Skin-homing Th2/Th22 cells in papuloerythroderma of Ofuji.

Papuloerythroderma of Ofuji (PEO) appears to be a T cell-mediated skin disease; however, the pathogenesis of PEO remains unclear. We report two cases of PEO and examine cytokine production and expression of skin-homing receptors in circulating T cells in the patients. The percentages of interleukin 4 (IL-4)-, IL-13- and IL-22-producing CD4+ and CD8+ T cells were markedly higher in the circulation of patients with PEO than in those of healthy subjects. The expression of both cutaneous lymphocyte antigen (CLA) and CC chemokine receptor 4 (CCR4) were significantly upregulated in the circulating CD4+ and CD8+ T cells. Moreover, serum levels of thymus and activation-regulated chemokine (TARC), a chemoattractant for CCR4, were increased. The number of IL-4-, IL-13- and IL-22-producing T cells, expression of CLA and CCR4 by T cells, and serum TARC levels significantly decreased after complete remission of PEO. These results suggest that skin-homing Th2/Th22 cells may play a role in the pathogenesis of PEO.

Malignant atrophic papulosis in an infant.

We report a 7-month-old girl with malignant atrophic papulosis (Degos' disease). She also showed spontaneous aggregation of platelets. A good clinical response was obtained by treatment with aspirin and dipyridamole.

Cytokines in the pruritic papular eruption of HIV.

BACKGROUND: The immunopathogenic mechanism of the pruritic papular eruption (PPE) of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is poorly understood, and the objective of the present study was to determine the concentration of the serum cytokines interleukin-2 (IL-2), IL-4, IL-5, IL-10, IL-12, and gamma-interferon (gamma-IFN) in an attempt to recognize the pattern of CD4+/CD8+ lymphocytes occurring in this dermatosis. MATERIALS AND METHODS: The study was conducted on 11 HIV-positive PPE patients, matched for sex and age with eight HIV-infected patients with no dermatosis and 10 healthy HIV-negative individuals. Cytokines were quantified by enzyme-linked immunoabsorbent assay (ELISA) using monoclonal antibodies (R & D Systems) and the data were analyzed by the Mann-Whitney, Kruskall-Wallis, and Spearman correlation tests. RESULTS: An increased concentration of IL-2 was observed in both the HIV-positive (77.65 pg/mL, P < 0.001) and PPE (20.42 pg/mL, P < 0.05) groups when compared with the HIV-negative group (9.50 pg/mL). The IL-2 concentration was significantly higher (P < 0.05) in the HIV-positive group than in the PPE group. Similarly, the gamma-IFN concentration was higher in the HIV-positive (14.97 pg/mL) and PPE (12.67 pg/mL) groups when compared with the HIV-negative group (8.58 pg/mL). The IL-12 concentration was similar in the PPE and HIV-positive groups (1.82 and 1.68 pg/mL, respectively), but higher than in the HIV-negative group (1.17 pg/mL). The same occurred with IL-5 (17.78, 17.79, and 15.74 pg/mL, respectively). There was no significant difference in IL-4 concentration among the PPE, HIV-positive, and HIV-negative groups (10.95, 7.88, and 10.16 pg/mL, respectively), and the same was observed for IL-10 (22.41, 21.13, and 20.92, respectively). There was a negative correlation between serum gamma-IFN concentration and peripheral CD4+ lymphocyte number (r = - 0.6256) in the PPE group (P < 0.05). CONCLUSIONS: The lower levels of IL-2 and gamma-IFN and the negative correlation between gamma-IFN and peripheral CD4+ lymphocytes may indicate an early phase of immunosuppression in PPE.

Striae and acne following cardiac surgery in a child.

We report a 13-year-old girl with extensive striae and an acneiform eruption following surgery for complex congenital heart disease. These findings were associated with elevated serum and urinary cortisol levels with loss of diurnal rhythm. The resolution of the eruption and the fading of her striae coincided in time with normalization of her blood parameters on day 72 postoperatively. We conclude that the cause of steroid excess in our patient was stress induced by the cardiac surgery and a complicated and protracted postoperative course. To our knowledge, this is the first report in the English language literature of skin changes due to endogenous hypercortisolaemia caused by intense physical and emotional stress.