Alopecia areata: more on pathogenesis and therapy.
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Biomedical subjects
Publications and source records attributed to A Tosti.
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Eight cases of subungual epidermoid cysts associated with distinctive nail abnormalities are reported. Toes and thumbs were the most frequent sites affected by this probably not rare condition. The most striking clinical features were subungual hyperkeratosis associated with shortened and dystrophic nail plate. A history of trauma was frequent. In all cases, the nail biopsy showed marked hyperplasia of the nail bed and epidermoid cysts in the dermis. The authors propose a new classification for subungual epidermoid cysts.
The case of a 20-year-old girl who had morphea with bullous lesions is reported. Two bullae appeared on an indurated patch of morphea on the right side of the trunk. A half-moon-shaped lesion was localized along the superior border of the patch and the other followed the anterior border and extended into the patch. Both contained a hemorrhagic fluid. The bullae spontaneously regressed in a few months without therapy. We emphasize the very rare occurrence of hemorrhagic bullous lesions as a complication of morphea.
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We report 36 patients with thimerosal-induced follicular allergic contact conjunctivitis. 18 patients had follicular conjunctivitis without eyelid involvement, while 5 patients had follicular conjunctivitis associated with an allergic contact dermatitis of the eyelids; all these patients had been using thimerosal-containing eye drops. A further 13 patients were soft contact lens wearers who became sensitized to their own thimerosal-containing lens solutions. All 36 patients showed a positive patch test reaction to thimerosal, while only 1 of them reacted to an ophthalmic solution. Thimerosal sensitization appears to be clinically relevant in ophthalmic patients.
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Since alopecia areata might be due to an aberrant T-cell-mediated immunity, the purpose of our study was to compare the results obtained with Thymopentin to those of topical sensitizing therapies, such as squaric acid dibutylester or diphencyprone. Statistical analysis showed no differences between the results obtained with these two therapies. Therefore, Thymopentin can be considered to be a new therapeutic agent which, like the classic topical drugs squaric acid dibutylester or diphencyprone, has immunoreactive properties and might provide some hope to patients with severe alopecia areata.
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A 23-year-old girl affected by Papillon-Lefèvre syndrome developed, during Etretinate therapy (1 mg/kg/day), two liver abscesses caused by pyogenic bacteria and a subphrenic abscess. The immunological effects of retinoids may precipitate severe infections in patients with Papillon-Lefèvre syndrome, who probably have a basic, even though not always evident, defect of PMN chemotaxis.
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A patient with lichen planopilaris with peculiar leukonychia is described. The histologic findings from examination of the nail biopsy specimen are discussed.
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