title: Human T-lymphotropic virus 1 (HTLV-1)-associated lichenoid dermatitis induced by CD8+ T cells in HTLV-1 carrier, HTLV-1-associated myelopathy/tropical spastic paraparesis and adult T-cell leukemia/lymphoma.
abstract: Human T-lymphotropic virus type 1 (HTLV-1) induces adult T-cell leukemia/lymphoma (ATLL), HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and carrier. ATLL is a mature CD4+ CD25+ CCR4+ T-cell neoplasm, and approximately half of patients have direct skin involvement manifesting patch, plaque, tumor, multiple papules, erythroderma and purpura. However, there exist secondary eruptions without tumor cell infiltration in patients with ATLL or HAM/TSP and carriers of HTLV-1. To clarify the presence of reactive skin eruptions in HTLV-1-infected individuals, we reviewed our patients with HTLV-1-associated diseases. In 2002-2012, we saw 50 ATLL or HAM/TSP patients and HTLV-1 carriers presenting with skin lesions. We retrospectively selected cases that histologically showed lichenoid tissue reactions with predominant infiltration of CD8+ T cells, but not CD4+ tumor cells. The cases included erythroderma (HTLV-1 carrier), lichen planus (HTLV-1 carrier), alopecia areata (HAM/TSP), chronic actinic dermatitis (HTLV-1 carrier to acute ATLL conversion) and discoid lupus erythematosus (smoldering ATLL). They were graft-versus-host disease-like, major secondary lesions and seen in HTLV-1 carriers and patients with HAM/TSP and smoldering ATLL. We coin the term HTLV-1-associated lichenoid dermatitis (HALD) to encompass the conditions. HALD may occur in association with the elevated immunity toward HTLV-1-infected CD4+ T cells, thus sharing the pathogenetic role of cytotoxic T cells with HAM/TSP.
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tokura
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Kawakami
authors.affiliation: Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sugita
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kasuya
authors.affiliation: Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Tatsuno
authors.affiliation: Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sawada
authors.affiliation: Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Dermatology and Wound Healing, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Shimauchi
mesh_terms: D000328:Adult; D000368:Aged; D018414:CD8-Positive T-Lymphocytes / Q000502:physiology*; D005260:Female; D015490:HTLV-I Infections / Q000150:complications*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications*; D017512:Lichenoid Eruptions / Q000276:immunology / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015493:Paraparesis, Tropical Spastic / Q000150:complications*; D012867:Skin / Q000473:pathology
keywords: CD8+ T cell; adult T-cell leukemia/lymphoma carrier; cytotoxic lymphocytes; human T-lymphotropic virus 1-associated myelopathy; human T-lymphotropic virus type 1; lichenoid dermatitis