Linear pemphigus vulgaris after X-ray irradiation

The authors report the case of a 64-year-old female with a pemphigus vulgaris that relapsed on her left cheek following X-irradiation. The lesion developed not only on the irradiated area but also along a linear streak. Blaschko lines seem to represent the linear systematization pattern more likely to account for this unusual distribution.     

Discoid lupus erythematosus exacerbated by X-ray irradiation

We describe a patient, previously known to have discoid lupus erythematosus (LE) developing a LE rash in the precise distribution of radiation therapy given for the treatment of a bronchogenic neoplasm.     

Exacerbation of pemphigus by rifampicin

Rifampicin therapy caused exacerbation of skin lesions, rising serum pemphigus antibody titres, and decreased serum betamethasone levels in a 59-year-old man with pemphigus vulgaris. Exacerbation of pemphigus was confined to the period of rifampicin therapy and seems to be best explained by the effect of rifampicin on the metabolism of betamethasone. Physicians prescribing rifampicin for the treatment of tuberculosis should be aware of its potential to produce such an important adverse reaction.     

Herpetiform pemphigus induced by penicillamine

A patient with arthritis is described who developed a dermatitis herpetiformis-like rash after 8 months of D-penicillamine therapy and which cleared soon after the drug was discontinued. The histopathological findings were compatible with a diagnosis of pemphigus, showing intra-epidermal vesicles and spongiosis but no acantholysis. Intercellular antibody was detected by indirect immunofluorescence at the onset of the eruption (titre 1 in 160) and also found in serum taken prior to penicillamine treatment (titre 1 in 20). It is now well known that D-penicillamine can induce pemphigus. The findings reported here suggest the possibility that the patient was predisposed to develop the eruption before the drug was given.     

Paraneoplastic pemphigus triggered by radiotherapy

Paraneoplastic pemphigus is a recently described autoimmune disease characterized by painful mucosal ulceration and polymorphous skin lesions in association with an underlying neoplasm. Distinct autoantibodies bind desmoplakin I, desmoplakin II, bullous pemphigoid antigen and an uncharacterized 190kDa antigen. A case is presented of paraneoplastic pemphigus that developed after radiotherapy for non- Hodgkin's lymphoma in a 53 year old man. Multiple skin biopsies showed a lichenoid reaction without acantholysis. Immunofluorescence and mucosal biopsies were required to establish the correct diagnosis. Corneal opacities resembling lichenoid graft-versus-host disease and retinal haemorrhages, which developed in the patient, have not been previously documented. Despite high doses of immunosuppressive agents and plasmaphoresis, the patient eventually died from respiratory failure.     

Induction of Darier's disease by repeated irradiation by ultraviolet B; protection by sunscreen and topical ascorbic acid

Darier's disease, keratosis follicularis, is frequently aggravated by sun exposure. Although there have been reports of Darier's disease reproduced by repeated exposure to ultraviolet B, little is known about its photo-protection. We artificially induced Darier's disease in a 47-year-old Korean man, and tested the protection afforded by sunscreen and topical ascorbic acid. Complete lesions of Darier's disease arose with repeated exposure of ultraviolet B (2,600 mJ/cm2 for 10 days), and sunscreen and topical ascorbic acid protected against its appearance. This result strongly suggests that sunscreen and ascorbic acid would be very helpful in preventing the aggravation of Darier's disease caused by sun exposure.     

X-ray irradiation of dermatoses in the genital area]

Report on empirical data of X-ray treatment of dermatoses in the genital area, concerning indications, technique and results. Irradiations are mainly successful in large patches of Bowen's disease and Bowen's carcinoma as well as in Queyrat's erythroplasia and Paget's disease. Carcinomata of the penis should not exceed the stages T1-T2. Regression of Peyronie's disease is accelerated. Psoriatic lesions disappear following Grenz-rays without further topical treatment. Grenz-rays can also prevent or delay local recurrences of herpes simplex eruptions in the genital area.     

Three cases of transition from pemphigus vulgaris to pemphigus foliaceus confirmed by desmoglein ELISA

We report 3 cases of pemphigus vulgaris (PV) confirmed by histology and direct and indirect immunofluorescence that showed transition to pemphigus foliaceus (PF) 2-4 years from the time of disease onset. Desmoglein (Dsg) ELISA testing of the sera from these 3 patients in the later stages of their disease showed the presence of anti-Dsg1 antibodies and the absence of anti-Dsg3 antibodies. These patients were on prednisolone and immunosuppressives at the time the sera were tested, and it is unclear if the transition from PV to PF is a permanent one or whether it is due to preferential suppression of Dsg3 antibodies below a certain threshold. Previously reported cases of transition from PV to PF and PF to PV are summarized.     

Induction of matrix metalloproteinase-9 secretion from human keratinocytes in culture by ultraviolet B irradiation

BACKGROUND: Matrix metalloproteinases (MMPs) are known as important enzymes involved in tissue metabolism. Among them, MMP-2 and MMP-9 are termed gelatinases, but their specific roles in vivo are still unknown, including their expression patterns following ultraviolet (UV) irradiation. OBJECTIVE: To elucidate the effects of UV irradiation on the skin, we analyzed the expression of MMP-2 and MMP-9 by primary human keratinocytes in culture. METHODS: We evaluated the enzymatic functions of MMP-2 and MMP-9 by gelatin-zymography, and of MMP-9 expression by immunofluorescence, using cultured keratinocytes after UV irradiation. RESULTS: The secretion of MMP-2 (72 kDa) remained at low levels under all conditions examined. Although MMP-9 (92 kDa) secretion was not induced by UVA, it was stimulated by UVB irradiation in a dose-dependent manner. In addition, an enzyme-linked immunosorbent assay showed the tendency to increase for the involucrin expression following UVB exposure. Cell viability was decreased by UVB irradiation in contrast to the induction of MMP-9 and involucrin. CONCLUSION: These results suggest that the induction of MMP-9 secretion is related to the inflammation including apoptosis of keratinocytes resulting from UVB irradiation.