Mary C. Massa

In situ Expression of Cytokines and Cellular Adhesion Molecules in the Skin of Patients with Systemic Sclerosis

Cytokines and cellular adhesion molecules (CAMs) may play a role in the inflammatory and fibrotic processes underlying systemic sclerosis (SSc). We compared the immunohistological distribution of cytokines and CAMs in skin biopsies from 12 SSc patients and 14 normal (NL) individuals. Among CAMs, vascular cell adhesion molecule-1 (VCAM-1), which mediates leukocyte-endothelial adhesion, showed increased expression on SSc versus NL endothelium and stratum granulosum. P-selectin was up-regulated in SSc versus NL stratum granulosum. The CD44 lymphocyte homing receptor showed the most striking differences between SSc and NL: its expression was increased in SSc stratum granulosum, stratum spinosum, on lymphocytes, and macrophages. Regarding cytokines, interleukin-6 (IL-6) expression was increased on SSc versus NL endothelium and fibroblasts. Tumor necrosis factor-alpha (TNF-alpha) reactivity was more prevalent in SSc than NL stratum granulosum, whereas IL-8 expression was higher on SSc compared to NL endothelium. Some CAMs, such as VCAM-1 and P-selectin, and cytokines, namely TNF-alpha and IL-8, were more commonly found in skin biopsies taken from early (< or = 1 years duration) SSc, while others, such as IL-6, showed up-regulation in the late stage of the disease. The results suggest that certain CAMs and cytokines may play a differential role in both the early, inflammatory, and the late, fibrotic stage of SSc.

Acquired ichthyosis and pityriasis rotunda

The association between AI and underlying malignant processes was initially recognized in the 1940s when Ronchese described AI in association with Hodgkins’s disease.l Sneddon subsequently described four cases of Hodgkins’s disease with widespread ichthyosis.* Reiches reported the association of acquired ichthyosis with breast cancer in 1950.3 The skin manifestations of multiple myeloma were reviewed by Bluefarb in 1955; this included three patients in a series of eight with multiple myeloma who had ichthyosiform atrophy of the skin.4 Since then many authors have reported AI in conjunction with various malignancies, chronic diseases, endocrine disorders, connective tissue diseases, malnutrition, medication, and acquired immunodeficiency syndrome (AIDS) (Table 1).

Angiolymphoid hyperplasia demonstrating extensive skin and mucosal lesions controlled with vinblastine therapy

Since Kimuras original description of an unusual subcutaneous disorder with distinctive histologic features of vascular and lymphoid proliferation, numerous descriptions of diseases with similar features have been reported. A variety of descriptive labels, including Kimuras disease, angiolymphoid hyperplasia (ALH) with eosinophilia, atypical pyogenic granuloma, papular angioplasia, and histiocytoid hemangioma, have been applied to these diseases. Although this information has broadened our understanding of the clinical and pathologic spectrum of ALH, the etiology and/or pathogenesis remains unknown. Our case report illustrates the wide range of clinical features of ALH, demonstrating extensive lesions on skin and mucosa. The extreme histologic variability with regard to eosinophils, lymphoid infiltrates, and vascular alterations is also illustrated. Dramatic response to vinblastine sulfate treatment has not been previously reported and may provide a viable treatment alternative in selected patients.

Yield from total skin examination and effectiveness of skin cancer awareness program. Findings in 874 new dermatology patients.

The authors reviewed 874 dermatology charts to assess the acceptance rate of total skin examination (TSE), incidental skin findings, and patient compliance regarding treatment recommendations. Of the 874 new dermatology patients studied, 707 (80.9%) agreed to TSE. Important incidental findings were found in 151 (21.4%). These included: (1) biopsy specimen‐confirmed malignant tumors (malignant melanoma, lentigo maligna, and basal cell and squamous cell carcinoma) in 24 of the 707 patients (3.4%), (2) biopsy specimen‐confirmed premalignant tumors (actinic keratosis with dysplasia), Bowenoid actinic keratosis, Bowenoid papulosis, and lentigo with dysplasia, in five (0.7%), (3) clinically diagnosed premalignant actinic keratosis in 64 (9.1%), (4) biopsy specimen‐confirmed dysplastic nevi in 17 (2.4%), and (5) congenital nevi in 41 (5.8%). Only 4.2% of the patients returned for a yearly TSE, and only 6.0% were found to follow all recommendations for monthly self examination, yearly professional examination, and sun protection. It is concluded that TSE for all new patients, and on a yearly basis for all return patients, is valuable in the detection of many skin conditions and allows skin cancer screening to be done, since patients for the most part do not follow recommendations for athome screening.

Pigmented Bowen's disease arising from pigmented seborrheic keratoses

We report three cases of pigmented Bowens disease that clinically and histologically had features of seborrheic keratoses. We speculate about the mechanism of pigmentation in these lesions and suggest that they arise from pigmented seborrheic keratoses.