BACKGROUND: Bullous eruption of diabetes(BD) is a rare cutaneous sign of diabetes mellitus(DM). The mechanism for the development of these lesions is unknown, although speculation has ranged from trauma to vascular insufficiency. OBJECTIVE: Our purpose is to evaluate the difference of basement membrane gene expression in cultured skin fibroblasts between patients with diabetes and normal controls. METHODS: Total RNA was extracted from cultured skin fibroblasts of DM and normal, and then Northern blot and slot-blot hybridizations were done. RESULTS: The mRNA levels of a(I) procollagen, a(IV) procollagen, fibronectin, and laminin B1 were not altered significantly in the DM. CONCLUSION: Our results suggest that BD has no relevance to the alteration of basement membrane components. Further studies are needed to clarify the underlying pathogenic mechanism of BD.
Basement Membrane* ; Blotting, Northern ; Diabetes Mellitus* ; Fibroblasts* ; Fibronectins ; Gene Expression ; Humans ; Laminin ; Procollagen ; RNA ; RNA, Messenger ; Skin*

BACKGROUND: Sun exposure and therapeutic irradiation have been shown to induce alterations in extracellular matrix (ECM) proteins, including elastin, glycosaminoglycan and collagens. The integrity of the connective tissue mainly depends on balanced rates of matrix synthesis and degradation of the extracellular matrix. Therefore, matrix metalloproteinases (MMPs) may be involved in ultraviolet irradiation (UVR)-induced alterations in ECM proteins. OBJECTIVE: To evaluate the effects of UVA as well as UVB irradiations on ST-1 gene expression in cultured human skin fibroblasts. METHODS: After exposure of different doses of UVA and UVB on cultured human skin fibroblasts, we examined the expression of ST-1 gene by Northern blot analysis, chloramphenicol acetyltransferase (CAT) assay with CAT construct containing AP-1 binding site. Additionally, we carried out the gel mobility shift assay to investigate the effects of UVR on the DNA-binding activity of AP-1. RESULTS: After UVR on fibroblasts, the steady-state levels of ST-1 mRNA were in-creased in response to UVA and UVB by 2.5-fold and 4.2-fold, respectively, as compared with controls. Similar results were obtained by CAT assay showing that CAT activity increased as the UVA and UVB doses increased. Furthermore, gel mobility shift assay demonstrated that both UVA and UVB increased AP-1 DNA binding complexes. CONCLUSION: UVB as well as UVA up-regulated ST-1 gene expression at transcriptional levels in vitro. We speculate that modulation of MMPs, including ST-1, gene expression by UVR may contribute to the connective tissue damage related to photoaging and other photocutaneous disorders.
Animals ; Binding Sites ; Blotting, Northern ; Cats ; Chloramphenicol O-Acetyltransferase ; Collagen ; Connective Tissue ; DNA ; Elastin ; Electrophoretic Mobility Shift Assay ; Extracellular Matrix ; Fibroblasts* ; Gene Expression ; Humans* ; In Vitro Techniques ; Matrix Metalloproteinases ; RNA, Messenger ; Skin ; Solar System ; Transcription Factor AP-1

We herein report a case of therapy-resistant dermatomyositis treated with oral prednisolone and chlorambucil combination therapy. Concurrently, she showed cervical carcinoma in situ(CIS). Initially, we started to treat her with combination oral prednisolone, intramuscular methotrexate, hydroxychloroquin, and removal of cervical CIS. However, our patient failed to respond to these regimens. Thus, we had have another combination treatment of oral prednisolone and chlorambucil. After the treatment of this combination regimen, her recalcitrant dermatomyositis improved dramatically without recurrence. There were no significant adverse side effects with chlorambucil therapy.
Chlorambucil* ; Dermatomyositis* ; Humans ; Methotrexate ; Prednisolone ; Recurrence

BACKGROUND: The clinical and histopathological classification of erythema multiforme(EM) and Stevens-Johnson syndrome (SJS) are difficult due to a lack of clear-cut criteria. In recent studies, some authors suggested that erythema multiforme and Stevens-Johnson syndrome were clinically and histopathologically different disorders. OBJECTIVE: The purpose of this study was to review the clinicopathological characteristics of the EM and SJS and to suggest specific findings for differentiating between the two diseases. METHODS: Fifty four patients with EM and SJS diagnosed in the Department of Dermatology of Dong-San Hcepita1 from January 1987 through to December 1996 were studied retrospectively. RESULTS: The results were summarized as follows. l. In view of causal factors, 54 cases were classified as drug-induced (n=22, 41%), herpes-induced (n=16, 30%), tuberculosis (n= 2, 3%), pneumonia (n=l, 2%), unknown (n=13, 24%). 2. Fifty four cases were clinically classified as SJS (n= 29, 54%), EM minor (n=-15, 2S%) and EM major (n = 10, 18%). 3. Erythema multiforme was found to be more related to herpes (13 of 25 cases) than to drugs (3 of 25 cases), while SJS was more related to drugs (19 of 29 cases) than to herpes (3 of 29 cases). 4. Varying degrees of necroti changes of keratinocytes were found in all the cases. The severity of degree or extent of necrosis was higher in patients with SJS than EM. 5. In demial changes, EM showed differences from SJS by having a denser and deeper lymphocytic infiltrate, and increased amount of extravasated erythrocytes. CONCLUSION: Taken together, although our findings could not provide a defmite clue to determine whether EM and SJS are different distinet entities or not, this study may be useful to differentiate and to understand the pathogenesis of EM and SJS. A prospective large scaled study should be conducted to definitively characterize these entities.
Classification ; Dermatology ; Erythema Multiforme* ; Erythema* ; Erythrocytes ; Humans ; Keratinocytes ; Necrosis ; Pneumonia ; Retrospective Studies ; Stevens-Johnson Syndrome ; Tuberculosis

BACKGROUND: Diabetes mellitus is a heterogeneous group of disorders characterized by high serum glucose levels and by disturbances of carbohydrate and lipid metabolism. There are many cutaneous signs of this common endocrinopathy, such as nercobiosis lipoidica diabeticorum, diabetic bullosis, shin spot, diabetic pruritus, etc. OBJECTIVE: In this study, we investigated whether extracellular matrix gene expression in cultured skin fibroblast is influenced by insulin and Insulin-like growth factor-I(IGF-I). METHOD: Total RNA was isolated from insulin or IGF-I treated human skin fibroblasts. The Northern blot and slot-blot hybridization were then conducted. RESULTS: The mRNA levels of pro α1(I) collagen, pro α1(I11) collagen, fibronectin in insulin and IGF-I treated normal skin fibroblasts increased compared with untreated normal skin fibroblasts. CONCLUSION: Our results show that insulin and IGF-I stimulate collagen formation in normal skin fibroblast at physiological concentrations. Therefore, these demonstrate that insulin can modulate the expression of extracellular matrix gene.
Blood Glucose ; Blotting, Northern ; Collagen ; Diabetes Mellitus ; Extracellular Matrix* ; Fibroblasts* ; Fibronectins ; Gene Expression ; Humans ; Insulin* ; Insulin-Like Growth Factor I ; Lipid Metabolism ; Methods ; Pruritus ; RNA ; RNA, Messenger ; Skin*

Cutaneous polyarteritis nodosa(CPAN) is a benign form of rare vasculitis of small and medium-size arteries with a recurrent but benign course without systemic involvement. We experienced a 61-year-old male who had two months history of multiple deep-purpurish livedo reticularis on both lower legs. Noncutaneous manifestations including malaise, fever, myalgia, and arthritis were absent. A skin biopsy specimen from the livedo reticularis on the leg showed perivascular and trans-mural neutrophilic and lymphocytic infiltration of medium-sized arteries in the dermal-subcutaneous junction and fibrinoid necrosis of the vessel walls. The patient was treated with colchicine for 2months and showed markded improvement.
Arteries ; Arthritis ; Biopsy ; Colchicine ; Fever ; Humans ; Leg ; Livedo Reticularis ; Male ; Middle Aged ; Myalgia ; Necrosis ; Neutrophils ; Polyarteritis Nodosa* ; Skin ; Vasculitis

We present a case of lymphangioma circumscriptum in a 17 year-old girl according to tihe clinical and histopathological findings. This case is unusual in that lesions developed on the vulva and thigh without preceding lymphedema. Our patient had a plaque of grouped vesicle-like papules resembling frog's apawn on The both labia majora of vulva and several scattered, skin tag like soft papules on the right upper thigh of theree years duration. Histopathologic findings showed variable sized, dilatated lymphatic channels lined by single layer of normal endothelial cells confined to the only upper dermis.
Adolescent ; Dermis ; Endothelial Cells ; Female ; Humans ; Lymphangioma* ; Lymphedema ; Skin ; Thigh ; Vulva*

In lepromatous leprosy, it is generally believed that there is not only defective CMl specific for M. leprae, but also generalized impairment of CMI and in erythema nodosum leprosum, an immune complex-mediated pathogenesis as well cell mediated immune pathogenesis have been proposed. Neopterin is a pyrazinopyrirnidine compound derived from GTP, its raised excretion has been related to activation of T-lymphocyte/macrophage axis. A study was performed to evaluate generalized CMI status in the LL and ENL and to investigate a relationship between levels of urinary neopterin and disease activity. Urinary neopterin was measured by high pressure liquid chromatography in 25 healthy subjects, in 25 patients with LL and in 25 patients with ENL. The results were as follaws 1. Urinary Neopterin levels of patients with LL was 188.9+147.3umol/mol creatinine, which was higher than that of control group(144.8+40.4umol/mol creatinine)(p<0.01). 2. Urinary Neopterin levels of patients with ENL was 884.1+970.5umol/mol creatinine, which was higher than of control group, and patients with LL(p<0.01, p<0.01). 3. Serial measurement of urinary neopterin from 1 week to 13 weeks after treatment of ENL in 4 cases of ENL showed good correlation between urinary neopterin levels and disease activity. In summary, it thus appears that measurement of urine neopterin in leprosy provides generalized CMI status and reliable index for activity of disease.
Axis, Cervical Vertebra ; Chromatography, Liquid ; Creatinine ; Erythema Nodosum* ; Erythema* ; Guanosine Triphosphate ; Humans ; Leprosy ; Leprosy, Lepromatous* ; Neopterin*

Vesiculobullous eruptions are a rare cutaneous manifestation of systemic lupus erythematosus (SLE). They are related to intense inflammation within the cutaneous lesions and subsequent blister formation. We report a case of vesiculobullous eruption of SLE in a 23-year-old male. The bullous eruptions were present ori the lip, forehead, both feet and hands. He met ARA(American Rheumatism Association) is criteria for a diagnosis of SLE and the eruptions developed during a systemic attack of the disease. Routine histology of the lesion showed subepidermal blisters with intact epidermis and dense neutrophilic infiltration in the upper dermis. Direct immunofluorescence of lesional skin showed a linear-granular pattern of immune deposits at the dermoepidermal junction. Electronmicroscopy of the lesional skin showing subepidermal bullae are located beneath the lamina densa. Combination therapy of prednisolone and hydrochloroquine showed complete clearing of the lesions within several weeks. We observed a good response without evidence of recurrence.
Blister ; Dermis ; Diagnosis ; Epidermis ; Fluorescent Antibody Technique, Direct ; Foot ; Forehead ; Hand ; Humans ; Inflammation ; Lip ; Lupus Erythematosus, Systemic* ; Male ; Neutrophils ; Prednisolone ; Recurrence ; Rheumatic Diseases ; Skin ; Young Adult

Ecthyma Gangrenosum is a rapidly progressing skin infection charact,erized by edema, hemorragic bullae and necrosis. Ecthyma Gangrenosum occurs almost exclusively in severely imrnunocompromised patients during the course of pseudomanas aeruginosa septisemia. A 5 month-old boy was transferred to our department because of multiple well defined central necrotic black-colored large erythematous bullae. In the bacterial cultures of skin, stool and liver aspiration fluid, Pseudomonas aeruginosa was grown. In the abdominal ultrasonogram and computed tomogram, the multiple liver abscess, hepatomegaly and ascites were shown on both hepatic lobes. Herein we report a case of ecthyma gangrenosum associated with liver abscess.
Ascites ; Ecthyma* ; Edema ; Hepatomegaly ; Humans ; Infant ; Liver Abscess* ; Liver* ; Male ; Necrosis ; Pseudomonas aeruginosa ; Skin ; Ultrasonography