Erschienen in:
The Journal of Dermatology, 46 (2019) 9, Seite 808-811
Sprache:
Englisch
DOI:
10.1111/1346-8138.14981
ISSN:
0385-2407;
1346-8138
Entstehung:
Anmerkungen:
Beschreibung:
AbstractDisseminated granuloma annulare (GA) is a rare granulomatous dermatitis of unknown etiology. Treatment is often challenging and lack of a uniformly effective treatment, adds to the disease morbidity. Tumor necrosis factor (TNF)‐α is an important cytokine in granuloma formation and previous reports have shown improvement of disseminated GA with anti‐TNF‐α therapy. Nevertheless, the underlying mechanism of actions of TNF‐α inhibitors in GA remains unclear. Our aim was to evaluate alterations in the inflammatory infiltrate in a patient who experienced complete clearance of GA after treatment with infliximab. A skin biopsy was obtained before and 24 weeks after treatment with infliximab 5 mg/kg at weeks 0, 2, 6, 14 and 24. Immunohistochemical stains were performed in pre‐ and post‐treatment biopsy specimens using CD1a, CD4, CD8, CD11c, CD32, CD68, CD69, CD163, CD183 and human leukocyte antigen (HLA)‐DR to characterize alterations of the infiltrates. Parallel with clinical improvement, we observed a marked decrease in myeloid (CD11c) dendritic cells, different macrophage subsets (CD68, CD32, CD163) and T cells. In addition, a marked reduction of activation markers (HLA‐DR, CD69) and CD183+ (CXCR3) cells was observed in post‐treatment biopsy specimens. In conclusion, the clinical improvement of disseminated GA by infliximab is paralleled by inhibition of activated myeloid dendritic cells, different macrophage subsets and type 1 T cells.