Marcella Guarrera

Flushing in rosacea: A possible mechanism

SummaryFlushing in rosacea has been investigated by means of (a) pharmacological inhibition of some possible chemical mediators and (b) titration of bradykinin as a possible effector directly in the blood. Clonidine-inhibited flushing was seen in all patients (mean 45%), other drugs had poorer results. Bradykinin increased in all patients at the climax of flushing (mean 60%). These findings support the hypothesis that epinephrine promotes a bradykinin release responsible for vasodilation.ZusammenfassungDie Flush-Reaktion bei Rosazea wurde (a) durch pharmakologische Hemmung einiger Mediatoren und (b) durch Titration von Bradykinin, das möglicherweise einen direkten Effektor im Blut darstellt, untersucht.Clonidin konnte die Flush-Reaktion bei allen Patienten (durchschnittlich um 45%) hemmen. Andere Medikamente zeigten schlechtere Ergebnisse. Der Bradykininspiegel fand sich auf dem Höhepunkt der Flush-Reaktion bei allen Patienten deutlich eleviert (durchschnittlich um 60%). Diese Ergebnisse belegen die Hypothese, daß Adrenalin die Freisetzung von Bradykinin fördert und somit eine Vasodilatation bewirken kann.

Anagen hairs may fail to replace telogen hairs in early androgenic female alopecia.

BACKGROUND Male baldness develops because of an increased duration of the lag phase. OBJECTIVE AND METHODS To assess if this occurs also in balding women we studied 2 women with Ludwig type I-II patterned baldness for 2 years with monthly phototrichograms. Hairs were identified as thick anagen hairs, thin anagen hairs and telogen hairs. RESULTS AND CONCLUSIONS Most of the hairs followed the expected development, namely they remained thick anagen hairs or they became thick from thin anagen, telogen from thick anagen or thin anagen from telogen hairs. Other hairs, though, became thin from thick anagen or telogen from thin anagen or thick anagen from telogen hairs. Still others did not regrow immediately after being in the telogen phase, leaving an empty space. Some empty spaces were not refilled for a long time. As in men, in balding women tiny bald spots develop corresponding to telogen hairs not replaced in due time.

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Photopatch tests: an Italian multicentre study from 2004 to 2006

Background:  Evaluation of possible photoallergic contact dermatitis in at‐risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used.

Allergic reaction to India ink in a black tattoo

An 18-year-old girl presented with intensely pruritic erythematous papules of 2 months duration, discretely scattered within and around a black tattoo on her right outer malleolus (Fig. 1). The tattoo had been made 3 months earlier by an amateur, who had used India ink (Pelikan 17 black) as a pigment. The symptoms were only partly responsive to topical corticosteroid therapy. Patch tests with the GIRDCA standard series were positive to nickel sulfate (π) and neomycin (π). The India ink brought by the patient and applied as is on the back, semi-occluded with MicroporeA tape, yielded a clear eczematous reaction (ππ) at D3 and D4. The patient denied permission for biopsy. According to the manufacturer, Pelikan 17 black India ink contains carbon black and natural resins. X-ray microanalysis of the ink was performed with a scanning electron microscope (SEM-Philips 515) attached to an energy dispersive spectrometer (EDS-EDAX 910). The inorganic component of the tattoo ink showed multiple elemental peaks, namely sodium, chlorine, barium, sulfur, potassium, silicon and traces of aluminium. No nickel was detected. As no further information was available, we could not further identify the sensitizer.

Flushing in rosacea: An experimental approach

SummaryA simple method is described which causes rosacea patients to flush. This flush is experienced similarly to the flush which occurs spontaneously and its intensity can be measured and monitored wuantitatively. Therefore, it can be used as a suitable experimental tool to measure and compare the inhibitory effects of some drugs, as well as the fluctuations of the blood level of certain chemical vasoactive mediators.ZusammenfassungEs wird eine einfache Methode zur Erzeugung des Flushsyndroms beim Rosaceakranken beschrieben. Dieser Flush ist dem spontanen Flush ähnlich. Seine Intensität kann durch Erfassung der Hauttemperatur gemessen werden. Diese Methode ist dazu geeignet, um die Inhibitionswirkungen einiger Arzneien und vasoaktiver Substanzen zu studieren und zu vergleichen.

Kenogen in female androgenetic alopecia. A longitudinal study.

Background: Kenogen indicates the physiological interval of the hair cycle in which the hair follicle remains empty after the telogen hair has been extruded and before a new anagen hair emerges. Kenogen frequency and duration are greater in men and women with androgenetic alopecia (AGA). Objective: To study the relationship of kenogen with female AGA. Methods: A woman with AGA, studied 14 years before, was re-examined for 2 years by the phototrichogram technique. Kenogen was identified when telogen lasted 3 months and shedding left the follicle empty. Results: Kenogen lasted 1–5 months, the longest duration affecting cycles of vellus hairs, and involved more hair follicles (16 vs. 8%) than in the first observation. Cycles of vellus hairs increased in number from 4 to 13%, and cycles with a normal succession of phases decreased from 60 to 32%. Conclusions: The number of kenogen phases increased in parallel with vellus hairs and the diminished number of normal hair cycles, features that mark AGA aggravation. Kenogen seems to be related also to the progression of female AGA.

Hair Growth Assessment Techniques

• Qualitative and quantitative methods are essential for objectively evaluating hair growth activity.

Allergic contact dermatitis from thiurams with pemphigus-like autoantibodies

A 42-year-old woman had undergone repeated reconstructive surgery of the lower limbs after a car accident. During rehabilitation, an emollient was applied daily on contracture scars. After 2 months, a severe erythemato-oedematous, vesicopustular, crusted reaction developed at skin donor and graft sites. A course of systemic antibiotics and topical corticosteroids was ineffective. Occlusive dressings of the lower legs with zinc paste bandages resulted in striking localized amelioration, while the thighs kept worsening and new vesicopustular lesions developed on the arms and face. Despite repeated swabs, bacteriological cultures remained negative. Allergic contact dermatitis from the emollient was suspected, but patch testing with the SIDAPA standard series and the emollient as is showed a ππ reaction to thiuram mix only. Further investigation revealed that the patient’s mother had been using latex gloves to apply first the emollient and then the topical corticosteroids. Patch testing with the gloves elicited a discrete vesicopustular reaction at D2 and D3. Epidermolysis, reminiscent of Nikolsky sign, developed, close to the patch test site, upon removal of the Scanpor tape. During patch testing the eczema flared and spread to the trunk. Pruritus was intense. Biopsy of a vesicopustular lesion from a thigh revealed subcorneal blistering and eosinophilic spongiosis. Direct immunofluorescence (DIF) was non-specific, showing only granular deposits of C3 at the dermoepidermal junction. Indirect immunofluorescence (IIF) demonstrated low titre (1/40) IgG autoantibodies to the intercellular substance. Weak serum positivity to desmoglein 1 and desmoglein 3 was found with ELISA. Western blot analysis was negative. Class II HLA-typing revealed the following haplotype: DR15, DR13, DR51, DR52, DQ1. Strict rubber contact avoidance was advised and systemic prednisolone, 0.5 mg/kg daily was introduced. The dermatitis partly subsided, but relapsed when the drug was tapered and took on a chronic relapsing course.

Allergic contact dermatitis from a wet suit

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