|Year : 2001 | Volume
| Issue : 5 | Page : 234-237
Immunopathology of skin lesions
Nazoora Khan , Veena Maheshwari , Indu Trivedi , Abul Kalam
Department of Pathology and Department of Dermatology, J N Medical College, Aligarh Muslim University, Aligarh - 202 002, India
8-23, Medical Colony, A.M.V. Aligarh-202 002, (U.P), India
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 (40.49±23.29) 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 2020 Jul 2];67:234-7. Available from: http://www.ijdvl.com/text.asp?2001/67/5/234/11255
| Introduction|| |
Altered immune mechanisms have been observed in various lesions like scabies, lichen planus and pemphigus. Immunological changes in various skin lesions have been studied by different workers and variable results obtained.,
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|| |
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-20°C for estimation of IgG and IgM by Manicini's Single Radial Immunodiffusion Technique, and immune complexes by Ploetylene glycol Precipitation test (PEG).
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|| |
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|| |
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|| |
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|| |
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.
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.
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.,
| Psoriasis|| |
Serum IgG, IgM and CIC were significantly raised as compared to controls, similar to the findings of other authors. 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. 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.
Some workers, 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.
| Lichen planus|| |
Serum IgG and IgM were significantly decreased in lichen planus, which is in accordance with the findings of other workers, whereas Shuttleworth et al did not find any alteration in Ig levels. Colloid body (which is the earliest pathological change) in lichen planus was shown to contain IgG, 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.
| Lupus erythematous|| |
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. Increased CIC has been observed in our study, a finding similar to that of Thomas et al.
| Pemphigus|| |
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. The role of immunology in bullous pemphigoid was confirmed by demonstrating the deposition of IgG and/ or C2 at the basement membrane zone. High titres of CIC were also desmostrated in 40% of the patients of pemphigus vulgaris, but Thomas et al found no significant increase in CIC levels with relation to disease activity.
| Vitiligo|| |
These patients showed an increased levels of serum IgG, IgM and CIC. IgG antibodies are directed against melanocytes resulting in depigmentation of the skin. 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|| |
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.
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., There was no significant change in serum CIC levels with increase in disease activity (P>0.05) but Tappiener et al found increased CIC with increase in disease activity in pemphigus patients.
| Effect of treatment|| |
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 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, further supporting the role of autoimmunity in the causation of vitiligo.
| Acknowledgement|| |
We thank Dr. Rajeev Sharma, Dermatologist Bishen Skin Centre, Marris Road, Aligarh, for his valuable suggestions and help rendered during this work.
| References|| |
|1.||Falk ES. Serum immunoglobulin values in patients with scabies, Br J Dermatol 1980; 102: 57-61. [PUBMED] |
|2.||Shuttleworth D, Graham Brown RAC Campbell A.C. The autoimmune background in lichen planus. Br J Dermatol 1986; 115: 119-203. |
|3.||Sood UD, Pasricha IS. Pemphigus and Hodgkins disease. Br J Dermatol 1978;90:575-578. |
|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. |
|5.||Jacyk WK, Greenwood BM. Serum immunoglobulins in Nigerian patients with lichen planus. Clin Exp Dermatol 1978 ; 3: 83-85. |
|6.||Mancini G, Carbonara AO, Hearmans IF. Immunological quantitation of antigens by single radial immunodiffusion. Int J Immunochem 1965; 2: 235-254. |
|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. |
|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. |
|9.||Thomas IL Russell PH. Immunodermatology Ist ed, Editers,Gigli IN, Meischer PA Mullen Eberhard HJ. Springer-Verlag, New York, 1983; P 97-16. |
|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. |
|11.||Kaneko F, Gushiken H, Kawagishi I, et al. Analysis of immunological response in psoriatic lesions. 3 Invest Dermatol 1980; 75 : 436-439. |
|12.||Christopher E. The immunopathology of psoriasis. Int Arch Allergy Immunol 1996; 110: 199-206. |
|13.||Barker IN. the immunopathology of psoriasis, Clin Rheumatol 1994; 8: 429-438. |
|14.||Stamkler L. Deficiency of circulating IgA and IgM in adult patients with lichen planus. Br J Dermatol 1975; 93 : 25-27. |
|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. |
|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. |
|17.||Lever WF and Lever GS. Histopathology of the Skin, 7th ed 3 B Lippicott Co, Philadelphia, 1990;p 494-516. |
|18.||Burnham TK, File G. Indirect cutaneous immunofluorescence I-morphologic observations in bullous diseases, malignancies and connective tissue diseases. Arch Dermatol1972;105: 52-58. |
|19.||Sharma R, Nadeem M, Chandra M. Bullous pemphigoid in childhood Indian J Dermatol Venereol Leprol 1996; 62 : 100-102. |
|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. |
|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. |
|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. |
|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. |
|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. |