Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein
Background Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities. Methods Forty‐three cases...
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| Veröffentlicht in: | Journal of cutaneous pathology 2019-05, Vol.46 (5), p.317-326 |
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| container_title | Journal of cutaneous pathology |
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| creator | Vyas, Nikki S. Charifa, Ahmad Desman, Garrett T. McNiff, Jennifer M. |
| description | Background
Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities.
Methods
Forty‐three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA.
Results
Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P |
| doi_str_mv | 10.1111/cup.13430 |
| format | Article |
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Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities.
Methods
Forty‐three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA.
Results
Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P < 0.05) in favor of a diagnosis of PS. The absence of PDCs and presence of eosinophils favored a diagnosis of AGEP (P < 0.05).
Conclusions
We found compelling evidence for the use of CD123 to highlight PDCs in these cases. The presence of PDCs and expression of MxA in dermal inflammatory infiltrate, as well as absence of eosinophils and presence of tortuous dilated capillaries favored a diagnosis of PS. Expression of MxA in the dermal infiltrate corresponds with a Th1 pathway in PS and may indicate a Th1 component in the early initial phase of AGEP.</description><identifier>ISSN: 0303-6987</identifier><identifier>EISSN: 1600-0560</identifier><identifier>DOI: 10.1111/cup.13430</identifier><identifier>PMID: 30667074</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>AGEP ; Capillaries ; CD123 antigen ; Dendritic cells ; Diagnosis ; Edema ; eosinophils ; Exocytosis ; Inflammation ; Interferon ; Keratinocytes ; Leukocytes (eosinophilic) ; Lymphocytes T ; MxA ; Myxovirus resistance proteins ; Papilloma ; plasmacytoid dendritic cells ; Psoriasis ; Pustulosis ; Skin ; Vasculitis</subject><ispartof>Journal of cutaneous pathology, 2019-05, Vol.46 (5), p.317-326</ispartof><rights>2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-a9cacd323eef63f3d16189e0e2df7b0fe5158b3ed42e0d59e819036fee26890c3</citedby><cites>FETCH-LOGICAL-c3530-a9cacd323eef63f3d16189e0e2df7b0fe5158b3ed42e0d59e819036fee26890c3</cites><orcidid>0000-0001-5026-1821 ; 0000-0002-1557-300X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcup.13430$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcup.13430$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30667074$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vyas, Nikki S.</creatorcontrib><creatorcontrib>Charifa, Ahmad</creatorcontrib><creatorcontrib>Desman, Garrett T.</creatorcontrib><creatorcontrib>McNiff, Jennifer M.</creatorcontrib><title>Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein</title><title>Journal of cutaneous pathology</title><addtitle>J Cutan Pathol</addtitle><description>Background
Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities.
Methods
Forty‐three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA.
Results
Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P < 0.05) in favor of a diagnosis of PS. The absence of PDCs and presence of eosinophils favored a diagnosis of AGEP (P < 0.05).
Conclusions
We found compelling evidence for the use of CD123 to highlight PDCs in these cases. The presence of PDCs and expression of MxA in dermal inflammatory infiltrate, as well as absence of eosinophils and presence of tortuous dilated capillaries favored a diagnosis of PS. Expression of MxA in the dermal infiltrate corresponds with a Th1 pathway in PS and may indicate a Th1 component in the early initial phase of AGEP.</description><subject>AGEP</subject><subject>Capillaries</subject><subject>CD123 antigen</subject><subject>Dendritic cells</subject><subject>Diagnosis</subject><subject>Edema</subject><subject>eosinophils</subject><subject>Exocytosis</subject><subject>Inflammation</subject><subject>Interferon</subject><subject>Keratinocytes</subject><subject>Leukocytes (eosinophilic)</subject><subject>Lymphocytes T</subject><subject>MxA</subject><subject>Myxovirus resistance proteins</subject><subject>Papilloma</subject><subject>plasmacytoid dendritic cells</subject><subject>Psoriasis</subject><subject>Pustulosis</subject><subject>Skin</subject><subject>Vasculitis</subject><issn>0303-6987</issn><issn>1600-0560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kU1v1DAQhi0EokvhwB9AlrjAIe04TpzkWC2fUhEc6Nny2pPWVWIHf6hd_gP_GW-zcEDCl5GsZ56Z0UvISwZnrLxznZczxhsOj8iGCYAKWgGPyQY48EoMfXdCnsV4C8BEL9qn5ISDEB10zYb8emdjsu4623hTCl1yTHlSgS7RB6uijVQ5Q5XOCek1Ogxqsj_RULxXLt3grJLP8djmD7h3tPzT3UOvH-kyqTgrvU_eGmrQmWCT1VTjNK3uL_cXdAk-oXXPyZNRTRFfHOspufrw_vv2U3X59ePn7cVlpXnLoVKDVtrwmiOOgo_cMMH6AQFrM3Y7GLFlbb_jaJoawbQD9mwALkbEWvQDaH5K3qzeMvdHxpjkbONhI-WwnCNr1g0NCKiHgr7-B731Obiynax5w2rRCMYL9XaldPAxBhzlEuyswl4ykIeMZMlIPmRU2FdHY97NaP6Sf0IpwPkK3NkJ9_83ye3Vt1X5G1zwnnQ</recordid><startdate>201905</startdate><enddate>201905</enddate><creator>Vyas, Nikki S.</creator><creator>Charifa, Ahmad</creator><creator>Desman, Garrett T.</creator><creator>McNiff, Jennifer M.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5026-1821</orcidid><orcidid>https://orcid.org/0000-0002-1557-300X</orcidid></search><sort><creationdate>201905</creationdate><title>Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein</title><author>Vyas, Nikki S. ; Charifa, Ahmad ; Desman, Garrett T. ; McNiff, Jennifer M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-a9cacd323eef63f3d16189e0e2df7b0fe5158b3ed42e0d59e819036fee26890c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>AGEP</topic><topic>Capillaries</topic><topic>CD123 antigen</topic><topic>Dendritic cells</topic><topic>Diagnosis</topic><topic>Edema</topic><topic>eosinophils</topic><topic>Exocytosis</topic><topic>Inflammation</topic><topic>Interferon</topic><topic>Keratinocytes</topic><topic>Leukocytes (eosinophilic)</topic><topic>Lymphocytes T</topic><topic>MxA</topic><topic>Myxovirus resistance proteins</topic><topic>Papilloma</topic><topic>plasmacytoid dendritic cells</topic><topic>Psoriasis</topic><topic>Pustulosis</topic><topic>Skin</topic><topic>Vasculitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vyas, Nikki S.</creatorcontrib><creatorcontrib>Charifa, Ahmad</creatorcontrib><creatorcontrib>Desman, Garrett T.</creatorcontrib><creatorcontrib>McNiff, Jennifer M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cutaneous pathology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vyas, Nikki S.</au><au>Charifa, Ahmad</au><au>Desman, Garrett T.</au><au>McNiff, Jennifer M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein</atitle><jtitle>Journal of cutaneous pathology</jtitle><addtitle>J Cutan Pathol</addtitle><date>2019-05</date><risdate>2019</risdate><volume>46</volume><issue>5</issue><spage>317</spage><epage>326</epage><pages>317-326</pages><issn>0303-6987</issn><eissn>1600-0560</eissn><abstract>Background
Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities.
Methods
Forty‐three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA.
Results
Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P < 0.05) in favor of a diagnosis of PS. The absence of PDCs and presence of eosinophils favored a diagnosis of AGEP (P < 0.05).
Conclusions
We found compelling evidence for the use of CD123 to highlight PDCs in these cases. The presence of PDCs and expression of MxA in dermal inflammatory infiltrate, as well as absence of eosinophils and presence of tortuous dilated capillaries favored a diagnosis of PS. Expression of MxA in the dermal infiltrate corresponds with a Th1 pathway in PS and may indicate a Th1 component in the early initial phase of AGEP.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>30667074</pmid><doi>10.1111/cup.13430</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5026-1821</orcidid><orcidid>https://orcid.org/0000-0002-1557-300X</orcidid></addata></record> |
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| subjects | AGEP Capillaries CD123 antigen Dendritic cells Diagnosis Edema eosinophils Exocytosis Inflammation Interferon Keratinocytes Leukocytes (eosinophilic) Lymphocytes T MxA Myxovirus resistance proteins Papilloma plasmacytoid dendritic cells Psoriasis Pustulosis Skin Vasculitis |
| title | Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein |
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