Serum and tissue CTACK/CCL27 chemokine levels in early mycosis fungoides may be correlated with disease-free survival following treatment with interferon alfa and psoralen plus ultraviolet A therapy.

BACKGROUND: Neoplastic T-cell recruitment into the skin is a critical step in the pathogenesis of mycosis fungoides (MF), and the cutaneous T-cell attracting chemokine, CTACK/CCL27, might be involved. OBJECTIVES: To investigate the clinical and prognostic significance of CTACK/CCL27 levels in patients with early-stage MF. METHODS: Serum samples and skin biopsy specimens were collected from 15 patients at the time of diagnosis and after the end of treatment with psoralen plus ultraviolet A/interferon alfa-2b combination therapy. Serum samples were also collected from 20 healthy donors as controls. CTACK/CCL27 serum levels were analysed by enzyme-linked immunosorbent assays. CTACK/CCL27 tissue expression was determined by immunohistochemistry on skin biopsy specimens taken at diagnosis and after therapy. Event-free survival was taken as the primary clinical outcome. RESULTS: In patients with MF at diagnosis, CTACK/CCL27 serum levels were not significantly different from healthy controls, whereas CTACK/CCL27 expression in the skin was increased in 87% of cases compared with normal controls. After therapy, all patients obtained a clinical complete remission, serum levels did not change significantly and tissue expression remained abnormal in 80% of patients, even if complete histological remission was recorded. Serum levels were not significantly different in cases with different intensity of cutaneous immunostaining. Eight patients experienced a relapse: the combination of high CTACK/CCL27 levels both in sera and skin increased the probability of experiencing an event at 51 months from 36% to 83%. CONCLUSIONS: Our data seem to indicate that CTACK/CCL27 levels in skin and sera after therapy might be correlated with risk of recurrence.

Clinical, power Doppler sonography and histological assessment of the psoriatic plaque: short-term monitoring in patients treated with etanercept.

BACKGROUND: To date, the diagnosis of psoriasis is based on both clinical history and physical examination, and its severity is assessed by the Psoriasis Area and Severity Index (PASI). Continuous technological advances in the field of sonography have led to the development of equipment with high power Doppler frequency, which allows for very detailed morphological information regarding the dermal blood flow. OBJECTIVES: To compare power Doppler sonography (PDS) with clinical and histological findings before and after etanercept treatment in patients with psoriasis. METHODS: Twelve patients with a clinical diagnosis of psoriasis were enrolled in this study. The PASI, PDS and histological examinations were assessed in all patients on the same day at baseline, and after 12 weeks of biological treatment. PDS examination was performed by an experienced sonographer, using a sonographic system equipped with transducer ranging from 6 to 18 MHz and Doppler frequency ranging from 7 to 14 MHz. RESULTS: At follow up there was a significant decrease in PASI. A significant change was also detected for the PDS findings (P = 0·005). At baseline the median value for factor VIII staining was 1·5, and the median value for vascular endothelial growth factor (VEGF) staining was also 1·5. At follow up there was a significant decrease in both factor VIII and VEGF staining scores. Moreover, a positive correlation between reduction in PDS score and improvement in clinical and histological scores was found: Spearman's ρ = 0·639, P = 0·0022; Spearman's ρ = 0·619, P = 0·0013; Spearman's ρ = 0·765, P = 0·0002, respectively. CONCLUSIONS: Our results show a significant correlation between PDS findings and both PASI and histological degree of vascularization before and after etanercept treatment. These data provide evidence in favour of the validity of PDS in the assessment of dermal perfusional changes in patients with psoriatic plaques.

Bullous SLE: response to methotrexate and relationship with disease activity.

We report on a case of 40-year-old female with systemic lupus erythematosus (SLE) who developed a severe bullous eruption on sun-exposed areas. The bullous manifestation was associated with a flare of lupus serologies, whereas the previous manifestations of the disease were quiescent. Due to prior intolerance to many drugs, she was given oral methotrexate (10 mg/week). The drug administration was followed by a rapid and full resolution of cutaneous lesions. Five months later she developed a class III lupus nephritis. Our case is the first report of efficacy of methotrexate in bullous SLE and rises the question of the relationship between bullous eruption and SLE activity.

Low dose interferon-alpha2b combined with PUVA is an effective treatment of early stage mycosis fungoides: results of a multicenter study. Cutaneous-T Cell Lymphoma Multicenter Study Group.

BACKGROUND AND OBJECTIVE: The early stages of mycosis fungoides (MF) can be treated but not cured by photochemotherapy (PUVA) alone; some recent studies of the effect of a combination of human interferon-alpha (IFN(alpha)) and PUVA reported a high degree of response. The aim of our study was to evaluate the activity of a low dose of IFN-alpha2b combined with PUVA. DESIGN AND METHODS: Twenty-five patients were included: 16 men and 9 women aged between 23-80 years; 19 patients ahd stage I and 6 stage II disease. In the induction phase, the dose of IFNalpha was gradually raised over 6-8 weeks to the target dose of 18 MU/week; in the maintenance phase, the combination with PUVA allowed IFNalpha to be reduced to a maximum dose of 6 MU/week; in this way the cumulative administration of IFNalpha and PUVA was considerably lower than in similar combination protocols. Treatment success was analyzed in terms of freedom from treatment failure (FFTF). RESULTS: After the induction phase 9/25 patients (36%) achieved complete remission (CR) and 15/25 (56%) achieved partial remission (PR). One to five months from the beginning of the maintenance phase, a CR was recorded in 19/25 patients (76%) and a PR in 5/25 patients (20%) accounting for an overall response rate of 96%. The median of FFTF was not reached; probability of FFTF was 82% at 12 months and 62% at 24 months. Disease free survival projected to 48 months was 75%. INTERPRETATION AND CONCLUSIONS: Even with low doses of IFNalpha plus PUVA it is possible to achieve excellent clinical responses,many of which are long-lasting, in patients with early MF.

Skin metastases from prostate cancer associated with malignant melanoma.

A 66-year-old man, admitted to the hospital for prostatic carcinoma, presented with a nodular lesion located on the presternal region and a small nodule (0.5 cm in diameter) simulating a scalp sebaceous cyst located on the scalp. Moreover, an irregular darkbrown lesion was observed on the left side of the abdomen, and a brownish macula was also present on the presternal region. Histologic examination of the two nodular lesions revealed cutaneous metastases from prostatic carcinoma. The pigmented lesion, localized on the abdomen, proved to be a superficial spreading melanoma with a maximal depth of 1.36 mm. Histologic examination of the brownish lesion on the presternal region revealed nevus cell nests within the epidermis and in the dermis. We discuss the propensity of developing a secondary cancer in a patient with a primary malignancy.

Prevalence of dermatophytes and yeasts (Candida spp., Malassezia furfur) in HIV patients. A study of former drug addicts.

The prevalence of dermatophytes and yeasts (Candida spp. and Pityrosporum spp.) was studied in 40 former drug-addicts, all of whom were HIV seropositive but otherwise had no other symptoms (2nd Stage CDC Atlanta, 1987). We considered 7 skin areas for dermatophytes and Pityrosporum spp. (scalp, forehead, nose, back, chest, groin, toe webs) and the mouth for yeasts. Dermatophytes were found in 8 (20%) and tinea pedis was the most common dermatophytosis: Tricophyton rubrum was the fungus most frequently isolated (6 cases or 15%). The HIV+ group showed almost the same rate of dermatophytes colonisation compared to a group of 121 athletes and to the control group. Candida spp. was present in 27 cases (67.5%) but clinical oral lesions were evident only in 5 patients (12.5%). Statistically significant differences were found in the presence of Candida spp. in HIV patients and controls (p less than 0.05). The lipophilic yeast Pityrosporum ovale was evaluated with quantitative and qualitative methods. Quantitative variations were evident between HIV patients and controls. P. ovale was present in 10 cases: 3 (7.5%) of them showed dischromic lesions while in 7 cases (17.5%) no clinical symptoms were evident.

[Dermatomycoses observed at the Dermatologic Clinic, Pavia University. 2) Pathology of Microsporum gypseum]. / Rilievi sulle dermatomicosi osservate nella Clinica Dermatologica, Università di Pavia. 2) Patologia da "Microsporum gypseum".

Microsporum gypseum infections are 0.4% of 4900 suspected dermatomycoses examined with direct microscopic exam and culture on Lactrimel medium or D.T.M. This geophilic dermatophyte was isolated in 20 cases (1.5% of all dermatophytes). More frequently M. gypseum caused tinea corporis (13 cases: 65%) and rarely tinea capitis (2 cases: 10%), tinea faciei (2 cases), tinea manus (2 cases) and tinea cruris (1 case). Both sexes are equally affected. Direct microscopic exam was negative in 2 cases. This dermatophyte was more frequently isolated during the summer and fall. Finally M. gypseum was not isolated in tinea pedis and tinea unguium.

[Efficacy of fenticonazole in patients with pityriasis versicolor]. / Studio dell'efficacia del fenticonazolo su pazienti affetti da Pityriasis versicolor.

Thirty patients suffering from Pityriasis versicolor were treated with fenticonazole in cream or lotion form with two applications a day. At microscopy, Malassezia furfur was encountered in 25 cases and Pityrosporum orbiculare in 5. Disappearance of the yeast was obtained on average in 2 weeks of treatment. Measurement of sebum content with a Sebumeter apparatus did not reveal significant difference (p greater than 0.05) between patients suffering from Pityriasis versicolor and controls and in treated patients, in the course of topical therapy.

[Psoriasis-pemphigoid association. Description of a case]. / Associazione psoriasi-pemfigoide. Descrizione di un caso.

The paper describes a case of an 85-year-old woman affected by psoriasis for 30 years who developed bullous pemphigoid after UVB treatment. Immunological and histological findings were typical of bullous pemphigoid cell-poor type. Bullous eruptions cleared following combined therapy with betamethasone and azathioprine. The literature on the subject and pathogenetic hypotheses for this unusual association are discussed.

[Findings on dermatomycoses observed at the Dermatologic Clinic, University of Pavia. A third pathology caused by Trichophyton rubrum]. / Rilievi sulle dermatomicosi osservate nella Clinica Dermatologica, Università di Pavia. 3 degrees patologia da "Tricophyton rubrum".

From 1974 to 1988 T. rubrum have been isolated in 304 cases (27.8% of dermatophytes) in the Department of Dermatology in Pavia and it is the second most frequent fungus after M. canis. Males are more frequently affected (61.1%) than females (38.9%). A single localization was found in 82.2% of the cases and two or more types of "Tineae" only in 17.8%. The age-group 31-40 is more frequently affected (29%). The most frequent dermatophytosis caused by T. rubrum was Tinea pedis (33.9%) while Tinea capitis resulted a very rare localization (2.1%). An increase of T. rubrum infections is noted particularly in the last years.

Pityriasis versicolor in the aged: a clinical investigation and epidemiological survey in 190 elderly hospitalized patients.

190 subjects over 60 yrs of age, hospitalized for long stays were checked for scaling and hyperpigmented patches of P. versicolor. 20 patients (10.5%) showed no clinical lesions; 170 patients (89.5%) showed scaling and/or hyperpigmented patches of which 13 patients (6.8%) on direct microscopic exam showed hyphae and yeasts of M. furfur, 64 (33.6%) only globular forms of P. orbiculare and 113 cases (59.4%) showed no fungal elements. Wood's light examination showed that 38 subjects (20%) were 6 positive for M. furfur and 23 for P. orbiculare while in the other 9 no fungal elements were observed on microscopic exam. Whereas 48/132 patients negative to Wood's light were positive for yeasts on microscopic exam (false negative). This study indicates that P. versicolor is not rare in the elderly and that Wood's light examination is not diagnostic. There was no relationship between P. versicolor and underlying illness.

Superficial mycoses observed at the Department of Dermatology of the University of Pavia. A 13-year survey.

Over a period of 13 years, 4,100 specimens were cultured for fungi. Pityriasis versicolor (Malassezia furfur) was demonstrated in 17.6%, dermatophytosis in 34.6% and candidiasis in 10.8%. The most frequently isolated strains were M. canis (31.5%), T. rubrum (26.3%), E. floccosum (19.7%), T. mentagrophytes (19.3%) for the dermatophytes and C. albicans (88.9%). Those rarely seen were: M. gypseum, T. violaceum, M. audouini, T. schoenleinii. We observed the absolutely complementary results of the microscopic examinations and the cultures of the specimens.