Dermatology

Zouboulis, Christos C.

doi: 10.1159/000051771pmid: 11752811

Kägi, Martin K.

doi: 10.1159/000051772pmid: 11752812

Cysteinyl leukotrienes have been shown to be important in the pathogenesis of both asthma and rhinitis. Improvement of skin manifestations in atopic dermatitis has been reported with leukotriene receptor antagonists. This article reviews current data on the experimental evidence and clinical efficacy of leukotriene receptor antagonists in the treatment of atopic dermatitis.

Waldmann, Volker; Wacker, Jörg

doi: 10.1159/000051773pmid: 11752813

Background: While for most human solid tumors genetic alterations of few distinct genetic regions have been found, studies on basal cell carcinomas (BCC) have shown the prevalence of several abnormalities including alterations of the three ras genes, GAP (GTPase activating protein), p53, PTCH (the human homologue of Drosophila patched) and SMOH (the human homologue of Drosophila smoothened). On the other hand, during the last decade, a new oncogene, protein kinase B (PKB/AKT), has been characterized and found to be overexpressed in certain human tumors. In vivo activation of PKB/AKT necessitates its recruitment to the cell membrane mediated by the N-terminal pleckstrin homology (PH) domain. Objective: We investigated whether mutations of this mandatory domain are present in a subset of human epidermal skin tumors. Methods: RNA of 19 human skin tumors including 13 BCC, 4 squamous cell carcinomas (SCC; including 1 keratoacanthoma) and 2 neurofibromas of different size and tumor stage were used for reverse transcription and subsequent PCR amplification of the PH domain of PKB/AKT. Results: Cycle sequencing of the purified PCR products did not reveal any mutation of the PH domain of PKB/AKT. Conclusion: In human BCC and SCC, mutations of the PH domain of PKT/AKT do not play a major role during the carcinogenesis of these tumors.

Delmonte, Sergio; Kanitakis, Jean; Cozzani, Emanuele; Parodi, Aurora; Rebora, Alfredo

doi: 10.1159/000051774pmid: 11752814

Background: Clinical, histological and immunological criteria distinguish pemphigus foliaceus (PF) from pemphigus vulgaris (PV), but whether and how often they are concordant in the same patient is unknown. Methods: Seven clinical records were selected from two hospital settings for having a diagnosis of PF and the initial serum and histopathological specimens still available. Controls were 8 PV records selected in the same way. Histopathological slides were re-evaluated. Stored sera were studied by indirect immunofluorescence (IIF), Western blot and ELISA. Results: Acantholysis was superficial in all PF patients and deep in all PV patients. Mucosal lesions were not exclusive of PV. IIF was positive in 43% of PF patients. Western blot revealed desmoglein 1 in 86% of PF patients and in 25% of PV. ELISA revealed anti-desmoglein-1 antibodies in up to 71% of PF and in 62% of PV patients, in 1 failing to detect anti-desmoglein-3 antibodies. Conclusions: Histopathology remains the most reliable criterion for diagnosing PF. Western blot and ELISA, especially in combination, may be only of confirmatory value.

Jonker, M.J.; de Boer, E.M.; Adèr, H.J.; Bezemer, P.D.

doi: 10.1159/000051775pmid: 11752815

Background: Oedema may be an early sign of chronic venous insufficiency (CVI), but swelling of the lower legs is a common phenomenon in many people. The distinction between physiological swelling and CVI is not clear. There is a gradual transition between healthy legs and the early stages of CVI. In case of CVI, medical elastic compression stockings are used in order to prevent oedema completely. In case of healthy people without demonstrable CVI, no medical stockings are required in the prevention of oedema but stockings exerting less compression. Objective: The aim of this study was to investigate the effect of mild compression on the development of swelling of the legs and the effect on subjective complaints in healthy subjects. Methods: The diurnal volume change (DVC) of the lower legs during full working days was monitored with an optical leg volume meter in 118 healthy volunteers (60 males, 58 females) without objective symptoms of CVI. The DVCs after wearing two kinds of class I support stockings (X: average pressure at the ankle of almost 14 mm Hg; Y: almost 18 mm Hg) were compared with the DVC after wearing a control stocking (Z: almost 6 mm Hg). Also, the effect on subjective feelings of the legs was noted. Results: It appeared that healthy people have a mean daily volume increase of the legs of 2.3% in females and 1.6% in males. Mild compression stockings reduced this daily increase with 31 and 18% in males and females, respectively, by stocking X and 37 and 32% by stocking Y. Subjective feelings occurred in 57% of all cases. A beneficial effect on subjective feelings, in particular of tired and swollen legs, was found. A difference in this beneficial effect between stocking X and Y was not obvious. Conclusions: Mild compression stockings reduce diurnal oedema and unpleasant feelings of the legs in healthy individuals.

Seishima, Mariko; Oyama, Zuiei; Yamamura, Mahiro

doi: 10.1159/000051776pmid: 11752816

Background: It is widely known that cytomegalovirus (CMV) primarily brings about subclinical and asymptomatic infection in the early stages of life and can cause various dermatological and systemic disorders under immunosuppressed conditions. Nonimmunosuppressed individuals very rarely present with cutaneous CMV involvement. Objective: In the present study, we described the clinical characteristics of 5 nonimmunosuppressed adult patients with positive IgM antibody to CMV. Methods: The systemic symptoms and dermatological features of these 5 patients were described. Laboratory examinations including blood cell counts, liver and renal functions were performed. IgG and IgM antibodies to CMV were also examined at the first consultation and 2–3 months after the skin eruption. Polymerase chain reaction for CMV DNA was performed in the skin samples of the patients. Results: All 5 patients had fever and complained of a sore throat. Multiple exudative erythema and target lesions with itching were observed mainly on the extremities. These symptoms and eruptions disappeared within 1 week after the onset and IgM antibody titers significantly decreased after 2–3 months. IgG antibody to CMV was already positive in 3 cases but was negative in 2 cases at the initial consultation. Conclusion: We propose that CMV infection may cause erythema multiforme by primary, recurrent infections or reactivation of CMV even in nonimmunosuppressed adults.

García-Pola Vallejo, M.J.; Huerta, G.; Cerero, R.; Seoane, J.M.

doi: 10.1159/000051777pmid: 11752817

Background: Stress and anxiety have frequently been mentioned as possible factors related to the development of oral lichen planus (OLP), although this association remains controversial. Objective: To determine whether anxiety and depression constitute risk factors in the development of OLP. Material and Methods: Eighty patients diagnosed as having OLP were studied: anxiety was evaluated by the Hamilton Anxiety Scale and depression with the Montgomery-Asberg Depression Rating Scale. The results were contrasted with those obtained in a control series of the same number of subjects (n = 80) matched for age and sex. Results: Significantly greater anxiety and depression were observed among patients with OLP than in the control group. Odds ratios of 2.8 and 4.4 were obtained for anxiety and depression, respectively. Conclusion: Our findings suggest that anxiety and depression constitute risk factors that could influence the development of OLP.

Liao, Y.H.; Chen, K.H.; Tseng, M.P.; Sun, C.C.

doi: 10.1159/000051778pmid: 11752818

Background: Geriatric health care has become a worldwide concern, but relatively few statistical studies are available about geriatric skin diseases. Moreover, no information exists regarding skin disorders among the elderly population in Taiwan that has become a geriatric country. Objective: To determine the characteristic pattern and the prevalence of various skin disorders for the elderly who visited the National Taiwan University in the last 7 years. Methods: Using a database from the Dermatology Outpatient Clinic of the National Taiwan University Hospital, 1993–1999 file, we conducted a retrospective cross-sectional study by evaluating the age, proportion, and gender of each specific cutaneous disease category, χ² tests were used for analyzing statistical significance. The analysis supplied odds ratios and 95% confidence intervals. Results: A total of 16,924 patients aged 65 years and older, which constituted 11% of the total patients seen at the Clinic of Dermatology from 1993 through 1999, were studied. The male to female ratio was 1.3 to 1. The most common cutaneous disorder in the elderly was dermatitis (58.7%), followed by fungal infections (38.0%), pruritus (14.2%), benign tumors (12.8%), and viral infections (12.3%). Cutaneous malignant tumors were found in 2.1%. Basal cell carcinoma occurred in 29.8%, actinic keratosis in 22.4%, Bowen’s disease in 13.3% and squamous cell carcinoma 13.3%. Interestingly, our cases of extramammary Paget’s disease showed a male predominance. Most melanomas were acral lentiginous melanoma located on the soles. The prevalence of common diseases in elderly patients compared with those outpatients of less than 65 years showed a 3-fold increased risk for pruritus. Moreover, the pattern of geriatric skin diseases in Taiwan was significantly different from Western countries. Conclusion: The prevalence of skin diseases in elderly patients emphasizes the importance of health education in geriatric people in Taiwan concerning appropriate use of emollients, proper foot care, sun protection and early detection of skin cancers.

Strumìa, R.; Varotti, E.; Manzato, E.; Gualandi, M.

doi: 10.1159/000051779pmid: 11752819

Background: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. Objective: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. Methods: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. Results: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell’s sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell’s sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. Conclusion: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Vadoud-Seyedi, J.; Heenen, M.; Simonart, T.

doi: 10.1159/000051780pmid: 11752820

Background: Botulinum toxin represents a novel therapeutic option for idiopathic palmar hyperhidrosis. However, so far there is no consensus on the way to administer botulinum toxin in this indication. Moreover, its use is limited by severe pain during the injections, especially with subepidermal injections close to ‘free nerve endings’. Objectives: To analyze the effectiveness and tolerability of intracutaneous injections of botulinum toxin after nerve blocks and to review the techniques of injections and the results reported by other groups. Methods: Twenty-three adult patients with refractory palmar hyperhidrosis were treated with intracutaneous injections of botulinum toxin after ulnar and median nerve blocks. Patients were followed up on a monthly basis. Results: In all patients botulinum toxin abolished sweating in the injected areas within 1 week. Anhidrosis lasted for 4–13 months. The intensity of pain was rated as absent (n = 13), mild (n = 8) or moderate (n = 2). Other side effects included hematoma (n = 2) and pain consecutive to nerve block (n = 1). Discussion: Intracutaneous injections of botulinum toxin after median and ulnar nerve block represent an effective and mildly painful technique to treat palmar hyperhidrosis and may be as safe as subepidermal injections.