Experimental Koebner phenomenon in patients with psoriasis.

BACKGROUND: The Koebner phenomenon is defined as 'the development of psoriasis at sites of traumatized skin'. The 'all-or-none principle' means that, if psoriasis occurs in one area of injury, all injured areas develop psoriasis or vice versa. The aim is to demonstrate the concordance of patients with the all-or-none principle when a standard method of trauma is employed. METHODS: Sixty-two patients with psoriasis were enrolled in the study. Demographic data and disease characteristics were recorded. The medial aspects of both forearms, devoid of lesions, were pricked using two sets of five 30-gauge needles at an angle of 30 degrees , with 2-cm intervals. On days 14 and 28, the patients' forearms were checked for the presence of a typical psoriatic plaque of white scales on an erythematous papule. RESULTS: On day 28, 45 patients (72.5%) had a negative Koebner response in all prick sites whereas 1 patient (1.6%) had psoriatic papules in 10 out of 10 prick sites. The rest of the patients (n = 16, 25.8%) had between 1 and 9 papules in number. CONCLUSION: Using standard methods of trauma, it is possible to induce psoriasis lesions as a Koebner response but this response is not always in concordance with the all-or-none principle previously described.

Scleredema adultorum associated with hyperkeratosis.

Scleredema adultorum is a rare skin disorder reported to occur usually following streptococcal infections. It has characteristic clinical and histopathologic findings; however, associated hyperkeratosis is not known. We report a 6-year-old girl with scleredema adultorum and hyperkeratosis. The patient's disease had a benign course. To our knowledge, this patient is the first reported with scleredema adultorum associated with hyperkeratosis.

Milia in regressing plaques of mycosis fungoides: provoked by topical nitrogen mustard or not?

OBJECTIVE: To report three cases of mycosis fungoides with milia formation in the regressing lesions. PATIENTS AND SETTING: Dermatology clinic of a university hospital (referral center). Three patients with mycosis fungoides with body surface involvement of 10% in one case (stage IIb) and exceeding 30% in two cases (stages IIb and III). All patients were treated with photochemotherapy and topical nitrogen mustard ointment in a concentration of 0.01%. After approximately 3 months multiple milia erupted on regressing plaques. RESULTS: The presence of milia was evident and was confirmed by histopathology. Regression of mycosis fungoides was noted in these plaques both clinically and in comparison with the pretreatment histologic appearance. Two of the patients showed a histological picture of follicular mucinosis. CONCLUSIONS: We do not know the significance of milia in mycosis fungoides (MF). However, we suggest that follicular rupture or a degenerative process might result in milia formation.

Familial atrophia maculosa varioliformis cutis.

Atrophia maculosa varioliformis cutis (AVMC) was first described by Heidingsfeld in 1918, as a rarely reported form of idiopathic macular atrophy on the cheek (1). It is characterized, clinically, by shallow, sharply demarcated depressions in various shapes. Extrahepatic biliary atresia (2) and pachydermodactyly (3) have been the only conditions associated with AMVC reported in the past 80 years. Although keratosis pilaris is a common skin disorder, it is related to other idiopathic atrophic conditions considered in the differential diagnosis of AMVC, namely keratosis pilaris atrophicans (4). However, the two associations may be coincidental. We observed a patient with keratosis pilaris, and her brother and an unrelated young man, whose findings led to a diagnosis of AMVC.

Comparison of two surgical approaches for treating vitiligo: a preliminary study.

BACKGROUND: Surgical techniques have recently been introduced for patients with vitiligo. Randomized controlled trials have not been performed. AIM: To compare the efficacy and side-effects of two surgical methods (suction blister vs. thin split-thickness graft technique) for the treatment of vitiligo. METHODS: Three suction blisters, approximately 0.8 cm in diameter, made with a special tool attached to a vacuum extractor, which were converted to erosions by removal of the roofs of the bullae, and one round erosion of approximately the same diameter, made using a silver knife, were created. One roof of a blister and two cutaneous thin split-thickness grafts taken from the gluteal region were transferred onto recipient vitiliginous areas; one was left alone. The results were evaluated by one non-blind and two blind observers bimonthly during the 3-month follow-up period. RESULTS: Repigmentation rates were 25-65% in the suction blister technique and 90% in the thin split-thickness graft technique (P < 0.001). CONCLUSIONS: The thin split-thickness graft technique is superior to the suction blister technique in treating vitiligo.

Comparación entre dos procedimientosquirúrgicos para tratar el vitíligo: estudiopreliminar / Comparison of two surgical approaches for treating vitiligo: a preliminary study

Antecedentes: Recientemente se han introducido varias técnicas quirúrgicas para tratar a los pacientes con vitíligo. No se han realizado hasta ahora ensayos controlados y aleatorios. Objetivo: Comparar la eficacia y los efectos secundarios de dos métodos quirúrgicos (técnica de injerto de ampollas de succión frente a técnicas de injerto de capas finas de piel) para el tratamiento del vitíligo. Métodos: Se elaboraron tres ampollas de succión de 0,8 cm de diámetro, aproximadamente, con un instrumento especial unido a un extractor de vacío, que se convirtieron en erosiones al extraer las cúpulas de las ampollas, y una erosión redonda de aproximadamente el mismo diámetro, con un bisturí de plata. La cúpula de una ampolla y dos injertos de capas finas de piel extraídos de la región glútea se trasladaron a las zonas de vitíligo receptoras; una se dejó sin tocar. Los resultados se evaluaron por un observador no ciego y dos ciegos, dos veces al mes, durante el período de seguimiento de tres meses. Resultados: Se observaron tasas de repigmentación del 25-65 por ciento con la técnica de ampollas de succión y del 90 por ciento con la técnica de injerto de capas finas de piel (p<0,001).Conclusiones: La técnica de injerto de capas finas de piel es mejor que la técnica de ampollas de succión para tratar el vitíligo (AU)