Cross-antigenicity between the scabies mite, Sarcoptes scabiei, and the house dust mite, Dermatophagoides pteronyssinus.

This study demonstrated that antigens of the parasitic mite Sarcoptes scabiei (SS) cross-react with antigens of the house dust mite Dermatophagoides pteronyssinus (DP). Crossed immunoelectrophoresis (CIE) reaction of SS extract with rabbit anti-DP serum resulted in multiple immunoprecipitates. Reciprocal CIE reactions gave similar results. Immunoprecipitates from both reactions bound IgE in the sera of dust-mite-sensitive patients who had no history of scabies. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis resolved protein/peptide bands of both SS and DP also bound serum IgE from dust-mite-allergic patients following immunoblotting. Non-allergic control sera gave no IgE binding to either SS or DP antigens. These results indicate that patients with atopy to dust mites exhibit circulating antibodies built to DP but that recognize determinants on SS antigens. It is highly probable that scabietic patients build antibodies to SS antigens that also recognize DP antigens. These results raise questions concerning the reported isotypic antibody responses to SS because the sensitivity of scabietic patients to house dust mites has not been previously evaluated. This cross-reactivity may play an important role in the susceptibility to scabies and its clinical manifestations.

Granulomatous vasculitis associated with herpes virus: a persistent, painful, postherpetic papular eruption.

Cutaneous granulomatous vasculitis manifesting as a postherpetic reaction pattern is uncommon hand has previously been reported as a delayed complication of varicella-zoster virus infection. We describe three patients who had persistent, painful, postherpetic papules in a zosteriform distribution that histologically demonstrated a small vessel granulomatous vasculitis. Herpes simplex virus DNA detected by the polymerase chain reaction technique was demonstrated in two cases.

Skin test and radioallergosorbent test characteristics of scabietic patients.

The scabies mite Sarcoptes scabiei and the Dermatophagoides house dust mites (HDM) are related phylogenetically and are the sources of several cross-reactive antigens. The purpose of this study was to investigate the immune response to S. scabiei and HDM in scabietic patients. Skin test sensitivity and serum IgE to both S. scabiei and HDM were determined for patients who had or previously had confirmed ordinary scabies. A retrospective group included nine subjects who had received successful treatment three weeks to one year prior to the study. A prospective group included 16 subjects with active scabies. Allergic histories were obtained, serum was collected, and skin prick tests (SPTs) were performed at enrollment for all and periodically over the next 12 months for the prospective patients. None of the individuals in either group reported a known sensitivity to HDM. Six of the nine retrospective patients were SPT positive to both S. scabiei and HDM and two of these showed circulating IgE specific for these antigens. At diagnosis, 13 of 16 patients with active scabies were SPT positive to S. scabiei and 12 of these were also SPT and/or radioallergosorbent test positive to HDM. Six patients had circulating IgE directed at both S. scabiei and HDM antigens while one subject had IgE to S. scabiei only and another had IgE directed at HDM only. Twelve of the 15 subjects tested also showed IgE and/or IgG binding to one or more bands on Western blots of an S. scabiei-specific protein fraction. This study indicated that approximately half of the patients with active scabies had S. scabiei- and HDM-specific circulating IgE while most patients cured of scabies lacked S. scabiei- and HDM-specific serum IgE. The data also suggested that antibodies to S. scabiei in scabietic patients also recognize HDM; however, some antibodies were directed at scabies-specific antigens.

Primary cutaneous phaeohyphomycosis caused by Drechslera spicifera.

A primary cutaneous lesion in a 5-year-old boy who had recently received chemotherapy for acute lymphocytic leukemia was found to be caused by a dematiaceous fungus, Drechslera spicifera. The lesion was an erythematous macule that rapidly developed necrotic ulcerations. The fungus, which is commonly found in soil and as a plant pathogen, was isolated from cultures of the lesion and from an excisional biopsy specimen. Hyphae and swollen hyphal cells resembling chlamydospores were observed in the biopsy specimen. Septate pigmented hyphae were found in the tissue, which is consistent with phaeohyphomycosis. Resolution of the infection occurred following excisional biopsy and systemic amphotericin B therapy. There was a concomitant recovery from neutropenia.

Behavior therapy techniques in treatment of exfoliative dermatitis.

We report here a case study in which behavior therapy techniques were used to treat the persistent and severe scratching of a patient with long-standing exfoliative dermatitis. A multiple-baseline clinical design across different body areas was used to evaluate the behavioral treatment program. This program consisted of (1) training the patient to monitor his scratching behavior and to use an incompatible response and distraction procedure contingent on the occurrence of scratching, and (2) differential attention by the therapist, so that the therapist's attention was contingent on intervals of nonscratching, and the therapist ignored the patient when he did scratch. The results indicated that the program was effective in almost completely eliminating scratching when a variety of therapists were and were not present. This suggests that the procedures used might easily be taught to the nursing staff.

Relapsing polychondritis. A case report and literature review.

Relapsing polychondritis is a systemic disorder characterized by recurrent inflammation and degeneration of cartilaginous tissue. The eyes, ears, nose, larynx, trachea, and articular areas are commonly involved. While ocular involvement, hearing, and vestibular dysfunction are frequently present, aortic valve and root disease as well as vasculitis also may occur. While the cause remains unknown, an autoimmune pathogenesis appears likely. Thus, dapsone and/or systemic corticosteroids remain the predominant effective therapies. Another case of relapsing polychondritis with an associated vasculitis syndrome is presented as well as a review of the current literature.

Multiple epitheliomata cuniculata occurring in a mutilating keratoderma.

We report on a young man with a congenital mutilating keratoderma in whom three epitheliomata cuniculata occurred during a two-year period. The clinical findings, associated disease states, and treatment of epithelioma cuniculatum (EC) are reviewed.

Lipedematous alopecia.

Lipedematous alopecia is an unusual disorder characterized by short, brittle scalp hairs associated with thickening of the scalp by adipose tissue. All except one reported case have been in African-American females. It is our purpose to report the seventh case of this condition.

Infestivity of Psoroptes cuniculi in rabbits.

Starving Psoroptes cuniculi were found to survive off the host for 4 to 21 days at relative humidities between 20% and 99% and temperatures between 5 and 30 C. Within these extremes, survival was greatest at low temperature and high relative humidity (RH). Mites were infestive for at least 50% of their survival times and may have infested new hosts in contaminated facilities. A temperature of 40 C and 20% RH maintained for 24 hours caused 100% mortality in test mites. Other selected combinations of temperature above 40 C and RH less than or equal to 75% also caused 100% mortality in 2 days or less. These conditions could be used to control these mites in vacated contaminated premises.

Symptomatic dermographism.

Urticaria is caused by physical factors in almost 12 percent of cases. These factors include pressure. Dermographism is the appearance of whealing and erythema within minutes where skin has been exposed to pressure or mechanical irritation. Symptomatic dermographism is present when "normal" pressures, such as those encountered in the activities of daily living, cause urticaria. Individuals with symptomatic dermographism can be shown to have a lower pressure threshold for the production of dermographism than normal individuals. A case of symptomatic dermographism is presented, and the differential diagnosis is discussed.

Subungual epidermal cyst.

A patient developed a painful subungual lesion which was an epidermal cyst on biopsy. The incidence and pathogenesis of subungual epidermal cysts are reviewed. This usually asymptomatic tumor should be considered in the differential diagnosis of subungual lesions.

Therapy of scabies: nursing homes, hospitals, and the homeless.

Scabies epidemics in nursing homes, acute and chronic care hospitals, residential facilities, and communities have become commonplace. Patients with keratotic (crusted, Norwegian) scabies are highly contagious and often initiate outbreaks in institutions. This is a review of problems associated with the management of scabies epidemics in health care facilities. A model treatment plan, readily customized to suit specific epidemic scenarios, is detailed.

Delayed pressure urticaria: an investigation of some parameters of lesion induction.

Two patients with delayed pressure urticaria were studied to define some of the physical parameters related to experimental lesion induction using a pressure-testing device. Graded pressures from 48 to 234 gm/mm2 were applied for 1 to 180 seconds on several anatomic areas. Experimentally induced lesions were symptomatically, clinically, and histologically identical to spontaneous wheals and reached a maximum size 9 hours after the stimulus. The threshold response found was related to the amount of pressure, the duration it was applied, and the anatomic area tested. Sites that previously reacted to pressure were refractory to additional stimuli for at least 24 to 48 hours. The mediator for delayed pressure urticaria remains unknown, and some patients do not respond to oral corticosteroids.

Laser treatment of hereditary multiple glomus tumors.

Familial multiple glomus tumors are rare. A family is reported here with the disease documented in three generations. While this type of glomus tumor is not classically associated with pain, all members of this family who exhibited multiple glomangioma were symptomatic. Treatment with both the argon laser and carbon dioxide laser was successful in relieving symptoms and improving the appearance of only the more superficial glomus tumors.