In the present study we evaluated, in involved and clinically uninvolved skin of Rosacea, microvessels density (MVD) and total vascular area (TVA) in addition to multiple morphologic characteristics of microvessels and also mast cells (MCs) number. We examined also the relationship between angiogenesis, MCs number and disease clinicopathological data. The study included 69 patients with Rosacea. A skin biopsy with a 4-mm punch was performed from clinically involved skin in each case. In nine randomly selected patients, facial biopsy specimens were obtained from both involved and clinically uninvolved skin. Histological sections, immunostained for factor VIII, were evaluated by image analysis for the quantification of MVD, TVA and several morphometric parameters related to the vessel size or shape. MCs detection in the dermis was carried out using the chloracetate esterase method (Fast Blue RR) in parafin sections. Serum antibodies against H.pylori were detected. Statistically important differences concerning the factors of angiogenesis between lesional and clinically non-lesional skin were demonstrated. A statistical important correlation was found also between high vascular density, PPR clinical type and the presence of ocular manifestations. MVD or TVA showed no correlation with the degree of solar elastosis or inflammation and with the Demodex density as well. However, high MVD values were found to correlate with granuloma formation in the dermis. MCs number were significantly greater in lesional compared to clinically non-lesional skin. Statistical significance was shown between MCs density and disease duration. However, no correlation between MCs number and blood vessel density was found. Angiogenesis seems to play an important role in the pathogenesis especially of the more severe clinical form of Rosacea. MCs seem to participate in evolution to disease chronicity by contributing to inflammation, angiogenesis and tissue fibrosis.

The larger number of T-lymphocytes in the periphery of vitiligo lesions and their association with angiogenesis are reported. The objective of this study was to investigate angiogenesis, VEGF and mast cell in vitiligo lesions. Specimens of 30 patients' biopsies, from lesional and perilesional nondepigmented skin were stained for mast cells, CD34 and VEGF. The evaluation was made by image analysis and the measured variables were statistically analyzed. A significantly increased number of CD34 and VEGF positive vessels and mast cells were detected in the centre of the lesion than in the periphery (p < 0.0001, p < 0.0001 and p = 0.001). There was a positive correlation of CD34, VEGF and mast cell number between the centre and the periphery of the lesions (r = 0.877, p < 0.0001; r = 0.946, p < 0.0001 and r = 0.863, p < 0.0001, respectively). The increased angiogenesis and mast cell numbers in the area where lymphocyte number is lower may be explained with the stepwise inflammatory process in vitiligo.

Acta Derm Venereol 88191 Letters to the Editor Sir, Reversible skin hyperpigmentation is one of the pigmentary changes associated with vitamin B12 deficiency. It is observed in patients with megaloblastic, non-pernicious anaemia, mainly in those with dark-coloured skin (1-3).We describe here a case of a 21-year-old Greek woman in whom hyperpigmentation (reddish-brown colour) was confined to the lateral surfaces of the legs. Increased angiogenesis was observed histologically in these areas. CASE REPORTA 21-year-old Caucasian female was referred to us because of gradually increasing hyperpigmentation on her legs, observed since she was 4 years old. The hyperpigmentation started from the inner thigh and had extended over the tibia over the past few years. She also reported developing concurrent "finger deformity".Her medical history included primary growth hormone deficiency, for which she had been treated with subcutaneous injections of growth hormone. She had been a vegetarian since she was 3 years old and did not consume any milk products.Physical examination revealed reticulated dark brown with reddish hue hyperpigmentation on both lateral surfaces of her legs (Figs 1a, 2A). Moreover, her fingers were in varying degrees of fixed flexion with impaired extension in all digits (Fig. 2B). The contractures were painless. No nail or tongue abnormalities were observed and neurological examination was normal.Routine investigations were within normal limits, with no changes in chronic B12 deficiency, except a low serum B12 concentration of 100 pg/ml (normal 160-900 pg/ml) and mild macrocytosis. Ht = 37.5%, Hb = 12.5 g/dl, MCV = 96 fl (normal = 78-95 fl), PLT = 250000, PT = 13.5 s, INR = 1, APTT = 35.6 s. Serum folate, Zn, ferritin, TIBC, T3, T4, TSH, DHEA, DHEA-S and ACTH were all within normal limits. The anti-intrinsic factor antibodies, anti-parietal cell antibodies, antimicrosomal thyroid and anti-thyrospherine antibodies, anti-gliadin and anti-tissue transglutaminase antibodies, anti-dsDNA, anti-ENA, RNP, anti-SM, SSA(Ro), SSB(Lo), antiJO1 and Ra-test were negative. Plain film radiological studies of her hands were normal, as was electromyography. The patient refused to undergo upper gastrointestinal endoscopy.Skin punch biopsies 4 mm in diameter were performed on her right crural and tibial areas. Microscopy showed increased numbers of basal cell layer melanocytes, as well as increased melanin granules in the basal layer and supral basal layer (Fontana stain). Multiple clusters of vessels CD34-positive (Fig. 3a,b) with a few lymphocytes and plasmacytes around them were observed in the dermis, as well as free melanin granules. Moreover, an increased number of fibroblasts and some giant cells were noted in the reticular dermis. Distortion of collagen fibres was found. Orcein (Shikata) staining revealed fragmented elastic fibres in the reticular dermis. There was an increased number of mast cells around the vessels. Vascular endothelial growth factor (VEGF) was weakly expressed by some endothelial and plasma cells. Pe...

PGP 9.5 and cyclin D1 coexpression was closely associated with tumor aggressiveness and can be classified as a marker for predicting the outcome of resection-treated skin cancer patients.

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