IgE in the serum and on mast cells in bullous pemphigoid.

In 25 patients with bullous pemphigoid, the presence of IgE on the epidermal basement membrane (BM) and the cell membrane of mast cells was investigated by immunofluorescence microscopy. In four cases, a linear staining of the BM was found. Strongly positive fluorescence of the mast cells was found in seven cases; in seven others there was weakly positive staining. The positive staining of mast cells seemed to be related to the serum IgE level. The IgE levels in the serum samples of 30 patients were determined by the immunoradiometric assay. In 11 cases, elevated levels (greater than 400 IU/mL) were found. Circulating IgE anti-BM antibodies could be demonstrated in one of 15 serum samples by indirect immunofluorescence. Our results do not indicate that IgE-mediated mechanisms play an important role in the pathogenesis of bullous pemphigoid.

The effect of occlusion of the skin with transdermal therapeutic system on Langerhans' cells and the induction of skin irritation.

Sensitization to drugs in transdermal therapeutic systems is a common unwanted event. We investigated whether prolonged occlusion of the skin causes skin irritation, and in this way might play a role in the possible induction of sensitization to drugs from these systems. Occlusion was effected with a placebo transdermal therapeutic system and silver-patch test in a time span ranging from eight hours to seven days in five groups of five volunteers. Skin irritation was judged on clinical aspects, histopathologic and immunofluorescence findings, and changes in the Langerhans' cell systems. The results indicate that occlusion with the systems used in this experiment provokes only slight or no skin irritation.

Bullous pemphigoid and epidermolysis bullosa acquisita. Differentiation by fluorescence overlay antigen mapping.

BACKGROUND AND DESIGN: From previous studies, we concluded that the fluorescence overlay antigen mapping (FOAM) technique could be of value to the differential diagnosis of the acquired subepidermal bullous skin disorders, bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). In these diseases, ultrastructural identification of the site of skin-bound IgG deposits at the epidermal basement membrane zone (EBMZ) may be essential to the correct diagnosis. Since ultrastructural studies are more expensive, time-consuming, and less widely available than immunofluorescence, we addressed the question of whether the FOAM technique can reliably identify the site of IgG deposits at the EBMZ, and distinguish BP from EBA. For this purpose, the technique was applied to perilesional skin from seven patients with BP and six with EBA, using computer-aided imaging of red-stained type VII collagen and green-stained IgG, according to previous findings. RESULTS: Digitized multicolor FOAM images of perilesional skin from patients with BP showed nonoverlap band patterns of green-stained lamina lucida IgG deposits (ultrastructurally proven) and red-stained type VII collagen. By contrast, FOAM images of EBA skin typically showed overlap patterns of green-stained sublamina densa IgG deposits and red-stained type VII collagen. These findings were observed also in skin tissue stored in Michel's transport medium or stored frozen for 15 years. CONCLUSIONS: The computer-aided FOAM technique may have great potential in distinguishing between IgG deposits above (BP) and just below (EBA) the lamina densa of the EBMZ in skin tissue. The technique is not as simple as saline-split skin methodology but offers more flexibility, and it certainly is quicker and less expensive than electron microscopy. Furthermore, the use of digitized fluorescence images offers improved possibilities for evaluating the various "linear" patterns of immune reactant deposition at the EBMZ in subepidermal bullous autoimmune skin diseases.

Paraneoplastic pemphigus as the presenting symptom of a lymphoma of the tongue.

A patient is described who initially presented with an acrovesicular eczema which subsequently developed into erythema multiforme with histopathological features of bullous pemphigoid. Although the various laboratory studies pointed to the diagnosis of paraneoplastic pemphigus (PNP), the underlying neoplasm was not detected until 6 months later, when the biopsies of an oral lesion showed the presence of an underlying non-Hodgkin lymphoma.

Paraneoplastic pemphigus caused by an epithelioid leiomyosarcoma and associated with fatal respiratory failure.

A patient is described who initially presented with pemphigus vulgaris, limited to the oral cavity, and weight loss. Although the various laboratory studies pointed to the diagnosis of paraneoplastic pemphigus (PNP), the underlying neoplasm was not detected until 6 months later, when the patient developed shortness of breath and routine physical examination on admission revealed an abdominal mass, which eventually was proven to be an epithelioid leiomyosarcoma. In spite of radical excision of the tumour and intensive treatment of the dyspnoea, the patient died of respiratory failure 19 months after the PNP had been diagnosed. Early diagnosis of PNP is stressed to possibly prevent fatal pulmonary involvement.

Quality of life and maladjustment associated with hair loss in women with alopecia androgenetica.

Quality of life and maladjustment related to hair loss were studied by means of a standardized interview in a group of 58 women with alopecia androgenetica who applied for treatment at the Department of Dermatology. The hair loss was found to have a negative influence on the quality of life on the majority of them. In 88%, hair loss had negative effects on their daily life; in about 75%, the hair problems were manifested in negative self-esteem and about 50% experienced social problems. General psychosocial maladjustment in relation to hair loss was indicated in almost one-third of the women.

Allergic reactions, "spillover' reactions, and T-cell subsets.

A strong positive, allergic patch-test reaction was elicited in 15 patients with an established allergy for a particular allergen. Patches with a marginally irritating concentration of sodium lauryl sulfate (SLS) were applied at fixed distances. The SLS patch situated adjacent to the allergic reaction was significantly enhanced in 12 of 15 patients (P less than 0.01) compared to more distant SLS reactions ("spillover'). Only quantitative differences were observed in the histologic pictures of the different types of reaction. The infiltrate consisted of lymphocytes and histiocytes, mainly located perivascular in the upper dermis. T-cell subsets were assessed with monoclonal antibodies using an immunoperoxidase technique. The distribution of the different T cells was the same for both reaction types. T cells located outside the perivascular infiltrates (e.g., in the epidermal vesicles) were OKT-8-positive (cytotoxic/suppressor T lymphocytes). Immunofluorescence examination did not show different patterns for the allergic or "enhanced toxic' reactions with regard to the presence of immunoglobulins and complement. The "spillover' phenomenon may cause false-positive patch-test reactions.

The expression of interleukin-8 receptor in untreated and treated psoriasis.

The expression of IL-8 in psoriasis has been clearly shown with the use of immunocytochemical, RT-PCR and in situ hybridization methods. The presence of its ligand, the IL-8 receptor, has been demonstrated by the RT-PCR technique. We report here a study of the expression of both IL-8 type A and B receptors by immunohistochemical techniques, using one polyclonal and four monoclonal antibodies. By this technique, we found that the neutrophilic granulocytes express the IL-8 type A receptor, whereas the IL-8 type B receptor was present on the keratinocytes. The type B receptor on the keratinocytes was localized in the suprabasal layers of the epidermis. Following therapy, the expression of the IL-8 type B receptor on the keratinocytes was reduced. This could suggest that IL-8 in psoriasis is involved in the disturbed differentiation rather than in proliferation, probably via an autocrine loop.

[Drug induced alopecia]. / Haaruitval door gebruik van geneesmiddelen.

Hairs are produced in hair follicles that have a cyclic activity. The cycles that normal hair follicles go through are the metabolically active anagen phase, the catagen transitional phase and the resting telogen phase. Loss of more than 120 hairs daily is called alopecia. Drugs typically cause a diffuse, reversible alopecia by influencing one of the cycles that hair follicles go through. Because hair loss can have many causes, a causal relationship between a suspected drug and hair loss may be hard to prove. The principal categories of drugs that may cause alopecia listed in the literature are cytostatics, anticoagulants, interferons, tretinoid derivatives and lithium carbonate. The Netherlands Pharmacovigilance Foundation LAREB has received reports of alopecia as side effect of antimalarials, beta-receptor blocking agents, sex hormones, ACE inhibitors, angiotensin II antagonists and anticoagulants.

[Diagnosis of dermatomycoses using the sellotape-KOH method]. / Diagnostiek van dermatomycosen door middel van de sellotape-KOH-methode.

In a group of 84 adult male workers in an industrial plant, who used a common shower room, the applicability of the adhesive tape-KOH technique for routine mycologic examination was investigated. The tape technique was compared with the conventional cover slip technique in interdigital and plantar lesions. The tape technique gave more frequent positive results than the cover slip technique (74% and 57% respectively). However, examination of the tapes was more difficult than that of the cover slips. The latter method therefore appears more appropriate for routine microscopical mycologic examination.

[Acute hemorrhagic edema of childhood and its differentiation from Schoenlein-Henoch purpura]. / Acuut hemorragisch oedeem van de kinderleeftijd en het onderscheid met Henoch-Schönlein-purpura.

In two young patients with an elevated temperature, a girl aged 6 months and a boy aged 10 months, purpura and oedema were noticed on the face, ears, arms and legs. On one occasion the boy lost blood anally. A histopathological examination revealed leucocytoclastic vasculitis with fibrin deposits. The diagnosis was 'acute haemorrhagic oedema of infancy' (AHOI), a relatively unknown variant of palpable purpura due to leucocytoclastic vasculitis affecting infants and young children (up to two years of age). AHOI is characterised clinically by marked oedema and fever as well as large palpable purpuric and ecchymotic skin lesions in a target-like pattern mainly on the face, ears and extremities. The skin lesions heal spontaneously within one to three weeks and internal organs are rarely affected. This is in contrast to Henoch-Schönlein purpura, which was observed in a 5-year old boy suffering from similar skin lesions on the legs as well as painful joints, in whom IgA deposits were found in the vasculitis. Henoch-Schönlein purpura is clinically characterised by palpable purpura on the extensor surfaces of the legs and on the buttocks, whereas in AHOI larger purpura and ecchymoses are found on the face, ankles and wrists, with far more extensive oedema. There are also histological differences: in AHOI there is more extensive vasculitis with fibrin deposits and IgA deposits are seen in a minority of cases. Awareness of this relatively unknown form of leucocytoclastic vasculitis will assist in making an early diagnosis possible, thereby avoiding unnecessary treatment and concern.

[Oral lichen planus: an overview]. / Lichen planus van het mondslijmvlies. Een overzicht.

Lichen planus is a mucocutaneous disease of unknown etiology. There is a great difference between the course of lichen planus of oral mucosa and that of the skin. Some authors consider oral lichen planus a premalignant condition. Whether this is true still remains to be settled. The dentist is advised to discuss a patient with oral lichen planus with the oral and maxillofacial surgeon, both with regard to the establishment of the diagnosis and the possible treatment and follow-up.