Punch Biopsy Specimens Research Articles

Malignant (Anaplastic) Amelanotic/Hypomelanotic Melanoma in a Kurdish Gelding

We report an 11-year-old Kurdish gelding with an anaplastic malignant melanoma arising from his right lateral of the neck, which developed over 6 weeks. A ~10 cm in diameter, firm, and non-ulcerated nodular subcutaneous mass located at the middle and proximal of the left side of the neck was detected in a physical examination. No evidence of local extent or metastasis was detected. Complete surgical excision was performed under general anesthesia. Gross morphology and histopathological examination of the mass confirmed an anaplastic malignant melanoma, in which the major part of the mass has little or no pigmentation. The gelding was euthanized due to tumor regrowth. The heterogeneity in pigmentation of equine melanocytic tumors can make diagnosis difficult in punch biopsy specimens. Anaplastic malignant melanoma is most often a very aggressive neoplasm and surgical excision was not effective in this case.

Effect of Monochromatic Infrared Energy on Quality of Life and Intraepidermal Nerve Fiber Density in Painful Diabetic Neuropathy: A Randomized, Sham Control Study.

Monochromatic infrared energy (MIRE) has evoked mixed results for symptomatic relief of painful diabetic peripheral neuropathy (DPN). However, intraepidermal nerve-fiber density (IENFD) the gold standard for small-fiber neuropathy has not been evaluated. We assessed the IENFD, pain symptoms and quality of life (QoL) with MIRE therapy compared to placebo in painful DPN. Participants with type 2 diabetes and painful DPN were randomized to receive MIRE or sham therapy dosed thrice a week for 12 weeks. Quantitative assessment of IENFD was performed from 3 mm skin punch-biopsy specimens at baseline and after 12 weeks. We also assessed the QoL with Norfolk QOL, symptom severity with visual analogue scale (VAS), and neuropathy assessment with Michigan neuropathy severity instrument and neuropathy disability score. Thirty-eight participants were enrolled and 30 completed the study protocol. The mean age of participants in MIRE cohort was 59.1 ± 9.2 years, duration of diabetes 12.9 ± 3.1 years, and symptom duration of 3.9 ± 3.7 months. The mean IENFD was 0.90 ± 0.73/mm2 (P < 0.01) and 1.71 ± 1.11/mm2 in the MIRE cohort and 0.60 ± 0.89/mm2 and 2.17 ± 0.98/mm2 (P < 0.01) in sham cohort at baseline and after 3 months. The median decline in VAS was 5.1 (4.0-7.6) and 3.0 (0.4-5.6) points (intergroup difference, P = 0.01); and an increase in Norfolk QoL-DN by 15 (11-18) and 4 (4-14.2) points (intergroup difference, P = 0.021) in MIRE and sham cohort, respectively after 3 months. MIRE therapy does not increase IENFD over short-term usage. However, MIRE therapy provides symptomatic benefit and improves QoL in patients with painful DPN.

The study of epidemiological, clinical, histopathological and dermoscopic features of lichen planus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Lichen planus (LP) is a common papulosquamous condition seen by the dermatologists. It can involve the skin, mucous mebranes, hair and nails. There are many subtypes of LP with various clinical, histopathological and dermoscopic features. In this study we intended to study the epidemiological, clinical, histopathological and dermoscopic features of LP.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 73 patients of LP, above the age of 18 years who qualified the inclusion and exclusion criteria were included in the study. A proforma of epidemiological details was noted, clinical and dermoscopic examination of the lesions were done. The punch biopsy specimens of cutaneous lesions were subjected to histopathological examination and the findings noted.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 73 patients included in the study, 44 were males and 29 females with a ratio of 1.51:1. Classic LP was the commonest type of LP. Wickham’s striae (WS) was the most typical and commonest dermoscopic feature of cutaneous LP except lichen planus pigmentosus. Hyperkeratosis, hypergranulosis, acanthosis, band shaped lymphocytic infiltrate, melanophages, basal cell degeneration and saw tooth shaped rete ridges were the significant histopathological features.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; LP is more common in young adults and shows a male preponderance. WS is the most important diagnostic feature seen on dermoscopy of all the cutaneous types of LP excluding LPP. Interface dermatitis with a band of lymphocytic infiltrates and dermal melanophages is a notable feature of histopathology of LP.&lt;/p&gt;

Production of IL-31 in CD45RO+CLA+H4R+ T Cells in Atopic Dermatitis.

IL-31 is involved in pruritus in atopic dermatitis (AD) and the pathogenesis of AD. However, the mechanism of IL-31 production is not fully understood. We sought to investigate the association between CD45RO+CLA+H4R+ T cells and IL-31 production. Immunofluorescence studies were performed retrospectively on punch-biopsy specimens from five people with AD and three healthy controls. In addition, blood samples were collected prospectively from eight patients with AD and eight healthy controls for sorting CD45RO+CLA+H4R+ T cells. There was no overlap of patients between the biopsy group and the blood sampling group. Sorted cells were stimulated with 4-methylhistamine (4MH), and the level of IL-31 was measured by an enzyme-linked immunosorbent assay. Immunofluorescence showed co-localization of H4R and IL-31 in lesional AD skin but not in normal skin of healthy controls. The proportion of CLA+H4R+ T cells among CD3+CD45RO+ lymphocytes was 18.3 ± 6.2% in patients with AD and 11.2 ± 7.6% in healthy controls. In the AD group, production of IL-31 by CD45RO+CLA+H4R+ T cells increased from 32.4 ± 13.3 pg/mL to 47.5 ± 18.7 pg/mL by 4MH stimulation after 24 h (p < 0.001). However, in the control group, production of IL-31 was 20.1 ± 10.6 pg/mL without and 22.1 ± 9.3 pg/mL with 4MH stimulation (p > 0.05). According to our study, CD45RO+CLA+H4R+ T cells are an important source of IL-31 in AD, and may be a target for treatment of IL-31-induced pruritus.

A study of histomorphology and immunohistochemistry of papillary squamotransitional cell carcinoma: A rare variant of squamous cell carcinoma of cervix.

Background: Papillary squamotransitional cell carcinoma is a histopathological subcategory of squamouscell carcinoma of the uterine cervix that often resembles transitional cell carcinoma of the urinary tract.Histologically, it can be misdiagnosed as transitional cell carcinoma or other papillary lesions of thecervix. Stromal invasion on biopsy is difficult to diagnose due to the exophytic papillary growth of thetumor. It also has a propensity for local recurrence and late metastasis. The study is performed to diagnoseand categorize this uncommon variant of carcinoma cervix.Materials and Methods: Eighteen cases of Papillary squamotransitional cell carcinoma were diagnosedon a punch biopsy specimen on routine hematoxylin and eosin-stained sections. The tumors werecategorized into three groups according to the percentage of squamous and transitional components.Further, immunohistochemical evaluation for cytokeratin7 and cytokeratin20 was done.Results: The mean age of the patients was 51.61 years (range 37-62 years). The most common clinicalpresentation was postmenopausal bleeding. All the cases showed papillary architecture with fibrovascularcores. The papillae were lined by three cell types: clear, intermediate, and basaloid. Stromal invasionwas seen in all the cases. All the cases showed positive immunostaining for cytokeratin7 and negativeimmunostaining for cytokeratin20.Conclusions: Papillary squamotransitional cell carcinoma deserves accurate pre-operative biopsydiagnosis due to the risk of misdiagnosis as benign papillary or malignant transitional lesions.Immunohistochemistry plays an important role in the diagnosis of these tumors and is recommended inevery case. Late recurrence and metastasis warrants a longer duration of follow up.&#x0D;

Quality Assessment of Endoscopic Forceps Biopsy Samples under Magnifying Narrow Band Imaging for Histological Diagnosis of Cervical Intraepithelial Neoplasia: A Feasibility Study

The current standard for diagnosing cervical intraepithelial neoplasia (CIN) is colposcopy followed by punch biopsy. We have developed flexible magnifying endoscopy with narrow band imaging (ME-NBI) for the diagnosis of CIN. Here, we investigated the feasibility of targeted endoscopic forceps biopsy (E-Bx) under guidance of ME-NBI for the diagnosis of CIN. We prospectively enrolled 32 consecutive patients with confirmed or suspected high-grade CIN undergoing cervical conization. Next to colposcopy, the same patients underwent ME-NBI just before conization. ME-NBI was performed, and 30 E-Bx samples were taken from lesions suspicious for high-grade CIN and 15 from non-suspicious mucosa. We recalled 82 punch biopsy (P-Bx) specimens taken from lesions suspicious for high-grade CIN under colposcopic examination before enrollment. The proportion of sufficient biopsy samples, which had an entire mucosal layer with subepithelial tissue, for the diagnosis of CIN was evaluated by both methods. Performance of targeted E-Bx for the final diagnosis of at least high-grade CIN was calculated. Seventeen P-Bx specimens were unavailable. The proportion of sufficient samples with E-Bx was 84%, which was similar to that with P-Bx (87%) (p = 0.672). The sensitivity, specificity, and accuracy of ME-NBI using E-Bx was 92%, 81%, and 88%, respectively. In conclusion, ME-NBI-guided E-Bx samples were feasible for histological diagnoses of CIN, and further investigation of its diagnostic accuracy is warranted.

Histopathological evaluation of cutaneous reactions to tattoos: Study at a tertiary care center.

Tattooing has been around for many years and is becoming an increasingly common fashion trend. As there are often few regulatory laws regarding the practice, an increase in the incidence of cutaneous reactions to tattoo inks is noted. These include allergic reactions, granulomatous dermatitis, infections, lichenoid dermatoses, and sometimes malignancy. The present study examines the histopathological changes seen in patients with cutaneous reactions to tattoo ink. A prospective observational study was conducted over 18months in the dermatology clinic of a tertiary care center in western India. The study population included 22 patients with cutaneous reactions over the tattoos. Punch biopsy specimens were sent to study the pattern of histopathological response. All 22 patients studied were between the ages of 17 and 35 years. The mean duration of development of reaction was 8.1 months. Most of the reactions were seen in black ink tattoos performed by amateurs. Perivascular and spongiotic dermatitis suggestive of allergic response was the most common feature on histopathology. Granulomatous response and lichenoid response were seen in five and three biopsies, respectively. Legalization is needed for this practice to prevent tattoo reactions. Histopathological evaluation is important as tattoo reactions may be associated with skin infections and malignancies.

Six steps to reach optimal scanning in ex vivo confocal microscopy

Six steps to reach optimal scanning in ex vivo confocal microscopy

Noninflammatory comedones have greater diversity in microbiome and are more prone to biofilm formation than inflammatory lesions of acne vulgaris.

The ability of Cutibacterium acnes strains to form biofilms has been correlated with their virulence. This study examined biofilm and skin microbiota in acne patients in order to understand their role in the development of acne lesions. Thin sections of punch biopsy specimens of (i) uninflamed comedones, (ii) inflammatory lesions, and (iii) uninvolved adjacent skin of acne patients were examined. Epiflourescence and confocal laser scanning microscopy were used for biofilm detection, and pyrosequencing with taxonomic classification of 16s rRNA gene amplicons was used for microbiota analysis. Of the 39 skin specimens from patients with mild-moderate acne (n=13) that were studied, nine (23%) contained biofilm. Among these specimens, biofilm was most frequently detected in comedones (55.6%) and less frequently in inflammatory papules (22.2%) and uninvolved skin (22.2%). Comedones demonstrated the highest mean alpha diversity of all the lesion subtypes. The relative abundance of Staphylococcus was significantly higher in comedones (11.400%±12.242%) compared to uninvolved skin (0.073%±0.185%, P=0.024). The microenvironment of the comedone differs from that of inflammatory lesions and unaffected skin. The increased frequency of biofilm in comedones may account for the lack of host inflammatory response to these lesions.

Spectrum of Non-neoplastic Skin Lesions: A Histopathological Study based on Punch Biopsy (A Study of 200 Cases)

Introduction: Accurate diagnosis of skin is of utmost importance for management of different skindisorders presenting with the similar clinical signs and symptoms. Therefore to confirm the diagnosis andstart treatment biopsy becomes inevitable and for obtaining diagnostic full-thickness skin specimens Punchbiopsy is the primary method.Aims &amp; Objective: The present study was to analyse the incidence and age &amp; sex distribution of dermatologicaldisorders presenting to B.J. Medical College, Civil Hospital Ahmedabad (tertiary care centre), Gujarat andaccess their histopathological profileMaterials &amp; Methods: This was a retrospective study carried out at the department of Pathology B.J.Medical College &amp; Civil Hospital, Ahmedabad for a period of 1 year (1st January 2018 to 31st December2018). With necessary clinical details obtained in a proforma, punch biopsy specimen is sent to thehistopathology section for final diagnosis. Formalin fixed, paraffin embedded sections were prepared &amp;slides were routinely stained with H &amp; E and special stains applied wherever necessary. Data obtained wastabulated and analysed.Results: Total 232 cases were analysed. 21-30 years age group constituted 22% of the total cases. Male/Female ratio is 61/39. Hypopigmented patch/plaque was the most common clinical lesion (27%). Hansen’sdisease was the most common histopathological diagnosis reported (30%) followed by vesiculobullouslesions (12%).Conclusion: Punch biopsy is a very simple outdoor procedure and very useful for skin lesions. Hansen’sdisease is still most common skin disease for which biopsy is done followed by vesiculobullous lesion.Tattoo induced granuloma is also a common lesion along with lichenoid lesion.

Longitudinal brush pigmentation on the hyponychium, a dermoscopic feature observed in pediatric nail matrix nevi

Longitudinal brush pigmentation on the hyponychium, a dermoscopic feature observed in pediatric nail matrix nevi

Host-Pathogen Interactions in Human Polyomavirus 7‒Associated Pruritic Skin Eruption

Host-Pathogen Interactions in Human Polyomavirus 7‒Associated Pruritic Skin Eruption

334 Impact of injury-induced inflammation on ex vivo skin culture as a preclinical model for atopic dermatitis

Ex vivo skin culture holds promise as a preclinical model for understanding pathogenic mechanisms and testing therapeutics for skin diseases. This project studied the impact of ex vivo culture on the transcriptome profile and cytokine/chemokine production of nonlesional and lesional skin from adult atopic dermatitis (AD) patients (n=19) with moderate to severe disease. Punch biopsy (2mm) specimens were immediately processed for RNA (baseline) or cultured for 48 hours (37°C, 5% CO2, DMEM-10% FBS), followed by RNA isolation and supernatant collection. Transcriptome analyses were performed with HTA2.0 arrays (Affymetrix), and supernatants were analyzed with multiplex immunoassays. Microarray data analysis (t-SNE) revealed cultured samples clustered separately from baseline samples, which suggested culturing the skin had a dominant effect on gene expression and obscured AD transcriptome profiles. Relative to baseline samples, cultured AD skin exhibited increased inflammatory cytokine and chemokine transcripts. Proteins encoded by these transcripts were also detected in culture supernatants. These data demonstrated AD skin culture activates an inflammatory response distinct from that seen in vivo. Ex vivo culture of healthy donor skin also activated this response, which was determined to be interleukin-1 alpha (IL-1α)-dependent. In ex vivo skin culture, this IL-1α-induced inflammatory response obscured the ability of selected recombinant cytokines to induce known target genes. In conclusion, IL-1α activates a defined inflammatory response during ex vivo skin culture, which can obscure the native (in vivo) transcriptome/secretome of skin specimens. These results suggest including IL-1α neutralization as part of ex vivo skin culture systems would create a better preclinical skin disease model for evaluating therapeutic compounds.

Concordance among in vivo reflectance confocal microscopy, trichoscopy, and histopathology in the evaluation of scalp discoid lupus.

Reflectance confocal microscopy (RCM) has been used for the evaluation of several inflammatory skin conditions, including skin discoid lupus erythematosus (DLE), and has been correlated with conventional histopathology (HP). However, RCM is not being widely used in trichology. Few reports and just preliminary data suggest the use of RCM as a complementary tool in alopecias. To correlate the major RCM features of scalp DLE with trichoscopy and HP findings of biopsy specimens obtained from the same lesions. This is an observational, analytical, and cross-sectional study involving 12 patients with a clinically established diagnosis of scalp DLE. Patients underwent global clinical photograph, trichoscopy, and RCM examination in the same site followed by two 4-mm punch biopsy specimens for HP analysis. Inter-methods agreement among RCM imaging, trichoscopy, and horizontal histopathology sections (HHS) were calculated using Cohen Kappa (k) statistics. Statistical analysis of the agreement between RCM and HP features disclosed an overall agreement similar to skin DLE. Seven of the eleven features evaluated had agreement superior to 75%. We also evaluated RCM features associated with three of their corresponding trichoscopic findings for further investigation of their agreement with HP. Statistical analysis showed an enhancement with agreement of 86% when the non-invasive techniques are used together. Consistent correlation between RCM and HP observed in our study supports the reliability of RCM in the diagnosis of scalp DLE. RCM may be considered a promising tool for scalp DLE microscopic evaluation and presents similar RCM features to DLE in other body sites. By associating clinical, trichoscopic and RCM evaluation, dermatologists will have a non-invasive arsenal for the assessment of hair and scalp disorders, benefiting patients.

Diagnosis of Mycobacterium abscessus/chelonae complex cutaneous infection: Correlation of tissue culture and skin biopsy.

Mycobacterium abscessus and M. chelonae belong to the rapid-growing nontuberculous mycobacteria (NTM) group, which are defined by their ability to form visible colonies on agar within 7 days of subculture. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. However, the presence of vacuoles in many specimens has been reported as a specific histologic finding. Herein, we correlate the histopathology of patients with tissue-culture positive M. abscessus/M. chelonae complex in order to identify features that may prompt a rapid categorization of the infectious etiology. The cohort includes 33 skin punch biopsy specimens from 28 patients who had associated positive tissue cultures. The most frequent clinical presentation was a single or multiple nodule. Twenty-seven specimens (81.81%) were found to have vacuoles. The observation of certain histologic features (ie, polymorphonuclear microabscesses and epithelioid granuloma formation) should raise the possibility of infection by NTM. In addition to these findings, we believe the presence of vacuoles in the dermal and subcutaneous inflammation should raise suspicion for NTM.

Cutibacterium acnes persists despite topical clindamycin and benzoyl peroxide

Cutibacterium (formerly Propionibacterium) acnes persists in the dermis despite standard skin antiseptic agents, prompting some surgeons to use topical antimicrobials such as benzoyl peroxide and clindamycin prior to shoulder arthroplasty surgery. However, the efficacy of these topical agents has not been established. The upper backs of 12 volunteers were randomized into 4 treatment quadrants: topical benzoyl peroxide, topical clindamycin, combination topical benzoyl peroxide and clindamycin, and a negative control. The corresponding topical agents were applied to each site twice daily for 3 days. A 3-mm dermal punch biopsy specimen was obtained from each site and cultured for 14 days to assess for C acnes growth. Positive cultures were assessed for the hemolytic phenotype. The McNemar test was used to compare the proportion of positive cultures in each group. C acnes grew in 4 of 12control sites (33.3%), 1 of 12benzoyl peroxide sites (8.3%), 2 of 12clindamycin sites (16.7%), and 2 of 12combination benzoyl peroxide-clindamycin sites (16.7%). The C acnes hemolytic phenotype was present in 2 of 12control specimens (16.7%) compared with 0 (0.0%) in the benzoyl peroxide group, 2 of 12 (16.7%) in the clindamycin group, and 2 of 12 (16.7%) in the combination benzoyl peroxide-clindamycin group. There were no statistically significant differences between treatment arms. The topical application of benzoyl peroxide and clindamycin did not eradicate C acnes in all subjects. The clinical implications of these findings are yet to be determined.

Histologic and clinical cross-sectional study of chronic hair loss in patients with cutaneous chronic graft-versus-host disease

While scalp alopecia represents a distinctive feature of chronic graft-versus-host disease (cGVHD), little is known about the clinical and histologic presentation of hair loss. We sought to classify the clinical presentations and histologic findings of chronic hair loss in patients with cutaneous cGVHD. A prospective cohort of 17 adult hematopoietic cell transplantation (HCT) recipients with cutaneous cGVHD was enrolled. Dermatologic examinations were performed, and punch biopsy specimens of the scalp were obtained. Biopsy specimens were analyzed with hematoxylin-eosin and immunohistochemical stains in all cases and fluorescence in situ hybridization analyses in specific cases. Clinically, 4 patterns of hair loss were described-patchy nonscarring (41.2%), diffuse nonscarring (11.8%), diffuse sclerotic (11.8%), and patchy sclerotic (5.9%). The location of the inflammatory infiltrate on hematoxylin-eosin-stained specimens correlated with the hair loss pattern patients had clinically, with cell populations around the bulb and bulge in nonscarring and sclerotic cases, respectively. Fluorescence in situ hybridization studies in female cGVHD patients with male donors demonstrated green Y chromosomes limited to the area of the hair follicle affected by inflammatory cells. This study describes the various clinical and histologic subtypes of long-standing alopecia in adult cGVHD patients and suggests that this alopecia may be a direct manifestation of cGVHD of the hair follicle.

Crisaborole and atopic dermatitis skin biomarkers: An intrapatient randomized trial

Crisaborole ointment 2% is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate atopic dermatitis (AD). The mechanism of action of crisaborole and its effects on lesional measures of disease severity are not yet well defined. This phase 2a, single-center, vehicle-controlled, intrapatient study was designed to further characterize the mechanism of action of crisaborole through evaluation of clinical efficacy and changes in skin biomarkers in adults (n=40) with mild-to-moderate AD. Two target lesions were randomized in an intrapatient (1:1) manner to double-blind crisaborole/vehicle applied twice daily for 14days. Patients then applied crisaborole (open-label) to all affected areas for 28days. Punch biopsy specimens were collected for biomarker analysis at baseline, day 8 (optional), and day 15. Crisaborole treatment resulted in early improvement in lesional signs/symptoms versus vehicle, with improvement in pruritus (pruritus numeric rating scale) observed as early as 24hours after the first application. Crisaborole-treated lesions showed significant percentage improvement from baseline in lesional transcriptomic profile compared with vehicle at day 8 (91.15% vs 36.02%, P<10-15) that was sustained until day 15 (92.90% vs 49.59%, P<10-15). Crisaborole significantly modulated key AD biomarkers versus vehicle, including TH2 and TH17/TH22 pathways and epidermal hyperplasia/proliferation. Molecular profiles and epidermal pathology normalized toward nonlesional skin and correlated with clinical changes in lesion severity and barrier function. Crisaborole reversed biomarker profiles of skin inflammation and barrier function, with associated improvements in clinical efficacy measures, highlighting the therapeutic utility of targeting phosphodiesterase 4 in patients with AD.

Clinical and histopathological presentation and successful treatment with ciclosporin for canine sarcoidosis: a case report

Sarcoidosis is a granulomatous disease histologically characterized by naked granulomas in various mammals. Canine sarcoidosis is a rare disease which can cause nonpruritic papule, plaques and nodules on the trunk, neck, face and ear; it is usually treated with corticosteroids. To date, there are no published reports on alternatives to corticosteroids treatment. To report a case of canine cutaneous sarcoidosis successfully treated with oral ciclosporin. An 11-year-old beagle dog was presented with multiple pleomorphic plaques on the lateral thighs and dorsal trunk. Skin punch biopsy specimen were collected and analysed via routine histological examination and immunohistochemistry. After 14weeks of oral ciclosporin treatment, repeat skin biopsy specimens were collected. Histopathological examination revealed noncaseating epithelioid cell granuloma formation in the dermis. Dermal epithelioid cells were positive for CD18 and Iba1, but not for CD3, CD20 and E-cadherin based on immunohistochemistry findings. Acid-fast bacteria, fungi and Leishmania spp. were not detected by special stains, culture or polymerase chain reaction. An initial two week treatment with immunosuppressive doses of oral prednisolone and doxycycline was not effective. Skin lesions were almost in remission after 14weeks of oral ciclosporin treatment without adverse events. Histologically, the dermal granulomatous lesions regressed and were replaced by fibrous tissues after ciclosporin treatment. This case report describes the clinical and histopathological presentation including immunohistochemistry and treatment outcome of a case of canine sarcoidosis Ciclosporin may be an effective alternative to corticosteroids for treating canine sarcoidosis.

Significance of IL-17A-producing CD8+CD103+ skin resident memory T cells in psoriasis lesion and their possible relationship to clinical course

BackgroundA number of studies have shown the relationship between the pathogenesis of psoriasis and skin resident memory T (TRM) cells. ObjectiveTo investigate the cytokine profile of TRM cells from skin lesions of psoriasis and the relationship of skin TRM cells to the future clinical course of psoriasis. MethodsWe used stocked samples of T cells that were ex vivo expanded from skin biopsies of 10 patients with psoriasis vulgaris. A half of 4-mm punch biopsy specimens was subjected to expansion of skin-infiltrating T cells using IL-2 and anti-CD3/CD28 antibody-coated microbeads. More than 106 T cells per specimen were stocked at −80°C. Defrosted cells were subjected to flow cytometric analysis. Another half of skin biopsies were subjected to immmunofluorescence staining for CD103 and other markers. ResultsThe biopsied skin revealed CD8+CD103+ TRM cells were present in the epidermis of psoriasis and associated with acanthosis. Sorted CD103+ T cells were mostly CD8+ memory T cells expressing CD69 with a skin-homing potential. A part of CD8+CD103+ T cells produced interferon-γ, IL-17A or IL-22. Notably, CD8+CD103+ TRM cells more frequently produced IL-17A than did CD8+CD103− T cells. We retrospectively divided the 10 cases into the non-advanced therapy group, and the advanced therapy group in which systemic biologics or others were initiated within one year. The frequency of CD8+CD103+IL-17A+ TRM cells tended to be higher in the advanced therapy group. ConclusionThese results suggest that IL-17A-producing CD8+CD103+ TRM cells are associated with a progressive clinical course of psoriasis.