Dermatologica最新文献

We report a patient with scalp lesions of primary localized cutaneous nodular amyloidosis. The extensive examination revealed no systemic involvement. Analysis of glycosaminoglycans (GAGs) in amyloid deposits showed a twofold increase as compared with normal skin, which was due to the increase in dermatan sulfate. Local disorders of GAG metabolism may be related to the amyloid fibril formation. Amyloid fibrils were purified and identified electron-microscopically, which consisted of two major 12,000- and 13,000-dalton and minor 29,000- and 48,000-dalton peptides. Western blotting analysis showed a minor 29,000-dalton peptide reactive with antibodies against both kappa and lambda light chains of immunoglobulin. There is a possibility that some components of amyloid in some cases of primary localized cutaneous nodular amyloidosis may consist of both kappa and lambda immunoglobulin light chains.

We applied a simple silver staining technique to visualize nucleolar organizer regions associated proteins (AgNORs) for the study of 47 melanocytic lesions (20 malignant melanomas, 5 dysplastic nevi, 4 Spitz nevi, 2 Reed and Gartman's fusiform nevi and 16 melanocytic nevi). A statistically significant difference existed between the numbers of AgNORs per cell in benign and malignant lesions as a group. However, some overlapping counts were found, limiting the usefulness of the technique in differentiating benign from malignant lesions in individual cases.

Fifty patients with the chief complaint of Raynaud's phenomenon (RP) presented at our scleroderma clinic from March to December 1990. Physical examination, routine laboratory tests (blood, urine and chest X-ray), determination of the pattern of RP, antinuclear antibody (ANA) tests and examination for nailfold bleeding were performed. Three patients were diagnosed as having systemic sclerosis sine scleroderma, 15 patients as having RP with positive anticentromere antibody and 6 patients as having an incomplete form of mixed connective tissue disease. Thus, a total of at least 24 patients out of 50 (48%) were shown to have a scleroderma spectrum disorder. A definite RP pattern (triphasic or biphasic and bilateral), positive ANA and positive nailfold bleeding were strongly correlated statistically, suggesting that these are simple useful findings for the early detection of scleroderma spectrum disorders in patients with RP. We expect that there are many undiagnosed patients with an early-stage scleroderma spectrum disorder in the general population.

According to the distribution of the dermal melanocytes, Ota's nevus was classified into 5 types: superficial (type S), superficial dominant (type SD), diffuse (type Di), deep dominant (type DD), and deep (type De). The histological types were, as expected, relatively well-correlated with the color of the nevus: the most brownish lesions represented type S or type SD, while the most bluish lesions showed types Di, DD or De. Furthermore these types were strongly correlated with the location of the nevus: types S and SD were more frequent on cheeks, whereas types Di, DD and De more frequently occurred on eyelid, temple and forehead. When combining both colorations and locations of the nevus, our classification appeared much more significant. Our new histological classification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.

We report the case of an 18-year-old black woman with urticarial vasculitis, vestibuloauditory dysfunction and superficial keratitis. Oral steroid therapy was effective in reducing most clinical manifestations with high-dosage dependency. However, only intravenous pulses of methylprednisolone allowed slight improvement of hearing. In this case, we emphasize urticarial vasculitis as a new manifestation of atypical Cogan's syndrome. A significant titer of Chalmydia trachomatis antibodies was found in our patient: their role in the pathogenesis of Cogan's syndrome is discussed.

A randomized trial comparing chemoimmunotherapy (bacillus Calmette-Guérin + chemotherapy) and immunotherapy (bacillus Calmette-Guérin alone) was carried out in high-risk stage I and II malignant melanoma patients. Eight-two evaluable patients were included. The follow-up median duration was 11 years. Recurrent melanoma developed in 28 patients (34%). The overall survival rate was 76% at 5 years and 65% at 10 years. There were no statistical differences in survival probability or disease-free survival (DFS) probability between the two treatment groups. Survival and DFS were also analyzed in relation to various prognostic factors. Statistically significant differences were only seen in a subset of 33 patients with lower limb malignant melanoma, the prognosis being better for the chemoimmunotherapy group in this location. Because of the small number of patients in each group, a week positive effect of either of these two treatments cannot be ruled out. Chemoimmunotherapy only seems to improve the prognosis of stage I or II malignant melanoma of the legs.

Irritant hand eczema is a well-known risk in adults, who have suffered from severe atopic dermatitis during childhood. We therefore studied the involvement of the skin on the hands in 29 consecutive patients admitted for severe atopic dermatitis. Only 5 of the 29 patients had eczema in the palmar skin (p less than 0.01; sign test). There was no correlation with the existence of hyperlinearity, extent of disease, concomitant asthma, total serum IgE or work.

A case of senile erythroderma with serum hyper-IgE is presented. It is comparable to 8 cases previously described by Japanese authors.

Thirty patients with different clinical manifestations of morphea (circumscribed scleroderma) were investigated for serum antibodies against Borrelia burgdorferi determined by ELISA and Western blot analysis. Forty-six percent of the patients were seropositive. Western blots confirmed the ELISA results in 10 of 25 patients (40%), showing a reactivity pattern which can be seen in the course of Lyme borreliosis. In some cases the outcome after antibiotic treatment suggests a direct correlation between the further development of skin lesions and Borrelia infection. Because of these findings we suggest some morphea types to be possibly due to a B. burgdorferi infection.

Nine patients with chronic stable psoriasis (4 males and 5 females) were entered in this trial. Eicosapentaenoic acid (EPA) ethylester (90% pure) without docosahexaenoic acid (DHA) in gelatin-coated capsules at a daily dose of 3.6 g was administered to 9 patients for 3 months, 7 patients for 6 months and 6 patients for 12 months. The clinical changes of skin lesions of the patients with 12 months of treatment were as follows: marked improvement 1, improvement 3, relative improvement 1, no change 1. A clinical improvement of skin lesions was first observed 2-3 months after EPA treatment. The supplementation of highly purified EPA caused a significant increase in the content of plasma EPA and docosapentaenoic acid without affecting that of arachidonic acid (AA) and DHA. EPA decreased the production of leukotriene B4 (LTB4) and increased the formation of leukotriene B5 (LTB5) and 5-hydroxyeicosapentaenoic acid significantly in A23187-stimulated neutrophils. The LTB5/LTB4 ratio positively correlated with the plasma EPA/AA ratio and was directionally related to the clinical score, although the directional data were not statistically significant. We could not observe any side effects of EPA over 1 year. Although its effects are modest, it is nontoxic and its favorable effect appears to continue for the duration of its usage, indicating that EPA could be beneficial for the long-term treatment of psoriasis.