Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA).

OBJECTIVE: This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment. METHODS: Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient's study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point. RESULTS: Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point (p = .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments. CONCLUSIONS: A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.

Mixed cryoglobulinemia in chronic hepatitis C infection. A clinicopathologic analysis of 10 cases and review of recent literature.

We present 10 cases of mixed cryoglobulinemia in patients infected with hepatitis C, including pertinent clinical, serologic, and pathological data. The findings attributable to MC appear to be similar in patients who are HCV-infected as in those with unknown HCV status. The prevalence of MC in HCV-infected patients appears to be lower in our region (13%) than in southern Europe (50-90%) although some of this difference is due to our requirement that patients included in our study have a cryocrit of at least 5%. In our patients, cryoglobulins were shown to be deposited in skin and kidney, but not in liver. The mechanisms by which HCV and MC are related remain uncertain. Although we and others have evidence for enrichment of HCV RNA in the cryoprecipitates of some patients, this was not always the case, and it is not yet clear that this finding is of fundamental pathogenic importance. Finally, it appears that some patients with HCV and MC may have a beneficial clinical response of vasculitic symptoms to therapy with alpha-interferon, as well as to glucocorticoids or other immunosuppressants. In our group, no predictors were apparent to distinguish responders from nonresponders before treatment. Similarly, the duration of response remains to be determined.

Perianal pseudoverrucous papules and nodules in children.

BACKGROUND: Pseudoverrucous papules and nodules were originally described as a reaction to irritation in association with urostomies. These changes have not been described as occurring on the perianal skin or around colostomies. OBSERVATIONS: Five children had remarkably similar-appearing papules and nodules of the perianal and suprapubic skin. The rash consisted of more than a dozen 2- to 8-mm shiny, smooth, red, moist, flat-topped, round lesions. This peculiar and striking reaction appears to be the result of encopresis or urinary incontinence. Biopsy specimens reveal reactive acanthosis or psoriasiform spongiotic dermatitis. The lesions regress when the irritating factor is removed. CONCLUSIONS: Recognition of this entity is important because pseudoverrucous papules and nodules may mimic more serious dermatoses and unnecessary workup may be initiated. Although this reaction involving perianal skin has not been reported previously, we believe it is not uncommon.

Mononuclear phagocytic and dendritic cell systems.

This review presents a classification scheme for disorders of the mononuclear phagocyte and dendritic cell systems. Previous classifications, based primarily on cytomorphology, are now obsolete. Electron microscopy, enzyme histochemistry, and, especially, immunocytochemistry have revealed the histiocyte identified by hematoxylin-and-eosin staining to be not one but several cell types. Currently, two broad groups of histiocytic cells are recognized, the monocyte-macrophage group and the dendritic cells. Dendritic cells are further subclassified as Langerhans cells, indeterminate cells, interdigitating cells, and dermal dendrocytes. Many disorders of the skin and other organs are characterized by proliferation of "histiocytic"-appearing cells. Some of these diseases clearly behave in a malignant fashion, whereas others follow a benign or variable course. At present, the proliferating cell type has been identified in only a few of these disorders by ultramicroscopy and cytochemical and immunocytochemical methods. Nevertheless, the pieces of the puzzle are beginning to fall into place. In general, those disorders that typically behave in a malignant fashion have been more extensively studied. The benign histiocytic disorders of children and adults are a heterogeneous group of diseases. Currently, some of these disorders are unclassified or classified with uncertainty. For example, how should severe histiocytosis with massive lymphadenopathy be classified? There is a proliferation of nonlymphoid mononuclear cells that are positive for S-100 protein and negative for CD1 and that exhibit lymphophagocytosis. Is this then a mononuclear phagocytic or dendritic cell disorder? Juvenile xanthogranuloma is a disorder of macrophages. Self-healing reticulohistiocytosis and solitary Langerhans cell histiocytoma are benign proliferative disorders of Langerhans cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Granulomatous eruption after BCG vaccine immunotherapy for malignant melanoma.

In a patient receiving intralesional bacille Calmette-Guérin vaccine injections for recurrent cutaneous metastases of malignant melanoma of the right leg, a striking eruption developed on that limb only. The eruption consisted of multiple 1 to 2 mm, reddish brown, flat-topped papules, with confluence into plaques. Histopathologic examination showed multiple tuberculoid granulomas within the papillary and reticular dermis; special stains and cultures were negative for mycobacteria.