fibrin and Erythema

We obtained biopsies from early, fully developed, and late lesions of erythema elevatum diutinum (EED) in a 49-year-old man. The histologic and electron-microscopic findings were compared with those reported in the literature and three other cases from our files. Early lesions show leukocytoclastic vasculitis with capillary proliferation. Later lesions show vasculitis, dermal aggregates of neutrophils, fibrosis, and areas of granulation tissue. Newly formed vessels in granulation tissue may be more susceptible to damage by immune complexes, and the early formation of granulation tissue in EED may prevent an early resolution of vasculitis. Damage to dermal connective tissue in EED incites either scarring or, rarely, a fibrohistiocytic proliferation. Ultrastructural examination of one case showed histiocytes with myelin figures and intracellular lipid and cholesterol.

Topics: Erythema; Fibrin; Granulation Tissue; Humans; Leukocytes; Male; Microscopy, Electron; Middle Aged; Skin; Vasculitis; Venules

Induration is a characteristic feature of delayed-type hypersensitivity skin reactions and is the usual measure of their intensity. The precise basis of induration has not been established, although activation of the clotting system with consequent fibrin deposition has been clearly implicated. In this study, two subjects with congenital afibrinogenemia, a genetic defect in fibrinogen synthesis, were skin tested with standard microbial antigens: streptokinase-streptodornase, monilia, mumps, and tuberculin purified protein derivative. One positive delayed reaction from each subject was biopsied at 40-48 h and compared with 23 biopsies of similar skin tests in normal volunteers. The eight skin tests in the afibrinogenic subjects lacked induration, although the erythema was similar in size (10-34 mm in diameter), intensity, and time-course to those in normals. Biopsies from the two strongest reactions from the afibrinogenemic subjects showed a typical perivascular mononuclear infiltrate. No more than traces of fibrin/fibrinogen were detected by immunofluorescence, in striking contrast to the abundant fibrin/fibrinogen deposition in 23 positive, indurated reactions in normal subjects. These findings indicate that fibrinogen itself is essential for the development of induration in delayed-type skin reactions in man. As judged by 1-mum sections and fluorescence, this is probably a result of the formation of an extravascular fibrin gel.

Topics: Adult; Afibrinogenemia; Erythema; Fibrin; Fibrinogen; Humans; Hypersensitivity, Delayed; Lymphocytes; Macrophages; Male; Monocytes

Erythema elevatum diutinum consists of chronic, often painful, predominantly acral skin nodules and plaques, associated with an underlying cutaneous vasculitis. A patient with this disorder is described, who had an elevated sedimentation rate, positive antinuclear factor, impaired clot lysis, and dramatic fibrin deposition in skin vessel walls. A variety of treatments were without benefit in this case as in most others, but phenformin produced marked improvement for periods of 11 and 16 months on two occasions. Protection of the lesions from minor trauma is also important.

Topics: Adjustment Disorders; Antibodies, Antinuclear; Blood Coagulation; Blood Sedimentation; Erythema; Female; Fibrin; Humans; Middle Aged; Phenformin; Vascular Diseases

Topics: Aged; Allergens; Antibodies; Antibody-Producing Cells; Basement Membrane; Biopsy; Carbon Radioisotopes; Complement System Proteins; Erythema; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Lymphocytes; Lymphoma; Male; Middle Aged; Photosensitivity Disorders; Skin; Skin Tests; Ultraviolet Rays

Topics: Biopsy; Cytoplasm; Dermatitis Herpetiformis; Desmosomes; Erythema; Fibrin; Glycogen; Histocytochemistry; Humans; Immunoglobulins; Lipids; Microscopy, Electron; Skin

Topics: Basement Membrane; Blood Vessels; Collagen; Cytoplasmic Granules; Erythema; Fibrin; Humans; Male; Microscopy, Electron; Middle Aged; Mitochondria; Purpura; Skin Diseases