Correlation of dermal and blood eosinophilia with bullous pemphigoid disease severity.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease associated with immune response against BP-180 and BP-230. Peripheral blood eosinophilia and dermal infiltration of eosinophils are common findings in BP. OBJECTIVE: The aim of our study was to demonstrate a statistical correlation between dermal and peripheral blood eosinophilia, anti BP-180, and anti BP-230 IgG and clinical severity of BP. METHODS: A total of 27 patients with newly diagnosed BP were included. Severity of disease was assessed according to the bullous pemphigoid disease activity index (BPDAI). Anti-BP-180 and anti-BP-230 titers, peripheral blood eosinophilia, and dermal eosinophil infiltration and tissue inflammation severity were assessed for each patient. RESULTS: A significant correlation was found between the serum levels of anti-BP-180 and anti-BP-230, and dermal eosinophilia and tissue inflammation severity with objective and subjective BPDAI scores. In addition, there was a significant correlation between the percentage of peripheral blood eosinophils and subjective BPDAI scores and urticarial/eczematous lesions. Moreover, the mucosal component did not show any correlation with autoantibody levels and inflammation severities. CONCLUSION: Anti-BP-180 and anti-BP-230 levels, tissue inflammation severity, and dermal eosinophilia had a strong and significant correlation with BP severity. In addition, percentage of peripheral blood eosinophilia showed a correlation with subjective BPDAI scores.

Immunohistochemical Staining in the Assessment of Melanoma Tumor Thickness.

Vertical tumor thickness has great influence in the prognosis and staging of melanoma. The aim of this study was determination of the differences between melanoma tumor thickness in conventional hematoxylin and eosin (H&E) and immunohistochemical techniques. Thirty-six biopsy specimens were included in our study. For each sample, four adjacent tissue sections were stained with H&E, in addition S-100, Melan- A and HMB-45 staining was performed on the next serial sections. The mean thickness of tumor invasion was 2.16, 2.38, 2.22 and 2.29 mm in H&E, S-100, HMB45 and Melan-A sections evaluation, respectively. The mean difference of the Breslow thickness between H&E and S-100 and also, between H&E and Melan-A stained slides were statistically significant (p˂0.05) while no difference was found in the tumor thickness of the H&E and HMB45 staining evaluation (p = 0.278). Greater tumor thickness was observed in 25 lesions (69.4%) with S-100, 20 lesions (55.5%) with Melan-A and 17 (47.2%) lesions in HMB-45 rather than H&E staining. Conclusively, it appears that H&E staining cannot prove the actual size of melanoma invasion in some cases and immunohistochemical examination can be a complementary method in this situations. Of the melanoma associated immunomarkers, the combination of S-100 and Melan-A staining may suffice to measure depth of tumor invasion.