Journal of the American Academy of Dermatology · 2016
Atrophying pityriasis versicolor as an idiosyncratic T cell-mediated response to Malassezia: A case series.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Levy Jonathan Michael Stephen, Magro Cynthia
Аннотация
BACKGROUND: Atrophying pityriasis versicolor (PV), first described in 1971, is a rare variant in which lesions appear atrophic.
OBJECTIVE: We sought to determine the pathophysiology of atrophying PV.
METHODS: A retrospective chart review identified 6 cases of atrophying PV. In all cases, routine light microscopy, an elastic tissue stain, and immunohistochemical assessment for the expression of CD3, CD4, CD8, GATA3 and CXCR3 was performed.
RESULTS: All cases demonstrated hyperkeratosis with intracorneal infiltration by pathogenic hyphal forms as well as epidermal attenuation and papillary dermal elastolysis. A supervening, mild-to-moderate, superficial lymphocytic infiltrate was noted and characterized by a focal CD8+ T cell-mediated interface dermatitis along with a mixed T-cell infiltrate composed of GATA3+ and CXCR3+ T cells.
LIMITATIONS: Small sample size and the loss of some patients to follow-up.
CONCLUSION: Atrophying PV represents the sequelae of a mixed helper T-cell (TH1 and TH2) idiosyncratic immune response to Malassezia and can present as a protracted dermatosis that may clinically mimic an atypical lymphocytic infiltrate. TH1 cytokines can recruit histiocytes, a source of elastases, and upregulate matrix metalloproteinase activity, which may contribute to epidermal atrophy.
OBJECTIVE: We sought to determine the pathophysiology of atrophying PV.
METHODS: A retrospective chart review identified 6 cases of atrophying PV. In all cases, routine light microscopy, an elastic tissue stain, and immunohistochemical assessment for the expression of CD3, CD4, CD8, GATA3 and CXCR3 was performed.
RESULTS: All cases demonstrated hyperkeratosis with intracorneal infiltration by pathogenic hyphal forms as well as epidermal attenuation and papillary dermal elastolysis. A supervening, mild-to-moderate, superficial lymphocytic infiltrate was noted and characterized by a focal CD8+ T cell-mediated interface dermatitis along with a mixed T-cell infiltrate composed of GATA3+ and CXCR3+ T cells.
LIMITATIONS: Small sample size and the loss of some patients to follow-up.
CONCLUSION: Atrophying PV represents the sequelae of a mixed helper T-cell (TH1 and TH2) idiosyncratic immune response to Malassezia and can present as a protracted dermatosis that may clinically mimic an atypical lymphocytic infiltrate. TH1 cytokines can recruit histiocytes, a source of elastases, and upregulate matrix metalloproteinase activity, which may contribute to epidermal atrophy.