Pityriasis rotunda: a survey of 42 cases observed in Sardinia, Italy

BACKGROUND

Pityriasis rotunda (PR) is an uncommon dermatosis characterized by multiple, round or oval, sharply demarcated scaling patches that are dyschromic and asymptomatic. It has been described in Japanese and in blacks, usually in association with certain infective or malignant systemic diseases.

OBJECTIVE

The aim of this study is to further clarify this rare entity which in Italy seems to be confined to the island of Sardinia.

METHODS

We studied 42 Sardinian patients, 22 males and 20 females, in an age range of 3-32 years. In 29 cases, the disease involved more than one family member. The patients were observed in Cagliari, the capital city of Sardinia.

RESULTS

Bacterial, viral and fungal investigation yielded negative results. Haematochemical and immunological examination and thyroid, hypophyseal and adrenal hormones did not reveal any alterations. No systemic pathologies were found associated with the disease.

CONCLUSIONS

The cases studied by us and those previously reported seem to indicate the presence of two distinct types of PR with significant prognostic differences.

Distribution of AVT gene expressing neurons in the prosencephalon of japanese quail and chicken

Detailed anatomical studies about the distribution of arginine-vasotocin (AVT) gene expressing neurons in the avian brain are so far non-existent. Most of the investigations are limited to discrete brain nuclei in the chicken and concern particular experimental conditions. Since no data on AVT gene expression are up to now available in Japanese quail, we report here the distribution of AVT mRNA containing neurons within the prosencephalon of this bird and a comparison with the same system of the chicken. The AVT mRNA containing perikarya were detected with a specific AVT cDNA probe directed toward the distal 3' glycopeptide encoding part of the chicken AVT gene. The specificity of the probe was tested by Northern and Southern blot analysis. The AVT gene expressing neurons showed the same pattern of distribution in both species; however, a larger number of labelled neurons was observed in the chicken by visual inspection of the sections. AVT gene expressing neurons were distributed within the hypothalamus (in the medial and ventral aspects of the rostral preoptic area, in the lateral forebrain bundle, close to the ependyma of the third ventricle and in several periventricular hypothalamic nuclei) and in some extrahypothalamic regions (around the nucleus rotundus, close to the nucleus commissurae pallii and in a region probably corresponding to the nucleus strial terminalis). AVT gene expressing neurons were observed close to the organum septi laterale of the chicken. Taken together, these results confirm the specificity of the employed probe and its suitability for further studies on the modulation of AVT gene expression in quail.

Intracerebral sex differences in the vasotocin system in birds: possible implication in behavioral and autonomic functions

The brain vasotocinergic system demonstrates clear sexual dimorphism in birds investigated so far. This paper examines the evidence obtained in studies on gallinaceous (domestic fowl, Japanese quail) and passerine (canary, junco, zebra finch) birds. Vasotocin (VT)-immunoreactive parvocellular neurons are present in the nucleus of stria terminalis of males, but they are less abundant or absent in the corresponding structure of females. A similar difference has been observed in the dorsal paraventricular area of domestic fowl. Sex-related differences in VT-gene expression have been confirmed by in situ hybridization. Moreover, overall brain content of VT mRNA in cockerels is about twice that of hens, suggesting that VT synthesis may also be sexually dimorphic in other brain areas where morphological sex differences have not yet been revealed. The vasotocinergic system in birds is implicated in body fluid homeostasis, and during ontogeny it starts to respond to osmotic challenges in a sexually dimorphic way. Photoperiod, aging, or castration--all associated with changes in circulating testosterone levels--affect sexually dimorphic VT pathways and cell clusters. Sexually dimorphic vasotocinergic circuits are distributed in regions containing steroid-concentrating cells and are closely intermingled with aromatase-containing neurons that may mediate activational effects of gonadal steroids on this peptidergic system. However, it remains undetermined whether the observed neuroanatomical sex differences are related to sexually dimorphic autonomic and behavioral effects induced by VT. Most likely, VT in birds has a modulatory rather than a specific regulatory function in control of male sexual behavior and vocalization.

Tinea capitis in adults

Between 1973 and 1994, 17 cases of tinea capitis in adults were observed in the Dermatology Clinic of the University of Cagliari (Italy). The patients were all women (age range 17-76 years) and came from the district of Cagliari. At the time of referral, they presented with a disease duration varying from 8 to 10 months. The main clinical feature was scalp lesions, but in two cases mycotic lesions on the face were also present. The following dermatophytes were isolated: Microsporum canis (eight cases), Trichophyton violaceum (four cases), Trichophyton mentagrophytes (four cases) and Trichophyton verrucosum (one case). Systemic treatment with griseofulvin or terbinafine led to complete recovery in 40-50 days. In discussing the pathogenesis and transmission mode of the disease, the authors hypothesize that endocrine disorders influencing the secretion and composition of sebum may facilitate dermatophyte invasion of the scalp in the adults.

Testosterone effects on the neuronal ultrastructure in the medial preoptic nucleus of male Japanese quail

Dorsolateral neurons of the medial preoptic nucleus (POM) of male Japanese quail are sensitive to the plasma levels of testosterone: their volume and optical density in Nissl-stained sections increase in castrated birds treated with testosterone. The present study was performed on castrated male quail treated or not with Silastic implants filled with testosterone to describe the ultrastructural variations induced by testosterone in these neurons. Gonadally intact male birds were included as controls. The ultrastructure of neurons, taken from the dorsolateral portion of the POM, was dramatically affected by the endocrine manipulations. Quantitative evaluations demonstrated a significant decrease in castrated birds of the rough endoplasmic reticulum (RER), of free polyribosomes, of Golgi complexes, and of dense bodies; these changes paralleled the decrease in cell size. The cell size and the percentage of volume occupied by the intracellular organelles in castrated birds treated with testosterone were comparable to values observed in controls. These ultrastructural changes are similar to those observed in neuronal targets for other gonadal hormones, supporting the idea that testosterone stimulates the development of cytoplasmic structures involved in protein synthesis and secretion. In addition, exposure to testosterone affects the synaptic inputs to POM. These ultrastructural changes are presumably related to the physiological effects (e.g., activation of male sexual behavior) exerted by testosterone on this preoptic region.

Mapping of neurochemical markers in quail central nervous system: VIP- and SP-like immunoreactivity

The distribution of cells and fibres containing vasoactive intestinal polypeptide (VIP) and substance P (SP) was investigated in the brain of Japanese quail focussing on the centers involved in reproductive activities. SP-immunoreactive (ir) structures were chiefly present within the ventral telencephalic regions, the periventricular hypothalamus and the dorsal aspects of thalamus. VIP immunopositive structures were rarely associated with recognizable nuclei and they were observed in the organum septi laterale (LSO), the lobus paraolfactorius (LPO), the eminentia mediana (ME), the nucleus striae terminalis (nST) and the area ventralis of Tsai (AVT). SP- and VIP-ir structures were both associated with regions implicated in the control of reproduction. SP was mainly distributed within regions that control male copulatory behavior (the preoptic region, the anterior hypothalamus and the central gray), whereas VIP was prevalently located in the mediobasal hypothalamus that is implicated in the control of female reproductive activities.

Vasotocinergic innervation of sexually dimorphic medial preoptic nucleus of the male Japanese quail: influence of testosterone

The distribution of vasotocin (VT)-immunoreactive (IR) fibers was described in the preoptic and septal regions of the male quail brain. The density of VT-IR fibers was measured in the sexually dimorphic preoptic nucleus (POM) and lateral septum (SL) of adult male quail (Coturnix japonica) by means of quantitative image analysis. Experimental manipulations of the hormonal environment in the peripubertal period influenced this distribution. In both regions, the VT immunoreactivity was reduced or absent when males were castrated. The immunoreactivity was restored to its original level in castrated males by Silastic implants of testosterone. These changes were anatomically specific as evidenced by the fact that the density of VT fibers did not vary in the hypothalamo-neurohypohysial tract as a function of the endocrine condition of the subjects. No change was also observed in the number of VT-IR cells in the periventricular region close to the POM. Previously published data show that VT or its mammalian homolog, vasopressin are implicated in the control of a wide range of instinctive behaviors. The steroid-dependent VT afferents to the POM, a key area controlling male copulatory behavior in quail could therefore be involved in the control of the sexual behavior in this species. The outputs of the POM which contains steroid-receptors could therefore be modulated by steroids in two different ways: directly through the steroid receptors it contains and indirectly through its steroid-sensitive peptidergic afferents.

Morphometric studies demonstrate that aromatase-immunoreactive cells are the main target of androgens and estrogens in the quail medial preoptic nucleus

The volume and cytoarchitectonic organization of the sexually dimorphic medial preoptic nucleus (POM) of the quail are sensitive to plasma levels of testosterone (T). We previously showed that, in castrated quail, T or its estrogenic metabolite, estradiol (E2), increases the size of the large neurons located in the lateral part of POM. Embryonic treatments with estrogens are also known to affect permanently the size of these large neurons. Since the lateral POM also contains a dense population of aromatase-immunoreactive (ARO-ir) cells, and these are known to be a target for steroids, we hypothesized that the effects of steroids identified in previous experiments were primarily directed to these ARO-ir cells. This idea was tested in two experiments in which the size of these cells was measured in male quail under various endocrine conditions. In experiment 1, a detailed analysis of ARO-ir and of non-immunoreactive cells in the POM of adult, sexually mature males revealed that the immunoreactive perikarya are larger than the non-immunoreactive cells and that they constitute the vast majority of the large cells (area > 50 microns 2) in the POM. In experiment 2, it was shown that T and E2 actually increase the size of ARO-ir cells in the POM while the androgenic metabolite of T, dihydrotestosterone has no effect at this level. Taken together, these data suggest that the sex differences and the steroid-induced changes in cell size previously described in the study of POM sections stained for Nissl material largely concern aromatase-containing cells. Since aromatization of T plays a limiting role in the activation of male copulatory behavior, these changes may represent the morphological signature of the mechanisms causally involved in the control of this behavior.

Afferent and efferent connections of the sexually dimorphic medial preoptic nucleus of the male quail revealed by in vitro transport of DiI

The medial preoptic nucleus of the Japanese quail is a testosterone-sensitive structure that is involved in the control of male copulatory behavior. The full understanding of the role played by this nucleus in the control of reproduction requires the identification of its afferent and efferent connections. In order to identify neural circuits involved in the control of the medial preoptic nucleus, we used the lipophilic fluorescent tracer DiI implanted in aldheyde-fixed tissue. Different strategies of brain dissection and different implantation sites were used to establish and confirm afferent and efferent connections of the nucleus. Anterograde projections reached the tuberal hypothalamus, the area ventralis of Tsai, and the substantia grisea centralis. Dense networks of fluorescent fibers were also seen in several hypothalamic nuclei, such as the anterior medialis hypothalami, the paraventricularis magnocellularis, and the ventromedialis hypothalami. A major projection in the dorsal direction was also observed from the medial preoptic nucleus toward the nucleus septalis lateralis and medialis. Afferents to the nucleus were seen from all these regions. Implantation of DiI into the substantia grisea centralis also revealed massive bidirectional connections with a large number of more caudal mesencephalic and pontine structures. The substantia grisea centralis therefore appears to be an important center connecting anterior levels of the brain to brain-stem nuclei that may be involved in the control of male copulatory behavior.

The density of melatonin receptors is dependent upon the prevailing photoperiod in the Japanese quail (Coturnix japonica)

Two groups of Japanese quail (Coturnix japonica) were exposed to two different photoperiods (short and long days: LD 8:16 and LD 16:8, respectively), and their brains examined for the presence and distribution of melatonin receptors by means of quantitative in vitro autoradiography. Animals belonging to the LD 8:16 group expressed a significantly higher melatonin receptor density in the optic tectum and nucleus triangularis, while the LD 16:8 animals had a higher density of receptors in the hyperstriatum and nucleus preopticus dorsalis. These data demonstrate an apparent influence of the photoperiod on the density of melatonin receptors, especially in nuclei of the tectofugal pathway, related to the control of visual pattern and intensity discrimination, localization and orientation.

Topographical distribution of reduced nicotinamide adenine dinucleotide phosphate-diaphorase in the brain of the Japanese quail

The distribution of reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase activity was histochemically investigated in the Japanese quail brain. This enzyme is now considered responsible for the synthesis of nitric oxide, a novel neural messenger whose distribution has not been described in the avian brain until now. The histochemical technique provides a simple and reliable method for staining selected populations of neurons throughout the avian brain. In the telencephalon several regions showed heavily stained NADPH-diaphorase positive neurons and processes. In particular the paleostriatal-paraolfactory lobe complex showed the greatest presence of both positive cells and processes. Neurons and processes were also observed in several regions of the hyperstriatum as well as in the archistriatal nucleus taeniae. Some regions, such as the ectostriatum and the hippocampus, had no positive elements. In the diencephalon, the magnocellular hypothalamic system, which in mammals shows NADPH-diaphorase activity, did not show any particular accumulation of reaction product. On the contrary, retinorecipient areas, such as the visual suprachiasmatic nucleus and the lateral geniculate complex, displayed a composite structure of both positive neurons and processes. The brainstem revealed a large NADPH-diaphorase positive population extending through the tegmental nuclei to the locus coeruleus and subcoeruleus. A complex organization was also observed in the optic lobe, where fusiform elements were distributed within the stratum griseum and superficialis of the tectum. In the medulla, a dense terminal field was observed at the level of the nucleus of the solitary tract, whereas scattered neurons were located within the reticular nuclei. Although the staining of neurons and tracts was highly selective, the positive cells did not correspond to any single known neurotransmitter, neuropeptide, or neuroactive molecule system. Several sensory pathways were heavily stained for the NADPH-diaphorase, including part of the olfactory, visual, and auditory pathways. The findings of the present study reveal that the NADPH-diaphorase-containing systems in the avian brain are organized according to a pattern comparable, because of its complexity, to that observed in mammals. However, important interspecific differences suggest that this novel neural system might be involved in diverse tasks.

Distribution and characterization of melatonin receptors in the brain of the Japanese quail, Coturnix japonica

2-[125I]iodomelatonin was used to study the distribution and properties of the melatonin receptor in the Japanese quail brain. High receptor density was detected in the major targets of direct retinal input (optic tectum, nucleus of the optic basal rout, ventrolateral geniculate nucleus), as well as areas representing terminals in the visual pathways (nucleus rotundus, ectostriatum, thalamo-hyperstriatal pathway). Binding was also found in the piriform cortex, the hypophyseal pars tuberalis, the oculomotorius nucleus and the associated Edinger-Westphal nucleus, and in the nuclei of the third, fourth and sixth cranial nerves. A comparison of the receptor pharmacological profile to that of the mammalian brain demonstrated pharmacological identity of the two binding sites. In the saturation experiments, GPT gamma S decreased the binding affinity, numerical Kd values increasing from approximately 35 pM to approximately 150 pM.

Implication of testosterone metabolism in the control of the sexually dimorphic nucleus of the quail preoptic area

In quail, testosterone (T) activates male copulation and affects the volume and cytoarchitectonic organization of the medial preoptic nucleus (POM). T metabolism (especially its aromatization) is critical for the production of these behavioral effects. We wondered whether T metabolism is also playing a role in the induction of the morphological changes in POM. We compared the effects of T and of its metabolites in this nucleus. To obtain an independent evaluation of the role played by aromatase, morphological effects of T associated or not with the aromatase inhibitor R76713 were also assessed. As previously observed, T increased the POM volume and the cross-sectional area of the neurons in the lateral part of the nucleus. The effects of T on the neurons in the lateral POM were mimicked in part by the combined treatment with estradiol and 5 alpha-dihydrotestosterone. They were also blocked by the aromatase inhibitor. This suggests that T aromatization plays a critical role in the mediation of the cytoarchitectonic effects of T. A specific role for androgens alone remains to be established.

Effects of in ovo estradiol benzoate treatments on sexual behavior and size of neurons in the sexually dimorphic medial preoptic nucleus of Japanese quail

In male Japanese quail, the injection of estradiol benzoate (EB) in the egg causes a complete loss of the testosterone (T)-induced copulatory behavior (behavioral demasculinization). This treatment is only effective if performed before day 12 of incubation. This suggests that embryonic estrogens affect in a permanent way brain structures controlling sexual behavior. The medial preoptic nucleus (POM) is the only sexually dimorphic brain nucleus identified in quail and it is a key center for the action of T on behavior. Recent morphometric studies revealed that the dorsolateral population of neurons in the POM is sensitive to variations of plasma T levels in adult males but not in females. These effects are not observed in the medial part of the POM. This sexually differentiated feature might therefore be organized by the embryonic hormonal environment. Quail embryos of both sexes were treated with EB or received a control injection either on day 9 or on day 14 of egg incubation and the cell size in the dorsolateral and medial POM was evaluated by classical morphometric techniques. EB treatment on day 9 decreased cell size in the dorsolateral POM neurons of males but had no effect in females. No effect was also observed when the treatment was performed on day 14. The medial POM neurons were not affected. The decrease in neuronal size observed in the dorsolateral POM of males treated with EB on day 9 was correlated with their behavioral demasculinization. Some of these males showed a weak sexual behavior during the tests and in parallel had significantly larger neurons.(ABSTRACT TRUNCATED AT 250 WORDS)

Localization of neuropeptide Y-immunoreactive cells and fibres in the brain of the Japanese quail

In the present study, we have demonstrated, by means of the biotin-avidin method, the widespread distribution of neuropeptide Y (NPY)-immunoreactive structures throughout the whole brain of the Japanese quail (Coturnix coturnix japonica). The prosencephalic region contained the highest concentration of both NPY-containing fibres and perikarya. Immunoreactive fibres were observed throughout, particularly within the paraolfactory lobe, the lateral septum, the nucleus taeniae, the preoptic area, the periventricular hypothalamic regions, the tuberal complex, and the ventrolateral thalamus. NPY-immunoreactive cells were represented by: a) small scattered perikarya in the telencephalic portion (i.e. archistriatal, neostriatal and hyperstriatal regions, hippocampus, piriform cortex); b) medium-sized cell bodies located around the nucleus rotundus, ventrolateral, and lateral anterior thalamic nuclei; c) small clustered cells within the periventricular and medial preoptic nuclei. The brainstem showed a less diffuse innervation, although a dense network of immunopositive fibres was observed within the optic tectum, the periaqueductal region, and the Edinger-Westphal, linearis caudalis and raphes nuclei. Two populations of large NPY-containing perikarya were detected: one located in the isthmic region, the other at the boundaries of the pons with the medulla. The wide distribution of NPY-immunoreactive structures within regions that have been demonstrated to play a role in the control of vegetative, endocrine and sensory activities suggests that, in birds, this neuropeptide is involved in the regulation of several aspects of cerebral functions.

Clinical efficacy and tolerability of terbinafine in patients with pityriasis versicolor

The antifungal efficacy and tolerability of 1% terbinafine cream vs. 1% bifonazole cream were assessed in a single blind randomized trial in patients with pityriasis versicolor. Terbinafine, a drug of the allylamines group, a new class of anti-mycotic agents, blocks sterol biosynthesis in the pathogen through inhibition of squalene epoxidase and consequent squalene accumulation, a primarily fungicidal process. Forty pityriasis versicolor patients, (18 M, 22 F; mean age 32.4 years; min. 16, max. 65), used 1% terbinafine cream or 1% bifonazole cream for a maximum of 4 weeks. All patients were followed-up weekly both clinically and mycologically. Clinical cures, defined as negativization of each clinical parameter, were recorded for 20 terbinafine patients (100%) and 19 bifonazole patients (95%), with routine microscopy and Wood's light tests both negative. By the 2nd week of treatment, 2 terbinafine patients were mycologically cured (10%). By the 3rd week, 14 terbinafine patients (70%) and 5 bifonazole patients (25%) were mycologically cured. The present controlled clinical trial consequently demonstrates that terbinafine is rapidly effective and well tolerated for treatment of pityriasis versicolor.

The serotoninergic system in the brain of the Japanese quail. An immunohistochemical study

The presence and topographical localization of the serotoninergic system in the brain of the Japanese quail (Coturnix coturnix japonica) have been studied by means of peroxidase-anti-peroxidase immunocytochemistry. The perimeter, diameter, area, and shape factor of immunoreactive cells have been recorded and analyzed morphometrically for intra- and interspecies comparison. The data reported here confirm and extend results previously obtained in the brain of other avian species. Serotonin-immunoreactive neurons of the quail are mainly located in the hypothalamic paraventricular organ and adjacent areas, and in the brainstem where they form three separate groups. The first of these groups consists of small-sized neurons located in the ventro-rostral mesencephalon. The second group is composed of medium-sized neurons located in the dorsal mesencephalo-pontine region. The third group is also formed by medium-sized neurons, and is located ventrally in the ponto-medullary region. In the quail brain, serotoninergic neurons are not restricted to nuclei located in the vicinity of the midsagittal plane, but show some lateralization, especially in the brainstem. The organization of the different groups of immunoreactive neurons based on this topographical distribution and morphometric analysis has been compared with descriptions of the serotoninergic system in other birds. Serotonin-immunoreactive nerve fibers are widely distributed throughout the brain, but appear to be particularly abundant in regions involved in the control of reproductive activities, such as the septal region, the medial preoptic nucleus, the nucleus intercollicularis, and the external zone of the median eminence. The data reported here have allowed the drawing of a map of serotonin-immunoreactive structures.

Immunocytochemical distribution of glial fibrillary acidic protein in the central nervous system of the Japanese quail (Coturnix coturnix japonica)

In the present study we detailed the distribution of GFAP-immunopositive structures within the central nervous system of the Japanese quail. Different fixation and embedding procedures were applied. The best results were obtained on frozen cryostatic sections from freshly dissected brains subsequently fixed by a short immersion in cold acetone. Immunopositive structures were observed both with immunofluorescence, and with immunoperoxidase methods. Immunoreactive cell bodies and processes were observed within the whole central nervous system, and different cell types can be identified on the basis of their topographical location and morphology. A first class of astrocytes is composed of intensely stained unipolar cells lining the inner surface of the pia mater and the large blood vessels. A second type is represented by multipolar astrocytes of variable size, provided with an irregular cell body. The last type is represented by similar elements, showing an immunonegative cell body, that can be identified only by the presence of converging processes. These three types of cells, and several isolated processes, show a differential distribution within the quail central nervous system, both in the grey and in the white matter. Present results suggest that GFAP may represent a good marker for at least part of the astroglial population in quail.

[Sweet's syndrome]

The authors describe a clinical case of Sweet's syndrome in a 41-year-old man. From the clinical-instrumental tests carried out a paraneoplastic syndrome is excluded.