Twenty-one patients seen in a temperate climate who had a clinical diagnosis of brachioradial pruritus are presented. The history and clinical manifestations of the patients indicate that the symptoms were neuralgiform and caused by cumulative sun exposure.
During recent years, inborn errors of human IL-17 immunity have been demonstrated to underlie primary immunodeficiencies with chronic mucocutaneous candidiasis (CMC). Various defects in receptors responsible for sensing of Candida albicans or downstream signalling to IL-17 may lead to susceptibility to Candida infection. While CMC is common in patients with profound T cell immunodeficiencies, CMC is also recognised as part of other immunodeficiencies in syndromic CMC, or as relatively isolated CMC disease. We describe a 40-year-old woman with a clinical picture involving cutaneous bacterial abscesses, chronic oral candidiasis and extensive dermatophytic infection of the feet. By whole exome sequencing, we identified a STAT1-gain-of-function mutation. Moreover, the patient's peripheral blood mononuclear cells displayed severely impaired Th17 responses. The patient was treated with antifungals and prophylactic antibiotics, which led to resolution of the infection. We discuss the current knowledge within the field of Th17 deficiency and the pathogenesis and treatment of CMC.
Transcutaneous oxygen pressure measurements (TcPO2) were performed in ten healthy men (age 30.6 years, range 28-35) in six regions: anterolaterally 10 cm below and above the knee on both legs, 5 cm laterally to umbilicus and on the inside of the left humerus, which was subsequently biopsied for measurements of epidermal thickness from the basal lamina to the uppermost layer of stratum granulosum. Transcutaneous oxygen pressure was on average 70 mmHg (range 42-88 mmHg), and that of epidermal thickness 70 microns (range 43-120 microns). Epidermis was thinnest on the inside of the humerus (mean +/- SD) 61.3 mu +/- 11.0 and about 25% thicker (NS) in the regions above and below the knees. The relationship between TcPO2 (y) and epidermal thickness (x) could be described by the regression equation y = alpha i - 0.26x where the intercept alpha i differed between subjects, the mean value being 88 mmHg (range 77-103). The common regression coefficient of -0.26 was significantly different from zero (p less than 0.01, r2 = 0.49). Although the oxygen gradient across the total epidermis can not be estimated from skin biopsies, correction for the thickness of the living part of the skin may prove beneficial when TcPO2 measurements are used as an indicator of wound healing. The results suggests that the change of oxygen tension across the living part of epidermis is 0.26 mmHg/micron at various skin locations in different subjects.
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