The expression of RAGE and EN-RAGE in leprosy.

BACKGROUND: Extracellular newly identified RAGE-binding protein (EN-RAGE) is a ligand of the receptor for advanced glycation endproducts (RAGE) and has been termed S100A12. The ligation of EN-RAGE with RAGE on the endothelium, mononuclear phagocytes and lymphocytes triggers cellular activation with the generation of the key proinflammatory mediators interleukin (IL)-1beta and tumour necrosis factor (TNF)-alpha. OBJECTIVES: The aim of this study was to investigate the presence of RAGE and EN-RAGE, their spatial localization and their coexpression in leprosy lesions. METHODS: Immunohistochemistry and confocal laser scanning microscopy were used to evaluate the expression of RAGE and EN-RAGE in leprosy. By enzyme-linked immunosorbent assay, RAGE and EN-RAGE were detected in the serum. RESULTS: (1) In the multibacillary (MB) and paucibacillary (PB) groups, the level of RAGE production was significantly higher than in patients with atypical mycobacterial infection or sarcoidosis (P < 0.01). In the MB group, the production of RAGE was higher than in the PB group (P < 0.01), and it was higher in patients without the lepra reaction than in patients with the lepra reaction (P < 0.05). (2) In MB, PB and atypical mycobacterial infection, the level of EN-RAGE production was significantly higher than in sarcoidosis (P < 0.01). (3) In the confocal laser scanning microscopic examination, the RAGE and EN-RAGE proteins were detected in lepromatous leprosy. These proteins are spatially colocalized along the cell surface, which is in agreement with their receptor-ligand interaction. (4) A comparable amount of EN-RAGE was detected in the serum of the MB and PB groups. Patients with the reaction showed a higher level of EN-RAGE than patients without the reaction in leprosy. CONCLUSIONS: Our data suggest that in leprosy, RAGE and EN-RAGE may be involved in the proinflammatory process rather than the antimycobacterial activity, especially during the lepra reaction. The blockade of the interaction of RAGE and EN-RAGE at the early stage of the inflammatory process may minimize the inflammatory response and consequent tissue damage or the sequelae of leprosy.

Prurigo pigmentosa from contact allergy to chrome in detergent.

Prurigo pigmentosa is a recurrent inflammatory dermatosis characterized by pruritic erythematous papules and reticulate hyperpigmentation that occurs most frequently in spring and summer. The etiology of prurigo pigmentosa remains unknown. Numerous authors have suggested that various contact allergens may be pathogenic or triggering factors, but nearly all attempts to identify an allergen have been unsuccessful. We report a case of prurigo pigmentosa induced by contact allergy to chrome in detergent, supporting the conclusion that contact allergens such as chrome may play a rôle in inducing prurigo pigmentosa.

Generalized seborrheic dermatitis in an immunodeficient newborn.

We report the case of a female infant with failure to thrive, generalized seborrheic dermatitis, and intermittent diarrhea. Results of laboratory investigation revealed low serum immunoglobulin G IgG levels. She failed to gain additional weight and experienced recurrent infection. She died 3 months later.

An ultrastructural study of the retention hyperkeratosis of experimentally induced comedones in rabbits: the effects of three comedolytics.

The precise pathologic processes of comedo formation in acne are not well understood. Retention hyperkeratosis may play an important role. To evaluate the effects of three topical comedolytics, 20% azelaic acid, 0.1% tretinoin and 5% benzoyl peroxide, on the retention hyperkeratosis of experimentally induced comedones (EIC), an ultrastructural study was done. After formation of EIC with 50% oleic acid in paraffin oil on the external ears of rabbits, each comedolytic was applied for 4 weeks. Biopsies were taken every week and, using a Hitachi H-600 transmission electron microscope, morphologic observations were done in the upper portion of the follicular epithelium. In EIC, after application of each comedolytic, the markedly thinned horny layer was loosely adhered by extremely few desmosomes and desmosomal bodies. The number and size of tonofilaments and keratohyaline granules decreased, but the number of variable sized Odland bodies increased in the upper epidermis. These findings appeared 1 week after application of either azelaic acid or benzoyl peroxide, and 3 weeks after application of tretinoin. For the first 2 weeks of tretinoin application, EIC showed rather compact hyperkeratosis with more desmosomes and desmosomal bodies than before. Azelaic acid tretinoin and benzoyl peroxide increased the number of Odland bodies, and the horny cells became less adhesive. This lysis of retention hyperkeratosis resulted in comedolysis. During 4 weeks of treatment with these three comedolytics, only tretinoin normalized the keratinization process.

The antibacterial efficacy of econazole nitrate in interdigital toe web infections.

Twenty-four patients with severe interdigital toe web infections and no evidence of dermatophyte colonization received randomized treatment with either econazole nitrate (Spectazole) or its vehicle. Of the patients treated with econazole nitrate, 88% had good to excellent responses, whereas no patient treated with the vehicle showed improvement. The total aerobic flora in the econazole group decreased 93%, with decreases in the large-colony diphtheroids, lipophilic diphtheroids, and gram-negative bacteria. The results of this study demonstrate that the antibacterial activity of econazole nitrate makes it an effective agent for the treatment of severe interdigital bacterial infections uncomplicated by dermatophyte colonization.

Subungual bacteria of the hand: contribution to the glove juice test; efficacy of antimicrobial detergents.

Methodologies for evaluating the efficacy of antimicrobial agents in the bacterial flora of the hand involve variations of the "glove juice" or "sterile bag" procedures. In this study we demonstrate that the subungual flora contribute significantly to the recovery of bacteria in these procedures. Culturing hands that had the subungual spaces sealed with acrylic polish demonstrated a decay type of curve for the number of bacteria recovered in successive samplings with 10(6) colony forming units (CFU) bacteria recovered in the first sampling and 10(3) in the sixth while the opposite hand on which the subungual spaces were not sealed demonstrated a continuous recovery of 10(6) CFU. Serial scrubbings of three minutes with plain detergent, 10% povidone-iodine or 4% chlorhexidine demonstrated a three logarithm reduction for povidone-iodine and four logarithm reduction compared to plain detergent alone for chlorhexidine in hands that had subungual spaces sealed, while the opposite hand showed only a 0.5 to 1.0 logarithm reduction. Povidone-iodine produced a 0.6 logarithm reduction and 4% chlorhexidine or 1.4 logarithm reduction in the density of subungual bacteria.

A clinical study of topical mucopolysaccharides & polydeoxyribonucleoprotein (Foltene) therapy in alopecia.

We performed clinical trials to evaluate the therapeutic effects of Foltene in patients of the several types of hair fallings. Thirty patients with male pattern baldness, alopecia areata and seborrheic alopecia were included in this study. Foltene was applied every other day for 40 days, and followed by maintenance therapy of twice application a week. The duration of whole therapy was 6 months. We conclude that Foltene is an effective and agent for male pattern baldness, alopecia areata and seborrheic alopecia from the following results. Ten patients with male pattern baldness was treated with Foltene for 6 months. Foltene had therapeutic effects of 50% in hair regrowth, 70% in decreased hair falls, 30% in decreased dandruff, 50% in decreased seborrhea. Thirteen patients with alopecia areata was treated with Foltene for 6 months. Foltene had therapeutic effects of 61.6% in hair regrowth, 53.9% in decreased in hair falls, 53.9% in decreased dandruff, 77.0% in decreased seborrhea. Seven patients with seborrheic alopecia was treatment with Foltene for 6 months. Foltene had therapeutic effects of 85.8% in hair regrowth, 57.2% in decreased hair falls, 42.9% in decreased dandruff, 85.8% in decreased seborrhea. The degree of therapeutic success was related to the duration of therapy. The side effects were as followed: itching sensation developed in 2 patients (6.7%); tingling sensation in 3 patients (10.0%); burning sensation in 1 patient (3.3%); erythema in 3 patients (10.0%).

Cutaneous metastatic adenocarcinoma of stomach--nodular and inflammatory carcinoma.

A 65-year-old male patient presented multiple cutaneous nodules on trunk and an erythematous inflammatory lesion resembling erysipelas on left side of neck. Result of skin biopsies disclosed groups of metastatic adenocarcinoma cells in the dermis, subcutaneous tissue, and lumina of the lymphatic vessels. Histopathologic examination of the stomach, along with the gastroscope, established that the cutaneous metastasis was of stomach origin.