G. Achten

Cutaneous malignant melanoma and exposure to sunlamps and sunbeds: a descriptive study in Belgium.

Two recently published case-control studies have highlighted the possibility of an association between the development of cutaneous malignant melanoma and exposure to sunlamps and sunbeds. Little is known about the behaviour patterns with regard to exposure to sunlamps and sunbeds in Western Europe. This descriptive study compares usage patterns of sunlamps and sunbeds of melanoma patients with the general population in Belgium. Evidence is given that melanoma patients are greater users of artificial ultraviolet sources than the general population, and that the incidence of melanoma in different geographical areas increases proportional to the percentage of people using tanning devices. Although this descriptive study may well be biased or refuted, it does advocate the need for further epidemiological research addressing specifically the issue of melanoma and exposure to artificial sources of ultraviolet radiation.

Graft versus host reaction: an ultrastructural study

Graft versus host reaction (GvH) following leukocytic transfusions occurred in a 34-year-old man with a generalized lymphosarcoma. Histologic and ultrastructural studies were performed, with special reference to dyskeratotic cells scattered in the epidermis. These cells are usually considered to be a constant and important feature of GvH reaction. Dense aggregation of tonofilaments, including cytoplasmic organelles and loss of desmosomes, were seen in dyskeratotic cells. Several intracellular desmosomes with tonofilaments bound to their attachment plaque were observed. Some of these cells were able to reach the horny layer; some others were phagocytosed by neighboring keratinocytes. These cells could be the result of a toxic damage to the epidermis, provoked by the immunologic phenomenon implicated in GvH reaction. Later in the clinical course, bullae formations occurred, showing some features of toxic epidermal necrolysis (TEN), as well as features of GvH reaction.

Disrupted Desmosomes in Induced Lesions of Familial Benign Chronic Pemphigus

An occlusive dressing was applied to the unaffected skin of the back of a patient with familial benign chronic pemphigus (FBCP). Small lesions of FBCP appeared after 48 h, and the ultrastructure of successive biopsies was studied. It was concluded that: (a) the initial phenomenon in FBCP is the result of an insufficiency of cellular adhesion. This confirms several previous reports. (b) desmosomes are separated in two halves, invaginated in vacuoles and later deeply included in the cell. The particular fate of these disrupted desmosomes has already been observed after the action of several enzymes on the epidermis and in Dariers disease.

Clinical and immunologic response to Isoprinosine in alopecia areata and alopecia universalis: Association with autoantibodies

Twenty patients with alopecia universalis, alopecia semiuniversalis and alopecia areata were studied for their immune parameters. Fourteen of them received an oral treatment with Isoprinosine, a synthetic immunomodulator. Ten patients showed the presence of several autoantibodies. No significant abnormalities in various T cell rosette markers were found, but T4/T8 ratios tended to be elevated. Erythrocyte antibody complement (EAC) rosettes were usually decreased. Treatment with Isoprinosine produced a clinical response, as judged by total or partial hair growth, in nine of the fourteen patients treated. It was striking to observe that seven of the nine responders had autoantibodies prior to treatment. These autoantibodies disappeared or decreased with Isoprinosine therapy. In contrast, only one of five nonresponders had serum autoantibodies. After treatment, both groups showed an increase in blood-active T rosettes. These results suggest that alopecia is a heterogeneous disease subdivided by the presence or absence of autoantibodies since clinical response was mainly obtained in patients presenting autoantibodies.

Elastosis in chronic radiodermatitis AN ULTRASTRUCTURAL STUDY

The electron microscopic study of six cases of chronic radiodermatitis from sun‐exposed and unexposed skin, confirms the observation of elastosis previously described with light microscopy. The pathological findings are comparable with those found in actinic elastosis; increased width of the fibres, irregularity of their shape, increased density and granularity of the microfibrils and holes with many lobes in the matrix.

Fixed drug eruption: ultrastructural study of dyskeratotic cells

Electron microscopic studies have been carried out on three cases of fixed drug eruption, with particular regard to the dyskeratotic cells. The authors have tried to show the sequence of events leading from a normal basal keratinocyte to a dyskeratotic body. Ribosomes were first increased in number; then the the tonofbrillar system looked thicker, cytoplasmic organelles degenerated and numerous melanosomes appeared. Many dyskeratotic bodies were later found in epidermal macrophages and in the intercellular space. Several intra‐cytoplasmic desmosomes were found in the dyskeratotic cells and their evolution is discussed. The increased number of melanosomes seen in the dyskeratotic bodies could be due to injury to epidermal cell and thei evolution be due to injury to epidermal lysosomal catabolism or it could be due to an apparent increase in melanosome numbers, within cells whose volume has been reduced.

The Normal and Pathologic Nail

Clinical diagnosis of nail diseases remains difficult. In effect, a single disease can present widely differing lesions, and, conversely, a given nail malformation can be the expression of a variety of diseases of varying etiology, evolution, and prognosis. It is the area of the nail ihat is affected, rather than the disease itself, that determines the clinical aspect of the nail. It seems, therefore, logical to study ungual pathology, after having examined normal nail structure. Then we will describe diseases of the matrix, diseases of the nail hed and (he hyponychium, and finally, those of the nailplate. This overview does not pretend to be exhaustive. Only those affections most frequently observed by the clinician will be discussed.

Dermatofibromes, élastomes et surdité: un nouveau cas de syndrome de Buschke-Ollendorff?

The authors propose a new case of Buschke-Ollendorff syndrome: a female patient aged 54 years presents 17 tumoral lesions out of which some are dermatofibromas and other elastomas. Deafness appeared 5 years after the cutaneous lesions and seems to be the result of a pathological condensation of petrous bones.

Staphylococcal scalded skin syndrome in an adult

The staphylococcal form of toxic epidermal necrolysis or staphylococcal scalded skin syndrome (SSSS) is exceptionally seen in an adult patient. We report a case of SSSS in a 21-year-old male who suffered from a fulminant pneumopathia due to a phage group II Staphylococcus aureus. The onset of that clinical picture in an adult patient is unusual and could be due to a deficient immunity, as previous case reports have emphasized. Unfortunately, the sudden death of our patient did not allow us to investigate his immunological defences.

Larva migrans of the oral mucosa.

A case of buccal larva migrans is presented. This rare peculiar localization is discussed. The different treatments are mentioned with special regard to the topical and systemic use of the thiabendazole.