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We describe a patient in whom pemphigus foliaceus developed after cutaneous squamous cell carcinoma (SCC) metastasized to regional lymph nodes. Immunologic analysis revealed that production of anti-desmoglein 1 autoantibodies started when SCC metastasized, and the SCC expressed desmoglein 1, suggesting a pathogenic role of metastasized SCC in developing pemphigus foliaceus. (J Am Acad Dermatol 2001;45:767-70.)

Background: Recent studies have reported that T H 1 and T H 2 cells express CXCR3 and CCR4, respectively. Objective: Our goal was to assess the association of CCR4 and CXCR3 expression with T H 2 and T H 1 cells and association of CCR4 and CXCR3 expression with inflammation in patients with atopic dermatitis (AD). Methods: Intracellular cytokine production and chemokine receptor expression in blood T cells were examined by flow cytometry. Immunohistochemical expression of chemokine receptors was also investigated in chronically lesional skin. Results: CCR4 + and CXCR3 + CD4 + T cells predominantly produced IL-4 and IFN-γ, respectively. Although the frequency of CXCR3 + cells among CD4 + CD45RO + T cells was similar for patients with AD (n = 29) and healthy control subjects (n = 19), patients with severe AD (n = 14) had a reduced frequency of CXCR3 + cells. In contrast, the frequency of CCR4 + cells and the CCR4/CXCR3 ratio were higher in patients with AD (n = 22) than healthy control subjects (n = 16) and correlated with disease severity of AD. The frequency of CCR4 + cells correlated positively with eosinophil numbers and serum IgE levels, whereas the frequency of CXCR3 + cells correlated inversely with eosinophil numbers. The frequency of CCR4 + or CXCR3 + cells was similar in patients with psoriasis (n = 6) and healthy control subjects. Immunohistochemical analysis showed that the frequency of CCR4 + cells among CD4 + T cells in chronically lesional skin of patients with AD (n = 9) was higher than that of patients with psoriasis (n = 4). Conclusion: Our data suggest the association of CCR4 expression with T H 2 cells, the predominance of CCR4 + cells in blood from patients with AD, and an important role of CCR4 in the migration of T H 2 cells from blood into AD lesional skin. (J Allergy Clin Immunol 2001;107:353-8.)

To determine whether serum soluble L-selectin (sL-selectin) levels are elevated in patients with systemic sclerosis (SSc) and whether serum sL-selectin levels change after treatment with lipo-prostaglandin E1 (lipo-PGE1), serum sL-selectin levels were examined by ELISA in patients with SSc (n=24), psoriasis vulgaris (n=22), and contact dermatitis (n=9), as well as normal control subjects (n=26). In five patients with SSc, serum sL-selectin levels were examined before and after intravenous injections of lipo-PGE1. Serum sL-selectin levels were significantly increased in patients with SSc (P

A 24-year-old woman with autoimmune thrombocytopenia and hypothyroidism had an inflammatory bullous eruption in the mouth, face, and trunk that left no milia or scars after healing. Histologic examination revealed a subepidermal bulla and a neutrophil infiltration. Direct immunofluorescence examination showed deposition of IgG and C3 in the basement membrane zone (BMZ). Indirect immunofluorescence examination with 1M sodium chloride-split skin showed IgG binding to the dermal side. Immunoblot analysis demonstrated IgG autoantibodies reacting with 290 kD dermal protein. We diagnosed this as epidermolysis bullosa acquisita (EBA) with a nonscarring inflammatory feature. Treatment with oral dapsone, 75 mg, and prednisolone, 20 mg, cleared the eruption. Reduction of the prednisolone dosage was associated with multiple erosions in the esophagus. Direct immunofluorescence examination revealed linear deposition of IgG in the esophageal BMZ. To our knowledge, this is the first report of EBA with esophageal involvement and deposition of IgG in the BMZ of the esophagus.