The Journal of dermatology
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An otherwise healthy 31-year-old man presented with multiple, vesicular, subepidermal blistering on the head, face, chest and oral cavity, leaving shallow scar formation, typical of Brunsting-Perry type pemphigoid. Direct immunofluorescence showed linear deposition of immunoglobulin (Ig)G and C3 along the basement membrane zone (BMZ), and indirect showed anti-BMZ autoantibodies (IgG, >40×) reacting with the dermal side under the salt-split study. Immunofluorescence staining for type IV collagen and laminins, as well as routine electron microscopy, demonstrated that the cleavage level of the blister was intra-lamina lucida. ⋯ The patient was treated with combination therapy consisting of 30 mg prednisolone, 900 mg nicotinamide and 750 mg tetracycline, and the number of newly forming blisters decreased. We concluded that Brunsting-Perry type pemphigoid, a rare autoimmune blistering disease, includes cases showing characteristics of epidermolysis bullosa acquisita as well as bullous pemphigoid. This case showed discrepancy between the blistering level (intra-lamina lucida) and location of antigen (lamina densa and sub-lamina densa areas).
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Eighty two patients with chronic urticaria and 17 patients with prurigo chronica multiformis were referred to our department from October 2004 to February 2007 and were tested for Helicobacter pylori antigen using the polyclonal H. pylori stool antigen test (enzyme-linked immunosorbent assay method). H. pylori antigen was detected in 25 (30.5%) of the 82 patients with chronic urticaria and in 10 (58.8%) of the 17 patients with prurigo chronica multiformis. Those findings were not significantly higher than the positive rate for H. pylori stool antigen in healthy age-matched controls. ⋯ The eradication therapy for H. pylori was more effective for treating prurigo chronica multiformis and the skin symptoms started to improve within 3-14 days after the therapy. However, that therapy was not always effective for treating chronic urticaria. We suggest that H. pylori may be an important pathogenetic factor, especially for prurigo chronica multiformis, and that eradication therapy should be considered to treat intractable cases.
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Propionibacterium acnes plays an important role in the development of acne, and inflammatory lesions are improved by antibiotics. Long-term use of antibiotics may result in development of resistant strains and treatment failure. The aim of the present study was to investigate the isolation rate of P. acnes and to evaluate its antibiotic susceptibility to widely used antibiotics in acne in Korea. ⋯ The patients who were previously treated with topical or systemic antibiotics showed higher MIC in doxycycline. Antibiotic resistance of P. acnes is still low in Korea, but at this point, there is an increasing trend of MIC. Caution and acknowledgement of increased risk of antibiotic resistant P. acnes should be advised in acne antibiotic treatment to minimize and avoid the emergence of the resistant strain.