Ichthyosis

The reliability of clinical signs to differentiate between autosomal dominant ichthyosis (ADI) or sex-linked ichthyosis (SLI) were assessed. SLI was defined as ichthyosis in combination with steroid sulphatase deficiency. Age of onset and format of the scales were found to be reliable signs to ascertain the diagnosis of ADI or SLI. The ADI-like appearance in histopathology seems to be of little diagnostic value.     

Role of Cell-Mediated Immunity in Spontaneous Regression of Plane Warts

Human papillomavirus-induced plane warts most often occur in the second decade of age. Afterward, they either spontaneously regress or are eradicated in the course of various treatments. As proved by in vivo and in vitro tests as well as clinical observations, they most often affect and persist longer in immunocompromised hosts. In this work it was confirmed that specific-ie, anti-HPV-directed, cell-mediated immunologic response plays a role in spontaneous regression of plane warts and that preservation of nonspecific immunity is prerequisite for spontaneous regression of plane warts.     

TRICHOTILLOMANIA: A TRICHOTILLOSIS, A TRICHOTILLOTIC, OR A TIC TRICHOTILLOSIS

A 35-year-old Pakistani man working in Saudi Arabia was referred to the Dermatology Clinic, King Fahd Hospital, AlBaha for the evaluation of patches of hair loss from the beard and moustache (Fig. 1). The patches were of 4 years' duration and asymptomatic. The patient was married and had one child. His family was living in Pakistan, but there were no relevant problems, marital or otherwise, and he was happy at work. He spent his vacations back at home with his family. Past history of hair loss was negative. He appeared stable, relaxed, and reasonably dressed and did not manifest psychotic or psychoneurotic features. On the chin there was a well-demarcated patch of alopecia on which broken-off hair and hair of varying lengths were present. There was no scarring or inflammatory signs. Similar patches were seen on the peripheral parts of the moustache. The nails and rest of the skin were normal. A diagno-sis of trichotillomania was made and discussed with the patient. He acknowledged the self-induced nature of his hair loss and admitted to be habitually indulging in it.     

LEPROMATOUS LEPROSY TREATED WITH RECOMBINANT INTERFERON GAMMA: CUTANEOUS HISTOLOGIC CHANGES

We report on the histologic changes occurring in single cutaneous lesions, from six active lepromatous patients, 1 week following the administration of three daily intradermal injections, 35 micrograms each, of recombinant interferon gamma (rIFN-gamma). Except for a strong induration at the injection site, rIFN-gamma produced no adverse systemic reactions and was able to promote a remarkable influx of T-lymphocytes, mononuclear phagocytes with large nuclei, nonvacuolated cytoplasm, and reduced lysozyme reactivity. Furthermore, despite no clear-cut reduction of mycobacterial dermal burden, bacilli showed a clear increase in the granular appearance. Present findings provide a basis for further elucidation of rIFN-gamma as an additional tool for leprosy treatment.     

SQUAMOUS CELL CARCINOMA IN SOUTHERN AND NORTHERN AUSTRALIA

Squamous cell carcinoma (scc) of the skin was studied in two similar populations, one living in the temperate zone of Australia, the other living in the tropics. In the tropics, the patients were significantly younger, the man to woman ratio approached unity, and women had significantly more sccs on the legs. In the temperate zone, men had significantly more on the head and neck, but women had significantly more on the upper and lower limbs.     

MELASMA-LIKE (PIGMENTED) ACTINIC LICHEN PLANUS

Four patients suffering from pigmented actinic lichen planus were studied. Clinically, the lesions are melasma-like, affecting mainly the face and exacerbating in summer and spring time. The histopathologic and immunofluorescence studies showed typical changes of actinic lichen planus. The possibility of pigmented actinic lichen planus should be considered in every patient with facial melanosis.     

Pilot study: Association between Helicobacter pylori in adenoid hyperplasia and reflux episodes detected by multiple intraluminal impedance in children

Objectives

The aim of this pilot study was to investigate an association between laryngopharyngeal reflux detected by combined multiple intraluminal impedance and pH monitoring and Helicobacter pylori in adenoid hyperplasia detected with real time polymerase chain reaction (PCR).

Methods

The study group consisted of 30 children (median age 5.34 years) with extraesophageal symptoms of gastroesophageal reflux disease with adenoid hyperplasia. All children underwent adenoidectomy with subsequent PCR detection of H. pylori DNA in the tissue and multiple intraluminal impedance and pH monitoring. The most proximal impedance sensor was located 1 cm caudal to the entrance of the oesophagus.

Results

We found significant differences in the number of reflux episodes among patients with PCR positivity (median 35) and negativity (median 0) of H. pylori (p-value of Mann–Whitney U-test 0.0056). Patients with PCR positivity of H. pylori had significantly more reflux episodes reaching the upper oesophageal sphincter (p-value of Mann–Whitney U-test 0.023). The absence of reflux episode was the only independent factor for PCR negativity of H. pylori in the multiple logistic regression model.

Conclusions

These results support the hypothesis that reflux episodes reaching the upper oesophageal sphincter may play an important role in the transmission of H. pylori into lymphoid tissue of the nasopharynx and thus may contribute to adenoid hyperplasia in children.     

Serum cartilage oligomeric matrix protein and clinical signs and symptoms of potential pre-radiographic hip and knee pathology

OBJECTIVE: To examine the cross-sectional relationship between serum cartilage oligomeric matrix protein (COMP) and hip and knee clinical signs and symptoms in a sample of adults without radiographic hip or knee osteoarthritis (OA). DESIGN: A total of 145 persons with available sera and no evidence of radiographic hip or knee OA (Kellgren-Lawrence grade 0) were randomly selected from the Caucasian participants of the Johnston County Osteoarthritis Project. COMP was quantified by a competitive ELISA assay with a monoclonal antibody 17-C10. Hip and knee clinical signs and symptoms were assessed by physical examination and interview, and their associations with Ln COMP analysed with general linear models. RESULTS: After adjustment for age, gender, body mass index (BMI), and other symptomatic joints, mean Ln COMP was statistically significantly higher among persons with hip-related clinical signs (P=0.018), among those with hip-related symptoms (P=0.046), and among individuals meeting American College of Rheumatology clinical criteria for hip OA (P=0.021). There were no statistically significant associations between any of the knee-related clinical signs and symptoms and Ln COMP. CONCLUSION: Serum COMP may be useful as a biomarker of pre-radiographic hip joint pathology; its utility as a biomarker of pre-radiographic knee joint pathology is unclear.     

A comparative analysis of bone and cartilage metabolism in two strains of guinea-pig with varying degrees of naturally occurring osteoarthritis

OBJECTIVE: To evaluate the interaction of bone and cartilage in knee osteoarthritis (OA) pathogenesis in two guinea-pig strains with appreciable differences in bone metabolism. DESIGN: Two guinea-pig strains were evaluated for their susceptibilities to OA using semi-quantitative histological grading of knee joints and quantification of biomarkers including urinary excretion of hydroxylysyl-pyridinoline (HP) and lysyl-pyridinoline (LP) collagen cross-links, serum osteocalcin (OC), and synovial fluid levels of keratan sulfate (KS). RESULTS: At 12 months of age, Strain 13 guinea-pigs had minimal to mild histological evidence of OA compared to the Hartley strain guinea-pigs. The Hartley strain, with more severe OA, had a higher rate of bone formation (serum osteocalcin) and bone resorption (HP and LP) evident at a young age with persistence of a greater rate of bone formation at 12 months of age. The Strain 13 possessed much thicker subchondral bone at the outset (2 months) compared to the Hartley; however, the Hartley strain showed the greatest increase in subchondral bone thickness coincident with the development of cartilage degeneration. Thus, the process of subchondral bone thickening, in contrast to the absolute initial subchondral bone thickness, was a hallmark of OA in the guinea-pig. Moreover, Strain 13 had lower intraarticular proteoglycan turnover. Levels of synovial fluid keratan sulfate were positively correlated with the severity of histological OA. CONCLUSIONS: This pilot study represents the first evidence of differential susceptibility to OA in guinea-pigs. Comparison of these two strains of guinea-pig has revealed that increased metabolism within the affected tissues, cartilage and bone, is associated with the development and progression of OA. This work demonstrates that the Strain 13 is a viable age-matched control to the Hartley strain and merits a more in depth evaluation of the contribution of bone and bone metabolism to OA.