Michelangelo La Placa

Adalimumab-induced psoriasis of the scalp with diffuse alopecia: A severe potentially irreversible cutaneous side effect of TNF-alpha blockers

To the Editor: Anti-tumor necrosis factor (TNF) agents have revolutionized the treatment of chronic inflammatory bowel disease. Adalimumab, a recombinant human IgG monoclonal antibody, selectively blocks TNF-alpha (TNF-a) and has been successfully used in the treatment of Crohn’s disease (CD). Regimens with early use of biologic therapy are under discussion because they might alter the natural history of CD. Physicians treating patients with TNF-a blockers should be aware that possible complications of biologic therapy are not only opportunistic infections and the development of malignant tumors, but also cutaneous side effects. In the recent literature there is evidence that adalimumab may induce psoriasis in individuals who have no personal or family history of psoriasis. Clinical presentations include plaque or guttate psoriasis or palmoplantar pustulosis. We herein report two cases of severe and diffuse alopecia due to scalp psoriasis. Psoriasiform alopecia under adalimumab therapy may be severe and diffuse and, most important, irreversible. A 19-year-old woman with a 3year history of CD was started on adalimumab monotherapy (40 mg, every 2–3 weeks) after failing to respond to various therapy regimens, including mesalofalk, azathioprine, and infliximab. Three months after the initiation of adalimumab the patient observed diffuse alopecia and erythematous scaly plaques on the scalp, abdomen, trunk, and extremities. Clinical examination revealed intense erythema with exudative discharge and severe alopecia over most of the scalp (Fig. 1a). Two biopsies from the scalp showed the characteristic features of psoriasis, without any evidence of a scarring alopecia. The scalp lesions cleared with complete hair regrowth after withdrawal of adalimumab. The second patient was a 31year-old woman with a 2-year history of CD. Treatment with sulfasalazine

Sensitive Chemiluminescence In Situ Hybridization for the Detection of Human Papillomavirus Genomes in Biopsy Specimens

We developed a sensitive chemiluminescence in situ hybridization assay for detection of human papillomavirus (HPV) DNA for objective and semiquantitative evaluation of the results. The hybridization reaction was performed using either digoxigenin-, biotin-, or fluorescein-labeled probes, visualized with alkaline phosphatase as the revealing enzyme and a highly sensitive 1,2 dioxetane phosphate as chemiluminescent substrate. The light emitted from the hybridized probes was detected, analyzed, and measured using a high-performance, low light-level imaging luminograph connected to an optical microscope and to a personal computer for quantification of the photon fluxes and for image analysis. The system operated in consecutive steps: First, hybridized specimens were recorded in transmitted light. Then the net luminescent signal was recorded, and then an overlay of the two images provided by the transmitted light and by the luminescent signal allowed the spatial distribution of the target DNA to be localized, measured, and evaluated. Biopsy specimens from different pathological conditions associated with HPV, which had previously been proved positive for HPV DNA with the polymerase chain reaction (PCR), were analysed. The chemiluminescence in situ hybridization proved sensitive and specific with digoxigenin-, biotin-, or fluorescein-labeled probes, and provided an objective evaluation of the results. The results obtained with chemiluminescence in situ hybridization were also compared with results obtained with in situ hybridization with colorimetric detection, with good concordance of the data. Chemiluminescence in situ hybridization therefore offers the possibility of detecting HPV DNA with great sensitivity in biopsy specimens. Moreover, the images of the samples, stored in the computer, are a permanent record of the reaction and can also be sent for evaluation or comparison to other laboratories using computer networks.

Complement-mediated in vitro bactericidal activity of monoclonal antibodies reactive with outer-surface-protein OspB of Borrelia burgdorferi

Murine monoclonal antibodies (mAbs) were obtained against the outer-surface-protein OspA and OspB and against the 41-kDa flagellar antigen of Borrelia burgdorferi. The specificity of mAb was determined by the Western blotting technique and the surface association of the antigens was inferred by immunofluorescence of living bacteria. In an in vitro assay in the presence of complement, two mAbs reactive with the Ospa were able to kill borreliae, whereas several mAbs reactive with the OspA as well as with the 41-kDa flagellar protein were not.

Malignancies in bullous pemphigoid: A controversial association.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder that has been reported to be associated with malignancies. Some authors described several cases of pemphigoid associated with malignancies (PAM); however, the evidence of this correlation still remains controversial. Several theories have been postulated to explain the relationship between malignant neoplasms and BP; the main theory suggests that antibodies directed against tumor‐specific antigens of malignant cells may cross‐react with antigens (like BP antigens) in the basement membrane zone leading to the formation of blisters. We performed an extensive review of the English published work focusing on the epidemiology, the pathogenetic theories and the clinical and histological aspects of the disease. We identified 40 cases of PAM: of these, seven cases were associated with hematological malignancies and 33 with solid tumors. Physicians should be aware of the existence of PAM and we suggest an oncological screening in early‐onset pemphigoid, in patients with a former oncological history, in those with signs and symptoms that could be related to a neoplasm and in BP refractory to common immunosuppressive therapy.

Sensitization to benzocaine on a condom

Case Report A 44-year-old man presented with a !-year history of erythematous desquamative lesions on the penis and scrotum. Erythematous desquamative lesions were also found to be present in the periorbital region and on the frontal area of the hairline. Patch tests with the GIRDCA standard series demonstrated a positive reaction to benzocaine 5% pet. (D2+/D3++). Reviewing the history revealed that the patient habitually used retarding condoms, and that the dermatitis worsened after sexual intercourse. Further patch tests with a rubber series, a piece (1 em X I em) of the same brand of condom that the patient used, a piece (I em X I em) of the same condom washed clean of lubricant, and pure polyethylene glycol and pure glycerin, other components of the lubricant, were positive only to the lubricated condom (D2I D3++).

Functional Activities of Antibodies Directed against Surface Lipoproteins of Borrelia hermsii

Enriched preparations for mouse polyclonal immunoglobulin G (IgG) antibodies reactive with surface‐exposed epitopes (Ab‐SEE) of the 22‐kDa and 24‐kDa membrane lipoproteins of living Borrelia hermsii (HS 1 strain) cells were obtained by an antibody absorption technique using living spirochetes. In vitro, the antibody preparations both inhibited spirochetal growth and were borreliacidal in the presence of complement. The monovalent Fab antibody fragments, prepared from antibody‐enriched preparations, did not inhibit the growth of the bacteria, whereas they killed the bacteria in the presence of complement. The two‐dimension gel electrophoresis of B. hermsii cells showed that 3H‐labeled fatty acids incorporated into the 22‐kDa and 24‐kDa lipoproteins were resolved into one and three compact spots, respectively. The spots were recognized by the Ab‐SEE preparations reactive with the 22‐kDa and 24‐kDa proteins, by Western blotting.

Scalp Psoriasiform Contact Dermatitis with Acute Telogen Effluvium due to Topical Minoxidil Treatment

Topical minoxidil, the only approved treatment for female pattern hair loss (FPHL), has been associated with scalp allergic contact dermatitis (ACD). We report the case of 2 female patients who developed ACD from minoxidil solution with severe telogen effluvium and psoriasiform scalp dermatitis. Scalp dermoscopy was useful to identify the psoriasiform vascular pattern, whereas patch testing made it possible to differentiate the cause of sensitization. In one case, minoxidil was the sole cause of scalp dermatitis, while in the other patient it was only the vehicle, thus permitting the patient to continue the treatment for FPHL.

Dermoscopic subpatterns of granulomatous skin diseases

the Divisions of Dermatology at the Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a Bologna, and the Ospedale Santa Chiara, Trento, Italy. ing sources: None. licts of interest: None declared. ints not available from the authors. spondence to: Riccardo Balestri, MD, Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a di Bologna, Clinica Dermatologica, Via Massarenti 1, 40138 Bologna, Italy. E-mail: ilsabo@libero.it. J Am Acad Dermatol 2013;69:e217-8. 0190-9622/

Serum antibody reactivity to human intracisternal A-type particle retrovirus proteins in systemic sclerosis patients.

36.00 a 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.03.030

Overexpression of MLH‐1 and psoriasin genes in cutaneous angiofibromas from tuberous sclerosis complex patients

Serum antibodies against human intracisternal A-type particle (HIAP) endogenous retrovirus have been found to be associated with various autoimmune pathologies. To evaluate the presence of serum antibody reactivity to HIAP proteins in systemic sclerosis, a Western blot analysis was performed on sera from 42 patients with systemic sclerosis, in comparison with 18 sera from patients with primary biliary cirrhosis and 52 healthy subjects. A positive Western blot was found in 55.5% of serum samples from patients with primary biliary cirrhosis and in 66.0% of patients with systemic sclerosis. None of the 52 healthy subjects showed positive results. Although this difference may be attributable either to an autoimmune response to antigenically related cellular proteins or to a specific antibody response to HIAP proteins expressed as an incidental consequence of attendant pathological processes, the high prevalence of antibodies against HIAP proteins demonstrated in patients with systemic sclerosis may be considered a hallmark of this disease.