Magro C M, Crowson A N
Department of Pathology, Beth Israel Hospital, Boston, Massachusetts.
Int J Dermatol. 1994 Mar;33(3):172-8. doi: 10.1111/j.1365-4362.1994.tb04943.x.
We encountered 10 patients whose biopsies showed an eosinophilic pustular follicular reaction, a histomorphology alleged to be pathognomonic of eosinophilic folliculitis (EF). Only seven of these patients fell within the clinical spectrum of EF. Seven patients had conditions associated with immune dysfunction, including three patients with an atopic history. Potential antigenic stimuli could be elicited in six cases.
Formalin-fixed biopsy specimens from all 10 patients were available for examination. Hematoxylin and eosin-, alcian blue-periodic acid-Schiff (PAS)- and PAS-diastase-stained sections cut from paraffin-embedded tissue were examined by light microscopy. Immunoperoxidase preparations with antibody to IgE were performed on paraffin sections and the number of IgE-decorated cells quantitated in each case. Four patients also had biopsy material submitted in Michel's medium, on which direct immunofluorescent studies were conducted.
IgE-coated mononuclear cells were present in patients whose lesions would logically be expected to derive from dominant type I hypersensitivity mechanisms and absent or minimal in biopsies from those patients in whom the pathogenetic basis of lesions derived principally from cell-mediated immunity.
The eosinophilic pustular follicular reaction, while characteristic of EF, is not exclusive to that entity. It represents an expression of an excessive immediate or delayed-type hypersensitivity reaction to various auto-, epicutaneous, or ingested stimuli. A background of immune dysregulation may be contributory.
我们遇到了10例活检显示嗜酸性脓疱性毛囊反应的患者，这种组织形态学被认为是嗜酸性毛囊炎（EF）的特征性表现。这些患者中只有7例属于EF的临床范畴。7例患者有与免疫功能障碍相关的疾病，其中3例有特应性病史。6例患者可引发潜在的抗原刺激。
所有10例患者的福尔马林固定活检标本可供检查。对石蜡包埋组织切片进行苏木精和伊红染色、阿尔辛蓝-过碘酸希夫（PAS）染色以及PAS-淀粉酶染色，通过光学显微镜检查。对石蜡切片进行抗IgE抗体的免疫过氧化物酶制备，并对每例中IgE标记细胞的数量进行定量。4例患者还提交了保存在米歇尔培养基中的活检材料，并进行了直接免疫荧光研究。
在那些病变理论上预期源于主要的I型超敏反应机制的患者中存在IgE包被的单核细胞，而在那些病变发病机制主要源于细胞介导免疫的患者的活检标本中则不存在或数量极少。
嗜酸性脓疱性毛囊反应虽然是EF的特征，但并非该疾病所特有。它代表了对各种自身、经皮或摄入刺激的过度即刻或迟发型超敏反应的一种表现。免疫调节异常的背景可能起作用。
