Intralesional vitamin D3 versus intralesional purified protein derivative in treatment of multiple warts: A comparative clinical and immunological study.

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty-five patients with multiple extragenital warts were treated with IL-PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin-12 (IL-12) and interferon-gamma (IFN-γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL-PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p < .001). Significant increase was found in both serum IL-12 and IFN-γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN-γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL-12 and IFN-γ levels.

Zinc-Responsive Necrolytic Acral Erythema in a Patient With Psoriasis: A Rare Case.

Necrolytic acral erythema (NAE) is a recently recognized dermatosis almost exclusively associated with hepatitis C virus (HCV) infection, and closely related to zinc deficiency. We present the case of a 60-year-old man with a history of psoriasis and chronic HCV infection, who developed new lesions of NAE extending from previous elephantine psoriatic plaques on bilateral lower legs. According to previous reports, resolution of NAE has been successfully achieved by treatment of the underlying HCV infection, or the use of oral zinc therapy. Our patient exhibited good response to zinc therapy. By reporting this case, we would like to raise the awareness of physicians to this unique acrally distributed dermatosis, which is distinct from psoriasis by its pathological feature of aggregated necrotic keratinocytes and its good response to zinc therapy rather than topical corticosteroids.

Association between peripheral vascular endothelial dysfunction and livedoid vasculopathy.

BACKGROUND: Livedoid vasculopathy (LV) is a disease characterized by multiple painful and recurrent ulcerations on the feet, accompanied by atrophic scars. Many researchers suggest that a hypercoagulable status is the pathogenetic factor for LV. However, the cause of LV remains elusive. OBJECTIVE: We sought to determine if endothelial dysfunction is present in patients with LV. METHODS: This prospective study included 16 patients with LV and active ulcers and 16 matched control subjects. We reviewed detailed clinical parameters, including antinuclear antibody, high-sensitivity C-reactive protein, protein C, protein S, homocysteine, anti-SSA, anti-SSB, anticardiolipin antibody, and serum lipid profiles. Flow-mediated vasodilation of the brachial artery was used as an indicator of vascular endothelial function using high-resolution 2-dimensional ultrasonic imaging. RESULTS: Blood pressure, blood biochemistry, high-sensitivity C-reactive protein, and homocysteine were not significantly different in patients with LV and control subjects. Nitroglycerin-mediated vasodilation was not significantly different in patients with LV and control subjects. However, flow-mediated vasodilation was much less in patients with LV than in the control group (3.58 ± 2.32% vs 7.51 ± 2.40%, P < .001). LIMITATIONS: The study was performed at a single site with a limited sample size. CONCLUSION: Peripheral vascular endothelial dysfunction was demonstrated in patients with LV by reduction of brachial flow-mediated vasodilation.

Necrolytic acral erythema seronegative for hepatitis C virus--two cases from India treated with oral zinc.

BACKGROUND: Necrolytic acral erythema (NAE) is a distinct skin entity and is strongly associated with chronic hepatitis C virus (HCV) infection. It is distinguished by its acral location, typical clinical and histopathologic features, and positive serum antibodies against HCV. Most cases have been treated with variable success using oral zinc, amino acids, and interferon with or without ribavirin therapy. METHODS: We report two patients with the clinical and histopathologic features of NAE; however, both tested seronegative for HCV. Both patients were treated with oral zinc acetate with good response, with one showing a partial relapse after stopping oral zinc. The clinical features, histopathologic findings, association of HCV, and treatment of NAE in different case reports were reviewed. CONCLUSION: NAE has a strong association with HCV, particularly in prevalent countries such as Egypt. Nevertheless, it may occur independently without HCV association, and oral zinc may prove to be a less toxic therapeutic option for such cases.

Livedoid vasculopathy: further evidence for procoagulant pathogenesis.

OBJECTIVE: To further characterize the clinical and pathologic features, disease associations, and laboratory abnormalities of livedoid vasculopathy. DESIGN: Retrospective study of patients identified from our institutional database from January 1, 1990, to December 31, 2000. SETTING: Tertiary care institution. Patients Forty-five patients with biopsy-proved livedoid vasculopathy. MAIN OUTCOME MEASURES: Clinical presentation, histopathologic diagnosis, results of testing for coagulation abnormalities, and assessment of vascular status. RESULTS: Thirty-two patients (71.1%) were female (mean age, 45 years; age range, 10-85 years). Bilateral lower extremity disease occurred in 36 patients (80.0%), ulceration in 31 (68.9%), and atrophie blanche in 32 (71.1%). In patients tested, transcutaneous oximetry measurements were decreased in 20 (74.1%) of 27, and factor V Leiden mutation (heterozygous) was noted in 2 (22.2%) of 9, decreased activity for protein C or protein S in 2 (13.3%) of 15, prothrombin G20210A gene mutation in 1 (8.3%) of 12, and lupus anticoagulant in 5 (17.9%) of 28. Anticardiolipin antibodies were present in 8 (28.6%) of 28 patients, and elevated homocysteine levels in 3 (14.3%) of 21. Intraluminal thrombosis was observed in 44 (97.8%) of 45 skin biopsy specimens. Direct immunofluorescence disclosed multiple vascular conjugates in 31 (86.1%) of 36 biopsy specimens. CONCLUSIONS: Livedoid vasculopathy was predominantly bilateral, affected the lower extremities, and was associated with ulceration and atrophie blanche. Histologic evidence of intraluminal thrombosis was observed in almost all biopsy specimens reviewed. Laboratory testing revealed numerous heterogeneous coagulation abnormalities, providing further evidence of procoagulant mechanisms.

Influence of perches and footpad dermatitis on tonic immobility and heterophil to lymphocyte ratio of chickens.

The purpose of the present study was to analyze the effect of perches and footpad dermatitis on stress and fear levels of chickens. In experiment 1 heterophil to lymphocyte ratio and tonic immobility duration were measured in 36-wk-old hens (36 birds) from 2 Spanish breeds of chickens (Black Menorca and Quail Castellana) housed in pens with or without perches from 20 wk of age. There was a significant difference in the heterophil to lymphocyte ratio between perch treatments (P < 0.05), the ratio of hens with perches being lower than that of hens without perches. Hens with perches had significant lymphophilia (P < 0.05). There was no significant difference for the duration of tonic immobility between hens with or without perches. Thus, hens with perches were less stressed than hens without perches, as indicated by the heterophil to lymphocyte ratio. Heterophil to lymphocyte ratio and heterophil number for Black Menorcas were significantly smaller (P < 0.001) than for Quail Castellanas, whereas lymphocyte number was greater in Black Menorcas. The Black Menorca hens had significantly (P < 0.01) shorter tonic immobility duration. In experiment 2 heterophil to lymphocyte ratio and tonic immobility duration were measured in 52-wk-old cocks (36 birds) of each of two different Spanish breeds of chickens (Black Barred Andaluza and Red Barred Vasca) housed in cages from 36 wk of age and showing or not showing footpad dermatitis. There was no significant effect of footpad dermatitis on the heterophil to lymphocyte ratio, its numerator, or its denominator, whereas there was significant effect on tonic immobility duration (P < 0.05) with tonic immobility of cocks with footpad dermatitis being longer than that of cocks without footpads. Thus, cocks with footpad dermatitis were more fearful than cocks without footpad dermatitis, as indicated by the tonic immobility duration. Heterophil to lymphocyte ratio and heterophil number were significantly smaller (P < 0.05) for Black Barred Andaluzas than for the Red Barred Vascas.

A phase I/II randomized, double-blind, placebo-controlled, dose-ranging study evaluating the efficacy, safety and pharmacokinetics of ravuconazole in the treatment of onychomycosis.

OBJECTIVE: To determine the effectiveness and safety of ravuconazole in the treatment of toenail onychomycosis. DESIGN: A phase I/II randomized, double-blind, double-dummy, placebo-controlled, dose-ranging study. Four 12-week dosing regimens were used: 200 mg/day; 100 mg/week; 400 mg/week and placebo. Subjects returned at weeks 2, 4, 6, 8, 10, 12, 14, 16, 24, 36 and 48 for assessment. Subjects were enrolled at 10 dermatology practices (seven in the United States, one in Canada, two in France). SUBJECTS: Adults with distal subungual onychomycosis of one great (hallux) toenail (minimum area of 25%), and at least 2 mm of proximal nail clear of disease were selected. Onychomycosis was confirmed by direct microscopy and/or fungal culture. Subjects with conditions known to produce abnormal-appearing nails were excluded. One hundred and fifty-one subjects were randomized in a 2:2:2:1 ratio to the treatments above. MAIN OUTCOME MEASURES: Primary efficacy was the effective cure rate at week 48 (mycological cure, and clinical cure or > 30% improvement). RESULTS: Effective cure was found in 56% of subjects using 200 mg/day. Effective cure was 10% in subjects receiving 100 mg/week, 8% of subjects using 400 mg/week, and 15% of subjects using placebo. Mycological cure was seen in 59% of subjects in the 200-mg/day group, which was significantly higher than the rates found in the other groups. Drug-related adverse events were infrequent in all treatment arms. Headache was the most frequently reported event. Abnormal laboratory tests were infrequent over the 12 weeks of dosing. Abnormal laboratory findings with increases beyond normal of Grade 2, 3 or 4 were found in 8/148 subjects (5.4%). Only the 200 mg daily regimen had a mean plasma steady state concentration of ravuconazole exceeding the MIC(90) adjusted for 98% protein binding (3000 ng/mL). CONCLUSIONS: For the treatment of onychomycosis, ravuconazole 200 mg/day for 12 weeks is the most effective of the regimens investigated. The safety of all regimens was acceptable. The concentrations of ravuconazole in the plasma compared to the adjusted MIC(90) may be useful in predicting the clinical and mycologic response of therapy.

Papular-purpuric "gloves and socks" syndrome: polymerase chain reaction demonstration of parvovirus B19 DNA in cutaneous lesions and sera.

We report a typical case of papular-purpuric "gloves and socks" syndrome (PPGSS) in which primary infection by parvovirus B19 was demonstrated by seroconversion to this virus; parvovirus B19 DNA was also identified by polymerase chain reaction (PCR) methods in the sera of the patient and in the cutaneous biopsy specimen, both taken 4 days after the onset of clinical manifestations. To our knowledge, this is the fourth published case in which parvovirus B19 DNA has been recovered from the skin by PCR. Serologic studies and PCR investigations in cutaneous biopsy for other viruses including herpes simplex virus types 1 and 2, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6, 7, and 8 were negative. Clinically, our case presented some additional features, which have not been previously described in cases of PPGSS, namely dysuria with vulvar edema and erythema, and unilateral petechial rash on the breast. The histopathologic findings of our case were nonspecific and consisted of an interface dermatitis with slight vacuolar degeneration at the dermoepidermal junction and a superficial perivascular inflammatory infiltrate mostly composed of lymphocytes, with numerous extravasated erythrocytes. We review the cases of PPGSS published in the literature with respect to the different viruses that have been proposed as etiologic agents and conclude that acute infection by parvovirus B19 is the only one that has been adequately proved.

Hematology of fledgling Manx shearwaters (Puffinus puffinus) with and without 'puffinosis'.

Hematological parameters were measured in 14 fledgling Manx shearwaters (Puffinus puffinus), with the disease puffinosis and in 10 birds that did not have the disease, on the Island of Skomer between 2 and 11 September 1991. The mean plasma fibrinogen concentration was significantly higher in the diseased birds and some of these had abnormally elevated monocyte counts. No other significant differences were observed.

[The function of the hypophysis-thyroid system in patients with rubromycosis]. / Funktsional'noe sostoianie sistemy gipofiz--shchitovidnaia zheleza u bol'nykh rubromikozom.

Blood plasma thyroxine, triiodothyronine, thyroxine-binding globulin, and thyrotropic hormone have been radioimmunoassayed in 148 patients with rubromycosis. Reduced function of the thyroid has been detected in 39% of patients. Specific antifungal therapy does not essentially influence the function of the hypophyseal-thyroid system.

[The glycolytic status of peripheral blood phagocytes and its therapeutic correction in patients with foot mycoses]. / Glikoliticheskii status fagotsitov perifericheskoi krovi i ego terapevticheskaia korrektsiia u bol'nykh mikozami stop.

Changed glycogen levels in the neutrophils and monocytes is a pathogenetic component contributing to the development of mycoses of the soles and a characteristic feature of nonspecific immune reactivity. The neutrophilic phagocytic activity is depressed in such patients, and the monocytes are functionally inert. Furazolidonum, potassium orotate, and riboflavin are effective stimulants of the cell-mediated defense in such patients.

Serum lipid changes during acitretin (etretin) treatment of psoriasis and palmo-plantar pustulosis.

The effects of acitretin (free acid of etretinate) on the serum lipoprotein pattern and on the fat elimination in serum of 8 patients with psoriasis and 4 with palmo-plantar pustulosis were studied. The drug was given for 12 weeks; the average daily dose was 40 mg. Lipoprotein analyses and an intravenous fat tolerance test (IVFTT) were performed on three occasions (before, after 8 weeks' treatment, as well as 8 weeks after the end of the treatment). Acitretin increased the triglyceride concentration of the very low density lipoproteins by about 50% (p less than 0.02) and reduced the cholesterol of the high density lipoproteins significantly (p less than 0.001), leading to an increased low density/high density lipoprotein cholesterol ratio (p less than 0.02). The IVFTT indicated a lowering of the fat elimination capacity. All changes reverted to the original values after an 8-week wash-out period. The data suggest that the effects of acitretin on the lipoprotein metabolism resemble those of etretinate and isotretinoin.

Response of bacterial antigen in palmoplantar pustulosis.

Motilities of leukocytes in response to bacterial antigens or sera were examined in tissues from patients with palmoplantar pustulosis (PPP). Accelerated migration towards bacterial antigens was detected in the case of Staphylococcus epidermidis in 9 of 19 patients, to Propionibacterium acnes in 5 of 19, to Proteus mirabilis and Staphylococcus aureus in 3 of 19, while no acceleration was found in neutrophils from the controls. A significantly accelerated migration of normal lymphocytes in response to both patients' and control sera was nil. Inhibition of migration of guinea pig peritoneal exudate cells mixed with lymphocytes from PPP patients was detected in 12 out of 14 patients with the addition of S. epidermidis antigen and 8 of 14 with the addition of P. acnes antigen, while no such inhibition was detected in all 7 controls. The accelerated migration of neutrophils and inhibition of macrophages may participate in the development of PPP.

Angiogenic capability of peripheral blood mononuclear cells in psoriasis.

The angiogenic capability of peripheral blood mononuclear cells (MNCs) from patients with psoriasis was tested by lymphocyte-induced angiogenesis assay. The study was performed in 36 patients with psoriasis vulgaris, six with generalized pustular psoriasis of the von Zumbusch type, and five with palmo-plantar pustular psoriasis. When patients with psoriasis vulgaris were considered as a whole, no significant differences in the angiogenic capability of their MNCs could be detected, as compared with controls. However, when cases of psoriasis were classified into various types, the differences in angiogenic capability of MNCs became evident. This capability was found to be markedly increased in the active form of psoriasis vulgaris and decreased in the stationary stage of the disease. It was increased in palmo-plantar pustular psoriasis but markedly decreased in generalized pustular psoriasis of the von Zumbusch type.

Increased in vivo secretory activity of neutrophil granulocytes in patients with psoriasis and palmoplantar pustulosis.

The relationship between psoriasis and palmoplantar pustulosis (PPP) is uncertain, as is the role of the neutrophil granulocyte in these conditions. In a previous comparative study of the rate of polymorphonuclear leucocyte (PMN) phagocytosis of IgG- and IgG-C3b-coated particles, an increased uptake rate was found in both diseases. Further information on the in vivo activity of PMNs in these conditions may be obtainable by determining the level of lactoferrin (LF) in serum from such patients, since LF serves as a specific marker of the turnover and activity of the circulating pool of neutrophils. In this study on 19 patients with psoriasis and 20 patients with PPP, elevated levels of LF were found in both conditions. In contrast, the levels of lysozyme and beta 2-microglobulin, which are markers of monocyte-macrophage and lymphocyte activity, respectively, were normal. This suggests the selective activation of neutrophils in these disorders. LF was significantly correlated (P less than 0.05 and 0.001, respectively) to the rates of phagocytosis of IgG- and IgG-C3b-coated particles, but not to the chemotaxis of isolated PMNs. There was no correlation between the severity of the disease and the levels of serum LF. The data suggest the increased in vivo activity of neutrophils in psoriasis and PPP.