Diagnostic and neural analysis of skin cancer (DANAOS). A multicentre study for collection and computer-aided analysis of data from pigmented skin lesions using digital dermoscopy.

BACKGROUND: Early detection of melanomas by means of diverse screening campaigns is an important step towards a reduction in mortality. Computer-aided analysis of digital images obtained by dermoscopy has been reported to be an accurate, practical and time-saving tool for the evaluation of pigmented skin lesions (PSLs). A prototype for the computer-aided diagnosis of PSLs using artificial neural networks (NNs) has recently been developed: diagnostic and neural analysis of skin cancer (DANAOS). OBJECTIVES: To demonstrate the accuracy of PSL diagnosis by the DANAOS expert system, a multicentre study on a diverse multinational population was conducted. METHODS: A calibrated camera system was developed and used to collect images of PSLs in a multicentre study in 13 dermatology centres in nine European countries. The dataset was used to train an NN expert system for the computer-aided diagnosis of melanoma. We analysed different aspects of the data collection and its influence on the performance of the expert system. The NN expert system was trained with a dataset of 2218 dermoscopic images of PSLs. RESULTS: The resulting expert system showed a performance similar to that of dermatologists as published in the literature. The performance depended on the size and quality of the database and its selection. CONCLUSIONS: The need for a large database, the usefulness of multicentre data collection, as well as the benefit of a representative collection of cases from clinical practice, were demonstrated in this trial. Images that were difficult to classify using the NN expert system were not identical to those found difficult to classify by clinicians. We suggest therefore that the combination of clinician and computer may potentially increase the accuracy of PSL diagnosis. This may result in improved detection of melanoma and a reduction in unnecessary excisions.

Polyunsaturated fatty acids in plasma, red blood cells and mononuclear cell phospholipids of patients with atopic dermatitis.

Recent studies of polyunsaturated fatty acids (PUFA) in plasma and blood cell components of patients with atopic diseases have indicated disordered fat metabolism as linoleic acid (18:2n-6) tends to be increased while the more unsaturated fatty acids, such as gamma-linolenic acid (18:3n-6) and arachidonic acid (20:4n-6) are present in decreased amounts. To further clarify these abnormalities, we examined the PUFA content in phospholipids derived from plasma, red blood cells and mononuclear cells (MNC) in patients with atopic dermatitis. In plasma no significant differences were found between patients and controls. In red blood cells dihomo-gamma-linolenic acid (20:3n-6) was reduced in eczema patients, as compared with controls. The most significant findings in eczema patient MNC were reduced ratios of 20:4n-6/20:3n-6 in total lipids and in phosphatidyl ethanolamine (PE) and of 20:4n-6/18:2n-6 in both total lipids, phosphatidyl choline (PC) and PE. These findings indicate a disordered fatty acid metabolism in MNC of patients with atopic dermatitis. It is possible that these changes in the fatty acid profile of MNC may account for some of the immunological abnormalities seen in these patients.

Increased urinary excretion of 1.4-methyl-imidazoleacetic acid in patients with atopic dermatitis.

To investigate whether the overall histamine turnover is increased in patients with atopic dermatitis, without respiratory disease, the urinary excretion of the main histamine metabolite 1.4-methyl-imidazoleacetic acid (MIAA) was examined in 23 patients and in 23 age- and sex-matched non-atopic controls. The patients excreted significantly more MIAA than the controls. One third of the patients however, showed MIAA excretion within or below normal range. The MIAA excretion was neither correlated to the severity of the eczema nor to the total serum IgE. It was concluded that histamine does not play a significant role in the pathophysiology of atopic dermatitis, and that the great variation in MIAA excretion, and hence the histamine turnover, reflected the spectrum of histamine releasability in the patients.

Eosinophilic cellulitis: five cases.

Five cases of eosinophilic cellulitis or Wells' syndrome are described. While only few children have been included in earlier reports, 4 of the 5 patients in the present paper were below 10 years of age, with the youngest being only 20 months when the disease started. One of the children developed hard and tender subcutaneous swellings on the scalp, the histology of which showed extensive subcutaneous necrotizing granulomas. Similar lesions have not been described previously in connection with eosinophilic cellulitis. Eosinophilic cellulitis may be called a rare disease. However, it is important that clinician and histopathologist are both acquainted with the pathological features of this condition, as the disease often responds readily to steroid therapy.

Reduction of the number of immunocompetent cells in the acute stage of herpes zoster.

Circulating and in situ mononuclear cell subsets were phenotypically characterized during both the acute and convalescent phase of herpes zoster infections in 14 patients. In peripheral blood a significant reduction in the absolute number of Leu 4+ T cells, Leu 2a+ suppressor/cytotoxic T cells, Leu 3a+ helper/inducer T cells, Leu 7+ killer cells, and B1+ B cells were found during the acute stage compared to convalescents and normal controls. In contrast no change in the absolute number of MO2+ monocytes was seen in the acute stage of the disease. During convalescence a return to normal values in the lymphocyte subsets and killer cells was seen within 1-2 months after the initial disease presentation. In skin biopsy specimens from 4 of the 14 patients with active herpes zoster lesions the cellular infiltrate consisted of T cells (Leu 4+) the majority being helper/inducer T cells (Leu 3a+). Most of the cells expressed HLA-DR (Ia) antigens and were according to this in an activated state. The observed changes in effector and regulatory cell numbers may have implications for the acquisition of Varicella-zoster virus infections, the immune deficiency state associated with the disease, and/or the immune response to resolve the infection.

Dapsone in the treatment of cutaneous lupus erythematosus.

Thirty-three patients with chronic discoid lupus erythematosus (DLE) who had received dapsone for 1-27 months were reviewed. The dapsone treatment gave excellent results in 8 patients (24%), some effect in 8 patients (24%), while no response was seen in 17 patients (52%). Of the patients who had earlier been treated with hydroxychloroquine (HCQ), 76% responded excellently to the treatment. Of 6 patients who received a combined dapsone and HCQ therapy, 2 responded well. Six patients (18%) terminated the dapsone treatment because of side effects, none of which were serious. It is concluded that dapsone might be an alternative or a supplement to HCQ in the treatment of DLE, when the latter causes adverse reactions or fails to be effective. However, we find that HCQ remains the drug of choice when systemic treatment is needed.

Circulating lymphocyte subsets in patients with alopecia areata.

Lymphocyte subsets in peripheral blood of fourteen patients with patchy alopecia areata or alopecia universalis were estimated using monoclonal antibodies and immunofluorescence. The median percentage of circulating Leu 2a, 3a, 4 and 7 positive cells ("T-suppressor/cytotoxic", "T-helper/effector", total T-cells and killer and natural killer cells) were normal.

Delusions of infestation treated with pimozide: a follow-up study.

Fourteen patients with monosymptomatic delusions of infestation were followed-up 19-48 months after treatment with pimozide was terminated. Seven patients had remained in remission since the treatment. Three had developed relapses, but were without symptoms with intermittent treatment. Four patients responded poorly to pimozide and had still symptoms at the follow-up. The study indicates, that a large proportion of patients with monosymptomatic delusions of infestation treated with pimozide will be able to discontinue the medication for years without recurrence of their delusions.

Recall of UVB-induced erythema in breast cancer patient receiving multiple drug chemotherapy.

One day after sunbathing, a breast cancer patient received intravenous methotrexate, cyclophosphamide and 5-fluorouracil and had a recall of her UV erythema over the following week. Phototesting with UVA and UVB prior to and after a subsequent chemotherapy treatment showed a UVB-induced recall of erythema, as well as a phototoxicity-like response. Skin biopsies from test sites were compatible with phototoxic dermatitis. The occurrence of both erythema recall and the phototoxicity-like reaction suggests that more than one mechanism is involved in this side effect.

Sister chromatid exchange in patients treated with methotrexate for psoriasis.

Sister chromatid exchange (SCE), which is considered a sensitive method in evaluation of mutagenicity and may be an indicator of carcinogenicity, was determined in lymphocytes from 8 patients with severe psoriasis who underwent treatment with oral methotrexate (MTX). During the treatment period (median 118 days, range 50-298 days) a significant increase in SCE compared to the pretreatment value was found in 1 patient only. It is concluded that no long-term damage as measured by SCE occurs in lymphocytes from psoriasis patients treated with MTX.

Acute febrile neutrophilic dermatosis with genital involvement.

More than 80 cases of acute febrile neutrophilic dermatosis have been published since Sweet in 1964 described the syndrome. Besides skin eruptions, some patients have mucous membrane lesions involving mouth and lips. This report describes a patient with a pustular eruption consistent with Sweet's syndrome, who is believed to be the first with involvement of genital mucosa.

Urticaria pigmentosa treated with oral disodium cromoglycate.

4 patients with urticaria pigmentosa were treated with oral disodium cromoglycate (DSCG) for 2 months. During the treatment urine excretion of the main histamine metabolite, 1,4-methylimidazoleacetic acid (MIAA), was determined, and sequential skin biopsies were examined. DSCG was found to have beneficial effect on pruritus and whealing in 3 patients. The one treatment failure was in a patient without pruritus. The skin lesions remained unchanged. DSCG treatment had no effect on MIAA excretion or on the number of mast cells found in the skin biopsies.

Pityriasis amiantacea and psoriasis. A follow-up study.

59 patients with pityriasis amiantacea (PA) were followed up after 8 years on average. 15% had suffered from psoriasis and 19% were aware of psoriasis in their relatives. The incidence of psoriasis was significantly higher (p less than 0.01) than in the Scandinavian population, and the predisposition to psoriasis was significantly higher than in the population (p less than 0.001), but significantly lower (p less than 0.01) than in psoriatic patients. PA seems to be a manifestation of psoriasis in many cases.