Functional analyses of the skin surface of the areola mammae: comparison between healthy adult male and female subjects and between healthy individuals and patients with atopic dermatitis.

BACKGROUND: Although the nipple and areola of the breast constitute a unique and prominent area on the chest, so far no study has been done on the functional properties of their skin surfaces. OBJECTIVE: To study the stratum corneum (SC) covering the areola using noninvasive methods. METHODS: Eighteen adult healthy subjects comprising nine men and nine women and 18 age- and sex-matched patients with atopic dermatitis (AD), none of whom had visible skin lesions, participated in the study. Transepidermal water loss (TEWL), skin surface hydration and skin surface lipid levels were measured on the areola and adjacent breast skin. The size of the skin surface corneocytes of these skin regions was assessed. RESULTS: All the healthy subjects showed significantly higher TEWL accompanied by smaller sized corneocytes on the areola than on the adjacent breast skin. Only female subjects revealed a significantly higher skin surface hydration state together with significantly increased skin surface lipid levels on the areola than on the adjacent breast skin. These sex differences were observed even in patients with AD. Comparison between healthy individuals and the patients with AD demonstrated higher TEWL, decreased skin surface hydration state and lower skin surface lipid levels associated with smaller sized corneocytes in the areola in the patients with AD, especially in male patients. CONCLUSIONS: In adults, the SC barrier function and SC water-binding capacity of the areola were functionally poorer than in the adjacent skin, being covered by smaller sized corneocytes and lower amounts of skin surface lipids, especially in men and in patients with AD.

Efficacy of ALA-PDT vs blue light in the treatment of acne.

BACKGROUND: Photodynamic therapy (PDT) is based on the principle of using light excitation of a wavelength-specific endogenous or exogenous photosensitizer to destroy the target tissue, and has shown efficacy in the treatment of certain non-melanoma skin cancers. PDT using aminolevulinic acid (5-ALA) has attracted attention in the treatment of acne vulgaris. METHOD: Twenty patients with moderate to severe acne vulgaris on the face were treated with four sessions of topical ALA-PDT with blue light (415 nm) on the right side of the face compared with blue light alone on the left side of the face, each treatment being 1 week apart. Ten percent of topical ALA was applied to acne spots on the right side of the face with a 1-h incubation period and the entire face was treated with 48 J/cm(2) of 415 +/- 5 nm light from an articulated LED planar array. Evaluation was performed by counting acne lesions at baseline, 4, 8, 12 and 16 weeks after the beginning of the treatment. Biophysical measurements included sebum levels and the erythema, and melanin indices. RESULT: At the given assessment times 4, 8, 12 and 16 weeks after the beginning of the treatment, the mean percent reduction in inflamed lesions counts tended to be higher in the ALA-PDT areas; it was 32%, 50.9%, 65.9% and 71.1%, respectively, compared with the blue-light-alone treatment, which was 20.7%, 27%, 57.7% and 56.7%, respectively, but without any statistical significance (P=0.092). There was no demonstrable significant change in sebum excretion, erythema or the melanin index after treatment. The side effects were pain, stinging, peeling, erythema, pruritus, oozing and pustules. These side effects were stronger on the ALA-PDT-treated side. CONCLUSION: From this study, the trend for ALA-PDT with blue light to be superior to blue light alone was observed, but it did not reach statistical significance. ALA-PDT had more side effects.

A case of actinic prurigo in Thailand.

Actinic prurigo is a separate entity from the polymorphous light eruption that affects American Indians. It has been reported mainly from North and South America, with only few reported cases from Britain or Asia. We report a case of actinic prurigo in a Thai girl who showed cheilitis and pruritic papules on exposed areas for three years. We were able to induce populovesicular lesions by three consecutive irradiations with 100 J/cm2 UVA and 2 minimal erythematous dose of UVB. However, three weeks after irradiation, a prurigo papule developed at the UVB irradiated site.

Hypopigmented mycosis fungoides: treatment and a 6(1/2)-year follow-up of 9 patients.

BACKGROUND: The clinical course of hypopigmented mycosis fungoides has not been well described. OBJECTIVE AND METHODS: We sought to review the management and follow-up of patients with hypopigmented mycosis fungoides evaluated between January 1990 and August 1998. RESULTS: There were 7 African American and 2 Asian patients (5 male and 4 female patients); 8 had stage Ia and 1 had stage Ib disease. The mean age at diagnosis was 34.4 years, the mean latent period was 9.2 years, and the mean follow-up period after diagnosis was 6.5 years. Treatment modalities used included psoralen UVA, UVB, and topical mechlorethamine. Eight had complete clinical responses, and another had a partial response. The remission period ranged from 2 months to 3 years. In all but one patient, lesions recurred; all responded rapidly to another course of therapy. CONCLUSION: Hypopigmented mycosis fungoides is characterized by early onset, occurrence in dark-skinned individuals, and good response to therapy. Recurrences are common. In most, it has a biologically benign course.

Linear IgA bullous dermatosis of childhood: a long-term study.

BACKGROUND: Linear IgA bullous dermatosis (LAD) of childhood is a rare acquired subepidermal blistering disease of young children. Most of the studies were reported from the USA and European countries. METHOD: Twelve cases of Thai patients diagnosed as LAD of childhood were analyzed concerning clinical, histopathological, immunopathological findings including treatment responses and courses compared with those of Caucasians. RESULT: The mean age of onset was 5.1 years. The areas of common involvement were the perioral region, lower abdomen, perineum, buttock, inner thighs and extremities. Histopathology in half of the cases showed features of dermatitis herpetiformis or bullous pemphigoid. All patients had positive linear IgA band at the basement membrane zone (BMZ) by direct immunofluorescence. Only one patient had positive circulating anti BMZ antibody at the titer of 1:10. Most patients responded well to dapsone. The mean duration before remission was 1.9 years. CONCLUSION: Our study in Thai patients with LAD of childhood produced data similar to previous studies carried out in the Caucasian nations.

HIV, UV and immunosuppression.

Cutaneous diseases are common manifestations of infection with human immunodeficiency virus (HIV). Phototherapy with ultraviolet B (UVB) and photochemotherapy with 8-methoxypsoralen plus UVA (PUVA) have been used successfully to treat several of these skin conditions, including psoriasis, folliculitis, pruritus, and eczema. However, in view of the known immunosuppressive effects of UV radiation, concerns have been raised about potential adverse effects of UV on persons infected with HIV. In the following report, we review the effects of UV in HIV-infected cell lines in vitro, in animal models, as well as in human studies. Based on currently available data, UV radiation, as used in phototherapy and photochemotherapy, appears to have no adverse effects in HIV-infected individuals.