Clinical and Immunological Analysis of Annular Erythema Associated with Sjögren Syndrome

Abstract

Clinical and immunopathological analysis was performed on 24 cases of Sjögren syndrome with annular erythema (AESjS). AESjS predominantly appears on the cheek of the face where skin temperature is relatively low in comparison with other sites. VCAM-1 and ICAM-1 were strongly expressed on endothelial cells of AESjS, while epidermal expression of ICAM-1 was focal and weak. VCAM-1 mRNA expression was also much more intense compared to systemic lupus erythematosus. The lymphocyte response to staphylococcal enterotoxin B was higher in AESjS than that of controls, and cells positive for T cell receptor Vβ6,9,12 were expanded after the culture. Superantigen-driven endothelial-cell-dependent T cell infiltration to the skin plays a crucial role in AESjS.

Annular erythema associated with Sjögren’s syndrome: review of the literature on the management and clinical analysis of skin lesions

“…One hundred-eighteen Japanese publications are currently listed by access to (Igaku-Chuo-Zasshi) when 'Kanjo Kouhan' and 'She-guren Shoukou-gun' are entered as key words. Eleven foreign studies [6][7][8][9][11][12][13][14][15][16][17], except for our articles [3][4][5], from PubMed and 53 Japanese reports from IgakuChuo Zasshi [10, as well as those from our own research (1976)(1977)(1978)(1979)(1980)(1981)(1982) were selected according to the following criteria: (1) fulfilling the diagnostic criteria of SS; (2) clinical and histopathological features, including a coat-sleeve infiltration pattern of T lymphocytes around the blood vessels and skin appendage without the epidermal changes in the cutaneous LE consistent with our first report [3]. Cases of apparent SCLE or Sweet disease with characteristic clinical and histopathological cases were excluded, even though such cases were published as AESS.…”

“…In addition to these skin lesions, SS patients occasionally develop annular erythema (AE) with perivascular and periappendageal lymphocytic infiltration, which is characterized by a wide elevated border and central pallor [3][4][5]. Since only a few cases of AE in SS have been reported in Caucasians [6][7][8] and because AE in Japanese and Oriental SS patients share many clinical features with subacute cutaneous lupus erythematosus (SCLE), the most photosensitive type of lupus erythematosus (LE) [9], SS manifesting with AESS has been thought to be the Oriental counterpart of SCLE.…”

Immunohistochemical Analysis of Interleukin-17 Producing T Helper Cells and Regulatory T Cells Infiltration in Annular Erythema Associated with Sjögren's Syndrome

“…In 1989, we reported four patients with primary SS who presented with distinct annular erythema characterized by a wide, elevated border and central pallor1. This peculiar erythema, which is also known as annular erythema associated with Sjögren's Syndrome (AESS), can be differentiated from autoimmune annular erythema and subacute cutaneous lupus erythematosus (SCLE), both clinically and histologically1,2,3,4. Based on the literature reported since 2007, this type of erythema preferentially occurs in Oriental, but not Occidental, populations1,4.…”

Anul�res Erythem bei Sj�gren-Syndrom

“…Im Vergleich zum SCLE (Tabelle 2) treten die Hautverän-derungen beim AE-SS zwar auch in lichtexponierten Arealen auf, können aber ebenfalls durch andere physikalische Faktoren wie Kälteeinwirkung induziert werden und heilen ohne Hypo-oder Depigmentierungen ab [4,5,25]. Histopathologisch wird das AE-SS aufgrund fehlender Veränderungen der Epidermis und der BasalmemMiyagawa et al [11] rezidivierende, erythematöse, [6,7,15].…”

“…Die Assoziation von anulärem Erythem und Sjögren-Syndrom (AE-SS) wurde erstmals 1989 von Teramoto et al [22] bei japanischen Patienten beschrieben. In weiteren Untersuchungen wurde herausgestellt, daß die anuläre Form des SCLE bei Kaukasiern nicht nur histologisch vom AE-SS bei Asiaten abgegrenzt werden kann ( [3,4], Tabelle 2), sondern daß die unterschiedliche klinische Ausprägung der anulären Hautveränderungen bei Kaukasiern und Asiaten auf genetische Unterschiede zurückzuführen ist [5,10,15,25]. Aufgrund immunologischer Befunde wird andererseits in der jüngsten Literatur diskutiert, daß beiden Krankheitsbildern ein gemeinsamer Pathomechanismus zugrunde liegt.…”