Follicular mucinosis associated with early stage cutaneous T-cell lymphoma: successful treatment with interferon alpha-2b and acitretin

BACKGROUND

Follicular mucinosis (FM) is a rare dermatosis characterized by mucin deposits in the pilosebaceous units. It is divided into a primary-benign type and a secondary type associated mostly with lymphomas. No standard effective therapy is available for the primary FM while in the secondary form treatment is aimed against the underlying disease.

METHODS

We report a case of secondary FM in which a cutaneous T-cell lymphoma was detected 6 years after the initial eruption.

RESULTS

Complete remission was achieved with combination therapy of interferon alpha-2b at a dose of 6 million U subcutaneously three times a week, and acitretin 35 mg/day, for 6 months.

CONCLUSION

Regular clinical and histopathological evaluation is suggested for all patients with FM. For cases associated with cutaneous T-cell lymphoma the combination of interferon alpha and acitretin seems to be a good therapeutical approach.

Giant tumour of the heel: acquired fibrokeratoma

Fibrokeratoma is a rare benign invasive tumour usually located on the digits. We report a 35-year-old patient with a giant acquired fibrokeratoma of the heel. Despite its large size and unusual location, the tumour was microscopically benign and was successfully excised.

Superficial chemical peels

Superficial chemical peeling (SCP) involves the application of a peeling agent to the skin, resulting in destruction of part or all of the epidermis. SCP is mainly recommended for facial rejuvenation, photoaging and superficial rhytides, pigmentary dyschromias and acne. It can be used on all Fitzpatrick skin types, no sedation is needed, and the desquamation is usually well accepted. Overpeel and complications are very rare. The most commonly used SCP agents are glycolic acid 20-70%, trichloroacetic acid 10-35%, Jessner's solution, salicylic acid, pyruvic acid, resorcinol 30-50% preparations, and solid carbon dioxide. The careful selection of patients is critical for the outcome of a SCP and contraindications must be seriously considered. The peel procedure is generally common for all SCP agents but a good knowledge of the specific characters of each agent is of great importance in order to decide which to use for each individual patient.

The AIDS profile in a low risk country: the central role of bisexual men

BACKGROUND

Policies and measures for the prevention of human immunodeficiency virus Type 1 (HIV-1) transmission require adequate information about the risk profile of AIDS which is time-, place- and population-dependent. We have studied the risk factors for AIDS among men in Greece, a country with relatively low incidence of AIDS.

METHODS

A case-control study of all male patients with incident disease, who have been diagnosed in the major university-affiliated, AIDS Unit from February 1995 through August 1997 was conducted in Athens, Greece, a country with relatively low incidence of AIDS. Eighty-three AIDS patients were enrolled and an equal number of orthopaedic patients as controls. All interviews were conducted by the same physician and took place in the hospital.

RESULTS

There were no differences among heterosexual men with AIDS, homo- or bi-sexual men with AIDS, and controls with respect to any socio-economic variable. The odds ratio for AIDS among homo- or bi-sexual men, in comparison with heterosexual men, was 51.5 (95% confidence intervals 21.6-122.7). Blood transfusion, intravenous drug abuse and haemophilia were less important risk factors for AIDS in this study. Condom use was generally very low and there was a tendency for lesser use among men at highest risk for HIV transmission, that is, those with a preference for receptive anal intercourse.

CONCLUSIONS

AIDS among men in Greece is mainly driven by homosexual behaviour, but the relatively high proportion of bisexual men and the relatively low frequency of condom use are warning signs for the potential of the epidemic to expand in the future. The relatively low incidence of AIDS in Greece, in comparison with other European populations, may be due to a phase difference in the epidemic, but it could also be due to the traditional role separation of homosexuals in this geographical area, and the easy accessibility of disposable syringes and needles in Greece.

Lymphomatoid papulosis type A: clinical, morphologic, and immunophenotypic study

BACKGROUND

Lymphomatoid papulosis (LyP) is a cutaneous clonal or polyclonal Ki-1 + T-cell lymphoproliferative disorder, morphologically resembling Ki-1 + anaplastic large cell lymphomas (Ki-1 + ALCL) or Hodgkin's disease (HD). Lymphomatoid papulosis usually has a characteristic benign clinical course with remissions and relapses of the cutaneous eruptions.

METHODS

The authors studied three patients with LyP. In each case the diagnosis was established based on the typical clinical history and presentation of the cutaneous lesions as well as the morphologic and immunophenotypic findings.

RESULTS

In all three cases the skin biopsies showed a polymorphic, nonepidermotropic, dermal lymphocytic infiltrate, composed of small lymphocytes and fewer large, atypical cells. The large cells were positive for the activation markers CD30 (Ki-1) and CD45R (leukocyte common antigen), and were negative for the HD marker CD15 (Leu MI).

CONCLUSIONS

In most cases, LyP can be distinguished from Ki-1 + ALCL and HD on the basis of clinical, morphologic, and/or immunophenotypic findings. We emphasize the importance of the recognition of LyP as a clinicopathologic entity and the awareness of dermatologists, oncologists, and surgical pathologists in differentiating LyP from other primary cutaneous Ki-1 + lymphoproliferative disorders (Ki-1 + ALCL and HD). The prognosis of cutaneous Ki-1 + ALCL and HD is usually different from LyP and requires a different therapeutic approach.

Hydrofluoric acid burns

We observed seven patients who presented consecutively with hydrofluoric acid hand burns. The clinical characteristics of these patients and the course of their disease and treatment are reviewed. Dermatologists should be aware that a hydrofluoric acid burn constitutes a dermatologic emergency. Specialized treatment is required to prevent topical, system, and even lethal toxic effects.

Hepatitis E virus infection in individuals at high risk of transmission of non-A, non-B hepatitis and sexually transmitted diseases

The aim of the study was to determine the prevalence of hepatitis E virus (HEV) infection among individuals at high risk of transmission of non-A, non-B hepatitis or sexually transmitted diseases (STDs), and to evaluate whether they have an increased risk of exposure to HEV. Serum samples from 125 thalassemia patients, 300 intravenous drug users, 420 hemodialysis patients, 263 individuals with STDs, 47 human immunodeficiency virus (HIV) infected homosexual men, and 316 healthy volunteers were tested for immunoglobulin G (IgG) and M (IgM) antibodies to HEV (anti-HEV) by enzyme immunoassays (EIAs) following a predetermined algorithm (Abbott Labs). Anti-HEV IgG was confirmed in 3/125 (2.4%) thalassemia patients, 5/300 (1.7%) intravenous drug users, 27/420 (6.4%) hemodialysis patients, 4/263 (1.5%) STD patients, 1/47 (2.1%) homosexual men, and 7/316 (2.2%) of the reference group. No patient was found positive for anti-HEV IgM. The higher prevalence which was observed in hemodialysis group was due to the confounding effect of age, as multivariate analysis showed. The anti-HEV prevalence increased significantly with age (p = 10(-4)). No significant association was found between anti-HEV, anti-HCV, and anti-HBc. In conclusion, individuals at high risk of non-A, non-B hepatitis and STDs have no increased risk of exposure to HEV and the higher prevalence of anti-HEV IgG among older subjects may be due to an epidemic form of HEV infection which occurred some decades ago, when the sanitary conditions in our country were poor.