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CASE REPORT
Year : 2000  |  Volume : 66  |  Issue : 6  |  Page : 308-309

Interface Dermatitis in a Patient with Aids




Correspondence Address:
P Devakar Yesudian


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Source of Support: None, Conflict of Interest: None


PMID: 20877111

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  Abstract 

Interface dermatitis is a histological reaction pattern which is seen in a number of conditions. One of the recent associations of the histology is in Acquired Immune Deficiency Syndrome. There are differentiating factors between interface dermatitis occurring in AIDS and those occurring in other conditions. These are discussed in detail.


Keywords: Interface dermatitis, AIDS


How to cite this article:
Yesudian P D, Krishnan S, Jayaraman M, Jan. Interface Dermatitis in a Patient with Aids. Indian J Dermatol Venereol Leprol 2000;66:308-9

How to cite this URL:
Yesudian P D, Krishnan S, Jayaraman M, Jan. Interface Dermatitis in a Patient with Aids. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jun 4];66:308-9. Available from: http://www.ijdvl.com/text.asp?2000/66/6/308/4956



  Introduction Top


Interface dermatitis is a histological reaction pattern seen in a variety of dermatological conditions. It is characterised by obscuring of the dermoepidermal junction with vacuolar alteration of the basal layer, a dense cellular infiltrate (lichenoid) at the junction, or both.[1] Recently it has been described in association with the acquired immune deficiency syndrome.[2] We report one such case.


  Case Report Top


A 35 -year- old lorry driver was referred from the AIDS ward with complaints of generalised skin rash of four weeks duration. He was a known case of AIDS with manifestations of fever, recurrent diarrhoea and weight loss over the past 6 months. He was only on multivitamin tablets. On examination, there was a generalised maculopapular rash involving the trunk and upper and lower limbs. There was minimal scaling in some of the lesions. The scalp also showed similar lesions. There was no evidence of target lesions. The oral and genital mucosa were not involved. A differential diagnosis of seborrheic dermatitis and a drug reaction was offered. Skin biopsy showed small vacuolar spaces in the basal layer at the dermoepidermal junction with necrotic keratinocytes and mild inflammatory infiltrate in the dermis. Pigmentary incontinence was also seen. This was consistent with the histopathology of interface dermatitis of AIDS. [Figure - 1]


  Discussion Top


Interface dermatitis is a histological pattern which is seen in erythema multiforme, morbilliform viral exanthems, collagen vascular diseases, lichen sclerosus et atrophicus and other conditions.[3] It has also been described in patients with AIDS in which the clinical manifestation is either a seborrheic dermatitis or a drug reaction. [Figure - 2]

The interface dermatitis occurring in AIDS differs from that occurring in other conditions in the following ways. When compared with non AIDS patients, there is greater degree of vacuolar alteration, more frequent necrotic keratinocytes and an infiltrate notable by the absence of eosinophils and polymorphonuclear leukocytes.[2] Our case showed these characteristics.

The occurrence of vacuolar interface dermatitis in patients with AIDS may be consequence of specific changes in the immune system generated by infection with the human immunodeficiency virus. These changes include polyclonal B cell activation with circulating immune complexes, T-helper cell deficiency and dysfunction and Langerhans cell depletion.[4] Investigations directed at understanding the pathogenesis of interface dermatitis in patients with AIDS may expand our knowledge of the immunological dysfunction in patients with AIDS and contribute to our understanding of the pathogenesis of other interface dermatitides.

In conclusion, it can be said that although interface dermatitis in patients with AIDS shares some features in common with several other interface processes the clinical and histological findings in patients with AIDS and interface dermatitis preclude the assignment of these patients to any one of the known interface dermatitides.

 
  References Top

1.Ackerman AB. Histologic Diagnosis of Inflammatory Skin Diseases. Philadelphia: Lea and Febiger, 1978.  Back to cited text no. 1    
2.Rico MJ, Kory EP, Gould EW, et al. Interface dermatitis in patients with the acquired immunodeficiency syndrome. J Am Acad Dermatol 1987; 16: 1209-1218.  Back to cited text no. 2    
3.Pinkus H. Lichenoid tissue reactions. Arch Dermatol 1937; 107: 840-846.  Back to cited text no. 3    
4.Belsito DV, Sanchez MR, Bear RL. Reduced Langerhans cell Ia antigen and ATPase activity in patient with the acquired immunodeficiency syndrome. N Engl J Med 1984; 310: 1279-1282.  Back to cited text no. 4    


Figures

[Figure - 1], [Figure - 2]



 

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Online since 15th March '04
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