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Biomedical subjects

D F Mutasim

Publications and source records attributed to D F Mutasim.

At least 19 recordsLinked to original sources
PubMed1999

An open clinical trial of fluvoxamine treatment of psychogenic excoriation.

The purpose of this study was to examine the safety and efficacy of fluvoxamine in the treatment of psychogenic (neurotic) skin excoriation. Fourteen subjects with psychogenic excoriation were given fluvoxamine in a 12-week, open-label trial after completion of the Structured Clinical Interview for DSM-IV. All subjects met DSM-IV criteria for at least one comorbid psychiatric disorder, with mood disorder the most common. Most subjects' excoriation had features of an impulse control disorder. Both completers (N = 7) and the entire group had significant improvement on the modified Yale-Brown Obsessive Compulsive Scale but no improvement on the Hamilton Rating Scale for Depression. In the self-report data, the seven completers had significant reduction in behaviors involving the skin (e.g., scratching, picking, gouging, or squeezing) and in global assessment of symptoms. Endpoint analysis of all 14 subjects' self-report data demonstrated significant improvement in the presence of skin sensations, skin appearance and lesions, behaviors involving the skin, control over skin behavior, and global assessment. The results of this preliminary open trial suggest that fluvoxamine may be effective in reducing psychogenic excoriation, and this effect seems to be independent of mood. Controlled studies are needed to confirm these findings.

Adult↗
PubMed1998

Cutaneous pseudolymphomas.

Cutaneous pseudolymphoma refers to a heterogeneous group of benign reactive T- or B-cell lymphoproliferative processes of diverse causes that simulate cutaneous lymphomas clinically and/or histologically. The inflammatory infiltrate is bandlike, nodular, or diffuse and is composed predominantly of lymphocytes with or without other inflammatory cells. Depending on the predominant cell type in the infiltrate, cutaneous pseudolymphomas are divided into T- and B-cell pseudolymphomas. Cutaneous T-cell pseudolymphomas include idiopathic cutaneous T-cell pseudolymphoma, lymphomatoid drug reactions, lymphomatoid contact dermatitis, persistent nodular arthropod-bite reactions, nodular scabies, actinic reticuloid, and lymphomatoid papulosis. Cutaneous B-cell pseudolymphomas include idiopathic lymphocytoma cutis, borrelial lymphocytoma cutis, tattoo-induced lymphocytoma cutis, post-zoster scar lymphocytoma cutis, and some persistent nodular arthropod-bite reactions. This review attempts to discuss current aspects of the classification, pathogenesis, clinical spectrum, histopathologic and immunohistochemical diagnosis, and laboratory investigations for clonality in the various types of cutaneous pseudolymphomas.

Diagnosis, Differential↗
PubMed1998

Characteristics of 34 adults with psychogenic excoriation.

BACKGROUND: Psychogenic excoriation, characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. The purpose of this study was to provide data regarding the demographics, phenomenology, course of illness, associated psychiatric comorbidity, and family history of subjects with psychogenic excoriation. METHOD: Thirty-four consecutive subjects were recruited from an outpatient dermatology practice and by advertisement. Subjects completed the Structured Clinical Interview for DSM-IV augmented with impulse control disorder modules, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview for family history, demographic data, and clinical features. RESULTS: Most subjects were women who described a mean age at onset of 38 years and a chronic course. Subjects excoriated multiple sites, most frequently the face. The behavior caused substantial distress and dysfunction. All 34 subjects met criteria for at least 1 comorbid psychiatric disorder, with a mood disorder the most common. Family histories were notable for depressive disorders and psychoactive substance use disorders. Most subjects experienced both mounting tension before excoriation and relief after excoriation as in impulse control disorders. A minority of subjects excoriated skin as part of obsessive-compulsive disorder. Body dysmorphic disorder with preoccupation about the skin's appearance precipitated excoriation in about a third of subjects. CONCLUSION: Psychogenic excoriation is chronic, involves multiple sites, and is associated with a high rate of psychiatric comorbidity. The behavior associated with the excoriation is heterogeneous and spans a compulsive-impulsive spectrum. Most subjects in this sample described features of an impulse control disorder.

Adult↗
PubMed1997

Follicular psoriasis: an under-reported entity. A report of five cases.

Follicular psoriasis is not rare in dermatological practice, although only a few cases have been reported. We describe five patients with follicular psoriasis, one man and four women. The patients ranged in age from 23 to 73 years. Lesions consisted of erythematous scaly follicular papules located on the trunk and extremities. Two patients had associated plaque-type psoriasis of the scalp. None had nail involvement at the time of diagnosis. Histological examination of several biopsy specimens revealed the changes of psoriasis in the follicular epithelium.

Adult↗
PubMed1996

Herpes simplex virus infection masquerading as condyloma acuminata in a patient with HIV disease.

Verrucous lesions in patients with human immunodeficiency virus (HIV) disease may be caused by viruses other than the human papillomavirus. We describe a 32-year-old HIV-positive black man who presented with a verrucous lesion of the intergluteal cleft that clinically resembled condyloma acuminata or verrucous carcinoma. Histopathological examination revealed the changes of herpes virus infection, and culture of the tissue confirmed the presence of herpes simplex virus. Human papillomavirus was not detected by in situ hybridization or the polymerase chain reaction. Significant regression of the lesion was seen after 6 weeks of treatment with oral acyclovir.

AIDS-Related Opportunistic Infections↗
PubMed1995

Pyostomatitis vegetans associated with ulcerative colitis. Temporary clearance with fluocinonide gel and complete remission after colectomy.

Pyostomatitis vegetans is a rare condition characterized by pustules that affect the oral mucosa. It is consistently associated with inflammatory bowel disease and is usually resistant to treatment. We present the case of a 65-year-old white man with pyostomatitis vegetans that was associated with ulcerative colitis and adenocarcinoma of the colon. Fluocinonide gel resulted in a complete but temporary clearance of the lesions. Complete remission was achieved immediately after a total colectomy.

Adenocarcinoma↗
PubMed1993

Skin explant culture: a reliable method for detecting pemphigoid antibodies in pemphigoid sera that are negative by standard immunofluorescence and immunoblotting.

We investigated the presence of bullous pemphigoid antibodies in bullous pemphigoid sera that are negative by standard indirect immunofluorescence. We incubated each of four indirect immunofluorescence-positive bullous pemphigoid sera, seven indirect immunofluorescence-negative bullous pemphigoid sera, one indirect immunofluorescence-negative herpes gestationis serum, three indirect immunofluorescence-positive epidermolysis bullosa acquisita sera, five indirect immunofluorescence-negative epidermolysis bullosa acquisita sera, and two normal human sera with fresh human skin explants in medium 199 at 4 degrees C for 48 h. All bullous pemphigoid sera, herpes gestations serum, and the three indirect immunofluorescence-positive epidermolysis bullosa acquisita sera had IgG that bound the basement membrane zone of skin explants with moderate to marked intensity as demonstrated by immunofluorescence. Normal sera and indirect immunofluorescence-negative epidermolysis bullosa acquisita sera failed to bind the explant basement membrane zone. Immunoblotting of bullous pemphigoid sera showed five of seven indirect immunofluorescence-negative bullous pemphigoid sera to bind high-molecular weight and/or low-molecular weight bullous pemphigoid antigens from epidermal extracts. We conclude that the skin explant culture system is a very sensitive method for the detection of bullous pemphigoid antibodies in all bullous pemphigoid sera.

Adolescent↗
PubMed1993

Established methods in the investigation of bullous diseases.

We have discussed an approach to the diagnosis of bullous diseases based on available and established methods. We highlighted the clinical features that help distinguish the various diseases. We then outlined a histopathologic pattern approach to the differential diagnosis and extensively discussed the value of immunofluorescence in the diagnosis of bullous diseases.

Diagnosis, Differential↗
PubMed1993

Drug-induced pemphigus.

Drug-induced pemphigus is a heterogenous group of disorders in which a drug induces acantholysis. The majority of patients have immune features of pemphigus and have a course similar to idiopathic pemphigus. Few patients do not have a detectable autoimmune process, and their eruption usually resolves with discontinuation of the associated drug. The mechanism of induction of the autoimmune process and acantholysis is not clear.

Fluorescent Antibody Technique↗
PubMed1993

Paraneoplastic pemphigus.

Paraneoplastic pemphigus is a newly recognized disease that occurs in some patients with lymphoproliferative neoplasms and occasionally, solid tumors. Patients present with an acute illness of the mucosa and skin that shares clinical and histologic features with erythema multiforme, toxic epidermal necrolysis, and pemphigus vulgaris. These patients have antibodies against a complex of epithelial proteins that are present in desmosomes and hemidesmosomes. The course is usually fatal, except in some patients who undergo total resection of their neoplasm.

Animals↗
PubMed1993

Cicatricial pemphigoid.

Cicatricial pemphigoid presents with oral or ocular inflammation and blisters that are followed by scarring. The differential diagnosis of cicatricial mucositis includes other subepithelial blistering disorders. The disease is usually chronic and can be associated with high morbidity. Treatment of severe cases with immunosuppressive agents is usually helpful.

Fluorescent Antibody Technique↗
PubMed1993

The distribution of IgA pemphigus antigen in human skin and the role of IgA anti-cell surface antibodies in the induction of intraepidermal acantholysis.

BACKGROUND AND DESIGN: IgA pemphigus is an uncommon intraepidermal vesiculopustular disease that has clinical and histologic similarity to subcorneal pustular dermatosis and pemphigus foliaceus. All patients have IgA antibodies bound to the epidermal cell surface, and half of the patients have circulating IgA anti-cell surface antibodies detected by standard immunofluorescence testing. We studied the distribution of IgA pemphigus antigen in human skin and the pathogenetic role of circulating IgA antibodies in the induction of intraepidermal vesicle formation. We used skin specimens from numerous sites of two cadavers, as well as from neonatal foreskin, and serum specimens of two patients with IgA pemphigus. OBSERVATIONS: Organ culture and immunofluorescence studies revealed the following: (1) IgA pemphigus antibodies bound preferentially to the granular layer in the vast majority of skin sites that were tested. In one cadaver, binding was preferential to the spinous layer of plantar and buttock skin. No binding was observed in oral and esophageal mucosa. (2) Neither bound nor circulating IgA antibody was complement fixing. (3) One IgA pemphigus serum specimen that was negative by standard immunofluorescence had IgA antibodies that bound the epidermal cell surface after incubation under explant culture conditions. (4) Both IgA pemphigus serum specimens induced acantholysis in skin explant cultures. CONCLUSIONS: When antibodies from one IgA pemphigus serum specimen are used, the expression of IgA pemphigus antigen in human skin shows regional variability, interindividual variability, and variability in the microscopic distribution within the epidermal cell layers. IgA pemphigus antibodies play a role in the pathogenesis of IgA pemphigus. The skin explant culture is more sensitive than is standard immunofluorescence to detect circulating IgA antibodies.

Acantholysis↗
PubMed1991

The relevance of immunohistochemical techniques in the differentiation of subepidermal bullous diseases.

There are several subepidermal bullous diseases. In some, the clinicopathological features are distinctive, whereas in others there is a variable degree of overlap that necessitates the use of ultrastructural and biochemical studies to distinguish the different diseases. In this paper, we review the literature and describe our experience using simplified immunological techniques in the diagnosis of subepidermal bullous diseases.

Diagnosis, Differential↗
PubMed1989

Definition of bullous pemphigoid antibody binding to intracellular and extracellular antigen associated with hemidesmosomes.

Bullous pemphigoid (BP) antibodies are deposited predominantly in the lamina lucida in vivo; however, circulating BP antibodies bind in vitro to the cytoplasmic plaque of basal cell hemidesmosomes. We examined the ability of IgG in nine BP sera to bind to intracellular or extracellular antigen. On skin cryosections, indirect IF showed IgG bound to basement membrane zone (BMZ) and indirect ImmunoEM confirmed intracellular binding on the cytoplasmic plaque of hemidesmosomes. In contrast, when normal skin was exposed to BP serum in organ culture, direct IF showed fainter linear deposition of IgG along the BMZ, and direct ImmunoEM demonstrated extracellular IgG binding in the lamina lucida, predominantly beneath hemidesmosomes. Four of nine sera showed complement fixation on indirect IF samples (IgG bound to intracellular antigen) and three showed complement fixation on direct IF specimens (IgG bound to extracellular antigen). Three of the nine sera contained complement fixing antibodies detectable only in antibody populations specific for intracellular or extracellular antigen. Western immunoblots showed that five of nine sera recognized a 240-kD protein and four of nine recognized a 180-kD protein. There was no correlation between the presence (or absence) of either band and the detection of complement fixing antibodies specific for intracellular or extracellular antigen. BP autoantibodies bind both intracellular and extracellular antigen, and IgG binding exclusively to extracellular antigen that mimics the in vivo situation can be detected by using organ culture. Complement fixation may be restricted to antibodies specific for intracellular or extracellular antigen. These findings underscore the complexity of the autoantibody-antigen system in BP and have implications regarding the proposed pathogenicity of the autoantibodies.

Antigen-Antibody Reactions↗
PubMed1987

Linear immunofluorescence staining of the cutaneous basement membrane zone produced by pemphigoid antibodies: the result of hemidesmosome staining.

Bullous pemphigoid autoantibodies bind the basement membrane zone of stratified squamous epithelium in a linear pattern, as shown by indirect immunofluorescence; however, other patterns of staining, such as tubular (with convolutions), cytoplasmic, and membranous, have been noted. Recently, by using indirect immunoelectron microscopy, we have shown that bullous pemphigoid antibodies bind specifically to hemidesmosomes. The purpose of this investigation was to correlate the various patterns of basement membrane zone staining by bullous pemphigoid antibodies by immunofluorescence and to correlate these patterns with the ultrastructural findings. We employed adult human skin, neonatal human foreskin, neonatal mouse skin, and rabbit cornea as substrates for electron microscopy and indirect immunofluorescence using bullous pemphigoid serum. For indirect immunofluorescence, cryosections were obtained at vertical, oblique, and horizontal planes with respect to the basement membrane zone. We show that the immunofluorescence band of basement membrane zone staining results from the coalescence of fluorescence from individual hemidesmosomes. We also show that the pattern of basement membrane zone staining depends on the ultrastructural morphology of the basement membrane zone in each tissue and on the angle of sectioning.

Animals↗
PubMed1987

An autoantibody in pemphigus serum, specific for the 59 kD keratin, selectively binds the surface of keratinocytes: evidence for an extracellular keratin domain.

We have identified a novel IgG antikeratin autoantibody in the serum of a Brazilian pemphigus foliaceus patient (Cascas-42). This antibody is specific for the 59 kD acidic murine keratin and its 56.5 kD human counterpart (Moll's catalogue #10), and is distinct from the pemphigus antibody system. Antikeratin autoantibodies present in the Cascas-42 serum were purified by affinity chromatography with a 59 kD murine keratin-agarose column (IAP-Cascas-42 antibodies). The specificity of the IAP-Cascas-42 antibodies was tested by indirect immunofluorescence and immunoelectron microscopy against epidermal cryosections, trypsin-dissociated keratinocytes, and epidermal cell cultures. The serum was also tested with extracts from unlabeled and surface 125I-labeled keratinocytes (Iodo-Gen method) by immunoblot analysis of one- and two-dimensional polyacrylamide gel electrophoresis. The IAP-Cascas-42 antibodies bind the intercellular spaces of murine epidermis, and the cell surfaces of viable, dissociated murine keratinocytes, as well as murine epidermal cells in culture by immunofluorescence and immunoelectron microscopy. These autoantibodies did not stain cytoplasmic keratins and did not react with parallel human epidermal substrates. The Cascas-42 serum identified the 59 kD murine acidic keratin and its 56.5 kD human counterpart in epidermal extracts by two-dimensional polyacrylamide gel electrophoresis and immunoblot analysis. In addition, surface radioiodination of viable murine keratinocytes selectively labeled the 59 kD keratin suggesting that a domain of this molecule is exposed on the cell surface. The 125I-labeled 59 kD keratin was also recognized by the Cascas-42 serum by immunoblotting and autoradiography. These studies suggest that in murine epidermis, the 59 kD keratin is a transmembrane protein with an extracellular domain recognized by the IAP-Cascas-42 antibodies.

Animals↗