C. Veller Fornasa

Family history, smoking habits, alcohol consumption and risk of psoriasis

Summary We have conducted a multicentre case‐control study to assess the epidemiological importance of previously suggested risk factors for psoriasis, including family history of the disease, smoking and alcohol consumption. Newly diagnosed psoriatics, with a history of skin manifestations no longer than 2 years were eligible as cases; as controls we selected subjects with newly diagnosed dermatological conditions other than psoriasis. Interviews were performed by trained medical investigators using a structured questionnaire. Two‐hundred and fifteen cases, aged 16–65 years (median age 38), and 267 controls, aged 15–65 years (median age 36), were interviewed and included in the analysis. Family history was a risk factor for psoriasis; the multiple logistic regression (MLR) adjusted‐odds ratio was 18.8 (95% confidence interval 6.4–54.8) for a history in parents, and 3.2 (95% confidence interval 1.5–6.6) for a history in siblings. The risk of psoriasis was higher for current smokers than for those who had never smoked. The MLR adjusted odds ratio was 2.1 (95% confidence interval 1.1–4.0) for people smoking 15 cigarettes or more per day. The risk of psoriasis was higher for alcohol drinkers: compared with teetotallers the MLR adjusted‐odds ratios were 1.3 (95% confidence interval 0.8–2.3) for subjects drinking one or two drinks/day and 1.6 (95% confidence interval 0.9 to 3.0) for those drinking three or more. However, the trend in risk was not statistically significant. Our study confirms the role of family history in psoriasis and provides some evidence of a dose‐response relationship for an association between smoking habits and psoriasis.

Sex hormone-binding globulin and saliva testosterone levels in men with androgenetic alopecia

Sex hormone binding globulin (SHBG), plasma testosterone and saliva testosterone were measured in sixty‐four men with androgenetic alopecia and in forty males within the same age range without alopecia. There was a significant reduction in SHBG levels in bald men, compared with controls. Plasma testosterone levels were not raised in bald men, but their salivary testosterone levels were significantly higher than in controls.

Influence of metabolic genotype GSTM1 on levels of urinary mutagens in patients treated topically with coal tar

Fifteen hospitalized, non-smoking, dermatological patients were treated with ointment containing 2% coal tar (CT) in order to assess the influence of metabolic genotype GSTM1 on urinary mutagen levels. Urinary 1-pyrenol, the main metabolite of pyrene, was used to check the high exposure to PAH of this population. The mean levels of urinary 1-pyrenol found in the 24-h urine of our patients were 467. 8+/-211.0 nmoles-24 h (range 94.6-890.1 nmoles-24 h). Mutagenicity was assessed on urine samples collected over a period of 24 h, after three consecutive days of topical application, using the bacterial mutagenesis test on Salmonella typhimurium strains TA98 and YG1024 in the presence of microsomal enzymes. The latter strain turned out to be more sensitive than the former in revealing urinary mutagens in these patients (42 693+/-30 867 vs. 6877+/-6040 net revertants-24 h). The mutagenicity on YG1024 strain and 1-pyrenol levels of urine samples were correlated (Spearmans rank correlation coefficient=0. 6678, P<0.01, z=2.795). The influence of genotype GSTM1 on urinary mutagen levels was assessed on strain YG1024. The values of urinary mutagenicity of subjects with genotype GSTM1-null (n=6) were on average higher than those of GSTM1-positive subjects (n=9) (55 498+/-45 957 vs. 34 156+/-11 933 net rev.-24 h), a non-significant statistical difference. The mean total excretion of mutagens corrected for PAH exposure (net rev./nmoles of urinary 1-pyrenol) in GSTM1-null patients was double that of GSTM1-positive ones (136. 8+/-34.7 vs. 70.8+/-23.3 net rev./nmoles of urinary 1-pyrenol; one-tailed Mann-Whitney U-test, U=11.5, P<0.05). These results indicate a greater body burden of promutagens, resulting from skin application of CT, in GSTM1-null subjects.

Minocycline in Granulomatous Cheilitis: Experience with 6 Cases

Cleto Veller Fornasa, MD c/o Department of Dermatology, Via Cesare Battisti, 206, I-35100 Padova (Italy) Granuiomatous cheilitis. originally described by Miescher [1], is clinically characterized by intermittent lip swelling (which may become long-standing) and is accepted by many authors as an oligosymptomatic form of Melkersson-Rosenthal syndrome [2, 3]The cause of this condition is unknown. A genetic predisposition is suspected. Relationships with Crohn’s disease, sarcoidosis, vaso-motor instability, infections and allergies have been suggested [4–8]. Various therapeutic regimens for granuiomatous cheilitis have produced disappointing or variable results [4, 9, 10], e.g. systemic or intralesional steroids, clofazimine, hydroxychloroquinc sulfate or cheiloplasty. On reviewing the literature, we found only little mention of antibiotic treatments [2, 11, 12]. Fisher [13] reported a good response using a combination of tetracycline (500 mg daily) and prednisone (10 mg every other day) for 2.5 years. We have used minocycline in 6 patients with granuiomatous cheilitis. Report of Cases In the last 3 years we have studied 6 patients with granuiomatous cheilitis, 4 women and 2 men, median age 33.4 years, median age of onset 29.2 years. All 6 patients had persistent swelling lasting for 4–48 months. Histologically the tissue involved showed in all cases nonnecrotizing granulomas, edema, lymphangiectasia and perivascular lymphocytic infiltration. Special stains showed no evidence of fungal organisms or acid-fast bacilli. There was no evidence of odontogenic infections. Clinical and laboratory studies were normal in 5 of the 6 patients. The sixth case, previously reported [14], was a 29-year-old female presenting a 4-month history of persistent macrocheilitis. She was a chronic carrier of Salmonella and had suffered from recurrent cystitis and vul-vovaginitis. Several investigations (generation of H202 and 02 by neutrophils and monocytes, nitroblue tetrazolium test, activation of NADPH oxidase in cell-free systems, measurement of cytochrome b558) performed on the patient’s and her mother’s phygocytes led to the diagnosis of chronic granuiomatous disease, type I, X-linked form. A 4to 6-month trial with systemic steroids and a 5to 7-month trial with clofazimine (Lamprene) produced no effect in any of the 6 patients.

Circulating immune complexes in granuloma annulare

Vasculitis as a primary event in the origin of granuloma annulare has been proposed on the basis of histopathological, direct immunofluorescence, and clinical studies [2, 3, 8, 9]. Vasculitis may result from deposition of circulating immune complexes [6]; it has also been shown that the deposition of immune complexes may lead to a granulomatous response [6, 7]. However, up to now, few immunological studies have been made on the serum of granuloma annulare patients. To our knowledge, only one study has reported the presence of circulating immune complexes [4], while another using a different method did not confirm this finding [5] We studied 30 patients with localized granuloma annulare (9 males, 21 females, mean age 30 years, range 3 -61 years; Table 1). The disease had been present from 1 month to 6 years. The clinical diagnosis of granuloma annulare was confirmed in all patients by routine histopathology. None of the patients had impaired glucose tolerance nor clinical evidence of systemic disease. A control group of 90 randomly selected and apparently healthy subjects, from the same geographical area, ageand sex-matched with the granuloma annulare patients was also studied. Sera of all patients and controls were examined for the presence of circulating immune complexes using the Raji cell test [1] and for the presence of thyroid microsomal, gastric parietal cell, adrenal cortex, islet cell, mitochondrial, and smooth muscle autoantibodies using indirect immunofluorescence techniques on normal human and animal tissues.

Auto-immune disorders in localized scleroderma.

Localized scleroderma is a connective tissue disorder in which an abnormal accumulation of collagen and ground substance leads to the formation of circumscribed patches of skin sclerosis. Activated T-lymphocytes, monocytes and macrophages are present in the early inflammatory phase characterizing the onset of the disease, and are thought to be responsible for the release of different soluble factors that might modulate fibroblast growth and synthetic activity, thus paving the way for the development of the sclerotic phase [7, 14, 19]. A condition of immunological dysregulation accompanies the inflammatory phenomena, as suggested by various clinical evidence. Antinuclear antibodies [1, 16, 21] and high titres of antibodies to ss-DNA are commonly found in localized scleroderma [3, 5], and the presence of anticentromere antibodies [13], smooth muscle antibodies, rheumatoid factor [15, 21] and mild eosinophilia [4, 6] have also been reported. Many cases have been reported in which localized scleroderma was found to coexist with discoid lupus erythematosus [18], systemic lupus erythematosus [9, 10, 11], vitiligo, lichen sclerosus and atrophicus [17, 20], and other diseases in which autoimmune phenomena are known to play a significant role [2, 8, 12]. The purpose of our study was to evaluate the incidence in localized scleroderma of clinical and serological findings of associated organ-specific and systemic autoimmune disease. A total of 51 patients (9 males, 42 females) were studied, with a mean age at presentation of 39.0 years (standard deviation 16.8) and a mean duration of symptoms of 48.3 months (range 1-84). Of these patients, 36 were affected by morphoea in plaques, and 15 had linear scleroderma. The presence of overt auto-

Relationship between body weight and blood pressure and some metabolic parameters in psoriatic patients

The relationship between body weight and blood pressure, total serum cholesterol, triglycerides, uric acid and glucose was investigated in 203 psoriatic patients in comparison with 904 healthy controls. In the psoriatic patients, these parameters were clearly related to their body weight. Those psoriatic patients of normal weight exhibited lower mean values of all the parameters compared with overweight psoriatic patients while they did not differ from control subjects of normal weight. Our results suggest that only overweight psoriatic patients exhibit the metabolic abnormalities frequently reported in the literature, while psoriatic patients of normal weight do not differ from the general population in this respect.

Diminished blood filterability in psoriasis

Erythrocytes of psoriasis demonstrate altered membrane phosphorylation in vitro, a finding consistent with structural membrane abnormalities [2]. As membrane abnormalities may modify red blood cell deformability [2, 4] we have studied erythrocyte deformability in psoriasis using a filtration technique proposed by Reid [6]. Nineteen patients with psoriasis vulgaris (12 males, 7 females; aged 21 7 0 years, mean 42 years) were investigated. During the 2 months before the investigation the only treatments were emollient creams and ointments. The patients were compared with an equal number of ageand sex-matched healthy controls. Psoriatic patients and controls showed no evidence of diseases known to be associated with altered erythrocyte deformability [3, 7, 8]. All the patients and the controls had normal values for total serum cholesterol, triglycerides, glucose, total plasma protein and gamma-globulin, plasma fibrinogen, erythrocyte sedimentation rate, hematocrit, red blood cell count, mean red cell volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, white blood cell count, platelet count, and whole blood and plasma viscosity. None had a family history of hypertension [3]. For the filterability study, 5 ml of blood withdrawn, with minimal occlusion, from an arm vein after 12 h fasting was anticoagulated with 2 mg ethylenediaminotetraacetic acid (EDTA) and immediately incubated at 37~ for 15 min; five separate samples of 1 ml each were then filtered through uni-pore polycarbonate membranes (Bio Rad Laboratories, Richmond, Calif.) containing cylindri-

Penile chancre: an unusual presentation of cat-scratch disease.

© 2008 The Authors JEADV 2009, 23 , 169–243 Journal compilation