Primary cutaneous cryptococcosis in an HIV-negative patient.

We report a case of primary cutaneous cryptococcosis in an HIV-negative patient, who presented with painless, ulcerated lesions involving the right forearm (fingers and elbow), which developed over 45 days. On the basis of the clinical appearance, serological and cultural examinations were performed to confirm the diagnosis; the histological evaluation of a skin biopsy showed an acute inflammatory infiltrate containing several PAS + Cryptococci. Subsequently, the patient was treated with fluconazole (400 mg/day for 10 days, then a maintenance therapy of 200 mg/day); after one month, the cutaneous lesions were remarkably improved, but, although a series of further laboratory and clinical examinations was scheduled, the patient repeatedly refused any other re-evaluation, and he was lost from follow-up.

Effects of medium-term PUVA therapy on peripheral T-lymphocyte subsets in psoriatic patients.

Three to four months' PUVA treatment is a widely-adopted procedure to induce psoriasis remission and for the purpose of this study is called "medium-term". The 32 psoriatic patients considered revealed a statistically significant baseline decrease in OKT3+ (p less than 0.001), OKT4+ (p less than 0.001) and OKT8+ (p less than 0.001) as compared with 40 healthy controls, while OKT4/OKT8 was normal. Variance analysis within the psoriatic group failed to reveal further significant variation in the immunological parameters during the 3 months under study. Nevertheless, there was a marked trend towards a reduction in OKT4+ cells and OKT4/OKT8 as compared with baseline values after 3 months. These results suggest that "medium-term" PUVA therapy does not statistically restore the pre-existing baseline changes in T-lymphocyte subsets of the psoriatic patients. The non-statistically significant effects as regards OKT4+ may be due to the small number of patients who reached 3 months' treatment (9 patients) but could be regarded as the first step towards the significant changes described here in long-term PUVA-treated psoriatic patients.

Treatment of cutaneous T cell lymphomas with PUVA.

A series of 39 patients with CTCL was treated with PUVA over a period of 5 years, comprising 6 patients in stage IA, 13 in stage IB, 15 in stage IIA and 5 in stage IIB. PUVA treatments were administered four times weekly until clearing; a maintenance therapy employed 2 to 1 exposures per week for 2 months. Complete clinical and histological examinations were taken. We obtained a complete remission in all stage IA patients, and a partial remission in stage IB and IIA patients, who required longer treatment schedules and more frequent maintenance therapy. Stage IIB patients required additional local and/or systemic therapy to achieve a partial remission. Recurrences were observed in 33% stage IA patients, in 84% stage IB patients and in all stage IIA and IIB patients. They responded to new induction phases only in early-stage CTCL. PUVA is well accepted by patients, and compares well with other treatments.

Low-dose isotretinoin in severe acne.

A selected group of 60 patients who had been resistant to previous systemic antibiotic therapy was treated with low-dose isotretinoin (0.5 mg/kg/day in two doses) for 12 to 20 weeks. The results confirmed the efficacy of the drug on pustular, nodular and cystic acne even with low-dose treatment. In only one case was it necessary to suspend the treatment because of an increase in serum cholesterol and triglycerides. The authors therefore advise the use of low dosage and that treatment should be restricted to cases of severe acne.

[Clinical manifestations associated with the presence of lupus anticoagulant]. / Manifestazioni cliniche associate alla presenza di anticoagulante lupico.

The case of a woman with systemic lupus erythematosus with unusual clinical, cutaneous and biologic features and lupus anticoagulant is presented. According to the literature this association is not fortuitous: a new syndrome characterized by the presence of a subgroup of antiphospholipid antibodies has been recognized. The cutaneous symptoms of this syndrome include: leg ulcers, livedo reticularis, widespread cutaneous necrosis and distal cutaneous ischemia. In our patient a nearly complete picture of the clinical and biologic features of this syndrome, including a characteristic retinal vein thrombosis is present.

[Immunohistochemical study of neoplasms of the sweat glands]. / Studio immunoistochimico delle neoplasie delle ghiandole sudoripare.

The paper reports a study of 34 sweat gland tumours, 3 of which were malignant. In line with recent publications on the topic, no immunophenotype is identified which could differentiate between pathologies of an eccrine as opposed to apocrine origin. With regard to the possibility of distinguishing malignant from benign tumours, the paper reconfirms the importance of CEA which is the only immunomarker common to all the malignant forms examined.

[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.

Blood transfusions in the therapy of a case of prolidase deficiency.

A case is reported of a 15-year-old boy with prolidase deficiency and marked urinary excretion of the iminodipeptide gly-pro. Prolidase activity of erythrocytes against substrate glycyl-proline was deficient, but after blood transfusions this was increased to 15.7% of donor activity and declined to 12% and 3.4% of normal activity after 8 and 45 days, respectively. Urinary iminodipeptide levels following transfusion remained unaltered.

Effect of solid detergent washing on values of skin electrical impedance.

We have studied the electrical behaviour of the skin on 20 volunteers, before and after cleaning with solid detergent. The aim was to study one of the possible variables of the measurements. The results have shown that the cleaning has globally reduced the electrical skin parameters of the forehead, without influencing other parts examined (dorsal and palmar surfaces of the hand). The result has been attributed to the elimination of the hydrolipidic film of the surface and in particular that of the sebum of the forehead. The data give an idea as to how to obtain more homogeneous final results, as well as studying the sebum production function.

Feasibility and safety of a new technique of extracorporeal photochemotherapy: experience of 240 procedures.

BACKGROUND AND OBJECTIVE: Extracorporeal photochemotherapy (ECP) is a therapeutic approach based on the biological effects of ultraviolet light (UV) - A and psoralens on mononuclear cells collected by apheresis. Recently, ECP has been under investigation as an alternative treatment for various immune and autoimmune diseases. The aim of this study was to evaluate the safety and feasibility of a new three-step ECP technique, in terms of reproducibility, acceptance, tolerability, and short and long term side effects. DESIGN AND METHODS: Seventeen patients affected by acute or chronic graft-versus-host disease (GvHD), pemphigus vulgaris, or interferon-resistant chronic hepatitis C and one patient being treated for prevention of heart transplant rejection underwent 240 ECP procedures. MNC collection and processing parameters were recorded, biological effects of UV-A/8 methoxy-psoralen (8-MOP) were evaluated, and short and long term side effects were monitored. RESULTS: At a mean follow up of 7 months (range 2-19) 240 ECP had been completed, a mean of 7,136 mL (range 1,998-10,591) of whole blood having beenprocessed per procedure. The mean of total nucleated cells collected per procedure was 6.5x109 (range 0.65-23.8), with a mean MNC percentage of 85% (41. 4-98%) in a mean final volume of 115.5 mL (37-160). No severe side effects were documented and no infectious episodes occurred throughout the course of the treatment. INTERPRETATION AND CONCLUSIONS: The new ECP technique was highly reproducible as regards the collection and each processing step. Short and long term side effects were mild. No increase in infectious episodes was recorded. All patients willingly underwent ECP, demonstrating an excellent tolerability for the procedure even after several courses.