Unilateral acne after facial palsy

We describe a case of unilateral acne which appeared after an episode of facial nerve palsy. An 18-year-old female patient presented with papules and pustules predominantly located on the side where the facial paralysis occurred. The patient suffered right facial paralysis, which was treated with prednisone and kinesiotherapy with massages, electrostimulation, and infrared light. Two weeks later, acne lesions appeared in the area affected by the paralysis. As suggested in other cases of paralysis, including cases of Parkinson's disease and spinal cord injury, an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions.

A comprehensive pathophysiology of dandruff and seborrheic dermatitis - towards a more precise definition of scalp health

Despite an increasing knowledge of dandruff and seborrheic dermatitis (D/SD), the pathophysiological understanding is still incomplete but suggests a role of Malassezia yeasts in triggering inflammatory and hyper-proliferative epidermal responses. The objective of this report is to review published literature from in vivo studies of D/SD populations to provide a more complete description of overall scalp health. New biomolecular capabilities establish a depth of pathophysiological understanding not previously achievable with traditional means of investigation. Biomarkers representing inflammation, hyper-proliferation and barrier function are all perturbed by the D/SD condition and robustly respond to therapeutic resolution. These biomarkers can be sampled noninvasively, enabling their use in routine clinical evaluations as either surrogate endpoints or complementary ones to classical signs/symptoms to broaden the etiological learning.

Oxidative stress in patients with scalp seborrheic dermatitis

Seborrheic dermatitis (SD) is a common, chronic inflammatory skin disease that mainly affects the scalp. The objective of this study was to evaluate the activities of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) in scraping samples of patients with scalp SD. Thirty consecutive patients with a diagnosis of scalp SD and thirty-one healthy volunteers were enrolled. The samples were obtained by scraping the skin surface of the scalp. SOD and CAT activities and MDA levels were measured in scraping samples by spectrophotometric method. SOD and CAT activities and MDA levels were significantly higher in patients than in controls (p<0.001 all). There was a positive correlation between the severity of the disease and itching scores (contingency coefficient = 0.671, p<0.001). Except for this correlation, there was no significant correlation among age, sex, duration and severity of the disease, itching scores, antioxidant enzymes and MDA levels in the patient group (p>0.05). Cutaneous oxidative stress in patients with SD may play an important role in the pathogenesis of the disease. Further clinical and laboratory evaluation of the oxidant/antioxidant system in patients with SD is warranted.

Seborrheic dermatitis: an update

Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. The prevalence of adult seborrheic dermatitis is estimated at 5%. Although the exact cause of seborrheic dermatitis has yet to be understood, Malassezia yeasts, hormones (androgens), sebum levels and immune response are known to play important roles in its development. Additional factors including drugs, winter temperatures and stress may exacerbate seborrheic dermatitis. A variety of treatment modalities are available, including antifungal agents, topical low-potency steroids and calcineurin inhibitors (immunomodulators). This review summarizes current knowledge on the etiopathogenesis and therapy of adult seborrheic dermatitis.

Scalp stratum corneum histamine levels: novel sampling method reveals association with itch resolution in dandruff/seborrhoeic dermatitis treatment

Dandruff and seborrhoeic dermatitis are accompanied by bothersome itch. We have established a novel non-invasive methodology to sample histamine levels in the stratum corneum in order to facilitate an understanding of pruritogenesis in this condition. Histamine levels were assessed in two groups of subjects with dandruff before and after 3 weeks of treatment with a commercial potentiated zinc pyrithione shampoo. A comparative population without dandruff was also studied. Itch self-perception was quantified on a visual analogue scale. The histamine level in subjects with dandruff was more than twice that in those who did not have dandruff. Under conditions known to resolve flaking symptoms, the shampoo led to a reduction in histamine in subjects with dandruff to a level that was statistically indistinguishable from those who did not have dandruff. This reduction in histamine was accompanied by a highly significant reduction in the perception of itch intensity. These findings suggest an association between the subjective perception of itch in the scalp and the level of histamine in the skin.

Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis

PURPOSE

To evaluate the clinical findings, tear film functions and ocular surface changes in patients with seborrhoeic dermatitis.

METHODS

This prospective study involved 63 patients with seborrhoeic dermatitis (Group 1) and 65 control subjects (Group 2). Best-corrected visual acuity measurement, slit-lamp examination, Schirmer I test, tear film break-up time (BUT), Rose Bengal staining and conjunctival impression cytology were performed in all patients. Subjective ocular complaints were scored using an Ocular Surface Disease Index (OSDI) questionnaire. Results between the two groups were compared.

RESULTS

In group 1, meibomitis, blepharitis and conjunctival hyperemia were seen significantly more frequently than in group 2 (p < 0.001). Impression cytology revealed grade 0 changes in 25 (39.6%) eyes, grade 1 changes in 22 (34.9%) eyes, grade 2 changes in 13 (20.6%) eyes and grade 3 changes in 3 (4.7%) eyes in group 1, whereas grade 0 changes in 48 (73.8%) eyes, grade 1 changes in 11 (16.9%) eyes and grade 2 changes in 6 (9.2%) eyes were seen in group 2 (p = 0.032). Mean goblet cell density was 795 ± 55 cells/mm(2) in group 1 and 1820 ± 100 cells/mm(2) in group 2 (p < 0.001). Mean Schirmer I and mean BUT results were statistically lower in group 1 than in group 2 (p = 0.043 and p < 0.001, respectively). Mean Rose Bengal scores and mean OSDI scores were statistically higher in group 1 than in group 2 (p = 0.002 and p < 0.001, respectively).

CONCLUSIONS

Our data show that patient with seborrhoeic dermatitis has decreased tear production, tear film instability and significant degeneration of the ocular surface epithelium, compared with normal subjects.

Serum and tissue angiotensin converting enzyme in patients with psoriasis

Recent evidence suggests that the angiotensin converting enzyme (ACE) is present in skin. The real value of the determination of ACE activity as a clinical-biochemistry test for the diagnosis of psoriasis has not been attained. Serum and tissue ACE were measured in 60 patients with psoriasis, 20 patients with lichen planus, 20 patients with seborrhoic dermatitis and in 20 healthy individuals. The serum and tissue ACE activity was determined before and after therapy, using the spectrophotometric method and hippuryl-l-histidyl-l-leucine as a substrate. The results showed that serum ACE activity before therapy was significantly increased in both groups--patients with psoriasis (p < 0.001) and patients with lichen planus (p < 0.001) in comparison to healthy individuals. However, there were no significant differences in serum ACE activity among patients with seborrhoic dermatitis and healthy individuals. After therapy, serum ACE activity significantly decreased in both groups of patients with psoriasis and patients with lichen planus comparing it to the level found in the control group. The values in both were similar. The tissue ACE activity in altered skin was significantly increased only in the patients with psoriasis in comparison to uninvolved skin of these patients, as well as the skin of healthy individuals. After therapy, there were no significant differences in tissue ACE activity between the treated skin and the healthy skin. In conclusion, determination of tissue angiotensin converting enzyme activity can be used in the differential diagnostic of indistinct clinical forms of psoriasis.

The study of CD20 and CD45.Ro antibodies in the inflammatory infiltrate involved in acne and seborrheic dermatitis

The aim of our study was to evaluate the role of CD20 and CD45.Ro antibodies in acne and seborrheic dermatitis. A number of 20 patients with papular, pustular or nodular acne and another 20 patients with seborrheic dermatitis were available for our study. We removed bioptic material from all of them and we perform histochemical and immunohistochemical processing within the Laboratory of Histology, Histopathology and Immunohistochemistry of the University of Medicine and Pharmacy of Craiova. In acne, we could reveal a positive CD45.Ro immunomarking in rare lymphoid cells situated in the middle derma at a distance from the affected pilosebaceous follicle and in the inflammatory infiltrate subepidermically, and also a negative immunomarking in the inflammatory cells from the proximity of the affected pilosebaceous follicle. In patients with seborrheic dermatitis we noticed a positive immunomarking infiltrate of the papillary derma and a positive immunomarking of membrane for CD45.Ro in many lymphoid cells of the inflammatory infiltrate situated in the papillary derma predominantly disposed perivasculary. Conclusions. The absence of the cells marked with CD45.Ro in the proximity of the pilosebaceous follicle interested in acne excludes the direct participation of B- and T-lymphocytes in the perifollicular inflammatory process, though the T-lymphocytes can be revealed in a small number at a distance from the affected follicle. The inflammatory infiltrate from the seborrheic dermatitis proved to be rich in positive CD45.Ro cells and poorer in positive CD20 cells.

Differentiation of Hidroacanthoma Simplex from Clonal Seborrheic Keratosis-An Immunohistochemical Study

Hidroacanthoma simplex (HS) is an uncommon poroid neoplasm confined within the epidermis. The clinical features of HS are not distinctive and histopathologically HS may be confused with clonal seborrheic keratosis (CSK) if cystic or ductal structure is not present. The purpose of our study was to differentiate HS from CSK by the immunohistochemical expressions of various cytokeratins, CEA, CD1a, and S-100 protein, as well as by the degrees of deposition of melanins and glycogen. Four cases of HS and seven cases of CSK were included in the research. In contrast with CSK, HS showed a very low density of Langerhans cells (19.9 +/- 7.7 versus 3.1 +/- 1.0 CD1a (+) cells/mm, P = 0.027) and sparse melanin deposition in the nests. However, HS could not be set apart from CSK by the expressions of cytokeratins. The nests of both HS and CSK showed very similar patterns of cytokeratin expression and seemed to be mainly composed of basaloid cells with focal differentiation toward epidermal suprabasal cells.

Seborrheic dermatitis, increased sebum excretion, and Parkinson's disease: a survey of (im)possible links

The concept of skin as a mirror of parkinsonism, dates back at the beginning of the last century. Since then, much evidence has been accumulated supporting a causal association between the neurological disturbance and changes detectable on areas of the integument with the richest sebaceous gland supply, namely seborrheic dermatitis and/or seborrhea. However, the many persisting sources of perplexity weighing on some general aspects of the skin condition itself (lack of standardized diagnostic criteria, high variability of estimates of prevalence, and controversies on etiology and pathomechanisms) must have to date hampered assessment of the real nature, and significance (if any) of the links observed. The three major pathogenical pathways so far conceived in this context will be critically reviewed on the basis of evidences provided in the literature.

A non-invasive tape absorption method for recovery of inflammatory mediators to differentiate normal from compromised scalp conditions

BACKGROUND/AIMS

A simple non-invasive tape (Sebutape) adsorption method was used to recover inflammatory proteins from normal and compromised human scalp (i.e. dandruff and seborrheic dermatitis) in order to assess the inflammatory and immunologic changes relevant to these clinical conditions.

METHODS

The scalps of subjects identified by a dermatologist as having either dandruff (n = 18), seborrheic dermatitis (n = 19) or normal scalp (n = 16) were visually graded to obtain total adherent scalp flaking scores (TASFS). Sebutape samples were then collected from both the high and low TASFS scalp sites using a one-minute tape application. To recover inflammatory molecules, tapes were extracted in buffered saline with sonication and the tape extracts analysed using commercial immunoassay methods for pro-inflammatory cytokines [i.e. interleukin-1alpha (IL-1alpha), IL-1beta, IL-1 receptor antagonist (IL-1ra), IL-8 and tumor necrosis factor-alpha (TNF-alpha)] and the immunologic cytokines [i.e. IL-2, IL-4, IL-10, IL-12, IL-15 and interferon gamma (IFN-gamma)]. Nitric oxide (NO) was also assayed on tape extracts using the Greiss reaction. To account for differences in protein loading on the tapes all cytokine and NO results were normalized using the total protein (TP) amounts recovered in tape extracts.

RESULTS

The IL-1alpha/TP levels recovered from dandruff and seborrheic scalps were significantly decreased (P = 0.03) compared to normal appearing scalp levels. The scalp levels of IL-1ra/TP and the ratio of IL-ra to IL-1alpha were significantly (P = 0.002) or directionally (P = 0.07) higher in seborrheic dermatitis scalps and dandruff scalps, respectively, compared to normal scalps. The IL-1ra and the IL-1ra/IL-1alpha ratio values correlated well with the TASFS. The TNF-alpha/TP levels recovered from dandruff scalps were significantly higher (P = 0.02) than levels recovered from seborrheic dermatitis and normal scalp subjects. IL-2/TP was significantly increased (P = 0.01) and IFN-gamma and NO significantly decreased (P = 0.05) in the seborrheic dermatitis scalp samples compared to normal controls.

CONCLUSION

The Sebutape method has proven useful for distinguishing normal from diseased scalp conditions. The cytokines recovered from the scalp tape samples showed distinct patterns that differentiated dandruff, seborrheic dermatitis and normal scalp populations. These methods may also prove useful for monitoring the clinical efficacy of therapeutic actives for treating dandruff and seborrhea.

Dandruff: a condition characterized by decreased levels of intercellular lipids in scalp stratum corneum and impaired barrier function

Dandruff is a major problem, yet little is known about the underlying mechanism and subsequent biochemical changes occurring in the scalp skin that lead to its manifestation. The characteristic flaking and scaling of the scalp experienced by dandruff sufferers suggests, similar to the changes classically seen in xerosis, that the desquamation process is impaired. We initiated studies to quantify the biochemical nature of the stratum corneum in the scalp of healthy individuals and dandruff sufferers. Total amounts and relative ratios of stratum corneum lipids species were analysed in scalp stratum corneum samples collected during studies conducted in the UK and Thailand in order to examine ethnic differences. In both populations, dandruff was associated with a dramatic decrease in free lipid levels, with significant decreases in ceramides, fatty acids, and cholesterol. Detailed sub-analysis of the major ceramide species within the total ceramide fraction revealed a decrease in ceramide 1 and increased proportions of ceramide 6i and 6ii. In a separate study, we demonstrated that dandruff sufferers show both an elevated blood flow and an increased reported incidence of itch in response to histamine topically applied to the scalp compared with no-dandruff controls. Taken together these two studies indicate that the quality and resilience of the epidermal water barrier is impaired in the scalp of dandruff sufferers. We propose that the perturbed barrier leaves dandruff sufferers more prone to the adverse effects of microbial and fungal toxins, and environmental pollutants, thus perpetuating their impaired barrier.

[Hormones--underestimated problem in dermatology. Part I. Diseases connected with excessive androgenisation]

This article is devoted to hormonal pathogenesis of chosen dermatoses--acne vulgaris and androgenetic alopecia--basis of the latest literature. Authors take note of possible role of many different hormonal factors, not only androgens, in etiology these diseases. The further study of mentioned problems can lead to new clinical and therapeutic implications in dermatology.

Sebum excretion rates in mothers and neonates

As neonates have a high sebum production compared with 6-month-old babies, we wished to investigate the relationship of sebum production in mother and neonate. The sebum excretion rate (SER) was therefore measured in 10 mothers prenatally, and in each mother and baby as soon after birth as possible, and again 5-12 weeks postnatally. There was a significant correlation between the maternal and neonatal SER perinatally. The perinatal SER in the babies was markedly higher than the postnatal sample. These observations suggest an important role for the maternal hormonal environment on the infant sebaceous glands. There is animal evidence which suggests that the endocrine environment of the neonate influences the sebaceous gland development in puberty, but it is not known whether babies with a high SER are more prone to seborrhoea and acne in later life.

Tear lactoferrin levels in chronic meibomitis associated with acne rosacea

PURPOSE

To determine tear lactoferrin levels in patients with chronic diffuse meibomitis associated with acne rosacea and to investigate their role in the development and perpetuation of some inflammatory ocular surface complications.

METHODS

In this non-randomized, controlled trial performed in a tertiary care center, eight patients with biopsy-proven acne rosacea and blepharitis, and ten patients with seborrheic blepharitis not associated with acne rosacea formed the study groups and ten normal patients were used as controls. Schirmer I test results, tear break-up time and radial immunodiffusion (Lactoplate) tests on tear samples of the three groups were compared.

RESULTS

Compared to controls, tear lactoferrin concentrations were lower in both the acne rosacea and seborrheic blepharitis groups. However, this decrease was significant in only the seborrheic blepharitis group (p = 0.026). One patient in the acne rosacea group, with the lowest measurement, developed bacterial keratitis.

CONCLUSIONS

Though within the normal range, tear lactoferrin levels in patients with acne rosacea and seborrheic blepharitis were lower than controls. Low concentrations of lactoferrin may play a role in the ocular surface inflammatory components associated with these diseases.

Association of meibum oleic acid with meibomian seborrhea

PURPOSE

We sought to determine whether patient meibum fatty acid unsaturation is associated with meibomian gland secretion consistency.

METHODS

Meibomian gland secretions were dissolved in chloroform and separated into lipid classes by thin-layer chromatography. Fatty acids in individual lipid classes were characterized by gas chromatography after transmethylation.

RESULTS

Meibum from patients with meibomian seborrhea was higher, and meibum from patients with meibomian keratoconjunctivitis (meibomianitis) was lower in the monounsaturated fatty acid, oleic acid, than that of other disease groups and normal subjects.

CONCLUSION

Our results strongly suggest that the melting characteristics of meibum, influenced primarily by the amount of oleic acid in wax and sterol esters and free fatty acids, greatly influence the consistency of meibomian gland secretions.

Sebum rheology evaluated by two methods in vivo. Split-face study of the effect of a cosmetic formulation

Modulation of the rheological characteristics of sebum at the surface of the skin might represent a valuable strategy for the treatment of seborrhea. In this field, only a small number of studies have addressed sebum diffusion within the stratum corneum. In an open, split-face study conducted on 20 men, we measured the sebosuppressive effect of Effidrate cream which is based on a glycerol alkyl-ether. Measurements were made in the morning at three-week intervals for a total period of 3 months. Sebum casual levels and sebum excretion rates were measured using a SM810 Sebumeter. Lipid-absorbent Sebutape was also used to collect all the sebum released from infundibular reservoirs over a four-hour period. Clinical assessments were relatively uninformative but the photometric measurements showed that Effidrate cream had a sebosuppressive action. The underlying biological mechanism remains unclear but a hypothesis based on enhanced sebum absorption by the stratum corneum is discussed.

Expression of the human erythrocyte glucose transporter Glut1 in cutaneous neoplasia

BACKGROUND

The increased glucose uptake seen in cancer cells correlates with the expression of human erythrocyte glucose transporter (Glut1) protein in certain human malignancies.

OBJECTIVE

Our purpose was to determine Glut1 expression in cutaneous neoplasms.

METHODS

A polyclonal anti-Glut1 antibody (MYM) and a standard ABC immunoperoxidase technique were used to determine Glut1 expression in invasive squamous cell carcinomas (SCCs), SCC in situ, basal cell carcinomas (BCCs), melanomas, actinic keratoses (AKs), seborrheic keratoses, common acquired nevi, and scars with regenerative epidermal hyperplasia.

RESULTS

All of the cases of SCC in situ, 14 of 15 (93%) of the SCC, and 13 of 15 AKs (87%) showed intense membranous staining for Glut1. Glut1 staining was present in the epidermis of 8 of 15 scars (53%) but was not detected in any BCC, even in areas of focal keratinization and squamous metaplasia. Glut1 reactivity was absent in the melanomas and seborrheic keratoses.

CONCLUSION

Glut1 expression in a cutaneous lesion strongly suggests a proliferative lesion of the squamous cell type.

Skin surface lipids in HIV-positive patients with and without seborrheic dermatitis

BACKGROUND

Seborrheic dermatitis (SD) is a frequent complication of infection with the human immunodeficiency virus (HIV). Most studies examining the cause of SD have concentrated on the roles of Pityrosporum ovale and sebaceous lipids. Previous studies of skin surface lipid from patients with SD have produced conflicting results, with some authors reporting an abnormal lipid composition and others finding little or no abnormality.

METHODS

The composition of skin surface lipid was studied in 15 HIV-positive and 10 HIV-negative men with SD, in 14 HIV-positive men without SD, and in 16 unaffected controls. Total lipids were extracted from unaffected forehead skin into petroleum ether and separated into lipid classes by thin layer chromatography. The lipid classes were quantitated by densitometry after charring with sulfuric acid.

RESULTS

Patients, HIV-positive with SD, had significantly lower proportions of free fatty acid (FFA) and higher levels of triglyceride than normal controls. Patients, HIV-positive without SD, had a significantly increased proportion of FFA compared to HIV-positive patients with SD. Patients with SD, both HIV-positive and HIV-negative, had a similar pattern of skin surface lipid. Levels of FFA were lower and those of triglyceride higher than in the patients unaffected by SD, whether HIV-positive or not. There was no significant difference found between groups in free cholesterol, wax esters, and squalene.

CONCLUSIONS

Abnormalities of skin surface lipid composition may play a part in the development of SD in both HIV-positive and HIV-negative men.

Epidermal expression of 65 and 72 kd heat shock proteins in psoriasis and AIDS-associated psoriasiform dermatitis

BACKGROUND

Psoriasiform dermatitis is common in patients with AIDS. The expression of heat shock proteins by keratinocytes has been postulated to be a significant factor in the physiopathology of psoriasis and might be subject to modulation in HIV-infected patients.

OBJECTIVE

We sought to evaluate the epidermal expression of 65 and 72 kd heat shock proteins (HSPs) in lesions of AIDS-associated psoriasiform dermatitis (AIDS-PD) and compare it with that in psoriasis vulgaris and seborrheic dermatitis in patients not infected with HIV.

METHODS

Sections from paraffin-embedded blocks of biopsy specimens of AIDS-PD (eight cases), psoriasis vulgaris (eight cases), seborrheic dermatitis (four cases), and normal skin (four cases) in non-HIV-infected patients were immunohistochemically stained by the avidin-biotin-peroxidase method and two monoclonal antibodies directed against the major 65 kd HSP antigen (HSP65) and against 70/72 kd HSP. The intensity, distribution, and cellular pattern of the epidermal stain were graded and assessed blindly.

RESULTS

The epidermal expression of HSP65 in biopsy specimens from AIDS-PD lesions was irregular, with less intensity and less tendency to perinuclear arrangement than in psoriasis or seborrheic dermatitis not associated with AIDS. The expression of HSP72 was also less intense and more uniform in AIDS-PD.

CONCLUSION

The altered interplay of T cells and keratinocytes in a situation of immune derangement such as AIDS might account for the differences observed in the expression of HSP65 and HSP72 by keratinocytes in psoriasis and AIDS-PD.

Immunolocalization of low-molecular-weight stress protein HSP 27 in normal skin and common cutaneous lesions

Stress proteins, which are found ubiquitously in mammalian cells, appear to be implicated in the regulation of cell growth and protection from environmental insult. Although we previously demonstrated the expression of low-molecular-weight stress protein, HSP 27, in cultured keratinocytes, HSP 27 has not yet been identified in human skin. Using standard immunohistochemistry on routinely processed paraffin sections, we examined specimens of common epidermal lesions and normal skin with a monoclonal antibody to HSP 27. Normal skin from the breast, foreskin, and lower extremity demonstrated strong cytoplasmic staining in the suprabasal epidermis. There was no change in the intensity of staining or cellular localization related to age, body location, or gender. Sections of actinic keratosis, superficial basal cell carcinoma, seborrheic keratosis, and psoriasis also exhibited strong cytoplasmic staining in the suprabasal layers of the epidermis. In contrast, cutaneous squamous cell carcinoma demonstrated only weak cytoplasmic staining throughout the infiltrating tumor. This is of particular interest, since other investigators have reported a loss of HSP 27 expression in oncogenically transformed cells that exhibit a tumorigenic phenotype. To our knowledge, this study provides the first demonstration of HSP 27 expression in human skin.

Effect of a topical erythromycin-zinc formulation on sebum delivery. Evaluation by combined photometric-multi-step samplings with Sebutape

Zinc displays 'in vitro' some antiandrogen activity through an inhibition of the 5 alpha-reductase activity. The clinical relevance of this effect is unknown, particularly during zinc therapy of acne. As sebum production could be a pharmacological target, a sensitive method was used for measuring the rate of sebum delivery to the skin surface during treatment with a topical 4% erythromycin-1.2% zinc acetate formulation. A series of four successive 1-h samplings with Sebutape was taken to derive the rate of sebum output from the slope of the regression line given by cumulative data. As a control the classical photometric method was used. Such combined evaluation revealed a sebosuppressive effect for the topical zinc formulation tested.

Analyses of skin surface lipid in patients with microbially associated skin disease

The composition of the total skin surface lipid, free fatty acids and fatty acid of triglyceride was used in discriminant analyses to classify patients with severe acne vulgaris (AV), pityriasis versicolor (PV), seborrhoeic dermatitis (SD) and atopic dermatitis (AD). It was not possible to discriminate between the PV and SD patients but all the lipid groups gave a satisfactory separation between AV, PV + SD and AD patients. A similar separation was obtained when the sex of the patient was studied but not when both sex and disease were taken into account. The results suggest that there are fundamental differences in the composition of skin lipid between patients with microbially associated diseases, but the precise role of the organisms has not been ascertained.

Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis

Thirty-seven patients with clinically diagnosed infantile seborrhoeic dermatitis (ISD) were studied in an attempt to establish the significance of transepidermal water loss (TEWL) and water content in the stratum corneum, in active disease and after recovery. All the patients were treated daily with topically applied borage oil (containing 24% gamma-linolenic acid). With this regimen they were completely free from all skin symptoms within 3-4 weeks. Analyses of essential fatty acids in serum showed aberrations as previously described, with elevated levels of 18:1w9 and 20:2w6. TEWL and water content were recorded at the time of diagnosis and after treatment from the right forearm in skin that was free from symptoms and not treated with borage oil. Twenty-five healthy children in an age-matched group without skin disorders were used as controls. Significant differences in TEWL between patients and controls were found before treatment. After treatment no significant differences were found. There were no significant differences between controls and patients regarding water content in the stratum corneum. Gamma-linolenic acid is suggested to be of importance in maintaining normal TEWL and also in promoting recovery in patients suffering from ISD.

Penetration of tinidazole into skin blister fluid following its oral administration

Plasma and skin blister fluid concentrations of tinidazole following a single oral dose of 2 g drug, and after multiple doses of 0.25 g every 12 h, were determined. Skin blisters were produced by direct application of 0.25% cantharidin ointment to the skin. The maximum concentration in plasma of about 36 mg.l-1 was observed after about 2 h, whereas in skin blister fluid the peak occurred after about 6 h and was 30 mg.l-1. The half-life in plasma was slightly shorter than in blister fluid at 17 and 19 h, respectively, but the difference was not significant. The penetration of tinidazole into cantharidin-induced skin blister fluid, defined according to Wise as the ratio of the AUCs in blister fluid and plasma was 1.00. During routine treatment with tinidazole (0.25 g every 12 h), the concentrations in plasma and blister fluid collected before and 3 h after the morning dose exceeded the minimal inhibitory concentrations for susceptible pathogens. The results provide a pharmacokinetic basis for the proven efficacy of tinidazole in the treatment of protozoal and anaerobic infections.

PCNA expression in cutaneous keratinous neoplasms and verruca vulgaris

Using an antibody to PCNA and a standard immunohistochemical system, the authors examined normal epidermis and cutaneous neoplasias for expression of PCNA, a protein associated with DNA polymerase delta and DNA replication. In squamous cell carcinoma in situ (SCCI), a unique expression of PCNA, which frequently involved the nuclei of all keratinocytes within the lesion, was found. Heaviest staining was in the uppermost layers of the epidermis. PCNA expression ended abruptly at the histologic margin of the lesion. Because SCCI can be associated with the presence of human papillomavirus (HPV) DNA, the authors evaluated PCNA expression in verruca vulgaris and found a pattern similar to that in SCCI. Assuming that PCNA expression in these two lesions is related to cell division, the authors hypothesize that the mechanisms that control proliferation in SCCI may be similar to those operative in verruca vulgaris.

Epidermal growth factor receptors in idiopathic and virally induced skin diseases

The altered distribution of epidermal growth factor receptors (EGF-R) in hyperproliferative skin lesions such as psoriasis vulgaris, seborrheic keratoses, acanthosis nigricans, ichthyosis, and others implies aberrant control of growth/proliferation by epidermal growth factor (EGF), transforming growth factor alpha (TGF alpha), and other growth factors/cytokines. Whether overexpression of EGF-R: 1) correlates with epidermal proliferation, 2) serves as a hallmark of specific dermatoses, or 3) is due to modulation by multiple growth factors remains unclear. To correlate distributions of EGF-R with in vivo proliferative status, two benign diseases of unknown etiology, seborrheic keratoses and acrochordons (skin tags), were examined using EGF-R immunolocalization and 125I-EGF binding techniques. Lesions documented as growing by clinical criteria or 5-bromodeoxyuridine incorporation (a measure of cell proliferation) were compared to nongrowing lesions of the same type. To correlate distributions of EGF-R to specific dermatoses, skin diseases of viral etiology (verruca vulgaris and molluscum contagiosum) were also probed by EGF-R immunolocalization and 125I-EGF binding. Elevated immunostaining for EGF-R and 125I-EGF binding sites were associated with actively growing seborrheic keratoses and skin tags whereas normal patterns of immunostaining and 125I-EGF binding were seen in nongrowing seborrheic keratoses and skin tags. Viral diseases showed unique patterns. No EGF-R were detected in verruca vulgaris. Molluscum contagiosum lesions showed intense EGF-R in basal keratinocytes and no EGF-R in virally infected cells. Thus elevations in EGF-R show a positive in vivo correlation with proliferation in at least two differing benign diseases of the epidermis. The decreased levels of EGF-R in virally infected lesions suggests that EGF-R may show unique patterns for specific dermatoses and are not universally elevated in benign hyperproliferative skin disorders.

In-vitro DNA synthesis of keratinocytes in normal human skin, psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma

The DNA-synthesizing cells in benign and malignant keratotic diseases including psoriasis, seborrhoeic keratosis, Bowen's disease and basal cell carcinoma were studied. Cells in S-phase were labelled after small pieces of the lesions were incubated in tissue culture medium that contained 5-bromo-2'-deoxyuridine (BrdU). The labelling of DNA was analysed using the labelling index and pattern. Although the malignant diseases tended to show a higher DNA labelling index, neither this nor the loss of polarity alone was associated with malignancy. However, a higher DNA labelling index together with a loss of polarity was characteristic for malignancy.

Skin surface lipids in HIV sero-positive and HIV sero-negative patients affected with seborrheic dermatitis

Skin surface lipids of patients affected with seborrheic dermatitis both HIV sero-negative (C group) and HIV sero-positive (B group) have been studied by capillary Gas chromatography-Mass spectrometry (GC-MS) in comparison with normal age matched controls (A group) to determine whether, among the three groups of individuals, there were qualitative and quantitative changes in lipid class composition and in the fatty acid and alcohol components of lipid fractions. With regard to percent composition of skin surface lipid fractions, no significant differences were found between HIV sero-positive and HIV sero-negative patients with seborrheic dermatitis. The observed significant reduction of total lipids (micrograms/sq cm) in the sites affected with the disease in comparison with controls was associated with a slight but significant decrease of squalene (P less than 0.05) and with a corresponding increase of cholesterol and cholesterol esters (P less than 0.05). These abnormalities in lipid fractions and total lipids were not observed in the uninvolved skin of subjects with seborrheic dermatitis. Fatty acid and alcohol patterns of skin lipid fractions were not significantly different among the three groups of individuals.

[Lectin histochemistry in psoriasis, lichen planus and keratosis seborrheica]

Using 14 different biotinyl lectins and avidin horseradish peroxidase, we studied the lectin binding patterns in the epidermis of the lesions in 37 cases of psoriasis, 9 cases of lichen planus and 18 cases of keratosis seborrheica. In comparison with normal human skin, epidermal lectin binding patterns in these diseases showed considerable qualitative and quantitative abnormalities, among which some were characteristic. These findings revealed significant changes in keratinocytic glycoconjugates in these diseases, providing clues to their pathogeneses. The detected changes suggest that the maturation pathway of the keratinocytes in psoriasis differs qualitatively from the normal cases and is not merely a result of rapid transit of the cells.

Increased epidermal growth factor receptors in seborrheic keratoses and acrochordons of patients with the dysplastic nevus syndrome

Seborrheic keratoses and acrochordons may change in biologic behavior with pregnancy or during treatment with sex steroids. Because epidermal growth factor receptor localization may change in hyperproliferative skin diseases, we compared epidermal growth factor receptor immunolocalization in seborrheic keratoses and acrochordons from women who were or were not pregnant or taking oral sex steroid hormones. Epidermal growth factor receptor was further investigated in growing and quiescent seborrheic keratoses and acrochordons from women with and without the dysplastic nevus syndrome. The epidermal growth factor receptor concentration was strikingly elevated in suprabasilar keratinocytes of growing seborrheic keratoses and acrochordons from patients with the dysplastic nevus syndrome who were pregnant or taking sex steroid hormones and less elevated in growing seborrheic keratoses from other patients. In contrast, the epidermal growth factor receptor distribution pattern in acrochordons did not correlate as well with the history of growth of these lesions in normal patients. These data suggest sex steroids may affect epidermal growth factor receptor metabolism in benign epidermal hyperproliferative lesions, particularly in patients with the dysplastic nevus syndrome.

Seborrheic dermatitis and HIV infection. Qualitative analysis of skin surface lipids in men seropositive and seronegative for HIV

We measured skin surface lipids (cholesterol, free fatty acids, triglycerides, wax esters, and squalene) in patients seropositive for human immunodeficiency virus (HIV) and those seronegative for HIV with and without seborrheic dermatitis. Cholesterol and wax ester fractions were similar in all four groups but triglycerides and squalene were significantly increased and free fatty acids significantly decreased in HIV-positive patients, regardless of the presence of seborrheic dermatitis. In addition, a strong negative correlation was found between free fatty acid and triglyceride levels. We conclude that abnormalities of skin surface lipids are not associated with the development of seborrheic dermatitis in HIV-positive persons but are associated with HIV infection itself.

Detection of the interferon-gamma-induced protein 10 in psoriasiform dermatitis of acquired immunodeficiency syndrome

Interferon-gamma-induced protein 10 is a 10-kd protein produced by human keratinocytes following an exposure to interferon gamma. Keratinocytes within psoriatic plaques and within delayed-type hypersensitivity reactions have been shown to stain strongly with an affinity-purified rabbit antibody prepared against interferon-gamma-induced protein 10, suggesting a possible role for interferon gamma in the production of the lesions. A psoriasiform eruption has been seen in patients with acquired immunodeficiency syndrome (AIDS). Its severity appears to correlate with the degree of immunodeficiency in the early stages of AIDS. We stained 10 lesions of psoriasiform dermatitis of AIDS with the anti-interferon-gamma-induced protein 10 antibody using immunoperoxidase techniques. As controls, we studied 10 lesions of non-AIDS psoriasis, six lesions of seborrheic dermatitis with psoriasiform hyperplasia, one lesion of lichen simplex chronicus, and four biopsy specimens of normal skin from patients with AIDS. In addition, normal skin specimens taken from patients with AIDS and human immunodeficiency virus-negative patients at time of autopsy were examined. An identical, strong and diffuse staining pattern was seen in all cases of psoriasiform dermatitis of AIDS, non-AIDS psoriasis, seborrheic dermatitis, and lichen simplex chronicus. The specimens of normal skin showed only weak basal layer staining with anti-interferon-gamma-induced protein 10. Thus, the presence of interferon-gamma-induced protein 10 in keratinocytes was associated with psoriasiform hyperplasia and could be detected in both AIDS-associated and classic psoriasis.

Neutrophil zinc levels in psoriasis and seborrhoeic dermatitis

The median zinc content of neutrophils was significantly reduced in 16 patients with psoriasis in comparison to both normal controls and six patients with seborrhoeic dermatitis (P less than 0.05). This reduction was unrelated to the extent of skin involvement. Plasma and erythrocyte zinc levels were unchanged.

Immunohistochemical study on keratin expression in certain cutaneous epithelial neoplasms. Basal cell carcinoma, pilomatricoma, and seborrheic keratosis

We investigated immunohistochemically 20 basal cell carcinomas (BCC), five pilomatricomas, and nine seborrheic keratoses using anti-BCC keratin monoclonal antibody (BKN-1) and anti-hair keratin monoclonal antibodies (HKN-2, HKN-4- -7). The neoplastic cells in all the cases of BCC were always uniformly stained by BKN-1, HKN-2, and HKN-4, indicating that the BCC cells display a constant antigenicity of keratin, which may be different from that of the normal epidermis. Although no fluorescence by HKN-6 or HKN-7 was seen in any cases of BCC, HKN-5 partially but strongly stained the neoplastic nests in most cases of BCC; BCC may have differentiation toward the lower part of hair follicular epithelium. In pilomatricoma, all the anti-keratin monoclonal antibodies showed a similar staining pattern; the differentiating neoplastic cells undergoing transition from basaloid to eosinophilic were positively stained by each antibody in all the cases. This finding of pilomatricoma corresponds to that of the differentiating cells in the inner hair layers, especially in the hair cortex. In seborrheic keratoses, no fluorescence was recognized with HKN-5- -7, which stain the lower follicular cells in the normal human skin. The staining patterns of seborrheic keratosis by BKN-1, HKN-2, and HKN-4 were similar to those of the normal interfollicular epidermis. These anti-keratin monoclonal antibodies seem to be useful for the investigation of the direction of differentiation of skin adnexal neoplasms.

Monoclonal antibody labeling for cytokeratins and filaggrin in the human pilosebaceous unit of normal, seborrhoeic and acne skin

The distribution of cytokeratins and filaggrin in human pilosebaceous unit was investigated in specimens obtained from normal (n = 15), seborrhoeic (n = 6), and acne skin (n = 6), using the monoclonal antibodies CK8.12, CK8.13, CK4.62, CK8.60, KL1, PKK2, RPN 1160, and an antibody for filaggrin. The type and amount of cytokeratin content was correlated with the stage of cell differentiation in these three skin types. In all specimens studied the sebocytes. The sebaceous duct cells, and the infundibular cells contained cytokeratins, no clear differences were found between normal, seborrhoeic, and acne skin. During sebocytic maturation the amount and type of cytokeratin content changed gradually and the labeling pattern was partly different compared to the interfollicular epidermal pattern. In the sebaceous duct and the infundibulum, the labeling pattern using KL1, CK8.12, and CK8.13 was similar to that seen in interfollicular epidermis, whereas labeling with CK8.60 and PKK2 was different. These findings indicate that sebaceous duct and infundibular cells express transitional patterns of differentiation between epidermal keratinocytes and sebocytes. Filaggrin was expressed only in some sebaceous duct cells and in infundibular cells. In seborrhoeic and in acne skin, however, the reactivity of antibody to filaggrin was more intense and was already observed in the lower parts of the sebaceous duct and the infundibulum. Although no filaggrin was found in the intermediate cells of the sebaceous duct and the infundibulum in normal skin, these cell types clearly contained filaggrin in seborrhoeic and acne skin.

Seborrhoea in acne-prone and acne-free patients

We have studied the relationship between seborrhoea and acne by using the Lipometre and Sebutape films. Seborrhoea is more intense in acne-prone than in acne-free patients. For a given overall amount of sebum excreted, the individual activity of sebaceous follicles differs in the two groups of individuals tested. Seborrhoea in acne-prone patients is due to the presence of some highly active follicles that are almost never encountered in acne-free patients.

Effect of percutaneous absorption of hydrocortisone on adrenocortical responsiveness in infants with severe skin disease

Percutaneous absorption of hydrocortisone was studied in 18 children (aged from 6 weeks to 14 1/2 years) with atopic or seborrhoeic dermatitis, by measuring their serum cortisol before and after application of 1% hydrocortisone cream. Endogenous secretion of cortisol was suppressed with dexamethasone. A 24 h absorption test was performed on nine children. In six, percutaneous absorption was detected. The highest serum cortisol level was reached within the first 6 h. A 4 h absorption test was developed on the basis of the 24 h test. This short absorption test was performed on nine children, and in eight of them absorption of hydrocortisone was detected. The rise of serum cortisol ranged from 98 to 2669 nmol/l. The 2 h ACTH test was performed to evaluate the effect of previous treatment with topical glucocorticoids. Suppressed adrenocortical function was found in five of 13 children, and was associated significantly with high post-application serum cortisol levels. This occurred more often in infants with a severe skin disorder than in older children or in those with mild or moderate skin disease.

[A new and original therapy for seborrheic dermatitis]

The AA describe the results of an original therapy for seborrhoic dermatitis in both localized and spread forms (Leiner's Disease). Due to similarity of seborrhoic dermatitis in the two forms with acrodermatitis enterophatica and considering that this last disease reacts positively after Zinc administration, the AA stated the validity of such therapy also for seborrhoic dermatitis and discuss its possible mechanism of action.

[Endocrine regulation mechanisms in the skin with special reference to steroid hormone receptors]

The aetiological factors involved in various dermatological diseases are often endocrine in origin. The interaction of hormones in the skin is multi-layered and the meaning of multiple hormonal activities in the skin itself not fully understood. This paper tries to present factors influencing the action of sexual steroids in the periphery and points to the relevance of hormone receptors. Hormonal interaction in the skin can be measured by hormone receptor determination. Present data seem to point to peripheral hormone metabolism which is independent of central hormone regulation in involved skin areas. Besides, "target-organ" sensitivity for hormonal stimulation seems to be elevated.

Infantile flexural seborrhoeic dermatitis. Neither biotin nor essential fatty acid deficiency

The allegedly beneficial effect of biotin in the treatment of infantile 'flexural' seborrhoeic dermatitis was evaluated in a double-blind controlled study. No beneficial effect could be confirmed, and it is therefore unlikely that this disease is caused by biotin deficiency. Nor could this scaly dermatitis be ascribed to an essential fatty acid deficiency. Serum and adipose tissue fatty acids resembled each other and reflected the fatty acid composition of the diet.

Glutathione in human epidermal tumors. Basal and squamous cell epithelioma, verruca seborrhoeica

Methods for the determination of glutathione in small epidermal and tumor fragments are compared. The best results were obtained by an enzymatic cycling technique. The total glutathione concentrations in basal cell epithelioma, squamous cell epithelioma, and verruca seborrhoeica were 2.08, 1.81, and 1.87 mg/g dry weight, respectively. In normal epidermis adjacent to the basal cell epitheliomas the concentration was 1.27 mg/g dry weight.

Percutaneous absorption of phenol and methyl alcohol in Magenta Paint B.P.C

Estimations of phenol and methyl alcohol in the urine of 16 infants with seborrhoeic eczema treated with Magenta (Castellani's) Paint B.P.C. were made to determine the degree of absorption. Phenol was detected in four cases and methyl alcohol in none.

[Porphyrinsynthesis of Propionibacterium acnes in acne and seborrhea (author's transl)]

The porphyrin productions of P a.-strains, isolated on the one hand from inlfammatory acne lesions, on the other hand from sebaceous follicle filaments from 10 persons each were compared quantitatively and qualitatively, after the appropriate material had been pooled, With respect to the acne strains one could observe a somewhat increased porphyrin production as well as the discharging of a precentually greater portion of porphyrins to the surrounding material. When separated by TLC the acne material showed a more intense coproporphyrin band.

Androgen receptor in human skin

Cytosol androgen receptor was assayed in 18 human skin biopsies by an exchange technique with a labelled potent synthetic androgen, methyltrienolone (R 1881), under conditions which measured total (i.e. both free and occupied) binding sites. Androgen binding sites were only present in skin biopsies from patients with marked seborrhoea often accompanied by acne (8 cases) and no sites were detected in normal skin biopsies (7 cases). Three biopsies from seborrhoeic patients, however, did not contain androgen receptor. Although no direct quantitative correlation could be drawn between binding site concentration and sebum excretion, it would seem that the androgen receptor content nevertheless constitutes an important parameter in the study of the hormonal control of seborrhoea.