1/8. Delayed cutaneous reaction to jellyfish.A 57-year-old woman presented with a widespread papulonodular eruption. The dermatitis had appeared about 1 week after her return from a trip to the Red Sea, where she had come into contact with a shoal of unidentified jellyfish; however, that contact had not been followed by cutaneous lesions and/or symptoms. The patient also stated that she had had previous contacts with jellyfish during other trips to exotic seaside resorts. The dermatitis was characterized by papulonodular lesions, round or oval in shape, of a few millimeters in diameter, with a color ranging from pink to red to brown, and with a smooth and regular surface. The lesions were grouped in an apparently random fashion (Fig. 1) or arranged linearly (Fig. 2). The patient complained of pruritus and burning. Histopathologic examination showed the presence of some necrotic keratinocytes; in the upper and mid dermis, edema and a predominantly perivascular and periadnexal lymphohistiocytic infiltrate, with numerous neutrophils and eosinophils, were observed (Fig. 3). The patient was treated with hydroxyzine (37.5 mg/day) and hydrocortisone butyrate, which resulted in the rapid disappearance of the symptoms; however, the cutaneous lesions persisted for about 3 weeks.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/8. Delayed cutaneous reactions to heparin in antiphospholipid syndrome during pregnancy.BACKGROUND: Clinical symptoms related to antiphospholipid antibodies often first occur during pregnancy with the diagnosis of antiphospholipid syndrome (APS). Unfractionated heparin (UFH) and low-dose aspirin are considered as first-line treatments for pregnant women with APS and recurrent fetal loss. However, in addition to an increased incidence of hemorrhagic side-effects and thrombocytopenia there are a number of drug eruptions with cutaneous components secondary to the use of UFH. One of these eruptions has been classified as a delayed type I.V. hypersensitivity reactions at the sites of UFH injections. The majority of these reactions occur in pregnant women. METHOD: We present three pregnant patients who developed delayed hypersensitivity reactions at the sites of UFH injections. Two patients had documented APS and the other patient had two previous spontaneous abortions. RESULTS: The histopathologic and immunohistochemical findings in the biopsy specimens from the sites of the delayed reactions were distinctive. The inflammatory infiltrate contained CD3 and CD4 lymphoid cells with plasma cells, and eosinophils. There was a marked increased in mast cells with increased stromal cells within the dermis and increased vascular proliferation. CONCLUSIONS: The distinctive histopathologic and immunohistochemical features seen in the delayed hypersensitivity reactions at the sites of UFH injections may be modulated by the immunomodulatory effects of UFH as well as the hormonal levels and cytokine patterns during pregnancy. Alternative therapies may not always be successful in resolving the reactions.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
3/8. Late phase allergic reaction to a CT contrast medium (iotrolan).A 46-year-old male developed wide-spread erythema and edema after intravenous injection of a CT contrast medium (iotrolan). The skin eruption appeared at 6 h, reached a maximum at 9 to 12 h, and faded within 36 h after injection. A challenge with an intradermal injection of the agent provoked the same reaction where the eruption had originally appeared, but had no effect on previously unaffected regions. Histopathologic examination revealed a perivascular infiltration of small round cells, and a few neutrophils, and eosinophils in the dermis and focal spongiosis in the epidermis. This is the first report of a late phase allergic skin reaction induced by iotrolan.- - - - - - - - - - ranking = 2keywords = dermis (Clic here for more details about this article) |
4/8. Psoriasiform intradermal test reaction to ABPC in a patient with psoriasis and ABPC allergy.We experienced a case of psoriasis with ABPC allergy which showed a psoriasiform intradermal test reaction to ABPC. A 22-year-old man with a history of psoriasis since the age of 17 was admitted to our department because he developed erythrodermic psoriasis after oral administration of ABPC. About 1 year later, he again developed erythroderma after administration of ABPC. Intradermal testing with 2% ABPC was performed. We found infiltrating erythema at day 2, followed by a gradually increasing psoriasiform reaction at 6 days on the site of ABPC skin test. We examined the infiltrating cells in the skin test reaction immunohistochemically. Most of the infiltrating cells in the dermis were activated helper/DTH-type T cells. Among the infiltrating cells in the epidermis, we observed more cytotoxic/suppressor-type T cells than helper/DTH-type T cells. A possible role of a DH reaction to ABPC in inducing the psoriatic lesion is discussed in relation to the pathomechanisms of psoriasis.- - - - - - - - - - ranking = 2keywords = dermis (Clic here for more details about this article) |
5/8. Phytohemagglutinin (PHA) skin test. Characterization of immunological properties and clinical application.Immunological properties of phytohemagglutinin (PHA) skin reaction were investigated by animal and clinical experiments. In the guinea pigs an intradermal dose of PHA-P produced erythema and induration with a maximal response at 24 hours after the injection. Histologically it was characterized by perivascular infiltration of lymphoid cells in the dermis and subcutis, being similar to that of tuberculin (PPD) skin reaction. PHA skin reaction, however, showed some difference from that of PPD in the initial cellular response in that the former was composed of small mononuclear cells and granulocytes with rapid development and the latter was composed of large mononuclear cells (macrophages) and granulocytes with slow development. Intradermal injection of 1:1000 dilution of PHA-P produced a similar erythema in man. In 39 of 59 patients with connective tissue diseases, the results of the in vivo (skin test) and in vitro (lymphocyte transformation) response to PHA correlated well. In the 59 patients, the incidence of the positive rate of the PHA tests (55.9%) was significantly higher than that of the DNCB test (33.9%) and of the PPD test (23.7%). These observations suggest that the PHA skin test has properties of delayed hypersensitivity and is highly sensitive and that it may be a useful measure of cell-mediated immunity.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
6/8. Delayed and persistent cutaneous reactions to coelenterates.Three patients are described who developed firm, persistent papules and plaques at sites of previous contact with two species of coelenterates. Histologically, a predominantly mononuclear inflammatory cell infiltrate located primarily in the reticular dermis was observed with destruction of hair follicle epithelium and arrectores pilorum. Epidermal changes included focal spongiosis and exocytosis of lymphocytes. The eruptions subsided no sooner than 7 weeks from time of onset. It is hypothesized that this cutaneous reaction represents a persistent delayed hypersensitivity response to an antigenic component of the coelenterate nematocyst.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
7/8. An unusual late reaction to Zyderm I injections: a challenge for treatment.We describe a patient who, 2 1/2 years after injection with Zyderm I collagen, developed large erythematous indurated nodules and plaques at the facial injection sites. This occurred despite a prior negative skin test with the injectable material. Histopathologically, a sarcoid-like foreign-body reaction was present in the dermis and subcutaneous fat and muscles. Retesting with Zyderm I collagen on the forearm produced a positive reaction that showed, histologically, a sarcoid-like reaction similar to that which was found in the face. Various modes of therapy have failed to clear the facial lesions and disfigurement.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
8/8. IgE bullous disease.We report two patients with the typical picture of bullous pemphigoid who lacked two critical diagnostic immunopathological features of the disease, namely IgG or C3 bound to the epidermal basement membrane and circulating IgG antibodies directed against the basement membrane zone (BMZ). Both patients had dense infiltrates of eosinophils within their skin lesions, as well as markedly elevated serum IgE levels, while immunofluorescent studies with anti-IgE antibody revealed heavy IgE deposition on inflammatory cells within the dermis surrounding the bullae. These cells were confirmed to be eosinophils by means of specific staining with antibody to major basic protein (MBP). We speculate that this 'IgE bullous disease' resulted from IgE-mediated hypersensitivity induced by focal infection, both patients initially being helped by antibiotics. However, dramatic clearing of bullae was seen following surgical removal of a battery implant (Patient 1), and bilateral above-the-knee amputations of gangrenous legs (Patient 2).- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |