Thirty-two Greek patients with histologically documented Kaposi's sarcoma, aged 46 to 82 years, were typed for HLA-A, B and DR antigens. None of them was homosexual and they had not been subjected to any immunosuppressive therapy. The study revealed a significant increase of HLA-DR5 (53.1% vs. 21.4%, R.R. 4.1) and a decreased frequency of HLA-DR1 (3.3% vs. 16.6%, R.R. 0.16). An increased frequency of HLA-B18 was also noted (43.7% vs. 20.7% R.R. 2.96). These results indicate that the same positive association with HLA-DR5 antigen is observed in Greek patients as in other patients of Mediterranean origin and support the view that HLA linked factor(s) may have a role in the development of the disease.
An 18‐year‐old woman had a 3‐year history of previously stable plaque‐type psoriasis that covered most parts of her body, arms, and legs.
In June 1993, she started treatment with calcipotriol cream, which was prescribed by her dermatologist.
Two weeks after starting this treatment, she had an exacerbation of her psoriasis with a generalized pustular eruption and she was admitted to the dermatology unit of “A. Sygros” Hospital.
On admission, the clinical examination revealed a bright red erythema of most of her skin and numerous pinhead‐sized pustules that covered all the psoriasis lesions (Fig. 1).
The eruption covered the patient's body, legs, and arms, whereas flexures and genitalia remained free. She also complained of malaise. The patient's laboratory studies showed the following values: hemoglobin 12.8 g/dL; hematocrit 39%; WBC 14,000/mm3; platelets 28,000/mm3; erythrocyte sedimentation rate 48/h. The blood chemistry surveys were all in the normal range and so were all enzyme studies. Urinalysis was normal. Chest x‐ray showed no abnormality.
Previous treatment
During the 3‐year history, the patient had been using different treatments to control her disease. The last treatment was fluocinamide 0.05% cream, which she had stopped 8 weeks before starting treatment with calcipotriol. On clinical examination no signs of cutaneous atrophy, suggesting the overuse of topical steroid, was found.
Histopathologic Findings
A 4‐mm punch biopsy was taken from a lesion and it revealed the epidermis to be slightly acanthotic and the formation of intraepidermal pustules underneath the stratum corneum with spongiform pustules at the shoulders of the lesion. In the dermis there was a perivascular infiltrate of lymphocytes and a few neutrophils with dilatation of blood vessels (Fig. 2).
Course
Calcipotriol cream was immediately withdrawn and treatment with methotrexate (MTX) was started (25 mg i.m. weekly). The dose was gradually decreased and discontinued 8 weeks later with no relapse of pustules or the plaque‐type psoriasis until now.
One hundred tumors of epidermal origin were studied by means of indirect immunofluorescence technique with sera from patients with proven pemphigus and bullous pemphigoid. We found that in tumors of epidermal origin, there was a loss of antigenicity of the intercellular substance and basement membrane; this was minimal for benign tumors, greater for premalignant tumors, and very clear for malignant tumors. We also found a gross correlation between the histologically proven malignancy of squamous cell carcinoma and the grade of antigenic loss; both for the intercellular substances and for the basement membrane antigens. However, this did not yeild definite results in the group with basal cell carcinoma. With regard, especially, to the intercellular substance antigen, it seemed to be completely independent of histologic type of basal cell carcinoma. We found that the duration of the epidermal tumor did not correlate with the percentage of intercellular substance and basement membrane antigenic loss. This suggested that the antigenic loss was an early feature of neoplastic behavior. The deeper parts of the malignant tumors in the dermis showed a lower percentage of antigenicity for both antigens.
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