Acta Dermato-Venereologica 99-13CompleteContent

1284 SHORT COMMUNICATION Immunohistochemical Evaluation of Matrix Metalloproteinases-1, -9, Transient Receptor Potential Vanilloid Type 1, and CD117 in Granulomatous Rosacea Compared with Non-granulomatous Rosacea Jong Bin PARK, Kee Suck SUH, Ji Yun JANG, Seol Hwa SEONG, Myeong Hyeon YANG, Jin Seuk KANG and Min Soo JANG* Department of Dermatology, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan, 602-702, Korea. *E-mail: ksderm77@ unitel.co.kr Accepted Oct 15, 2019; E-published Oct 17, 2019 Rosacea is a common chronic inflammatory skin di- sease that almost exclusively affects the central facial skin in a symmetrical pattern. Granulomatous rosacea (GR) is the only variant of rosacea characterized by its unique histopathological findings (1). As with non- granulomatous rosacea (NGR), the pathogenesis of GR remains unclear. It has been shown that exposure of skin to ultraviolet radiation (UVR) upregulates matrix metal- loproteinases (MMPs), mast cell, and transient receptor potential vanilloid type 1 (TRPV1) expression, and that these factors are involved in the pathogenesis of rosacea (2, 3). However, immunohistochemical expression of TRPV1 and CD117, which are key markers of neurovas- cular dysregulation, in GR has not been reported. This study compared the immunohistochemical expression of MMP-1, MMP-9, TRPV1 and CD117, and the grade of inflammation in GR lesions with those of NGR lesions, and attempted to identify the relationship between GR and neurovascular dysregulation. METHODS This study included 22 patients clinically and histopathologically diagnosed with rosacea at the Department of Dermatology, Kosin University Gospel Hospital, Busan, Korea. Haematoxylin and eosin (H&E) staining was used to confirm the histopathological diagnosis of GR and NGR. In addition, the degree of epidermal and dermal inflammation was evaluated. Two dermatologists scored the samples using a 5-point semi- quantitative scale (0=normal with no inflammation, to 4=wide spread inflammation). Paraffin-embedded tissue sections were stained using monoclo- nal antibodies against CD117, MMP-1, MMP-9 and TRPV1. For quantitative evaluation of CD117 immunoreactivity, the number of positive cells was counted manually in 3 different fields at a magnification of ×200, and the mean calculated. In addition, ex- pression of MMP-1, MMP-9 and TRPV1 was evaluated by digital morphometry with an image analysis program (ImageJ, NIH, Bethesda, MD, USA). Images were evaluated and the selected pixels representing positive cells were expressed as the percentage of the total area. Expression of immunoreactivity was graded on a 5-point semi-quantitative scale (0 = 0%, 1 = < 10%, 2 = 10–50%, 3 = 50–90%, 4 = > 90%). Student’s t-test was used to compare staining patterns between groups using the Statistical Package for the Social Sciences, ver- sion 17.0 for Windows (SPSS Inc., Chicago, IL, USA). Results were considered statistically significant at a p-value < 0.05. Data are expressed as the mean ± standard deviation. RESULTS The 11 patients with GR comprised 5 males and 6 fema- les, while 4 patients in the NGR group were male and 7 were female. The mean age was 49.8 years (range 22–71 years) in the GR group, and 49.9 years (range 30–73 years) in the NGR group. The mean duration of disease was 9.9 months in the GR group and 17.3 months in the NGR group (Fig. 1A–D). The mean degree of inflammation evaluated by a 5-point semi-quantitative scale was 3.09 (range 2–4) in the GR lesions, and 2.27 (range 2–3) in the NGR lesions. The mean score in GR lesions was significantly higher than in the NGR lesions (p = 0.01) (Tables SI and SII 1 ). The mean number of CD117 + cells was 29.61 (range 22.67–39.0) in the GR lesions, and 24 (range 10.33– 39.33) in the NGR lesions. However, there were no statistically significant differences in the mean number of CD117 + cells between the 2 groups (p = 0.127). The Fig. 1. (A, B) Patients with granulomatous rosacea (GR) had periocular lesions and showed an asymmetrical distribution. (C, D) Patients with non- granulomatous rosacea (NGR) spared the periocular area and showed a symmetrical distribution. Permission is given to publish these photos. For complete details, see Fig. S1 1 . doi: 10.2340/00015555-3349 Acta Derm Venereol 2019; 99: 1284–1285 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.

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