Photolichenoid dermatitis: a presenting sign of human immunodeficiency virus.

Photolichenoid dermatitis is an uncommon eruptive dermatitis that often occurs in association with a photosensitizing drug. Photodermatitis, in general, is an uncommon clinical manifestation of human immunodeficiency virus (HIV), most often affecting patients of African and Native American descent. Photolichenoid dermatitis has infrequently been reported in patients with HIV who have not been exposed to a photosensitizing drug. We report a case of an African patient with a photodistributed depigmenting eruption without exposure to a photosensitizing drug. Histologic examination revealed a patchy perivascular and bandlike lymphocytic infiltrate with melanophages, interface changes, and dyskeratotic keratinocytes, consistent with photolichenoid dermatitis. Laboratory examination was significant for a positive HIV-2 antibody. Photolichenoid dermatitis may be a presenting sign of HIV infection and may not necessarily be associated with exposure to a photosensitizing drug. Testing for HIV should be done in patients who present with photodistributed depigmenting eruptions, even in the absence of exposure to a photosensitizing drug, and particularly in patients of African and Native American descent.

Erythema multiforme photoinduced by paroxetine and herpes simplex virus.

Erythema multiforme (EM) is a self-limited skin disease, characterized by the abrupt onset of symmetric red papules that may evolve into target lesions often precipitated by an infection. Photosensitive erythema multiforme (PEM) is a rare disorder characterized by the distribution of the lesions on sun-exposed areas. It has been described at the sites of sunburn, following episodes of polymorphic light eruption or herpes labialis and in association with drugs. To our knowledge, PEM photoinduced by selective serotonin reuptake inhibitors has not been reported. We describe a patient who had two consecutive episodes of PEM related to two different triggers: paroxetine and HSV infection. In the first episode, systemic photosensitivity was confirmed with the photobiological study. UVB-MED was decreased when the patient was taking paroxetine and did not change after its substitution for duloxetine. However, it became normal after the withdrawal of both drugs, suggesting a cross-reactivity reaction. The UVB photopatch test with paroxetine was positive. The second episode occurred after a herpes labialis relapse. At that time, UVB-MED was normal.

The characteristics of human papillomavirus expression and cell proliferation in actinic keratosis and Bowen's disease of the skin.

The aim of our study was to elucidate the characteristics of HPV expression and cell proliferation in actinic keratosis and Bowen's disease of the skin. We examined immunocompetent patients with premalignant lesions of the skin such as actinic keratosis and Bowen's disease. 10 patients were involved in each group. Clinical study included gross features of lesion, growth rate, colour, size. Paraffin sections from biopsy specimens were were stained by hematoxylin-eosin and von Gieson. Immunohistochemistry was performed using monoclonal antibodies against HPV, oncoprotein p53, anti-apoptotic protein Bcl-2, proliferation marker PCNA. Strongly, moderately and weakly positive cells were counted. Actinic keratosis and Bowen's disease failed to show the specific clinical features, therefore, they can not be diagnosed based on clinical signs only and morphological examination seems to be mandatory. The immunohistochemical study has showed that in both actinic keratosis and Bowen's disease HPV was positive in 60%, and 40% were HPV-negative suggesting the similar incidence of HPV infection in these premalignant lesions. Our results suggest that HPV(+)/p53(+) types of actinic keratosis and Bowen's disease are characterized by higher proliferation activity in comparison to HPV(-)/p53(+) types, and expression of Bcl-2 is associated with HPV-negativity, therefore, these premalignant lesions of the skin require immunohistochemical examination with evaluation of expressions of human papillomavirus, proliferation marker PCNA and anti-apoptotic protein Bcl-2. The differential diagnosis of actinic keratosis and Bowen's disease should be based on the following immunohistochemical criteria: incidences of positivity for p53, Bcl-2 and PCNA are similar, but expression intensity and anatomical localization are different: their expressions are higher in Bowen's disease, positive cells are found primarily in upper epidermis in actinic keratosis, while whole epithelium is involved in Bowen's disease.

Human papillomavirus infection in actinic keratosis and bowen's disease: comparative study with expression of cell-cycle regulatory proteins p21(Waf1/Cip1), p53, PCNA, Ki-67, and Bcl-2 in positive and negative lesions.

We examined the presence of human papillomavirus (HPV) DNA in tissues of premalignant skin lesions, i.e., actinic keratosis (n = 13) and Bowen's disease (n = 62), taken from 69 Japanese immunocompetent and renal transplant recipient patients. Detection and typing of HPV DNA were performed using polymerase chain reaction (PCR) and sequence analysis or restriction fragment length polymorphism (RFLP) analysis, respectively. The positivity rates of HPV DNA in tissues of actinic keratosis and Bowen's disease were 77% and 65%, respectively. Twenty-seven HPV types were detected in 50 (67%) premalignant skin lesions, in which Z95963 (accession no. in the EMBL Databank), Z95968, AJ010823, and AJ000151 have been described as partial sequences of unknown HPV types. Furthermore, 2 unknown types, HPVX1 and HPVX2, were found in specimens of actinic keratosis. Sequence analysis showed that HPVX1 is related to HPV-37 (86.1% sequence homology) and that HPVX2 is related to HPV-38 (79.7%). These results indicate that various mucosal and epidermodysplasia verruciformis-related HPV types are associated with the pathogenesis of actinic keratosis and Bowen's disease. In addition, 24 specimens of HPV-positive or HPV-negative premalignant skin lesions were examined immunohistochemically for proliferating cells to determine biological differences between HPV-positive and HPV-negative lesions. Immunohistochemistry for p21(Waf1/Cip1), p53, proliferating cell nuclear antigen (PCNA), Ki-67, and Bcl-2 revealed that there was no significant difference in the cell proliferation activity between HPV-positive and HPV-negative lesions, suggesting that HPV infection alone does not induce cell proliferation in those lesions.

Chronic actinic dermatitis as the presenting feature of HIV infection in three Chinese males.

There have been a few reports in the literature of chronic actinic dermatitis (CAD) associated with HIV infection, mostly in African--Americans of skin type VI, where photosensitivity predated the diagnosis of HIV infection. We report three cases, all Chinese males with skin type III or IV, who presented to our centre with CAD, and in whom advanced asymptomatic HIV infection was subsequently diagnosed. All had CD4 cell counts less than 100 cells/ micro L, with no evidence of AIDS-related complex. They were treated conservatively with photoprotection and topical steroids with mild to moderate improvement. A comparison with nine previously reported cases is made. The pathogenesis of CAD is unclear, but predominance of CD8 cells in severe cases and reversal of the CD4 : CD8 ratio in lesional skin and peripheral blood of HIV-negative CAD patients has been observed. CAD may be consequent to, and a presenting feature of, advanced HIV infection.

Photolocalized varicella in a middle-aged adult.

We report a case of photolocalized varicella occurring in a middle-aged woman. Photolocalized or actinic varicella is rarely described, and most reported cases have occurred in children. This is the first case in a middle-aged adult.

Chronic actinic dermatitis associated with human immunodeficiency virus infection.

Chronic actinic dermatitis is a photodistributed, eczematous dermatitis that preferentially affects elderly men and persists for months to years. Its occurrence in individuals infected with human immunodeficiency virus (HIV) has been described in five patients. We report four additional cases of this uncommon, chronic photodermatosis associated with HIV infection. In two of the patients, photosensitivity was a presenting disorder leading to the diagnosis of HIV infection. All patients were men of skin type VI with a mean age of 50 years, all had decreased minimal erythema doses to ultraviolet B, three of the four patients had decreased minimal erythema doses to ultraviolet A and all had CD4 cell counts of < 200 x 10(6)/L.

Detection of epidermodysplasia verruciformis-like human papillomavirus types in malignant and premalignant skin lesions of renal transplant recipients.

To evaluate the putative role of human papillomaviruses (HPV) in the development of skin cancer in renal transplant recipients, a series of skin biopsies from premalignant and malignant skin lesions was analysed using the polymerase chain reaction. Four different consensus primer pairs were used. HPV DNA was detected in five of 24 cases of squamous cell carcinoma, in one of three cases of Bowen's disease, in none of four basal cell carcinomas, in two of seven cases of actinic keratosis and in one of five cases of keratoacanthoma. Typing by direct sequencing of the amplified HPV DNA was possible in seven of nine cases, and revealed epidermodysplasia verruciformis (EV)-associated HPV types, or HPV types related to EV-associated types. Hence, HPV DNA could be detected in a significant proportion of (pre)malignant skin tumours in renal transplant recipients. The finding that some of the detected HPV types were as yet uncharacterized EV-related types, suggests that HPV DNA could be present in a higher percentage of lesions, and might be detected with refinement of the techniques.