Immunologic studies in patients with alopecia areata.
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Biomedical subjects
Publications and source records attributed to E J Feuerman.
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Congenital temporal triangular alopecia (CTTA) is a condition that occurs very rarely and is often unresponsive to treatment. It is necessary to differentiate it from other conditions such as alopecia areata in order to avoid prolonged treatment which may cause adverse side effects. Two additional cases of CTTA are presented herein. The first case was initially seen eighteen years ago. CTTA was diagnosed after a short period of time, but only after the patient had been mistakenly treated for alopecia areata. In the second case, CTTA was diagnosed during the first examination and no treatment was given. I believe that this condition is not as rare as formerly thought, and I also think that some cases may be misdiagnosed when the physician is not aware that he is presented with a case of CTTA.
Hereby described is a case of a young girl suffering from widespread dermatophytosis caused by Trichophyton violaceum which proved intractable to accepted methods of therapy throughout a number of years. The girl was also found to have a history or recurrent respiratory tract infection and pyoderma in addition to verrucae vulgares, and Giardia lamblia in the gastrointestinal tract. Investigation revealed a marked immunological deficit seen in both the cellular and humoral system. It is suggested that in similar cases resistant to therapy it may be helpful to carry out a comprehensive investigation of the immunological system.
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The T & B lymphocytes in frozen sections of skin obtained from patients with various lympho-infiltrating disorders of the skin were identified using an immunofluorescent technique. Anti T-lymphocytes serum was used as a T marker and anti Ig GMA serum and HL-B alloantigens as B markers. The method confirmed to be efficient in preliminary experiments. Specimens were obtained from patients with lymphocytic infiltration of the skin (LIS), lymphadenosis benigna cutis (LBC), lymphoma cutis (LC) and mycosis fungoides (MF). In LIS and LBC the dominant cell was found to be the T lymphocyte, suggesting that a local immune reaction of the cell mediated type may play a role in their etiology.
Cell-mediated immunity using the E-rosette technique, the graft-versus-host reaction and intradermal skin tests were investigated in two groups of patients, twenty-two with benign lymphoproliferative diseases of the skin (lymphocytic infiltration of the skin and lymphadenosis benigna cutis) and nine with malignant lymphoproliferative diseases (mycosis fungoides and lymphoma cutis). The effect of thymic hormone upon T lymphocytes which proved to have impaired functional capacity was investigated. Seventeen of the twenty-two patients with benign lymphoproliferative diseases were found to have intact cellular immunity whereas seven of the nine patients with malignant disease proved to be immunodeficient. The determination of immune competence may be of help in establishing the correct diagnosis in doubtful cases and might also be useful in the follow-up of these patients. The improvement in functional capacity of T lymphocytes resulting from their interaction with a thymic hormone indicates that it holds therapeutic promise.
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The sign of Leser-Trélat was observed in a patient with multiple seborrheic keratoses and hemangiomata. The increase in these lesions of the skin preceded the development of a poorly differentiated lymphocytic lymphoma, a type of malignancy which has not yet been reported in association with this sign.
77 Vitiligo patients were investigated for their HLA phenotype. Analysis of this material according to age of onset and ethnic origin revealed some significant characteristics. Young Jewish Moroccan patients showed a high frequency of B13 when compared to matching controls. Young patients of Yemenite origin had a strikingly high frequency of BW35. Jewish Yemenites showed a lack of B13 both in patients and in controls. It is suggested that studies by undertaken to clarify this problem further.
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Of 9 adults, 5 males, 4 females, with wide dissemination of Candida albicans skin lesions, the eruption started in the groin, from which it spread to other areas in most cases. In 5 cases the disseminated lesions were papulo-pustular; the rest were erythematous-squamous. Hyphae and yeast cells of C. albicans were found on direct microscopy. Diabetes was present in 5 patients, lymphoma in 1, and bullous pemphigoid in another. Onychia and paronychia were found in 7 patients, intertriginous lesions of the fingers in 4 and oral thrush in 2. Intradermal skin tests were negative. The percentage and absolute numbers of T-lymphocytes were normal in 6 of 7 patients, whereas their functional activity was imparied in 4 of 6 patients, as evidenced by the negative Graft-versus host reaction. The role of concurrent disease in the pathogenesis of the candidosis is discussed.
Two dermatophytic agents, Trichophyton rubrum and Trichophyton mentagrophytes were used in the experimental inoculation of psoriatic lesions in 27 volunteer patients (13 males and 14 females with an age range from 17 to 72 yr). T. rubrum was inoculated in 14 patients and T. mentagrophytes (varietas granulare) in 13. For purposes of control in each patient the same agent was also inoculated on healthy skin. Results were noted once a week for a period of 1 mo. A positive response was found in 12 of the 14 patients inoculated with T. rubrum but only in 4 of the 13 inoculated with T. mentagrophytes. Healthy skin was found to have a positive response in only 5 cases, in 4 with T. rubrum, and in 1 with T. mentagrophytes. These results confirm the possibility of invasion of psoriatic lesions by dermatophytes and suggest that the coexistance of psoriasis and dermatophytic infection may be not always purely coincidental. The importance of the awareness of the presence of mycotic lesions and their possible spread with the application of steroid ointments under occlusive dressings in a psoriatic patient is stressed.
HLA antigens were determined in a group of fifty-two patients with lichen planus. In the group as a whole the frequency of A28 was increased but not significantly so. When the patients were subdivided according to the results of an oral glucose tolerance test, however, a highly significant increase in the frequency of A28 was found among the non-diabetic patients.
Electron microscopic examination of skin biopsies taken from the lesions in two cases of erythema chronicum migrans revealed Rickettsia-like bodies free in the cytoplasm or within phagolysosomes in macrophages. There was also phagocytosis of cellular debris and collagen, and elastic fibers within macrophages.