Search

A rare type of cutaneous papular sarcoidosis is the lichenoid form. We describe a 36-year-old woman who presented with a symmetrical, asymptomatic lichen-like eruption on her upper limbs. The biopsy showed a non-necrotizing granulomatous infiltrate compatible with sarcoid. Chest X-ray revealed Type I bilateral, asymptomatic, hilar adenopathy with no parenchymal abnormalities. High levels of angiotensin converting enzyme and a 67gallium lung scan supported the diagnosis of sarcoidosis.

A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.

Cell-mediated immunity using the E-rosette technique, the graft-versus-host reaction and intradermal skin tests were investigated in two groups of patients, twenty-two with benign lymphoproliferative diseases of the skin (lymphocytic infiltration of the skin and lymphadenosis benigna cutis) and nine with malignant lymphoproliferative diseases (mycosis fungoides and lymphoma cutis). The effect of thymic hormone upon T lymphocytes which proved to have impaired functional capacity was investigated. Seventeen of the twenty-two patients with benign lymphoproliferative diseases were found to have intact cellular immunity whereas seven of the nine patients with malignant disease proved to be immunodeficient. The determination of immune competence may be of help in establishing the correct diagnosis in doubtful cases and might also be useful in the follow-up of these patients. The improvement in functional capacity of T lymphocytes resulting from their interaction with a thymic hormone indicates that it holds therapeutic promise.

In a patient with subcorneal pustular dermatosis (SPD) the appearance of new pustular lesions characteristic of the disease was triggered by two episodes of drug eruption (induced by dapsone and quinidine sulphate respectively) and by the intra-dermal injection of the recall antigens Candida and streptokinase-streptodornase, performed for evaluation of delayed hypersensitivity. Both episodes of drug eruption were probably the result of an immediate-type hypersensitivity reaction towards the offending drugs, as indicated by positive mast cell degranulation tests.

The T & B lymphocytes in frozen sections of skin obtained from patients with various lympho-infiltrating disorders of the skin were identified using an immunofluorescent technique. Anti T-lymphocytes serum was used as a T marker and anti Ig GMA serum and HL-B alloantigens as B markers. The method confirmed to be efficient in preliminary experiments. Specimens were obtained from patients with lymphocytic infiltration of the skin (LIS), lymphadenosis benigna cutis (LBC), lymphoma cutis (LC) and mycosis fungoides (MF). In LIS and LBC the dominant cell was found to be the T lymphocyte, suggesting that a local immune reaction of the cell mediated type may play a role in their etiology.

In two Arab brothers presenting the characteristic clinical picture of epidermodysplasia verruciformis (EV), histological examination revealed large clear cells in the granular layer and uppermost part of the prickle cell layer of the epidermis. The report of this histological picture in two cases by other authors in the past had aroused considerable discussion as to the true diagnosis. The finding of large clear cells in our two confirmed cases of EV supports the opinion that this does not necessarily contradict the diagnosis of EV. Electron microscope investigation revealed groups of particles in the nuclei of a few keratinocytes in the granular layer which were compatible with papova virus particles. The changes seen in the clear cells support the theory of the viral etiology of EV. Ehe immunological studies showed intact humoral immunity but impaired cellular immunity.