Skin Immunologic - Pathology
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General
- Classification:
- Hypersensitivity - response to normally harmless substances
- Auto-immune - antobodies or T-cells reactive against self-antigens
- Mostly involves mixture of types described below
Type I reactions
- Mediated by pharmacologically active substances from mast cells and basophils
- Due to antigen-antibody (usually IgE) binding to receptors on those cells
- Substances include histamine, serotonin, leukotriens, prostaglandins
- Can be systemic or local
- Skin becomes pruritic, raised erythematous borders of wheals
- Immediate reaction
- Includes:
- Atopic dermatitis
- Urticaria
- Angioedema
- Fly bite hypersensitivity
- Gastrointestinal parasites
- Food
- Microscopically:
- Capillary dilation, oedema, mast cell degranulation, eosinophil infiltration
Type II reactions
- Cytotoxic reaction
- IgG and IgM interaction with antigens bound to cellular membranes
- Often involves complement fixation -> cellular damage
- In skin - circulating antibody to proteins of desmosomes in intercellular areas along basement membranes at epidermal-dermal junction
- Includes:
Type III reactions
- Complement fixing immune complexes
- IgG or IgM
- Complexes deposit in tissue -> fix complement -> cytokines and othe factors attrack neutrophils -> release lysosomal enzymes, activation of complement and coagulation, platelet aggregation -> tissue damage
- Immune complex vasculitis -> purpura haemorrhagica
- Includes:
Type IV reactions
- Delayed hypersensitivity
- Haptens bind to carrier proteins (mainly epidermal)
- Mediated by sensitised T-cells -> release cytokines +/- recruit lymphocytes
- Used in diagnosis of tuberculosis, histoplasmosis and coccidiomycosis
- Perivascular mononuclear cell accumulation
Hypersensitivity reactions
Allergic contact dermatitis
- Usually involves Type IV reaction
- Pruritic lesions with self-inflicted trauma
- At areas in contact with allergen
- Grossly:
- Erythema, papules, +/- vesicles, exudation -> crusts
- If chronic, lichenification, hyperpigmentation, alopecia
- Microscopically:
- Spongiotic superficial perivascular dermatitis
- Mononuclear cells
- If chronic, epidermal hyperplasia
- May involve eosinophils
Atopy
- Involves Type I reaction
- Mainly causes pruritus
- Dogs - face rubbing and foot licking; secondary pyoderma or seborrhea
- Cats - facial, ear or generalised pruritus, miliary dermatitis, eosinophilic granuloma complex, symmetric alopecia
- Horses - pruritic hea, pinnae, ventrum, legs, tailhead or recurrent urticaria
- Lesions generally due to self-trauma
- Microscopically:
- Hyperplastic superficial perivascular dermatitis
- Mast cells, eosinophils, nonmetachromatic mononuclear cells
- Perivascular inflammation may be involved especially in horses
Culicoides Hypersensitivity
Flea Bite Hypersensitivity
Autoimmune reactions
Bullous pemphigoid
- Dogs and horses
- Involves oral cavity, mucocutaneous junctions, groin and axilla
- Subepidermal vesicles and bullae
- Antibodies bound to basement membrane
- Grossly:
- Similar to Pemphigus vulgaris
- Microscopically:
- Bullae containing fibrin, neutrophils or eosinophils
- Basement membrane forms floor of bullae and roof is lined with basal cells
- Bullae may rupture -> ulcers
Dermatomyositis
- See also Canine dermatomyositis
- Affects puppies of collies and shetland sheepdogs from 8 weeks of age
- Lesions - vesiculating dermatitis
- Face, lips, external ears, later distal extremities
- Microscopically: interface dermatitis and basal cell degeneration of epidermis and follicular wall, atrophy of follicles, epidermal vesicles and pustules, dermal scarring
Lupus erythematosus
- Systemic (SLE)
- Multiple organs involved
- Cats, dogs, horses
- Immune dysregulation:
- Damaged T-cell suppressor function, either primary deficiency or antibody mediated
- Cytokine dysregulation
- Resulting B-cell hyperactivity -> antibodies to self antigens -> antigen-antibody complexes deposited in various tissues -> Type III hypersensitivity
- Lesions localised or generalised
- Erythema, alopecia, depigmentation, crusting and scaling, ulceration
- Microscopically: lymphohistiocytic interface dermatitis, thickened basement membrane, vasculitis, subepidermal vesicles, basal cell degeneration
- Discoid
- Milder variant of systemic
- Depigmentation, erythema, scaling, erosions, ulceration, crusting
- Usually involves nasal planum, dorsum of muzzle, occasionally pinnae, lips, oral mucosa or periocular area
- Microscopically: lichenoid interface dermatitis, often with lymphocytes, plasma cells, basal cell degeneration, loss of pigment