Giovanni Maria Palleschi

Tinea capitis in the adult: Two case studies

The authors describe two cases of tinea capitis in adults, one due to Microsporum canis and the other to Trichophyton rubrum. The atypical clinical presentation of the dermatophytosis in these two cases is stressed. It is hypothesized that in both cases the disease spread from primary lesions on the face.

SERUM EOSINOPHIL CATIONIC PROTEIN (ecp) IN BULLOUS PEMPHIGOID

Background. The importance of eosinophils in the pathogenesis of the major forms of pemphigoid (bullous pemphigoid, cicatricial pemphigoid, herpes gestationis) remains to be confirmed.

KAPOSI'S VARICELLIFORM ERUPTION IN PEMPHIGUS FOLIACEUS

A 83-year-old man was seen in January 1993, because of a pruritic eruption, consisting of numerous erosions surrounded by erythema and covered by large crusts and scales with sharply defined margins (Fig. 1). The eruption was localized on the scalp, chest, abdomen, and back. A biopsy specimen taken from a lesion on the back revealed a subcorneal, acantholytic bulla. Direct immunofiuorescence (DIF) of a perilesional sample demonstrated IgG and C3 deposits in the epidermal intercellular space. Indirect immunofiuorescence (IIF) showed circulating antibodies directed against the intercellular substance (titer 1:80). A diagnosis of pemphigus foliaceus was made and prednisone therapy (60 mg per day) was instituted.

Pharmacologic modulation by cetirizine of some adhesion molecules expression in psoriatic skin lesions

Background. Adhesion molecules play a major role in the pathogenesis of inflammatory skin diseases by regulating lymphocyte trafficking and homing in an inflamed area.

Development of oesophageal involvement in a subject with pemphigus vulgaris: a case report and review of the literature

We present the case of a 50‐year‐old‐man with pemphigus vulgaris involving the oropharyngolaryngeal mucosa and oesophagus. Oesophageal involvement of pemphigus vulgaris is relatively uncommon, especially in subjects in clinical remission, and has been rarely described in the literature. Endoscopic examination should be performed to avoid inappropriate therapy due to misdiagnosis of steroid‐induced oesophagitis and peptic ulcers.

Epidemiology of the Dermatophytoses in the Florence Area: 1982–84.1. Microsporum canis Infections*

Summary: Microsporum canis was the most frequently isolated dermatophyte between 1982 and 1984, with an incidence of 45.19%. This dermatophyte caused almost all cases of tinea capitis (94.99%) and the majority of cases of tinea corporis (75.73%).

Rosacea in a monozygotic twin.

We read the interesting Letter by Lee and Cooper that appeared in a recent issue of your Journal. The Authors reported the appearance of acne vulgaris in two monozygotic twins, a finding that further supports a role of genetic factors in such disease. Acne and rosacea are chronic, polymorphous skin diseases that share some clinical features, including the involvement of seborrhoeic areas (particularly the face) and the appearance of papules and pustules during the clinical course. Acne and rosacea are currently considered multifactorial diseases resulting from either genetic predisposition or exogenous triggering factors. Two 51-year-old Caucasian female monozygotic twins, with no relevant past illnesses, were in good physical and psychologic health, did not take medications and did not follow any specific diet. They lived separately, one in town and the other in the country. Only the latter was affected for nearly 20 years by rosacea, that was characterized at the time of our observation by papules and pustules (subtype 2, grade 2) involving the forehead, nose, cheeks and neck (Fig. 1). She was successfully treated with oral and topical metronidazole for 6 weeks. While diseases affecting monozygotic twins represent an experimentum naturae suggesting a role for genes in the pathogenesis, the presence of a disease only in one twin highlights the role of the environment. Little is known about the aetiopathogenesis of rosacea. Many exacerbating factors, such as heat, alcohol, sunlight, drugs and certain foods, are known to be triggering factors. Nonetheless, the increased prevalence of rosacea among Caucasians and relatives of affected individuals suggests a genetic cause. Rosacea has been rarely reported to affect identical andnon-identical twins. In the case reported here, the appearance of rosacea in only one of two monozygotic twins suggests environmental factors may play a major role. We suspect that, as the twins lived in quite different surroundings, differences in food habit, daily exposure to sunlight and microbial colonization of the skin may have triggered the phenotypic expression of the disease. Post-zygotic gene mutations predisposing to the development of rosacea, cannot be excluded as well. Nevertheless, as no genes involved in the pathogenesis of rosacea are known to date, this hypothesis is destined to remain purely speculative.

The Role of Cyclosporine A in the Treatment of Pemphigus Erythematosus

Abstract: Steroids are effective in the autoimmune bullous disease pemphigus; however, treatment may be difficult to sustain because of severe side effects. Cyclosporine A acts mainly on helper/inducer T lymphocytes and has few side effects at few doses. We report three patients with pemphigus erythematosus who had a relapse while receiving the maintenance dose of steroid therapy. All patients who were treated with both cyclosporine A (5 mg/kg/d) and prednisone (1 mg/ kg/d) responded remarkably well to combined therapy. After clearing, prednisone was discontinued and cyclosporine A was reduced to 2 to 3 mg/kg/d. With this treatment, all patients have been virtually free of symptoms, have remained well, and have had normal laboratory values.

Fibrillar pattern of a plantar acquired melanocytic naevus : correspondence between epiluminescence microscopy and transverse section histology

The main epiluminescence microscopy (ELM) patterns observed on volar acquired melanocytic naevi are the parallel‐furrow, the lattice‐like and the fibrillar patterns. Because of the peculiar arrangement and configuration of epidermal rete ridges in the glabrous skin, the traditional histological picture does not provide an exact correlation with ELM features. In particular, the fibrillar pattern lacks a histopathological correlate. To clarify the microscopic features of the fibrillar pattern, we used transverse histological sectioning to study an acquired compound melanocytic naevus of the sole, characterized by a mixed parallel‐furrow/fibrillar pattern on ELM. Low‐magnification images of transverse sections allowed us to highlight the typical anatomical arrangement of the volar skin clearly, while high‐magnification images demonstrated that the fibrillar pattern corresponded to parallel striae of intensely pigmented corneocytes arranged obliquely to the cutaneous surface.

Discoid lupus erythematosus lesions developed on lupus erythematosus profundus nodules

We describe this case of LEP for its unusual way of presentation. It first appeared with a LEP pattern, followed by a typical DEE of the skin, overlying the nodules only. Moreover, our histologic findings showed the typical pattern of lymphocytic lobular panniculitis, with hyaline necrosis of fat, the lymphoid nodule, and even the lymphocytic nuclear “dust.” The epidermal changes, with the liquefaction degeneration of the basal cell layer, a moderate follicular hyperkeratosis, and a perivascular and periappendeal lymphocytic infiltrate, were also observed in the abdominal lesion that developed last without clinically evident DLE.