Biomedical subjects
A Menter
Publications and source records attributed to A Menter.
Cutaneous T-cell lymphoma in association with silicone breast implants.
BACKGROUND: Cutaneous T-cell lymphoma (CTCL) is a chronic malignancy of helper T cells with the CD4 phenotype. It occurs less frequently in young women but is increasing in incidence for unknown reasons. Silicone breast implants have been associated with T-cell-mediated autoimmune reactions. OBJECTIVE: Our purpose was to suggest the hypothesis that CTCL may arise after breast implants and that different patients with CTCL may be stimulated by different antigens. METHODS: Investigators with many patients with CTCL were queried regarding the occurrence of CTCL in women after breast implants. RESULTS: Three cases of confirmed CTCL after breast implants were identified and are reported. In one patient with Sézary syndrome and CTCL, the disease went into remission after removal of implants, resolution of chronic staphylococcal infection, and initiation of photopheresis and interferon alfa therapy. Another patient had progressive disease. CONCLUSION: CTCL may occur in association with breast implants in young female patients, but causality is unknown. If CTCL is antigen driven, then it is likely to result from several different antigens in different groups of patients.
Tars and anthralins.
The pharmacology, mechanisms of action, and historic perspectives of tar and anthralin are discussed. Traditional Goeckerman and Ingram regimens are presented in the context of newer advances in psoriasis treatment. Recommendations for therapy with tar and anthralin, either as monotherapy or adjunctive therapy, are reviewed and referenced.
Gene for familial psoriasis susceptibility mapped to the distal end of human chromosome 17q.
A gene involved in psoriasis susceptibility was localized to the distal region of human chromosome 17q as a result of a genome-wide linkage analysis with polymorphic microsatellites and eight multiply affected psoriasis kindreds. In the family which showed the strongest evidence for linkage, the recombination fraction between a psoriasis susceptibility locus and D17S784 was 0.04 with a maximum two-point lod score of 5.33. There was also evidence for genetic heterogeneity and although none of the linked families showed any association with HLA-Cw6, two unlinked families showed weak levels of association. This study demonstrates that in some families, psoriasis susceptibility is due to variation at a single major genetic locus other than the human lymphocyte antigen locus.
The annual cost of psoriasis.
BACKGROUND: The need for comparative cost figures for psoriasis therapy has become increasingly important. OBJECTIVE: Our purpose was to compare the yearly costs of various psoriasis treatments. METHODS: Ten patients were selected for each treatment modality and the average total cost per year, per patient was evaluated. RESULTS: All treatments evaluated were cheaper than inpatient therapy, with Goeckerman treatment in the day-care setting the most expensive and hydroxyurea the cheapest. Cyclosporine, which was used for comparison, was at least twice as expensive as all the other treatments except for Goeckerman treatment in the day-care setting, compared with which it was about 70% more expensive. CONCLUSION: No single treatment appears to be universally superior to others. In considering specific treatment for psoriasis, cost analyses, including appropriate laboratory and other specialized evaluations, must be taken into account. With use of these data, practitioners and health care organizations may be better able to select appropriate therapy.
Characterization of T-cell clones generated from skin of patients with psoriasis.
BACKGROUND: The infiltrating cells in psoriasis include a subpopulation of autoreactive T cells. OBJECTIVE: The aim of this study was to further characterize skin-infiltrating T lymphocytes in patients with psoriasis. METHODS: Forty-five T-cell clones were generated from skin biopsy specimens from two patients. RESULTS: Phenotypic studies on 25 of 45 clones revealed that 19 (76%) of the clones were CD4+, 5 (20%) were CD8+, and 1 (4%) clone was CD4- and CD8-. Twenty-three clones were stained for identification of T-cell receptors. Twenty-two clones expressed alpha/beta T-cell receptors and one clone (CD4-/CD8-) expressed no T-cell receptor. Nineteen clones (42%) were autoreactive with no restriction to class I or class II HLA antigens. By contrast, proliferation of two of the seven clones was inhibited by class I monoclonal antibody, whereas proliferation of four of seven clones was inhibited by class II monoclonal antibody. CONCLUSION: These data suggest that skin-infiltrating lymphocytes in patients with psoriasis may recognize HLA-associated molecules, perhaps the peptide of the HLA groove. The recognition of the peptide is presumably inhibited when monoclonal antibody is bound to the HLA molecule.
Erythema gyratum repens: a paraneoplastic eruption.
Erythema gyratum reopens is a slowly expanding, mildly scaling dermatosis with a "wood-grain" pattern and is seen in patients with an underlying malignancy. To date only 49 cases have appeared in the literature, 41 of which (84%) were associated with a neoplasm, most commonly of the lung. Several patients also had pruritus, palmoplantar keratoderma, ichthyosis, vesiculobullous lesions, and/or eosinophilia. Histopathologic findings are nonspecific. The skin findings usually disappear with therapy for the underlying malignancy.
Psoriasis symposium. Topical therapy.
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Can maintenance cyclosporine be used in psoriasis without decreasing renal function?
Nephrotoxicity attributable to cyclosporine therapy is dose dependent and unlikely to occur in psoriasis treatment protocols using less than 5 mg/kg/d in otherwise healthy patients. Any long-term or maintenance protocol should include regular monitoring of urea nitrogen/creatinine levels and blood pressure. Cyclosporine is a potent drug, and it is reasonable to monitor its administration to otherwise healthy psoriasis patients with yearly measurement of glomerular filtration rate (GFR), especially in elderly patients or patients with diminished renal reserve (eg, diabetes). There is no convincing evidence of irreversible renal dysfunction in psoriasis patients on low-dose cyclosporine protocols, nor is there evidence that cyclosporine in low doses in completely safe or banal. Therefore, we suggest monitoring GFR at 3, 6, and 12 months after initiating therapy, provided serum creatinine level is stable. If serum creatinine level increases by > 30% over baseline, GFR should be monitored more frequently and the dose of cyclosporine adjusted if there is a persistent decrease.
Psoriasis symposium. Cyclosporine.
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Psoriasis in practice.
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Panniculitis in an immunocompromised patient.
We present a patient in whom histoplasmosis panniculitis developed during steroid therapy for pancytopenia secondary to myelodysplasia. Although the cutaneous manifestations of disseminated histoplasmosis are rare, we review them because of the increasing numbers of organ-transplant patients, as well as other patients with immunodeficiency, including acquired immune deficiency syndrome, in whom the risk of this unusual presentation of histoplasmosis must be considered.
Characterization of skin-infiltrating lymphocytes in patients with psoriasis.
In this study, skin-infiltrating cells in psoriasis patients were characterized in biopsies from both involved and uninvolved skin. Histologic examination of biopsies showed the presence of both CD4+ and CD8+ T cells and the lack of B lymphocytes. Skin biopsies were also placed in tissue culture medium supplemented with human serum, interleukin-2 (IL-2), and irradiated autologous blood lymphocytes. T lymphocytes grew from both plaques and univolved skin biopsies and consisted of a heterogeneous population of T-cell subsets. The immunophenotypic analysis of cultured cells was comparable to the histologic examination on frozen section, i.e., there was a greater number of CD4/CDw29+ cells than CD8+/CD45+ cells. Cultures were tested in the primed lymphocyte test (PLT) and cell-mediated lympholysis (CML) assays. All cultures tested demonstrated secondary proliferative but not cytolytic reactivity. The PLT results indicate that the cell cultures generated are autoreactive. This autoreactivity was found to be directed against non-human leukocyte antigens (HLA), i.e., minor HLA with some restriction to major HLA antigens.
Acute bullous hemorrhagic eruption. Acute febrile neutrophilic dermatosis (Sweet's syndrome).
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Comparative study of 5% permethrin cream and 1% lindane lotion for the treatment of scabies.
A multicenter, randomized, investigator-blind controlled trial was conducted to compare the safety and efficacy of a single, whole-body application of 5% permethrin cream with that of 1% lindane lotion for the treatment of scabies in 467 patients. At 14 +/- 3 days after treatment, the mean active lesion count decreased from pretreatment levels of 85 (range, 4 to 600) in both treatment groups to 14 (range, 0 to 133) in the permethrin group and to 15 lesions (range, 0 to 500) in the lindane group. At 28 +/- 7 days after treatment, complete resolution had occurred in 181 (91%) of 199 patients treated with permethrin and in 176 (86%) of 205 patients given lindane. Pruritus due to scabies persisted at 28 +/- 7 days in 14% of the permethrin group and in 25% of the lindane group. The most frequent adverse effects were new or increased pruritus and mild, transient burning or stinging; the latter was slightly more frequent following permethrin treatment and appeared to be related to severity of infestation. Because of a lower potential for neurologic toxicity, permethrin may be preferable to lindane for the treatment of scabies particularly in children.
Methotrexate-induced cirrhosis requiring liver transplantation in three patients with psoriasis. A word of caution in light of the expanding use of this 'steroid-sparing' agent.
Methotrexate has been used for many years to treat refractory psoriasis. Three cases of methotrexate-induced cirrhosis requiring orthotopic liver transplantation are presented to emphasize the importance of strict adherence to published criteria for patient selection, monitoring of cumulative drug dosages, and the performance of serial liver biopsies. Each patient had been treated with long-term methotrexate therapy (cumulative doses far in excess of 1.5 g) without undergoing serial liver biopsies, contrary to well-established treatment guidelines. Caution must be exercised in using methotrexate as a steroid-sparing agent in the treatment of inflammatory diseases because of its potential to cause severe hepatotoxic effects with long-term usage and cumulative doses above 1.5 g. Patients easily become psychologically dependent on the drug, and physicians need to guard against the false sense of security engendered by normal results on liver function studies.
Cyclosporine therapy for psoriasis: serum creatinine measurements are an unreliable predictor of decreased renal function.
With increasingly widespread use of cyclosporine for the treatment of psoriasis, it is imperative to identify reliable markers of cyclosporine-induced nephrotoxicity. Five patients with extensive psoriasis and no significant preexisting renal disease were treated with oral cyclosporine (average dosage, 5 mg/kg per day; average duration of treatment, 9 weeks). Changes in serum creatinine measurements made immediately before and at the end of treatment were compared with changes in glomerular filtration rate as determined by 125I-iothalamate clearance. During treatment, the average serum creatinine value only increased from 1.0 +/- 0.2 to 1.1 +/- 0.3 mg/dl (+/- standard deviation), whereas iothalamate-based estimates of glomerular infiltration rate decreased from 100 +/- 22 to 63 +/- 37 ml/min/1.73 m2 (p less than 0.02). Simultaneous 125I-iothalamate and 24-hour creatinine clearances were obtained in two patients at the end of treatment and at 2 weeks after cyclosporine therapy. Glomerular filtration rates determined by iothalamate clearance were 14% to 30% lower than those calculated by 24-hour creatinine clearances. Neither serum creatinine measurements nor creatinine clearances (whether calculated or measured) accurately reflect the cyclosporine-induced decline in renal function as determined by glomerular filtration rate. In contrast, 125I-iothalamate clearance is a more accurate measurement of glomerular filtration rate, which provides a sensitive marker for monitoring potential cyclosporine-induced nephrotoxicity.
Guttate psoriasis and vitiligo: anatomic cohabitation.
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