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Palmo-plantar pustulosis: the sweat duct and the inflammation
S178
Free cotttttuttticatiott
FC27-5 The Lancaster itch inventory: A novel instrument for the assessment of pruritis B. Kirby, R.M. Levine, P.V. Harrison, R. Garry, S. Lepoer-Power, E. Chronicle. Deparfnlent of Psychology, University of Lancaster; Lancaster; Department of Dertnatology,
Queen
Victoria
Hospital,
Morecatttbe,
UK
This inventory assessesvarious dimensions of itch. Using experiments involving interviews with patients, categorisation of itch descriptors, and organisation of these descriptors, an inventory was devised. This inventory in the form of a questionnaire was administered to 24 patients with psoriasis, and 32 haemodialysis patients with psoriasis. The inventory score was submitted to discriminant function analysis. This showed that patients with psoriasis tended to score more highly overall (p < 0.05). This was more significant for emotional qualities, heat and unpleasantness of itch dimensions. This inventory provides a profile of symptoms that differentiates between different dermatological diagnoses and is a potential assessment tool in clinical practice.
FC27-6 Perforin+/CDI+ blood lymphocytes in psoriasis and generalized drug eruptions
FC27.
Miscellaneous
2
aggressive behaviour, the use of systemic chemotherapy is indicated. The 20 years experience of a referral group in Italy is reported here. Methods: One hundred and nine patients were treated with six drugs in monochemotherapy: vinblastine, vinorelbine and oral etoposide in first line and vinblastine, i.v. etoposide and i.m. bleomycin in second line. Objective responses and toxicity were evaluated according to WHO criteria. Results: In first line, the activity of the three drugs was similar (CR + PR: 60-80%), whereas this percentage fell to 50% in second line. Toxicity was limited and acceptable for each treatment. Conclusion: Our experience confirms the usefulness of treating patients affected by aggressive MEKS with systemic chemotherapy, in order to obtain control of the disease and to reduce the related symptoms. The evaluation of the role of a drug in comparison to another one requires the implementation of large comparative trials, in order to establish a “standard” systemic treatment for this disease.
FC27-8 Palmo-plantar pustulosis: The sweat duct and the inflammation
C. Behrendt, B. Bonnekoh. H. Gollnick. Dept. of Derttta-
G. Michaelsson, E. Hagforsen, K. Nordlind. Dep. Dertttatology
tology,
& Vettereology,
Otto-van-Guericke-Uttiversity,
Magdebutg,
Genttatty
Perforin expressed in CD8+ cytotoxic T cells is known to mediate the lysis of target cells carrying microbial as well as neoplasia-associated antigens, and to play an important role in autoimmune reactions and transplant rejections. The aim of the present pilot study was to detect the relative amount of perforin+ cells among CD8+ peripheral lymphocytes (perforin+/CDI+-ratio) in various skin disorders. The co-expression of both antigens was determined by flow-cytometry following permeabilization of the plasma membrane. In a control group of individuals not affected by an inflammatory skin disease the perforin+/CD8+ ratio was 50 f 16% (n = 8). The corresponding results for the parameter were 53 f 9% in acute urticaria (n = 4), 69 f 15% in severe psoriasis (n = 7) and 7 1 f 12% (n = 7) in generalized drug eruptions. In n = 2 patients with drug-induced Stevens-Johnson syndrome a decrease of the perforin+/CD8+ ratio was detected during the course of the disease between the day of admission (80% and 7 1%) and after 7 days of systemic steroid regimen (53% and 20%, respectively). Thus, as compared to controls we found increased perforin+/CDI+ ratios in drug eruptions as well as in psoriasis, but not in acute urticaria. The parameter may be of future interest for the monitoring of cytotoxic activity in peripheral blood, and the finding’s pathogenic role in psoriasis will have to be elucidated.
FC27-7 Chemotherapy of Mediterranean Kaposi’s sarcoma in the elderly: A continuous experience L. Brambilla, V. Boneschi, S. Fossati, R. Labianca’, S. Ferrucci. Institute of Dermatology, IRCCS Ospedale Maggiore, Milano; ’ Unit of Medical Oncology, Ospedali Riuniti,
Berganto,
Italy
When mediterranean
Kaposi’s sarcoma (MEKS)
shows an
University
Hospital,
751 85 Uppsala,
Sweden
This study was undertaken to get more information about the inflammatory process in palmo-plantar pustulosis (PPP) and its possible relation to the sweat gland duct. Biopsies were taken from the palms of 22 patients with PPP CD3+ T lymphocytes, tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils were studied with the PAP or APAAP technique and the sweat gland and its duct with a mixture of antibodies to keratin (AEl/AE3) and PAP The acetylcholine synthesizing enzyme cholinacetyl-transferase (CHAT) and degrading acetylcholinesterase (AChE) were visualized with monoclonal antibodies and PAP The pustules were filled with neutrophils and eosinophils. Below the pustule in the papillary dermis eosinophils and dense infiltrates of mast cells and of lymphocytes were present. The sweat gland and the dermal part of the duct did not differ in involved and control skin. However, in none of the PPP specimens could any epidermal sweat ducts be detected, whereas ducts were present in all control specimens. Both CHAT and AChE were present in the sweat gland and the dermal parts of the duct. In normal skin CHAT was present in the lower part of the acrosyringium and AChE mainly in the lower intracomeal part of the duct corresponding to the localization of the pustule. Fewer AChE+intracomeal ducts were visible in PPP than in controls. CHAT was also present in granulocytes and AChE in mast cells. The results indicate that the acrosyringium may be the target for the inflammation in PPP.
Free cotttttuttticatiott
FC27-5 The Lancaster itch inventory: A novel instrument for the assessment of pruritis B. Kirby, R.M. Levine, P.V. Harrison, R. Garry, S. Lepoer-Power, E. Chronicle. Deparfnlent of Psychology, University of Lancaster; Lancaster; Department of Dertnatology,
Queen
Victoria
Hospital,
Morecatttbe,
UK
This inventory assessesvarious dimensions of itch. Using experiments involving interviews with patients, categorisation of itch descriptors, and organisation of these descriptors, an inventory was devised. This inventory in the form of a questionnaire was administered to 24 patients with psoriasis, and 32 haemodialysis patients with psoriasis. The inventory score was submitted to discriminant function analysis. This showed that patients with psoriasis tended to score more highly overall (p < 0.05). This was more significant for emotional qualities, heat and unpleasantness of itch dimensions. This inventory provides a profile of symptoms that differentiates between different dermatological diagnoses and is a potential assessment tool in clinical practice.
FC27-6 Perforin+/CDI+ blood lymphocytes in psoriasis and generalized drug eruptions
FC27.
Miscellaneous
2
aggressive behaviour, the use of systemic chemotherapy is indicated. The 20 years experience of a referral group in Italy is reported here. Methods: One hundred and nine patients were treated with six drugs in monochemotherapy: vinblastine, vinorelbine and oral etoposide in first line and vinblastine, i.v. etoposide and i.m. bleomycin in second line. Objective responses and toxicity were evaluated according to WHO criteria. Results: In first line, the activity of the three drugs was similar (CR + PR: 60-80%), whereas this percentage fell to 50% in second line. Toxicity was limited and acceptable for each treatment. Conclusion: Our experience confirms the usefulness of treating patients affected by aggressive MEKS with systemic chemotherapy, in order to obtain control of the disease and to reduce the related symptoms. The evaluation of the role of a drug in comparison to another one requires the implementation of large comparative trials, in order to establish a “standard” systemic treatment for this disease.
FC27-8 Palmo-plantar pustulosis: The sweat duct and the inflammation
C. Behrendt, B. Bonnekoh. H. Gollnick. Dept. of Derttta-
G. Michaelsson, E. Hagforsen, K. Nordlind. Dep. Dertttatology
tology,
& Vettereology,
Otto-van-Guericke-Uttiversity,
Magdebutg,
Genttatty
Perforin expressed in CD8+ cytotoxic T cells is known to mediate the lysis of target cells carrying microbial as well as neoplasia-associated antigens, and to play an important role in autoimmune reactions and transplant rejections. The aim of the present pilot study was to detect the relative amount of perforin+ cells among CD8+ peripheral lymphocytes (perforin+/CDI+-ratio) in various skin disorders. The co-expression of both antigens was determined by flow-cytometry following permeabilization of the plasma membrane. In a control group of individuals not affected by an inflammatory skin disease the perforin+/CD8+ ratio was 50 f 16% (n = 8). The corresponding results for the parameter were 53 f 9% in acute urticaria (n = 4), 69 f 15% in severe psoriasis (n = 7) and 7 1 f 12% (n = 7) in generalized drug eruptions. In n = 2 patients with drug-induced Stevens-Johnson syndrome a decrease of the perforin+/CD8+ ratio was detected during the course of the disease between the day of admission (80% and 7 1%) and after 7 days of systemic steroid regimen (53% and 20%, respectively). Thus, as compared to controls we found increased perforin+/CDI+ ratios in drug eruptions as well as in psoriasis, but not in acute urticaria. The parameter may be of future interest for the monitoring of cytotoxic activity in peripheral blood, and the finding’s pathogenic role in psoriasis will have to be elucidated.
FC27-7 Chemotherapy of Mediterranean Kaposi’s sarcoma in the elderly: A continuous experience L. Brambilla, V. Boneschi, S. Fossati, R. Labianca’, S. Ferrucci. Institute of Dermatology, IRCCS Ospedale Maggiore, Milano; ’ Unit of Medical Oncology, Ospedali Riuniti,
Berganto,
Italy
When mediterranean
Kaposi’s sarcoma (MEKS)
shows an
University
Hospital,
751 85 Uppsala,
Sweden
This study was undertaken to get more information about the inflammatory process in palmo-plantar pustulosis (PPP) and its possible relation to the sweat gland duct. Biopsies were taken from the palms of 22 patients with PPP CD3+ T lymphocytes, tryptase+ mast cells, EG2+ eosinophils, lipocalin+ neutrophils were studied with the PAP or APAAP technique and the sweat gland and its duct with a mixture of antibodies to keratin (AEl/AE3) and PAP The acetylcholine synthesizing enzyme cholinacetyl-transferase (CHAT) and degrading acetylcholinesterase (AChE) were visualized with monoclonal antibodies and PAP The pustules were filled with neutrophils and eosinophils. Below the pustule in the papillary dermis eosinophils and dense infiltrates of mast cells and of lymphocytes were present. The sweat gland and the dermal part of the duct did not differ in involved and control skin. However, in none of the PPP specimens could any epidermal sweat ducts be detected, whereas ducts were present in all control specimens. Both CHAT and AChE were present in the sweat gland and the dermal parts of the duct. In normal skin CHAT was present in the lower part of the acrosyringium and AChE mainly in the lower intracomeal part of the duct corresponding to the localization of the pustule. Fewer AChE+intracomeal ducts were visible in PPP than in controls. CHAT was also present in granulocytes and AChE in mast cells. The results indicate that the acrosyringium may be the target for the inflammation in PPP.