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Plasma anaphylatoxin concentrations in inflammatory skin diseases.

To study the possible involvement of the complement system in inflammatory skin disorders, we measured the concentrations of C3a and C4a anaphylatoxins in the peripheral blood of 148 patients with various inflammatory skin disorders and 48 healthy control subjects by radioimmunoassay. Significant increases in mean levels of both C3a and C4a anaphylatoxins were found in 59 patients with psoriasis. Remarkable increases in both C3a and C4a anaphylatoxins were also noted in some patients with leukocytoclastic vasculitis, urticarial vasculitis or unspecified toxic erythema. On the other hand, elevation of C4a alone was noted in a case of systemic lupus erythematosus. In contrast, using the mean of the normal control +/- 2 S.D., no significant anaphylatoxin elevation was found in 16 patients with pustulosis palmaris et plantaris, 7 with pityriasis rosea, 3 with erythema multiforme, and 3 with erythema nodosum or autoimmune bullous dermatoses.

Anaphylatoxins↗

Human herpesvirus 7 in dermatology: what role does it play?

Human herpesvirus 7 (HHV-7) was discovered in 1989 as a new member of the beta-herpesvirus subfamily. Primary infection occurs early in life and manifests as exanthema subitum, or other febrile illnesses mimicking measles and rubella. Thus, HHV-7 has to be considered as a causative agent in a variety of macular-papular rashes in children. In addition, HHV-7 was found in some cases of other inflammatory skin disorders, such as psoriasis. There are controversial data on the detection of HHV-7 in pityriasis rosea, but so far there is not enough evidence for a pathogenetic association of HHV-7 with this exanthematic skin disease. Although HHV-7 can be found in some cases of Hodgkin's disease, there are no data supporting a direct causative role in this lymphoma type nor in other nodal or primary cutaneous lymphomas. In various epidemiologic forms of Kaposi's sarcoma, infection of monocytic cells with HHV-7 was demonstrated, which may indirectly influence tumor biology. In the context of immunosuppression, HHV-7 has recently been identified as an emerging pathogen in transplant recipients and may exacerbate graft rejection in renal transplant recipients. The ability of HHV-7 to induce cytokine production in infected cells could make HHV-7 an important pathogenetic co-factor in inflammatory and neoplastic disorders. Moreover, the restricted cellular tropism of HHV-7 may render this virus an interesting vector for gene therapy. Thirteen years after the discovery of HHV-7, there has been considerable progress in characterizing its genetic structure, virus-induced effects on infected host cells and in the development of diagnostic tools. Nevertheless, the role of HHV-7 in various skin diseases and the clinical manifestations of reactivation of HHV-7 infection have still to be defined.

Herpesvirus 7, Human↗

[In vitro cytokine induction in leukocytes by human herpesvirus 7].

Virus infections of the immune system may alter the normal cytokine profile, which leads to symptoms of illnesses. HHV-7 revealed lately has been known as one of the causative agents of exanthem subitum and pityriasis rosea, while its latent infection can be reactivated in immunocompromised conditions. Their pathomechanism has not been explored yet, therefore, the production of some cytokines by separated leukocytes was studied upon primary and secondary infections. After combined treatments with live or inactivated viruses and/or mitogens, the cytokines were quantitated in the supernatant of cells by sandwich ELISA. It was established that, individual cytokines were produced at maximal output at different times postinfection. The quantity of their molecules depended on the primary or repeated infections. Inactivated viral particles also induced cytokine release. Production of IL-2 and IFN-gamma due to mitogen activation could be augmented in primary, but was diminished in secondary infections. Release of TNF-alpha and IL-1 beta was parallel, but the combinatory effect with mitogens increased the quantity of IL-1 beta. HHV-7 induced early IL-10 production, which is known to inhibit cytokine release from helper lymphocytes and consequently might play a role in those acute inflammatory skin diseases mentioned above. In contrast to the related HHV-6 found in severe immunosuppressed conditions, the effect of HHV-7 on the balanced production of different cytokines seems to be related to the mild symptoms of skin disorders caused and that of moderate immunosuppression upon reactivation.

Cytokines↗

Differential diagnosis of annular lesions.

Although most annular lesions will be typical of a dermatophytosis, physicians must consider other possible diagnoses. Tinea corporis can often be diagnosed on the basis of a positive potassium hydroxide examination. Topical and systemic antifungals are usually curative. Pityriasis rosea is characterized by small, fawn-colored lesions distributed along skin cleavage lines. Treatment is symptomatic. Granuloma annulare is characterized by nonscaly, annular plaques with indurated borders, typically on the extremities. One half of cases resolve spontaneously within two years. Sarcoidosis can present as annular, indurated plaques similar in appearance to the lesions of granuloma annulare. Diagnosis is based on histopathology and the involvement of other organ systems. Hansen's disease can mimic tinea corporis by presenting as one or more annular, sometimes scaly, plaques. Urticaria may affect 10 to 20 percent of the population. The annular plaques lack scale and are evanescent. Subacute cutaneous lupus erythematosus can present in an annular form on sun-exposed surfaces or in a papulosquamous form. Erythema annulare centrifugum typically presents as annular patches with trailing scale inside erythematous borders.

Antifungal Agents↗

Pattern of pediatric dermatoses in a referral center in South India.

This study was undertaken to determine the pattern of dermatoses in children in south India. All children <14 years presenting to us between May 2001 and June 2002 were recruited. A total of 2100 children (males -995; females- 1105) with 2144 dermatoses were recorded. Infections and infestations were the most common dermatoses (54.5%) followed by dermatitis and eczema (8.6%), pigmentary disorders (5.7%), insect bite reaction (5.27%), hair and nail disorders (5.2%), miliaria (4.1%), nutritional deficiency disorders (2.8%), urticaria (2.5%), genetic disorders (2.1%), psoriasis (1.4%), collagen vascular disorders (0.5%), hemangiomas (0.5%), drug eruptions (0.3%), pityriasis rosea (0.2%) and others (5.8%). Pyodermas were the most common dermatoses (47.13%) followed by scabies (30.6%) amongst infections and infestations. Atopic dermatitis was noticed only in 3 patients. Insect bite reactions (papular urticaria) (5.27%) and miliaria (4.1%) were attributed to the tropical weather conditions in this coastal area. Genetic disorders including ichthyosis and palmoplantar keratoderma contributed to 2.1% of cases and could be due to the high incidence of consanguinous marriages in this society.

Adolescent↗

Imatinib mesylate and dermatology part 2: a review of the cutaneous side effects of imatinib mesylate.

Cutaneous reactions to imatinib are common and occur in 9.5% to 69% of patients depending on the series reported. Maculopapular eruptions, erythematous eruptions, edema, and periorbital edema are the most common adverse events observed. Imatinib can also induce severe skin eruptions and generalized skin eruptions. Toxic epidermal necrolysis and Stevens Johnson syndrome has been linked to the use of imatinib. Imatinib has caused acute generalized exanthematous pustulosis. Purpuric vasculitis and mycosis fungoides-like reactions has occurred after imatinib use. Rarer side effects include: hypopigmentation, lichenoid reactions, pityriasiform eruptions, pityriasis rosea, psoriasis, reactivation or induction of porphyria cutanea tarda, neutrophilic eccrine hidradenitis, Sweet's syndrome, erythema nodosum, EBV-positive cutaneous B-cell lymphoproliferative disease, possible induction of squamous cell, hyaline cell syringomas, follicular mucinosis, pseudolymphoma-type drug eruptions, and malpighian epitheliomas. Most cutaneous eruptions caused by imatinib do not necessitate discontinuance of imatinib and are usually self limited, despite continued treatment. Administration of oral or topical corticosteroids can ameliorate some of imatinib's cutaneous side effects.

Antineoplastic Agents↗

Skin manifestations in AIDS patients.

Skin lesions occur in virtually all patients during the unfolding evolution of their HIV infection--usually a succession of conditions reflecting the gradual decline of immunity. Hairy leucoplakia can occur at any stage and in all risk groups. Kaposi's sarcoma is seen only in homosexually acquired AIDS. A transient rash may accompany the initial HIV seroconversion illness, but may go unnoticed. Documented examples show macular red oval lesions, similar to pityriasis rosea, but extending onto the face, palms and soles, preceded by a flu-like illness with lymphadenopathy and lymphopenia simulating glandular fever. Seroconversion occurs within weeks. During the following weeks or years the gradually declining immunity may only be documented by decreasing numbers of CD4 positive lymphocytes with the emergence of 'idiopathic' inflammatory skin conditions (eg, seborrhoeic dermatitis, psoriasis), as well as autoimmune conditions (eg, thrombocytopenia, morphoea or alopecia areata). As immunity itself declines, skin infections emerge. Shingles affects over 25% of HIV-positive patients--sometimes involving numerous dermatomes, accompanied by multiple distant chicken pox lesions and followed by post-herpetic neuralgia. Onychomycosis and tinea pedis are universal, but sometimes occult patterns with follicular lesions due to Trichophyton rubrum may spread widely over the beard and chest. Uncomfortable mucosal candidosis, sometimes with oesophageal extension, may only become controllable with oral imidazoles. Molluscum contagiosum may be seen in hundreds over large areas, whole soles can be shod in verrucae and vulgar warts appear in the most unusual sites, for example on the palate or up nostrils. Dry skin develops into acquired ichthyosis and eczema crackelé.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗

In vitro propagation of tissue-infiltrating lymphoid cells from lesional skin by culture in IL 2-containing medium.

Using an in vitro culture system, we have propagated lymphoid cells infiltrating the tissues of allergic contact dermatitis and several inflammatory dermatoses, and those drawn from the blister observed at the sites of allergic contact dermatitis. Approximately 10(7) cells were eventually obtained after 3 weeks from 3 mm punch-biopsied tissues by their culture in human IL 2-containing medium. Studies by flow-cytometrical analysis demonstrated that the proliferated cells were composed of 32-88% Leu-1-bearing (Leu-1+) cells, 70-90% Leu-2a-bearing (Leu-2a+) cells, 10-40% Leu-3a-bearing (Leu-3a+) cells, 70-90% HLA-DR-bearing (HLA-DR+) cells, and less than 10% Tac (IL 2 receptor)-bearing (Tac+) cells. Only the cultured cells derived from lesional tissue of pityriasis rosea and those from the blister content of contact dermatitis showed low percentage of T cell phenotype-bearing cells. These results suggest that the described method has opened a new system that enables us to culture possible effector lymphoid cells actually infiltrating various lesional skin.

Antigens, Differentiation, T-Lymphocyte↗

Expression of CD36 (OKM5) antigen on epidermal cells in normal and diseased skin.

The expression of the CD36 (OKM5) antigen was studied with the PAP technique on sections of skin from healthy subjects and of normal and diseased skin from patients with various skin diseases. In specimens from healthy subjects the antigen was found on vascular and perivascular structures and in some cases it was seen on cells of the acrosyringium. A net-like pattern of CD36 was observed in the upper part of the stratum spinosum in skin lesions of patients with psoriasis, lichen planus, pityriasis rosea, morbilliform drug reactions, necrobiosis lipoidica, lichen amyloidosus, Darier's disease and ichthyosis vulgaris. Expression of CD36 was also seen in the nonlesional skin just below the granular layer in 3 of 5 patients with factitial urticaria with immediate dermographism, but not in delayed dermographism or chronic urticaria. In ichthyosis vulgaris CD36 was also expressed in dendritic cells of the basal layer and in a patient with a graft versus host reaction it was recognized both on scattered keratinocytes and on dendritic cells in the epidermis. The role of the expression of the CD36 antigen in the skin is unknown. The activated cells might possibly serve as antigen-presenting cells and/or have a modulatory influence on an inflammatory reaction.

Antibodies, Monoclonal↗

[Cutaneous side effects of gold therapy. Clinical and histologic results].

Based on our own observations in 40 patients and a review of the literature the clinical and histological aspects of dermatitis caused by gold therapy are discussed. There is a broad spectrum of cutaneous side effects following gold therapy. In most of the patients a nonspecific dermatitis can be observed. The skin lesions may also mimic lichen planus, pityriasis rosea or various forms of eczema, obscuring early diagnosis. Histologically four types of reactions can be differentiated including a dermatitis type, vasculitis type, a lichenoid and an urticarial type.

Arthritis, Rheumatoid↗

Skin diseases in children in Singapore.

Singapore has developed over the past 3 decades with improvement in housing, nutrition and general health. The pattern of skin diseases has changed from conditions like pyodermas and malnutrition to predominantly eczemas. The paediatric cases seen at Middle Road Hospital consist of 13% of general dermatology cases (509 of 37,964 total new cases in 1986). About 2.7% (138) of the children were below 1 year, 32.5% (1630) were below 1-4 years and 64.5% (3251) were below 14 years of age. The ten most common dermatoses (1986) follow a similar trend in most of the developed towns of Asia. This includes eczemas 32.0% (1603 cases); 14.5% (730) of atopics, non-specified eczemas 9.6% (481), hand eczema 4.1% (209), contact dermatitis 1.7% (90), discoid eczema 1.15% (57), seborrhoeic 0.7% (36). The remaining are viral warts 6.8% (342), scabies 3.2% (302), acne 3.7% (180), pyoderma 3.5% (175), dermatophytes 3.3% (169), urticaria 2.6% (134), pityriasis rosea 0.1% (51) and vitiligo 0.09% (46).

Adolescent↗

Dermatological manifestations of toxic agents.

A great variety of cutaneous disorders can be seen as reactions to toxic substances. To limit the extent of this review, cutaneous manifestations known to have an immunological mechanism are simply listed with pertinent references. The report has been focused to cover the cutaneous manifestations of toxic agents of non-immunological and unknown mechanisms. Entities discussed include acne, alopecia, dermatitis caused by spider bites, pityriasis rosea, and chemically-induced scleroderma.

Humans↗

[Cutaneous reactions to gold salts].

OBJECTIVE: Evaluate the clinical features of skin reactions to gold salts. INTRODUCTION: Gold dermatitis is described in the literature as a group of reactions non-specifically associated with these drugs. PATIENTS AND METHODS: Ten patients (7 males, 3 females, mean age 59.6 years [corrected] with a skin reaction were studied over a 6 year period. All were treated with Allochrysine for rheumatoid arthritis (n = 8), rhizomelic pseudopolyarthritis (n = 1) or arthropathic psoriasis (n = 1). RESULTS: The delay to the first signs was from 2 weeks to 8 months. Three lichenoid eruptions (including two with buccal lesions and two which followed an autonomous course), 2 pityriasis rosea (one with eosinophilia and one with liver disease), 2 eczematoid dermatoses and one urticaria were observed. Pathology examinations (8/10) were in agreement with clinical diagnosis. Imputability was 14 (1 case), 13 (8 cases) and 12 (1 case). DISCUSSION: The clinical features observed were variable and in agreement with a particular clinical situation. They were not specific to gold salts and cannot be qualified as "gold dermatitis". Two autonomous and severe lichenoid eruptions were observed. Generalized lesions were associated with biological signs. This situation must be considered as a marker of severity.

Adult↗

Papular spongiotic dermatitis of smallpox vaccination: report of 2 cases with review of the literature.

We report 2 cases of nonspecific postvaccinial dermatitis following smallpox vaccination. The patients presented with diffuse, pruritic, erythematous macules and papules 11 days (case 1) and 7 days (case 2) following routine smallpox vaccination. Biopsies of the lesions demonstrated spongiotic dermatitis without evidence of viral cytopathic changes. One case showed a pityriasis rosea-like histologic pattern. The exanthema resolved without sequelae with symptomatic treatment (case 1). Review of historical literature demonstrated the association of a variety of nonspecific cutaneous complications with vaccinia inoculation, including erythema multiforme, urticaria, and pityriasis rosea. The association of these various dermatitides with smallpox immunization is not well known and is likely underreported.

Adult↗

Lichenoid eruption produced by captopril.

Captopril, an oral active dipeptidylcarboxypeptidase inhibitor with antihypertensive properties, has been reported to have the following cutaneous side effects: macular and papular skin eruptions, urticaria, angioedema, mouth ulcers, pemphigus, and pityriasis rosea-like eruptions. Here, to the best of our knowledge, is the first case in which a pityriasis rosea-like eruption evolved into a lichenoid drug eruption. Also discussed is the remarkable similarity in the side effects of captopril, gold compounds, d-penicillamine, and organic mercurials.

Captopril↗

The skin clinic.

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Granuloma↗