title: HTLV-1-associated infective dermatitis demonstrates low frequency of FOXP3-positive T-regulatory lymphocytes.
abstract: BACKGROUND
  Human T-lymphotropic virus (HTLV)-1-associated infective dermatitis (ID) is a rare severe chronic eczema, considered as a harbinger for the development of cutaneous adult T-cell leukemia/lymphoma (ATLL) and/or HTLV-1-associated myelopathy (HAM)/tropical spastic paraparesis (TSP). The pathogenesis of ID remains unclear. High numbers of peripheral blood CD4+ CD25+ FoxP3+ regulatory T cells (Tregs) have been reported in ATLL and HAM/TSP.
  
  
  OBJECTIVE
  To investigate the status of Tregs, unknown to date, and the histopathological features of ID.
  
  
  METHODS
  We studied 16 skin biopsies from 15 Peruvian adults and children with ID by immunohistochemistry.
  
  
  RESULTS
  Histopathological patterns were seborrheic dermatitis-like and lichenoid. Intraepidermal lymphocytes were conspicuous. The infiltrate was composed of a CD3+ T cell infiltrate with a predominance of CD8+ over CD4+ cells. CD4+ CD25+ FoxP3+ Tregs were rare and their numbers were significantly lower than those reported in other inflammatory dermatoses.
  
  
  CONCLUSIONS
  Tregs have an essential role in maintaining immune homeostasis of skin. Treg dysregulation ends in severe clinical manifestations. The clinical presentation of ID, with lesions resembling those seen in patients with atopic dermatitis and with mutations in the FoxP3 gene, is in agreement with a common Treg-deficient skin environment in these disorders, possibly secondary to HTLV-1 infection.
authors: Departments of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA. Electronic address: ctcabala@mdanderson.org.
authors: Carlos A
authors: CA
authors: Torres-Cabala
authors: Departments of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors: Jonathan L
authors: JL
authors: Curry
authors: Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors: Elsa Ml
authors: EM
authors: Li Ning Tapia
authors: Departments of Pathology and Dermatology, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Cesar
authors: C
authors: Ramos
authors: Departments of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors: Michael T
authors: MT
authors: Tetzlaff
authors: Departments of Pathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors: Victor G
authors: VG
authors: Prieto
authors: Hematopathology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
authors: Roberto N
authors: RN
authors: Miranda
authors: Departments of Pathology and Dermatology, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Francisco
authors: F
authors: Bravo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017252:CD3 Complex / Q000032:analysis; D016516:CD4-CD8 Ratio; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004485:Eczema / Q000276:immunology* / Q000473:pathology / Q000821:virology; D005260:Female; D051858:Forkhead Transcription Factors / Q000032:analysis*; D015490:HTLV-I Infections / Q000276:immunology* / Q000473:pathology; D015368:Human T-lymphotropic virus 1; D006801:Humans; D008297:Male; D008875:Middle Aged; D017193:Skin Diseases, Viral / Q000276:immunology* / Q000473:pathology; D050378:T-Lymphocytes, Regulatory / Q000737:chemistry*; D055815:Young Adult
chemical_list: D017252:CD3 Complex; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors
keywords: FoxP3; HTLV-1; Histopathology; Immunohistochemistry; Infective dermatitis; Tregs