Results of the treatment in cases of cold urticaria, cold pruritus and cold rhinitis with peritol (zyproheptadinhydrochlorid) (author's transl)]

19 patients with cold urticaria, 5 with cold pruritus and 2 with cold rhinitis were successfully treated with peritol with the exception of one patient who suffered from a symptomatic pruritus due to polycythemia vera. Even in cases of recurrence the treatment was at once successful. Therefore peritol seems to be useful in the treatment of diseases due to cold.     

Congenital Hemangioma of Eccrine Sweat Glands

Abstract: We present six patients with congenital hemangioma of eccrine sweat glands. In every one the lesion was congenital, clinically angiomatous, painless, and nonsweating, with progressive involution over months. Histotogically all specimens showed many dilated capillaries with prominent endothelial cells associated with trie eccrine sweat gland coils.     

Ultrastructural study of iron deposition in the eccrine sweat glands of patients with iron overload

An ultrastructural study of eccrine sweat glands was carried out on three patients with iron overload (two with idiopathic haemochromatosis and one with transfusional haemosiderosis). In all three patients small electron-dense particles were seen in both eccrine sweat glands and macrophages. They appeared primarily in the clear cells of the eccrine sweat glands as membrane-bound irregularly shaped bodies, and were shown to contain iron by energy dispersive X-ray microanalysis. Iron aggregates in and around sweat glands were also seen on light microscopy.     

Squamous syringometaplasia in lobular panniculitis and pyoderma gangrenosum

Squamous metaplasia of eccrine sweat glands has been most frequently described in chronic cutaneous ulcerations with associated epidermal hyperplasia. We found examples of the process in skin biopsy specimens from five patients: three had associated lobular panniculitis and two had lesions of pyoderma gangrenosum. The metaplasia was located in the mid-to-deep reticular dermis in all five patients and extended into the superficial subcutis in one. Immunohistochemical stains for CEA and S-100 protein were used to accentuate the relationship of the metaplastic islands with eccrine ducts. It is postulated that necrosis of a portion of the eccrine duct is the stimulus for this process.     

Comparison of proliferating cells between human adult and fetal eccrine sweat glands

Studies of sweat glands had demonstrated that there were degenerating cells and proliferating cells in the eccrine sweat glands. To compare the differences in the proliferating cells between human adult and fetal eccrine sweat glands, immunostaining of proliferating-associated proliferating cell nuclear antigen (PCNA) and Ki67 nuclear antigen (Ki67) was performed, and the location and the percentage of the positive staining cells were analyzed. The results showed that a few cells of the secretory and ductal portion in both the adult and fetal eccrine sweat glands stained positive with Ki67 and PCNA. The labeling index of PCNA in adult eccrine sweat glands was 34.71 ± 8.37%, while that in the fetal was 62.72 ± 6.54%. The labeling index of PCNA in fetal eccrine sweat glands was higher than that in adult. Myoepithelial cells were negative staining with anti-PCNA antibody in adult eccrine sweat glands, while in the fetal a few myoepithelial cells were positive staining. Labeling index of Ki67 in adult eccrine sweat glands was similar to that in the fetal, ranging from 0.5 to 4.3%. Myoepithelial cells of the adult and fetal eccrine sweat glands both were negative staining with anti-Ki67 antibody. We concluded that the myoepithelial cells had proliferating ability only in fetal eccrine sweat glands, and that the proliferating ability of fetal eccrine sweat glands was stronger than that of the adult. Competing interest statement: The authors declare that they have no competing financial interests.     

Aquagenic pruritus

The clinical characteristics of aquagenic pruritus (AP) based on a series of thirty-six patients are presented. AP is characterized by the development of severe, prickling-like skin discomfort that is without observable skin lesions and that is evoked by contact with water at any temperature. Other causes of pruritus associated with water contact must be excluded. In the thirty-six patients, skin discomfort developed within minutes of water contact in approximately half. In others, discomfort began 2 to 15 minutes after water exposure had ceased. The pruritus was usually generalized, lasting from 10 to 120 minutes (average, 40.6 minutes), and in 55% was associated with symptoms of acute emotional liability. There was no increased prevalence of atopy. Thirty-three percent reported a family history of water-related itching. Of fourteen patients treated with ultraviolet B phototherapy, eight (57%) noted significant relief. Of thirty-four patients, sixteen (47%) noted partial relief with oral antihistamine therapy. Patients with polycythemia rubra vera (PRV) may present with symptoms similar to those of AP, and all patients with symptoms consistent with AP should be investigated for the presence of PRV.     

Water-induced itching

In this paper the current knowledge on water-induced pruritus is reviewed. To the present, three forms, namely aquagenic pruritus (AP), aquagenic pruritus of the elderly (APE) and water-related itching in polycythemia rubra vera (PRV), have been recognized. Despite clinical similarities it appears that the pathophysiology is different in the three forms. The currently most effective treatment for AP is addition of sodium bicarbonate to the water, control of xerosis with emollients for APE and aspirin for water-induced itching in PRV.     

Polycythaemia rubra vera and water-induced pruritus: blood histamine levels and cutaneous fibrinolytic activity before and after water challenge

We studied blood histamine activity (HA) and cutaneous fibrinolytic activity (CFA) in a patient with polycythaemia rubra vera (PRV) and water-induced pruritus, before and after water exposure. The results suggest that the water-induced itching in PRV is associated with an increase in HA. In addition, markedly increased levels of CFA were found both before and after water exposure. These findings have been previously reported in patients with aquagenic pruritus (AP) but not in patients with PRV. As the water-induced itching in PRV and AP share many common features, these findings suggest that the pathophysiology of the water-induced pruritus in these two conditions may be similar.     

Immunohistochemical demonstration of migration inhibitory factor in different types of urticaria

Because urticarial lesions can persist for extended periods of time, we have investigated the histochemical expression of an antibody against the cytokine macrophage inhibitory factor in 23 patients with different types of urticaria. Positive staining of upper and middermal dendritic cells was noted in sections from all three biopsy specimens of acute urticaria, eight of chronic urticaria, and all six of urticaria pigmentosa lesions. In all but one biopsy specimen, endothelial cells reacted as well. In three sections (two chronic urticaria, one urticaria pigmentosa), luminal lining cells of sweat glands were also noted to stain positively. In contrast, lesional skin from all eight patients with pressure urticaria was negative, as was the clinically normal skin of all patients, with the exception of one patient with urticaria pigmentosa. The data suggest that cytokines may be involved in lesions of acute type immunologic processes and that they need not be expressed in delayed type reactions.     

Newborn with pseudohypoaldosteronism and miliaria rubra

Pseudohypoaldosteronism type 1 is a rare autosomal recessive disorder with salt-wasting, hyperkalemia, metabolic acidosis, and multiorgan aldosterone unresponsiveness, which results in an excessive loss of sodium chloride through urine, sweat and saliva, among other secretions. Inflammation of and around the damaged eccrine glands has been attributed to the deleterious effects of excessive eccrine gland salt exposure. Such a high concentration of salt in the sweat causes cutaneous lesions similar to those appearing in miliaria rubra.     

First case of congenital idiopathic hypohidrosis in China

A 43-year-old Chinese man presented with generalized hypohidrosis, which he had had since birth, without obvious abnormalities of other skin appendages except a sparse beard and axillary hairs. The sweat test revealed localized sweating on the face, axillae and palms. Histopathologic examination showed that the sweat glands were absent in the forearm and thigh, but some eccrine and apocrine sweat glands were present in the right axilla. S-100 was expressed in the nerve terminals surrounding the acini and ducts of the eccrine sweat glands, while PGP9.5 was positive in the acini of apocrine glands and the nerve terminals surrounding the eccrine glands in the axilla. To our knowledge, this is the first case of congenital idiopathic hypohidrosis in China.     

Urticarial vasculitis as a symptom of Muckle-Wells syndrome?]

A patient is reported with a history of several years of chronic urticaria, transient fever, arthralgias and secondary systemic amyloidosis. A biopsy of an urticarial lesion showed necrotizing vasculitis and amyloid deposits in the eccrine sweat glands. Amyloid A deposits were also detected in kidney and rectum biopsies. This patient is likely to represent a variant of the Muckle-Wells syndrome (chronic relapsing urticaria, fever, arthralgia, deafness and renal amyloidosis). Hitherto undescribed is the presence of a necrotizing vasculitis as cause of the urticarial rash; further investigation will determine whether or not this finding represents the rule rather than an exception.     

Palmoplantar eccrine hidradenitis: seven new cases

Palmoplantar eccrine hidradenitis is a self-limited disease characterized by painful erythematous papules and nodules of abrupt onset on the soles, and less frequently on the palms, of young individuals in good health. We describe seven children, four girls and three boys, between 4 and 12 years of age, with characteristic cutaneous and histopathologic findings of palmoplantar eccrine hidradenitis. All patients had complete resolution of their lesions within 2-4 weeks without treatment, however, one child experienced recurrences. All skin biopsy specimens showed a deep dermal mixed infiltrate with abundant neutrophils surrounding eccrine sweat glands, the histologic hallmark of the disease. Palmoplantar eccrine hidradenitis is a distinct clinical entity in which physical activity, excessive sweating, and prolonged wetness are possible triggering factors. The regression of the lesions is usually rapid, with complete clearance after 1 month, although there may be recurrent episodes.     

An immunohistochemical study of normal sweat glands using an antibody to the breast cyst fluid protein (GCDFP-15)

In this study, we applied the antibody against the molecular weight 15,000 protein purified from breast cyst fluid (GCDFP-15) to cutaneous tissue, especially to sweat glands. Breast cyst fluid was obtained by needle aspiration from patients with gross cystic disease. DEAE-cellulose column chromatography was performed and followed by SDS-polyacrylamide gel electrophoresis. Antisera against the purified protein were prepared in rabbits. We stained specimens of normal skin by the PAP method. The normal apocrine gland cells were strong positive and eccrine gland dark cells were positive. Eccrine gland clear cells were weak positive or negative. Duct cells of both glands were negative. From these observations, we suggest that this antibody is useful for detecting seromucous cells of sweat glands, including both the apocrine gland cells and eccrine dark cells in the skin.     

Antigen expression of human eccrine sweat glands

Background:  The proliferating abilities of sweat glands are very limited, so researches on the repair and regeneration of sweat glands are important. First of all, we must find out reliable and specific antigen markers of sweat glands.
Objective:  To investigate the antigen expression of human eccrine sweat glands.
Methods:  The development of eccrine sweat glands was investigated by hematoxylin and eosin staining, and the antigen expression was detected by immunohistochemical techniques.
Results:  Human eccrine sweat glands expressed cytokeratin (CK) 7, CK8, CK14, CK18, CK19 and epithelial membrane antigen (EMA). Carcinoembryonic antigen (CEA) was only expressed in sweat glands in the adult skin. Developing and developed sweat glands all had some cells expressing Ki67 and p63 antigens. Epidermal growth factor (EGF) was mainly localized in the secretory cells and ductal cells. Some myoepithelial cells were also labeled with anti-EGF antibody. In the older fetus, positive staining for EGF was seen in the lumen of the secretory portion. EGF receptor (EGFR) was expressed in the ducts.
Conclusions:  Human eccrine sweat glands express CK7, CK8, CK14, CK18, CK19, CEA, EMA, Ki67, p63, EGF and EGFR. In skin, CEA can be used as a specific immunological marker of sweat glands.     

Pityriasis rubra pilaris with acantholysis and lichenoid histology.

Acantholytic foci have been reported several times in pityriasis rubra pilaris (PRP). Lichenoid tissue reactions were also mentioned in the literature regarding PRP. We report a 58-year-old patient who, after having colon cancer, had PRP with biopsies showing acantholytic lesions and a heavy lichenoid lymphocytic infiltration. Investigation by serial sectioning of the acantholytic lesion suggested an involvement of the intraepidermal eccrine duct and further investigation with carcinoembryonic antigen (CEA) staining demonstrated a CEA-positive eccrine duct in the acantholytic foci. We suggest that acantholysis in PRP is induced by proteolytic enzymes, urea, and other substances in eccrine sweat in keratin-plugged acrosyringia. This patient had a combination of three relatively rare features of PRP-acantholysis, lichenoid reaction, and a cancer background.     

The secretory clear cell of the eccrine sweat gland as the probable source of excess sweat production in hyperhidrosis

Primary hyperhidrosis is characterized by excessive sweating in palmar, plantar and axillary body regions. Gland hypertrophy and the existence of a third type of sweat gland, the apoeccrine gland, with high fluid transporting capabilities have been suggested as possible causes. This study investigated whether sweat glands were hypertrophied in axillary hyperhidrotic patients and if mechanisms associated with fluid transport were found in all types of axillary sweat glands. The occurrence of apoeccrine sweat glands was also investigated. Axillary skin biopsies from control and hyperhidrosis patients were examined using immunohistochemistry, image analysis and immunofluorescence microscopy. Results showed that glands were not hypertrophied and that only the clear cells in the eccrine glands expressed proteins associated with fluid transport. There was no evidence of the presence of apoeccrine glands in the tissues investigated. Preliminary findings suggest the eccrine gland secretory clear cell as the main source of fluid transport in hyperhidrosis.     

Immunohistochemical study of angiotensin receptors in normal human sweat glands and eccrine poroma

BACKGROUND: Angiotensin II exerts its actions through its specific receptors. However, expression of these receptors has not been determined in sweat glands. OBJECTIVES: To clarify the expression and localization of the angiotensin receptors in normal human sweat glands and eccrine poroma. METHODS: Expression of angiotensin type 1 (AT1) and type 2 (AT2) receptors in normal human eccrine and apocrine sweat glands and 12 cases of eccrine poroma was studied using immunohistochemistry. RESULTS: In eccrine sweat glands, the acrosyringium and the inner surfaces and luminal cells of the intradermal duct showed positive staining with AT1. In apocrine sweat glands, the intraepithelial duct and luminal cells of the intradermal duct showed positive staining with AT1. In 12 cases of eccrine poroma, some of the tumour cells in the tumour strands and cells surrounding the luminal structures stained positively. There were no positive findings with AT2. CONCLUSIONS: Studying AT1 distribution may be useful in understanding the pathophysiology of sweat glands and sweat gland tumours.     

Cutaneous sarcoidosis and polycythemia vera

Polycythemia vera is classified with myelogenous leukaemia, agnogenic myeloid metaplasia and primary thrombocythemia as a myeloproliferative syndrome. Cutaneous symptoms have been reported with polycythemia vera, including facial plethora, aquagenic pruritus, urticaria, purpura, Sweet's syndrome and pyoderma gangrenosum. However, polycythemia vera associated with systemic sarcoidosis has been rarely reported. An unusual case of polycythemia vera associated with cutaneous sarcoidosis is described.     

Assessment of cellular proliferation of eccrine acrospiromas and eccrine sweat gland carcinomas by AgNOR counting and immunohistochemical demonstration of proliferating cell nuclear antigen (PCNA) and Ki-67

Argyrophil nucleolar organizer regions (AgNORs) were counted and immunostaining using antibodies raised against proliferating cell nuclear antigen (PCNA) and Ki-67 was carried out on eccrine acrospiroma and eccrine sweat gland carcinoma, to determine the malignant potential and prognosis of these tumours. Formalin-fixed and paraffin-embedded tissue specimens surgically excised from 25 patients with eccrine sweat gland carcinoma (20 cases of eccrine porocarcinoma, four cases of ductal sweat gland carcinoma and one case of malignant clear cell hidradenoma) and 25 patients with eccrine acrospiroma (16 cases of eccrine poroma, four cases of poroid hidradenoma and five cases of clear cell hidradenoma) were used. PCNA and Ki-67 labelling indices were categorized semiquantitatively into four grades. Significant differences were noted between eccrine sweat gland carcinoma and eccrine acrospiroma with these three methods (P < 0.01). When a cut-off of 5 was chosen, the AgNOR value distinguished eccrine sweat gland carcinoma from eccrine acrospiroma with high specificity and sensitivity. Moreover, we compared the results of these three methods between stages 1 or 2 (17 cases) and stage 3 (eight cases) eccrine sweat gland carcinomas, and no significant differences were observed. From these findings, these three methods are useful in discriminating malignant from benign lesions of eccrine tumours, but have no value in estimating the aggressiveness of eccrine sweat gland carcinomas.