Multiple minute parakeratotic keratoses of the hands in a patient with systemic lupus erythematosus.
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Biomedical subjects
Publications and source records attributed to M T Chuan.
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BACKGROUND: Bullous pemphigoid (BP) is an inflammatory subepidermal blistering disease associated with autoantibodies that recognize hemidesmosomal proteins. In addition to autoantibodies, the cell-mediated immune reaction is considered to play an important part in blister formation. Objectives To investigate some T-cell activation markers and inflammatory cytokines in the blister fluid and sera of patients with BP. METHODS: We measured soluble CD4 (sCD4) and soluble CD8 (sCD8), which have been, respectively, associated with CD4 and CD8 T-cell activation. Enzyme-linked immunosorbent assays were also used to quantify the production of the leucocyte chemoattractant interleukin (IL) -8 and of the cytokines IL-1alpha, IL-1beta, IL-6, IL-10 and tumour necrosis factor-alpha in the blister fluid and sera of 11 patients with BP. RESULTS: The mean +/- SD level of sCD4 in patients' blisters (42.4 +/- 25.0 units mL-1) was significantly elevated (P < 0.005) compared with that in their sera (11.2 +/- 8.9) and that in the suction blisters of 10 healthy people (11.4 +/- 5.4; P < 0.005). Mean +/- SD IL-8 concentrations in BP blisters (4683.6 +/- 3878.1 pg mL-1) were much higher than those in their sera (17.1 +/- 18.9; P < 0.001), and were very significantly elevated (P < 0.005) in comparison with those in suction blisters of healthy persons (512 +/- 292). sCD4 levels in BP blisters were inversely related to IL-10 levels (P = 0. 03, r2 = 0.85), IL-8 levels were positively related to sCD8 levels (P = 0.01, r2 = 0.54), and IL-1beta levels were positively related to sCD8 concentrations (P < 0.005, r2 = 0.65). CONCLUSIONS: The correlations suggest that there is a delicately orchestrated network of cytokines and cell-mediated immunity operating in BP blisters.
To evaluate the response to oral psoralen ultraviolet-A (PUVA) photochemotherapy in patients with vitiligo in Taiwan, we retrospectively reviewed the clinical data of 21 vitiligo patients treated from 1990 to 1998. Diagnosis included generalized vitiligo in 16 patients, focal vitiligo in three, and acrofacial vitiligo in two. All patients were treated two to three times per week over a period of 3 to 19 months with 0.2 to 0.4 mg/kg of trioxsalen 2 hours before exposure to long-wave ultraviolet light irradiation. The results for PUVA therapy showed 10 patients (48%) had an excellent response (75-100% repigmentation), four (19%) had a good response (50-75% repigmentation), one had a moderate response (25-50% repigmentation), and six (29%) had a poor response (0-25% repigmentation). Despite the high rate of satisfactory outcomes, the response to PUVA therapy with respect to specific localization revealed poor response in eight out of 10 patients with vitiligo on the hands and feet. Acute adverse effects of PUVA included pruritus in eight patients xerosis in one patient, and burning with blistering in four patients. Long-term adverse effects such as actinic keratosis and skin cancer were not found within the follow-up period, which ranged from 2 months to 7 years. Our findings indicate that long-term oral PUVA with trioxsalen is an effective treatment for vitiligo in Taiwanese patients.
BACKGROUND: Pigmented dermatofibrosarcoma is a rare tumor of the skin and constitutes 1-5% of all dermatofibrosarcoma. Most cases present as polypoid multinodular growth. Occasional cases may be atrophic. We report an extraordinary case with progressive infraorbital atrophy. OBSERVATION: A 24-year-old woman came to us for a diffuse bluish atrophic lesion over the left infraorbital area. The lesion progressed gradually over 2 years. Histologic examination revealed mature spindle cell proliferation in the lower dermis and hypodermis. Interspersed were some heavily pigmented melanocytes. CONCLUSION: We report an unusual case of progressive bluish discoloration and atrophy of the infraorbital area. This is a rare manifestation of dermatofibrosarcoma.
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To evaluate the clinical applicability of anti-native DNA antibodies (anti-nDNA) in systemic lupus erythematosus (SLE), two conventional methods--the Farr radioimmunoassay (Farr assay) and the Crithidia luciliae immunofluorescent technique (CL-IF assay)--were compared in 180 sera of antinuclear antibody (ANA)-positive systemic lupus erythematosus (85 active and 95 inactive), 31 sera of ANA-positive non-SLE rheumatic diseases and 40 sera from healthy subjects. The results further appraised the clinical significance of anti-nDNA antibodies in the diagnosis of systemic lupus erythematosus, especially those patients with nephritis. The CL-IF assay was found less sensitive in the detection of anti-nDNA than the Farr assay. As a tool for differentiating SLE from non-SLE rheumatic diseases, the CL-IF assay is not as sensitive as the Farr assay (sensitivity of CL-IF and Farr assay = 38.3% versus 60.0%). But the CL-IF test is much more convenient and efficient in the detection of active stage SLE and lupus nephritis than the Farr assay. The efficiency of anti-nDNA tests by the CL-IF and Farr assays for diagnosing active SLE were 85.8% versus 79.6%, for lupus nephritis were 76.1% versus 64.4% and finally for both conditions were 81.7% versus 62.2%. As an index of disease activity during the course of treatment, titers of anti-nDNA antibodies by Farr assay proved much more reliable than those by Crithidia luciliae assay. For the detection of anti-nDNA antibodies, simultaneous utilization of these two methods for fresh cases and using the Farr assay alone during the course of treatment are recommended.
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Ciclopiroxolamine is now under use as an antifungal agent for about a decade. Its activity is well-known in moderate climates, but there is a lack of knowledge on the activity in tropical and subtropical areas. 49 patients suffering from onychomycosis (42) and/or tinea pedis (33) were enrolled in a clinical trial in Taiwan. The patients received ciclopiroxolamine 1% cream 2-3 times a day for 3 to 24 month. In addition, infected nails were filed to facilitate drug penetration. In onychomycosis, 14% of the patients were cured and another 36% improved. One patient relapsed after 10 months. Cure was achieved more easily, if there were only modest alterations of the nail plate. With respect to tinea pedis the results were more favourable, the cure rate was 42%, another 45% of the patients improved. Following this dosage regimen, side effects did not occur. The results show onychomycosis to be highly resistant to antifungal therapy, perhaps even more as compared to tinea pedis in temperate climates. The good tolerability favours topical ciclopiroxolamine for this recalcitrant disease.