What's new in pediatric dermatology in 2011?

Based on the review of the medical publications, this article summarizes the main advances in the field of pediatric dermatology which occurred during the last year. The main results concern psoriasis, atopic dermatitis, acne and hemangiomas. A particular attention was given to genodermatoses.     

Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999

Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

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Antécédents: Au cours des dernières décennies, le taux dincidence des mélanomes au sein des populations blanches a augmenté de façon considérable. Une légère hausse a été observée dans le taux de mortalité liée à cette condition. Les survies par cause et sans récidive sont fonction des caractéristiques de la tumeur et possiblement de son site, ainsi que du sexe et de lâge du patient. Il est difficile dévaluer précisément ces tendances sans les données, souvent inexistantes, sur lépaisseur de la tumeur. Objectif: Létude détermine les tendances de lincidence des mélanomes, de la mortalité et de la survie en Saskatchewan au cours dune période de trente ans, et comporte une analyse de lépaisseur des tumeurs. Méthodes: Des données sur des cas de mélanomes primitifs durant un intervalle de 30 ans (1970–1999) ont été obtenues du Saskatchewan Cancer Registry. Un échantillon randomisé de 50% des dossiers a été examiné en vue de tirer de linformation sur lindice de Breslow, le niveau dinvasion de Clark et autres données démographiques qui ne figurent pas dans le registre. Une analyse multivariable de régression a été effectuée afin de déterminer limportance des facteurs de pronostic sur lincidence et les taux de survie de cinq ans. Résultats: Le nombre de patients inscrits a augmenté considérablement au cours de la durée de létude. Une hausse marquée des cas de lésions minces a été notée dans toutes les fourchettes dâge. Les sites des tumeurs varient selon le sexe. Les risques que présentent les tumeurs à la tête et à la nuque augmentent avec lâge. Le taux de mortalité chez les femmes sest stabilisé avec le temps; le taux de mortalité chez les hommes a augmenté durant les années 1990. Les facteurs influant sur le pronostic de cinq ans sont lépaisseur de la tumeur, le niveau dinvasion de Clark et le sexe du patient. Conclusion: Laugmentation observée des cas de mélanomes semble réelle et non le résultat dun meilleur suivi ou dun dépistage plus efficace. Les caractéristiques des tumeurs (indice de Breslow et niveau de Clark) et le sexe des patients sont des indicateurs dun pronostic de surmortalité de cinq ans.

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Support for this work was provided by the College of Medicine, University of Saskatchewan Scholarship Fund. Presented at the Canadian Dermatology Association 76th Annual Meeting, Halifax, Nova Scotia, July 2001.     

Pathergy reaction in different body areas in Behçet's disease

Behçet's disease (BD) is a chronic inflammatory multisystemic disorder characterized mainly by vasculitis. Although the pathergy reaction (PR) has been accepted as one of the major criteria in this disease, there is a lack of a standardized method to measure PR. The aim of this study was to evaluate results of PR in different body areas and the effect on the positive rate of PR of application of numerous needle pricks. The pathergy test was performed using simultaneous 16 needle pricks with 20G disposable needles on different body areas of 56 patients with BD, 49 patients with recurrent aphthous stomatitis (RAS) and 17 healthy subjects. No positive PR was found in healthy controls, but was observed in nine patients with RAS (18.3%). It was detected in 48 of 56 patients with BD, a positive rate of 85.7%. The site most frequently positive for PR was the forearm, while the least frequent was the abdomen. Multiple needle pricks could play an important role in increasing the positive rate of PR in BD, and it may be important in the investigation of aetiological factors in RAS.     

Tumor vaccines: a role in preventing recurrence in melanoma?

Patients presenting with thick primary melanomas or those with regional nodal metastases have a high risk of recurrence after surgery alone. Chemotherapy has limited efficacy in the adjuvant setting, and while the use of high-dose interferon in the adjuvant setting has been reported to improve survival, treatment with interferon is not without significant cost and toxicity. Mounting evidence suggests a prominent role for the immune system in the natural history of melanoma, and the clinical success of interferon highlights the potential for immunotherapy to prevent recurrence. Many researchers hope to use melanoma vaccines to reduce recurrence without significant toxicity, and many different vaccine strategies are under investigation. Peptide vaccines attempt to induce immunity to melanoma MHC-restricted peptide antigens by delivering the peptide to the patient along with an immune adjuvant meant to induce inflammation and stimulate immunity. While peptide vaccines have advantages with regard to cost and feasibility, it is still unclear whether highly purified peptides will stimulate an adequate immune response. An alternative approach is the use of cellular vaccines. Autologous cellular vaccines present all biologically relevant antigens to the immune system, but this is limited to individuals with sufficient tumor to prepare a vaccine. Allogeneic cellular vaccines are based on the fact that melanoma-associated antigens are shared among a large number of patients, so a vaccine prepared from a cultured cell line could stimulate an anti-tumor immune response in many patients. Allogeneic vaccines are available for all patients, and can be standardized, preserved and distributed in a manner akin to any other therapeutic agent. Because of this, they are more readily available for evaluation in large trials, and there are two major allogeneic vaccines presently being evaluated as an adjuvant therapy for melanoma. Several additional approaches to vaccine therapies are being investigated including among others ganglioside vaccines, viral oncolysates, cytokine gene-modified tumor cell vaccines, dendritic cell vaccines, anti-idiotype antibodies and DNA vaccines. While there appears to be tremendous potential for vaccines, it must be remembered that there has been significant interest in immunotherapy for melanoma for over 50 years and, to date, no large prospective, randomized trial has shown a survival benefit.     

Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996–2002: prevention failure?

OBJECTIVE: To investigate trends in homosexual men's sexual risk behaviour for HIV infection in Scotland. METHODS: Cross sectional surveys in 1996, 1999, and 2002 were carried out in "gay" bars in Glasgow and Edinburgh, Scotland. 6508 men-2276 (79% response rate) in 1996, 2498 (78%) in 1999, and 1734 (62%) in 2002. RESULTS: In 1996, 10.7% of men surveyed and in 1999, 11.2% reported unprotected anal intercourse (UAI) with casual partners, compared with 18.6% in 2002 (p < 0.001). There was also a significant increase in men reporting that they "knew" their casual partners' HIV status, despite no increase in HIV testing among men who reported UAI with casual partners. In 2002, increases in UAI with more than one partner, in UAI with casual partners and in reporting seroconcordance remained significant after adjusting for confounding factors including HIV testing status and demographic characteristics. CONCLUSIONS: High risk sexual behaviour among homosexual men in Scotland increased between 1999 and 2002. Men showed increased confidence of shared antibody status, despite no increase in HIV testing, or evidence of discussion of HIV status. Explanations for this must include consideration of a cultural shift in the perception of HIV and "prevention failure" on the part of governments and health agencies.     

Β-Adrenergic receptors in psoriasis: evidence for down-regulation in lesional skin

Lesional psoriatic skin displays reduced responsiveness to -adrenergic stimulating agents. To elucidate whether the receptor protein itself is responsible for this, lesional and non-lesional psoritatic skin was investigated ex vivo for maximal -adrenergic binding density (B _max) and -adrenergic binding affinity (K _D). Epidermal crude membrane homogenates (ECMH) were prepared from split-thickness skin biopsies and saturated with the lipophilic -adrenergic antagonist (—)-¹²⁵I-iodocyanopindolol (ICYP) as radioligand. Specific binding was saturable and Scatchard transformation of the binding data revealed a homogeneous class of -adrenergic receptors in all nine experiments. The maximal -adrenergic binding density was significantly less in lesional than in non-lesional psoriatic skin (B _max=49.7 ± 7.2 fmol/mg protein vs. 67.1 ± 2.2 fmol/mg protein, n=9, P<0.05). The binding affinity was similar in lesional and in non-lesional skin (K _D=9.0 ± 1.5 pmol/l vs. 8.0 ± 0.9 pmol/l). These results could at least partially explain the reduced responsiveness of the -adrenergic system in lesional psoriatic skin seen after stimulation with -adrenergic agonists.     

How fast are UV-dimers repaired in human skin DNA in situ?

Sheehan et al (2002) published a paper on UV-dimers in human skin and their repair with contradictions in their own data. In one experiment they applied two doses, 0.65 and 2 MED, but the apparent dimer levels, measured by a immunohistochemical technique, only increased in skin of type II (Fig 2a). The authors offered as explanation that the level of DNA damage would saturate. The dimer levels reached are at around 1 dimer per 1 million nucleotides, and there has been no evidence for saturation when a quantitative postlabeling technique has been used (Bykov et al, 1998). There is no reason for saturation until most of the thydmidyl-thymidine positions would be occupied in DNA, which, based on literature with other intrastrand cross-linkers, would require dimer levels 1 : 100 (F?rsti et al, 1989), or 10,000 times higher levels of dimer than that obtained by an irradiation at a MED dose.     

Experimental study of δ-ALA-PDT in the treatment in BXSB lupus-prone mice

Extracorporeal photochemotherapy can correct immune disease and treat many autoimmune diseases. The aim of this study was to investigate the effects of delta-aminolevulinic acid photodynamic therapy (δ-ALA-PDT) on BXSB mouse. The 24-h urine protein, titers of serum antinuclear antibodies, peripheral blood lymphocyte apoptosis and deposition of immune complex in renal glomeruli were determined in BXSB mice after δ-ALA-PDT treatment. Results showed that δ-ALA-PDT treatment could reduce 24-h urine protein, titers of serum antinuclear antibodies, and deposition of immune complex in renal glomeruli. The δ-ALA-PDT treatment could also lead to significant increase in the rate of peripheral blood lymphocytes.     

“Pseudo” Nomenclature in Dermatology: What's in a Name?

In the bewildering array of scientific nomenclature in the medical field, it is important to use correct terminology, know their aberrations and the reason behind a specific terminology. This paper is an attempt towards compiling all the pseudo-nomenclatures coined in dermatology, in order to make it easier to retain and recollect these pseudo names, signs, morphology, diseases, and conditions. It is also imperative to know the true entities that these pseudo names masquerade as, so as to understand the explanation for assigning the term ‘pseudo’ to these conditions. A total of 52 pseudo-terms have been compiled here in reference to dermatology. Most of these pseudo-nomenclatures were coined due to some clinical or histopathological resemblance to the true conditions, while some were premature conclusions drawn from a flawed understanding of the basic nature of the condition. Clear understanding of each of these terms and the explanation behind them being pseudo will enable a dermatologist to avoid misdiagnosis and needless confusion.     

Pentoxifylline--efficient in the treatment of venous ulcers in the absence of compression?

The aim of the study was to test the efficacy and tolerability of pentoxifylline on the healing of venous ulcers in the absence of standard limb compression. The study used a prospective randomized, open, controlled, comparative, parallel group design. The study included 80 eligible patients with confirmed venous ulcers (with clinical and photoplethysmography findings). The patients received either pentoxifylline 1200 mg per day (3 x 400 mg) orally in addition of local therapy, or the same local therapy alone. The main outcome measures were complete healing of ulcers, change in the ulcer area over the six-month observation period, and tolerability of the drug. The results showed that complete healing occurred in 23 (57.5%) patients receiving pentoxifylline and 11 (27.5%) patients without pentoxifylline (log rank test =2.49, p=0.013). Unwanted effects of pentoxifylline occurred in 11/40 (27.5%) patients but were mild. Pentoxifylline is concluded to be efficacious in healing of venous ulcers in patients unable to tolerate compression therapy.     

Wunder in der Dermatologie?

Miracles which can be observed in different religions are often closely connected to medicine. These miraculous cures, considered to be inexplicable by medical science, have been documented in Christian religion and in occidental culture for more than 2000 years. These miraculous healings are also reported in the field of dermatology. The miraculous bulletins documented by the Catholic Church take their beginning in the Old Testament and extend to the miraculous cures of Lourdes in present time. We provide an overview of miraculous healings of skin diseases, whereby accounts documented in the Bible, reports during the Middle Ages, and cases documented throughout the last century are discussed. In view of modern medicine, most of the miraculous healings do not meet modern demands of science, but remain important as milestones in medical and religious history.