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Journal of the American Academy of Dermatology
Volume 71, n° 1
pages 100-107 (juillet 2014)
Doi : 10.1016/j.jaad.2014.01.892
accepted : 21 January 2014
Dermatopathology

Comparative analysis of rosacea and cutaneous lupus erythematosus: Histopathologic features, T-cell subsets, and plasmacytoid dendritic cells
 

Theodore T. Brown, MD a, Eun-Young K. Choi, MD a, Dafydd G. Thomas, MD, PhD a, Alexandra C. Hristov, MD a, b, May P. Chan, MD a, b,
a Department of Pathology, University of Michigan, Ann Arbor, Michigan 
b Department of Dermatology, University of Michigan, Ann Arbor, Michigan 

Reprint requests: May P. Chan, MD, Department of Pathology, University of Michigan, 1301 Catherine St, Medical Science I, M3261, Ann Arbor, MI 48109.
Abstract
Background

Distinction of rosacea and cutaneous lupus erythematosus (LE) can be challenging because of significant clinical and histologic overlap. A controlled study comparing these conditions is lacking.

Objective

We compared the histologic features, T-cell subsets, and plasmacytoid dendritic cells in rosacea and LE.

Methods

Biopsy specimens of rosacea (n = 27) and facial LE (n = 30) were retrospectively reviewed and reacted with Alcian blue and periodic acid–Schiff stains, and CD4, CD8, CD25, and CD123 immunostains.

Results

LE demonstrates a lower CD4:CD8 ratio (1.74 vs 2.80, P  = .0064), fewer CD4+CD25+ regulatory T cells (13% vs 31%, P < .0001), and more CD123+ plasmacytoid dendritic cells (18% vs 6%, P  = .0137) than rosacea. The plasmacytoid dendritic cells in LE are more likely to form clusters (P  = .0137) and comprise at least 20% of the infiltrate (P  = .0340). Also associated with LE are follicular plugging (P  = .0039), perineural lymphocytic infiltrate (P  = .0211), abundant mucin deposition (P  = .0031), and conspicuous basement membrane thickening (P  = .0073), whereas Demodex infestation (P  = .0064) and sebaceous hyperplasia (P  = .0029) are significantly associated with rosacea.

Limitations

Although statistically significant, the immunophenotypic differences are rather small and limited for routine use.

Conclusion

The infiltrates in rosacea and LE differ immunophenotypically, and may aid in their distinction in addition to conventional histologic examination.

The full text of this article is available in PDF format.

Key words : CD123, CD25, CD4:CD8 ratio, immunophenotype, lupus erythematosus, plasmacytoid dendritic cells, regulatory T cells, rosacea

Abbreviations used : LE, PAS, PDC, Treg



 Supported by University of Michigan Anatomic Pathology Projects Committee.
 Conflicts of interest: None declared.



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