COVID-19 preventive behaviours among people with anxiety and depressive symptoms: findings from Japan

OBJECTIVES

The aim of the study was to examine COVID-19 preventive behaviours among individuals with mental health problems.

STUDY DESIGN

This is a pooled cross-sectional study.

METHODS

Online survey data were analysed from 2000 Japanese adults collected in April and May 2020. Information was obtained on 13 COVID-19 preventive behaviours and anxiety and depressive symptoms using the Generalized Anxiety Disorder 7-item scale and Patient Health Questionnaire-9, respectively. Linear regression analysis was used to examine the associations.

RESULTS

In models adjusted for demographic and socio-economic factors, anxiety (coefficient: -0.77, 95% confidence interval [CI]: -1.30, -0.24) and depressive symptoms (coefficient: -0.82, 95% CI: -1.34, -0.30) were both associated with significantly lower engagement in COVID-19 preventive behaviours.

CONCLUSION

Our results highlight the importance of facilitating the performance of preventive behaviours in individuals with mental health problems to prevent the spread of COVID-19 in this population.

Repeated episodes of fixed eruption 3 months after discontinuing pegylated interferon-alpha-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection

We report a 73-year-old man who developed repeated episodes of erythematous, bullous plaques beginning 3 months after discontinuation of combination treatment with pegylated interferon (IFN)-alpha-2b and ribavirin for hepatitis C virus infection. The first episode resolved within a week without treatment, but the lesions recurred about once a month and were associated with high fever. Physical examination found darkly reddish, pigeon-egg-sized erythematous plaques with occasional flaccid blisters, predominantly on the trunk and proximal limbs, lip and penis. Histological examination showed well-demarcated foci of full-thickness epidermal necrosis and exocytosis of lymphoid cells. Pegylated IFN-alpha2b and ribavirin produced no response in lymphocyte stimulation tests. Systemic prednisolone led to rapid healing of skin lesions at the time of the fifth episode, leaving pigmented macules, but lesions recurred at the same sites within weeks of discontinuation of this treatment. It is uncertain whether this case represented a prolonged drug rash provoked by pegylated IFN-alpha2b or a fixed eruption in response to another antigen.

Effects of oral administration of ciclosporin A on skin carcinogenesis: a study using the two-stage carcinogenesis protocol in mice

BACKGROUND

Development of malignant skin neoplasms in patients receiving cyclosporin A (CsA) has been reported. The relationship between the pathogenesis of skin carcinogenesis and the dose of CsA is still unclear.

AIM

To clarify the effect of oral administration of CsA, especially its dose, on skin carcinogenesis.

METHODS

Hr-1 hairless mice were assigned to the following four groups: (i) control group (n = 8), given vehicle intragastrically six times/week and acetone applied to the skin of the back; (ii) chemical-alone (n = 11), given vehicle intragastrically + application of 7,12-dimethylbenz[a]anthracene (DMBA) once week and 12-O-tetradecanoyl-phorbol-13-acetate (TPA) twice week to the back; (iii) CsA-alone group (n = 8), given CsA intragastrically (10 mg/kg) six times/week and vehicle applied to the back twice week; and (iv) CsA + chemical group (n = 8), given 10 mg/kg CsA intragastrically + topical DMBA and TPA. The number of papules > 3 mm in diameter that had developed on the back after 15 weeks was counted. The mean epidermal thickness and number of dermal infiltrates were determined. The same experiments were performed using CsA at doses of 5 and 20 mg/kg.

RESULTS

Oral administration of either 10 or 20 mg/kg CsA significantly enhanced the formation of papillomas by DMBA and TPA, but no enhancement was observed when 5 mg/kg CsA was administered. The mean epidermal thickness and number of dermal infiltrates were significantly greater in the CsA + chemical group than in the chemical-alone group.

CONCLUSION

These data suggest that oral administration of CsA in excess of a certain dose can accelerate tumour development in mice.

Association of verrucous skin lesions and skin ulcers on the feet in patients with diabetic neuropathy

We report the simultaneous or chronological association of verrucous skin lesions and diabetic ulcers on the feet of three diabetic patients. All three patients had poor diabetic control and were suffering from complications such as neuropathy, retinopathy and nephropathy at the time of presentation. In patient 1, verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) and a diabetic skin ulcer developed simultaneously. In patient 2, VSLDN preceded the development of diabetic ulcers, while in patient 3, diabetic ulcers preceded VSLDN. These associations suggest that VSLDN and diabetic ulcers are closely related in their aetiology and pathogenesis. Strategies for the treatment and prevention of VSLDN should include multiple treatment modalities combined with foot care as proposed by the international working group on the diabetic foot.

Photocontact dermatitis to ketoprofen

A case of photocontact dermatitis from ketoprofen is described in a 19-year-old woman with a 3-day history of pruritic lesions on the right forearm. Physical examination revealed a 105 x 46 mm, dark reddish lesion consisting of edematous erythema and papules on the extensor aspect of the right forearm. In photopatch testing, positive reactions to as-is (Mohrus compress [Hisamitsu Pharmaceutical Co, Inc, Tosu, Japan]), ketorofen 1% in petrolatum (pet.), suprofen 1% pet., and tiaprofenic acid 1% pet. were seen. We must consider the anatomic sites on which nonsteroidal anti-inflammation medicaments are applied, as well as their effects.

Structural diversity of mast cell granules in black and white skin

BACKGROUND

There are conflicting reports of structural differences between black and white skin, other than pigmentary differences.

OBJECTIVES

To evaluate differences in mast cells between black and white skin.

METHODS

Biopsies of normal buttock skin were obtained from four African-American males (29.2 +/- 3.0 years old) and four Caucasian males (29.4 +/- 1.2 years old) and processed routinely for electron microscopy. For the quantitative assessment of mast cell granules, five electron micrographs at a final magnification of x 53,700 were analysed for each individual, using a computer-assisted image analyser. More than 10 granules per cell, and a total of 1210 granules, were evaluated for their internal structures.

RESULTS

Mast cells in black skin contained larger granules than those in white skin (P < 0.0001). In black skin, fusion of granules seemed to account for the larger sizes. The percentage of granule matrix occupied by curved lamellae was higher in white skin, whereas parallel-linear striations were more frequent in black skin (P < 0.05). The subgranular distribution of the mast cell proteases, tryptase and cathepsin G, were evaluated by immunoelectron microscopy. Tryptase reactivity was localized preferentially over the parallel-linear striations and partially over the dark amorphous subregions within granules of black skin, whereas it was confined to the peripheral area of granules, including curved lamellae, in white skin. Cathepsin G reactivity was more intense over the electron-dense amorphous areas in both groups, while parallel-linear striations in black skin and curved lamellae in white skin were negative.

CONCLUSIONS

This study has confirmed ultrastructural differences in mast cell granules between black and white skin, which may be of functional importance.

Unsuspected lung cancer accompanied by catamenial pneumothorax

A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules. Chest drainage failed to completely reexpand the lung, necessitating video-assisted thoracic surgery. Thoracoscopy showed pleural thickening in the apical segment without bullae or air leakage, dark-brown pigmentation of the diaphragm, and an unsuspected small nodule about 5 mm in diameter on the diaphragmatic surface of the right lower lobe. Pneumothorax was treated by mechanical abrasion of parietal pleura and upper lobe wedge resection. The lower lobe and nodule were wedge-resected using staplers. The nodule was bronchioloalveolar carcinoma of Noguchi's type B. To improve curability and check for diaphragmatic lesions, right posterolateral thoracotomy was conducted on post-video-assisted thoracic surgery day 28. Aggressive intraoperative lymph node exploration yielded no remarkable histological findings. Nonanatomical lower lobe wedge resection was done and the diaphragm with pinhole-like perforations was partially resected. The resected lung showed no cancerous tissue. Endometrial tissue was histologically confirmed in the resected diaphragm. The patient has remained asymptomatic in 14-month follow-up. This is, to our knowledge, the first lung cancer accompanied by catamenial pneumothorax.

Differential property of antigenic characterization between piroxicam and ampiroxicam in contact hypersensitivity

Piroxicam (PXM; a non-steroidal anti-inflammatory drug) has been reported to induce photosensitivity. In our previous report, however, ultraviolet-A (UVA)-irradiated or non-irradiated PXM did not induce any reactions in the in vivo model of contact hypersensitivity, while positive patch testing was shown by ampiroxicam (APX; a prodrug of PXM). The purpose of the present study was to clarify the influence of protein on the antigenicity of PXM using this model. Animals sensitized by UVA-irradiated 1% APX showed positive patch testing (open application) in UVA-irradiated 1% APX, while they were negative in challenge by UVA-irradiated PXM with or without 5% human serum albumin (HSA). Although animals sensitized by 1% thiosalicylate (TOS), which is thought to be an active hapten of PXM, were cross-reacted with UVA-irradiated 1% APX, they failed to react with UVA-irradiated 1% PXM with or without HSA. On the other hand, intra-dermal testing (intra-dermal application) in UVA-irradiated 0.1% PXM with 5% HSA was positive in animals sensitized by UVA-irradiated 1% APX, while 5% HSA alone, 0.1% PXM with 5% HSA and UVA-irradiated 0.1% PXM did not induce any reactions under this condition. Furthermore, concentration of PXM in the presence of HSA was reduced by UVA-irradiation in a time dependent manner, while the degradation of PXM was not observed in the absence of HSA. Finally, PXM almost disappeared at 120 min after the initiation of UVA-irradiation. The degradation of PXM irradiated by UVA was dependent on the concentration of HSA at the range of 0 to 4%. Hence, these results suggest that the presence of protein is necessary for the induction of the antigenic activity of PXM and the antigenic characterization of PXM is different from that of APX in contact hypersensitivity.

Intrapulmonary mature teratoma

Intrapulmonary teratoma is reported in a 22-year-old male. A chest X-ray in a physical examination showed a round shadow in the left hilum of a 22-year-old man who, on admission, reported slight malaise and a decrease in body weight. Computed tomographic scan and magnetic resonance imaging of the chest showed a heterogeneously dense cystic lesion. The preoperative diagnosis was anterior mediastinal teratoma, and the tumor was located in the anterior segment of the left upper lobe after thoracotomy. Segmentectomy of the left upper division showed a 4.0 x 3.5 cm tumor diagnosed as an intrapulmonary mature teratoma--the 27th such case reported in the English-language literature. This is, to the best of our knowledge, the first intrapulmonary teratoma involving magnetic resonance imaging.

Hairless guinea pig skin: anatomical basis for studies of cutaneous biology

In order to characterize the microscopic anatomy of hairless guinea pig (HL-GP) skin, we utilized light microscopy with a computer-assisted image analysis system, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). SEM revealed that the hair shafts of HL-GPs were thin, short, extremely irregular in diameter and often twisted and curled. The HL-GP epidermis was of similar thickness to that of human skin with distinct strata, serrated/non-serrated basal keratinocytes and shallow dermal papillae. The density of Langerhans cells in epidermal sheets, visualized by adenosine-s-triphosphatase staining, was similar to that of normal-haired guinea pigs (HD-GPs), although the dendrites of HL-GPs were thicker and shorter than those of HD-GPs. The dermal vasculature of HL-GPs was well-developed and similar to that of humans, demonstrating a network of vertically oriented capillary loops. HL-GPs had significantly more dendritic or spindle-shaped dermal interstitial cells than humans and HD-GPs. Collectively, these data suggest that HL-GP skin is more similar to human skin than to the skin of HD-GPs and other rodents and, therefore, the HL-GP may be a useful animal for studying cutaneous biology, experimental pathology, pharmacology and toxicology.

Reductive metabolism of stilbene oxide and styrene oxide to the olefins in rats

The present study provides the first evidence that stilbene oxide and styrene oxide are reductively metabolized to the corresponding olefins in rats. When cis- or trans-stilbene oxide was given orally to rats, both cis- and trans-stilbene were isolated from the urine and feces. Styrene was also isolated from the urine and feces of rats given styrene oxide. These metabolites were identified unequivocally by UV and mass spectral comparison with authentic samples, and on the basis of their TLC and HPLC behavior. However, these olefins were not detected in the urine or feces of antibiotics-treated rats dosed with cis- or trans-stilbene oxide. Cecal contents of the untreated rats exhibited olefin oxide reductase activities toward cis- and trans-stilbene oxides under anaerobic conditions. The results suggest that intestinal bacteria play an important role in the reduction of olefin oxides to the corresponding olefins in the animal body.

Antigenic characterization in ampiroxicam-induced photosensitivity using an in vivo model of contact hypersensitivity

Ampiroxicam (APX), a prodrug of piroxicam (PXM), has been reported to induce photosensitivity. Antigenic characterization of these photosensitivities, however, is still insufficient. The purpose of the present study was to elucidate further mechanism of photosenstivity induced by APX and PXM using an in vivo model of contact hypersensitivity in guinea pigs. Animals sensitized with ultraviolet-A (UVA)-irradiated 1% APX showed positive reaction in the patch testing to UVA-irradiated 1% APX and 1% thiosalicylate (TOS), while they were negative in challenge with UVA-irradiated 1% PXM, non-irradiated APX and PXM, whereas none of UVA-irradiated or non-irradiated APX and PXM showed positive patch test reaction in animals sensitized with UVA-irradiated 1% PXM or control vehicles. Animals sensitized with 1% TOS were successfully challenged by 1% TOS and cross-reacted with UVA-irradiated 1% APX; however, they failed to react with UVA-irradiated PXM, non-irradiated APX and PXM. Indeed, the in vitro study revealed that the concentration of APX was easily reduced by the increase of UVA irradiation dose, as compared with that of PXM. Interestingly, absorption spectrum of UVA-irradiated APX was similar to that of TOS, which is thought to be an active hapten of PXM. In the present study, we succeeded in the development of a novel animal model reflecting the clinical observations. Furthermore, these results suggested that contact hypersensitivity induced by UVA-irradiated APX is developed by photoproducts of APX itself, but not by the biotransformation of APX to PXM.

Quantitative and ultrastructural analysis of inflammatory infiltrates in male pattern alopecia

In order to determine whether lymphocytic inflammation around the lower infundibula in male pattern alopecia is incidental or a general phenomenon, we performed morphometric and ultrastructural analysis of inflammatory infiltrates in the transitional zones of the vertex and occipital hairy scalps of 19 patients with male pattern alopecia. Six normal subjects served as controls. The number of inflammatory infiltrates around the follicular infundibula of the alopecic vertices and non-alopecic occiputs of male pattern alopecia patients was significantly greater than the corresponding control value. The number of mast cells in the widened fibrous tracts in the vertices of male pattern alopecia patients was significantly greater than those in the adventitial fibrotic sheaths of control subjects and the non-alopecic occiputs of male pattern alopecia patients. These data support the idea that the inflammatory process may be, at least in part, responsible for the development of male pattern alopecia.

Multiple fixed drug eruption caused by iomeprol (Iomeron), a nonionic contrast medium

Most cases of drug eruption caused by nonionic contrast media (NICM) reported to date have been of the erythema multiforme type. Herein we report the first case of multiple fixed drug eruption (FDE) caused by iomeprol (Iomeron(R)). A 67-year-old woman developed multiple pea-sized erythematous papules on the trunk and extremities 4 days after receiving 100 ml of iomeprol for a computed tomography examination. Some of the papules coalesced, forming 7 large plaques on the limbs. Six months later, the patient was mistakenly administered iomeprol again. On the following morning, erythematous plaques admixed with vesicles recurred at the same sites as during the previous episode. In both episodes, the lesions cleared leaving pigmentation that faded with 6 weeks. Both patch testing and an intradermal test with iomeprol on lesional pigmented skin were positive. The present case indicates that NICM may cause multiple FDE and that repeated administration of the causative agent may increase the severity of the eruption.

[Stump curettage cytologic examination of excised tumor is more sensitive than histologic examination]

Some malignant lung tumors relapse on the cutting line in spite of a negative histologic stump. Histologic examination is limited to only few sites of excised sample. Conversely, stump curettage cytologic examination is useful to examine the whole area. We conducted a simultaneous histological and cytological study to assess the value of stump curettage cytologic examination. Forty-two staple-excised peripheral small lesions (< 3 cm in diameter) from 35 patients, aged 50 to 82 years, were assessed. Ten were subject to VATS and 32 to thoracotomy. Preoperative diagnoses were: 15 undiagnosed lesions (lung cancer: 8, benign lesion: 7), 18 lung cancers and 9 metastatic cancer. The whole area of the excised stump was curetted before observing the cross section to prevent malignant cell contamination. After that, the sample was cut vertically to staple line and pathologically examined. Thirty-eight percent (11/29) of histologically negative stumps were cytologically positive. Twenty-seven malignant lesions underwent only excision and 6 stumps were finally cytologically positive. Two of 6 cytological positive lesions relapsed at the staple site were excised at the second operation. Stump curettage cytological examination was more sensitive than histological examination to detect malignant cell contamination.

Two unusual cases of argyria: the application of an improved tissue processing method for X-ray microanalysis of selenium and sulphur in silver-laden granules

Using a simplified tissue processing method for X-ray microanalysis, we have characterized the elemental composition of silver-laden granules deposited in the skin of two patients with argyria. The introduction of ethanol as a fixative and nylon mesh as a supporting grid, and the avoidance of electron staining, have facilitated the minimization of unwanted microanalytical emission peaks generated from conventional chemicals and metals, which often disturb precise clarification of elements of pathological interest in argyria. The two main X-ray microanalytical findings in this study were: (i) the consistent presence of sulphur and the inconsistent occurrence of selenium in the silver-laden granules, and (ii) successful mapping of the distribution of trace amounts of selenium present in argyria. The simplified tissue processing method could be useful in future critical X-ray microanalysis studies.

[Two cases of metastasizing benign leiomyomatosis from myoma uteri]

Case 1. A 50-year-old woman was referred to our hospital because of multiple bilateral small round lesion on chest radiography. She had undergone total hysterectomy for myoma uteri at the age of 33. She underwent thoracoscopic tumor excision at left lung. The lesion was proved benign. Right side lesions were laterly excised using thoracotomy. Case 2. A 49-year-old woman was referred to us because of two ovoid lesion at left lung area of chest radiography. She also had undergone total hysterectomy for myoma uteri at the age of 37. She underwent tumor extirpation using thoracotomy. All samples of two patients revealed, pathologically, lesions were consisted of benign spindle-like calls similar to those of myoma uteri. Therefore, we consider these lesions were pulmonary metastasis of myoma uteri. Myoma uteri has certain potential of metastasizing to the lung, in spite of benign disease.

Safe pleural contraction employing a new tip for electrosurgical units. An ex vivo experiment

BACKGROUND

Certain pulmonary lesions are treated by lung tissue contraction induced by heat administered by laser or electrosurgical unit (ES). ESs are comparatively less expensive, less complicated and more ubiquitous than a lasers but with their conventional tip carries the a risk of damaging the pleura. We developed a large ball tip (M-tip) for ES and evaluated its effect on the pleura in comparison with that of Nd:YAG laser in ex vivo lung.

METHOD

We employed lobes obtained through surgical resection. Using the Nd:YAG laser, the lung was irradiated for 2 seconds at levels of 5, 10 and 20 watts (10, 20 and 40 Joules). Using the M-tip ES, the pleura received treatment at levels of 10, 20 and 40 watts for 2 seconds (20, 40 and 80 Joules) in spray coagulation mode. Upon completion of these procedures, 144 tissue specimens obtained from 24 lobes were examined under light microscopy.

RESULTS

Upon the application of Nd:YAG at 20 Joules, 22 (92%) of 24 visceral pleura demonstrated amorphous degeneration. With the application of ES at 40 Joules watts, 24 (100%) samples examined demonstrated amorphous degeneration (P = 0.47). Of the samples where pleural destruction was evident (Nd:YAG; 40 Joules, ES; 80 Joules), an accompanying air leak pattern (pleural destruction associated with slight parenchymal contraction) was observed in 5 (21%) of the samples treated with Nd:YAG and in 10 (42%) of those treated with the M-tip ES (p = 0.12).

CONCLUSION

The M-tip ES induced proper contraction of the pleura with relatively little destructive damage to the pleura at 40 Joules. Accordingly, it may be possible to induce pleural contraction using this new device with the same degree of safely that the Nd:YAG laser provides.

Flame figures associated with bullous pemphigoid

We report a case of bullous pemphigoid showing the histological features of flame figures. An 80-year-old man was admitted with multiple, tense, thumb-sized blisters among erythematous plaques on his trunk and limbs. A biopsy showed accumulations of eosinophil granules on the collagen fibers, forming characteristic "flame figures", in addition to the features of bullous pemphigoid. We retrospectively examined biopsy specimens from 34 patients with bullous pemphigoid treated in our department over the last 10 years for the presence of flame figures. They were observed in 3 of these patients (8.8%), all of whom were more than 80 years of age. Our retrospective study indicates that the association of flame figures with bullous pemphigoid is not rare, considering the fact that the present case is only the third report of this association. Our data also suggest that the degree of dermal eosinophilia and the formation of flame figures could be related.

Prurigo pigmentosa (Nagashima) associated with anorexia nervosa

Prurigo pigmentosa (Nagashima), which is not rare in Japan, is an inflammatory disease of unknown aetiology. The characteristic lesions are pruritic red papules, superseded by reticular hyperpigmentation, characteristically on the back, neck, and chest. We now report a case of prurgio pigmentosa associated with anorexia nervosa. These findings suggest that the ketosis produced by anorexia nervosa may well contribute to the pathogenesis of prurigo pigmentosa.

Dominantly inherited epidermal acantholysis in dogs, simulating human benign familial chronic pemphigus (Hailey-Hailey disease)

We report on dominantly inherited epidermal acantholysis in three dogs, a sire and two female offspring. The skin lesions were characterized by hairless, hypertrophic plaques. Histopathologically, these lesions showed epidermal hyperplasia with individual enlargement of keratinocytes, extensive acantholysis and minimal dyskeratosis. Ultrastructural analysis revealed that attachment plaques of desmosomes were still intact while some tonofilaments were detached from them in early lesions; there were well-developed microvilli at dissociated cell surfaces. The data imply that these animals have undergone a process similar to human benign familial chronic pemphigus (BFCP). Immunohistochemical examination revealed that staining for E-cadherin and actin variably remained in dissociated keratinocytes. Focal intracellular staining for desmosomal glycoproteins and desmosomal proteins were observed within the dissociated keratinocytes. This dominantly inherited acantholytic disease in dogs could be a useful animal model for investigating the pathogenesis of BFCP in humans.

[The role of surgery for chronic empyema of the advanced ages]

Chronic empyema, a sequelae of pulmonary tuberculosis, is now a only tuberculosis-related disease which was remained to be treated surgically. The candidates who have basically poor respiratory function are now attained advanced age. Over a 15 years period (1980-95), 22 patients 70 years of age or older underwent surgical intervention for chronic empyema at our hospital. There were 17 men and 5 women, ranging from 70 to 80 years of age (median age 75.0). They were 15.3% of all 145 surgically treated patients during same period. The empyema continued latent from 25 to 58 years (average 39.8 years). On admission they complained of productive cough (9), fever (9), hemosputam (5) and mass on the chest wall. Their Hugh-Johnes classification for dyspnea was I.: 4, II.: 6, III.: 11, IV.: 1 respectively. Their %VC ranged from 31.5 to 79.0 (average 54.8). In fifteen patients, tubercle bacilli (5), aspergillus (3) and other bacteria (9) were discovered in the empyema space. Surgical procedures consisted of 1 pneumonectomy (4.5%), 12 decortication or curettage of empyema wall (54.5%), 4 extraperiosteal air plombage (18%) and 5 other procedures (muscle or omental plombage, thoracoplasty, fenestration and others) (22.7%). There were no operative death and no lethal postoperative complication. In contrast, lethal postoperative complications such as GVIID, MOF and gastrointestinal bleeding occurred in the younger group. There were 2 cases of late respiratory failure in 70 years or older and 6 cases in younger group. Seventy-four years man who, preoperative %VC 33.0, underwent pneumonectomy died of asphyxia 6 month postoperatively. Another 74 years man who, preoperative %VC 76.1, developed respiratory failure after relapse of pulmonary tuberculosis. Four patients of younger group who developed late respiratory failure had all received thoracoplasty as a second operation. Other 2 patients, preoperative %VC 33.0 and 27.4 respectively, had undergone pneumonectomy. The risk of lethal postoperative complication or late respiratory failure were dependent mainly on preoperative respiratory function or surgical procedure selected rather than the age of patients.

Increased factor XIIIa transglutaminase expression in dermal dendrocytes after treatment with alpha-hydroxy acids: potential physiologic significance

BACKGROUND

Topical alpha-hydroxy acids (AHAs) have been shown to improve photoaging in human skin.

OBJECTIVE

We studied factor XIIIa transglutaminase expression in dermal dendrocytes (DDs) and mast cell degranulation after treatment of the skin with AHAs.

METHODS

Skin biopsy specimens obtained from patients after 4 to 8 months of treatment with lotions containing 25% AHAs were evaluated for factor XIIIa transglutaminase expression with immunoperoxidase and electron microscopy. Immunoperoxidase-stained sections were studied by means of semiquantitative methods and image analysis. Mast cell degranulation was studied by image analysis.

RESULTS

Increased factor XIIIa transglutaminase expression was seen after treatment with AHAs. All treated sites had increased scores compared with control sites by semiquantitative methods. Seventy-five percent of treated sites showed an increased mean area over control sites of factor XIIIa transglutaminase positivity with image analysis. These results correlated with an increased level of mast cell degranulation in treated sites and with activation of DDs as seen by electron microscopy.

CONCLUSION

Treatment of the skin with AHAs leads to mast cell degranulation and increased expression of factor XIIIa transglutaminase by activated DDs. Mast cell degranulation may lead to activation of DDs and increased factor XIIIa transglutaminase expression, via the action of tumor necrosis factor-alpha. We speculate that clinical and histologic improvement in photoaged skin after treatment with AHAs may be somehow related to this process.

Effects of alpha-hydroxy acids on photoaged skin: a pilot clinical, histologic, and ultrastructural study

BACKGROUND

alpha-Hydroxy acids (AHAs) have been reported to improve aging skin. The mechanisms of action of AHAs on epidermal and dermal compartments need clarification.

OBJECTIVE

Our purpose was to determine the effects of AHAs on photoaged human skin by clinical and microanalytic means.

METHODS

Patients applied a lotion containing 25% glycolic, lactic, or citric acid to one forearm and a placebo lotion to the opposite forearm for an average of 6 months. Thickness of forearm skin was measured throughout the study. Biopsy specimens from both forearms were processed for analysis at the end of the study.

RESULTS

Treatment with AHAs caused an approximate 25% increase in skin thickness. The epidermis was thicker and papillary dermal changes included increased thickness, increased acid mucopolysaccharides, improved quality of elastic fibers, and increased density of collagen. No inflammation was evident.

CONCLUSION

Treatment with AHAs produced significant reversal of epidermal and dermal markers of photoaging.

Enhancing effect of ultraviolet A on ornithine decarboxylase induction and dermatitis evoked by 12-o-tetradecanoylphorbol-13-acetate and its inhibition by curcumin in mouse skin

BACKGROUND

Previous studies have demonstrated appreciable tumor induction in mouse skin by daily irradiation with high-power long-wavelength ultraviolet A (UVA).

OBJECT

The aim of the present study was to examine the enhancing effects of UVA on changes in mouse skin mediated by the tumor promoter 12-o-tetradecanoylphorbol-13-acetate (TPA) by measurement of ornithine decarboxylase (ODC) activity and morphometric analysis. In addition, we examined the inhibitory effects of curcumin, a component of turmeric, on these changes.

METHOD

ODC activity in the epidermis of CD-1 mice was determined by the method of Russell and Snyder. Epidermal and dermal thickness, and the number of dermal infiltrating inflammatory cells were quantified using a computer-assisted image analyzer.

RESULTS

A combination of topical TPA application and UVA irradiation produced a greater increment of ODC activity at 4 h than TPA alone (p < 0.05). Histopathologically, TPA plus UVA tended to increase the dermal infiltrating inflammatory cells in contrast to TPA alone. Pretreatment of mice with curcumin significantly abrogated the TPA-induced changes in ODC activity and the dermal infiltrating inflammatory cells as well as the TPA plus UVA-mediated enhancement of these changes.

CONCLUSION

Our data indicate that UVA irradiation (18.72 J/cm2) significantly enhances ODC induction at an early stage (4-6 h) after topical application of TPA, and aggravates the dermatitis elicited by TPA. Pretreatment with curcumin significantly inhibits these enhancing effects.

Computer-assisted three-dimensional reconstruction of human dermal dendrocytes

We attempted to characterize the three-dimensional structure of dermal dendrocytes and to clarify the spatial relationships between dermal dendrocytes and mast cells, macrophages, and nerves. Normal human adult skin (breast, n = 2) was routinely processed for electron microscopy. Every other section (about 50 per data set) was collected at 80-nm intervals traversing about 8 microns of tissue. Grids showing the same cells were photographed by electron microscopy at a magnification of 4000x. Based on the 10-20 photographs per data set, cell outlines were digitized into the reconstruction program at appropriate layers and aligned. Thin, elongated cytoplasmic "dendrites" of dermal dendrocytes in two-dimensional micrographs proved to be thin, membrane-bound flaps in three-dimensional reconstruction. For dermal dendrocytes concentrated about superficial vessels (perivascular dendrocytes), the flaps enshrouded the vessel wall, and for dermal dendrocytes directly beneath the epidermis (subepidermal dendrocytes), these flaps were aligned parallel to the dermal-epidermal junction. The three-dimensional feature of dermal dendrocytes (perivascular and subepidermal) is quite similar to that of perivascular adventitial veil cells, suggesting ultrastructurally identified perivascular dendrocytes and veil cells must be identical cells. In conventional ultrathin sections, 20-40% of perivascular dendrocytes and occasional subepidermal dendrocytes were closely associated with mast cells. When viewed by computer-assisted three-dimensional reconstruction, membrane flaps of dermal dendrocytes consistently shrouded mast cell membranes for 50-90% of their perimeter; mast cells resembled a ball in a baseball glove (dermal dendrocytes). Occasional dermal dendrocytes surrounded non-myelinated nerves in the superficial dermis. Membrane flaps also enabled dermal dendrocytes to present extensive areas to the plasma membranes of adjacent monocyte/macrophages. These findings indicate that dermal dendrocytes are non-dendritic cells that are spatially related to mast cells, monocyte/macrophages, microvessels, and nerves by their membranous flaps. This suggests the need for further study of functional interactions between these cells.

Adult-onset xanthogranuloma appearing symmetrically on the ear lobes

Clinical backgrounds of patients with adult-onset xanthogranuloma are somewhat different from those of patients with juvenile xanthogranuloma, but the histologic findings of both forms of the disease are identical. The lesions of the adult form are usually asymmetric. We describe a patient with adult-onset xanthogranuloma that appeared symmetrically on the ear lobes. This case suggests a possible role for mechanical stimuli (e.g., earrings) in the pathogenesis of adult-onset xanthogranuloma.

Role of mast cells in early epithelial target cell injury in experimental acute graft-versus-host disease

The skin is a major target organ for graft-versus-host disease (GVHD), the principal complication of allogeneic bone marrow transplantation. The purpose of the present study was to test whether mast cell degranulation might be related to early target cell injury in the development of acute GVHD. We employed two irradiated murine strain combinations, one in which disease was mediated by CD4+ effector T cells (B10.D2-->DBA/2), and the other by CD8+ effector T cells (B10.BR-->CBA). As compared to controls, both models exhibited mast cell degranulation of differing extents and patterns, as well as dyskeratosis in the epidermis before the influx of effector lymphocytes. These results suggested that factors produced and released by degranulated dermal mast cells might contribute to early target cell injury. Accordingly, the possible role of tumor necrosis factor (TNF)-alpha, a cytokine recently discovered in mast cell granules, was investigated by the injection of anti-TNF-alpha antibody during the course of disease mediated by either CD4+ or CD8+ T cells. Although overall survival of recipients undergoing CD4+ T-cell-mediated GVHD was only slightly improved and the extent of mast cell degranulation was not affected by anti-TNF-alpha antibody treatment, the skin exhibited a significant diminution in the number of dyskeratotic cells/linear mm at 3-4 weeks post-transplantation. In contrast, anti-TNF-alpha antibody failed to enhance survival or reduce the number of dyskeratotic cells in the skin during CD8+ T-cell-mediated disease. Finally, to determine whether CD8+ T-cell-mediated GVHD was at all dependent upon mast cell involvement, the C3H.SW-->B6WWv strain combination was utilized, in which recipients were genetically deficient in mast cells. Onset of GVHD was significantly delayed in B6WWv mice and was clearly correlated to the appearance and increase of de novo mast cells at later time points.

Novel interactions between dermal dendrocytes and mast cells in human skin. Implications for hemostasis and matrix repair

BACKGROUND

Dermal dendrocytes are a newly-recognized cell type in human skin. They express coagulation Factor XIIIa (FXIIIa), also known as fibrin stabilizing factor, and their number is increased in certain inflammatory dermatoses. Current dogma suggests that these recently described cells may represent a subset of antigen-presenting macrophages. The present study therefore was undertaken to examine further the phenotype and potential function of these novel cells.

EXPERIMENTAL DESIGN

Conventional ultrastructure, single and dual label immunofluorescence and immunocytochemistry, confocal laser scanning microscopy, and immunoelectron microscopy were used to define structure and potential heterogeneity among dermal dendrocytes. Human neonatal foreskin organ culture exposed to mast cell secretagogues, inhibitors, and relevant recombinant cytokines (tumor necrosis factors alpha) was employed to gain insight into functional characteristics of FXIIIa expression.

RESULTS

We found that dermal dendrocytes are phenotypically unique dermal cells, separate from conventional macrophages, with antigenic heterogeneity of FXIIIa and CD34 expression related to their microanatomical location in the dermis. Moreover, they express specialized membrane-matrix plaques that may stabilize their placement in various dermal strata. Finally, superficial subpopulations of dermal dendrocytes are closely-associated with mast cells and show enhanced FXIIIa expression in response to mast cell degranulation, an event that appears to result from liberation of mast cell tumor necrosis factor in the dendrocyte microenvironment.

CONCLUSIONS

These new insights establish dermal dendrocytes as distinctive fixed skin cells with potential functional capacity for mast cell-dependent facilitation of fibrin cross-linking and matrix remodeling. These previously unrecognized phenotypic and functional characteristics of dermal dendrocytes therefore may be relevant to cellular interactions responsible for cutaneous wound healing and hemostasis.

Immunohistochemical and ultrastructural characterization of tonofilament and hemidesmosome abnormalities in a case of epidermolysis bullosa herpetiformis (Dowling-Meara)

BACKGROUND

A neonate with epidermolysis bullosa herpetiformis (EBH) (Dowling-Meara) had an undescribed ultrastructural and immunohistochemical abnormality.

OBJECTIVE

The objective was to clarify the ultrastructural and immunohistochemical abnormalities in EBH to gain further insight into the pathogenesis of this disorder.

METHODS

Tissue from the patient was studied with routine histochemistry, electron microscopy, and immunohistochemistry.

RESULTS

Excessive clumping of tonofilaments on electron microscopic examination, anomalous hemidesmosomes, and immunohistochemical evidence of aberrant keratin expression by basal epidermal cells was found.

CONCLUSION

This case of EBH provides further evidence for primary abnormalities involving cytoskeletal-membrane attachment plaque formation in this rare disorder.

Pigmented malignant pilomatrixoma: report of a case and review of the literature

An unusual variant of malignant pilomatrixoma displaying melanization of epithelial elements is described. Melanization is a rare event even in the benign form of this adnexal neoplasm. Previously reported cases of malignant pilomatrixoma are reviewed; none containing pigment have been previously reported to our knowledge. Possible etiologies for lack of pigment in most benign and malignant pilomatrixoma are discussed.

Eccrine syringofibroadenoma (Mascaro): an ultrastructural study

To confirm the eccrine acrosyringeal differentiation of eccrine syringofibroadenoma (ESFA) and to elucidate the histogenesis of its angiofibrotic stroma, a case of ESFA from a 45-year-old man was examined by light and electron microscopy. Histologically, the parenchyma featured anastomosing, slender epithelial cords containing small cuboidal cells and occasional duct-like structures. The stroma had increased numbers of mast cells, increased capillaries with swollen endothelial cells, and prominent fibrosis. Ultrastructurally, the following findings were characteristic of ESFA: a) abundant glycogen particles in epithelial cells, b) numerous intracytoplasmic and extracellular spaces lined with microvilli, c) intraepithelial duct formation, consisting of microvilli, vesicles, rod-shaped dense bodies, multivesicular dense bodies, and peripheral network of tonofilaments, and d) large numbers of mast cells, closely associated with fibroblasts, surrounding increased numbers of capillaries containing swollen endothelial cells. These ultrastructural features support the acrosyringeal differentiation of ESFA. We hypothesize that mast cell hyperplasia and degranulation may play an important role in the formation of the angiofibrotic stroma.

MS-1 sinusoidal endothelial antigen is expressed by factor XIIIa+, HLA-DR+ dermal perivascular dendritic cells

We have recently described a monoclonal antibody, termed MS-1, which reacts with sinusoidal endothelium as well as interstitial cells in a variety of nonlymphoid organs. In this report, we characterize the phenotypes of MS-1-positive cells in normal human skin. Double immunohistochemical and immunofluorescence labeling techniques demonstrate that MS-1 antibody identifies two cell types in human dermis: the first represented by weakly reactive lymphatic endothelial cells; and the second comprised of strongly reactive, highly dendritic perivascular cells which constitutively express both HLA-DR and factor XIIIa. These MS-1-positive dendritic interstitial cells are ultrastructurally distinctive, separate from mast cells, phagocytic macrophages, pericytes, blood vascular endothelial cells, and fibroblasts. MS-1-positive cells express this protein in discrete cytoplasmic compartments, and possibly as small plasma membrane-associated regions. The phenotype, dendritic morphology, and perivascular localization of MS-1-positive cells suggest that MS-1 antibody recognizes an epitope expressed by cells previously referred to as dermal perivascular dendritic cells or dermal dendrocytes. We have proposed that MS-1 protein may serve as an anchoring molecule for endothelial cells in sinusoidal spaces in the absence of well-formed basement membranes. MS-1 may similarly function to maintain the spatial relationship of dermal perivascular dendritic cells with the microvasculature.

Simultaneous development of insulin dependent diabetes mellitus and alopecia areata universalis

Alopecia areata universalis developed gradually over nine months in a 25-year-old woman. When her scalp hairs were totally lost and other body hair began to fall out, the symptoms of insulin dependent diabetes mellitus, an organ-specific autoimmune disease, developed rapidly and progressed to diabetic coma. Alopecia did not regress after the metabolic state improved following insulin therapy. Biopsy of the scalp skin revealed significant reduction of the total number of hair bulbs and prominent lymphocyte infiltration into the remaining hair follicles. Insulin dependent diabetes mellitus and alopecia areata universalis are both thought to be related to the autoimmune mechanism and sometimes coexist. However, simultaneous development of these two disorders is extremely rare.

[Increased corneocyte surface area in the diabetic skin]

In attempt to prove the hypothesis that corneocyte surface area in diabetics is larger than that in age-matched non-diabetics, we collected corneocytes from 50 diabetics and 43 non-diabetics in different decades of life. We measured surface areas of 27 +/- 3 corneocytes in each subject, utilizing an image analyser (Kontron MOP-10), then we counted mean number of corneocytes collected in 7 diabetics and 7 non-diabetics. There was a significant correlation between corneocyte surface area and chronological age in non-diabetics, whereas there was no significant correlation in diabetics. Corneocyte surface area of diabetics was larger than that of non-diabetics in every decades of life. The differences were statistically significant in 4th, 7th and 8th decades of life. Mean number of corneocytes collected in non-diabetics was 2.21 +/- 0.47 (X 10(5)), whereas that in diabetics was 2.49 +/- 0.55 (X 10(5)). The present study suggested that turnover time of corneal layer of the skin might be delayed in diabetics.