Atrophying pityriasis versicolor as an idiosyncratic T cell-mediated response to Malassezia: A case series.
BACKGROUND
Atrophying pityriasis versicolor (PV), first described in 1971, is a rare variant in which lesions appear atrophic.


OBJECTIVE
We sought to determine the pathophysiology of atrophying PV.


METHODS
A retrospective chart review identified 6 cases of atrophying PV. In all cases, routine light microscopy, an elastic tissue stain, and immunohistochemical assessment for the expression of CD3, CD4, CD8, GATA3 and CXCR3 was performed.


RESULTS
All cases demonstrated hyperkeratosis with intracorneal infiltration by pathogenic hyphal forms as well as epidermal attenuation and papillary dermal elastolysis. A supervening, mild-to-moderate, superficial lymphocytic infiltrate was noted and characterized by a focal CD8+T cell-mediated interface dermatitis along with a mixed T-cell infiltrate composed of GATA3+and CXCR3+T cells.


CONCLUSIONS
Small sample size and the loss of some patients to follow-up.


CONCLUSIONS
Atrophying PV represents the sequelae of a mixed helper T-cell (TH1 and TH2) idiosyncratic immune response to Malassezia and can present as a protracted dermatosis that may clinically mimic an atypical lymphocytic infiltrate. TH1 cytokines can recruit histiocytes, a source of elastases, and upregulate matrix metalloproteinase activity, which may contribute to epidermal atrophy.
University of Alberta, Edmonton, Canada.
Jonathan Michael Stephen
JM
Levy
Weill Cornell Medical College, Manhattan, New York. Electronic address: cym2003@med.cornell.edu.
Cynthia
C
Magro
D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D001284:Atrophy; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D003937:Diagnosis, Differential; D005260:Female; D050990:GATA3 Transcription Factor / Q000032:analysis; D006644:Histiocytes / Q000201:enzymology / Q000276:immunology; D006801:Humans; D016130:Immunophenotyping; D008178:Lupus Erythematosus, Cutaneous / Q000175:diagnosis; D008290:Malassezia / Q000276:immunology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000175:diagnosis; D054367:Receptors, CXCR3 / Q000032:analysis; D012189:Retrospective Studies; D018417:Th1 Cells / Q000276:immunology*; D018418:Th2 Cells / Q000276:immunology*; D014010:Tinea Versicolor / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology
D015703:Antigens, CD; C515187:CXCR3 protein, human; D050990:GATA3 Transcription Factor; C494749:GATA3 protein, human; D054367:Receptors, CXCR3
CD4; CD8; CXCR3; GATA3; Malassezia; T(H)1; T(H)2; atrophy; pityriasis versicolor