Notes: 1,25-Dihydroxyvitamin D3 [1,25(OH)2 D3] may be an immunomodulatory drug which could have a role in controlling collagen deposition, and inducing reversal of fibrosis in some tissues. These observations prompted a study of the possible use of this hormone for the treatment of scleroderma. A 35-year-old woman, who had been suffering from localized scleroderma for 2 years, was given oral 1,25(OH) 2 D3 for 6 months. The effects of the treatment were evaluated using clinical and physical measurements (skin thickness, extensibility properties of the skin). The evolution of the patient's condition during the 6-month therapy suggests that 1,25(OH)2 D3 is beneficial in localized scleroderma. The mechanisms of action are discussed in relation to the literature, which suggests both immunoregulatory and inhibitory effects on fibroblast growth.

Notes: Background  Recently, units have been developed that are capable of delivering large fluences of narrowband ultraviolet (UV) B selectively to cutaneous lesions within a reasonable time.Objectives  To analyse the efficacy of a novel nonlaser 308-nm monochromatic excimer light (MEL) delivery system in various dermatoses usually treated by narrowband UVB phototherapy.Methods  Fifty-four patients with chronic and resistant localized dermatoses were enrolled in a prospective study: 17 with palmoplantar pustular psoriasis, seven with plaque-type psoriasis, four with nail psoriasis, eight with chronic atopic dermatitis of the hands, 10 with chronic nonatopic dermatitis of the hands and eight with alopecia areata. The 308-nm xenon chloride MEL delivery system (Excilite; DEKA, Florence, Italy) was used to produce an average incident dose rate of 50 mW cm−2 at a tube-to-skin distance of 15 cm and with a maximum irradiating area of 512 cm2. The initial dose was based on multiples of a predetermined minimal erythema dose (MED), and subsequent doses were based on the response to treatment. Treatments were scheduled weekly for a maximum of 10 weeks. Clinical responses were evaluated using photographic documentation and (except for alopecia areata) clinical score.Results  The MED ranged from 250 to 350 mJ cm−2 (mean ± SD 318·2 ± 28·4). MEL at 308 nm was the most effective for palmoplantar pustular psoriasis with a mean improvement of 79% after a mean of 5·3 treatments and a mean dose of 11·8 MED per treatment. Plaque-type psoriasis was significantly less sensitive to treatment and nail psoriasis demonstrated no benefit from treatment. Chronic palmar atopic dermatitis was cleared in two patients and the mean improvement was 54% as compared with 46% in patients with chronic nonatopic dermatitis of the hands. Four complete regrowths among the eight patients with alopecia were observed after a mean of 5·1 treatments. The percentages of improvement had significantly decreased at the 6-month visit, and only four patients (24%) with palmoplantar pustular psoriasis still demonstrated a significant improvement. Common side-effects included intense erythema and, more rarely, blisters, but these were well tolerated.Conclusions  Our preliminary results confirm the efficacy of this novel 308-nm MEL delivery system, which appears to be effective and safe for palmoplantar pustular psoriasis. To a lesser extent, plaque-type psoriasis, chronic atopic and nonatopic dermatitis of the hands and alopecia may also benefit from this treatment.

Notes: A 70-year-old woman with chronic edema of the lower limbs was diagnosed as having a “malignant angioendotheliomatosis,” because histologic examination showed a strict intravascular location of a malignant proliferation. Immunochemical studies actually disclosed the lymphomatous origin of malignant cells. The recent literature regarding the nosology of this rare condition is reviewed.

Notes: We report an unusual case of chronic actinic dermatitis associated with α1-antitrypsin deficiency and who responded well to treatment with danazol.

Notes: The humoral and cell-mediated immune response to human papillomavirus type i (HPV-i) has been studied in 162 patients carrying papillomas of various clinical types: deep plantar wart or myrmecia, common wart, flat wart, and anogenital wart. Circulating antibodies were detected by immunodiffusion and microcomplement fixation, using purified HPV-i particles as type-specific antigen. A significant association between myrmecia and anti-HPV-i antibodies was found (39% of the cases).Cell-mediated immunity was evaluated by a study of delayed hypersensitivity (DH). The main capsid components of HPV-i (HPV-i CP), consisting mostly of a polypeptide of molecular weight 54,000, were injected intradermally. In addition to the type-specific antigens, HPV-i CP contain other antigenic determinants shared by various types of human papillomaviruses and masked in intact viral particles. The DH tests to HPV-i CP showed no differences between the carriers of different papilloma types, confirming the presence of common antigenic determinants. Moreover, they gave rise to an increase or to new anti-HPV-i antibody production mostly in myrmecia carriers (78% and 33% of the cases, respectively), and to new DH to HPV-i CP in all groups of papilloma carriers (33% to 56%, depending on the clinical papilloma type).

Notes: Skin surface lipid levels in forty-five newborn babies and 193 infants aged less than 12 months were determined by an optical density method, using samples collected on ground glass. Although there was a wide individual range, sebum levels in the first week of life were very high, and were of the same magnitude as in adults. Females displayed a different pattern of sebum excretion from males. On the first day of life, the levels in females were lower than in the males but a large increase took place between the 3rd and 6th day, followed by a fall, bringing the level below that of the males. At 6 months the levels were low in both sexes. These findings suggest that there is a strong stimulation of sebum secretion before birth which probably stops at or soon after birth. Androgen may be involved in this stimulation and the probable role of dehydroepiandrosterone (DHEA) is discussed. Very few studies have been carried out on sebum secretion in newborn children. Emanuel (1936) was the first to demonstrate that the sebum level in newborn babies can be nearly as high as in adults. The levels then gradually decline to settle at a very low baseline until puberty. Since this study, our knowledge has remained elementary, in spite of repeated allusions to a seborrhoeic pathology in the newborn. This shortcoming is probably due to the fact that the techniques available were either dangerous for the child (i.e., the ether cup method used by Emanuel (1936)), or difficult and lengthy (i.e. the extraction on filter paper used by Strauss & Pochi (1961) and Cunliffe & Shuster (1969)). The Schaefer & Kuhn-Bussius (1970) photometric method, being both harmless and quick, is free from these drawbacks and enables sebum secretion to be measured at birth.

Notes: Background  Angiogenesis has been reported as a parameter of potential prognostic value in solid tumours, as it may facilitate tumour growth and metastasis. One of the most important growth factors involved in angiogenesis is vascular endothelial growth factor (VEGF).Objectives  To determine the predictive value of circulating VEGF levels in a cohort of patients with melanoma.Methods  In a prospective cohort study, 324 patients with cutaneous melanoma at different clinical stages were investigated over 2 years (2002–04). VEGF was measured in plasma using enzyme-linked immunosorbent assay. Two hundred and eight patients were able to be followed up for progression of their disease and for blood sample collection (mean ± SD follow-up 13·4 ± 0·8 months). Data were compared with the extent of the disease and the clinical course.Results  A significant increase in plasma VEGF levels was found in patients with melanoma compared with healthy controls, with statistically significant differences between patients in stages I, II and III vs. those in stage IV, but not between patients in stages I, II and III. When considering the 237 patients in stages I and II, no statistical correlation was found between plasma VEGF levels and tumour thickness. Baseline plasma VEGF levels were not significantly higher in patients who relapsed compared with nonprogressing patients. Among the 35 patients (two stage I, eight stage II and 25 stage III) who experienced a progression during follow-up, an increase in plasma VEGF level to 〉 100 pg mL−1 was found in 20 (sensitivity 57·1%), while 38 of the 173 remaining nonprogressing patients demonstrated an increase in VEGF level, indicating a specificity of 78%. In addition, an increase in plasma VEGF level was found in 58 patients during follow-up, of whom 20 showed evidence of progression, indicating a positive predictive value of 34·5%. However, among the 150 remaining patients who did not demonstrate any increase in plasma VEGF level during follow-up, only 15 experienced a progression, indicating a negative predictive value of 90%.Conclusions  Our data confirm that blood VEGF levels are significantly increased in patients with melanoma and, more interestingly, that the absence of plasma VEGF level increase during follow-up appears to be associated with remission.

Notes: Contact photoallergy to ketoprofen gels has been widely reported, and cross-sensitivity reactions with other compounds, such as tiaprofenic acid, fenofibrate and benzophenones, are well known. However, positive photopatch tests to other different non-benzophenone-related compounds have recently been observed. We report the results of photopatch testing in patients with contact photoallergy to ketoprofen and discuss the spectrum of cross-sensitization to ketoprofen. 18 consecutive patients with a history of photocontact dermatitis from ketoprofen were investigated. Patch and photopatch tests were performed. As expected, we observed positive photopatch tests to Ketum* gel and ketoprofen 2·5% in petrolatum in all patients (100%). However, it was remarkable to note positive photopatch tests to other unexpected and non-relevant allergens, including fentichlor (67%), tetrachlorosalicylanilide (28%), triclosan (17%), tribromsalan (11%) and bithionol (11%), with no clinical relevance. Interestingly, these agents belong to the family of halogenated salicylanilides and related compounds, which have been forbidden in Europe since the 1970s. Our results raise the question of hyper-photosusceptibility to non-relevant allergens induced by photosensitivity to ketoprofen. The mechanism may involve the high photoreactivity induced by the association of a benzene ring with an oxygen group.