Markers of immunologic injury in progressive alopecia areata

In a selected group of 8 patients with progressive alopecia areata (AA) leading to AA universalis, immunological aspects (in the peripheral blood and the tissue) were studied during the period of the initial attack of the disease. The peripheral T-cell helper/suppressor ratio appeared not to be a reliable parameter for the disease activity. The intrabulbar and peribulbar distribution of T-cells, Langerhans cells and of HLA-DR expression in and around the anagen hair follicles in the progressive areas of the disease (region of exclamation-mark hairs) may suggest a T-cell-mediated injury primarily in the peribulbar regions of the follicles. The data presented tend to support the possibility that in the early development of AA, the dermal pailla (capillary network?) may be the prime target of immunologic injury.

Comparison of oral treatment of uncomplicated urogenital and rectal gonorrhoea with cefuroxime axetil ester or clavulanic acid potentiated amoxycillin (Augmentin)

In a randomised study of two drugs for the oral treatment of uncomplicated urogenital and rectal gonorrhoea the therapeutic effect of cefuroxime axetil ester (CAE) and amoxycillin plus clavulanic acid (A + C) was compared. Cefuroxime axetil ester 1.5 g was given to 129 men and 118 women. Amoxycillin 3.0 g and clavulanic acid 0.25 g was given to 131 men and 122 women. Both treatments were combined with probenecid 1.0 g and administered in a single oral dose. Of the 500 patients thus treated, 376 were assessable. In the group taking CAE, failure rates were 0.9% for the men and 0% for the women; and the overall failure rate was 0.5%. In the group taking A + C the equivalent failure rates were 4.6%, 1.2%, and 3.1%. The differences were not significant. Penicillinase producing Neisseria gonorrhoeae (PPNG) was isolated from 5.6% of the assessable patients. All 10 PPNG infections in the group taking CAE and four of 11 PPNG infections in the group taking A + C were cured. These numbers were too small to draw a definite conclusion about the efficacy of both drugs in this type of infection. Postgonococcal urethritis was observed in 35% of the men in the group taking CAE and in 32% of those in the group taking A + C. Side effects were noted in 38% of the group taking CAE and 28% of the group taking A + C. Nausea and vomiting were more commonly observed in the group taking CAE; and diarrhoea was more commonly observed in the group taking A + C.

Contact allergy to preservatives--II

To determine whether the prevalence of allergic reactions to certain preservatives warrants their inclusion in a routine series for patch testing, a tray of 14 preservatives was tested in 501 consecutive suspected contact dermatitis patients. More than 1% positive reactions were found with DMDM hydantoin, Kathon CG, and alkyl trimethyl ammonium chloride only. The concentration of alkyl trimethyl ammonium chloride (0.1% aqua) was considered too high. Of 6 patients reacting to the formaldehyde releaser DMDM hydantoin, 4 were positive to formaldehyde. Kathon CG may be an important allergen in the Netherlands, and it is worthwhile for dermatologists there to add it to the standard test series. The recent inclusion of quaternium-15 in the ICDRG standard series appears to be of little value to them.

Sensitization to sodium hypochlorite causing hand dermatitis

2 patients are reported with chronic hand dermatitis related to sensitization to sodium hypochlorite, as the active component in a bleaching product. To avoid irritant reactions in patch testing, a sodium hypochlorite concentration of 1.0% appeared to be useful. It is concluded that with regard to the frequent use of bleaching agents, allergy to sodium hypochlorite must be considered in certain cases of unidentified chronic allergic hand dermatitis.

Sensitization to epichlorohydrin and epoxy system components

In an epoxy resin manufacturing plant, 26 of 228 (11.4%) workers had work-related eruptions; 19 were patch tested. The test series consisted of chemicals used in the manufacturing process, a standard battery and some other sensitizers. The prevalence of sensitization to epichlorohydrin and/or epoxy resins in the whole group was 6.1%. A relatively high prevalence (3.5%) of epichlorohydrin sensitization was found. 10 cases of sensitization to liquid epoxy resin (MW about 385) were observed, in 7 cases combined with allergy to solid epoxy resin (MW 980). Sensitization to Bisphenol A was not seen.

Treatment of uncomplicated urogenital gonorrhoea in women with a single dose of enoxacin

One hundred and twenty-three female patients suffering from uncomplicated urogenital gonorrhoea were treated in a double blind randomised trial with either 200 mg enoxacin (one capsule of 200 mg, one of placebo) or 400 mg enoxacin (two capsules of 200 mg). The cure rate in the 46 evaluable patients in the 400 mg group was 100%, and in the 40 evaluable patients in the 200 mg group 98.7%. Minor side effects such as nausea, headache and skin rash occurred in three of 109 evaluable patients (2.8%). The minimum inhibitory concentration of enoxacin for the Neisseria gonorrhoeae strains isolated varied between 0.03 and 0.12 mcg/ml. Enoxacin would seem to be a very effective drug in the treatment of uncomplicated urogenital gonorrhoea in female patients.

Double-blind comparison of 200-mg ketoconazole oral tablets and 1200-mg miconazole vaginal capsule in the treatment of vaginal candidosis

In a double-blind, randomized study the efficacy of oral ketoconazole (400 mg for 5 days) was compared with that of topical miconazole (1200 mg a single dose) in the treatment of 42 patients with vaginal candidosis. One week after the start of therapy the mycological cure rate was 87% in the ketoconazole group and 95% in the miconazole group, indicating that both regimens are equally effective. No major side-effects were observed.

Evaluation of an enzyme immunoassay for the diagnosis of chlamydial infections in urogenital specimens

A total of 194 male urethral and 402 cervical specimens were obtained from patients at the venereal disease outpatient clinic of University Hospital, Rotterdam, The Netherlands, to evaluate the IDEIA test (Boots Celltech) for the detection of chlamydial infections. The prevalences of culture-positive males and females were 17.5 and 8.2%, respectively. The respective overall sensitivities and specificities found were 67.6 and 93.7% for the males and 63.6 and 93.8% for the females. The highest sensitivity (83.3%) was found in male patients with more than 20 leukocytes per field in the sediment of the first-voided urine (magnification, X250) and in women with more than 10 leukocytes per field in a cervical Gram stain (magnification, X800). However, in men without urethritis and in women with fewer than 10 leukocytes per field in the Gram stain, sensitivities of 44.4 and 40%, respectively, were found. Culture-positive, IDEIA-negative results were predominantly observed in samples with few inclusions in the culture.

Treatment of uncomplicated gonococcal urethritis in men with two dosages of ciprofloxacin

One hundred and sixty-four male patients suffering from urethral gonorrhoea were treated in an open randomised trial with either 250 mg (n = 85) or 500 mg (n = 79) ciprofloxacin administered in one tablet. Cure rates in both groups were 100%. Postgonococcal urethritis was observed in 31 of 85 (36%) patients in the first group, and in 21 of 79 patients (27%) in the second group. Side-effects were minor, occurring in four patients in the 250 mg group (4.7%) and in seven in the 500 mg group (8.9%). The side-effects consisted of nausea, diarrhoea and headache. Ciprofloxacin would appear to be a very effective drug in the treatment of urethral gonorrhoea in males.

Sensitization to chloramphenicol; a persistent problem

A surprisingly high incidence of chloramphenicol sensitization is reported in 8 patients with periocular or periauricular dermatitis. In 6 of them, relevance was established to the use of topical chloramphenicol. Concurrent sensitization to polymyxin B sulphate was found in 2. The findings stress the fact that chloramphenicol allergy remains a persistent problem.

Test battery for metal allergy in dentistry

Some alloys used in restorative dentistry may evoke an allergic contact stomatitis in certain persons. In order to protect patients from materials with undesired reactions, and considering corrosion characteristics of different alloys used, it is useful to devise an adequate patch test battery to include the most relevant metals. Dental alloys are composed of a combination of various metals. 12 different ions of frequent occurrence (Au3+, Pd2+, Zn2+, Mo6+, Sn2+, Ga3+, In3+, Co2+, Cr3+(6+), Ni2+, Fe2+(3+) and Si4+) were epicutaneously tested as the aqueous solution of the respective salt. The concentrations are given in g/100 ml and also in m.mole/l. The 12 different metal ion solutions were patch tested on patients in 3 groups: one group with a positive history of contact stomatitis (30 patients, group 1), one group with a positive history of contact dermatitis (16 patients, group 2), and a control group (17 persons, group 3). In contrast to the control group, a remarkable high percentage (11%) of positive skin reactions to Pd was found in groups 1 and 2. No allergic or irritant skin reactions were detected to Ga, Sn and Zn. No irritant reaction was observed at pH values as low as 1.5. In the case of SiCl4 (pH = 0.5), 41% positive irritant reactions were evoked. In the group with a positive history of contact dermatitis (group 1), a positive reaction was found more often (69%) than in the group with a positive history of contact stomatitis (30%) (group 2). The difference between these groups was mainly caused by reactions to Ni and Pd.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythema multiforme in childhood and early infancy

Erythema multiforme is said to be rare in childhood and especially in early infancy. Three infants, none older than 1 year, were seen with this condition; all showed typical clinical features. In one of the three infants, no distinctive etiological factor(s) could be found. One was suffering from congenital hepatitis (cause unknown) and another from a staphylococcal infection.

Subepidermal bullous autoimmune disease associated with immune nephritis. Immunomorphologic studies

There are only a few reports of the association of immune-complex glomerulonephritis with bullous pemphigoid. The occurrence of immune-complex nephritis with linear IgA bullous disease has not been previously reported. We report two cases, one a case of bullous pemphigoid and the other a case of linear IgA bullous disease, both of which were associated with immune-complex glomerulonephritis. The clinical and immunomorphologic data are briefly discussed.

Experience with a modified solid-phase enzyme immunoassay for detection of gonorrhea in prostitutes

The modified Gonozyme Test (Abbott Laboratories; Chicago, IL), a new enzyme immunoassay for detection of Neisseria gonorrhoeae, was evaluated in testing of 266 prostitutes. When the enzyme immunoassay was used with material from the cervix, the prevalence of gonorrhea was 8.4%. As compared with culture results, this rate represents a sensitivity of 88% and a specificity of 99.2%. A sensitivity of 71% and a specificity of 98.9% were registered for tests of urethral material. In a comparison of the two tests without accepting either one as standard, the sensitivity of the enzyme immunoassay was 90% for material from the cervix and the specificity was 100%. There are several possible causes for discordance between results of culture and of enzyme immunoassay. The high predictive value of a negative enzyme immunoassay in screening urogenital samples from prostitutes makes this test very suitable for rapid elimination of gonorrhea from this pool of patients.

Evaluation of the direct fluorescent antibody test for diagnosis of chlamydial infections

The direct fluorescent antibody test and two culture methods were compared for accurate diagnosis of chlamydial infections. Using the same samples, 109 were found to be positive in the microtitre method with the direct confirmation test without subpassage, whereas 66 were positive in the vial method with Giemsa staining and subpassage. The direct test was evaluated for accuracy using cervical and male urethral specimens. Specimens for culture were obtained prior to sampling for the direct test. For cervical samples the sensitivity of the direct test, with the vial method taken as reference, appeared to be 72.2% with a specificity of 93.5%. With the microtitre method as standard, these values were 55.9% and 91.3%, respectively for females, and for male patients 49% and 95.6%, respectively. For cervical samples, in which sampling for the direct test was carried out prior to sampling for culture, the values were 46.3% and 93.2% respectively. Both culture method and study population influenced the sensitivity of the direct test. According to our findings, the direct test cannot replace the culture method for diagnosis of chlamydial infections.

Solid-phase enzyme immunoassay for detection of Chlamydia trachomatis

The prototype of a solid-phase enzyme immunoassay for the detection of Chlamydia trachomatis antigen was tested in 403 men and 135 women attending a venereal disease clinic. Culture on HeLa 229 cells was used as reference method. In men the overall sensitivity and specificity of the enzyme immunoassay was 70% and 98.5% respectively. In the 158 men with non-gonococcal urethritis the sensitivity and specificity was 73% and 96.5% respectively, in the 31 men with post-gonococcal urethritis 82% and 100%, in the 48 men with gonococcal urethritis 67% and 100%, in the 125 men with discharge but normal urinary sediment 54% and 99.1% and in the 41 men with no signs or symptoms 50% and 100%. In women the sensitivity and specificity of the assay was 70% and 92% respectively. On account of the low degree of sensitivity in both men and women and the low degree of specificity in women the prototype of the enzyme immunoassay is not yet considered suitable for clinical use. An improved model is being developed.