J.C. den Hollander

Alterations in leucocyte subsets and histomorphology in normal‐appearing perilesional skin and early and chronic hidradenitis suppurativa lesions

Summary Background  Current insight into the histopathological course of events during disease progression in hidradenitis suppurativa (HS) is fragmentary.

Hyperpigmentation during interferon-alpha therapy for chronic hepatitis C virus infection

Summary Many types of skin disorders concomitantly occur with hepatitis C virus infection. These skin lesions may be induced or worsened during antiviral therapy with interferon‐alpha (IFN). To our knowledge, hyperpigmentation of the skin—and especially of the tongue—has not been reported so far. We describe two dark‐skinned patients who developed hyperpigmented skin and tongue lesions during combination therapy with IFN and ribavirin. Immunohistochemical analysis of tongue biopsies confirmed the suspicion of melanin deposits in these areas of hyperpigmentation. We hypothesize that during interferon therapy, melanocytes may produce more melanin pigment in the presence of α‐melanocyte stimulating hormone and sufficient amounts of tyrosine, leading to melanin deposits and clinical hyperpigmentation.

Separation of the umbilical cord histological findings

Even though the separation of the umbilical cord receives a great deal of interest, the process of cord separation has not been reported in the literature. A histological study of the umbilical area was carried out on 25 neonates who died within 7 days of birth (mean age at death 3 days). The umbilical cord itself became dried and mummified. Polymorphonuclear leucocytes infiltrated the areas between the mummifying cord stump and the vital tissues of the abdominal wall, forming a demarcation zone. No other leucocytes were present, and no bacteria were seen in any of the preparations studied.

Multiple familial trichoepithelioma and familial cylindroma: one cause!

1 Häberle M, Hausen BM. Allergische Reaktionen auf Macadamia, die Königin der Nüsse. Allergologie 2006; 3: 103–108. 2 Häberle M, Hausen BM. Soforttyp-Allergie nach Genuss von Macadamia-Nüssen. Allergo J 2002; 11: 42. 3 Herbst RA, Kügler K, Frosch PJ. Anaphylaxie nach Verzehr von Macadamianüssen. Dermatologie Beruf Umwelt 2004; 52: 73. 4 Lerch M, Egger C, Bircher AJ. Allergic reactions to macadamia nut. Allergy 2005; 60: 130–131. 5 Pallares DE. Allergy to macadamia nut. Ann Allergy Asthma Immunol 2000; 85: 385–386. 6 Sutherland MF, O’Hehir RE, Czarny D, Suphioglu C. Macadamia nut anaphylaxis: Demonstration of specific IgE reactivity and partial cross-reactivity with hazelnut. J Allergy Clin Immunol 1999; 104: 889–890. 7 Senti G, Ballmer-Weber BK, Wüthrich B. Nüsse, Samen und Kerne aus allergologischer Sicht. Schweiz Med Wochenschr 2000; 130: 1795–1804. 8 Knight TE, Hausen BM. Dermatitis in a nutshell: occupational exposure to Macadamia integrifolia. J Am Acad Dermatol 1996; 35: 482–484. 9 Roux KH, Teuber SS, Sathe SK. Tree Nut Allergens. Int Arch Allergy Immunol 2003; 131: 234–244. 10 Ring J 2004 Angewandte Allergologie 3. Auflage. Urban & Vogel München.

Takayasu's arteritis: a rare cause of cardiac death in a Caucasian teenage female patient

A caucasian teenage Dutch schoolgirl with known chronic low visual acuity and albinism, presented with frank acute pulmonary oedema, died after 1 h of cardio-pulmonary resuscitation for bradyarrhythmia and cardiac arrest. Two weeks prior to presentation, during sport training, she complained of oppressive chest pain on exertion accompanied with vomiting without any other systemic symptoms. Post-mortem examination revealed supravalvular stenosis of the pulmonary trunk and ascending aorta with irregular intimal thickening associated with stenosis of the left coronary artery. Microscopic examination demonstrated cellular infiltration of the wall of the aorta and pulmonary trunk with formation of granulomas with multinucleated giant cells. These features are compatible with Takayasus arteritis.

Use of Skin Substitute Dressings in the Treatment of Staphylococcal Scalded Skin Syndrome in Neonates and Young Infants

Background: Staphylococcal scalded skin syndrome (SSSS) is a rare toxin-mediated skin disease caused by Staphylococcus aureus and seen in infants and children younger than 5 years. Objectives: The supportive role of skin substitutes in SSSS is stressed as a new and relatively unknown method. Methods: Retrospective observational case-series study, in neonates and young infants diagnosed with SSSS. Results: Seven infants with SSSS, treatment with antibiotics, skin substitutes, strict pain relief strategy and prognosis were described. One of them was severely affected and deceased. Conclusion: This study describes 7 infants with SSSS and stresses the important role of skin substitutes as Omiderm® and Suprathel® as valuable adjuvant treatment modality.

Umbilical Cord Separation: Histological Findings and Perinatal Factors

The aim of this study was to investigate if perinatal factors influenced the histology of the umbilical area of neonates who died when umbilical cord separation was occurring or had just been completed. It was found that the older the infant was at death the greater the degree of infiltration of polymorphonuclear leucocytes into the area of separation of the umbilical cord. The infiltration was less when the infant was delivered by caesarean section than when the infant was delivered vaginally. The other factors studied (sex, birth-weight, gestational age, positive blood culture, time of rupture of the membranes) did not influence the histological findings.

Unusual late nodular presentation of secondary syphilis

A 20-year-old man presented with a five-week history of an eruption of papules and nodules disseminated over his body and face. We propose that this patient has a late form of secondary syphilis with a nodular, granulomatous inflammation in urgent need of treatment. Otherwise late irreversible sequelae could develop and unwanted possible further sexual transmission could take place.

Support for the hypoxia theory in the pathogenesis of infantile haemangioma.

The pathogenesis of infantile haemangioma (IH) is unknown. Several mechanisms have been proposed, including hypoxia, which triggers upregulation and stabilization of hypoxia‐inducible factor (HIF)1α. HIF1α stimulates downstream transcription of target genes that enhance angiogenesis.

Marked Bilateral Lower Eyelid Ectropion in Cutis Laxa: A Paraneoplastic Process in Multiple Myeloma

Purpose: To describe a bilateral involutional lower eyelid ectropion in a patient with cutis laxa, a paraneoplastic process in multiple myeloma. Design: Case report. Results: A 60-year-old male presented with a marked involutional left lower eyelid ectropion. Systemic history included cutis laxa, a paraneoplastic feature of multiple myeloma. After surgical treatment, the ectropion recurred; furthermore, a right lower eyelid ectropion developed. In addition, a distinct dermatochalasis of both upper eyelids was present. Conclusions: This case is the first description of a marked bilateral involutional ectropion in cutis laxa acquisita.