Rete Ridges Research Articles

Histopathological spectrum of lichen sclerosus Et atrophicus

Introduction: Lichen sclerosus (LS) et atrophicus is an inflammatory disorder of unknown etiology affecting skin and mucosa, especially the genital area. Clinically, its main features are whitish papules which converge to form plaques and atrophic patches. Histopathology of LS et atrophicus is characterized by the constellation of an atrophic epidermis with loss of rete ridges, some lymphocytes in the basal layer, a subepidermal band of sclerosis, and a lichenoid infiltrate of lymphocytes beneath that band is diagnostic of LS. Materials and Methods: Skin specimens from 25 patients with LS were collected from the hospital records for 5 years. The diagnosis of all cases was made on the basis of clinical morphology and histopathologic features. Sections were stained with hematoxylin and eosin, periodic acid-Schiff, and Elastic-Van Gieson. Criteria evaluated included hyperkeratosis, epidermal atrophy, follicular plugging, basal cell vacuolation, vascular ectasia, hyalinosis, inflammatory infiltrate, dermal edema, and deep dermal fibrosis. Results and Conclusion: Of a total of 25 patients, 18 patients had extragenital (EG) LS and 7 had genital manifestations. Mean age of patients with EG was 28 years, and genital was 38 years. To summarize, the main histopathological findings seen in LS are essentially the same as reported in literature, namely, hyperkeratosis, epidermal atrophy, follicular plugging, basal cell vacuolation, vascular ectasia, hyalinosis, inflammatory infiltrate, dermal edema, and deep dermal fibrosis. Moreover, some interesting differences between the EG and genital forms of LS were seen. However, since the figures are too small to comment on, studies comprising larger series of patients are required to bring out a statistical significance.

Significance of vascular endothelial growth factor and CD31 and morphometric analysis of microvessel density by CD31 receptor expression as an adjuvant tool in diagnosis of psoriatic lesions of skin.

Pathogenesis of psoriasis is a debated issue. Several mechanisms have been proposed to identify the etiology and pathogenesis so that specific treatments can be given to patients with psoriasis. (1) To compare pattern and distribution of vascular endothelial growth factor (VEGF) and CD31 in patients with psoriasis and other psoriasiform lesions of skin. (2) To study the correlation between VEGF and CD31 expression, clinical severity, and histopathology of psoriasiform lesions of skin. (3) Evaluation of microvessel density (MVD) by using computer-assisted quantitative image analysis in psoriatic skin lesions. This study was conducted on eighty cases, out of which forty were diagnosed cases of psoriasis and forty cases of clinically suspected psoriasiform lesions, submitted in the Department of Pathology, Pt. B.D. Sharma, University of Health Sciences, Rohtak, for histopathological examination. Histopathological sections were stained by routine hematoxylin and eosin staining, and these biopsies were further subjected to immunohistochemical staining with VEGF and CD31 as per standard technique. Assessment of various histopathological features revealed strong correlation between epidermal hyperplasia, suprapapillary thinning, and elongation of rete ridges. Suprabasilar keratinocytes in psoriatic lesions stained intensely for VEGF. The difference for number of microvessels and MVD in psoriasis and psoriasiform lesions was statistically significant. Correlation between intensity of VEGF staining by suprabasilar keratinocytes and MVD was found to be highly significant in psoriatic lesions. The present study concluded that psoriatic lesions exhibit potent angiogenic activity. Early lesions show increased MVD along with other histomorphological parameters such as hypogranulosis, parakeratosis and Munro's microabscesses. Overexpression of VEGF by suprabasilar keratinocytes correlated with increased MVD in papillary dermis.

Histological study on the effect of nicotine on adult male guinea pig thin skin.

Tobacco smoking has been identified as an important factor in premature skin aging to detect the histological changes occurred in adult male guinea pig thin skin under the influence of low and high doses of nicotine; which constitutes approximately 0.6%–3.0% of the dry weight of tobacco. Fifteen adult male pigmented guinea pigs were equally divided into three groups: group I, control; group IIA, low dose nicotine treated; 3 mg/kg subcutaneously for 4 weeks; and group IIB, high dose nicotine treated; 6 mg/kg subcutaneously for 4 weeks. Specimens from the back thin skin were processed for light and electron microscopy. Nicotine administration revealed flattened dermo-epidermal junction and reduced rete ridges formation. Collagen bundles were disorganized with increased spaces between them. A reduction in the amount of elastic fibers in the dermis were also observed compared to group I. Ultrastructurally, keratinocytes had hyperchromatic nuclei, intracytoplasmic vacuoles, disruption of desmosomal junctions, irregular tonofilaments distribution, and increased inter-cellular spaces. These changes were more pronounced with high dose nicotine administration. The epidermal thickness was reduced in low dose nicotine administration. But, high dose nicotine administration revealed increased epidermal thickness compared to the control group. Nicotine induced structural changes of adult male guinea pig thin skin. These changes were more pronounced with high dose nicotine administration.

Antipsoriatic and Anti-inflammatory Studies of Berberis aristata Extract Loaded Nanovesicular Gels.

Objective:Novel nanovesicular gel of Berberis aristata extract was developed and evaluated for its anti-inflammatory and antipsoriatic activity.Materials and Methods:Transferosomes were prepared using soya phosphatidylcholine and edge activators (Tween 80, Span 80, and sodium deoxycholate) by a modified lipid film hydration technique using rotary evaporator and evaluated for various parameters. The quantification and standardization of extract have been carried out using its alkaloid content as berberine as biomarker. Topical application of imiquimod (IMQ) (immune modifier) on the shaved back of mice developed psoriasis-like inflammation followed by histopathological study of inflamed skin.Results:The size of transferosomes was in the range of 265–345 nm whereas polydispersity index ranges from 0.10 to 0.63, and for zeta potential, it was from −19.3 to −43.3 mV. Transferosomes were further added to Carbopol 934P for gel formation and subsequently evaluated for their physicochemical properties. Their efficacy against inflammation, IMQ-induced psoriasis, and skin sensitivity was compared with conventional formulation (commercial formulation-Angle Gloss, Phytolab Pvt. Ltd.). Percent inhibition of edema by transferosomal gel (55.76%) was more as compared to conventional gel of extract (33.5%) found out by Carrageenan-induced paw edema method. Primary irritation index was found to be <0.4 inferring its safe use for topical formulation.Conclusion:Histopathological report showed that, in psoriasis-induced animal treated with topical application of extract loaded transferosomal gel showed a marked reduction in thickness of epidermis, length of rete ridges as compared to conventional gel formulation. It can be inferred that B. aristata extract loaded transferosomal gel can function as potential anti-inflammatory and antipsoriatic formulation.SUMMARY The objective of the present research work was to prepare Berberis aristata extracts (roots, ethanolic 70%v/v) loaded transferosomal gel, to perform in vitro characterization and in vivo evaluation of their efficacy against inflammation as well as imiquimod (IMQ)-induced psoriasis in animalsThe remarkable enhancement in the in vitro release efficiency of B. aristata extract loaded transferosomal gel resulted in improved anti-inflammatory activity. The prepared novel formulation of B. aristata has also shown its efficacy against IMQ-induced psoriasis. Abbreviations used: SPC: Soyaphosphatidylcholine, PDI: Polydispersity index, IMQ: Imiquimod, EA: Edge activator, BE: Berberine, TEM: Transmission electron microscopy, PBS: Phosphate buffered saline, H and E: Hematoxylin and eosin, ZP: Zeta potential, EE: Entrapment efficiency.

Pulsed-dye laser efficacy in the treatment of psoriasis in adult patients: An evidence-based case report

1024x768 Psoriasis is a chronic inflammatory skin disease known to be highly responsive to phototherapy. Narrow-band UVB (NBUVB) phototherapy has been one of the standard treatments for its moderate to severe form. However, its lack of efficacy in treating stable psoriatic plaques on extremities has lead researchers to find alternative treatments, one of which is pulsed-dye laser (PDL). Laser has been known to be effective in treating vascular lesions; in psoriasis, elongation of rete ridge along with tortuous dermal capillaries are one of the first pathologies identified early in the disease progression. Several in vivo and preliminary studies have found the molecular mechanism of action of laser on abnormal vessel growth. In this article, we report a psoriasis vulgaris case in adult whose lesions responded well to NBUVB phototherapy. The psoriatic plaques on her extremities were stable despite NBUVB therapy and some topical treatments afterwards. With knowledge of emerging role of PDL in inflammatory skin disease such as psoriasis, we conducted a literature search and critically appraised the resulting articles. The systematic review article found evaluates PDL efficacy as a treatment for inflammatory skin diseases, including psoriasis, and was appraised using a worksheet from British Medical Journal Evidence-Based Medicine Toolkit. Its validity, importance, and applicability aspects were evaluated, leading to a conclusion that PDL can be used as an alternative treatment for psoriasis plaques in trunks, extremities, hands, or feet (both stable and unstable), with minimal and transient side effects (hyperpigmentation, hypopigmentation, and blistering). Keywords : psoriasis, treatment, pulsed-dye laser Normal 0 false false false EN-US X-NONE X-NONE

Application of confocal laser scanning microscopy in the differentiation between seborrheic keratosis and Bowen's disease

Objective To evaluate the application value of confocal laser scanning microscopy (CLSM) in the differentiation between seborrheic keratosis and Bowen's disease. Methods CLSM was used to observe typical skin lesions in 88 patients clinically diagnosed with seborrheic keratosis and 18 patients clinically diagnosed with Bowen's disease. Then, tissue specimens were resected from these lesions and subjected to histopathological examination. Results CLSM imaging of seborrheic keratosis lesions showed gyrus-like structures and keratin-filled inclusion cysts in the epidermis with trabecula-like extension of rete ridges in all the 88 cases, basal cells arranged in a cordike or radial pattern in 9 cases, and bright reflective structures in the basal layer and dermis in 6 cases. CLSM imaging of Bowen's disease lesions revealed disorderly arrangement of large, irregularly shaped atypical cells in some areas in the middle and lower epidermis, and infiltration of scattered mononuclear cells in the superficial dermis. Conclusion CLSM images of seborrheic keratosis are different from those of Bowen's disease, and CLSM may be helpful for their differential diagnosis. Key words: Keratosis, seborrheic; Bowen's disease; Microscopy, confocal; Diagnosis; Comparative study

Novel approaches to characterize age-related remodelling of the dermal-epidermal junction in 2D, 3D and in vivo.

The dermal-epidermal junction (DEJ) forms epidermal protrusions down into the dermis (rete ridges) and dermal projections up into the epidermis (dermal papillae). Usually visualized in two-dimensions (2D), our knowledge of how the DEJ changes with ageing is limited. We aimed to characterize how this structure exists in 3D and changes with age. Photoprotected and photoexposed skin were imaged using reflectance confocal microscopy (RCM) in young and aged individuals. Biopsies of the imaged areas were processed for histological sectioning and for imaging using micro-computed X-ray tomography (microCT). Images obtained from RCM and microCT were used to 3D reconstruct the DEJ. DEJ heights obtained from microCT images showed strong correlation with histology-measured heights. We proposed a novel definition of rete ridges (RRm ) and dermal papillae (DPm ), which allowed easier automated measurement of reduced DPm and RRm volumes in aged skin from microCT reconstructions. An algorithm to map DPm connectivity showed reduced lengths of DPm branches with age. Three-dimensional images illustrated the complex topography of the DEJ and highlighted the distinct morphology of dermal papillae compared with rete ridges, which is not evident when evaluating 2D sections. Ex vivo imaging was more successful in differentiating DEJ architecture with respect to age.

Complete regression of primary cutaneous malignant melanoma associated with distant lymph node metastasis: a teaching case mimicking blue nevus.

BackgroundMalignant melanoma (MM) tends to be spontaneously regressed, however, complete regression of primary cutaneous MM is an extremely rare phenomenon. Our aim is to be aware that pathologists and/or dermatologists can readily misinterpret it as the other benign or malignant lesions.Case presentationA gradually growing and verrucous hypopigmented macule had been noticed in the right sole of a 65-year-old Japanese male since 2 years before, and it turned to be a solitary bluish to black patch with surrounding depigmentation and was recently decreased in size. In parallel, the patient had a rapidly growing black-pigmented mass lesion at the right inguen. The cutaneous specimen from the sole showed an aggregation of many melanophages predominantly in the middle to deep layer of dermis, associated with surrounding fibrosis, reactive vascular proliferation and CD8-positive T-lymphocytic infiltrate, covered by attenuated epidermis with absence of rete ridge. However, no remnant MM cells were completely seen in the step-serial sections. We first interpreted it as blue nevus. By contrast, the inguinal mass revealed a diffuse proliferation of highly atypical mono- to multi-nucleated large cells having abundant eosinophilic cytoplasm in the enlarged lymph node tissue. Immunohistochemical findings demonstrated that these atypical cells were specifically positive for HMB45 and Melan A. Therefore, we finally made a diagnosis of complete regression of primary cutaneous MM associated with distant lymph node metastasis of MM.ConclusionCareful, not only general/cutaneous but histopathological, examinations should be necessary and adjunctive aids for reaching the correct diagnosis of complete regression of cutaneous MM.

Regression in cutaneous melanoma: a comprehensive review from diagnosis to prognosis.

Histological regression in primary cutaneous melanoma occurs in 10-35% of cases. Although a large body of literature exists to suggest that histological regression serves very little purpose in predicting biologic behaviour with melanoma, recognizing the presence of regression at clinical and histological ground may still retain some value in grading melanoma aggressiveness. In the current review, a comprehensive overview of the main aspects of regression will be provided. Histologically, many classifications have been reported so far, but all of them only agreed on the presence of an infiltrate of lymphocytes admixed with pigment-laden macrophages underlying an atrophic epidermis with flattened rete ridges. Upon dermoscopy, regression is also named Blue White Scar-like areas and could be variably admixed with granularity or peppering. Almost fully regressed lesions represent a main diagnostic issue in dermoscopy, and thus, confocal microscopy can be of help to identify whether the tumour is melanocytic or not. The clinical utility of regression as a prognostic factor has been challenged recently. Nowadays, evidences showed that it is less likely associated to SLN metastases.

Observation of viable alloskin vs xenoskin grafted onto subcutaneous tissue wounds after tangential excision in massive burns.

BackgroundStaged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive burns. Alloskin is the gold standard of a biological temporary skin substitute, and the main drawback to its wider use is the limited number of donors. In this paper, we compare the use of fresh pigskins to cryopreserved alloskins as temporary skin substitutes on subcutaneous tissue wounds after tangential excision by observing the clinical performances of these grafts in cases of a massive burn.MethodsWe selected six adult massive burn patients undergoing tangential excision and skin grafting on subcutaneous tissue wounds (TESGSTW) at our burn center from January 1, 2003 to December 31, 2013. The general clinical data and survival percentage of skins at postoperative weeks (POWs) 1, 2, and 3 were analyzed. In our clinical practice, we also observed the phenomenon that several viable cryopreserved alloskin or fresh pigskin grafts used as temporary coverage on subcutaneous tissue wounds had long-term survival after repeated desquamation. The macroscopic and histological results of one typical case were also analyzed.ResultsIn this study, the first three TESGSTW operations were performed at 2–3, 5–8, and 11–16 days post-injury. The operation areas were 30.3 ± 7.9 % total body surface area (TBSA), 19.0 ± 6.0 % TBSA, and 12.0 ± 1.7 % TBSA, respectively. The survival percentage of the cryopreserved alloskins or fresh pigskins at POWs 1, 2, and 3 were 80.0 ± 10.0 % vs 75.7 ± 5.3 % (t = 1.01, P = 0.16), 71.2 ± 10.6 % vs 66.4 ± 6.2 % (t = 1.09, P = 0.30), and 48.7 ± 2.5 % vs 35.0 ± 7.0 % (t = 3.83, P = 0.03), respectively. The microscopic observation of the survival of alloskins or pigskins in one typical case showed rete ridges and a basilar membrane at the joint of the epidermis and dermis at an early stage; these structures disappeared with extended time post-operation.ConclusionsFrom the clinical observations, fresh pigskin and cryopreserved alloskins could be used with equal effectiveness at an early stage (within 2 weeks post-operation) as temporary coverage on massive burns after TESGSTW. After engraftment, several cryopreserved alloskins or fresh pigskins could co-survive in a massive burn patient for an extended amount of time. The co-survival of alloskin and pigskin will provide clues for further research into skin transplantation.Electronic supplementary materialThe online version of this article (doi:10.1186/s41038-016-0045-9) contains supplementary material, which is available to authorized users.

Nævus mucineux de révélation tardive

Mucinous nevus is a rare disease characterized by mucin deposits in the dermis, with only 23cases reported to date. It belongs to the connective tissue nevus family and is characterized by dermal mucin deposits. Two histological subtypes have been described: pure mucinous dermal nevus (connective tissue nevus of the proteoglycan [CTNP]) and combined mucinous nevus (combined CTNP) associating epidermal nevus with dermal mucin deposits. Lesions generally appear in childhood or early adulthood. We report herein the case of a 59-year-old man with a symptomatic lesion. A 59-year-old man consulted for unilateral lesions occurring linearly along the Blaschko line on the right lower limb, composed of brown verrucous papules, which started at the age of 50. The patient complained of itching caused by friction from clothes. Histological examination of a papule highlighted an acanthotic epidermis, with elongation of rete ridges and mucin deposits in the dermis showing uptake of alcian blue stain. The clinicopathological analysis enabled diagnosis of combined CTNP. We treated this nevus by surgical dermabrasion and observed a slight and cosmetically acceptable scar. To our knowledge, our patient is the oldest reported to date and the only one to have complained of symptoms. Our review of the literature highlights the importance of skin biopsy to guide aesthetic or symptomatic treatment. CO2laser and dermabrasion are recommended for combined CTNP as they treat the epidermal component with low risk of secondary scarring. However, these techniques should be avoided in pure dermal CTNP, where surgical excision alone is acceptable in order to achieve optimal cosmetic results.

Tracheobronchial papillomatosis.

Abstract Recurrent respiratory papillomatosis (RRP) is a rare clinical entity characterized by squamous cell papillomas in the tracheobronchial tree. RRP is caused by human papillomavirus (HPV) 6 and 11. HPV-specific memory T cells in adults suggest most infections are asymptomatic or self-limited. However, a small subset of patients develop persistent HPV infection and invasive malignancies. RRP is observed in infants following vertical transmission and in adults in the second and third decade following sexual transmission. There is low malignant potential, although patients with smoking or radiation history, p53 mutations, or HPV-11 subtype have increased risk of transformation into squamous cell cancer. We present a case of tracheobronchial papillomatosis in a 73-year-old man who presented with exertional dyspnea. History was notable for a laryngeal polyp resected 30 years prior. Pulmonary function testing suggested variable intrathoracic obstruction (Figure A). Computerized tomography of the chest revealed a 1.4 × 1.1 × 2.0 soft tissue mass adherent to the mid thoracic trachea (Figure B). We performed rigid bronchoscopy with laser devascularization and mechanical debridement. Pathology demonstrated well-differentiated squamous epithelium overlying fibrovascular cores (rete ridges) with elongated nuclei characteristic of squamous papillomatosis (Figure C). The quadrivalent HPV vaccine is approved for prevention of genital warts and gynecologic malignancies caused by HPV 6, 11, 16 and 18. Vaccination could potentially reduce the prevalence of RRP by decreasing vertical and sexual transmission of HPV 6 and 11. Ongoing investigations are currently evaluating the role of vaccination in patients with preexisting RRP.

Occurrence and identification of contagious ecthyma in blackbuck.

A carcass of male free ranging adult blackbuck (Antilope cervicapra) was presented for necropsy examination exhibiting thick confluent nodular skin lesions around the mouth and the dry scaly crusts/fissures on the skin of abdomen, thigh and shoulder with subcutaneous haemorrhages. The skin sample around mouth was found positive for orf virus (ORFV) identified by counterimmunoelectrophoresis and PCR. Histopathology of the mouth skin revealed the hyperkeratinization, epidermal sloughing and epithelial hyperplasia showing acanthosis with rete ridges and few eosinophilic intracytoplasmic inclusion bodies in keratinocytes. Further, comparative B2L gene sequence analysis revealed that the virus isolate from blackbuck had shown 97.8-99.6 and 97.6-99.5% identity at nucleotide and amino acid levels respectively with Indian isolates and maximum identity with ORFV 79/04, an isolate from India. Phylogenetic analysis based on B2L gene also revealed the same evolutionary relationship that it is closely related to Indian isolates. This seems to be the first report of orf in blackbuck from Indian subcontinent.

Paracrine Factors from Irradiated Peripheral Blood Mononuclear Cells Improve Skin Regeneration and Angiogenesis in a Porcine Burn Model.

Burn wounds pose a serious threat to patients and often require surgical treatment. Skin grafting aims to achieve wound closure but requires a well-vascularized wound bed. The secretome of peripheral blood mononuclear cells (PBMCs) has been shown to improve wound healing and angiogenesis. We hypothesized that topical application of the PBMC secretome would improve the quality of regenerating skin, increase angiogenesis, and reduce scar formation after burn injury and skin grafting in a porcine model. Full-thickness burn injuries were created on the back of female pigs. Necrotic areas were excised and the wounds were covered with split-thickness mesh skin grafts. Wounds were treated repeatedly with either the secretome of cultured PBMCs (SecPBMC), apoptotic PBMCs (Apo-SecPBMC), or controls. The wounds treated with Apo-SecPBMC had an increased epidermal thickness, higher number of rete ridges, and more advanced epidermal differentiation than controls. The samples treated with Apo-SecPBMC had a two-fold increase in CD31+ cells, indicating more angiogenesis. These data suggest that the repeated application of Apo-SecPBMC significantly improves epidermal thickness, angiogenesis, and skin quality in a porcine model of burn injury and skin grafting.

Differential immunohistochemical expression profiles of perlecan-binding growth factors in epithelial dysplasia, carcinoma in situ, and squamous cell carcinoma of the oral mucosa

The intercellular deposit of perlecan, a basement-membrane type heparan sulfate proteoglycan, is considered to function as a growth factor reservoir and is enhanced in oral epithelial dysplasia and carcinoma in situ (CIS). However, it remains unknown which types of growth factors function in these perlecan-enriched epithelial conditions. The aim of this study was to determine immunohistochemically which growth factors were associated with perlecan in normal oral epithelia and in different epithelial lesions from dysplasia and CIS to squamous cell carcinoma (SCC). Eighty-one surgical tissue specimens of oral SCC containing different precancerous stages, along with ten of normal mucosa, were examined by immunohistochemistry for growth factors. In normal epithelia, perlecan and growth factors were not definitely expressed. In epithelial dysplasia, VEGF, SHH, KGF, Flt-1, and Flk-1were localized in the lower half of rete ridges (in concordance with perlecan, 33–100%), in which Ki-67 positive cells were densely packed. In CIS, perlecan and those growth factors/receptors were more strongly expressed in the cell proliferating zone (63–100%). In SCC, perlecan and KGF disappeared from carcinoma cells but emerged in the stromal space (65–100%), while VEGF, SHH, and VEGF receptors remained positive in SCC cells (0%). Immunofluorescence showed that the four growth factors were shown to be produced by three oral SCC cell lines and that their signals were partially overlapped with perlecan signals. The results indicate that perlecan and its binding growth factors are differentially expressed and function in specific manners before (dysplasia/CIS) and after (SCC) invasion of dysplasia/carcinoma cells.

Plaque with pearly raised borders on the forearm

A 29-year-old male presented with an annular plaque on his arm for 7 months. Physical examination revealed 6 mm annular plaque with raised borders and a shiny stellatepurple center (Fig. 1). Dermoscopic evaluation revealed a ring of white spiked structurless areas at the periphery; an intense structurless steel purple area was observed at the center of the lesion (Fig. 2). Hystopathological examination showed a band-like infiltrate of lymphocytes, pigment incontinence, saw tooth rete ridges, hypergranulosis and hypekeratosis (Figs. 3 and 4). Clinical Image

Epidermal Cells Expressing Putative Cell Markers in Nonglabrous Skin Existing in Direct Proximity with the Distal End of the Arrector Pili Muscle.

Inconsistent with the view that epidermal stem cells reside randomly spread along the basal layer of the epidermal rete ridges, we found that epidermal cells expressing stem cell markers in nonglabrous skin exist in direct connection with the distal end of the arrector pili muscle. The epidermal cells that express stem cell markers consist of a subpopulation of basal keratinocytes located in a niche at the lowermost portion of the rete ridges at the distal arrector pili muscle attachment site. Keratinocytes in the epidermal stem cell niche express K15, MCSP, and α6 integrin. α5 integrin marks the distal end of the APM colocalized with basal keratinocytes expressing stem cell markers located in a well-protected and nourished environment at the lowermost point of the epidermis; these cells are hypothesized to participate directly in epidermal renewal and homeostasis and also indirectly in wound healing through communication with the hair follicle bulge epithelial stem cell population through the APM. Our findings, plus a reevaluation of the literature, support the hierarchical model of interfollicular epidermal stem cell units of Fitzpatrick. This new view provides insights into epidermal control and the possible involvement of epidermal stem cells in nonmelanoma skin carcinogenesis.

Clinical and Histopathological Characteristics of Psoriasis in Dr. Hasan Sadikin General Hospital Bandung from 2009 to 2013

Background : Psoriasis is a chronic inflammatory skin disease characterized by alterations in epidermal growth and differentiation. Its primary cause remains unknown, and its clinical and histopathological characteristics sometimes change from time to time. The study aimed to reveal the clinical and histopathological characteristics among psoriasis patients in Dr. Hasan Sadikin General Hospital Bandung. Methods : This study involved 162 medical records of psoriasis patients who visited the Department of Dermato-Venereology and 40 medical records of psoriasis patients who visited the Department of Pathological Anatomy of Dr. Hasan Sadikin Hospital, from 2009 to 2013. Medical record data were collected to describe the patient’s clinical and histopathological characteristics of psoriasis. The collected data were analyzed by frequency distribution. Results : From the clinical medical records, the characteristics found among the psoriasis patients were: 14 (8.6%) having familial history, 160 (98.8%) having reddish plaque, 155 (95.7%) having silvery scale, 40 (24.7%) having pustules, 6 (3.7%) having positive Auspitz sign, 48 (29.6%) having nail involvement, and 20 (12.4%) having tongue involvement. In addition, from the histopathological medical records, the characteristics of epidermis among the psoriasis patients found were: 36 (90%) having hyperkeratosis with parakeratosis, 39 (98%) having rete ridge elongation and/or acanthosis, 35 (88%) having Munro’s microabcess and/or micropustules of Kogoj, 15 (38%) having thin stratum granulosum, and 30 (75%) having blood vessels dilatation. Conclusions : In psoriasis, the most common clinical characteristics are reddish plaque while the most common histopathological characteristics are elongation of the rete ridges and/or acanthosis. [AMJ.2016;3(4):556–61] DOI: 10.15850/amj.v3n4.938

Classic Juvenile Pityriasis Rubra Pilaris Treated with Oral Alitretinoin

Dear Editor: Pityriasis rubra pilaris (PRP) is a papulosquamous disorder of unknown etiology. Although treatment of PRP is challenging, oral retinoids, including acitretin and isotretinoin, are used as first-line treatment. Recently, alitretinoin, a novel panagonist retinoid, has been reported to be effective for PRP. Here, we described a case of refractory PRP that showed remarkable response to alitretinoin. A 37-year-old man, presenting with relapsing skin lesions over the whole body since 1 year of age, had been diagnosed with and treated for PRP since he was 10 years old. He had a familial PRP history on his mother's side. Physical examination at the first visit revealed erythematous pruritic scaly papuloplaques on the trunk and lower extremities, which was not distinctive due to previous treatments in other hospitals (Fig. 1A, B). Palmoplantar keratoderma was mildly observed. Neither follicular hyperkeratosis nor generalized erythroderma with island of normal skin was seen. The skin biopsy from the left thigh revealed regular acanthosis with broad rete ridge, parakeratosis, and perivascular lymphocytic infiltration with occasional eosinophils (Fig. 1C). There was no confluent hypergranulosis or alternating orthokeratosis and parakeratosis. Classic juvenile PRP was diagnosed. Several treatment options were administered for 1 year in our hospital, which included neotigasone 20~30 mg for 13 months, narrow-band ultraviolet-B phototherapy for 6 months, methotrexate 12.5 mg per week for 1 month, prednisolone 0.5~5 mg for 12 months, and superpotent topical steroid for 6 months. However, none of these treatments led to stable remission. Therefore, oral alitretinoin (30 mg daily) was initiated and continued for 5 months, combined with superpotent topical steroid. The skin lesions and pruritus significantly disappeared in 4 weeks and were not aggravated for 5 months (Fig. 2). Also, there were no side effects except mild dryness. Laboratory test did not show any abnormalities including serum cholesterol. The patient stated that alitretinoin was most effective and tolerable compared with other therapies. Therefore, we decided to continue the same dosage of alitretinoin as far as it was well-tolerated. Fig. 1 Clinical findings of pityriasis rubra pilaris presented at the first visit to our hospital. Multiple erythematous scaly papuloplaques on (A) the trunk and (B) the lower extremities. (C) Histopathologic findings revealed regular acanthosis with broad rete ... Fig. 2 No skin lesion was seen on the (A) trunk and (B) lower extremities after the 5 months course of oral alitretinoin. PRP can be clinically divided into 6 subtypes1. It comprises an adult-onset (classic or atypical adult type), juvenile-onset (classic, circumscribed or atypical juvenile type) and human immunodeficiency virus-associated form. Classic juvenile PRP begins in the first 2 years after birth, showing similar features of classic adult type. Systemic retinoids such as acitretin and isotretinoin have antiproliferative, immuno-modulatory, and anti-inflammatory effects that are mediated by intranuclear retinoid acid receptors (RARs). However, alitretinoin (9-cis-retinoic acid) uniquely binds not only to RARs, but also to retinoid X receptors with high affinity. Owing to this dual interaction, alitretinoin may be more effective than conventional retinoids2. Moreover, alitretinoin inhibits production of nitric oxide and proinflammatory cytokines such as tumor necrosis factor-α, interleukin-1β and interleukin-12p403. In addition, alitretinoin results in fewer mucocutaneous side effects than other retinoids2. To our knowledge, only few cases of adult-onset PRP treated with alitretinoin have been reported2,3,4,5. This is the first case of refractory classical juvenile PRP that responded well to alitretinoin. In conclusion, alitretinoin could be a promising alternative for treating refractory classic juvenile PRP.

Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp.

BackgroundThe differential diagnosis of psoriasis and seborrheic dermatitis can be difficult when both conditions are localized to the scalp without the involvement of other skin sites.ObjectiveWe aimed to evaluate the histopathological differences between psoriasis and seborrheic dermatitis on the scalp and identify favorable criteria for their differential diagnosis.MethodsWe evaluated 15 cases of psoriasis and 20 cases of seborrheic dermatitis of the scalp that had been clinicopathologically diagnosed. Skin biopsy sections stained with H&E were examined. Additional immunohistochemistry was performed, including Ki-67, keratin 10, caspase-5, and GLUT-1.ResultsOn histopathological examination, mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, and clubbed and evenly elongated rete ridges were significantly more frequently observed in psoriasis. Follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis were significantly more common in seborrheic dermatitis. Moreover, significantly higher mitotic figures were observed in psoriatic lesions than in seborrheic dermatitis. Immunohistochemistry did not show any difference between psoriasis and seborrheic dermatitis.ConclusionHistopathological features favoring psoriasis include mounds of parakeratosis with neutrophils, spongiform micropustules of Kogoj, clubbed and evenly elongated rete ridges, and increased mitotic figures (≥6/high-powered field). Features indicating seborrheic dermatitis are follicular plugging, shoulder parakeratosis and prominent lymphocytic exocytosis. Immunohistochemistry was not helpful in differentiating psoriasis from seborrheic dermatitis.