J.H. Saurat

International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies

C . E L L I S * A N D T . L U G E R † O N B E H A L F O F T H E I C C A D I I F A C U L T Y : D . A B E C K , R . A L L E N , R . A . C . G R A H A M B R O W N , Y . D E P R O S T , L . F . E I C H E N F I E L D , C . F E R R A N D I Z , A . G I A N N E T T I , J . H A N I F I N , J . Y . M . K O O , D . L E U N G , C . L Y N D E , J . R I N G , R . R U I Z M A L D O N A D O A N D J H . S A U R A T

The lichen planus‐like eruption after bone marrow transplantation

A lichen planus‐like eruption was seen in four patients after bone marrow transplantation. The skin and mucous membrane appearance closely mimicked lichen planus. The histopathology was also very similar to lichen planus. The occurrence of a lichen planus‐like eruption (LPLE) after an immune basal cell damage related to the graft‐versus‐host reaction raised the question of the immune nature of this eruption. The correlation found between biological signs of graft‐versus‐host reaction and the outbreak or relapse of the lichen planus‐like eruption supports the hypothesis that the skin changes could be a sign of a chronic immune response against recipient epidermis.

A phase IIIb, multicentre, randomized, double-blind, vehicle-controlled study of the efficacy and safety of adalimumab with and without calcipotriol/betamethasone topical treatment in patients with moderate to severe psoriasis: the BELIEVE study

Background  Data are lacking on the use of topical therapies in combination with tumour necrosis factor blockers for the treatment of psoriasis.

Review of the potential photo-cocarcinogenicity of topical calcineurin inhibitors: Position statement of the European Dermatology Forum

ABSTRACT  Topical Calcineurin Inhibitors (TCIs) used for the treatment of atopic eczema modify the immune regulatory function of the skin and may have the potential to enhance immunosuppressive ultraviolet (UV) effects. Current recommendations on UV protection in eczema patients treated with PCIs are inconsistent and have given rise to uncertainty and anxiety in patients. Therefore, the European Dermatology Forum (EDF) developed a position statement which reviews critically the available data with regard to the problem, especially analysing and commenting the limitations of rodent models for the human situation. There is no conclusive evidence from rodent trials to indicate that long‐term application of TCIs is photococarcinogenic. There is a need for further studies to investigate the validity of mouse models as well as long‐term cohort studies in patients using TCIs. Available data suggest that long‐term application of TCIs is safe, that there is no evidence of increased skin cancer risk and that it is ethical to treat patients with TCIs when indicated.

Skin antibodies in bone marrow transplanted patients

Direct and indirect immunofluorescent studies were performed in seventeen bone marrow transplanted patients (BMT). No immunoglobulins were found in the maculo papular lesions of the early graft versus host reaction. Globular deposits of IgM and complement were found in the skin specimens from lichen planus like eruptions; these were very similar to those found in idiopathic lichen planus. Circulating epidermal cytoplasmic antibodies (ECA) were detected in 15 of 17 (88%) patients as shown by a longitudinal study of 118 sera. This frequency was significantly higher than in other groups in this study (133 subjects). ECA did not correlate with a graft versus host reaction. It is postulated that they develop as a consequence of chronic skin damage in subjects with disorders of the immune system which stimulate the production of numerous antibodies.

Interleukin 1 immunoreactivity in sebaceous glands

Interleukin 1 (IL‐1) immunoreactivity in sebaceous glands was studied in paraffin sections of normal human skin. A panel of antibodies against IL‐1α and β was tested using an immunoperoxidase labelling method. All the antibodies showed a similar specific labelling pattern: both glandular and ductal cells were immunoreactive for both IL‐1α and β, provided optimal tissue fixation was used.

Immunohistochemical identification of interleukin 1α and β in human eccrine sweat-gland apparatus

Bouin‐fixed paraffin sections or acetone‐fixed cryostat sections were labelled with the avidinbiotin complex (ABC) or peroxidase‐antiperoxidase (PAP) method using three monoclonal antibodies (MAbs) and two polyclonal antisera to human recombinant interleukin i beta (IL‐iβ) and three polyclonal antisera to human recombinant interleukin iα (IL‐iα). In the secretory coil both IL‐α and β were detected in the clear, but not in the dark cells. Both luminal and basal cells of the coiled and straight ducts expressed IL‐iα and β, the IL‐i labelling being more intense in the luminal cells. IL‐i was not usually detected in the initial portion of the intraepidermal eccrine sweat duct, whereas intense labelling was seen in the upper part including through the stratum corneum. In skin biopsies of the palm, taken after exercise, there was only faint IL‐i labelling of the secretory cells, whereas the luminal cells of the dermal ducts showed intense labelling for both IL‐iα and β. In the acrosyringium, exercise did not alter the pattern for IL‐iα and β, except that in the palm, some of the antibodies to IL‐iβ produced a more intense immunolabelling of the acrosyringeal cells. This study identifies a distinct and similar distribution of the two forms of IL‐i throughout the eccrine sweat‐gland apparatus and indicates that part of the IL‐i epidermal pool originates from the sweat.

Immunofluorescent tracing of cytoplasmic components involved in keratinocyte differentiation.

Sera with epidermal cytoplasmic antibodies (E.C.A.) produced by human subjects after bone marrow transplantation have been studied by indirect immunofluorescence on rabbit lip sections. These sections were used in order to give on a single specimen, areas of mucosa, of parakeratotic and of orthokeratotic epithelium. It has been demonstrated that E.C.A. distinguished the basal cell layer from the upper cell layers on the three areas. Moreover, E.C.A. were not found to react identically on mucosal, parakeratotic and orthokeratotic epithelium. These findings strongly suggest that the target antigens for E.C.A. are molecules involved in keratinocyte differentiation.

An evaluation of dermoscopy fluids and application techniques.

Summary Background Dermoscopy, a noninvasive technique used to help physicians better visualize pigmented skin lesions, is becoming widely used by dermatologists. Yet despite its popularity, to our knowledge basic aspects such as the best immersion fluid (IF) to use and proper procedures for applying the IF and dermatoscope have never been the subject of a systematic investigation.

Epidermis and thymus. similar antigenic properties in hassall's corpuscle and subsets of keratinocytes

Using human sera obtained from bone marrow transplant recipients which contain antibodies to cytoplasmic epidermal antigens, we have found a cross reactivity between epidermis and thymus in immunofluorescence. The shared antigen(s) were only localized in the Hassalls corpuscle on the thymus and the upper (stratum spinosum) compartment of the epidermis. The basal cell layer did not show shared antigens. Antigenic similarity between epidermis and thymus may thus be restricted to a subset of keratinocytes.