RESEARCH - Anti-thyroid autoantibody-associated interface dermatitis in UCTD

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J Rheumatol. 2006 Dec 15; [Epub ahead of print]

Anti-Thyroid Autoantibody-Associated Interface Dermatitis in Individuals

with Undifferentiated Connective Tissue Disease - An Unrecognized Subset of

Autoimmune Disease?

Cheng W, Gilliam AC, Castrovinci A, Pazirandeh M.

From the Department of Dermatology and Division of Rheumatology, Department

of Internal Medicine, Case/University Hospitals of Cleveland, Cleveland,

Ohio, USA.

OBJECTIVE: Skin conditions in individuals with undifferentiated connective

tissue disease (UCTD) are poorly classified and characterized, and

autoantibodies in serum can be heterogeneous and not always specific. We

have identified a new subset of individuals with UCTD, interface dermatitis,

and increased anti-thyroid antibodies. METHODS: We retrospectively reviewed

892 cases of individuals with UCTD. Serologic markers for CTD and

autoantibodies against microsomes and/or thyroglobulin were analyzed. Skin

lesions and medication history were documented, and persistent or recurrent

skin lesions were biopsied. RESULTS: Anti-thyroid antibodies for

thyroglobulin and/or microsomes (ATAb) were positive in 526 (59%). The

ATAb(+) and ATAb(-) groups had similar antinuclear antibody (ANA) positivity

(32% vs 28%, respectively), average age (59 vs 58 yrs), and female-male

ratio (8:1 vs 6:1). ATAb positivity was significantly associated with a

dermatitis manifested as erythematous macules/patches or papules on legs,

upper arms, back, and shoulders in 9% (47/526) of ATAb(+) individuals versus

2% (7/366) in ATAb(-) individuals (p < 0.0001). Seventeen individuals with

dermatitis, 15 ATAb(+) and 2 ATAb(-), had biopsies. Twelve biopsies (80%)

from ATAb(+) individuals and one ATAb(-) individual showed a cell-poor

lymphocytic interface dermatitis with vaculopathy of basal layer

keratinocytes, dermal mucin deposition, and perivascular mononuclear

inflammatory cell infiltrates in the upper dermis that spared eccrine

glands. The interface dermatitis was not significantly associated with hypo-

or hyperthyroidism, or medications.

CONCLUSION: We describe an ATAb-associated interface dermatitis in roughly

9% of ATAb(+) patients with UCTD, which may represent a new subset of

autoimmune disease. ATAb may be a useful marker for some individuals with

UCTD.

PMID: 17183617

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

7183617

Not an MD