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Biomedical subjects

D Creamer

Publications and source records attributed to D Creamer.

32 records · Page 2Linked to original sources
PubMed2000

Incipient osteomalacia occurring in chronic actinic dermatitis.

Incipient osteomalacia developed in a Pakistani patient living in the UK after strict sunlight avoidance forming part of the management of the photosensitivity disorder, chronic actinic dermatitis. The patient's skin type and diet, which included calcium-binding phytates in chappattis, had increased his risk of the condition. Proximal muscle weakness and bony tenderness resulting from the disorder resolved on vitamin D replacement therapy.

Humans↗
PubMed1999

Lichenoid tissue reaction in porphyria cutanea tarda.

We report a patient presenting with lichenoid plaques on exposed skin who had the metabolic features of porphyria cutanea tarda (PCT). Histology of lesional skin demonstrated a lichenoid inflammatory cell infiltrate in the upper dermis, while direct immunofluorescence revealed immunoreactive colloid bodies. Monochromator irradiation testing demonstrated photosensitivity in the visible spectrum consistent with porphyria. Solar-simulated irradiation induced a papular reaction with lichenoid histological changes. We propose that this atypical presentation of PCT may reflect a lichenoid tissue response to a porphyrin-mediated photochemical reaction.

Facial Dermatoses↗
PubMed1999

Rowell's syndrome.

Rowell's syndrome is the name given to a distinct group of patients with lupus erythematosus who develop erythema multiforme-like lesions and have a characteristic serological picture. We report a case of a 29-year-old woman of Afro-Caribbean origin who presented with an erythema multiforme-like eruption on the hands. Subsequently she developed painful erythematous swellings on the feet and scaly plaques on the forearm and thigh consistent with subacute cutaneous lupus. She developed a positive antinuclear factor and had positive anti-Ro and anti-La antibodies and a positive rheumatoid factor. All of these features are consistent with Rowell's syndrome which we believe is a rare but distinct variant of cutaneous lupus erythematosus.

Adult↗
PubMed1999

Polymorphic light eruption occurring solely on an area of naevoid telangiectasia.

We report the case of a 60-year-old woman presenting with polymorphic light eruption occurring solely on an area of acquired naevoid telangiectasia. We have hypothesized that increased blood flow in the telangiectatic skin may reduce the threshold for expression of photosensitivity by permitting enhanced inflammatory cell trafficking to the overlying tissue.

Estrogen Replacement Therapy↗
PubMed1999

Polymorphic light eruption occurring in common variable hypogammaglobulinaemia, and resolving with intravenous immunoglobulin therapy.

A 55-year-old woman with a past history of lower respiratory tract infections presented with a photosensitive eruption. Polymorphic light eruption (PLE) was diagnosed on the basis of the temporal relationship to sun exposure and the diagnosis was supported by positive monochromator irradiation tests in the ultraviolet A wavelength spectrum. Investigation of the patient's immune status identified low levels of all immunoglobulin (Ig) subtypes consistent with common variable hypogammaglobulinaemia. Intravenous Ig replacement therapy, instituted to minimize risks from bacterial infections, was commenced and over the ensuing months resulted in a complete resolution of the PLE. PLE is considered to represent a type IV hypersensitivity reaction directed against a cutaneous autoantigen induced by exposure to ultraviolet light. In PLE, nonspecific immunomodulatory mechanisms of intravenous Ig may be active, such as a reduction in the synthesis of cytokines and a blockage of the IgG Fc receptors on macrophages.

Adjuvants, Immunologic↗
PubMed1998

Photo(chemo)therapy: advances for systemic or cutaneous disease.

Phototherapy and photochemotherapy using ultraviolet radiation are frequently used in dermatological practice. The same techniques are increasingly finding a role in the management of systemic illnesses. Visible light is used therapeutically in neonatology, psychiatry and oncology.

Female↗
PubMed1997

Localization of endothelial proliferation and microvascular expansion in active plaque psoriasis.

Expansion of the dermal microvasculature is a prominent feature of psoriasis. Although the pathogenetic process resulting in vascular morphological changes remains unclear, considerable evidence suggests the involvement of angiogenesis. To assess the degree and site of psoriatic microvascular expansion, immunohistochemical studies were performed on paired lesional and non-lesional specimens from 10 patients with active, untreated plaque psoriasis. Five-micron thick sections were labelled with monoclonal antibody JC/70A specific for the endothelial marker CD31, and vascular quantification was achieved using hue-saturation-intensity image analysis. Assessment of vasculature in the papillary dermis (superficial plexus) demonstrated a fourfold increase in endothelial surface area of lesional compared with non-lesional skin (P < 0.01), while there was no significant increase in vasculature of the upper reticular dermis. Subsequently, 18-micron thick sections were double-labelled with MIB-1 antibody to the nuclear proliferation marker Ki-67 and JC/70A. Endothelial cell proliferation was identified in the vertical limbs of capillary loops in eight out of 10 lesional biopsies and in no non-lesional biopsies. The endothelial MIB-1 labelling index was 3.1% of total endothelial cells of the superficial plexus. These findings confirm endothelial proliferation underlying psoriatic microvascular expansion, and indicate that this process is limited to a specific site in the dermal capillary bed.

Adult↗
PubMed1997

Overexpression of the angiogenic factor platelet-derived endothelial cell growth factor/thymidine phosphorylase in psoriatic epidermis.

Considerable evidence indicates that the microvascular changes observed in psoriasis are a result of angiogenesis. Vascular proliferation is driven by the local production of molecules which have angiogenic activity. Platelet-derived endothelial cell growth factor/thymidine phosphorylase (PDECGF/TP) is a potent angiogenic factor active in in vivo angiogenesis assays and overexpressed in several tumour types. We have demonstrated by ribonuclease protection analysis a consistently high degree of PDECGF/TP mRNA production in lesional psoriatic skin, while immunohistochemical studies revealed strong PDECGF/TP immunoreactivity in lesional epidermis, with nuclear staining present in basal keratinocytes and cytoplasmic immunoreactivity in suprabasal layers. Non-lesional skin showed minimal PDECGF/TP mRNA production and weak epidermal immunostaining. These results indicate a potential role for PDECGF/TP in the pathophysiology of psoriasis, and reveal a target for antiangiogenesis therapy in the treatment of this disease.

Adult↗
PubMed1995

Altered vascular endothelium integrin expression in psoriasis.

Considerable evidence indicates that microvascular changes observed in psoriasis are a result of vascular proliferation. A critical step in the sequence of events leading to neovascularization involves interactions between endothelial cells and extracellular matrix proteins mediated in part by the integrin family of adhesion molecules. A number of endothelial integrins have been shown to participate in neovascularization, including members of the beta 1, beta 3, and beta 4 subfamilies. To investigate the role of these integrins in psoriasis, specimens of lesional and nonlesional skin were taken from 10 patients with active, untreated plaque disease. Vascular endothelium was labeled with monoclonal antibodies specific for alpha 2, alpha 5, alpha 6, beta 1, av beta 3, and beta 4 integrins. The use of image analysis permitted quantification of immunoperoxidase staining and comparison of endothelial labeling in lesional and nonlesional skin. There was a significant increase in endothelial staining of av beta 3 integrin in lesional compared with nonlesional skin, both in superficial and deep vasculature. In contrast, there was a significant decrease in endothelial beta 4 staining in lesional compared with nonlesional superficial dermal vessels, alpha 2, alpha 5, alpha 6, and beta 1 staining showed no significant difference between the two groups. These results demonstrate an important role of av beta 3 and beta 4 integrins in the microvascular changes of psoriatic lesions.

Adult↗