Axillary injection of botulinum A toxin in a patient with muscle cramps associated with severe axillary hyperhidrosis.

Muscle cramps may be caused by fluid and salt loss induced by diffuse or focal hyperhidrosis. Recent reports have described the efficacy of botulinum, toxin in the treatment of primary focal hyperhidrosis. Botulinum toxin inhibits sweating by blocking exocytosis of acetylcholine from presynaptic cholinergic nerve terminals. We report the case of a patient who complained of frequent muscle cramps associated with unusually severe axillary hyperhidrosis. We used botulinum toxin to treat the excessive focal sweating presuming that it would also reduce the muscle cramps. A total dose of 200 MU of botulinum A toxin (Dysport) per axilla markedly reduced sweating and cramps. The beneficial effect started four days after the injection and it was still present five months later. Treatment was repeated in the sixth month with analogous results. No side-effects were observed and no compensatory sweating occurred.

Analysis of risk factors for cutaneous warts in renal transplant recipients.

We have investigated some possible risk factors for cutaneous warts in a consecutive group of renal transplant recipients treated with three different immunosuppressive regimens: prednisolone + azathioprine (PA), prednisolone + azathioprine + cyclosporin (PAC), prednisolone + cyclosporin (PC). Kaplan and Meier analysis showed an earlier onset of warts in the PAC and PC groups than in the PA group (p < 0.0001), which might be related to the different immunosuppressive action of the pharmacological treatments including cyclosporin. Seven patients had skin cancer: 4 of them also had multiple warts on the cancer site. In 2 patients, histological examination demonstrated the neoplastic transformation of a wart. Maintenance posology of azathioprine, cyclosporin and prednisolone may be an important risk factor for cutaneous warts; on the other hand HLA-B mismatch and HLA-A11 seem to have no effect.

Renal transplantation and skin diseases: review of the literature and results of a 5-year follow-up of 285 patients.

We present a review of the current literature on skin diseases in renal transplant recipients (RTR) and the results of a 5-year follow-up of 285 patients. Many skin diseases are only an aesthetic and functional cause for interest, but HPV infections and skin cancers are significantly more frequent in RTR than in immunocompetent subjects and can affect a patient's prognosis. For this reason, we feel dermatological surveillance of RTR is necessary for early diagnosis and treatment of all high-risk lesions.

Metastatic hypopharyngeal carcinoma mimicking necrotizing vasculitis of the skin.

Clinical features of cutaneous necrotizing vasculitis were the presenting signs of a hypopharyngeal carcinoma in a forty-three-year-old man. A definite diagnosis was established by examination of fine-needle aspiration biopsy and scalpel biopsy specimens. Among the dermatoses simulated by metastatic pharyngeal carcinoma, necrotizing vasculitis has not, to our knowledge, been reported previously.

Lack of pancreatic maldigestion in atopic dermatitis.

Twenty adult patients affected by atopic dermatitis (AD) were submitted to the p-aminobenzoic acid (PABA) test in order to evaluate the proteolytic pancreatic function. All but one showed a normal PABA test. These results seem to exclude a proteolytic maldigestion as a pathogenetic factor in AD.

Effects of hydroxychloroquine on 'band test' in discoid lupus erythematosus.

Ten cases of localized and generalized discoid lupus erythematosus are reported in which previously untreated patients were given hydroxychloroquine sulphate 600 mg daily for 10 days followed by 400 mg for 20 days. The purpose of the study was to evaluate the effect of this drug on the 'lupus band' before and after treatment, in diseased, unaffected sun-exposed, and unaffected non sun-exposed skin. A good response from both the clinical and immunopathologic (i.e. reduction or disappearance of the immune reactants) standpoint was evident in 6/10 patients; in another 3 patients a good clinical but not immunopathologic response was recorded, while in 1 case a clinical worsening corresponded to an immunofluorescence improvement. In 5/10 cases (4 females, 1 male) one or more immunoglobulin classes which were present in the 'lupus band' before therapy remained at the dermoepidermal junction after treatment.

Intestinal permeability in patients with atopic eczema.

Passive intestinal permeability was measured in 15 adult patients with atopic eczema. Values in the patients did not differ significantly from those in 12 healthy control subjects. These results suggest that altered intestinal permeability is not important in the pathogenesis of atopic eczema in adults.

Increased erythrocyte membrane arachidonate and platelet malondialdehyde (MDA) production in psoriasis: normalization after fish-oil.

Evidence exists of platelet activation and increased thromboxane B2 production in psoriasis. In 13 patients suffering from psoriasis, we determined the lipid composition of erythrocyte membrane, erythrocyte and platelet glutathione peroxidase activity (E-GSH-Px; Plt-GSH-Px), platelet MDA production and bleeding time. Compared with normal controls, psoriatics showed a significant increase in erythrocyte membrane arachidonic acid (AA) (p less than 0.001) and polyunsaturated fatty acids (PUFA) (p less than 0.001), platelet MDA production (p less than 0.01) and E- and Plt-GSH-Px activity (p less than 0.01; p less than 0.01). After 8 weeks of fish-oil supplementation (20 ml/day) we observed the following changes: a) marked amelioration of skin lesions; b) normalization of membrane lipid pattern and platelet MDA production; c) a further increase in E- and Plt-GSH-Px activity (p less than 0.01; p less than 0.01); d) significant prolongation of bleeding time (p less than 0.05). Our data demonstrate: 1) a generalized perturbation of membrane lipid pattern in psoriasis, characterized by an excess of AA; 2) an activation of AA metabolism in platelets suggested by increased MDA production and GSH-Px activity; 3) dietary fish-oil may normalize membrane lipid pattern and reduce platelet hyperactivity in psoriasis.

Exocrine pancreatic function in chronic urticaria patients is normal.

25 patients with chronic urticaria suspected to be of 'alimentary origin', were studied for a quantitative or qualitative deficiency of pancreatic enzyme secretion. All showed a normal fecal chymotrypsin excretion and 23/25 a normal bentiromide (PABA) and pancreolauryl test. In 2 females the urinary PABA and pancreolauryl tests were borderline pathological. This does not support the hypothesis that a pancreatic deficiency (of the kind which could be identified with the methods used) is associated with chronic urticaria in patients in whom improvement of urticaria occurs under a hydric or low antigenic diet.

Pleomorphic lipoma of the dermis.

A case of pleomorphic lipoma is described. The neoplastic tissue developed exclusively within the dermis and characteristically involved the fibrous root sheaths of hair follicles, where several layers of lamellar collagen encircled the follicles and entrapped atypical spindle and multinucleated cells. A possible origin of this tumour in the adventitial dermis is postulated.

Treatment of psoriatic arthropathy with etretinate: a two-year follow-up.

In psoriatic arthropathy the data obtained after two years of etretinate treatment in 20 adult male patients, are reported. The beneficial effects of the drug on the objective symptoms are accompanied by an improvement in the biohumoral parameters evaluated. The dose was 1 mg/kg/day for one month, with subsequent adjustments in relation to the results obtained with a maintenance dose of 25 mg/day, or where possible, 10 mg/day, or on alternate days, for a maximum period of 25 months. The side effects appeared to be of an acceptable degree of severity. The authors consider etretinate one of the drugs of first choice in the treatment of psoriatic arthropathy.