Histopathological And Related Immunohistochemical Study Of Facial Hormone Dependence Dermatitis

Objective:Facial hormone dependence dermatitis is due to improperly use glucocorticoid for a long time.The symptom is improved by the application of glucocorticoid,while it will rapidly relapse or even be more serious after discontinuation of treatment.To avoid dermatitis recurrence,patients totally dependent on external glucocorticoid so that the skin form dependence to glucocorticoid,but pathogenesis is not very clear.We investigate the expression of GR in facial hormone dependence dermatitis,and the epidermis,dermis infiltrated T lymphocytes by using immunohistochemical methods.To discuss the pathogenesis of facial hormone dependence dermatitis from the perspective of immunology looks for effective treatment.Methods:25 patients with facial hormone dependence dermatitis were well clinically diagnosed.10 patients with facial subacute eczema were diagnosed by clinical and histopathological method.All of them were collected from the dermatological department of the Tianjin Changzheng hospital from April 2006 to March 2008. Another 10 facial skin specimens which are normal by appearance were taken as control group.They had no statistical difference in age and gender between controls and the patients.Paraffin-embedded specimens were conventionally cut to 5μm serial sections for pathological analysis,and using monoclonal antibodies for immunohistochemical staining.The experimental results were analyzed by SPSS11.5.Normality and homogeneity of variance was used to analyze by One-way ANOVA and SNK-q test;Using Kruskal-Wallis H,Mann-Whitney U rank sum test analyzed level of non-normal data and information.Results:1.The epidermis was parakeratosis,acanthotic,intercellular or intracellular edema, slight spongiosis.The dermal papillae was prominent and contain ecstatic vessels. A perivascular and periadnexal inflammatory infiltrate occurred in the dermis.2.The expression of GR-α:The GR-αwas distributed in the all stratums of epidermis with more quantity of cells in all the patients with facial hormone dependence dermatitis.8 of 25 patients with facial hormone dependence dermatitis were strongly positive,3 positive,14 weakly positive.In the controls, the GR-αexpression was mainly stained in the cells of stratum basale with much quantity of cells.All of 10 cases were weakly positive.In the patients with facial subacute eczema,the GR-αwas also expressed in the all stratums of epidermis with more quantity of cells.1 of 10 patients with facial subacute eczema was strongly positive,1 positive,8 weakly positive.The results showed there were statistically significant differences in GR-αexpression among of the three groups (P＝0.028＜0.05).3.The expression of GR-β:The GR-βwas not expressed or mainly expressed in the cells of stratum basale with small quantity of cells in the patients with facial hormone dependence dermatitis.21 of 25 patients were negative,only 4 weakly positive.In the controls,it was mainly expressed in the cells of stratum basale with small quantity of cells.8 of 10 cases were negative,only 2 weakly positive. In the patients with facial subacute eczema,7of 10 cases were negative,only 3 weakly positive.The results showed there were not statistically significant differences in GR-βexpression among of the three groups(P＝0.652＞0.05).4.The expression of GR-αhad statistically significant difference between patients with facial hormone dependence dermatitis and controls(P＝0.014＜0.017),but hadn't statistically significant difference between patients with facial hormone dependence dermatitis and facial subacute eczema(P＝0.166＞0.017);There was not significant difference between the facial subacute eczema and controls(P＝0.147＞0.017).5.The expression of GR-αand GR-βwas mainly distributed in the epidermis;The little expression of GR-αand GR-βwas distributed in the dermis.6.There was not or little CD4 and CD8 in the superficial dermis expression of normal skin tissue,but a large number of CD4 and CD8 was expressed where was the dermal papilla,superficial dermis in Facial subacute eczema and facial hormone dependence dermatitis.The level of CD8~+T cell in facial hormone dependence dermatitis were higher than that of controls,and there had a significant statistical difference(P＝0.000＜0.017);The level of CD8~+T cell in facial subacute eczema were higher than that of controls,and there had a significant statistical difference(P＝0.002＜0.017).The level of CD4~+T cell in facial hormone dependence dermatitis and facial subacute eczema were higher than that of controls,but they hadn't statistically significant difference (P＝0.076＞0.05).Although the CD4~+/ CD8~+ ratio in facial hormone dependence dermatitis increased,compared with controls,there was no statistical difference (P＝0.342＞0.05).Conclusion:1.The histopathogical change of facial hormone dependence dermatitis was basically similar to subacute dermatitis,and the heterogeneity maybe relate to the original disease.2.The GR-αwhich was distributed in the all stratums of epidermis with more quantity of cells in all the patients with facial hormone dependence dermatitis was more than controls,suggesting that the GR-αincreased in lesions because of local changes in the structure of skin tissue and inflammation,while the GR-αand GC affinity significantly reduce.They maybe relevant with immunopathological process of facial hormone dependence dermatitis.3.There were a lot of T lymphocytes infiltration in Facial hormone dependence dermatitis and the CD4~+/CD8~+ratio was disorder,suggesting that the lesion of facial hormone dependence dermatitis may be existence of different mechanisms of T lymphocyte activation.