Evaluation of zinc level in skin of patients with necrolytic acral erythema

Summary Background Necrolytic acral erythema (NAE) is considered a cutaneous sign of hepatitis C virus infection. Its exact pathogenesis is still not fully understood, with some reports about decreased serum zinc levels but none about its level in the skin. Objectives To assess skin (lesional and perilesional) and serum zinc levels in patients with NAE and compare them with levels in control subjects. Methods Fifteen patients with NAE and 10 healthy controls were included in this study. Assessment of zinc level, in serum by graphite furnace atomic absorption spectrophotometry and in lesional and perilesional skin biopsies by flame atomic absorption spectrometry, was done in all subjects. Re‐evaluation of serum and lesional skin zinc level was done after oral zinc treatment. Results Mean ± SD zinc levels were significantly lower in patients (serum 0·44 ± 0·13 mg L^?1; lesional skin 42·6 ± 18·9 mg L^?1; perilesional skin 32·5 ± 17·2 mg L^?1) than controls (serum 1·17 ± 0·29 mg L^?1; skin 100·1 ± 2·77 mg L^?1), with a positive correlation between lesional and perilesional skin zinc (r = 0·91, P < 0·01). Oral zinc supplementation significantly increased serum and skin zinc levels (by 159% and 4%, respectively; P < 0·05). Conclusions NAE is associated with decreased serum and skin zinc levels. Oral zinc supplementation corrects decreased levels of plasma and skin zinc much earlier than the desired clinical benefits appear.     

Oral zinc sulphate therapy for acne vulgaris.

A double-blind controlled clinical trial was performed to evaluate the effect of oral zinc sulphate, 0.6 g daily, on acne vulgaris. Twenty patients received zinc sulphate tablets and 19 were given placebo tablets. Thirteen of the zinc group and 12 of the placebo group received their medication throughout a 12-week period, while the remaining patients were treated for 4 or 8 weeks. In all patients the numbers or papular and pustular acne lesions on the face and the back were significantly reduced, while larger infiltrates remained practically unaltered during the trial, which was performed from March through May 1975. No statistically significant difference in the improvement of the groups was demonstrable. Pretreatment serum zinc values, which were normal in all patients, rose significantly in the zinc group as well as in the control group, but the increase in the former was significantly higher. The negative therapeutical results might be attributable to the limited number of patients or related to the zinc dosage. Furthermore, the results might have been influenced by the unexplained rise in serum zinc values in the control group. A possible weak beneficial effect of zinc might also have been camouflaged by the seasonal variation in the severity of acne which was noted in this study.     

450例银屑病患者的口腔表现调查结果

为了探讨银屑病在口腔粘膜的临床表现及与皮损间的关系 ,对450例有皮肤病损的银屑病患者进行了口腔常规检查 ,并排除某些与银屑病可疑口腔病损有相似症状、体征的疾病。发现11例银屑病患者口腔粘膜发生病损 ,主要在红皮病型、掌跖脓疱型及关节病型中表现出来 ,有地图舌样损害、沟纹舌、粘膜糜烂、牛肉色变及口角炎 ,与皮损间有消长一致的关系。提示口腔粘膜可发生银屑病 ,其临床表现呈多样性 ,损害的发生与皮损的类型及严重程度有关。     

Oral zinc therapy of acne. Absorption and clinical effect.

In a double-blind controlled comparison that lasted eight weeks, tablets of zinc sulfate monohydrate, 411 mg total daily dosage, and a lactose placebo were administered orally to 22 male subjects with moderate acne. At the same time, levels of zinc were determined in serum and urine. There were no statistically significant differences in the lesion counts (papules, pustules, open comedones, and closed comedones) in the zinc-treated and lactose-treated cases, despite evidence in serum and urine of absorption of zinc. The data from this study indicate that oral zinc therapy has no early clinical effect on male patients with moderate acne.     

Dermatologic therapy in geriatric patients

Demographic changes in our society will lead to an increasing proportion of elderly people. Age‐associated multimorbidity often results in polypharmacy and elevates the risk of adverse drug reactions. Decisive alterations in pharmacokinetics and pharmacodynamics are detectable in old age, primarily a decrease in total body water, an altered ratio of muscle mass to fatty tissue, and decreased renal function. Changes in gastrointestinal transit, plasma protein binding, hepatic drug metabolism, and an increased susceptibility to drug‐induced cognitive decompensation have also been reported. All these alterations should be considered in geriatric dermatotherapy to minimize drug‐related complications caused by over‐ or underdosage and drug interactions.     

Oral spironolactone therapy in male patients with rosacea.

Spironolactone at 50 mg/day was orally administered for four weeks to 13 male patients with rosacea in order to observe its clinical effectiveness. Serum estradiol (E2), 17OH-progesterone (17OH-P4), testosterone (T), androstenedione (delta 4 A), dihydrotestosterone (DHT), dehydro-epiandrosterone sulfate (DHEA-S) were measured prior to and after treatment. Although there were no significant changes in T, delta 4A, DHT, or DHEA-S, the serum levels of 17OH-P4 increased significantly. E2 tended to increase, although the change was not significant. Two of the 13 patients discontinued spironolactone treatment because of general malaise, but seven of the remaining eleven patients exhibited an improvement in their rosacea. These findings demonstrate that a low dose of spironolactone is effective in the treatment of rosacea in some male patients and suggest that it is possible that changes in the metabolism of sex steroid hormones such as cytochrome p-450 isozymes have some bearing on the etiology of rosacea.     

Oral zinc sulphate therapy in acne vulgaris: a double-blind trial

The effect of zinc sulphate and placebo was compared in a double-blind trial in 56 patients suffering from acne vulgaris. Serum vitamin A levels were studied in all, before and at the end of therapy, 29 patients received zinc sulphate 600 mg daily and 27 patients received placebo. Patients on placebo showed no improvement. After 12 weeks of treatment with zinc sulphate, 17 patients (58%) showed significant improvement. There was a statistically significant decrease in the number of papules, infiltrates and cysts. In zinc-treated cases there was statistically significant increase in serum vitamin A levels, while no change was found in the placebo group.     

Elevated plasma homocysteine level is possibly associated with skin sclerosis in a series of Japanese patients with systemic sclerosis

Homocysteine is a sulfhydryl‐containing amino acid that is derived from dietary methionine, and there has been increasing evidence that elevated plasma homocysteine levels are associated with increased risk of cardiovascular diseases, including carotid, coronary and peripheral arterial disease (PAD). The association of plasma homocysteine levels with peripheral vascular involvements, such as Raynaud phenomenon (RP), digital ulcers (DU) in systemic sclerosis (SSc) patients has not been well studied. The objective of this study was to examine plasma homocysteine levels and their clinical associations in patients with SSc. Plasma homocysteine levels in 151 Japanese patients with SSc and 20 healthy controls were examined. No significant differences were observed in plasma homocysteine levels between SSc patients and healthy individuals. Demographic and clinical features of the SSc patients revealed that severe skin sclerosis, anti‐topoisomerase I antibody positivity, complications of DU, acro‐osteolysis (AO) and interstitial lung disease (ILD) were significantly more prevalent among the patients with elevated plasma homocysteine levels. The plasma homocysteine levels were positively correlated with modified Rodnan total skin score. The plasma homocysteine levels in the SSc patients with DU, AO and ILD were significantly higher than those in the SSc without DU, AO and ILD, respectively. Plasma homocysteine levels did not correlate with either the mean or max intima‐media thickness (IMT) or plaque score, suggesting that plasma homocysteine levels might not be associated with carotid artery atherosclerosis in SSc patients. The measurement of plasma homocysteine levels in SSc patients might be useful for the risk stratifications of severe skin sclerosis, DU and AO.     

Intravenous zinc sulfate therapy in zinc-depleted patients.

Zinc sulfate was administered intravenously in 3 patients with severe conditional zinc deficiency. The dosage ranged from 10 to 20 mg ionic zinc daily, and the duration of the treatment did not exceed 2 weeks. The rise in serum zinc and urinary zinc per 24 h, as well as in serum alkaline phosphatase, occurred at a faster rate than observed in a patient who was given 135 mg zinc daily by mouth. No subjective or biochemical side effects of the intravenous zinc therapy was observed.     

Hand-foot skin reaction in patients treated with sorafenib: a clinicopathological study of cutaneous manifestations due to multitargeted kinase inhibitor therapy

BACKGROUND: Hand-foot skin reaction is a distinctive cutaneous side-effect of antineoplastic kinase inhibitor-targeted therapy. Severe hand-foot skin reaction requires postponement of treatment or dose reduction. Histopathological studies of skin toxicity associated with kinase inhibitors are currently unavailable. OBJECTIVES: To report the clinical and histopathological findings of hand-foot skin reaction produced by the multikinase inhibitor sorafenib. METHODS: Nine patients with metastatic carcinoma-seven with renal cell carcinoma (RCC), one with melanoma and one with hepatocellular carcinoma (HCC)-received continuous, oral sorafenib 400 mg twice daily. Hand-foot skin reaction was defined and graded according to National Cancer Institute Common Toxicity Criteria 3.0. Biopsies from lesions of erythematous scaly or blistering skin were obtained from five cases (four RCC and one HCC). RESULTS: Seven of the nine (78%) patients developed hand-foot skin reaction characterized by well-demarcated, tender, erythematous papules and plaques with greyish blisters or hyperkeratotic, callus-like formations on palmoplantar surfaces and distal phalanges. Skin biopsy of hand-foot skin reaction lesions revealed epidermal acanthosis, papillomatosis, parakeratosis, dispersed dyskeratotic cells and keratinocyte vacuolar degeneration. Other skin toxicities included angular cheilitis, seborrhoeic dermatitis and perianal dermatitis. CONCLUSIONS: The clinical manifestations and histopathological features of sorafenib-induced skin reactions are unique. The most relevant histopathological findings of hand-foot skin reaction include keratinocyte vacuolar degeneration, the presence of intracytoplasmic eosinophilic bodies, and intraepidermal blisters in the stratum malpighii. Further studies are warranted to elucidate the mechanisms of this novel multitargeted kinase inhibitor-associated skin reaction.     

A severe 'stasis eczema', associated with low plasma zinc, treated successfully with oral zinc

We describe a case of non-ulcerating severe stasis eczema in an elderly female associated with a low plasma zinc and which responded to treatment with oral supplements. The dermatological changes were not accompanied by oedema and were most marked over the lower legs and ankles, with patchy erythematous lesions extending to the inner thighs, over the dorsal surface of both hands and the forearms. There was some excoriation and a degree of lichenification. These lesions were intensely pruritic and resolved almost completely following treatment with oral zinc sulphate (220 mg daily) on two separate occasions. Histological appearances of biopsy material included those of stasis eczema but there was also a marked degree of parakeratosis. The cause of the low plasma zinc was not identified.     

Photochemotherapy of psoriasis with relevance to 8-methoxypsoralen plasma level and low intensity irradiation.

The 8-methoxypsoralen (8-MOP) plasma level was determined in 31 patients during treatment with PUVA (psoralen + UVA light). The UVA light source was of a low intensity type, giving only 2 mW/sec/cm2 and required an irradiation time of 30 minutes. The lesions of 19 patients healed completely. Following an oral dose regimen adjusted to the patient's weight, the 8-MOP values at 2 hours varied from 2 ng/ml to 167 ng/ml (mean 56 ng/ml). There was no clearcut relation between the 8-MOP plasma level and the clinical response but in 9 patients there was a prompt response to treatment when the dose of psoralen was increased by 10 mg. In 5 patients the 8-MOP plasma levels was determined hourly for the first 4 hours and showed a peak at 2 hours except in one patient with very low values who had a peak at 4 hours. The augmentation of pigmentation was measured by means of reflectometry on three univolved areas. Two peaks were observed--one during the first week and the other after 2--3 weeks of therapy.     

Immunosuppressive drug therapy as a potentiator of skin tumours in five patients with lymphoma.

In four cases of stage 1 chronic lymphatic leukaemia and one of well-differentiated, lymphosarcoma confined to the head and neck regions, the use of immunosuppressive drugs has potentiated in an actinically damaged skin the production of florid BCC, SCC and malignant melanoma. As of now no metastases have occurred in the four survivors. A case of Gorlin's syndrome and lymphatic leukaemia has failed to respond to topical 5 flurouracil therapy, whilst under the influence of chlorambucil therapy.     

Oral zinc in acne vulgaris: a clinical and methodological study.

In a double-blind investigation of 54 patients suffering from acne vulgaris, the effect of 0.6 g of oral zinc sulphate daily versus placebo was studied. During the active treatment period of 6 weeks, the acne improved by about one-third, as rated with a score system. Clinical comparison with placebo showed the result of zinc sulphate therapy to be slightly, but statistically significantly better. Various methods for the clinical evaluation of acne were studied. Counting of acne lesions was found to be a more precise method than assessment according to the opinion of the patients and the assessment of colour photographs. The correlation between the results obtained by lesion counting and evaluation by photographs was low, as was also the reproducibility of photographic assessment.