Sweat gland function in dermatophytosis.

In 54 cases of dermatophytosis, sweat gland disturbances and their possible mechanisms were studied. The basic perspiratory malfunction was intense hypohidrosis, with some hyperhidrotic phenomena being observed at particular points of the exanthem (margin and disc) in a few cases. It is worth noting that in 51.85% of the cases, hypohidrotic phenomena were also observed in areas of normal skin adjacent to the lesions. One of the most important forms of perspiratory disturbances was the closure of sweat ducts at the keratin level. The inflammatory process in the dermis may also affect gland function. Finally, there is a discussion of the significance of perspiratory disturbances in relation to special aspects of the disease.

Immunological study of keratoacanthomas.

Twelve patients with keratoacanthoma were studied to assess the role and importance of immunological factors in tumor regression. Direct immunofluorescence was determined with immunoglobulins, complement (C3), and fibrin to estimate the deposition of these factors in the lesion area. Indirect immunofluorescence was also undertaken using pemphigus and bullous pemphigoid sera against the keratoacanthoma lesion to study the presence or absence of tissue-specific antigens (T.S.A.) in intercellular substance and basement membrane. Finally, the cell-mediated immunity was studied using two in vitro parameters: (a) The estimation of T-lymphocytes through the formation of E-rosettes and (b) the estimation of the leukocyte migration inhibition factor (LIF). Our findings show that specific humoral immune mechanisms are apparently not involved in the spontaneous regression of keratoacanthoma. Cell-mediated immune mechanisms are evidently not responsible for the resolution of the tumor.

Delayed hypersensitivity and differences of histologic pattern in allergic cutaneous vasculitis.

Fourteen patients with allergic cutaneous vasculitis of either the polymorphonuclear (PMN)- or the mononuclear (MN)-predominant type were studied as regards the following parameters: the disease duration, histology, monoclonal antibody typing of the mononuclear cell infiltrate from recent lesions, and the delayed hypersensitivity (DH) response, assessed both by recall antigens (tuberculin type) and the dinitrochlorobenzene skin test. From the results, it was shown that in PMN-predominant vasculitis, DH reactions were well elicited, whereas in MN-predominant vasculitis, DH skin reactions were somehow impaired. In MN-predominant cases, many OKT3+, OKT4+, OKT8+, and OKM1+ cells were usually seen to surround the skin vessels, whereas in PMN-predominant cases, rare OKT8+, OKT4+, or OKM1+ cells were seen in the dermis. The epidermal dendritic cell system, as revealed by the Na(1)34 monoclonal antibody, was unaffected in both types of allergic cutaneous vasculitis.

Topical treatment of condylomata acuminata with Solcoderm.

Of 85 patients with condylomata acuminata treated topically with Solcoderm, the lesions were apparently eradicated in all but 11 (12.9%), and recurrences were noted in 6 during a 3-month follow-up. Only 1 treatment was required in 55 (64.7%) of the treated subjects.

Sweat gland disturbances in granuloma annulare and necrobiosis lipoidica.

We studied sweat gland distribution, density and activity in thirteen cases of granuloma annulare and ten cases of necrobiosis lipoidica, using a combination of the plastic impression and starch-iodine methods. The pattern of sweat gland disturbance in the two diseases was entirely different. In necrobiosis lipoidica an intense and uniform hypohidrosis was detected throughout the lesion, whereas in granuloma annulare the disturbance followed the morphology of the lesion (the papular border showed complete anhidrosis, whereas the flat central part of the lesion showed only moderate hypohidrosis or normal sweating). The method assigns numerical values to the 'relative density' and the 'relative activity' of the functioning sweat glands compared with normal skin, thus permitting statistical evaluation of the results.

Skin surface marking on the prickle cell layer.

We have shown that skin surface marking exists on the prickle cell layer after provocation of intra-epidermal vesiculation with a 50% solution of NH4OH.

Immunohistochemistry in lichen planus.

An immunohistochemical study has been undertaken on 25 biopsy specmens taken from lichen planus lesions, using antisera against human fibrin, immunoglobulins IgG, IgA, IgM and C3 (B1C/B1A) complement component. The findings of the present research are discussed and evaluated in relation to the problem of the etiopathogenesis of the disease.

Evaluation of various antigenic substrates for the detection of antinuclear antibodies.

The present study deals with the evaluation of some substrates for the detection of nuclear antibodies by the indirect immunofluorescence method. We have examined white male mouse liver imprint, white female pregnant mouse liver imprint, compound substrate consisting of male mouse liver, kidney and gastric wall sections, skin sections from psoriatic patients, skin sections from squamous cell carcinomata, male rabbit spleen imprint, skin sections from healthy adults people, skin sections from basal cell epitheliomata, skin sections from patients with lichen planus, male mouse spleen imprint and male guinea pig spleen imprint. To evaluate the substrates, we have employed 4 selected sera from patients with collagen disease. It was observed that some types of antinuclear antibodies demonstrate greater affinity for certain substrates and the fluorescent nuclear pattern might change on serial dilutions. From all the substrates studied, the white male mouse liver imprint and the male rabbit spleen imprint were considered as the most efficient for routine purpose as they are both sensitive and easily obtainable.

Some further features for differential diagnosis between squamous cell carcinomas and basal cell epitheliomas.

Two further methods for the characterization of epidermal skin tumors are described: the antinuclear antibody (ANA) immunofluorescent test, which consists of indirect immunofluorescence with known high titer sera containing homogenous ANAs on epidermal skin tumors, and the ammoniacal-silver cytochemical method, which specifically stains nuclear histones. Squamous cell carcinomas (SCCs), basal cell epitheliomas (BCEs) as well as control specimens from normal skin and benign epidermal hyperplasias were studied. The ANA immunofluorescent test was positive for most SCCs, mixed SCC and basal cell carcinomas and metatypical BCEs. The ammoniacal-silver method gave a characteristic staining pattern shared among SCCs, mixed carcinomas and metatypical BCEs. BCEs, besides metatypical ones, were always negative by the ANA immunofluorescent test and the same applied for the control specimens. The ammoniacal-silver method gave a characteristic staining pattern for BCEs and control sections quite different from the staining pattern of the more aggressive forms of epidermal tumors. The two methods usually yielded parallel results.

Mycosis fungoides: evaluation of immunohistochemical criteria for the early diagnosis of the disease and differentiation between stages.

Lesional skin specimens from twenty-eight patients with mycosis fungoides were studied by evaluating immunohistochemical criteria, primarily with monoclonal antibodies. It was demonstrated that significant differences exist between the control and the premycotic-stage group in regard to the monoclonal antibodies BE1, BE2, and OKT9. The detection of specific antigenic determinants on the surface of cell populations early in the course of the disease seems to be of considerable value for the early diagnosis of the disease. Statistically significant differences were found between the premycotic stage and the plaque stage in regard to T lymphocytes, macrophages, OKT6+, OKT4+, OKT8+, and BE2+ cells in the dermal infiltrate. Significant differences were also shown between the plaque and tumorous groups, concerning macrophages, T cells, and OKT9+ cells in the dermis, as well as epidermal dendritic cells. Differences between stages may supplement histologic data for the follow-up of the disease with or without treatment.

Congenital sensory neuropathy with anhidrosis (hereditary sensory neuropathy type IV).

Hereditary sensory neuropathies comprise a group of rare childhood diseases which are classified into four types. We present a Greek boy 11 years old with hereditary sensory neuropathy type IV (congenital sensory neuropathy with anhidrosis) whom we have followed up and studied during the last seven years. Our patient presented for the first time with recurrent hyperthermic episodes without sweating, and lack of pain sensation from the first months of life. Insensitivity to pain and thermal stimuli had resulted in burns on the extremities and self-mutilation of the tongue, lips and fingertips. When he was five and seven years old respectively he had two painless fractures of the ankles which led to insoluble orthopedic problems. He also suffered from mental retardation, which was obvious from his first years of life. Sweat gland investigations showed significant hypohidrosis or anhidrosis although the sweat glands were normal microscopically. Hereditary sensory neuropathy type IV, although rare, is important for dermatologists because it must be differentiated from other anhidrotic syndromes, and in view of the poor prognosis of the condition.

Coexistence of pemphigus vulgaris, malignant melanoma and low-grade lymphoma.

A 53-year-old female patient with pemphigus vulgaris under continuous immunosuppressive therapy for about 2 years presented a superficial spreading malignant melanoma on a pre-existing melanocytic naevus. After surgical removal of the inguinal lymph node group, a diffuse low-grade polymorphous immunocytoma was proved both histologically and immunocytochemically. The possible induction mechanisms are discussed.

Infiltrate of syphilitic lesions before and after treatment.

An immunohistological study of skin biopsy specimens from patients with early syphilis was undertaken before and after treatment (one day after intramuscular administration of 2.4 MIU benzathine penicillin and eight days later, after a total administration of 3.6 MIU. In chancres from seronegative patients treatment with 3.6 MIU usually resulted in fewer immunocompetent cells in the infiltrate. In lesions of secondary syphilis treatment with 2.4 MIU benzathine penicillin produced a significant decrease in immunocompetent cells. After treatment with 3.6 MIU there was no further decrease. It was worth noticing that even eight to nine days after the initial pretreatment biopsy, when 3.6 MIU had been administered, the overall lymphohistiocytic infiltrate was not substantially diminished. Significantly more suppressor (T8+) cells were found in lesions of primary syphilis than of secondary syphilis, and they showed remarkable exocytosis. Activated local T8+ cells may release immunosuppressive lymphokines.