Second Intention Healing after Shave Excision of Benign Tumors on the Lid Margin

Background

Defects caused by excision of benign lid margin tumors are conventionally repaired by reconstructive surgery. However, second intention healing is another option for managing wounds on the lid margin.

Objective

To evaluate the effectiveness of second intention healing after a shave excision of benign tumors on the lid margin.

Methods

Lid defects following a shave excision of the lid margin tumor were allowed to heal by second intention in 25 patients (26 lesions). The epithelialzation period was calculated, and cosmetic and functional results and complications were evaluated by photographs and ophthalmological examination.

Results

The locations of the defects were as follows: upper lid (n=13), lower lid (n=11), and both upper and lower lids (n=1). The mean tumor size was 3.8×3.6 mm, and the mean epithelialization period by second intention was 6.1±1.2 weeks. Pathological examinations revealed intradermal nevus (12 cases), compound nevus (five cases), squamous papilloma (five cases), and epidermal cyst (three cases). No patients had a corneal erosion, trichiasis, or hypertrophic scar, except loss of cilia in two cases. The functional and cosmetic results were satisfactory in all patients.

Conclusion

Healing by second intention is a safe and effective alternative to surgical reconstruction after a shave excision of benign lid margin tumors.     

Pustular eruption after drug exposure: is it pustular psoriasis or a pustular drug eruption?

Generalized pustular eruptions with fever present a diagnostic challenge. A history of preceding drug exposure, and rapid disappearance of the eruption after the drug is stopped, suggest a drug-induced aetiology rather than pustular psoriasis. We describe and evaluate the clinical and histological features of four patients who developed a generalized pustular eruption following drug administration. The history of preceding drug exposure and the presence of a variable number of eosinophils in the inflammatory infiltrate in the lesions of these cases suggested that the generalized pustular eruptions were drug-induced.     

Interleukin-15 is not a constitutive cytokine in the epidermis, but is inducible in culture or inflammatory conditions

The regulation in the skin of interleukin-15 (IL-15), a potent modulator of T-cell-mediated immune responses, is not fully understood. We investigated the levels of IL-15 and its mRNA produced by epidermal and cultured keratinocytes and found that normal keratinocytes did not constitutively express IL-15 in the epidermis, but in culture began to produce the cytokine. Some epidermal keratinocytes expressed IL-15 in inflammatory conditions associated with infiltration of neutrophils and eosinophils. IL-15 was detected only in the cell lysates, not in the supernatants of cultured keratinocytes. Dexamethasone (10(-5)-10(-6) M) markedly inhibited IL-15 mRNA expression by normal and transformed keratinocytes in a range of pharmacological concentrations. IFN-gamma (200 and 400 U/ml) slightly increased the IL-15 message level in a squamous cell carcinoma cell line, HSC-5, in a dose-dependent fashion, whereas no significant change was observed in cultured normal human keratinocytes. Our data indicate that IL-15 is not a constitutive cytokine in epidermal keratinocytes but is inducible.     

Changes in the dermoscopic appearance of melanocytic naevi after photochemotherapy or narrow-band ultraviolet B phototherapy

BACKGROUND: Although phototherapeutic modalities are commonly used for the treatment of skin diseases, the effects of therapeutic ultraviolet (UV) irradiation on the dermoscopic appearance of melanocytic naevi are unknown. OBJECTIVES: We aimed to analyse the effects of photochemotherapy (psoralen plus ultraviolet A, PUVA) and narrow-band ultraviolet B phototherapy (NB-UVB) on the dermoscopic appearance of naevi. PATIENTS AND METHODS: We monitored 187 melanocytic naevi of 38 patients receiving NB-UVB or PUVA treatment for miscellaneous skin diseases. Dermoscopic images of naevi were taken before, shortly after, and after a median of 31 weeks after the UV therapy. A random selection of naevi was covered during UV treatment, the others remained uncovered. Baseline and follow-up images of naevi were viewed side by side on a computer screen to compare size, pigmentation, and dermoscopic structure of naevi. RESULTS: Twenty-one patients received NB-UVB treatment, and 17 patients received PUVA treatment. Of 187 naevi, 70 (37%) were covered and 117 (63%) were uncovered during UV treatment. When NB-UVB- and PUVA-treated patients were analysed together, an increase in size of uncovered lesions was seen in both treatment groups. Pigmentation appeared darker at the end of UV treatment in 67.5% (n=79) of uncovered naevi compared with 41.4% (n=29) of covered naevi (P<0.001). In patients receiving NB-UVB therapy, a significant increase in the number of dots or globules in 20.3% (n=14) of uncovered naevi compared with only 5.0% (n=2) of covered naevi (P=0.03) was found. This effect was not observed after PUVA therapy. With the exception of four naevi with continuous enlargement and seven naevi with a persisting increase in dots and globules, the observed changes were reversible. All naevi with persistent changes belonged to the NB-UVB group. CONCLUSION: In general, PUVA and NB-UVB therapy cause reversible dermoscopic changes in melanocytic naevi. Increase in dots and globules is more frequent with NB-UVB.     

The neuroendocrine peptide catestatin is a cutaneous antimicrobial and induced in the skin after injury

Epithelia establish a microbial barrier against infection through the production of antimicrobial peptides (AMPs). In this study, we investigated whether catestatin (Cst), a peptide derived from the neuroendocrine protein chromogranin A (CHGA), is a functional AMP and is present in the epidermis. We show that Cst is antimicrobial against relevant skin microbes, including gram-positive and gram-negative bacteria, yeast, and fungi. The antimicrobial mechanism of Cst was found to be similar to other AMPs, as it was dependent on bacterial charge and growth conditions, and induced membrane disruption. The potential relevance of Cst against skin pathogens was supported by the observation that CHGA was expressed in keratinocytes. In human skin, CHGA was found to be proteolytically processed into the antimicrobial fragment Cst, thus enabling its AMP function. Furthermore, Cst expression in murine skin increased in response to injury and infection, providing potential for increased protection against infection. These data demonstrate that a neuroendocrine peptide has antimicrobial function against a wide assortment of skin pathogens and is upregulated upon injury, thus demonstrating a direct link between the neuroendocrine and cutaneous immune systems. JID JOURNAL CLUB ARTICLE: For questions, answers, and open discussion about this article please go to http://network.nature.com/group/jidclub.