doi: 10.1111/j.1365-2230.1990.tb02037.xpmid: 2347112
SummaryMulti‐system Langerhans‐cell histiocytosis is rare in adults. We report five cases under our care and advocate a conservative approach to the treatment of such patients.
HENG, M.C.Y.; HENG, H.L.; ALLEN, S.G.
doi: 10.1111/j.1365-2230.1990.tb02038.xpmid: 2347113
SummaryIt has been observed that the beneficial anti‐inflammatory effects of topical steroids in psoriasis are counteracted by increasing instability of the disease, with rebound phenomena associated with the cessation of these drugs. We report the occurrence of multi‐layered fragmentation and disorganization of the basal laminae in active, untreated psoriatic lesions, resolving and uninvolved, inadvertently steroid‐treated psoriatic skin, as well as in a variety of non‐psoriatic dermatoses treated with fluorinated topical steroids for prolonged periods. These changes, which were associated with a moderate to severe loss of dermal collagen, were not found in untreated and treated psoriatic controls, with or without concomitant α1‐antitrypsin deficiency, who had not received steroids, suggesting that they were probably the consequence of prolonged fluorinated steroid use. This conclusion is supported by the observation that the largest number of layers (10‐15) of fragmented basal laminae was noted in the patients who had received fluorinated steroids for 6 years or more, while those on 4 years or less of fluorinated steroid therapy exhibited only three to seven layers of fragmented basal laminae. In psoriatic lesions, the fragmentation of the basal lamina was associated with the presence of basal keratinocyte herniations (BKH), the frequency of which has been shown to parallel clinical psoriatic activity. The persistence of these electron‐microscopic markers of psoriatic activity (i.e. BKH) in psoriatic plaques treated with prolonged fluorinated steroids suggests that loss of integrity of the basement membrane, as indicated by the presence of multi‐layered fragmentation of the basal lamina, may account for the instability of the psoriatic lesions treated with prolonged topical fluorinated steroids.
BERTH‐JONES, J.; COATES, P.A.A.; GRAHAM‐BROWN, R.A.C.; BURNS, D.A.
doi: 10.1111/j.1365-2230.1990.tb02039.xpmid: 2161303
SummaryWe report three cases of systemic sclerosis demonstrating four different neurological complications: trigeminal neuropathy, peripheral neuropathy, carpal‐tunnel syndrome and prolonged response to local anaesthesia. A review of the literature reveals a wide range of neurological abnormalities associated with systemic sclerosis. When they occur, these are often presenting features.
PALACIO‐HFRNANZ, A. DEL; GUARRO‐ARTIGAS, J.; FIGUERAS‐SALVAT, M.J.; ESTEBAN‐MORENO, J.; LOPEZ‐GOMEZ, S.
doi: 10.1111/j.1365-2230.1990.tb02040.xpmid: 2347114
SummaryThe clinical outcome and the effects on morphogenesis and cell infrastructure induced by a 1% ciclopiroxolamine solution in six patients with proven pityriasis versicolor were studied. Treatment regimens consisting of a once‐daily application for 1 day, 2 days (Days 1 and 4) or 3 days (Days 1, 4 and 8). Clinical evaluation, scanning (SEM) and transmission electron microscopy (TEM) were performed on skin scrapings before treatment, and at 3, 7, 15 and 21 days after the start of therapy. SEM techniques have shown severe changes in the surface ultrastructure of yeasts and hyphae of Pityrosporum spp. (Malassesia furfur) 15 days after the start of therapy. TEM techniques showed extensive internal disruption, mainly severe necrosis of the cytoplasm, 3 and 7 days after the start of treatment. However, KOH direct microscopy showed apparently normal morphology of Pityrosporum spp. (Malassezia furfur) at all assessment points. The final clinical cure in all the patients was achieved 21 days after the start of therapy.
ROSEEUW, D.; WILLEMSEN, M.; KINT, R.T; PEREMANS, W.; MERTENS, R.L.J.; VAN CUTSEM, J.
doi: 10.1111/j.1365-2230.1990.tb02041.xpmid: 2161302
SummaryNinety‐four patients with dermatophytosis and 16 patients with pityriasis versicolor were assigned under double‐blind conditions to oral itraconazole (100 mg once daily) or placebo. The medication consisted of two capsules, each containing 50 mg of active substance, or placebo and was given for 15 or 30 days in patients with dermatophytosis and for 15 days in patients with pityriasis versicolor. Patients with pityriasis versicolor who had not responded at the end of the double‐blind period were treated on an open basis with itraconazole (100 mg once daily) for 15 days. In the treatment of dermatophyte infections for 30 days, both clinical response and mycological cure were significantly superior in the itraconazole group compared with placebo. Oral administration of itraconazole (100 mg once daily) was also highly efficacious in the treatment of pityriasis versicolor. None of the placebo patients was clinically or mycologically cured at the end of the double‐blind phase compared to seven out of eight itraconazole patients. All placebo patients who entered the open phase responded to itraconazole treatment.Three itraconazole‐treated patients and nine placebo‐treated patients reported side‐effects.
HARRIS, D.W.S.; SPENCER, M.‐J.; TIDMAN, M.J.
doi: 10.1111/j.1365-2230.1990.tb02042.xpmid: 2140738
SummaryPapuloerythroderma is a newly described entity. The clinical features of a case and the therapeutic response to systemic corticosteroids arc described, together with the immunohistochemical and ultrastructural characteristics of the associated inflammatory infiltrate.
doi: 10.1111/j.1365-2230.1990.tb02043.xpmid: 2347099
SummarySkin‐surface water loss (SSWL) and transepidermal water loss (TEWL) were studied after a plastic occlusion stress test (POST) in visually non‐damaged skin treated with 7%, sodium lauryl sulphate for 3 days (open application). After removal of the 24‐h plastic occlusion, SSWL and TEWL were recorded continuously for 25 min. SSWL decay curves show significant differences between control and treated areas. The total amount of water trapped within the stratum corneum and released after 1 min is significantly reduced (P < 0·01) in the treated site. Higher TEWL (P < 0·02) in visually non‐irritated skin is noticeable in the terminal part of the curve reflecting the damage of the water barrier in irritated skin. The data suggest that clinically normal skin exposed to subliminal irritant stimuli is less capable of storing water within the stratum corneum resulting in decreased hydration. The POST appears to be a simple and reliable tool to investigate non‐visible hut biologically relevant changes in stratum corneum function.
KEMMETT, D.; ELLIS, J.; SPENCER, M.‐J.; HUNTER, J.A.A.
doi: 10.1111/j.1365-2230.1990.tb02044.xpmid: 2347100
SummaryThe Laugier‐Hunziker syndrome is an acquired, benign, macular hyperpigmentation of the lips and buccal mucosa. The nails arc often involved with the development of melanonychia. Twenty‐two previous cases have been recorded in the literature. We present details of six Caucasian patients with the Laugier‐Hunziker syndrome who are the first recorded from Britain. They all had acquired, macular hyperpigmentation of the lips and buccal mucosa. In five of these patients longitudinal pigmented bands were found on the nails. None had other family members affected. Although this is the first report of British patients with this syndrome, we believe that the condition is probably more common than is generally recognized.
doi: 10.1111/j.1365-2230.1990.tb02045.xpmid: 2347101
SummaryThe intense blue‐green light of the argon laser has proven very effective in the treatment of a great variety of vascular skin disorders, Venous lakes (Bean Walsh) of the lips are blood‐filled dome‐shaped lesions, their treatment often requiring; surgery, Fifty‐one patients suffering from this disorder were treated with the argon laser with 1‐5 2·0‐mm spot size, 0·3‐s. pulse duration and 1·8‐3·0‐W power. In most cases treatment was carried out without local anesthesia. Laser impact was followed immediately by shrinking of the lesions and replacement by a whitish‐grey plaque. Excellent cosmetic results were obtained in 90% of the patients. Three patients showed mild scarring. At 18 months follow‐up only one patient showed a recurrence. The argon laser appears to be a highly effective non‐invasive treatment modality for venous lakes of the lips.
doi: 10.1111/j.1365-2230.1990.tb02046.xpmid: 2347102
SummaryThe pseudolymphoma syndrome is a reversible reactive condition consisting of fever, lymphadenopathy and generalized rash. Initial cases were associated with anticonvulsants, although other drugs have now been implicated.1 We report on a case associated with atenolol.
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