Eleanor Mallon

HLA-C and guttate psoriasis

Background Psoriasis is a heterogeneous disease in its clinical expression. Both genetic and environmental factors are thought to contribute to the pathogenesis of the inflammatory and hyperproliferative components of the typical skin lesions. Predisposing genetic influences include associations with human leucocyte antigens (HLA) of which that with HLA‐Cw6 is the strongest. Guttate psoriasis is a specific clinical manifestation of psoriasis frequently associated with group A β‐haemolytic streptococcal throat infection.

Cryosurgery in the treatment of basal cell carcinoma : Assessment of one and two freeze-thaw cycle schedules

background It has become routine practice in many centers to use two successive freeze‐thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by this, we have investigated the cure rate achieved with one freeze‐thaw cycle compared with that achieved with two freeze‐thaw cycles in the treatment of facial basal cell carcinomas of a uniform type and clinically in the best prognostic group. Superficial truncal basal cell carcinomas are reported to respond to less aggressive cryosurgery, and we have investigated the cure rate achieved with one freeze‐thaw cycle. objective To compare the efficacy of one freeze‐thaw cycle versus two freeze‐thaw cycles in the treatment of facial basal cell carcinomas. Second, to investigate the efficacy of one freeze‐thaw cycle in the treatment of superficial truncal basal cell carcinomas. This was investigated in a prospective randomized post‐treatment follow‐up study. method Over the past 7 years, we have treated 84 facial basal cell carcinomas with either a single 30‐second freeze‐thaw cycle or a double 30‐second freeze‐thaw cycle. Patients were allocated randomly into one of the two treatment schedules, and the cure rates achieved were compared. Second, 29 superficial truncal basal cell carcinomas were treated with a single 30‐second freeze‐thaw cycle. Patients were followed up to assess response to therapy. result A 95.3% cure rate was achieved in the treatment of facial basal cell carcinomas with a double freeze‐thaw cycle. This compared with a cure rate of only 79.4% when facial lesions were treated with a single freeze‐thaw cycle. Treatment of superficial truncal basal cell carcinomas with a single freeze‐thaw cycle achieved a cure rate of 95.5%. conclusion We recommend that, in order to achieve high cure rates that are equivalent to many reports of formal excision or radiotherapy, facial basal cell carcinomas require a double freeze‐thaw cycle with liquid nitrogen. One freeze‐thaw cycle to truncal basal cell carcinomas achieves high cure rates, equal to that achieved with a double freeze‐thaw cycle to facial basal cell carcinomas.background It has become routine practice in many centers to use two successive freeze-thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by this, we have investigated the cure rate achieved with one freeze-thaw cycle compared with that achieved with two freeze-thaw cycles in the treatment of facial basal cell carcinomas of a uniform type and clinically in the best prognostic group. Superficial truncal basal cell carcinomas are reported to respond to less aggressive cryosurgery, and we have investigated the cure rate achieved with one freeze-thaw cycle. objective To compare the efficacy of one freeze-thaw cycle versus two freeze-thaw cycles in the treatment of facial basal cell carcinomas. Second, to investigate the efficacy of one freeze-thaw cycle in the treatment of superficial truncal basal cell carcinomas. This was investigated in a prospective randomized post-treatment follow-up study. method Over the past 7 years, we have treated 84 facial basal cell carcinomas with either a single 30-second freeze-thaw cycle or a double 30-second freeze-thaw cycle. Patients were allocated randomly into one of the two treatment schedules, and the cure rates achieved were compared. Second, 29 superficial truncal basal cell carcinomas were treated with a single 30-second freeze-thaw cycle. Patients were followed up to assess response to therapy. result A 95.3% cure rate was achieved in the treatment of facial basal cell carcinomas with a double freeze-thaw cycle. This compared with a cure rate of only 79.4% when facial lesions were treated with a single freeze-thaw cycle. Treatment of superficial truncal basal cell carcinomas with a single freeze-thaw cycle achieved a cure rate of 95.5%. conclusion We recommend that, in order to achieve high cure rates that are equivalent to many reports of formal excision or radiotherapy, facial basal cell carcinomas require a double freeze-thaw cycle with liquid nitrogen. One freeze-thaw cycle to truncal basal cell carcinomas achieves high cure rates, equal to that achieved with a double freeze-thaw cycle to facial basal cell carcinomas.

HLA-Cw*0602 and HIV-associated psoriasis.

The aetiopathogenesis of psoriasis is unknown, but genetic and environmental factors may be involved. Psoriasis may not be one disease but a cutaneous inflammatory reaction pattern consequent upon several different independent or related stimuli in susceptible individuals. There are controversial issues regarding the immunological basis of psoriasis and the role of CD4 vs. CD8 T lymphocytes. Psoriasis has been associated with HLA-Cw6 and Cw7 by serology and specifically with HLA-Cw*0602 by polymerase chain reaction (PCR) typing. Psoriasis is probably no more common in HIV infection than in the general population; however, it may appear for the first time or pre-existing psoriasis may worsen and be difficult to treat in HIV disease. We have investigated the prevalence of HLA-C alleles, in the specific clinical context of HIV infection complicated by type 1 psoriasis, in a case control study of 14 men with HIV disease and type 1 psoriasis and 147 HIV-infected patients without psoriasis. Typing was performed using PCR with sequence-specific amplification primers. Eleven of 14 patients (79%) with psoriasis carried the HLA-Cw*0602 allele compared with 24.5% of those without psoriasis (odds ratio = 11.31; 95% confidence limits 2. 73 to 65.36; P = 0.0001). Two patients without the HLA-Cw*0602 allele carried instead the closely related Cw*0401/3 allele. The results confirm the previously reported association between the HLA-Cw*0602 allele and type 1 psoriasis, and suggest that the association with HLA-Cw*0602 is stronger in HIV-associated psoriasis although this trend needs to be supported by a larger sample. The immunodysregulation resulting from HIV infection may trigger psoriasis in those genetically predisposed by the Cw*0602 allele. As CD8 T cells recognize antigens in the context of class I major histocompatibility complex, the identification of an HLA class I association in HIV-associated psoriasis strengthens the argument for an important role for CD8 + T lymphocytes in the immunopathogenesis of psoriasis. Investigations of the pathogenesis of psoriasis should take account of clinical and other subtypes already identified.

Neonatal bullous eruption as a result of transient porphyrinemia in a premature infant with hemolytic disease of the newborn.

We describe the clinical and biochemical features of an infant with marked transient porphyrinemia in whom blistering developed while the infant was undergoing phototherapy for severe Rh isoimmunization. The cause of the transient porphyrinemia was likely to be multifactorial--abnormal porphyrin metabolism or accumulation in a premature infant with multisystem disease and multiple drug therapy. In addition, the infant received an unusually large amount of phototherapy. No evidence for an associated porphyria has been obtained. We believe this is a unique case because transient porphyrinemia associated with neonatal blistering does not appear to have been reported previously. Furthermore, blistering associated with phototherapy is rare.

Lymphedema and wound healing

Abstract The lymphatic system is a widespread vascular network that plays a vital role in homeostasis of the extracellular space. The role of the lymphatics is often neglected and the aim of this article is to emphasize the important contribution the lymphatics make to maintenance of cell equilibrium and normal wound healing. The most important role of the lymphatics is the control of the interstitial microcirculation. The lymphatic vessels remove from the extravascular space macromolecules and particulate matter too large to reenter the blood capillaries. If these materials are not removed, the osmotic and hydrostatic forces within the tissues change and disease results. Failure of the lymphatics leads to pollution of the tissues because of the excesses of protein, other macromolecules, and fluid around the cells. The lymphatics are the pathway for exit of T lymphocytes and Langerhans cells. The immunologic processes that occur in the skin need the lymphatic system to function. Macrophages and Langerhans cells leaving the skin travel in the lymphatics to lymph nodes where they are recognized and induce an immunologic response. Contact dermatitis cannot develop without the lymphatics, as cellular immunity cannot develop without lymphatics directing antigen from the skin to the lymph node. Patients with lymphedema are prone to develop secondary infection as the lymphatics are the normal pathway for clearance of bacteria from the interstitium.

Alopecia neoplastica without alopecia: A unique presentation of breast carcinoma scalp metastasis

The scalp is a relatively common site of cutaneous metastasis. The usual presentation is of single or multiple firm scalp nodules. A well-recognized but rarer presentation is alopecia neoplastica that is seen as single or multiple areas of cicatricial alopecia. We describe a unique presentation of scalp metastasis in a patient with breast carcinoma in whom hair loss was clinically inconspicuous. The metastasis responded to combination chemotherapy.

Cheveux incoiffables—diagnostic, clinical and hair microscopic findings, and pathogenic studies

Three possible mechanisms of the hair shaft abnormality in cheveux incoiffables have been investigated in nine patients. Cheveux incoiffables hairs were found to exhibit a normal distribution of cystine‐rich protein within both the cuticle and the cortex, as determined by silver methenamine ultrastructural cytochemistry. Resistance to stretching, at 65% relative humidity and constant temperature, was similar to normal controls. Resistance to bending forces was also assessed, and was equivalent in both groups. On scanning electron microscopy, all patients with cheveux incoiffables demonstrated longitudinal grooving of the hair shaft, and the hairs were triangular or heart‐shaped in cross‐section. In addition, there appeared to be minimal cuticular weathering. Even hairs of 20–30 cm length showed only minimal cuticular and cortical weathering, compared with normal hair shafts of similar length and diameter. It is possible that the reduced progressive weathering renders the hair shaft more rigid, and could serve to explain the ‘stand on end’ appearance of the hair which is typical of this condition. However, the characteristic cross‐sectional shape of the hair shaft in cheveux incoiffables may render it more rigid and resistant to bending forces. This latter theory has yet to be fully investigated.