Moira Mori

Topical corticosteroids and unwanted local effects. Improving the benefit/risk ratio.

SummaryThe main goal of pharmacological research in the field of topical corticosteroids (TCs) is to dissociate efficacy and adverse effects as much as possible. The optimal use of TCs, i.e. the careful evaluation of the benefit/risk ratio, depends on: (i) the chemical structure of the TC; (ii) the type of vehicle; (iii) the mode of application; and (iv) the features of the skin to be treated. The recent availability of TCs characterised by a good dissociation between efficacy and adverse effects makes the classic and widely used classification system of TCs based upon potency out of date. Indeed, TCs with increasing potency have been characterised up to now, as a rule, by an increasing risk of adverse effects. Therefore, a classification system taking into major account the benefit/risk ratio seems particularly needed for clinical use in dermatology.

BCA-1, A B-cell chemoattractant signal, is constantly expressed in cutaneous lymphoproliferative B-cell disorders

We analysed the immunophenotypic and molecular expression of BCA-1 (B-cell-specific chemokine) and CXCR5 (BCA-1 receptor) in normal skin and different cutaneous lymphoproliferative disorders (cutaneous T-cell lymphoma (CTCL); cutaneous B-cell lymphoma (CBCL); cutaneous B-cell pseudolymphoma (PCBCL)), with the aim of investigating their possible involvement in the pathogenesis of cutaneous B-cell disorders. BCA-1 and CXCR5 were constantly expressed in CBCL and PCBCL, but not in normal skin and CTCL. BCA-1 and CXCR5 were constantly coexpressed by CD22+ B-cells, while CD35+ follicular dendritic cells coexpressed BCA-1 in PCBCL cells only. In low grade CBCL, as compared with high grade CBCL, the intensity of CXCR5 expression on neoplastic CD22+ cells was lower than that of BCA-1. The image analysis of reverse transcriptase-polymerase chain reaction (RT-PCR) products showed a significant quantitative difference between PCBCL/low grade CBCL and high grade CBCL. The above findings, although only observed in a small series of patients, are in keeping with findings in MALT gastric and gastric MALT lymphomas, adding further evidence of the close similarities between CBCL and MALT lymphomas.

Wide-area 308-nm phototherapy with nonlaser light in the treatment of psoriasis: results of a pilot study

gical atypia is also seen. At the sides of the lesions inward turning of the rete pegs is seen but there are no other findings supportive of human papillomavirus infection. These particular histological findings reflect the unusual clinical appearance of these rather punctate keratotic lesions which do not fit into the ordinary categories of solar keratoses or Bowen’s disease seen on sun-exposed sites. Sunbed-related NMSC has been reported but no reports have described the distinct appearance and histology of these dysplastic lesions which could be synonymous with sunbed use.

Architectural and Antigenic Features of Follicular Dendritic Cells as a Clue to the Histogenesis of Primary Cutaneous B-Cell Lymphoma

Primary cutaneous B-cell lymphoma (CBCL) are B-cell non-Hodgkin’s lymphoma primarily presenting in the skin without any detectable extracutaneous lesion despite careful and complete staging procedures.1–4 Previous studies of our group indicate that CBCL should be considered as a unique type of a low grade lymphoma4 In fact, CBCL have: 1. non aggressive clinical behavior (mostly loco-regional extension, good response to local treatments, low tendency to spread, and excellent prognosis);1-4 2. uniform immunophenotypic (CD5-, CD10-)2,4 and genotypic features of neoplastic B-cells (lack of bcl-2 gene rearrangement),2,5 and 3. histologic evidence of centrocyte-like (monocytoid, parafollicular) cells in their whole morphologic spectrum, plasma cells, reactive lymphoid follicles and lymphoepithelial lesions.4 These typical features are strikingly similar to those described in so-called MALT (Mucosa-Associated Lymphoid Tissue) lymphoma,6,7 suggesting the interpretation of CBCL as the cutaneous counterpart of MALT lymphoma, i.e., Skin-Associated Lymphoid Tissue (SALT)-related B-cell lymphoma4,8,9 The close clinical, histologic, immunologic, and genotypic similarities of CBCL and MALT-lymphoma with monocytoid/parafollicular lymphoma6 suggest the hypothesis of a common marginal cell origin for these neoplasms.9

Morphologic and Antigenic Features of Dendritic Cells in Immune-Mediated Dermatoses: A Hypothesis of Differentiation

Both Langerhans cells (LC) and dermal dendritic macrophages (DMΦ) deserve attention as antigen presenting cells in the skin, as reviewed elsewhere.1 The morphologic, antigenic and functional features of the formers are extensively dealt with in many chapters of this volume. Dendritic MΦ are characterized by the expression of CD36 antigen and contain many lysosomes;2 they can stimulate mixed cell reactions in vitro, but it is not known whether they stimulate immune responses in vivo or rather inhibit them, perhaps by activating suppressor cell circuits.3,4 The differentiation pathways of LC and DMΦ are incompletely known. The formers, in particular, are considered to derive from circulating precursors which express CD14 antigen “dimly”5 or not at all;6 it is not clear whether these precursors should be considered as true monocytes or a specialized cell type.7,8 It has been proposed that LC can differentiate from DMΦ, but the evidence in favour is weak.9

Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: review from a dermatologic perspective

Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.

CD30 ± cutaneous T-cell lymphoma associated with sarcoidosis*

We observed a 61‐year‐old woman, presenting with deeply infiltrating, erythemato‐cyanotic, sometimes ulcerated or crusted plaques and nodules, mainly located on the lower limbs. Similar lesions had been present for more than 4 years, with a typical evolution: fast growth, followed by ulceration and necrosis, resulting in hyperpigmented, atrophic patches. The patient had had Rx‐confirmed, symptomatic lung sarcoidosis for 5 years. Histological examination of skin lesions showed diffuse dermal and hypodermal lympho‐histiocytic infiltrate, mainly composed of pleomorphic cells. On immunohistochemistry, the infiltrate was mainly composed of CD2 ±, CD3 ±, CD45RO ±, CD4 ±, CD30 ±, CD25 ‐ T‐cells, with sparse CDla ± dendritic cells. The typical clinical evolution (relapsing, self‐regressing plaques and nodules), morpho‐immuno‐logical features of skin lesions, and strong expression of CD30 antigen by neoplastic T‐cells suggest the possible classification of this case as CD30 ± (Ki‐1 ±) cutaneous T‐cell lymphoma. The association with systemic sarcoidosis, together with a down‐regulated cell‐mediated immune response, suggests the possibility that this latter may be a common denominator in the development of the two diseases.