TNF-inhibitor associated psoriatic alopecia: Diagnostic utility of sebaceous lobule atrophy.

The increasingly successful and widespread use of Tumor Necrosis Factor inhibitors (TNFi) to treat autoimmune and inflammatory conditions has also been accompanied by adverse reactions, both systemic and cutaneous. Psoriasiform cutaneous rashes are well described. Recently, TNF inhibitor associated psoriatic alopecia (TiAPA) is being more frequently reported. The purpose of this study is to describe the features of TiAPA, including marked atrophy of sebaceous lobules as a histologic clue to diagnosis, helping to distinguish it from other types of alopecia. Clinical and histopathological features of 3 patients who developed scalp alopecia while on TNFi treatment were examined. Clinical follow up was conducted after discontinuation of TNFi. A review of the previous literature on the subject was also conducted. Atrophy of sebaceous lobules is a potentially reversible, characteristic and conspicuous feature of TiAPA that can be distinguished from idiopathic psoriatic alopecia by clinical history of drug exposure and sometimes by histologic presence of a mixed inflammatory response including plasma cells and eosinophils.

Cutaneous histologic artifact associated with the use of a needle-free anesthesia device for skin biopsy.

A needle-free system that delivers lidocaine to the dermis using pressurized gas is often used as an alternative anesthetic for venipuncture and intravenous catheterization in children. This case report illustrates the potential histologic artifacts that may arise when using a needleless device for a cutaneous punch biopsy. We suggest against using a needleless system for pediatric skin biopsies.

Disseminated fusariosis presenting as panniculitis-like lesions on the legs of a neutropenic girl with acute lymphoblastic leukemia.

Fusarium is a filamentous fungus found naturally in the soil and as a contaminant of plumbing systems. In immunocompetent patients, Fusarium causes localized infection, most commonly onychomycosis. Fusarium tends to be resistant to commonly used antifungal medications. In immunocompromised patients, this antifungal resistance is of particular concern because localized infection quickly becomes disseminated disease with high mortality rates. Disseminated fusariosis presents with skin lesions more often than any other systemic fungal infection. We present a case of fusariosis in an 11-year-old neutropenic patient with acute lymphoblastic leukemia whose only symptom of the fungal infection consisted of painful, indurated nodules and plaques on her legs. The diagnosis and treatment of this invasive fungal infection is also discussed.

Effects of interleukin-12 and interleukin-15 on measles-specific T-cell responses in vaccinated infants.

Understanding the infant host response to measles vaccination is important because of their increased mortality from measles and the need to provide effective protection during the first year of life. Measles-specific T and B-cell responses are lower in infants after measles vaccination than in adults. To define potential mechanisms, we investigated age-related differences in measles-specific T-cell proliferation, CD40-L expression, and IFN-gamma production after measles immunization, and the effects of rhIL-12 and rhIL-15 on these responses. Measles-specific T-cell proliferation and mean IFN-gamma release from infant PBMCs were significantly lower when compared with responses of vaccinated children and adults. Infant responses increased to ranges observed in children and adults when both rhIL-12 and rhIL-15 were added to PBMC cultures. Furthermore, a significant rise in T-cell proliferation and IFN-gamma release was observed when infant PBMCs were stimulated with measles antigen in the presence of rhIL-12 and rhIL-15 compared to measles antigen alone. CD40-L expression by infant and adult T cells stimulated with measles antigen was comparable, but fewer infant CD40-L(+) T cells expressed IFN-gamma. These observations suggest that lower measles-specific T-cell immune responses elicited by measles vaccine in infants may be due to diminished levels of key cytokines.