title: Interleukin 4 and interferon-gamma expression of the dermal infiltrate in patients with erythroderma and mycosis fungoides. An immuno-histochemical study.
abstract: BACKGROUND
  Erythroderma, or generalized erythema of the skin, may result from different causes. At present it is unclear whether the underlying patho-mechanisms that lead to erythroderma are identical or different depending on the original disease. The aim of this study was to investigate the dermal cytokine profile in different types of erythroderma and mycosis fungoides.
  
  
  METHODS
  Snap-frozen skin biopsy specimens from 33 patients with erythroderma were studied. Thirteen had idiopathic erythroderma, 7 erythrodermic atopic dermatitis, 5 Sézary syndrome and 8 had erythroderma from miscellaneous causes. We also studied 6 patients with mycosis fungoides (5 plaques and 1 tumor) and 5 healthy non-atopic volunteers. The biopsies were immunohistochemically stained for interleukin 4 (IL-4) and interferon gamma (IFN-gamma). All positive cells for IL-4 and IFN-gamma in the dermis were counted and the number of positive cells was calculated per mm2. IL-4/IFN-gamma ratio was calculated for each biopsy.
  
  
  RESULTS
  The patients with idiopathic erythroderma, atopic dermatitis and miscellaneous erythroderma, all showed more IFN-gamma-positive cells than IL-4-positive cells in the dermis. The median IL-4/ IFN-gamma ratio for these three groups was 0.6, 0.9 and 0.45, respectively. These differences were not statistically significant. All patients with Sézary syndrome however, showed more IL-4-positive cells than IFN-gamma-positive cells. The median IL-4/IFN-gamma ratio was 1.8, which is significantly higher than in the other groups p<0.05). In mycosis fungoides roughly the same number of cells expressed IL-4 and IFN-gamma. The median IL-4/IFN-gamma ratio was 1.0, which is significantly lower than in Sézary syndrome (p<0.05).
  
  
  CONCLUSIONS
  The dermal infiltrate in patients with Sezary syndrome mainly shows a T-helper 2 (Th2) cytokine profile, this in contrast to T-helper 1 (Th1) cytokine profile in benign reactive erythroderma. This indicates that although a relative uniform clinical picture of erythroderma is obvious, a different patho-mechanisms may be underlying.
authors.affiliation: Department of Dermatology and Allergology, University Medical Center Utrecht, The Netherlands. v.sigurdsson@azu.nl
authors.forename: V
authors.initials: V
authors.lastname: Sigurdsson
authors.forename: J
authors.initials: J
authors.lastname: Toonstra
authors.forename: I C
authors.initials: IC
authors.lastname: Bihari
authors.forename: C A
authors.initials: CA
authors.lastname: Bruijnzeel-Koomen
authors.forename: W A
authors.initials: WA
authors.lastname: van Vloten
authors.forename: T
authors.initials: T
authors.lastname: Thepen
mesh_terms: D000911:Antibodies, Monoclonal; D001706:Biopsy; D003873:Dermatitis, Exfoliative / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007124:Immunoenzyme Techniques; D007371:Interferon-gamma / Q000378:metabolism*; D015847:Interleukin-4 / Q000378:metabolism*; D009182:Mycosis Fungoides / Q000378:metabolism* / Q000473:pathology; D012751:Sezary Syndrome / Q000378:metabolism* / Q000473:pathology; D012867:Skin / Q000378:metabolism; D012878:Skin Neoplasms / Q000378:metabolism* / Q000473:pathology; D018417:Th1 Cells / Q000378:metabolism; D018418:Th2 Cells / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D015847:Interleukin-4; D007371:Interferon-gamma