Dermatoscopy can be used to evaluate the nail apparatus (ie, onychoscopy), and it is helpful for the diagnosis of numerous nail diseases and tumors. This article reviews the information that can be obtained in cases of nail dyschromia and especially in cases of melanonychia, in which the distinction between benign melanocytic activation or proliferation and malignancy is crucial. Dermatoscopic changes that accompany specific nail diseases are also reviewed, such as those observed with subungual hemorrhage, bacterial and fungal nail infections, psoriasis of the nail, lichen planus of the nail, and vascular abnormalities of the nail fold.

We found no major differences between atazanavir/ritonavir and darunavir/ritonavir in efficacy, clinically relevant side effects, or plasma cholesterol fractions. However, atazanavir/ritonavir led to higher triglycerides and more total and subcutaneous fat than darunavir/ritonavir. Also, fat gains with atazanavir/ritonavir were associated with insulin resistance. Clinical Trials Registration. NCT01274780.

In order to compare results of allergen immunotherapy in paediatric and adult populations, 22 children with a history of ragweed hay fever were matched with an equal number of adults for skin sensitivity to ragweed and all were given a 1-year course of immunotherapy with a partially purified ragweed extract. Biological responses were measured by nasal challenges with ragweed before therapy was started, after 12 weekly injections and when the maintenance dose had been reached and also by methacholine bronchoprovocation tests before and after 12 months of therapy. Skin-test sensitivity to ragweed and control allergens, and ragweed-specific IgE and IgG antibody responses were measured at the same intervals as the challenges and at the end of the study. The effect of the therapy on clinical symptoms was not evaluated. Before therapy the groups of adults and children were comparable by all indices, except for TAME esterase activity in nasal washes during ragweed nasal challenge which was significantly lower in children. During treatment, mediators released during sequential nasal challenges declined to undetectable levels in most patients and changes in nasal ragweed sensitivity were comparable in both groups. Ragweed IgE increases after 12 weeks of therapy and IgG levels at maintenance therapy tended to be higher in the children, but neither difference was statistically significant. At the end of the study IgE and IgG antibody levels were comparable in both groups. Results of methacholine inhalation tests did not change significantly in either group. The decrease in skin sensitivity to ragweed was similar in both groups. We conclude that ragweed immunotherapy leads to immunological and biological consequences that are comparable in children and adults.

While the cutaneous manifestations of the imported fire ant (IFA) sting are well known, neurologic sequalae are much more unusual. We report 2 cases of grand mal seizures associated with the sting of the IFA. The first patient suffered numerous stings without evidence of systemic reactions prior to the onset of the seizure. The second patient had manifestations of anaphylaxis prior to the occurrence of seizure. In both cases, the onset of seizures was delayed. As the geographic range of the IFA increases and more patients are stung, unusual reactions will be seen in greater frequency.

We have measured serum levels of IgG subclasses and total IgG, IgA and IgM in a group of 34 recurrent aphthous stomatitis (RAS) patients. At the time of blood collection, 23 of the 34 patients had active oral lesions. The remaining 11 patients were at an inactive stage. All measurement were performed in the Beckmann 360 Array Protein System. Serum levels of IgG2 subclass were significantly lower (P < 0.05) in the whole group of patients (34) when compared to the control group. This relationship was still significant (P < 0.05) when only the 11 patients without active oral lesions were considered but disappeared in patients at an active stage. We conclude that low serum levels of IgG2 may play a role in the pathogenesis of RAS, just as in other recurrent infectious diseases, and that serum levels of this immunoglobulin subclass, as well as total IgA, may undergo transient changes, depending on the different periods of activity and quiescence of the disease.

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Many recent studies have established the eosinophil as an active proinflammatory participant in a variety of disease states, most notably in allergic and helminthic disorders. In order to understand the effector role of eosinophils, factors which promote a selective eosinophilic infiltrate must be delineated. Eosinophil adherence to vascular endothelium is the first step in the formation of such an infiltrate. However, studies thus far have failed to identify factors which selectively activate the adherence of eosinophils. We have therefore speculated that the selective enrichment of eosinophils may result from nonselective recruitment of several leukocyte types combined with the production of local factors that promote the survival of eosinophils and not of other cells. We report that endothelial cell-conditioned medium selectively prolongs eosinophil survival up to 6 days in culture in a dose- and time-dependent manner. Stimulation of human vascular endothelial cells with IL-1 caused an increase in the generation of eosinophil survival-promoting activity, whereas stimulation with platelet-activating factor did not. Supernatants from human vascular endothelial cells cultured for 48 h in the presence of the glucocorticoid, dexamethasone, were less active in promoting eosinophil survival than control supernatants. These results suggest that factors produced locally in the vascular microenvironment may selectively promote eosinophil survival and may be under the regulation of cytokines and glucocorticoids.