Characterization of vulvar skin of healthy Thai women: influence of sites, age and menopause.

Although the physiological characteristics of vulvar skin have been characterized in Caucasians, little is known about the vulvar skin of Asian women. This study assessed the moisture content, transepidermal water loss (TEWL) and pH of vulvar skin of 99 healthy Asian women residing in Bangkok, aged 20-69 years, during their non-menstrual period, including 39 post-menopausal women. Skin pH was acidic at all sites, and the pH of the vulvar areas was significantly higher than the control sites (inner thigh, inner forearm). Skin moisture was slightly, but significantly, lower around the vulvar area and the thigh than around the forearm. TEWL was significantly higher in vulvar areas than control sites. Ageing and menopause did not cause notable alterations in most properties of vulvar skin. In conclusion, the vulvar skin of Asian women has similar properties to that of Caucasians.

Incontinentia pigmenti achromians of Ito: an ultrastructural study.

A clinico-pathological and EM study of a Thai boy with hypomelanosis of Ito, one of the neurocutaneous syndromes, is reported. At birth, typical skin hypopigmentation on the trunk and a hypopigmented streak on the left lower extremity were noted Associated cutaneous pathology shows a decrease of melanin granules within basal and malpighian keratinocytes. Ultrastructural studies highlight a normal appearance for basal and malpighian keratinocytes, but a lack of melanosomes in the malpighian cells. Melanosomes are also dramatically reduced in the basal keratinocytes, which appear small, single or clustered and surrounded by a membrane. Melanocytic degeneration has been observed and dendritic melanocytes contained various stages of nonmelanised (stage II), partially melanised premelanosome (stage III) and rarely stage 4 melanosomes. The authors observed an increase in the number of Langerhans cell which have not previously been described. There were unmyelinated axon of nerve containing melanosomes at the dermoepidermal junction. The significance of these findings will be worthwhile to note that abnormal nerve termination in close relationship with basal keratinocyte, degenerated melanocyte, premelanosomes and langerhans cell are important in explaining the pathogenesis of Hypomelanosis of Ito.

Localized periorbital edema induced by Ibuprofen.

We documented localized periorbital edema in one patient with ibuprofen sensitivity without underlying chronic urticaria. The reaction developed one hour after ingestion of 200 mg of ibuprofen. No systemic symptoms were observed. No other NSAIDs did not induce symptoms. This patient was able to tolerate doses of ibuprofen after pretreatment with terfenadine. These observations suggest that histamine played a central role in this ibuprofen-induced skin reaction. Treatment with terfenadine enabled the patient to tolerate ibuprofen without experiencing any side effects. To the best of our knowledge, this is the first reported case of periorbital edema induced by ibuprofen.

Treatment of multiple lesions of Bowen's disease and squamous cell carcinoma with topical imiquimod.

We observed complete clinical and histopathologic remission of papules, plaques and nodules in two patients with multiple lesions of Bowen's disease and squamous cell carcinoma. Our findings indicate that topical imiquimod is a potentially promising therapeutic approach for the local treatment of early forms of cutaneous neoplasia, such as Bowen's disease and squamous cell carcinoma because it is a non-invasive therapy with a good cosmetic outcome. It may therefore be worthy of consideration in a subgroup of patients who cannot have or do not wish to have surgery.

Electron microscopic study in a case of solitary mastocytoma.

The authors report a solitary mastocytoma with a solitary red infiltrated plaque on the dorsum of the right foot for 2 months. Histologically there were numerous mast cells infiltrating the dermis. Electron microscopy revealed CLCs located in phagosomes of activated macrophages as well as in the stromal tissue, close association between CLCs formation and damaged eosinophils was documented Charcot-Leyden crystals (CLCs) have been found in many conditions associated with eosinophilia, but their occurrence in skin diseases is very rare. These occurrences showed the evidence that the formation of CLCs in a mastocytoma correlated to the individual and related to the biology of mast cells, basophils, eosinophils and macrophages. Phagosomes probably acted as the localization of CLCs formation. The pathological role of CLCs in a mastocytoma needs further investigation.

Immunohistochemical localization of cathepsin L and cystatin A in normal skin and skin tumors.

Cathepsin L, a cysteine proteinase, and cystatin A, an inhibitor of cysteine proteinases, are thought to regulate the invasion and metastasis of malignant cells. In this study, the expression of cathepsin L and cystatin A in skin tumors was investigated immunohistochemically in order to examine the relationship between these two enzymes in the pathophysiology of malignant cells. Formalin-fixed and paraffin embedded specimens from normal skin, seborrheic keratoses, and squamous cell carcinomas were reacted with polyclonal antibodies against rat cathepsin L or cystatin a which cross-react to human cathepsin L and cystatin A, respectively. The consequent immunostaining of these enzymes was observed to be strong in normal skin (4 cases) and seborrheic keratosis (6 cases). In well-differentiated squamous cell carcinoma (SCC) (9 cases), staining for cathepsin L and cystatin A was moderately positive in differentiated tumor cells and negative in undifferentiated SCC (5 cases). The degree of staining of these enzymes was inversely correlated with the differentiation of the malignant cells. These results suggest that the immunohistochemical analysis of cathepsin L and cystatin A is a useful indicator for an aspect of malignancy in human epidermal keratinocytes.

The ultrastructural study in a case of Fabry disease.

An investigation of the ultrastructural study was conducted on specimens from a typical patient with Fabry disease. Numerous characteristic cytoplasmic inclusions were observed in the vascular endothelial cell, pericyte, smooth muscle cell, nerve and eccrine sweat glands, the lamellar pattern of which were considerably variable in various types of gland cells. Large vacuolar inclusions predominated in clear cells of the secretory coil; lesser vacuoles were also seen in the coiled duct, and the basal cells of the straight duct toward the coiled duct displayed mulberry-like figures. There were some clear cells showing cell damage and necrosis in the secretory coil. Lamellated bodies were noted in the axons and schwann cells around the eccrine sweat glands. The small blood vessels around the eccrine glands were narrowed by swollen endothelial cells with heavy inclusions. These intracytoplasmic deposits may be responsible for the decreased sweating ability in Fabry disease. The factors related to hypohidrosis are also discussed.