Distribution by Scientific Domains

Kinds of Blisters

  • suction blister

  • Terms modified by Blisters

  • blister formation
  • blister rust

  • Selected Abstracts

    Histopathologic Differential Diagnosis of Subepidermal Cutaneous Blisters and Erosions at Autopsy

    C. Kovarik
    The histopathologic differential diagnosis of subepidermal blisters is broad and most commonly includes primary dermatologic diseases (i.e. bullous pemphigoid), secondary blistering conditions (i.e. bullous lichen planus), and drug reactions (i.e. toxic epidermal necrolysis); however, when examining blister specimens taken during autopsy, several other entities need to be added to the differential diagnosis. For one year, we biopsied cutaneous blisters and erosions found during autopsies performed at the Dallas County Medical Examiner's Office and examined them histologically. The objective of this study was to determine the primary cause of blisters and erosions seen at autopsy, characterize them histologically in order to allow differentiation from other blistering conditions, and emphasize causes of subepidermal blisters that are often not considered in the differential diagnosis. We present eight representative cases in order to illustrate the following points. The majority of blisters and erosions examined were subepidermal and secondary to physical causes, such as burns, defibrillation, submersion, fetal maceration, and decomposition. Although primary skin conditions need to be considered when examining blisters and erosions at autopsy, the most common entities are secondary to physical causes, and these need to be included in the differential diagnosis in order to obtain an accurate diagnosis. [source]

    Paederus dermatitis in Egypt: a clinicopathological and ultrastructural study

    M Assaf
    Abstract Background, Outbreaks of paederus dermatitis (PD) have been observed in different parts of the world, yet the histopathological and ultrastructural changes and their relationship to pederin toxin have not been described. Objective, To describe the clinical presentations of PD in Egypt and to study the effects of pederin toxin on the skin by evaluating the histopathological and ultrastructural changes of some representative cases. Methods, One hundred and thirteen patients with PD were studied clinically and epidemiologically. Skin biopsies were taken from 40 patients for histopathological examination and from 20 patients for electron microscopic (EM) examination. Results, Clinically, the most common presentation comprised erythematous plaques with micropustules. Blisters exhibited a linear configuration in 40% of the patients and kissing lesions were observed in 13%. Multiple lesions occurred in 78% of the patients and the face was the most commonly involved site (48%). The insect was identified as Paederus alfierii. Histopathological examination revealed features of acute irritant dermatitis in the upper epidermis. Mitotic figures and apoptotic changes such as chromatin condensation and DNA fragmentation were identified in the basal and suprabasal layers. These features were confirmed by EM. Conclusions, Clinical, histopathological and, for the first time, ultrastructural characteristics of paederus dermatitis are described. The pathological abnormalities of the upper epidermis are caused by the irritant effect of pederin toxin. The presence of apoptosis within the lower epidermis can be related to this toxin, a point that needs further research, hoping for its future implications in the management of hyperproliferative disorders. [source]

    Autologous Cultured Melanocytes in Vitiligo Treatment

    BACKGROUND Surgical treatment of vitiligo is indicated when lesions are localized in poorly responding areas. OBJECTIVES The objectives were: (1) to establish the melanocyte culture obtained from the epidermis of vitiligo patients for future treatment; (2) to estimate the influence of selected factors on the formation of suction blisters and the results of culture; and (3) to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus psoralen and ultraviolet A (PUVA) therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA-therapy (CP), and only PUVA therapy (OP). METHODS Forty patients were qualified for the study. The roofs of the suction blisters were used as a melanocyte source for culture establishment or were directly transplanted. RESULTS The CMP procedure was successfully performed on only 10 of 20 patients because of the difficulties in cell culture establishment. The SBP method was carried out on all 20 patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSIONS The effectiveness of culture depends on time of suction blister forming, phototype, and previous PUVA therapy. This study demonstrated the advantage of the SBP over the CMP method. [source]

    Epidermal Grafting After Chemical Epilation in the Treatment of Vitiligo

    Chi-Yeon Kim MD
    Background. Vitiligo on hairy areas like the scalp and eyebrows is frequently associated with leukotrichia and repigmentation by photochemotherapy is usually difficult because of a deficient melanocyte reservoir. Although epidermal grafting to supply melanocytes is very effective for stable vitiligo, hair growth inhibits successful transfer of melanocytes from grafted epidermis in dense hair-bearing regions. Objective. To investigate the effectiveness of preoperative chemical epilation to improve the results of epidermal graft by suction blister on hairy areas. Methods. Two patients who had vitiligo with leukotrichia on the face and scalp were treated with epidermal grafting using suction blister after chemical epilation. Two weeks after the graft they were treated with topical psolaren plus ultraviolet A (PUVA) therapy. Results. Epidermal grafting was performed successfully, and successful repigmentation of the skin with significant improvement of leukotrichia was observed in each of two patients. Conclusion. Chemical epilation followed by epidermal grafting is a safe, easy, and effective treatment for vitiligo affecting hairy regions. [source]

    Hair removal using an 800-nm Diode Laser: Comparison at different treatment intervals of 45, 60, and 90 days

    Navid Bouzari MD
    Background, Some laser irradiation parameters such as wavelength, fluence, pulse duration, and spot size have been shown to influence the damage of any target inside the skin, however, the role of some patients' factors such as hair growth cycle is still under debate. Objective, To determine the association of treatment interval and laser treatment outcome. Methods, In a retrospective chart review of 176 patients undergoing laser-assisted hair removal with a diode laser 24 patients were selected. All accepted to cease the therapy, and be followed-up for 5 months. At the end of the study the patients were questioned about the efficacy of the treatment as well as the adverse effects. Hair counting was also performed. The adverse effects (pain, blister or erosion, hyperpigmentation, hypopigmentation, and folliculitis) were questioned during the follow-up period. Results, The mean hair reduction was 78.1%, 45.8%, and 28.7% in 45, 60, and 90-day interval groups, respectively (P < 0.0001). Conclusion, The treatment interval was related to the treatment outcome in our study. [source]

    Treatment of acquired syndactyly by gauze-fixed epidermal graft after radiosurgery

    Seong Eon Kim MD
    Background, Acquired syndactyly is a rare disease that occurs mostly after disease, trauma, or other inflammatory conditions. It is usually treated by surgical incision with a flap or full-thickness skin graft, which is very invasive and requires hospitalization. Objective, The objective was to treat acquired syndactyly with an epidermal graft by suction blister after radiosurgery, because this procedure is much less invasive and can be performed in an outpatient base. Methods, A 65-year-old Korean woman had acquired syndactyly after various traditional treatments for tinea pedis. Five days after separation of syndactyly with radiosurgery, we prepared an epidermal sheet by suction blister, placed it on sterile meshed gauze, and applied it to the separated lesion. Results, The patient's lesion was completely healed after 7 days. Conclusion, Gauze-fixed epidermal graft after radiosurgery is a very effective and simple treatment for shallow acquired syndactyly. [source]

    A case of Adamantiades-Behçet disease with ischemic optic neuritis (posterior optic neuropathy)

    Satoko Shima
    Summary Adamantiades-Behçet disease (ABD) may present with cutaneous and ophthalmologic finings. A 29-year old woman complained of fever and general fatigue, along with erythema nodosum and vesiculo-pustular lesions on the legs, acneiform lesions, genital ulcerations and painful oral ulcers. She also complained of reduced visual acuity, visual disturbance and blurred vision in the left eye. Her left visual acuity was 6/20. Light reflex in the left eye was reduced. The relative afferent pupillary defect (RAPD) was positive in the left eye where a central scotoma was present. The vitreous was clear; the optic disc, macula, retina and iris were all normal. Uveitis was not observed. The patient was diagnosed with ischemic optic neuritis (posterior optic neuropathy) with ABD. Histopathological findings taken from a blister on the leg showed subepidermal bulla, dense dermal neutrophil infiltration, and extravasation of erythrocytes, suggesting leukocytoclastic vas-culitis. She was treated orally with high-dose corticosteroids (methylprednisolone 500 mg/d) for three days. Her general condition and ophthalmic symptoms resolved completely. Optic neuropathy with ABD is very rare; we know of two previous cases [1, 2] of ABD with ischemic posterior optic neuritis. [source]

    Putative role of proteolysis and in,ammatory response in the toxicity of nerve and blister chemical warfare agents: implications for multi-threat medical countermeasures,

    F. M. Cowan
    Abstract Despite the contrasts in chemistry and toxicity, for blister and nerve chemical warfare agents there may be some analogous proteolytic and in,ammatory mediators and pathological pathways that can be pharmacological targets for a single-drug multi-threat medical countermeasure. The dermal,epidermal separation caused by proteases and bullous diseases compared with that observed following exposure to the blister agent sulfur mustard (2,2,-dichlorodiethyl sul,de) has fostered the hypothesis that sulfur mustard vesication involves proteolysis and in,ammation. In conjunction with the paramount toxicological event of cholinergic crisis that causes acute toxicity and precipitates neuronal degeneration, both anaphylactoid reactions and pathological proteolytic activity have been reported in nerve-agent-intoxicated animals. Two classes of drugs already have demonstrated multi-threat activity for both nerve and blister agents. Serine protease inhibitors can prolong the survival of animals intoxicated with the nerve agent soman and can also protect against vesication caused by the blister agent sulfur mustard. Poly (ADP-ribose) polymerase (PARP) inhibitors can reduce both soman-induced neuronal degeneration and sulfur-mustard-induced epidermal necrosis. Protease and PARP inhibitors, like many of the other countermeasures for blister and nerve agents, have potent primary or secondary anti-in,ammatory pharmacology. Accordingly, we hypothesize that drugs with anti-in,ammatory actions against either nerve or blister agent might also display multi-threat ef,cacy for the in,ammatory pathogenesis of both classes of chemical warfare agent. Published in 2003 by John Wiley & Sons, Ltd. [source]

    A case of suspected contact dermatitis in a juvenile cynomolgus monkey (Macaca fascicularis)

    Joanne Morris
    Abstract Background, A 2-year-old male cynomolgus monkey (Macaca fascicularis) presented with vesicular dermatitis exhibiting freshly ruptured blisters, crusts, and papules on the extremities and face. Methods, Complete blood count, serum chemistry, skin biopsy, skin scrape, and culture of a fresh blister were initially submitted for diagnostics. Results, Skin biopsy of the affected area revealed a non-suppurative eosinophilic dermatitis with mild thickening of the epidermis. Serum chemistry showed a marked eosinophilia (1.74 × 103/,l, 17.4%). All other results were within normal limits. Initial differentials included contact dermatitis, immune-mediated disease such as pemphigus or psoriasis. Repeated blood work and skin biopsies were collected as well as serum for allergen-specific IgE latex and food allergy testing. Herpes B virus was added to the differential list after an oral lesion was noted upon repeated physical examination and samples were collected for testing. Repeat blood work maintained a marked eosinophilia and food allergy testing was within normal limits. Serum IgE for latex was equivocal and a follow-up latex sensitivity test was performed and was within normal limits. Repeated skin biopsies were consistent with acute eosinophilic spongiotic dermatitis with vesicles most likely due to contact dermatitis. No therapy was initiated during the diagnostic period and no etiology was confirmed. Conclusions, Over time the dermatitis and eosinophilia resolved spontaneously. The animal is currently free of any lesions and maintains an eosinophil count within normal limits. [source]

    Autologous suction blister grafting for chronic leg ulcers

    U Costanzo
    Abstract Background, Non-healing leg ulcers represent a treatment problem. Objective, Investigate grafting of autologous suction blister roofs as treatment. Methods, Twenty-nine chronic, non-healing leg ulcers of various aetiologies in 18 inpatients were treated by autologous epidermal grafting using the roofs of suction blisters. Results, 55% of ulcers completely healed 2 to 6 weeks after grafting. A 50,90% reduction in size was documented in 34% and no change was observed in 11% of ulcers. Twelve weeks after grafting, 89% of ulcers were healed completely. In most ulcers, we observed a stimulation of reepithelialization from the wound edge (,edge effect') and an accelerated formation of healthy granulation tissue. During a follow-up period of 12 months, 90% of the ulcers remained healed. Conclusion, Grafting of autologous suction blister roofs is an effective treatment option for non-healing leg ulcers. The advantages of the method are its lack of pain, low costs and immediate availability. [source]

    Large Atypical Melanocytic Nevi in Recessive Dystrophic Epidermolysis Bullosa: Clinicopathological, Ultrastructural, and Dermoscopic Study

    Fernando Gallardo M.D.
    The lesion was clinically atypical and fulfilled the criteria for a malignant melanocytic proliferation. A complete surgical excision was performed. Histopathologic examination disclosed a compound melanocytic nevus without melanocytic atypia. Ultrastructural examination showed melanocytic cells located both at the roof and the floor of the blister. Several months later, three pigmentary lesions with a similar clinical appearance developed. Periodic clinical and dermoscopic examinations were recommended. Dermoscopic examination disclosed a globular pattern with brown globules and black dots distributed all over the lesions. The lesions also exhibited blue-greyish dots and multiple rounded white structures corresponding to milia-like cysts. No dermoscopic features suggestive of malignancy were noted. Acquired melanocytic nevi showing atypical clinical features have been reported to occur in areas of blistering in patients with epidermolysis bullosa. These nevi appear as large, asymmetrical pigmentary lesions with irregular borders. Initially, they are very dark in pigmentation, with color variegation and loss of pigment, and even becoming papillomatous over time. Histopathologic examination can show features of compound/junctional nevus as well as persistent/recurrent nevus. The concept of "epidermolysis bullosa nevus" has been proposed to define these peculiar lesions. The clinical, histopathologic and ultrastructural features of these nevi are reviewed. The usefulness of dermoscopic examination in the routine diagnosis and follow-up of these lesions are stressed. [source]

    Identification of sources and inheritance of resistance of Chinese Brassica vegetables to white blister

    PLANT BREEDING, Issue 6 2009
    M. R. Santos
    Abstract There is no information in the literature about the variability of resistance of Chinese Brassica vegetables, pak choi and Chinese cabbage, to the white blister disease caused by Albugo candida (Pers.) Kuntze. A collection of 43 accessions of pak choi and 19 accessions of Chinese cabbage was screened for resistance to the Portuguese A. candida isolate Ac 506 at the cotyledon stage. Different levels of resistance were found among the germplasm tested, ranging from complete resistance to full susceptibility. Most of the accessions were highly susceptible with less than 10% of resistant seedlings, and only four accessions of pak choi, presenting more than 50% resistant seedlings, were considered as new sources or resistance to white blister. Inheritance of resistance at the cotyledon stage was studied in two crosses between the most resistant pak choi accession, BRA 117, and the highly susceptible rapid cycling Brassica rapa line CrGC 1.19. It was proposed that resistance to white blister in pak choi BRA 117 is controlled by two nuclear genes with dominant recessive epistatic gene action. [source]

    Epidermolysis bullosa nevus arising in a patient with Dowling,Meara type epidermolysis bullosa simplex with a novel K5 mutation

    Abstract We report herein a 4-year-old girl with Dowling,Meara type epidermolysis bullosa (EB) who presented with peculiar pigmented nevi. Blister formation had repeatedly occurred on the erythematous plaques in a circinate fashion since birth, and marked hyperkeratosis was observed on the palms and soles associated with nail deformity. Her mother and maternal grandmother also had similar symptoms. In addition to the blistering lesions, the patient had three large, asymmetrical, pigmented plaques with color variegation. Light and electron microscopic findings of the blistering lesions showed a subepidermal blister with intracytoplasmic granules in keratinocytes as well as degeneration of basal cells and aggregation of tonofilaments. The pigmented lesions revealed histopathological features of compound nevus without malignant changes. Gene analysis revealed an E478K (Glu to Lys) mutation in exon 5 of the keratin 5 (K5) gene. These findings, together with clinical features, were consistent with those of Dowling,Meara type EB associated with so-called EB nevus. [source]

    Keratinocytes in the depigmented epidermis of vitiligo are more vulnerable to trauma (suction) than keratinocytes in the normally pigmented epidermis, resulting in their apoptosis

    A-Y. Lee
    Summary Background, Vitiligo may develop following minor physical trauma. However, in autologous epidermal grafting, depigmentation of the donor (normally pigmented) site from a suction blister is rare, even in cases displaying failure of repigmentation at the recipient (depigmented) site. Objectives, To examine whether the suction procedure is more likely to damage keratinocytes in the depigmented than in the normally pigmented epidermis of vitiligo, and to determine what kind of damage occurs to the keratinocytes. Methods, Paired roofs of suction blisters from five patients with generalized vitiligo, five with localized and seven with segmental type, were used for the study. Multiple new lesions developed in two of the five patients with the generalized type. Apoptosis of keratinocytes in the epidermis was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-digoxigenin nick end labelling (TUNEL) staining, with immunohistochemistry for Bax and active caspase 3. Expression of Bcl-2, Bax, FLIP and p53, activation of caspases 3, 8 and 9, and cleavage of poly(adenosine diphosphate ribose) polymerase (PARP) in the epidermis were analysed by Western blotting in four patients with each type. Results, Apoptotic keratinocytes, which stained with TUNEL and anti-Bax and antiactive caspase 3 antibodies, were scattered in the blistered epidermis, mainly in the lower portions. The depigmented epidermis displayed significantly more apoptotic keratinocytes than the normally pigmented epidermis. The numerical difference between the paired epidermides was related to the disease activity and not to the type of lesions. The number of apoptotic keratinocytes in the normally pigmented epidermis was as high as that in the depigmented epidermis in the two patients with active generalized type vitiligo. Expression of Bax and p53 in the depigmented epidermis was higher than in the normally pigmented epidermis, whereas expression of FLIP was lower. In addition, the activation of caspases 3, 8 and 9, and cleavage of PARP, were increased in the depigmented compared with the normally pigmented epidermis. The degree of difference in expression and activation was parallel to the results of the TUNEL assay. Conclusions, The keratinocytes in the depigmented compared with the normally pigmented epidermis of vitiligo may become apoptotic more easily after suction. [source]

    Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study

    Richard Reading
    Healing of hymenal injuries in prepubertal and adolescent girls: a descriptive study . McCannJ., MiyamotoS., BoyleC. & RogersK. ( 2007 ) Pediatrics , 119 , e1094 , e1106 . DOI: 10.1542/peds.2006-0964. Objective, The objective of this study was to identify the healing process and outcome of hymenal injuries in prepubertal and adolescent girls. Methods, This multicentre, retrospective project used photographs to document the healing process and outcome of hymenal trauma that was sustained by 239 prepubertal and pubertal girls whose ages ranged from 4 months to 18 years. Results, The injuries that were sustained by the 113 prepubertal girls consisted of 21 accidental or noninflicted injuries, 73 secondary to abuse, and 19 ,unknown cause' injuries. All 126 pubertal adolescents were sexual assault victims. The hymenal injuries healed at various rates and except for the deeper lacerations left no evidence of the previous trauma. Abrasions and ,mild' submucosal haemorrhages disappeared within 3,4 days, whereas ,marked' haemorrhages persisted for 11,15 days. Only petechiae and blood blisters proved to be ,markers' for determining the approximate age of an injury. Petechiae resolved within 48 h in the prepubertal girls and 72 h in the adolescents. A blood blister was detected at 34 days in an adolescent. As lacerations healed, their observed depth became shallower and their configuration smoothed out. Of the girls who sustained ,superficial', ,intermediate,' or ,deep' lacerations, 15 of 18 prepubertal girls had smooth and continuous appearing hymenal rims, whereas 24 of 41 adolescents' hymens had a normal, ,scalloped' appearance and 30 of 34 had no disruption of continuity on healing. The final ,width' of a hymenal rim was dependent on the initial depth of the laceration. No scar tissue formation was observed in either group of girls. Conclusions, The hymenal injuries healed rapidly and except for the more extensive lacerations left no evidence of a previous injury. There were no significant differences in the healing process and the outcome of the hymenal injuries in the 2 groups of girls. [source]

    DRESS syndrome caused by efalizumab

    J. M. L. White
    Summary We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) to efalizumab. A 52-year-old man developed a widespread papulovesicular rash after 4 weeks of treatment with efalizumab (1.0 mg/kg/week) for treatment-resistant severe psoriasis. Histology revealed a subepidermal blister with eosinophil-rich inflammatory cell infiltrate. Subsequently, the patient developed high peripheral eosinophilia, abnormal liver function, malaise and fever, all requiring inpatient admission. Efalizumab was discontinued immediately, but the rash persisted for 4 months and was only controlled by oral prednisolone at a dose of 30 mg/day. To our knowledge, this is the first reported case of DRESS caused by efalizumab. [source]

    P28 Interleukin-8 from keratinocytes can be used to test for contact allergy

    CONTACT DERMATITIS, Issue 3 2004
    Bolli Bjarnason
    Objective:, To investigate whether secretion of interleukin-8 (IL-8) proteins by keratinocytes following in vitro exposure to a contact allergen can be used to detect contact allergy. Methods:, Suction blisters were made on skin of allergic and anergic subjects to urushiol, the contact allergen of poison ivy. Keratinocyte cultures were prepared and exposed to the allergen in vitro. Controls were the allergen solvent. Variable allergen concentrations, allergen exposure times and cell culture times were used. At the end of each culture time, IL-8 RNA and protein of the culture supernatants were analyzed by PCR and ELISA. Results:, The concentration of IL-8 in the supernatants proved to be a successful way to distinguish between subjects who patch tested positive with a non-toxic concentration of urushiol and subjects who tested negative. In the allergic subjects, a correlation was established between the dose of the allergen and the IL-8 protein concentration in the supernatants. Conclusions:, In vitro testing of contact allergies in patients makes possible an objective assessment of their allergic status without causing a booster effect or risking active sensitizations. The results indicate that the method may be used as an alternative method to animal models for testing consumer products before their marketing, thus avoiding ethical problems and problems related to interpretation of tests because of biological differences between animals and humans. [source]

    P73 The magnitude of contact allergy responses can be quantified with imaged perfusion

    CONTACT DERMATITIS, Issue 3 2004
    Bolli Bjarnason
    Objective:, The objective of this study was to determine whether the magnitude of the perfusion of the contact hypersensitivity response as measured by the laser Doppler perfusion imaging (LDPI) technique was associated with immunological parameters implicated in the pathogenesis of the disease. Methods:, Urushiol was applied on one of the forearms of volunteers for 48 hours while the other forearm served as a control. Twenty-four hours later, measurements of perfusion of the patch test sites were performed with the LDPI technique. To determine whether there was a correlation with immunological parameters associated with human contact hypersensitivity, suction blisters were produced at the test sites. Blister fluid was removed and examined for the cytokine interleukin-8 (IL-8). Results:, There was an extremely close correlation between the magnitude of the contact hypersensitivity response as measured by the imaged perfusion and the level of IL-8 in the blister fluid (r = 1.00). Compared to subjects with visually positive urushiol reactions, patients who failed to develop urushiol contact hypersensitivity despite repeated exposures to that substance had both greatly diminished perfusion and blister fluid IL-8 levels. Conclusion:, The results indicate that LDPI is a sensitive method of quantifying contact hypersensitivity reactions in humans and that the magnitude of the measurements with this technique correlates extremely well with cutaneous cytokine levels that have been implicated in the immunopathogenesis of contact hypersensitivity. [source]

    Autologous Cultured Melanocytes in Vitiligo Treatment

    BACKGROUND Surgical treatment of vitiligo is indicated when lesions are localized in poorly responding areas. OBJECTIVES The objectives were: (1) to establish the melanocyte culture obtained from the epidermis of vitiligo patients for future treatment; (2) to estimate the influence of selected factors on the formation of suction blisters and the results of culture; and (3) to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus psoralen and ultraviolet A (PUVA) therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA-therapy (CP), and only PUVA therapy (OP). METHODS Forty patients were qualified for the study. The roofs of the suction blisters were used as a melanocyte source for culture establishment or were directly transplanted. RESULTS The CMP procedure was successfully performed on only 10 of 20 patients because of the difficulties in cell culture establishment. The SBP method was carried out on all 20 patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSIONS The effectiveness of culture depends on time of suction blister forming, phototype, and previous PUVA therapy. This study demonstrated the advantage of the SBP over the CMP method. [source]

    Hemorrhagic Bullae After Cryosurgery in a Patient With Hemophilia A

    John G. Hancox MD
    BACKGROUND. A case of hemorrhagic bullae and blisters on the hand of a patient with hemophilia A after cryosurgery for verruca vulgaris is reported. OBJECTIVE. To discuss a hemorrhagic complication in a patient with hemophilia A after cutaneous cryosurgery. METHODS. This is an observatory case report. RESULTS. Even minimal cryosurgery can induce hemorrhagic bullae in patients with hemophilia A. CONCLUSION. The risks and benefits of cryosurgery should be weighed carefully in patients with bleeding disorders such as hemophilia. [source]

    Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite Laser

    Sorin Eremia MD
    Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source]

    Photorejuvenation for Asian Skin by Intense Pulsed Light

    Kei Negishi MD
    Background. Dermabrasion and deep chemical peeling are used in the treatment of photoaged skin. These ablative procedures are effective enough to produce a certain improvement but have often caused postinflammatory hyperpigmentation among Asian patients. To avoid such adverse effects, a new, nonablative procedure has been sought. Objective. To determine the effectiveness of photorejuvenation for Asian skin using intense pulsed light (IPL). The specific parameters used, improvement ratios, side-effects, and downtime required are also discussed. Methods. Ninety-seven patients were treated for photoaging using IPL. The cutoff filters of 550 nm and 570 nm were utilized for three to six treatments at intervals of 2 to 3 weeks. Results. Treatment results were evaluated and rated by both patients and physicians at the end of the third treatment based on improvement in pigmentation, telangiectasia, and skin texture. A combined rating of "good" or "excellent" was given to more than 90% of the patients for pigmentation, more than 83% for telangiectasia, and more than 65% for skin texture. There were some minor complications in four cases: one had erythema that continued to the next day and three had minor blisters leaving no marks. Conclusion. Photorejuvenation using IPL is a completely safe and effective procedure even for Asian skin. It will be increasingly used for skin rejuvenation in the future. [source]

    Suction Device for Epidermal Grafting in Vitiligo: Employing a Syringe and a Manometer to Provide an Adequate Negative Pressure

    Han-uk Kim MD
    Background. Suction devices for epidermal grafting need a suction pump to provide a negative pressure. The authors have developed a suction device in which a syringe and a manometer are employed to provide a negative pressure. Objective. The purpose of this study was to evaluate the efficacy of our suction device in vitiligo patients. Methods. The suction device was used to obtain epidermal blisters from the donor site. A CO2 laser was employed to remove the depigmented epidermis. The blister roofs of the donor site were harvested and were placed onto the recipient area. Ten patients with stable vitiligo were treated by epidermal grafting. Results. Epidermal blisters were produced by suction in all patients. Also, all 10 patients regained repigmentation. Conclusion. Our suction blister device is simple and inexpensive to make, and it may become an alternative to the other suction devices. [source]

    Animal models for autoimmune bullous dermatoses

    Katja Bieber
    Abstract:, Autoimmune bullous dermatoses are a group of severe diseases, which are clinically characterized by blisters and erosions of skin and/or mucous membranes. In order to investigate the pathogenesis of these potentially life-threatening diseases and to develop more specific therapeutic approaches, animal models have been developed that aim to reproduce the clinical, histological and immunopathological findings. We here review established and novel animal models of autoimmune skin blistering diseases and discuss their applications and limitations. [source]

    Mechanisms of blister induction by autoantibodies

    Cassian Sitaru
    Abstract:, Autoimmune diseases are characterized by defined self-antigens, organ specificity, autoreactive T cells and/or autoantibodies that can transfer disease. Autoimmune blistering diseases are organ-specific autoimmune diseases associated with an immune response directed to structural proteins mediating cell,cell and cell,matrix adhesion in the skin. While both autoreactive T and B cells have been detected and characterized in patients with autoimmune blistering diseases, current evidence generally supports a pathogenic role of autoantibodies for blister formation. The immunopathology associated with blisters induced by autoantibodies relies on several mechanisms of action. Autoantibodies from patients with pemphigus diseases can exert a direct effect just by binding to their target mediated by steric hindrance and/or by triggering the transduction of a signal to the cell. In most subepidermal autoimmune blistering conditions, in addition to the binding to their target antigen, autoantibodies need to interact with factors of the innate immune system, including the complement system and inflammatory cells, in order to induce blisters. Generally, decisive progress has been made in the characterization of the mechanisms of blister formation in autoimmune skin diseases. However, various aspects, including the exact contribution of steric hindrance and signal transduction for pemphigus IgG-induced acantholysis or the fine tuning of the inflammatory cascade triggered by autoantibodies in some subepidermal blistering diseases, still need to be addressed. Understanding the mechanisms by which autoantibodies induce blisters should facilitate the development of more specific therapeutic strategies of autoimmune blistering diseases. [source]

    In vivo UVB irradiation induces clustering of Fas (CD95) on human epidermal cells

    Bo Bang
    Abstract:,In vitro studies with human cell lines have demonstrated that the death receptor Fas plays a role in ultraviolet (UV)-induced apoptosis. The purpose of the present study was to investigate the relation between Fas expression and apoptosis as well as clustering of Fas in human epidermis after a single dose of UVB irradiation. Normal healthy individuals were irradiated with three minimal erythema doses (MED) of UVB on forearm or buttock skin. Suction blisters from unirradiated and irradiated skin were raised, and Fas, FasL, and apoptosis of epidermal cells were quantified by flow cytometry. Clustering of Fas was demonstrated by confocal laser scanning microscopy on cryostat sections from skin biopsies. Soluble FasL in suction blister fluid was quantified by ELISA. Flow cytometric analysis demonstrated increased expression intensity of Fas after irradiation, with 1.6-, 2.2- and 2.7-fold increased median expression at 24, 48 and 72 h after irradiation, respectively (n = 4). Apoptosis was demonstrated by the TUNEL reaction, and the maximum of apoptotic cells was detected at 48 h after irradiation. Double-staining for Fas and TUNEL showed that apoptosis was restricted to the Fas-positive epidermal subpopulation, but there was no correlation between the intensities of Fas expression and TUNEL reaction. Median expression intensity of FasL-positive cells transiently decreased to 0.9- and 0.8-fold of the preirradiation respective level after 24 h and 48 h, respectively, and returned to the respective preirradiation level at 72 h after irradiation (n = 4). Concentrations of soluble FasL in suction blister fluid from UVB-irradiated skin did not differ from those in unirradiated skin (n = 5). Confocal laser scanning microscopy showed a rapid clustering of Fas within 30 min after irradiation. A simultaneous clustering of the adapter signalling protein FADD suggested that Fas clustering has a functional significance. Our results are in accordance with previous findings from in vitro studies, and suggest that Fas is activated in vivo in human epidermis after UVB exposure. [source]

    Genotype,phenotype correlation in skin fragility-ectodermal dysplasia syndrome resulting from mutations in plakophilin 1

    T. Hamada
    Abstract: We report a 42-year-old Japanese man with an unusual autosomal recessive genodermatosis. The clinical features comprised normal skin at birth, loss of scalp hair at 3-months of age after a febrile illness, progressive nail dystrophy during infancy, palmoplantar keratoderma starting around the age of 18 years and trauma-induced skin fragility and blisters noted from the age of 20 years. Skin biopsy of rubbed non-lesional skin revealed widening of spaces between adjacent keratinocytes from the suprabasal layer upwards. Electron microscopy demonstrated a reduced number of hypoplastic desmosomes. Immunohistochemical labeling showed a reduction in intercellular staining for the desmosome component plakophilin 1. Mutation analysis revealed a homozygous intron 11 donor splice site mutation in the plakophilin 1 gene, 2021+1 G>A (GenBank no. Z34974). RT-PCR, using RNA extracted from the skin biopsy, provided evidence for residual low levels of the full-length wild-type transcript (,8%) as well as multiple other near full-length transcripts, one of which was in frame leading to deletion of 17 amino acids from the 9th arm-repeat unit of the plakophilin 1 tail domain. Thus, the molecular findings help explain the clinical features in the patient, who has a similar but milder phenotype to previously reported patients with skin fragility-ectodermal dysplasia syndrome associated with complete ablation of plakophilin 1 (OMIM 604536). This new ,mitis' phenotype provides further clinicopathological evidence for the role of plakophilin 1 in keratinocyte cell,cell adhesion and ectodermal development. [source]

    A novel mutation in the ATP2C1 gene is associated with Hailey,Hailey disease in a Chinese family

    Zhou Jiang Liu MD
    Background, A three-generation Chinese family with Hailey,Hailey disease (HHD) was identified and characterized. The proband developed HHD with severe recurrent blisters and crusted erosions involving the body folds. Skin biopsy studies showed epidermal hyperkeratosis and defects in cell-to-cell adhesion. Three other members in the family were also affected with HHD and had the same clinical manifestations. The purpose of this study was to identify the pathogenic gene or mutation in the family. Methods, All exons and exon,intron boundaries of ATP2C1 were polymerase chain reaction (PCR) amplified and sequenced with DNA samples from the proband. Restriction fragment length polymorphism (RFLP) analysis for the intron 23,exon 24 boundary of ATP2C1 was performed in all family members and in 100 normal control subjects. Results, A novel 2-bp deletion (c.2251delGT) was detected in exon 24 of the ATP2C1 gene. The mutation was present in the three other affected family members and in two asymptomatic young carriers, but not in the other normal family members or the 100 normal controls. The mutation resulted in a frameshift change and led to the formation of a premature termination codon (PTC) four amino acid residues downstream from the sixth transmembrane domain. Conclusions, Our results indicate that the novel c.2251delGT (p.V751fs) mutation in the ATP2C1 gene is responsible for HHD in this Chinese family. This study expands the spectrum of ATP2C1 mutations associated with HHD. [source]

    Mast cells and transforming growth factor-, expression: a possible relationship in the development of porphyria cutanea tarda skin lesions

    Glalcyara Lançoni MD
    Background, Porphyria cutanea tarda (PCT) is a metabolic disease characterized by vesicles and blisters in sun-exposed areas and scleroderma-like lesions in sun-exposed and non-sun-exposed areas. Mast cells participate in the pathogenesis of bullous diseases and diseases that show sclerosis, including PCT. Moreover, transforming growth factor-, (TGF-,) is the main cytokine in the development of tissue sclerosis. The correlation of mast cells and TGF-, with the lesions of PCT has not been examined, however. The possible role of mast cells and TGF-, (and the relationship between them) in the development of PCT lesions is discussed. Methods, To quantify mast cells and cells expressing TGF-, in skin samples from patients with PCT and controls, immunohistochemical studies were performed in tissue sections allied to morphometric analyses. Results, The numbers of mast cells and cells expressing TGF-, per square millimiter were increased in the PCT group relative to controls, and there was a direct and significant correlation between the mast cell number and cells expressing TGF-, in PCT. Conclusions, The results suggest that the increased number of mast cells and of cells expressing TGF-,, as well as their direct correlation, may contribute to the pathogenesis of the skin lesions in PCT. [source]

    Eccrine squamous syringometaplasia mimicking a herpetic infection

    Vicent Alonso MD
    A 69-year-old woman with a history of hypertension and essential tremor was diagnosed with a Burkitt-like diffuse large-cell lymphoma. She received chemotherapy with cyclophosphamide, vincristine and adriamycin (HyperCVAD). Ten days after starting the second cycle of chemotherapy (HyperCVAD), she presented with well-defined, intense, erythematous macules which coalesced to form a symmetric diffuse erythema located on the upper back. Later, the lesions progressed and affected the lower back and perineal areas, extending to the groin. In a few days, a gradual diminution of the erythema was seen, with subsequent development of postinflammatory gray-brownish hyperpigmentation. On the lower back, there were also superficial erosions. Some asymptomatic, closely grouped, gray papules, vesicles, and blisters were found in the groin, resembling the typical lesions of herpetic infection (Fig. 1). Two biopsies of the groin and one of the upper back were performed, and were processed for histopathologic and microbiologic study. Figure 1. Closely grouped gray papules, vesicles, and blisters on the groin mimicking a herpetic infection The histopathologic study showed epidermal hyperplasia with acanthosis and papillomatosis. In both biopsies, eccrine ducts covered by mature squamous epithelium were found in the reticular dermis (Fig. 2a,c). In the sample from the groin, an intracorneal bulla was found. Numerous normal isolated cornified cells were seen within the lumen of the bulla (Fig. 2d). An inflammatory mononuclear infiltrate was also present in a periductal and perivascular distribution. No multinucleation, ground-glass nuclei, or peripheral margination of chromatin were found. Therefore, no morphologic evidence of herpes virus infection was present. Figure 2. Low (a), medium (b), and high (c) magnification showing epidermal hyperplasia and squamous syringometaplasia involving dermal eccrine ducts. (d) Medium power magnification of the intracorneal bulla (hematoxylin and eosin staining; a, ×40; b, ×100; c, ×400; d, ×100) Cultures and serologic analyses for herpes simplex virus (HSV) 1 and 2, varicella zoster virus (VZV), and cytomegalovirus (CMV) were negative. The lesions were treated with topical corticosteroids, with a good response in a few days. [source]