Abnormal expression of the co-stimulatory molecule B7-H3 in lichen simplex chronicus is associated with expansion of Langerhans cells.

BACKGROUND: The co-stimulatory molecule B7-H3, a cell surface transmembrane glycoprotein, was assessed for its functional and prognostic role in lichen simplex chronicus (LSC). AIM: To investigate if abnormal expression of the co-stimulatory molecule B7-H3 in LSC is associated with Langerhans cell (LC) expansion. METHODS: We used immunohistochemistry to stain LSC skin tissue, and evaluated if the immunostaining of B7-H3 and interleukin (IL)-6 was significantly different. RESULTS: Our results indicated that B7-H3 is abnormally expressed in LSC skin tissue and positively regulates LC expansion. We also found that IL-6 might modulate B7-H3 expression. Moreover, LC expansion in LSC leads to the proliferation of T cells. CONCLUSIONS: Our study indicates the potential value of immunotherapy as a treatment for LSC.

Eosinophilic neuritis and eosinophilic panniculitis in a patient with advanced acquired immunodeficiency syndrome.

The pruritic, papular eruption of human immunodeficiency virus with associated peripheral eosinophilia is well documented. We describe a 32-year-old African American man with advanced acquired immunodeficiency syndrome; a generalized painful, pruritic, papular rash; peripheral blood eosinophilia; and perineural eosinophilic infiltrates with eosinophilic panniculitis. To our knowledge, the latter 2 features have not been previously described in the literature on human immunodeficiency virus dermatoses. We propose that eosinophilic neuritis and eosinophilic panniculitis may represent additional findings in the spectrum of cutaneous disease seen in patients with advanced acquired immunodeficiency syndrome.

[Atopy patch testing with aeroallergens and food]. / Atopie-Patch-Test mit Aeroallergenen und Nahrungsmitteln.

The atopy patch test (APT), a patch test employing allergens known to elicit IgE-mediated reactions which is assessed by evaluating eczematous skin lesions after 24 h to 72 h, was developed as a diagnostic tool for characterizing patients with aeroallergen-triggered atopic eczema (AE, atopic dermatitis). Positive APT reactions are associated with allergen-specific T-cell responses. The specificity of APT is higher than the specificity of skin prick tests or RAST. More studies for the standardization of APT methods are necessary, especially with regard to food APT.

Evaluation of contact sensitization in vulvar lichen simplex chronicus. A proposal for a battery of selected allergens.

OBJECTIVE: To determine the role of contact sensitization in vulvar lichen simplex chronicus and to select appropriate batteries of allergens to test. STUDY DESIGN: Between 1993 and 2000, 61 women affected by vulvar lichen simplex chronicus were enrolled to evaluate the role of contact hypersensitivity. All the patients underwent patch tests with the Italian standard series and with a wide battery of allergens (preservatives, perfumes, emulsifiers, medicaments) and products they used routinely. RESULTS: Of the women, 47.5% had at least one positive patch test, and relevant positivities were observed in 26%. The relevant allergens were usually medicaments and preservatives. CONCLUSION: It would be acceptable to reduce the number of allergens tested, in particular omitting the perfume series. Patch tests are a helpful diagnostic tool in vulvar lichen simplex chronicus and improve prescribing practice.

[Psychophysiologic and psychoneuroimmunologic studies in neurodermatitis. Overview and critical evaluation]. / Psychophysiologische und psychoneuroimmunologische Ergebnisse zur Neurodermitis. Ubersicht und kritische Bilanz.

Results of psychophysiological, psychoendocrinological, and psychoneuroimmunological research on the skin in patients with atopic dermatitis were evaluated. 11 investigations were selected and analysed with respect to both design and results. In 6 instances, healthy or ill control groups were included, rarely did the sample size exceed 30. With respect to physiology, blood pressure, heart rate and EDA were most commonly assessed; with respect to immunology, number of leucocytes and differential blood count and with respect to psychology, anxiety, neuroticism and stress perception. The results involving stress induction, itching induction and the relationship of personality and skin parameters were not consistent. The best established relationship is that between skin reactivity (flare, wheal size and pruritus) on the one hand and cognitive appraisal of stress-stimuli and the experimental situation on the other hand. Psychoendocrinological and even more psychoimmunological indicators of the stress of reaction-unlike psychophysiological indicators-were correlated with the skin response. Only half of the studies found an elevated physiological stress reaction in patients with atopic dermatitis.

Detection of circulating T cells with CD4+CD7- immunophenotype in patients with benign and malignant lymphoproliferative dermatoses.

BACKGROUND: Cutaneous T-cell lymphomas (CTCLs) are malignancies of CD4+ T cells that involve the skin. CD4+CD7- cells may represent a malignant population in CTCL. OBJECTIVE: Our purpose was to compare the percentage of CD4+CD7- cells and the expression of pan-T-cell antigens in blood lymphocytes from 31 patients with benign dermatoses with 35 patients who had CTCL. METHODS: The patients with CTCL were classified as follows: 10 with mycosis fungoides (MF), seven with pre-Sézary syndrome (pre-SS), and 18 with Sézary syndrome (SS). Flow cytometry was used to determine the percentage of CD4+CD7- cells and the CD4/CD8 ratio and to detect aberrant expression of the pan-T-cell antigens CD2, CD3, and CD5. RESULTS: We found a mean of 5.8% CD4+CD7- cells for the 16 normal control subjects and 9.3% for the benign cases (p = 0.13). The patients with pre-SS and SS had a higher percentage of CD4+CD7- cells (22.4% and 35.5%, respectively) than patients with benign dermatoses (p < 0.01); no difference was found between patients with benign dermatoses and those with MF (p = 0.80). The mean CD4/CD8 ratio was 3.1 for the normal control subjects compared with 7.4 for the patients with benign dermatoses (p < 0.01). Patients with SS had a ratio of 49, which was higher than the ratio for those with benign dermatoses (p < 0.01); however, the ratio for patients with MF and pre-SS did not differ from that of the group with benign dermatoses (p = 0.71 and 0.55, respectively). Aberrant CD2, CD3, or CD5 expression was observed in 66% of patients with SS, 29% with pre-SS, 30% with MF, but in none of the patients with a benign dermatosis. CONCLUSION: Small numbers of CD4+CD7- cells can be found by flow cytometry in patients with a benign dermatosis and in normal control subjects. This T-cell subset is expanded in pre-SS and SS but not in MF. Aberrant pan-T-cell antigen expression is commonly observed in patients with SS but not in patients with a benign dermatosis.

Lichen simplex chronicus.

A review of the literature for the last 20 years shows no monumental advances in the diagnosis or treatment of the disease; however, there have been some very intriguing insights into the causes. The physical and emotional aspect of the skin condition is well known but the genetic, vascular, and neurogenic implications are of interest.

[Neurodermatitis and food allergy. Clinical relevance of testing procedures]. / Neurodermitis und Nahrungsmittelallergie. Klinische Relevanz von Testverfahren.

In 132 children with neurodermitis, we measured specific IgG and IgE antibodies against components of cow's milk, soy milk, and egg. In addition we performed epidermal tests by rubbing the nutrients onto the intact skin. The results were compared to the effect of complete omission of milk, egg, and soy during four weeks and with the outcome of subsequent reexposition. We used standardized scales to evaluate the neurodermitis and the skin reactions and for the clinical response to the oral challenge. The best prediction for the outcome of the oral challenge was obtained by the epidermal test which had to be done with whole milk, soy milk and egg white; there was no further advantage in testing egg yolk or soy oil. IgE antibodies followed next in their predictive value. No further precision was gained by the combination of epidermal testing with IgE results, by the measurement of IgE antibodies to the constituents of cow's milk, of IgG antibodies, and of the platelet count during oral challenging. Positive reactions to oral administration after four weeks' omission of allergenic food were relatively frequent in the age group below three years, but rare in school children and adolescents.

[The use of H-1 antihistamine preparations in neurodermatitis patients]. / Primenenie H-1 antigistaminnykh preparatov u bol'nykh neirodermitom.

Correlations between clinical variants of neurodermatitis course and patients' lymphocyte sensitivity to histamine are analyzed. The atopic form is associated with high lymphocyte sensitivity to histamine. Administration of H-1 antihistaminic agents to these patients is not always justified. Antihistaminic drugs should be prescribed to neurodermatitis patients with due consideration for the individual sensitivity of patient's lymphocytes to histamine.

[Pathogenesis and clinical aspects of atopic dermatitis]. / Pathogenese und Klinik der atopischen Dermatitis.

Atopic dermatitis (a. D.) is a chronically relapsing inflammatory disease of the skin caused by a genetically transmitted hypersensitivity to environmental substances. Its pathogenesis is complex and multifactorial: heredity of atopic constitution, disturbances of humoral (hyperimmunoglobulinemia-E) and cellular (defect of suppressor-T-cells) immunity, abnormal vascular reactions and abnormal skin functions. A. D. shows different forms in different age groups: Eczema infantum in infancy, Eczema flexurarum in childhood and Neurodermatitis disseminata and pruriginosa while and after puberty. Typically for all forms is a pruritus and the status neurodermiticus. The healing of a. D. is spontaneously possible at any time, but not predictable for a special case.

Calcitonin gene-related peptide immunoreactivity in prurigo nodularis: a comparative study with neurodermatitis circumscripta.

Eight patients with intensely pruritic lesions of chronic idiopathic prurigo nodularis and three patients with neurodermatitis circumscripta were investigated using the indirect immunofluorescence method. Results showed similarities in epidermal hyperplasia but not in nerve proliferation and neuropeptide immunoreactivity. Increased numbers of calcitonin gene-related peptide (CGRP) and substance P immunoreactive nerve fibre bundles were detected in specimens taken from prurigo nodularis lesions, but no increased immunoreactivity could be seen in specimens taken from patients having neurodermatitis circumscripta compared to normal skin. The neuropeptides, CGRP and substance P, may be responsible for the intense itching of prurigo nodularis lesions.

[The rehabilitation of children with neurodermatitis by using local natural conditions]. / Reabilitatsiia detei, bol'nykh neirodermitom, s ispol'zovaniem mestnykh prirodnykh uslovii.

Local natural factors, used at a seasonal hospital, are a highly effective means of rehabilitation therapy of children suffering from neurodermatitis, as evidenced by clinical observations and the time course of the immunity and nonspecific defense parameters. A relationship between the efficacy of heliothalassotherapy and the HLA classification of the patients has been revealed.

[The leukocyte migration inhibition reaction in children with neurodermatitis]. / Reaktsiia tormozheniia migratsii leikotsitov u detei, bol'nykh neirodermitom.

This test (LMIT) with epidermal antigens and ConA, made in capillaries, has been carried out in examinations of 70 children aged 3-10, suffering from neurodermatitis. It has revealed a specific dose-dependent sensitization to epidermal antigens and reduced parameters of ConA-effected LMIT in such patients and a relationship between the ConA-effected leukocyte migration activity and the dermatosis stage.

[The natural cytotoxicity and morphofunctional status of the surface of mononuclear cells of the blood in neurodermatitis in children]. / Estestvennaia tsitotoksichnost' i morfofunktsional'noe sostoianie poverkhnosti mononuklearov krovi pri neirodermite u detei.

Essential changes in the mononuclear glycocalix structure and function and a reduction of the blood natural cytotoxicity have been detected in children suffering from neurodermatitis. These shifts depended on the disease pattern and did not recover in clinical remission.

[Climate therapy and change in cellular immunity]. / Klimatherapie und Anderung der zellulären Immunität.

The cell-mediated immunity was investigated by delayed hypersensitivity reactions on recall antigens (tetanus, diphtheria, streptococci, tuberkulin, candida, trichophyton, proteus/Multitest-Merieux) in 56 patients with atopic dermatitis (34 females, 22 males) under mountain-climatic therapy (Davos, 5118 ft). The testscore of 7.9 mm (females 8.2/males 7.5) was lowered in comparison to the normals within the literature (females 15.4/males 21.0). Anergy was found in 8.8% in females (normal 4%) and in 9.1% in males (0.4%). After treatment the score raised up to 9.9 mm (25.3%, p less than 0.005), more obvious in males (29.3%/9.7 mm) than in females (22.0%/10.0 mm). The mean number of positive skin-reactions raised from 2.0 to 2.6 (p less than 0.001). These data let assume an influence of mountain-climatic therapy on the cell-mediated immunity.