Biomedical subjects
A F Nikkels
Publications and source records attributed to A F Nikkels.
Images in clinical medicine. A medical mystery.
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Allergic reactions to decorative skin paintings.
BACKGROUND: Dye mixtures containing henna, P-phenylenediamine (PPD), and indigo are applied to the skin in various parts of the world for religious purposes, social recognition or fun. AIM: To identify eventual allergens responsible for contact sensitization to skin decoration in three young children. Lesions remained strictly limited to the site painted during the summer holiday. None of the children had a previous history of contact dermatitis, but two of them suffered from severe seasonal allergic rhinoconjunctivitis. FINDINGS: Patch testing revealed severe contact hypersensitivity to PPD in all three patients, and one child presented a positive prick test to 1% henna in water. The eruptions resolved following spontaneous elimination of the dyes and topical applications of corticosteroids, but left residual depigmentation. CONCLUSION: PPD is the main allergen identified in allergic reactions to decorative skin paintings.
[How I explore ... the risk of metastasis from melanoma].
The development of new therapeutic protocols for malignant melanoma calls for an upgraded assessment of the individual risk to develop metastases. The predictive sentinel lymph node method is best practiced in a multidisciplinary approach. The selective lymphadenectomy of the first draining lymph node is followed by minutely detailed histologic examination combined with immunohistochemistry.
[Relativity of the management of skin cancers. A plea for synergy between general practitioners and the dermatologist-oncologist].
The clinical diagnosis and treatment of cutaneous cancers represent a frequent situation in cancerology. About one third of all human cancers take their origin from the skin. The general practitioner and the dermatologist-oncologist play the key role in that field of health care.
[Factual approach to the treatment of genital herpes].
Genital herpes is a sexually transmitted disease. After the primary infection, the virus establishes a life-long latency in the sacral dorsal root ganglia. Recurrences may occur at an unpredictable rate. The clinical signs are not always easy to recognize and viral identification techniques may be helpful such as immunohistochemistry and in situ hybridization on Tzanck smears and muco-cutaneous biopsies. The treatment of genital herpes can follow one of three strategies using antiviral drugs, non-specific immunomodulators, and vaccination. The new oral antiviral drugs decrease the severity of clinical manifestations without, however, providing a definitive cure. In this article recent knowledge about the clinical aspects, differential diagnosis, diagnostic methods, treatment options and management is reviewed.
[Eruptive tropical viroses].
Eruptive tropical virosis are severe diseases which may prove to be sometimes fatal diseases. They are characterized by erythemato-purpuric cutaneous lesions associated with hyperthermia. Polyarthralgia or severe haemorrhage can also be part of the clinical presentation. Rapid diagnosis and preventive measures are mandatory, particularly when human transmission is possible.
[Tattoos. From ritual to ornament with their complications].
Tattoos are performed for distinct purposes which range from social rituals to aesthetic aims. They are permanent or transient according to the site of the pigments being located either in the dermis or in the stratum corneum, respectively. Tattoos may be responsible for allergic reactions, infections or psychological distress of the subject who requests to be relieved of it.
Shingles developing within recent surgical scars.
Occurrence of varicella and recurrence of herpes simplex on traumatized sites of the skin are well-described events. By contrast, herpes zoster occurring specifically at the site of previously injured skin has not yet been reported. Two patients are presented who developed shingles limited to skin on and around recent surgical scars. Varicella zoster virus was identified using immunohistochemistry on skin biopsy specimens and Tzanck smears. We suspect that the occurrence of herpes zoster involving surgical scars is usually misdiagnosed and therefore unrecognized. Whether shingles adjacent to scars represents a coincidental event or is specifically triggered by local injury is unknown.
Chronic herpes simplex virus type I glossitis in an immunocompromised man.
Herpes simplex virus (HSV) type 1 (HSV-1) infection of the tongue commonly accompanies acute primary herpetic gingivostomatitis. However, recurrent infection of the tongue is exceptional and is restricted to immunocompromised individuals. A 57-year-old man with corticosteroid-dependent chronic obstructive pulmonary disease and sciatica presented with a chronic median glossitis due to HSV-1. The main clinical and histological feature was massive necrosis of the entire mucosa. Immunohistochemistry demonstrated a considerable amount of HSV gB, gC and gD envelope glycoproteins dispersed in the chorion. In contrast, HSV-1 DNA was detected only in a limited number of epithelial cells using in situ hybridization. The extent of necrosis and the pattern of viral DNA and envelope protein distribution represent unique features of median herpetic glossitis, which are not found in more common types of HSV infection.
Chronic verrucous varicella zoster virus skin lesions: clinical, histological, molecular and therapeutic aspects.
The outbreak of HIV infection introduced a new phenomenon in varicella zoster virus (VZV) pathology, namely the long-standing wart-like skin lesions that are frequently associated with resistance to thymidine kinase (TK)-dependent antiviral agents. This paper reviews the clinical, histological, and molecular aspects and the therapeutic management of these verrucous lesions. The majority of lesions are characterized by chronically evolving, unique or multiple wart-like cutaneous lesions. The main histopathological features include hyperkeratosis, verruciform acanthosis and VZV-induced cytopathic changes with scant or absent cytolysis of infected keratinocytes. The mechanism that establishes the chronic nature of the lesions appears to be associated with a particular pattern of VZV gene expression exhibiting reduced or nondetectable gE and gB synthesis. Drug resistance to TK-dependent antiviral agents is a result of nonfunctional or deficient viral TK. This necessitates alternative therapeutic management using antiviral agents that target the viral DNA polymerase.
Simultaneous reactivation of herpes simplex virus and varicella-zoster virus in a patient with idiopathic thrombocytopenic purpura.
Simultaneous reactivation of distinct Herpesviridae with development of clinical manifestations is exceptional. We report a 48-year-old woman suffering from idiopathic thrombocytopenic purpura. As the disease remained refractory to corticosteroids, immunoglobulins and splenectomy, a cure of vinblastine was administered. An atypical stomatitis developed few days later. Immunohistochemistry on a Tzanck smear and a biopsy evidenced a Herpes simplex virus type 1 (HSV-1) infection. The patient presented simultaneously a single necrotic lesion on the abdomen. Immunohistochemistry on a skin biopsy revealed the presence of the varicella-zoster virus (VZV) gE, gB and IE63 proteins. Intravenous aciclovir was initiated. The present case of simultaneous clinical infections by HSV-I and VZV underlines the importance of complementary viral identification testing in the event of unusual clinical presentations.
Breaking the relentless course of Hallopeau's acrodermatitis by dapsone.
We report the case of a 74-year-old man who suffered for four years from recurrent generalized pustular eruptions associated with acrodermatitis continua of Hallopeau (ACH). Initial therapy using topical corticosteroids, tars and PUVA failed to improve the acral lesions. The disease was also unresponsive to systemic therapy using corticosteroids, methotrexate, etretinate, acitretine and cyclosporin A. Serious side-effects were experienced with these drugs. A marked improvement of the generalized pustules was observed under treatment combining etretinate and methotrexate, without having any effect on the acropustulosis. During hospitalization, a topical tar therapy cleared the pustular rash. Again no effect was observed on the acral lesions. Disulone (DDS) therapy, initiated at a dose of 200 mg/day, completely cleared ACH after 4 weeks. The disease relapsed when the dose was reduced to 100 mg/day. Increasing the DDS to 150 mg/day was rapidly followed by a new clearance of the acral lesions. After a 3-month treatment, the patient has remained lesion free and no DDS-related side-effects have occurred. In conclusion, sulfones may be considered as an alternative therapeutic option in drug-resistant ACH.
[Drug clinics. How I treat zona].
The treatment of herpes zoster relies on the intravenous or oral administration of antiviral drugs. Oral aciclovir for shingles is hindered by its low bioavailability. New antiviral drugs with improved oral bioavailability (famciclovir and valaciclovir) allow a better efficacy. The opportuneness of treating herpes zoster is different in the immunocompetent and immunocompromised patients, and during childhood and pregnancy.
[Image of the month. What is your diagnosis? A painful balanitis].
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Are granulomatous reactions in old zoster lesions due to an immune response to varicella zoster virus envelope glucoproteins?
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The in vitro and in vivo production of a 31.5-kD keratinolytic subtilase from Microsporum canis and the clinical status in naturally infected cats.
BACKGROUND: Microsporum-canis-infected cats, especially the asymptomatic infected ones, are mainly responsible for the zoonotic disease. The important variability of the clinical signs in cats is poorly understood. Recently, a 31.5-kD keratinolytic subtilase was found to be a putative virulence factor. OBJECTIVE: To investigate the possible relationship between the clinical status of dermatophytic cats and the production of the keratinase. METHODS: Seven M. canis strains isolated either from clinically affected, asymptomatic infected or mechanical carrier cats were tested for the in vitro production of the enzyme. The immunohistochemical detection of the enzyme was also assessed in skin biopsies of 4 symptomatic and 7 asymptomatic naturally infected cats. RESULTS: All the strains produced in vitro a 31.5-kD keratinolytic subtilase. The enzyme was present in all but 1 of the infected cats. CONCLUSION: The production of the keratinase is not a factor directly responsible for the clinical picture seen in M.-canis-infected cats.