Primary cutaneous T cell lymphomas: photochemotherapy immunomodulation with analysis of the inflammatory-expansive cellular dynamic.

Primary cutaneous T cell lymphomas (CTCLs) are characterized by hyperproliferation of malignant CD4+ T cells with primary localization on the skin. The common characteristics are the migration of the malignant mature T-lymphocytes into the epidermis, with hyperproliferation of malignant CD4+ T cells and epidermotropism. Sézary syndrome (SS) is the leukemic variant. It was established that CTCLs arise from a clonal expansion of CD4+ T cells with an identical rearrangement of the T cell receptor. The purpose of this study was to evaluate the immunomodulation effect of photochemotherapy-A (psoralen plus ultraviolet A (PUVA)). Pre- and post-PUVA punch skin biopsies of nine patients were stained immunohistochemically for CD34+, CD8+, CD7+, CD16+, CD56+, CD1a+, Bcl2+, p53+, CD45RA+, and CD45RO+ cells. The results showed a pre-PUVA cells/mm(2) without significant difference among expansive or reactive cells. Post-PUVA analysis showed a significant decrease in the mean of expansive-reactive cells. PUVA immunomodulated decreasing cellular infiltrate. These findings could contribute to the comprehension of how PUVA acts. We achieved ectoscopic clearance of the lesions, although post-PUVA, there still was a mononuclear pathological infiltrate. This result demonstrates that the PUVA treatment should only be withheld when the histological analysis is normal.

Reduction of skin-homing cytotoxic T cells (CD8+ -CLA+) in patients with vitiligo.

BACKGROUND: Vitiligo is a frequently acquired, hereditary disease, characterized by achromic macules due to the absence of melanocytes. In contrast with earlier studies, in which the main pathogenic role was attributed to anti-melanocyte antibodies, recent papers have emphasized a role for CD8(+) cytotoxic T lymphocytes in melanocyte destruction. Fifteen percent of peripheral T cell express cutaneous lymphocyte-associated antigen (CLA), responsible for skin-homing T cell. Phototherapy is used to treat patients with generalized vitiligo and it has been shown to interfere with CLA(+) T cells in other skin diseases. OBJECTIVE: To describe peripheral blood T cell subpopulations' frequency and ability to express the skin-homing molecule (CLA) in patients with non-segmental vitiligo, before and after photochemotherapy (PUVA). PATIENTS AND METHODS: Twenty-two patients with generalized and active spreading vitiligo were submitted to 30 PUVA-8MOP sessions. Lymphocyte immunophenotyping was performed by flow cytometry using anti-CD3, anti-CD8 and anti-CLA monoclonal antibodies. Fifteen healthy volunteers, sex- and age-matched, were included as a control group. RESULTS: CD8(+) -CLA(+) T cells were significantly reduced in number in untreated vitiligo patients (P=0.008) when compared with control individuals, albeit with a more intense CLA expression (P=0.028). These findings were not altered after PUVA. No significant difference was noticed in CD4/CD8 ratios nor in CD4-CLA(+) T cell numbers between vitiligo patients and controls, both before and after PUVA. CONCLUSIONS: CD8-CLA(+) T cells are reduced in peripheral blood of patients with non-segmental vitiligo. This finding may be related to the previously reported increase of CD8(+) cells in both lesions and perilesional skin of these patients.

Redução dos linfócitos T-CD8+ citotóxicos observada com a terapia Puva em paciente com vitiligo / Reduction of cytotoxic T-CD8+ lymphocytes observed during PUVA therapy in a patient with vitiligo

Na patogênese do vitiligo tem-se enfatizado o papel das células T citotóxicas. Identificadas pelo antígeno linfocitário cutâneo (CLA), essas células já foram descritas no sangue de pacientes com outras dermatoses e podem ser depletadas pela fototerapia concomitantemente à melhora clínica. Descreve-se caso de vitiligo generalizado com melhora clínica expressiva após Puva, no qual houve redução de 25% dos linfócitos T CD8+-CLA+ circulantes.

The role of cytotoxic T cells (CD8+) has been emphasized in the pathogenesis of vitiligo. This cell population, identified by a skin homing molecule (cutaneous lymphocyte associated antigen Â- CLA), has been described in patients with other dermatoses and can be reduced with phototherapy. The authors present the case of a patient with generalized vitiligo and clinical recovery after PUVA parallel to a 25% reduction in CD8+-CLA+ T cells in the peripheral blood.

Pitiríase rósea: [revisão] / Pityriasis rosea: [review]

Pitiríase rósea é doença inflamatória aguda da pele, que regride espontaneamente, normalmente sem deixar seqüelas, em período que varia de quatro a oito semanas. Clinicamente é caracterizada pelo aparecimento de típicas lesões eritêmato-pápulo-escamosas. Atinge todas as idades, embora seja mais comumente observada entre 10 e 35 anos. Apesar de exaustivas pesquisas, sua etiologia ainda permanece desconhecida. São discutidos alguns aspectos epidemiológicos, anatomoclínicos, diagnósticos diferenciais, doenças associadas, com ênfase no tratamento e etiologia da doença.

Pityriasis rosea is a skin disease characterized by acute inflammation that fades away spontaneously without scar tissue formation for an average period of 4 to 8 weeks. Clinically, it is characterized by the occurrence of typical erythematous papulosquamous lesions distributed mainly over the trunk and extremities. It affects people of all ages, but is more often observed in the age range of 10 to 35 years. Even though it is extensively studied, its etiology remains unknown. In this study, the authors analyze some epidemiologic aspects, differential diagnosis, related diseases, and give special attention to treatment and possible etiology.

Human neutrophils susceptibility to Paracoccidioides brasiliensis: an ultrastructural and cytochemical assay.

Paracoccidioidomycosis, caused by the dimorphic fungus Paracoccidioides brasiliensis, is the most prevalent systemic mycosis of Latin America, with Brazil accounting for 80% of the reported cases. The great number of neutrophils found in P. brasiliensis granulomas demonstrates the importance of polymorphonuclear neutrophils (PMN) cells during this mycotic infection. It has been found that neutrophils from healthy human donors can ingest and kill the fungus through a typical phagocytic process. The present work tests the phagocytic ability of neutrophils collected from patients that had had and were considered cured of paracoccidioidomycosis. Transmission electron microscopy and cytochemical studies indicate that patients' neutrophils eventually degenerate during phagocytosis of P. brasiliensis. Endogen peroxidase and NAD(P)H-oxidase are activated during the process showing that the respiratory burst and the neutrophil degranulation are triggered by the attachment of the yeast cells. Apparently these processes are not enough to kill P. brasiliensis. Although fungicidal activity can be determined by colony forming unit (CFU) counting, qualitative data suggest, as noted, that neutrophils from patients with treated paracoccidioidomycosis degenerate during the phagocytosis process. Hence, this work demonstrates the existence of a functional neutrophil deficiency against P. brasiliensis in susceptible individuals. The exact origin of this susceptibility is still to be determined in further studies.

Increase in dermal collagen fibril diameter and elastogenesis with UVB exposure: an optical and ultrastructural study in albino Balb/c mice.

Cutaneous aging is a complex biological phenomenon, dependent not only on the innate or intrinsic process ("biological clock"), but also on extrinsic elements, primarily chronic sun exposure (photoaging). In order to verify dermal morphological changes in the elastic fiber system and collagen associated with aged skin, we performed a light and electron microscopic study on exposed-shaved albino mice, which were exposed to UVB radiation. The experimental group consisted of 48 exposed animals, randomly distributed in three groups and submitted to different radiation doses (A, 28800 J/m2; B, 57600 J/m2; and C, 86400 J/m2) and studied 0, 30, 60 and 90 days of exposure discontinuation. Nonexposed-shaved and nonexposed-nonshaved animals were included as controls. From the day of exposure discontinuation and subsequently, the elastic system and collagen network were progressively modified. The increase in collagen fibril diameter was prominent in the 60 and 90 day groups (p<0.05), as noticed on electron microscopy. Elastic fiber density also increased after irradiation (p<0.05). On electron microscopy, elastogenesis was seen in the deep dermis. The comparative study among the groups disclosed clear relationship between doses and "elastotic changes". It also showed that chronological aging of mice skin was apparently intensified after UVB exposure. Skin elastogenesis seems to be a major consequence of UVB exposure, apart from elastolysis, and occurs not only in humans but also in hairless mice submitted to continuous, long-term UVB exposure.

Expression of keratins 14, 10 and 16 in marginal keratoderma of the palms.

Marginal keratoderma of the palms (MKP), also known as degenerative collagenous plaques of the hands, is an infrequent disease affecting individuals with photoaged skin and submitted to mechanical trauma of the hands. The aim of the study was to study the expression of keratin 14 (K14) in the basal layer and keratins 10 (K10) and 16 (K16) in the suprabasal layer, and to establish the effect of growth factors and receptors of the epidermal growth factor in the genesis of hyperkeratosis observed in MKP. The study included 14 patients with MKP. Expression of keratins 10, 14 and 16 was visualized by immunohistochemical staining using monoclonal antibodies by standard immunoperoxidase method. As control three normal skin samples were used. Absence or weak expression of keratins 14 and 10, and strong expression of keratin 16 was recorded in MKP patients. It was concluded that MKP patients present weak expression of keratins 14 (basal membrane) and 10 (suprabasal layer) but strong expression of keratin 16, emphasizing the importance of stimulation of epidermal growth factor receptors by ultraviolet radiation and traumatism.

Viability of yeast form cells of Paracoccidioides brasiliensis after sonication.

To perform in-vitro studies with Paracoccidioides brasiliensis yeast cells it is necessary to avoid the presence of clumps of cells while maintaining their integrity. Because of the multiple budding type of growth, the bud cells are always attached to the mother cell and the yeast cells keep growing, resulting in the formation of large clumps. In order to obtain free cells, the cultures are usually sonicated. The present study shows that sonication induces lesions in a significant number of cells, as evaluated by labelling of the cells with acridine orange and Janus green vital dyes. In some cases labelling was initially observed in only one cell of the clump; however, the other cells also became labelled after a few minutes. These observations were confirmed by scanning and transmission electron microscopy of treated cells. Colony forming units (c.f.u.) on BHI plates also confirmed the decrease in cell viability following sonication.

Vitamina C / Vitamin C

Há muito o papel do ácido ascóbico (AA) no metabolismo do tecido conjuntivo tem sido reconhecido, sobretudo a partir do século 16, quando o escorbuto começou a ser prevenido com sumo de frutas cítricas. As primeiras publicações referentes ao uso tópico da vitamina C,inicialmente em cobaio, datam da década de 1960. Entretanto, só mais recentemente tem-se dado valor a essa via de aplicação. Os autores apresentam revisão sobre o assunto, discorrendo sobre o histórico da vitamina C, seus efeitos no metabolismo do tecido conjuntivo, no processo de cicatrização, sobre sua atividade antioxidante e mecanismos de ação

Perfil evolutivo das subclasses de imunoglobulinas Gama em pacientes de Pênfigo foliáceo endêmico / Evolutionary profile of Immunoglobulin Gamma Subclass in patients with endemic pemphigus foliaceus

A subclasse da imunoglobulina (IgG)4 é a mais encontrada no pênfigo foliáceo (PF), tanto na forma endêmica (PFE) como na forma não endêmica. Apesar da constatação da patogenicidade dos anticorpos (Ac) IgG4 realizada experimentalmente em camundongos Balb/c, ainda não é bem compreendido o valor de outras subclasses, e nem seria possível que elas também tivessem participação na etiopatogênese do PFE. O objetivo era estabelecer o perfil das subclasses de IgG durante a evolução do pênfico foliáceo endêmico (PFE). Utilizando o método da imunofluorescência indireta (IFI) com anticorpos monoclonais, estudou-se o comportamento dessas subclasses, em relação à evolução da doença, no soro de 47 doentes de PFE e 31 controles sadios. Destes últimos, 12 eram parentes geneticamente relacionados, e 19 não parentes. Os pacientes foram distribuídos em cinco grupos: com menos de seis meses de doença, de sete a 12 meses, com mais de 13 meses, pacientes em recaída e em cura. Os resultados obtidos nesses diferentes grupos foram relacionados às seguintes variáveis: atividade clínica, forma da doença, tempo de disseminação das lesões e tratamentos utilizados. Não houve resultados positivos no grupo de controles. O pequeno número de casos positivos de IgG2 (14,9 por cento) e menor ainda de IgG3 (2,1 por cento) não permitiu uma análise estatística desses dados, restringindo-a às IgG1 e IgG4. Quantitativamente a IgG4 esteve presente em todas as fases evolutivas da doença, exceto na cura; IgG1, ao contrário, apresentou comportamento peculiar, aparecendo em fases de início da doença (menos de seis meses) e em períodos de recaída. Quando comparado o perfil qualitativo da IgG1 ao perfil quantitativo da IgG4 notou-se comportamento análogo, sugerindo que os altos títulos de IgG4 são acompanhados de maior positividade da IgG1. Os resultados permitem supor que a IgG1 possa ter relevante participação no mecanismo imunorregulatório do PFE e que essa subclasse represente um marcador sensível para o início ou reinício da atividade clínica

Estudo multicentrico, aberto e nao comparativo da eficacia e tolerabilidade do tioconazol solucao spray no tratamento da pitiriase vesicolor / Open non-comparative, multicentric trial of efficaccy and tolerability of tioconazole spray solution in the treatment of pityriasis versicolor

Os investigadores analisaram a eficacia e a tolerabilidade do tioconazol solucao spray a 1 por cento(tralen Spray- Pfizer)em 50 pacientes com pitiriase versicolor,num modelo de estudo multicentrico aberto nao comparativo.A solucao foi aplicada uma vez ao dia por dez dias(primeiro ciclo),entao foi realizada uma nova avaliacao e um segundo ciclo de tratamento foi recomendado sea cura clinica e /ou micologica nao houvesse sido obtida.Uma avaliacao final foi realizada 30 dias apos o final do ultimo ciclio.A avaliacao global mostrou que:Todos os pacientes haviam se curado ou melhorado dos sintomas no dia final do ciclo final;somente 18,2por cento dos pacientes precisaram de um segundo ciclio;trinta dias apos o dia final do tratamento houve 4,5 por cento de recidiva.A eficacia micologica foi detreminada tambem a cada reavaliacao,com testes micologicos positivos em 2,3 por cento apos o tratamento e 9,1 por cento apos 30 dias do tratamento.Nemhum avento adverso foi observado durante o curso do tratamento,indicando uma tolerabilidade excelente.Na opiniao dos investigadores e dos pacientes oproduto foi considerado execelente ou bom em 95,5 por cento e muito bom ou bom em 97,7 por cento respectivamente.Os investigadores concluiram que a solucao spray a 1 por cento de tioconazol em aplicacao uma vez ao dia por 10 ou 20 dias(quando necessario)mostrou ser extremamente eficaz e bem tolerado no tratamento da pitiriase versicolor

Antibióticos utilizados na dermatologia e seu emprego durante a gravidez / Antibiotics in dermatology and their use during pregnancy

Revisäo das indicaçöes de drogas antibacterianas em doenças dermatológicas, bacterianas ou näo, em gestantes. Este trabalho aborda os principais antibióticos usados na prática dermatológica e, utilizando as categorias propostas pela Food and Drug Administration, classifica-os quanto ao efeito sobre a embriogênese humana

Tinea capitis in adult after local corticotherapy

A case of Tinea capitis in an adult caused by Trichophyton tonsuran is described. The patient had no signs of systemic immunosupression but was using topical corticosteroid at the site of the infection. The lesion resembled seborrheic dermatitis. Trichophyton tonsurans seems to be increasing as a cause of tinea capitis specially in adults in Rio de Janeiro, Brazil. Its clinics and epidemiology are discussed

Tricograma / Trichogram

O autor faz uma revisao da técnica de realizaçao do tricograma e discute sua interpretaçao e importância como método complementar no diagnóstico e prognóstico das alopecias. Sao também analisados os achados do tricograma em algumas formas de alopecias, como a androcronogenética areata, alopecias de causas externas, alopecia medicamentosa, na tricotilomania, na dermatite seborréica, na psoríase e nas doenças carenciais.

Envelhecimento cutâneo: prevençäo / Skin aging: prevention

A prevençäo do envelhecimento cutâneo é discutida quanto a sua correlaçäo causal com o câncer e dependência fotônica. Säo discutidas as principais medidas de fotoproteçäo cutânea como o horário adequado à exposiçäo solar, modificaçöes climáticas, vestuário, tipos de pele, a defesa natural da pele e o emprego dos foto-protetores físicos e químicos