[Pediatric psoriasis]

Psoriasis is a cutaneous inflammatory disorder that may be seen in childhood, sometimes complicated by serious forms. The diagnosis is often more difficult than in adults, because initial lesions may be atypical or pauci-symptomatic. Psoriasis is a chronic disease, with a prognosis worse than atopic dermatitis; patients and their family generally need long term therapy and supportive care. The treatment is not different from that of the adult, but is less studied and less validated by specific pediatric controlled studies.

Anaphylaxis to the carbohydrate carboxymethylcellulose in parenteral corticosteroid preparations

BACKGROUND

Carboxymethylcellulose is a carbohydrate widely used as additive in tablets, cosmetics, some injectable hormone formulations, food (as E466) and as active principle in hydrocolloid dressings. Anaphylaxis to carboxymethylcellulose in parenteral corticosteroid preparations has previously been reported. Typically, skin tests were positive in such cases, occasionally specific IgE or histamine release have been demonstrated.

CASE REPORT

We report on 3 patients who suffered from anaphylactic symptoms after local injection of corticosteroid preparations. Intracutaneous skin tests with carboxymethylcellulose were positive; in 2, sulfidoleukotriene release could be measured in the cellular antigen stimulation test (CAST). Specific IgE could not be identified. Oral provocation tests with typical doses of carboxymethylcellulose as found in food and tablets were negative.

CONCLUSION

In patients with anaphylaxis to parenteral administration of carboxymethylcellulose, small amounts are tolerated by the oral route. Skin tests and CAST are useful diagnostic tools.

[Skin manifestations of diabetes mellitus]

Cutaneous manifestations of diabetes mellitus are common and manifold. In the course of their disease, 30-70% of type I and type II diabetics are affected. At a closer look, the majority of all diabetics would show preclinical alterations of the vessel walls or of the connective tissue. In the diabetic patient, it is important to be familiar with and to look for the possible cutaneous alterations, which have to be diagnosed on mainly clinical grounds. Some of them can be a consequence or an accompanying symptom of a poorly controlled diabetes and therefore they can potentially help the responsible physician to prevent more serious complications. Some of these dermatoses are so called marker lesions and can precede the manifestation of the diabetes by years. The exact pathogenesis of most of these dermatoses is unknown. It is reasonable to assume though that vessel and connective tissue alterations as well as the impairment of the immune system and other associated metabolic changes caused by the diabetes play an important role.

[Hair-like hyperkeratoses in patients with kidney transplants. A new cyclosporin side-effect]

We report a 31-year-old renal transplant patient treated with cyclosporin A who developed an unusual sebaceous gland hyperplasia accompanied by a disseminated follicular spiny hyperkeratosis. Those alterations were most evident on his face and limbs. In some locations hairy hyperkeratosis with authentic hair neogenesis was found. The histology of these alterations showed a marked hyperkeratosis of the hair follicles with formation of hair-like spikes either alone or in connection with hairs. The presence of true hairs distinguishes our case from the morphologically similar disseminated spiked hyperkeratosis and other spiny keratinization disorders. Scanning electron microscopy helped to demonstrate the hair-like structure of these keratoses. Some of the sebaceous glands showed cystic widening of their lumina, which were filled with abundant amorphous eosinophilic material, a finding similar to earlier observations. Our case demonstrates that these skin alterations should be classified as side effects of cyclosporin A and that they are apparently dose-dependent.