Junctional adhesion molecule-A is abnormally expressed in diffuse cutaneous systemic sclerosis skin and mediates myeloid cell adhesion.

OBJECTIVE: To investigate the role of junctional adhesion molecule-A (JAM-A) in the pathogenesis of systemic sclerosis (SSc). METHODS: Biopsy specimens from proximal and distal arm skin and serum were obtained from patients with SSc and normal volunteers. To determine the expression of JAM-A on SSc dermal fibroblasts and in SSc skin, cell surface ELISAs and immunohistology were performed. An ELISA was designed to determine the amount of soluble JAM-A (sJAM-A) in serum. Myeloid U937 cell-SSc dermal fibroblast and skin adhesion assays were performed to determine the role of JAM-A in myeloid cell adhesion. RESULTS: The stratum granulosum and dermal endothelial cells (ECs) from distal arm SSc skin exhibited significantly decreased expression of JAM-A in comparison with normal volunteers. However, sJAM-A was increased in the serum of patients with SSc compared with normal volunteers. Conversely, JAM-A was increased on the surface of SSc compared with normal dermal fibroblasts. JAM-A accounted for a significant portion of U937 binding to SSc dermal fibroblasts. In addition, JAM-A contributed to U937 adhesion to both distal and proximal SSc skin. CONCLUSIONS: JAM-A expression is dysregulated in SSc skin. Decreased expression of JAM-A on SSc ECs may result in a reduced response to proangiogenic basic fibroblast growth factor. Increased JAM-A expression on SSc fibroblasts may serve to retain myeloid cells, which in turn secrete angiogenic factors.

Cephalexin rash in infectious mononucleosis.

The ampicillin rash occurring in cases of infectious mononucleosis is well documented. Similar phenomena have also been observed with other antibiotics. The case of a patient with infectious mononucleosis treated with cephalexin who later showed a rash is presented and the previous literature is reviewed. The rash seen in this patient, who was treated with cephalexin, may be similar to the rash seen with ampicillin treatment of patients with infectious mononucleosis. The mechanism by which these eruptions occur is not completely understood, although there are many interesting theories. Perhaps rashes during infectious mononucleosis in association with other antibiotics are actually more common, but just not recognized. A heightened awareness of this possibility may therefore lead to recognition of more cases and further understanding of this entity.

Localized bullous pemphigoid occurring in a surgical wound.

Localized forms of bullous pemphigoid have been reported to occur in sites of trauma. The case of a 79-year-old female who developed blisters at the site of an abdominal surgical wound is reported. The diagnosis of bullous pemphigoid was made by histology and immunofluorescence studies. The reported cases of localized bullous pemphigoid associated with surgical wounds are reviewed.

Skin signs of systemic disease. When the problem is more than skin-deep.

The cutaneous manifestations of systemic diseases are diverse. In some cases, they are the first signs of an underlying disorder, such as Cowden's disease, dermatomyositis, and Lyme disease. Sister Mary Joseph's nodule (metastatic involvement of the umbilicus) is an ominous sign of internal malignant disease. Drug-induced skin necrosis may result from therapy with coumarin (Coumadin, Panwarfin, Sofarin) or heparin.

Costochondritis presenting as a peculiar skin lesion.

Costochondritis is an important complication of median sternotomy that can present months to years after surgery. Delay in diagnosis may result in more disability and increased medical costs. The varied clinical manifestations of costochondritis are reviewed and a case is presented.

Antibacterial activity of lidocaine in combination with a bicarbonate buffer.

BACKGROUND: The antibacterial properties of lidocaine have been previously described. Recent reports indicated that the addition of NaHCO3 to lidocaine reduces the pain associated with the injection. This study was conducted to determine the antibacterial activity of lidocaine buffered with NaHCO3. METHODS: Rates of killing of six species of bacteria were determined in the presence of buffered and unbuffered lidocaine. When bacteria were incubated with lidocaine buffered with NaHCO3 at either 25, 50, or 100 mEq/L, there was a decrease of > 99% of all bacteria tested over the 6 hours of the assay. This dramatic rate of killing was not observed in the unbuffered control preparations. RESULTS: The results of this study indicate that NaHCO3 enhances the killing effect that has been described for lidocaine alone. The inability to recover common pathogenic bacteria from biopsy specimens could be the result of exposure to local anesthetic agents such as lidocaine that are buffered with NaHCO3.

In situ expression of cytokines and cellular adhesion molecules in the skin of patients with systemic sclerosis. Their role in early and late disease.

Cytokines and cellular adhesion molecules (CAMs) may play a role in the inflammatory and fibrotic processes underlying systemic sclerosis (SSc). We compared the immunohistological distribution of cytokines and CAMs in skin biopsies from 12 SSc patients and 14 normal (NL) individuals. Among CAMs, vascular cell adhesion molecule-1 (VCAM-1), which mediates leukocyte-endothelial adhesion, showed increased expression on SSc versus NL endothelium and stratum granulosum. P-selectin was up-regulated in SSc versus NL stratum granulosum. The CD44 lymphocyte homing receptor showed the most striking differences between SSc and NL: its expression was increased in SSc stratum granulosum, stratum spinosum, on lymphocytes, and macrophages. Regarding cytokines, interleukin-6 (IL-6) expression was increased on SSc versus NL endothelium and fibroblasts. Tumor necrosis factor-alpha (TNF-alpha) reactivity was more prevalent in SSc than NL stratum granulosum, whereas IL-8 expression was higher on SSc compared to NL endothelium. Some CAMs, such as VCAM-1 and P-selectin, and cytokines, namely TNF-alpha and IL-8, were more commonly found in skin biopsies taken from early (< or = 1 year's duration) SSc, while others, such as IL-6, showed up-regulation in the late stage of the disease. The results suggest that certain CAMs and cytokines may play a differential role in both the early, inflammatory, and the late, fibrotic stage of SSc.

Acanthosis nigricans and a rectal carcinoid.

Malignant acanthosis nigricans is often related to adenocarcinomas of the gastrointestinal tract, but it has also been found to coexist with tumors of the amine precursor uptake and decarboxylation system. It can precede, accompany, or follow the appearance of the underlying tumor. Evaluation of our patient's new-onset acanthosis nigricans led to the discovery of an asymptomatic rectal carcinoid tumor. To our knowledge, this is the first report of acanthosis nigricans associated with a carcinoid tumor of the rectum. It emphasizes the importance of considering underlying malignancy in the evaluation of patients with acanthosis nigricans.

Lichenoid drug eruption secondary to propranolol.

Propranolol, a widely prescribed beta-adrenergic receptor blocker, has occasionally been associated with adverse cutaneous reactions. We present a case of ulcerative lichenoid drug eruption of the penis secondary to propranolol therapy. This unusual clinical presentation has not been described previously in the literature.

Cutaneous lesions of histoplasmosis with transepidermal elimination in a patient with acquired immunodeficiency syndrome.

Histoplasma capsulatum is a dimorphic pathogenic fungus that produces a variety of self-limiting disease syndromes in healthy persons, but commonly disseminates in immunocompromised hosts. Although histoplasmosis has been recently described in patients with acquired immunodeficiency syndrome, it is an uncommon finding, occurring in fewer than 0.5 percent of patients with acquired immunodeficiency syndrome. We are reporting a second case of disseminated histoplasmosis presenting as keratotic papules with transepidermal elimination of Histoplasma capsulatum. Our case demonstrates the importance of including histoplasmosis in the differential diagnosis of keratotic papules occurring in patients with acquired immunodeficiency syndrome.

Yield from total skin examination and effectiveness of skin cancer awareness program. Findings in 874 new dermatology patients.

The authors reviewed 874 dermatology charts to assess the acceptance rate of total skin examination (TSE), incidental skin findings, and patient compliance regarding treatment recommendations. Of the 874 new dermatology patients studied, 707 (80.9%) agreed to TSE. Important incidental findings were found in 151 (21.4%). These included: (1) biopsy specimen-confirmed malignant tumors (malignant melanoma, lentigo maligna, and basal cell and squamous cell carcinoma) in 24 of the 707 patients (3.4%), (2) biopsy specimen-confirmed premalignant tumors (actinic keratosis with dysplasia, Bowenoid actinic keratosis, Bowenoid papulosis, and lentigo with dysplasia, in five (0.7%), (3) clinically diagnosed premalignant actinic keratosis in 64 (9.1%), (4) biopsy specimen-confirmed dysplastic nevi in 17 (2.4%), and (5) congenital nevi in 41 (5.8%). Only 4.2% of the patients returned for a yearly TSE, and only 6.0% were found to follow all recommendations for monthly self examination, yearly professional examination, and sun protection. It is concluded that TSE for all new patients, and on a yearly basis for all return patients, is valuable in the detection of many skin conditions and allows skin cancer screening to be done, since patients for the most part do not follow recommendations for at-home screening.

Pigmented Bowen's disease arising from pigmented seborrheic keratoses.

We report three cases of pigmented Bowen's disease that clinically and histologically had features of seborrheic keratoses. We speculate about the mechanism of pigmentation in these lesions and suggest that they arise from pigmented seborrheic keratoses.

Autoimmune hemolytic anemia in a patient with mycosis fungoides.

We report a case of autoimmune hemolytic anemia in a patient with mycosis fungoides. We propose that autoimmune hemolytic anemia may be induced by cutaneous lymphoproliferative diseases. Thus, hemolysis should be considered as a mechanism of anemia in patients with mycosis fungoides.

Malignant transformation of oral lichen planus: case report and review of the literature.

Lichen planus is a mucocutaneous disorder well known to both dermatologists and dentists. Traditional belief holds that oral lichen planus predisposes to the development of squamous cell carcinoma of the oral cavity. We present a case that illustrates such a malignant transformation in a patient who smoked and had actinically damaged skin.

Procainamide-induced urticarial vasculitis.

Dermatologists are often faced with the difficulty of evaluating drug reactions in patients receiving multiple medications. Unfortunately, few drugs produce distinctive lesions; many types of medications can produce identical eruptions. One common drug-induced eruption is urticaria. We report a specific eruption due to procainamide: urticarial vasculitis.

Erythema with features of seborrheic dermatitis and lupus erythematosus associated with systemic 5-fluorouracil.

Multiple cutaneous reactions have been reported in association with topical and systemic 5-fluorouracil therapy. Three patients are reported who noted facial erythema with features of both seborrheic dermatitis and lupus erythematosus following the administration of systemic 5-fluorouracil.