Chandrasekaran Yazhini, Radhakrishnan Balaji, Ganapathy Shivasekar
Department of Pathology, Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Centre, Sri Ramaswamy Memorial Institute of Science and Technology (SRMIST), Chengalpattu, IND.
Cureus. 2024 Oct 17;16(10):e71702. doi: 10.7759/cureus.71702. eCollection 2024 Oct.
Introduction Psoriasis involves rapid cell growth and abnormal differentiation of skin cells. Dysregulation of apoptosis has been proposed in the pathogenesis of psoriasis. The role of Bcl-2 as an anti-apoptotic protein in pathogenesis has not been studied in detail in these cases. Our study aims to evaluate the expression of Bcl-2 in different skin compartments in psoriasis and psoriasiform dermatitis cases. Materials and methodology An analytical cross-sectional study was performed using paraffin blocks of psoriasis and psoriasiform dermatitis patients between 2022 and 2023. For light microscopy screening, sections were initially stained with hematoxylin and eosin stains. In further sections, a primary antibody against Bcl-2 was applied. The level of Bcl-2 expression in keratinocytes of supra-basal and basal epidermal layers and dermal lymphocytes was evaluated using a scoring system. Results Sixty patients, 30 with psoriasis and 30 with psoriasiform dermatitis were included. Among the histopathological features, parakeratosis (p - 0.038), Munro's microabscesses (p - 0.001), supra-papillary plate thinning (p - 0.004), and increased dermal vasculature (p - 0.001) were significantly associated with psoriasis when compared with psoriasiform dermatitis. Most psoriatic lesions had hypogranulosis whereas it was alternating hypo and hypergranulosis in psoriasiform dermatitis (p - 0.001). Acanthosis was regular in psoriasis lesions (p - 0.036). Bcl-2 expression was seen in dermal lymphocytes in all psoriasis and psoriasiform lesions with significantly stronger positive expression compared to basal and supra-basal layers. Psoriasis cases demonstrated more significant Bcl-2 positivity in dermal lymphocytes and basal layers than psoriasiform dermatitis cases. Conclusion Bcl-2 has stronger expression in dermal lymphocytes and basal layers than supra-basal layers, which comply with the proposed pathogenesis. Increased Bcl-2 expression in psoriasis cases compared with other psoriasiform dermatitis lesions implies the more chronic and recurrent nature of the disease.
引言
银屑病涉及皮肤细胞的快速生长和异常分化。细胞凋亡失调被认为与银屑病的发病机制有关。在这些病例中，抗凋亡蛋白Bcl-2在发病机制中的作用尚未得到详细研究。我们的研究旨在评估Bcl-2在银屑病和银屑病样皮炎病例不同皮肤层中的表达情况。
材料与方法
采用2022年至2023年间银屑病和银屑病样皮炎患者的石蜡块进行分析性横断面研究。用于光学显微镜筛查时，切片最初用苏木精和伊红染色。在进一步的切片中，应用抗Bcl-2的一抗。使用评分系统评估基底上层和基底层角质形成细胞以及真皮淋巴细胞中Bcl-2的表达水平。
结果
纳入60例患者，其中30例患有银屑病，30例患有银屑病样皮炎。在组织病理学特征中，与银屑病样皮炎相比，银屑病的角化不全（p = 0.038）、Munro微脓肿（p = 0.001）、乳头上方板变薄（p = 0.004）和真皮血管增多（p = 0.001）与银屑病显著相关。大多数银屑病皮损有颗粒层减少，而银屑病样皮炎则表现为颗粒层减少与增多交替（p = 0.001）。银屑病皮损中的棘层肥厚是规则的（p = 0.036）。在所有银屑病和银屑病样皮损的真皮淋巴细胞中均可见Bcl-2表达，与基底上层和基底层相比，阳性表达明显更强。银屑病病例真皮淋巴细胞和基底层的Bcl-2阳性比银屑病样皮炎病例更显著。
结论
Bcl-2在真皮淋巴细胞和基底层中的表达强于基底上层，这与所提出的发病机制相符。与其他银屑病样皮炎皮损相比，银屑病病例中Bcl-2表达增加意味着该疾病更具慢性和复发性。
