Cutaneous lupus erythematosus-treatment with pulsed dye laser

Because of its vascular selectivity, the flashlamp-pumped pulsed dye laser (585 nm) is efficacious in the treatment of vascular lesions and is successfully used for the treatment of port-wine stains and haemangiomas in children. Based on the encouraging results with these cutaneous vascular disorders, the cutaneous lesions of patients with lupus erythematosus (LE) have now also been treated with the pulsed dye laser. Cutaneous lesions in lupus erythematosus are often difficult to treat with readily available local therapeutic methods. We report here on a group of 12 patients whose LE lesions were treated with the pulsed dye laser. In 10 patients, the LE was limited to the skin, while two patients had systemic LE (SLE). Even in the two patients with SLE, a significant improvement of skin lesions was achieved. After a mean number of 51 laser sessions, a median clearance rate of 70% was attained for nine patients. In one case, the laser treatment failed to clear the lesions. Two patients did not show any visible improvement of the lesions, but pain and itching were significantly reduced. There were few side-effects. No prolonged laser-induced scarring occurred and in only two patients was hyperpigmentation seen, which had resolved completely after 4 and 5 months, respectively. During a median follow-up of 7 months (range: 3-32 months), only one patient (after a complete clearance of the skin lesions) had a small relapse. In summary, the pulsed dye laser is an effective therapy for the treatment of superficial skin lesions in LE.     

Cutaneous pH in children affected by atopic dermatitis and in healthy children: a multicenter study

Background/aims: Several studies have been conducted in order to assess, objectively and non-invasively, atopic skin parameters. Since little is known about clinically uninvolved, perilesional and lesional skin pH in atopic children at different stages of the disease, we studied cutaneous pH in atopic and healthy children and investigated possible relationships among different sites, phases of the disease and main symptoms.
Methods: Two hundred and eighty-four children of both sexes, 143 atopic and 141 healthy children, aged 3 months to 11 years, examined in 10 different Italian dermatological centres were included in the study and subjected to clinical examinations and pH measurements.
Results: Atopic children presented statistically significant higher pH values than controls, not only at the level of eczematous lesions (P=0.004) and of perilesional skin (P=0.003) but also at the level of apparently healthy skin (P=0.002). A progressive statistically significant increase in pH values was observed from healthy to perilesional to lesional skin. In acute dermatitis, children affected by moderate itching (considering itching complaints and scratching lesions) presented, at the level of lesional and perilesional skin, statistically significant higher pH values than children affected by mild itching.
Conclusion: The correlation found in this study between severity of itch and skin surface alkalinity, far from demonstrating a therapeutic role of acidic substances against itching in atopic children, deserves new epidemiological studies on a large scale in order to identify new strategies of treatment of atopic skin.     

润肤止痒乳剂治疗血虚风燥证慢性湿疹临床研究

目的观察润肤止痒乳剂治疗慢性湿疹血虚风燥证的疗效。方法选择60例慢性湿疹血虚风燥证患者,随机分入润肤止痒乳剂治疗组和曲安缩松尿素软膏组,记录治疗前后两组瘙痒程度、面积积分、皮损积分。根据评分标准进行比较。结果治疗后两组患者症状均有改善,润肤止痒乳剂在治疗2周后疗效低于曲安缩松尿素软膏组;4周后疗效明显优于曲安缩松尿素软膏组,且润肤止痒乳剂可明显改善瘙痒症状,但对皮损改善却不如曲安缩松尿素软膏明显。结论润肤止痒乳剂治疗慢性湿疹血虚风燥证患者临床疗效较好,患者依从性强。     

Occupational pigmented contact dermatitis from azo-dyes

A 51-year-old man had been working in a dye factory for 25 years and had noticed itching and pigmentation on the extremities for the past 5 years. Patch testing showed positive reactions to Sudan I and Vacanceine Red, among the azo dyes which he had been handling. After he changed his work, he became free from erythematous lesions with itching. The pigmentation almost disappeared 10 months later.     

Topical tacrolimus for the treatment of lichen simplex chronicus

Owing to severe itching and scratching, the natural course of lichen simplex chronicus (LSC) is clinically characterized by typical lichenoid lesions. Topical corticosteroids are often used to treat LSC but after withdrawal a relapse will sometimes occur. Therefore, LSC can be difficult to treat over time. We report a 13-year-old boy suffering from LSC on two symmetrical circumscribed areas on the temple, whose lesions healed completely with tacrolimus 0.1% ointment within approximately 9 months. During active treatment no adverse drug reaction was observed. The patient is completely free of symptoms 3 years after cessation of treatment. We conclude that topical tacrolimus can be used as an effective, long-lasting therapeutic modality in treating LSC, especially in sensitive skin areas such as the face.     

Combined pizotiphen and cinnarizine treatment in urticaria factitia

30 patients suffering from urticaria factitia were treated with pizotiphen and cinnarizin for 6 weeks. In 13 patients, the effect of treatment was controlled by means of the dermographism test. Placebo administration failed to affect the subjective and objective symptoms. During treatment with pizotiphen and cinnarizin, the flare significantly decreased within the first week and finally did not differ from that observed in healthy persons after 6 weeks of therapy. 19 out of 30 patients were totally free of symptoms. In 11 cases, treatment resulted in significant reduction of the urticaria, but only 7 patients still complained of itching. After repetition of the therapy, 5 patients were free of symptoms; 2 patients still reported on slight itching one year after treatment.     

进行性骨发育异常三例分析

目的 探讨进行性骨发育异常的临床病理特征、诊断及治疗.方法 分析3例进行性骨发育异常患儿的临床病理资料,并复习相关文献.结果 3例患儿均为女性,出生后数天至数月发病,临床表现为头皮、躯干、四肢质硬的淡红色或肤色丘疹、结节或斑块,无明显症状.组织病理学检查均显示真皮中深层成片的骨或骨样组织形成.3例患儿血清钙、磷及甲状旁腺激素水平均未见明显异常.例1口服碳酸氢钠片并切除右下腹皮疹,随访约7个月右下腹皮疹无复发,但其他皮疹较前凸出、增大、变硬,并出现新发皮疹;例2外用阿达帕林凝胶,皮疹未增多,但皮损增大,质地变硬;例3未治疗,已失访.结论 进行性骨发育异常临床表现为向深部进行性发展的质硬的斑丘疹、斑块,目前尚无有效方案预防或治疗.     

Polycyclic Annular Lesion Masquerading as Lupus Erythematosus and Emerging as Tinea Faciei Incognito

Tinea incognito is a dermatophytic infection induced by immunosuppressive agents that lacks the classic features of a typical fungal infection. Although the treatment of tinea incognito is simple and relatively easy, its clinical manifestation varies and can masquerade as various skin disorders, causing misdiagnosis and thus preventing prompt and appropriate treatment. Here, we report an interesting case of tinea incognito occurring after topical steroid administration in an immunosuppressed patient with dermatitis artefacta. A 40-year-old female patient who had been taking systemic glucocorticoid for 4 years for chronic inflammatory demyelinating polyneuropathy presented with itching multiple erythematous erosive lesions on the face and upper chest for 2 months. Initial biopsy produced nonspecific findings. The skin lesion was aggravated and became polycyclic and erythematous; after azathioprine was added, her chronic inflammatory demyelinating polyneuropathy became aggravated. A second biopsy confirmed hyphae in the cornified layer. Complete remission was achieved after admonishing oral terbinafine and topical amorolfine.     

A two-step schedule for the treatment of actinomycotic mycetomas

Actinomycotic mycetomas usually respond slowly to treatment with antibiotics. In an attempt to hasten clinical resolution, we used a 2-step regimen consisting of an intensive phase of therapy with penicillin, gentamycin and co-trimoxazole for 5-7 weeks, followed by maintenance therapy with amoxicillin and co-trimoxazole. Seven patients were treated, all of whom showed significant reduction in discharge and swelling after the intensive phase. Maintenance therapy was continued for 2-5 months after the lesions became completely inactive. Five patients completed maintenance therapy, which was given for 6-16 months (mean 10.7 months), and remained free of disease during a mean post-treatment follow-up period of 6.4 months. The other 2 patients also responded satisfactorily and continue to receive maintenance therapy. Side-effects necessitating a modification of the treatment schedule occurred in 2 patients but reversed on discontinuation of the drugs responsible. This treatment schedule produces a rapid clinical response during the initial, intensive phase and promotes compliance with the longer maintenance phase of treatment necessary to achieve a complete cure.     

Photochemotherapy in cutaneous T cell lymphoma and parapsoriasis en plaques. Long-term follow-up in forty-three patients

Forty-three patients with clinical plaque- and tumor-stage mycosis fungoides, the erythrodermic/Sézary syndrome variant of mycosis fungoides, and parapsoriasis en plaques were treated with oral psoralens and ultraviolet A (PUVA). Pretreatment skin biopsies, evaluated by light microscopy, revealed seventeen diagnostic, seventeen suggestive, and nine nonspecific specimens. Clinical and histologic parameters were followed for an average of 38.4 months (range, 4-67 months). Twenty-five patients had complete clearing, and fourteen did not respond. Most patients in the complete-response group had either plaque lesions of mycosis fungoides or parapsoriasis en plaques prior to PUVA. Most patients in the no-response group had either tumor lesions or the erythrodermic/Sézary mycosis fungoides at the start of PUVA. In the no-response group the treatment modalities used prior to PUVA were twice the number used in the complete-response group. Patients in the complete-response group had clearing of their lesions after an average PUVA dose of 117 joules/cm2. Relapse occurred in seventeen patients after an average remission time of 6.3 months and responded to additional PUVA. Patients whose skin remained clear after the first course of PUVA continued to have clear skin for up to 58 months, with an average complete remission of 29.5 months by the end of the study period. Histologic evaluation before PUVA and at clearing revealed a definite trend toward a normal microscopic picture, but at least a mild inflammatory infiltrate usually persisted. At the end of the study period, the lesions of ten patients had entirely cleared for an average of 44 months, the lesions of five had cleared during a second course of PUVA, five had stable limited-plaque disease while receiving maintenance PUVA, eleven were undergoing electron beam radiation therapy or chemotherapy for progressive disease, ten had died, and two patients were lost to follow-up. Therefore, in the early stage of mycosis fungoides, PUVA may induce significant disease-free intervals. Prior treatment with a variety of modalities, the patient's age, and/or the duration of disease may affect response to PUVA.     

308-nm Excimer Laser for the Treatment of Alopecia Areata in Children

Abstract:  Alopecia areata (AA) is a common skin disease which is characterized by nonscarring localized or diffused hair loss. In this study we assessed the efficacy of 308-nm Excimer laser in the treatment of alopecia areata in children. A total of 9 children with 30 recalcitrant patches alopecia areata and two children with alopecia areata totalis were enrolled in this study which included seven male and four female patients, aged between 4 and 14 years and the durations of their disease were between 7 and 25 months. All of these patients had more than one lesion of alopecia areata and at least one of them was left as a control for comparison. The lesions were treated with the 308-nm Excimer laser twice a week for a period of 12 weeks. Regrowth of hair was observed in 18 (60%) alopecia patches in the scalp, while there was no response in the control patches and over the extremities. Only four patients with scalp lesions showed a recurrence of alopecia after 6 months post laser therapy. So, 308-nm Excimer laser is considered an effective safe therapeutic option for patchy alopecia areata in children.     

Topical photodynamic therapy for prevention of new skin lesions in renal transplant recipients

Preclinical data suggest that topical methyl aminolevulinate photodynamic therapy may have potential in preventing new skin lesions in transplant recipients. An open intra-patient randomized study investigated the prevention potential of this treatment in 27 renal transplant patients with actinic keratoses and other skin lesions in two circular contralateral areas (5 cm diameter). The treatment area surface was debrided and methyl aminolevulinate cream (160 mg/g) was applied for 3 h prior to illumination by non-coherent red light (570-670 nm, light dose 75 J/cm2). The control area was not treated. The mean time to occurrence of the first new lesion was significantly longer in treated than control areas (9.6 vs 6.8 months, treatment difference 2.9 [95% confidence interval 0.2 to 5.5] months, p = 0.034). Over 12 months, 62% (16/26) of treated areas were free from new lesions compared with 35% (9/26) in control areas. These findings indicate that topical methyl aminolevulinate photodynamic therapy is a promising preventive treatment against new skin lesions in immunosuppressed patients.     

Neutrophilic Dermatoses in Two Children with Idiopathic Neutropenia: Association with Granulocyte Colony-Stimulating Factor (G-CSF) Therapy

Painful neutrophilic skin lesions were observed in two children receiving granulocyte colony-stimulating factor (G-CSF) for treatment of idiopathic neutropenia. A girl with cystic fibrosis and cyclic neutropenia developed an erythematous papular eruption without fever or neutrophilia 7 months after commencing therapy with G-CSF. A skin biopsy specimen revealed microscopic, sterile, neutrophilic abscesses. A boy with chronic neutropenia and recurrent inflammatory skin lesions developed multiple erythematous nodules following administration of G-CSF. A biopsy specimen showed neutrophilic panniculitis. We believe that these skin eruptions belong to a spectrum of neutrophilic dermatoses that can be induced or aggravated by G-CSF therapy.     

Pyogenic granulomas following topical application of tretinoin

Topical tretinoin is used in the treatment of acne and other dermatoses. The most common side-effects are itching, dryness and reddening of the skin. We report an additional cutaneous reaction, which occurred in patients using topical tretinoin. Pyogenic granulomas developed in two patients with acne and in one with dermatofibroma following application of tretinoin. The granulomas grew on the lesions after 2-3 weeks of therapy initiation. All patients were men and the granulomas developed in their trunk. The lesions resolved when topical tretinoin was ceased. Although the number of patients reported is too small to estimate the true incidence of this reaction, it is likely that dermatologists will encounter similar reactions in patients treated with topical tretinoin for acne or other reasons.     

Treatment of lichen sclerosus with carbon dioxide laser vaporization

We have treated 10 patients (five women and five men) with lichen sclerosus (LS), verified by histopathological studies from skin biopsies, with CO₂ laser vaporization. All men studied had LS of the penile skin, of the women, three had extragenital lesions and two LS of the perineal skin. The mean follow-up time was 32 months (range 3-79 months). One man had both penile and urethral LS. All penile lesions of the five men were clinically cured by laser treatment: however, urethral lesions of one patient recurred despite three separate treatments. The two women with perineal LS improved after laser treatment. However, LS recurred on the treated area in one and on the margins of the treated area in another. Two women with LS on the skin of the breast became asymptomatic after treatment. One woman had several lesions on the skin of the trunk that improved after treatment but were not cured completely. The present study suggests that carbon dioxide vaporization may be an effective treatment of skin lesions in LS.     

Pityriasis lichenoides in children: therapeutic response to erythromycin

Fifteen of twenty-two children with pityriasis lichenoides were treated with oral erythromycin. Eleven (73%) had a remission, usually within 2 months. Two others showed partial improvement, and two were unimproved. Seven of the children who experienced a remission were off erythromycin and free of lesions after 2 to 5 months of therapy. A trial of erythromycin as described herein should be considered in children with pityriasis lichenoides before other, possibly more toxic, measures are instituted.     

Role of foods in irregular aggravation of skin lesions in children with atopic dermatitis

Atopic dermatitis is a common inflammatory skin disease that especially affects children and adolescents. Many environmental factors have been recognized as relevant in aggravating skin lesions of the disease. However, it remains to be determined whether foods play a role in worsening of skin lesions in children with atopic dermatitis. In the present study, we investigated whether foods play a role in irregular aggravation of skin lesions in children with the disease. The study population consisted of 69 patients aged 3-15 years with atopic dermatitis. They were hospitalized and open challenge tests were performed with suspected foods. Photographs of representative skin lesion sites were taken at baseline and before and after the challenge. We determined challenge-positive foods by evaluating the comparable before/after challenge photographs. One to three (average, 1.9) challenge-positive foods were confirmed in 52 (75%) of the 69 patients examined. Predominant offending foods were chocolate, cheese and yogurt. Specific immunoglobulin E values to offending foods were mostly negative. We asked patients to exclude challenge-positive foods from their diets. They were then discharged and followed up for 3 months at our outpatient clinic. Exclusion of the offending foods for 3 months brought about a remarkable improvement in the disease. These results suggest that foods play an important role in irregular aggravation of skin lesions in children with atopic dermatitis.     

Topical propranolol therapy for infantile hemangiomas

The nonselective beta-adrenergic receptor antagonist propranolol is an effective therapy for infantile hemangiomas. Systemic propranolol therapy shows a rapid therapeutic effect with good drug tolerability. We report on the efficacy of local application of propranolol ointment in superficial hemangiomas of the skin. In our outpatient department, 45 children with 65 hemangiomas were treated with 1% propranolol in a hydrophilic ointment topically applied twice a day. Before start of treatment and at each visit, clinical photographs were taken. If ultrasound did not confirm occult deeper components, children were included in the study. Treatment in the proliferative phase within the first 6 months of life (including seven preterm infants) induced regression in 59% and cessation of growth in 26% of the hemangiomas. No response or proliferation of subcutaneous components was observed in 15%. Clinically, no side effects caused by the beta-receptor blocker were noticed. Treatment of two ulcerated hemangiomas of the perineal region twice using a flash lamp pulsed-dye laser and propranolol ointment in the surrounding lesion led to healing of the ulcers in 3 and 6 weeks, respectively. In six patients, topical therapy was started between the ages of 7 and 33 months. Even in these hemangiomas, improvement was obvious after 2 or 3 months. Propranolol administered topically in 1% ointment could have a beneficial effect on superficial hemangiomas of the skin. The treatment was well tolerated without side effects even in preterm infants and in children with numerous or large lesions.     

Severe skin pain after PUVA treatment.

Severe skin pain lasting one or two months occurred in 8 of 210 patients treated with PUVA. The pain started 4--8 weeks after the initial dose, mostly about one week after discontinuation of the treatment. It was a prickling, burning pain, usually coming in bouts and confined to limited areas "deep under the skin". In some respects the pain was related to itching, but the patients could easily distinguish between the two sensations. A variety of drugs was tried, but none had any noteworthy effect on this peculiar pain.     

Atopic dermatitis in patients with normal and raised IgE levels

In a group of 535 children and 103 adult patients with atopic dermatitis no differences were observed between persons with normal and raised IgE level with respect to incidence of lesions in the first or the first three months of life, the total number of the positive RAST results and the most intense reactions, that is 4 degrees, the percent of helper and suppressor T-cells, duration of remission, darkening of lower eyelids, cheilitis, involvement of the hands, the feet, the elbow flexures or knee flexures. On the other hand, in individuals with raised IgE level, especially in patients with IgE level tenfold higher or more than normal, the co-existence of alergic diseases of the respiratory system, the appearance of itching after sweating, itching after emotion, pityriasis alba, and eczema of breasts were