Prolonged effects of antidandruff shampoos - time to recurrence of Malassezia ovalis colonization of skin

Most active antidandruff shampoos exhibit a strong activity against the yeast Malassezia ovalis. The present study was undertaken to compare the prolonged antifungal effect of three proprietary shampoos containing either 2% ketoconazole, 1.5% zinc pyrithione or 2.5% selenium sulphide. Superficial squames were harvested from the scalp in the days following a 6-week antifungal shampoo treatment. Counts of yeasts highlighted by a fluorochrome were made using computerized image analysis. Data show the increased duration of yeast reduction for the ketoconazole shampoo over the two other formulations. The lingering effect of ketoconazole is explained by the combination of its antifungal and pharmacokinetic properties.

Responsive corneosurfametry following in vivo skin preconditioning

Skin is subjected to many environmental threats, some of which altering the structure and function of the stratum corneum. Among them, surfactants are recognized factors that may influence irritant contact dermatitis. The present study was conducted to compare the variations in skin capacitance and corneosurfametry (CSM) reactivity before and after skin exposure to repeated subclinical injuries by 2 hand dishwashing liquids. A forearm immersion test was performed on 30 healthy volunteers. 2 daily soak sessions were performed for 5 days. At inclusion and the day following the last soak session, skin capacitance was measured and cyanoacrylate skin-surface strippings were harvested. The latter specimens were used for the ex vivo microwave CSM. Both types of assessments clearly differentiated the 2 hand dishwashing liquids. The forearm immersion test allowed the discriminant sensitivity of CSM to increase. Intact skin capacitance did not predict CSM data. By contrast, a significant correlation was found between the post-test conductance and the corresponding CSM data. In conclusion, a forearm immersion test under realistic conditions can discriminate the irritation potential between surfactant-based products by measuring skin conductance and performing CSM. In vivo skin preconditioning by surfactants increases CSM sensitivity to the same surfactants.

[Anterior lenticonus: diagnostic aid in Alport syndrome]

Anterior lenticonus is a rare condition in which the lens presents a conical protrusion of its anterior cortex. Sometimes isolated, it may be an ocular manifestation of Alport syndrome, a hereditary nephritis accompanied by deafness and other ocular signs such as flecked retinopathy or posterior polymorphous corneal dystrophy. All these manifestations are a result of a genetic defect in type IV collagen, a major component of basal membranes in the human body. The clinical aspects and therapy of anterior lenticonus and Alport syndrome are described, as well as the exploration that must begin when anterior lenticonus is discovered. This exploration is essential so that this diagnosis can be made as soon as possible.

Hand and forearm skin: comparison of their respective responsiveness to surfactants

BACKGROUND/AIMS

Skin compatibility of detergent products is usually evaluated using predictive tests where products are applied on the back or the forearm of the volunteers, even if those products come more readily into contact with consumers' hands. The current study aimed at comparing the skin responsiveness of hands and volar and dorsal forearms to a surfactant solution.

METHOD

Volunteers soaked simultaneously their forearms and hands in a solution of anionic surfactants, at 40 degrees C for 20 min, thrice a day and for 2 consecutive days. Skin condition on the hands, and the volar and dorsal forearms was evaluated by clinical examination and instrumental measurements.

RESULTS

Significant differences were observed at baseline for various skin parameters, especially those related to skin dryness. After repetitive contacts with the surfactant solution, a parallel evolution of most skin parameters was observed--i.e., an absence of change in instrumentally measured erythema and transepidermal water loss, a similar decrease in corneometry values, and a similar increase in staining of the stratum corneum strippings and in clinical dryness. However, an opposite effect of the soakings on the cohesiveness between corneocytes harvested by tape strippings from hand and forearm was observed.

CONCLUSION

For most parameters, skin responsiveness to surfactants appears to be quite similar on the hands and forearms. It is inferred that forearms can be conveniently used to predict interaction of surfactants with hands.

Clinical course and predictive factors for cyclosporin-induced autologous graft-versus-host disease after autologous haematopoietic stem cell transplantation

The administration of cyclosporin A (CyA) after autologous haematopoietic stem cell transplantation (HSCT) induces a systemic autoimmune syndrome mimicking graft-vs.-host disease (GVHD). This syndrome, termed autologous GVHD has notable anti-tumour activity in animal studies. We intended to induce autologous GVHD with CyA in patients undergoing an autologous HSCT. We prospectively studied 118 patients with miscellaneous malignancies undergoing an autologous HSCT with low-dose CyA to characterize the clinical syndrome, its frequency and clinical course, and to determine the factors affecting its incidence. Patients received CyA from d -1 through to d 28, first starting at 2 mg/kg intravenously and then orally as soon as feasible. The dose was adjusted to achieve pre-dose blood levels around 100 ng/ml. A skin biopsy was performed when a skin rash was observed. Thirty-three percent of the patients developed clinical GVHD: clinical stage 1 in 21 patients, stage 2 in seven patients, and stage 3 in three patients. Although total body irradiation (TBI) or high-dose cyclophosphamide were previously thought to be needed, autologous GVHD occurred in five out of 12 patients (42%) after a preparative regimen with high-dose melphalan alone. Autologous GVHD was significantly more frequent in patients older than 33 years, in patients who had received high doses of granulocyte-macrophage colony forming units (CFU-GM) and in those with a diagnosis of myeloid malignancy, compared with those with lymphoid malignancies or solid tumours. A significant negative association was also found with HLA-DR6. In lymphoma patients, GVHD occurred more frequently in advanced disease than in first or second complete remission (CR1-2) patients. All other factors studied were not predictive for GVHD. In conclusion, CyA-induced GVHD is reproducibly and safely induced with doses of CyA adapted to achieve blood levels around 100 ng/ml. In retrospective analysis, there was no survival advantage for patients with GVHD. Phase III trials with this approach are needed to evaluate its anti-tumoral effect.

The boosted antifungal topical treatment (BATT) for onychomycosis

Despite promising pharmacodynamic and pharmacokinetic profiles, modern antifungals exhibit limited efficacy in the treatment of onychomycoses. The clinical and mycological data are far from reaching a complete cure even after long-course treatments extending over many months. After reviewing the histological presentation of onychomycoses, one of the main reasons for treatment failure and disease recurrence appears to be the presence of dormant chlamydospores and arthroconidia inside the infected nail plate. Accordingly, we present a novel concept in onychomycosis treatment. It consists of the combination of an antifungal with a device boosting germination of fungal propagules in order to render these cells more responsive to treatment. Preliminary results of a pilot study support such a concept.

Breast cancer metastatic to the eyelids

Metastases to the eyelids are rare. They may appear as diffuse swellings, nodules or ulcerations. Most often they correspond to the dissemination of a breast adenocarcinoma. An 83 year old woman is reported with mammary adenocarcinoma metastasizing to the eyelids.

Corneocyte desquamation

Corneocyte desquamation at the skin surface is a complex biologic event which is normally regulated for providing an inconspicuous shedding of single corneocytes. When altered, the process gives rise to xerotic and ichthyotic conditions. The present review focusses on important biologic and molecular aspects responsible for normal and altered corneocyte desquamation. There is a complex relationship between epidermal cell production, maturation and desquamative loss. Corneocyte hydration, stratum corneum barrier function and enzymatic corneodesmolysis are involved in a dynamic interrelationship. Many physiological and environmental factors acting in a different time frame influence desquamation.

Classical Ehlers-Danlos syndrome caused by a mutation in type I collagen

Classical Ehlers-Danlos syndrome (EDS) is characterized by skin hyperelasticity, joint hypermobility, increased tendency to bruise, and abnormal scarring. Mutations in type V collagen, a regulator of type I collagen fibrillogenesis, have been shown to underlie this type of EDS. However, to date, mutations have been found in only a limited number of patients, which suggests genetic heterogeneity. In this article, we report two unrelated patients with typical features of classical EDS, including excessive skin fragility, in whom we found an identical arginine-->cysteine substitution in type I collagen, localized at position 134 of the alpha1(I) collagen chain. The arginine residue is highly conserved and localized in the X position of the Gly-X-Y triplet. As a consequence, intermolecular disulfide bridges are formed, resulting in type I collagen aggregates, which are retained in the cells. Whereas substitutions of glycine residues in type I collagen invariably result in osteogenesis imperfecta, substitutions of nonglycine residues in type I collagen have not yet been associated with a human disease. In contrast, arginine-->cysteine substitutions in type II collagen have been identified in a variety of chondrodysplasias. Our findings show that mutations in other fibrillar collagens can be causally involved in classical EDS and point to genetic heterogeneity of this disorder.

Chronic verrucous varicella zoster virus skin lesions: clinical, histological, molecular and therapeutic aspects

The outbreak of HIV infection introduced a new phenomenon in varicella zoster virus (VZV) pathology, namely the long-standing wart-like skin lesions that are frequently associated with resistance to thymidine kinase (TK)-dependent antiviral agents. This paper reviews the clinical, histological, and molecular aspects and the therapeutic management of these verrucous lesions. The majority of lesions are characterized by chronically evolving, unique or multiple wart-like cutaneous lesions. The main histopathological features include hyperkeratosis, verruciform acanthosis and VZV-induced cytopathic changes with scant or absent cytolysis of infected keratinocytes. The mechanism that establishes the chronic nature of the lesions appears to be associated with a particular pattern of VZV gene expression exhibiting reduced or nondetectable gE and gB synthesis. Drug resistance to TK-dependent antiviral agents is a result of nonfunctional or deficient viral TK. This necessitates alternative therapeutic management using antiviral agents that target the viral DNA polymerase.

Adult groin hernias: new insight into their biomechanical characteristics

The biomechanical properties of the transversalis fascia and rectus abdominis aponeurosis were assessed in adult groin hernias, using a computerized-suction device (Cutometer) equipped with a 2-mm probe. Evaluations were made ex vivo on fresh samples collected from 63 patients with unilateral or bilateral hernias and 30 control subjects without hernias. Under 50 and 200 mbar suctions, there was no statistical difference between the overall mechanical properties of control and patient aponeuroses. For both 50 and 200 mbar suctions, the maximum distension (MD) and the biological elasticity (BE) of fasciae from direct hernias were significantly increased, compared with control fasciae. In the same comparison, the MD-50 and -200 and the BE-50 of patient fasciae from the non-herniated sides were also significantly increased. It is concluded that the presently reported biomechanical alterations seem to be the cause and not the consequence of the hernias. These data suggest that a functional connective tissue pathology probably plays a role in the genesis of groin hernias.

Mechanical properties of skin and liposuction

BACKGROUND

Liposuction removes fat, setting the skin under tension, and could therefore alter the overall viscoelastic properties of the teguments.

OBJECTIVE

To measure in vivo the mechanical properties of skin at the site of liposuction and to compare the viscoelastic values with those of the inner aspect of the forearms.

METHODS

The Cutometer SEM 474 equipped with a 8-mm probe was used.

RESULTS

Data show that cutaneous laxity, which is characteristic for an aging aspect, is not higher at the liposuction sites than on the reference area.

CONCLUSION

Liposuction does not increase the clinical aspects of skin aging.

Mechanical properties of the diabetic waxy skin

BACKGROUND

In some diabetic patients, the skin of the hands has a waxy appearance.

OBJECTIVE

To study subclinical skin stiffening in diabetic patients using a noninvasive, in vivo suction device measuring skin extensibility and elasticity. Skin thickness was also measured by high-resolution ultrasonography.

METHODS

Evaluations were made on the dorsum of the hands and on the volar aspect of the forearms.

RESULTS

In type 1 diabetic patients, the extensibility of skin was decreased while values of thickness and elasticity were increased. These alterations were most prominent on the hands. Similar modifications, although less pronounced, were also found in type 2 diabetic subjects.

CONCLUSION

The reported biomechanical changes indicate the presence of subclinical skin stiffening in many patients with diabetes mellitus. Such noninvasive biometrological evaluations could be used for monitoring, rating and correlating some diabetes-associated disorders.

Paradoxical response to itraconazole treatment in a patient with onychomycosis caused by Microsporum gypseum

A Columbian patient presented with a rare type of onychomycosis caused by Microsporum gypseum. Oral treatment with itraconazole formulation (Funazol) available in Columbia failed to improve the nail alteration. The fungitoxic effect of itraconazole was assessed on the M. gypseum strain cultured from the nail of the patient by using the method of culture of fungi on cyanoacrylate skin surface strippings (CSSS). In addition, a comparative evaluation of the oral bioavailability of itraconazole was made in volunteers after intake of Funazol and Sporanox. In the ex vivo bioassay on CSSS, topical itraconazole proved to be highly active against M. gypseum. After oral intake, however, the itraconazole bioavailability of Funazol relative to Sporanox averaged only 3.5%. Antifungal pulse therapy with Sporanox, 400 mg daily for 1 week per month for 4 months, cured the patient. This study shows that itraconazole is hardly or not absorbed from the oral formulation Funazol. Both the oral bioavailability and consequently therapeutic efficacy of the genuine drug (Sporanox) are highly superior.

Acquired nail beading in patients receiving itraconazole--an indicator of faster nail growth? A study using optical profilometry

Nail surfaces of toe-nail fragments were analysed by optical profilometry in patients treated with two different dosages of itraconazole: 200 mg continuous dosing for 12 weeks, or a pulse-dose regimen of 1 week per month of 400 mg itraconazole daily for 3-4 months. The use of the latter regimen seemed clinically to increase nail growth, which was accompanied in several patients by the occurrence of nail surface irregularities. This aspect was studied by computerized optical profilometry. Nail beading was characterized by a higher number of peaks and a larger mean roughness value (Ra). Such findings are reminiscent of other nail alterations resulting from a faster matrix turnover. A substantially greater number of peaks and larger Ra were found in the patients receiving the pulse treatment than in those receiving the continuous-dose regimen. Pulse therapy with itraconazole therefore appears to modify the structure of the nail plate, probably as a result of, or in association with, an increased rate of growth.

Dansyl chloride labelling of stratum corneum: its rapid extraction from skin can predict skin irritation due to surfactants and cleansing products

The irritation potential of surfactants and body cleansing products was determined by evaluating the removal of dansyl chloride from the skin. Dilute solutions (2% active ingredient, w/v) of surfactants and soap extract fluorescence from the skin within 30 min. This is probably a physicochemical effect as it is too rapid to be due to a modification of epidermal cell turnover rate. Such an extraction of the fluorescent dye occurs without any clinical sign of irritation. However, it may represent an early phase of the skin irritation process, because it is related to the ranking of irritant products as determined by other assessment methods.

Endoscopic cure of a giant sacral meningocele associated with Marfan's syndrome: case report

An unusual anterior sacral meningocele associated with Marfan's syndrome, with demonstrated dural anomalies related to Marfan's syndrome is reported. Endoscopy enabled complete exploration of the meningocele, its morphological description, and ultimate cure. The meningocele resembled an hourglass made up of intrasacral and anterior sacral components. The communication of this bilobed malformation with the dural sac was so small that only the intrathecal injection of a colored solution allowed its localization. The closure of this communication was accomplished under endoscopic view by a single stitch. The postoperative course of the patient was characterized by immediate disappearance of the preoperative clinical signs. Computed tomographic scans demonstrated progressive complete collapse of the anterior sacral meningocele and partial resolution of the intrasacral component. Dural anomalies of Marfan's syndrome are described, and their relationship to the formation of the meningocele is discussed.

A comparison of intraperitoneal prostheses for the repair of abdominal muscular wall defects in rats

We compared the tissue response to the intraperitoneal implantation of three different prostheses (Gore-Tex, Mersilène, Vicryl-Mersilène) used to repair abdominal wall defects in rats. Vicryl-Mersilène is a new experimental prosthesis made of Dacron (Mersilène) coated with absorbable polyglactin (Vicryl). The least amount of adhesions to omentum and gut was found with Mersilène. Gore-Tex was responsible for the accumulation of neutrophils rather than macrophages mostly collected in close contact with Mersilène and Vicryl-Mersilène. Fibrosis, evaluated by histology and computerized morphometry, was mostly found with Vicryl-Mersilène. This should allow a better incorporation of Mersilène and a tighter anchorage to the abdominal wall, after Vicryl resorption.

Recessive metaphyseal dysplasia without hypotrichosis. A syndrome clinically distinct from McKusick cartilage-hair hypoplasia

Among children with recessive metaphyseal dysplasia involving the knees and extremities, two types can be distinguished. In true cartilage-hair hypoplasia, as described by McKusick, many patients show clinical hair involvement and variable immunodeficiency. We present a series of six patients with the same radiological changes, but without apparent hypotrichosis. We suggest that they should be considered as having a variant form of cartilage-hair hypoplasia, with a clinically distinct phenotype, which could be as common as 'true' cartilage-hair hypoplasia among non-Amish populations. Microscopic examination of the hair may show reduction in the diameter of the hair shaft. This form of metaphyseal dysplasia may result from allelic heterogeneity.

[Granulomatous vasculitis]

Granulomatous vasculitis are defined as a pathological process due to the destruction of vessels by a granulomatous infiltrate. The inflammatory infiltrate is made of several cellular lines in variable proportions. These diseases are classified according to the affected organs and to the nature of the vessels. Some granulomatous vasculitis remain cryptogenetic in nature, others have an infectious origin, and still others follow a necrotizing leucocytoclastic vasculitis with immune complexes.

Candida albicans septicemia with folliculitis in heroin addicts

Disseminated candidiasis occurring in heroin abusers has been reported in the recent years as a peculiar type of septicemia. Dermatological lesions consist of folliculitis with Candida albicans within hair shafts.

How is the basement membrane attached to the dermis? Stereology of the interlacing fibers at the underface of the dermo-epidermal basement membrane

A three-dimensional view of the underface of the dermoepidermal basement membrane is provided by scanning electron microscopy and correlated with aspects of optical and transmission electron microscopy. A thin network of interlacing fibers runs parallel to the basement membrane and appears to be attached to it from site to site through loops of anchoring fibers. A model of the attachment of the basement to the dermis is proposed.

Massive lymphocyte-mediated apoptosis during the early stage of pseudopelade

The early evolving lesions of the hair follicles are described in pseudopelade, a type of cicatricial alopecia where clues for the diagnosis of lupus erythematosus or lichen plano-pilaris are lacking. A sudden and synchronized cell death of all the cells of the epithelial sheaths of the hair follicles occurs and is associated with a dense infiltration by lymphocytes. The epidermis remains uninvolved. This unique aspect is most probably related to the mechanism of apoptosis. Its intensity and extension are much more pronounced than in lichen planus and in lupus erythematosus. Pathogenesis of at least some cicatricial alopecias could therefore be related to massive apoptosis without evident and close relationship with the classical etiologies, i.e. lichen planus and lupus erythematosus.

Nevi of connective tissue. A reappraisal of their classification

Nevi of connective tissue may be conveniently divided according to clinical and pathologic presentations into two types, namely, the adventitial and the reticular. Nevi of adventitial connective tissue are usually small and situated on the extremities. They are characterized by accumulations of fibroblasts and apposition of collagen around adnexa and vessels. Nevi of reticular connective tissue are usually situated on the trunk. They consist of faulty distributions and amounts of collagen bundles, elastic fibers, or proteoglycans.

Molluscum contagiosum may affect primarily the epidermis without involving hair follicles

Lesions of molluscum contagiosum occur on palms and in skin tags. Their origin in places where there are no hair follicles proves that the epidermis itself may be infected by the causative poxvirus. The central umbilications of lesions are therefore not necessarily related to acrotrichia.

Skin surface stripping in diagnosing and monitoring inflammatory, xerotic, and neoplastic diseases

Skin surface stripping is a useful and simple diagnostic tool for the diagnosis of a number of diseases that affect the skin during childhood and adolescence. The procedure has proved to be especially valuable in inflammatory, xerotic, and neoplastic conditions as it provides information regarding pathologic changes as well as diagnosis.

Isolation of the vascular plexuses from the dermis

A technique for isolation of the blood vessels from the dermis is presented. A number of characteristics of the vessels may be visualized in this way.

Neoplastic proliferation in a case of epidermotropic high-grade malignant lymphoma associated with hypercalcemia

We report a case of epidermotropic high-grade malignant lymphoma associated with hypercalcemia occurring in a European woman aged 30 years. The clinical, histological, and biological presentation of the patient could enter the spectrum of HOTS (hypercalcemia, osteolysis, T cell lymphoma syndrome). The proliferation of neoplastic lymphocytes was very high in patch, plaques, and nodules of the skin.