Dermatitis artefacta: unusual appearance in an older woman.

Dermatitis artefacta is a rare and difficult condition for diagnosis and treatment, with the highest incidence of onset in late adolescence to early adult life. Most patients are young women who have a personality disorder; borderline features are common and the patient's denial of psychological distress makes management and treatment difficult. Patients use a variety of means to cause the skin changes. Clinical presentation of the skin lesions does not conform to those of known dermatoses and are located on easily reached parts of the skin. We report an unusual case of a 72-year-old woman with symmetrical changes under the breasts and in the right inguinal region. The lesions were composed partly of haemorrhagic round lesions and partly of scars. A skin biopsy was taken and consultations with the psychiatrist, internist and the patient's family led to the diagnosis of self-induced dermatitis. The skin lesions were covered by occlusion techniques and the lesions improved very rapidly. The patient was discharged from the hospital under psychiatric and family care.

CD44-mediated cyclooxygenase-2 expression and thromboxane A2 production in RAW 264.7 macrophages.

OBJECTIVE AND DESIGN: CD44 is the major cell surface receptor for hyaluronan (HA) on macrophages. Stimulation of macrophages via the HA-CD44 pathway leads to the enhanced expression of inflammatory gene products, including cytokines, chemokines, and adhesion molecules. We have examined whether activation of CD44 by crosslinking is capable of activating the cyclooxygenase (COX) and prostaglandin (PG)/thromboxane (TX) pathway in cultured macrophages. MATERIALS AND METHODS: CD44 was crosslinked on RAW 264.7 mouse macrophages using specific rat anti-mouse CD44 monoclonal antibodies and anti-rat IgG. Total RNA was extracted and subjected to RT-PCR analysis for genes of the PG/TX synthetic pathway. Supernatants were analyzed for PGE2 and TXB2 using specific ELISAs. RESULTS: Transcripts for COX-1, COX-2, TX synthase (TXS), and PGE2 synthase (PGES) were all constitutively expressed in the mouse macrophage cell line RAW 264.7. Crosslinking of CD44 markedly enhanced COX-2 and weakly increased TXS mRNA, whereas COX-1 and PGES mRNA did not change significantly in these cells. Crosslinking of CD44 selectively increased the production of TXB2 but not PGE2. CONCLUSIONS: These findings suggest that the activation of the CD44 pathway plays a unique role in PG synthesis. Activation of this pathway results in enhanced TXA2 but not PGE2 production. This leads to an imbalance of the TXA2/PGE2 profile which favors a proinflammatory and vasoconstrictory response.