis were treated within 2 weeks. The acute dermatitis lesions cleared significantly within 2 weeks, but the LTR lesions persisted for more than 6 weeks. Conclusion: Patients with quinolone-induced photosensitivity should be treated within 2 weeks of onset to prevent LTR. (J Am Acad Dermatol 1998;38:945-9.)