Cataldo Patruno

Acne and allergic contact dermatitis.

204 patients (43 male and 161 female; average age 19.4 years), under treatment for at least 2 months, entered our study. A special series of allergens was used for patch testing (Table 1), applied with van der Bend square chambers and read at 2 and 3 days. In the case of a positive reaction, patch tests and repeated open application tests (ROAT) were done with each component of the topical product.

The balance between pro- and anti-inflammatory cytokines is crucial in human allergic contact dermatitis pathogenesis: the role of IL-1 family members.

The interleukin (IL)‐1 family includes 11 members that are important in inflammatory processes. It includes various agonists and two antagonists, IL‐1Ra and IL‐36Ra. Our aim was to investigate whether the IL‐1 family is involved in allergic contact dermatitis (ACD). The expression of IL‐1 family members was evaluated by PCR and immunohistochemistry in the positive patch test reaction site (involved skin) and in the uninvolved skin of ACD patients. We also examined these cytokines in an ex vivo model of ACD. The antagonistic activity of IL‐36Ra was evaluated by injecting recombinant IL‐36Ra in uninvolved skin biopsies of ACD patients. IL‐1Ra and IL‐36Ra expression was quantified in mononuclear cells of nickel‐sensitized patients challenged in vitro with nickel. IL‐33 involvement in ACD was investigated by intra‐dermal injection of anti‐IL‐33 in the uninvolved skin of patients ex vivo. Results showed that IL‐1β, IL‐1Ra, IL‐36α, IL‐36β, IL‐36γ and IL‐33 expression, but not IL‐36Ra expression, was enhanced in ACD‐involved skin. Immunohistochemical analysis and ex vivo skin cultures confirmed these results. Injection of anti‐IL‐33 in ACD‐uninvolved skin inhibited IL‐8 expression, whereas IL‐36Ra inhibited IL‐36α, IL‐36β, IL‐36γ and IL‐8 expression. Nickel induced IL‐1Ra expression in lymphocytes of nickel‐sensitized patients. Hence, various IL‐1 agonists and antagonists may be involved in ACD pathogenesis.

A multicentre study of contact sensitization in children

The results of 7 months of patch testing with a standard series of 26 allergens, in 323 children with eczerematous conditions or itching palmoplantar psoriasis under the age Of 14 years are reported. 114 (35.3%) of the children had 1 or more positive reactions to this standard series. 28 children (8,7%) were poly sensitive. On the basis of personal history, additional series of allergens and/or specific allergens were also tested, 61.7% (90/146) of positive reactions were considered relevant to the current dermatitis. Metals, medicaments, preservatives or fragrances, and shoe components were the major sources of contact sensitization. It is suggested that patch testing he done more frequently in evaluating dermatitis in children.

Patch testing in children

We looked through our records of patients with ulcers on the legs who had g1ven positive patch test reactions and found that the most frequent allergens were lanolin, the para group and balsam of Peru (Table 2). Our patients had positive reactions Similar to the adults. Th1s report IS of mterest because of the extreme rarity of the congemtal coagulation defect, and because 1t IS a umque expenmental model for studymg topical sensitization of chrome ulcers. Our cases show that only the zone of ulcerated skm and the Circulatory abnormalities are the major predisposmg factors for sensitizatiOn. Age and skm atrophy do not seem to be Implicated.

Managing Moderate-to-Severe Psoriasis in the Elderly

Managing psoriasis in the elderly can be difficult for physicians, who must consider comorbidities, the resulting polypharmacy, and progressive functional impairment of several organs. Indeed, topical agents are the first-line treatment for limited disease. Phototherapy is recommended if topical drugs are not sufficient and the patient has multiple comorbidities and risk factors that make them a poor candidate for an oral or injectable systemic agent. The most important pharmacokinetic alteration in the elderly population is the decreased excretory capacity of the kidney; thus, cyclosporine should be considered a last resort treatment, and the administered dose of methotrexate should be lowered according to the reduction in estimated creatinine clearance. Acitretin can be used in the absence of severe renal insufficiency, paying attention to lipid profile, treating eventual hyperlipidemia, and closely monitoring liver enzymes. Available data on biological drugs in the elderly are limited. Biologics are associated with a small but significant overall risk of infections. However, there is no convincing evidence that the relative risk of infection with anti-tumor necrosis factor (TNF)-α therapy increases with age. Nevertheless, the package inserts for biologics recommend caution when administering these medications to the geriatric population, due to the high baseline risk of infection in such patients. Etanercept seems to be well tolerated, possibly because of its lower immunosuppressive characteristics compared with other biologics. However, studies with larger sample sizes are needed to confirm its safety.

Psoriasis and melanocytic naevi: does the first confer a protective role against melanocyte progression to naevi?

Background  Some of the cytokines that have effects on melanogenesis are also reported to be involved in psoriasis.

BULLOUS PEMPHIGOID INDUCED BY A THERMAL BURN

A 75-vear-old woman sustained a thermal burn to her right arm. Topical therapy with a cream containing betamethasone valerate 0.1% and gentamicin 0.1% led to the healing of the burn in the course of 2 weeks. No systemic drug was administered. She developed tense bullae at the injured skin 40 days later (Fig. 1). During the next 2 months, new blisters with an erythematous basis appeared on the left

Effect of weather and environmental factors on the clinical course of psoriasis

Dear Editor, Psoriasis is a chronic disease, the prevalence of which shows geographic variations,1 suggesting that it might be influenced by climatic factors such as sun exposure and humidity.2 ,3 In order to assess the effect of weather and both outdoor and indoor environmental factors on the clinical course of psoriasis, we analysed the answers given to a specific questionnaire administered to 300 consecutive patients attending the psoriasis outpatient clinic of our department. The role of exposure to rainy, windy, muggy, hot, cold and sunny climates, as well as of seasonality in relation to the outdoor environment and the effect of domestic heating and ventilation systems …

Visceral leishmaniasis infection in a patient with psoriasis treated with efalizumab.

LDS751/SSC revealed: 4% lymphocytes, 2% monocytes, 66% granulocytes, 6% immature blast cells, 18% erythroblasts and other CD45– cells, confirming the diagnosis of pancytopenia. Physical examination revealed splenomegaly and hepatomegaly, confirmed by ultrasonography too. Serology for typhoid fever and brucellosis was negative. The examination of a Giemsastained smear from a bone marrow aspirate detected Leishmania amastigotes, and indirect immunofluorescence antibody test (ELISA) serology was positive at the titre of 1/640. The IgM + IgG ELISA test detected an IgM antiLeishmania concentration of 1.6 ! 10 –7 M , indicating a primary infection. A polymerase chain reaction for the amplification of Leishmania genomic sequences in peripheral blood and in bone marrow samples confirmed the diagnosis. The patient was treated intravenously with teicoplanin, ciprofloxacin, furosemide, albumin and folic acid and intramuscularly with vitamin B 12 . Despite the initial treatment, the patient remained febrile in a markedly fluctuant manner so that a combination of piperacillin sodium and tazobactam was added to his intravenous treatment. He was not started on a course of any antiparasitic treatments. After 6 weeks, the bone marrow examination did not detect any Leishmania parasites. Leishmaniasis is a parasitic (protozoan) disease, caused by various species of Leishmania . Humans, wild animals and domestic animals are known to act as reservoir hosts. In Italy the domestic and wild canines are the reservoir of the parasite Leishmania infantum . Our patient was living in Campania, southwest Italy, which has long been known to be endemic for VL [1] . A consistent principle is that healing and resistance to reinfection are associated with expanding numbers of Leishmania -specific Th1 cells, production of -interferon and activation of macrophages to kill intracellular amastigotes. Efalizumab (Raptiva ) is a humanized monoclonal immunoglobulin G1 antibody that binds with high specificity and affinity to the -subunit of leucocyte function-associated antigen 1 on the surface of T cells. Efalizumab is one of several biological therapies used for the treatment of psoriasis. Its efficacy in clinical trials has ranged from 24 to 38% of patients achieving a 75% or better improvement from baseline in PASI score at 12 weeks, increasing to 44% at 24 weeks in one trial [2, 3] . The most common adverse events seen are fever, chills, headache, nausea and myalgias, usually occurring within 48 h of the initial conditioning dose [4] . More serious adverse effects are rare but include reports of psoriasis flares during and after discontinuation of treatment, infection and malignancy [5] . Malignancies occur more frequently in populations that are immunosuppressed or immunodeficient, and the development of biological therapies for psoriasis that target the immune system has focused attention on the risk. From an analysis of 2,980 psoriasis patients treated with efalizumab, the incidence of malignancy over the relatively short duration of the clinical trials (aver

Statistical evaluation of the persistence of acquired hypersensitivity by standardized patch tests

Numerous studies have focused attention on the influence of various biological and environmental factors on contact hypersensitivity. In order to evaluate the persistence and/or modification of allergic contact sensitivity 10 a number of common contact sensitizers, the same standardized patch tests were repeated on 174 subjects with contact sensitivity after a lime lapse of 5 years (1987–1992). In 18.4% of the cases, 1 or more sensitivities were lost: 28.7% of the patients had a higher number of positive patch tests after 5 years, while the remaining 52.9% of the patients showed no change in the number of positive patch tests. In 88%, the positive allergens were unchanged, whereas in the remaining 12% of the subjects, they showed 1 or more variations. The association between the allergens most often positive was calculated for both the 1st and the 2nd patch lest results. Moreover, to evaluate the frequency of an allergens positivity. We studied the disappearance of old sensitivities and the appearance of new sensitivities by the McNemar test. Cobalt chloride was the only allergen with a significant frequency of new positivities over the period of observation (p < 0.01). Logistic regression analysis was performed to evaluate the possible influence of positive tests to other allergens, and of some clinical findings associated with contact dermatitis, on the sensitivity to cobalt chloride in 1987 and in 1992.