The eosinophil and cutaneous edema

Although eosinophils are readily identified in skin tissue, their role in cutaneous disease has been obscure. Recent studies have elucidated the structure, content, and several activities of the eosinophil. The eosinophil is a potent parasite-killer cell and probably mediates damage to respiratory epithelium in bronchial asthma. We review information showing an association between cutaneous edema and eosinophil degranulation in tissue. These studies show that eosinophils release and deposit toxic granule proteins extensively in the skin despite the existence of few intact eosinophils in tissue. The evidence suggests that the eosinophil functions not only as a parasite-killer cell but also as a proinflammatory cell that may be pathophysiologically related to the development of cutaneous edema.     

Liminal perception threshold of cutaneous distension

BACKGROUND: Cutaneous sensorial perception is complex and proves to be difficult to quantify. Skin sensitivity to mechanical distension is largely unexplored. We have developed an original method aimed at quantifiying these physiological parameters.VOLUNTEERS AND METHODS: The study was performed on 24 adult volunteers aged 20 to 50 years. A Cutometer SEM 474 equipped with 2 and 4 mm diameter probes was used to exert a progressive or a steep suction on the cheeks. The intensities of both the suction and the skin deformation observed at the earliest moment the traction was perceived by the volunteers were recorded.RESULTS: The liminar sensorial detection under progressive suction force was 1.5 times lower when using the 4 mm probe than the 2 mm probe. Suction necessary for liminar sensation was 7 times lower under steep suction than in response to the progressive mode. The skin deformation corresponding to the liminar sensorial perception was almost constant (C=0.5 p. 100) for each subject. By contrast, a large inter individual heterogeneity unrelated to age was present.COMMENTS: Sensitivity of facial skin to stretching can be explored using a precise suction method. Perception is more related to the rate of traction than to the surface area submitted to suction. Cutaneous deformation, nearly constant for each individual, appears to be the main parameter. Steep and progressive suctions appear to stimulate distinct types of mechanoreceptors. The presently described method can be applied in cosmetology and in functional investigation of various diseases such as diabetes, acromegaly and atopic dermatitis among others.     

Alkane-induced edema formation and cutaneous barrier dysfunction

Summary Certain mineral oils and hydrocarbons require repeated topical application to cause irritation. A structure activity relationship of pure n-alkanes was undertaken in a mouse ear edema model to investigate the mechanism of cumulative irritancy. Alkanes were applied twice daily over a 4-day period. Dodecane was found to be non-irritating, while tridecane elicited a response only at 96 h. Tetradecane was the strongest irritant with significant increases (p<0.05) in ear thickness observed at 48 h. Hexadecane, octadecane, and eicosane exhibited progressively decreasing activity. Permeability of the ears to hydrocortisone was monitored in vitro during tridecane-and tetradecane-induced irritation. Significant increases in permeability were observed 24 h before edema formation. A positive correlation was found between the extent of edema formation and enhancement of permeability. Loss of barrier function would result in increased cutaneous availability of the alkanes. Increased permeability prior to edema formation indicates that induction of barrier dysfunction may be a factor in the mechanism of alkane-induced irritation.     

The cutaneous manifestations of the Klippel-Trenaunay-Weber syndrome

The Klippel-Trenaunay-Weber syndrome (KTWS) is the widely accepted eponym for the condition of angioosteohypertrophy. The clinical features of limb overgrowth and various vascular malformations have been previously well-described, but the spectrum of dermatological manifestations of the KTWS is less well-documented. For this reason we have evaluated the natural history of the cutaneous lesions in 20 affected individuals. It has emerged that the hitherto unreported problem of aseptic cellulilis is a frequent and potentially severe complication in the KTWS.     

Palpebral edema as a cutaneous manifestation of hyperthyroidism

Three cases of palpebral edema associated with Graves' disease are described. These patients had unilateral edema and minimal erythema of the upper eyelid. Notable was that, histologically, dermal edema and dilation of lymphatic vessels were observed, but deposition of mucopolysaccharides was not. In 2 cases, edema of the eyelid was resistant to treatment with an antithyroid drug. Unilateral edema of the upper eyelid is an important cutaneous manifestation that indicates the presence of hyperthyroidism.     

Disseminated cutaneous granulomatous eruptions associated with myelodysplastic syndrome and acute myeloid leukaemia

Two elderly male patients presented with similar, widespread, papular, granulomatous eruptions and developed myelodysplastic syndromes. The first showed histological features of diffuse granuloma annulare and had mild hypergammaglobulinaemia, slightly abnormal liver function and a leucoerythroblastic anaemia. He developed acute myeloid leukaemia (AML) secondary to a background myelodysplastic syndrome and was treated with combination chemotherapy during which his eruption settled; his AML and his skin are in remission 1 year later. The second developed a myelodysplastic syndrome and a similar rash with histological features of papular cutaneous sarcoidosis but no systemic abnormalities apart from mild hypergammaglobulinaemia, cutaneous anergy to multiple recall antigens and activation of circulating monocytes. He has remained well but his rash and myelodysplastic syndrome have persisted. These cases are interesting because of the striking similarity of their granulomatous eruptions and their associated haematological abnormalities. Patients with such disseminated, granulomatous cutaneous infiltrations should be investigated to exclude associated haematological abnormalities if there is any abnormality of their peripheral blood picture.     

Infantile acute hemorrhagic edema and rotavirus infection

Infantile acute hemorrhagic edema (AHE) is a benign condition characterized by a dramatic onset of inflammatory edema and ecchymotic purpura in a target or cockade pattern. It is considered an uncommon form of cutaneous vasculitis occurring in children younger than 2 years of age. The outbreak is frequently preceded by an immunization or various infections. We describe an 11-month-old girl with rosette-shaped purpuric plaques on the face and limbs, clinically consistent with a diagnosis of AHE of the skin, associated with fever and diarrhea. Laboratory investigations showed a rotavirus infection, which has not previously been reported in association with AHE of the skin. The disease had a benign course without relapses. Appropriate microbiologic investigations are advisable to confirm the possible etiologic role of rotavirus.     

Leukomelanoderma following acute cutaneous graft-versus-host disease

Acute graft versus host disease (GVHD) is characterized by a selective epithelial inflammation that can affect the skin, digestive tract, and liver. Development of pigmentary abnormalities can be observed in sites where acute cutaneous GVHD has occurred, and usually consists of hyperpigmented spots. We observed atypical pigmetary changes consisting of a combination of hyper- and hypopigmentation, so called leukomelanoderma, in a young allogeneic bone marrow recipient who suffered repetitive acute GVHD. The histopathological examinations showed features of a post-inflammatory process. Because keratinocytes produce inflammatory cytokines including tumor necrosis factor (TNF)-alpha and interleukin (IL)-1alpha, which may be implicated in the inflammatory phenomena seen in acute GVHD, we studied whether these inflammatory cytokines might be implicated in these pigmentary changes. The cytokines tested were IL-1alpha, IL-2, TNF-alpha and IL-10. The expression of TNF-alpha increased in the hyperpigmented skin relative to normal and hypopigmented skin. While TNF-alpha was variably distributed in proportion to different degrees of pigmentation, other molecules were detected at minimal levels in all samples. This observation may indicate that the production of TNF-alpha by epidermal microenvironment may be involved in postinflammatory pigmentary changes.