Biomedical subjects
Publications and source records attributed to C L Meneghini.
Secrétan's syndrome is characterized by hard persistent edema of the dorsum of the hands. Usually, the condition is self-inflicted, but the authors have seen four cases that were occupationally related. The patients were fishing divers, and the mechanism appeared to be the constrictive action of the tight diver suit and pricks from sea urchin spines. Lymphographic abnormalities were present in one case.
1,476/2,320 of our cases of atopic dermatitis (AD) start in the first six months of life. The diagnosis is usually easy, but at this age it is sometimes more difficult, mainly because of lack of or rare evidence of scratching, but also because of the brief clinical history that does not allow observation of the characteristic chronic and relapsing course. Moreover, the major atopic disorders-asthma, rhinitis-usually appears later in the natural history of atopic subjects. From a differential diagnosis point of view, AD is the most definite dermatological disorder at this age. Other not well defined conditions occurring in the first six months of life are usually referred to as infantile seborrheic dermatitis, a name that has been used for at least four different disorders: cradle cap, cradle cap with involvement of inguinal, axillary and retroauricular folds, napkin psoriasis and Leiner's erythroderma. From a clinical point of view, AD in the first months of life is characterized by the prevalence of exudating lesions; moreover, the lack of or the rare evidence of scratching allows us to observe isolated vesicular lesions that are found with difficulty in the further course of the disease.
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The incidences of sensitisation to Kathon CG are reported for patients routinely tested from 1984 to 1986 in Bari, London, Louvain, Nijmegen, Oulu and San Francisco. For these 3 years, the overall frequency of sensitisation varied for women from 3.3% in Oulu to 0.6% in London and San Francisco and for men from 1.4% in Oulu to 0% in San Francisco. Women were predominantly sensitised, probably by cosmetics, toiletries and domestic cleaners. Occupational sensitisation was much less frequent.
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Twenty-two non-ulcerated basal cell carcinomas and 30 non-ulcerated squamous cell carcinomas were selected to study the reactive cellular infiltrate, utilizing histological, histoenzymatic and immunological methods. Substantial differences in cell behaviour were observed between the two tumors: advanced and metastatic squamous cell carcinoma showed prominent presence of T8+ lymphocytes, Leu 7+ cells, macrophages, mast cells and granulocytes, notably eosinophils. Degranulation of mast cells was seen both in the tumor itself and in the adjacent stroma. The basal cell carcinoma presented a low count of T4+, T8+ lymphocytes, whereas Leu 7+ cells and granulocytes were absent.
Patch tests with the standard series of chemical allergens were performed on 8,230 patients having various dermatoses. The frequency of contact sensitization among categories of dermatoses varied markedly. While only 21% of persons whose diagnosis was occupational contact dermatitis reacted allergically to at least one chemical, reactions were observed in 70% of those whose skin had been damaged by mechanical traumas. Cuts, wounds, and abrasions incurred on the job, while not very serious injuries per se, should be regarded as having greater clinical importance insofar as they increase the likelihood of contact sensitization to allergens.
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Over the years, changes have had to be made in the list of topical drugs most frequently responsible for allergic contact dermatitis. The 4 most common sensitizers in Italy in the past have been penicillin, sulfonamide, promethazine and neomycin. Now the list is headed by neomycin, benzocaine and ethylenediamine. Antihistamines and parabens are less frequently observed as sensitizers. The increasing topical use of new drugs and additives, as well as older sensitizers, produces reactions to other substances, such as non-steroidal anti-inflammatory agents, some antimycotic drugs, propylene glycol and benzoyl peroxide.
Many immunological alterations have been reported in atopic dermatitis, and it is likely that in some cases they are capable of worsening the clinical course of atopic dermatitis (AD). More frequently these alterations are responsible for conditions associated with AD such as asthma, food allergy and infections. It seems probable that in some cases they are evidence of a preclinical allergic manifestation. However, in most cases, it is likely that the immunological alterations do not affect significantly the clinical course of the disease.
Certain infections such as Kaposi's herpetic eruption, impetigo, recurrent cutaneous herpes simplex and warts are more frequent in subjects with atopic dermatitis. It is likely that the continuous alterations of the skin are more important than immunological factors in increasing the frequency of some infections in subjects with atopic dermatitis. Moreover, these infections do not seem to affect significantly the clinical course of atopic dermatitis.
A case of severe bullous dermatosis in the newborn son of a mother with herpes gestationis is reported. Bullous lesions appeared in the child about 2 hours after delivery and regressed completely without specific treatment by the end of the first month, leaving numerous epidermal cysts. The immunologic phenomena were both qualitatively and quantitatively comparable to those obtained in the mother, i.e., deposition of complement (C3) and smaller amounts of IgG at the dermo-epidermal junction of the affected skin. A transient increase of the total serum IgE was demonstrated in the mother, while the serum IgE level in the newborn was less than 5 U/ml. The pathogenetic role of IgG autoantibodies in herpes gestationis and, more generally, in autoimmune diseases is discussed.
Patterns of distribution of allergic contact dermatitis follow a certain order in time. The disease starts at a given site, most often as a unilateral acrodermatitis and, should it become chronic, spreads locally. The subsequent pattern of distribution varies depending on the primary site and the type--occupational or otherwise--of the disease. In this study data collected two decades ago are confronted with the more recent ones relating to 1055 cases of occupational allergic contact dermatitis. Examination of this material brought to light no essential difference between the older and more recent patterns of distribution of secondary sites. The incidence, however, of certain multiple localizations and of the primary or secondary involvement of the face has diminished.
T cell subsets (theophylline-sensitive T lymphocytes and T gamma lymphocytes), and the activity of soluble immune response suppressor (SIRS) factor have been investigated in a total of 53 patients with squamous cell carcinoma (SCC) of the skin. Eight of these had metastatic regional lymph nodes. The results showed decreased values for theophylline-sensitive T lymphocytes and elevated values for T gamma cells. Suppressor function evaluated by means of SIRS factor was normal in 36 patients with non-metastatic skin SCC and decreased in 8 with metastatic skin cancer.
The expression of Fc-IgG receptors on mononuclear phagocytes (monocytes/macrophages), as well as the activity of soluble immune suppressor supernatant of T-cell proliferation (SISS-T) factor have been investigated in 23 patients with squamous cell carcinoma (SCC) of the lower lip, including 8 patients with metastases in the regional lymph glands. The results demonstrated a significant increase of the expression of Fc-IgG receptors only on circulating monocytes of patients with metastatic SCC. The suppressor function evaluated by means of the SISS-T factor proved normal in patients with nonmetastatic skin SCC and reduced in 8 patients with metastatic SCC.
Two lymphocyte subpopulations, T cells bearing a receptor for the Fc fragment of IgG (T gamma) and theophylline-sensitive T cells, were investigated in 49 patients with allergic contact dermatitis (ACD) in the acute phase and compared with a control group. Patients with ACD had markedly reduced relative T gamma and theophylline-sensitive T lymphocyte levels, compared with normals (P less than 0.0005). The patients also showed reduced absolute T gamma and theophylline-sensitive T cells with respect to the controls (P less than 0.01). To determine whether decreased levels of T gamma and theophylline-sensitive T cells were related to the activity of ACD, the same T-cell subsets were determined in 10 of 49 patients after the clearing of the contact dermatitis. Both T-cell subpopulations were found within the normal range.