Biomedical subjects
Publications and source records attributed to R A Wakeel.
We report a case of Jessner's lymphocytic infiltrate of the skin in an 11-year-old boy. This benign lymphocytic infiltrate was originally described in 1953, and classically occurs in middle-aged men. Its occurrence in children appears to be very rare, and there are only two other case reports in the literature.
This is a case report and family study of a 65-year-old man with chronic prurigo lesions, in whom we demonstrated a selective deficiency of circulating T-helper/inducer lymphocytes (CD4+), in the absence of any apparent predisposing disease. He is seronegative for human immunodeficiency virus (HIV types 1 and 2) and human T-cell lymphotropic virus (HTLV-I and HTLV-II), and fulfils the criteria for the syndrome of idiopathic CD4+ T lymphocytopenia. He has an atopic diathesis, has had a severe adult chickenpox infection, chronic staphylococcal infections, tinea pedis and recalcitrant warts. He has also suffered from respiratory infections, for which no specific aetiological agent has been identified. His peripheral total lymphocyte count has been persistently abnormal since it was first measured in 1969. He has a marked CD4+ T-cell lymphocytopenia. His son, who does not have any skin disorder, has a low CD4+ T-cell count.
In the past 4 years, a high incidence (118/362) of positive patch test reactions to E45 cream were noted in 2 patch testing clinics. 18/54 of those patch tested to all the ingredients demonstrated allergies to ingredients. The most frequent was triethanolamine; lanolin allergy occurring in only 1 patient. The remaining reactions may be explained as irritant reactions resulting from triethanolamine stearate (TES) formation within the cream. The irritancy of triethanolamine stearate was demonstrated in patients and controls. Conductivity studies showed that TES arises from the combination of the ingredients triethanolamine and stearic acid. The formulation of E45 cream was being changed at the time of writing, with the removal of triethanolamine from the product.
Topical cyclosporin A (CyA; Sandimmun) in a formulation incorporating the penetration enhancers (PE) propylene glycol (18%) and azone (2%) was tested for efficacy in a double-blind, vehicle-controlled trial in 5 chronic plaque psoriatic patients. On each patient, two similar plaques were treated daily, under occlusion, for 4 weeks with either 8% (w/v) CyA, containing PE, or with vehicle comprising olive oil with PE. All sites improved significantly, but there was no significant difference between those receiving active and control preparations. Cryostat sections of biopsies performed after 4 weeks' treatment showed significant reductions in CyA compared with vehicle-treated sites in the number of cells, positive for CD3 and CD25 in the epidermis and CD25 and HLA-DR in the dermis. These results suggest that amounts of CyA adequate to affect the lymphocytic infiltrate penetrated the epidermis but that only partial suppression occurred in the dermis, as indicated by the reduction in lymphocyte activation status.
Relapsing polychondritis is a rare disease which often presents firstly to ear, nose and throat (ENT) departments. Its complications, respiratory, cardiovascular, renal and neurological are life-threatening; thus it is important to recognize the disease and its complications early. Treatment for relapsing polychondritis may have serious side-effects which should be taken into account when managing these patients. We report two young patients with relapsing polychondritis and their treatments; both had severe tracheal stenosis responding in one case to pharmacological and in the other to surgical intervention.
Erythema gyratum repens (EGR) is a cutaneous manifestation of malignant disease. We report an unusual accumulation of activated epidermal Langerhans cells in the upper layer of the epidermis and propose that these cells play an important immunopathological role.
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We describe a case of papuloerythroderma. This is a distinctive clinical entity characterized by pruritus, red-brown flat-topped papules exhibiting the "deck-chair" sign, eosinophilia, and lymphopenia. We propose that the Langerhans cell may have a central role in the pathogenesis of papuloerthroderma and we describe an excellent response to photochemotherapy.
D-VAC Pollens (Bencard), a standard depot pollen vaccine, was withdrawn in the mid-1970s. We report a case in which subcutaneous granulomata developed 12 years after desensitizing injections by this product.
A seven-point scoring system has been adopted by the Cancer Research Campaign to help non-dermatologists recognize melanoma (MM). Its value is reviewed in the light of increasing referrals of pigmented lesions. One-hundred and ninety-five patients (M:F, 43:152; mean age = 43 years, s.d. = 19) were asked whether their lesions possessed the seven points before diagnosis. The dermatologist assessed the signs. Six patients were unable to comply and some had multiple lesions; thus, 216 lesions were fully assessed by patient and dermatologist, and six by the dermatologist alone. Histology was obtained where appropriate. There were eight MMs, 95 naevi, 80 seborrhoeic warts, three dysplastic naevi, and 36 other lesions. Seven of the eight MMs were diagnosed clinically; the other was biopsied because of suspicious features and was a nodular MM. Four lesions suspected to be MMs proved benign. The predictive value (PV) of a clinical diagnosis of MM was 64% and of non-MM was 99%. Using accepted cutpoints for the seven-point system (refer if score greater than or equal to 3) patients' scores gave a PV for MM of 7% and for non-MM of 99%. Two MMs scored less than three. Dermatologists' scores gave a PV for MM of 8% and for non-MM of 99%. One MM scored less than 3. Univariate analyses showed that enlargement (P less than 0.05), dermatologists' assessments of an irregular margin (P less than 0.001), size (P less than 0.05) and pigmentary irregularity (P less than 0.05), and patients' assessments of size (P less than 0.05) were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
We present a case of erysipelas which complicated chronic discoid lupus erythematosus (CDLE) of the face. The diagnosis and implications for management are discussed. The changing epidemiology and clinical spectrum of erysipelas are reviewed.
Oil-based mud, a complex mixture containing amines in emulsifiers, is used in offshore drilling operations. It is a skin irritant that occasionally gives rise to allergic contact sensitivity. In patch testing patients with allergy to drilling mud, we have identified polyamine (diethylenetriamine and triethylenetetramine) sensitivity in 5 patients. All 5 patients were also allergic to emulsifiers. These emulsifiers are cross-linked fatty acid amido-amines, in which unreacted amine groups are thought to cross-sensitize with these constituent polyamines. Cross-reactivity between ethylenediamine, diethylenetetramine and triethylenetetramine was found in 9 subjects.
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A 36-year-old female patient with severe autosomal recessive dystrophic epidermolysis bullosa, who had spent her entire life from age 2 as an inpatient in the dermatology unit, recently died of metastatic squamous cell carcinoma of the skin. The development of malignancy was not prevented by continuous medical and nursing supervision and, despite early detection, rapidly led to her death. Oral phenytoin and topical mupirocin ointment had not reduced blistering.
An 82-year-old man presented with rapid enlargement of a long-standing rhinophyma. Following an uncomplicated excision of rhinophyma, histologic examination showed that the enlargement was entirely due to basal cell carcinoma. Radiotherapy was administered, and the nose has now healed satisfactorily. There are few reports of an association between rhinophyma and basal cell carcinoma; but it is claimed that it occurs more frequently than is expected by chance. The evidence for this is reviewed. Previous reports were anecdotal or contained biases that prevent generalization of the results and, in addition, a statistical analysis was incorrect. There is insufficient evidence to claim an association between basal cell carcinoma and rhinophyma.
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