Stefano Cavicchini

Laugier-Hunziker syndrome: A clinical, histopathologic, and ultrastructural study of four cases and review of the literature

Four cases of Laugier-Hunziker syndrome are described. In all patients (two men and two women between 39 and 57 years of age) pigmentation of the lower lip and hard palate was found. in addition, two patients had involvement of the buccal mucosa; another patient also had pigmentation of the upper lip, the gums, the soft palate, and the fingers of both hands. Histopathologic examination demonstrated an accumulation of melanin in the basal layer keratinocytes and an increase in the number of melanophages in the papillary dermis. Ultrastructural study showed the presence of numerous mature melanosomes in the cytoplasm of the keratinocytes of the basal layer and of the melanophages in the papillary dermis. Alterations of the melanocytes were not observed.

Oral hairy leukoplakia.

Oral hairy leukoplakia was first described in homosexual men infected with the human immunodeficiency virus. It is thought to be caused by infection with both the Epstein-Barr virus and human papillomavirus. We report 59 cases of oral hairy leukoplakia. The disease was diagnosed in patients in all risk groups and was categorized in all classes of the Walter Reed classification without significant differences in prevalence. Epstein-Barr virus could be demonstrated in all tissue samples examined; human papillomavirus was found in only a few specimens. In our series oral hairy leukoplakia had a chronic course, although temporary spontaneous healing occurred in some cases. Its appearance was a poor prognostic sign because acquired immunodeficiency syndrome developed in a significant proportion of patients within a few months of onset.

Successful treatment of disseminated superficial actinic porokeratosis with methyl aminolevulinate‐photodynamic therapy

Sirs, Disseminated superficial actinic porokeratosis (DSAP) is an autosomal dominant cutaneous disorder with a slowly progressive course over years, characterized by multiple, superficial lesions with a slightly elevated, sharply defined ridge which involve the sun-exposed areas of the extremities. Porokeratosis lesions are usually triggered by ultraviolet light, explaining why the disease is more frequent in geographic areas with high sun exposure, and becomes more prominent in summer. Although different therapeutic options have been proposed, including cryotherapy with liquid nitrogen, 5fluorouracil, and vitamin D3 analogs (1–3), therapy of DSAP is still a challenge, mostly because of the multiplicity of the skin lesions and the frequent relapses of the disease. Photodynamic therapy (PDT) is a minimally invasive treatment that has been shown to be effective in patients with certain types of skin cancer and inflammatory dermatoses. Using appropriate photosensitizing drugs and light doses, highly reactive oxygen species lead to selective cell damage and indirectly stimulate inflammatory cell mediators (4). Recently, Nayeemuddin et al. described three cases of DSAP treated with 5aminolevulinic acid (5-ALA)-PDT, a topical phototherapy using 5-ALA as a photosensitizer, and concluded that results were disappointing (5). This work prompted us to try an alternative PDT modality in a similar case, using topical methyl aminolevulinate (MAL), a more lipophilic derivative of 5-ALA which shows improved penetration and lesional selectivity, and causes less pain during illumination (6). A 50-year-old man had a 10-year history of asymptomatic lesions on the distal part of the upper and lower extremities. His skin disease was unresponsive to etretinate, 5-fluorouracil and topical steroids. Clinical examination revealed several symmetrical, brownish-red ring-like lesions of 0.5– 1.0 cm in diameter surrounded by a hyperkeratotic border, involving the distal part of the limbs (Figure 1A). Histology from a single lesion showed

The avidin-biotin peroxidase complex (ABCPx) in skin immunoelectron microscopy

SummaryThe interaction between avidin and biotin can be exploited in immunoperoxidase techniques in three main ways: the labeled avidin-biotin technique (LAB); the bridge avidin-biotin technique (BRAB); the performed avidin-biotin complex (ABCPx). In a comparative study of these three methods and the peroxidase antiperoxidase method using serial dilutions of antinuclear positive serum, the ABCPx method yielded the most intense staining. For this reason, the ABCPx method has been applied in immunoelectron microscopy (IEM) techniques on normal and pathological skin employing monoclonal. OKT4, OKT6, and OKT8 antibodies to detect target membrane antigens. The authors notes that the ANCPx method allows strong staining both in normal and pathological skin and improves tissue preservation.

Acral persistent papular mucinosis in two sisters

We describe two young sisters with an asymptomatic papular eruption on the forearms, the clinical, histopathological and ultrastructural features of which were consistent with acral persistent papular mucinosis. Familial occurence of this uncommon disease is exceptional.

Spiny hyperkeratosis of the fingers as an unusual sign of epidermodysplasia verruciformis

6. ing collagenosis associated with diabetes mellitus. N Engl J Med 1982;306:81,-4. Prioleau PG, Varghese M. The perforating dermatoses: difficult diagnosis in dermatology. New York: Churchill Livingstone, 1988;19:359-73. Cochran RJ, Tucker SB, Wi31:55-8. Mehregan AH. Perforating dermatoses: a clinicopathologic review. Int J Dermatol 1977;16:19-22.

Scar sareoidosis associated with vitiligo, autoimmune thyroiditis and autoimmune chronic hepatitis

and genital uleeration of the disease. hut its role in the treatment of associated vasculitis is unclear. (Jur paiient had a reduction in frequeney of the episodes of mucosal uleeration and vasculitis when taking the drug, but as he did not relapse after stopping treatment, the improvement could bave been spontaneous. However, it is elear that the vasculitis responded well to oral prednisolone given in short courses for each new outbreak.

Preoperative antibiotic prophylaxis in flexural surgery of difficult contamination-prone areas of the skin: The utility of a single dose of antibiotic

The aim of this multicentre controlled study was to analyse the effect of the timing of antibiotic administration on the preoperative prophylaxis of wound infections in contamination-prone areas of the skin and to verify the utility of a single dose of prophylactic antibiotic compared with other multiple dose schemes. A total of 527 patients were surgically treated for skin neoplasms arising in contamination-prone areas. The four prophylactic programmes, to which the patients were randomly allocated, were as follows: (A) no antibacterial prophylaxis; (B) intramuscular cephazolin, 1 g every 12 h beginning 48 h prior to surgery and continuing for 48 h after surgery; (C) intramuscular cephazolin, 1 g every 12 h beginning 2 h before surgery and continuing 24 h after surgery; and (D) intramuscular cephazolin, 1 g single dose 2 h before surgery. The rate of postoperative infections was: group A 12%, group B 4.6%, group C 0.77%, group D 2.96%. Our study confirms the utility of antibiotic prophylaxis in preventio...

Morbilliform exanthem induced by imiquimod in a patient with drug-related immunosuppression

1 Bongartz T, Sutton AJ, Sweeting MJ et al. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies. Review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295: 2275–85. 2 Chakravarty EF, Michaud K, Wolfe F. Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors. J Rheumatol 2005; 32: 2130–5. 3 Askling J, Fored CM, Brandt L et al. Risk of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists. Ann Rheum Dis 2005; 64: 1421–6. 4 Fulchiero GJ, Salvaggio H, Drabick JJ et al. Eruptive latent metastatic melanomas after initiation of antitumour necrosis factor therapies. J Am Acad Dermatol 2007; 56: S65–7. 5 Lebas D, Staumont-Salle D, Solau-Gervais E et al. Cutaneous manisfestions during treatment with TNF-alpha blockers: 11 cases. Ann Dermatol Venereol 2007; 134: 337–42.