摘要:

SummaryThe term vasculitis embraces a heterogeneous group of conditions which may occur as primary phenomena or secondary to disorders such as rheumatoid arthritis or systemic lupus erythematosus. Classification of vasculitis is often difficult in the absence of identifiable aetiological factors or specific serological markers. However, the primary systemic vasculitides can be segregated morphologically, according to the size of blood vessels involved and the presence of granulomata (Table 1). Recently, the discovery of circulating antineutrophil cytoplasmic antibodies (ANCA) in many patients with these disorders, whose differing specificities substantiate the histological classification, has led to interest being focused on their relevance in the development of vasculitis. This paper reviews the historical aspects of the detection of ANCA, and the value of these antibodies in the diagnosis and management of the primary systemic vasculitides likely to be encountered by the dermatologist. The clinical features in patients with these vasculitides are also outlined.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05010.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryIn order to investigate possible alterations in c‐kitprotein expression on epidermal melanocytes in different hypopigmentary disorders, we have examined skin specimens from one patient with piebaldism, one patient with naevus depigmentosus, and five patients with vitiligo. Cryosections were examined by immunohistochemistry using monoclonal antibodies against the c‐kitprotein (YB5.B8) and melanosomes (TA99).In piebaldism, hypomelanotic epidermis contained only a few TA99‐positive epidermal melanocytes and no detectable c‐kitprotein, whereas in naevus depigmentosus the expression of c‐kitprotein was strong, and TA99 immunoreactivity was faint. In vitiligo lesions, no epidermal immunoreactivity for melanosomes or c‐kitprotein was found. Normally pigmented skin of all patients showed immunoreactivity of epidermal melanocytes for both c‐kitprotein and melanosomes.Different hypomelanotic lesions can thus be differentiated by absent melanocyte c‐kitprotein and low or no expression of melanosomal marker in piebaldism, normal c‐kitbut low melanosome expression in naevus depigmentosus, and the absence of all melanocyte ma

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05011.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryIn order to obtain greater insight into the nature of B‐cell epitopes in bullous pemphigoid (BP), we generated a BP recombinant protein of 55 kDa Mr(rBP 55) from a cDNA sequence encoding for the carboxyterminal region of the 230 kDa BP antigen. Serum IgG from guinea‐pigs immunized with rBP 55 stained the basement membrane zone of normal human skin and immunoprecipitated the rBP 55 protein, and also the 230 kDa BP antigen recovered from extracts of cultured keratinocytes, thus confirming that the rBP 55 amino acid sequence is present in native BP antigen. The reactivity of sera from 60 patients with BP was analysed using an immunoblot assay on epidermal protein extracts and on the rBP 55 protein. Forty of the 60 BP sera (66%) contained autoantibodies to the 230 kDa polypeptide in an epidermal extract, and 37 of these 40 sera (92%) recognized the rBP 55 protein. In contrast, no reactivity against rBP 55 was detected with 20 BP sera devoid of autoantibodies against the 230 kDa antigen. Likewise, sera from patients with autoimmune blistering skin disorders other than BP (epidermolysis bullosa acquisita or pemphigus vulgaris), and control sera, were unreactive to rBP 55.These results clearly demonstrate the immunogenicity and antigenicity of the C‐terminal end of the 230 kDa BP antigen. They confirm that this 555 amino acid segment, corresponding to rBP 55, contains major epitopes which can bind BP patients' autoantibodies, and suggest that the rBP 55 protein could be useful for further characterization of these B‐cell e

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05012.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryAlthough frequently linked clinically with autoimmune disease, no immunogenetic basis for lichen sclerosus has ever been established. In this study, we examined in detail the HLA antigens of 84 patients with histologically proven disease, compared with 357 controls. Patients with lichen sclerosus did not have the expected HLA A1, B8, DR3, DQ2 autoimmune profile. Instead, DQ7 was present in 39 of 78 (50%) of patients compared with 89 (25%) controls (P<0.001). In addition, 61 of 78 patients (78%) had either DQ7, DQ8 or DQ9 antigens, or a combination of these, compared with 142 (40%) controls (P<0.01). Raised levels of DQ7 correspond to a glutamic acid residue at position 45 of the DQB1 locus. Proline amino acids at position 55 of this DQB1 locus could explain the raised levels of DQ7, 8 and 9, and exert a secondary effect. There is preliminary evidence that the immunogenetic profile of patients with this disease may affect disease expression with regard to site and extent of involvement.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05013.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryA 28‐day treatment regimen was undertaken by 12 volunteers, in which 5% (w/v) benzoyl peroxide (BP) in an aqueous gel was applied daily to the entire face. Clinical efficacy of the treatment was assessed after 2, 4, 9, 14 and 28 days, and the surface and follicular microbial populations were enumerated using established techniques. Viable counts were obtained for propionibacteria and Micrococcaceae. Mean numbers of propionibacteria recovered from the skin surface and follicular casts were significantly reduced after 2 days' treatment (P<0.01), and the population was maintained at a significantly lower level throughout the study (P<0.01), with mean values approaching the lower detection limit of the assay. Significant reductions in the surface and follicular Micrococcaceae were observed after 2 days' treatment, and at all subsequent visits (P<0.05). After 2 days' treatment, only slight reductions in mean acne grade and mean inflamed lesion count were observed. However, at all subsequent visits the mean acne grade was significantly reduced (P<0.05) compared with To. The mean non‐inflamed lesion count was lower than the pretreatment level at all visits, although the results were variable. The results indicate that significant reductions in surface and follicular microorganisms may be obtained after 48 h treatment with BP. Therefore, the non‐specific antibacterial action of BP may be utilized in short intervening courses to reduce the carriage of antibiotic‐resistant micro‐organisms and thus improve the long‐term efficacy of antibiotic acne treatments. The speed of clinical improvement may be limited by the rate at which old lesions disappear, rather than the effectiveness of the treatment in preventing new lesi

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05014.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryHigh‐frequency sonography has been shown to be a useful tool in planning operative strategy in the surgery of malignant melanoma (MM). The purpose of the present study was to compare sonometric and histometric data of tumour thickness in primary cutaneous MM, applying statistical methods in order to evaluate the pre‐operative relevance of sonometry. The thickness of 259 melanomas was measured preoperatively by a 20‐MHz B scan, and postoperatively by histometry. Statistical analysis was performed using Pearson's correlation coefficient and absolute and relative differences. Although the correlation between sonometry and histometry was good (r=0·88), there was a mean difference of 0·39 mm (relative difference 28%). Overall, sonometry was in agreement with the corresponding histological classes in 75% of cases. However, tumours assessed by ultrasound as between 0·55 and 0·95 mm thick were incorrectly classified according to histology in 34%, and those between 1·30 and 1·70 mm were incorrectly classified in 50% of cases.Our data reveal greater differences between sonometry and histometry using appropriate statistical methods. A concept to assess differences between sonometry and histometry is

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05015.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryThere is evidence that T lymphocytes play a critical role in the pathogenesis of drug‐induced bullous exanthems. Sulphonamides are known to be among the most frequent aetiological agents in these severe drug‐induced cutaneous hypersensitivity reactions. Several studies indicate that cytochrome P450‐dependent metabolites of sulphonamides act as the nominal allergens. A 70‐year‐old woman with a severe blistering exanthem caused by cotrimoxazole (sulphamethoxazole and trimethoprim) was studied. We employed anin vitroapproach to determine whether cytochrome P450‐dependent enzymes activated drug‐specific T lymphocytes from this patient. Immunohistochemical analysis of involved skin revealed a majority of epidermal CD8+T lymphocytes, whereas the dermal infiltrate was composed of both CD4+and CD8+T cells. Dermal T lymphocytes isolated from lesional skin proliferated in response to sulphamethoxazole, but not to trimethoprim, in the presence of autologous mononuclear cells used as antigen‐presenting cells. The antigen‐specific response of sulphamethoxazole‐specific T cells was significantly augmented in the presence of murine liver microsomes with P450‐dependent catalytic activities. Our observations suggest that some cutaneous hypersensitivity reactions to sulphamethoxazole are due to drug‐specific T lymphocytes. Cytochrome P450‐dependent enzymes may play a critical role in the formation of the nominal antigen, which is recognized by

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05016.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryAn international committee has recently decided on standard definitions of common dermatological terms. However, some inconsistencies remain. Those concerning the definitions of ‘plaque’ and ‘patch’ could be resolved by making the lower limit of size of these lesions 0.5 cm, to correlate with the proposed 0.5 cm upper limit of size of a macule and a papule.The practice of describing crust, scale, etc. as secondary lesions should be abandoned. Instead, the type of lesion (e.g. papule, plaque, nodule), and its surface features (e.g. scale, crust, etc.) should be described separately. The concept of smooth/normal as a surface feature should be included.A scheme is recommended for describing skin lesions, which is based on the following features: (i) their site, distribution and arrangement; (ii) lesion morphology, under the following headings: palpation, type, surface, colour, border, size, shape; and (iii) associated features, such as changes affecting the nails, mouth, scalp and g

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05017.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryWe report our experience, and review the literature, concerning ‘intensive care dermatology’. Over a period of 14 months, 27 patients who had significant cutaneous problems were seen in the intensive care unit. These included primary dermatological conditions, multisystem disorders with cutaneous signs, complications of dermatological therapy, and skin conditions developing as complications of intensive care. We discuss the diagnosis and management of dermatological problems in the intensive care u

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05018.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

SummaryThe aim of this survey was to quantify the level of handicap experienced by patients with severe psoriasis, and to assess the value that patients place on their disease using various questionnaire techniques. Dermatologists throughout the U.K. each gave a questionnaire to up to five psoriasis patients, who were either being admitted for in‐patient care or were starting systemic therapy. Three hundred and sixty‐nine questionnaires were completed. Of the 150 patients currently working, 59·3% had lost a mean of 26 days (SD 21·9) from work during the preceding year because of their psoriasis, and of the 180 not working 33·9% attributed not working to their psoriasis. The mean Psoriasis Disability Index (PDI) score was 38·2% (SD 23·3,n= 248), with the mean sub‐scores of the ‘daily activities’ and ‘treatment’ sections being greater than those of the other three sections. Despite having severe psoriasis, the majority of patients felt that it would be worse to have diabetes, asthma or bronchitis than to have psoriasis. Forty‐six, 42 and 32% considered it would be either ‘better’ or ‘the same’ to have diabetes, asthma or bronchitis, respectively. However, in those patients who also had the comparative disease, 87, 80 and 77% considered it would be ‘better’, or ‘the same’ to have the comparative disease. Forty‐nine per cent of patients (n= 362) stated they would be prepared to spend 2 or 3 h each day on treatment if this might result in normal skin for the rest of the day. Three hundred and sixty‐four (98·9%) of patients stated they would prefer to have a complete cure of their psoriasis rather than be given £1000 cash. Seventy‐one per cent (n=336) of patients said they would be prepared to pay £1000 or more, and 38% (n=336) said they would pay £10,000, for a cure for their psoriasis. There was a substantial correlation (0·48) between the PDI score and the amount a patient indicated they would pay for a cure.This survey of patients with severe psoriasis reveals major handicap caused by the disease, and illustrates the extent

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1995.tb05019.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY