Direct immunofluorescence studies in alopecia areata and male pattern alopecia.

Direct immunofluroescence studies were performed on hairy and alopecic areas of scalp in patients with alopecia areata, alopecia totalis and male pattern alopecia. Abnormal deposits of C3 and occasionally of IgG and IgM were found in 92% of 12 patients with alopecia areata and in 21% of patients with male pattern alopecia. No abnormalities were seen in 4 patients with alopecia totalis. In both alopecia areata and male pattern alopecia, the deposits were most common along the basement zone of the inferior segment of hair follicles and occurred with equal frequency in alopecic and normal scalp. These observations suggest that immune factors may play a role in the pathogenesis of alopecia areata.

Mal de Meleda treated with 13-cis retinoic acid.

Identical twins with mal de Meleda, a rare genodermatosis, displayed the characteristic "glove and sock" hyperkeratosis, hyperhidrosis, and malodor. Their parents, who are first cousins, are unaffected and originated from Calabria, Italy, which is not far from Meleda (Mljet). The disorder is probably transmitted as an autosomal recessive trait. Previous therapy with grenz rays, topical preparations of adrenocorticosteroids, lactic acid, retinoic acid, and bland emollients had been unsuccessful. One of the twins was treated with 13-cis retinoic acid taken by mouth for 16 weeks with dramatic improvement. The major adverse effect was cheilitis, which did not force discontinuation of the treatment.

Thermalism in Argentina. Alternative or complementary dermatologic therapy.

Our study took place in the region of the Copahue Volcano in the Andes Mountain range, 1900 m above sea level. Fifty-five patients who came to the Copahue Thermal Basin Complex (Neuquén, Argentina) for treatment of psoriasis vulgaris were clinically evaluated for participation in this study. Thermal products--waters, mud, and/or algae--were the only therapeutic agents used, except for bland emollients for xerosis. Treatment for brief periods (10 +/- 3 days) resulted in notable improvement.

[Cutanea tarda porphyria in 2 patients with kidney transplantation]. / Porfiria cutánea tarda en dos pacientes con trasplante renal.

Two patients who developed porphyria cutanea tarda, six and eight years after a successful renal transplantation are reported. There was no history, in either of them, of alcohol abuse, blood transfusion, iron or estrogen therapy and any hemodialysis in the last years. There is no evidence to support that a renal allograft is capable to develop porphyria cutanea tarda. Nevertheless, it would be interesting to consider its possible influence, due to the longer survival of these patients.

[Speaking with images. Audiovisual communication materials. When and how to teach with slides]. / Hablando con imágenes. Medios audiovisuales de comunicación. Cúando y cómo enseñar con diapositivas.

The importance of audiovisual communication in dermatology is stressed. Different programming technics and methods for conferences and informal presentations are mentioned.

Interest of corrective makeup in the management of patients in dermatology.

BACKGROUND: Disfiguring dermatoses may have a significant impact on patients' quality of life, namely on their relationship with others, self image, and self esteem. Some previous studies have suggested that corrective foundation can improve the quality of life (QOL) of patients with facial dermatoses; in particular, in patients with acne vulgaris or pigmentary disorders. OBJECTIVE: The aim of this prospective study was to evaluate the impact of the skin conditions of patients with various skin diseases affecting their face (scars, acne, rosacea, melasma, vitiligo, hypo or hyperpigmentation, lentigines, etc) on their QOL and the improvement afforded by the use of corrective makeup for 1 month after being instructed on how to use it by a medical cosmetician during an initial medical consultation. METHODS: One hundred and twenty-nine patients with various skin diseases affecting the patients' face were investigated. The patients were instructed by a cosmetician on how to use corrective makeup (complexion, eyes, and lips) and applied it for 1 month. The safety of the makeup application was evaluated and the QOL was assessed via a questionnaire (DLQI) and using a 10-cm visual analog scale (VAS) completed before the first application and at the final visit. The amelioration of their appearance was documented by standardized photography. RESULTS: No side effects occurred during the course of the study. A comparison of the standardized photographs taken at each visit showed the patients' significant improvement in appearance due to the application of corrective makeup. The mean DLQI score dropped significantly from 9.90 ± 0.73 to 3.49 ± 0.40 (P < 0.0001). CONCLUSION: Our results suggest that dermatologists should encourage patients with disfiguring dermatoses to utilize appropriate and safe makeup to improve their appearance and their QOL. Corrective makeup can also complement the treatment of face dermatological diseases in order to improve patient's adherence.

Brooke-Spiegler syndrome - report of four families: treatment with CO2 laser.

BACKGROUND: Brooke-Spiegler syndrome is a well known but rare cutaneous disorder characterized by the presence of multiple trichoepitheliomas and cylindromas. METHODS: Four families with Brooke-Spiegler syndrome are described. RESULTS: Spiradenomas developed on the back in two patients. A CO(2) laser was used to treat facial trichoepitheliomas in two patients with good results. CONCLUSIONS: The large number of facial lesions in this syndrome often produce a significant emotional impact. We believe that it is important to provide patients with a good therapeutic option. CO(2) laser therapy may fill this role.

Indications and technique of biopsy for diseases of the scalp.

Indications for biopsy of scalp skin are discussed and the technique for obtaining adequate tissue for histologic examination is described.

Diagnosing the common alopecias.

Ample scalp biopsies, including subcutaneous fat, are easily obtained by excision or punch biopsy. Using a knowledge of normal hair patterns and histologic features, the physician can identify common baldness, trichotillomania, alopecia areata, discoid lupus erythematosus, lichen planopilaris, tinea capitis and follicular mucinosis. While hair loss is usually of more psychologic than physiologic significance, accurate diagnosis can be of great importance.

Pancreatic panniculitis in a kidney transplant recipient.

BACKGROUND: Pancreatic panniculitis is a rare complication of pancreatic disease. Histopathologic findings are pathognomonic and may be helpful for early diagnosis. METHODS: We present a female kidney transplant recipient, with systemic lupus erythematosus on immunossuppresive therapy, who developed panniculitis. RESULTS: Histological features strongly suggested pancreatic panniculitis and this was confirmed by clinical, laboratory and image findings. CONCLUSION: The characteristic histologic features of pancreatic panniculitis may help to uncover undiagnosed pancreatic disease. Early therapy may avoid ensuing serious complications.

Burning mouth syndrome.

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) is a frequent process that produces marked oral dysesthetic symptoms. There is controversy over its etiopathogenesis and diagnosis. Therapeutic results are unsatisfactory. The objectives of this study were: (1) to analyze a possible agreement on the definition of BMS; (2) to analyze its cause; (3) to propose a therapeutic scheme that has been shown to be highly effective in our experience and has not been previously reported. METHODS: Five hundred patients with symptomatology of BMS were retrospectively evaluated with a study protocol, specially designed for this disease. Patients with local or general disease processes that could cause secondary asymptomatic stomatodynia were excluded from the study. RESULTS: Most of the patients evaluated were women over 60 years of age with oral symptoms, including a sensation of heat and burning, and pain, lasting for months or years, and a history of multiple unsuccessful treatments. The patients showed depression associated with anxiety, with evidence of psychiatric disorders in the family. Based on these findings and eliminating symptomatic painful conditions of the mouth that may stimulate this syndrome, we diagnosed a genuine or basic BMS of psychosomatic origin. Therapies used in the treatment of these neurotic conditions were not always useful. Tranylcypromine associated with anxiolytics and hypnotics in low doses plus the support of psychotherapy by the stomatologist were the most effective treatments. CONCLUSIONS: The BMS should be defined as a psychosomatic process causing oral dysesthesias for months or years.

DermRx. An experiment in computerizing information on dermatologic therapy.

The Task Force for Creating a Biomedical Communications System for Dermatology was commissioned by the American Academy of Dermatology to develop an experimental segment of a computerized data bank on dermatologic therapy. The Task Force has completed such a "first generation" system and has named it DermRx. Its data bank carries the following information on each entry: the name of the disease; topical, systemic, physical, and other kinds of treatment; caveats; references to the literature; and the date and reviewer(s). The DermLit and DermRx programs are two components of a projected broader concept of an eventual comprehensive Biomedical Communications System for Dermatology. Such a system is envisaged as a means of making available to dermatologists diverse data relevant to practice, teaching, research, and business aspects of the specialty. At the moment, access to the stored information on dermatologic literature and therapy is by telephone call to, or by correspondence with, the central computer facility at Northwestern University. Eventually it is projected to be accessible by dedicated microcomputers housed in the physician's office. This preliminary report on DermRx is presented to review the progress of the project to date and to elicit comment upon its structure and value.

Biological therapies in the systemic management of psoriasis: International Consensus Conference.

Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

Estudio clínico para evaluar el efecto de dos cremas humectantes con protector solar en la piel de pacientes que utilizan tretinoína0, 025% para el tratamiento del fotodaño / Clinical study to evaluate the effect of two facial moisturizer test products

Introducción: La exposición a la radiación ultravioleta (RUV) produce un deterioro en la piel denominado fotodaño, que puede mejorarse con la aplicaciónde tretinoína. Este tratamiento, sin embargo, puede causar efectos colaterales.El objetivo es comparar las diferencias en la eficacia, tolerancia y preferencias al utilizar tretinoína al 0,025%, junto con dos productos hidratantes diferentes.Materiales y métodos: Estudio abierto, prospectivo, doble ciego, randomizado. Cincuenta y siete mujeres de 35 a 55 años, con daño solar, se aplicaronen el período de pre-condicionamiento, una crema humectante en cada hemicara: una con niacinamida y otra sólo con componentes hidratantes.Luego, se agregó tretinoína tópica al 0,025%. Se evaluó fotodaño, tolerancia y preferencias.Resultados: En el período de precondicionamiento no se hallaron diferencias significativas en la tolerancia. La pérdida trans epidérmica de agua(PTEA) fue significativamente peor para el humectante B. La textura de la piel mejoró significativamente para ambos humectantes. En el período detratamiento la tolerancia disminuyó más para el humectante B en las semanas 2 y 4, mejorando al final del estudio. Los parámetros relacionados confoto daño mejoraron, más para el humectante A.La PTEA aumentó en las semanas 2 y 4, más para el humectante B; para luego disminuir.Comentario: La tretinoína tópica es bien tolerada, cuando se la utiliza en combinación con cremas humectantes. La niacinamida agrega beneficios ala acción hidratante de un producto, ya que cumple un rol en la prevención de efectos adversos y en la potenciación de los efectos beneficiosos delretinoide (AU)

Introduction: Ultraviolet radiation exposure cause a deleterious effect in the skin called photodamage. Tretinoin application can improve this damage,however it can also cause adverse effects. The objective of this paper is to compare the differences in tolerance and patient preference when usingtretinoin 0.025% along with two different moisturizers.Material and methods: It was and open, prospective, randomized, double blinded study. Fifty sevenwomen, 35 to 55 year old with photodamagedskin, applied during a preconditioning period a different moisturizer in each side of the face. One of them contained niacinamide and the other onlyhydrating components. After 15 days topical tretinoin 0,025% was added. Efficacy, tolerance and preferences were evaluated.Results: We didn’t find significative differences in tolerance during the preconditioning period. Transepidermal water loss (TEWL) was significativelyworse for moisturizer B. Skin texture improved for both used products. During the treatment period, tolerance was worse for moisturizer B in weeks 2 and 4. There was a more important improvement in photodamage related items for moisturizer A. TEWL were high for both products in weeks 2 and4, diminishing afterwards. This elevation was higher for moisturizer B.Comment: topical tretinoin is well tolerated when used in combination with moisturizer creams. Niacinamide adds benefits because it helps preventingadverse events and promote desirable anti age effects of the retinoid (AU)

Periartritis nudosa predominantemente cutanea: consideraciones a proposito del estudio de dos casos: revisión del tema / Nodose periarthritis cutaneous predominant: consideration apropos of the study of twuo cases: review of the theme

Se presentan dos casos de PANC de 15 y 68 años respectivamente pertenecientes al sexo masculino. El caso 1 presenta nódulos, livedo reticular y racemoso con adelgazamiento, astenia y anemia sin compromiso visceral ostensible. Evoluciona con involución de lesiones cutáneas y síntomas generales luego de un breve período de administración de corticoesteroides por via general. Se halla assintomático en la actualidad sin corticoterapia. El caso 2 presenta livedo racemoso y reticular con áreas atróficas y nódulos ocasionales. Se trata con antiinflamatorios no esteroides y no tiene evolución posterior conocida. Se resumen las características que permiten diferenciar formas predominantemente cutáneas de las sistémicas cuyo tratamiento y pronóstico difieren, sosteniendo la idea de un espectro continuo semejante a lo del lupus eritematoso

Periartritis nudosa predominantemente cutanea: consideraciones a proposito del estudio de dos casos: revisión del tema / Nodose periarthritis cutaneous predominant: consideration apropos of the study of twuo cases: review of the theme

Se presentan dos casos de PANC de 15 y 68 años respectivamente pertenecientes al sexo masculino. El caso 1 presenta nódulos, livedo reticular y racemoso con adelgazamiento, astenia y anemia sin compromiso visceral ostensible. Evoluciona con involución de lesiones cutáneas y síntomas generales luego de un breve período de administración de corticoesteroides por via general. Se halla assintomático en la actualidad sin corticoterapia. El caso 2 presenta livedo racemoso y reticular con áreas atróficas y nódulos ocasionales. Se trata con antiinflamatorios no esteroides y no tiene evolución posterior conocida. Se resumen las características que permiten diferenciar formas predominantemente cutáneas de las sistémicas cuyo tratamiento y pronóstico difieren, sosteniendo la idea de un espectro continuo semejante a lo del lupus eritematoso (AU)