MIDAS questionnaire in the emergency setting

Migraine is a common disorder and is a major cause of disability and loss of working performance in western countries. Therefore, many tools have been developed to assess migraine related disability. Among these, the Migraine Disability Assessment (MIDAS) questionnaire has been shown to be of particular interest, as it is valid, reliable and useful for therapeutic decisions. In this pilot study, we address the validity of the MIDAS questionnaire in an unselected population of migraine patients in the emergency setting. We found that the MIDAS scores in the emergency room were similar to those collected in a specialised headache centre. This result suggests that the MIDAS questionnaire could be reliably used in the emergency setting, hence avoiding unnecessary delays in the treatment of migraine patients.

Treatment of psoriatic nails with topical cyclosporin: a prospective, randomized placebo-controlled study

BACKGROUND

Nail involvement is a frequent event in the course of psoriasis causing severe distress. While systemic cyclosporin (CsA) represents a well-established therapy of psoriasis, its topical use is limited by the difficult penetration of the molecule through the skin and the nail because of its highly lipophilic nature.

OBJECTIVES

We carried out a prospective randomized placebo-controlled study in order to analyze the effectiveness and tolerability of topical oil-dissolved 70% CsA solution in nail psoriasis.

METHODS

Sixteen adult patients with nail psoriasis, divided randomly into two groups of 8 patients (group A and group B), were treated respectively with a 70% maize-oil-dissolved oral CsA solution and maize oil alone. To compare the therapeutic effectiveness, all patients were evaluated, before starting the treatment and after 12 weeks of therapy, by the same dermatologists. The patients were also asked to assess the severity of their nail involvement at baseline and at the end of the treatment.

RESULTS

In group A, 3 patients came to a complete resolution of nail lesions and 5 showed a substantial improvement of the overall severity score. In group B, a slight improvement was noted in only 1 patient. All the patients of group A judged positively the results of the therapy, while in group B only 1 patient reported a moderate improvement.

CONCLUSION

Our results show that topical therapy with oral CsA solution is a safe, effective and cosmetically highly acceptable treatment modality for nail psoriasis. The ability of CsA to influence keratinocyte proliferation and T-cell lymphokine release, reducing the cornification of the upper layers of the epidermis, may prevent the typical alterations observed in nail psoriasis.

Dermatomyositis in 132 patients with different clinical subtypes: cutaneous signs, constitutional symptoms and circulating antibodies

We retrospectively studied 132 patients with dermatomyositis; 84 had idiopathic, 30 paraneoplastic, 5 juvenile and 13 amyopathic forms of the disease. The commonest features were macular erythema, heliotropic erythema and Gottron's papules. Flagellate erythema occurred in 5% of patients with idiopathic dermatomyositis and correlated with the disease activity. Necrotic lesions were also found in this group of patients but did not always signal malignancy. The prevalence of malignancy was high (23%). Raynaud's phenomenon occurred in 10.6% of patients, also in those with malignancy. Dysphagia, interstitial lung disease and arthralgias affected 20%, 8% and 40% of patients, respectively. Anti-Jo-1 antibodies were found in 5% of patients with idiopathic dermatomyositis and low titre ANA in 1/3 of patients. ANA did not correlate with the disease activity. We confirmed the data from the literature, but no cutaneous sign, constitutional symptom or circulating antibody was found marking a particular subtype of the disease.

Pretibial myxoedema associated with Hashimoto's thyroiditis

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves' disease, although it may also develop in subjects with non-thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58-year-old woman with biopsy-proven Hashimoto's thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.

Changes in the distribution of laminin alpha1 chain in psoriatic skin: immunohistochemical study using confocal laser scanning microscopy

BACKGROUND

Recent studies have demonstrated the presence in psoriatic skin of ultrastructural and molecular alterations in the basement membrane and an altered polarized distribution of the integrins. Previous studies have demonstrated the existence of some epithelial cell lines synthesizing only laminin beta and gamma chains that, in the absence of the laminin alpha chain, do not form a distinct basal lamina.

OBJECTIVES

To investigate a possible reduction/absence of the laminin alpha 1 chain in keratinocytes in psoriatic skin and to correlate this with fibronectin distribution.

METHODS

Using monoclonal antibodies against the laminin alpha1 chain or human plasma fibronectin and using confocal laser scanning microscopy, we evaluated the immunohistochemical expression of these two proteins in cutaneous biopsies from involved and uninvolved skin of the sacral region of 12 men with extensive chronic plaque psoriasis. Site-matched biopsies of normal skin from four men without psoriasis were used as controls.

RESULTS

In normal skin antilaminin alpha 1 chain antibodies stained the dermal-epidermal junction in a regular and continuous manner. In involved and uninvolved psoriatic skin large regions of discontinuous immunostaining were observed, mainly at the apex of the dermal papillae; in the same regions, clusters of keratinocytes appeared markedly reactive and fibronectin was overexpressed in the papillary dermis under the interruptions of the basement membrane.

CONCLUSIONS

The present study defines the location of the laminin alpha1 chain in involved and uninvolved psoriatic skin and suggests a possible role of the alteration of this chain, together with T-cell lymphokines and fibronectin, in the dysregulation of cell morphological processes.

Phototrichogram using videomicroscopy: a useful technique in the evaluation of scalp hair

The purpose of our work is to contribute to the definitive standardization of the phototrichogram in view of the new possibilities offered by information technology. We placed under investigation a 1 cm2 scalp area on the vertex of 28 healthy volunteers (20 women and 8 men) between the ages of 18 and 30 (average age was 23.32 +/- 3.48 years). We performed the examination using a computerised videomicroscope equipped with lenses x 20 and x 50. The results obtained can be summarized as follows: total hair density was 260 +/- 30/cm2 in men and 300 +/- 20/cm2 in women; telogen percentage was higher in men (16.5 +/- 1.5% vs 11 +/- 1% of women); thin hairs (< 0.040 mm) were 9.4 +/- 1.8% in men and 9 +/- 2% in women; growth rate was 0.35 +/- 0.03 mm/day in men and 0.38 +/- 0.03mm/day in women. Thanks to its integration with digital imaging, the phototrichogram has undoubtedly become an examination of primary importance in trichology because of its simplicity and sensitivity even if it cannot yet be considered the ideal technique to replace all the others.

Successful treatment of pustulotic arthro-osteitis (Sonozaki syndrome) with systemic cyclosporin

Pustulotic arthro-osteitis, first described by Sonozaki, is a relatively rare disorder, the prevalence of which is probably underestimated in dermatological literature; its early recognition can prevent misdiagnosis, unnecessary surgery, and the use of prolonged and ineffective antibiotic treatment.

Multiple familial basal cell carcinomas including a case of segmental manifestation

BACKGROUND

A tendency to develop multiple basal cell carcinomas at an early age is a characteristic feature of some rare hereditary disorders; moreover, multiple basal cell carcinomas are sometimes observed as a corollary of familial basaloid follicular hamartomas or familial multiple trichoepitheliomas.

OBSERVATION

We report 3 cases of multiple basal cell carcinomas involving 3 successive generations of a family, with a segmental manifestation of lesions in one of these patients. No additional cutaneous or extracutaneous anomalies were found.

CONCLUSIONS

We hypothesize that a gene mutation may have caused the tumors observed in this family as an autosomal dominant trait. The segmental arrangement of tumors may reflect loss of heterozygosity: at an early stage of embryogenesis, a postzygotic mutation would give rise to a population of cells either homozygous or hemizygous for the underlying gene. The segmental arrangement following the lines of Blaschko would visualize the dorsoventral proliferation of a cell clone characterized by loss of the corresponding normal allele.

"Sporadic" dystrophic epidermolysis bullosa: a new dominant or mitis recessive mutation?

We describe a case of dystrophic epidermolysis bullosa which occurred in a young boy who presented thickened and dystrophic nails both in hands and feet, atrophic scars on the elbows and knees, some large bullae and milia on the hands and ankles. The parents were clinically unaffected and the family medical history was negative for blistering disease. The immunofluorescence for type VII collagen was positive, yet low in intensity and the number of anchoring fibrils was reduced, as revealed by transmission electron microscopy. The diagnosis of a "sporadic" case of dominant dystrophic epidermolysis bullosa was suggested, although a mitis case of recessive dystrophic epidermolysis bullosa cannot be excluded on the basis of clinical, immunofluorescent and ultrastructural examination. However recent studies, carried out in a series of seemingly sporadic cases, have pointed out the possibility of inheritance of two mutant alleles from unaffected parents. This implies that 'mild' recessive dystrophic epidermolysis bullosa is commoner than once thought. This information is important for genetic counselling and determination of recurrence risk in the present and future generations.

Clinical, histological and immunopathological features of 58 patients with subacute cutaneous lupus erythematosus. A review by the Italian group of immunodermatology

BACKGROUND

Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of cutaneous lupus erythematosus clinically characterized by psoriasiform and/or annular lesions and by a mild or absent systemic involvement.

OBJECTIVE

The Italian Group of Immunodermatology of the Italian Society of Dermatology and Venereology reviewed the cases of SCLE seen in 10 years (1987-1996).

PATIENTS

Forty-six women and 12 men have been retrospectively studied, 42% had annular lesions, 39% psoriasiform ones and 16% both.

RESULTS

Lesions were mainly localized on the neck and face and relapsed in spring and autumn. Seventeen patients had 4 or more American College of Rheumatology criteria and could be classified as having systemic lupus erythematosus. The most frequent histopathological alterations were epidermal atrophy, hydropic degeneration of the basal layer and perivascular lymphocytic infiltrate. Deposits of immunoglobulins and C3 at the dermo-epidermal junction on the clinically involved skin were present in 86% of the patients. Dust-like particles in the epidermis were only found in 3% of cases. Anti-Ro/SSA antibodies were found in 71% of the cases and anti-dsDNA only in 5% of cases.

CONCLUSIONS

SCLE is a particular subset of cutaneous lupus erythematosus with peculiar clinical and immunopathological features.

Subcorneal pustular dermatosis and IgA lambda myeloma: a uncommon association but probably not coincidental

The present report deals with a case of subcorneal pustular dermatosis (SCPD) associated with IgAlambda myeloma and reviews the literature for similar cases. Three relevant points arise from this case: the association of the dermatosis with an IgAlambda myeloma that, as far as we know, has been described only three times previously; the longest period of time between the onset of the dermatosis and that of the myelopathy observed up to now; the good therapeutic response to etretinate, useful in the management of severe recalcitrant forms of SCPD.