Inflammation in acne vulgaris: leukocyte attraction and cytotoxicity by comedonal material.

The chemoattraction of comedonal material for leukocytes was evaluated. Material from open comedones attracted mononculear leukocytes but did not attract polymorphonuclear leukocytes. At higher concentrations, comedonal material was cytotoxic for leukocytes of both types. Of the comedonal components tested, free fatty acids produced the greatest cytotoxicity. The attraction and killing of leukocytes by comedonal components may be the mechanisms for the initiation or the enhancement (or both) of inflammation in acne vulgaris.

Normal mouse skin lymphocyte, Langerhans cell, and keratinocyte responses to intradermal injections of interferon-alpha and interferon-gamma.

To investigate the skin immune responses induced by intradermal injections of interferon-alpha (IFN-alpha) and interferon-gamma (IFN-gamma), normal C3H mice were injected intradermally with murine recombinant interferon-alpha (rIFN-alpha), interferon-gamma (rIFN-gamma), or the combination of rIFN-alpha and rIFN-gamma, three times per week for 2 or 4 weeks. Contralateral sites were similarly injected with placebo (saline). The results showed that after 6 or 12 injections of rIFN-alpha (10,000 IU/per injection), epidermal ATPase+ and Ia+ Langerhans cells (LGs) decreased significantly (p < 0.01 and p < 0.05) but dermal lymphocytic infiltrates, including CD3+ (pan-T cells), L3T4+ (T helper cells), Lyt-2+ (T suppressor/cytotoxic cells), MOMA+ (macrophages and monocytes), and dermal Ia+ cells, increased significantly (p < 0.01) compared with both saline injection sites and untreated skin. In contrast to rIFN-alpha, 6 injections of 10,000 IU rIFN-gamma failed to induce significant changes in either epidermal LGs or dermal lymphocytic infiltrates, except for an increase in dermal MOMA+ cells. High-dose rIFN-gamma injections (50,000 IU) strongly enhanced the expression of Ia antigen in epidermal keratinocytes (KCs), increased dermal lymphocytic infiltrates, and decreased the LGs in a similar pattern to that of rIFN-alpha. Furthermore, rIFN-gamma (50,000 IU) injections induced Ia antigen expression on the KCs in the contralateral saline injection areas, suggesting a systemic effect. Injections of a combination of rIFN-alpha and rIFN-gamma failed to show synergism for induction of skin immune responses.

Rapid identification of monocytes in a mixed mononuclear cell preparation.

A method for identifying monocytes by the "non-specific esterase" stain is described. This method is particularly applicable to mononuclear cell suspensions obtained by Ficoll--Hypaque density gradient separations and allows rapid as well as accurate determinations.

Treatment of Kaposi sarcoma with vinblastine.

Five cases of Kaposi sarcoma with vinblastine sulfate treatment were compared with 18 cases reported in the literature. Our experience with a low-dosage schedule emphasizes that toxicity is not necessary for a favorable result. Vinblastine seems to be an effective treatment for Kaposi sarcoma and, in selected cases, may supplement radiation therapy or be used alone.

Paresthesia from cutaneous exposure to a synthetic pyrethroid insecticide.

Occupational exposure to fenvalerate, a synthetic pyrethroid insecticide, has been reported to cause paresthesia. An assay was devised in our laboratory for subjective grading of the sensation produced by the topical application of this compound. The present double-blind study compared human discrimination of topically applied technical fenvalerate, the heavy-ends fraction of fenvalerate, and ethyl alcohol (vehicle). Both forms of fenvalerate showed a statistically significant increase in inducing paresthesia over the vehicle alone. The onset of the cutaneous sensations occurred at one hour, peaked at three to six hours, and lasted approximately 24 hours. Numbness, itching, burning, tingling, and warmth were the most frequently reported sensations. The difference between the two fractions of fenvalerate was not statistically significant.

Trial of intralesional interferon alfa in the treatment of alopecia areata.

Eleven patients with alopecia areata, ranging from patchy disease to alopecia universalis, were treated with intralesional interferon alfa-2 on a selected area of alopecia. Follow-up at 3 months revealed local terminal hair growth in one patient. At 12 months, variable disease activity was seen. Regional lymphadenopathy, a new finding with interferon, was seen in four patients during the treatment. Immunohistochemical studies showed some changes in the inflammatory infiltrates and in HLA-DR expression that may be related to the interferon or to the dynamics of the inflammatory infiltrate in alopecia areata. Interferon, at the dosage and treatment schedule used in our trial, had no significant effect on alopecia areata.

Development of an objective comedogenicity assay.

The rabbit ear comedogenicity assay is useful as a screening procedure for evaluating agents that come in contact with human skin. Controversy exists regarding the reliability of this assay because of differences in results from various laboratories. The subjective nature of the standard method of grading may also contribute to this variation. We use a more objective comedogenicity assay that utilizes increasing follicular orifice size on the rabbit ear as a measure of comedogenic activity. A generally linear increase in the degree of follicular orifice area was noted with several agents evaluated over a four-week application period. Further, a noninvasive Silastic elastomer mold was used to allow measurement of the same follicular orifice areas over time.

Benign papular acantholytic dermatosis.

Seven male patients, aged 41 to 63, had benign papular acantholytic dermatosis. The patients complained of firm, intensely pruritic, 1- to 3-mm, reddish-brown or flesh-colored papules. The lesions were usually found on the upper part of the torso or on the neck. At least five of the seven patients reported that sunlight initiated or exacerbated the condition. The mean duration of the disorder exceeded two years. Histologically, the predominant lesion in all seven cases was acantholysis. Dyskeratosis was not a characteristic finding, being absent in five of the seven cases and minimally present in two. We will compare the features of benign papular acantholytic dermatosis with those of other papular acantholytic disorders.

Neonatal lupus erythematosus. A report of three cases associated with anti-Ro/SSA antibodies.

Three patients had neonatal lupus erythematosus syndrome. All three infants were girls who presented with characteristic skin lesions but without evidence of congenital heart block. All three mothers were asymptomatic at the time of delivery and have remained so until the present time. All mothers were positive for anti-Ro/SSA antibodies, as were the infants prior to 6 months of age. Anti-La/SSB antibodies were not present in either the mothers or the infants. HLA typing revealed that two of the mothers were positive for B8 and DR3, while the third mother was positive for B8 and DR2. Two of the infants were positive for B8 and DR3, while the third infant was positive for DR2 only.

The effect of an intralesional sustained-release formulation of interferon alfa-2b on basal cell carcinomas.

Intralesional interferon alfa-2b has been proven effective in the treatment of basal cell carcinomas. Because nine injections over a 3-week period have been necessary to produce clinically significant cure rates, a sustained-release protamine zinc chelate interferon formulation has been developed. In this study, 65 basal cell carcinomas were treated in one of two dosing schedules with intralesional sustained release interferon alfa-2b (10 million IU per injection). Thirty-three patients received a single injection and 32 patients received one injection per week for 3 weeks. At study week 16, 80% of evaluable tumors treated with three injections and 52% treated with one injection were cured histologically. Two patients discontinued injections because of side effects. A sustained-release protamine zinc preparation of interferon alfa-2b shows promise as a practical, effective, and cosmetically elegant treatment for basal cell carcinoma.

Thalamic hemorrhage with neglect and memory disorder.

A patient with right thalamic hemorrhage developed left-sided hemi-inattention, indifference, motor neglect, and hypokinesia. He also developed a severe memory deficit at the time of hemorrhage. Observations in this patient suggest that, in addition to a syndrome of neglect and hypokinesia, an amnesic syndrome can arise from unilateral lesions involving the right thalamus.

Prevention of occupational skin disease.

Each occupational setting has unique risks for occupational skin disease based on the materials used, the workplace environment, and the skin type of each worker. Virtually all programs for the prevention of skin disease can be designed around the principles outlined in this article. Most problems can be eliminated by well-designed prevention programs. All workers are entitled to a safe working environment that reduces to the extent possible the risks of acquiring occupational skin disease.

Normal human skin lymphocytic and Langerhans' cell responses to intradermal interferon alpha-2 beta injections.

The effects of intradermal injection of interferon alpha-2 beta on normal human skin were studied in 12 healthy adult volunteers using 500,000 international units recombinant human interferon alpha-2 beta, 3 times a week for five injections (n = 6) and nine injections (n = 6). Saline injections served as control sites. Lymphocytic infiltrates and the population of epidermal Langerhans' cells in the injection areas were observed. The results showed that epidermal Langerhans' cells (both adenosine triphosphatase positive and CD-1+) decreased significantly whereas human leukocyte antigen-DR expression in keratinocytes was enhanced. Dermal CD-3+ (Pan T cells), CD-4+ (T helper cells) and human leukocyte antigen DR+ cells increased. No significant differences in the number of CD-19+ (B cells) and CD-57+ (NK cells) were observed. There were no significant differences between the five-injection and nine-injection groups.

Expression of Hras-p21 and keratin K13 in UVR-induced skin tumors in Sencar mice.

An ultraviolet radiation (UVR)-induced Sencar mouse skin carcinogenesis model was established to investigate the expression of Hras-p21 and keratin K13 in different stages of carcinogenesis, including UV-exposed nontumor skin, papillomas, squamous-cell carcinomas (SCCs), and malignant spindle-cell tumors (SCTs). Expression of Hras-p21 and K13 was examined in paraffin-embedded tumor sections by using immunohistochemical, immunofluorescent, and double staining techniques with specific antibodies. Positive Hras-p21 staining was detected in 1/3 (33%) papillomas, 24/36 (67%) of SCCs, but not in UVR-exposed nontumor skin or SCTs. Positive staining of the malignant progression marker K13 was found in 22/36 (61%) of SCCs only. Coexpression of Hras-p21 and K13 was found in 17/36(47%) SCCs. H-ras exons 1 and 2 were amplified from skin/tumor sections by using nested polymerase chain reaction (PCR). PCR-based single-strand conformation polymorphism (SSCP) analysis and gene sequencing revealed three point mutations, one in UVR-exposed nontumor skin (codon 56), and two in SCCs (codons 13 and 21). There were no clear relationships between point mutations of H-ras and the positive staining of Hras-p21 and K13. These results indicate that overexpression of ras-p21 in conjunction with aberrant expression of K13 is a frequent event in UVR-induced SCCs in Sencar mouse skin. Point mutation of the H-ras gene appeared to be a rare event in UVR skin carcinogenesis and not to be responsible for overexpression of Hras-p21.

Hyperactivity and frustration: the influence of control over and size of rewards in delaying gratification.

This study examined the differential effects of frustration on normal children and those diagnosed as having Attention Deficit Disorder with Hyperactivity. Each group consisted of 16 boys between the ages of 6 and 8 years who were prematched for age, grade, and classroom placement. All children completed a series of arithmetic problems in order to earn toy rewards. Using a variant of Mischel's (1974) delay-of-gratification paradigm, children were presented with two choice-of-delay conditions in a randomly assigned, counterbalanced sequence: a free-choice conflict situation involving a long-passive or short-active reward delay, and a short-active delay. Results showed that a significantly greater proportion of hyperactive children chose to complete problems for an immediate reward compared to their normal control counterparts (p less than .01). Group differences were no longer apparent in the short-active delay trial. The results are discussed in terms of frustration tolerance and contributing factors such as cognitive-attentional style. Implications for treatment and future directions are delineated.

Occupational tropical acne.

Tropical acne, a major problem for military personnel assigned to hot, humid areas, has not been reported previously in the United States. Here, a case of tropical acne is reported in an occupational setting in which the working environment simulated tropical conditions. This raises the possibility that heat and humidity may be contributing factors to inflammatory acne in susceptible individuals.

Reactive perforating collagenosis of diabetes mellitus and renal failure.

We believe that the disease we are reporting is associated with diabetes, particularly in patients on renal dialysis, and the perforation is initiated by scratching. Decreasing pruritus is the only needed treatment as the lesions tend to resolve on their own. While this entity has been called Kyrle's disease, it more correctly is reactive perforating collagenosis, both clinically and histologically. Whether this is a variant of what Kyrle originally described is not clear. We propose that this entity be called reactive perforating collagenosis of diabetes and renal failure.