Angiofibromas with multiple epidermoid cysts in tuberous sclerosis: new mutation or post‐traumatic?

Tuberous sclerosis is a genetic multisystem disorder characterized by widespread hamartomas in several organs. Clinically, more than 90% of affected patients have skin lesions including facial angiofibromas, periungual fibromas, hypomelanotic macule, etc. Periungual fibroma is one of the major diagnostic criteria of tuberous sclerosis and has the same pathology (angiofibroma) as the facial papules. We herein describe an interesting histologic variant of angiofibromas coupled with multiple epidermoid cysts in a 33‐year‐old patient with tuberous sclerosis.     

What do gay men know about human papillomavirus? Australian gay men's knowledge and experience of anal cancer screening and human papillomavirus

OBJECTIVE: The objective of this study was to determine levels of experience and knowledge concerning anal dysplasia, anal Pap smear tests, and human papillomavirus (HPV) among gay and other homosexually active men. STUDY DESIGN: Three hundred eighty-four men attending a large gay community event in Melbourne completed a short survey. RESULTS: Ninety-two percent identified as gay and 4.8% as bisexual. A total of 6.4% were HIV-positive and a further 3.5% did not know their HIV status. On a range of measures, it was clear that the men knew very little about anal cancer (19% scored zero on a 12-point knowledge scale) and virtually nothing about HPV (47% scored zero on an 8-point knowledge scale). A total of 55.1% had never heard of an anal Pap smear and 44.8% had ever heard of HPV; 56.4% did not know whether it affected men and/or women. CONCLUSIONS: The test for anal dysplasia is still largely unknown among Australian gay men and they currently have poor sense of personal susceptibility to the disease. Health education strategies are suggested to improve this situation.     

Detection of human papillomavirus type 11 in a case of Buschke-Löwenstein tumor

We here report a 31-year-old male affected by a papillary tumor in his pubic region. At 26 years of age, he consulted a nearby clinic and was prescribed a topical cream. Although the condition was not relieved, he left the disease untreated. The gradually growing tumor adversely affected his quality of life, and he consulted another clinic, where he was referred to our hospital for surgery. The tumor had infiltrated the tissue at the base of the penis, but not the glans. After careful examination, we performed local excision of the tumor and a split-thickness skin graft. On pathological examination, elongation of the epidermis and koilocytes in the uppermost portion of the spinous layer were observed. Moreover, PCR examination confirmed the presence of human papillomavirus (HPV) type 11 in the tumor tissue. These findings supported a diagnosis of Buschke-L?wenstein tumor (BLT).     

The acetowhite test in genital human papillomavirus infection in men: what does it add?

BACKGROUND: Many genital human papillomavirus (HPV) infections are clinically invisible epithelial lesions. They remain so for a considerable time before some develop into clinically apparent lesions. The inapparent and asymptomatic nature of these lesions poses a problem in the detection and management of genital HPV infection. Without reliable, and readily available diagnostic methods, no definite therapeutic approach can be recommended or followed. The acetowhite test has been recommended to help determine the extent of the affected area. OBJECTIVE: To evaluate the acetowhite test in detecting inapparent subclinical HPV involvement in male patients with clinically apparent warts. METHODS: Two hundred and two uncircumcised patients with genital warts were included. Patients with concomitant inflammatory lesions were excluded. The warts and adjacent normal skin/mucosa of normal appearance were wrapped in gauze soaked in 5% acetic acid for about 3-5 min. The area was subsequently examined with a hand lens (x 8). RESULTS: All of the 116 hyperplastic warts became acetowhite, as well as a narrow rim of surrounding skin. Few flat warts in dry areas only became dull white and none pure white. No whiteness was observed in the surrounding area. Only 15 of 26 flat warts in moist areas became acetowhite. One (eroded lesion) of 13 verruca vulgaris type lesions and none of the pigmented papules gave positive results to the acetowhite test. CONCLUSIONS: The sensitivity of the acetowhite test for hyperplastic warts is very high, but for other types of warts is low. Detection of subclinical HPV-infected areas is difficult; the acetowhite test did not assist in the identification of additional areas of infection in our patients.     

Silver duct tape occlusion in treatment of plantar warts in adults: Is it effective?

Duct tape occlusive therapy may represent a convenient alternative to the standard wart therapies. The objective of the current study is to assess the therapeutic effect of duct tape occlusion in comparison to cryotherapy in treatment of plantar warts in adults, in a prospective comparative randomized non‐inferiority design. A total of 100 patients presenting with plantar warts were divided into two equal groups. First group was treated with silver duct tape occlusion for up to 8 weeks or disappearance of warts, whichever occurred first. Second group was treated with cryotherapy every 2 to 3 weeks for a maximum of four sessions or disappearance of warts. There was a statistically significant lower rate of complete resolution in duct tape than cryotherapy group (20% vs 58%, P = .0001, respectively). Degree of response to treatment in the duct tape and cryotherapy groups was not correlated to patients' age (P = .361 and .334, respectively) or disease duration (P = .266 and .285, respectively), while there was a statistically significant inverse relationship between the number (P = .0032 and .001, respectively) and diameter of warts (P = .013 and .003, respectively) and the degree of response in the two studied groups. Cryotherapy has higher efficacy than duct tape in the treatment of plantar warts in adults; however, duct tape may represent a practical and convenient alternative to cryotherapy in certain circumstances.     

Is endogenous glycerol a determinant of stratum corneum hydration in humans?

Although stratum corneum (SC) hydration has been primarily of concern to the cosmetic industry, it serves an important biosensor function. In murine models, not only deiminated products of filaggrin-derived amino acids ("NMF") but also endogenous glycerol from circulation into the epidermis via aquaporin 3 channel and from triglyceride turnover in sebaceous glands (SG) are important determinants. We assessed here whether endogenous glycerol could also be linked to SC hydration in humans. SG-enriched sites are more hydrated than SG-impoverished sites, and SC hydration correlates with both sebum production and SC glycerol content, but the correlation is more significant for SC glycerol content than for sebum content. Moreover, gender-related differences in sebum content are not associated with altered SC hydration. SC hydration is also linked to SC glycerol content in SG-impoverished sites, suggesting a role for non-SG-derived (? from circulation) glycerol in SC hydration. Finally, short-term water immersion produces a parallel decline in SC hydration and SC glycerol content, with glycerol levels returning to normal over several hours. These results suggest that endogenous glycerol of both circulatory and SG origin comprises an H2O-extractable pool that influences SC hydration in humans. These results also provide a rationale for the development of glycerol-containing therapeutic moisturizers.     

Papular palmoplantar hyperkeratosis following chronic medical exposure to arsenic: human papillomavirus as a co-factor in the pathogenesis of arsenical keratosis?

This study presents the case of a 38-year-old patient from Pakistan with vitiligo, who developed multiple verrucous papules on the palms and soles several years after receiving "herbal treatment" from a travelling Indian doctor for a period of 12 months. Histopathological examination showed changes consistent with the diagnosis of arsenical keratosis. Molecularbiological examination of a skin biopsy detected an atypical human papillomavirus. This observation supports the concept of human papillomavirus as a co-factor in the pathogenesis of premalignant arsenic-induced skin tumours.     

Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution‐associated disease?

Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.     

Immunopathologic features of allergic contact dermatitis in humans: participation of plasmacytoid dendritic cells in the pathogenesis of the disease?

Contrary to our abundant knowledge about the sensitization phase of human contact hypersensitivity, little is known about the cell types orchestrating the effector phase. In order to address this issue, we phenotypically analyzed biopsies from 72 h epicutaneous patch test reactions (n=10) and normal human skin (n=5) for the presence of various leukocyte differentiation antigens. The inflammatory infiltrate was dominated by CD3+/CD4+ T cells with approximately 30% of the cells coexpressing CD25 and CTLA-4, a phenotype consistent with either activated effector or regulatory T cells. In our search for professional antigen-presenting cells, we were surprised to find not only sizeable numbers of CD1a+ dendritic cells and CD1c+ dendritic cells, but also of CD123+, CD45RA+, BDCA-2+, CLA+, and CD62L+ plasmacytoid dendritic cells. Although virtually absent in normal human skin, these cells were detectable already 6 h after hapten challenge and were often found in close proximity to CD56+ natural killer cells, indicative of a functional interaction between these cell types. The detailed knowledge of the cellular composition of the inflammatory infiltrate in allergic contact dermatitis and its kinetics should form the basis for the investigation of the immunologic and molecular events operative in the perpetuation and resolution of the eczematous response.     

Influence of an anti-integrin α6 monoclonal antibody on the in vitro infection of human HaCaT keratinocytes with human papillomavirus (HPV) 6/11 virus particles

Objective To investigate the influence of an anti-integrin α6 monoclonal antibody (GoH3) on the in vitro infection of a human keratinocyte cell line HaCaT with HPV6/11 virus particles (VP). Methods HaCaT cells were infected in vitro with 4 different concentrations of HPV6/11 VP alone, HPV6/11 VP of 106 copies/ml after incubation with 6 different dilutions of GoH3, or 8 clinical isolates of HPV6/11 VP of 106 copies/ml before or after the incubation with 1∶ 100 dilution of GoH3. After additional culture, the infected HaCaT cells were collected and fluorescence quantitative (FQ)-PCR was performed to detect the HPV DNA load in cells. The inhibition rate of CoH3 on the infection was calculated. Results The viral load was different among the HaCaT cells infected with different concentrations of HPV6/11 VP (P < 0.01). The inhibition rate on the infection positively correlated with the concentration of CoH3 when the dilution was more than 1∶ 100; however, when the dilution was less than 1∶ 100, the increase in CoH3 concentration had no influence on the inhibition rate. The average viral load in HaCaT cells infected with clinical isolates of HPV6/11 VP was (5.81 ± 2.51) × 104 copies/ml in the absence of GoH3, (3.02 ± 1.21) × 104 copies/ml with the presence of CoH3, and the average inhibition rate of GoH3 was (46.9 ± 4.7)%. Conclusions GoH3 could partially suppress the adhesion of HPV6/11 VP to HaCaT cells, hinting that integrin a6 is an important HPV6/11 VP receptor on host cells.     

Influence of an anti-integrin α6 monoclonal antibody on the in vitro infection of human HaCaT keratinocytes with human papillomavirus (HPV) 6/11 virus particles

Objective To investigate the influence of an anti-integrin α6 monoclonal antibody (GoH3) on the in vitro infection of a human keratinocyte cell line HaCaT with HPV6/11 virus particles (VP). Methods HaCaT cells were infected in vitro with 4 different concentrations of HPV6/11 VP alone, HPV6/11 VP of 106 copies/ml after incubation with 6 different dilutions of GoH3, or 8 clinical isolates of HPV6/11 VP of 106 copies/ml before or after the incubation with 1∶ 100 dilution of GoH3. After additional culture, the infected HaCaT cells were collected and fluorescence quantitative (FQ)-PCR was performed to detect the HPV DNA load in cells. The inhibition rate of CoH3 on the infection was calculated. Results The viral load was different among the HaCaT cells infected with different concentrations of HPV6/11 VP (P < 0.01). The inhibition rate on the infection positively correlated with the concentration of CoH3 when the dilution was more than 1∶ 100; however, when the dilution was less than 1∶ 100, the increase in CoH3 concentration had no influence on the inhibition rate. The average viral load in HaCaT cells infected with clinical isolates of HPV6/11 VP was (5.81 ± 2.51) × 104 copies/ml in the absence of GoH3, (3.02 ± 1.21) × 104 copies/ml with the presence of CoH3, and the average inhibition rate of GoH3 was (46.9 ± 4.7)%. Conclusions GoH3 could partially suppress the adhesion of HPV6/11 VP to HaCaT cells, hinting that integrin a6 is an important HPV6/11 VP receptor on host cells.