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The authors describe the case of a 42-year-old woman with typical targetoid lesions of erythema multiforme. The histopathological examination confrmed the diagnosis, local and systemic corticosteroid were started. Following the treatment initiation, symptoms showed regression. While tapering the systemic therapy, symptoms recurred and showed slightly changed clinical picture as well. Second histopathological examination confrmed. The diagnosis of erythema annulare centrifugum. After ophthalmological examination systemic chloroquine therapy was started, which resulted in gradual improvement of the symptoms. The authors summarized by evaluating this patient’s case the diferential diagnostic difculties of fgurate erythemas.

Background Allergen immunotherapy (AIT) is considered a curative treatment in some atopic diseases, but in AD contradictory clinical results exist and the action of AIT has not been elucidated. In the literature, there is no evidence for parallel investigations of permeability barrier, cutaneous and blood immune responses after AIT in AD. Objectives The objective was to investigate immune parameters in the blood and skin and to detect clinical and barrier changes after AIT in AD. Methods Mild-to-moderate AD patients (n = 14) with concomitant allergic rhinitis to house dust mites were selected. All patients received topical treatment, while eight patients were randomly selected for adjuvant AIT also. At baseline and after 6 months, clinical, barrier and immunological investigations (serum and skin tests) were performed. In selected patients, biopsies from atopy patch tests (APTs) were analysed by immunohistochemistry for AD-relevant immune cells and mediators. Results In the adjuvant AIT group, clinical parameters and barrier functions improved significantly. Blood immune parameters displayed no significant changes. Post-AIT APT became negative in all patients in the AIT group, but remained positive in the non-AIT group. Cutaneous dendritic cell and T-cell recruitment decreased significantly after allergen challenge in the AIT group, but no significant changes in skin or serum immunoglobulin E levels or prick test (SPT) reactivity were detected. Conclusions Allergen immunotherapy is a beneficial adjuvant treatment for sensitized AD patients. AIT improves not only clinical symptoms, but also permeability barrier functions. The effect of AIT on sensitization should be detected by APT, not by SPT.

In addition to producing sebum, sebocytes link lipid metabolism with inflammation at a cellular level and hence, greatly resemble adipocytes. However, so far no analysis was performed to identify and characterize the adipocyte-associated inflammatory proteins, the members of the adipokine family in sebocytes. Therefore, we determined the expression profile of adipokines [adiponectin, interleukin (IL) 6, resistin, leptin, serpin E1, visfatin, apelin, chemerin, retinol-binding protein 4 (RBP4) and monocyte chemoattractant protein 1 (MCP1)] in sebaceous glands of healthy and various disease-affected (acne, rosacea, melanoma and psoriasis) skin samples. Sebaceous glands in all examined samples expressed adiponectin, IL6, resistin, leptin, serpin E1 and visfatin, but not apelin, chemerin, RBP4 and MCP1. Confirming the presence of the detected adipokines in the human SZ95 sebaceous gland cell line we further characterized their expression and secretion patterns under different stimuli mimicking bacterial invasion [by using Toll-like receptor (TLR)2 and 4 activators], or by 13-cis retinoic acid (13CRA; also known as isotretinoin), a key anti-acne agent. With the exception of resistin, the expression of all of the detected adipokines (adiponectin, IL6, leptin, serpin E1 and visfatin) could be further regulated at the level of gene expression, showing a close correlation with the secreted protein levels. Besides providing further evidence on similarities between adipocytes and sebocytes, our results strongly suggest that sebocytes are not simply targets of inflammation but may exhibit initiatory and modulatory roles in the inflammatory processes of the skin through the expression and secretion of adipokines.

Background The formation of metastases and the efficacy of systemic therapies in cutaneous malignant melanoma (CMM) depend on the characteristics of the tumour cells and the host immune response. Aberrant expression of metallothionein (MT) has been observed in several types of cancers with poor prognoses. Objective To perform an immunohistochemical study on primary CMM comparing the MT expression of tumours without metastases (n = 23) to that of samples with haematogenous metastases (n = 23) and to examine the correlation between MT staining and immunological markers relevant in CMM progression. Methods The immunohistochemical labelling of different tumour sections was analysed using tissue microarrays for the evaluation of the suitability of this method in future studies. Results Our results suggest that MT overexpression is significantly more frequent in primary CMM with haematogenous metastases (P = 0.018) and that the overexpression is independent of the Breslow tumour thickness (R = 0.102, P = 0.501). Interestingly, MT overexpression of the tumour cells was correlated with the presence of tumour-infiltrating CD68+ macrophages (P = 0.003), a known predictive factor for melanoma progression, thereby suggesting a role for MT in the development of a defective host immune response. Furthermore, the presence of CD163+ macrophages infiltrating the tumours correlated with metastasis formation (P

Az erythroderma a testfelszín csaknem egészét érintő bőrgyulladás, amelyet hyperaemia, bőrmegvastagodás, hámlás jellemez. A testfelület nagy részére lokalizálódó gyulladás az etiológiai tényezőtől függetlenül önmagában is előidézhet életveszélyes állapotot. Parazitafertőzés az erythroderma hátterében extrém ritka. A scabieses megbetegedésért (közismerten rühesség) egy, az atkák családjába tartozó élősködő, a Sarcoptes scabiei var. hominis tehető felelőssé. Míg a „klasszikus” scabies prevalenciája világviszonylatban magas, addig a súlyosabb, veszélyesebb formával – a scabies norvegicával, más néven crustosus scabiesszel – jóval ritkábban találkozhat a klinikus, felismerése és kezelése epidemiológiai szempontból kiemelkedően fontos. A szerzők scabies norvegica két esete kapcsán ismertetik az erythroderma és a scabies differenciáldiagnosztikai problémáit és a fertőzés epidemiológiai jelentőségét.

Jellyfish bites in Hungary are rare. Yet, from a differential diagnostic point of view this epizoonozis might gain importance given the ever-growing popularity of seaside tourism. A 10 year old female patient was stung by a jellyfish while sea-bathing in the Adriatic in the summer of 2005. A couple of minutes after the bite urticaria were formed in the contacted area accompanied by a burning and sore sensation. In a few hours the above lesions turned livid and the patient developed low-grade fever and general discomfort. In acute therapy she received thorough rinse with vinegar, antibiotic ointment and systemic calcium. General symptoms regressed within 24 hours and dermatological symptoms improved progressively. Finally, the patient grew symptomless in 4 weeks altogether due to general antihistamine and local antibiotic therapy. 3 months later the patient presented again with hyperaemic papules and an increasing itching and burning sensation in the previously jellyfish-contacted area. Histopathology showed vascular involvement and eosinophilic infiltration. The inflammatory symptoms gradually diminished to locally applied steroids in an occlusive bandage leaving behind hypopigmentation. Although bare-skin contact with the different poisonous jellyfish species usually do lead to the forming of dermatological symptoms, vascular involvement developed months after the encounter in the exposure site has seldom been published. The article covers the main potential symptoms of jellyfish stings--both local and general--going into details about the possible dermatological differential diagnoses. Furthermore, the most venomous jellyfish species, their geographical habitats, do's and don't-s of first aid, therapy and prevention are being briefly discussed by the authors.

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive chromosomal instability syndrome characterized by severe immunodeficiency, growth retardation, microcephaly, a distinct facial appearance, and a high predisposition to lymphoid malignancy. We report a 7-year-old white girl with NBS associated with cutaneous tuberculosis. The patient presented with multiple red-brown, centrally scaring plaques on the leg and had neither pulmonary nor systemic manifestation of tuberculosis. Polymerase chain reaction testing using Mycobacterium genus- and Mycobacterium tuberculosis species-specific primers confirmed the clinical diagnosis of cutaneous tuberculosis. This is the first report describing the simultaneous presentation of NBS and cutaneous tuberculosis.

Notch is a highly conserved transmembrane receptor that determines cell fate. Notch signaling denotes cleavage of the Notch intracellular domain, its translocation to the nucleus, and subsequent activation of target gene transcription. Involvement of Notch signaling in several cancers is well known, but its role in melanoma remains poorly characterized. Here we show that the Notch1 pathway is activated in human melanoma. Blocking Notch signaling suppressed whereas constitutive activation of the Notch1 pathway enhanced primary melanoma cell growth both in vitro and in vivo yet had little effect on metastatic melanoma cells. Activation of Notch1 signaling enabled primary melanoma cells to gain metastatic capability. Furthermore, the oncogenic effect of Notch1 on primary melanoma cells was mediated by beta-catenin, which was upregulated following Notch1 activation. Inhibiting beta-catenin expression reversed Notch1-enhanced tumor growth and metastasis. Our data therefore suggest a beta-catenin-dependent, stage-specific role for Notch1 signaling in promoting the progression of primary melanoma.