Capillaropathy and capillaroneogenesis in the pathogenesis of rosacea.

BACKGROUND: Dilatation of vascular vessels in rosacea has generally been attributed to yielding to deranged connective tissue. In contrast, in a previous study a degrading effect of insufficient vascular vessels in connective tissue has been demonstrated in connection with diabetic microangiopathy. In yet another paper, it was demonstrated that the fusing of damaged capillaries, which had lost part of their adjacent walls due to functional inadequacy, led to the formation of dilated vessels. These pathogenetic patterns are the main subjects of this study of rosacea. METHODS: Punch biopsies from rosacea lesions were examined by light microscopy and immunochemistry in order to identify structural changes leading to the formation of telangiectasias. RESULTS: Deranged connective tissue is secondary to damaged capillaries. The primary damage may be evoked mostly by environmental influences, mainly the sun. CONCLUSIONS: Infections, infestations, and granulomatous formations are not primary in the development of rosacea.

Malassezia furfur in infantile seborrheic dermatitis.

Malassezia furfur is important in the pathogenesis of a number of dermatologic diseases including seborrheic dermatitis in adults. It has also recently been suggested that M. furfur might be the etiologic agent in infantile seborrheic dermatitis (ISD). We studied the presence of M. furfur in 21 children with the clinical diagnosis of infantile seborrheic dermatitis. Laboratory analyses showed aberrant patterns of essential fatty acids (EFA) in serum characterized by elevated levels of 18:1w9 and 20:2w6. Samples for M. furfur were taken from the foreheads and chests of children with infantile seborrheic dermatitis at the time of diagnosis, directly after treatment to complete healing, and after 1 year with no signs of infantile seborrheic dermatitis. All the patients were treated topically with borage oil containing 25% gammalinolenic acid (GLA). No reduced growth of M. furfur was seen on contact plates prepared with borage oil. The growth of M. furfur seems not to be related to the clinical symptoms in ISD.

Essential fatty acids in infantile seborrheic dermatitis.

BACKGROUND: In infantile seborrheic dermatitis (ISD) several different pathogenetic mechanisms have been proposed. OBJECTIVE: The purpose of the study was to investigate the importance of essential fatty acids (EFAs) and their metabolites in the origin of ISD. METHODS: The serum EFA patterns of 30 children with ISD, 1 to 6 months of age, were studied for 2 to 5 months. Blood samples were obtained at the time of diagnosis and after spontaneous recovery. Control samples were taken from age-matched healthy children. RESULTS: In children with active dermatitis levels of EFA 18:1w9 were increased and levels of 18:2w6 were decreased, whereas 20:4w6 levels remained normal. The rare fatty acid 20:2w6 was found in significant amounts in 20 patients, but at only barely detectable levels in the controls. All deviant values but the levels of 20:2w6 were normal at the time of recovery. Breast milk samples were obtained at the time of diagnosis from the patients' mothers and from a control group consisting of healthy nursing mothers. The EFA patterns were identical. The differences in EFA pattern between children with ISD and those free of skin disease were significant. The normalization of the deviation in ISD paralleled the recovery at any age it occurred. CONCLUSION: The laboratory findings suggest a transient impaired function of the enzyme delta-6-desaturase. The altered EFA pattern in ISD may be important in the pathogenesis of the disease.

Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis.

Thirty-seven patients with clinically diagnosed infantile seborrhoeic dermatitis (ISD) were studied in an attempt to establish the significance of transepidermal water loss (TEWL) and water content in the stratum corneum, in active disease and after recovery. All the patients were treated daily with topically applied borage oil (containing 24% gamma-linolenic acid). With this regimen they were completely free from all skin symptoms within 3-4 weeks. Analyses of essential fatty acids in serum showed aberrations as previously described, with elevated levels of 18:1w9 and 20:2w6. TEWL and water content were recorded at the time of diagnosis and after treatment from the right forearm in skin that was free from symptoms and not treated with borage oil. Twenty-five healthy children in an age-matched group without skin disorders were used as controls. Significant differences in TEWL between patients and controls were found before treatment. After treatment no significant differences were found. There were no significant differences between controls and patients regarding water content in the stratum corneum. Gamma-linolenic acid is suggested to be of importance in maintaining normal TEWL and also in promoting recovery in patients suffering from ISD.

The histopathogenesis of the flame figure in Wells' syndrome based on five cases.

Characteristics of Wells' syndrome are recurrent episodes of edema and erythema of sudden onset, often covering large areas of the skin. Microscopy shows marked eosinophilia and the presence of so-called flame figures. The flame figures have been considered to be either secondary to aggregates of expelled eosinophilic granules and disintergrating eosinophils, or foci of necrobiotic collagen. Our study indicates that the flame figure is secondary to disintegration of eosinophils and consists of aggregates of eosinophilic granules and nuclear fragments and not of necrobiotic collagen. We consider Wells' syndrome to be a distinctive clinical and histological reaction, which can be triggered by many different, mostly unknown factors.

Acrodermatitis chronica atrophicans, erythema chronicum migrans and lymphadenosis benigna cutis--spirochetal diseases?

Seven cases of acrodermatitis chronica atrophicans (ACA), 11 cases erythema chronicum migrans (EMC) and 3 cases of lymphadenosis benigna cutis (LABC) have been analysed. In Warthin-Starry stained sections, spirochetal structures were present in all cases. The spirochetes were mesodermotropic and irregularly distributed.

Leukoderma syphiliticum: ultrastructural observations on melanocyte function.

A case of genital leukoderma syphiliticum was analysed submicroscopically. No treponema pallidum organisms could be detected intra- or extracellularly in the epidermis or in the dermis. The melanocytes were only slightly reduced in number and had mostly normal outlines. The melanogenesis was impaired and small melanosomes with decreased deposition of melanin were mostly produced at the expense of normal melanin granules. A partial block in the melanin transfer mechanism seems to be in evidence. As no direct destructive action of spirochetes on the melanocytes is observed, an indirect effect is assumed, e.g. by a tyrosinase inhibitor.

The influence of PUVA treatment on the substructure of nevocellular nevi in psoriatic patients.

The influence of PUVA treatment on junction A-cell nevi in psoriatic patients has been analysed. After long-term PUVA therapy the nevocytes display an obvious increase in melanosome synthesis. The melanosomes are clearly polymorphous, without any predominant configuration. The structural organization of the melanosomes is profoundly aberrant. Formation of autophagosomes is conspicuous. The cytoplasmic filaments are displaced peripherally. No convincing signs of malignancy are observed electron microscopically. Light microscopical findings of a bridging proliferation of nevocytes between junction nests is a precautionary observation, however.

Light and electron microscopic aspects of pemphigus herpetiformis (eosinophilic spongiosis) in comparison with other acantholytic disorders.

Histopathological and electron microscopic analyses of pemphigus herpetiformis in a 64-year old woman with a previously operated atoxic goitre and suffering from a nephrotic syndrome and a chronic non-aggressive hepatitis revealed acantholysis preceded by eosinophilic spongiosis. Light microscopically the acantholysis is characterized by the occurrence of necrobiotic epidermal cells. No dyskeratotic cells are found. The mechanism of acantholysis depends on an exuberant elongation of desmosomes, leading to their disruption, spongiotic acantholysis. A conspicuous convolution of specific tight intercellular spaces is observed. Intracytoplasmatic occurrence of such tight intercellular spaces is seen in sections. Pseudomyeloid bodies of various types seem to be of significance. Particles closely similar to pox viruses are observed. The acantholytic process is compared with other acantholytic disorders in which the above-mentioned findings were not observed.

Submicroscopic aspects of the keratinization, dyskeratinization and acantholysis of fogo selvagem.

Histopathological, cytomorphological and electron microscopic analyses in a case of fogo selvagem are reported. Contradictory to the light microscopical findings, the acantholysis as seen with the electron microscope involves the basal layer but not the subcorneal layers--at least not the most superficial part of the granular layer. A conspicuous disintegration of the tonofilament-desmosome complexes give rise to the concomitant dyskeratosis. This aberrant process, including an association between retracing tonofilaments and defective Odland bodies, results in the terminal stage of monstrous defective and specific keratohyalin. In cytoplasm, target-like structures similar to virions of the herpes virus group were observed. The dynamics of the pathological process is discussed.

Lichen simplex chronicus Vidal: comparative submicroscopic aspects of acanthotic disorders.

Electron microscopic analyses of lichen simplex chronicus Vidal (LSC) are reported. The submicroscopic organization is described. The frequent occurrence of collagen fibres directly juxtaposed to and contiguous with the lamina basalis seems to be a distinguishing feature of the LSC. Discontinuations in the lamina basalis are rarely indicated. A ubiquitous fragmentation and a certain paucity of tonofilamentous structure are present in cells preceding parakeratosis. There is an indubitable paucity of tonofilament-keratohyalin association. Mitochondria, endoplasmic reticulum and ribosomes are abundant. Odland bodies of type II are completely dominant. Parakeratosis and observed submicroscopically deficient or incomplete orthokeratosis are related to the numbers of defective Odland bodies. The keratinization of some acanthotic disorders is discussed.

Cellular changes in the psoriatic epidermis. X. Microplanimetric studies on epidermal cell size during treatment.

Results of microplanimetric measurements of cells in the pronounced macrocytic psoriatic epidermis during treatment with flubenisolon 17 alpha-valerate are reported. The size of cytoplasm, nucleus and nucleolus has been estimated weekly in biopsies until complete regression. No significant differences in the ratios nucleus/cytoplasm and nucleolus/nucleus could be demonstrated. When the lesions are clinically healed, the epidermal cells are still slightly enlarged.

Cellular changes in the basaloid cell papilloma.

Electron microscopic analyses of basaloid cell papillomas of the solid and papillomatous types are reported. The submicroscopic organization is described. Some of the ultrastructural findings, e.g. an increased number of mitochondria, a certain mitochondrial polymorphismus, the occurrence of irregularly shaped intracytoplasmic vesicles, the abundance of endoplasmic reticulum hypertrophy and the remarkable presence of microtubule-like structures, an unusual finding in a material fixed at the temperature used, are indicating an altered metabolic activity. The alternating presence and absence of keratohyalin is found to be submicromorphologically related to the formation of A- respectively B-cells. This is compared with the formation of parakeratosis in psoriatic lesions without keratohyalin. A formation of orthokeratosis as seen by the light microscopical procedure seems possible without preceeding occurrence of keratohyalin.