Anogenital warts and human papillomavirus: knowledge, perceived nuisance and risk perception in Dutch soldiers.

Genital warts are one of the most prevalent sexually transmitted infections in the Netherlands and cause both frustration and misinterpretation in young adults. Poor knowledge may be associated with shame and depression. We used questionnaires to study knowledge, perceived nuisance and risk perception in 100 predominantly heterosexual men with clinically-confirmed condylomata acuminata. Our data show that the majority of patients considered having warts as (very) bothersome. Results confirmed the Internet as a widely used information source. Incorrect information on the relationship between warts and both anogenital cancers and infertility was widespread. Results from knowledge questionnaires showed that higher knowledge scores were associated with higher perceived nuisance. We hypothesize that high levels of nuisance related to genital warts may stimulate the need to seek information and therefore increase knowledge. It does not seem likely that an increase of human papillomavirus-related knowledge would increase experiences of nuisance.

Spontaneous cure of American cutaneous leishmaniasis due to Leishmania naiffi in two Dutch infantry soldiers.

We report two Dutch infantry soldiers who acquired American cutaneous leishmaniasis (ACL) during military jungle training in Surinam. The lesions had existed for 3 and 5 months, respectively, before the soldiers presented for treatment. The lesions occurred on the head and right thigh, and were small, uncomplicated and symptomless. PCR for Leishmania revealed Leishmania naiffi in both patients. No treatment was given, and the lesions in both men healed spontaneously within 4 and 6 weeks, respectively, after presentation to our clinic. CL is one of the important 'tropical' diseases in The Netherlands, primarily due to the increasing numbers of cases in travellers and in military personnel serving overseas. ACL due to L. naiffi is thought to be a mild expression of CL with a self-limiting nature. Lesions seem to be single, mostly small, ulcerating and usually appear on the hands, arms and legs. No case of mucocutaneous leishmaniasis has yet been attributed to this parasite.

Intraepidermal accumulation of polymorphonuclear leukocytes in annular pustular psoriasis.

A case of annular pustular psoriasis is described. The annular zone of the lesion provides a model for studying the dynamics of intraepidermal accumulation of polymorphonuclear leukocytes in psoriasis. It could be shown that the unstimulated accumulation of polymorphonuclear leukocytes was limited to the clinically involved skin. The appearance of polymorphonuclear leukocytes proved to be associated with acanthosis. The micropustule formation following topical application of leukotriene B4 was markedly decreased in lesional, prelesional and postlesional skin, compared to the response in the clinically uninvolved skin of patients with chronic plaque psoriasis. Although leukotriene B4 might have an initiating role in the intraepidermal accumulation of polymorphonuclear leukocytes other factors are a conditio sine qua non for the peripheral spreading of the lesion in annular pustular psoriasis.

Leukotriene B4 fails to induce penetration of polymorphonuclear leukocytes into psoriatic lesions.

The intraepidermal accumulation of polymorphonuclear leukocytes following the epicutaneous application of leukotriene B4 (LTB4) was studied in lesional and clinically uninvolved skin of five patients with chronic stable plaque psoriasis. The lesions were found to be wholly unresponsive to LTB4, doses of 100 ng failing to produce either micropustules or exocytosis. This phenomenon was sharply localized; the response immediately adjacent to the lesion being identical to that in more distant uninvolved skin. We speculate that both the reduced response to LTB4 in the psoriatic patient and also the tolerance to LTB4 seen after repeated applications, result from the induction of a P450-linked hydroxylase.

Etretinate modulates the leukotriene B4 induced intra-epidermal accumulation of polymorphonuclear leukocytes.

The effect of etretinate on the intra-epidermal accumulation of polymorphonuclear leukocytes following epicutaneous application of leukotriene B4 was studied in five psoriatic patients. Polymorphonuclear leukocytes were quantified using the marker enzyme elastase. An inverse relationship was found between the dosage of etretinate and the number of infiltrating polymorphonuclear leukocytes.

Reduction of leukotriene B4-induced intraepidermal accumulation of polymorphonuclear leukocytes by methotrexate in psoriasis.

The leukotriene B4 (LTB4)-induced intraepidermal accumulation of polymorphonuclear leukocytes (PMN) was quantified, using an elastase assay, in psoriatic patients receiving methotrexate and in untreated psoriatic patients. Methotrexate in therapeutic dosages inhibited PMN infiltration in six patients who had improved considerably on treatment with the drug, a gradual increase being seen during the days on which no methotrexate was taken. Two patients were in relapse, despite methotrexate treatment, and both failed to show any change in LTB4-induced accumulation of PMN.

Response of polymorphonuclear leukocytes to topical leukotriene B4 in healthy and psoriatic skin.

The in situ infiltration of polymorphonuclear leukocytes following the topical application of leukotriene B4 to the clinically uninvolved skin of psoriatic patients and the skin of normal controls has been quantified using elastase as a marker enzyme. The magnitude of this response in the psoriatic patients proved to be significantly diminished compared with the response in the controls. The time course of the response was similar in both groups, maximum elastase activity being seen about 18 h after application of the LTB4.

Intraepidermal accumulation of polymorphonuclear leukocytes in chronic stable plaque psoriasis.

The intraepidermal penetration of polymorphonuclear leukocytes is an early event in the pathogenesis of psoriasis. In the present study we quantified these cells in biopsies from lesional epidermis of chronic stable plaque psoriasis. In this phase intraepidermal penetration of polymorphonuclear leukocytes was shown in 41% of the lesions. Micropustules of Kogoj were seen in 10% of the lesions. Pronounced parakeratosis was associated with the presence of polymorphonuclear leukocytes. Microabscesses of Munro were located exclusively within areas of parakeratosis. The absence of polymorphonuclear leukocytes in the majority of skin biopsies from chronic stable plaque psoriasis is compatible with the cyclic pattern of the exocytosis of these cells.

Elastase, a marker for neutrophils in skin infiltrates.

The enzyme elastase (EC 3.4.21.37) has proved to be a convenient and extremely sensitive marker for the quantification of neutrophils in cutaneous infiltrates. Fluorometric assay using the synthetic substrate MeOSuc-Ala-Ala-Pro-Val-N-methylcoumarin permitted the measurement of this enzyme in as few as five cells and was linear up to about 1000 cells per sample. The mean activity of lysates of human blood-derived neutrophils was 0.57 +/- 0.08 pmol of 7-amino-4-methyl-coumarin released per hour per neutrophil. Extracts of normal human skin contained no measurable elastase activity but resulted in a slight inhibition of the neutrophil enzyme (mean 12%). Application to the in vivo situation has been demonstrated by the use of leukotriene B4 as chemotactic agent. A reproducible neutrophil infiltrate was found at a dose of 2 ng, well below the threshold for the appearance of microabscesses.