Subcutaneous sarcoidosis associated with vitiligo, pernicious anaemia and autoimmune thyroiditis

We report a patient with pernicious anaemia, primary autoimmune hypothyroidism and vitiligo, who presented with subcutaneous nodules. Histopathology of the nodules revealed noncaseating granulomas, consistent with a diagnosis of sarcoidosis. Mild pulmonary sarcoid was also detected. Although an association between sarcoidosis and other autoimmune diseases is well-recognized, the presence of the particular autoimmune diseases in our patient and the involvement of subcutaneous fat in the sarcoidal inflammation, appears to represent a most unusual clinicopathological combination.     

他克莫司软膏治疗白癜风一例

患者男,13岁.因左眼旁皮肤出现白斑,渐扩大,于2007年5月15日来院就诊.患者自1年前开始左眼内侧皮肤出现白斑,未治疗,后渐扩大.发病前局部无外伤、炎症及用药史.既往史及家族史:患者平素身体健康,家族中无类似病史.     

The association of chronic urticaria and angioedema with autoimmune thyroiditis

Background An increased frequency of autoimmune thyroiditis is seen in patients with chronic urticaria and angioedema (CUA) and it has been hypothesized that autoimmunity may be playing a role in the pathogenesis of CUA. The aim of this study was to learn the extent of autoimmune thyroid disease in a series of patients who presented with CUA. Methods Thyroid function tests and thyroid autoantibodies were measured by radioimmunoassay and immunoradiometric assay respectively in 94 CUA patients and 80 age- and sex-matched healthy volunteers. Results Eleven patients (11.7%) were found to have thyroglobulin antibodies (TGA) and nine patients (9.57%) thyroid microsomal (TMA) titers ranging from 150 to 1340.37 and from 165.73 to 8000 lU/mL respectively. Both antibodies were detected in three control cases (3.7%). The association was statistically significant (P < 0.01). Six of 11 patients had thyroid dysfunction and the other five cases were euthyroid. Conclusions Our results justified the use of TMA and TGA for the early diagnosis of autoimmune thyroiditis in combination with CUA. The higher frequency of these antibodies in our patients, along with results from previously published data, suggest that this entity may reflect an autoimmune basis in some CUA patients. Thyroid function tests are not enough to rule out thyroid disease, and thyroid antibody tests should be carried out in all patients with CUA.     

Treatment of chronic urticaria with PUVA or UVA plus placebo: A double-blind study

Summary Chronic urticaria is a disease for which the available range of treatment modalities is limited. Ultraviolet radiation has recently been shown to affect histamine release from mast cells. We therefore studied the effects of PUVA and UVA on chronic urticaria. Nineteen patients took part in the study, which was designed as a randomized double-blind study. Eleven patients received PUVA, and 8 received UVA plus a placebo. In the PUVA group, 7 patients showed improvement, 3 noticed no change, and 1 became worse. In the group that received UVA plus placebo, 5 patients experienced an improvement, whereas the other 3 showed no change. The differences between the groups were not statistically significant. However, the probability of achieving this degree of improvement in both groups just by chance is less than 1%. Consequently, the improvement noted could have been due to either UVA alone or a placebo effect. It is concluded that PUVA is not better than UVA in the treatment of chronic urticaria.     

局部PUVA治疗白癜风的疗效观察

为了探讨局部PUVA治疗癜风的疗效,对80例白癜风患者进行局部PUVA治疗。结果表明经30次治疗后,总有效率为85.00%,其中125例（18.75%）患者痊愈。局限型白癜风有较好的疗效。疗效与病程相关,与皮肤光毒反应无关。     

无色素性色素失禁症并发白癜风

报告1例无色素性色素失禁症并发白癜风.患儿女,lO岁.出生后1年面部、躯干及左下肢出现色素减退斑.皮肤科检查:面部、躯干、左下肢见特殊形状的色素减退斑,部分色素减退斑呈旋涡状或泼墨状;左下肢及右胸部各有1枚钱币大界限清楚的色素减退斑.腰部皮损组织病理检查:表皮基底层见较多色素颗粒及个别黑素细胞,真皮未见明显炎性细胞浸润.     

桥本甲状腺炎合并白癜风、硬化萎缩性苔藓一例

患者女,22岁。1年前于右侧额部头皮及右侧面颊部出现片状白斑,同时伴有右侧额部白发。就诊前4个月出现右面部、颈部、躯干、上肢、下肢萎缩性斑片,伴有色素脱失和色素沉着,不伴疼痛和瘙痒,皮疹逐步扩大,局部变硬。近来左腹部及左膝上方出现类似硬化萎缩性皮损。家族中无类似病史。体检：神清,营养中等,双侧甲状腺I度肿大,质韧,无明显压痛,左侧甲状腺可触及结节。其他各系统检查无异常。皮肤科情况：右侧额部头皮及右侧面颊部片状白斑,右侧额部白斑局部毛发呈白色。右侧面颈部、右侧躯干、右侧上肢及下肢、左腹部、左膝上方大腿部沿皮纹走向可见多个大小不一的萎缩性斑片,表面微皱,羊皮纸样萎缩,触之质硬（图1）……     

Combined treatment of solar urticaria with plasmapheresis and PUVA

We describe a patient suffering from severe solar urticaria, unresponsive to conventional treatments, in whom a circulating photoallergen was demonstrated, and who subsequently responded to treatment with a combination of plasmapheresis and PUVA.     

Solar urticaria: treatment with PUVA and mediator inhibitors

Several therapeutic regimes for solar urticaria were evaluated. A short course of PUVA therapy produced a marked increase in the minimal dose of radiation required to produce urticaria in the six patients treated. This objective evidence of improvement was supported by the patients' reports of greatly increased tolerance to sun-exposure. Chlorpheniramine, an antihistamine, produced a slight increase in the minimal dose of radiation necessary to produce urticaria but its effectiveness was limited by side-effects. Indomethacin, an inhibitor of prostaglandin synthetase, produced no beneficial effect.     

Cutaneous mucinosis associated with SLE--a case provoked by PUVA

A patient with SLE which was complicated by a characteristic cutaneous mucinosis is reported. The skin lesions were composed of intradermal soft nodules, purple-red plaques, and alopecia of the scalp. Acid mucopolysaccharides accumulated in each lesion. PUVA provoked an infiltrated skin lesion in which acid mucopolysaccharides were deposited in the dermis. Deposition of immunoglobulins and complements were also observed at the dermo-epidermal junction and on the vascular walls. Some immunological processes which may stimulate the synthesis of acid mucopolysaccharides in the dermis were suggested.     

Refractory case of adrenergic urticaria successfully treated with clotiazepam

Adrenergic urticaria (AU) is a rare type of stress‐induced physical urticaria characterized by widespread pruritic urticarial papules. Diagnosis can be made by i.d. injection of adrenaline or noradrenaline, which produces the characteristic rash. Although the lesions of AU typically respond to beta‐blockers such as propranolol, the therapeutic options for AU are limited. Here, we report a case of AU that was resistant to beta‐blockers and successfully treated with clotiazepam. The clinical picture of AU resembles that of cholinergic urticaria (CU), however, positive noradrenaline test and negative acetylcholine skin test were useful for the differential diagnosis of AU and CU. Although his symptoms were resistant to several therapeutic methods including olopatadine (H₁ antagonist), lafutidine (H₂ antagonist) and propranolol, the severity and frequency of his attacks and his subjective symptoms were reduced by oral clotiazepam, an anxiolytic benzodiazepine. Dermatologists should be aware that anxiolytic benzodiazepines may be a therapeutic option in AU.     

Calcipotriol and PUVA as treatment for vitiligo

We performed a prospective study to evaluate efficacy of the combination of calcipotriol and psoralen plus ultraviolet A (PUVA) in the treatment of vitiligo. Twenty-three patients with essentially bilateral symmetrical lesions of vitiligo were included. Calcipotriol (0.005 %) ointment was applied twice daily over the right side of the body, and the other side was not treated. PUVA was performed three times per week. All patients received at least forty five sessions of PUVA. Patients were evaluated clinically and photographed all fifteen weeks. At the fifteenth session, 69 percent of the patients had minimal to moderate improvement on the calcipotriol side compared to 52 percent on the PUVA-only side (p = 0.015). At the forty-fifth session, 52 percent showed marked improvement on the calcipotriol side compared to 30 percent on the PUVA-only side (p = 0.13), with more intense repigmentation on calcipotriol-treated areas. Treatment was well tolerated, and no adverse effect was noted. This combination was an effective treatment for vitiligo, especially in initiating repigmentation.