Validation of the diagnostic criteria for atopic dermatitis in the adult Thai population.

Atopic dermatitis is a chronic inflammatory skin disorder, for which it is difficult to obtain epidemiologic findings. In a previous study, we suggested the following diagnostic criteria for atopic dermatitis in the adult Thai population: visible flexural dermatitis, a history of flexural dermatitis, a rash of more than six months duration and visible dry skin. However these criteria were not validated against physicians' diagnoses. In the present study, we validated these diagnostic criteria for atopic dermatitis in the Thai population in a clinical setting. A case-controlled study was performed on a total of 259 patients; 33 subjects with active atopic dermatitis, 26 with inactive atopic dermatitis, 100 controls presenting with an inflammatory skin disorder other than atopic dermatitis and 100 controls without any skin disease. Each patient was examined according to the above criteria. Sensitivity, specificity, relative value, positive predictive value, and negative predictive value were calculated for each individual criterion and for composite criteria. Our data confirmed that in order to achieve satisfactory sensitivity and specificity for diagnosing atopic dermatitis in Thai people older than 13 years, a patient must have a history of flexural dermatitis plus two or more of the other mentioned criteria.

Transepidermal water loss, hydration, pH and elasticity of skin in atopic dermatitis and normal Thai subjects.

In order to obtain objective data on skin functions in patients with atopic dermatitis (AD), we studied, by means of measurement of transepidermal water loss (TEWL), skin surface hydration, pH, and elasticity of dry and normal skin at the dorsum and volar aspects of the forearms in patients with atopic dermatitis compared with normal subjects. Transepidermal water loss (TEWL), skin surface hydration, pH, and elasticity function were measured using Tewameter TM 210, Corneometer CM 820, Skin-pH-meter pH 900, and Cutometer SEM 575, respectively. Forty-one subjects, twenty-five atopic dermatitis patients with dry skin, sixteen atopic dermatitis patients without dry skin, and twenty normal subjects, were recruited in the study. Considering all skin sites together, no significant differences were found between the mean values of TEWL in the same sites, the dorsum and volar forearms, of subjects in each group of patients (p = 0.717, and p = 0.981, respectively). Statistically, there were significant differences between the mean values of skin surface hydration at the dorsum and volar forearms (p = 0.019 and p = 0.019, respectively) and skin pH at the dorsum and volar forearms (p = 0.036 and p = 0.043, respectively). Regarding the elasticity function of the dorsum, immediate recovery and biological elasticity were significant differences in each group of the patients (p = 0.048 and p = 0.019, respectively), meanwhile, the elasticity function of the volar forearms, immediate recovery, elasticity index, elastic recovery index, viscoelastic ratio and relative elastic recovery were significant differences (p = 0.014, p = 0.029, p < 0.001, p < 0.001 and p < 0.001, respectively). Therefore, further well-controlled studies, investigating the skin morphology of patients with atopic dermatitis, should be pursued to provide more targeted therapies and establish an optimal standard of care for all patients with atopic dermatitis.

Multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma: a rare simultaneous occurrence.

A rare simultaneous occurrence of multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma was diagnosed in a 70-year-old man who presented with fever, polyarthralgia, weight loss, vascular purpura, anemia, generalized lymphadenopathy, and hepatosplenomegaly. He had no risk of HIV infection and serological tests for HIV were negative twice, but a low number of T-cells and a reversed CD4/CD8 ratio were observed. During hospitalization, he developed Kaposi's sarcoma at the right sole. Lymph node biopsies revealed multicentric Castleman's disease together with a large B-cell lymphoma, which showed monotypic IgM-lambda lymphocytes. To our knowledge, this is the first report in which systemic manifestations of all three diseases occurred simultaneously prior to any specific treatment. The altered immune status and human herpesvirus-8 infection might have played a role in the pathogenesis of this occurrence.

Poststeroid panniculitis in an adult.

Poststeroid panniculitis is a rare complication of corticosteroid therapy. All reported cases have occurred in children. In this communication, we describe a 41-year-old woman who presented to us with multiple subcutaneous nodules which appeared after reduction of the dose of oral prednisolone administered for systemic lupus erythematosus. Histopathological examination confirmed the diagnosis of poststeroid panniculitis. To our knowledge, this is the first case report in which poststeroid panniculitis occurs in an adult.

Etiologic agents of cutaneous infectious granuloma: 2 year-experience from granuloma clinic, Siriraj Hospital.

Etiological diagnosis of cutaneous infectious granuloma is difficult to achieve and leads to difficult in patient management. We proposed to search for etiologic agents by special stain of histologic sections, cultural method and PCR technique for tuberculous and non-tuberculous mycobacteria. The skin biopsy specimens were obtained from dermatologic patients who attended Granuloma Clinic, Siriraj Hospital from January 1994 to December 1996. Sixty-nine cases of mixed cell granuloma were found during the 2-year-period. The causative agents had been found in 45 cases (65.22%). Mycobacterial infections were documented in 25 cases. Five cases of tuberculous infection were diagnosed by PCR method. Non-tuberculous mycobacterial infections were diagnosed by cultural method in 14 cases and the other 6 cases were diagnosed by acid-fast stain in histologic section alone. Actinomycotic mycetoma were diagnosed in 4cases. Fungal infections were documented in 16 cases, which caused by hyaline fungi 7 cases and dematiaceous fungi 9 cases. About one-third of all cases (24 cases) the etiologic agent could not be identified.