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Perineural inflammation in morphea (localized scleroderma): systematic characterization of a poorly recognized but
Catharine A Dhaliwal1, Andrew I MacKenzie, Asok Biswas
1Department of Pathology, Western General Hospital, Edinburgh, UK.
Abstract:
The association between morphea and perineural inflammation has been reported sporadically but never studied systematically. To assess the prevalence and nature of perineural inflammation in various clinicopathologic stages of morphea and a cohort of other inflammatory dermatoses, 80 morphea and 36 control skin biopsies were studied using hematoxylin/eosin and S100 stains. Perineural inflammation was semiquantitatively analyzed (scored), which along with the pattern (concentric vs. marginal) and cellular composition was compared in the two groups. Perineural inflammation was identified in 84% and 61% of morphea and control cases, respectively. Examination of only routinely stained sections could still detect this feature in 58% of morphea and 33% of control biopsies. Mean perineural inflammation score in morphea (0.65) was significantly higher than in the control group (0.23) (p < 0.0001) and the inflammation tended to show a concentric pattern with plasma cell neurotropism. Intraneural inflammation was limited to four morphea cases. Although perineural inflammation is common in morphea, it is not unusual to find this feature in other inflammatory conditions. Nevertheless, perineural inflammation can serve as an important diagnostic adjunct in difficult cases of morphea if one considers its greater intensity, predominantly concentric pattern and the tendency to show plasma cell neurotropism.
Insights
Perineural inflammation is common in morphea (84% of cases) and often more intense than in other inflammatory skin conditions. This finding can aid in diagnosing challenging morphea cases.
Area of Science:
- Dermatopathology
- Inflammatory Dermatoses
Background:
- Perineural inflammation association with morphea reported sporadically.
- Systematic study on perineural inflammation in morphea lacking.
Purpose of the Study:
- Assess prevalence and nature of perineural inflammation in morphea.
- Compare perineural inflammation in morphea versus other inflammatory dermatoses.
Main Methods:
- Analyzed 80 morphea and 36 control skin biopsies.
- Used hematoxylin/eosin and S100 stains.
- Semiquantitatively scored perineural inflammation, analyzing pattern and cellular composition.
Main Results:
- Perineural inflammation found in 84% of morphea and 61% of controls.
- Mean inflammation score significantly higher in morphea (0.65 vs. 0.23).
- Morphea cases showed predominantly concentric pattern with plasma cell neurotropism.
Conclusions:
- Perineural inflammation is a common feature in morphea.
- While present in other conditions, its intensity and pattern aid morphea diagnosis.
- Perineural inflammation can be a valuable diagnostic adjunct for morphea.
