E. Quintanilla

Skin cancer in heart transplant recipients

BACKGROUND The frequency of skin cancer in organ transplant recipients is high, up to 15%. OBJECTIVE Our purpose was to determine the incidence of skin cancer in patients who underwent immunosuppression after heart transplantation and to determine the factors important in the appearance of skin cancer. METHODS We studied the frequency of skin cancer in 92 of 111 patients after they underwent heart transplantation between January 1984 and December 1993. RESULTS At least one cutaneous neoplasm (squamous cell carcinoma and/or basal cell carcinoma) developed in 14 patients (15.2%). The basal cell carcinoma to squamous cell carcinoma ratio was 1:1.5. The skin cancer appeared an average of 31.5 months after transplantation; the average was 36 months for squamous cell carcinoma and 25.3 months for basal cell carcinoma. Cumulative risk rose from 4.3% at 1 year up to 43.8% at 7 years after transplantation. The overall incidence of both types of skin cancer was 45.3 per 1000 posttransplant person-years, with an incidence of 25.8 for basal cell carcinoma and 29.1 for squamous cell carcinoma. Most skin cancers developed between 2 and 3 years after transplantation. All patients were exposed to a significant amount of ultraviolet radiation and had skin type II or III. We did not find a significant association between skin cancer and haplotype HLA-A3, HLA-A11, HLA-DR, and the number of mismatches for HLA-B. CONCLUSION We found an increased progressive cumulative incidence of skin cancer in heart transplant recipients for two reasons: (1) immunosuppression and increased exposure to ultraviolet radiation in some patients, and (2) the skin type of certain patients. We emphasize the need for photoprotection in this group of patients and regular skin cancer screening examinations.

Photo-induced toxic epidermal necrolysis caused by clobazam

Toxic epidermal necrolysis (TEN) is a life‐threatening disease, the pathogenesis of which remains largely unknown. We describe a 23‐year‐old woman under treatment with clobazam who developed lesions of TEN In light‐exposed areas. Patch and photopatch tests with clobazam were negative. The cellular phenotype and cytokines were studied in blister fluid. The cellular infiltrate was composed mainly of T lymphocytes with a predominant cyloloxic phenotype. Tbere was an increase in the level of tumour necrosis factor (TNF)‐α in blister fluid compared with the control (a patient with bullous pemphigoid).

Occult spinal dysraphism: a neurosurgical problem with a dermatologic hallmark.

Abstract: Lumbosacral congenital cutaneous lesions have been recognized tor a long time by neurologists and neurosurgeons as markers of occult spinal defects, but only a few cases have been published and discussed in the dermatologic literature. Based on a case report, we emphasize the importance of early diagnosis of these lesions, the use of new diagnostic techniques, and the correct management.

Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity

Summary An infant is described with an overlap picture of eosinophilic pustular folliculitis and infantile acropustulosis.

Chronic Balanitis with Palisading Granuloma: An Atypical Genital Localization of Necrobiosis lipoidica Responsive to Pentoxifylline

We report a case of necrobiosis lipoidica located on the glans penis of a patient without diabetes mellitus. Both clinical and histologic features favor the diagnosis of necrobiosis lipoidica, even though the location is unusual. Treatment with pentoxifylline was effective. The differential diagnosis is discussed.

CD24 expression on human keratinocytes

Abstract: CD24 or Nectadrin is a cell surface glycoprotein expressed in pre‐B lymphocytes, T lymphocytes, neurons, muscle cells and carcinoma cells. Its function is not completely known, but it has been suggested that it is involved in cell adhesion and signalling. CD24 has recently been identified as the human molecule homologous to the murine heat‐stable antigen (HSA). HSA is expressed by murine keratinocytes and delivers costimulatory signals in T‐cell activation. Long‐term cultures of normal human keratinocytes (HKC) were obtained from skin of human female breast sections and either left untreated or were treated with phorbol‐12‐myristate‐13‐acetate (PMA) at 10–100 ng/ml, calcium 0.5–2 mM or IFN‐γ 100–1000 U/ml, for 24–48 h. Using RT‐PCR and flow cytometry we showed that HKC express low levels of CD24 even under basal conditions, and the treatment with calcium, PMA or IFN‐γ increased levels of CD24 mRNA and protein. To the best of our knowledge, this is the first report to measure CD24 expression and production by cultured HKC in basal conditions and after stimulation. Further studies are needed to determine biological and therapeutical relevance of these findings.

Perianal basal cell carcinoma.

Perianal basal cell carcinoma (BCC) is a rare tumour and only a few case reports can he found in the literature. In this location, it is important to differentiate a BCC from a basaloid cloacogenic carcinoma, as the first is an invasive but localized tumour, while the second has a high capacity for metastasis.

Malignant atrophic papulosis. A report of two cases with altered fibrinolysis and platelet function

Malignant atrophic papulosis is a systemic vaso‐occlusive disorder characterized by typical skin lesions. We report two new cases with impairment of blood fibrinolytic activity and alterations in platelet function. The first case showed an increase in plasminogen activator inhibitor‐1 (PAI‐1) activity, and the second case had a decrease in platelet aggregation induced by adenosine diphosphate and adrenaline but normal with collagen. The impairment of blood fibrinolytic activity and platelet aggregation may have pathogenic and therapeutic implications in malignant atrophic papulosis.

Transfusion-associated acute graft-versus-host disease in a heart transplant recipient

Summary We report a heart transplant recipient who developed graft‐versus‐host disease (GVHD) following blood transfusion. We consider that heart transplant recipients should be included in the category of immunosuppressed patients who may develop this disease after being treated with blood products. We also consider that, at the present time, irradiation of blood products is the only useful method of avoiding development of GVHD in these patients.

Subcutaneous nodules as the first clinical manifestation of sarcoidosis

We report the case of a 61–year‐old male who presented with a febrile illness accompanied by arthralgia and myalgia. Two months later he developed multiple subcutaneous nodules and enlarged parotid glands. Later two erythematous plaques, clinically compatible with erythema nodosum (EN), were observed. Laboratory investigations revealed abnormal levels of angiotensin converting enzyme and chest radiography showed bilateral hilar enlargement. The biopsy of the cutaneous lesions demonstrated multiple non‐causeating granulomas in the subcutaneous tissue without any alterations in the epidermis and the dermis. The cultures for Mycobacteria and fungi were both negative. The clinical picture and histopathological findings were compatible with subcutaneous nodular sarcoidosis. The response to steroid treatment was satisfactory.