Heterogeneity of serum IgE levels in atopic dermatitis

To determine whether serum IgE levels in patients with atopic dermatitis (AD) have a relationship to familial background of atopic respiratory disease (ARD), serum IgE levels were measured in 50 AD patients who had personal history of ARD, 37 AD patients who did not have personal history of ARD but had family history of ARD, and 52 "pure" AD patients who had neither personal nor family history of ARD. The "pure" AD patients showed significantly lower serum IgE levels than AD patients who had personal or family history of ARD. It is suggested that AD patients may be classified into at least two subgroups: those with ARD predisposition who have an enhanced IgE producing potential, and those without ARD predisposition who have a low or not-enhanced ability for IgE production.     

过敏性皮肤病患者血清吸入性过敏原特异性IgE研究

为了了解吸入性过敏原在过敏性皮肤病中的作用，采用酶联免疫吸附试验检测148例荨麻疹，138例湿疹和49例异位性皮炎血清屋尘，尘螨，霉菌，豚草花粉，艾蒿花粉，树花粉等6种常见吸入性过敏原特异IgE。结果显示70．9％荨麻疹，79．0％湿疹和77．6％异位性皮炎患者血清中至少有一种吸入性过敏原特异IgE为阳性，均显著高于健康对照组13．0％的阳性率（P＜0．01），有异位性病史的异位性皮炎患者血清吸入性过敏原特异IgE的阳性率为90．3％，显著高于无异位性病史者的阳性率58．3％（P＜0．05），提示吸入性过敏原诱发的I型变态反应在荨麻疹，湿疹和异位性皮炎的发病中起了一定作用，并且有异位性病史的异位性皮炎患者比无异位性病史的患者对吸入性过敏原敏感。     

Tick-borne dermatologic diseases

Inquiries regarding tick exposure can be important in dermatologic diagnosis and treatment since ticks can be vectors of a diversity of infectious diseases. The classic teaching is that ticks are best removed with nail polish, solvents, petrolatum, mineral oil, or a hot match. However, a recent evaluation of tick removal revealed that mechanical removal with forceps preceded and followed by disinfection is the most effective method. In most cases, should the characteristic dermatologic lesion or systemic symptoms appear, appropriate treatment should be initiated for presumptive diseases.     

Total and specific IgE levels in patients with atopic dermatitis

Ten young adults with chronic atopic dermatitis have been followed for up to 18 months through periods of clinical exacerbation and remission. Sequential estimation of total levels of circulating IgE and specific IgE by the radioallergosorbent technique (RAST) showed no significant correlation between IgE levels and severity of skin involvement. However, a clear correlation between clinical history, prick tests and RAST tests was obtained in several cases. Serum IgE levels in seven patients with ‘pure’ atopic dermatitis were elevated to levels similar to those found in three patients with additional respiratory symptoms.     

秋水仙碱在皮肤科中的应用

秋水仙碱是从植物中提取的一种生物碱,最早用于治疗急性痛风,多年来被广泛应用于临床,治疗多种疾病。秋水仙碱的疗效显著,副作用较少,虽然在皮肤科领域并没有明确的适应症,但其在皮肤科的临床应用范围却很广泛,尤其适用于有中性粒细胞浸润的疾病。     

New drugs for dermatologic diseases

Since its isolation less than 20 years ago, cyclosporine has become one of the major drugs in the armamentarium of transplant surgeons. A serendipitous event in 1979 suggested the drug might offer significant benefits in patients with psoriasis. Multiple trials have subsequently confirmed its usefulness in psoriasis at steadily decreasing dosages. Administered orally, the drug must be taken in a ritualistic fashion as it tends to sequestrate on the sides of the glass. A routine determination of blood levels becomes important in order to maintain the peak and trough concentrations within a relatively narrow window of safety. Depending on the particular assay used, significant differences in concentrations appear, making knowledge of the laboratory's normal values essential. Blood levels of cyclosporine vary with multiple drugs, including erythromycin, prednisone, and ketoconazole. The drug acts principally via its interference with the function of the helper T lymphocytes. Clofazimine (Lamprene) offers another weapon, especially for therapy of resistant pustulosis of the palms and soles.     

The matriptase-prostasin proteolytic cascade in dermatologic diseases

The proper development and function of skin and hair are dependent on proteolytic activities. Specifically, the matriptase-prostasin cascade is a series of proteolytic reactions in the epidermis integral to normal regulation of desquamation. An increasing amount of research describing this pathway has recently become available, and the importance of this pathway is exhibited by the association of genetic defects in this pathway with human diseases of the skin and hair. Given the relevance of this pathway to dermatology, we provide a review of the current understanding of its relevance to distinct clinical entities, including ichthyosis-hypotrichosis and Netherton syndromes.     

Diagnostic reliability of the Tzanck smear in dermatologic diseases

Background The Tzanck smear is a simple, easily applicable, rapid, and inexpensive test for the diagnosis of erosive vesiculobullous, tumoral, and granulomatous diseases. The diagnostic accuracy of the Tzanck smear is known, but its diagnostic reliability has been evaluated only in herpetic infections and basal cell carcinoma. Objectives The aim of this study was to evaluate the diagnostic reliability of the Tzanck smear in erosive vesiculobullous, tumoral, and granulomatous diseases. Methods Patients evaluated by Tzanck smear at Ba?kent University Faculty of Medicine, Department of Dermatology, between February 2009 and July 2010, were included. Three dermatologists were involved in the study. Dermatologist A performed a clinical dermatologic examination, took the smear material, made a clinical diagnosis, and compared the clinical and cytological diagnoses. Dermatologists B and C evaluated the smears. Agreement between the latter two dermatologists on the cytological diagnoses was determined. Results In 500 patients, a total of 272 (54%) erosive vesiculobullous, 190 (38%) tumoral, and 38 (8%) granulomatous lesions were diagnosed. The diagnostic reliability of the Tzanck smear was reasonably substantial (κ = 0.59) for all types of lesions, substantial for erosive vesiculobullous (κ = 0.79) and granulomatous (κ = 0.68) lesions, and moderate (κ = 0.50) for tumoral lesions. Conclusions The Tzanck smear may be used for the evaluation of erosive vesiculobullous and granulomatous lesions with brief training. However, the evaluation of tumoral lesions by Tzanck smear requires more experience.     

Review of teleconsultations for dermatologic diseases

BACKGROUND: Telemedicine has been increasingly used in some areas to provide consultation for isolated populations that might otherwise have difficulty accessing specialty care. Little information exists on what types of patients or diseases are being seen in dermatology telemedicine consultation services. OBJECTIVE: To review our consultations done over a regional telemedicine network with an emphasis on looking at what type of patient, cutaneous diseases, and diagnostic or therapeutic recommendations were made. RESULTS: Between August 1992 and December 1997, 796 teleconsultations were done. The most common diagnoses made were eczemas, follicular based diseases, skin infections, and skin tumours. Steroids were the most commonly recommended therapy, along with antibiotics, antihistamines, and antifungal therapy. Diagnostic recommendations commonly made were a skin biopsy and potassium hydroxide preparation. CONCLUSIONS: Common skin problems were seen by our dermatology teleconsultation service. A significant number of diagnostic biopsies and potassium hydroxide preparations were recommended. The efficacy of telemedicine in the delivery of dermatologic care is reviewed.     

Vaccines for viral diseases with dermatologic manifestations

Vaccines against infectious diseases have been available since the 1800s, when an immunization strategy against smallpox developed by Jenner gained wide acceptance. Until recently, the only vaccination strategies available involved the use of protein-based, whole killed, and attenuated live virus vaccines. These strategies have led to the development of effective vaccines against a variety of diseases with primary or prominent cutaneous manifestations. Effective and safe vaccines now used worldwide include those directed against measles and rubella (now commonly used together with a mumps vaccine as the trivalent MMR), chickenpox, and hepatitis B. The eradication of naturally occurring smallpox remains one of the greatest successes in the history of modern medicine, but stockpiles of live smallpox exist in the United States and Russia. Renewed interest in the smallpox vaccine reflects concerns about a possible bioterrorist threat using this virus. Yellow fever is a hemorrhagic virus endemic to tropical areas of South America and Africa. An effective vaccine for this virus has existed since 1937, and it is used widely in endemic areas of South America, and to a lesser extent in Africa. This vaccine is recommended once every 10 years for people who are traveling to endemic areas. Advances in immunology have led to a greater understanding of immune system function in viral diseases. Progress in genetics and molecular biology has allowed researchers to design vaccines with novel mechanisms of action (eg, DNA, vector, and VLP vaccines). Vaccines have also been designed to specifically target particular viral components, allowing for stimulation of various arms of the immune system as desired. Ongoing research shows promise in prophylactic and therapeutic vaccination for viral infections with cutaneous manifestations. Further studies are necessary before vaccines for HSV, HPV, and HIV become commercially available.