CUTANEOUS INFLAMMATION LIMITED TO THE REGION OF THE ULCER IN CHRONIC VENOUS INSUFFICIENCY

Background: The role of inflammatory reactions in the pathogenesis of chronic venous insufficiency and the persistence of venous ulcerations is still not totally clear and remains a hotly debated topic. An inve stigation of the intensity and distribution of ICAM-1 expression and d ifferent inflammatory cells should help clarify whether inflammatory p rocesses are limited locally to the area of the ulcer or if an upregul ation can also be observed in clinically unaffected skin of CVI-III pa tients, as a sign of a primary inflammatory process. Patients and meth ods: We examined two skin areas in 10 patients with venous ulcerations . One area was at the border of the ulcer and another in clinically un affected skin (distance from the ulcer: 12.6 +/- 5.1 cm). In addition skin specimens were obtained from the perimalleolar skin of 10 healthy controls. Our histological and immunohistochemical examinations were focused on inflammatory cells (B and T lymphocytes, macrophages, and m ast cells) and on the adhesion molecule ICAM-1. Results: A very strong expression of ICAM-1 could be seen at the border of the ulcer: This t issue also showed a dense infiltration, mainly by T lymphocytes and ma crophages. In some cases the tissue was infiltrated by an increased nu mber of mast cells. This is the typical picture of a chronic inflammat ory reaction. Compared to healthy controls, the clinically unaffected skin of patients showed not an increased expression of ICAM-1 and only in some cases we could find a flight perivascular infiltrate of T lym phocytes. Conclusions: These data imply that the upregulation of endot helial adhesion molecules (ICAM-1) and dermal infiltration by T lympho cytes and macrophages in CVI-III patients is limited to the region of the ulcer; or at least to skirt areas with a severe microangiopathy, a nd is part of a secondary elimination of necrotic tissue (an 'injury a nd repair' process). These local chronic inflammatory reactions are ce rtainly an important factor in the persistence and recurrence of venou s ulcerations.