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Phlyctenular keratitis associated with meibomitis in young patients.

PURPOSE: To describe the unique clinical features of phlyctenular keratitis, including the association with meibomitis, in young patients. DESIGN: Observational case series. METHODS: The study population consisted of 23 Japanese patients aged under 35 years with phlyctenular keratitis. We examined their clinical history, signs and symptoms, human leukocyte antigen (HLA), bacterial cultures of meibum, and the efficacy of antibiotics. The minimal diagnostic criteria included corneal nodules consisting of cellular infiltrates and superficial neovascularization. RESULTS: Of the 23 patients, 20 (87%) were women, and 13 (56.5%) had a history of chalazia. In all cases, the lesions and the severity of corneal nodules and neovascularization corresponded well with the location and the severity of meibomitis. The frequency of HLA-A26 and HLA-B35 was significantly increased in our patients (P = .003 and .016, respectively). Propionibacterium acnes in bacterial cultures of pure meibum in 12 of the 20 patients (60%) was statistically more highly positive than those in four of the 17 age-matched normal control subjects (23.5%; P = .028). CONCLUSION: The characteristics of phlyctenular keratitis in our cases include significantly higher prevalence in female patients, severity variation of ocular surface manifestation corresponding to meibomitis, specific HLA association, and possible P. acnes involvement.

Adolescent↗

Acne and diet.

Forbidden foods? "The first law of dietetics seems to be: If it tastes good, it's bad for you" (Isaac Asimov, Russian-born biochemist and science fiction writer). This was essentially the Magna Carta for dermatologists of the 1950s: anything coveted by the teenage palate was suspect for morning after acne. Today, half a century later, although the slant has shifted away for this line of thinking in our dermatologic textbooks, several articles on the beliefs and perceptions of acne patients showed that nothing much has changed and that they expect us to give them detailed instructions of what "acne-related" foods they should avoid. In one such study(1), diet was the third most frequently implicated factor (after hormones and genetics) as the cause of the disease, with 32% of the respondents selecting diet as the main cause, and 44% thinking that foods aggravate acne. In another study that analyzed knowledge about causes of acne among English teenagers, 11% of the responders blamed greasy food as the main cause of the disease(2), whereas in another study found that 41% of final-year medical students of the University of Melbourne chose diet as an important factor of acne exacerbation on a final examination.(3)

Acne Vulgaris↗

The influence of two azones and sebaceous lipids on the lateral organization of lipids isolated from human stratum corneum.

The main problem with topical application of compounds to administer drugs to and regulate drug levels in a human body, is the barrier formed by the intercellular lipid matrix of the stratum corneum (SC). In a search for possibilities to overcome this barrier function, a good understanding of the organization and phase behavior of these lipids is required. SC lipid model studies especially provide a wealth of information with respect to the lipid organization and the importance of certain subclasses of lipids for the structure. Previously, we have shown that electron diffraction (ED) provides detailed information on the lateral lipid packing in both intact SC (G.S.K. Pilgram et al., J. Invest. Dermatol. 113 (1999) 403) and SC lipid models (G.S.K. Pilgram et al., J. Lipid Res. 39 (1998) 1669). In the present study, we used ED to examine the influence of two azones and sebaceous lipids on the lateral phase behavior of lipids isolated from human SC. We established that human SC lipids are arranged in an orthorhombic packing pattern. Upon mixing with the two enhancers the orthorhombic packing pattern was still observed; however, an additional fluid phase became more apparent. In mixtures with sebaceous lipids, the presence of the hexagonal lattice increased. These findings provide a basis for the mechanism by which these enhancers and sebaceous lipids interact with human SC lipids.

Azepines↗

Acne.

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Acne Vulgaris↗

What causes acne?

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Acne Vulgaris↗