Regina Treudler

Adamantiades-Behçet’s disease: interleukin-8 is increased in serum of patients with active oral and neurological manifestations and is secreted by small vessel endothelial cells

Abstract The serum levels of several cytokines were determined in 94 patients with Adamantiades-Behçet’s disease (ABD), aged 36.1 ± 11.0 years, during the active stage ( n = 75) and the inactive stage ( n = 19) of the disease. A group of 75 healthy individuals matched for age and sex served as controls. Cytokine levels were determined using commercially available ELISA kits. Of the 75 patients with active disease and 19 with inactive disease, 38 (51%) and 4 (21%), respectively, and 23 healthy controls (31%) were found to have detectable levels of interleukin 8 (IL-8) in their serum ( P < 0.05). Also, increased IL-8 serum levels were found in patients with active disease (median 12 pg/ml, P = 0.010) compared to patients with inactive disease (≤ 10 pg/ml) and to healthy controls (≤ 10 pg/ml). In particular, patients with oral aphthous ulcers ( n = 51, 34 pg/ml) and neurological features ( n = 4, 71 pg/ml) exhibited increased IL-8 levels. In contrast, there was no correlation between disease activity and the serum levels of IL-1α, IL-1β, tumor necrosis factor alpha (TNF-α), soluble intercellular adhesion molecule-1 or basic fibroblast growth factor (bFGF). In a second set of experiments, the involvement of dermal microvascular endothelial cells in IL-8 secretion was investigated. Immortalized human dermal microvascular endothelial cells (HMEC-1 cells) were maintained for 4 h in vitro with serum from 18 ABD patients or with IL-1β, a known stimulator of IL-8 synthesis, TNF-α or their combination at five- to tenfold higher concentrations than those found in the serum of ABD patients. Increased IL-8 secretion was found after incubation with ABD patients’ serum (median 20 pg/ml), but IL-1β TNF-α and IL-1β + TNF-α failed to induce IL-8 secretion by HMEC-1 cells (≤ 1–1.2 pg/ml) in biologically relevant concentrations. Our study showed increased IL-8 serum levels in ABD patients with active oral and neurological manifestations. Human microvascular endothelial cells may, at least partially, be responsible for the enhanced IL-8 secretion in the active stage of the disease.

Twenty-eight cases of juvenile-onset Adamantiades-Behçet disease in Germany

Background and Objective: Adamantiades-Behçet disease is a rare entity at a juvenile age. We aimed to enlighten epidemiological and clinical characteristics of juvenile-onset disease in Germany. Methods: Data from the German Registry were used to compare clinical and epidemiological features of patients with juvenile-onset (≤16 years) and adult-onset (>16 years) disease diagnosed according to the criteria of the International Study Group. Results: Twenty-eight (17%) of 168 patients of the German Registry exhibited the onset of the disease and 8 (5%) of them the complete symptom complex at a juvenile age. Juvenile-onset disease was characterized by an increase in familial cases (25 vs. 8% in patients with adult-onset; p = 0.047). The frequency of diagnostic signs was similar between the two study groups. In juvenile-onset disease, delayed development of the complete symptom complex (median value 35 months vs. 12 months after onset; p = 0.014) and lower prevalence of severe complications (9 vs. 29%; p = 0.042) were detected. Conclusions: The major clinical features of juvenile-onset and adult-onset disease in Germany are comparable, but in juvenile-onset disease, the course is delayed and patients experience less severe complications. In addition, there is a higher rate of familial occurrence of the disease in patients with juvenile-onset.

Increase in sensitization to oil of turpentine: recent data from a multicenter study on 45,005 patients from the German-Austrian Information Network of Departments of Dermatology (IVDK).

Contact allergy to oil of turpentine was reported to have become rare. However, the evaluation of standardized data of 45,005 patients tested 1992–1997 in 30 Dermatological Centers associated with the German‐Austrian Information Network of Departments of Dermatology (IVDK) showed an increase in positive patch test reactions to turpentine from 0.5% during the years 1992–1995, up to 1.7% in 1996 and 3.1% in 1997. In particular, 17,347 patients tested in 1996–1997 were evaluated in detail by comparing 431 individuals with positive patch test reactions with the rest of the group found negative to turpentine. Using the so‐called MOAHLFA index, the following characteristics were shown. Turpentine allergy (a) was found to be significantly less frequent in men and in patients with occupational dermatitis, (b) showed no difference in its association with atopic dermatitis, (c) patients with turpentine allergy had significantly less symptoms of the hands, more symptoms of the legs or in the face and (d) were significantly more often aged over 60 years. Also, patients sensitized to turpentine had increased rates of additional sensitizations. The definite reason for the increase in turpentine sensitization in the population tested here is not clear. Therefore, a detailed exposure analysis is necessary; the new increase in turpentine allergies may be due to popular topical remedies or household chemicals.

A Case of Cutaneous Rosai-Dorfman Disease Refractory to Imatinib Therapy

BACKGROUNDnRosai-Dorfman disease is a non-Langerhans cell histiocytosis that recently has been treated successfully with imatinib mesylate in a patient with a systemic variant of the disease.nnnOBSERVATIONSnWe describe a 69-year-old man with cutaneous Rosai-Dorfman disease manifesting as progressive, deeply infiltrated skin lesions. Histopathologic examination of the lesions demonstrated dense dermal infiltrate positive for CD68, stabilin-1, and S-100, but not for CD1a. The histiocytes were positive for platelet-derived growth factor receptor alpha, the target molecule for imatinib. During the 5-year course of the disease, multiple therapeutic approaches (tuberculostatic drugs, topical and systemic glucocorticoids, thalidomide, isotretinoin, and methotrexate) did not result in significant improvement. Imatinib mesylate therapy (600 mg/d for 2(1/2) weeks and then 400 mg/d for 10 weeks) had no effect, despite the expression of platelet-derived growth factor receptor alpha on the histiocytes.nnnCONCLUSIONSnFailure of imatinib therapy in our patient may be due to a lack of functioning target molecules, the therapy protocol, or the course of the disease. Cutaneous and systemic variants of Rosai-Dorfman disease may be different clinical entities or at least may respond differently to tyrosine kinase inhibitors.

Contact sensitization to modern wound dressings in 70 patients with chronic leg ulcers.

Background Patients with chronic leg ulcers typically experience contact allergy to topical treatments. Although declared as hypoallergenic, modern wound dressings have caused several reported cases of contact allergy. Objective The aim of the study was to evaluate any allergenic potential of modern wound dressings in patients with leg ulcers. Methods Seventy-one patients were included in our prospective observation. Patch tests were performed with a selection of 10 modern wound dressings and with selected allergens according to series of the German Contact Dermatitis Research Group (DKG). Results Of 70 patients eligible for evaluation, 12 (17%) were positive for the hydrogel NuGel, followed by the hydrocolloid NuDerm (n = 7/70, 10%) and the ionic silver−containing wound dressing Aquacel Ag and the gauze Adaptic (both n = 4/70, 5%). Patients with recalcitrant ulcers of prolonged duration showed a significant higher number of epicutaneous sensitizations to wound dressings than patients with shorter ulcer duration. Conclusions The allergenic potential of modern wound dressings should not be underestimated. There is need for precise declaration of all ingredients.

Benzoyl peroxide: is it a relevant bone cement allergen in patients with orthopaedic implants?

Contact allergies to orthopaedic implant material are discussed to be relevant for postoperative complaints. We aimed at determining the prevalence of sensitizations to implant metals and to bone cements in patients with implants. We investigated 13 consecutive patients with suspicion of contact allergy to implant material. Epicutaneous patch testing was performed with metals and bone cement components including benzoyl peroxide (BPO). The chief complaints were skin disorders (n = 3), loosening of implant (n = 2), swelling (n = 6), and pain (n = 2). 6 patients had a sensitization to at least 1 allergen. 3 patients reacted to BPO, being of possible relevance in 1 of these patients suffering from dermatitis. Other sensitizations, such as those to nickel, fragrance, and balsam of Peru, were observed, with no clinical relevance (n = 1, respectively). BPO in bone cements may lead to type 4 sensitizations of which the relevance, however, remains questionable. Nevertheless we recommend this allergen to be tested in patients with complicated cemented orthopaedic implants.

Maggots Do Not Survive in Pyoderma Gangrenosum

Application of maggots is well established in wound therapy. We report upon 2 patients with leg ulcers due to pyoderma gangrenosum who received immunosuppressive therapy and in whom a reduced survival of maggots (Lucilia sericata sp.) led to ineffectiveness of this therapy.

Intravenous cidofovir treatment for recalcitrant warts in the setting of a patient with myelodysplastic syndrome

Cidofovir is an acyclic nucleoside phosphonate with broad‐spectrum activity against DNA viruses, including human papilloma virus (HPV). However, data on the efficacy of cidofovir in an immunosuppressive setting remain contradictory. We report for the first time on the promotion of the healing of recalcitrant warts in a patient with myelodysplastic syndrome with intravenous cidofovir treatment.

Eosinophilic Cellulitis (Wells' Syndrome) in Association with Angioimmunoblastic Lymphadenopathy

Eosinophilic cellulitis (Wells syndrome) is an uncommon inflammatory disease with clinical polymorphism. It is often associated with infectious, allergic or myeloproliferative diseases; however, the exact aetiology is unknown. This report describes a rare case of eosinophilic cellulitis in association with angioimmunoblastic lymphadenopathy. The typical skin findings of Wells syndrome disappeared completely following chemotherapy and autologous stem cell transplantation.

Follicular drug eruption induced by gefitinib (ZD 1839, iressa): clinical picture correlates with in vitro data of focal epidermal necrosis after epidermal growth factor inhibition in skin cultures.

A few similar lesions were noticed on his trunk. There was a bilateral ciliary injection of the conjunctiva. Routine laboratory testing showed an elevated C-reactive protein (60 mg/l, normal ! 6), mild anemia with hemoglobin 11.4 g/dl (normal 14–18) and prostate-specifi c antigen 119 g/l (normal ! 4). Staphylococcus aureus was isolated from the face. Under the diagnosis of a drug-induced follicular dermatitis and conjunctivitis with bacterial superinfection, we discontinued the treatment with Iressa. Flucoxacillin and ampicillin were administered for 8 days; chlorhexidine 1% in lotio alba aquosa was applied topically. Conjunctival lesions were treated with antibiotic eye drops (polymyxin B, bacitracin, neomycin). These combined measures led to complete disappearance of the skin lesions within 3 weeks. In May 2002, the urologists decided to reintroduce the ZD 1839 medication with 250 mg/day, and after 2–3 weeks the patient developed the same clinical picture as in January 2002. The patient then refused any further therapy for his carcinoma; he died in March 2003. In general, Iressa has been reported to be well tolerated with only minor adverse events, the most frequent ones including skin Dermatology 2005;211:375–376 DOI: 10.1159/000088514