Psoriatic microangiopathy modifications induced by PUVA and etretinate therapy. A nail-fold capillary microscopic study.

Histological and capillaroscopy alterations of capillary circulation in psoriasis are well known: the most common of them are the increase of "minor dystrophies", the higher haematic flux in the psoriatic plaques and the abnormal visibility of the venous subpapillary plexus (in arthropathic less than 65-year-old patients). The predisposition of psoriatic patients to a vascular damage has often been stressed in literature. In the present study, we have evaluated the effects of systemic etretinate or PUVA therapy on capillary functions. We examined the nail-folds of 30 patients (ranging 15-64 years) affected by diffuse psoriasis for less than three years. This study has been performed by using a Leitz capillary microscopy. We evaluated the percentage of capillary minor dystrophies (type I-IV) and the flow rate before and after 1 month of treatment. These parameters were assessed by means of a 1-4 rating scale. Our results underline that a significant percentage of 1st type dystrophies is a prognostic rather than a diagnostic parameter in the capillaroscopic evaluation of psoriasis.

[Lymphadenosis benigna cutis of the mammary areola: Lyme borreliosis?]. / Lymphadenosis benigna cutis dell'areola mammaria: borreliosi di Lyme?

This lesion began two months after a tick bite on the left breast, occurring during a trip in Karst (highland behind the city of Trieste). This area represents an ecological shell for Ixodes ricinus, hard tick often infested with Borrelia burgdorferi, the aetiological agent of Lyme disease. Some days after tick-bite, the patient developed a typical ECM of the left breast; this lesion resolved in two months. Shortly after, an erythematous, infiltrated nodule appeared on the left areola; ist size was about two cm. Histological diagnosis confirmed that the lesion was a LABC; the lymphocytic infiltrate consisted in a large number of B cell (detected with monoclonal antibodies). Indirect immunofluorescence for Borrelia burgdorferi (after absorption with Treponema phagedenis) was positive (titre 1/128-IgG). The lesion was treated with doxycycline, 200 mg/day per os for two weeks. The lesion cleared up three months after the end of therapy. Till today (two year thereafter), the patient didn't present with local or general signs of Lyme borreliosis; furthermore the serological test for Borrelia burgdorferi became negative.