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Notes: The cutaneous distributions of intercellular-adhesion molecule-1 (ICAM-1) and lymphocyte-function-associated antigen-1 (LFA-1) in epidermal tumours were studied.

Notes: The development of cutaneous proliferative lesions following renal transplantation has been well documented in the literature. Those lesions most commonly seen include viral warts, actinic keratoses and basal-cell and squamous-cell carcinomata. More recently it has been suggested that melanocyte proliferation, both benign and malignant, may follow renal transplantation, probably as a result of immunosuppression. We report the case of an identical twin who developed numerous benign melanocytic naevi following renal transplantation; no such proliferation of naevi occurred in his identical sibling.

Notes: Hamartoma moniliformis (Latin: monile = necklace), also known as linear papular ectodermal-mesodermal hamartoma, consists of a benign, permanent, linear, flesh coloured papular eruption on the head, neck and upper chest.1 It is asymptomatic and occurs most commonly in negroes, after puberty. The condition does not appear to the hereditary.Since the initial description of the disorder in mentally retarded subjects from an institution, occasional cases have appeared in the literature. We report a case of a female adult negro of normal intelligence, showing extensive involvement of the upper trunk.

Notes: Background Elongated and tortuous capillary loops are distinctive features of psoriasis. The significance of these microvascular changes in the pathogenesis of plaques, however, remains unclear.Objectives To determine what part the expanded superficial capillary bed plays in the pathogenesis of clinical lesions by selectively thermolysing psoriatic capillaries with a pulsed dye laser (PDL).Methods Cutaneous lesions were biopsied before and after treatment and sections assessed by standard immunohistochemical techniques for changes in known indicators of angiogenesis, including endothelial surface area, endothelial cell proliferation and endothelial cell expression of adhesion molecules. We also measured lymphocytic infiltration and epidermal thickness, and quantified the presence of a marker of keratinocyte proliferation before and after treatment.Results The effect of the PDL was limited to the superficial capillary bed, with no changes in the microvessels (including venules and arterioles) of the upper reticular dermis. Although there was significant clinical improvement in plaques after treatment (P = 0·02), complete clearance of lesions was not achieved. Thermolysis of psoriatic capillaries caused a reduction in both endothelial surface area (P 〈 0·01) and endothelial cell proliferation in the superficial dermis (P = 0·04). Endothelial expression of surface adhesion molecules (integrins and E-selectin) important in angiogenesis was not, however, altered by treatment. The CD4+ and CD8+ T-cell infiltrate was significantly reduced in the superficial papillary dermis (P = 0·02 and P = 0·04, respectively), but not in the epidermis or upper reticular dermis. Laser treatment significantly reduced epidermal thickness (P = 0·001), but did not alter epidermal keratinocyte proliferation (P = 0·2).Conclusions The results demonstrate that dermal capillary changes alone are unlikely to be causal in psoriasis. They indicate that the expanded psoriatic capillaries may be important in facilitating the access of activated T cells to the skin and in maintaining the psoriatic plaque. These results do not refute the consensus view that plaque formation may be mediated by the release of growth factors/cytokines from activated epidermal T cells/keratinocytes.

Notes: Background Streptococcal infection is strongly associated with guttate psoriasis (GP) and may also exacerbate chronic plaque psoriasis (CPP), possibly through the release of superantigenic toxins. Objectives To investigate superantigen-induced generation of cutaneous lymphocyte associated antigen (CLA) -positive lymphocytes in GP compared with CPP. Methods Peripheral blood lymphocyte (PBL) expression of CLA and T-cell receptor Vβ chain was assessed in patients with CPP and with active and resolved GP. Expression of superantigen-reactive Vβ families was compared with in vitro superantigen-induced peripheral blood mononuclear cell (PBMC) proliferation. Results Peripheral blood mononuclear cells from patients with active GP showed a twofold increased proliferation after stimulation with streptococcal pyogenic toxins A and streptococcal pyogenic toxins C compared with controls (P 〈 0·01), whereas the response to the staphylococcal toxins and mitogenic stimulation was the same in all groups. Peripheral blood lymphocytes (PBL) from patients with active GP showed increased use of the superantigen-reactive families Vβ2 (P 〈 0·01) and Vβ17 (P 〈 0·05), which was not evident in the other patient groups or controls. This pattern of Vβ expression was only observed in CLA-positive T cells. Furthermore, there was a positive correlation between Vβ2 expression and enhanced proliferation after stimulation with SPEA (r = 0·82, P 〈 0·01) and SPEC (r = 0·74, P 〈 0·05) in active GP. Conclusions This study supports the concept that streptococcal infection precipitates acute GP at least in part through superantigen driven generation of Vβ-restricted CLA-positive skin homing lymphocytes, whereas we could find no evidence for a similar mechanism occurring in the maintenance of stable CPP.

Notes: We report the first case of lichen planus pemphigoide (LPP) secondary to ingestion of ramipril, an angiotensin-converting enzyme inhibitor. Clinical, histological and immunofluorescent findings were all consistent with a diagnosis of LPP. Linear basement membrane zone (BMZ) staining with IgG and C3 was only seen at the rood of split-skin preparations and circulating autoantibody to the BMZ was present at a titre of 1/100. Controlled immunoblotting of epidermal extracts detected the bullous pemphigoid antigens of 230 and 180 kDa.

Notes: Summary Background Skin-homing, memory T lymphocytes play an important role in the pathogenesis of psoriasis by interacting with the vascular addressin, E-selectin and trafficking into lesional skin. Thus an attractive option for targeted therapy of the disease would be blockade of skin-homing T cells with an antibody directed at E-selectin. Objective We performed a multicentre, randomized, placebo-controlled trial to investigate the clinical efficacy and side-effect profile of a humanized monoclonal antibody to E-selectin, CDP850, in the treatment of moderate to severe chronic plaque psoriasis. Methods Patients with moderate/severe chronic plaque psoriasis were selected for study. Nine male subjects (mean age 37 years, range 25–47) were given 20 mg kg−1 CDP850 intravenously as a single dose and four subjects (three males, one female; mean age 40 years, range 23–50) received placebo infusion. Clinical response to treatment was assessed using the psoriasis area and severity index (PASI). Skin biopsies were taken for immunohistochemical analysis at the baseline, pretreatment, visit and also at day 2 and weeks 1 and 4 postinfusion. Results The treatment was well-tolerated with a minimal side-effect profile. Plasma E-selectin levels were significantly decreased in those subjects who received CDP850 compared with those who had placebo for the entire study period. At the end of study (8 weeks postinfusion), there was no significant reduction in PASI from baseline for either the CDP850 or placebo-treated groups. Immunohistochemical analysis of biopsies taken from lesional psoriatic skin showed that 2 days after dosing with CDP850, staining for E-selectin was decreased, although not absent, on dermal vascular endothelial cells when compared with baseline (P 〈 0·01). This decrease in E-selectin expression was maintained 4 weeks after infusion (P 〈 0·05). It was not, however, accompanied by a significant reduction in numbers of neutrophils or lymphocytes in the dermis. There was a statistically significant increase in CD1a-positive epidermal Langerhans cells compared with pre-dose levels at week 1 (P 〈 0·05). Conclusions This clinicopathological study shows that anti-E-selectin (CDP850), although a well-tolerated, logical and safe therapy, does not appear to possess a therapeutic role in the treatment of chronic plaque psoriasis.