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-85- Clinical Investigation 9/4 Room-D
DETECTION OF APOPTOSIS IN EPIDERMIS OF GRAFT-VERSUS-HOST DISEASE By TUNEL METHOD.
Mamiko Ishiwa, Michiko Aihara, Tetuo Nagatani, Hirosi Nakajima.
Department of Dermatology, Yokohama CityUniversity School of Medicine, Yokohama, Japan.
We investigate whether apoptosis is involved in theprocess of graft-versus-host disease (GVHD). Apoptosis wasdetected by TdT-mediated dUTP-biotin nick end labeling(TUNEL) method. 20 cases (acute 17cases and chronic 3 cases)of GVHD after allogenic bone marrow transplantation andperipheral blood¡¡stem cell transplantation were assessed.The positive staining cells by TUNEL method were found inthe epidermis of the cases with histologic grade III and IV, but not in the cases with grade I and II. According to thisresult, apoptosis in epidermis seem to increase as histologic grades advanced.
-86- Clinical Investigation 9/4 Room-D
SKIN MANIFESTATIONS OBSERVED IN HEPATITIS C VIRUS ANTIBODY P0SITIVE PATIENTS.
Ken Minami1, Masaru Ito1, Yasuo Kubota1, Masako Mizoguchi1, Shiro Iino2.
1Depertment of Dermatology, 2Institute of Medical Science, St. Marianna University of Medicine, Kawasaki, Japan.
By using questionnaires, we studied the skin manifestations of 148 hepatitis C virus antibody positive patients with the following diseases: 2 asymptomatic carriers, 123 chronic hepatitis and 23 liver cirrhosis all of whom were receiving care at the St. Marianna Institute of Medical Science. Thirty-seven percent (55/148) of the patients complained of the cutaneous lesions and were examined by dermatologists further. Both sexes are equally affected (23 male and 22 female). The mean age was 56.1 years, ranging from 13 to 81 years. The history of blood transfusions were noted in 25/55 patients. The levels of serum GOT, GPT and also titer of HCV-RNA did not show any differences despite the presence of skin manifestations. In the 55 patients, 7 chronic urticaria, 2 lichen planus and 2 leukocytoclastic vasuculitis with cryoglobulinamia were included. Twenty-four percent (13/55) of the patients were given Interferon-¦Á. We also investigated the presence of HCV antigen in the lesional skin by using immunohistochemical staining with several monoclonal anti HCV antibodies.
-87- Clinical Investigation 9/4 Room-D
IMMUNOHISTOCHEMICAL CHARACTERIZATION OF INFILTRATING CELLS IN XANTHOMA.
Ken Miyoshi, Yasuaki Hirose, Mitsunori Ikeda, Yasuo Yamamoto, Hajime Kodama.
Department of Dermatology, Kochi Medical School, Kochi, Japan.
Mononuclear cells infiltrate and play important roles by synthesizing a variety of cytokines in the xanthoma lesions. The purpose of the present study is to immunohistochemically characterize the infiltrating cells in xanthoma lesions. Around the blood vessels where a little number of cells infiltrated, CD68 positive macrophages were the main constituents and no lymphocytes infiltrated. At the sites where moderate numbers of mononuclear cells and foam cells perivasculary infiltrated, both CD45 RO (OPD4) positive CD4 cells and CD8 cells infiltrated adjacent to the blood vessels. Macrophages, CD68 positive foam cells and a small number of T cells surrounded them, but no CD20 positive B cells were observed. In the areas where foam cells infiltrated densely, most cells were CD68 positive and a small number of T and B cells was intermingled. These findings indicate that monocyte-derived macrophages primarily infiltrate at the very early stage of xanthoma formation. Then T cells infiltrate and interact with macrophages developing foam cell infiltrating lesions. a-Smooth muscle actin expressing cells were not observed in the various types of xanthoma lesions indicating that fibroblasts are not differentiated to myofibroblastic cells which potentially induce fibrosis.
-88- Clinical Investigation 9/4 Room-D
MERGENCE AND MECHANISM OF RESISTANCE TO ANTIVIRAL AGENTS OF VARICELLA-ZOSTER VIRUS.
Mitsuru Ida1, Masaaki Morohashi1, Kimiyasu Shiraki2.
1Department of Dermatology, 2Department of Virology, Toyama Medical and Pharmaceutical University, Toyama, Japan.
In immunocompromised patients, acyclovir (ACV)-resistant varicella-zoster viruses (VZVs) have been induced by prolonged ACV therapy. We compared the appearance of drug- resistant viruses by treatment with ACV or penciclovir (PCV) in vitro. The VZV-infected cells were treated with increasing concentrations of either drug. No resistant virus emerged by PCV treatment. ACV-resistant viruses were isolated by ACV treatment and proved to be thymidine kinase (TK)-deficient by characterization. Analysis of their DNA sequences of the TK gene showed that the mutations were significantly found at the sites next (down stream) to two or more sequential guanosine-nucleotides (5'-GG-X-3') (P<0.001).
-89- Clinical Investigation 9/4 Room-D
DERMAL MICROABSCESSES IN CTCL.
Toshifumi Nakagawa, Toshihiko Numahara, Takashi Takaiwa.
Department of Dermatology, Kagawa Medical University, Kagawa, Japan.
Histologically, CTCL is characterized by a pleomorphic dermal cellular infiltrate with epidermotropism as either single-cell exocytosis or Pautrier's microabscesses. In this study, we have investigated whether microabscesses similar to Pautrier's are present in the dermal infiltrates of CTCL. Materials and Methods: Electron microscopic study was carried out on skin specimens obtained from 13 patients with clinically active CTCL. Results: In almost all the specimens examined, numerous dendritic cells were found in the dermis, often tightly adhering to tumor cells. Occasionally clusters of tumor cells were surrounded by dendritic cells. Although being a rare finding, some of the tumor cells were grouped around Langerhans cell. In one occasion, tumor cells were seen to immigrate into epidermis through the canal-like structure formed by dendritic cells. Conclusions: The tumor cells of CTCL cluster in microabscesses in the dermis as well as in the epidermis. Dendritic cell appears to play an active role in the formation of these microabscesses.
-90- Clinical Investigation 9/4 Room-D
RELATIONSHIP BETWEEN AGE-OF-ONSET AND ACTIVITY, SEVERITY AND FAMILY HISTORY OF PSORIASIS.
Seok Beom Park, Jai Il Youn.
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
Various efforts to classify psoriasis, clincal features such as extents, types and severity, have been made, but of little value in understanding the disease. Recently, attempts have been made to distinguish psoriasis subtype according to the age-of-onset but rarely in Orientals. In this study, we decided to investigate the age-of-onset of psoriasis and to determine whether there is any relationship between the age-of-onset and other clinical features. We compared age-of-onset and associated clinical activity, severity and the incidence of psoriasis in third degree relatives in 846 patients who were diagnosed and treated for psoriasis during the period from 1983 to 1994 at psoriasis clinic in Seoul National University Hospital. The results at 10-year intervals without differentiating the sexes shows a peak age-of-onset between 20 and 29 years and a gradual decline in incidence after the peak age.If they are divided into two groups with separation at the age-of-onset, two distinct disease pattems can be recognized. The early onset type shows a hereditary tendency with more severe and extensive clinical features. The other type of late onset tends to run a mild course with less hereditary tendency. This represents different pathomechanism in distinct disease pattems in psoriasis.