Correlation of serum IgE levels and clinical manifestations in patients with actinic prurigo.

BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.

Correlation of serum IgE levels and clinical manifestations in patients with actinic prurigo

Abstract BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate.

Actinic Prurigo.

Actinic prurigo is an idiopathic photodermatosis that affects the skin, as well as the labial and conjunctival mucosa in indigenous and mestizo populations of Latin America. It starts predominantly in childhood, has a chronic course, and is exacerbated with solar exposure. Little is known of its pathophysiology, including the known mechanisms of the participation of HLA-DR4 and an abnormal immunologic response with increase of T CD4+ lymphocytes. The presence of IgE, eosinophils, and mast cells suggests that it is a hypersensitivity reaction (likely type IVa or b). The diagnosis is clinical, and the presence of lymphoid follicles in the mucosal histopathologic study of mucosa is pathognomonic. The best available treatment to date is thalidomide, despite its secondary effects.

Actinic prurigo: a case-control study of risk factors.

BACKGROUND: Actinic prurigo (AP) is an idiopathic photodermatosis that usually onsets during childhood and predominates in women. It is characterized by the symmetrical involvement of sun-exposed areas of the skin, lips, and conjunctiva. OBJECTIVES: This study aimed to analyze the risk factors associated with AP using a case-control design. METHODS: All patients diagnosed with AP during 1990-2006 at Dr. Manuel Gea González General Hospital in Mexico City were included. Respective controls were recruited. Race, demographic, geographic, socioeconomic, environmental, clinical, and nutritional risk factors were assessed. RESULTS: A total of 132 persons were enrolled. These included 44 cases and two control groups comprising, respectively, dermatology and non-dermatology outpatients without AP or any autoimmune disease. Distribution by gender, age, place of birth, place of residence, and economic status did not differ significantly among the three groups. A total of 256 variables were analyzed. Only 19 variables were found to be statistically significant (P < 0.05). These were: use of a boiler; use of firewood; car ownership; use of earthenware; mixed material housing; socioeconomic level 1; sun exposure; use of soap; lemon consumption; use of moisturizing hair cream; living with pets in the house; living with farm animals; age; having a family member with AP; having had surgery; having had trauma; having been hospitalized; use of oral medication; and use of herbal medication. Of 40 macro- and micronutrients analyzed, 11 were found to have statistically significant effects (P < 0.05). CONCLUSIONS: Multiple epidemiologic, geographic, clinical, and immunologic factors are involved in the etiology of AP. This study proposes a clear line for research directed at specific risk factors that refer to an individual's clinical, allergic, health, and socioeconomic status. Further study should also investigate the etiologic role of diet in AP and the molecular mechanisms behind the development of AP to establish whether AP is caused by exposure to polycyclic aromatic hydrocarbons.

Bullous aplasia cutis congenita: case report and review of the literature.

Aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura. It can be a part of various syndromes and can be associated with multiple genetic diseases, malformation patterns, or a combination of all. It is even considered as a form frustre of a neural tube defect in several literatures. Bullous aplasia cutis congenita is a clinical subtype of the condition, with extremely few cases reported in the literature. It presents as a cystic or bullous lesion at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Some cases present with a dark collar hair sign around the lesion, which can be even more indicative of an underlying neural tube defect. Management remains controversial and depends on the characteristics of the lesion, but conservative treatment is usually chosen.

Dermatosis cenicienta (Eritema discrómico perstans) / Ashy dermatosis (Erythema dischromicum perstans)

La dermatosis cenicienta (DC) es una hipermelanosis idiopática, adquirida, generalizada, macular, azul grisáceo ceniciento que aparece en individuos sanos. Descrito por primera vez por Oswaldo Ramírez en El Salvador en 1957. La etiología de la DC es desconocida; es más común en América Latina y Asia, aunque se han descrito casos en diferentes partes del mundo. Afecta principalmente a individuos de piel oscura, de ambos sexos, con un predominio por la segunda década de la vida. La DC se presenta como una enfermedad crónica y asintomática, de larga evolución, de importancia cosmética principalmente. Afecta comúnmente el tronco, brazos, cuello y cara, sin preferencia por áreas expuestas. El diagnóstico diferencial debe hacerse con el liquen plano pigmentado y pigmentación macular eruptiva idiopática, principalmente. En la histopatología, se observa una epidermis ligeramente aplanada con áreas de vacuolización e hiperpigmentación de la capa basal, con infiltrado escaso perivascular linfocitario. Las opciones terapéuticas son muchas, pero pocas han resultado efectivas, el único tratamiento que al parecer tiene más eficacia es la clofazimina a una dosis promedio de 100mg tres veces por semana durante tres a cinco meses

The ashy dermatosis (A O) is an idiopathic acquiredblue-gray macular hyperme/anosis, widespread, that appears in hea/thy individua/s. /t was first described by Oswaldo Ramirez from El Salvador in 1957. The etio/ogy of the AD remains unknown; ít's more common in Latin America and Asia, though cases have been described worldwide. /t affects both sexes, most commonly dark skin individuals, in the second decade of the Me. The AD has a chronic and asymptomatic course with a long evolution, with just cosmetic importance, It usually affects the trunk, arms, neck and face, rarely the exposed areas. The dífferential diagnosis must be done especíally with the lichen planus pigmentosus and idiopathic macular eruptive pigmentation. The histopatology shows a lightly smoothed epidermis with areas of vacuolization and hyperpigmentation of the basal cell layer, with scanty perivascular limphocytic infiltration. There are many therapeutíc optíons, but few of them are effective. The only treatment that apparently has been more effective is clofazimine using an average dose of 100 mg three times per week during three to five months

Evaluation of subcision as a treatment for cutaneous striae.

BACKGROUND: Treatment options for cutaneous striae are very limited. OBJECTIVE: To determine if subcision is an effective treatment for cutaneous striae and compare a combination with 0.1% tretinoin cream against a single treatment. METHODS: 14 patients were evaluated, each with 3 white striae. One stria received treatment with subcision, one with tretinoin cream in a 0.1% concentration, and one with subcision plus tretinoin. The length of follow-up was 3 months. Two blind investigators evaluated improvement by comparison of the initial and final digital photographs. RESULTS: Only 7 patients completed 3 months follow-up. A decrease of width and clinical improvement was observed with the 3 treatments. However, some striae showed no change at all and there was no statistically significant difference between treatments. Three patients presented necrosis in striae treated with subcision. CONCLUSIONS: There are no studies in the medical literature about subcision for the treatment of cutaneous striae. This is a preliminary study and considering the undesirable effects of necrosis in a high percentage of striae treated with subcision, the subjective way of evaluation, and the small study group, we can not recommend subcision as a treatment for cutaneous striae. Large studies are necessary to corroborate or to discard our findings.

Diagnosis and treatment of actinic prurigo.

Actinic prurigo (AP) is an idiopathic photodermatosis that affects mainly the mestizo population in Latin America. It has an early onset, a slight predominance in women, and affects the sun-exposed areas of the skin, causing erythematous papules and lichenified plaques secondary to intense and chronic pruritus. Lesions can be induced by both ultraviolet A (UVA) and ultraviolet B (UVB). An association with several human leukocyte antigen (HLA) alleles has been reported. AP is unique among all photodermatoses in its remarkable response to thalidomide. In the past the microscopic features of AP have been considered as nonspecific; however, the constant finding of dense lymphocytic inflammatory infiltrates and the immunogenetic features of AP support the existence of an immunologic mechanism in its pathogenesis.

Actinic prurigo cheilitis: clinicopathologic analysis and therapeutic results in 116 cases.

Objective. This study describes the clinicopathologic features and therapeutic results of 116 patients with actinic prurigo cheilitis seen over an 11-year period. Study Design. A retrospective study was carried out with hospital records and a microscopic slide review from a large dermatology department in Mexico City, Mexico. Results. The study consisted of 42 male (36.2%) and 74 female (63.8%) patients, with a male to female ratio of 1:1.7. Age ranged from 9 to 82 years (mean, 27.9 years; standard deviation, 14.2). Thirty-two cases (27.6%) were found in which cheilitis was the only manifestation of this condition. Pruritus, tingling, and pain of the vermilion were recorded in 96 cases (82.7%). Typical histopathologic findings included in most cases the presence of acanthosis, spongiosis, basal cell vacuolation, ulceration with serohematic crust formation, edema of the lamina propria, lymphocytic inflammatory infiltrate with well-defined lymphoid follicles, and variable numbers of eosinophils and melanophages. Improvement of the symptoms was obtained in 112 cases (96.5%) with sun-protective measures and diverse antiinflammatory agents. However, complete resolution of the labial lesions were more frequently achieved with the combination of topical steroids, thalidomide, and sun-protective measures (42.2%) as compared with topical steroid therapy plus sun-protection measures (16.3%; P <.005). Conclusion. Our findings confirm that lip lesions may appear as the only manifestations of this photodermatosis and that it has typical clinical and microscopic features and should therefore be considered a specific form of cheilitis.

Estudio inmunohistoquímico para demostrar la presencia de linfocitos T y B en el infiltrado inflamatorio de las biopsias de piel, labio y conjuntiva de pacientes con prurigo actínico / Immunohistochemistry study to demostrate the presence of T and B lymphocytes in skin, lip and conjunctival biopsies of actinic prurigo patients

Se reportan los resultados de un estudio inmunohistoquímico del infiltrado inflamatorio de biopsias de la piel, el labio y la conjuntiva de pacientes con prurigo actínico (PA), donde se aplicaron anticuerpos monoclonales contra vimentina (para saber si el tejido necesitaba recuperación antigénica), contra antígeno común leucocitario (CD45), UCHL-1 (anti-CD45RO) marcador de linfocitos T, L-26 (anti-CD20) marcador de linfocitos B. Se demostró la presencia de linfocitos B y T en los infiltrados inflamatorios; cuando éstos se disponen en folículos linfoides los linfocitos B se encuentran al centro y los T en la periferia

Enfermedad de Paget: presentación de 8 casos / Paget's disease: report of 8 cases

Se comunican 8 casos de enfermedad de Paget estudiados en la consulta dermatológica del Hospital General "Dr. Manuel Gea González", de 1980 a 1993. Cinco casos se presentaron en mama y el tiempo de evolución varió de 6 meses a un año. Tres fueron extramamarios de 1 a 6 años de evolución. Clínicamente presentaron placas eritemato-escamosas con eccema y en genitales eritema y descamación con aspecto de candidosis. Cinco pacientes fueron tratados con mastectomia radical y quimioterapia. Un caso extramamario falleció por asociación con otro carcinoma y metástasis del mismo

Micobacteriosis atípicas: aspectos clínico-epidemiológicos de 44 casos / Atypical mycobacteriosis: clinico-epidemiological aspects of 44 cases

Se hace una revisión de la literatura sobre los más destacados aspectos clínicos y terapéuticos de las microbacteriosis se comunican 44 casos. Diez fueron de las siguientes formas: un caso de linfadenopatía y lesiones esporotricoides por M. Kansasii; un caso por M. marinum y tres por microbacterias no determinadas; unalinfadenopatía, probablemente por M. scrofulaceum; un caso de abscesos por microbacterias y otro de lesión verrugosa; una microbacteriosis cutánea ulcerosa y un caso de microbacteriosis de SIDA, así como una epidemia nosocomial en 34 casos

Carcinoma de la glándula de Meibomio: informe de un caso / Meibomian gland carcinoma: a case report

Se comunica un caso de carcinoma de la glándula de Meibomio en una mujer de 82 años de edad. Este tumor es poco frecuente y puede condundirse clínica e histológicamente con un carcinoma epidermoide.