Detection of T lymphocytes and T lymphocyte subsets in lichen planus: in situ and in peripheral blood

Direct immunofluorescence and immune function in patients with oral lichen planus

Background/Purpose

Direct immunofluorescence and immune function and patients with oral lichen planusThe etiology of oral lichen planus (OLP) is unknown, our purpose was to evaluate the diagnostic value of direct immunofluorescence (DIF) and to investigate the immune functions in OLP.

Materials and methods

We enrolled 65 patients with suspected lesions of OLP and 47 controls. In all participants, clinical and serologic testing were conducted. The histopathologic and DIF tests were conducted in 65 patients. The severity of OLP was evaluated by reticular/hyperkeratotic, erosive/erythematous, ulcerative (REU) scoring system.

Results

By hematoxylin and eosin (H&E) staining and DIF examination, 71.2% (42/59) were diagnosed as OLP, 28.8% (17/59) were diagnosed as non-OLP. DIF demonstrated 64.3% positive reactivity with 2 distinct distribution patterns and 8 staining patterns. Compared to the controls, serum IgA in OLP was higher (P < 0.01), and serum CD3+ cells, IgM, IgE, C3 and C4 were lower (P < 0.05). Pearson correlation analysis in OLP revealed correlations between REU score and IgM, IgA of DIF (r = 0.54, P = 0.026; and r = 0.56, P = 0.020, respectively), between serum IgG and IgG of DIF (r = 0.51, P = 0.038), between serum CD4+ and the ratio of CD4+/CD8+, IgM in DIF (r = −0.50, P = 0.048; and r = −0.54, P = 0.031, respectively), between serum CD8+ and IgM, IgA in DIF (r = 0.52, P = 0.038; and r = −0.50, P = 0.047, respectively).

Conclusion

A combination of H&E test and DIF is useful for the diagnosis of OLP. Compared to controls, immune changes happen to patients with OLP. There are significant associations between the OLP lesions and general cellular and humoral immune status, localized humoral immune response.

Familial Coexisting and Colocalized Psoriasis and Vitiligo Responding to Alefacept

Background:

Psoriasis is an immune-mediated, chronic, inflammatory disease that significantly impairs both physical and emotional aspects of an individual's quality of life. Vitiligo leads to depigmentation of skin, in which some or all melanocytes in the interfollicular epidermis and occasionally those in the hair follicles are selectively destroyed. The coexistence of the two disorders is rarely seen.

Objective:

To report two cases of the rare coexistence of psoriasis and vitiligo in a family.

Methods:

After providing informed written consent, both patients were given alefacept 15 mg/kg weekly injections for 12 weeks. The patients were monitored both clinically and with all relevant laboratory investigations. These patients were then followed up once a month for 2 years.

Results:

Treatment with alefacept led to complete clearance of vitiligo along with the expected improvement in psoriasis. In the 2-year follow-up, vitiligo did not recur, although psoriasis relapsed and was appropriately treated.

Conclusion:

Use of alefacept in vitiligo may turn out to be a possible novel off-label treatment option in vitiligo. But the results need to be reproduced in larger studies

Evaluation of the profile of the immune cell infiltrate in lichen planus, discoid lupus erythematosus, and chronic dermatitis

AIMS

The term 'interface dermatitis' refers to those dermatoses in which an inflammatory process involves the dermoepidermal junction, with injury and even necrosis of the basal cell keratinocytes. Interface dermatitis can be characterised further as being either vacuolar or lichenoid changes. Immune cell infiltrate is a constant feature in interface dermatitis. In this study, we hypothesised that 'the profile of the immune cell infiltrate varies between lichenoid and vacuolar interface dermatitis'. This investigation tries to test this hypothesis and to characterise immune cells in interface dermatitis.

METHODS

Thirty-one interface dermatitis lesions (interface dermatitis group: 19 cases of lichen planus, LP; and 12 cases of discoid lupus erythematosus, DLE) and 20 specimens of normal skin (control group) were examined using immunoperoxidase staining methods. Antibodies targeting histiocytes/dendritic cells (CD68+), T cells (CD3+), B cells (CD20+), T cells with either cytotoxic potential (TIA-1+) or cytotoxic activity (Granzyme-B+) were used to decorate the immune cells. In addition, 16 cases of chronic dermatitis [lichen simplex chronicus (LSC), non-interface dermatitis group] were included to substantiate findings in the interface dermatitis group. The results were scored as mean values of positively stained immune cells.

RESULTS

The numbers of immune cells were significantly high (p < 0.05) in the lesional skin (LP, DLE and LSC) compared with normal skin. The most prevalent cell populations were CD3+ T lymphocytes followed by CD68+ cells. Most of the CD3+ cells were resting (TIA-1+, cytotoxic potential) rather than active T cells (Granzyme-B+, active cytotoxicity). Numeric variations were seen between interface and chronic dermatitis groups with significant increase of the density of immune cells in the interface dermatitis (p < 0.05). We found some variations in the composition and distribution of immune cell infiltrate between LP (lichenoid change) and DLE (vacuolar changes). The mean counts of CD3+ cells were high in LP compared with DLE (p < 0.05). Alternatively, the density of CD20+ cells was high in DLE compared with LP (p < 0.05). High density of CD3+ (perivascular location and dermoepidermal junction, p < 0.05) positively stained cells was found in LP compared with DLE. In contrast, high density of CD20+ (perivascular location and dermoepidermal junction, p < 0.05), TIA-1+ and Granzyme-B+ (perivascular location and dermoepidermal junction, p > 0.05) positively stained cells was observed in DLE compared with LP.

CONCLUSIONS

Here we report some variations in the profile (density and positioning) of the immune cell infiltrate between LP and DLE. These variations include high density of CD68+ cells and CD3+ T lymphocytes in LP and DLE; and the numeric dominance of CD20+ B-lymphocytes in DLE compared with LP. Also, some differences in the density of TIA-1+ and Granzyme-B+ cytotoxic T cells between LP and DLE were observed. Our findings suggest a possible link between the type of these cells and the development of interface dermatitis lesions. The possible ramifications of these findings are open for further investigations.

Assessment of the peripheral immunocompetent cells in patients with reticular and atrophic-erosive lichen planus

OBJECTIVE

To assess the cellular and humoral immunity in patients with reticular and atrophic-erosive oral lichen planus (OLP).

STUDY DESIGN

Lymphocyte phenotype analysis of 50 patients with OLP and 16 control subjects was performed by means of flow cytometry. The results were analyzed by the Mann-Whitney U test.

RESULTS

In the patient group the percentage of naïve helper T cells was significantly decreased, while that of memory cells was increased, resulting in a significantly higher ratio of memory to naïve cells in the OLP group than in the control group. In the group of patients with atrophic-erosive OLP, the percentages of cytotoxic/suppressor T cells and cytotoxic/suppressor naïve T cells were found to be slightly decreased.

CONCLUSIONS

The results indicate that the relative ratio of immunocompetent cells in the peripheral blood is altered in patients with lichen planus and that the exact character of these disturbances depends on OLP form. Some of the alterations observed in these patients are typical to autoimmune diseases, thus promoting the concept of autoimmune etiopathogenesis of lichen planus.

Tuberculosis verrucosa cutis in a patient with long-standing generalized lichen planus: improvement of lichen after antitubercular polychemotherapy

Tuberculosis verrucosa cutis (TBVC) is a rare form of skin tuberculosis in Western communities, and is generally seen in certain risk groups. A 52-year-old housewife with recalcitrant generalized cutaneous and mucosal lichen planus (LP) of more than a 20-year duration presented with an erythematous-edematous plaque with a warty surface containing deep hemorrhagic fissures and numerous orifices draining purulent material on the back of her left hand. On the basis of clinical, histological and bacteriological findings, TBVC was diagnosed. The patient was successfully treated with isoniazid, rifampicin, ethambutol and pyrazinamide. Interestingly, all lichen lesions improved completely with this therapy. To the best of our knowledge, this is the first documented case of TBVC associated with LP, which was cured by antitubercular polychemotherapy. The case is presented because it reflects a possible reciprocal causal relationship between two cutaneous conditions of different natures.

Perforin expression in peripheral blood lymphocytes and skin-infiltrating cells in patients with lichen planus

BACKGROUND

Current evidence suggests that lichen planus is a T-cell-mediated autoimmune disease in which cytotoxic mechanisms have been poorly investigated.

OBJECTIVES

We investigated the expression of perforin in subpopulations of peripheral blood lymphocytes (PBL) in exacerbation and remission phases of the disease as well as in skin lesions.

METHODS

We performed a simultaneous detection of perforin (intracellular molecule) and cell surface antigens on PBL by flow cytometry, and skin lesions were investigated by immunohistochemistry.

RESULTS

The most interesting finding was a significant increase of perforin expression in cytotoxic T lymphocytes (CD3+ perforin+ cells) in the exacerbation phase of disease (P < 0.05), which was mostly located in the CD8+ subpopulation (CD8+ perforin+) (P < 0.01). Using immunohistochemistry we confirmed the infiltration of T lymphocytes in skin lesions, especially of CD4+ and CD8+ phenotypes, compared with uninvolved (P < 0.05) and healthy skin (P < 0.01). The expression of perforin was also significantly higher in lesional skin compared with nonlesional and healthy skin (P < 0.05).

CONCLUSIONS

Our results clearly show the upregulation of perforin expression in peripheral blood as well as in lesions of patients with lichen planus and therefore suggest an important role for perforin in this autoimmune disease.

Peripheral T-cell subsets in patients with reticular and atrophic-erosive oral lichen planus

OBJECTIVE

Oral lichen planus (OLP) presents with various clinical forms that can be classified into 2 major types: reticular OLP and atrophic-erosive OLP. Our objective was to investigate immunologic differences between these 2 types.

STUDY DESIGN

We investigated possible immunologic differences between 26 patients with reticular OLP and 26 patients with atrophic-erosive OLP.

RESULTS

No differences were detected in serum Ig levels or complement levels. However, the mean proportions of CD4+CD45RO+ and DR+ lymphocytes were significantly higher in patients with atrophic-erosive OLP than in patients with reticular OLP, whereas the mean proportion of CD8+CD45RA+ lymphocytes was significantly lower in patients with atrophic-erosive OLP.

CONCLUSION

These findings suggest that the 2 clinical types of OLP might have different immunopathogenic mechanisms.

Oral metronidazole treatment of lichen planus

BACKGROUND

Oral metronidazole has been reported to be effective in some patients with idiopathic lichen planus (LP) who did not have concomitant protozoal infections of the intestinal or genital tracts.

OBJECTIVE

Our purpose was to evaluate the efficacy of this drug in the treatment of generalized LP.

METHODS

Nineteen patients with LP who were free from intestinal and genital protozoal infections were treated with oral metronidazole, 500 mg twice daily, for 20 to 60 days and were followed up for a period of 5 to 36 months.

RESULTS

Fifteen patients (78.9%) improved with metronidazole treatment. Complete response was observed in 13 patients (7 women and 6 men). Two patients responded partially. Worsening of the lesions was observed in 1 of the 4 nonresponding patients.

CONCLUSION

Metronidazole may be an alternative therapy for the treatment of generalized LP. Its immunomodulatory activity seems to be a possible mechanism of action besides its antimicrobial activity.

Lichen planus

Lichen Planus is a relatively common inflammatory dermatosis of unknown origin. The present review summarizes the histological and clinical features of lichen planus and variants, including lichenoid drug reactions, are described. Possible mechanisms of pathogenesis of lichen planus are reviewed. The development of malignancy in association with lichen planus and the association with hepatitis are discussed. Treatment options for the more difficult manifestations of lichen planus are proposed.