K F Wagner

United States Army Medical Research Institute of Chemical Defense, Maryland, United States

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Publications (57)175.6 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background There are reports of increased reactions in HIV-1 + patients to ultraviolet light sometimes in association with medication. In addition, there are also reports of increased morbidity associated with radiation therapy in HIV-1 + patients. Methods Three HIV-1 + patients developed cutaneous toxic reactions to radiation therapy; two with Kaposi's sarcoma (KS) and one with non-Hodgkin's lymphoma.Conclusions Although the mechanisms which resulted in these reactions are not clear, they may be related to depletion of endogenous scavengers and may be accentuated by the pattern of immune dysregulation present in HIV-1 disease.
    International journal of dermatology 06/2008; 36(10):779 - 782. DOI:10.1046/j.1365-4362.1997.00255.x · 1.23 Impact Factor
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    ABSTRACT: Background There have been scattered reports of HIV+ patients with increased reactions to light as well as anecdotal reports of HIV+ patients with increased morbidity secondary to radiation therapy.Methods As a part of a military study of HIV+ patients, we followed 987 patients for cutaneous disease for 4 years. All patients were questioned on a periodic basis about increased sensitivity to light. These patients received a physical examination at each protocol visit, and they were given the opportunity to receive all their dermatologic care within the HIV clinic. Fourteen of the patients with photo-induced eruptions were evaluated clinically at the time of the eruption, and 11 of these were biopsied.Results Thirty-three of the patients reported photo-induced reactions unrelated to oral medications. Although sensitivity to light often began in the early stages of HIV disease, reactions became more severe and more chronic with disease progression. Histologic features varied from few to numerous apoptotic/necrotic keratinocytes within the mid to upper levels of the epidermis associated with a perivascular inflammatory infiltrate, to apoptotic/necrotic keratinocytes throughout an acanthotic epidermis with a liehenoid/interface infiltrate.Conclusions Although the pathogenesis of these light reactions is not known, these reactions may be related to depletion of endogenous scavengers which results in increased oxidative stress and is modulated by the pattern of immune dysregulation and metabolic dysregulation induced by HIV disease.
    International journal of dermatology 06/2008; 36(10):745 - 753. DOI:10.1046/j.1365-4362.1997.00285.x · 1.23 Impact Factor
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    ABSTRACT: Background. While biopsies are often required for adequate diagnosis of skin lesions in HIV–1 infected patients, these procedures result in the possible exposure of medical personnel to blood and contaminated instruments. To reduce exposure of medical personnel to contaminated needles we have used collagen sponges instead of sutures to control bleeding from punch biopsy sites in HIV–1 infected patients.Methods. A collagen sponge was placed in all punch biopsy sites in HIV–1 infected patients. In cases where there was clinical evidence of local infection the sponges were removed 5–6 minutes after hemostasis was obtained.Results. In over 500 biopsies in which Helistat collagen sponges were used, there have been no cases of secondary infection, and there have been no delays in healing.Conclusions. We believe that the use of these sponges provides a high degree of safety for the physician, which may assure that the commonly atypical clinical lesions seen in HIV–1 disease are biopsied. In addition, these sponges provide hemostasis, particularly significant in this patient population, and convenience, without a significant risk of secondary infection, and may provide some benefit in healing.
    International journal of dermatology 05/2007; 32(11):835 - 837. DOI:10.1111/j.1365-4362.1993.tb02781.x · 1.23 Impact Factor
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    ABSTRACT: Background. In patients with HIV-1 disease there has been an increasing association with human papilloma virus (HPV) infections in multiple locations as well as an increase in associated tumors. In addition, there has been increased recovery of HPV in individuals with decreasing T4 cell counts.Case Report. Recently we have seen an HIV-I+ patient with a cutaneous lesion on the nipple, as well as multiple perianal lesions in which HPV-16 was demonstrated by in-situ hybridization. Although these lesions contained the same subtype of HPV virus, they had very different clinical and histopathologic morphologies, and this represents the first reported association of HPV-16 in a nipple lesion.Discussion. Our patient illustrates that in HIV-I disease, HPV infections may present in more diffuse and atypical locations. In addition, the diffuse staining with the in-situ probe for HIV-16 within the lesions, tends to support the findings of others, that viral recovery increases with the immune suppression induced by HIV-I.
    International journal of dermatology 05/2007; 32(9):664 - 667. DOI:10.1111/j.1365-4362.1993.tb04023.x · 1.23 Impact Factor
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    ABSTRACT: Background and Objective. Anetoderma has been reported in patients with HIV-1 disease. In patients with autoimmune disease, anetoderma has been associated with increased levels of antiphospholipid antibodies (APL) that include anticardiolipin antibodies (ACA) and lupus anticoagulant (LA). This has led to speculation that the autoimmune phenomena seen in HIV-1 disease and the immune dysregulation induced by HIV-1 disease may play a role in the development of these lesions. We have seen both primary and secondary lesions of anetoderma in patients followed for HIV-1 disease. In this study, we wanted to determine whether there was an association in the development of anetoderma and elevated anticardiolipin antibodies (ACA) in HIV-1 patients.Methods. Quantitative ACA levels were measured in eight HIV-1-infected patients with anetoderma and four HIV-1-infected patients without anetoderma.Results. Anticardiolipin antibodies were moderately elevated in seven of eight patients with lesions and were borderline in the four HIV-1-positive patients without lesions of anetoderma.Conclusions. There appears to be a correlation between increased ACA and the development of cutaneous lesions of anetoderma in HIV-I disease. Patterns of immune dysregulation, including APL, may predispose to the development of lesions of anetoderma in HIV-1-positive patients. Although some of the lesions appear to represent primary anetoderma, the majority of our patients develop lesions in areas secondary to well characterized eruptions.
    International journal of dermatology 05/2007; 34(6):408 - 415. DOI:10.1111/j.1365-4362.1995.tb04442.x · 1.23 Impact Factor
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    ABSTRACT: Drug reactions are common in HIV-1 disease, with the incidence having been reported to increase with increasing stage and with CD4+ T-cell counts below 200/μl. However, there have been numerous reports of patients in which rechallenge, dosing changes or continued therapy have resulted in no recurrence or else clearing of the eruption.We followed 974 HIV-1-positive patients for 46 months as a part of a military study of HIV-1 disease. Within this group there were a total of 283 drug eruptions, with cutaneous manifestations in 201 patients in which clinical characteristics were noted and 86 patients in which cutaneous biopsies were performed. Serological evidence of reactivation or acute Epstein-Barr virus (EBV) or cytomegalovirus (CMV) infections were also noted, as well as peripheral eosinophilia.The incidence of drug eruptions significantly increased with increasing Walter Reed stage and decreasing CD4 counts and CD4/CD8 ratio, as well as with increasing age and in patients with increased numbers of other dermatological diagnoses. In addition, white patients had significantly more drug eruptions than did black. Serological or culture evidence of acute or reactivated EBV or CMV was significantly increased in patients with drug eruptions. The majority of the eruptions were maculopapular or morbilliform with a predominantly perivascular mononuclear cell infiltrate.
    Clinical and Experimental Dermatology 04/2006; 22(3):118 - 121. DOI:10.1111/j.1365-2230.1997.tb01038.x · 1.23 Impact Factor
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    ABSTRACT: CD30 is a member of the tumour necrosis factor/nerve growth factor receptor superfamily, which is expressed on CD4+ and CD8+ T-cell clones which produce T helper (Th) 2-type cytokines. It has been proposed that disease progression in HIV-1 is associated with Th1 to Th2 cytokine switching. In 70 cutaneous biopsies from HIV-1 positive patients in different stages of disease, we performed a battery of immunohistochemical stains. These included antibodies to CD3, UCHL-1, OPD-4, L-26, KP-1 and CD30 (Ki-1). In addition, we used a similar battery of stains on cutaneous biopsies of HIV-1 negative patients with inflammatory dermatoses which are established as Th1 or Th2 dominant, e.g. polar leprosy. CD30+ cells were rarely present in early stages of HIV-1 disease, but commonly present in later stages of disease. However, there were cases of late HIV-1 disease which did not contain CD30+ cells. Increased numbers of CD30+ cells were more commonly seen in later stages of HIV-1 disease. However, the expression of CD30 appeared to be better in predicting other established Th2 cutaneous infiltrates in HIV-1 negative patients than in predicting a Th2 cutaneous cytokine pattern in advanced HIV-1 disease.
    British Journal of Dermatology 06/1998; 138(5):774-9. DOI:10.1046/j.1365-2133.1998.02212.x · 4.10 Impact Factor
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    ABSTRACT: One important factor in understanding the pathogenesis of human immune deficiency virus (HIV) disease is documenting the patterns of immune dysregulation present in HIV-positive patients. The cells which home to skin are mainly certain subsets of T cells and, as opposed to the peripheral blood, where circulating factors may inhibit terminal phenotypic differentiation, the cutaneous environment potentiates differentiation during cutaneous eruptions. The authors' aim was to characterize the inflammatory dermatoses in biopsy specimens from HIV-positive patients with immunohistochemical stains for lymphoid markers, activation markers, and adhesion molecules and to determine if there was any correlation with the type of dermatosis and the HIV-disease stage. Lymphoid and activation markers as well as adhesion molecules were studied on cutaneous biopsy specimens from 96 inflammatory dermatoses in HIV-positive patients. The dermatoses included psoriasiform dermatoses with and without a lichenoid component, perivascular lymphoid dermatoses, perivascular and periadnexal inflammatory dermatoses, spongiotic dermatoses, granulomatous dermatoses, and neutrophilic dermatoses with and without vasculitis. Results: Although there was a decrease in CD4/CD8 ratios in the cutaneous inflammatory dermatoses with progression of the disease, the ratios of CD4/CD8 cells were far higher than those in the peripheral blood. There were also increasing numbers of CD23+ cells and increased E-Selectin expression on endothelial cells from the early stages of disease, with no consistent pattern of ICAM-1 expression on epithelial cells with disease progression. The expression of lymphoid markers, activation markers, and adhesion molecules in the skin with progression of HIV disease, is consistent with a T helper (Th)1 to Th0/Th2 cytokine pattern of immune dysregulation. This cytokine pattern may be modified by the cytopathic effects of HIV on lymphoid and dendritic populations and by effects of other concurrent infections. Significant numbers of CD4+ T cells in skin infiltrates, with low peripheral CD4 T-cell counts, suggest that the cutaneous T-cell populations may be distinctive.
    Journal of Cutaneous Maedicine and Surgery 05/1998; 2(4):212-9. · 0.71 Impact Factor
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    ABSTRACT: Post-infection vaccination with human immunodeficiency virus type 1 (HIV-1) specific antigens has been hypothesized as a mechanism for generating a more effective immune response to the HIV-1 virus. Cutaneous reactions at the site of immunization may provide information on the pattern of immune activation induced by the vaccine. To evaluate exaggerated local cutaneous reactions in eight HIV-1+ patients enrolled in a phase I and II gp160 vaccine study. Cutaneous biopsy specimens were obtained and evaluated using routine histologic, immunofluorescence, and immunohistochemical techniques. A mononuclear cell infiltrate with tissue eosinophilia, in some cases forming flame figures, was present on histologic sections. There was no evidence of immune complex deposition. Activated T-helper cells formed a major portion of the mononuclear cell infiltrate. A delayed-type hypersensitivity reaction, mediated by T cells with a T-helper 2 cytokine pattern, was favored by clinical and histologic features. The most likely antigen stimulating this reaction is residual lepidopteran used in the preparation of the vaccine; however, baculovirus antigens may also play a role. In addition, the adjuvant, aluminum phosphate, as well as the underlying patterns of immune dysregulation present in HIV-1+ patients, may potentiate these reactions.
    International Journal of Dermatology 05/1998; 37(4):293-8. · 1.23 Impact Factor
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    ABSTRACT: There have been scattered reports of HIV+ patients with increased reactions to light as well as anecdotal reports of HIV+ patients with increased morbidity secondary to radiation therapy. As a part of a military study of HIV+ patients, we followed 987 patients for cutaneous disease for 4 years. All patients were questioned on a periodic basis about increased sensitivity to light. These patients received a physical examination at each protocol visit, and they were given the opportunity to receive all their dermatologic care within the HIV clinic. Fourteen of the patients with photo-induced eruptions were evaluated clinically at the time of the eruption, and 11 of these were biopsied. Thirty-three of the patients reported photo-induced reactions unrelated to oral medications. Although sensitivity to light often began in the early stages of HIV disease, reactions became more severe and more chronic with disease progression. Histologic features varied from few to numerous apoptotic/necrotic keratinocytes within the mid to upper levels of the epidermis associated with a perivascular inflammatory infiltrate, to apoptotic/necrotic keratinocytes throughout an acanthotic epidermis with a lichenoid/interface infiltrate. Although the pathogenesis of these light reactions is not known, these reactions may be related to depletion of endogenous scavengers which results in increased oxidative stress and is modulated by the pattern of immune dysregulation and metabolic dysregulation induced by HIV disease.
    International Journal of Dermatology 11/1997; 36(10):745-53. · 1.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are reports of increased reactions in HIV-1+ patients to ultraviolet light sometimes in association with medication. In addition, there are also reports of increased morbidity associated with radiation therapy in HIV-1+ patients. Three HIV-1+ patients developed cutaneous toxic reactions to radiation therapy; two with Kaposi's sarcoma (KS) and one with non-Hodgkin's lymphoma. Although the mechanisms which resulted in these reactions are not clear, they may be related to depletion of endogenous scavengers and may be accentuated by the pattern of immune dysregulation present in HIV-1 disease.
    International Journal of Dermatology 11/1997; 36(10):779-82. · 1.23 Impact Factor
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    ABSTRACT: Drug reactions are common in HIV-1 disease, with the incidence having been reported to increase with increasing stage and with CD4+ T-cell counts below 200/microliters. However, there have been numerous reports of patients in which rechallenge, dosing changes or continued therapy have resulted in no recurrence or else clearing of the eruption. We followed 974 HIV-1-positive patients for 46 months as a part of a military study of HIV-1 disease. Within this group there were a total of 283 drug eruptions, with cutaneous manifestations in 201 patients in which clinical characteristics were noted and 86 patients in which cutaneous biopsies were performed. Serological evidence of reactivation or acute Epstein-Barr virus (EBV) or cytomegalovirus (CMV) infections were also noted, as well as peripheral eosinophilia. The incidence of drug eruptions significantly increased with increasing Walter Reed stage and decreasing CD4 counts and CD4/CD8 ratio, as well as with increasing age and in patients with increased numbers of other dermatological diagnoses. In addition, white patients had significantly more drug eruptions than did black. Serological or culture evidence of acute or reactivated EBV or CMV was significantly increased in patients with drug eruptions. The majority of the eruptions were maculopapular or morbilliform with a predominantly perivascular mononuclear cell infiltrate. HIV-1 positive patients have an increased incidence of drug reactions, the incidence having been reported to increase in patients with less than 200 CD4+ T cells/microliter. However, at very low T4 counts, especially those less than 25/microliter, and at a CD4/CD8 ratio of less than 0.10, the probability of reactions to trimethoprim-sulphamethoxazole (TMP-SMZ) is decreased in late-stage HIV-1 patients. Maculopapular or morbilliform eruptions are the most common clinical presentations, often accompanied by one or more of the following: fever, arthralgias, eosinophilia, and serum transaminase elevation. Histologically the majority of these eruptions show a perivascular mononuclear cell infiltrate, sometimes with focal interface changes and apoptotic, necrotic cells within the epidermis. Acute hypersensitivity reactions and toxic epidermal necrolysis (TEN) or Stevens-Johnson's syndrome (SJS) with diffuse epidermal apoptosis and necrosis have also been less commonly described. In a study of cutaneous manifestations in an HIV-1 positive military population, drug reactions were evaluated in terms of clinical features, histopathology, demographic features and laboratory findings.
    Clinical and Experimental Dermatology 06/1997; 22(3):118-23. · 1.23 Impact Factor
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    ABSTRACT: The high incidence of cutaneous disease in HIV-1+ patients may be a marker of the chronic state of immune activation. In addition, specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the eruption. We have observed that HIV-1+ patients with pityriasis lichenoides et varioliformis acuta (PLEVA) were in the early to midstage of HIV-1 disease. To determine if there was a correlation between the phenotype of the lymphoid infiltrate and surface markers of the epidermis and the known changes in early or late-stage HIV-1 disease, we studied five HIV-1+ patients with PLEVA. Cutaneous biopsy specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenotype of the lymphoid infiltrate. The HIV-1+ patients showed increased expression of HLA-DR on keratinocytes as well as on the mononuclear and dendritic cell populations in the epidermis and dermis. The majority of T cells were activated CD8+ cells. Immunophenotyping of the inflammatory infiltrate in these patients is consistent with a pattern of immune dysregulation seen only in earlier stages of HIV-1 disease. Thus, PLEVA may be useful as a marker of early to midstages of HIV-1 disease.
    International Journal of Dermatology 03/1997; 36(2):104-9. · 1.23 Impact Factor
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    ABSTRACT: Because mucosal immune responses may be important in protection against human immunodeficiency virus type 1 (HIV-1), HIV-1-specific immune responses at mucosal sites in natural infection were compared. Total antibody concentrations and HIV-1-specific binding antibody responses in four distinct mucosal sites and serum were assessed in 41 HIV-infected and 19 HIV-seronegative women. HIV-1 gp160-specific IgG responses were detected in >99% of mucosal samples in infected subjects, with the highest titers in genital secretions. HIV-1-specific IgA was detected in the majority of endocervical secretions (94%) and nasal washes (95%) but less often in vaginal washes (51%) and parotid saliva (38%). There was no significant correlation between mucosal immune response and most clinical factors. Based on methodologic considerations, frequencies of detection, and HIV-1-specific responses, nasal washes and genital secretions may each provide important measures of HIV-1-specific mucosal immune responses in infected women.
    The Journal of Infectious Diseases 03/1997; 175(2):265-71. DOI:10.1093/infdis/175.2.265 · 5.78 Impact Factor
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    ABSTRACT: Although intralesional vinblastine has been used with some success in the treatment of cutaneous lesions of Kaposi's sarcoma (KS), lesions commonly recur. When large lesions are treated, frequently there is considerable discomfort and, in some cases, secondary ulceration. Hyaluronidase has been used to increase dispersion of drugs administered by local injection. Our purpose was to determine whether intralesional hyaluronidase administered before intralesional vinblastine increases the dispersion of vinblastine and decreases toxicity. We treated six patients who had multiple cutaneous plaque lesions and tumors of KS with intralesional vinblastine, intralesional vinblastine preceded by intralesional hyaluronidase, or intralesional hyaluronidase alone. Both intralesional vinblastine and intralesional vinblastine preceded by intralesional hyaluronidase caused clinical regression of lesions of KS; however, the combination of hyaluronidase and vinblastine was more effective in treating tumor nodules. In addition, lesions treated with hyaluronidase and vinblastine recurred less often than those treated with vinblastine alone and showed no evidence of residual KS in two patients undergoing biopsy between 4 and 6 months after therapy. Intralesional hyaluronidase enhances vinblastine in the treatment of cutaneous lesions of KS without adding to the systemic toxicity.
    Journal of the American Academy of Dermatology 03/1997; 36(2 Pt 1):239-42. · 5.00 Impact Factor
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    ABSTRACT: Background The high incidernce of cutaneous disease in HIV-1 + patients may be a marker of the chronic state of immune activation. In addition, specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the eruption. We have observed that HIV-1 + patients with pityriasis lichenoides et varioliformis acuta (PLEVA) were in the early to midstage of HIV-1 disease.Materials and methodsTo determine if there was a correlation between the phenotype of the lymphoid infiltrate and surface markers of the epidermis and the known changes in early or late-stage HIV-1 disease, we studied five HIV-1 + patients with PLEVA. Cutaneous biopsy specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenotype of the lymphoid infiltrate.ResultsThe HIV-1 + patients showed increased expression of HLA-DR on keratinocytes as well as on the mononuclear and dendritic cell populations in the epidermis and dermis. The majority of T cells were activated CD8+ cells.Conclusions Immunophenotyping of the inflammatory infiltrate in these patients is consistent with a pattern of immune dysregulation seen only in earlier stages of HIV-1 disease. Thus, PLEVA may be useful as a marker of early to midstages of HIV-1 disease.
    International journal of dermatology 02/1997; 36(2):104-109. DOI:10.1046/j.1365-4362.1997.00006.x · 1.23 Impact Factor
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    ABSTRACT: Background: Although intralesional vinblastine has been used with some success in the treatment of cutaneous lesions of Kaposi's sarcoma (KS), lesions commonly recur. When large lesions are treated, frequently there is considerable discomfort and, in some cases, secondary ulceration. Hyaluronidase has been used to increase dispersion of drugs administered by local injection.Objective: Our purpose was to determine whether intralesional hyaluronidase administered before intralesional vinblastine increases the dispersion of vinblastine and decreases toxicity.Methods: We treated six patients who had multiple cutaneous plaque lesions and tumors of KS with intralesional vinblastine, intralesional vinblastine preceded by intralesional hyaluronidase, or intralesional hyaluronidase alone.Results: Both intralesional vinblastine and intralesional vinblastine preceded by intralesional hyaluronidase caused clinical regression of lesions of KS; however, the combination of hyaluronidase and vinblastine was more effective in treating tumor nodules. In addition, lesions treated with hyaluronidase and vinblastine recurred less often than those treated with vinblastine alone and showed no evidence of residual KS in two patients undergoing biopsy between 4 and 6 months after therapy.Conclusion: Intralesional hyaluronidase enhances vinblastine in the treatment of cutaneous lesions of KS without adding to the systemic toxicity.(J Am Acad Dermatol 1997;36:239-42.)
    Journal of the American Academy of Dermatology 02/1997; 36(2):239-242. DOI:10.1016/S0190-9622(97)70288-3 · 5.00 Impact Factor
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    ABSTRACT: Delayed hypersensitivity reactions (DTH) are lost with progression of HIV disease. This loss of DTH commonly occurs before the onset of opportunistic infections and is an independent predictor of disease progression. We wanted to determine whether patients in late HIV disease with a history of allergic contact dermatitis (ACD) to poison ivy continue to react to poison ivy. Twelve HIV+ patients with a past history of ACD to poison ivy were tested with an extract prepared from poison ivy leaves. All but 1 patient had CD4+ T cell counts < 200/microliters, and 5 patients had had an opportunistic infection. All 12 patients showed positive reactions ranging from mild erythema and infiltration to marked erythema with bulla formation. ACD is considered a variant of DTH, and as DTH results in a T helper 1 cytokine pattern. However, the antigen-specific effector cells in ACD may be more diverse than in DTH. This diversity could explain the continued reaction to some contact allergens in late disease and may be important in the use of contact allergens for immunotherapy.
    Dermatology 01/1997; 195(2):145-9. · 1.69 Impact Factor
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    ABSTRACT: Background: Delayed hypersensitivity reactions (DTH) are lost with progression of HIV disease. This loss of DTH commonly occurs before the onset of opportunistic infections and is an independent predictor of disease progression. Objective: We wanted to determine whether patients in late HIV disease with a history of allergic contact dermatitis (ACD) to poison ivy continue to react to poison ivy. Methods: Twelve HIV+ patients with a past history of ACD to poison ivy were tested with an extract prepared from poison ivy leaves. All but 1 patient had CD4+ T cell counts < 200/μl, and 5 patients had had an opportunistic infection. Results: All 12 patients showed positive reactions ranging from mild erythema and infiltration to marked erythema with bulla formation. Conclusions: ACD is considered a variant of DTH, and as DTH results in a T helper 1 cytokine pattern. However, the antigen-specific effector cells in ACD may be more diverse than in DTH. This diversity could explain the continued reaction to some contact allergens in late disease and may be important in the use of contact allergens for immunotherapy.
    Dermatology 01/1997; 195(2):145-149. DOI:10.1159/000245718 · 1.69 Impact Factor
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    ABSTRACT: Pruritus in HIV-1+ patients is common and increases with disease progression. The causes of pruritus are numerous including xerosis, drug and photoeruptions, follicular and papular eruptions as well as infestations and infections by a wide range of organisms. One other possible factor contributing to pruritus is the pattern of immune dysregulation. With advancing HIV-1 disease there is Th1 to Th2 cytokine switching. After some positive results with prostaglandin inhibitors, we undertook a study in which we randomly placed patients on four different forms of therapy for their pruritus. The therapies included hydroxyzine with or without doxepin at night, pentoxifylline, indomethacin and topical moisturization with medium-strength topical steroids. All patients were evaluated for both subjective relief as well as side effects. Patients placed on indomethacin obtained relief more consistently and more completely. Patients on pentoxifylline had the fewest side effects of all oral therapies. Patients on antihistamines with or without doxepin had the highest incidence of side effects, although more of these patients reported a greater degree of relief than patients on pentoxifylline. All patients on oral therapy overall had greater relief than patients using topical steroids. The systemic therapies which may modulate the pattern of immune dysregulation seen in HIV-1 disease may be beneficial in the pruritus seen in late-stage patients.
    Dermatology 01/1997; 195(4):353-8. DOI:10.1159/000245987 · 1.69 Impact Factor

Publication Stats

652 Citations
175.60 Total Impact Points

Institutions

  • 1996–2008
    • United States Army Medical Research Institute of Chemical Defense
      Maryland, United States
  • 1993–2007
    • Walter Reed Army Institute of Research
      Silver Spring, Maryland, United States
    • Walter Reed National Military Medical Center
      • Department of Dermatology
      Washington, Washington, D.C., United States
  • 2006
    • Armed Forces of the Philippines Medical Center
      Malanday, Calabarzon, Philippines
  • 1997
    • US Army Medical Research Institute of Chemical Defense
      Aberdeen Proving Ground, Maryland, United States
  • 1992–1996
    • Henry M Jackson Foundation
      Maryland City, Maryland, United States
  • 1993–1995
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
    • Armed Forces Institute of Pathology
      Ralalpindi, Punjab, Pakistan