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Staining intensity was high (+++) in the supporting cells of the hypertrophied sebaceous acini (Figure 6),which would suggest a high-level expression. In the pilosebaceousfollicle, in the infrainfundibular area, dyskeratotic,vacuolated keratinocytes appear to be less stained(+) (Figure 7). Comedones, also present in AF, showedstaining for cytokeratins only in the follicular wall(Figure 8). Macrophages in the perifollicular dermis hadspecific receptors able of being activated by P. acnes,amplifying the inflammatory reaction.In AF, the dermal perifollicular inflammatory infiltratewas dominated by CD3+ cells (T-lymphocytes) andCD68+ cells (of the mononuclear phagocyte system)(Figure 9), fact supporting the hypothesis of the involvementof delayed hypersensitivity reaction (type IV)in the pathogenesis of acne. CD3+ cells accounted for40–50% of all cells in the perifollicular inflammatoryinfiltrates.CD68+ macrophages were present in all cases of acnestudied, regardless of the type of inflammatory lesion.Their number was higher in AF, being located in the closevicinity of dilated and broken follicle wall, and someof them presenting as epithelioid cells and giant cells,additional argument supporting the cell-mediated hypersensitivityas a major pathogenic mechanism in acne.Together with lymphocytes and neutrophils, they mightconstitute the foreign body granulomatous reaction.CD20+ cells (B-lymphocytes) (Figure 10) were foundin small numbers and only in the severe forms of acne,including AF (less than 20 cells in the entire inflammatoryinfiltrate).Chronic inflammatory inflammation, characteristic toacne lesions, was also accompanied by angiogenesis. Byspecific immunostaining for CD34+ endothelial cells, ourstudy revealed the presence of blood capillaries aroundthe pilosebaceous follicles, within the inflammatory orpericystic infiltrate (Figure 11).
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