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Active psoriasis and profound CD4+ lymphocytopenia

C M Hardman1, B S Baker, J Lortan

  • 1Department of Dermatology, St Mary's Hospital, London, U.K.

The British Journal of Dermatology
|June 1, 1997
PubMed
Summary

A human immunodeficiency virus (HIV)-negative patient with chronic plaque psoriasis and severe CD4+ lymphocytopenia still maintains active skin lesions. Activated CD4+ T cells in his psoriatic plaques suggest these cells are sufficient to sustain the disease process.

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Area of Science:

  • Immunodermatology
  • Clinical immunology

Background:

  • Psoriasis is a chronic inflammatory skin disease.
  • CD4+ T cells play a crucial role in psoriatic pathogenesis.
  • Lymphocytopenia, a low lymphocyte count, can impact immune function.

Observation:

  • A human immunodeficiency virus (HIV)-negative patient presented with widespread chronic plaque psoriasis and profound CD4+ lymphocytopenia.
  • The patient had a history of numerous cutaneous malignancies and viral warts.
  • Despite low peripheral blood CD4+ T-cell counts, activated CD4+ T cells were present in his psoriatic plaques.

Findings:

  • The number of activated CD4+ T cells in the patient's psoriatic plaques was comparable to that in individuals without lymphocytopenia.
  • This suggests that localized T-cell activation within the skin can persist even with systemic CD4+ T-cell deficiency.

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  • The findings indicate that sufficient activated CD4+ T cells are present in psoriatic plaques to maintain the disease.

    • Implications:

    • This case highlights a potential dissociation between peripheral blood T-cell counts and T-cell activity at the site of skin inflammation.
    • Understanding this mechanism could offer new insights into the management of psoriasis in patients with lymphocytopenia.
    • Further research is warranted to explore the specific roles of CD4+ T cells in psoriasis and their implications in immune-compromised states.