Actinic keratosis in the en‐face and slice imaging mode of high‐definition optical coherence tomography and comparison with histology

Background Optical coherence tomography (OCT) allows real‐time, in vivo examination of nonmelanoma skin cancer. An innovative high‐definition (HD)‐OCT with a horizontal (en‐face) and vertical (slice) imaging mode offers additional information in the diagnosis of actinic keratosis (AK) and may potentially replace invasive diagnostic biopsies. Objectives To define the characteristic morphological features of AK by using HD‐OCT in the two imaging modes compared with histopathology as gold standard. Methods In total, 20 AKs were examined by HD‐OCT in the en‐face and slice imaging modes and characteristic features were described and evaluated in comparison with the histopathological findings. Furthermore, the HD‐OCT images of a subgroup of AKs were compared with those of the clinically normal adjacent skin. Results The preoperative in vivo diagnostics showed the following features in the en‐face imaging mode of HD‐OCT: disruption of stratum corneum, architectural disarray, cellular/nuclear polymorphism in the stratum granulosum/stratum spinosum, and bright irregular bundles in the superficial dermis. In the vertical slice imaging mode the following characteristics were found: irregular entrance signal, destruction of layering, white streaks and dots, and grey areas. In contrast, the clinically healthy adjacent skin showed mainly a regular epidermal ‘honeycomb’ pattern in the en‐face mode and distinct layering of the skin in the slice mode. Conclusions HD‐OCT with both the en‐face and slice imaging modes offers additional information in the diagnosis of AK compared with conventional OCT and might enhance the possibility of the noninvasive diagnosis of AK prior to treatment procedures and possibly in the monitoring of noninvasive treatment strategies.     

NXCL‐4950, a novel composite applicable to peripheral skin,is capable of increasing skin temperature by enhancing capillary circulation

Background. Rapid skin warming and prompt correct medical treatment lead to dramatic improvement in patients with peripheral capillary‐related damage, such as injuries, Raynaud disease and frostbite. Aim. To characterize a novel composite, NXCL‐4950, for use in a cosmetic lotion. Methods. The effects of NXCL‐4950 on enhancing skin blood flow, skin temperature warming, and expansion of peripheral blood vessels and scalp microvessels were investigated. Results. Monitoring by laser Doppler perfusion imaging and thermal imaging showed that application of NXCL‐4950 to the hands increased skin blood flow and temperature relative to the control (or placebo) group. For the 20 participants with a high Raynaud Condition Score, application of NXCL‐4950 to the skin resulted in a mean increase of 215.53% in microvessel diameter and mean increase of 164.96% in the speed of blood flow. When NXCL‐4950 was applied to the scalp, the microvessels around the hair roots were clearly visible after 20 min. Conclusion. NXCL‐4950 is a potential candidate for enhancing peripheral skin temperature, and might be useful in the treatment of capillary‐related disorders.     

Plasma trough levels of adalimumab and infliximab in terms of clinical efficacy during the treatment of psoriasis

We examined the relation between adalimumab and infliximab plasma trough levels, anti‐adalimumab and anti‐infliximab antibody formation. We analyzed plasma from 32 adalimumab‐treated and 20 infliximab‐treated psoriasis patients for evaluating trough levels of each drug. The presence of anti‐adalimumab and anti‐infliximab antibodies was analyzed and the severity of psoriasis was evaluated. At week 28, 25 out of 32 and at week 48, 21 out of 30 adalimumab‐treated patients maintained as more than PASI 75. At week 28, 12 out of 20 and at week 48, nine out of 18 infliximab‐treated patients were evaluated as more than PASI 75. In patients treated with 40 mg adalimumab every other week, the mean trough level was 7.62 μg/mL (range, 0.05–10.6) at week 48. In patients treated with 80 mg adalimumab every other week, the mean trough level was 8.61 μg/mL (range, 0.08–13.5) at week 48. Mean trough level of infliximab‐treated cases (4.1–5.2 mg/kg; mean, 4.6) was 4.64 μg/mL (range, 0.03–16.9) at week 48. Anti‐adalimumab antibody was detected in five out of 32 cases and anti‐infliximab antibody was detected in six out of 20 cases, respectively, at weeks 24 and 48. The optimal cut‐off values of adalimumab and infliximab concentration for more than PASI 75 were more than 7.84 μg/mL and more than 0.92 μg/mL, respectively. The trough levels of adalimumab and infliximab in psoriasis patients were positively associated with clinical response and were significantly lower in cases having anti‐adalimumab or anti‐infliximab antibodies.     

Ultraviolet A1 phototherapy for mycosis fungoides

Background. Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma, and is characterized by a malignant proliferation of CD4+ cells. Psoralen ultraviolet A (PUVA) irradiation is the most common treatment for cutaneous lesions. However, PUVA carries the risk of adverse reactions to psoralens and long‐term risk of skin cancer. UVA1 may be a safer alternative. Aim. To assess the efficacy of UVA1 phototherapy in patients with early‐stage MF (T1–T2). Methods. Four patients with early‐stage MF were treated with 1630–2710 J/cm² UVA1 given in 29–40 fractions, and the effect was assessed by clinical examination and by high‐resolution ultrasonography. Results. Complete clinical remission of MF was achieved in all cases. Conclusions. This preliminary report indicates that UVA1 phototherapy might be an efficient treatment for early‐stage MF.     

Increased risk of psoriasis following chronic rhinosinusitis without nasal polyps: a population‐based matched‐cohort study

Background Although chronic rhinosinusitis without nasal polyps (CRSsNP) and psoriasis both share immunological disturbances as pathological factors, no prior study has investigated the risk for psoriasis among patients with CRSsNP. Objectives To investigate the subsequent risk for psoriasis following a diagnosis of CRSsNP by utilizing a cohort study design and a population‐based dataset in Taiwan. Methods In total, 13 242 subjects with CRSsNP were included in the study cohort and 39 726 subjects were randomly extracted for the comparison cohort. We individually tracked each individual in this study (n = 52 968) for a 5‐year period following their index date to identify those subjects who received a subsequent diagnosis of psoriasis. Cox proportional hazards regression analysis was conducted to calculate the 5‐year risk of subsequent psoriasis following a diagnosis of CRS among the sampled subjects. Results The incidence rate of psoriasis during the 5‐year follow‐up period was 1·41 [95% confidence interval (CI) 1·14–1·71] per 1000 person‐years and 0·69 (95% CI 0·59–0·81) per 1000 person‐years for the study and comparison cohort, respectively. Stratified Cox proportional hazards regression revealed that the hazard ratio for psoriasis during the 5‐year follow‐up period for subjects with CRSsNP compared with the control group was 2·01 (95% CI 1·54–2·62) after adjusting for monthly income, geographical region, hypertension, diabetes, coronary heart disease and hyperlipidaemia, and censoring the cases who died during the 5‐year follow‐up period. Conclusion This study detected an increased risk for psoriasis among patients with CRSsNP.     

Penetration and haptenation of p‐phenylenediamine

Although p‐phenylenediamine (PPD) has been recognized as an extreme sensitizer for many years, the exact mechanism of sensitization has not been elucidated yet. Penetration and the ability to bind to proteins are the first two hurdles that an allergen has to overcome to be able to sensitize. This review is an overview of studies regarding PPD penetration through skin (analogues) and studies on the amino acids that are targeted by PPD. To complete this review, the auto‐oxidation and N‐acetylation steps involved in PPD metabolism are described. In summary, under normal hair dyeing exposure conditions, <1% of the applied PPD dose penetrates the skin. The majority (>80%) of PPD that penetrates will be converted into the detoxification products monoacetyl‐PPD and diacetyl‐PPD by the N‐acetyltransferase enzymes. The small amount of PPD that does not become N‐acetylated is susceptible to auto‐oxidation reactions, yielding protein‐reactive PPD derivatives. These derivatives may bind to specific amino acids, and some of the formed adducts might be the complexes responsible for sensitization. However, true in vivo evidence is lacking, and further research to unravel the definite mechanism of sensitization is needed.     

Ulcer recurrence after in‐hospital treatment for recalcitrant venous leg ulceration

Background Leg ulceration caused by chronic venous disease occurs in 1% of the adult Western population. A majority of these patients is successfully treated in the outpatient setting. A minority of patients is hospitalized, most frequently because of the lack of healing tendency. The literature provides recurrence rates for ulcer disease, but lacks specific data on recurrence rates after in‐hospital treatment of recalcitrant venous leg ulcers. Objectives To investigate time to ulcer recurrence after in‐hospital treatment of venous leg ulceration. Methods A multicentre, retrospective cohort study of patients admitted for leg ulceration between 1996 and 2007 was conducted. Results Data could be collected for 107 of the patients. Of these, 27 had conservative treatment (bed rest, local wound care, pain management) and 48 patients underwent surgical ulcer treatment with (n = 19) or without (n = 29) initial vacuum‐assisted closure (VAC) treatment. The treatment method was ‘miscellaneous’ in the remaining 32 patients. Median admission time was 30 days, median percentage of closure at discharge was 95%, and median time to ulcer recurrence 60 days. The Mann–Whitney U‐test showed significant differences between the conservative group and the surgery group, the latter having a longer length of hospital stay (P < 0·0001) and a higher percentage of ulcer closure (P < 0·0001), but there was no difference in time to ulcer recurrence (P = 0·273). Comparable differences were demonstrated between the conservative group and the VAC plus surgery group. No significant differences could be demonstrated between the surgically treated patients and those treated by VAC and surgery. Conclusions Hospital stay is significantly shorter in cases of surgical treatment of recalcitrant venous leg ulcers. Most ulcers recur within 2 months after hospital discharge. Recurrence of venous leg ulcers after hospital admission is independent of the method of treatment and cause of ulceration.     

Spindle cell variant of epithelioid sarcoma: an easily misdiagnosed tumour

Epithelioid sarcoma is a histologically distinct soft tissue sarcoma of high grade malignancy. We report a case of epithelioid sarcoma in a young man who presented with multiple nodules over the left forearm, with bony invasion and pulmonary metastases. The histological features of the dermal tumour were those of a malignant spindle cell tumour with positive cytokeratin and vimentin staining and differed from the classical epithelioid sarcoma in its absence of typical necrobiotic nodular epithelioid pattern. It was the clinical presentation and the histology of the subcutaneous nodules that led to the final diagnosis of epithelioid sarcoma. This case illustrates a predominance of spindle cell pattern in the dermal tumour of epithelioid sarcoma, which has previously been reported as fibroma-like variant of epithelioid sarcoma.