Immunohistology of amicrobial pustulosis of the folds

Abstract

Amicrobial pustulosis of the folds (APF), is a rare pustular eruption, predominantly involving the cutaneous folds, the external auditory canals and the scalp, occurring in patients who exhibit a wide spectrum of autoimmune abnormalities. There is a lack of data on the immunohistology of APF. We report a new case of APF associated with features of systemic lupus erythematosus (LE). Extensive immunohistological examinations of lesional and nonlesional skin were performed. The results of our immunohistological studies indicate that immunostaining with p53, Bcl-2, and CD8 antigens could be useful in differentiating APF from closely related inflammatory conditions such as psoriasis and cutaneous LE. However, studies on a larger sample size including controls are needed to substantiate our findings.

Amicrobial Pustulosis of the Folds Associated with Autoimmune Disorders: Systemic Lupus Erythematosus Case Series and First Report on the Association with Autoimmune Hepatitis

“…All patients remained disease-free after discontinuation of topical treatment and a slow tapering of prednisone to the therapeutic dosage prior to APF was achieved in the following months without flares of the dermatosis. A higher response rate was reported for oral steroids (0.5 to 1-milligram per kilogram of prednisone QD) and these are considered the mainstay of therapy even though recurrences after treatment suspension are common and given the few published cases [5,11,13,16],no consensus actually exists. Other therapeutic modalities, all with inconsistent results, include oral retinoids, sulfas, cimetidine, zinc supplementation and vitamins C and D [1,7,10,11,17].…”

“…In addition, a high expression of involucrin and Ki67 in epidermal keratinocytes suggests that cell proliferation and differentiation may also be affected, probably as a secondary phenomenon [15,16]. …”

Inflammatory Cells, Cytokines and Matrix Metalloproteinases in Amicrobial Pustulosis of the Folds and other Neutrophilic Dermatoses

“…Both disorders mentioned above can be idiopathic or occur in association with a wide variety of conditions, particularly IBD, haematological malignancies and autoimmune systemic diseases such as SLE ( 12). To date, only prelim inary finding s on the immunohistology and cytokine pattern of three single cases of APF have been reported (9,13). In this study, in six patients with APF, we evaluated not only the cytokine profile but also the phenotype of the inflammatory infiltrate and the expression of tissue damage mediators.…”

Amicrobial pustulosis of the folds: Report of 4 cases

“…Amicrobial pustulosis of the folds (APF) is a rare disorder characterized by aseptic pustules involving skin folds, which is often associated with autoimmune disease and female sex . Since its initial description in 1991, approximately 40 cases are found in the literature . Márquez‐Balbás et al proposed mandatory criteria including pustulosis affecting 1 or more major folds, histologic findings of intraepidermal spongiform pustulosis with neutrophil infiltrate in the dermis, and aseptic pustules.…”

“…literature. [1][2][3][4][5][6][7][8][9][10][11] Márquez-Balbás et al 8 proposed mandatory criteria including pustulosis affecting 1 or more major folds, histologic findings of intraepidermal spongiform pustulosis with neutrophil infiltrate in the dermis, and aseptic pustules. Their minor criteria include the association with 1 or more autoimmune disorders, such as antinuclear antibody (ANA) titers of 1:160 or more, and the presence of additional autoantibodies.…”