Papulonecrotic tuberculid with inflammatory nodular lesions of the lower leg: a report of two cases

Two cases of papulonecrotic tuberculid (PNT) with inflammatory nodules of the lower leg are reported. One is a 43-year-old woman with lymphadenitis tuberculosa, and the other is a 54-year-old man with penis tuberculid and epididymitis of possible tuberculous etiology. In both cases, PPD skin test was strongly positive, and antituberculous therapy was markedly effective. Although the theory of the etiology of PNT is changing due to the recent decrease in active tuberculosis, we think that one cause of so-called PNT is still tuberculosis, at least in Japan.     

Papulonecrotic Tuberculid in a 2-Year-Old Girl: With Emphasis on Extent of Disease and Presence of Leucocytoclastic Vasculitis

Abstract: The clinicopathologic features of childhood papular necrotic tuberculid (PNT) have been detailed in 10 patients. PNT is characterized by symmetric, acral papular lesions that undergo necrosis. Despite widespread cutaneous involvement, the number of lesions is usually sparse. The extensor aspects of the limbs are usually involved and trunk involvement is uncommon. Vasculitis, an integral component of PNT, has been documented only once in childhood PNT. We describe PNT in a 2-year-old girl in whom a multitude of lesions were present all over the body, including unusual involvement of flexor surfaces of the limbs, trunk, perineum, and vulva. Biopsied tissue revealed the characteristic features of PNT, including leucocytoclastic vasculitis. There was prompt response to antituberculous therapy. Based on the findings in this patient, we believe that the clinical spectrum of this eminently treatable disease in children must be expanded in terms of distribution and number of lesions to include extensive limb and trunk, perineal, and vulval involvement; the histopathologic spectrum of childhood PNT must include leucocytoclastic vasculitis; and adult and childhood PNT share common histopathologic features, including a common cellular immunohistochemical profile, thereby suggesting a common pathogenesis.     

Tuberculids as sentinel lesions of tuberculous epididymo-orchitis

BACKGROUND: Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids. METHODS: A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out. RESULTS: Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3-34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions. CONCLUSION: Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids.     

Papulonecrotic tuberculid. Identification of Mycobacterium tuberculosis DNA by polymerase chain reaction.

Sections from 22 formalin-fixed, paraffin-embedded skin biopsies from 12 patients with papulonecrotic tuberculid (PNT) were examined for the presence of Mycobacterium tuberculosis DNA with use of the polymerase chain reaction. All patients had a positive tuberculin skin test and a compatible clinical picture and responded to antituberculous therapy. Histological examination showed the typical morphology of PNT lesions with dermal necrosis surrounded by an ill-formed granulomatous infiltrate. Mycobacterial DNA was detected in 11 of the 22 biopsies. None of the negative controls showed positive DNA identification by amplification. Great care was taken in avoiding false-positive results due to contamination. After reviewing the literature, we believe this is the first time that PNT lesions have been investigated by PCR for the presence of mycobacterial DNA. These findings provide direct proof that mycobacterial products are present in PNT lesions and support the theory that this organism is in some way responsible for the development of PNT.     

Recurrences of gonorrhea in men (the characteristics of the course and treatment)

The examination has involved 218 patients. The incidence of relapses in acute and subacute gonorrhea has made up 6.3%, 5.2% in chronic and 4.5% in complicated condition. Recurrences were observed in 5.3 days on an average after therapy of new gonorrhea cases and in 8.8 days after treatment of chronic disease. Mixed urogenital infection was recorded in 37.8% of cases; in gonorrhea eventuating in clinical cure it was observed in 24% of cases. Relapses developed in 50.2% of patients after antibiotic therapy and in 49.8% after combined treatment. A single relapse occurred in 85.6% of patients; two and more relapses in 14.4%. The disease recurred after penicillin therapy in 6.5% after aminoglycosides in 6.9%, and after tetracyclin treatment in 4.2% of cases. Therapy with proteolytic enzymes (chymotrypsin, trypsin 5 mg i.m. twice a day) combined with antibiotics resulted in etiological cure in 99.3% of patients, the incidence of postgonorrheal symptoms reduced and made up 6.8% (in the patients not administered protease this share made up 19.2%), and the length of inpatient treatment shortened by 8-14.6 days.     

Papulonecrotic tuberculid

Papulonecrotic tuberculid (PTB) is a form of cutaneous tuberculosis with characteristic clinical and histological manifestations. The incidence of PNT is very low in Spain. We present the case of a 22-year-old male patient from a middle-class social and economic background, with clinical and histological criteria of PNT, but who showed negative for molecular traces of mycobacteria using PCR.     

清热凉血汤治疗银屑病进行期临床及实验室观察

目的观察清热凉血汤治疗银屑病进行期的临床疗效及血液流变学变化。方法将63例患者随机分为两组,治疗组32例用清热凉血汤内服治疗,对照组31例用复方青黛胶囊治疗。结果严重程度指数(PASI)评分:两组治疗后与治疗前比较均明显降低(P<0.05),治疗后8周治疗组分值明显低于对照组(P<0.05)。总有效率治疗组(81.3%)明显优于对照组(51.6%)(P<0.01)。血液流变学检测:治疗组治疗前后各项指标差异均有明显统计学意义(P<0.01);对照组治疗前后各项指标比较差异无明显统计学意义(P>0.05);两组治疗前后各项指标比较差异有明显统计学意义(P<0.01)。结论清热凉血汤治疗银屑病进行期有较好的临床效果和改善血液黏稠度的作用。     

心理干预在大学生Ⅲ型前列腺炎中的临床疗效

目的:探讨心理干预在大学生Ⅲ型前列腺炎治疗中的临床疗效.方法:63例大学生Ⅲ型前列腺炎患者,随机分为实验组(心理干预联合药物治疗)32例和对照组(药物治疗)31例,分别于治疗前后依据美国国立卫生研究院慢性前列腺炎症状评分(NIH-CPSI)、疼痛不适评分、排尿症状评分、生活质量评分、总评分和焦虑自评量表(SAS)标准分进行评分,比较治疗后临床效果.结果:两组间治疗后 NIH-CPSI总评分、SAS标准分有统计学差异(P<0.05);实验组治疗前后 NIH-CPSI总评分有统计学差异(P<0.05),SAS标准分有统计学显著性差异(P<0.01);对照组治疗前后 NIH-CPSI总评分、SAS标准分有统计学差异(P<0.05).结论:心理干预联合药物治疗大学生Ⅲ型前列腺炎比单纯药物治疗效果显著.     

Angiosarcoma. A rare secondary malignancy after breast cancer treatment

Life-saving mastectomy and radiation therapy are established in the treatment of early stage breast cancer. Angiosarcoma, i.e. malignant angioendothelioma, is a rare tumor which can develop after several years of such treatment. The number of post-operative and post-irradiation angiosarcomas has increased in recent years. We report four cases of angiosarcoma which occurred after treatment of breast cancer and review the literature. In two of these cases the angiosarcoma developed on the irradiated breast skin after partial mastectomy and radiation therapy, in the other two cases the angiosarcoma appeared on a chronically edematous arm after radical mastectomy and radiation therapy.     

Clinical efficacy of paiteling in the treatment of condyloma acuminatum infected with different subtypes of HPV

Condyloma acuminatum (CA) is a type of mucosal benign hyperplasia skin disease that is caused by human papillomavirus (HPV) infection, which mainly occurs in the genitalia and anus. The aim of the present study was to explore the clinical efficacy underlying the traditional Chinese medicine paiteling in the treatment of CA via the detection of HPV. One hundred CA patients were enrolled in the current study and were externally treated with paiteling for 5 weeks. HPV subtypes were examined both before the treatment and at 6 months after the treatment. After the external paiteling therapy, 92 cases were cured, and the apparent efficiency was 92.0% (92/100), while 8 cases exhibited recurrence. Before the external paiteling therapy, the numbers of cases of low‐risk, high‐risk, and mixed types of HPV were 40, 35, and 25, respectively. At 6 months after treatment, the numbers of negative cases of low‐risk, high‐risk, and mixed types of HPV were 38, 32, and 20, respectively. The results demonstrated that external paiteling treatment has a good curative effect on the treatment of CA.     

中西医结合治疗结节性痒疹临床观察

目的探讨中西医结合治疗结节性痒疹的临床疗效。方法结节性痒疹湿热证患者94例,分为西医对照组45例和治疗组49例,两组患者均以西药常规治疗,对照组外用复方地塞米松霜,治疗组加用中药止痒汤并外用中成药冰黄肤乐软膏封包治疗,均10天为1个疗程,共用4个疗程。分别于第2、4个疗程结束后观察疗效,随访半年观察复发情况。结果两组有效率比较差异无显著性意义(χ2=1.92,P>0.05),但其治愈率、近期疗效、远期复发率和副作用方面,治疗组明显优于对照组。结论在西药治疗基础上加用中药止痒汤及冰黄肤乐软膏封包治疗对结节性痒疹具有良好的疗效。     

强脉冲光治疗雀斑的美容修复护理体会

目的探讨强脉冲光治疗雀斑术前及术后美容修复护理的重要性。方法将78例雀斑患者随机分为治疗组44例和对照组34例。治疗组在强脉冲光治疗前、后均使用美容仪器进行皮肤修复护理,并于术后选择胶原蛋白系列护肤品(商品名:露莲娜胶原蛋白系列,北京黄寺美容外科医院和北京奥通科技公司研制),对照组直接进行强脉冲光治疗。结果治疗组雀斑皮损改善有效率(90.91%)明显高于对照组(67.65%),两组差异有统计学意义(P<0.01);皮肤整体状态也较对照组明显改善。结论强脉冲光治疗雀斑结合系统的美容修复护理(面部皮肤护理配合使用胶原蛋白系列护肤品),有利于加快雀斑消退、修复皮肤组织的损伤,治疗效果和美容效果明显提高。     

Perforating Granuloma Annulare Mimicking Papulonecrotic Tuberculid

Perforating granuloma annulare (PGA), a rare variant of granuloma annulare, is characterized by transepidermal elimination of altered collagen that clinically manifests an umbilicated papule with a central crust. It can be confused with papulonecrotic tuberculid (PNT) because of their similar appearance. Unlike PGA, PNT is usually related to tuberculosis infection with a typical histologic finding of wedge-shaped dermal necrosis. Here, we report the first Korean case of PGA mimicking PNT both clinically and histologically. A 43-year-old Korean woman presented with erythematous papules localized on the extensor surface of her limbs for one year. Some of these papules had a central umbilication or a crust. Regarding comorbidity, she had latent tuberculosis diagnosed with QuantiFERON®-TB Gold test about five months ago. She was on antituberculous medication. Initially, a diagnosis of papulonecrotic tuberculid accompanied by latent tuberculosis was considered. However, despite taking the antituberculous medication for five months, her skin lesions were not improved. Biopsy specimen from her arm lesion showed wedge-shaped area of necrosis in the dermis. Additionally, there were multiple focal mucin depositions and palisading granulomatous inflammation throughout the dermis. A diagnosis of PGA was made and she was treated with topical corticosteroid. After two weeks of applying topical corticosteroid, most of her skin lesions disappeared, leaving some hyperpigmented scars.     

HLA‐DRB1*04:05 in two cases of Vogt–Koyanagi–Harada disease‐like uveitis developing from an advanced melanoma patient treated by sequential administration of nivolumab and dabrafenib/trametinib therapy

Although uveitis is reported as a rare adverse event (AE) associated with dabrafenib/trametinib therapy or nivolumab, the occurrence of severe uveitis is extremely rare. We describe two cases of Vogt–Koyanagi–Harada (VKH)‐like uveitis developing after the sequential administration of nivolumab and dabrafenib/trametinib therapy. Interestingly, both cases had HLA‐DRB1*04:05, which is strongly associated with VKH disease, and achieved biologically complete remission after the treatment for uveitis. Our cases suggest a possible correlation between VKH‐like uveitis as an AE and the clinical outcomes of sequential administration of nivolumab and dabrafenib/trametinib therapy for the treatment of advanced melanoma.     

Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma?

Metastatic renal cell carcinoma (mRCC) is a challenging disease. Despite the new targeted therapies, complete remissions occur only in 1%-3% of the cases, and the most effective first-line treatment drugs have reached a ceiling in overall survival (ranging from 9 to 49 mo). Metastasectomy remains to be the only curative option in most patients with mRCC. Prognostic nomograms have been recently published, so we have tools to classify patients in risk groups, allowing us to detect the cases with the higher risk of recurrence after metastasectomy. Although sparse, there is some evidence of effectiveness of neoadjuvant targeted therapy before metastasectomy; but with an increase in surgical complications due to the effects of these new drugs in tissue healing. We have aimed to answer the question: Is there a role for systemic targeted therapy after surgical treatment for metastases of renal cell carcinoma? We have made a search in Pubmed database. As far as we know, evidence is low and it’s based in case reports and small series of patients treated with adjuvant drugs after neoadjuvant therapy plus metastasectomy in cases of partial response to initial systemic treatment. Despite the limitations and high risk of bias, promising results and cases with long-term survival with this approach have been described. Two ongoing clinical trials may answer the question that concerns us.     

Itraconazole therapy in lymphangitic and cutaneous sporotrichosis

Itraconazole, a new orally absorbable azole derivative, was used for the treatment of 17 patients with cutaneous and lymphangitic sporotrichosis. The drug, administered at a dose of 100 mg/day, proved to be effective in all cases. Lesions disappeared and cultures became negative after 90 to 180 days of therapy. There were no major side effects. Posttherapy evaluations, done in 14 of 17 cases for an average of 115 days, revealed no relapses. Objective evaluation of the treatment by means of a scoring system indicated complete resolution of the pretherapy abnormalities at varying periods; thus, 35.3% (six of 17) of the patients had recovered by 90 days, 45.4% (five of 11) by 120 days, and 83.3% (five of six) by 150 days of therapy. Consequently, therapy with itraconazole is an adequate alternative to iodide treatment in sporotrichosis.     

Short course bifonazole therapy in pityriasis versicolor

Ninety patients were randomly assigned to one of three treatment regimens for pityriasis versicolor consisting of a once daily application of bifonazole 1% solution for a single day, 2 days (day one and day three) or 3 days (day one, day three and day six). Overall clinical cure rates 3 weeks after the end of therapy ranged from 69·9% to 89·9%. Statistical analysis showed a significant difference (p 0·04) in favour of three days therapy at the assessment three weeks and 90 days after the etui of therapy. Short-term therapy with three applications of bifonazol seems to be effective in most cases of pityriasis versicolor, and needs to be compared against alternative forms of antifungal therapy.     

Immunohistochemical Staining of Surfactant Proteins A and B in Skin of Psoriatic Patients Before and After Narrow-Band UVB Phototherapy

Background

Psoriasis is a chronic inflammatory disorder that is mediated by elements of the innate and adaptive immune systems. Surfactant proteins (SPs) play an important role in host defense mechanisms. They are thought to have a potential role in some inflammatory skin diseases including psoriasis.

Objective

The aim of the study was to evaluate SP-A and SP-B immunohistochemical staining in skin of psoriatic patients before and after narrow-band UV radiation type B (NB-UVB) phototherapy.

Study Design

Immunohistochemical staining for SP-A and SP-B was performed on tissues from 20 psoriatic patients before and after NB-UVB. Results were compared with the degree of improvement assessed by the Psoriasis Area and Severity Index (PASI) and duration of treatment.

Results

In unaffected skin, SP-A and SP-B were restricted to the basal layer; however, in psoriatic skin, they appeared in suprabasal layers in 80% and 85% of cases, respectively. Dermal inflammatory cells showed SP-A in 11 cases (55%) and SP-B in only one case (5%). After treatment by NB-UVB, SP-A and SP-B staining showed predilection to the basal layer. Absence of SP-A staining in suprabasal layers after NB-UVB therapy was correlated to better response to therapy (p = 0.003) and shorter duration of treatment (p < 0.0001).

Conclusions

SP-A and SP-B positivity is increased in psoriatic skin and reduced after NB-UVB therapy. Absence of SP-A in suprabasal layers after NB-UVB therapy is associated with better response and shorter duration of treatment.     

13-cis-retinoic acid for dyskeratinizing diseases—clinicopathological responses

Fifteen patients with Darier's disease (five patients), epidermolytic hyperkeratosis (five patients), and pityriasis rubra pilaris (five patients) were treated with doses ranging from 1.0 to 3.0 mg per kg body weight of 13 -cis retinoic acid. There was marked clinical improvement in the patients with Darier's disease which was sustained in two out of five on stopping treatment after 6 months. Three patients with pityriasis rubra pilaris went into remission, and required no further treatment on stopping 13-cis retinoic acid after 6 months; however two patients did not respond at all. All five patients with epidermolytic hyperkeratosis responded, but relapsed rapidly on discontinuation of therapy. The major histological change noted was the reduction in stratum corneum organisation and cohesion, with reduction in stratum corneum layers. Serum cholesterol and triglycerides became raised after 1 month's therapy, but tended to fall during the following 5 months of therapy. High density lipoproteins remained depressed during treatment. In selected cases, 13-cis retinoic acid is a useful therapy for Darier's disease, pityriasis rubra pilaris and epidermolytic hyperkeratosis.     

Childhood Linear IgA Bullous Dermatosis in Tunisia

Abstract:   The objective was to determine the demographic characteristics, the clinical features, the immuno-histological findings and response to treatment of childhood linear IgA bullous dermatosis (LABD) in Tunisia. We collected all the cases of auto-immune bullous diseases of childhood, diagnosed from January 1987 to December 2006. Based on clinical, histological, and immunofluorescent features, we identified 25 cases of LABD. Sixteen male and nine female children with a mean age of 7.5 years were identified. Clinical manifestations were characterized by a vesiculo-bullous eruption in all cases associated with mucous membrane involvement in two cases. Dapsone was the main therapy in 19 cases, associated with systemic corticosteroids in eight cases. Exclusive antibiotic therapy was successful in five cases. Sixteen of those patients had resolution of disease after a mean period of 15 months and eight patients had severe clinical presentation and required a prolonged follow-up. Childhood LABD is the most frequent bullous dermatosis in Tunisia. The majority of our patients responded rapidly to dapsone treatment and were stabilized for long time. Our cases were characterized by a minimal mucosal involvement and favorable outcome. Treatment with antibiotherapy was interesting. Erythromycin and oxacillin may be considered as an alternative therapy.