Minocycline-induced hyperpigmentation in leprosy

Summary A 36-year-old man was treated with dapsone. rifampicin and diazirines for borderline lepromatous leprosy. After 9 months, his leprosy plaques became progressively more red and after 23 months, tau diazirines was stopped and he was given minocydine instead. Six weeks later, he developed blue hack pigmentation in his leprosy lesions. The histology was consistent with minocydine-indicted hyperpigmentation. This is the first report of minocycline-induced pigmentation in leprosy. We suggest it is important to consider this side-effect before the administration of minocydine in leprosy, particularly if it is prescribed in place of clofazimine.     

Complement allotypes in Japanese patients with pemphigus and bullous pemphigoid

The allotypes of C6, C7, factor B (BF) and factor I (IF) of the human complement system were studied in 11 Japanese patients with pemphigus (5 with pemphigus vulgaris and 6 with pemphigus foliaceus) and 17 with bullous pemphigoid (BP) to investigate the genetic background of these diseases. The allotypes were detected by using isoelectric focusing and immunoblotting. The frequency for IF*A allele in the pemphigus patients was significantly higher (p = 0.009) than that in healthy controls (n = 60). A significant association of IF A allotype with pemphigus was also observed (p = 0.027), with a relative risk of 6.3. There was no association between the C6, C7, BF or IF allotypes and BP. These data suggest that IF A allotype may be an etiological genetic factor in the development of pemphigus.     

The hormonal profile of patients with pemphigus and bullous pemphigoid

Radioimmunoassays of some hypophyseal, adrenal, thyroid, pancreatic, and sexual gland hormones, carried out in patients with pemphigus and bullous pemphigoid, have revealed increased levels of ACTH and hydrocortisone in their blood sera, vs. the reference values. Glucocorticoid therapy has normalized the ACTH level, and hydrocortisone content has proved to be below the norm. The blood plasma triiodothyronine level has been elevated, whereas insulin and glucagon lowered in the patients with pemphigus vs. those with bullous pemphigoid. In females of a menopausal age, suffering from pemphigus, increased levels of estradiol and reduced ones of testosterone have been detected, as compared to those suffering from bullous pemphigoid. These data evidence a varying functional activity of the endocrine glands in these dermatitides.     

Evidence for cell-mediated autoimmunity in patients with pemphigus vulgaris and bullous pemphigoid

Summary Lymphoid cells from 4 of 5 patients diagnosed as pemphigus vulgaris (PV) and 6 of 7 patients diagnosed as bullous pemphigoid (BP) demonstrated specific cell-mediated immunity by the production of migration inhibitory factor (MIF) in the presence of autologous epidermal saline extracts. Clinical treatment of these patients with immunosuppressive agents resulted in a state of unresponsivenes of their lymphoid cells to similar concentrations of the antigen. Controls consisted of lymphoid cells from patients with bullous burns or various drug allergies which failed to show significant MIF production in the presence of autologous skin extract. These studies suggest that both PV and BP patients posses cell-mediated immunity (CMI) to their own autologous tissue antigens and this CMI may play a role in the pathogenesis of these diseases.     

Minocycline-induced cutaneous hyperpigmentation: confocal laser scanning microscope analysis

BACKGROUND: Minocycline has a characteristic yellow-green fluorescent emission. This fluorescence has been previously demonstrated only in type 1 minocycline-induced skin hyperpigmentation. OBJECTIVE: To investigate whether the fluorescence can be detected in other types of minocycline-induced cutaneous hyperpigmentation, and to study the possible mechanisms. METHODS: Biopsies of pigmented and nonpigmented skin from 3 patients with different types of skin hyperpigmentation induced by minocycline were analysed by light microscopy and Confocal Laser Scanning Microscope (CLSM). RESULTS: A yellow-green fluorescence was observed in the hyperpigmented skin of two patients with type 2, and one patient with type 4 minocycline-induced cutaneous hyperpigmentation. No fluorescence was detected in the non-pigmented skin. CONCLUSION: Minocycline can possibly serve as a fluorescent probe in the diagnosis of all types of minocycline-induced cutaneous hyperpigmentation.     

天疱疮与类天疱疮的治疗

天疱疮与大疱性类天疱疮是最为常见的获得性大疱病。 50年代,皮质类固醇的问世并应用于大疱病的治疗,使这 2个重症皮肤病的预后大大得到改善。早期制定的大剂量服用皮质类固醇方案虽然能控制皮疹,但长期服药的结果也带来一系列的不良反应,如糖尿病、高血压、骨质疏松、股骨头无菌坏死等,甚至因不良反应导致死亡,如严重的感染、消化道溃疡穿孔造成大出血等。目前,对大疱病的治疗可选择不同的药物,然而皮质类固醇仍是治疗天疱疮、类天疱疮的首选药物,但如何合理使用,如何减少和预防不良反应的发生则是临床医生共同探讨的问题。本文…     

The events leading to the death of patients with pemphigus and pemphigoid

This paper is based upon a study of all available records of patients certified as having died in hospital from pemphigus and pemphigoid in England and Wales from 1962 to 1969. The results differ from most published series in that many of the 210 patients died still with extensive skin lesions and with biochemical abnormalities, such as low serum albumin, sodium and chloride, which were secondary to this. Side-effects of treatment, such as diabetes, peptic ulceration, and infections, were also important but the commonest immediate causes of death were respiratory tract infections and pulmonary embolism.     

Therapy of pemphigus and pemphigoid

Severe cases of pemphigus vulgaris should be treated with prednisone in high dosage (180-360 mg daily). In milder cases, we prefer the combined therapy with prednisone 40 mg every other day and an immunosuppressive drug, i.e. azathioprin, cyclophosphamide, or methotrexate. For treatment of bullous pemphigoid, the combined therapy is usually sufficient.     

Phylogenetic studies with pemphigus and pemphigoid antibodies.

Indirect immunofluorescence (IF) studies were performed on skin from a variety of vertebrate specimens and IgG fractions from pemphigoid and pemphigus sera. Pemphigoid antigen was present in fish, amphibian, reptilian, avian and mammalian skin, whereas pemphigus antigen was observed in avian and mammalian skin only.     

天疱疮和类天疱疮患者发生糖皮质激素诱导性糖尿病的风险和危险因素分析

目的 探讨天疱疮和类天疱疮患者糖皮质激素诱导性糖尿病（GDM）的发生情况和相关危险因素。 方法 收集2011年12月至2013年1月接受糖皮质激素（激素）治疗的天疱疮和类天疱疮住院患者,比较发生GDM和未发生GDM两组患者的年龄、性别、体质指数（BMI）、病理类型、糖皮质激素的起始剂量、日激素最大剂量、糖尿病家族史、免疫抑制剂治疗等因素的差异。组间比较采用独立样本t检验,应用χ2检验和Fisher确切概率法对计数资料进行分析;用Logistic回归模型进行危险因素分析。 结果 经糖皮质激素治疗的68例天疱疮和类天疱疮患者中,26例（38.2%）发生了GDM。在发生和未发生糖尿病两组患者间进行单因素分析,结果显示：激素起始量（P < 0.05;OR 1.023;95% CI 1.002 ～ 1.044）、日激素最大剂量（P < 0.01;OR 1.037;95% CI 1.013 ～ 1.062）、激素治疗时间（P < 0.05;OR 1.143;95% CI 1.028 ～ 1.271）、BMI（P < 0.01;OR 1.265;95% CI 1.080 ～ 1.481）、地塞米松使用（P < 0.01;OR 6.0;95% CI 1.887 ～ 19.076）是天疱疮和类天疱疮患者发生GDM的危险因素。多因素Logistic回归分析显示：BMI（P < 0.05;OR 1.223;95% CI 1.017 ～ 1.471）和日激素最大剂量（P < 0.05;OR 1.037;95% CI 1.009 ～ 1.065）是GDM发生的独立危险因素。 结论 38.2%的天疱疮和类天疱疮患者经糖皮质激素治疗后发生了GDM,BMI和日激素最大剂量可能是GDM发生的独立危险因素。     

天疱疮和大疱性类天疱疮患者外周血滤泡辅助性T细胞水平的研究

目的 探讨滤泡辅助性T细胞（Tfh）在天疱疮和大疱性类天疱疮发病中的作用。 方法 天疱疮和大疱性类天疱疮患者各10例,与天疱疮和大疱性类天疱疮患者年龄、性别相匹配的正常人对照各10例。采用流式细胞仪检测外周血单一核细胞（PBMC）中Tfh水平,采用酶联免疫吸附法（ELISA）检测其血清中白介素21（IL-21）水平,同时检测大疱性类天疱疮患者血清中抗BP180-NC16A抗体滴度,并进行抗体滴度与IL-21、Tfh水平的相关性分析。结果 天疱疮患者组血清中IL-21水平（95.33 ± 33.69 ng/L）显著高于其正常人对照组（54.50 ± 18.13 ng/L）（t = 3.38,P ＜ 0.01）,Tfh水平（12.08% ± 4.74%）亦显著高于其正常人对照组（6.15% ± 1.62%）（t = 3.74,P ＜ 0.01）。大疱性类天疱疮患者组血清中IL-21水平（106.70 ± 44.91 ng/L）显著高于其正常人对照组（55.37 ± 15.89 ng/L）（t = 3.41,P ＜ 0.01）,Tfh水平（11.85% ± 3.14%）亦显著高于其正常人对照组（6.03% ± 1.74%）（t = 5.13,P ＜ 0.01）。大疱性类天疱疮组抗BP180-NC16A抗体滴度与IL-21水平呈正相关（r = 0.77,P ＜ 0.01）,与Tfh水平亦呈正相关（r = 0.67,P ＜ 0.05）。结论 天疱疮和大疱性类天疱疮患者Tfh及其分泌的细胞因子IL-21水平均明显升高,可能在其发病过程中起一定的作用。     

Immune complexes in pemphigus and bullous pemphigoid

28 serum and 10 blister fluid specimens obtained from 28 pemphigus vulgaris (PV) patients were assayed for immune complexes using the polyethylene glycol (PEG)assay. 11% of sera and 30% of the blister fluids have elevated levels of immune complexes. Anti-intercellular cement substance (ICS) antibody could not be detected in PEG precipitates, but was present in the supernatants from the serum. However, anti-ICS antibody was found in 70 of the precipitated complexes from the blister fluid. 18 serum and 31 blister fluid specimens obtained from 18 bullous pemphigoid (BP) patients were assayed for immune complexes using the PEG assay. 17% of sera and 31% of the blister fluids have elevated levels of immune complexes. Antibasement membrane zone (BMZ) antibody could not be detected in the PEG precipitates, but was present in the supernatants obtained from the sera. Anti-BMZ antibody was found in 57% of the precipitated complexes from the blister fluids. This data further supports the hypothesis that the majority of the complexes in PV and BP are formed in situ.     

The treatment of pemphigus and pemphigoid

The management of pemphigus and pemphigoid is briefly reviewed. Consideration is given to the use of three intravenous daily ‘bolus’ injections of high-dose methyiprednisolone for the treatment of pemphigus, and to long acting tetraeosactrin (Synacthen Depot) injections with concurrent azathioprine for rapid control of bullous pemphigoid in the elderly. The great value of topical and intralesional steroid therapy used in conjunction with an anti-staphylococcal systemic antibiotic is stressed.     

Minocycline-induced hyperpigmentation: rapid resolution after 755nm alexandrite picosecond laser treatment

ABSTRACT

Minocycline-induced pigmentation (MIP) is an infrequent complication of minocycline therapy, with four subtypes each with distinct clinical features and histologic staining patterns. MIP may resolve following discontinuation of minocycline therapy or it may persist indefinitely. A 64-year-old Caucasian male presented with a 6 month history of progressive blue-gray facial pigmentation distributed symmetrically over his face. One session utilizing a 755 nm picosecond Alexandrite laser resulted in immediate and significant clearance of the pigment in all treated areas. Long-term follow-up at 2 years revealed no recurrence of the MIP.