Daisuke Oka

T‐cell subsets in lesions of systemic and discoid lupus erythematosus

In 6 patients with untreated systemic lupus erythematosus (SLE) in the progressive stage, and in 6 with discoid lupus erythematosus (OLE), an analysis of inflammatory infiltrates was performed in situ using the avidin‐biotin‐peroxidase complex (ABC) method with monoclonal antibodies. In all patients, over 75% of the infiltrates reacted with the pan T‐cell antibody OKT3, but only sporadically with that of B‐cell OKB7. In addition, a large number of the infiltrates were OKT8‐positive, indicating that they were in an activated state. Many OKT8‐positive cells were seen infiltrating the epidermis especially in the vicinity of basal keratinocytes. Staining for T‐cell subsets revealed that the proportion of OKT8‐positive cells (suppressor/ cytotoxic) was from 2 to 3 fold higher than that of OKT4‐positive cells (helper/inducer) in lesions of SLE. On the contrary, in OLE, a predominance of OKT4‐pos‐itive cells (the OKT4/OKT8 ratio was from 1:1 to 3:1) was observed. Thus, our results provide further evidence that these 2 main types of LE show quite contrary findings on immunohistochemical analysis of T‐cell subsets, and that besides the humoral immune mechanism, the cell‐mediated immune mechanism may be involved in the pathogenesis of these disorders.

Expression of human lymphocyte antigen (HLA)-DR on tumor cells in basal cell carcinoma

Immunohistologic studies of eight patients with basal cell carcinoma were undertaken using a series of monoclonal antibodies. In all of the patients, the majority of dermal infiltrates reacted with OKT3 and OKIa1 (HLA-DR), with a slight predominance of OKT4+ helper/inducer T cells (the mean OKT4/OKT8 ratio was 1.8). Both OKT4+ and OKT8+ cells were seen infiltrating the tumor masses. In addition, in five cases, human lymphocyte antigen (HLA)-DR was demonstrated on some tumor cells close to a vast number of HLA-DR+ infiltrates surrounding the carcinoma, but not on epidermal keratinocytes and tumor cells devoid of the HLA-DR+ infiltrates. A considerable number of OKT6+ dendritic cells were also observed surrounding the carcinoma. Staining with OKB7 and OKM1 revealed negligible reactive cells, and virtually none of the dermal infiltrates reacted with Leu-7 (HNK-1). These findings suggest that in addition to varied immunologically competent cells, expression of HLA-DR antigen on tumor cells may participate in a cellular immune reaction, a defense mechanism against tumor cell proliferation in basal cell carcinoma.

Coexistence of Psoriasis vulgaris and Pemphigus foliaceus

Masako Yokoo, MD, Daisuke Oka, MD, Hiroaki Ueki, MD, Department of Dermatology, 577 Masushima, Kurashiki 701-01 (Japan) Sir: A number of combined cases ofpsoriasis and autoimmune diseases such as myasthenia gravis, Crohn’s disease, ulcerative colitis, and systemic lupus erythematosus have been reported [1, 2]. Recently, there have been many reported cases of psoriasis associated with bullous pemphigoid [3]. However, the coexistence ofpsoriasis and pemphigus is a very rare event. Here we describe a patient with both psoriasis vulgaris and pemphigus foliaceus. Report of a Case. A 51-year-old Japanese male developed brownish red papules and plaques on his lower legs in August 1986. The lesions were sharply demarcated and covered with layers of silver scales. He was treated with topical corticosteroids by his local physician under the diagnosis of psoriasis vulgaris. In April 1987, bullous and erosive lesions appeared on his neck and axilla, these later spread to the trunk and extremities. The patient was then referred to our outpatient department. On physical examination, the lesions were confluent, with various-sized flaccid bullae, erosions, scales and crusts being present (fig. 1). Nikolsky’s sign was positive. He did no have any oral lesions. Biopsy studies were performed. Epidermis showed extensive acantho-lyticsubcorneal fissure and bulla (fig. 2). These findings tended to confirm the clinical diagnosis of pemphigus foliaceus. Direct immunofluo-rescent studies showed intercellular deposits of IgG and C3. By indirect immunofluorescence serum was positive, demonstrating circulating intercellular antibodies at a titer of 1:256. There were slight elevations of ESR, CRP and complementlevels. Other serological studies and routine hematological tests were all within normal limits or were negative. Treatment with 60 mg of prednisolone daily was started. With time, the eruptions improved and we were gradually able to decrease the dose of prednisolone. For 6 months, neither bullous nor psoriatic lesions were observed. However, when the dose of prednisolone was reduced to 15 mg daily, erythema with white scales appeared on his trunk. Biopsy of these eruptions revealed acanthosis of epidermal rete ridges, paraker-atosis ‚ and absence of the granular layer. These eruptions confirmed the diagnosis of psoriasis vulgaris. Comment. It has been known that psoriasis coexists with autoimmune diseases such as myasthenia gravis, Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, and bullous pemphigoid [1–3]. Pemphigus also coexists with other autoimmune disorders such as thymo-ma, myasthenia gravis, systemic lupus erythematosus. and bullous pemphigoid [4, 5]. However, the coexistence ofpsoriasis and pemphigus has only been very rarely reported. In the English literature ‚ only 6 cases have been reported to our knowledge [6–9]. It is not easily determined

Distribution of 2,4-dinitrophenyl groups on the epidermal Langerhans cells of guinea pigs following skin painting with 2,4-dinitrochlorobenzene.

It has been postulated that epidermal Langerhans cells (LC) are essential for induction and elicitation of contact sensitivity (CS) to simple chemical allergens. Although the precise role of LC in CS has not been determined, recent reports have focused on a function for LC in the presentation of antigen to T lymphocytes. To investigate this possibility, the distribution of allergen on the epidermal LC of inbred strain 13 guinea pigs was observed by the immunofluorescent method using antibodies against Ia antigen and hapten. 2,4-Dinitrophenyl groups were found to be localized on/in Ia-positive epidermal LC of the animals following skin painting with 2,4-dinitrochlorobenzene. This finding is discussed in relation to the role of LC as antigen presenting cells in CS.

The suppressive effect of tape-stripping treatment of guinea-pig skin on the induction of contact sensitivity by intradermal injection of haptenated epidermal cells

SummaryContact sensitivity (CS) to 2,4-dinitrochlorobenzene (DNCB) was produced in inbred JY1-strain guinea pigs by the intradermal injection of epidermal cells (ECs) prepared from DNCB-painted skin (DNP-ECs). When the site of DNP-EC-induced CS was pretreated by tape stripping, the rate and intensity of the challenge reactions to DNCB were diminished. The ability of DNP-ECs to induce CS returned to normal when normal peritoneal macrophages together with DNP-ECs were administered into the stripped skin. Normal ECs had a similar effect. Using either anti-Ia antiserum and complement or allogeneic ECs (strains 2 and 13), Ia-positive cells among the ECs (presumably Langerhans cells) were found to be essential for the recovery of CS. Tape-stripping treatment also resulted in the development of immunological tolerance, as assessed by subsequent painting with a sensitizing dose of DNCB. These findings suggest that the immunological function of the mononuclear-phagocyte system in the dermis may be impaired when the epidermal surface is markedly disturbed by tape-stripping treatment.

ANTIGEN IN CONTACT SENSITIVITY

The distribution of DNP groups on epidermal single cells and epidermal sheets prepared from the skin of guinea pigs three hours after painting with 5% DNCB‐ethanol solution was examined by scanning immunoelectron microscopy using bacteriophage T4 as a visual marker. The study showed that DNP groups were distributed diffusely on the surface of epidermal cells, in particular keratinocytes, and suggests that DNCB may bind to the surface components of epidermal cells when painted on the skin.

Effects of topical cyclosporin A on guinea-pig toxic contact dermatitis

SummaryIt is known that the topical application of cyclosporin A (CsA) has a significant suppressive effect on allergic contact dermatitis. In this study, we investigated the effect of topical CsA on toxic (non-allergic) contact dermatitis. Topical CsA significantly suppressed the toxic contact reaction to croton oil. This suppressive effect was short-lived and reversible. Significant inhibition of the reaction to croton oil persisted for 3 days after stopping the CsA. The toxic reaction was blocked when CsA was applied within 6 h of the croton oil application, but when application of CsA was delayed until 12 h after the oil application there was no significant suppressive effect. Topical administration of CsA could become a valuable tool for treating toxic and allergic contact dermatitis without producing the adverse reactions caused by systemic therapy.

The Distribution of 2,4‐Dinitrophenyl Groups on Thy‐1 Positive Cells in the Epidermis of Mouse Following Skin Painting with 2,4‐Dinitrochlorobenzene

The distribution of 2,4‐dinitrophenyl (DNP) groups on Thy‐1 positive epidermal cells in vivo after 2,4‐dinitrochlorobenzene (DNCB) was painted on the skin surface of C3H/He mice was examined. Epidermal cell suspensions (EC) derived from trypsin‐separated mouse ear skin painted with DNCB were double‐stained for DNP groups and Thy‐1 protein using FITC‐anti‐DNP antibody, biotinylated anti‐mouse Thy‐1,2 monoclonal antibody, and phyco‐erythrin conjugated avidin. There were on the average 1.7% Thy‐1+ ECs; DNP groups were detectable on 77.8% of them when the specimen was treated with anti‐DNP followed by anti‐Thy‐1,2 incubation. The incidence of Thy‐1,2+ EC with DNP groups decreased when cells were treated with these antibodies in the reverse order. The significance of these findings is discussed in relationship to the mode of DNCB Thy‐1+ EC binding.

Differing lectin-binding patterns of malignant melanoma and nevocellular and Spitz nevi.

SummaryThe lectin-binding patterns of primary malignant melanoma, nevocellular nevus, and Spitz nevus were studied on formalin-fixed, paraffin-embedded sections using a series of biotinylated lectins —concanavalin A (ConA), Ricinus communis agglutinin-1 (RCA1), dolichos biflorus agglutinin (DBA), soybean agglutinin (SBA), maclura pomifera agglutinin (MPA), peanut agglutinin (PNA), wheat germ agglutinin (WGA), and Ulex europeus agglutinin-1 (UEA1)- and employing the avidin-biotin-peroxidase complex method. In nevocellular and Spitz nevi, all of the nevus cells were positively stained with ConA and RCA1. No positive staining was observed, however, with the other lectins and no change in binding patterns occurred following neuraminidase pretreatment. In malignant melanoma, all of the melanoma cells were positively stained with ConA and RCA1, and some were also stained with MPA, PNA, and WGA. Inaddition, DBA, SBA, MPA, PNA, and WGA labeled all of the melanoma cells after neuraminidase pretreatment. No positive staining was observed with UEA1 despite neuraminidase pretreatment. The present results showed that malignant melanoma and nevocellular and Spitz nevi have different lectin-binding patterns and different responses to neuraminidase pretreatment. We, therefore, belive that the lectin staining on paraffinembedded sections can be a useful probe for the differentiation of these diseases.

A Case of Sho-seiryu-to-Induced Drug Eruption.

51歳男子。昭和60年に感冒薬(ルルK細粒®)にて中毒疹の既往あり。平成2年4月7日夕方および翌朝に小青竜湯を内服。昼より臀部から大腿にかけて強いそう痒を伴った浸潤性の紅斑が出現。小青竜湯とルルK細粒の同一構成成分であるマオウ, カンゾウの貼付試験が陽性であることより, これらが原因の薬疹と診断した。