Electrophoretic pattern of human hairbulb tyrosinase

A small gel electrophoretic system has been developed for the study of tryosinase from human hairbulb melanocytes. Enzyme is released from the hairbulb with Triton X-100. Electrophoresis is run in 60 mm microcapillary pipettes with an internal diameter of 1.5 mm. With this technique, tyrosinase from normally pigmented brown, black, blond, and red hairbulbs gives a single band when the gel is stained with L-dopa for enzyme activity. Tryosinase from tryosinase-positive oculocutaneous albino and Hermansky-Pudlak syndrome hairbulbs gives a single L-dopa band. Neuraminidase pretreatment of the tyrosinase from normal and albino hairbulbs changes the migration of the tyrosinase band to a less anodal position. Trypsin pretreatment has no effect. We conclude that human hairbulb tyrosinase is a glycoprotein and that tyrosinase-positive albino tyrosinase has no major electrophoretic difference from normal enzyme.     

Local absorption of zinc from wounds treated with various zinc-compounds.

It is shown that in the rat, zinc is absorbed from excisional wounds into serum, from various locally applied zinc oxide preparations as well as from zinc peroxide and zinc sulphate. The most pronounced absorption of zinc to serum was recorded from wounds treated with zinc peroxide. Microscopically the cellular inflammatory response observed in wounds treated with a gauze sponge impregnated with a zinc sulphate solution was weaker than that found with the other treatment methods used.     

Anogenital epidermolytic acanthomas: effective treatment of pruritus with 0.1% tacrolimus ointment

Epidermolytic acanthoma is an uncommon benign tumor with a predilection for the anogenital region, that is characterized histologically by epidermolytic hyperkeratosis. Most reported cases are asymptomatic while some are pruritic. Treatment of this condition is challenging and not well studied. We report a 55‐year‐old man with pruritic anogenital epidermolytic acanthomas that persisted despite various topical and ablative therapies, and whose pruritus was not relieved with emollients and antihistamines. He was given 0.1% tacrolimus ointment twice daily and experienced a marked improvement in his pruritus within 2 weeks. At 1 month, there was marked improvement in itch score from 8 to 3.5 (maximum of 10), itch frequency from 20 times a day to once every 4 days, sleep score from 5 to 1 (maximum of 5), and Dermatology Life Quality Index score from 15 to 5 (maximum of 30). Apart from a transient burning sensation, no other adverse effects were noted. To our knowledge, this is the first report of the effective use of a topical calcineurin inhibitor in relieving the intractable itch associated with epidermolytic acanthoma.     

Inter-single-sequence-repeat-PCR typing as a new tool for identification of Microsporum canis strains

BACKGROUND: Microsporum canis is a ubiquitous dermatophyte that commonly causes human infections. Since contact with infected animals is the usual way of infection, tracing its source is an essential preventive measure. OBJECTIVE: To type isolates of M. canis from human patients whose skin was affected, and from some animals (dogs and cats) that were closely associated to the patients. METHODS: The inter-single-sequence-repeat-PCR (ISSR-PCR) technique has been used for typing 24 isolates of M. canis. Seventeen isolates tested were from human patients, 5 from cats and 1 from a dog RESULTS: A total of 21 genotypes were identified. The same genotype was found infecting a patient and a cat that was living closely with him, but another member of the same family proved to be infected with two genotypes different from that. Clinical specimens from two patients had been contaminated with the same genotype, probably in the laboratory where the samples were handled. CONCLUSION: These results demonstrate that ISSR-PCR polymorphism is a reliable method for the identification of the M. canis strains.     

Cutaneous mucinosis associated with dermatomyositis and nephrogenic fibrosing dermopathy: fibroblast hyaluronan synthesis and the effect of patient serum

BACKGROUND: Dermal mucin is an amorphous gelatinous substance composed primarily of hyaluronan (HA) and sulphated glycosaminoglycans (GAGs). In primary cutaneous mucinosis, accumulation of mucin is a characteristic feature of lichen myxoedematosus, scleromyxoedema and reticular erythematous mucinosis. Secondary mucinoses are disorders where mucin deposition is an additional finding, and deposition is associated with lupus erythematosus, dermatomyositis, scleroderma and granuloma annulare. The underlying cause of the abnormal mucin deposition is unknown. An increasing number of cases of a fibromucinous scleromyxoedema-like disorder associated with renal dysfunction, recently termed nephrogenic fibrosing dermopathy (NFD), is being reported. OBJECTIVES: To examine the synthesis of sulphated GAGs and HA by fibroblasts derived from uninvolved and involved skin of a patient with dermatomyositis and two patients with NFD, and the effect of patient serum. METHODS: GAGs were quantified by a radiometric assay and HA was determined by an enzyme-linked HA-binding protein assay. RESULTS: We found that fibroblasts derived from active lesions of NFD synthesize elevated levels of GAGs, and in particular HA, compared with normal controls, while serum from the patient with dermatomyositis and the two patients with NFD stimulates GAG synthesis, including HA synthesis, by both control and patient fibroblasts. CONCLUSIONS: Fibroblasts from patients with active NFD are either activated to synthesize elevated levels of HA or contain another cell type, possibly derived from circulating fibrocytes. In both disorders, there is additionally a serum-derived factor that stimulates production of sulphated GAGs and HA by fibroblasts.     

TRICHOTHIODYSTROPHY – BIOCHEMICAL AND CLINICAL STUDIES

We are reporting the clinical examination of two children with abnormal hair together with a microscopic and biochemical examination of their hairs. A diagnosis of trichothiodystrophy (TTD) is suggested since both hair samples are cystine-deficient and contain abnormal patterns of amino acids and proteins. The cystine deficiency was found to be due to a reduction in the amount and cystine content of the high-sulphur (HS)* protein fraction. An electrophoretic study of the two samples of HS protein gave patterns which differed in a major way from the pattern of a normal HS fraction with the loss of most normal components including the ultra-high-sulphur fraction. The pattern of spots of the two abnormal HS proteins not only differed from the normal but from each other and from a third sample of protein from a previously studied TTD hair. It is suggested that this may provisionally support the concept of heterogeneity of TTD.     

A study of clinical and aetiological factors and possible associations of lichen sclerosus in males

Lichen sclerosus is a chronic skin condition with a predilection for the genital area. In the present study, 35 male patients with lichen sclerosus were interviewed and examined. Blood screens were performed and histology was requested if not already performed. The findings indicate that lichen sclerosus in males exists as a spectrum of disease, ranging from a mild form with white plaques and few symptoms to a severe form with inflammation, atrophy and scarring with possible urological consequences. In many areas it differs from the condition in females; the association with autoimmune disease is weaker and there is less perianal and extragenital involvement The association with malignancy in males is of lesser significance than initially believed.     

Allergic contact dermatitis from allyl isothiocyanate in a Danish cohort of 259 selected patients

Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology, Gentofte Hospital, Denmark, from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+ reaction. One of the patients with a positive reaction provided samples of margarine, salad cream, oil and mayonnaise. These were analysed with high‐performance liquid chromatography, and a moderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking ‘tulip fingers’ or allergic contact dermatitis from garlic and onions. In conclusion, allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases, despite frequent exposure. The large number of ?+ reactions raises the question as to whether the recommended patch test concentration is too low.     

Nickel contact dermatitis in a blood bank

Twenty blood donors developed a dermatitis at the site of venesection within a few hours of giving blood. A local anaesthetic administered with a Dermo-Jet had been used before extracting blood. In only 2 cases was sensitivity to the local anaesthetic found. In the others the reaction was caused by nickel released from the Dermo-Jet. The quantity of nickel released is greater from the anaesthetic solution than from deionised water. It increases with the time that the anaesthetic remains in the Dermo-Jet. The release of nickel is greater from a used Dermo-Jet than from a new one. Histology revealed a lymphohistiocytic infiltrate at the level of the deep dermis.     

Fas ligand in pemphigus sera induces keratinocyte apoptosis through the activation of caspase-8

The Fas/Fas ligand system triggers the extrinsic apoptotic pathway and is involved in several inflammatory conditions, also at the skin level. The Fas/Fas ligand cell death pathway plays a major role in anoikis, a type of apoptosis characterized by cell detachment. As pemphigus is characterized by loss of cell to cell adhesion, we evaluated the role of anoikis and Fas ligand in this bullous disease. We report that, in suprabasal epidermis from perilesional pemphigus skin, most keratinocytes are apoptotic. Moreover, Fas ligand levels are markedly increased in sera from pemphigus patients, whereas they are undetectable in sera from patients undergoing steroid treatment. Sera from untreated patients but not from patients under steroids induce keratinocyte apoptosis. Pemphigus-sera-induced cell death is partially inhibited by pretreatment with anti-Fas ligand antibodies and by incubation with caspase-8 inhibitor Z-IETD-FMK. Finally, caspase-8 is activated in keratinocytes provided with sera from pemphigus patients, whereas cleavage is partially blocked by pretreatment of sera with anti-Fas ligand antibody. These results suggest that increased Fas ligand in pemphigus sera is responsible for keratinocyte apoptosis, which occurs through the activation of a caspase-8-driven extrinsic apoptotic pathway.     

Interventions for treating oral lichen planus: a systematic review

Oral lichen planus (OLP) is a common chronic inflammatory disease associated with cell-mediated immunological dysfunction. Symptomatic OLP is painful and complete healing is rare. The aim of this review was to assess the evidence for the efficacy and safety of treatments for symptomatic OLP. The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched in January 2011 to identify all randomized controlled trials (RCTs) evaluating any intervention for the treatment of symptomatic OLP. A total of 28 trials were included in this Cochrane review. There was no evidence from three RCTs that topical pimecrolimus is better than placebo in reducing pain from OLP. There was weak evidence from two RCTs that topical aloe vera may be associated with a reduction in pain compared with placebo. There was weak and unreliable evidence from two small trials, at high risk of bias, that topical ciclosporin may reduce pain and clinical signs of OLP. There was no evidence (from five trials each evaluating a different steroid and/or calcineurin inhibitor) that there is a difference between treatment with topical corticosteroids (TCSs) compared with topical calcineurin inhibitors with regard to reducing pain associated with OLP or that any specific steroid therapy is more or less effective at reducing pain. Although TCSs are considered to be the first-line treatment, we did not identify any RCTs that compared TCSs with placebo in patients with symptomatic OLP. From the 28 trials included in this systematic review, the wide range of interventions compared means there is insufficient evidence to support the superior effectiveness of any specific treatment.     

Relationship between cobalt and nickel sensitization in females

The view generally held in the literature is that the frequent occurrence of concomitant nickel and cobalt sensitivity is due in simultaneous sensitization from -suspenders, jewelry, etc.
In a study population consisting of 168 unselected female twins representing a random sample of the general population, only a few were found with concomitant nickel and cobalt sensitivity, and then mainly among those with hand dermatitis.
Similar concomitant cobalt and nickel was found only in dermatological female patients with hand dermatitis. The conclusion is that concomitant nickel and cobalt sensitization from metal alloys worn in direct contact with the skin is rare and that cobalt sensitization is probably a phenomenon secondary to an already existing hand dermatitis.     

Relapse in leprosy after multidrug therapy and its differential diagnosis with reversal reaction

Relapse may be caused either by persisters or through reinfection in a patient released from treatment after MDT. Differentiating relapse from reversal reaction is not always easy, on histological and clinical grounds. A therapeutic trial with steroids for 2-4 weeks can be used to differentiate relapse from reversal reaction occurring in the skins. However, if a patient develops nerve function deficit after release from treatment, it is best to initiate antileprosy treatment along with a long course of steroids.     

Follicular hybrid cyst (trichilemmal cyst and pilomatricoma) arising within a nevus sebaceus

We report a case of follicular hybrid cyst arising in a nevus sebaceus. Histopathologic findings showed one part with the features of a trichilemmal cyst and the other part with those of a pilomatricoma. To our knowledge, this is the first case of follicular hybrid cyst associated with nevus sebaceus. We consider that the cyst in our case is derived from the hair matrix and from the follicular isthmus.     

A syphilis-positive organ donor -- management of the cardiac transplant recipient: a case report and review of the literature

Syphilis as a public health problem has not been resolved. Because donor organs are scarce, Treponema pallidum seropositivity is no longer considered a contraindication to transplant. However, there is little guidance on the management and monitoring on the recipient of organs from patients with syphilis. We present a case of a patient successfully transplanted with a heart from a seropositive donor and a review of the literature.     

A Case of Melanoacanthoma: Immunohistochemical Staining Using VECTOR? NovaRED? to Distinguish Melanocytes from the Cutaneous Pigment

Melanoacanthoma is a rare benign mixed tumor of both keratinocytes and melanocytes. Although some authors said that it is a rare variant of seborrheic keratosis, it has clinical and histological features distinct from seborrheic keratosis. It has large dendritic melanin-laden melanocytes throughout all levels of epidermis showing a disruption of melanin transfer from the melanocytes to neighboring keratinocytes. However, it is difficult to distinguish melanocytes clearly from cutaneous pigment in immunohistochemical stain with usually used brown chromogen. We used chromogen with brick-red indicator product (VECTOR® NovaRED™) in S-100 and melan-A immunohistochemical staining to distinguish melanocytes from melanin laden keratinocytes. We suggest that the immunohistochemical staining using this novel chromogen may be useful in the diagnosis of melanoacanthoma.     

Image Gallery: Pyoderma gangrenosum of the penis

Hidradenitis suppurativa (HS) is a serious skin disease. The cause of HS not known, but it is thought that a disturbance in the immune system's response plays an important role. Studies have found elevated levels of small proteins called cytokines in HS skin. Cytokines are signalling molecules that cells of the immune system use to communicate with each other. Some cytokines cause more inflammation in the skin and others reduce it. IL‐17A is one of the cytokines that cause inflammation, and it was found to be elevated in HS skin. If you remove IL‐17A from the skin tissue, inflammation is reduced and may even disappear. Secukinumab is an antibody that binds and destroys IL‐17A. Because there is a lot of IL‐17A in the skin of HS patients, we have tried this new treatment in a patient with severe disease. Our patient is a 47‐year‐old man, with severe HS. He has been treated for many years and only had temporary benefit from several other treatments that have been tried. We carefully recorded the patient's experience of the treatment, comparing the results at the start of treatment with those after 12 weeks of treatment. After treatment with secukinumab the patient reported fewer boils (going from 23 to 7); less pain (going from 5 to 3 on a ten point scale) and less pain/utility loss/handicap (going from 7 to 4 on a ten point scale). The results may be taken to imply that medications targeting IL‐17A could provide a possible treatment approach for HS in the future.     

Hair follicle-like change over histiocytomas

Epidermal hyperplasia is a common finding overlying histiocytomas. Occasionally, a distinctive type of basaloid hyperplasia occurs, with differentiation into primitive hair follicle tissue. This study attempts to characterize this change and determine whether it is associated with any particular clinical or histological feature. Data from patients with histiocytomas displaying induction of pilar epithelium in the epidermis above the lesions was compared with data from controls who did not show this change. The size, site, and duration of histiocytomas were similar in both groups, as were the predominant cell type and distance of histiocytoma from the epidermis. Serial sectioning of histiocytomas showed that the induction of pilar epithelium was a focal phenomenon, often missed in routine sections. It is suggested that histiocytoma cells may produce a "hair organizing mediator."     

Histopathology of keratotic papules of the limbs in frontal fibrosing alopecia

Frontal fibrosing alopecia (FFA) is a scarring type of alopecia that presents clinically as progressive frontotemporal hairline regression and eyebrow loss, mainly in postmenopausal women. An additional common finding is keratotic papules on the face or (less commonly) on the trunk and extremities. The histopathology of the facial keratotic papules associated with FFA is the same as that of lichen planopilaris. There are very few FFA cases with biopsies from extrafacial sites and no cases of folliculocentric keratotic papules with biopsies from extrafacial sites. In the current report, we describe the histopathology of one such keratotic papule from the arm of a 75‐year‐old woman with FFA and show that the morphology is that of lichen planopilaris and that the papules are identical to those found in Graham–Little–Piccardi syndrome.