Ultrastructural studies in stable vitiligo

Vitiligo is a disease of melanocytes characterized by achromic lesions in the skin, affecting the epidermis and the pilosebaceous follicle. We performed an ultrastructural analysis of biopsy specimens from four patients with noninflammatory, stable vitiligo of long duration (three had generalized vitiligo and one had segmental vitiligo). The samples were taken from the oldest achromic lesions, and the biopsy sites were far from normal skin. In all cases we noted alterations in keratinocytes, Langerhans cells, and melanocytes. We also found lymphocytes in the epidermis, and these cells and macrophages were noted in the dermis. The basal membrane disappeared at some points, and sometimes it was possible to see dermal cells with processes that engulfed either granular material or vesicles of epidermal origin in such areas. Our studies suggest that even in stable vitiligo, achromia implies intense cytologic activity, probably involving cell-mediated cytotoxicity, and ultrastructural findings resemble those of a lichenoid reaction.

Van der Woude syndrome. A case report

We describe several members of a family with Van der Woude syndrome, a genetic and congenital malformation syndrome with autosomal dominant inheritance and 70% to 80% penetrance with variable expressivity. It is characterized by clinical signs localized to the face, such as bilateral or unilateral pits on conical elevations in babies or extensive depressions in adults, both in the vermilion border of the lower lip, with cleft lip, with or without cleft palate and uvula. Small accessory or heterotopic salivary glands empty into sinuses or fistulas in the lips. This eight member family had various clinical signs of the condition. All had cleft lip and palate. We studied the major characteristics of the eight patients and describe histopathologic and immunohistochemical features.

Hemostasis and platelet aggregation in purpuric pigmented angiodermatitis eruptions

Ten patients with chronic purpuric and pigmented angiodermatitis in the extremities and two patients with acute and disseminated eczematoid-like purpura angiodermatitis were studied with current hemostasis parameters: (1) platelet aggregation, (2) platelet circulating aggregates, (3) clotting factor measurements and high molecular weight kininogen (HMWK) in their coagulation fraction. The results showed: (1) reactional thrombocytosis with morphologic changes; (2) increased levels of platelet circulating aggregates; (3) increased response of platelet aggregation to different agonists, especially at very low doses, and also when we used washed platelets resuspended in normal plasma; (4) delayed activation of the contact system; (5) decrease of the activity of the fibrinolysis activators; and (6) diminished function activity of the HMWK coagulation fraction. As a physiopathogenic hypothesis in these patients, there is a cutaneous pathology that could be entailed to these hematologic alterations of the platelet-HMWK-endothelial cells-kinins-coagulation-fibrinolysis system.

Sleep and nighttime pruritus in children with atopic dermatitis

The number of scratching episodes and average frequency with which they started during each sleep stage as well as the effects of nighttime pruritus on objective sleep parameters in nine children with atopic dermatitis were assessed in the sleep laboratory. Scratching episodes occurred during rapid eye movement (REM) sleep and non-REM (NREM) sleep. The largest average frequency corresponded to stage 1, followed by stage 2, REM sleep, stage 4, and stage 3. Sleep maintenance was markedly altered. Total sleep time decrease was related mainly to smaller amounts of stage 4 NREM sleep. REM sleep percentage of total sleep time was increased as compared with normal children of the same age. Furthermore, in six of nine patients REM sleep latency was found to be decreased.

Familial spastic ataxia associated with Ehlers-Danlos syndrome with platelet dysfunction

Four members of a family with consanguineous relationships, the proband and his three children (2 sons and 1 daughter) are affected with Familial Spastic Ataxia and with Ehlers-Danlos' Syndrome with platelet aggregation dysfunction. In the four cases, this exceptional association appears remarkably homogeneous both in clinical and laboratory studies. The two syndromes are of dominant-autosomic transmission and probably originated in a new mutation which presumably maintained a genetic linkage. Spastic ataxia is characterized by a precocious onset and a slow evolution. The first-born son shows a dominant pyramidal syndrome with mild ataxia suggesting that it is a transitional form of familial spastic paraplegia. The Ehlers-Danlos syndrome pertains to form II or "mitis" with moderate skin hyperelasticity and joint hypermobility. The abnormal platelet aggregation curves have the same profile in all the patients. The first-born son also presents a mitral valve prolapsus as we may find either in Ehlers-Danlos syndrome or in spastic ataxia. The neurophysiological, tomographical, histological, ultrastructural and biochemical studies attempt to accomplish a better definition of these associated nosological entities.

Hyphal production by Pityrosporum ovale

Pityrosporum ovale with abundant hyphae was found in 8 patients with lesions of the scalp and glabrous skin. It is thought that P. ovale in its mycelial form can produce lesions on seborrheic areas of the skin that probably represent a clinical form of tinea versicolor.