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skin autoantibodies 657 skin immunity
Sjögren’s syndrome.
(LE) cell test is positive in 25% of patients. Numerous
antibodies are produced, including autoantibodies against
salivary duct cells, gastric parietal cells, thyroid antigens,
and smooth muscle mitochondria. Antibodies against
ribonucleoprotein antigens are termed Ro/SSA and La/SSB.
Approximately 90% of the patients have these antibodies.
Anti-SSB shows greater specificity for Sjögren’s syndrome
than do anti-SSA antibodies that also occur in SLE. Patients
who have Sjögren’s syndrome with rheumatoid arthritis may
have antibodies to rheumatoid-associated nuclear antigen
(RANA). A positive correlation exists between HLA-DR3
and primary Sjögren’s syndrome and between HLA-DR4
and secondary Sjögren’s syndrome associated with rheumatoid
arthritis. Genetic predisposition, viruses, and disordered
immunoregulation may play a role in pathogenesis.
About 90% of the patients are 40- to 60-year old females.
In addition to dry eyes and mouth and associated visual or
swallowing difficulties, 50% of the patients show parotid
gland enlargement. Drying of the nasal mucosa is accompanied
by bleeding, pneumonitis, and bronchitis. A lip biopsy
to examine minor salivary glands is needed to diagnose
Sjögren’s syndrome. Inflammation of the salivary and
lacrimal glands was previously called Mikulicz’s disease.
Mikulicz’s syndrome is enlargement of the salivary and lacrimal
glands due to any cause. Enlarged lymph nodes that
reveal a pleomorphic cellular infiltrate with many mitoses
are typical of Sjögren’s syndrome and have been referred
to as pseudolymphoma. Patients have a 40-fold greater risk
than others for lymphoid neoplasms.
skin autoantibodies
Autoantibodies detectable by immunofluorescence associated
with selected bullous skin diseases and useful for
categorizing them. The three principal categories of bullous
skin diseases are intraepidermal bullae with an immunological
etiology, subepidermal bullae with immunological
pathogenesis, and nonimmune bullous disorders.
skin-associated lymphoid tissue (SALT)
Diffuse epidermal T cells, including αβ and γδ T cells and
dendritic (Langerhans) cells together with dermal αβ T
cells, fibroblasts, macrophages, and lymphatic vessels.
skin-fixing antibody
An antibody such as immunoglobulin E (IgE) retained in
the skin following local injection as in passive cutaneous
anaphylaxis. Antibody with this property was referred to
previously as reagin before IgE was described.
Early depiction of skin grafts from forehead, neck, and cheek used to restore
mutilation of the nose, ear, and lip.
skin graft
Skin from an individual (autologous graft) or donor skin
applied to areas of the body surface that have undergone
third-degree burns. A patient’s keratinocytes may be
cultured into confluent sheets that can be applied to the
affected areas, although these may not “take” because of
the absence of type IV collagen 7S basement membrane
sites for binding and fibrils to anchor the graft.
skin immunity
The skin, the largest organ of the body, shields the interior
environment from a hostile exterior. The skin defends the
host through stimulation of inflammatory and local immune
responses. Antigen applied to or injected into the skin
drains to the regional lymph nodes through the skin’s extensive
lymphatic network. Cells of the epidermis and papillary
and reticular dermis play critical roles in the skin’s
immune function. Keratinocytes (epidermal epithelial cells)
secrete various cytokines such as granulocyte–macrophage
colony-stimulating factor (GM-CSF), interleukin-1 (IL1),
IL3, IL6, and tumor necrosis factor (TNF). T lymphocytes
in the skin may secrete interferon-γ (IFN-γ) and other
cytokines that cause these epithelial cells to synthesize
chemokines that lead to leukocyte chemotaxis and activation.
Stimulation by IFN-γ may also lead to expression of
major histocompatibility complex (MHC) class II molecules.
Other epidermal cells include Langerhans’ cells that
form an extensive network in the epidermis that permits
their interaction with any antigen entering the skin. The
few lymphocytes in the epidermis are principally CD8 + T
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