The hyperreactive systemic inflammatory response seen in aged individuals after lipopolysaccharide administration is accompanied by an exacerbated pulmonary inflammatory response, which may contribute to the higher mortality seen in the aged given an inflammatory insult.

No abstract

To review the literature on atopic dermatitis (AD) clinical trials published in the United States between 2000 and 2009 to examine the representation of racial and ethnic minorities in those trials and determine the extent to which investigators reported on demographic variables and performed a subanalysis. A PubMed search was performed including all clinical trials for management of AD published between 2000 and 2009. Three reviewers analyzed articles matching the search criteria. Data recorded included incorporation of demographic data at baseline and in the analysis and result interpretations. Of 645 PubMed search results, only 78 articles originated in the United States and fit the search criteria; 59.5% of these included reports of race or ethnicity. Of the studies reporting race or ethnicity, the subject population mainly included 62.1% white, 18.0% black, 6.9% Asian, and 2.0% Hispanic. Despite increasing awareness in the United States of the importance of reporting demographic data in clinical trials, there has been no significant improvement in reporting in AD clinical trials over the past 10 years. When reporting occurs, the categorization of ethnicities, methods of reporting data, and incorporation of the data into the results are lacking or flawed. In addition, aside from blacks, U.S. minorities appear to be underrepresented in AD clinical trials.

No abstract

Scurvy, or hypovitaminosis C, is an uncommon condition that exists today primarily within certain unique populations-particularly the elderly subjects, patients with neurodevelopmental disabilities or psychiatric illnesses, or others with unusual dietary habits. Vitamin C is an essential nutrient in the human body, and is important in synthesizing collagen factor whose faulty production is responsible for most of the clinical manifestations of scurvy. These clinical manifestations can include dystrophic or corkscrew hairs, gingival hyperplasia, and weakened blood vessel walls, causing bleeding in the skin, joints, and other organs. Although rare in the Unites States, the presence of scurvy should not be forgotten because of its presence among susceptible populations. Moreover, with its diagnosis, treatment and cure is one of the simplest in modern medicine. We report a case of scurvy in a 10-year-old autistic child.

The objective of the study was to catalog hair shaft abnormalities in individuals with ectodermal dysplasia (ED) syndromes using light microscopy and to compare findings with those in unaffected controls. Light microscopy was performed in a nonblinded manner on hair shafts from 65 participants with seven types of ED (hypohidrotic ED, ED-ectrodactyly-cleft lip or palate, ankyloblepharon-ectodermal defects-cleft lip and palate, Clouston syndrome, Goltz syndrome, Schopf-Schulz Passarge syndrome, and oculodentodigital dysplasia) and 41 unaffected controls. Hair donations were collected at the 28th Annual National Family Conference held by the National Foundation for Ectodermal Dysplasia. Control participants were recruited from a private dermatology practice and an academic children's hospital outpatient dermatology clinic. Sixty-five affected participants and 41 unaffected controls were included in the analysis. We assessed the hair shafts of ED and control participants for abnormalities visible using LM. Light microscopy identified various pathologic hair shaft abnormalities in each type of ED, although none of the findings were statistically significantly different from those of the control group. Light microscopy is a poor adjuvant tool in the diagnosis of ED syndromes. Most findings are nonspecific and not sufficiently sensitive.

No abstract

An 80-year-old woman with celiac sprue presented with an acute bullous eruption on the bilateral flexural forearms. She had coincident onset of diarrhea and vomiting which led to dehydration, renal failure, and hospitalization. She denied a history of similar eruptions. Prehospitalization medications were unchanged over the past year and included clonidine, olmesartan, simvastatin, diphenoxylate/atropine, omeprazole, and furosemide.Cutaneous examination revealed erythematous targetoid plaques with dusky centers symmetrically distributed on the chin, neck, flexural forearms, central chest, breasts, flanks, inner thighs, and anterior legs ( Figure 1 and Figure 2). In addition, there were numerous tense vesicles and bullae in the same distribution (Figure 1). Palms, soles, and mucous membranes were spared. Laboratory studies revealed a mild leukocytosis and findings consistent with acute renal failure. AbstractThe clinical diagnosis of bullous pemphigoid (BP) can be challenging given the polymorphic nature of the disease. We present a case of erythema multiforme (EM)-like BP in an 80-year-old woman with celiac disease. Skin biopsies showed intraepidermal and subepidermal bullae with direct immunofluorescence (DIF) demonstrating IgG and C3 linear deposition at the basement membrane. The etiology of our patient's BP is unclear but may be associated with furosemide usage and is temporally associated with a flare of celiac sprue. To our knowledge, only four other published cases document EM-like lesions in BP. Atypical presentations of BP should be confirmed with histology and direct immunofluorescence.