C4d immunohistochemical stain of formalin-fixed paraffin-embedded tissue as a sensitive method in the diagnosis of bullous pemphigoid.

BACKGROUND: Bullous pemphigoid (BP) is the most common type of subepidermal bullous disease. Direct immunofluorescence (DIF) is the gold standard for diagnosis, but it requires a fresh tissue specimen. This study was conducted to evaluate the accuracy of using immunohistochemical (IHC) analysis for the detection of C4d in paraffin-embedded tissue of BP cases. METHODS: A retrospective study was performed on 30 BP cases (confirmed by Hematoxylin and eosin [H&E] and DIF) and 30 controls. IHC studies were performed on formalin-fixed paraffin-embedded (FFPE) tissues. RESULTS: Of 30 BP patients (11 male and 19 female), 27 (90%) were C4d positive and three patients (10%) were C4d negative. The C4d deposits were seen as linear brown stain along the dermoepidermal junction (18 cases), around basal keratinocytes (eight cases), or Civatte-like (three cases). Two cases revealed more than one pattern in IHC staining. Of 30 control specimens, 26 (86%) cases were C4d negative and four (13.4%) were positive for granular deposits of C4d which were diagnosed as dermatitis herpetiformis. CONCLUSION: C4d IHC study is a valuable diagnostic tool with sensitivity of 90% and specificity of 86.7%, and is especially useful in cases in which frozen specimens are not available or FFPE specimens are the only available material for analysis.

The efficacy of methotrexate plus pioglitazone vs. methotrexate alone in the management of patients with plaque-type psoriasis: a single-blinded randomized controlled trial.

Recently, thiazolidinediones have shown to be efficacious with a favorable safety profile when used in the treatment of chronic plaque-type psoriasis. The aim of this study was to evaluate and compare the efficacy and safety of a combination of methotrexate plus pioglitazone and methotrexate alone in plaque-type psoriasis. A total of 44 adult patients with plaque-type psoriasis were included in the study. Patients were randomized to treatment with methotrexate alone (group A) or methotrexate plus pioglitazone (group B) for 16 weeks. The primary efficacy outcome measure was psoriasis area and severity index (PASI) score change between the study groups at week 16 relative to baseline. The secondary efficacy outcome measure was dermatology life quality index (DLQI) score change between the two groups at week 16 relative to baseline. The PASI 75 score was also measured. After 16 weeks of therapy, the percentage of reduction in the mean PASI score was 70.3% in group B and 60.2% in group A. PASI 75 was achieved in 14 patients (63.6%) in group B compared with two patients (9.1%) in group A within 16 weeks, which was significant (P < 0.001). At 16 weeks from the baseline, a 63.6% decrease in the mean DLQI score of group B was seen, while the decrease for group A was 56.9%. Pioglitazone enhances the therapeutic effect of methotrexate in plaque-type psoriasis, as demonstrated by a reduction in the mean PASI scores. In terms of DLQI, there was no extra benefit by the addition of pioglitazone to methotrexate therapy.

Combination therapy of infantile hemangioma with pulsed dye laser with topical propranolol: a randomized clinical trial.

BACKGROUND: The combination of pulsed dye laser (PDL) and topical propranolol are used with variable effectiveness for the treatment of infantile hemangiomas (IH), particularly for superficial lesions. OBJECTIVE(S): The aim of this study was to investigate whether the therapeutic efficacy of prescribing topical propranolol along with PDL was superior to PDL therapy alone in the treatment of IH. METHODS: A total of 19 patients with IH were recruited to the study. Among them, nine patients were treated with PDL, 3 sessions 4 weeks apart, and 10 patients underwent PDL treatment alongside with topical propranolol for 12 weeks. The therapeutic efficacies of each regimen were assessed by comparing photographs of skin lesions before and after the treatment based on the cessation of the lesion growth, reduction in the lesion size, and lightening of the lesion color. RESULTS: No side-effect was reported by the parents. Among nine patients in PDL group, only two (22%) had excellent clearance, one (11%) had good, three (30%) had weak, and three (30%) had no responses. On the other hand, among 10 patients who were treated with both the PDL and topical propranolol, five (50%) showed excellent responses and five (50%) displayed good responses. Statistical data analysis with Mann-Whitney test revealed a significant difference in the clinical response between two treatment groups. CONCLUSION: The combination of PDL and topical propranolol seem to be a safe and effective therapy, and results in better clinical responses in the treatment of IH than PDL therapy alone.