fibrin and Pemphigoid--Bullous

Diagnosis of bullous pemphigoid (BP) and pemphigus is based on clinical features, histology, immunofluorescence and laboratory data.. To evaluate features of BP and pemphigus at reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in order to provide a rapid non-invasive bed-side diagnosis. Secondary objective was to evaluate the detectability of clinically non-visible lesions.. This was an observational, retrospective, multicentre study in which patients with suspicious lesions for BP or pemphigus underwent clinical assessment, RCM, OCT, blood tests and skin biopsy for histological and direct immunofluorescence examinations from January 2014 to December 2015. A total of 72 lesions in 24 selected patients were evaluated. Additionally, apparently unaffected skin at two different distances [near (1-2 cm) and far (2-3 cm)] from each lesion was examined to test subclinical lesion detectability.. RCM was able to detect subepidermal and intra-epidermal blisters, respectively, in 75% and 50% of the patients affected by BP and pemphigus. At OCT, the exact blister level was identified in all patients. Acantholytic cells were observed only at RCM in pemphigus (62.5%). Fibrin deposition inside the blisters was only found in BP, evidenced both at RCM and OCT. Among patients with BP, subclinical blisters were detected in nine (9.4%) clinically healthy skin, while among patients with pemphigus were observed in 10 (20.8%) apparently unaffected skin.. RCM and/or OCT provide useful information for a rapid diagnosis of BP and pemphigus and for the identification of biopsy site. Combined use of RCM and OCT is optimal because associates the higher resolution of RCM with the greater penetration depth of OCT. OCT could be an optimal tool for treatment monitoring, especially in the cases of subclinical lesions. However, histopathologic and immunologic examinations remain the gold standard for establishing the final diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Asymptomatic Diseases; Fibrin; Humans; Microscopy, Confocal; Middle Aged; Pemphigoid, Bullous; Pemphigus; Point-of-Care Systems; Retrospective Studies; Skin; Tomography, Optical Coherence

Factors regulating the attachment and directional migration of a regenerating epidermis in wound healing are poorly understood. In studies of guinea pig 4-mm skin wounds, left uncovered for 1-28 days, biopsied and processed for 1-micrometer section and immunofluorescence, the epidermis migrated over an irregular thickened provisional matrix containing fibrin and fibronectin. The provisional matrix lacked two major components of normal basement membrane, laminin and type IV collagen, which can mediate tenacious epithelial attachment to plastic in vitro and may limit epidermal cell migration in vivo. Upon completion of wound reepithelialization at 7-9 days after wounding, the basement membrane zone lost its thickened appearance, fibronectin and fibrinogen disappeared, and type IV collagen and laminin reappeared. Although these findings do not prove that epidermal cell migration during reepithelialization required a fibrin and fibronectin matrix, they demonstrate that epidermal cells do move over such a substratum during in vivo wound repair.

Topics: Animals; Antigens; Basement Membrane; Collagen; Epidermal Cells; Epithelium; Female; Fibrin; Fibrinogen; Fibronectins; Fluorescent Antibody Technique; Glycoproteins; Guinea Pigs; Laminin; Male; Membrane Proteins; Microscopy, Electron; Pemphigoid, Bullous; Wound Healing

We have studied by electron and light microscopy the inflammatory reaction in lesions at various stages of clinical development from a patient with bullous pemphigoid. The evolution of clinical lesions was associated with a sequence of histopathologic events which began with alterations of mast cells and proceeded to infiltration, first with lymphocytes and later with eosinophils and basophils. Mast cells in the papillary and reticular dermis demonstrated a unique, focal, irregular loss of granule contents. Intact eosinophils demonstrated intracytoplasmic losses of granule contents and karyorrhectic and karyolytic eosinophils had released membranebound granules. Partially and completely degranulated basophils were present within a fibrin gel which formed in the dermis. Thus, the sequence of histopathologic events in the pathogenesis of bullous pemphigoid includes mast cell granule alterations and release of granule contents from eosinophils which are undergoing nuclear and cytoplasmic damage.

Topics: Basophils; Cytoplasmic Granules; Eosinophils; Fibrin; Humans; Inflammation; Macrophages; Mast Cells; Pemphigoid, Bullous; Skin; Skin Diseases, Vesiculobullous