Localized Periorbital Edema Induced by Ibuprofen

We documented localized periorbital edema in one patient with ibuprofen sensitivity without underlying chronic urticaria. The reaction developed one hour after ingestion of 200 mg of ibuprofen. No systemic symptoms were observed. No other NSAIDs did not induce symptoms. This patient was able to tolerate doses of ibuprofen after pretreatment with terfenadine. These observations suggest that histamine played a central role in this ibuprofen-induced skin reaction. Treatment with terfenadine enabled the patient to tolerate ibuprofen without experiencing any side effects. To the best of our knowledge, this is the first reported case of periorbital edema induced by ibuprofen.

Characterization of vulvar skin of healthy Thai women: influence of sites, age and menopause

Although the physiological characteristics of vulvar skin have been characterized in Caucasians, little is known about the vulvar skin of Asian women. This study assessed the moisture content, transepidermal water loss (TEWL) and pH of vulvar skin of 99 healthy Asian women residing in Bangkok, aged 20-69 years, during their non-menstrual period, including 39 post-menopausal women. Skin pH was acidic at all sites, and the pH of the vulvar areas was significantly higher than the control sites (inner thigh, inner forearm). Skin moisture was slightly, but significantly, lower around the vulvar area and the thigh than around the forearm. TEWL was significantly higher in vulvar areas than control sites. Ageing and menopause did not cause notable alterations in most properties of vulvar skin. In conclusion, the vulvar skin of Asian women has similar properties to that of Caucasians.

An oral nutraceutical containing antioxidants, minerals and glycosaminoglycans improves skin roughness and fine wrinkles

Various nutraceuticals (dietary supplements) are claimed to have cutaneous antiageing properties, however, there are a limited number of research studies supporting these claims. The objective of this research was to study the effectiveness of an oral nutraceutical containing antioxidants, minerals and glycosaminoglycans on cutaneous ageing. In this double-blind, placebo-controlled trial, 60 women aged 35-60 years were randomized to receive oral dietary supplement (n = 30) or placebo (n = 30), once daily for 12 weeks. The depth of skin roughness and fine wrinkles were measured using surface evaluation of skin parameters for living skin (Visioscan) at baseline, and at the 4, 8 and 12 weeks of treatment. Surface evaluation using a replica film (Visiometer) at baseline and at the 12th week of treatment was also carried out. Statistical differences in objective skin improvement were assessed by the independent t-test. The volunteers' satisfaction was tested using the chi-squared test. The baseline depth of skin roughness and fine wrinkles in the treatment group and the placebo group were 100.5 and 100 mum, respectively. At the end of the study, the depth of skin roughness and fine wrinkles in the treatment group showed a 21.2% improvement, whereas improvement in the control group was 1.7%. This difference was statistically significant (P < 0.001). With regard to the volunteers' satisfaction, there was no statistically significant decrease in the homogenization of skin colour, however, a statistically significant reduction in pore size and depth of skin roughness and fine wrinkles were observed (P < 0.05). No side effects were noted throughout the study. The oral dietary supplement containing antioxidants, minerals and glycosaminoglycans improved skin roughness and fine wrinkles but did not affect skin colour change in female volunteers.

Treatment of multiple lesions of Bowen's disease and squamous cell carcinoma with topical imiquimod

We observed complete clinical and histopathologic remission of papules, plaques and nodules in two patients with multiple lesions of Bowen's disease and squamous cell carcinoma. Our findings indicate that topical imiquimod is a potentially promising therapeutic approach for the local treatment of early forms of cutaneous neoplasia, such as Bowen's disease and squamous cell carcinoma because it is a non-invasive therapy with a good cosmetic outcome. It may therefore be worthy of consideration in a subgroup of patients who cannot have or do not wish to have surgery.

Incontinentia pigmenti achromians of Ito: an ultrastructural study

A clinico-pathological and EM study of a Thai boy with hypomelanosis of Ito, one of the neurocutaneous syndromes, is reported. At birth, typical skin hypopigmentation on the trunk and a hypopigmented streak on the left lower extremity were noted Associated cutaneous pathology shows a decrease of melanin granules within basal and malpighian keratinocytes. Ultrastructural studies highlight a normal appearance for basal and malpighian keratinocytes, but a lack of melanosomes in the malpighian cells. Melanosomes are also dramatically reduced in the basal keratinocytes, which appear small, single or clustered and surrounded by a membrane. Melanocytic degeneration has been observed and dendritic melanocytes contained various stages of nonmelanised (stage II), partially melanised premelanosome (stage III) and rarely stage 4 melanosomes. The authors observed an increase in the number of Langerhans cell which have not previously been described. There were unmyelinated axon of nerve containing melanosomes at the dermoepidermal junction. The significance of these findings will be worthwhile to note that abnormal nerve termination in close relationship with basal keratinocyte, degenerated melanocyte, premelanosomes and langerhans cell are important in explaining the pathogenesis of Hypomelanosis of Ito.

Electron microscopic study in a case of solitary mastocytoma

The authors report a solitary mastocytoma with a solitary red infiltrated plaque on the dorsum of the right foot for 2 months. Histologically there were numerous mast cells infiltrating the dermis. Electron microscopy revealed CLCs located in phagosomes of activated macrophages as well as in the stromal tissue, close association between CLCs formation and damaged eosinophils was documented Charcot-Leyden crystals (CLCs) have been found in many conditions associated with eosinophilia, but their occurrence in skin diseases is very rare. These occurrences showed the evidence that the formation of CLCs in a mastocytoma correlated to the individual and related to the biology of mast cells, basophils, eosinophils and macrophages. Phagosomes probably acted as the localization of CLCs formation. The pathological role of CLCs in a mastocytoma needs further investigation.

Immunohistochemical localization of cathepsin L and cystatin A in normal skin and skin tumors

Cathepsin L, a cysteine proteinase, and cystatin A, an inhibitor of cysteine proteinases, are thought to regulate the invasion and metastasis of malignant cells. In this study, the expression of cathepsin L and cystatin A in skin tumors was investigated immunohistochemically in order to examine the relationship between these two enzymes in the pathophysiology of malignant cells. Formalin-fixed and paraffin embedded specimens from normal skin, seborrheic keratoses, and squamous cell carcinomas were reacted with polyclonal antibodies against rat cathepsin L or cystatin a which cross-react to human cathepsin L and cystatin A, respectively. The consequent immunostaining of these enzymes was observed to be strong in normal skin (4 cases) and seborrheic keratosis (6 cases). In well-differentiated squamous cell carcinoma (SCC) (9 cases), staining for cathepsin L and cystatin A was moderately positive in differentiated tumor cells and negative in undifferentiated SCC (5 cases). The degree of staining of these enzymes was inversely correlated with the differentiation of the malignant cells. These results suggest that the immunohistochemical analysis of cathepsin L and cystatin A is a useful indicator for an aspect of malignancy in human epidermal keratinocytes.

The ultrastructural study in a case of Fabry disease

An investigation of the ultrastructural study was conducted on specimens from a typical patient with Fabry disease. Numerous characteristic cytoplasmic inclusions were observed in the vascular endothelial cell, pericyte, smooth muscle cell, nerve and eccrine sweat glands, the lamellar pattern of which were considerably variable in various types of gland cells. Large vacuolar inclusions predominated in clear cells of the secretory coil; lesser vacuoles were also seen in the coiled duct, and the basal cells of the straight duct toward the coiled duct displayed mulberry-like figures. There were some clear cells showing cell damage and necrosis in the secretory coil. Lamellated bodies were noted in the axons and schwann cells around the eccrine sweat glands. The small blood vessels around the eccrine glands were narrowed by swollen endothelial cells with heavy inclusions. These intracytoplasmic deposits may be responsible for the decreased sweating ability in Fabry disease. The factors related to hypohidrosis are also discussed.

Ultrastructural study of glomus tumor

The fine structure of five cases of glomus tumor was described. All of the cases showed a solid type, and the glomus cells were shown to be typical or modified smooth muscle cells. The authors' conclusion is that the glomus cells were not derived from pericytes, but from smooth muscle cells of vascular part of the glomus, and are thought to be a specialized smooth muscle cell tumor.

Nodular cutaneous amyloidosis involving the glan penis: report of a case

Nodular cutaneous amyloidosis is a rare disease that predominantly affects women in their sixth and seventh decades. The genital organ is the rarest cutaneous location with only four reported cases of vulvar involvement. We report the first known case of this entity involving the glan penis. The clinical feature of nodular cutaneous amylodosis, the histopathology, the pathogenesis and the therapy are discussed.

Fixed drug eruption due to atenolol: a case report

We report a case of (generalized) fixed drug eruption induced by atenolol, a beta adrenoreceptor blocking agent. Atenolol has been shown to be effective treatment for hypertension, angina pectoris and cardiac arrhythmia. However, adverse skin reactions are very rare. We present a case of (generalized) fixed drug eruption due to atenolol and review the cutaneous reaction to the drug.

Congenital localized multiple fibromatosis: a case report

Clinical, histopathologic and electronmicroscopic findings in a case of congenital localized multiple fibromatosis of interscapular region are presented. This 10 year-old Japanese girl developed this lesion since she was 3 weeks old, metastases have never been observed. The histological and electron-microscopic features point to the hamartomous origin of this tumor with partial differentiation of its cells towards myofibroblasts and atypical fibroblasts. The differential diagnosis from other soft tissue tumors in infancy and early childhood is discussed.

Methotrexate induced pericarditis and pericardial effusion in psoriatic patient

We describe a 62-year-old woman with Psoriasis who presented as Methotrexate-induced pericarditis and pericardial effusion. Aspiration of the pericardium was required and the patient made a satisfactory recovery. At six-months follow-up, she remained well, psoriasis plaques was controlled by topical crude coal tar and topical corticosteroid. These complications are extremely rare, but have been described as isolated phenomena associated with methotrexate therapy.

Epidermolysis bullosa letalis (Herlitz disease): a case report

A case of junctional epidermolysis bullosa was reported. A four-month-old boy was presented with generalised blisters after minor trauma since birth. There was no family history of blistering diseases or consanguinity. Skin examination revealed blisters primarily on the upper and lower extremities. Erosions were also noted on the face, abdomen and buttocks. The lesions healed without milia or scarring formation. Anonychia of all fingers and toe nails were noted. Skin biopsy from the blisters showed subepidermal bulla with a few inflammatory cells. Electron microscopic examination revealed cleavage plane at the lamina lucida and the absence of hemidesmosomes. These findings supported a diagnosis of junctional epidermolysis bullosa. The patient was treated with topical and systemic antibiotics. However, the blisters gradually increased. He died of uncontrolled sepsis and diarrhea.

Electron microscopy: application and progress in diagnostic methods on skin disease

Electron microscopy is now widely used in the evaluation of disease tissue. Indeed, these relatively new diagnostic methods have become essential to the fields of dermatology. Their value in the pathology of skin is no less great: Definitive diagnosis of most connective tissue disorders (amyloidosis, hyalinosis, etc.) is not possible without ultrastructural and histochemical analysis. Cellular inclusions are helpful in the diagnosis of a number of skin disorders: filamentous and granular inclusions in recurrent digital fibroma of childhood and tubuloreticular inclusions in collagen vascular diseases. Hair abnormalities are best analyzed by scanning electron microscopy.

Keratoderma hereditaria mutilans. Etretinate treatment and electron microscope studies

Keratoderma hereditaria mutilans is a rare inherited cornification disorder characterized by hyperkeratosis of palms and soles with a characteristic "honey-comb" appearance, keratotic constriction furrows of one or more digits (pseudo-ainhum) and threatening spontaneous amputation. Approximately 30 cases have been reported, but the ultrastructural features have not been well characterized. In this article, we describe the clinical, histologic, and ultrastructural findings in our patient. A biopsy specimen taken before treatment with etretinate showed hyperkeratosis with a well-preserved granular layer and acanthosis. Ultrastructural examination disclosed that the spinous cells and granular cells contained marked swollen mitochondria, many desmosomes, and that corneocytes contained many membrane coating granules (MCG) and lipid like vacuoles. After initiation of treatment, considerable clinical improvement was observed, but without significant histologic modification. The principal post-treatment ultrastructural changes were the reduction of mitochondrial swelling in spinous and granular cells and the reduction in the number of MCG in corneocytes. The intercellular spaces showed increased amounts of fine and coarse granular substances. Stimulation of Langerhans cells was observed. Marginal band formation occurred normally after treatment.

White piedra

A 39-year-old Thai man had eczema on the left groin accompanied by asymptomatic white nodules on the public hair for two weeks. Examination with the Wood's lamp, microscopic examination, culture and biochemical testing showed organisms compatible with Trichosporon beigelii. The diagnosis of "White Piedra" was made, and this is the first case of White Piedra to be reported in Thailand.

Contact urticaria syndrome and anaphylactoid reaction from topical clioquinol and bacitracin (Banocin): a case report

Topical application of a clioquinol and Bacitracin powder resulted in contact urticaria and an anaphylactoid reaction. Prick tests with clioquinol and bacitracin solution produced a wheal and flare response. This problem is unusual, but has been reported and previous reports are summarized.

Infantile acropustulosis

Infantile acropustulosis (IA) is a well-recognised syndrome described primarily among black male infants, which may also occur among white and East Asian children. The eruption occurs mainly on the distal areas of the extremities and is characterised by recurrent crops of 1 to 2 mm pruritic papules and pustules in infants from 2 to 10 months of age. We report one patient with infantile acropustulosis and a history of atopic dermatitis and abnormally high IgE serum value. Immunofluorescent studies of involved skin gave negative results. Infantile acropustulosis has been reported by several authors within recent years. The clinical and histological features and differential diagnosis of infantile acropustulosis are discussed. This disease is uncommon but not rare, and persists for about two years.