Keratoacanthoma in vitiligo lesion after UVB narrowband phototherapy.

The treatment of vitiligo is still a challenge. Among various therapeutic modalities, phototherapy with UVB narrowband (UVB-NB) is presently considered a treatment of choice for this skin disease. The exact skin cancer risk deriving from UVB-NB is a serious concern to be determined. We report a case of keratoacanthoma developed in the vitiligo area during a prolonged course of UVB-NB therapy.

Clinical trial of the efficacy and safety of oral etretinate with calcipotriol cream compared with etretinate alone in moderate-severe psoriasis.

BACKGROUND: The aim of this clinical trial was to assess the efficacy and safety of calcipotriol cream associated with oral etretinate compared with etretinate alone in the treatment of moderate-severe psoriasis. METHODS: This controlled multicenter trial, within patients (hemiparts), enrolled 86 in- or out-patients (62 males, 24 females), mean (+/-SD) age 57.1 +/- 14.2 years, with psoriasis vulgaris on both sides of the body, and mean (+/-SE) baseline PASI score (Psoriasis Area and Severity Index) 30.7 +/- 0.9. All patients took oral etretinate 50 mg/day and applied calcipotriol cream (50 microg/g) on one half of their body twice a day. Treatment was continued for 9 weeks, and patients were seen every 3 weeks. RESULTS: At the end of the first 3 weeks the PASI score indicated a significant clinical difference between the two sides of the body (P < 0.001, ANOVA), with a reduction of 50.7% in the score for the calcipotriol-treated half, compared with a 39% reduction for the untreated half. By the 9th week of treatment the PASI score was 81.4% lower on the treated half, and 70.3% on the untreated side (P < 0.001, ANOVA). CONCLUSIONS: These findings suggest that patients with moderate-severe psoriasis might benefit from treatment with etretinate plus calcipotriol, with the aim of achieving a faster response and an overall smaller total dose of etretinate.

Primary unusual cutaneous cryptococcosis in an HIV former drug-abuser patient.

We describe an HIV-positive patient suffering from cutaneous cryptococcosis who was a former intravenous drug abuser and who presented a nodulo-ulcerated lesion on the back of his left hand. This was caused 4 months previously when the patient was injured by a pigeon nesting in an abandoned house. After fluconazole treatment for 4 months, no other visceral infections were recorded 18 months after complete healing of the lesion.

In vivo transcutaneous penetration of nicotinates and sensitive skin.

Proclivity to develop irritant reactions and transcutaneous penetration of nicotinates has been investigated in 20 subjects of both sexes, divided into reactors and nonreactors on the basis of the responses to irritant stimuli. 1% sodium lauryl sulphate (patch application for 24 h) and 5% lactic acid in aqueous solutions were used to detect chemical and sensory (subjective) irritation. The vasodilatation induced was measured using a chromameter for 1 h after topical application of the chemical. The area-under-the-curve response and the peak response was used to assess the in vivo penetration of methyl nicotinate (10 mM in aqueous solution). Significant differences were found between reactors and non-reactors. Non-reactors showed a significantly decreased area-under-the-curve response and peak response to methyl nicotinate compared to reactors. Nicotinate-induced vasodilatation has been used as a model to study transcutaneous penetration of chemicals; the correlation between increased penetration of nicotinates and skin hyperreactivity to irritant substances may suggest an increased transcutaneous penetration of water-soluble chemicals in individuals with sensitive skin.

Prevalence of atopy in vitiligo. A preliminary report.

59 patients suffering from vitiligo were investigated anamnestically and clinically with intradermal (prick tests) and laboratory tests (RAST and total IgE count) for the presence of atopy. Clinical manifestations (allergic rhinitis, asthma) and intense positive prick tests and RAST with an increase in total IgE count were found in 13 patients (22%). This frequency was significantly higher than that found in the normal population in our area (11.9%; p = 0.0212). These patients had a significantly higher incidence of vitiligo in their families (76.9 vs. 29.7% of the non-atopic; p less than 0.025), an earlier onset (14.1 vs. 24 years of the nonatopic) and a rapid worsening of the disease.

Ranking of surfactant skin irritancy in vivo in man using the plastic occlusion stress test (POST).

Irritant effects and disturbance of water-holding capacity induced by surfactants were investigated using the plastic occlusion stress test (POST) technique. 4 surfactants (sodium lauryl sulphate (SLS), sorbitan monolaurate, cocoamidopropyl betaine and benzalkonium chloride) and an amphoteric/nonionic (A/N) mix were investigated. 1 x daily for 3 days, test surfactants were applied to marked sites (open) on the volar forearm. After 24 h occlusion with a plastic chamber on the 4th day, skin surface water loss (SSWL) (g/m2h) was recorded continuously for 25 min with an evaporimeter. The differences between the surfactants were statistically significant (Friedman's test p less than 0.01). SLS and the A/N mix revealed significant differences compared to the other compounds (p less than 0.05), both in decay constants and in values recorded at the beginning and at the end of the decay curve. The study suggests a mechanism for the high irritant potential of sodium lauryl sulphate compared to other surfactants: sorbitan monolaurate and benzalkonium chloride seem to influence (at the concentrations tested) to a lesser extent the water-holding capacity of the stratum corneum. The clinical and biological relevance of these observations requires long-term clinical correlations with final product use tests.

[A clinical study on the use of norfloxacin in the therapy of urethritis caused by Chlamydia trachomatis]. / Studio clinico sull'impiego della norflossacina nella terapia delle uretriti da Chlamydia trachomatis.

Norfloxacin (NOR) was given to 37 patients affected by urethritis due to Chlamydia trachomatis (CT), as demonstrated by clinical findings and fluorescent monoclonal antibody in urethral swab. The patients were divided into two groups according to a randomization list, and given either: NOR 400 mg t.i.d. or NOR 800 mg b.i.d. for 10 days. The 2 groups were comparable in terms of age, clinical presentation and duration of symptoms. Six out of 18 patients treated by regimen 2 had persistence of CT at the end of treatment (2 cases were clinically improved), while 4 out of 19 patients in group 1 dit not respond to the treatment. Overall 12 patients in group 2 (66.6%) and 15 patients in group 1 (79%) were asymptomatic and negative for fluorescent antibody at the end of the treatment. Both regimens were well tolerated. Our data show that NOR given at dosage higher than those usually recommended (e.g. 400 mg b.i.d.), may be of value for the treatment of urethritis due to Chlamydia trachomatis.

Adult Ki-1-positive large cell anaplastic lymphoma presenting with skin lesions.

We describe an adult case of anaplastic large cell lymphoma who presented with nonepidermotropic skin lesions histologically simulating malignant histiocytosis. The patient later developed systemic symptoms and peripheral lymphadenopathy. B- and T-cell markers and the Leu-M1 antigen were absent from immunohistochemically investigated skin lesions and lymph nodes. The expression of Ki-1 antigen by most tumor cells was the distinctive immunologic character of this disorder which helped to clarify the pathological diagnosis. The unusual clinical, pathologic, and immunologic features of this patient represent the adult counterpart of a clinicopathologic syndrome, so far described in children and adolescents, of Ki-1 lymphoma presenting with skin lesions and peripheral lymphadenopathy. Prompt recognition of this disorder and early delivery of chemotherapy seem important to improve prognosis.

[Cutaneous, muscular and cerebral cysticercosis]. / Cisticercosi cutanea, muscolare e cerebrale.

We present a case of cysticercosis with cutaneous subcutaneous muscular and cerebral involvement. The patient, a 34 years old man, developed over ten years multiple calcified cysts diffusely on the body. Analysis of a calcified cyst revealed the presence of cysticercus. A therapy with praziquantel proved successful.

Different role of secretory IgA in the pathogenesis of RAST-positive and RAST-negative atopic dermatitis.

Secretory-IgA (SIgA) concentrations were determined in whole saliva, unstimulated or stimulated by lemon juice, of thirty-eight children with atopic dermatitis, which comprised three adolescents, sixteen with IgE detected by RAST to one or more common allergen and twenty-two without specific IgE by RAST. There were thirty healthy controls matched for age and sex. The mean amount of total IgE was significantly greater in the RAST-positive than in the RAST-negative group. The mean SIgA concentration in unstimulated saliva of the RAST-positive atopic dermatitis group was less than that of the RAST-negative atopic dermatitis group and control groups, through the mean concentrations of SIgA of stimulated saliva were not significantly different in the three groups. It is suggested that the pathogenesis of atopic dermatitis may differ in children with or without specific-IgE antibodies; in those who were RAST-positive deficient exclusion of allergen by the intestinal barrier contributed to the pathogenesis, but not in those who were RAST-negative.