Background: Recent studies have shown that photodynamic therapy (PDT) is effective in the treatment of acne vulgaris. No studies have compared the treatment effect of aminolevulinic acid-PDT (ALA-PDT) and methyl amino...Background: Recent studies have shown that photodynamic therapy (PDT) is effective in the treatment of acne vulgaris. No studies have compared the treatment effect of aminolevulinic acid-PDT (ALA-PDT) and methyl aminole-vulinate-PDT (MAL-PDT). Objective: We sought to compare the treatment effect and tolerability of ALA-PDT versus MAL-PDT in the treatment of acne vulgaris in a controlled randomized investigator-blinded trial. Methods: Fifteen patients with at least 12 facial inflammatory acne lesions had one split-face PDT treatment with MAL and ALA. Results: Twelve weeks after treatment we found a 59% decrease in inflammatory lesions from baseline, with no significant differences in effectiveness between the two treatments. All patients experienced moderate to severe pain during illumination and developed erythema, pustular eruptions, and epithelial exfoliation after treatment, which were more severe and uniform in the ALA-PDT-treated area. Limitations: The study is paired and controlled, but the results should be evaluated with consideration given for the number of participating patients. Conclusion: PDT appeared to be an effective treatment for inflammatory acne vulgaris with no significant differences in the response rate between ALAPDT and MAL-PDT. ALA-PDT resulted inmore prolonged and severe adverse effects after treatment.展开更多
Background: Erythroderma is a diffuse, inflammatory skin reaction that, in rare instances, is associated with hematologic maligancies such as cutaneous T-cell lymphoma (erythrodermic mycosis fungoides) or T-cell leuke...Background: Erythroderma is a diffuse, inflammatory skin reaction that, in rare instances, is associated with hematologic maligancies such as cutaneous T-cell lymphoma (erythrodermic mycosis fungoides) or T-cell leukemia (S′ ezary syndrome or adult T-cell leukemia/lymphoma). Observations: We screened 30 patients with erythroderma (20 patients with erythroderma of known etiology and 10 patients with idiopathic erythroderma) for the presence of circulatingmonoclonal T-lymphocyte populations using T-cell receptor (TCR)-γ genespecific polymerase chain reaction and automated capillary DNA electrophoresis. Moreover, the phenotypic analysis of peripheral blood CD4+ lymphocytes was performed using the following surface markers: CD3, CD7, CD8, CD25, CD26, CD27,CD28, CD29,CD30, CD45RO,CD45RA,CD56, CD134,HLA-DR, TCRα β , TCRγ δ , and cutaneous lymphocyte antigen (CLA). In 5 patients with idiopathic erythroderma we detected T-cell clones in peripheral blood (in 1 case, associated with the presence of the same clone in the skin) and a 2-fold increase in the proportion of CD3+ CD4 + CD7-CD26-cells. Cell depletion studies indicated that the monoclonal T cells were present within the CD4 + CD7- cell population. Clinically, all patients had chronic, recalcitrant erythroderma but none developed any hematological malignancy during their lifetimes or fulfilled the criteria for cutaneous lymphoma or S′ ezary syndrome. Conclusions: A proportion of patients with chronic erythroderma present with the monoclonal expansion of CD4 + CD7-CD26- lymphocytes in their blood. This condition represents a probably benign T-cell dyscrasia, or one of very low malignancy. Alongside monoclonal gammapathy of undetermined significance (MGUS) and monoclonal (B-cell) lymphocytosis of undetermined significance (MLUS), we propose using monoclonal T-cell dyscrasia of undetermined significance (MTUS) to underline a conceptual similarity between this disorder and the more common types of lymphocytic dyscrasia.展开更多
Neutrophil dermatosis of the dorsal hands (NDDH) is a recently described skin manifestation regarded as a subset of acute febrile neutrophilic dermatotis (Sweet syndrome). We describe 5 cases with pustular and ulcerat...Neutrophil dermatosis of the dorsal hands (NDDH) is a recently described skin manifestation regarded as a subset of acute febrile neutrophilic dermatotis (Sweet syndrome). We describe 5 cases with pustular and ulcerative plaques and/or bullae and vesicles of the dorsal hands. Three of the patients also had skin changes at sides other than the hands. Associated conditions were found in two patients, one patient treated with hemodialysis for chronic glomerulonephritis, and one patient had suffered from a streptococcal tonsillitis prior to the eruption. Two of the patients had fever, two had neutrophil leucocytosis in peripheral blood and two had elevated sedimentation rates. Histological findings showed signs of vasculitis in biopsies from two of the patients. NDDH is discussed on the basis of prior case reports concerning the subject, and it is concluded that Neutrophil dermatosis of the dorsal hands should be regarded as a localized variety of Sweet syndrome.展开更多
文摘Background: Recent studies have shown that photodynamic therapy (PDT) is effective in the treatment of acne vulgaris. No studies have compared the treatment effect of aminolevulinic acid-PDT (ALA-PDT) and methyl aminole-vulinate-PDT (MAL-PDT). Objective: We sought to compare the treatment effect and tolerability of ALA-PDT versus MAL-PDT in the treatment of acne vulgaris in a controlled randomized investigator-blinded trial. Methods: Fifteen patients with at least 12 facial inflammatory acne lesions had one split-face PDT treatment with MAL and ALA. Results: Twelve weeks after treatment we found a 59% decrease in inflammatory lesions from baseline, with no significant differences in effectiveness between the two treatments. All patients experienced moderate to severe pain during illumination and developed erythema, pustular eruptions, and epithelial exfoliation after treatment, which were more severe and uniform in the ALA-PDT-treated area. Limitations: The study is paired and controlled, but the results should be evaluated with consideration given for the number of participating patients. Conclusion: PDT appeared to be an effective treatment for inflammatory acne vulgaris with no significant differences in the response rate between ALAPDT and MAL-PDT. ALA-PDT resulted inmore prolonged and severe adverse effects after treatment.
文摘Background: Erythroderma is a diffuse, inflammatory skin reaction that, in rare instances, is associated with hematologic maligancies such as cutaneous T-cell lymphoma (erythrodermic mycosis fungoides) or T-cell leukemia (S′ ezary syndrome or adult T-cell leukemia/lymphoma). Observations: We screened 30 patients with erythroderma (20 patients with erythroderma of known etiology and 10 patients with idiopathic erythroderma) for the presence of circulatingmonoclonal T-lymphocyte populations using T-cell receptor (TCR)-γ genespecific polymerase chain reaction and automated capillary DNA electrophoresis. Moreover, the phenotypic analysis of peripheral blood CD4+ lymphocytes was performed using the following surface markers: CD3, CD7, CD8, CD25, CD26, CD27,CD28, CD29,CD30, CD45RO,CD45RA,CD56, CD134,HLA-DR, TCRα β , TCRγ δ , and cutaneous lymphocyte antigen (CLA). In 5 patients with idiopathic erythroderma we detected T-cell clones in peripheral blood (in 1 case, associated with the presence of the same clone in the skin) and a 2-fold increase in the proportion of CD3+ CD4 + CD7-CD26-cells. Cell depletion studies indicated that the monoclonal T cells were present within the CD4 + CD7- cell population. Clinically, all patients had chronic, recalcitrant erythroderma but none developed any hematological malignancy during their lifetimes or fulfilled the criteria for cutaneous lymphoma or S′ ezary syndrome. Conclusions: A proportion of patients with chronic erythroderma present with the monoclonal expansion of CD4 + CD7-CD26- lymphocytes in their blood. This condition represents a probably benign T-cell dyscrasia, or one of very low malignancy. Alongside monoclonal gammapathy of undetermined significance (MGUS) and monoclonal (B-cell) lymphocytosis of undetermined significance (MLUS), we propose using monoclonal T-cell dyscrasia of undetermined significance (MTUS) to underline a conceptual similarity between this disorder and the more common types of lymphocytic dyscrasia.
文摘Neutrophil dermatosis of the dorsal hands (NDDH) is a recently described skin manifestation regarded as a subset of acute febrile neutrophilic dermatotis (Sweet syndrome). We describe 5 cases with pustular and ulcerative plaques and/or bullae and vesicles of the dorsal hands. Three of the patients also had skin changes at sides other than the hands. Associated conditions were found in two patients, one patient treated with hemodialysis for chronic glomerulonephritis, and one patient had suffered from a streptococcal tonsillitis prior to the eruption. Two of the patients had fever, two had neutrophil leucocytosis in peripheral blood and two had elevated sedimentation rates. Histological findings showed signs of vasculitis in biopsies from two of the patients. NDDH is discussed on the basis of prior case reports concerning the subject, and it is concluded that Neutrophil dermatosis of the dorsal hands should be regarded as a localized variety of Sweet syndrome.
