Tinea Capitis in Adults

Objective: To determine the epidemiology and the aetiology of tinea capitis in the elderly in Turin (Italy). Methods: We prospectively collected all cases of adult tinea capitis in the Dermatology Clinic of the University of Turin from January 1997 to December 2012. Results: 13 patients (4 males and 9 females) with a mean age of 56.5 years were found to be affected by tinea capitis among a total number of 508 (2.6%). Diagnosis was made on clinical appearance and mycological examination. Culture identified M. canis in 7 patients (53.8%), T. mentagrophytes in 3 patients (23.1%), T. rubrum in 2 patients (15.4%) and T. violaceum in 1 patient (7.7%). 6 cases reported contact with animals. Treatment consisted in administration of Griseofulvin at the dose of 500 mg/d or Terbinafine at the dose of 250 mg/d for at least 8 weeks. A complete recovery was observed in 10 patients, whereas 3 of them suffered from cicatritial alopecia. Conclusion: This study wants to highlight the importance of considering tinea capitis as a differential diagnosis in elderly patients with scaly scalp lesions, even though it is considered to be rare in adults.

玫瑰糠疹与人类疱疹病毒6和人类疱疹病毒7相关的额外证据

To elucidate the role of human herpesvirus (HHV)-6 and-7 (HHV-7) in pityriasis rosea (PR), we measured their DNA load in plasma, peripheral blood mononuclear cells (PBMC), and tissues using a calibrated quantitative real-time PCR assay. We also studied HHV-6-and HHV-7-specific antigens in skin by immunohistochemistry and anti-HHV-7 neutralizing activity using a syncytia-inhibition test. Plasma and PBMC were obtained from 31 PR patients (14 children, 17 adults), 12 patients with other dermatites, and 36 blood donors. Skin biopsies were obtained from 15 adults with PR and 12 with other dermatites. HHV-6 and HHV-7 DNA were detected in 17%and in 39%of PR plasmas, respectively, but in no controls. HHV-7 viremia was associated with a higher PBMC load and, in adults, with systemic symptoms. HHV-7, but not HHV-6, levels in PBMC were higher in PR patients than in controls. HHV-6 and HHV-7 antigens were found only in PR skin (17%and 67%of patients analyzed, respectively), indicating a productive infection. Syncytia-neutralizing antibodies were found in PR patients and controls, but their titers were lower in patients with HHV-7 viremia. These data confirm the causal association between PR and active HHV-7 or, to a lesser extent, HHV-6 infection.

大剂量阿昔洛韦治疗玫瑰糠疹

Background: The association of human herpesvirus 6 (HHV-6) and HHV-7 with pityriasis rosea suggests that systemic drugs directed against HHV may hasten recovery of patients with pityriasis rosea. Objective: The purpose of this study was to verify the efficacy of oral acyclovir in the treatment of pityriasis rosea. Methods: Eighty-seven consecutive patients were treated for 1 week with either oral acyclovir (800 mg 5 times daily) or placebo. In all patients, the time of lesion clearing and the number of new lesions appearing during treatment were recorded. Results: On the 14th day of treatment, 79% of treated patients fully regressed compared with 4% of the placebo group. The lesions cleared in 18.5 days in treated patients and in 37.9 days in the placebo group. Clearance was achieved in 17.2 days in patients treated in the first week from onset and in 19.7 days in the patients treated later. On the 7th day, there were significantly fewer new lesions in patients treated in the first week than in those treated later. Limitations: This trial was neither randomized nor double blind. Objectivity was achieved by counting the lesions. Conclusion: Acyclovir may be effective in the treatment of pityriasis rosea, especially in patients treated in the first week from onset, when replicative viral activity of HHV is probably very high.

红斑毛细血管扩张性酒渣鼻的电视毛细血管镜图像改变

Background: Rosacea is a common chronic dermatosis that involves the cutaneous microvasculature of the face. There are no objective measures for assessing the severity of erythematotelangiectatic rosacea. Objective: Our purpose was to characterize and provide objective measures of vessel changes in erythematotelangiectatic rosacea by videocapillaroscopy. Methods: We compared 30 patients with erythematotelangiectatic rosacea with 30 age-and sex-matched patients with facial seborrheic dermatitis and 30 healthy control subjects. Videocapillaroscopy was performed both on the cheeks and on the nailfold region. The analyzed parameters of the face were morphological (background color, vessel irregularities) and quantitative (polygonal net perimeter, telangiectasia, and vessel diameters). Results: Characteristic alterations of skin vessels were observed in facial rosacea, with a pattern distinct from that of facial seborrheic dermatitis. In particular, rosacea showed neoangiogenesis and significantly larger polygons (13.21 ± 3 vs 7.8 ± 3 mm; mean ± standard deviation, P< .001),more prominent telangiectases (267.8 ± 108 vs 118.2 ± 35 μ m; P< .001) and larger mean vessel diameter (46.71 ± 9 vs 24 ± 10 μ m; P< .001) compared with seborrheic dermatitis. Seborrheic dermatitis displayed more polygon irregularities and vessel tortuosity. In contrast, no differences were found in the nailfold region. Limitations: Vessel irregularities and overall erythema may be difficult to quantify. Conclusions: Videocapillaroscopy may represent a valid adjunctive method in the early diagnosis and measurement of erythematotelangiectatic rosacea.

浸润细胞、相关的细胞因子和趋化因子受体在皮肌炎皮损中的表达

Background: There have been only two reports on immunophenotypic characteriza tion in the cutaneous lesions of dermatomyositis (DM) that emphasize the importa nce of the infiltrating CD4+ T lymphocytes. Objectives: To characterize the imm unophenotype of the cells that infiltrate the lesional skin of DM and to evaluat e the possible T-helper (Th) polarization Th1/Th2 through detection of specifi c cytokines, chemokine receptors and markers of cellular activation. Methods: Sk in biopsy specimens derived from pathognomonic lesions (Gottron’s papules and Gottron’s sign) of eight patients withDMwere immunostainedwith a large panel o fmonoclonal antibodies to CD3, CD4, CD8, myeloperoxidase(MPO), eosinophil cation ic protein, tryptase, CD40, CD40 ligand (CD40L), HLA-DR, interleukin (IL)- 2, IL- 4, IL- 5, IL- 13, interferon-γ , tumour necrosis factor-α , recept or 3 for CXC chemokines (CXCR3) and receptor 3 for CC chemokines, using the alka line phosphatase-antialkaline phosphatase method. Control specimens were obtai ned from five healthy subjects and from six patients with discoid lupus erythema tosus. Results: Activated CD4+ Th lymphocytes (HLA-DR+ CD40L+ ) were the principal infiltrating cells in the lesional skin of DM; the CD4/CD8 ratio was a pproximately 2· 5. A mixed Th1/Th2 profile and higher Th1 cytokine production t ogether with significant staining for CXCR3 were detected. Neutrophil granulocyt es were the second most abundant population; eosinophil granulocytes were very p oorly represented. Conclusions: Activated CD4+ T cells presumably mediate the main pathogenetic mechanisms in pathognomonic skin lesions. The interaction betw een CD40 andCD40L could be an important mecha nismof cellular activation in cutaneous immune-mediated inflammation by ind uction of secretion of proinflammatory cytokines and chemokines. Neither Th1 nor Th2 clear polarization was found, although there was a slight Th1 prevalence. T here was a significant quantity of MPO+ cells (neutrophil granulocytes) in the in-flamed tissue, and they might have a role in sustaining the chronic inflam mation.

镍性接触性皮炎与月经周期

According to some reports in the literature, the hormonal fluctuations which occur during the menstrual cycle may affect the clinical expression of contact allergy to a greater or lesser degree. In clinical practice, too, patient history often shows exacerbation of the contact dermatitis during the days immediately preceding menstruation. On the contrary, the follicular phase of the cycle seems to have a temporary protective role in inhibiting the eliciting phase of allergic contact dermatitis. One possible explanation for this phenomenon is of immunological type:it has been demonstrated that oestradiol induces inhibition of delayed hypersensitivity type reactions, probably by acting in directly on cell shaving a regulatory function in cell mediated immunity. To investigate any inhibitory effect of the ovulatory phase of the menstrual cycle on contact sensitization, 30 selected fertile women, allergic to nickel sulfate and with a regular menstrual cycle lasting between 25 and 32 days, were enrolled. Patch tests were performed with a series of 10 serial aqueous dilutions of nickel sulfate, from 5%to 0.0013%. The 30 women were tested at 2 different times,in the ovulatory phase (demonstrated by transvaginal ultrasound) and the progestinic phase; they were subdivided into 2 groups of 15 women:in one group, the tests were made first in the ovulatory phase, and in the other, first in the progestinic phase of the menstrual cycle. There was a minimum interval of 5 weeks between the 2 test phases. The study shows that during ovulation the patch tests elicited significantly less intense responses than in the progestinic phase. These data therefore suggest that the ovulatory phase of the cycle has a significant inhibitory role on delayed hypersensitivity type reactions. For this reason, negative responses to patch tests executed in this phase could likely be false-negatives, and after careful evaluation of the phenomenon and of the clinical condition and patient history, it may be considered advisable to repeat the tests during the progestinic phase of the menstrual cycle.

眼部“非瘢痕性”黏膜类天疱疮与抗层粘连蛋白5抗体有关

Mucous membrane pemphigoid is a rare, chronic autoimmune disease characterized by subepidermal blistering and scarring, predominantly affecting mucous membranes. Ocular involvement frequently occurs and often represents the only manifestation of the disease. We describe a 62- year- old woman with a bilateral 18- month duration of conjunctival hyperaemia, associated with erythema and oedema of the eyelids, lacking any typical ocular signs of mucous membrane pemphigoid such as subconjuctival fibrosis and scarring. Histology was not significant. Direct immunofluorescence of the conjunctiva showed IgG, IgA and complement deposition along the basement membrane zone. Immunoprecipitation analysis of affinity purified laminin- 5 revealed a band consistent with the β 3 chain of laminin- 5. This represents the first case of pure ocular mucous membrane pemphigoid associated with antilaminin- 5 antibodies.

鉴别发生于同一患者的雄激素性脱发与慢性静止期脱发:一种简单的无创性方法

Background: Distinguishing chronic telogen effluvium (CTE)-from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient. Observations: One hundred consecutive patients with hair loss who were clinicall y diagnosed as havingCTE, AGA, AGA+CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided “blindly”into 5 cm or longer, intermediate length (>3 to < 5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having a t least 10%of them were classified as having AGA.We assumed that patients shedd ing 200 hairs ormore had CTE. The κstatistic revealed, however, that the best c oncordance between clinical and numerical diagnosis (κ=0.527)was obtained by se tting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 wi th 10%or more of hairs that were 3 cm or shorter and who shed fewer than 100 ha irs were diagnosed as having AGA; 34 with fewer than 10%of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 wit h 10%or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA +CTE; and 14 with fewer than 10%of hairs that we re 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CT E in remission. Conclusion: This method is simple, noninvasive, and suitable for office evaluation .

多西环素成功治疗HIV阴性嗜酸性脓疱性毛囊炎

Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji.It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities.In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients.EPF has been described in immunocompetent adult caucasian patients only occasionally.The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate.We describe an HIV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline.The treatment led to the complete remission of the lesions within 2 months.

用聚乙二醇脂质体阿霉素治疗IVB期蕈样霉菌病

Background:Previous studies have shown that pegylated liposomal doxorubicin(LD)is effective in the treatment of relapsing or recalcitrant cutaneous T-cell lymphoma. Objectives:To evaluate the activity and toxicity of LD in patients with stage IVB mycosis fungoides (MF). Methods:In this retrospective study, we evaluated outcomes and recorded adverse effects in 10 patients with MF (seven men and three women) with extracutaneous involvement. Patients were treated with LD 20 mg m-2 administered intravenously every 4 weeks. Results:All patients received at least two cycles of LD, three patients received four cycles and one patient received six cycles. Three patients (30%) had a partial response and two patients had stable disease. Grade 1-2 leucopenia occurred in three of the 10 patients, and grade 4 leucopenia in one. Three patients had grade 2 palmoplantar erythrodysaesthesia. Conclusions:This study demonstrates that LD is beneficial in terms of activity and toxicity in stage IVB MF. These observations should be verified in larger studies.