Vesiculo-bullous Darier's disease.
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Abscess↗
Biomedical subjects
S M Burge
Publications and source records attributed to S M Burge.
Elastic fibre damage induced by low-dose D-penicillamine.
We have studied 23 patients receiving penicillamine for the treatment of rheumatoid arthritis to determine the prevalence of penicillamine-induced elastosis. One female patient had pseudoxanthoma elasticum-like skin changes and bramble-bush elastosis without calcification in the involved skin. Penicillamine elastosis was present in the joint capsule in 62% of eight patients or 64% of II joints examined and was detected in joint capsules after as little as I year of treatment.
Adult↗
Darier's disease: a focal abnormality of cell adhesion.
Cell adhesion in clinically normal and involved skin in Darier's disease has been investigated using a suction blister technique. We have been unable to detect a subclinical abnormality in cell adhesion which could predispose to the development of acantholytic papules. There may be synthesis of functionally deficient desmosomes, increased breakdown of desmosomes or abnormalities in other adhesion proteins on the surface of the keratinocyte in Darier's disease, but the abnormality in adhesion is focal and restricted to the clinically and histologically abnormal papules.
Acantholysis↗
External ocular findings in lupus erythematosus: a clinical and immunopathological study.
A selected group of 18 patients with systemic lupus erythematosus (SLE) and 30 patients with chronic cutaneous lupus erythematosus (CCLE) showed an unexpectedly high incidence of problems involving the globe or eyelids. Five SLE patients had recurrent episcleritis, two CCLE patients had lower tarsal plaques, and two further CCLE patients had erosion of the lower lid margins associated with conjunctival scarring and symblepharon. This association has not previously been reported. There was an unexpectedly high incidence of deposition of immunoreactants in a linear pattern at the basement membrane zone in normal bulbar conjunctiva, which occurred in both SLE (42%) and CCLE (50%). The significance of these findings is discussed. We believe surface ocular problems in lupus erythematosus to be under-reported and that direct immunofluorescence of bulbar conjunctival biopsy might be helpful in diagnosis.
Adult↗
Darier's disease and other dyskeratoses: response to retinoids.
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Darier Disease↗
Darier's disease: an immunohistochemical study using antibodies to proteases.
The expression of plasminogen activators, plasminogen and fibrinogen was investigated in 10 specimens of normal skin and in the involved skin of seven males with Darier's disease, using immunohistochemical techniques. Changes in the localization of proteases were found in the involved skin of Darier's disease, plasminogen being expressed by suprabasal cells and fibrinogen being detected in the keratotic plug.
Darier Disease↗
Mucosal involvement in systemic and chronic cutaneous lupus erythematosus.
The prevalence and pattern of mucosal involvement in 121 patients with lupus erythematosus (LE) was investigated. Fifty-three patients had systemic LE (SLE) and 68 patients had chronic cutaneous LE (CCLE). Twenty-one per cent (11/53) of patients with SLE and 24% (16/68) of patients with CCLE had signs of mucosal involvement, but the pattern of involvement differed in the two groups. Nasal mucosal lesions were a feature in 2% (I/53) of patients with SLE and 9% (6/68) of patients with CCLE. Hyperkeratotic lichen planus-like plaques on buccal mucosa and the palate occurred in 9% (6/68) of patients with CCLE and 4% (2/53) of patients with SLE. Episcleritis occurred in 9% (5/53) of patients with SLE and not seen in CCLE. Erythematous plaques on the lower eyelids were present in 6% (4/68) of patients with CCLE and these were associated with conjunctival scarring in two patients. Vulval lesions were present in 5% (2/42) of female patients with CCLE. Oral plaques may occur when the disease is relatively quiescent elsewhere. The prevalence of mucosal involvement in lupus is underestimated as the lesions may be asymptomatic.
Adult↗
The lupus band test in oral mucosa, conjunctiva and skin.
The prevalence and clinical significance of subepithelial immunoglobulin and complement deposition (the lupus band) were examined in the uninvolved sun-protected skin of the forearm, the uninvolved sun-protected lip mucosa and sun-protected bulbar conjunctival mucosa in systemic lupus erythematosus (SLE) and chronic cutaneous lupus erythematosus (CCLE). In SLE, linear deposition of an immunoreactant at the BMZ was detected in 32% (6/19) of skin biopsies; 21% (4/19) of lip mucosal biopsies and 42% (5/12) of conjunctival biopsies. There was no significant difference in the sensitivity of the test at different sites in SLE and no correlation between a positive test in skin, lip or conjunctiva and clinical mucosal involvement. In CCLE, linear deposition of an immunoreactant at the BMZ was found in 3% (1/32) of skin biopsies; 3% (1/29) of lip mucosal biopsies and 50% (10/20) of conjunctiva and clinical mucosal involvement. In the conjunctiva, IgG was present in all but one of the biopsies and was the only immunoreactant in 90% (9/10) of positive CCLE biopsies and 60% (3/5) of positive SLE biopsies. In lupus erythematosus immunoreactants may be deposited in the basement membrane zone beneath non-keratinizing mucosal surfaces of the lip and the eye as well as the skin. In CCLE, the test may be positive in conjunctiva when skin and lip are negative.
Adolescent↗
Darier's disease, keratins and proteases: a review.
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Darier Disease↗
Darier's disease: an immunohistochemical study using monoclonal antibodies to human cytokeratins.
The pathogenesis of Darier's disease was investigated by immunohistochemical staining of skin biopsies from involved and uninvolved skin in 14 patients, using monoclonal antibodies specific for keratins expressed in simple epithelia, stratified squamous epithelia and during skin specific differentiation as well as keratins expressed in mucosa and some benign epidermal hyperproliferative states. Uninvolved perilesional skin from Darier's patients showed a normal profile of keratin expression, whereas in lesional skin there was apparent delay in the expression of the suprabasal skin specific keratins. Suprabasal keratins were not detected in basal cells, thus there was no true premature keratinization. The presence of hyperproliferative keratins was restricted to suprabasal cells in lesional skin. Four patients were receiving treatment with etretinate at the time of biopsy, but results in these patients did not differ from patients using topical treatments. Etretinate did not influence the profile of keratin expression in uninvolved or involved skin. The expression of type VII collagen was examined and was normal throughout uninvolved and lesional skin in Darier's disease.
Adult↗
Pigment change and melanocyte distribution in guinea pig skin after cutaneous freeze injury.
Cryosurgery has been recommended for the treatment of cutaneous neoplasms, including benign and malignant melanocytic tumors. The main side effect of this treatment is pigment disruption which may be prolonged. There are no quantitative studies on melanocyte distribution after freeze injury. In this study the effect of standardized freeze times on melanocytes in guinea pig skin (tricolored) is described at the anatomic level and at the light and electron microscopic level. Melanocytes are quantified in epidermal sheets following dopa staining at 1-, 2-, and 3-month intervals after freezing. All the lesions were initially hypopigmented with a peripheral rim of hyperpigmentation. This was a transient phenomenon associated with an absence of melanocytes. Pigment migrated into the lesions so that after 3 months all the lesions on black skin were diffusely hyperpigmented. Pigment was slower to return to the red skin. Hair follicles were destroyed in the center of the lesion. The epidermal sheets demonstrated that the hyperpigmentation was an epidermal phenomenon and was associated with increased numbers of melanocytes (p less than 0.001). These melanocytes were distributed evenly throughout the lesion in contrast to the irregular distribution in normal skin.
Animals↗
Punched-out porokeratosis. A histological variant of disseminated superficial actinic porokeratosis.
This paper describes an unusual histological variant of disseminated superficial actinic porokeratosis in which there were areas of full-thickness coagulative epidermal necrosis. The diagnosis of porokeratosis was confirmed with a further biopsy, which demonstrated a coronoid lamella and some underlying basal cell liquefaction. The significance of the pathology is discussed.
Epidermal Cells↗
Pigment changes in human skin after cryotherapy.
We have investigated the changes in pigmentation and melanocyte distribution in human skin after a standardized freeze injury. All lesions developed hypopigmentation with a peripheral rim of hyperpigmentation. Abnormalities in pigmentation persisted for at least 6 months. Hyperpigmentation was predominantly an epidermal phenomenon. After brief freezes, hypopigmentation persisted despite the presence of functional melanocytes. After prolonged freezes, the consistent finding was an absence of melanosomes in keratinocytes, although melanocytes were present. We conclude that prolonged changes in skin color are frequent after brief freezes and that hypopigmentation is not synonymous with an absence of melanocytes. This suggests that hypopigmentation after the cryosurgical treatment of malignant melanocytic tumors may not equate with cure.
Adult↗
Periungual and subungual arteriovenous tumours.
We describe the clinicopathological findings in five cases of an acquired vascular tumour involving periungual or subungual tissue. We believe that these represent acral arteriovenous tumours (cirsoid aneurysms). There are no previous reports of subungual or periungual acral arteriovenous tumours.
Female↗
Stevens-Johnson syndrome and toxic epidermal necrolysis in a patient with systemic lupus erythematosus.
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Aged↗
Acute palmoplantar pustulosis.
This paper describes five cases of an uncommon acral rash, acute palmoplantar pustulosis, which is precipitated by infection, and may represent a true pustular bacteria. Acute and chronic palmoplantar pustulosis are probably different forms of the same disease, but the prognosis in the acute form is good and aggressive therapy is not indicated. The relationship to psoriasis is discussed.
Acute Disease↗
Dermatitis repens, Lapière and generalized pustular psoriasis.
The presence of subcorneal pustules in a solitary, indolent, crusted plaque, or in erythema annulare-like lesions with a trailing scale, is evidence of atypical psoriasis. When these lesions appear late in life there is a significant risk of generalized pustular psoriasis with a poor prognosis. A case is presented in whom both of these atypical forms occurred and who developed severe generalized disease. Clinical and histological features are described.
Acrodermatitis↗