Is skin ageing in the elderly caused by sun exposure or smoking?

BACKGROUND: There is little clear evidence of a strong association between cumulative sun exposure and skin wrinkling. Contradictory findings also exist on the association between facial wrinkling and smoking status. OBJECTIVES: To identify the significant determinants of skin wrinkling in a cohort of older subjects and to assess whether skin wrinkling can be used as an objective measure of cumulative sun exposure. METHODS: This study was carried out in the South Glamorgan health district, Wales, U.K., between 1988 and 1991. A random sample of 792 older subjects (60 years and over) was obtained from the Health Authority register of patients registered with general practitioners. A range of phenotypic and environmental data was collected during a home visit by interview and examination by an experienced dermatology research fellow. Skin wrinkling/ageing was assessed by examining the face, neck and dorsum of the hand and scored on a 10-point ordinal scale. Cumulative sun exposure was assessed by asking subjects to estimate their average outdoor time during each of three periods of adult life. This measure showed acceptable repeatability (r = 0.64 for estimates obtained 1.4 years apart). RESULTS: The response rate was 71% and the mean age of participants was 71 years. The mean +/- SD skin ageing score was 5.5 +/- 1.5. In multiple logistic regression models only age and daily cigarette consumption were significantly associated with skin ageing. Cumulative sun exposure was significant on univariable analysis but this effect was removed by adjusting for age. Smoking 20 cigarettes per day was equivalent in effect to almost 10 years of chronological ageing. CONCLUSIONS: Smoking is an important determinant of macroscopic skin ageing/wrinkling in older subjects. This evidence suggests that skin ageing does not clearly provide an objective measure of cumulative ultraviolet exposure, and caution should be exercised before it is used in this way. The association between smoking and wrinkling provides important information for potential use in education campaigns to reduce smoking prevalence among young people.     

The use of lasers in cutaneous sarcoid: Is there a role?

Sarcoid is a granulomatous disease that can affect the skin solely or as part of a systemic involvement. Cutaneous lesions of sarcoid may be difficult to treat and lasers are rarely used. In this article we report our case series and review the literature on the use of lasers in cutaneous sarcoid.     

Is condom use habit forming?: Condom use at sexual debut and subsequent condom use

OBJECTIVE: The objective of this study was to assess whether using a condom at adolescent sexual debut is associated with an increased likelihood of subsequent condom use. STUDY DESIGN: A nationally representative sample was used, including 4024 sexually active adolescents (12-18 years) from the National Longitudinal Study of Adolescent Health. Logistic regression was used to model the association of condom use at sexual debut on condom use at most recent sex (mean interval, 23 months). RESULTS: Condom use at adolescent sexual debut was associated with a twofold increased likelihood of condom use during most recent sex (odds ratio, 2.28; 95% confidence interval, 1.91-2.73). CONCLUSIONS: Among adolescents, early condom use is associated with an increased likelihood of subsequent condom use.     

Löffler syndrome caused by extensive cutaneous larva migrans: a case report and review of the literature

In rare cases, cutaneous larva migrans may be complicated by L?ffler syndrome. This syndrome is thought to result from a type I hypersensitivity reaction related to the pulmonary larval migration phase of various parasites. It is characterized by migratory pulmonary eosinophilic infiltrates and peripheral eosinophilia, with malaise, fever, and cough. Our patient was successfully treated with ivermectin, a corticosteroid cream, and inhalation medication in an early phase, which prevented complications. We present the details of this case and review the literature.     

Allergic contact dermatitis caused by isopropyl alcohol: a missed allergen?

Background. Isopropyl alcohol is a secondary alcohol, a structural isomer of propanol, that is widely used as an industrial solvent and as a preservative and antiseptic in the clinical environment. It is known to be a mild irritant for the eyes and mucous membranes, but is considered to be a weak and infrequent sensitizer. Objectives. To show that isopropyl alcohol should be considered as a potential allergen in patients with eczema who have contact with this substance. Materials and methods. We present a series of 1450 patients patch tested with isopropyl alcohol during the period 1992–2011. Results. Forty‐four patients showed an allergic response to isopropyl alcohol. Four cases presented as occupational hand eczema. Fourteen cases were seen in patients with leg ulcers. Twenty‐six patients presented with eczematous lesions following the use of products containing isopropyl alcohol to disinfect previous skin lesions. Eighty‐four per cent of the patients showed sensitization to three or more allergens. Relevance was present in 84% of the patients. Conclusions. We report here the first large case series of contact allergy to isopropyl alcohol, which demonstrates that sensitization to this substance might not be as uncommon as previously thought.     

Generalized pustular psoriasis or drug‐induced toxic pustuloderma? The use of patch testing

Pustular psoriasis is a rare but serious form of psoriasis. Clinically it may be difficult to differentiate from a pustular drug reaction. We report a case of a generalized pustular eruption triggered by exposure to amoxycillin in a patient with chronic psoriasis. Patch testing to 1% and 5% amoxycillin preparation confirmed a delayed hypersensitivity reaction.     

Dynamics of circulating microparticles in chronic kidney disease and transplantation:Is it really reliable marker?

The deterioration of endothelial structure plays a very important role in the development of vascular diseases. It is believed that endothelial dysfunction starts in the early stage of kidney disease and is a risk factor of an unfavorable cardiovascular prognosis. Because a direct assessment of biological states in endothelial cells is not applicable, the measurement of endothelial microparticles(EMPs) detached from endothelium during activation or apoptosis is thought to be a marker of early vascular disease and endothelial dysfunction in children with chronic kidney disease(CKD). Few studies have shown increased circulating EMPs and its relationship with cardiovascular risk factors in patients with CKD.MPs contain membrane proteins and cytosolic material derived from the cell from which they originate. EMPs having CD144, CD 146, CD31+/CD41-, CD51 and CD105 may be used to evaluate the vascular endothelial cell damage and determine asymptomatic patients who might be at higher risk of developing cardiovascular disease in CKD and renal transplant.     

Efficacy of plasmapheresis for the treatment of severe toxic epidermal necrolysis: Is cytokine expression analysis useful in predicting its therapeutic efficacy?

Toxic epidermal necrolysis (TEN) is a life-threatening, drug-induced disorder characterized by severe epidermal injury. Although there is no standard therapeutic intervention in TEN, plasmapheresis (PP) is being used increasingly to treat extremely ill TEN patients. In addition to conventional PP, double-filtration PP (DFPP) has been recently used for severe and refractory TEN. In this review, we focus on the clinical usefulness of PP by both demonstrating three cases of TEN refractory to conventional therapies, who were successfully treated with conventional PP or DFPP, and evaluating its therapeutic efficiency. We also provide evidence to suggest the mechanisms of action of PP by investigating the correlation between disease intensity and serum cytokine levels before and after treatment with PP or DFPP in these patients with TEN. At present, PP is a much more effective option for treatment of severe and/or recalcitrant TEN than any other treatment, such as pulsed corticosteroids and i.v. immunoglobulin.     

The diagnosis of Sézary syndrome on peripheral blood by flow cytometry requires the use of multiple markers

Background Diagnosis of Sézary syndrome (SS)‐defining blood involvement is hampered by the lack of Sézary cell‐specific markers and nonspecific morphology of the tumour cells. Objectives To identify the most reliable and easy to use markers for the diagnosis of SS‐defining blood involvement. Methods We studied 17 patients with SS and 11 control patients. We used flow cytometry for the detection of T‐cell antigens (CD3, CD4, CD7 and CD8), expression of the Sézary cell‐associated marker CD158k and T‐cell receptor (TCR)‐Vβ chain. Additionally, Sézary cells were identified by peripheral blood smear for lymphocytes with cerebriform nuclei. Results It was not possible to diagnose blood involvement in all patients with SS by a single marker or method, although none of the markers was increased in the control population. Sézary cells were detected by blood smears in 13 of 17 (76%), by flow cytometry by their CD4+ CD7? CD3^dim phenotype (> 1000 cells μL^?1) in 13 of 17 (76%) and by expression of CD158k in 11 of 17 (65%) patients with SS. A specific T‐cell clone was identified by identical TCR‐Vβ chain expression in 12 of 17 (71%) patients with SS. The identification of Sézary cells in individual patients varied for the different markers investigated. Conclusions The combination of identifying CD4+ CD7? CD3^dim cells, TCR‐Vβ chain and CD158k expression allowed a definite identification of SS‐defining blood involvement in every individual patient. All of these markers can be measured by flow cytometry which would avoid time‐consuming analysis of blood smears. These markers would also be suitable to monitor tumour cell load during therapy.     

Localized bullous eruption after intravenous injection of aciclovir: toxic or immunoallergic mechanism?

OBJECTIVE: To report a case of bullous eruption at and far from the site of aciclovir injection. CASE REPORT: A 50-year-old man was treated with intravenous aciclovir for Herpes simplex meningoencephalitis. Ten days after treatment onset, blisters appeared on his right forearm, at and far from the site of aciclovir injection. DISCUSSION: This adverse effect has not been frequently reported. To date, bullous eruptions were considered to result from extravasation of the aciclovir solution. In this case, an immunoallergic pattern was discussed with the presence of a histological leukocytoclastic vasculitis.     

Variability in the clinical pattern of cutaneous side‐effects of drugs with systemic symptoms: does a DRESS syndrome really exist?

OBJECTIVE: To improve the definition of the various clinical patterns of patients with drug-induced cutaneous side-effects with systemic symptoms, and their possible relationships with the triggering medication, with the ultimate goal of helping in the identification of the causal drug in difficult situations when the patient is taking several drugs. METHODS: Cases of drug-induced cutaneous side-effects associated with various systemic syndromes related to anticonvulsants (carbamazepine, phenytoin and phenobarbitone), minocycline, allopurinol, abacavir and nevirapine were collected retrospectively from the French Pharmacovigilance database (FPD) over a period of 15 years (1985-2000). The clinical patterns typical of the causative drugs were described and compared with data from the literature. RESULTS: Two hundred and sixteen patients with symptoms and signs consistent with cutaneous drug reactions with systemic symptoms were reported to the FPD during this period of time. Their pattern was similar to published data for these drugs, with fever, cutaneous eruption, hepatic abnormalities and eosinophilia being the most prominent but inconstant symptoms. There are clues suggesting that some particular lesional patterns may exist for some drugs. CONCLUSIONS: Although some trends emerge from these retrospective data, they suggest that no clear, unified outline can currently be defined for these multi-organ drug-induced reactions. Instead, a constellation of various symptoms and signs were recorded, that might be sorted in different patterns according to the causal drug, a finding that might indeed improve accurate identification of the causative drug in patients receiving several principal medications at a time. A national prospective study systematically collecting standardized data is required better to define the outlines of these severe adverse drug reactions and to evaluate prognostic data.