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Anti-Thyroid Autoantibody-Associated Interface Dermatitis in Individuals with Undifferentiated Connective Tissue Disease —An Unrecognized
Subset of Autoimmune Disease?
WANLI CHENG, ANITA C. GILLIAM, ANTHONY CASTROVINCI, and MAHMOOD PAZIRANDEH ABSTRACT. 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. (First Release Dec 15 2006; J Rheumatol 2006;34:81–8) Key Indexing Terms:
UNDIFFERENTIATED CONNECTIVE TISSUE DISEASES From the Department of Dermatology and Division of Rheumatology, Department of Internal Medicine, Case/University Hospitals of Cleveland, Cleveland, Ohio, USA. W. Cheng, MD; A.C. Gilliam, MD, PhD; A. Castrovinci, MD; Department of Dermatology; M. Pazirandeh, MD, Division of Rheumatology, Department of Internal Medicine, Case/University Hospitals of Cleveland. Address reprint requests to Dr. A. Gilliam, 529 BRB, Department of Dermatology, Case/University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-5028. E-mail: anita.gilliam@case.edu Accepted for publication September 21, 2006. |
