Early- and late-onset psoriasis: a cross-sectional clinical and immunocytochemical investigation.

BACKGROUND: There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases. OBJECTIVES: We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP. METHODS: We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study. RESULTS: Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4+ : CD8+ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006). CONCLUSIONS: Our findings provide further evidence for the difference between EOP and LOP.

Muckle-Wells syndrome/neonatal-onset multisystem inflammatory disease overlap associated with myelodysplasia and cerebrovascular accident.

We describe a patient with overlapping clinical features of Muckle-Wells syndrome and neonatal-onset multisystem inflammatory disease with an absence of mutation in exon 3 of the CIAS1 / PYPAF1 / NALP3 gene. Myelodysplasia and cerebrovascular accident were additional features in this patient, which to our knowledge have not been previously described in association with these disorders. The urticarial rash, myelodysplasia and raised inflammatory markers responded to treatment with the interleukin-1 receptor antagonist, anakinra.

Lifelong scaling and blistering in a family.

Ichthyosis bullosa of Siemens is a genodermatosis, which presents in childhood with mild blistering and hyperkeratosis. The heterogeneous clinical presentation may lead to misdiagnosis, even in the presence of a strong family history. Genetic testing and counselling may help in diagnosis and treatment.

Inflammatory epidermolysis bullosa acquisita mimicking toxic epidermal necrolysis and dermatitis herpetiformis.

We report a patient with a spectrum of clinical features simulating toxic epidermal necrolysis, bullous erythema multiforme and later, dermatitis herpetiformis (DH). The histological features were suggestive of DH, bullous pemphigoid (BP) and epidermolysis bullosa acquisita (EBA). Direct immunofluorescence results suggested BP or EBA. Indirect immunofluorescence on salt-split skin and immunoblotting analysis on normal human dermal extracts gave results that were diagnostic for EBA.

Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach.

AIMS: Whether immunohistochemical markers increase accuracy in predicting prognosis for gastrointestinal stromal tumours (GISTs) remains uncertain. However, past studies have used only small, heterogeneous patient groups. Our aim was to test previously studied and more novel morphological features as well as four immunohistochemical markers as prognostic indicators amongst a large cohort of surgically resected, gastric GISTs. METHODS AND RESULTS: Tissues from 127 gastric mesenchymal tumours were collected retrospectively and subjected to repeat histological assessment and immunophenotyping. Further immunohistochemistry was performed for Ki67, p53, Bcl-2 and cyclin D1. Complete follow-up data were collected for 108 patients with immunophenotyped diagnoses of GIST (i.e. c-kit+ tumours). At the census point, 52 patients were alive, 24 had died from their GISTs and the remainder of other causes. Univariate analysis showed the following predicted for shorter disease-specific survival: size > or =50 mm; necrosis, no intratumoral lymphocytes; mitotic count > or =5/50 high power fields; Ki67 labelling index > or =5%; p53 immunopositivity. Of these variables, multivariate analyses showed only mitotic count and, to a lesser extent, Ki67 labelling to be independent prognostic indicators. CONCLUSIONS: Mitotic count remains the best predictor of outcome following surgical resection of gastric GISTs. Ki67 immunohistochemistry does not provide better prognostication and p53, Bcl-2 and cyclin D1 immunohistochemistry provide no additional prognostication.

Effect of emu oil on auricular inflammation induced with croton oil in mice.

OBJECTIVE: To determine the acute anti-inflammatory effects of topically applied emu oil. ANIMALS: 96 male CD-1 mice assigned randomly to 4 groups, each comprising 24 mice. PROCEDURE: To induce auricular inflammation, 50 microl of a solution comprising 10 microl of croton oil dissolved in 1 ml of acetone was applied to the inner surface of the left auricle (pinna). One hour later, 3 or 5 microl of emu oil (low- and high-dose groups, respectively) or 5 microl of porcine oil (oil-control) was applied to the left pinna. Control mice remained untreated. Six mice per group were euthanatized 3, 6, 12, and 24 hours after induction of inflammation. Specimens of auricular tissue (ear plugs) were obtained, using a 6-mm biopsy punch. Magnitude of swelling was calculated as the weight difference between left (inflamed) and right (noninflamed) ear plugs; degree of edema was determined as the difference between wet and dry weights of the left ear plug. RESULTS: Magnitude of swelling was significantly reduced at 6 and 12 hours in mice treated with emu or porcine oil, compared with controls. The greatest reduction in swelling was detected in the high-dose emu group at 6 hours. Compared with controls, degree of edema was significantly reduced at 6 hours only in the high-dose group, whereas by 12 hours, all groups treated with oils had significantly less edema than controls. At 24 hours, magnitude of swelling and degree of edema did not differ among groups. CONCLUSION: Topically applied emu oil significantly reduced severity of acute auricular inflammation induced by croton oil in mice.