Sebum excretion rate in subjects treated with oral all-trans-retinoic acid

BACKGROUND AND OBJECTIVE

It is generally accepted that the inhibition of sebum excretion has a predictive value for anti-acne activity. Whereas oral 13-cisretinoic acid (13-cis-RA) decreases sebum excretion, it has not been shown so far if oral all-trans-retinoic acid (tretinoin, tRA) does so. The aim of this exploratory study was to investigate the effect of oral tRA on the sebum excretion rate (SER) in young male subjects.

METHODS

12 healthy volunteers with a baseline SER above 1.0 microgram/cm2/min were treated with 20 mg/day tRA for 4 weeks. The SER was measured at weeks 2 and 4. Adverse reactions were recorded.

RESULTS

The mean SER varied from 1.56 at baseline to 1.65 at week 2 and to 1.49 micrograms/cm2/min at week 4. Comparison with values obtained in the same subjects previously treated with either 13-cis-RA or 9-cis-retinoic acid indicated that tRA less sebosuppressive. Mucocutaneous reactions and headache were the most frequent side effects of oral tRA.

CONCLUSION

The lack of effect on the SER suggests that oral tRA would probably be ineffective against acne. The fact that, of the three isomers tested, only 13-cis-RA (which does not bind to nuclear receptors) shows activity may suggest that sebosuppression is not nuclear receptor mediated. We discuss other hypotheses related to pharmacokinetics.

Assessment of a circuit of exercises through heart rate response

OBJECTIVE

A circuit of seven exercises was designed for a cardiac population. This study evaluated whether the patients achieved their training heart rate during the circuit, recommended to be 70-85% of the maximum heart rate achieved during an exercise test.

DESIGN

Patients were randomly allocated to a starting exercise to balance any order effect from performing the exercises in a given sequence. Each of the seven exercises was performed for 30 s, so one circuit lasted 3.5 min. The circuit was repeated five times.

PATIENTS

Twenty patients who had had myocardial infarctions within 6 weeks of the study participated.

OUTCOME

Heart rate was measured to assess the stress placed on the cardiorespiratory system during the circuit. Measurements were taken at 10 and 20 s following the termination of each exercise and over two repetitions of the circuit (a total of 14 exercise periods).

RESULTS AND CONCLUSION

Comparisons of the readings taken at 10 and 20 s indicated, contrary to previously published findings, that no significant heart rate deceleration occurred within this period. Every exercise maintained the mean heart rate within the specified band of 70-85% of the maximum heart rate achieved during the exercise test. The study has shown that the selected exercises were suitable for use during a cardiac rehabilitation programme.

Hypohidrotic ectodermal dysplasia with recurrent otitis and sebaceous gland hypertrophy of the face

An isolated affected 19-year-old male with hypohidrotic ectodermal dysplasia (HED) had rare features of the syndrome such as recurrent otitis and multiple sebaceous gland papules of the face. Sebaceous gland hypertrophy is puzzling in the context of HED.

[Stenosing anal mass and venereal lymphogranuloma]

Anorectal stricture or stenosis can be one of the late manifestations of lymphogranuloma venereum (LGV) and presents symptoms, clinical and/or radiological aspects indistinguishable from rectal neoplasia. In such cases the differential diagnosis of chronic LGV is seldom considered initially. We describe the case of a white male patient travelling frequently to Thaïland, in whom the diagnosis of chronic anorectal LGV was established after exclusion of other causes, in the presence of a positive serology and with a complex clinical and radiological response after 6 weeks' treatment with tetracyclines. We also review a series of similar cases in the literature.

Podopompholyx due to pemphigus vulgaris and Trichophyton rubrum infection. Report of an unusual case

We report the case of a 48-year old man who after a disease-free interval of 7 years developed a relapse of pemphigus vulgaris (PV) presenting as pompholyx of the left foot. The patient was first thought to suffer from a dyshidrosic form of tinea pedis due to Trichophyton rubrum. Although the concomitant occurrence of a dermatomycosis and PV has been described previously, our case illustrates an unusual and misleading presentation of PV, which may delay the correct diagnosis.

Papular-purpuric 'gloves and socks' syndrome: not only parvovirus B19

We previously described an acute dermatosis characterized by pruritic erythematous and slightly papular lesions on the hands and feet in a 'gloves and socks' distribution associated with oral aphthoid lesions and fever (papular-purpuric 'gloves and socks' syndrome = PPGSS). We strongly suspected a viral origin, but serologic tests for a large panel of viruses remained negative. Subsequently, 2 cases of PPGSS with serologic evidence of a parvovirus B19 infection have been reported in the literature. Since then we observed 5 additional patients with a PPGSS. Parvovirus B19 infection could be confirmed in only 2 cases. Our findings suggest that the PPGSS can be another, yet undescribed manifestation of parvovirus infection. However, this cannot be shown in all the cases. As the papular acrodermatitis of childhood, this syndrome may be caused by various viral agents.

Genetic serum protein markers in eight south Indian caste and tribal populations

A total of n = 769 unrelated male and female individuals from eight endogamous caste (Brahmin, Kapu, Yadava, Relli) and tribal (Bagatha, Kotia, Manne Dora, Konda Dora) populations living in various districts of Andhra Pradesh (India) have been typed for haptoglobin (HP) types and transferrin (TF), group specific component (GC) and alpha 1-antitrypsin (PI) subtypes. The genetic heterogeneity among these population groups is considerable. This can be explained by lacking or at least only minimal gene flow among these caste and tribal groups, by which differences in their genetic profiles caused by locally acting genetic differentiation factors such as drift could be preserved.

[Multiple filiform hyperkeratoses]

We report on a 41-year-old female patient who presented with a 3-year history of multiple filiform hyperkeratoses on the trunk. The family history revealed that her uncle had similar skin lesions. Another patient presented with filiform hyperkeratoses only on the palms of the hands and soles of the feet. This condition, referred to in English as multiple minute digitate hyperkeratoses, is a rare, mostly hereditary, disorder of cornification. As yet there is no official name for this dermatosis in German; we propose "multiple filiforme Hyperkeratosen".

The incidence of Sweet's syndrome in Geneva. A retrospective study of 29 cases

Over a 12-year period (1979-1991), 29 cases of Sweet's syndrome (SS) were detected in the area of Geneva; 24 patients (82%) could be contacted for follow-up. The majority of SS occurred between 1979 and 1986, then from 1991 on. The annual distribution and especially the absence of cases during 4 years suggest an environmental or even infectious factor in SS. Only 4 cases had an underlying disease (ulcerative colitis, polycythemia, lymphoma, sarcoidosis) whereas in the other, a long-term follow-up, including iterative hematological evaluation, did not reveal any underlying condition. Twelve patients were treated by colchicine, 9 by potassium iodide and 5 by prednisone; in 3 patients remission was spontaneous. Nine patients (28%) relapsed; there was no relationship between the type of drugs used and the frequency of relapses.

[Bacillary angiomatosis: apropos of a case]

We report a case of bacillary angiomatosis (BA), a recently described opportunistic infection, in a 30-year-old patient with Aids who was referred for a purplish vascular nodule on the forehead, of one-month duration, surrounded by similar smaller papules. For the previous 4 months he had suffered from progressive cachexia with fever, chills, night sweats, arthralgias and bone pain for which no infectious or malignant cause had been discovered after an extensive medical work-up. Histological examination of the skin lesions using Warthin-Starry staining revealed lobular vascular proliferation and protuberant endothelial cells with clumps of small bacilli. These findings were confirmed by electron microscopy. We believe that this is the first case of BA diagnosed in Switzerland and discuss the skin lesions, systemic symptoms and evolution under antibiotic treatment.

Orbital and palpebral paraffinoma

Paraffinoma is a well-recognized complication of paraffin injection. We describe a 44-year-old man who had an ethmoidectomy for chronic sinusitis. A communicating fracture of the ethmoid bone into the orbit occurred intraoperatively. The nasal cavity was subsequently packed with gauze containing a petrolatum-based antibiotic ointment. Bilateral, periocular swelling developed 1 week later. Optical and electron microscopic studies revealed a paraffinoma.

Systemic corticosteroids do not prevent postherpetic neuralgia

We review the use of corticosteroids in preventing postherpetic neuralgia (PHN) in a retrospective study over 5 years and 10 months. Out of 113 patients evaluable, 46 (40%) had PHN. 21 of these 46 patients (38%) had received prednisone (p = 0.49; n.s.). Duration and intensity of PHN were not different in the prednisone-treated group. This long-term study does not support the use of prednisone for preventing PHN.

Histiocytic lymphophagocytic panniculitis (Rosai-Dorfman disease): a case report

A 68-year-old woman presented with a symmetrical enlargement of the face and submandibular area associated with essential thrombocytosis. Biopsy of the lesions revealed a septal and lobular panniculitis disclosing a lymphohistiocytic and plasma cell proliferation with lymphophagocytosis by histiocytes, compatible with Rosai-Dorfman disease. The lesions regressed spontaneously without therapy over a period of 4 months. Diagnosis was confirmed by electron-microscopic examination and immunocytochemical presence of S-100 antigen within the histiocytic cells. A 2-year follow-up did not demonstrate any evidence of recurrence.

[The significance of protein C deficiency in dermatology]

The protein C system is a physiological inhibitor of coagulation and is important for the regulation of hemostasis. Protein C deficiencies can be inherited or acquired, and they lead to enhanced thrombophilia. A number of clinical entities that are also of interest to dermatologists have been related to protein C deficiency. Inherited protein C deficiency can become manifest in various ways, e.g. as purpura fulminans neonatalis, as recurrent episodes of thrombosis and as coumarin necrosis. Acquired protein C deficiency can be observed in the course of purpura fulminans, disseminated intravascular coagulation, hepatic failure or in the presence of antiphospholipid antibodies. The clinical features, the possible pathogenesis and the therapy of these manifestations are briefly discussed.

[Lichen sclerosus et atrophicus]

A review of lichen sclerosus et atrophicus is presented in this article. Clinical manifestations, possible complications and histology are described. Particular emphasis is given to the aetiological hypotheses, which include genetic, autoimmune, hormonal and infectious mechanisms. Finally, the various treatments are discussed.

Papular-purpuric "gloves and socks" syndrome

We report five cases of an acute, self-limiting dermatosis that has not been previously described. It consists of a pruritic edema and erythema of the hands and feet in a gloves-and-socks distribution and is associated with oral lesions and fever. The clinical course is characterized by the rapid development of petechial purpura and clearing of lesions within 1 to 2 weeks. The disease appears to affect only young and otherwise healthy persons and occurs mostly during the spring. The etiology is unknown but might be of infectious origin.

[Hand dermatoses in children]

Dermatoses of the hand in children are part of an original entity which can be classified in two groups: a group involving exclusively the hands and another one which is predominantly involving the hands. Attention has been focussed mostly on hand dermatoses in children (acropustulosis of infancy, papular, acrodermatitis, hand foot and mouth disease, subungual, exostosis). We discuss also the diagnostic and therapeutic aspects of scabies in children.