Unsuitability of organ donation from a patient with a history of melanoma?

A 52-year-old man with a history of melanoma presented to the emergency department with a massive intracranial hemorrhage. The patient deteriorated rapidly and was being considered as a potential organ donor. Three years before presentation, the patient had undergone wide excision of a 3.75-mm melanoma from his back with sentinel lymph node biopsy, which yielded negative findings. He had been well until the day of presentation. Although there are no specific guidelines for candidacy of organ donation from patients with a history of melanoma, there are several reports of donor-derived melanoma in organ transplant recipients, most with grave consequences. The literature relevant to this case is reviewed and discussed.     

Vitiligo: a manifestation of apoptosis?

Vitiligo is a common cutaneous disorder that has significant biological and social consequences for those affected. It is characterized by a loss of melanocytes from the epidermis, which results in the absence of melanin, i.e. depigmentation. There are numerous hypotheses about the etiology of vitiligo, but no data to definitively prove one theory over another. It is likely that there are numerous causes for the loss of these melanocytes. One way to approach the identification of the etiology is to determine the mechanism by which the melanocytes are destroyed. The two known mechanisms for the destruction of cells are necrosis and apoptosis. One purpose of this paper is to review the extant data that might suggest which of the two mechanisms is operative against melanocytes in patients with vitiligo. The histological data, and some laboratory data, support apoptosis, rather than necrosis, as the mechanism for removal of melanocytes. Apoptosis can be induced by a variety of factors, including immune cytokines, some environmental chemicals (for example substituted hydroquinones such as monobenzone) or other molecular mechanisms. Current therapies, such as corticosteroids and ultraviolet light, do affect apoptosis in a variety of ways. Confirmation of apoptosis as a mechanism, and identification of how apoptosis is initiated to produce vitiligo, can serve as a basis for devising medications that might stop the progression of the disorder. The problem of vitiligo would be essentially solved if there was a medication that is well tolerated in children, adults and pregnant women, and that would halt the progression of the depigmentation. The study of apoptosis, mechanisms of its induction, and the ways to block apoptosis, is one possible way to find both the causes of depigmentation and medications to prevent its progression.     

Nevus marginatus: a distinct type of epidermal nevus or merely a variant of nevus sebaceus?

Epidermal nevi (EN) represent a heterogeneous group of mosaic skin lesions frequently following the lines of Blaschko. They are divided into organoid and nonorganoid types. Herein we report on a 35-year-old man with a rather unusual type of EN. A linear lesion involving the trunk and following Blaschko's lines was conspicuously bordered by dark brown papules. The flat reddish central area histopathologically showed sebaceous hyperplasia consistent with nevus sebaceus, an organoid EN type, whereas the elevated margin showed features of a common nonorganoid keratinocytic EN. For this peculiar disorder, we propose the term 'nevus marginatus'. So far it is not clear whether nevus marginatus represents a distinct entity or merely an unusual clinical variant of nevus sebaceus.     

Linear atrophoderma of Moulin: a disease related to immunity or a kind of connective tissue disease?

We describe a 28‐year‐old man with linear atrophoderma of Moulin (LAM), whose serum immunological markers were abnormal (including antinuclear antibody, ribonucleoprotein, immunoglobulin M and anti‐SM antibody). In addition, however, a histological analysis identified unexpected connective tissue disease changes in this patient. We speculate that the pathogenesis of LAM is associated with immunity or that LAM itself is a kind of connective tissue disease.     

Detection of DNA of Chlamydophila psittaci in subjects with psoriasis: a casual or a causal link?

Summary Background Recent evidence indicates that subclinical infection by Chlamydophila psittaci occurs in a significant percentage of patients with chronic inflammatory polyarthritis, including psoriatic arthritis. Objective To assess the prevalence of Chlamydiae infection in a large cohort of well‐characterized patients with psoriasis. Methods The presence of a subclinical C. psittaci infection was investigated in 64 patients with psoriasis, including 12 patients with psoriatic arthritis. Two hundred and twenty‐five healthy controls were also investigated. The presence of infection was assessed in peripheral blood mononuclear cells using several polymerase chain reaction protocols, targeting different regions of the bacterial genome. The DNA of other species (Chlamydophila pneumoniae and Chlamydia trachomatis) was also investigated. Results Chlamydophila psittaci infection was observed in a significantly higher percentage of patients with psoriasis (11/64, 17%) compared with healthy controls (1/225, 0·4%) (odds ratio 46·49, 95% confidence interval 5·87–368·03; P < 0·0001). No differences in age, sex or disease duration were noticed between positive and negative patients, but the majority of the positive patients were on immunomodulatory treatments. Conclusion Chlamydophila psittaci may be an infectious trigger possibly involved in the pathogenesis of psoriasis.     

Identification of a novel mutation in 3beta-hydroxysteroid-Delta8-Delta7-isomerase in a case of Conradi-Hünermann-Happle syndrome

The X-linked dominant Conradi-Hünermann-Happle (CDPX2, MIM 302960) syndrome belongs to the rare, heterogeneous group of diseases called chondrodysplasia punctata. The disease has been connected recently with deficiency of 3beta-hydroxysteroid-Delta8-Delta7-isomerase (also called emopamil-binding protein, EBP), catalysing an intermediate step in the conversion of lanosterol to cholesterol (1, 2). We report a case of CDPX2 with a new missense mutation (C-->G 439) in exon 4, leading to a R147G aminoacid substitution in the EBP.     

Aggravation of psoriasis by infections: a constitutional trait or a variable expression?

Focal infections are a well known triggering factor in patients with psoriasis. A question which remains to be answered is whether relapsing of psoriasis after infections is a constitutional trait of a restricted population or whether it is a feature of all patients in some phase of their disease. A questionnaire was mailed to patients with psoriasis comprising general questions, psoriasis related questions and questions on the relationship between focal infections and aggravation of psoriasis. The questionnaire was mailed to 126 patients and 45 questionnaires which were returned, were evaluable. From the 45 questionnaires the following preliminary conclusion can be drawn. Aggravation of psoriasis following infections appeared to be a consistent trait throughout the duration of psoriasis in 18% of patients as opposed to 71% of the patients who did not experience this association at all and 11% who experienced the association sometimes. Patients who experienced aggravation of psoriasis by infections as a consistent feature have an age of onset 9 years earlier as opposed to patients without this association and express guttate psoriasis in the vast majority as first manifestation at initiation of psoriasis. These patients had an average of 4.6 relapses per year in contrast to 1.1 per year in the patients without an association between infection and aggravation of psoriasis. In these patients infections proved to be responsible for 67% of the exacerbations. Stress was indicated in this subpopulation as a triggering factor as well in 88% of the patients. Although this conclusion only can be very preliminary based on the small group of patients, we may conclude that patients with a strong association between aggravation of psoriasis and infections belong to a restricted population of patients tending to an unstable course of the disease.     

Granulomatous slack skin: a distinct disorder or a variant of mycosis fungoides?

About 75% of cutaneous lymphomas belong to the group of T-cell lymphomas. Mycosis fungoides is the most common entity in this group. Granulomatous slack skin is a rare form of cutaneous T-cell lymphoma closely related to mycosis fungoides. We present here a patient with areas of lax skin for several years who developed a generalized erythroderma with associated immunoactivation and a deterioration in his general condition. This report discusses clinically and histologically the differential diagnoses, namely granulomatous slack skin and granulomatous mycosis fungoides, and suggests that these 2 disorders are only variants in the broad spectrum of a single disease.     

Slugging: TikTokTM as a source of a viral “harmless” beauty trend

“Slugging” is a viral beauty trend on TikTok^TM that entails slathering a petrolatum-based ointment on the skin as a last step in your evening skincare routine. Due to its occlusive nature, slugging has a potential risk for harm. Here, we screened top 50 TikTok videos on slugging and analyzed upload source, content, and quality of each video. Overall, 18 (36.7%) videos were deemed educational, discussing risks and/or benefits. By upload source, health care providers (HCPs) created more educational videos (87.5%, P = .009), while online influencers created more patient experience videos (43.3%). This difference was evident when comparing the upload source. DISCERN scores (a validated measure of video's quality as a source of information) differed significantly among HCP, influencers, and others (3, 2, 2, respectively, P = .01). Together, our study demonstrates that compared to influencers and others, HCPs created videos of more high-quality, educational content on slugging.     

Abnormal insect bite reactions: a manifestation of immunosuppression of HIV infection?

Pruritic papular eruptions are a common manifestation in patients infected with HIV. The significance of these lesions is not known. We have many apparently normal individuals presenting with exaggerated insect bite reaction on the exposed parts of the body as the only manifestation of HIV disease. A pilot study was done to see whether the appearance of exaggerated insect bite reactions is an indicator of impending immune suppression in HIV infected individuals. CD4 count was done in 10 serial patients presenting to our clinic with exaggerated insect bite response of recent onset and HIV infection. Out of the 10 cases, 8 showed low CD4 counts (less than 400/cmm). Further studies may prove that exaggerated insect bite reaction can be a marker of impending immunosuppression.