Biological treatment of colored wastewater by Streptomyces fulvissimus CKS 7

This study aims to investigate the biological processes related to the biodegradable potential of growing microbial cells for contaminated water treatment. Thus, the use of the Streptomyces fulvissimus CKS 7 (CKS7) has been evaluated for decolorizing efficiency of a solution containing a cationic triphenylmethane dye, crystal violet. The color reduction was monitored by UV-Vis spectroscopic analysis, through changes in their absorption spectrum and comparing the results with those of the respective controls. It was found that the CKS7 performed well and reached up to 100% effectiveness. The required process parameters have been apparently mild and include the reaction temperature of 27-30 °C, 10% inoculum size, under shaking conditions, whereas the time course of decolorization had been concentration dependent. A possible mechanism for removing dye from the working medium was accomplished in two steps: the binding of the dye on the bacterial cell surface, in addition to the dye biodegradation by the bacterial intracellular enzymes. After one cycle of the complete dye removal, the adapted culture was successfully reused for the same purpose. The phytotoxicity analysis revealed that non-toxic compounds were present in decolorized medium, indicating that the CKS7 bacteria seem to be a promising application for contaminated water treatment.

Fixed, low radiant exposure vs. incremental radiant exposure approach for diode laser hair reduction: a randomized, split axilla, comparative single-blinded trial

BACKGROUND

Diode lasers are the most commonly used treatment modalities for unwanted hair reduction. Only a few controlled clinical trials but not a single randomized controlled trial (RCT) compared the impact of various laser parameters, especially radiant exposure, onto efficacy, tolerability and safety of laser hair reduction.

OBJECTIVE

To compare the safety, tolerability and mid-term efficacy of fixed, low and incremental radiant exposures of diode lasers (800 nm) for axillary hair removal, we conducted an intrapatient, left-to-right, patient- and assessor-blinded and controlled trial.

METHODS

Diode laser (800 nm) treatments were evaluated in 39 study participants (skin type II-III) with unwanted axillary hairs. Randomization and allocation to split axilla treatments were carried out by a web-based randomization tool. Six treatments were performed at 4- to 6-week intervals with study subjects blinded to the type of treatment. Final assessment of hair reduction was conducted 6 months after the last treatment by means of blinded 4-point clinical scale using photographs. The primary endpoint was reduction in hair growth, and secondary endpoints were patient-rated tolerability and satisfaction with the treatment, treatment-related pain and adverse effects.

RESULTS

Excellent reduction in axillary hairs (≥ 76%) at 6-month follow-up visit after receiving fixed, low and incremental radiant exposure diode laser treatments was obtained in 59% and 67% of study participants respectively (Z value: 1.342, P = 0.180). Patients reported lower visual analogue scale (VAS) pain score on the fixed (4.26) than on the incremental radiant exposure side (5.64) (P < 0.0003). The only side-effect was mild and transient erythema. Subjects better tolerated the fixed, low radiant exposure protocol (P = 0.03). The majority of the study participants were satisfied with both treatments.

CONCLUSION

Both low and incremental radiant exposures produced similar hair reduction and high and comparable patient satisfaction. However, low radiant exposure diode laser treatments were less painful and better tolerated.

Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology

AIM

Lasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions.

METHODS

These guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines.

RESULTS

Lasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.

Telangiectasias resistant to sclerotherapy are commonly connected to a perforating vessel

Leg telangiectasias resistant to repeated courses of sclerotherapy in patients without deep and superficial venous incompetence are not uncommon. Little is known about factors which may underlie the resistance. Among 26 patients with such telangiectasias we found a direct communication of the vessels with deep and saphenous veins in 65% of patients. Ultrasound-guided injection of 0.5% polidocanol foam into the feeding veins or their perforating segments led to clearance of all the telanagiectasias. In 23% of cases no feeding veins could have been identified by ultrasound. Direct injections of a sclerosant into perforating feeding veins may clear refractory telangiectasias in a majority of patients though it is obvious that other factors may contribute to the failure of sclerotherapy in others.

Simple external manual manoeuvres to pass the radiofrequency catheter through a bending segment of a saphenous vein

Smooth passage of a catheter through a varicose saphenous vein during radiofrequency ablation may prove a challenging task. Various types of venous bending in the transverse and sagittal planes and their combinations within the saphenous compartment may be pretty well appreciated by ultrasound examination. Several simple manual manoeuvres like stretching, pushing or lifting along with limb re-positioning may often help the surgeon to advance the catheter through the segments by temporarily changing their special configuration. In this way the number of patients otherwise considered unsuitable for endovascular catheter procedures like radiofrequency or laser ablation may be considerably reduced.

Early granulomatous foreign body reactions to a novel alginate dermal filler: the system's failure?

BACKGROUND

Cutaneous granulomas after a soft filler injection represent one of the worst scenarios for both patient and injector.

OBJECTIVES

To present clinical and histopathological features of granulomatous nodular reactions induced by a new alginate-based dermal filler (Novabel(®)), and put it in context of the process of injectable soft tissue fillers approval and promotion in the EU.

METHODS

A case series of four patients injected with Novabel(®) for volume restoration of the face and hands, who developed severe foreign body reactions.

RESULTS

Four patients injected with Novabel(®) into tear troughs and/or dorsa of hands developed severe granulomatous reactions within months after injections. As we injected with the new filler into a total of 10 patients, a high incidence of 40% of the disfiguring adverse effect was observed. The inadequate response of manufacturer to our reporting the side-effects along with the available data on registration process of dermal fillers confirmed that the area is not well-regulated.

CONCLUSIONS

The status of dermal fillers as class III medical devices, and the process of their approval and marketing in the EU need to be seriously reconsidered to avoid unnecessary and serious adverse reactions.

Subcutaneous injection of liquid and foamed polidocanol: extravasation is not responsible for skin necrosis during reticular and spider vein sclerotherapy

BACKGROUND

Cutaneous necrosis is one of the most annoying complications of reticular and spider vein sclerotherapy. The precise incidence of the complication is not known, although various sources reported incidence between 0.2% and 1.2%. Among a few mechanisms proposed to explain it, extravasation of the sclerosant into the perivascular tissue has been cited as the major cause.

OBJECTIVES

The aim of the experimental study in rats was to examine the potential of various concentrations and volumes of polidocanol in both liquid and foam forms to cause cutaneous necrosis after superficial subcutaneous injection.

METHODS

Twenty-four female Sprague Dawley rats were injected subcutaneously different concentrations (0.5%, 1%, 2% and 3%) of polidocanol as well as different preparations of polidocanol (liquid vs. foam) and volumes (0.1-0.5 mL). The animals were sacrificed 10 days after injections and biopsy specimens were obtained.

RESULTS

Cutaneous necrosis was not seen at volumes <0.5 mL regardless of the concentration or form of polidocanol injected. Foam preparation was shown to be less potent in inducing necrosis with a minimal strength being 2% in comparison with the liquid form where 1% was sufficient to produce overt cutaneous necrosis.

CONCLUSIONS

This experimental study shows that extravasation of polidocal in usual circumstances of sclerotherapy of spider and reticular veins cannot be a significant cause of cutaneous necrosis rarely observed in this setting. It is particularly true for the foamed polidocanol where 1% strength seems safe if injected extravascularly in volumes up to 0.5 mL.

Pre-operative ultrasound with a 12-15 MHz linear probe reliably differentiates between melanoma thicker and thinner than 1 mm

BACKGROUND

Pre-operative determination of primary melanoma thickness could be a tool to identify those patients who could be treated with radical primary tumour excision and sentinel lymph node biopsy in a single procedure. An excellent correlation between sonographic and histological measurement of maximal tumour thickness has been achieved using 20-MHz transducers.

OBJECTIVE

To show that widely available high resolution ultrasound with 12-15 MHz linear probe could also reliably assess the thickness of primary melanoma.

METHODS

Sixty-nine patients underwent ultrasound evaluation of 70 clinically and dermoscopically suspicious pigmented skin lesions before surgical excision.

RESULTS

The sensitivity, specificity, positive and negative predictive values of ultrasound to detect melanoma > 1 mm were 92%, 92%, 95% and 81% respectively. The correlation between ultrasound and histological tumour thickness was very good [Pearson's correlating index 0.823 (P < 0.001)]. Mean difference between sonographic and histological measurements was 0.045 mm with limits of agreement estimated at -1.4 and +1.49, and a bias between two methods 45 microm.

CONCLUSION

Ultrasound examination with a 12-15 MHz linear transducer can reliably differentiate primary melanoma > 1 mm from those <or= 1 mm.

Drug-induced pruritic micropapular eruption: anastrozole, a commonly used aromatase inhibitor

Anastrozole, a selective nonsteroidal aromatase inhibitor is widely used as an adjuvant therapy for postmenopausal women with early hormone-sensitive breast cancer. There are few reports on cutaneous side effects of anastrozole. It may induce subacute cutaneous lupus erythematosus, erythema nodosum, cutaneous vasculitis, and nondescript skin eruptions. A 68-year-old woman was prescribed anastrozole after surgical removal of her breast cancer and adjuvant radiation therapy. Two months later she experienced a generalized pruritic micropapular eruption. History, clinical presentation, histology and inadvertent re-exposure to the drug confirmed that anastrozole triggered the exanthem. Pruritic micropapular eruption is a typical pattern for a drug hypersensitivity reaction. Anastrozole should be added to the list of medications able to induce not only non-specific eruptions but the type of exanthem typically triggered by drugs.

What is the news? A difference between men and women

It is a common observation that women and men react differently to stress and illness. We questioned 63 consecutive patients with pityriasis rosea and found that the women were overwhelmingly more likely than men to ask to hear unpleasant information before positive information.

Cytokine concentrations in basal cell carcinomas of different histological types and localization

BACKGROUND

Basal cell carcinoma (BCC) is the most common malignant skin tumor. Cytokines as major mediators of the immune system have been shown to play an important role in biology of the neoplasm with the general predomination of Th2 cytokines, whereas IFN-? and other Th1 cytokines are prevalent in spontaneously regressing tumors.

OBJECTIVE

We were interested in comparing cytokine levels in BCC and cutaneous squamous cell tumors with BCC of different localization and histological subtypes.

MATERIAL AND METHODS

Explants from freshly excised BCC from 18 patients, and cutaneous squamous cell tumors (solar keratoses and Bowen's disease) from 9 patients were cultivated for 24 h. Cytokine (IL- 2, IFN-gamma, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNFalpha, IL-1beta) concentrations in culture supernatants were determined by a sandwich immunoassay.

RESULTS

Tissue explants of BCC contained significantly higher concentrations of IL-1beta, IL-4, IL-5, and IL-6 compared to those of squamous cell tumors. Higher levels of TNF-alpha (p = 0.042), IL-4 (p = 0.028), and IL-5 (p = 0.012) were found in tumors localized to the head and neck compared to those on the trunk or extremities. Interleukin-6 concentrations were higher in aggressive BCC variants (infiltrative and micronodular), but the difference was not statistically significant (p = 0.068).

CONCLUSIONS

Confirming the earlier findings that BCC is a tumor with a Th2 cytokine microenvironment, this study further shows that BCC situated on the head and neck produce even more of certain Th2 cytokines (IL-4 and IL-5) and TNF-alpha, a crucial immunosuppressive cytokine released upon UVB irradiation.

Cervical fluid cytokines in pregnant women: Relation to vaginal wet mount findings and polymorphonuclear leukocyte counts

OBJECTIVE

The purpose of the study was to measure and compare concentrations of IFN-gamma, IL-8, IL-10 and IL-12 in cervical fluids of pregnant women with normal and pathologic microscopic findings of vaginal wet mount.

STUDY DESIGN

Vaginal samples were obtained from 100 pregnant women (22-32 weeks of gestation) without signs and symptoms of preterm labour (PTL), selected on the basis of the microscopic examination of vaginal wet mounts. Cytokine (IFN-gamma, IL-8, IL-10 and IL-12) concentrations were measured in cervical fluids by an enzyme-linked immunosorbent assay.

RESULTS

The cytokines were found in cervical fluids of the majority of pregnant women, with IFN-gamma and IL-8 detected in all samples. Concentrations of IL-8 were significantly higher in pregnant women with pathologic findings on vaginal wet mount, including elevated polymorphonuclear (PMN) cell counts.

CONCLUSION

A significant correlation between microscopic findings and cervical fluid IL-8 concentrations may make vaginal wet mount microscopy a useful tool for identification of patients with cervicovaginal inflammation, which is considered a risk factor for spontaneous preterm delivery.

A short review of diagnosis and compression therapy of chronic venous insufficiency

INTRODUCTION

Chronic venous insufficiency (CVI) is a venous disorder in the lower extremities associated with changes in the skin and subcutaneous tissue. Treatment with short-stretch compression bandages is highly recommended for advanced stages of CVI.

METHODS

The compression systems Rosidal Sys, Porelast, Coban, and Proguide were evaluated in 4 groups of mobile and active patients (n = 18) with CVI stage II or III. Sub-bandage pressures at point B1 were measured in the upright and supine positions 30 min and 12 h after the bandage was applied. Average pressures and values of the static stiffness index (SSI) were calculated for each group.

RESULTS

The Porelast, Rosidal Sys and Coban systems had SSI values in excess of 10 mmHg, 30 min and 12 h after application. The corresponding values for Proguide were below 10 mmHg.

CONCLUSION

Porelast, Rosidal Sys and Coban are very stiff systems, whereas Proguide is more similar to long-stretch compression bandages with a lower degree of stiffness.

Two cases of probable endogenous extensive cutaneous larva migrans in Serbia

Cutaneous larva migrans (CLM) is a skin infestation clinically characterized by erythematous serpiginous lesions caused by nematode larvae, usually of animal hookworms. It is most commonly seen in tropical and subtropical geographic areas. It is occasionally seen in Europe and other temperate climates, most often in patients that have previously traveled to tropical areas. We present two male patients that did not travel abroad with clinical features of extensive CLM located on the trunk acquired in an unusual way. CLM is not characteristic of Serbia, which is located in southeast Europe Unusually hot and sunny weather with heavy rainfall and high humidity during the summers of 2005 and 2006 were favorable conditions for the development of parasites in the soil and infestation with large numbers of larvae. To the best of our knowledge, this is the first report of extensive CLM in Serbia.

Terra firma-forme dermatosis in a child

We present a case of reticulate hyperpigmented patches symmetrically distributed on the arms of a 13- year-old boy that appeared after a summer seaside vacation. The lesions were easily wiped off with isopropyl alcohol, confirming the diagnosis of terra firma-forme dermatosis. Dermatologists should be aware of this relatively common skin condition.

Acute lipodermatosclerosis: an open clinical trial of stanozolol in patients unable to sustain compression therapy

Acute lipodermatosclerosis (ALDS) is a painful counterpart of chronic lipodermatosclerosis (LDS) resulting from venous insufficiency. Severe pain is the leading symptom and many patients with ALDS are unable to tolerate compression therapy. We evaluated clinical efficacy of stanozolol (2 mg bid for 8 weeks) for the reduction of pain and dermal-thickness in 17 patients with ALDS. All patients had superficial venous insufficiency documented by duplex scans, and in all of them incompetent perforators were found under the area of ALDS. Mean pain scores prior to institution of stanozolol (7+/-2; range 4-10) lowered significantly at the end of the 8-week treatment (3+/-2; range 0-5, p<0.001). Dermal thickness was also significantly reduced (p<0.01) over the treatment period. Side effects were not noted. Stanozolol, given over 8 weeks, effectively and safely alleviates pain and reduces dermal thickness in patients with ALDS.

Measurement of venous leg ulcers with a laser-based three-dimensional method: comparison to computer planimetry with photography

A lack of reproducible and practical methods to assess venous leg ulcer healing is a major problem encountered by investigators evaluating various treatments. We aimed to compare a new laser-based three-dimensional (3D) measuring device with computer planimetry with photography for the assessment of venous leg ulcers, and to estimate the reliability of measurements by the methods. Sixty measurements of perimeter and area of 15 venous leg ulcers, < 10 cm in diameter (eight patients; six females; mean age 71 years; range 52-90 years), were made with both methods. Two independent investigators performed the measurements at the first visit and 2-4 weeks later. The precision and accuracy of the methods were determined and compared. The accuracies for computer planimetry with photography in comparison with the laser-based 3D measuring method were 8.4% for perimeter and 16.0% for area measurements. The precisions of ulcer area and perimeter measurements did not differ significantly between the two methods (p=0.993 and 0.201, respectively). The main advantage of the laser-based measuring method is the 3D ulcer measurement with a precision of 7.5%, which also takes into account distortions created by the limb convexity. The system is accurate, inexpensive, user-friendly, and appropriate for everyday practice.

The prevalence of cutaneous manifestations in young patients with type 1 diabetes

OBJECTIVE

The aim of the study was to assess the prevalence of cutaneous disorders and their relation to disease duration, metabolic control, and microvascular complications in children and adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

The presence and frequency of skin manifestations were examined and compared in 212 unselected type 1 diabetic patients (aged 2-22 years, diabetes duration 1-15 years) and 196 healthy sex- and age-matched control subjects. Logistic regression was used to analyze the relation of cutaneous disorders with diabetes duration, glycemic control, and microvascular complications.

RESULTS

One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous disorder vs. 52 (26.5%) control subjects (P < 0.01). Diabetes-associated skin lesions were found in 81 (38%) patients. Acquired ichthyosis, rubeosis faciei, diabetic hand, and necrobiosis lipoidica were seen in 22 vs. 3%, 7.1 vs. 0%, 2.3 vs. 0%, and 2.3 vs. 0% of type 1 diabetic and control subjects, respectively. The frequency of cutaneous reactions to insulin therapy was low (-2.7%). The prevalence of fungal infections in patients and control subjects was 4.7% and 1.5%, respectively. Keratosis pilaris affected 12% of our patients vs. 1.5% of control subjects. Diabetic hand was strongly (odds ratio 1.42 [95% CI 1.11-1.81]; P < 0.001), and rubeosis faciei weakly (1.22 [1.04-1.43]; P = 0.0087), associated with diabetes duration. Significant association was also found between acquired ichthyosis and keratosis pilaris (1.53 [1.09-1.79]; P < 0.001).

CONCLUSIONS

Cutaneous manifestations are common in type 1 diabetic patients, and some of them, like acquired ichthyosis and keratosis pilaris, develop early in the course of the disease. Diabetic hand and rubeosis faciei are related to disease duration.

Expression of heat shock protein 70 (HSP70) in patients with colorectal adenocarcinoma--immunohistochemistry and Western blot analysis

The role of heat shock protein 70 (HSP70) expression has been investigated in various types of tumors. There are only little and controversial data about its clinical relevance in colorectal carcinoma, one of the most common carcinomas observed in humans. In this study we investigated expression of HSP70 in human colonic carcinoma and possible correlation with clinicopathology. To assess patterns (cytosolic and membrane) of HSP70 expression, the 48 surgically removed colorectal adenocarcinomas and 12 normal colonic and rectal mucosal samples were examined by immunohistochemistry and Western-blot. According to results of immunohistochemistry, expression of cytoplasmic HSP72 was significantly higher in colorectal carcinoma compared with normal and adjacent mucosa (p<0.01). In addition, there was significant increase in HSP72 expression in lymph node-positive compared to node-negative group (p<0.001). Dukes C2 stage of colonic cancer showed significantly higher immunohistochemical score than Dukes B2 and B1 stage groups (p< 0.05 i.e. p< 0.02). There was no relation between expression of HSP72 and degree of tumor differentiation. Using Western blot analyses, we noticed elevated levels of cytosolic HSP70 in colorectal cancer cells compared to normal. Densitometric analysis of blots of plasma membrane HSP70 expression has shown decrease in colorectal cancer cells compared to normal mucosa. According to our results, overexpression of HSP72 in malignant tissues of patients with colorectal carcinoma is related to tumor progression, suggesting that these proteins could play an important role not only in tumorigenesis but also in the development of drug resistance. Further research is necessary to clarify the mechanisms responsible for differential HSP70 expression as well as its definitive role in colorectal cancer.

Disseminated crusted papules in a newborn

BACKGROUND

Congenital self-healing Langerhans cell histiocytosis (Hashimoto-Pritzker disease) is the rarest form of Langerhans cell histiocytosis, usually confined to the skin and/or mucous membranes. Cutaneous eruption is mostly generalized, papular, nodular or vesicular. Despite impressive clinical presentation in a newborn it infrequently spreads to internal organs (which then portends a grave prognosis, indistinguishable from Letterer-Siwe disease).

CASE REPORT

We presented a full-term newborn, female, 3.3 kg who had a multitude of erythematous and crusted papules, nodules and pseudovesicles distributed all over the body, except for the mucous membranes. A biopsy and haematoxylin--eosin stain revealed dermal infiltration of pleomorphic histiocytes with eosinophilic ground-glass cytoplasm and round to bean-shaped nuclei. Over the next six weeks the eruption gradually subsided leaving no residues, or a few atrophic scars.

CONCLUSION

There is no need for specific treatment of congenital self-healing Langerhans cell-histiocytosis in the absence of multiorgan involvement. However, a close and regular follow-up is necessary to evaluate the children for systemic symptoms and signs.

Lupus band test and disease activity in systemic lupus erythematosus: does it still matter?

BACKGROUND

Lupus band test still has no clearly defined position within either diagnostic or disease activity measuring tools for systemic lupus erythematosus (SLE).

OBJECTIVES

We tested the hypothesis that positive LBT correlates with global activity of SLE measured by the SLE Disease Activity Index (SLEDAI) score.

METHODS

In total, 90 SLE patients who underwent biopsy of sunprotected non-lesional (SPNL) skin were studied prospectively. The skin specimen was processed for standard direct immunofluorescence. The patients were classified into groups as negative and positive LBT, and the latter were further subdivided on the basis of the type and morphology of the deposits. Every patient was thoroughly examined and assigned a SLEDAI score. The relationship between LBT findings and SLEDAI score was analysed.

RESULTS

The disease was significantly more active in patients with positive LBT and in those with a higher number of deposited immunoreactants. Almost all patients with renal involvement had a positive LBT.

CONCLUSIONS

LBT on SPNL skin may be a good marker of severe disease at presentation, particularly when three immunoglobulins are found at the dermoepidermal junction.

Dermatitis herpetiformis presenting as intertriginous dermatitis

A 54-year old man with atypical dermatitis herpetiformis Duhring lasting about three years is reported. The lesions were located exclusively in the pubic area, groins, inner thighs and perianal regions. Routine histopathology and the direct as well as the indirect immunofluorescence supported the diagnosis. Application of a gluten-free diet and dapsone alleviated the symptoms.

Great toenail onychomycosis caused by Syncephalastrum racemosum

Nondermatophyte molds are fungi found in soil and decaying plant debris and are generally considered to be uncommon or secondary pathogens of diseased nails. Prevalence rates of onychomycoses caused by nondermatophyte molds range between 1.45 percent and 17.60 percent. The most common nondermatophyte molds associated with nail disease are Scopulariopsis, Scytalidium, Fusarium, Aspergillus and Onychocola canadensis. Syncephalastrum racemosum, a nondermatophyte mold, belongs to the class Zygomycetae. Only one well-documented case of human disease attributed to this organism has been described. We describe a 45-year-old man with culture proven toenail onychomycosis due to Syncephalstrum racemosum.

Cutaneous small-vessel vasculitis with unexpected circulating and in situ bound pemphigus autoantibodies

Pemphigus or pemphigus-related autoantibodies have been found in sera of patients with diverse diseases, such as toxic epidermal necrolysis, thermal burns, and penicillin reactions. Here we report a patient with a typical cutaneous necrotizing vasculitis in whom immunofluorescence studies revealed the presence of circulating and tissue-bound pemphigus autoantibodies.

Pyoderma gangrenosum with spleen involvement and monoclonal IgA gammopathy

A 46-year-old man with a 3-year history of pyoderma gangrenosum was admitted with ulceration (6 x 5 cm), on the right leg. Previously he had been treated with tapering doses of prednisone (maximum dose 1 mg/kg per day); however, he had had a few exacerbations following each taper of prednisone dose. Immunoelectrophoresis demonstrated monoclonal IgA gammopathy of lambda light chains. Abdominal echography and abdominal computed tomographic scan revealed multiple splenic abscesses. Treatment was started with oral prednisone (1 mg/kg per day) and cyclosporin (5 mg/kg per day) and 6 weeks later complete remission was achieved. Systemic involvement in pyoderma gangrenosum is very rare, and according to our knowledge there are only a few cases with spleen involvement.

Psoriasis in a patient with dermatomyositis

Psoriasis has been consistently associated with arthritis and inflammatory bowel diseases, though there have been reports on patients with psoriasis and other autoimmune dermatoses. Sometimes, sharply demarcated scaly plaques located over extensor surfaces in patients with dermatomyositis may clinically resemble psoriatic lesions. Histologic findings of interface dermatitis, typical for dermatomyositis, help clinicians to rule out psoriasis. A patient is presented with dermatomyositis in which psoriatic lesions developed over the extremities and lower trunk. Histological examination confirmed the diagnosis of psoriasis. Both diseases have run independent courses. It is prudent to include psoriasis in the differential diagnosis of scaly eruptions occurring in dermatomyositis patients.

Recrystallization in different sunscreen formulations after cutaneous application

BACKGROUND

Data on the structure of sunscreens prior to and after application to the skin and the possible impact of these factors on their efficacy are still scant.

AIMS

The microscopic structure of several commercial sunscreen products containing benzophenone-3 (BP-3) was analysed under a light microscope, prior to and 2 h after application of the products to the skin, and compared with various control preparations with or without BP-3.

METHODS

All tested formulations were mounted on microscope slides, viewed under a light microscope and photographed. Samples were taken directly from original packages or from freshly prepared prescription formulations. Two hours after application to the skin, the samples were taken and processed for microscopy.

RESULTS

In some commercial sunscreens numerous crystals were formed upon cutaneous application, whereas others contained crystals both prior to and after epicutaneous application. A single commercial product (a lamellar ambiphyl emulsion, SPF28) retained its regular structure throughout the study. Control preparations with or without BP-3 and/or octyl methoxycinnamate contained crystals after cutaneous application.

CONCLUSIONS

Ingredients, most probably BP-3, in many commercial sunscreens are prone to recrystallization while on the skin which might interfere with their UV light-absorbing function.

Linear extragenital lichen sclerosus with underlying bony atrophy

We describe a 21-year-old male patient with linear extragenital lichen sclerosus. The lesions are confined to the left side of his body and consist of 3 long bands running along the left leg and several patchy and linear lesions on the left side of his trunk. An associated finding is a smaller diameter of the distal part of his left lower leg caused by bony atrophy of the underlying portion the tibia. This is the fifth reported case of linear lichen sclerosus.

Papular-purpuric "gloves and socks" syndrome caused by parvovirus B19

This paper presents a 15-year-old boy with an acute febrile illness accompanied by purpuric and papular lesions located mostly on the dorsal areas of his hands and feet with the additional changes on his knees and elbows. Serologic studies confirmed the acute infection by parvovirus B19. Apart from mild leukocytosis there were no other abnormalities in hematologic and laboratory findings. The diagnosis of papular-purpuric "gloves and socks" syndrome (PPGSS) was made. Cutaneous changes completely resolved two weeks later. Herein the patient's condition was described together with a brief overview of the PPGSS literature concerning this relatively rare viral exanthema.

Skin lesions--an indicator of disease activity in systemic lupus erythematosus?

Cutaneous manifestations have great diagnostic value for systemic lupus erythematosus (SLE). In this study we tried to establish a correlation between lupus erythematosus LE-specific and LE-nonspecific cutaneous lesions and disease activity measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Sixty-six patients with SLE were evaluated. They were divided into three groups having: (1) only LE-specific lesions (38 or 58.46%); (2) only LE-nonspecific lesions (4 or 6.15%); and (3) both types of lesions (23 or 35.38%). Results were analyzed using the Student t-test. Patients with LE-nonspecific skin manifestations had significantly increased disease activity compared to those with only LE-specific lesions. The number of different skin lesion types also correlated with disease activity. It was significantly increased in a group with three different types of lesion, either specific or nonspecific. Patients with only one type of lesion had mild disease. An intermediate disease activity was found in the group with two different lesion types. Lupus-specific skin manifestations serve primarily as an important diagnostic clue. In conclusion, patients with LE-nonspecific lesions have significantly more active SLE than those with LE-specific lesions and may therefore require more intensive therapy and disease monitoring.

Persistent erythema multiforme: a report of three cases

Three cases of persistent erythema multiforme, two of unknown aetiology and one precipitated by influenza are reported. Lesions were widespread, mostly atypical in appearance and regressed in response to immunosuppressants (systemic steroids and/or azathioprine) or, in one case, to dapsone. One patient developed erythroderma responding eventually to etretinate. Histology in all patients was consistent with the mixed, epidermodermal pattern of erythema multiforme. There were no significant laboratory abnormalities nor marked symptomatology apart from itching. The persistent form appears to belong to the spectrum of erythema multiforme being heterogeneous with respect to inducing stimuli, including viral antigens, neoplastic or inflammatory disease or unknown causes. Whenever it is possible, treatment should be adjusted depending on the causative agent.

Bullous delayed pressure urticaria; pressure testing may produce a systemic reaction

We report a patient with bullous delayed pressure urticaria (DPU) and chronic idiopathic urticaria (CIU) in whom a systemic reaction occurred. The reaction occurred 18 h after a pressure test had been performed on the right forearm. Blood histamine levels were more elevated in the sample taken from the forearm on which the test had be applied. Skin biopsy revealed both intraepidermal and subepidermal bullae with a sparse dermal inflammatory infiltrate and direct immunofluorescence showed linear deposition of fibrinogen along the epidermodermal basement membrane. As far as we are aware this is only the third case of bullous DPU reported and the first associated with generalized urticaria and angioedema and severe broncho-obstruction. Possible pathophysiological mechanisms are discussed.

Mechanisms involved in the binding of thymocytes to rat thymic dendritic cells

The effects of monoclonal antibodies (mAbs) to cell-surface molecules, divalent cations, and various cell-signaling and metabolic inhibitors on the binding of thymocytes to rat thymic dendritic cells (TDC) were studied using a rosette assay. It was found that TDC/thymocyte adhesion was stronger and faster at 37 degrees C than at 4 degrees C. Flow cytometric analysis demonstrated that bound thymocytes were predominantly CD4+CD8+ and CD4+CD8-, but in comparison to the phenotype of whole thymocytes, they were enriched in the mature TCR alpha beta hi subset. The binding of thymocytes to TDC at 37 degrees C was almost completely dependent on Ca2+ and Mg2+ and partly on an intact cytoskeleton and calmodulin-dependent protein kinase. The adhesion was independent of new protein synthesis and the activities of protein kinases A and C, tyrosine kinases, as well as phosphotyrosine protein phosphatases. The TDC/thymocyte adhesion at 37 degrees C was partly blocked by anti-LFA-1 (WT.1), anti-CD18 (WT.3), and anti-ICAM-1 (1A29)mAb. MAbs to class II MHC (OX-3 and OX-6), CD4 (W3/25), CD8 (OX-8), and alpha beta TCR (R73) stimulated the adhesion via an LFA-1-dependent pathway, whereas an anti-CD45 mAb (G3C5) stimulated the rosette formation independently of LFA-1. MAbs to CD2 (OX-34), CD11b (ED7), CD11b/c (OX-42), and class I MHC (OX-18) were without significant effects on the adhesion process.

Adhesion molecules involved in the binding and subsequent engulfment of thymocytes by a rat thymic epithelial cell line

A rat thymic epithelial cell (TEC) line (R-TNC.1) was established from a long-term TEC culture. Based on its ultrastructure, phenotype and cytokeratin profile, this line was characterized as a type of cortical TEC. R-TNC.1 cells had nursing activity which was manifested by the binding and subsequent engulfment of thymocytes. The role of adhesion molecules involved in these processes was studied extensively using a coculture of resting thymocytes and unstimulated or interferon-gamma (IFN-gamma)-stimulated R-TNC.1 cells. It was found that a number of adhesion molecules, such as CD2, CD4, CD8, LFA-1, CD18, ICAM-1 and Thy-1, was partly involved in the nursing activity. The effect of monoclonal antibodies (mAb) to these molecules depended on the incubation time and stimulation of R-TNC.1 cells. The inhibitory effect of mAb to CD2, LFA-1, CD18 and ICAM-1 on thymocyte engulfment was higher than their effect on thymocyte binding to the R-TNC.1 line. In addition, a LFA-1/CD18-dependent/ICAM-1-independent adhesion pathway was identified when unstimulated R-TNC.1 cells with minimal expression of ICAM-1 were used. The combination of inhibitory mAb did not completely abrogate the nursing activity of the R-TNC.1 line, suggesting the possible involvement of some other adhesion molecules.

A novel anti-rat CD18 monoclonal antibody triggers lymphocyte homotypic aggregation and granulocyte adhesion to plastic: different intracellular signaling pathways in resting versus activated thymocytes

We have raised a monoclonal antibody (mAb), NG2B12, directed against rat CD18, capable of inducing lymphocyte homotypic adhesion and granulocyte adherence to plastic. NG2B12-induced aggregation is temperature sensitive and requires metabolic energy, an intact cytoskeleton and the presence of Mg2+, but is independent of protein synthesis. Ca2+ is not only dispensable but exerts a suppressive effect on the NG2B12-induced adhesion. The adhesion is readily observed in thymocytes and concanavalin A blasts of thymocytes and splenocytes but is very weak in resting spleen and lymph node cells. NG2B12 also enhances phorbol 12-myristate 13-acetate (PMA)-induced aggregation in an additive fashion. The NG2B12-induced homotypic adhesion is mediated by LFA-1. mAb against ICAM-1 completely inhibited the induced adhesion of activated cells but inhibited only partially and in a time-dependent manner the adhesion of resting thymocytes. The activation of protein phosphatases 1 and 2A (as assessed by the use of okadaic acid) is necessary for the NG2B12-induced adhesion of both resting and activated thymocytes. In contrast, H-7 (an inhibitor of protein kinase C and A), substantially suppressed the adhesion of resting thymocytes, whereas W-7 (an inhibitor of calmodulin-dependent protein kinase) inhibited the adhesion of activated thymocytes. NG2B12 induces both adherence to plastic and homotypic aggregation of granulocytes; the events being blocked by anti-CD18 (WT.3) and anti-CD11b/CD11c (OX-42) mAb, augmented by okadaic acid and not modified by H-7 and W-7. Additionally, we have demonstrated that NG2B12 and PMA employ distinct intracellular signaling pathways in inducing adhesion of both thymocytes and granulocytes.

An adhesion-promoting anti-rat CD18 monoclonal antibody differentially alters thymocyte responses to various mitogens

Leukocyte function-associated antigen (LFA)-1 represents one of the major lymphocyte adhesion molecules being capable of both strengthening cell-cell contacts and cooperating with other relevant surface molecules in signal transduction. We have studied the effects of an adhesion-promoting anti-CD18 monoclonal antibody (mAb) (NG2B12) on thymocyte proliferation induced by various mitogens. As we have recently described, the adhesion-promoting function of this mAb strictly depends upon the activation of several intracellular protein kinases and phosphatases. In the present work we have found that NG2B12 inhibits concanavalin (Con) A-induced thymocyte proliferation suppressing IL-2 production by these cells. Conversely, this mAb enhances proliferative responses of thymocytes to phytohemagglutinin (PHA) and interleukin (IL)2 alone or in combination with the phorbol ester PMA. The effects of this mAb were compared with those of another anti-rat CD18 mAb which potently blocks the LFA-1/Intercellular adhesion molecules (ICAMs) interactions.

Role of beta 2 integrins in the binding of thymocytes to rat thymic macrophages

A role of beta 2 integrins and one of their ligands, ICAM-1, in thymic macrophage (TMF)/thymocyte interactions was studied. TMF were isolated as adherent cells from 4-day old culture of thymic-cell suspensions either from normal or hydrocortisone-treated rats. Adherent cells were 94-98% positive with ED1 (a pan-macrophage marker). The majority of them (75-95%) expressed the CD11b and CD18 molecules, and 60-70% expressed CD54 (ICAM-1). A low proportion of TMF (10-20%) expressed CD11a (LFA-1). The expression of all these antigens was upregulated by IFN-gamma and TNF-alpha. The effect of these mAbs on TMF/thymocyte binding was studied using a simple rosette assay by incubating unstimulated or IFN-gamma or TNF-alpha stimulated TMF, grown on microscopic slides with resting or ConA+IL-2 activated thymocytes. It was found that LFA-1/CD18 and ICAM-1 play a significant role in the TMF/thymocyte adhesion. In addition, a LFA-1-dependent/ICAM-1-independent adhesion pathway was observed, suggesting that LFA-1 might use another ligand. The inhibitory effect of anti-CD18 mAb (WT-3) was higher than the effect of anti-LFA-1 mAb (WT-1) and was a consequence of blocking the CD18 chain both on thymocytes and TMF. No significant difference in the expression and function of adhesion molecules was found between TMF obtained from normal or hydrocortisone-treated rats. The involvement of CD11b in these processes was of lesser importance than the role of the CD11a molecule. By using mAbs to different epitopes of the CD11b molecule, such as OX-42 (anti-CD11b/CD11c), ED7, and ED8 (anti-CD11b), it was found that they were either slightly or moderately inhibitory under certain experimental conditions or did not significantly modulate TMF/thymocyte binding. OX-42 was slightly stimulatory in some experiments. Cumulatively, these results show that beta 2 integrins play a significant role in TMF/thymocyte interactions and probably contribute to T-cell development in vivo.

Two novel monoclonal antibodies reactive with different components of the rat thymic epithelium

Two novel monoclonal antibodies (mAbs) (PT10B7 and PT13D11) have been raised against molecules of rat thymic epithelial cells (TEC). Streptavidin-biotin immunoperoxidase staining and double immunofluorescence using these mAbs and anti-cytokeratin (CK) antibodies showed that PT10B7 and PT13D11 mAbs bound to different components of rat TEC. PT10B7 mAb reacted with cortical and a subset of medullary TEC, whereas PT13D11 mAb labeled subcapsular/perivascular and most medullary TEC, including TE-R 2.5 TEC line of medullary origin. Their staining patterns were different from those seen using mAbs to CK10, CK18 and CK19 polypeptides and other anti-rat TEC mAbs produced so far. The differences in immunoreactivity of these two mAbs on rat thymus during ontogeny and on other epithelial cells of adult rats were also seen. Namely, PT13D11 stained ectoderm-derived epithelia, whereas PT10B7 stained some cells of simple epithelia. Cumulatively, these results reveal a fine phenotypic heterogeneity within rat thymic epithelium.