Michele Lomuto

Genetic susceptibility to fixed drug eruption : evidence for a link with HLA-B22

BACKGROUND Our observation of familial cases of fixed drug eruption (FDE) prompted us to consider a genetic predisposition to this disease. OBJECTIVE Our purpose was to determine whether there is any association between FDE and any of the major histocompatibility complex class I or II alleles. METHODS HLA class I and II typing was performed by lymphocytotoxicity assay in 36 unrelated patients with FDE. RESULTS Significantly higher (p < 0.0001) frequencies of the B22 and Cw1 antigens were found in the 36 patients with FDE. CONCLUSION Our data are the first to suggest a genetic predisposition to FDE.

Lack of hepatitis C virus replication intermediate RNA in diseased skin tissue of chronic hepatitis C patients.

The extent of extrahepatic hepatitis C virus (HCV) replication seems to be low‐level and confined to cells of hematopoietic lineage. However, given the spectrum of extrahepatic manifestations associated with HCV, several tissues other than the liver have been suggested as targets of HCV replication and damage. The presence and level of HCV RNA were examined in 19 skin tissue samples from patients chronically infected with HCV and referred for lichen ruber planus (n = 11) or cutaneous vasculitis associated with mixed cryoglobulinemia (n = 8). Serum HCV RNA was quantitated and genotyped by assays that are available commercially. Tissue HCV RNA of genomic‐ and minus‐strand polarity was titrated by a strand‐specific semiquantitative RT‐PCR. Low titers of genomic‐strand HCV RNA were found in three skin specimens from patients with cutaneous vasculitis due to mixed cryoglobulinemia, but in none with lichen ruber planus. The replication intermediate HCV RNA was not detected in any of the skin tissues examined, independent of the serum HCV RNA level or genotype. It is concluded that the occurrence of cutaneous vasculitis and lichen ruber planus in chronic hepatitis C patients is unlikely to be due to HCV replication in the skin. J. Med. Virol. 59:277–280, 1999.

Prognostic signs in melanoma: state of the art

Prognoses for melanoma patients are currently based on statistically confirmed parameters, above all the Breslow thickness and number of lymph node and/or distant metastases. However, metastases can develop even with ‘thin’ melanomas (< 0.7 mm), while survival has been recorded in patients with tumours classified as ‘thick’ (> 4 mm). This review of the literature examines the most recent advances in prognostic markers for melanoma (serological, immunohistochemical, histological, genetic and surgical). These markers offer interesting possibilities in terms of diagnostic certainty, identification of early growth phases and estimation of the tumours potential for progression and metastasis. It is reasonable to assume that their combined use can provide useful information for formulating prognoses that are not only statistically valid but also individualized.

Ashy dermatosis associated with cobalt allergy

23. Fould I, Koh D. Allergic contact dermatitis from resin hardeners during the manufacture of thermosetting coating paints. Contact Dermaritis 1992: 26: 87-90. 24. Bittersohl G, Hebener H. Zur Toxicitat von aliphatischen Aminen. Z Gesamte Hyg Grenzgeb 1978: 24: 529-534. 25. Agocs M, Etzel R, Parrish R, Paschal C, Campagna P, Cohen D, Kilbourne M, Hesse J. Mercury exposure from interior latex paint. New Eng! J Med 1990: 323: 1096-1101. 26. Flyvholm M-A, Manne T. Allergic contact dermatitis from formaldehyde a case study focussing on sources of formaldehyde exposure. Contact Dermatitis 1992: 27: 27-36. 27. Jones S, Kennedy C. Chloracetamide as an allergen in the paint industry. Contact Dermatitis 1988: 18: 304-305. Contact Dermatitis 1994: 31: 53

A new case of acromegaloid facial appearance (AFA) syndrome with an expanded phenotype.

A patient presenting with the findings of Acromegaloid Facial Appearance (AFA) syndrome is reported. This case also shows pericardial effusion and skin lesions that both enlarge the spectrum of the phenotype and lump AFA syndrome with another proposed distinct condition [Irvine et al., (1996) J med Genet 33:972-974].

Linear IgA Bullous Dermatosis after Contact with Sodium Hypochlorite

The onset of linear IgA bullous dermatosis (LABD) is generally spontaneous, but a number of cases of LABD have been reported either following drug exposure or in association with malignancies. We describe a patient who developed a vesicular eruption shortly after an irritant dermatitis caused by the contact with a detergent containing sodium hypochlorite. Direct immunofluorescence revealed linear deposits of IgA and C3 in the epidermal basement membrane. The patients serum contained IgA that immunoblotted a 180-kD polypeptide in extracts of human keratinocytes. The patient responded promptly to therapy with dapsone. We suggest a possible pathogenetic relationship between the chemical dermatitis and LABD in this patient.

Protein contact dermatitis with positive RAST in a slaughterman

A 26-year-old man developed an itching papulovesicular dermatitis, on the backs and sides of the fingers and wrists, a few months after starting work in a slaughterhouse. The dermatitis disappeared on holiday and relapsed immediately on return to work. It flared up at once on handling bloody meat and gut. On examination, he had erythematous microvesicular lesions on the backs and sides of the fingers, and lichenified scaly plaques on the backs of the hands. Personal history revealed atopic dermatitis in childhood and sporadic atopic respiratory symptoms. Patch tests with GIRDCA standard series, rubber and antibiotics series were negative at 2 and 3 days. Scratch-chamber tests performed with fresh cow meat and blood provoked, within a few minutes, itching and erythema and, after 20 min, oedema, microvesicles and wheals. Scratch tests with other meats, including pork, turkey and chicken, were negative. The patient did not react to cooked meat on scratch testing, and cow meat ingestion was well tolerated. Intradermal tests with standard extracts of cow meat (kindly provided by Bayropharm) showed a weakly positive reaction ( + + ). An i.e. test to Cilligen (Benzyl-penicilloyl-polylysine, Sigma Chern. Co., St. Louis, USA) was negative. The total IgE was 302 KU/1. RAST (Pharmacia Diagnostics, Uppsala) confirmed the results of the cutaneous tests, exibiting specific IgE to cow meat (class 3); IgE to Dermatophagoides pteronyssynus (class 4) and Dermatophagoides farinae (class 3) was also found.

PEMPHIGUS ERYTHEMATOSUS INDUCED BY CEFTAZIDIME

A 37-year-old Italian man was given a prescription for ceftazidime to treat folliculitis of the beard that had been present for approximately ten years. The drug was administered intramuscularly at home at a dose of 1 g/day. After a few days of treatment the patient began to experience diffuse pruritus over the entire trunk. On day 8 of treatment, flaccid bullae and crusted lesions appeared on the chest and gradually spread to the back and scalp. On day 10 of treatment the patient was hospitalized. Physical examination revealed the above lesions of the trunk and scalp (Fig. 1); there was no mucous membrane involvement. The patient was unaware of any allergies or hypersensitivity to drugs of any type. Laboratory studies, including complete blood count, erythrocyte sedimentation rate, assays for antinuclear and antidouble-stranded antibodies, lupus erythematosus cells, rheumatoid factor, complement levels, and immunoelectrophoresis showed normal or negative findings. Human leukocyte antigen (HLA) typing showed the presence of the following antigens: All, -, B7, B18, Cw7, -, DR2, DR11, DQ1, and DQ3. Histologic examination of one of the bullous lesions on the chest revealed the presence of a subcorneal blister and a few acantholytic cells. Direct immunofluorescence on perilesional skin showed deposits of immunoglobulin IgG and C3 among the cells and along the dermo-epidermal junction; indirect immunofluorescence was negative.

Nerds syndrome: An additional case report

NERDS is an eosinophilic disorder recently described by Butterfield and characterized by an association of nodules, eosinophilia, rheumatism, dermatitis and swelling. We describe an additional case, the third, of this new eosinophilic syndrome. The cardinal features included joint and cutaneous manifestations with prominent para-articular nodules and rheumatism, xerosis, recurrent urticarial eruption with angioedema associated with tissue and peripheral blood eosinophilia. A drug-induced (diclofenac) allergic rash and lymphadenopathy appeared during the course of the illness. Persistent leukocytosis with a maximum of 65% of eosinophils, mostly exhibiting the hypodense phenotype (activation index), was always present. During the acute phase of the disease, flow-cytometric analysis of blood and bone marrow revealed proliferation of activated CD4+/OKDR+ T helper cells and CD25+/OKDR+ eosinophils.