Fournier's gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation.

Three patients with ANLL developed Fournier's gangrene as an early complication after allo-BMT (two cases) and auto-BMT (one case); two patients were in first CR, the third had resistant disease. Patients developed fever, perineal pain, swelling and blistering of the genital area. Pseudomonas aeruginosa was isolated from the lesions and patients received systemic antibiotic therapy, surgical debridement and medication with potassium permanganate solution. Two patients made a complete recovery although one died of sepsis. The third had progressive involvement of the abdominal wall and later died of leukemia. Early diagnosis of this disorder and prompt initiation of appropriate therapy can prevent progression of this acute necrotizing infection.

Bullous lesions in Kaposi's sarcoma: case report.

Bullous lesions have been only rarely described in Kaposi's sarcoma (KS), and their histopathologic features have never been described in detail. We report a case of bullous lesions of KS in an 82-year-old Italian woman. The patient had typical smooth pale reddish-grey slightly-raised KS plaques on the legs, present for at least 10 years. Several dull grayish-pink blisters (0.5 to 2 cm in diameter) affected both dorsa of her feet and ankles symmetrically. Two punch biopsies were taken, one from an infiltrated KS plaque on the right buttock and the other from a bullous lesion on the right foot. Histopathologically, the late KS plaque on the buttock showed typical features of KS, with an increased number of spindle cells arranged in short bundles and extravasation of erythrocytes. The bullous lesion on the foot showed a full-thickness vascular neoplasm involving the upper and lower dermis and the subcutaneous fat. The upper portion of the lesion contained many newly formed, highly-dilated blood vessels, touching the overlying epidermis and separated from it by a narrow band of collagen and endothelial cells; wide, empty spaces characterized the superficial dermis, in which preexisting venules and bands of collagen associated with non-atypical endothelial cells floated. All these findings would suggest a lymphangiomatous lesion, if the presence of specific diagnostic criteria of KS were not recognizable at a deeper level of the lesion. Various criteria actually suggest that the bullous lesion may be regarded as an epiphenomenon of a KS plaque lesion: (a) full-thickness involvement of the reticular dermis and, in this case, also of the subcutaneous fat; (b) dense and patchy lymphoplasmocytic infiltrate typical of plaque lesions and, much less frequently, of patch lesions; (c) presence of ectatic blood vessels, filled with plasma and erythrocytes (pseudoangiomatous findings), a nonpathognomonic but highly characteristic finding of the plaque lesion; and (d) as in the KS plaque lesions, in the bullous lesion as well the reticular dermis was characterized by an increased number of anastomosing bizarrely shaped vascular spaces lined by non-atypical endothelial cells. We hypothesize that the prevalence of lymphangiomatous differentiation in the upper dermis represents one of the many features of KS lesions. When present, it may correlate with the clinical feature of a blister.

Is seborrhea a sign of autonomic impairment in Parkinson's disease?

An increase of sebum excretion rate (SER) is frequently observed in patients suffering from Parkinson's disease (PD). Some authors attribute it to the hyperactivity of the parasympathetic system, while others consider the possible action of androgens or of MSH-hormone. The aim of our study was to verify and quantify SER in 70 parkinsonian patients and compare it with SER in 60 normal subjects. We found higher values of SER in male subjects, both in normal and in parkinsonian patients. The highest rate of excretion was observed in parkinsonian males, in agreement with the possible main role of androgens or testosterone in sebum excretion, while the phenomenon did not appear to be related to abnormalities of the autonomic nervous system. The association of PD and sex hormones might therefore be crucial for the developing of seborrhea.

Alpha hydroxyacids modulate stratum corneum barrier function.

Alpha hydroxyacids (AHAs) are used to enhance stratum corneum desquamation and improve skin appearance. The purpose of this study was to evaluate whether some AHAs improve skin barrier function and prevent skin irritation. Eleven healthy subjects (aged 28 +/- 6 years, mean +/- SD) entered the study. Six test sites of 8 x 5 cm (four different AHAs, vehicle only (VE) and untreated control (UNT) were selected and randomly rotated on the volar arm and forearm. The four different AHAs at 8% concentration in base cream were glycolic acid (GA), lactic acid, tartaric acid (TA) and gluconolactone (GLU). The products were applied twice a day for 4 weeks (2 mg/cm2). At week 4, a 5% sodium lauryl sulphate (SLS) challenge patch test was performed under occlusion for 6 h (HillTop chamber, 18 mm wide) on each site. Barrier function and skin irritation were evaluated by means of evaporimetry (Servomed EP-1) and chromametry (a* value, Minolta CR200) weekly, and at 0, 24 and 48 h after SLS patch removal. No significant differences in transepidermal water loss (TEWL) and erythema were observed between the four AHAs at week 4. After SLS challenge, GLU- and TA-treated sites resulted in significantly lower TEWL compared with VE, UNT (P < 0.01) and GA (P < 0.05) both at 24 and 48 h. Similarly, a* values were significantly reduced after irritation in GLU- and TA-treated sites. This study shows that AHAs can modulate stratum corneum barrier function and prevent skin irritation; the effect is not equal for all AHAs, being more marked for the molecules characterized by antioxidant properties.

Effects of site and menstrual cycle on barrier function and stratum corneum water-holding capacity.

BACKGROUND/AIMS: Areas of the skin with similar anatomical structure may have different functional behaviour. In vivo barrier function and stratum corneum water-holding capacity during the menstrual cycle on two sites of the volar forearm (upper and lower) and on the anterior aspect of the thigh were evaluated using the plastic occlusion stress test (POST). METHODS: 13 healthy women (age 31 ± 4) with regular menses entered the study. POST was performed by applying a plastic chamber (1.8 cm diameter) on the skin for 24 h. After removal the skin surface water loss (SSWL) was measured using an evaporimeter (EP1-Servomed, Sweden) every 5 min for 30 min. Measurements were taken on the 10th and 25th day of the menstrual cycle. Statistical analysis was performed using one-factor Anova for repeated measures. Free and bound water compartments of evaporation were also analysed. RESULTS: Higher hydration and SSWL were detectable on the 25th day of the cycle. However, no significant influence of menstrual cycle was found. Significant differences between the upper and lower volar foream were detected (P < 0.001). CONCLUSION: The differences observed were mainly related to the evaporation of bound water, confirming a different barrier function at the sites investigated; therefore, it must be taken into account that adjacent skin sites with equal structure may have different functional behaviour.

Effects of water temperature on surfactant-induced skin irritation.

Surfactant-induced irritant reactions may be elicited by several endogenous and exogenous factors. Among these, surfactant concentration, and duration and frequency of exposure play important rôles. The study focuses on the influence of water temperature in determining damage of the skin barrier. 10 subjects of both sexes entered the study. 4 areas (4 x 4 cm2) were randomly selected on the volar forearm and were treated with a daily open application of 5% sodium lauryl sulphate for 4 days. The solutions were at 3 temperatures: 4 degrees, 20 degrees and 40 degrees C. One site served as untreated control. On the 5th day, skin irritation was evaluated using transepidermal water loss (TEWL) measurements, erythema (a* value), skin reflectance (L* value), hydration (capacitance) and desquamation (stripping). The results show a significant effect of the solution's temperature in determining skin irritation (P < 0.001). Skin damage was higher in sites treated with warmer temperatures and a highly significant correlation (P < 0.001) between irritation and temperature was found. In conclusion, the study shows that water temperature during washing has an important effect on the onset of irritant contact dermatitis.

Non-invasive evaluation of topical calcipotriol versus clobetasol in the treatment of psoriasis.

Topical treatment of psoriasis with calcipotriol has been proven effective. The efficacy of calcipotriol has been compared to that of topical corticoids in a number of studies using subjective visual scoring systems such as the PASI index. The purpose of this study was to compare, with objective data, the efficacy of calcipotriol and clobetasol propionate 0.05% in the treatment of plaque type psoriasis. Transepidermal water loss (TEWL) and laser Doppler velocimetry (LDV) were used to monitor restoration of water barrier and normalization of blood flow, respectively, in psoriatic plaques of the limbs of 24 male patients during 3 weeks of treatment. Data were compared to subjective evaluation using the PASI index of the same areas. Significant differences were recorded during treatment in both groups. The results correlated well with the PASI score. Clobetasol was faster in restoring barrier function than calcipotriol. However, no significant differences were detected between the two groups. The use of vitamin analogues may be effective in the topical treatment of psoriasis by normalizing skin biophysical parameters and minimizing the risks of side-effects induced by potent topical corticoids.

PUVA-treated psoriatic skin as a model for cutaneous wrinkling assessed by skin replicas.

Psoriatic patients may offer a useful model for PUVA-induced skin wrinkling. This study deals with the changes induced by PUVA therapy on the cutaneous microrelief of psoriatic patients assessed by surface replicas. A non-exposed body area (buttocks) was considered. The microrelief was evaluated by means of replicas analysed by an automatic image analyser. Three groups of patients were considered: 1) 10 psoriatic patients who had been undergoing PUVA treatment for the first time and who had received a total PUVA dose of 200 +/- 20 J/cm2; 2) 16 psoriatic patients in long-term PUVA treatment (> 1000 J/cm2); 3) 13 psoriatic controls whose buttocks had never been affected by psoriasis nor exposed to sunlight or PUVA. The results showed that the number and the entity of the cutaneous crests and furrows had been increased by PUVA therapy. In particular the skin pattern analysis showed significant statistical differences between the second and the third group, while no changes were evident between the first and third group (ANOVA and Tukey test for multiple comparisons). In conclusion, our findings indicate that long-term PUVA therapy causes marked changes in the cutaneous microrelief, that this phenomenon can be measured non-invasively and that the changes observed are dependent on the PUVA-dose energies received.

Effects of fluid volume changes during hemodialysis on the biophysical parameters of the skin.

Water plays an important role in maintaining skin suppleness and elasticity. We used hemodialysis as a model to investigate the effects on biophysical properties of the skin induced by removal of fluids and water from the body. The following parameters have been investigated before and immediately after a hemodialysis session: body weight, skin elasticity and distensibility, skin hydration, transepidermal water loss (TEWL) and skin thickness. A significant decrease was recorded after treatment in body weight, skin thickness (p < 0.01) and skin elasticity (p < 0.01). Significant linear correlations were found between stratum corneum water content, skin distensibility and TEWL. The data reveal that rapid removal of body fluids influences skin biophysical properties: early changes in skin thickness and ground substance occur in the dermis and affect mechanical properties of the skin. The decrease in water content in the upper layers of the skin occurs at a later stage and influences skin hydration rather than TEWL. This model is a useful tool to investigate water kinetics through the skin.

Bullous lesions in acrodermatitis enteropathica. Histopathologic findings regarding two patients.

Acrodermatitis enteropathica (AE) is an autosomic recessive disorder affecting early infancy. Two cases of infantile AE with low plasma zinc levels are reported in which unusually prominent bullous and vesicobullous lesions were seen on the hands and feet, in addition to the more typical erythematous and scaly patches. Both psoriasiform and bullous lesions responded dramatically to oral zinc-sulfate supplementation. The histopathologic features of the bullous lesions of AE have not previously been fully examined. Histologically, the bullous lesions were characterized by intraepidermal vacuolar changes with massive ballooning, leading to intraepidermal vesiculation and blistering, with prominent epidermal necrosis and with no acantholysis. The bullous lesions did not arise on erythematous patchy lesions, but developed ex novo on unaffected skin. The histopathologic differential diagnosis with other bullous conditions is discussed.

Effect of occlusive dressings on the stratum corneum water holding capacity.

Occlusion of the skin is used in clinical dermatology to promote wound healing and to increase the transcutaneous penetration of topically applied drugs. These effects are related to the degree of occlusion exerted and depend on the physicochemical nature of the dressing. We have evaluated the effects of four different materials on the skin barrier and the stratum corneum water holding capacity (WHC) using the Plastic Occlusion Stress Test (POST). The following materials were compared: hydrocolloid dressing, polyurethane film, polyethylene film, and a plastic chamber. These devices were applied on the volar forearm for 24 hours in 10 healthy volunteers (mean age 32 +/- 4 years). Upon their removal, the stratum corneum WHC, measured as skin surface water loss (SSWL), was recorded continuously for 25 minutes using an Evaporimeter. SSWL decay curves showed significant differences between the occlusive materials (analysis of variance, p less than 0.01). Higher SSWL values were recorded in sites occluded with the plastic chamber, whereas the polyurethane film resulted in poor occlusive capacity. Hydrocolloid dressing and polyethylene gave similar responses with higher WHC values compared to polyurethane (p less than 0.05). The relevance of these findings to clinical dermatology in terms of wound healing and drug absorption is discussed.

[Necrobiosis lipoidica diabeticorum in children. Description of a case]. / Necrobiosis lipoidica diabeticorum nel bambino. Descrizione di un caso.

A case of necrobiosis lipoidica diabeticorum (NLD) in a 12-year-old male patient is described. Diabetes mellitus (DM) was diagnosed at the age of 1.5 years. The onset of the first NLD lesion had been previously observed at the age of 7, on the back of the left foot. Three new lesions appeared at the age of 8, one on the left leg, the others on the thighs. At the age of 12, four infiltrated, reddish patches, with slight central atrophy were evident on his lower extremities. Histopathological features showed foci of collagen degeneration with sclerosis, surrounded by a chronic, mainly perivascular, granulomatous infiltrate, made up of lymphocytes and histiocytes. The patient is now 19-year old, with no eye or kidney failure, owing to a constant metabolic control of DM. A constant follow-up of the patient demonstrated a self-resolution of NLD plaques, with no evidence of further lesions.

[Efficacy of fenticonazole in patients with pityriasis versicolor]. / Studio dell'efficacia del fenticonazolo su pazienti affetti da Pityriasis versicolor.

Thirty patients suffering from Pityriasis versicolor were treated with fenticonazole in cream or lotion form with two applications a day. At microscopy, Malassezia furfur was encountered in 25 cases and Pityrosporum orbiculare in 5. Disappearance of the yeast was obtained on average in 2 weeks of treatment. Measurement of sebum content with a Sebumeter apparatus did not reveal significant difference (p greater than 0.05) between patients suffering from Pityriasis versicolor and controls and in treated patients, in the course of topical therapy.

[Thallium-induced alopecia]. / Alopecia da Tallio.

A case of accidental Thallium intoxication showing, as the only sign, alopecia of the scalp with depigmentation of the hair, is described. A 21 year old woman developed acute loss of hair after ingestion of contaminate tomatoes. No further signs of intoxication were evident. The diagnosis has been made by evidencing Thallium in the urine (colorimetric method) and in the hair (atomic absorption spectrophotometry). Moreover, the clinical and histopathological findings of Thallium alopecia are described.

Changes in the water holding capacity of psoriatic stratum corneum in vivo.

This study investigated the functional capacity of the stratum corneum of psoriatic skin to bind water in vivo during a relatively long period of time (water holding capacity--WHC). An electrical capacitance test was applied to the psoriatic skin on the elbows, perilesional skin and apparently normal skin of 11 patients and the elbows of 10 controls. Measurements of electrical capacitance were performed using a Corneometer Schwarzhaupt for 25 min. The WHC levels were calculated for this period. Our results demonstrate that the WHC of psoriatic stratum corneum does not differ from controls in the first 10 min. Only after the 20th min do the WHCs differ significantly (p less than 0.02). Despite the biochemical keratin changes in psoriatic plaque, the latter is highly hygroscopic, in particular in the first minute after bathing. Perilesional skin binds water like the stratum corneum of controls, though not beyond the 20th minute after bathing.