Search

In an attempt to determine the viral content and to observe the morphological features of clear cells in human warts of various clinical types, 17 lesions were studied with the electron microscope and 26 in thick sections. Plantar warts were, by far, the richest in viral particles, which are often found in crystalline arrangement. Morphologically, three groups observed in thick sections were also discovered with the electron microscope. In flat warts, poor in keratohyaline, the vacuolating process was total and massive, with abundant viral particles in the nucleus; two flat warts were taken from immunosuppressed patients and their appearance was quite similar to epidermodysplasia verruciformis lesions. In common warts, poorer in virus particles but rich in keratohyaline, vacuolization was often not complete. In plantar warts, characterized by their peculiar wealth in viral particles sometimes invading the cytoplasm, the production of keratohyaline was tremendous and the vacuolization, although often complete, was, however, not massive. Thus it seems that keratohyaline production is related to viral production but hampered by the vacuolating process and differing according to the ultrastructure of the three types of warts. It is suggested that the oncogenic potential of a wart (papilloma) may be related to decrease in keratohyaline production, i.e. cell maturation, and increase in vacuolization.

Summary Sebum excretion is the entire feature which governs sebum outflow to the skin surface through follicular pore. It can be measured by numerous methods, the first of which, devised by Emanuel in 1936, was a solvent extraction followed by desiccation and weighing. At present, virtually the only methods used are the gravimetric and photometric ones. The first one, using absorbent paper to collect the sebum, was introduced by Strauss and Pochi, and improved by Cunliffe and Shuster. Schaefer and Kuhn-Bussius' photometric method is about as accurate as the previous one, but more simple and more rapid to use. Two parameters can be used to quantify sebum excretion: one static, the casual level (CL), i.e. the skin surface lipid amount of a non protected area neither wiped nor washed; the other is dynamic, the sebum excretion rate (SER), i.e. the skin surface lipid flow of a previously cleaned area. The significant differences of these values between different sex and/or age matched groups, give an account of the various stimulation levels of the sebaceous glands according to the underlying endocrine state. Several attempts have been made to show a sebum excretion regulation. Unfortunately, because of the divergences of their results, there is still no definite evidence of such an event occuring. Numerous experiments have also been carried out on the effects of skin temperature and sweat on sebum excretion. The first of these two parameters can act upon sebum skin surface spreading by changing sebum viscosity. The second one can modify local surface tension. Finally, the existence of a circadian rhythm constitutes a further parameter which must not be neglected when interpreting investigations of sebum excretion.

An ultrastructural study of the dermis in a case of acrogeria is presented and compared with a healthy control of same age and sex. The overgrowing orceinophil material was mainly pseudoelastic. The collagen was hypoplastic and mostly immature. Inside and outside the fibroblasts a lot of a granulofilamentous substance intermingled with pseudoelastin and immature collagen was observed. Fibroblast cytoplasm was often distended by ergastoplasmic vacuoles filled with granulo filamentous substance and contained numerous pseudomyelinic bodies. These abnormalities suggest that acrogeria might be a fibroblast disease.

The authors report a case of suppurative hidradenitis of unusual severity affecting the axillary, inguinal, perianal, genital and sacral areas. The surgical treatment consisted initially of large excision of the axillary areas. A musculo-cutaneous latissimus dorsi island flap was then used to cover the defect. 45 days later, a complete excision, in only one operative session, of the inguinal, perianal, genital and sacral area was performed, associate durth colostomy. A mesh graft was performed 15 days after the excision. This procedure allowed an early scar.

Childhood (3 to 9 years) is a calm period of constant growth throughout which social contacts are discovered and intelligence and discretion take place. Consequently, most diseases are infectious. Microrelief was found twice shallower and skin (epidermis + dermis) twice thinner than in adults. Intervals between furrows were reduced parallel to total body surface, thus ruling out the possible existence of special shelters favouring bacterial growth. Sweating is lower, as are skin surface lipid levels, in contrast to the post-natal period, inducing dryness of skin. Although total skin stiffness in vivo was found to be identical to young adult skin, skin chapping is much more frequent. Since detergents as well as extended hot baths may reduce the stratum corneum water binding capacity, they should be used with discretion. Hence, skin care in this period of age should be based upon different criteria than in adults.

Photoplethysmography, cutaneous blood flow measurement by Xenon 133 were carried out before and after resolution by Puva therapy on a lesion and on the symmetrical healthy skin area of 29 psoriatic subjects. The increase of the blood pulsatility and cutaneous blood flows found before treatment, disappears after resolution. The correlation between the two methods is studied.

Using the ‘ground glass method’, the forehead seborrheic index of 72 patients was determined before and during local treatment with promestriene 1% in a o/w base. In hyperseborrheic patients a significant decrease of the seborrheic index was obtained from the 3rd week of treatment and maintained for all its duration, while in normoseborrheics no change was observed under the same conditions. It may be concluded that promestriene reduces the sebum secretion but only in hyperseborrheic patients.

The diffusion of radioactive inert gas xenon 133 through the epidermis in man was studied by compartimental model with a constant speed injection. From this we deduce the cutaneous and subcutaneous flow.

The skin relief influences the exterior aspect of the skin which is very sensitive to aging. It could also be related to the mechanical properties and structure of both dermis and stratum corneum. Consequently, quantitative measurement of the skin surface roughness would seem most useful, as it would permit a quantification of skin aging, an in vivo analysis of mechanical forces acting on the skin structure, and the detection of abnormalities otherwise not visible. The method described comprises three steps: (1) making a silicone rubber negative replica, (2) making an Araldite positive cast, (3) roughness measurement of the cast with a device commonly used in engineering, which provides quantitative parameters: Ra, Rp, Rt, Rmax and others. The reliability of each of these steps was checked, and also the absolute need to locate precisely the site of sampling and to know the angle of the scanning direction with the main axis of the limb or the body. The method seems useful for studying aging, either normal or affected by UV rays and other physiopathological events influencing the skin surface.

The humoral and cell-mediated immune response to human papillomavirus type 1 (HPV-1) 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-1 particles as type-specific antigen. A significant association between myrmecia and anti-HPV-1 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-1 (HPV-1 CP), consisting mostly of a polypeptide of molecular weight 54,000, were injected intradermally. In addition to the type-specific antigens, HPV-1 CP contain other antigenic determinants shared by various types of human papilloma-viruses and masked in intact viral particles. The DH tests to HPV-1 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-1 antibody production mostly in myrmecia carriers (78% and 33% of the cases, respectively), and to new DH to HPV-1 CP in all groups of papilloma carriers (33% to 56%, depending on the clinical papilloma type).

Herpes gestationis, a rare vesiculobullous dermatitis of pregnancy and the postpartal period, can be more easily identified today thanks to recent immunologic and ultrastructural researches. Comparing two new case reports with the data provided by the literature, underlines the individuality of the disease, in spite of the analogies it shows with bullous pemphigoid. Clinically, the illness only appears during pregnancy or the postpartal period and generally responds well to vitamin B6. Histologically the bullae at the dermal-epidermal junction are accompanied by extra- and intra-cellular epidermal edema and vacuolation of the basal cells. Ultrastructural examination shows that the initial alteration affects the plasmatic membrane of the basal cells. The immunologic mechanism of the disease is specific as the usual indirect in vitro immunofluorescent methods cannot reveal factor B.

Our observation concerns a patient aged 29 who has presented for the last two years a smooth lesion, non-infiltrated, golden yellow, and situated on the interior surface of the left knee. This lesion recalls the lichen aureus confirmed by standard histology nad Perls' coloration. There is capillary fragility without plaque anomaly. There is, however, no sign of subjacent venous incompetence.

This paper describes an original in vivo device to investigate and quantify cutaneous resorption of sebum. Such a phenomenon was explored using a photometric determination of residual skin surface lipids at different times following initial deposits of known amounts of artificial sebum on demarcated areas. The technique was carried out on seven healthy subjects. The chosen area was the anterior aspect of the forearm, owing to the very low sebum production of this site, less than the sensitivity of the measuring instrument. The kinetics of absorption of applied sebum turned out to be hyperbolic-like and well correlated with experimental results (r = 0.992), allowing a mathematical determination of the initial velocity of penetration of sebum into the skin, reaching 20 micrograms/cm2.min for a standard program including a mean initial deposit of 116 micrograms/cm2. This kinetics actually does not fit with a true percutaneous absorption of lipids but is compatible with that of absorption into the stratum corneum. It conveys the faster absorption of the latter for sebum, a well-known but not so far quantified property of stratum corneum. The model here described is not at once transposable to skin areas with high sebum production since, quite obviously in such zones, the stratum corneum is permanently saturated with skin surface lipids. Therefore, the conclusions of this work cannot be correlated with the regreasing parameters studied so far on the forehead, but they provide interesting data about the evolution of sebum following its output onto the skin surface and therefore a better understanding of sebaceous physiology.

In a double blind randomised investigation in 76 patients, roxithromycin (150 mg bd) and doxycycline (200 mg once daily) were compared in two groups of patients who were well-matched for age, sex, body weight, diagnosis, duration and severity of disease and associated pathological conditions, with infected skin conditions. Clinical effectiveness was 92% for roxithromycin and 82% for doxycycline, and bacteriological effectiveness also 92% and 82% respectively, the differences not being statistically significant.

In an attempt to demonstrate the effect of tetracycline or heparin therapy on the dermo-epidermal junction, the suction blister time was measured at the beginning and at the end of the study in 18 female Sprague-Dawley hairless rats, using the suction blister method. Suction blister time was defined as the time taken for the first sign of a vesicle to appear in the hole in the diaphragm of a suction chamber. 200 IU heparinate calcium was administered daily for 6 days in 6 rats. Six other rats received 27.5 mg tetracycline chlorhydrate daily for 6 days. The others did not receive any drug. Significant statistical differences in suction blister time before and after administration of the drugs were found in the heparin group (p less than 0.05), and in the tetracycline group (p less than 0.05), compared with the control group. Heparin and tetracycline were found to increase suction blister time significantly. These results suggest an increased cohesion in the dermo-epidermal junction due to heparin and tetracycline.

A typical case of Chédiak-Higashi disease is reported in a French four years old boy (no parents consanguinity). The clinical aspect of oculo-cutaneous and pilar hypopigmentation, associated with recurrent infections led to the diagnosis of C. H. disease which was confirmed by the presence of giant leukocytes granulations in the blood and giant melanosomes in epidermal melanocytes; these giant pigmented granules, are made of a limiting unique membrane with granular matrix and periodic filamentous structures, which correspond to stade I, II and III melanosomes. In keratinocytes, melanosomes are rare, never isolated and scattered in cytoplasm, but grouped in giant melanosomes complexes. No specific immunity deficiency is found in this patient but the chemotaxis of neutrophil polymorphonuclear leukocytes was decreased but restored by levamisole treatment. Concanavaline A Cap formation by polymorphonuclear leukocytes was abnormally increased, but returned at a normal level after cyclic GMP incubation and levamisole treatment. Unfortuntely, the patient died soon after accelerated phase had begun, in an anatomo-clinical picture of pseudo-lymphoma. A pathogenic discussion of CH disease is presented with the help of a study of 102 cases of literature.

The hormone-dependence of malignant melanoma is brought to mind by some epidemiological facts (rarely found in children, more frequently in females, higher frequency in case of prolonged use of oral contraceptives from an early age). On the other hand, estrogen receptors can be found in about 30 p. 100 of malignant melanomas. Starting from this hypothesis of a sub-population of hormone-dependent malignant melanomas, it seemed of interest to us to study the efficiency of an anti-estrogen, namely Tamoxifen (Nolvadex) in the management of metastatic malignant melanoma. It was used at a 40 mg daily dose-regimen on four patients (three post-menopausal females, one male) with multiple estrogen positive cutaneous metastases. In post-menopausal women, two cases of total regression were observed, associated with a distinct increase in progesterone receptors while under treatment and with a return to the initial stage when the treatment was stopped. This phenomenon can be explained by a double self-contradictory effect of the drug, already well known in other hormone-dependent cancers such as those of the breast or the endometrium, namely an anti-estrogen result on the tumoral growth and an estrogen result as attested by the synthesis of progesterone receptors. Certain malignant melanomas therefore behave as endocrine-dependent tumours and may so answer an anti-hormone treatment through a competitive fixation on estrogen-receptors. Our clinical results are in agreement with such a theory since Tamoxifen is at best effective on cutaneous metastases of post-menopausal women. The overall efficiency on all metastases is of the order of 10.6 p 100 (complete or partial regression).(ABSTRACT TRUNCATED AT 250 WORDS)

Two major biological roles of the epidermis as the interface between the interieur of the body and the environment can be defined: the barrier function and the role as a transporting surface. According to the immediate environment, the balance between these two functions has changed during evolution. In invertebrates, the transport dominates quite often over the barrier, whereas the opposite is true for terrestrial vertebrates. Morphologic and biochemical modifications in the various species together with corresponding changes in function allow a better insight into the role of each structural component.

Summary Mucosal lesions in lichen planus (LP) involve mostly mouth and genitals. Extension to oesophagus resulting in stenosis is exceptional (only eight cases have been reported so far). We describe two such cases and recall the clinical findings required to correlate an oesophageal stenosis to LP: age and sex status, associated mucosal LP lesions, location on the upper third of the oesophagus, histological features, flare-up of buccal lesions following dilatation. Systemic steroids are regarded as the best treatment in the case of oesophageal stenosis due to LP, the efficacy of etretinate is limited, and dilatations should be avoided. Dapsone proved to be efficient in severe erosive buccal LP, and could be considered as a valuable therapeutic alternative.

There are three reports on acute haemorrhagic oedema of the skin of infants, an illness which English-speaking authors do not individualize but only regard as a clinical variety of Henoch-Schönlein purpura. Yet the features of the disease, as described in children under two years of age, are very characteristic. --Clinical feature is the sudden appearance of oedemas on face and limbs and of cocarde-like purpura with an occasional temperature. --Histological feature is the presence of leukocytoclastic vasculitis. --Immunologically the disease is characterized by the deposit of immune complexes. --Ultrastructural examination confirms the presence of leukocytoclastic vasculitis accompanied by deposit of immune complexes and of platelets. These three reports enable the authors to study the nosological aspects of the illness among the varieties of allergic vasculitis.

The surface of the skin consists of a layer of dead, keratinised epithelial cells. It is not flat but forms a pattern of ridges and grooves. The best known of these are the fingerprints or dermatoglyphs, but even at sites where such patterns are absent the surface is not smooth but covered by a more-or-less regular pattern of intersecting grooves. The intersecting grooves form nearly regular geometrical figures (Tring and Murgatroyd, 1974) and the variations of these with site, age and disease have been described (Pinkus, 1927; Chin and Dobson, 1964; Verbov, 1975; Wagner and Goltz, 1979).

The effect of zinc on acne is unclear. In this study, only patients with an inflammatory acne were included in a double-blind trial using low doses of zinc gluconate (200 mg/day, corresponding to 30 mg zinc metal). We obtained a significantly different result between zinc and placebo groups in the inflammatory score (p less than 0.02). This efficiency could be explained by the action of zinc on inflammatory cells, especially granulocytes.