O. Mourellou

Plasmapheresis in toxic epidermal necrolysis

Background The treatment of toxic epidermal necrolysis (TEN) is usually based on the removal of the offending drug(s), fluid replacement, nutritional support, and local management. The mortality and morbidity, however, remain high and the death rate may be reduced to 10% only in special centers that use biologic dressings. Plasma exchange (PE) was proven efficacious in small series of patients and of no particular value in others.

The treatment of pemphigus vulgaris. Experience with 48 patients seen over an 11-year period.

We present a retrospective analysis of 48 patients with pemphigus vulgaris (PV) who were seen between 1978 and 1988. They were divided into three treatment groups: 25 (group A) received 40100 mg of oral prednisone daily; eight (group B) received > 100 mg of prednisone daily; 15 (group C) received 40 mg of oral prednisone every other day and azathioprine lOOmg daily. A second immunosuppressive agent was subsequently added to the treatment regimen of three patients in group A and eight patients in group B.

Epidemiologic survey of pemphigus vulgaris with oral manifestations in northern Greece: Retrospective study of 129 patients

Objective  To evaluate the epidemiology of pemphigus vulgaris (PV) in a Greek population and to compare it with other countries.

Hypertrophic and keloidal scars: an approach to polytherapy

Background  Cryotherapy and intralesional corticosteroids have been used separately or in combination as a treatment for hypertrophic and keloidal scars. The addition of silicone gel to the treatment schedule might be of interest.

Impetigo herpetiformis: menstrual exacerbations for 7 years postpartum

Impetigo herpetiformis (IH) is a rare pustular dermatosis that shares striking clinical and histological similarities to generalized pustular psoriasis. The case of a 26‐year‐old primigravida with IH progressing in the 30th week of her pregnancy is presented. The peculiarity of our presentation relies on the reappearance of the disease postpartum. Monthly exacerbations during menstruation lasted for 7 years. Some probable clues regarding the pathogenesis of IH are suggested.

Value of routine diagnostic criteria of bullous pemphigoid

Background and designThe clinical, histologic, and direct (DIF) and indirect (IIF) immunofluorescence findings are used in a critical, although arbitrary, manner in the routine diagnostic process of bullous pemphigoid (BP). Our purpose was to estimate their relative value. In the present retrospective study, a follow‐up of at least 18 months was used as a prerequisite for the final diagnosis of BP (63 patients) and controls (n = 159).

Neurosyphilis: a reality again

Editor The diagnosis of NS relies on epidemiological, clinical and biological measures. Diagnosis is difficult for many reasons: the disease is rare, it can mimic several others, incidental partial treatment with antibiotics given for other disorders may complicate the clinical picture, it may be difficult to obtain a reliable history, and new clinical pictures (‘formes frustes’) may occur. Our study describes 11 cases of NS diagnosed in the State Hospital for Skin and Venereal Diseases in Thessaloniki, North Greece between 1983 and 2003. Four cases of NS from a total of 758 cases of syphilis were registered during the period 1983–1993, and seven were registered from a total of 532 during the period 1993–2003. They were diagnosed during routine screening for syphilis (hospital admission, blood donation). Epidemiological and clinical features, positive serology (VDRL, TPHA) in serum and CSF, and neuroimaging findings and outcome were retrospectively analysed. All patients were hospitalized and treated by intravenous injection of aqueous crystalline benzathine penicillin G, 24 million IU administrated daily in doses of 4 million IU every 4 h, and probenecid 500 mg orally, 4 times daily, both for 14 days. This was followed by intramuscular injections of aqueous procaine benzathine penicillin G, 2.4 million IU, once a week for 9 weeks. Low-dose corticosteroids (methylprednisolone 4 mg per day) along with intravenous and intramuscular penicillin were prescribed in patients with advanced neurological and psychiatric symptomatology. Estimation of treatment effectiveness was performed every 6 months for 2 years. It comprised clinical examination (neurological, psychiatric) and serum and CSF changes. Re-treatment was performed if clinical signs, symptoms or CSF pleocytosis persisted or recurred, and was required in four patients (Table 1). There was a clear predominance of male subjects, the male–female ratio being 2.6 : 1. Patients ranged in age from 27 to 68 years, with an average age of 40.2 years (Table 1). All patients were heterosexual, HIV-negative, immunocompetent, and had an average socio-economic status. A history of syphilis was not found in any of the cases. Five patients presented asymptomatic NS, whereas six presented notable neurological and psychiatric syndromes (one, meningovascular, one, tabes dorsalis and four, general paresis). Two years after therapy, the CSF VDRL titres decreased from 1/2 to 1/16 in two cases, and from 1/2 to 1/8 in three cases, were stable (1/8) in one case, and became negative only in one (Table 1). Neuroimaging findings were nonspecific. The gadolinium test for stroke was not performed. The incidence and clinical spectrum of NS have changed over time. The classic descriptions of NS from the pre-antibiotic era, such as general paresis of the insane and tabetic NS are now considered to be only rarely encountered. Factors that determine the development and progression of tertiary disease are not known. In several studies 10–70% of patients with early syphilis were found to have CSF pleocytosis, elevated CSF protein or positive CSF VDRL.