The effects of water exposure on biophysical properties of normal skin.

BACKGROUND: Water exposure is an influential factor in some common dermatoses. It has also been shown that water has an effect on barrier function and biophysical properties of skin. The aim of this study was to evaluate the effect of water immersion on biophysical properties of normal skin. PARTICIPANTS & METHODS: Twenty healthy volunteers participated in this study. The volar aspect of volunteer's forearm was immersed in tap water for 30 min a day for five consecutive days. Biophysical skin parameters including TEWL, skin pH, capacitance, erythema and sebum content were measured using specific probes before and after the exposure and compared with unexposed other forearm as control. RESULTS: TEWL and pH of the exposed forearm increased significantly after 5 days of consecutive daily exposure to water. CONCLUSION: Water exposure increases the TEWL and pH of normal skin. Future studies evaluating the durability of the increased TEWL through monitoring the time course of events following skin immersion in water and susceptibility of skin to chemical irritants are required.

Diagnostic accuracy of BP180 NC16a and BP230-C3 ELISA in serum and saliva of patients with bullous pemphigoid.

BACKGROUND: Bullous pemphigoid (BP) is a subepidermal blistering disease, characterized by autoantibodies directed against BP180 and BP230. Collecting saliva is an easy and painless way of obtaining biological samples, and can be used for diagnosis of autoimmune diseases. AIM: To compare the diagnostic accuracy of serum and salivary BP180-NC16a and BP230-C3 in the initial diagnosis of BP. METHODS: We assessed 50 patients newly diagnosed with BP and 50 healthy controls. The diagnosis of BP was confirmed based on clinical, histopathological and immunofluorescence findings. Serum and saliva samples were collected from both groups, and BP180 and BP230 titres were assessed using commercially available ELISA kits. RESULTS: Using serum, the sensitivity of the serum BP180 and BP230 ELISA assays was 88% and 48%, respectively, and the specificity of both was 96%. Using saliva with the cutoff value proposed by the manufacturer, sensitivity was 56.2% and 14.6%, and specificity was 98% and 100%, respectively. Using the best calculated cutoff for saliva, sensitivity increased to 87.5% and 77.1%, and specificity to 96% and 62%, respectively. There was a significant correlation between serum and saliva BP180 levels and the severity of skin disease. Both serum and saliva BP230 levels were significantly higher in patients with mucosal involvement. CONCLUSION: Serum BP180 NC16a ELISA is a sensitive and specific test for the initial diagnosis of BP, whereas serum BP230-C3 ELISA is highly specific, but less sensitive. Saliva may be a noninvasive and convenient alternative for use in the BP180 NC16a ELISA to diagnose BP.

Pemphigus vulgaris-associated Kaposi's sarcoma: response to paclitaxel and review of the literature.

Systemic corticosteroids have long been the mainstay of treatment for pemphigus patients. However, the necessity of their high-dose and long-term administration has brought about a number of complications, sometimes causing significant morbidities. Maintaining a balance between therapeutic and undesirable effects of medications is not always easily achievable. Therefore, additional treatment modalities are frequently needed to control side-effects. Kaposi's sarcoma (KS) is a rare, potentially life-threatening complication in this setting. Due to the rarity of data on pemphigus-associated KS treatment, the best therapeutic approach is still undecided. Here, we report two cases of pemphigus patients who had developed extensive KS as a result of severe immunosuppressive therapy and were successfully treated with paclitaxel. In addition, we performed a review of literature to assess the results of the previously employed treatment modalities in this setting.

Diagnostic accuracy of punch biopsy in subtyping basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer in humans. The histological subtype reported by punch biopsy may influence the type of treatment. Few studies have investigated the accuracy of punch biopsy in diagnosing the true BCC subtype. OBJECTIVE: To determine the accuracy, sensitivity and specificity of punch biopsy in BCC subtype diagnosis. METHODS: In this retrospective study, 333 biopsy specimens and excisions were reviewed. Histological subtypes present in the initial biopsy were compared with tumour subtypes of the total excision. RESULTS: The concordance between the BCC subtype present in the biopsy specimen and in the subsequent excision specimen was 72.3%. The most common BCC patterns were nodular (158, 47.5%) and mixed subtype (90, 27%). Most mixed tumours contained one or more aggressive subtype (63/90, 70%). In 47/120 (39.1%) aggressive tumours (14.1% of the total), punch biopsy failed to correctly identify the aggressive component. The most commonly missed aggressive subtype was mixed aggressive including nodular/micronodular and nodular/infiltrative (30/47, 63.8%). In 45/213 (21.1%) non-aggressive BCCs (13.5% of total cases), punch biopsy incorrectly reported an aggressive subtype. The most commonly misidentified non-aggressive subtype was nodular (39/45, 86.6). The sensitivity and specificity of punch biopsy in diagnosing aggressive vs. non-aggressive BCC subtypes 60.8% (95% CI, 51.9-69.1) and 78.9% (95% CI, 72.8-83.8), respectively. The positive and negative predictive values were 61.9% and 78.1%, respectively. CONCLUSION: Punch biopsy has serious pitfalls in differentiating aggressive and non-aggressive BCC subtypes. Dermatologists should consider the possibility of aggressive components within non-aggressive BCCs reported using punch biopsy.