A study of clinical, histopathological and direct immunofluorescence diagnosis in pemphigus group Utility of direct immunofluorescence.

AIMS: To determine the diagnostic accordance between histopathological and direct immunofluorescence diagnosis of patients with autoimmune vesiculobullous skin diseases. BACKGROUND: The term pemphigus refers to a group of autoimmune blistering diseases mediated by auto-antibodies directed against desmoglein proteins. The differentiation between the various bullous diseases is important for treatment and prognosis. Direct immunofluorescence microscopy is still the gold standard in differentiating these diseases. METHODS: Patients with clinical diagnosis of vesiculobullous dermatitis from pemphigus group were included in the study. We retrospectively analyzed histopathologic and direct immunofluorescence results from skin or mucosal samples over 15-year period. RESULTS: 81 patients were included. The accordance was good in pemphigus vulgaris and pemphigus herpetiformis, but low in pemphigus vegetans, pemphigus foliaceus and pemphigus erythematosus. No accordance was in Hailey-Hailey disease and Grover´s disease. Uncommon result in our analysis included: intraepidermal IgG and IgM depositions at DIF in one Grover´s disease patient. CONCLUSION: Our results confirmed the relevance of direct immunofluorescence assays as a necessary diagnostic method for the definitive diagnosis of autoimmune blistering disease in the case, where the clinical feature and the results of histopathology are not clear (Tab. 4, Fig. 5, Ref. 26).

The treatment of facial atopic dermatitis in children who are intolerant of, or dependent on, topical corticosteroids: a randomized, controlled clinical trial.

BACKGROUND: Atopic dermatitis (AD) is most prevalent in areas of reduced skin barrier reserve, like face and neck, especially in children. Treatment with topical corticosteroids (TCS) is limited due to heightened risk of treatment-associated side-effects, thus necessitating alternative AD therapies. OBJECTIVES: The primary study objective was to determine the efficacy of pimecrolimus cream 1% in children with mild-moderate facial AD dependent on/intolerant of TCS. Secondary objectives included effects on overall Eczema Area and Severity Index (EASI), head/neck EASI, pruritus severity and time to clearance of facial AD. METHODS: A multicentre, double-blind (DB) study of < or = 6 weeks, followed by a 6-week, open-label (OL) phase was conducted. Two hundred patients (aged 2-11 years) were randomized 1:1 to pimecrolimus cream 1% (n = 99) or vehicle (n = 101) twice daily until clearance of facial AD or for a maximum of 6 weeks (DB phase). Sixteen patients receiving vehicle were allowed to switch to the OL phase at day 22. RESULTS: Significantly more pimecrolimus-treated vs. vehicle-treated patients were cleared/almost cleared of facial AD (Investigators' Global Assessment 0/1): 74.5% vs. 51.0%, P < 0.001 (day 43) [57.1% vs. 36.0%, P = 0.004 (day 22)]. Median time to clearance was 22.0 vs. 43.0 days (pimecrolimus vs. vehicle, respectively). Statistically significant differences for pimecrolimus vs. vehicle were also seen on head/neck EASI, overall EASI, and head/neck pruritus scores. Adverse events were mainly mild-moderate, occurring with similar frequency in both treatment groups. CONCLUSIONS: In children with facial dermatitis intolerant of/dependent on TCS, pimecrolimus cream 1% effectively controls eczema and pruritus and is well tolerated.

[Immunofluorescent analysis of anterior lens capsule allotransplantation for chronic corneal ulcers]. / Imunofluorescencná analýza allotransplantátov prednej sosovkovej kapsuly u chronických vredov rohovky.

This study uses immunofluorescent analysis to find out in histologic corneal sections a possible rejection reaction in anterior lens capsule allotransplantation for chronic corneal ulcers. The experiment included control group of rabbit corneas with repeat injury to epithelium and anterior stroma as well as surgically treated group. Fluorescein-conjugated human antibodies to IgA, IgM, IgG, complement and fibrinogen were used in the study. For detection we used method of direct immunofluorescence. Positive was only examination on fibrinogen in sections of treated group eyes 2 days after surgery. Last examination after 3 months failed to detect positivity in any of the tested markers. We preliminarily conclude that anterior lens capsule allotransplantation for chronic corneal ulcers does not result in rejection reaction and that components of humoral immunity do not participate in immune reaction.

Occurrence of Candida strains in cases of paronychia.

A total of 43 patients, 11 males and 32 females, with paronychia of the fingernails were examined for the presence of Candida spp. The yeast species isolated were identified using standard laboratory methods, including germ-tube production, morphology on rice agar with Tween 80, and mainly fermentation and assimilation of saccharides. In the male group, two Candida species were detected: C. albicans as the dominant species in 9 patients and C. parapsilosis in 2 cases. Similarly, C. albicans was the prevalent species also in females (n = 17); other Candida species detected were C. parapsilosis (n = 7), C. tropicalis (5) and C. krusei (3). In addition to the genus Candida, the following anaerobic and aerobic microorganisms were isolated from patients of both groups: Fusobacterium spp., Bacteroides spp., Staphylococcus aureus, alpha-hemolytic streptococci, group A beta-hemolytic streptococci, Klebsiella pneumoniae, Neisseria spp. and Pseudomonas aeruginosa.

Effect of vaccination therapy for acne, using a staphylococci antigenic complex in combination with clindamycin.

A group of 46 patients with acne vulgaris were prescribed clindamycin in combination with a vaccination therapy using a staphylococci antigenic complex (Polystafana; Sevapharma, Czechia). Acne papulopustulosa was diagnosed in 36 patients and acne indurata in 10 patients. The clinical effect of clindamycin and Polystafana was determined on the basis of the regression of the inflammatory manifestation of acne: regression by 0-30% was considered unsuccessful, by 30-80% satisfactory, and above 80% excellent; the immunomodulation effect of the treatment was evaluated in parallel. The clinical effect was excellent in 21 patients with acne papulopustulosa and in 6 with acne indurata; it was accompanied by pronounced immunomodulation effect as both cellular and humoral immunity was also tended to return to normal values. A satisfactory clinical effect was observed in 15 patients with acne papulopustulosa, whose cellular immunity component was also stimulated. Only 4 patients with acne indurata failed to respond successfully. These were the patients who showed a pronounced deficit of the cellular immunity component persisting even after the treatment. The administration of clindamycin in combination with Polystafana vaccination can be recommended as an effective means for the treatment of acne vulgaris.

The frequency of Candida species in onychomycosis.

Mycological investigation of 108 nail specimens taken from a total of 41 patients examined over three years included direct microscopy and repeated cultures. A higher incidence of onychomycosis of the fingernails (75%) was observed in women while afflictions of the toenails (71%) prevailed in men. The highest prevalence of onychomycosis was found in patients between 50 and 70 years of age. Candida albicans was the dominant organism causing onychomycosis (prevalence rate 60.9%), followed by C. parapsilosis (19.6%), C. tropicalis (9.8), C. krusei (4.9), C. guilliermondii and C. zeylanoides (2.4% each).

Electrophoretic karyotyping of Candida albicans strains isolated from premature infants and hospital personnel in a neonatal intensive care unit.

Electrophoretic karyotyping was used to compare DNA probes of yeasts isolated from blood of preterm neonates (n = 66) in a neonatal intensive care unit (NICU) and from the hands of healthy hospital personnel (n = 10). The yeasts were identified as Candida albicans using standard laboratory methods. DNA was extracted from yeasts and isolation of identical DNA strains from the pairs nurse-neonate suggested that one nurse transmitted one yeast strain by her hands to three neonates. Four neonates harbored two identical strains originating from two nurses, i.e. each nurse transmitted the same strain to two neonates. In the additional 7 cases transmission of 1 yeast strain by 1 nurse to 1 neonate was observed. Our data suggest that nonperinatal nosocomial transmission of C. albicans occurs in neonates, possibly via cross-contamination being transferred on hands of health care workers. The importance of careful hand washing of staff (health care workers) and other infection-control procedures (to prevent the nosocomial transmission of pathogens in the NICU environment) is emphasized.

Incidence of Candida species isolated from human skin and nails: a survey.

Distribution of Candida species was investigated by examining 245 samples from skin lesions and nails. The isolates were identified using standard laboratory methods including germ tube test, micromorphology of colonies on rice agar, the commercial kit, saccharide assimilation and fermentation tests. Eight species of Candida were identified: C. albicans accounted for 56.4% of the isolates, C. parapsilosis 29.1, C. tropicalis 7.8, C. pulcherrima 2.9, C. guilliermondii 1.5, C. krusei and C. zeylanoides for 0.9% each, and C. robusta for 0.5%. The factors significantly associated with colonization were prolonged antibiotic therapy, parenteral nutrition, low birth body mass of infants, intubation, duration of stay in hospital, indwelling intravenous catheter, malignancies, diabetes, surgery, and obesity.

Cutaneous candidosis in immunosuppressed patients.

One-hundred patients with candidosis of the skin, mucous membranes and nail plates (confirmed by cultivation) were examined. Topical or systemic antimycotic treatment was successful in 58 patients. After a complete evaluation, 42 patients were found to suffer from factors supporting candidosis--diabetes mellitus (12), anemia (3) and various local factors (10 patients); 27 patients showed a deficiency in cell-mediated immunity. In addition to intensive antimycotic therapy, successful treatment is affected by the actual immunity level and can be ensured by efficient immunomodulation treatment of immunodeficiency.

[Immunomodulating and therapeutic effects of the STAVA inj. preparation in acne vulgaris]. / Imunomodulacný a terapeutický efekt prípravku STAVA inj. u acne vulgaris.

The authors administered to 20 patients with acne vulgaris (14 patients with the papulopustulous form of acne, 6 patients with the indurative or cystic form of acne) the preparation STAVA inj. After treatment they evaluated the therapeutic effect of the preparation and the state of immunity of the patient. Treatment failed in three patients with the cystic form where there was a severe deficiency of the cellular immunity component. In six patients, where the cellular immunity was deficient treatment was satisfactory and it was almost restored to normal after treatment. In 11 patients the authors recorded an excellent therapeutic effect already after three weeks' administration and after treatment they recorded complete recovery of cellular immunity. The authors recommend this immunomodulating treatment when other treatment is not effective or contraindicated. In the conclusion they emphasize that STAVA inj. are an excellent immunostimulating preparation when cellular immunity is deficient. The therapeutic effect is good and so is the tolerance; there are no side-reactions.

[Sclerotherapy of vascular ectasias of the lower extremities]. / Sklerotizacná liecba cievnych ektázií dolných koncatín.

The authors treated a group of 138 female patients with injection solutions of Aethoxysklerol Fy Kreussler (SRN). They performed both the direct method of sclerotherapy by intravascular administration of the concentrations of 0.5 and 1%, and indirect method of sclerotherapy by intracutaneous administration of the concentration of 0.5%. The majority of patients were treated by both methods in the presented concentrations. The intravascular method has proved to be the most effective. This method yielded a very good homogenous result without recurrences in the site of sclerotization. The intracutaneous method yielded a less homogenous result and the recurrences occurred most frequently in the site of sclerotization in the focus. The therapeutic effect was evaluated after 1 year. After this period a good therapeutic effect was achieved in 57.97% out of 138 patients. In the third year a good therapeutical effect was achieved in 46.77% out of 62 patients. In the fifth year a good therapeutical effect was achieved in 50% out of 14 patients. Three patients were treated for the period of 10 years with a satisfactory effect. Significant side effects included focal hyperpigmentation of the skin (12 times), urticarial allergic reactions (3 times), and necrosis of the skin in two cases. Sclerotization of vascular cutaneous ectasies by means of the preparation Aethoxysklerol Fy Kreussler (SRN) is an appropriate and effective supplementary cosmetologic therapeutic method. (Tab. 1, Ref. 20.)

[Alopecia areata--an autoimmune disorder?]. / Alopecia areata--autoimúnne ochoreine?

The authors indicated examinations of actual immune states in 42 patients with alopecia areata in whom no cause of the disease was stated. The examination revealed a deficit in the cellular component of immunity and an increased level of immunoglobulin M and C3 component of complement. The examination of these patients included also the direct immunofluorescence examination of a skin excision from the alopetic focus. Out of 43 examined patients 30 had positive immunocomplex findings. Immunocomplexes were most frequently constituted of M immunoglobulin, C3 component of complement, as well as of A and G immunoglobulins. Immunocomplexes were localized in the lower and sometimes in the medium part of the folicle or perifolicullary, the intensity of fluorescence depended on the severeness of the disease. The deficit in the cellular component of immunity, dysimmunoglobulinemia in the peripheral blood and a positive immunocomplex findings in hair folicles at the examination of skin excisions from the alopetic focus by means of direct immunofluorescent method enables to include the disease of alopecia areata among autoimmune disease. The conclusion deals with the possibilities of utilization of local and general immunomodulation therapy. (Tab. 2, Fig. 1, Ref. 20.)

[Immunostimulation therapy in patients with alopecia areata]. / Imunostimulacná terapia u pacientov s alopecia areata.

The authors recorded decreased values of active and total E rosettes and increased values of IgM and C3 components of complement in 13 patients with alopecia areata. Direct immunofluorescence examination of skin excisions from the alopetic foci revealed immunocomplexes in hair follicles. On the basis of these examinations, excluding other causes of the disease of alopecia areata, the authors indicated the general immunostimulation therapy. (Decabris tbl., Transfer faktor inj.). This therapy resulted in an increase in active and total E rosettes and a decrease in IgM, and thus in the recovery of cellular and indirectly in the humoral component of immunity in the peripheral blood under the circumstances of a favourable clinical therapeutic effect.

[Defects in cellular immunity in patients with dermatophytosis]. / Defekt v celulárnej zlozke imunity u pacientov s epidermofýciou.

The authors examined in a group of 24 patients with epidermophytosis, refractory to general and local antimycotic treatment, persisting for 2-4 years, the immunity profile and compared the results with those in a group of healthy subjects. Epidermophytosis was diagnosed on the basis of the clinical picture, microscopic and cultivation examinations. The authors revealed in the patients with epidermophytosis a defect in the cellular immunity component, while there was no defect in the humoral component. They revealed also a shift in the proteins of the inflammatory phase which confirmed the long-term inflammatory process of the disease. In the conclusion the authors recommend to examine in patients with prolonged epidermophytosis refractory to general and local antimycotic treatment the immunological profile, and if there is a defect of cellular immunity despite antimycotic treatment to administer also immunostimulating preparations.