INVOLVEMENT OF CELL-ADHESION AND ACTIVATION MOLECULES IN THE PATHOGENESIS OF ERYTHEMA DYSCHROMICUM PERSTANS (ASHY DERMATITIS) - THE EFFECT OF CLOFAZIMINE THERAPY

Objectives: To assess the expression of several cell adhesion and lymp hocyte activation molecules in erythema dyschromicum perstans lesions, and to evaluate the effect of clofazimine therapy on the expression o f these molecules. Design and Methods: A prospective study. Skin biops y samples were obtained from patients before and after 3 months of clo fazimine therapy, and the expression of cell adhesion and activation m olecules was assessed by an immunohistochemical technique. Setting: Th is study was performed in a clinical referral center and an immunology research laboratory. Patients: We studied 6 patients with erythema dy schromicum perstans. A diagnosis was made on the basis of clinical and histological criteria. Two patients discontinued participation in the study: one because of adverse effects and the other for unknown reaso ns. Interventions: Patients were treated with clofazimine, 100 mg/d, f or 3 months.Main Outcome Measures: Expression of cell adhesion and lym phocyte activation molecules in skin biopsy specimens before and after clofazimine therapy. Results: Before clofazimine therapy, we detected a noticeable expression of intercellular adhesion molecule 1 and majo r histocompatibility complex class II molecules (HLA-DR) in the kerati nocyte basal cell layer. In addition, CD36, a thrombospondin receptor that is not expressed by normal skin, was detected in the strata spino sum and granulosum. The dermal cell infiltrate expressed the activatio n molecule AIM/CD69 acid the cytotoxic cell marker CD94. After clofazi mine therapy, the expression of intercellular adhesion molecule 1 and HLA-DR disappeared, as well as the mononuclear cell infiltrate. Conclu sions: Our results suggest that some cell adhesion and activation mole cules are involved in the pathogenesis of erythema dyschromicum persta ns. Clofazimine appears to have an important effect on the inflammator y phenomenon of erythema dyschromicum perstans.