Treatment of Psoriasis in Children: Is There a Role for Antibiotic Therapy and Tonsillectomy?

Numerous studies implicate subclinical or recurrent streptococcal infection as a trigger or maintenance factor in the pathogenesis of psoriasis in children. The purpose of this article is to review the efficacy of antibiotic therapy and tonsillectomy as treatments for childhood psoriasis. Clinical trials assessing the efficacy of antibiotics or tonsillectomy as treatments for childhood psoriasis were identified with a search of the medical literature and the results were compared. Only one controlled clinical trial was identified and it did not find a significant effect of antibiotic treatment on psoriasis. In other studies, the percentage of psoriasis patients who experienced disease clearance with antibiotic therapy ranged from 0% to 55%, with no patients experiencing disease worsening during treatment. No controlled trials of tonsillectomy for psoriasis were identified. The percentage of patients who experienced disease clearance after tonsillectomy in uncontrolled trials ranged from 32% to 53% and a similar percentage reported significant improvement in their psoriasis, with a maximum of 7% noting worsening of the disease after the operation. The available evidence does not demonstrate the efficacy of either antibiotic therapy or tonsillectomy in the treatment of childhood psoriasis. Because these treatments are relatively benign compared to other treatments for severe psoriasis, the use of antibiotic therapy or tonsillectomy may still be worth considering, especially for those patients with recurrent streptococcal infections that seem to trigger or maintain their skin disease.     

Cutaneous mastocytosis in human immunodeficiency virus: an unfortunate coincidence?

We report the case of a young man who developed cutaneous mastocytosis on the trunk and limbs after an episode of severe sunburn. He was diagnosed with human immunodeficiency virus (HIV) shortly afterwards. We discuss this interesting and previously unreported temporal relationship between the development of mastocytosis and recent HIV infection, speculating on the potential pathogenetic mechanisms of association.     

Acral Cutaneous Findings in Wrinkly Skin Syndrome: Are They Tripe Palms?

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.     

Is contact allergy in man lifelong?

In contradistinction from certain strains of mice, contact allergy in man is hypothesized to be either lifelong or at least to last for years. We examined follow-up studies on contact allergy, as evaluated by patch testing, attempting to quantify its natural history. The allergens include colophonium, gold sodium thiosulfate, nickel, and cobalt. At present, due to technical limitations, we cannot state in quantitative terms whether contact allergy in man is lifelong and whether its clinical manifestations change. Thus, we list some criteria for future studies which may help resolve the above question.     

Is vascular reactivity in skin predictable?

Background/aims: Cutaneous microdialysis can be used to follow the pharmacology and metabolism of an inflammatory reaction. It is assumed that an equilibration period compensates for the trauma of catheter insertion. Methods: In the present paper, the vascular reactivity of the skin to histamine was tested using assessment by laser Doppler perfusion imaging. In a group of six subjects, the provocation was preceded by insertion of a microdialysis catheter. In a second control group, histamine provocation alone was performed (six subjects). Results: The vascular response to histamine was greater in the microdialysis catheter group than the control group. The histamine provocation caused a greater response than catheter insertion. Further, there was a correlation between the response to catheter insertion and the histamine provocation. Conclusion: It appears that the insertion and/or presence of a microdialysis catheter increases vascular reactivity to subsequent provocation. The response to catheter insertion may predict skin reactivity in general in the individual subject.     

Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999

Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

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Antécédents: Au cours des dernières décennies, le taux dincidence des mélanomes au sein des populations blanches a augmenté de façon considérable. Une légère hausse a été observée dans le taux de mortalité liée à cette condition. Les survies par cause et sans récidive sont fonction des caractéristiques de la tumeur et possiblement de son site, ainsi que du sexe et de lâge du patient. Il est difficile dévaluer précisément ces tendances sans les données, souvent inexistantes, sur lépaisseur de la tumeur. Objectif: Létude détermine les tendances de lincidence des mélanomes, de la mortalité et de la survie en Saskatchewan au cours dune période de trente ans, et comporte une analyse de lépaisseur des tumeurs. Méthodes: Des données sur des cas de mélanomes primitifs durant un intervalle de 30 ans (1970–1999) ont été obtenues du Saskatchewan Cancer Registry. Un échantillon randomisé de 50% des dossiers a été examiné en vue de tirer de linformation sur lindice de Breslow, le niveau dinvasion de Clark et autres données démographiques qui ne figurent pas dans le registre. Une analyse multivariable de régression a été effectuée afin de déterminer limportance des facteurs de pronostic sur lincidence et les taux de survie de cinq ans. Résultats: Le nombre de patients inscrits a augmenté considérablement au cours de la durée de létude. Une hausse marquée des cas de lésions minces a été notée dans toutes les fourchettes dâge. Les sites des tumeurs varient selon le sexe. Les risques que présentent les tumeurs à la tête et à la nuque augmentent avec lâge. Le taux de mortalité chez les femmes sest stabilisé avec le temps; le taux de mortalité chez les hommes a augmenté durant les années 1990. Les facteurs influant sur le pronostic de cinq ans sont lépaisseur de la tumeur, le niveau dinvasion de Clark et le sexe du patient. Conclusion: Laugmentation observée des cas de mélanomes semble réelle et non le résultat dun meilleur suivi ou dun dépistage plus efficace. Les caractéristiques des tumeurs (indice de Breslow et niveau de Clark) et le sexe des patients sont des indicateurs dun pronostic de surmortalité de cinq ans.

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Support for this work was provided by the College of Medicine, University of Saskatchewan Scholarship Fund. Presented at the Canadian Dermatology Association 76th Annual Meeting, Halifax, Nova Scotia, July 2001.     

Pachydermodactyly in a Young Girl: Cutaneous Manifestation of a Psychiatric Disorder?

Abstract: ; Pachydermodactyly is a benign process characterized by painless fusiform skin swellings affecting radial and ulnar aspects of the proximal interphalangeal joints of the fingers. We report a case of this condition in a young girl, suggesting a major role of psychiatric disorder in the development of cutaneous lesions.     

Cocktails anyone? Cutaneous hazards from bartender drinks

Cocktails are mixed drinks that typically contain alcohol and are enjoyed worldwide. For some people, however, drinking cocktails can result in life-threatening or severely distressing cutaneous reactions. This contribution examines five areas of concern in this regard: (1) food allergies, (2) food intolerances, (3) phytophotodermatitis, (4) skin reactions to quinine present in tonic water, and (5) traumatic injuries from cocktail sticks and burns from flaming cocktails.     

Cutaneous anthrax: conservative or surgical treatment?

This article summarizes the diagnostic features and treatment recommendations for cutaneous anthrax, exemplified by a case report of nontypical cutaneous anthrax. The treatment of choice is medical, with ciprofloxacin or doxycycline the preferred antibiotics. However, surgical biopsy may be used if the clinical setting and microbiologic examination of swabs are not diagnostically conclusive. Histopathologic findings explain the clinical observation that most cutaneous anthrax lesions heal without scar formation.