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[Multiple basaliomas in pityriasis rubra pilaris].

This is a report of a 73 year old patient with pityriasis rubra pilaris and multiple basal cell carcinomas which especially appeared on the face. One of the tumors was located in the anal and perianal region. This is the first report of basal cell carcinomas in a patient with pityriasis rubra pilaris. Further observations will clarify whether there exists a closer relationship between the presence of basal cell carcinoma and pityriasis rubra pilaris. Therefore more attention should be paid to the existence of basal cell carcinoma in patients with pityriasis rubra pilaris.

Aged

[Pityriasis versicolor in Greece and its predisposition factors].

The age and seasonal incidence of 2610 patients with pityriasis versicolor in Greece were studied. Determination of the pH of Na and K ions of the sweat and the microbiol flora of the skin of pityriasis versicolor patients was undertaken. Besides these the effectiveness of a 1% selenium disulfid suspension was tested. The results indicate that the age groups of 20-29 and 30-30 years are mostly affected by the disease. A high incidence of the skin manifestation was noted during the summer and fall months. A difference of the pH of the sweat between pityriasis versicolor and healthy controls was observed, but no difference was found in the Na and K ions of the sweat among these two groups. Neither did the microbial flora from the skin lesions of patients and from corresponding sites of controls show any difference. The high relapse in this experiment indicates the relative ineffectiveness of selenium disulfid preparations when used as a 1% suspension in the treatment of pityriasis versicolor.

Adolescent

Treatment of pityriasis capitis (dandruff) with econazole nitrate.

63 patients of both sexes with pityriasis sicca or steatoides were examined for presence of Pityrosporum ovale on the scalp. Only those cases in which very numerous yeasts were seen in all squamae present in the preparation were considered positive. According to the severity or duration of pityriasis, 60% of the patients in this population represented severe cases and 38% refractory cases. A solution of econazole nitrate was applied as a spray, morning and evening, for a period of 10 to 20 days (mean). The overall assessment of the clinical effects of econazole nitrate indicated 56 favourable results, with complete disappearance of objective clinical signs in 47 cases; the course of pruritus proceeded roughly parallel with that of the objective signs. The mycological checking of the clinical results, performed at least 7 days after the conclusion of therapy, disclosed 6 failures and 57 successes. In 17 patients, the microscopic examination of squamae was complemented by culture before and after treatment: in all cases, the culture, positive before econazole nitrate therapy, became negative after treatment, thus confirming the results of direct examination. These data suggest that Pityrosporum ovale plays a pathogenetic part in pityriasis simplex capitis.

Adolescent

[Levels of selenium in urine after treatment of pityriasis versicolor with a 1.0% selenium sulfide].

The treatment of pityriasis versicolor by the topical application of selenium sulfide 1% was studied in two groups of patients. Diagnosis and response to therapy was determined by clinical observation. Wood's light fluorescence, and direct microscopic examination. The efficacy of three different therapeutic regimes was studied in one group by the application of the drug to the entire skin for either five minutes, fifteen minutes, or twelve hours for eighteen days. Each method proved equally effective in resolving the infection. Therefore, the cutaneous application of selenium sulfide 1 % for five minutes daily for eighteen days is the recommended treatment for pityriasis versicolor. The percutaneous absorption of selenium sulfide was also studied in another groups who applied the drug to the entire skin for five minutes for eighteen days. Fluorimetric analysis of urinary samples collected on the third and thirteenth days of treatment revealed no significant increase in the excretion of selenium as compared to pretreatment levels. Systemic toxicity was not observed in any of the patients treated. The results suggest that the selenium sulfide is absorbed poorly from the skin and is a safe and effective therapy for pityriasis versicolor.

Adult

A reappraisal of the role of Pityrosporum orbiculare in pityriasis versicolor and the significance of extracellular lipase.

Pityrosporum orbiculare is an obligate lipophilic yeast in vitro, which suggests it possesses an extracellular lipase crucial for nutrition. If present in vivo, the enzyme would enable the yeast to utilize skin surface lipids, which may therfore play an important role in the pathogenesis of pityriasis versicolor. Cultured P. orbiculare and biopsy material from patients with pityriasis versicolor were investigated for the presence of lipase by electron microscope histochemistry. At sites of lipase activity, fatty acid hydrolyzed from Tween 80 substrate reacts with Ca++ ions to form an insoluble Ca++ soap. Exchange of Ca++ with Pb++ enables the sites of lipase activity to be visualized as electron dense deposits of insoluble lead soap. Surface lipase activity was apparent when the technique was applied to P. orbiculare grown on lipid containing medium and its specificity confirmed by removal of substrate and inhibition by di-isopropyl fluorophosphate and quinine hydrochloride, but not by sodium fluoride. When the same technique was applied to stratum corneum infected with Pityrosporum furfur (Malassez), no reaction product could be detected. It is postulated that lipase, although critical for fungal nutrition in vitro, is unlikely to be of importance in vivo. Skin surface lipids are therefore probably not relevant to the pathogenesis of pityriasis versicolor.

Histocytochemistry

Ultrastructural studies of epidermal lesions in pityriasis lichenoides chronica: occurrence of tubular aggregates and intracytoplasmic desmosomes.

Very early skin lesions from four patients with pityriasis lichenoides chronica were examined by electron microscopy. Aggregates of tubular structures, which resembled those reported in endothelium in lupus erythematosus and are currently being observed in an increasing variety of conditions, were noticed in the epidermal cells of all patients. These cells also showed intracytoplasmic desmosomes, and isolated mitochondria and myelin-like figures in intercellular spaces, in addition to the occurrence of vacuoles and lysosomes in the cytoplasm, dilatation of endoplasmic reticulum and alteration of mitochondria. Occasionally, epidermal cells were seen to be individually filled with fibrils. These ultrastructural findings seem to indicate that in pityriasis lichenoides chronica some injury to epidermal cells occurs at the early stage of pathological processes, as suggested by light microscope studies.

Adult

Pityriasis lichenoides--an immune complex disease.

Circulating immune complexes have been detected in patients with pityriasis lichenoides during disease activity when IgM and C3 have been observed in dermal vessels on direct immunofluorescence of fresh lesions. This implies that pityriasis lichenoides is an immune complex disorder and that deposited complexes play a part in the pathogenesis of the condition. There is a characteristic pattern of immunofluorescence which may be a diagnostic aid.

Adolescent

An immunofluorescence study of pityriasis lichenoides.

In a study of 27 patients with pityriasis lichenoides IgM and C3 have been observed on direct immunofluorescence of fresh lesions. Other immunoglobulins and complement components were not observed. Immunofluorescence was seen in 31 (72%) of 43 fresh lesions. It occurred in the walls of superficial dermal vessels and along the dermal-epidermal junction. This pattern of immunofluorescence appears to be characteristic of the disease. Uninvolved skin showed the immunofluorescence less frequently and old scaly lesions none. The concept that pityriasis lichenoides is an immune complex disorder is discussed.

Complement C3

Relationship of pityriasis amiantacea to psoriasis. A follow-up study.

46 patients with pityriasis aminantacea have been reexamined with regard to the later development of psoriasis and atopic diseases, and their occurrence in first and second degree relatives. HLA antigens of the A, B and C series were also determined. Earlier suggestions of a close association with psoriasis were not confirmed. An association with atopic diseases could not be established. Occurrence of seborrheic dermatitis seems, however, common in patients with pityriasis amiantacea.

Adolescent

[Lichenoid pityriasis. Clinical study of 13 cases].

13 patients with Pityriasis Lichenoides are studied clinical and histologically, showing a clinical polymorphism of the lesions, mainly in the papulous, vesiculous, and necrotic ones. The data about age, sex, evolution and response to the treatment in the present study are similar to those found by other authors. Constantly, we found, a variable degree of vasculitis. In almost all the cases there was a damage of the epithelium --exoserosis and exocytosis--, as well as presence in some cases, of red cells extravasated within the epidermis. In upper dermis we found in all biopsies, divers degrees of perivascular cell infiltration mainly composed of lymphocytes and histiocytes with predominance of the last ones, in five cases. In the majority of our cases, there was a strong relationship between the clinical and the histological aspects, but in some cases, mild lesions showed an acute microscopical picture. We are of the opinion that Pityriasis Lichenoides must be considered as a different entity from Parapsoriasis. In addition, we think that PL, is a clinical picture that manifests itself as a chronic or an acute form, and both types can be seen in the disease evolution. Finally, we could not find an evident influence and a positive response to the treatment in our patients with the classical therapeutics.

Adult

[Pityriasis lichenoides chronica--a new indication for PUVA therapy? (author's transl)].

2 patients with long-standing and wide-spread pityriasis lichenoides chronica were treated with orally administered 8-methyoxypsoralen and UVA irradiation (PUVA therapy). After 15--21 PUVA treatments the patients were completely cleared. 3 and 4 weeks after the initial PUVA treatment, phase recurrences occurred in both patients. In 1 patient the lesions appeared clinically and histologically as pityriasis lichenoides et varioliformis acuta.

Administration, Oral

Cytolytic degeneration of keratinocytes adjacent to Langerhans cells in pityriasis rosea (Gibert).

Unique cytolytic degeneration of keratinocytes adjacent to Langerhans cells was observed in five cases of pityriasis rosea (Gilbert). In the cytolytic area, the normal keratinocyte structures were absent except for free ribosomes. In addition, a similar cytolytic part of a keratinocyte was enveloped by the elongated dendrites of the Langerhans cell and was detected within its cytoplasm. The significance of these findings is discussed with respect to anticytoplasmic antibodies in the sera of patients with pityriasis rosea.

Cell Membrane

Pityriasis lichenoides chronica presenting as hypopigmentation.

Seven black or dark skinned patients with pityriasis lichenoides chronica (PLC) are described, who presented with widespread hypopigmentation. The evidence on which a diagnosis of PLC was made is presented and the differential diagnosis discussed. The hypopigmentation was noted in some patients to be especially marked on the proximal parts of the limbs and axillary folds. A diagnosis of PLC should be considered in all dark skinned patients with a widespread hypopigmented rash.

Adolescent

Pityriasis rosea in a patient with epidermolysis bullosa dystrophica.

A patient with clinical and histologic features of epidermolysis bullosa dystrophica-recessive (EBD-R) developed superimposed clinical lesions of pityriasis rosea (PR). Electron microscopy showed distinct "blebbing" of basal cells at the basement membrane zone in clinically normal skin of a non-predilected area, as well as in scarred skin from a predilected area and a lesion of PR. An increased susceptibility of the basement membrane zone to proteolytic enzymes is suggested as a possible hypothesis to explain these observations.

Adult

Structure and biological function of human IgD. XVI. T and B lymphocytes in pityriasis rosea.

The relative frequency of peripheral blood T and B cells and their biological function(s) from a group of patients with pityriasis rosea (PR) was investigated during the acute and convalescent phases of the disease using rosetting, immunofluorescent tests, and in vitro cell culturing with anti-delta and anti-mu antibodies and phytohemagglutinin (PHA). The total number of immunoglobulin (Ig) bearing cells was significantly increased, in conjunction with a slight decrease in the T cell population. Lymphocytes with surface IgD, IgM, or both Ig, accounted for the increase in the B cell population. This increase was transient, since it was only observed during the acute phase of the disease. In spite of the increase in IgD/IgM bearing B cells, the mitogenic responsiveness of B or T lymphocytes to anti-delta, anti-mu, or PHA was similar to the same patients during the convalescent phase, or to normal donors. Similarly, the levels of serum IgM, IgD, IgG, IgA and IgE in PR remained constant and at a normal concentration throughout the experimental period. The significance of the transient increase in IgD/IgM bearing cells in the pathogenesis and etiology of PR and its possible impact on the immune system is discussed.

Adolescent

Pityriasis rubra pilaris responding to aminonicotinamide.

A 32-year-old man with pityriasis rubra pilaris diagnosed by clinical appearance and histologic examination was treated with 1% aminonicotinamide cream applied once daily. Improvement was noted within four days, and almost complete clearing occurred after two weeks of therapy. No side-effects were noted.

6-Aminonicotinamide

[Therapeutic aspects of seborrhea oleosa and pityriasis simplex capillitii].

The treatment of seborrhoea oleosa capillitii should aim at inhibiting depletion of the sebaceous glands, lipid synthesis in the sebaceous gland and microbial lipolysis of the triglycerides in the scalp and hair lipids. The use of isopropyl alcohol as a vehicle in a hair tonic reduces sebum depletion. Coal tar and estrogens reduce the lipid synthesis in the sebaceous gland. The lipolysis can be inhibited by various surfactants, isopropyl alcohol, colloidal sulphur, selenium disulphide, Omadine MDS and benzoyl peroxide. In the treatment of pityriasis simplex capillitii (dandruff) one aims at achieving inhibition of mitosis in the epidermis and, if possible, an additional "keratolytic" effect. Inhibition of mitosis could be demonstrated for coal tar, corticosteroids, selenium disulphide, cadmium sulphide, Omadine MDS, Zn Omadine and ichthyol sodium. Colloidal sulphur, salicylic acid, Omadine MDS and various surfactants act "keratolytically".

Adrenal Cortex Hormones