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  In this article
    Abstract
    Introduction
    Materials and Me...
    Results
    Extent of lesions
    Effect of treatment
    Discussion
    Psoriasis
    Lichen planus
    Lupus erythematous
    Pemphigus
    Vitiligo
    Alopecia areata
    Effect of treatment
    Acknowledgement
    References

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ORIGINAL ARTICLE
Year : 2001  |  Volume : 67  |  Issue : 5  |  Page : 234-237

Immunopathology of skin lesions


Department of Pathology and Department of Dermatology, J N Medical College, Aligarh Muslim University, Aligarh - 202 002, India

Correspondence Address:
8-23, Medical Colony, A.M.V. Aligarh-202 002, (U.P), India

   Abstract 

A study was conducted on 130 patients suffering from skin lesions which included psoriasis, lichen planus, DLE, pemphigus, vitiligo and alopecia areata. Forty age-and-sex-matched healthy individuals served as control. Serum IgG, IgM, and circulating immune complexes (CIC) were estimated. Significant increase in serum IgG (1937.2 1030.43 mg%) and IgM (232.12 136.98 mg%) was observed in all the skin lesions when compared with controls except in lichen planus where they were significantly lowered, values being 580.61 77.35 mg% and 66.88 6.59mg% respectively. CIC levels were significantly raised (P<0.00 1) in various skin lesions (40.4923.29) when compared with controls (17.68 3.21), but no significance was observed in lichen planus( 17.72 4.28). Serum IgG, IgM and CIC were statistically significantly altered depending on the extent of the lesion and lowered significantly to almost normal values following treatment, thereby confirming the role of immunity in the pathogenesis of these skin disorders.

How to cite this article:
Khan N, Maheshwari V, Trivedi I, Kalam A. Immunopathology of skin lesions. Indian J Dermatol Venereol Leprol 2001;67:234-7


How to cite this URL:
Khan N, Maheshwari V, Trivedi I, Kalam A. Immunopathology of skin lesions. Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2019 Jul 19];67:234-7. Available from: http://www.ijdvl.com/text.asp?2001/67/5/234/11255



   Introduction Top

Altered immune mechanisms have been observed in various lesions like scabies,[1] lichen planus[2] and pemphigus.[3] Immunological changes in various skin lesions have been studied by different workers and variable results obtained.[4],[5]
The present study was undertaken with the aim of evaluating the levels of serum IgG, IgM and circulating immune complexes (CIC) in healthy controls and in patients suffering from skin lesions, and to correlate these values with histopathological finding and the degree and extent of skin involvement.

   Materials and Methods Top

The study was carried out in the Department of Pathology, J.N. Medical College, Aligarh on patients suffering from different skin lesions which included psoriasis, lichen planus, discoid lupus erythematosus (DLE), pemphigus, vitiligo and alopecia areata. 5ml blood was collected in sterile vials from which serum was separated and stored at-20C for estimation of IgG and IgM by Manicini's Single Radial Immunodiffusion Technique[6], and immune complexes by Ploetylene glycol Precipitation test (PEG).[7]
Skin biopsies were taken from each patient, which were submitted for histopathology. The slides were stained by haematoxylin and eosin. Special stains wherever necessary were done to confirm the diagnosis.

   Results Top

Control group (40 cases): Serum IgG, IgM and CIC in controls were 1116.92+ 57.26 mg%, 129.88 + 3.52 mgm% and 17.68+ 3.21 respectively. No significant differences in these Igs and CIC were noted viz a viz age and sex of the individuals.
Study group (130 cases): The Igs and CIC levels are shown in [Table - 1]. Serum IgM levels were significantly elevated in all the skin lesions as compared to controls. The only exception was lichen planus where IgG significantly lowered. When various lesions were compared with controls, a significant (P<0.001) difference was noted in all lesions except alopecia areata where the elevation was statistically insignificant.
Similarly serum IgM levels were raised significantly in all lesions,except lichen planus where a lowering of serum IgM was noted as compared to controls. No significant alteration in IgM was observed in alopecia.The CIC levels were significantly raised in total skin lesions as compared with controls, however when CIC levels of psoriasis and lichen planus were compared with controls individually,no significant (p>0.05) difference was there.

   Extent of lesions Top

The involvement of skin was divided into 2 main groups viz. 1-36% and more than 37%. As shown in [Table - 2] serum IgG and IgM showed a significant difference (P<0.001) in their levels in relation to the extent of lesions, whereas the alteration in CIC levels was not statistically significant.

   Effect of treatment Top

Forty - four patients were followed up after treatment and it was found that serum IgG, IgM and CIC declined to almost normal levels and this decline was statistically significant [Table - 3].

   Discussion Top

The present study was undertaken to study the changes in the serum levels of Igs and CIC in patients suffering from different skin lesions. Fat et al observed that normal skin does sythesize Igs and lesions of various skin diseases produce these Igs in different patterns.[4]
Levels in controls: Serum IgG, and CIC in healthy controls did not reveal any significant alteration with respect to sex and age of the individuals. Our findings are consistent with those of other workers.[8]
Levels in diseases: Serum IgG, IgM and CIC in patients with different skin diseases were significantly altered as compared to controls(p<0.001). These findings are consistent with those of other workers.[9],[10]

   Psoriasis Top

Serum IgG, IgM and CIC were significantly raised as compared to controls, similar to the findings of other authors.[11] it is suggested that in psoriasis, stratum corneum antigen is either exposed or activated by epidermal trauma, which provokes an inflammatory response, and therefore IgG antibody production is triggered.[11] However Kaneko et al have demonstrated the presence of serum IgA within psoriatic stratum corneum and have speculated that serum IgA might initiate chemotaxis via the alternate pathway which in turn could unmask the antigenicity of the stratum corneum and lead to an IgG autoantibody reaction.[12]
Some workers[13],[14] have suspected cell mediated immue pathomechanism playing an active role in psoriasis and this is highlighted by the increased antigen presenting capacity of Langerhans cells isolated from psoriatic skin compared to normal skin.[14]

   Lichen planus Top

Serum IgG and IgM were significantly decreased in lichen planus, which is in accordance with the findings of other workers[9],[15] whereas Shuttleworth et al did not find any alteration in Ig levels.[2] Colloid body (which is the earliest pathological change) in lichen planus was shown to contain IgG,[16] and they concluded that Igs may play a primary role in the genesis of colloid body. Levels of CIC were almost the same as in controls. This fact point against a primary role of immune complex mediated injury in lichen planus. It is further supported by the complete absence of polymorphs in cellular infiltrate of lichen plan US.[17]

   Lupus erythematous Top

Serum IgG, IgM and CIC levels were markedly raised in lupus erythematosus and the values were significantly raised as the extent of the lesion increased. Band test showed deposition of IgG, IgM and complement components within the skin of lupus patients. This test can be of help in assessing the course of the disease.[18] Increased CIC has been observed in our study, a finding similar to that of Thomas et al.[10]

   Pemphigus Top

Serum IgG was significantly raised in pemphigus and correlated well with the extent of the lesion and clinical picture. Similar observations were made by Burnham et al.[19] The role of immunology in bullous pemphigoid was confirmed by demonstrating the deposition of IgG and/ or C2 at the basement membrane zone.[20] High titres of CIC were also desmostrated in 40% of the patients of pemphigus vulgaris,[21] but Thomas et al[10] found no significant increase in CIC levels with relation to disease activity.

   Vitiligo Top

These patients showed an increased levels of serum IgG, IgM and CIC. IgG antibodies are directed against melanocytes resulting in depigmentation of the skin.[22] He also found remarkable susceptibility of human melanocytes to complement mediated lysis in cytotoxicity assays in which heat inactivated vitiligo serum is used as an antibody source. It implies that complement mediated complexes attack melanocytes and be directly involved in producing the vitiligo lesions in vivo.

   Alopecia areata Top

No significant changes in IgG and IgM levels were seen, but CIC was raised significantly. An immune mechanism is thought to play a part,as the presence of intrabulbar T- lymphocytes are seen in the lesions.[23]
Extent of lesions: An increase in the levels of Igs with increase in disease activity was observed by noting the extent of skin involvement. A significant rise in IgG and IgM was observed when more than 37% of the skin was involved. Similar observations were seen by others.[11],[21] There was no significant change in serum CIC levels with increase in disease activity (P>0.05) but Tappiener et al[21] found increased CIC with increase in disease activity in pemphigus patients.

   Effect of treatment Top

Serum Igs and CIC levels were studied in 44 patients before and after treatment, and a significant decline to almost normal levels were seen after treatment. Singer et al[24] treated patients of pemphigus with corticosteroids and found a drastic reduction in mortality rates, thereby favouring the role of immunity in pemphigus.
Similarly placental extract, a biostimulant, has been used in the treatment of vitiligo,[25] further supporting the role of autoimmunity in the causation of vitiligo.

   Acknowledgement Top

We thank Dr. Rajeev Sharma, Dermatologist Bishen Skin Centre, Marris Road, Aligarh, for his valuable suggestions and help rendered during this work. 

   References Top

1.Falk ES. Serum immunoglobulin values in patients with scabies, Br J Dermatol 1980; 102: 57-61.  Back to cited text no. 1  [PUBMED]  
2.Shuttleworth D, Graham Brown RAC Campbell A.C. The autoimmune background in lichen planus. Br J Dermatol 1986; 115: 119-203.  Back to cited text no. 2    
3.Sood UD, Pasricha IS. Pemphigus and Hodgkins disease. Br J Dermatol 1978;90:575-578.  Back to cited text no. 3    
4.Fat Lai ARFM, Surmond DL VanFurth R. In vitro synthesis of immunoglobulins and complement in normal and pathological skin and the adjacent mucous membrane. Clin Exp Immunol 1973; 14 : 377-395.   Back to cited text no. 4    
5.Jacyk WK, Greenwood BM. Serum immunoglobulins in Nigerian patients with lichen planus. Clin Exp Dermatol 1978 ; 3: 83-85.   Back to cited text no. 5    
6.Mancini G, Carbonara AO, Hearmans IF. Immunological quantitation of antigens by single radial immunodiffusion. Int J Immunochem 1965; 2: 235-254.  Back to cited text no. 6    
7.Reyner AA, Glenn S Jr, Mary LR, et al. Application of polyethylene glycol turbidity assay for detection of circulating immune complexes in cancer patients. Am J Sung 1981; 141: 460-464.  Back to cited text no. 7    
8.Maheswari SC, Singh H. Serum immunoglobulins in healthy adults from Himachal Pradesh. Ind 3 Med Res 1982;76: 444-447. 9. Mahmood JM. Serum immunoglobulins in lichen planus. Br J Dermatol 1981; 104:207-208.  Back to cited text no. 8    
9.Thomas IL Russell PH. Immunodermatology Ist ed, Editers,Gigli IN, Meischer PA Mullen Eberhard HJ. Springer-Verlag, New York, 1983; P 97-16.  Back to cited text no. 9    
10.Beutner EH,Jabloska S, Jazabek CM, et al. Studies in immunopathology VI: studies of autoantibodies to the stratum corneum of psoriatic lesions Int Arch Allerg Appl immunol 1975;48: 436-439.   Back to cited text no. 10    
11.Kaneko F, Gushiken H, Kawagishi I, et al. Analysis of immunological response in psoriatic lesions. 3 Invest Dermatol 1980; 75 : 436-439.  Back to cited text no. 11    
12.Christopher E. The immunopathology of psoriasis. Int Arch Allergy Immunol 1996; 110: 199-206.  Back to cited text no. 12    
13.Barker IN. the immunopathology of psoriasis, Clin Rheumatol 1994; 8: 429-438.  Back to cited text no. 13    
14.Stamkler L. Deficiency of circulating IgA and IgM in adult patients with lichen planus. Br J Dermatol 1975; 93 : 25-27.  Back to cited text no. 14    
15.Baart De La Faille Kuyper EH, Baart De La Faille H.An immunofluorescence study of lichen planus J Br. Dermatol 1974; 90: 365-371.  Back to cited text no. 15    
16.Breaathen IR, Dal BI, Mellbye 03. Immunopathological in situ identification of the lymphoid cells in the skin infiltrate of lichen planus. Clin Exp Dermatol 1979;4: 175-179.  Back to cited text no. 16    
17.Lever WF and Lever GS. Histopathology of the Skin, 7th ed 3 B Lippicott Co, Philadelphia, 1990;p 494-516.  Back to cited text no. 17    
18.Burnham TK, File G. Indirect cutaneous immunofluorescence I-morphologic observations in bullous diseases, malignancies and connective tissue diseases. Arch Dermatol1972;105: 52-58.   Back to cited text no. 18    
19.Sharma R, Nadeem M, Chandra M. Bullous pemphigoid in childhood Indian J Dermatol Venereol Leprol 1996; 62 : 100-102.   Back to cited text no. 19    
20.Tappeiner G, Heine KG, Kahi JC. CIq binding substance in pemphigus and bullous pemphigoid. Detection with a I-CIq binding assay. Clin Exp Immunol 1977;28: 40-48.  Back to cited text no. 20    
21.Norris DA, Kissinger MR, Naughton MG, et al. Evidence for immunologic mechanisms in human vitiligo, patients sera induce damage and antibody dependent cellular cytotoxicity. J Invest Dermatol 1988; 90: 783-789.   Back to cited text no. 21    
22.Kohchiyama A, Hatamochi A, Veki H. Increased number of OKT6- positive dendritic cells in the hair follicles of patients with alopecia areata. Dermatologica 1995; 171: 327-331.  Back to cited text no. 22    
23.Singer HK, Hoshimoto K, Lazarus SG. Immunopathology Editors. Gigli In, Meischer PA and Muller Eberhard HJ. Springer Verlag New York 1983;p 19-35.  Back to cited text no. 23    
24.Chopra A, Singh SP, Mittal RR, et al. Oral psoralens vs injection of placental extract plus psoralens in vitiligo. Indian J Dermatol Venereol Leprol 1996;62: 22-23.  Back to cited text no. 24    

 

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