How predictive is a history of penicillin allergy?
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Biomedical subjects
Publications and source records attributed to S E Whitmore.
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BACKGROUND/AIMS: Photoreactivating light (PRL) after ultraviolet radiation (UVR) exposure causes photoreversal of cyclobutane pyrimidine dimers through the activation of photolyase. Although photoreversal has been demonstrated in the "three kingdoms of life," its existence in man remains controversial. We sought evidence for photoreversal in man. METHODS AND RESULTS: Seven subjects were spot-irradiated at two sites with 4 minimal erythema doses (MED) of solar-simulating UVR. Of the two sites, one was then immediately exposed to a PRL source. Epidermal biopsies were taken immediately after exposure. No significant difference in the quantity of pyrimidine dimers was detected comparing the "UVR only" site to the "UVR, PRL-exposed" site. Biopsies were repeated 24 h later and no significant difference in p53 protein expression or dendritic cell number was detected. However, the "UVR, PRL-exposed" site showed a greater reduction in pyrimidine dimer quantity. CONCLUSIONS: We found no evidence for a direct effect of PRL causing photoreversal of UVR-induced pyrimidine dimers in man. Our results do, however, suggest that some indirect effect of PRL may enhance pyrimidine dimer repair in the 24-h period following UVR exposure.
BACKGROUND: Human studies of the short-term cellular effects of tanning salon exposures are lacking. Findings of such studies may prove extremely helpful in educating consumers considering or currently attending tanning salons. OBJECTIVE: Our purpose was to determine whether tanning salon exposure causes DNA alterations and p53 protein expression in epidermal keratinocytes and/or circulating peripheral lymphocytes. METHODS: Eleven subjects received 10 full-body tanning salon exposures over a 2-week period. UV-induced DNA cyclobutane pyrimidine dimers and p53 protein expression were examined, comparing pretreatment peripheral blood lymphocytes and epidermal biopsy specimens with analogous specimens obtained after the 10 tanning salon exposures. RESULTS: Cyclobutane pyrimidine dimers in DNA and p53 protein expression were detected in epidermal keratinocytes, but were absent in lymphocytes. CONCLUSION: Similar to outdoor sun exposure, short-term recreational tanning salon exposure causes molecular alterations believed essential in the development of skin cancer.
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BACKGROUND: Although race is a determinant of bone density in women, it is not known whether it is also a determinant of skin thickness. OBJECTIVE: We attempted to determine whether skin thickness, like bone density, is greater in black than white women. METHODS: A cross-sectional study of skin thickness in 86 white and 40 black women, ages 20 through 69 years, was performed in the dermatology and medicine clinics at a university hospital and a local nursing care facility. Subjects included patients and their accompanying friends, family, staff, and nursing care facility residents: 86 white and 40 black women. Non-sun-exposed flexural forearm skin thickness was measured with the Harpenden caliper. RESULTS: There was no statistically significant difference in skin thickness in white (1.41 +/- 0.01 mm) compared with black (1.39 +/- 0.02 mm) women (P =.3). Controlling for potential confounders, including age, body mass index, age at menarche, age at menopause, oral contraceptive pill therapy, postmenopausal hormone replacement therapy, ingestion of caffeine and alcohol, cigarette smoking, and present and past exercise still revealed no significant relationship between race and skin thickness. CONCLUSION: Unlike bone density, there is no significant difference in non-sun-exposed skin thickness between white and black women.
Cutaneous and systemic immune function are believed to play an important role in cutaneous carcinogenesis. We therefore sought to determine whether the suntan parlor radiation sources commonly used in the United States cause measurable qualitative suppression of immune function and quantitative alterations in circulating T cell subpopulations. Subjects (n = 22) were recruited and randomly assigned to receive suntan parlor exposures (10 full-body UV exposures over a 2 week period, shielding only the right flexural arm) or no exposure. Baseline circulating T lymphocyte subpopulations (T helper lymphocyte, CD4; T suppressor/cytotoxic lymphocyte, CD8) were measured. Two weeks later (upon completion of UV exposures for those in this group), circulating T cell subpopulations were measured and dinitrochlorobenzene (DNCB) sensitization (in the UV group, on the UV-exposed buttock) was performed. Subsequent DNCB elicitation was performed in a bilateral fashion (in the UV group, on the right UV-shielded and the left UV-exposed upper arm). We found that subjects in the UV group demonstrated localized suppression of contact hypersensitivity sensitization and elicitation and also an increase in circulating CD8 cells when compared to the control group (P < or = 0.05). We conclude that suntan parlor exposures, as typically received in this country, suppress contact hypersensitivity and increase the circulating T suppressor/cytotoxic cell number quantity.
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The diagnosis of latex allergy is a clinical challenge that practitioners are confronting with increasing frequency. Distinguishing the causes of delayed-type reactions requires careful patch testing. For patients with immediate-type symptoms, currently available tests are imperfect. This review by four national experts presents practical approaches to a dermatologic dilemma.
BACKGROUND: The use of psychological therapies for patients with psoriasis has been proposed based on observations that the severity of their disease may correlate with emotional stress. The aim of this pilot study was to evaluate the effect of hypnosis as a treatment modality for patients with psoriasis. METHODS: We performed a 3-month randomized, single-blind, controlled trial of the use of hypnosis in adults with stable, chronic, plaque-type psoriasis. Highly or moderately hypnotizable subjects were randomized to receive either hypnosis with active suggestions of improvement (5 patients) or neutral hypnosis with no mention of their disease process (6 patients). After this period, the study was unblinded, and all the patients were treated for an additional 3 months with hypnosis with active suggestions of improvement. RESULTS: Highly hypnotizable subjects showed significantly greater improvement than did moderately hypnotizable subjects, independent of treatment group assignment (active suggestion or neutral hypnosis). CONCLUSION: Although this study included a very limited number of patients, the results suggest that hypnosis may be a useful therapeutic modality for highly hypnotizable subjects with psoriasis, and merits further testing in a larger patient population.
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The possibility that there is an increased risk of melanoma in patients with psoriasis treated with psoralen-UV-A (PUVA) therapy has raised concern on the part of physicians and patients about the long-term safety of this treatment. In response to this concern, the National Psoriasis Foundation sponsored a workshop at which invited participants with expertise in PUVA therapy, psoriasis treatment, melanoma and nonmelanoma skin cancer, and epidemiological and clinical trials were asked to develop a consensus on the following 3 issues: the risk of long-term adverse effects of PUVA therapy with emphasis on nonmelanoma and melanoma skin cancer; the guidelines for physicians and patients for selection and use of PUVA therapy with consideration of the risk-benefit ratio of this treatment compared with the risk-benefit ratios of alternative treatments; and the directions for further evaluation of the long-term effects Of PUVA therapy.
The decline in skin thickness that occurs with aging interests many different groups. Among these are pharmaceutical, cosmeceutical, and cosmetic companies promoting antiaging or antiwrinkling products, geriatricians and rheumatologists treating elderly and steroid-dependent patients who are "outliving" their skin, cosmetic surgeons, and dermatologists. Dermatologists are frequently asked how to prevent or slow aging of the skin. The answer regarding "photoaging" of sun-exposed skin is obvious; the answer regarding aging of photoprotected skin is not. Although the bulk of epidemiologic literature about aging and thinning of photoprotected skin is from the 1970s, literature regarding risk factors for and treatment of aging and thinning of the bony skeleton is more recent. Because both skin and bone are composed of more than 70% type I collagen, it may be hypothesized that the pathophysiologic processes involved in chronological atrophy of both tissues may overlap, thereby providing a foundation for further investigation of the skin. A better understanding of skin and bone loss may motivate the "appearance-conscious" public to modify risk factors (e.g., begin exercising) or select hormonal therapies (e.g., postmenopausal hormone replacement) to reduce aging of the skin. These measures may provide additional benefits, such as decreasing the risk of osteoporosis.
Two patients with Cronkhite-Canada syndrome (CCS) are reported, both of whom had diffuse alopecia, nail and skin changes, gastrointestinal polyposis, diarrhea, and wasting. A scalp biopsy was performed in one patient, and the specimen showed a marked noninflammatory loss of follicular units, miniaturization of the hair shafts, markedly dilated follicles, and a heavy deposition of glycosaminoglycans in the reticular dermis. This patient responded to prednisone therapy. The other patient was found to have elevated gastric acid levels and responded to ranitidine therapy. The conditions of both patients are now in remission two and six years later, respectively. Our patients have shown a temporally related remission of disease during treatment with prednisone and ranitidine, suggesting that each agent may be effective in CCS. However, randomized placebo-controlled trials are needed to prove the efficacy of these therapies. Further investigation of the histopathologic features of the associated alopecia may determine its cause.
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OBJECTIVE: To determine the effect of sun exposure on HIV progression. DESIGN: Cross-sectional survey nested within a longitudinal cohort study. SETTING: The Multicenter AIDS Cohort Study. PARTICIPANTS: A total of 1155 white HIV-seronegative and 496 white HIV-seropositive homosexual men, of whom 142 seroconverted during the study. MAIN OUTCOME MEASURES: T-helper lymphocyte decline and AIDS. RESULTS: No positive correlation was found between the development of AIDS or loss of T-helper lymphocytes and (i) phenotypic characteristics associated with enhanced ultraviolet radiation (UVR) sensitivity (hair or eye color, skin type), or (ii) reported UVR exposure (sun lamp/tanning bed use, frequency of beach vacations, sunscreen use), or (iii) composite score of UVR sensitivity and exposure history. The composite scores and individual measures of risk were not correlated with rate of T-helper lymphocyte decline (slope) based upon rank correlation (correlation coefficient, 0.04; P = 0.32). In fact, individuals purposefully seeking the sun had slower T-helper lymphocyte declines. Sensitivity to UVR was also not significantly associated with AIDS [odds ratio (OR), 1.11 per unit of higher composite score; 95% confidence interval (CI), 0.66-1.88; P = 0.63]. Among individuals who were HIV-infected at baseline, those who have been purposely seeking sun exposure were less likely to have AIDS (OR, 0.67; 95% CI, 0.39-1.11; P = 0.12). CONCLUSIONS: These data suggest that phenotypic characteristics of high UVR sensitivity and exposure are not highly correlated with decline in T-helper lymphocyte count or with progression to AIDS.
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