Dyshidrotic eczema: relevance to the immune response in situ

Ana Maria Abreu Velez, MD, Ph.D1, Frank J. Pinto, Jr, M.D,2Michael S. Howard, MD.1
1 Georgia Dermatopathology Associates, Atlanta, Georgia, USA.
2 Stamford Connecticut, New York, USA.

Context:  Pompholyx (called dyshidrosis by some) is one of the most common conditions and its immune response is presently poorly understood. Case report: We describe a 58 year old African American female with a clinical history of rheumatoid arthritis and type II diabetes who presented a chronic five-year, itchy vesicular/blistering rash involving her hands and feet. A lesional skin biopsy was taken for hematoxylin and eosin (H & E) analysis. In addition, a multicolor direct immunofluorescence (MDIF) and immunohistochemistry (IHC) studies were performed. The major findings to be reported were: the H & E examination revealed spongiotic dermatitis and pompholix. IHC and MDIF studies demonstrated focally deposits of positive CD45, CD3, CD8, anti myeloperoxidase (MPO), and anti-human IgE, C3C, C3D and anti-human-fibrinogen within the epidermal spongiotic process, as well as around the blood vessels surrounding the inflammatory process especially at the sweat glands and respective ductus. The patient began mycophenolate mofetil therapy, with successful clearing of the palms and soles. Conclusion: The significance of our findings indicates a complex immunological process including complement, MPO and T-cell immune response. In addition, possibly a secondary allergic process for the presence of IgE immune response and possibly aggravation by application of other medicines. Further immunological studies on pompholyx are needed. (Abreu Velez  AM, Pinto  FJ, Howard  MS. North Am J Med Sci 2009; 1: 117-120).

Keywords: Sweat glands, dyshidrotic eczema, pompholyx, immunohistochemistry, immunofluoresence, CD3, CD45, CD8

Correspondence to: Dr. Ana Maria Abreu-Velez, MD, Ph.D, Georgia Dermatopathology Associates, 1534 North Decatur Rd. NE, Suite 206, Atlanta, GA 30307-1000, USA. Tel.: (404) 3710077, Fax: (404) 3711900.  Email: abreuvelez@yahoo.com

Short Title: Dyshidrotic eczema, T cell response and IgE.