Koebnerization of reactive perforating collagenosis induced by laser hair removal

Laser hair removal, due to demonstrated efficacy and safety, has become a commonly performed office procedure. We report an unusual occurrence after laser hair removal with the 800 nm diode laser that previously has never been described. After laser hair removal treatment to the ventral surface of the ears, a patient developed lesions of previously diagnosed reactive perforating collagenosis. Interestingly, the lesions appeared on the dorsal surface of the ears. Perhaps the koebner phenomenon was invoked as the laser energy penetrated to the untreated dorsal surface, which was not protected by epidermal contact cooling.

[Vasculitis and collagenous-vascular involvement in association with sarcoidosis]

Sarcoidosis is a systemic granulomatous disorder of unknown origin. It unusually complicates systemic vascular involvement. We concisely review clinico-pathological findings of vascular involvement, including granulomatous angitis and microangiopathy. The clinical features of sarcoidosis may mimic those of many rheumatic disorders and sarcoidosis may coexist with autoimmune diseases. We review both rheumatologic manifestations, including bone, joint, and muscle of sarcoidosis and immunological findings of autoimmune diseases complicated with sarcoidosis, including 2-case reports of Sjögren's syndrome and dermatomyositis/polymyositis.

Acquired reactive perforating collagenosis

Acquired perforating disorder has been recognized as an uncommon distinct dermatosis in which altered collagen is eliminated through the epidermis. Several disorders accompanied by itching and scratching were reported to be associated with reactive perforating collagenosis. A 67-year-old white woman diagnosed as acquired reactive perforating collagenosis with poorly controlled diabetes mellitus and congestive cardiac failure is presented.

Frameshift mutation in the collagen VI gene causes Ullrich's disease

Patients with Ullrich's disease have generalized muscle weakness, multiple contractures of the proximal joints, and hyperextensibility of the distal joints. Recently, we found a deficiency of collagen VI protein in two patients with Ullrich's disease. In this study, we detected a homozygous 26 bp deletion in exon 14 of the collagen VI alpha 2 gene (COL6A2) in one patient. This mutation causes a frameshift and a premature termination codon, and results in a truncated collagen VI alpha 2 chain. Our data suggest that at least some cases of Ullrich's disease result from recessive mutations in COL6A2.

Injection site eosinophilic granulomas and collagenolysis in 3 horses

Three horses were presented with a history of having developed raised cutaneous nodules, within 24-48 hours, in areas of previous injections using standard silicone-coated hypodermic needles. Skin biopsies were taken from a selected cutaneous nodule from all horses for histopathologic evaluation. Histologically, the nodules were consistent with a diagnosis of equine eosinophilic granuloma. A hypersensitivity reaction to the silicone, or another component of the coating formulation, was hypothesized to be responsible for these lesions. Two horses were experimentally injected using both coated and noncoated stainless steel hypodermic needles and skin biopsies were obtained 14 days after injection. The sites of the coated needle injections were characterized by severe eosinophilic granulomatous inflammation with and without collagenolysis. The eosinophilic granulomas with and without collagenolysis observed in these horses are proposed to represent a complex immunologic response to the silicone-based coating of most hypodermic needles.

[Clinical findings and genetic bases of congenital complement deficiencies]

The clinical findings and genetic bases of inherited deficiencies of plasma complement components and complement control proteins are reviewed. In Japan, since the frequencies of late complement component deficiencies (LCCD) are high, clinical features of neisserial infections associated with LCCD are described in details. C 9 deficiency is one of the most frequent genetic disorders in Japan and most of them are healthy. However, C 9 deficiency is weakly but significantly associated with the development of meningococcal meningitis but not of systemic lupus erythematosus. The common Arg 95 Stop mutation was found in most individuals with C 9 deficiency. Molecular epidemiologic study revealed that homozygous and heterozygous Arg 95 Stop mutation of C 9 gene is found in approximately one of 1000 individuals and one of 15 individuals, respectively. Complement studies including C 9 antigen and DNA analyses should be performed in patients with meningococcal meningitis or recurrent bacterial infections.

Acquired reactive perforating collagenosis associated with diabetes mellitus: eight cases that meet Faver's criteria

Reactive perforating collagenosis (RPC) is characterized by umbilicated papules with a central adherent keratotic plug. Histologically, this condition shows transepidermal elimination of altered dermal collagen bundles into a cup-shaped epidermal depression. The present paper describes eight patients with associated diabetes mellitus who meet the diagnostic criteria for the acquired form of RPC (ARPC). Although half of these patients underwent dialysis, the lesions did not tend to develop after dialysis. Pruritus and the Koebner phenomenon were common, and histologically a microvasculopathy was noted in the dermis of all patients. We speculate that this disease is triggered by a cutaneous response to superficial trauma. Furthermore, this response acts synergistically with vasculopathy in the dermis, primarily in the case of diabetes mellitus. A secondary sign of ARPC may be degenerated collagen fibres as a result of transepidermal elimination.

[Chemokines and Chemokine receptors in collagen diseases]

The chemokine is a new class of cytokine. Now, more than 30 members of chemokine superfamily and 15 members of chemokine receptors (CXCR1-4, CCR1-8, CX3CR, CCR) have been identified. They were shown to be involved in the inflammatory response. The chemokine is classified into four subgroups (CXC, CC, C and CX3C). The local production of IL-8, MCP-1 and RANTES in rheumatoid inflamed joints has been reported. The predominance of several chemokines in other collagen diseases, such as SLE, systemic sclerosis and myositis is also described. Therefore, the inhibition of chemokines or chemokine receptors might be novel targets for various human disease, including collagen diseases.

[Role of adhesion molecules in the pathogenesis of collagen diseases]

Adhesion molecules play important roles and involve in many aspects of cell-cell or cell-extracellular matrix interactions in collagen diseases. In the present article, we describe the role of adhesion molecules in the pathogenesis of collagen diseases. Adhesion molecules on endothelial cells participate in leukocyte recruitment in collagen diseases. Adhesion molecules on RA synoviocytes which interact with MNCs and destroy chondrocytes by pannus formation. In PSS, adhesion molecules on fibroblasts play important roles to form fibrosis by interacting with MNCs or collagen fibrils. We further mention on adhesion molecules in interaction between MNCs and muscle fibers in myositis, those in vasculitis in SLE and other diseases, and autoantibodies inducing adhesion molecules on endothelial cells in PSS and Wegener's granulomatosis.