No abstract

Serum lactate dehydrogenase activity (LDH) was elevated in most cases with the severe type of atopic dermatitis (AD). We examined whether LDH correlated specifically with the clinical courses and the severity of AD skin eruptions. Blood eosinophil numbers (Eo), LDH and its isoenzymes, and serum IgE (IgE) levels in eighty patients with AD were measured before and after treatment. In improved groups, Eo and LDH decreased or returned to normal values after treatment. In contrast, both levels increased in patients who worsened after treatment. Thus changes in Eo and LDH correlated well with the clinical picture. However, IgE levels did not correlate with the clinical condition. High LDH levels were detected in the severe type of AD more frequently than in the mild type. A large majority of patients with elevated LDH (higher than 300 IU/l) before treatment had more severe skin eruptions. When the LDH before treatment was within normal limits, the LDH levels in improved patients showed a further decrease. Eo, LDH and IgE were correlated closely with the clinical scores of AD, and the relationship between LDH and clinical score was the highest. Elevations of LDH5 and LDH4 among the LDH isoenzymes were more prominent in the severe type of AD than in the mild type. We concluded that LDH was useful as a marker for evaluating the disease condition and severity of skin eruption of AD.

Reticulate pigmentation with or without skin atrophy, depigmentation and telangiectasia is frequently encountered on the neck of severe cases of adult type atopic dermatitis. These skin changes were graded clinically into 3 stages. Based on histological features, hyperplasia of the sebaceous gland, dilated tortuous capillaries, and mild degeneration of elastic fibers were noted in stage I lesions. Lesions of both stages II and III contained increased melanin in the basal cell layer with incontinence of pigment, remarkable destruction and degeneration of elastic fibers, proliferated and dilated capillaries, and deposition of mucinous substances. The numbers of mast cells in papillary dermis were significantly increased in late stage I and stage II lesions. Poikiloderma-like lesions on the neck could be attributable to chronic inflammation and delay of wound healing process, possibly caused by long-standing topical corticosteroid therapy.

The dermis and sera of 11 patients with pseudoxanthoma elasticum (PXE) were analyzed by several techniques which test for the presence and quantity of trace elements (Fe, Ni, Co, Cu, Mn, Cr, Zn, Pb, Cd, AI, S, K, CI, Ca and P), The investigative methods included 1) electron microscopic point X-ray microanalysis, 2) inductively coupled plasma atomic emission spectrophotometric analysis (ICP-AES), 3) X-ray diffraction analysis and/or 4) atomic absorption spectro-photometric analysis, 1) Among 7 specimens of dermis showing histological degeneration of the elastic fibers, 2 showed prominent levels of AI. In early degeneration ofthe elastic fibers, Ca was present in only small amounts; however, in more fully developed lesions, large quantities of both Ca and P were found, while Fe, Co, Ma and Zn were detected in trace amounts. 2) ICP-AES analysis confirmed large deposits of AI, Ca, and P in diseased dermis (AI: 32J ppm wet tissue); other elements were found in normal quantities, AI was not detected in the control dermis, 3) X-ray diffraction analysis suggested the pattern of hydroxyapatite [Ca lO(P04 )6(O H )2]' which indicates that most of the Ca exists in a crystalline form. 4) Atomic absorption spectrophotometric analysis confirmed a large concentration of ug/dl, mean=17.2; normal <10) in all test patient's sera. The combined analysis revealed an increased amount of AI in patient's sera as well as in the elastic fibers of the dermis at an early stage of this disease (PXE). These findings suggest a possible role for AI in the pathogenesis of PXE.Abbreviations: PXE: pseudoxanthoma elasticum, ICP-AES: inductively coupled plasma atomic emission spectrometry