Zombie Cells, Composite Cells of Fungal-Human Keratinocytes of Plantar Hyperkeratosis-Like Lesions.

Foot hyperkeratosis is common. They often coincide with fungal infections, are difficult to cure and relapse rates are high. In this case study, longstanding and intractable plantar hyperkeratotic lesions were investigated for potential causative agents by histological examinations, by using human cell culture medium to grow the infected skin tissue, by sequencing ribosomal DNA and whole genome. Aspergillus sydowii was identified as the pathogen in the hyperkeratotic lesions. A peculiars intracellular infection of the fungus appeared to merge with anucleated epithelial cells of the skin, in which not fungal cells but basophilic nucleus-like bodies and abundant fungal proteins were seen in the cells. The composite fungal-human zombie-like cells were found to grow in the culture and in hyperkeratotic lesions, and some were readily transformed to natural fungus. Such zombie cells might play roles in the pathogenesis and recurrences of plantar hyperkeratotic lesions, resistance to antifungal drugs and relapses of the fungal infections.

Queratolisis punctata / Pitted keratolysis

Se presenta caso de paciente de 13 años, de sexo femenino, con historia de 2 meses de evolución de lesiones aspecto crateriforme en planta de pie izquierdo, acompañado de bromhidrosis, dolor y ardor e impotencia funcional. El cultivo reveló la presencia de Staphylococcus aureus meticilino sensible. Las lesiones mejoraron con tratamiento antibiótico tópico con mupirocina y queratolíticos, quedando como diagnóstico una queratólisis punctata.

A 13-year-old female patient case is presented with a 2 months history of lesions on the left foot, accompanied by bromhydrosis, pain, burning, and functional impotence. Tissue culture revealed the presence of sensitive methicillin Staphylococcus aureus. The lesions improved with topical antibiotic treatment with mupirocin and keratolytics, final diagnosis was punctate keratolysis.

Pitted keratolysis: a clinical review.

BACKGROUND: Pitted keratolysis is a bacterial infection that affects the plantar epidermis. Despite the condition being reported in many countries affecting both shod and unshod populations, there is little guidance for clinicians providing evidence or best practice guidelines on the management of this often stubborn infection. METHODS: Using a structured search of a range of databases, papers were identified that reported treatments tested on patients with the condition. RESULTS: Most of the literature uncovered was generally of a low level, such as case-based reporting or small case series. Studies were focused mainly on the use of topical antibiotic agents, such as clindamycin, erythromycin, fusidic acid, and mupirocin, often in combination with other measures, such as hygiene advice and the use of antiperspirants. From the limited evidence available, the use of topical antibiotic agents shows some efficacy in the treatment of pitted keratolysis. However, there is currently no suggestion that oral antibiotic drug therapy alone is effective in managing the condition. CONCLUSIONS: Currently, there is no consensus on the most effective approach to managing pitted keratolysis, but a combination of antimicrobial agents and adjunctive measures, such as antiperspirants, seems to demonstrate the most effective approach from the current literature available.

iRHOM2-dependent regulation of ADAM17 in cutaneous disease and epidermal barrier function.

iRHOM2 is a highly conserved, catalytically inactive member of the Rhomboid family, which has recently been shown to regulate the maturation of the multi-substrate ectodomain sheddase enzyme ADAM17 (TACE) in macrophages. Dominant iRHOM2 mutations are the cause of the inherited cutaneous and oesophageal cancer-susceptibility syndrome tylosis with oesophageal cancer (TOC), suggesting a role for this protein in epithelial cells. Here, using tissues derived from TOC patients, we demonstrate that TOC-associated mutations in iRHOM2 cause an increase in the maturation and activity of ADAM17 in epidermal keratinocytes, resulting in significantly upregulated shedding of ADAM17 substrates, including EGF-family growth factors and pro-inflammatory cytokines. This activity is accompanied by increased EGFR activity, increased desmosome processing and the presence of immature epidermal desmosomes, upregulated epidermal transglutaminase activity and heightened resistance to Staphylococcal infection in TOC keratinocytes. Many of these features are consistent with the presence of a constitutive wound-healing-like phenotype in TOC epidermis, which may shed light on a novel pathway in skin repair, regeneration and inflammation.

Uveitis and desquamating rash of the palms and soles.

Syphilis, a sexually transmitted disease caused by the spirochete Treponema pallidum, can affect nearly every organ system in the body. In particular, skin manifestations of secondary syphilis are common but nonspecific and can be a true masquerader of other skin disorders. Concomitant infection with HIV has been increasing and may cause even more unusual skin presentations. We present a patient with the atypical combination of palmoplantar keratoderma and ocular symptoms that closely resembled reactive arthritis (or Reiter's syndrome). When evaluating patients with HIV infection, clinicians should maintain a high level of suspicion for syphilis to accurately diagnose and treat this curable but potentially fatal disease.

Prevalence and treatment of palmoplantar keratoderma and tinea pedis in patients with Sézary syndrome.

BACKGROUND: Mycosis fungoides (MF) and the Sézary syndrome (SS) are non-Hodgkin's lymphomas that present with cutaneous lesions. Sézary syndrome is characterized by blood involvement, exfoliative eryrthroderma, lymphadenopathy, pruritus, keratoderma, and immunosuppression. This study was to estimate the prevalence of palmoplantar keratoderma and tinea pedis in Sézary syndrome and to analyze the effectiveness of anti-fungal treatment. METHODS: We conducted a retrospective review of 1562 prospectively collected patients at the MD Anderson Cancer Center Cutaneous Lymphoma Clinic over sixteen years. All patients' palms and soles were evaluated for clinical evidence of keratoderma (hyperkeratosis) and for dermatophytosis (tinea pedis or unguum) by examining scales under 10% potassium hydroxide by light microscopy for hyphae. RESULTS: Of 138 Sézary syndrome patients (88 men, 50 women, median age at diagnosis 64 years), 85 (61.6%) had palmoplantar keratoderma; 45 of the 85 Sézary syndrome patients (52.9%) also had coexisting tinea pedis. Only 14 (10.1%) had tinea pedis without keratoderma. Treatment for tinea pedis resulted in microscopy cure of keratoderma in 12 of 45 (26.7%) patients and clinical improvement. CONCLUSIONS: The prevalence of palmoplantar keratoderma in Sézary syndrome is 61.6%, with co-existing tinea pedis found in 52.9%. Palmoplantar keratoderma with tinea pedis showed clinical improvement with fungicidal therapy suggesting that tinea often contributes to the pathogenesis and severity of Sézary syndrome-related keratoderma.

A case of nonfatal cutaneous melioidosis.

Melioidosis is a tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei. It is endemic in many parts of the world, including Southeast Asia, and has a mortality rate of about 45%. We report a case of localized nonfatal cutaneous melioidosis presenting as a persistent ulcer in an otherwise healthy young woman.

Prevalence of dermatomycoses in Mal de Meleda patients: a field study.

Mal de Meleda is a rare autosomal recessive form of palmoplantar keratoderma characterized by hyperkeratosis of the palms and soles. The presence of yeast and dermatophytes was investigated in 29 mal de Meleda patients from Koprucay canyon, Turkey, a newer geographical focus, and was found in 62.0% and 20.7% of cases, respectively. Antifungal resistance of isolates was not detected.

Dermatophytes and keratin in patients with hereditary palmoplantar keratoderma. A mycological study.

Fourteen patients with hereditary palmoplantar keratoderma of the Unna Thost variety were included in the study. Dermatophytosis was found in 7 of the 14 patients. Six were affected with T. rubrum and one with T. mentagrophytes. The growth pattern of dermatophytes in keratin from the patients did not differ from that of normal control individuals. Keratin from patients with hereditary palmoplantar keratoderma was sterilized with ethylene gas and placed in the center of culture plates, previously broad inoculated with control dermatophytes or dermatophytes isolated from patients. An inhibition zone around the keratin was found in 42.9% of the control dermatophytes and in 83.4% of the patient cultures. The inhibition zone was only seen in cultures with T. rubrum and not in those with T. mentagrophytes. No significant difference in minimal inhibitory concentration values against ketoconazole between control dermatophytes and dermatophytes from patients was demonstrated.

Immunological aspects of dermatophyte infections in hereditary palmo-plantar keratoderma.

Family and personal histories of atopy, total IgE level in serum, AB0 blood groups, trichophytin reactions, IgE RAST, IgG RAST and precipitating antibodies were investigated in patients with hereditary palmo-plantar keratoderma and dermatophytosis. 44% of the patients with dermatophytosis had a personal and/or family history of atopy and 67% a total IgE greater than 100 kU/ml. No significant differences in the rate of dermatophytosis were found between atopics and non-atopics, nor were there differences between patients with a total IgE above and those with a level below 100 kU/ml. The determination of AB0 blood groups showed that T. mentagrophytes occurred significantly more often in patients with blood group A. All delayed trichophytin reactions were negative. A positive immediate trichophytin reaction was found in only 1 patient, who also had a raised level of IgE antibodies against dermatophytes. The level of specific IgG antibodies was increased in patients infected with T. rubrum and E. floccosum, which two species were found to have at least one antigen in common. Homologous precipitating antibodies occurred in 54% of the patients with hereditary palmo-plantar keratoderma, which is a considerably higher value than that reported in dermatophyte infected patients without this inherited disorder.

Scanning electron-microscopy of plague in Papillon-Lef:evre syndrome.

Supra and subgingival plaque associated with periodontal lesions in patients with Papillon-Lefèvre syndrome were studied by examining extracted teeth and associated soft tissue by scanning electron and light microscopy. Four zones of plaque were described according to their location along the tooth surface. Supragingivally, cocci, filamentous bacilli and "corncob" formations were seen. Fusiform bacilli colonized the surface of supragingival plaque on the root surface. Subgingival sites, particularly apical areas, had numerous spirochetes adherent to the plaque surface as well as directly to the cementum surface. Microcolonies of bacteria, probably Mycoplasma, could be seen in the subgingival plaque. The findings of a potentially pathogenic plaque, attached subgingival spirochetes and microcolony formation may have important therapeutic and research implications.