L. Iglesias

ITRACONAZOLE VERSUS GRISEOFULVIN IN THE TREATMENT OF TINEA CAPITIS: A DOUBLE‐BLIND RANDOMIZED STUDY IN CHILDREN

Background. Tinea capitis is a fungal infection in which topical therapy is often unsuccessful. Griseofulvin has been considered to be a first‐line therapy. Other antifungal agents are the azole derivatives. Among these, itraconazole was compared with griseofulvin in children in a double‐blind study.

p16 INK4a Is Selectively Silenced in the Tumoral Progression of Mycosis Fungoides

Knowledge about the molecular mechanisms involved in the pathogenesis of tumoral progression in mycosis fungoides (MF) is still scarce. Because the 9p21 locus seems to be a good target for a detailed study in MF, this prompted us to compare the mechanisms of inactivation of the p16INK4a, p15INK4b, and p14ARF genes in aggressive and stable forms of MF, performing microsatellite analysis, methylation-specific polymerase chain reaction, direct sequencing, and p16INK4a protein expression by immunohistochemistry. Additionally, the p53 gene was also sequenced in tumoral lesions. Thirty-nine patients with stable MF were studied. Alterations in p16INK4a and p15INK4b genes were detected in 18% and 5% of the cases, respectively. None of the cases analyzed showed alterations of the p14ARF gene. In contrast with these findings, in the 11 patients with aggressive MF, alterations of the p16INK4a, p15INK4b, or p14ARF genes were found in 8 (73%), 3 (27%), and 2 (18%) cases, respectively. A significant proportion (4/11) of these alterations were already present in the p16INK4a gene in the initial plaque lesions in these aggressive forms of MF. Alterations in the p16INK4a gene, either methylation or loss of heterozygosity, were clearly more frequent than those in the p15INK4b and p14ARF genes. These p16INK4A alterations were confirmed using immunohistochemistry. None of the nine tumoral lesions analyzed showed mutations in exons 1-2 of the p16INK4a gene or in exons 5-8 of the p53 gene. These results seem to suggest that 9p21 alterations, and selectively p16INK4a silencing, could be a characteristic phenomenon in MF progression.

Verrucous carcinoma in association with hypertrophic lichen planus

Neoplastic transformation of lichen planus is a rare event. However, squamous cell carcinoma may develop in 0.3%–3% of patients with the oral form of the disease. On the other hand, less than 30 cases arising in cutaneous lichen planus have been reported, and only four cases of verrucous carcinoma in association with either form, one with an oral lesion and three with cutaneous lesions (one hypertrophic and one ulcerative).

Oral involvement in mycosis fungoides : Report of two cases and a literature review

Oral involvement is uncommon in cutaneous T-cell lymphomas and usually associated with poor prognosis. The clinicopathological and immunohistochemical findings of 2 new cases are described along with a literature review. The first patient had a 10-year history of mycosis fungoides when she developed lesions in the oral tissues. She died 6 months later despite treatment. The immunophenotype was CD3+, CD4+, CD8-, CD30-. The second patient had a mycosis fungoides for 5 years when she developed lesions in the uvula and oropharynx. She was treated with polychemotherapy and she is alive 5 years after oral involvement. The immunophenotype was CD3+, CD4-, CD8+, CD30-. There are conflicting reports about the prognosis in the CD8+ phenotype. The present cases and the literature review seem to indicate that in oral involvement the CD8- phenotype is not associated with a worse prognosis than the CD4+ subtype. However, it is necessary to study new cases to confirm this statement.

Aggressive granulomatous mycosis fungoides with clinical pulmonary and thyroid involvement

We report a patient with granulomatous mycosis fungoides (MF) that progressed to a tumoral pattern and finally developed clinical pulmonary and thyroid involvement, despite multiple and intensive treatments. We emphasize the visceral involvement in this case, which was manifest as dyspnoea simulating pneumonia and by palpable thyroid nodules. These features are very unusual even in classic MF, and this is the first case in our knowledge of thyroid involvement in granulomatous MF.

Taxol-lnduced Acral Erythema

Chemotherapy-induced acral erythema is a peculiar localized cutaneous response to several chemotherapeutic agents, mostly antimetabolites. Taxol is a recently developed antineoplastic drug that acts on the mitotic spindle and does not interfere with nucleic acid synthesis. We describe the first case of taxol-induced acral erythema and report on additional data concerning the pathogenesis of this kind of toxic eruptions.

Disseminated verruciform xanthoma

It induces life-threatening bleeding, which occurs postpartum, or in association with drugs, autoimmune disorders or malignancy. This disorder has recently been observed in association with various autoimmune diseases, including some associated with bullous skin diseases. To our knowledge, three cases of pemphigoid, one case of pemphigus vulgaris and one case of EBA with acquired haemophilia have been reported. It has been suggested that the altered immune response contributes to the induction of factor VIII inhibitor. Especially in the elderly, reduced suppressor T-cell activity is believed to modify immune tolerance and to lead to increased production of autoantibodies. Combination therapy with cyclophosphamide, vincristine and prednisolone has been recommended for treatment of acquired factor VIII inhibitor. Prednisolone alone induced remission in about 30% of patients. In the three patients with acquired haemophilia with pemphigoid described above, two patients were treated with corticosteroids alone, and one patient with corticosteroids and cyclophosphamide combination pulse therapy. In our patient, administration of corticosteroids was effective both for the EBA and for the acquired haemophilia. Our case suggests a possible cross-reactivity between type VII collagen and factor VIII. We have found just one report of acquired haemophilia A with EBA; however, this was a brief case report from otolaryngologists, the details of which were not clear. Ishikawa et al. reported a case of acquired haemophilia A in a patient with systemic lupus erythematosus (SLE). Some patients with bullous SLE, an unusual variant of SLE, have circulating anti-BMZ antibodies and antibodies directed against type VII collagen. The relationship between bullous SLE and EBA is an interesting question that has not been satisfactorily resolved. They are closely related disorders, and the clinical and pathological features characteristic of bullous SLE may occur in EBA. Ishikawa et al. treated their patient with corticosteroids and cyclophosphamide combination therapy. Factor VIII inhibitor was detected in the patient, although the SLE remained well controlled. The underlying causes of this disorder vary, but the levels of inhibitor in patients’ sera do not always correlate with the activity of the underlying disease. Prompt diagnosis and selection of adequate therapies for this disorder are therefore critical.

Lichenoid nail changes as sole external manifestation of graft vs. host disease

A 56‐year‐old‐man who had refractory anemia with an excess of blasts underwent an allogeneic peripheral blood stem cell transplantation (PBSCT) from his brother after preparation with melphalan and fludarabin. He received GvHD (graft‐vs.‐host disease) prophylaxis with cyclosporine from day –1 at a daily dose of 5 mg/kg of body weight. The daily dosage was tapered gradually from day +20. On post‐PBSCT day 68 he developed acute cutaneous GvHD grade 3 and acute gastrointestinal GvHD grade 2–3, which was resolved with a daily dose of 1 mg/kg of body weight of prednisone. The patient was discharged in good clinical condition and without signs of GvHD, and he started tapering his immunosuppressive treatment. By day 160 he developed oral lichen planus‐like changes, with several reticulate white lesions on the oral mucosa. A biopsy specimen was microscopically consistent with lichenoid GvHD ( Fig. 1 ). By day 150 after PBSCT, when he was being treated with CsA 100 mg once daily and prednisone 10 mg once daily, his fingernails started to grow abnormally and gradually became dystrophic and painful. Two months later his toenails became similarly affected. Although affecting all finger and toe nails, the lesions were especially important in both thumbs. Physical examination revealed multiple findings on his nails ( Fig. 2 ): thickening, fragility, onycholysis, longitudinal striations, and even pterygium. The micological cultures were negative. A biopsy specimen showed an sparse papillary dermis lymphoid infiltrate with focal exocytosis and presence of isolated multiple necrotic keratinocytes ( Fig. 3 ). These findings were interpreted as a lichenoid GvHD with oral and nail involvement. The patient did not have other associated cutaneous lesions. He did not develop signs or symptoms consistent with hepatic GvHD. In May 2000 thalidomide was added to the immunosuppressive therapy, at a daily dose from 100 to 300 mg according to tolerance (constipation, sedation, …). The lesions on the oral mucous showed a substantial improvement, but the nail changes remained more or less stable. Thalidomide was discontinued after 7 months because the patient displayed numbness and tingling in the hands and feet consistent with a peripheral neuropathy. Twenty days later he stopped taking thalidomide and the oral lichenoid lesions worsened, resulting in difficulty in eating. He also developed periungueal erythema, swelling and intense pain after minimal trauma. The daily dose of prednisone increased to 20–30 mg with moderate improvement. However, the dose could not be increased because of the secondary immunosuppressive effects. Twenty‐three months post‐PBSCT the patient remains with intense oral and nail lichenoid lesions.

A randomized comparative study: Amorolfine (cream 0.125%, 0.25% and 0.5%) in dermatomy coses

In a double-blind randomized comparative study, 75 patients with dermatomycoses (one cutaneous candidosis and 74 dermatophyte infections) were treated with amorolfine cream 0.125% (group A, 25 patients), 0.25% (group B, 25 patients) or 0.5% (group C, 25 patients). Treatment, consisting of a once daily application, was continued for 1 week after clinical cure, the maximum duration of treatment was limited to 6 weeks. Assessment of the results was based on both clinical and mycological parameters. At the end of the treatment clinical cure rates ranged from 76% to 84%, and mykological cure ranged from 64% to 76%. There were two patients in each group (8%) who did not respond to the treatment, and eight patients had to withdraw due to side-effects. At the assessment 2 months post-therapy 20 patients (80%) in group A, 17 (68%) in group B and 18 (72%) in group C were cured. There were six relapses: 3 (12%) in group B and 3 (12%) in group C. There was no significant difference between the three groups in terms o...

Anetoderma developing in juvenile xanthogranuloma.

Anetoderma is characterized by circumscribed oval macules with overlying wrinkled skin that is slightly depressed or bulges outwards. Skin biopsy shows a decrease of elastic dermal fibers. It may not be associated with an underlying disease (primary anetoderma) or may be related to many dermatoses (secondary anetoderma).