A comparative immunohistochemical study of epidermal and dermal/perifollicular Langerhans cell concentration in discoid lupus erythematosus and lichen planopilaris: a cross-sectional study

Abstract

Background

There are times when differentiation between discoid lupus erythematosus (DLE) and lichen planopilaris (LPP) becomes quite challenging clinicopathologically.

Objectives

The aim of this study was to evaluate and compare the concentration, distribution pattern and role of Langerhans cells (LCs), identified by CD1a staining in DLE and LPP.

Methods

Twenty-five specimens of skin biopsies from patients diagnosed with LPP and DLE were included. Immunohistochemistry (IHC) staining was performed against CD1a antigen to assess and compare the concentration and distribution pattern of LCs.

Results

Compared with LPP, the mean number of epidermal CD1a⁺ cells per three high power fields was significantly lower in DLE (p = 0.003). On the other hand, DLE cases had a significantly higher mean number of dermal/perifollicular CD1a⁺ cells in three high power fields than LPP cases (p = 0.01).

Limitations

A small sample size and limited IHC markers.

Conclusions

There are differences in the density and distribution pattern of LCs in LPP and DLE in the epidermis and perifollicular regions. Our findings of a statistically significant decrease in LC concentration in the epidermis of DLE cases and also in the perifollicular region of LPP may serve as helpful clues in further characterization of these entities, especially in equivocal cases. However, more extensive studies are required to better understand the underlying immunopathogenesis of these diseases in providing further clues to a specific diagnosis.

Keywords

Discoid lupus erythematosus lichen planopilaris immunohistochemistry Langerhans cell CD1a

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References

Ross

Tan

Shapiro

. Update on primary cicatricial alopecias. J Am Acad Dermatol 2005; 53: 1–37; quiz 38–40.

Harries

Paus

. The pathogenesis of primary cicatricial alopecias. Am J Pathol 2010; 177: 2152–2162.

Sellheyer

Bergfeld

. Histopathologic evaluation of alopecias. Am J Dermatopathol 2006; 28: 236–259.

Headington

. Cicatricial alopecia. Dermatol Clin 1996; 14: 773–782.

Olsen

Bergfeld

Cotsarelis

et al.

Summary of North American Hair Research Society (NAHRS)-sponsored workshop on cicatricial alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol 2003; 48: 103–110.

Lee

Wilkinson

Doyle

et al.

A comparative immunohistochemical study of lichen planus and discoid lupus erythematosus. Australas J Dermatol 1996; 37: 188–192.

Hutchens

Balfour

Smoller

. Comparison between Langerhans cell concentration in lichen planopilaris and traction alopecia with possible immunologic implications. Am J Dermatopathol 2011; 33: 277–280.

Andrews

Schenk

Barr

et al.

Immunopathology of cutaneous human lupus erythematosus defined by murine monoclonal antibodies. J Am Acad Dermatol 1986; 15: 474–481.

Bhan

Harrist

Murphy

et al.

T cell subsets and Langerhans cells in lichen planus: in situ characterization using monoclonal antibodies. Br J Dermatol 1981; 105: 617–622.

10.

Kohchiyama

Oka

Ueki

. T-cell subsets in lesions of systemic and discoid lupus erythematosus. J Cutan Pathol 1985; 12: 493–499.

11.

Robertson

Wray

. Immunohistochemical study of oral keratoses including lichen planus. J Oral Pathol Med 1993; 22: 180–182.

12.

Mori

Pimpinelli

Romagnoli

et al.

Dendritic cells in cutaneous lupus erythematosus: a clue to the pathogenesis of lesions. Histopathology 1994; 24: 311–321.

13.

Sontheimer

Bergstresser

. Epidermal Langerhans cell involvement in cutaneous lupus erythematosus. J Invest Dermatol 1982; 79: 237–243.

14.

Regezi

Daniels

Saeb

et al.

Increased submucosal factor XII la-positive dendrocytes in oral lichen planus. J Oral Pathol Med 1994; 23: 114–118.

15.

Hussein

. Evaluation of Langerhans’ cells in normal and eczematous dermatitis skin by CD1a protein immunohistochemistry: preliminary findings. J Cutan Pathol 2008; 35: 554–558.

16.

Moresi

Horn

. Distribution of Langerhans cells in human hair follicle. J Cutan Pathol 1997; 24: 636–640.

17.

Hasseus

Jontell

Brune

et al.

Langerhans cells and T cells in oral graft versus host disease and oral lichen planus. Scand J Immunol 2001; 54: 516–524.

18.

Xie

Jinnin

Zhang

et al.

Immunohistochemical characterization of the cellular infiltrate in discoid lupus erythematosus. Biosci Trends 2011; 5: 83–88.

19.

Mobini

Tam

Kamino

. Possible role of the bulge region in the pathogenesis of inflammatory scarring alopecia: lichen planopilaris as the prototype. J Cutan Pathol 2005; 32: 675–679.

20.

Lourenço

de Carvalho

Boggio

et al.

Lupus erythematosus: clinical and histopathological study of oral manifestations and immunohistochemical profile of the inflammatory infiltrate. J Cutan Pathol 2007; 34: 558–564.

21.

Hitchins

Fucich

Freeman

et al.

Immunophenotyping as a diagnostic tool to differentiate lichen planus from chronic graft-versus-host disease: diagnostic observations on two patients. J Investig Med 1997; 45: 463–468.

22.

Rahmati Roudsari

Malekzad

Sabeti

et al.

Immunohistochemistry profile of inflammatory cells in lichen planopilaris and discoid lupus erythematosus. Iran J Dermatol 2015; 18: 108–115.

23.

Barzilai A, Akhsan D, Hodak E, et al. Skin inflammatory infiltrate in lichen planopilaris and discoid lupus erythematosus of the scalp. The 15th joint meeting of the International Society of Dermatopathology, 14–15 March 2012; San Diego, CA, USA: Am J Dermatopathol 2012; p. e58 (abstract).