A. Lo Schiavo

Kaposi's sarcoma on a lymphedematous immunocompromised limb.

ABSTRACT: Kaposis sarcoma appeared on a chronically lymphedematous leg oi a 75‐year‐old man. lmrnunologic investigations revealed a lack of cellular immune response confined to the involved lower limb. Regional disorders of immune surveillance are thought to play an important role in the early stages of Kaposis sarcoma.

In vivo Enalapril-Induced Acantholysis

Enalapril is a widely used antihypertensive drug with a very powerful in vitro acantholytic effect. It has been known to potentially induce pemphigus in genetically predisposed subjects. The action mechanism is complex and still only partially understood. We describe the case of a 66-year-old man, affected with intermediary basal cell carcinoma, in whom the histological examination showed suprabasal acantholytic clefts in the perilesional epidermis. Surprisingly a second biopsy taken from the apparently healthy skin of his back confirmed the presence of acantholytic changes. Clinical signs of pemphigus were absent. The patient’s history did not reveal any relevant data but a mild arterial hypertension that had been treated for 1 year with 10 mg enalapril. Taking into account the patient’s history (enalapril long-term administration), the absence of any bullous or erosive lesions and the histological findings, a diagnosis was made of in vivo enalapril-induced acantholysis.

Are acantholysis and transglutaminase inhibition related phenomena

BACKGROUND The loss of intercellular cohesion among keratinocytes (acantholysis) may be considered the histologic marker of pemphigus. Many drugs, especially thiol drugs, proved to be able to provoke in vitro acantholysis by biochemical mechanisms interfering with the disulfide and thiol group balance. As to nonthiol drugs, the pathomechanism of acantholysis is still unexplained. OBJECTIVE To explain the molecular mechanism of enalapril-induced acantholysis a potential link between transglutaminase (TGase) activity and the effects of this drug was investigated. METHODS TGase activity in extracts from human breast skin cultured in the presence of thiopronine, captopril and enalapril were evaluated in vitro. The acantholytic potential of cystamine, a known TGase inhibitor, was also investigated. RESULTS Enalapril, the most powerful acantholytic drug in vitro, was found to inhibit both the purified enzyme and the TGase activity in the extracts from cultured human breast skin explants. Kinetic studies showed that enalapril inhibition was competitive with respect to the amino acceptor substrate and uncompetitive with respect to the amino donor substrate. Moreover, an acantholytic effect of cystamine on explants of normal human skin was shown. CONCLUSIONS These results suggest that acantholysis and the inhibition of TGase activity could be two related phenomena.

Pemphigus relapse and acetazolamide, a drug with an active amide group: a casual or causal relationship?

© 2008 The Authors JEADV 2009, 23, 702–738 Journal compilation

Contents Vol. 216, 2008

S.M. Aiba, Sendai S. Chimenti, Rome O. Chosidow, Paris B. Cribier, Strasbourg M.A. De Rie, Amsterdam C. Gelmetti, Milano E. Grosshans, Strasbourg K. Holubar, Vienna H. Hönigsmann, Vienna P. Joly, Rouen S. Karpati, Budapest A.D. Katsambas, Athens J.-M. Lachapelle, Brussels H.I. Maibach, San Francisco, Calif. J.M. Mascaro, Barcelona M.C. Mihm, Jr., Boston, Mass. G.E. Piérard, Liège G. Plewig, Munich F.C. Powell, Dublin A.-A. Ramelet, Lausanne J. Revuz, Créteil J. Ring, Munich M. Röcken, Tübingen R.A. Schwartz, Newark, N.J. N. Stavrianeas, Athens H. Traupe, Münster A. Vahlquist, Uppsala D.T. Woodley, Los Angeles, Calif. Offi cial Organ of