Propylthiouracil-induced cutaneous vasculitis

The use of propylthiouracil (PTU) is associated with the development of different auto-antibodies, amongst them are antineutrophil cytoplasmic antibodies (ANCA) that are involved in the pathogenesis of ANCA associated systemic vasculitis. The case of a 46-years old woman who presented cutaneous vasculitis when taking PTU for Graves' disease is reported. Perinuclear ANCA (p-ANCA) was positive with titer > 1/320, but anti-myeloperoxidase antibodies were not detected. Skin biopsy showed leucocytoclastic vasculitis. The patient improved within ten days after withdrawing PTU and the resolution of hyperthyroidism was achieved with radioiodine (131I). The p-ANCA test remained positive > 1/320 eight months and four years after PTU withdrawal.O uso do propiltiouracil (PTU) está associado ao desenvolvimento de diferentes auto-anticorpos, entre eles anticorpos anticitoplasma de neutrófilos (ANCA), que estão envolvidos na patogênese das vasculites sistêmicas ANCA-associadas (VSAA). Será relatado o caso de um paciente do sexo feminino, de 46 anos, que apresentou vasculite cutânea durante o uso de PTU como terapêutica para doença de Graves. O ANCA com padrão perinuclear (p-ANCA) foi positivo em títulos > 1/320, porém anticorpos antimielo-peroxidase (MPO) não foram detectados. A biópsia de pele revelou uma vasculite leucocitoclástica. Houve melhora clínica em dez dias após a retirada do PTU e optou-se pelo iodo radioativo (I131) para o tratamento do hipertireoidismo. O p-ANCA manteve-se positivo em títulos > 1/320 em duas medidas, realizadas oito meses e quatro anos após a suspensão do PTU.Hospital do Servidor Público Estadual Francisco Morato de OliveiraUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus

The pemphigus group comprises the autoimmune intraepidermal blistering diseases classically divided into two major types: pemphigus vulgaris and pemphigus foliaceous. Pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus are rarer forms that present some clinical, histological and immunopathological characteristics that are different from the classical types. These are reviewed in this article. Future research may help definitively to locate the position of these forms in the pemphigus group, especially with regard to pemphigus herpetiformis and the IgG/ IgA pemphigus.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Dermatology DepartmentUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Dermatology and Pathology DepartmentsUNIFESP, EPM, Dermatology DepartmentUNIFESP, EPM, Dermatology and Pathology DepartmentsSciEL

Differential expression of Ro/SSA 60 kDa and La/SSB, but not Ro/SSA 52 kDa, mRNA and protein in minor salivary glands from patients with primary Sjogren's syndrome

Objective. To analyze the protein and messenger RNA (mRNA) expression of La/SSB, Ro/SSA 60, and Ro/SSA 52 antigens in minor salivary glands (MSG) from patients with primary Sjogren's syndrome (pSS).Methods. La/SSB, Ro/SSA 60, and Ro/SSA 52 protein expression was studied by immunohistochemistry in MSG from 26 patients with pSS and 16 controls. mRNA expression was determined by real-time polymerase chain reaction in MSG of 10 patients with pSS and 7 controls.Results. La/SSB and Ro/SSA 60, but not Ro/SSA 52, mRNA expression was higher in samples from patients with pSS compared to controls (p < 0.05). La/SSB protein had higher expression in the cytoplasm of ductal cells than in the cytoplasm of mucous acinar cells in patients with pSS (p = 0.013) but not in controls. Ro/SSA 60 had higher expression in the cytoplasm of ductal cells than in the cytoplasm of serous acinar cells in patients with pSS (p = 0.006) but not in controls. The Ro/SSA 52 expression pattern was similar in patients and controls. There was no association between circulating autoantibodies to Ro/SSA or La/SSB and the aberrant expression of the cognate autoantigens.Conclusion. The increased Ro/SSA 60 and La/SSB mRNA expression in MSG of patients with pSS as well as the differential Ro/SSA 60 and La/SSB protein expression in ductal cells of MSG in patients with pSS suggest that these these 2 autoantigens, but not Ro/SSA 52, are probably involved in triggering and maintaining the tissue-specific autoimmune response in pSS MSG and may contribute to the antigen-driven immune response and local autoantibody productionUniv Fed Sao Paulo, Div Rheumatol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Pathol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Stomatol Div, BR-04023062 Sao Paulo, BrazilAdolpho Lutz Inst, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Rheumatol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Pathol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Stomatol Div, BR-04023062 Sao Paulo, BrazilWeb of Scienc

Inner gray halo, a novel dermoscopic feature for the diagnosis of pigmented actinic keratosis: Clues for the differential diagnosis with lentigo maligna

Background: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge.Objective: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations.Methods: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases.Results: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established.Limitations: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions.Conclusion: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.Universidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilAC Camargo Canc Ctr, Cutaneous Oncol Dept, BR-01509010 São Paulo, BrazilUniv Modena & Reggio Emilia, Dept Dermatol, Modena, ItalyUniversidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilWeb of Scienc

Does Preoperative Electrical Stimulation of the Skin Alter the Healing Process?

Background. in vitro studies have demonstrated that electrical current may affect fibroblast proliferation and synthesis of collagen fibers. in humans, the application of electrical current by positioning the positive electrode on skin wounds resulted in thinner hypertrophic scars. the aim of this study was to evaluate the effects of preoperative electrical stimulation on cutaneous wound healing in rats.Materials and Methods. Forty rats were divided into two groups of 20 animals each. in the control group, an incision was made on the back of the animals. in the stimulation group, a preoperative electrical stimulation was applied using a rectangular pulse current at a frequency of 7.7 Hz, and intensity of 8 mA, for 30 min, with the positive electrode placed on the back of the animal, and the negative electrode placed on the abdominal wall. Following, an incision was made on their back. Biopsy was carried out on postoperative day 7 and 14, and histologic analysis was performed.Results. the number of newly formed vessels, fibroblasts, and type III collagen fibers in the stimulation group on postoperative day 7 were greater than those in the control group.Conclusions. Preoperative positive-polarity electrical stimulation positively affects angiogenesis and fibroblast proliferation. (C) 2011 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo UNIFESP, Disciplina Cirurgia Plast, Dept Surg, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Pathol, BR-04024002 São Paulo, BrazilUniv City São Paulo UNICID, Phys Therapy Dept, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Disciplina Cirurgia Plast, Dept Surg, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Pathol, BR-04024002 São Paulo, BrazilWeb of Scienc

Low-dose oral isotretinoin versus topical retinoic acid for photoaging: a randomized, comparative study

BackgroundOral isotretinoin (ISO) is the only drug which promotes prolonged remission or cure of severe acne. It also has other properties, supporting its use for non-acne indications. Retinoic acid (RA) is gold standard treatment for photoaging. ISO for photoaging treatment was reported in non-controlled trials as alternative to RA, which causes skin irritation.ObjectiveTo compare clinical, histological, and immunohistochemical effects of low-dose ISO and 0.05% topical RA to treat photoaging.MethodsRandomized, comparative, evaluator-blinded, single-center study. Twenty-four healthy, Caucasian, 50 to 75-year-old men and women (menopausal or sterilized) with advanced photoaging were included. Twelve subjects received ISO, 20 mg/day, and 12 subjects were treated with RA cream, for six months; both treatments were administered every other day, and moisturizer and sunscreen were also used. Outcome measures included patient assessments, blinded photographic evaluations, Life Quality Index, histological (HE, Verhoeff) and immunohistochemical (p53, collagen type I) evaluations, adverse events, liver function, lipid profile, and blood count. Statistical analysis with generalized estimating equations and repeated measures ANOVA tests was used.ResultsEleven subjects in each group completed the study. Patient and photographic assessments showed overall improvement in skin appearance. Quality-of-life scores were reduced for all subjects. Histological analysis revealed corneal layer diminution, epidermal thickness increase, and elastosis reduction. Immunohistochemical findings revealed significant epidermal p53 reduction and dermal collagen 1 increase. No differences were found between groups; laboratory tests showed no significant alterations.ConclusionDespite being safe and effective, low-dose ISO was not superior to 0.05% RA for advanced photoaging treatment.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Dept Dermatol, BR-18618000 Sn Botucatu, SP, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Dermatol, BR-18618000 Sn Botucatu, SP, BrazilFAPESP: 2009/51271-9Web of Scienc