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Erythema elevatum diutinum – evidence for disease‐dependent leucocyte alterations and response to dapsone
Author(s) -
Grabbe J.,
Haas N.,
Möller A.,
Henz B.M.
Publication year - 2000
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1046/j.1365-2133.2000.03673.x
Subject(s) - dapsone , medicine , vasculitis , immunology , immune system , erythema , dermis , pathology , disease
Erythema elevatum diutinum (EED) is a type of leucocytoclastic vasculitis of unknown aetiology. We report a patient with unusually widespread and disabling EED that had been unresponsive to corticosteroids and antibiotics, but resolved on dapsone. Biopsies of fresh lesions showed typical features of leucocytoclastic vasculitis, with prominent neutrophil infiltration, marked expression of the β 2 ‐integrins CR3 and LFA‐1, and increased mast cell numbers. Older lesions exhibited granulation tissue and fibrosis, macrophages were more dominant, β 2 ‐integrins were expressed less markedly, and mast cell numbers were lower. In vitro chemotaxis of the patient’s peripheral blood neutrophils prior to treatment showed increased random migration and directed migration towards interleukin‐8 (by 424%), but a profoundly decreased responsiveness towards the bacterial peptide analogue N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP) (by 98%). These values returned to normal after dapsone treatment and clinical improvement 5 months later. These findings support the concept that in EED, activation via cytokines such as interleukin‐8 allows a selective recruitment of leucocytes to tissue sites, while immune complexes and bacterial peptides sustain the persistent local inflammatory infiltrate and the leucocytoclastic vasculitis.