A comparative study on the efficacy of treatment with 585 nm pulsed dye laser and ultraviolet B-TL01 in plaque type psoriasis.

BACKGROUND: Narrow-band ultraviolet-B and pulsed dye laser (PDL) affect psoriasis but via different pathways. OBJECTIVE: To compare the results of PDL with ultraviolet-B light therapy (UVB) and to look for synergism of both therapies in patients with plaque type psoriasis. METHODS: In each eligible individual, four similar target plaques were selected, and halves of these plaques were treated using PDL, UVB, or a combination of PDL and UVB or were not treated. Results were recorded single-blind using the Physician's Global Assessment score at study enrolment and Week 13. Nonparametric, paired statistical tests were used to test for differences within and between therapies.The results were also analyzed after dichotomization of the changes in the Physician's Global Assessment score into responsive and nonresponsive to treatment. RESULTS: A significant improvement of the psoriasis lesions was noted at Week 13 (P<.001) with each therapy. No significant differences were noted between the therapies. Synergism of PDL and UVB was not observed. CONCLUSIONS: PDL is safe for treating plaque type psoriasis, but its efficacy is limited to a subgroup of patients. Combining PDL with UVB has no additional benefit.

Correlation between the static and dynamic stiffness indices of medical elastic compression stockings.

BACKGROUND: Compression therapy with medical elastic compression stockings (MECS) has been used effectively for treating patients with chronic venous insufficiency for many years. OBJECTIVE: To study the correlation between static stiffness and the dynamic stiffness index of 18 different brands of MECS. METHODS: In all, 18 different brands of MECS were divided into 5 categories (class II round-knit, class II flat-knit, class III round-knit, class III flat-knit, and class IV flat-knit) and tested. The tension of the textile of the MECS at the B1 level was measured according to the Institut de Textile France method to calculate the static stiffness index. The dynamic pressure pulsations were measured with a newly developed dynamic pressure-determining device to calculate the dynamic stiffness index. RESULTS: The results showed that there was a positive correlation between the static stiffness index and the dynamic stiffness index. The dynamic stiffness indices were higher than the static stiffness indices. CONCLUSION: Although the stiffness of MECS is a further refinement to the current classification, which classifies MECS according to the pressure they exert at the B level, the dynamic stiffness index does not have any additional value over the static stiffness index as far as the classification of MECS is concerned. Either or both of these characteristics should be used to select the most suitable MECS for the patient.

Efficacy of 25% diluted fluticasone propionate 0.05% cream as wet-wrap treatment in cutaneous mastocytosis.

BACKGROUND: Mastocytosis is a disorder that can be subdivided into two forms: cutaneous and systemic. Patients with cutaneous mastocytosis only may suffer from cosmetic problems. Topical steroid application has been shown to be effective in cases of limited skin lesions. METHODS: A case-controlled pilot study was conducted during a 6-weeks treatment using diluted 25% fluticasone propionate 0.05% cream under wet-wrap occlusion in 5 adults and 6 children. Improvement was measured up to the 24th week after treatment using the SCORMA Index. RESULTS: The results of this pilot study showed a partial but clear cosmetic improvement in 9 of the 11 patients. The mean SCORMA Index decreased after treatment from 38 to 26. CONCLUSION: 25% dilution of fluticasone propionate 0.05% cream under wet-wrap occlusion is an alternative treatment modality for alleviating the symptoms of cutaneous mastocytosis, but the improvement may be moderate and fall short of the patient's expectations.

Concomitant treatment of psoriasis of the hands and feet with pulsed dye laser and topical calcipotriol, salicylic acid, or both: a prospective open study in 41 patients.

BACKGROUND: Psoriasis of the hands and feet is a chronic disease which is often resistant to the usual topical therapies. It has considerable morbidity and seriously affects the quality of life of patients. OBJECTIVE: We sought to prospectively evaluate the efficacy and safety of pulsed dye laser (PDL) treatment of psoriasis of the hands and feet. METHODS: In all, 41 patients with therapy-resistant psoriasis of the hands and feet were treated once every 4 to 6 weeks with PDL at 585-nm wavelength, 450-microsecond pulse duration, 7-mm spot diameter, and 5- to 6.5-J/cm2 fluence. Calcipotriol ointment and salicylic acid 5% to 10% ointment were used as keratolytic agents. Treatment efficacy was evaluated by blinded comparison of photographs of the lesions taken before and after PDL treatment in each patient. RESULTS: A good to very good improvement in the lesions was observed in 76% of the patients after treatment. An average duration of remission was 11 months. Side effects were transient purpura, moderate discomfort during the treatment, transient hyperpigmentation or hypopigmentation, and incidental transient crustae. LIMITATIONS: This was an open prospective study with a limited number of patients who were concomitantly treated with calcipotriol and salicylic acid ointment. Patients with photointolerance, on medication with phototoxic or photoallergic drugs, and with widespread psoriasis were excluded. CONCLUSIONS: Concomitant treatment with PDL and topical calcipotriol, salicylic acid, or both was a satisfactory modality for treating psoriasis of the hands and feet. There was a subjective improvement in the symptoms and quality of life in all patients.

Calculating the pressure and the stiffness in three different categories of class II medical elastic compression stockings.

BACKGROUND: Medical elastic compression stockings (MECSs) are currently classified according to the pressure they exert at the ankle at the point of its minimum girth (B level). Despite this classification, there are considerable differences between MECSs belonging to the same compression class from the same manufacturers and between different manufacturers. This makes it difficult for the clinician to choose the most suitable MECS for the patient. The stiffness may be used to distinguish between MECSs of different brands. OBJECTIVE: To calculate the pressure and the stiffness at the B level in three categories of class II MECSs from nine different brands. METHODS: Nine different brands of class II MECSs that were divided into three categories (flat-knitted custom-made, classic round-knitted ready-made, and modern (ultrathin) round-knitted ready-made) were tested. The tension of the textile of the MECSs was measured with the Instron tester (Instron International Ltd., Edegem, Belgium). The pressures and stiffness at the B level were calculated. RESULTS: The pressures exerted by flat-knitted custom-made MECSs were higher than those exerted by the ready-made round-knitted MECSs. Surprisingly, the former showed higher pressures than those published by the European Committee for Standardization. A wide range of stiffness was observed within the different brands and within the three different categories of MECS. CONCLUSION: Despite their assignment to compression class II, all nine brands of MECSs that were tested had widely ranging stiffness. This would indicate that the stiffness is an additional important characteristic for distinguishing between MECSs from different brands, which should be taken into account by the clinician in selecting the most suitable MECSs for the patient.

A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment.

Treatment of symptomatic oral lichen planus remains a challenging problem. This study compared the efficacy of topical tacrolimus ointment with triamcinolone acetonide ointment in patients with oral lichen planus. Twenty patients (group I) were treated with topical tacrolimus 0.1% ointment 4 times daily, and 20 (group II) were treated with triamcinolone acetonide 0.1% ointment 4 times daily. The clinical effect was graded after 6 weeks. In group I, 6 patients healed, 12 showed improvement and 2 showed no improvement. In group II, 2 patients healed, 7 improved and 11 showed no improvement. The most commonly reported side-effect in both groups was temporary burning or stinging at the site of application. Unfortunately, oral lesions recurred within 3-9 weeks of cessation of treatment in 13 of the 18 patients who had initially shown an improvement or were healed in group I and in 7 of the 9 patients in group II. Topical tacrolimus 0.1% ointment induced a better initial therapeutic response than triamcinolone acetonide 0.1% ointment. However, relapses occurred frequently within 3-9 weeks of the cessation of treatment.

Premalignant nature of oral lichen planus.

The issue as to whether oral lichen planus is a premalignant disorder is still controversial. This study aimed to examine oral malignancies associated with oral lichen planus and to investigate whether oral lichen planus has an intrinsic malignant potential or whether there are also contributing external risk factors. A retrospective cohort study in 200 Caucasian patients with oral lichen planus was conducted between 1991 and 2003. Aspects such as sex, age, clinical variant, affected anatomical sites, duration of the disease, histopathology, prior immunosuppressive treatment, exposure to potential carcinogens and other concomitant diseases were examined. Histopathological examination was repeated during the follow-up if a malignancy was suspected. Three (1.5%) of the 200 patients developed an oral squamous cell carcinoma at the same site following the initial diagnosis of oral lichen planus after a period of 3-6 years (mean 4.3 years). Contributing external risk factors were also noted in two of the three patients (smoking for 20 years and systemic immunosuppressive treatment for 2 years). The exact incidence of malignant transformation is difficult to establish, because of the low number of patients and because of the possible contribution of external risk factors, which may be relevant in oral malignancy.

Oral lichen planus in childhood.

Oral lichen planus is rare in childhood, and only a few reports on this subject have appeared in the literature. Our objective was to report individual cases of oral lichen planus in childhood from our practice and to review the literature on this subject. We recruited patients younger than 18 years with oral lichen planus and documented several clinical aspects, the histopathology, patch tests, and blood examination findings. Three patients from about 10,000 dermatology patients younger than 18 years seen from 1994 to 2003 were included. Of these three, an Asian girl aged 11 years had an asymptomatic, hyperkeratotic variant of oral lichen planus, which disappeared without any treatment after 1 year. An Asian boy aged 16 years had an erosive oral lichen planus with severe pain, which healed after intensive local and systemic treatment in 2 years. A Caucasian girl aged 14 years had a hyperkeratotic variant with a little soreness, which disappeared with local treatment after 3 months. Our findings indicated that oral lichen planus in childhood is rare and therefore at present it is not possible to draw firm conclusions considering its nature and etiology. Oral lichen planus in childhood seems to occur preferentially in those of Asian race. The clinical features resemble those of oral lichen planus in adults. However, generally the prognosis of oral lichen planus in childhood seems to be more favorable than in adults.

Deteccao de determinantes antigenicos compartilhados entre a proteina de choque termico 65 do Mycobacterium leprae e proteina de choque termico 60 humana / Detection of shared antigenic determinantes between Mycobacterium leprae heat shock protein 65 and human heat shock protein 60

Nestes estudos foram investigados se o Mycobacterium leprae (M. leprae) e o homem compartilham determinantes antigenicos que podem estar localizados nas Proteinas de Choque Termico (HSPs) e que podem ser responsaveis pela destruicao tecidual. Usando-se tecnica de coloracao unica pela imunoperoxidase em cortes feitos com criostato, observaram-se tres anticorpos que eram dirigidos contra HSP-60 (anticorpos policlonais SPA-804, SP-805 e o anticorpo monoclonal SPA-807, que provavelmente reagiram especificamente com macrofagos e celular epitelioides em biopsia cutaneas de pacientes com hanseniase. No Western Blot foi observado que todos os anticorpos contra HSP-60 humana a anticorpos monoclonais (MoAbs) contra HSP-65 do M. leprae (F47-10, F67-18, F88-1) reagiram intensamente com as proteinas do M. leprae sonicado com peso molecular de 65 kDa, indicando semelhanca de alguns determinantes antigenicos entre HSP-60 humana e HSP-65 do M. leprae. Subsequentemente, um estudo imunohistoquimico comparativo dos padroes de coloracao de anticorpos contra HSP-60 humana e anticorpos contra HSP-65 do M. leprae, usando cortes cutaneos feito em criostato de hanseniase paucibacilar (PB), multibacilar (MB) e outras doencas granulomatosas, revelaram que os MoAbs F47-10 e F67-18 reagiram somente fracamente com os granulomas em hanseniase PB e em outras doencas granulomatosas cutaneas, mas coravam o granuloma da hanseniase MB intensamente. O MoAb F88-1 e os anticorpos policlonais SPA-804, SPA-805 e o MoAb SPA 807 coraram os granulomas dos pacientes PB e de outros doencas cutaneas granulomatosas com a mesma intensidade daquela nos pacientes MB. Utilizando-se uma tecnica de dupla coloracao, observou-se que os determinantes antigenicos reconhecidos pelo MoAb contra HSP-60 humana (SPA-807) e os MoBbs contra a HSP-65 do M. leprae (F67-18, F47-10, F88-1) estavam, na maioria das vezes, localizados nos macrofagos. Esses achados nao contradizem nossa hipotese de que semelhancas entre determinantes antigenicos nas HSPs no M. leprae e no hospedeiro humano podem ser, no minimo em parte, responsaveis pela inducao de uma reacao autoimune na hanseniase causando formacao de granuloma com subsequente dano tecidual. Os resultados deste estudo tambem indicaram que alguns destes determinantes estao provavelmente localizados na HSP-60. Uma explicacao similar possivelmente se aplique aos achados em...

Detection of shared antigenic determinants between Mycobacterium leprae heat shock protein 65 and human heat shock protein 60

In these studies, it was investigated whether M. leprae and man share antigenic determinants which may be located on Heat Shock Proteins (HSPs), and which may be responsible for tissue destruction. Using immunoperoxidase single-staining technique on cryostat sections it was observed that three antibodies which are directed against HSP 60 (polyclonal antibodies SPA 804 and SPA 805 and monoclonal antibody SPA 807) probably reacted specifically with macrophages and epitheloid cells in leprosy skin sections. On Western Blotting, it was observed that the antibodies againts human HSP 60 nomoclonal antibodies (MoAbs) against M. leprae HSP 65 (F 47-10, F 67-18, F 88-1) all reacted strongly with sonicated M. leprae proteins with a molecular mass of 65 kDa undicating similarity of some antigenic determinants between human HSP 60 and M. leprae HSP 65. Subsequently, a comparative immunohistochemical study of the staining patterns of antibodies against human HSP 60 and antibodies against M. leprae HSP 65 using cryostat skin section of paucibacillary (PB) leprosy multibacillary (MB) leprosy and other granulomatous skin disorders revealed that the MoAbs F 47-10 and F 67-18 reacted only weakly with the granulomas in PB leprosy and in other granulomatous skin diseases, but stained MB leprosy granuloma strongly. The MoAb F 88-1 and the polyclonal antibodies SPA 804, SPA 805 and the MoAb SPA 807 stained granulomas of PB patients and of other granulomatous skin disorders with the same intensity as that MB patients. Using a double-staining technique, it was observed that the antigenic determinants recognized by the MoAb against human HSP 60 (SPA 807) and the MoAbs against M. leprae HSP 65 (F 67-18, F 47-10, F 88-1) were mostly located in the macrophages. These findings do not contradict our suggestion, Heath Shock Proteins of M. leprae and the human host may be at least in part responsible for the induction of an autoimmune reaction causing granuloma formation with subsequent tissue damage in leprosy. The results of this study also indicated that some of these determinats are probably located on HSP 60. A similar explanation possibly applies to the findings in the other granulomatous disease e.g. sarcoidosis probably micobacterial induced and necrobiosis lipoidica related to diabetis, in which antigenic similarities between bacterial HSP 65 and human HSP 60 are considered to play a part.

Environmental mycobacteria may induce recognition of auto-antigens: circumstantial evidence using maternal and cord blood

Background: It was assumed that the recognition of auto-antigens induced by environmental and infective micro-organisms may be involved in the clinical presentation of leprosy and a number of auto-imune diseases. Methodes: Serum antibodies to epidermal antigens in the blood of 21 healthy mothers and in the cordblood of their new-bor were compared using immunoblotting before and after absortion of the sera with mycobacteria (M. marinum, M. tuberculosis, M. kansaii). Results: Sera of the mothers caontained a higher antibody titre than that of their rspective babies. The pattern of bands for IgG was the same, for IgM the sera of 14 mothers showed more bandsthan that of their off-spring. Absorption with the mycobacteria, especially M. tuberculosis resulted in the partial or total disappearance of some bands. Conclusion: The results of this study provide some supportive evidence for the above-mentioned assumption. The observation that M. tuberculosis was the most effective in the absorption experiment may be because of the BCG vaccination all the mothers had received in infancy