bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropathology of White Matter Changes in Alzheimer’s Disease and Vascular Dementia
Authors: Englund Elisabet
Published: April 2003

Morphological white matter changes were investigated in clinically and neuropathologically diagnosed cases of Alzheimer’s disease (AD; 60 cases) and vascular dementia (VaD; 40 cases). In 33 of 60 AD cases, a white matter disease (WMD) characterized by tissue rarefaction, mild gliosis and a non-amyloid small-vessel sclerosis occurred in the central, preferentially frontal deep white matter. The mean vessel density was significantly lower than in normal control case frontal white matter. The presence of WMD did not parallel the severity of grey matter Alzheimer encephalopathy. In 25 of 60 AD cases, white matter degeneration with signs of both condensation and rarefaction of tissue elements was seen subjacent to advanced cortical degeneration in the temporal lobes. It concurred with WMD in only 13 cases and was judged to be of anterograde, Wallerian type and not related to angiopathy. In VaD, similar changes occurred, accompanied by several types of focal and topographically related lesions. For diffuse white matter pathology of similar appearance in vascular and neurodegenerative disease with dementia, there may be various at least partly contrasting aetiologies, which can be differentiated by the presence of even minor focal lesions in some cases. For the recognition of such subtle variations in the spectrum of WMD, modern imaging techniques are crucial for detailed clinical diagnosis and attempts at therapeutic intervention.
Global Change Assessments in Anti-Alzheimer Clinical Drug Trials
Authors: Knopman David
Published: April 2003

The assessment of efficacy in clinical trials in Alzheimer’s disease has been a controversial area. The US Food and Drug Administration has not accepted mental status assessment as a sole determinant of efficacy because of concerns about oversensitivity and lack of direct linkage to clinical importance. Global change instruments offer a number of advantages as primary outcome measures, chief among which is a wide range of responsiveness, a property well suited for trials of 1 to 2 years. Initial investigations with global change instruments have shown encouraging validity. Reliability has been only moderate, suggesting that the methodology needs further attention. A standardized format for interview and the acceptance of a set of anchor points that better define the ratings of change are two modifications that should improve reliability. Global change instruments, if properly explained to the patients, caregivers and primary physicians, will capture the concept of clinical importance.
Biochemical and Molecular Characterization of Neurofibrillary Degeneration in Frontotemporal Dementias
Authors: Delacourte André
Published: April 2003

Neurofibrillary degeneration (NFD) is a degenerating process characterized by the intraneuronal aggregation of abnormal tau proteins. These proteins have a biochemical signature which is disease-specific. They also have a neocortical distribution which is typical of the disease. Pathological tau proteins have been analyzed qualitatively and quantitatively in all diseases that may present the clinical symptoms of frontotemporal dementias. In Alzheimer’s disease, a disease with sometimes a frontal predominance, paired helical filaments (PHF) of neurofibrillary tangles are made of hyperphosphorylated tau, named PHF-tau. Their electrophoretic profile consists of four main bands (tau 55, 64, 69, 74 kD), resulting from the presence of the six tau isoforms. In Pick’s disease the phosphorylated tau from Pick bodies are made of two major components (tau 55, 64 kD) and a minor 69 kD resulting from the lack of tau isoforms with the translated exon 10 (E10–). Corticobasal degeneration (CBD) also has a different pattern of tau variants, with tau 64, 69 components and a minor tau 74. Pathological tau proteins that aggregate in CBD (and progressive supranuclear palsy) are exclusively made of E10+ tau isoforms. In frontotemporal dementias non-Alzheimer, non-Pick (Lund and Manchester criteria), we did not observe the presence of pathological tau proteins in 2 cases, but a third one presented a particular pattern of tau, with soluble pathological tau in frontotemporal areas. These data show that this group could be heterogeneous.In conclusion, the biochemical signature of tau distinguishes four classes of frontotemporal dementia. The characteristic tau phenotypes observed are linked to the specific neuronal networks that are affected in each disease.
Mapping Pathological 99mTc-d,l-Hexamethylpropylene Amine Oxime Uptake in Alzheimer’s Disease and Frontal Lobe Dementia with SPECT
Authors: Pagani Marco , Salmaso Dario , Ramström Christina , Jonsson Cathrine , Lundqvist Roger , Thurfjell Lennart , Schnell P.O. , Wägner Anna , Jacobsson Hans , Larsson Stig A.
Published: April 2003

Seventeen patients with probable Alzheimer’s disease (AD), 7 patients with frontal lobe dementia (FLD) and 19 control subjects (NOR) were examined by 99mTc-d,l- hexamethylpropylene amine oxime (99mTc-HMPAO) SPECT. Images were standardised in the same 3D space and averaged within each group. After normalisation, the three sets of images were analysed in all cerebral lobes, hippocampus, thalamus and basal ganglia. In AD, the 99mTc-HMPAO uptake values were significantly reduced, as compared to NOR, in the parietal, temporal and insular lobes. In patients with FLD, the uptake was altered in all lobes with the exception of the parietal lobe. The uptake in the nucleus caudatus decreased significantly in both AD and FLD as compared to NOR. The uptake in the anterior cingulate cortex was significantly reduced in FLD. Subtraction images highlighted all significantly decreased areas. In conclusion, standardising SPECT in a common space and subtracting data from a control group improves the visual interpretation of images. In this study, the typical temporo-parietal and fronto-parietal 99mTc-HMPAO uptake reductions were found in AD and FLD, respectively. The uptake in the nucleus caudatus was found to decrease significantly in AD and FLD and the one in the anterior cingulate cortex was reduced in FLD.
Correlation of the Expression Level of C1q mRNA and the Number of C1q-Positive Plaques in the Alzheimer Disease Temporal Cortex
Authors: Tooyama Ikuo , Sato Haruhisa , Yasuhara Osamu , Kimura Hiroshi , Konishi Yoshinori , Shen Yong , Walker Douglas G. , Beach Thomas G. , Sue Lucia I. , Rogers Joseph
Published: April 2003

We compared the expression level of C1q mRNA and the number of C1q-positive plaques in adjacent or nearby brain sections from Alzheimer disease (AD) and control cases. Small blocks of temporal cortex were fixed with 4% paraformaldehyde for 2 days at 4°C. After cryoprotection with solutions containing 10–20% glycerol and 2% dimethylsulfoxide, 40-µm sections were cut from the tissue blocks. A section from each case was stained by immunohistochemistry using a C1q antibody, while RNA was purified from adjacent or nearby sections using a combination of proteinase K pretreatment followed by extraction using Trizol reagent. The expression of C1q B chain mRNA was analyzed in these samples by the reverse-transcription polymerase chain reaction (RT-PCR). The intensities of the PCR products were measured by an image analyzer. The expression of C1q B chain mRNA was significantly more abundant in AD than in control cases (p < 0.05). Immunohistochemical analysis showed that C1q protein was localized in senile plaques in the AD brain. The number of C1q-positive plaques correlated with the expression level of C1q gene (p < 0.05). The present results suggest that C1q protein in senile plaques originates is endogenously produced in the AD brain.
Analysis of Alpha-2-Macroglobulin-2 Allele as a Risk Factor in Alzheimer’s Disease
Authors: Nicosia Francesca , Alberici Antonella , Benussi Luisa , Gasparini Laura , Ghidoni Roberta , Mazzoli Federica , Zanetti Orazio , Frisoni Giovanni Battista , Geroldi Cristina , Binetti Giuliano
Published: April 2003

A correlation between a 5-nucleotide deletion polymorphism in the A2M gene and an enhanced risk of developing Alzheimer’s disease (AD) was reported. We studied this polymorphism in sporadic AD patients and patients with frontotemporal dementia (FTD) by using an electrophoretical separation of PCR products on a Metaphor gel. Our results did not show any significant difference between A2M-2 allelic frequency (p = 0.89) or genotype frequency (p = 0.97) in the two different clinical series and in control subjects. The frequencies were not significantly different after stratification by APOE Ε4 status.
Is There a Typical Pattern of Brain SPECT Imaging in Alzheimer’s Disease?
Authors: Steinling M. , Defebvre L. , Duhamel A. , Lecouffe P. , Lavenu I. , Pasquier F. , Charpentier P.
Published: April 2003

The identification of new nosological forms such as Lewy body disease (LBD) requires a re-evaluation of the patterns observed in brain functional imaging in the various forms of dementia. We studied 60 demented patients, divided into three groups and fulfilling the clinical criteria for Alzheimer’s disease (AD), LBD and frontotemporal dementia (FTD), using Tc-HMPAO and a brain-dedicated SPECT system. After normalisation we applied a cut-off at two levels according to previously established criteria. We reaffirmed the already established data concerning FTD (mainly a bilateral frontal decrease) and for LBD (a severe diffuse decrease in the frontal regions and also in the posterior association cortex). In contrast, the decrease in AD was strictly limited to the parieto-occipital cortex, irrespective of the severity of the cognitive decline. We hypothesise that the major simplification concerning the pattern observed in AD can be explained by the fact that patients suffering from LBD have previously been included in the groups of AD patients.
Metabolism of Topical Retinaldehyde
Authors: Sorg O. , Didierjean L. , Saurat J.-H.
Published: April 2003

Objective: In order to circumvent the tolerance problems encountered with topical application of retinoic acid – a biologically active metabolite of vitamin A – we performed in various models a series of experiments aimed at assessing the bio-availability of topical retinaldehyde and its conversion into either retinoid stores or biologically active metabolites. Methods: (i) 3H-retinaldehyde was used as a precursor of either 3H-retinol or 3H-retinoic acid in human skin extracts and human cultured keratinocytes; (ii) the concentration of various retinoids resulting from the metabolism of topical retinaldehyde was determined in mouse skin and in human plasma. Retinoids were quantified by reverse-phase HPLC with UV detection. Results: Human keratinocytes were shown to take up retinaldehyde and to convert it into retinoic acid in a differentiation-dependent manner, differentiating cells oxidising retinaldehyde more efficiently. In vivo models allowed us to demonstrate that retinaldehyde is taken up by the skin and is then predominantly converted into retinyl esters – a storage form of vitamin A – while delivering relatively low amounts of retinoic acid from a large reservoir. Conclusion: Topical retinaldehyde can be used as a precursor of endogenous retinoids, since it is converted into both storage and bio-active forms of vitamin A.
Repair of UVA-Induced Elastic Fiber and Collagen Damage by 0.05% Retinaldehyde Cream in an ex vivo Human Skin Model
Authors: Boisnic S. , Branchet-Gumila M.-C. , Le Charpentier Y. , Segard C.
Published: April 2003

Background: Cellular effects of UV exposure are implicated in cutaneous aging. UV radiations induce structural and cellular changes in all the compartments of skin. Aim: To study the antiaging efficacy of a cream containing 0.05% retinaldehyde with an ex vivo technique using human skin in order to approximate in vivo metabolic conditions. Methods: Human skin explants were maintained alive in organ culture for 18 days and subjected to UVA exposure, thus simulating skin photoaging. Retinaldehyde cream was then applied to the surface of the epidermis for 2 weeks and the results were compared with those of nontreated skin explants. Dermal repair was analyzed histologically with quantification of collagen and elastic fibers, and biochemically by the measure of newly synthesized collagen as shown by adding tritiated proline to the culture medium. Results: UVA exposure induced significant alterations of collagen and elastic fibers as shown by morphometric analysis. In all UVA-exposed and then retinaldehyde-treated skin specimens, collagen and elastic fibers were restored to the level of nonexposed skin. UVA exposure induced a decrease in collagen synthesis, whereas in retinaldehyde-treated UVA-exposed skin the synthesis was similar to that of unexposed skin. Conclusion: It has been shown that retinaldehyde has many of the properties of tretinoin in its biological and beneficial effects on photoaging. We have verified some of these previous observations, especially on dermal connective tissue, by obtaining significant repair of elastic fibers and collagen alteration induced by UVA exposure.
Endotoxemia and the Effects of Dopamine on Renal Functions of Neonatal Piglets
Authors: Chin Anthony , Nguyen O’Conner Linh , Radhakrishnan Jayant , Fornell Linda , John Eunice
Published: April 2003

In this study, we observed the effects of moderate and high doses of dopamine on the renal functions of neonatal piglets during endotoxic shock. We found that fluid therapy alone was better at maintaining cardiac index and preventing elevation of systemic vascular resistance, than dopamine at 10 and at 20 µg/kg/min. Furthermore, urine output and glomerular filtration rate were reduced by dopamine. Following endotoxin administration dopamine decreased SVR and maintained a CI better than fluid alone. However, in spite of a better CI, greater deterioration in renal functions occurred in the dopamine groups as compared to the fluid group.
Quantitation of Herpes simplex DNA in Blood during Aciclovir Therapy with Competitive PCR ELISA
Authors: Bezold Guntram , Gottlöber Petra , Leiter Ulrike , Kerscher Martina , Krähn Gertraud , Peter Ralf-Uwe
Published: April 2003

Background: Monitoring viral load in blood has already been introduced into clinical routine for human immunodeficiency virus and hepatitis C virus. Objective: This study was conducted to monitor the decline of herpes simplex (HSV) viral load in the blood of a patient with gingivostomatitis herpetica prior and during aciclovir therapy. Methods: Analysis was done by quantitative PCR ELISA using an internal quantitation standard. Results: Copy numbers were 66/µl blood prior to therapy, 60 during oral medication with valaciclovir, 97 and 72 copies/µl blood during the first 2 days of intravenous aciclovir therapy, followed by a sharp decline to 8 and 9 copies on days 3 and 4. During the following days, HSV was no longer detectable. Conclusion: As this quantitative approach can be easily adjusted to any other PCR, it provides a reliable, easy-to-apply method for monitoring therapy, also during new antiviral clinical trials.
Mucocutaneous Manifestations in Japanese HIV-Positive Hemophiliacs
Authors: Shimizu Satoko , Chen Ko-Ron , Tagami Hisamichi , Hanabusa Hideji
Published: April 2003

Background: Although various mucocutaneous manifestations have been reported in patients infected with HIV by sexual transmission or intravenous drug use, the prevalence and characteristics of skin disorders in HIV-positive hemophiliacs coinfected with hepatitits C virus (HCV) have rarely been described. Objective: The purpose of this study was to clarify the characteristics of skin disorders in HIV-positive hemophiliacs and to identify differences in comparison with other HIV-positive groups. Methods: A prospective study of the prevalence of mucocutaneous manifestations in 110 Japanese hemophiliacs (53 HIV-positive hemophiliacs including 24 AIDS and 57 HIV-negative hemophiliacs) was performed from July 1997 to July 1998. Result: None of the hemophiliacs developed Kaposi’s sarcoma or sexually transmitted skin diseases. Eosinophilic folliculitis was observed in 3 AIDS patients. The incidence of folliculitis, common warts, seborrheic dermatitis, generalized eczema, oral candidiasis and herpes zoster was higher in HIV-positive than in HIV-negative hemophiliacs (p < 0.05). Although anti-HCV antibody was positive in all HIV-positive hemophiliacs, HCV-related dermatoses such as lichen planus and porphyria cutanea tarda were not observed. Conclusion: Although Kaposi’s sarcoma and sexually transmitted skin diseases such as molluscum contagiosum, condyloma, and scabies are frequently associated with HIV, they were not found in the HIV-positive hemophiliacs in our study. HIV infection-related mucocutaneous manifestations are influenced not only by the presence of HIV but also by other factors such as the mode of transmission and sexual habit.
Pyridoxine-Induced Photosensitivity and Hypophosphatasia
Authors: Kawada Akira , Kashima Atsuko , Shiraishi Hatsuki , Gomi Hiroko , Matsuo Itsuro , Yasuda Kazuto , Sasaki Goro , Sato Seiji , Orimo Hideo
Published: April 2003

We describe a case of photosensitivity due to pyridoxine hydrochloride (vitamin B6) in a heterozygote of hypophosphatasia. Photopatch tests using pyridoxine hydrochloride and pyridoxal 5′-phosphate, compounds referred to as vitamin B6, with ultraviolet light A irradiation were positive. Laboratory examination showed low serum alkaline phosphatase. Tissue-nonspecific alkaline phosphatase exon amplification from DNA of the patient’s lymphocytes detected deletion 1154–1156 hypophosphatasia mutation, indicating that this patient was diagnosed to be a heterozygote of hypophosphatasia. The seric pyridoxal 5′-phosphate level of this patient with hypophosphatasia was higher than in normals. Furthermore, after oral administration of vitamin B6 this level increased greatly and long-lastingly, and this might be related to the low level of alkaline phosphatase in this patient. Photosensitivity in this patient may have been caused by abnormal metabolism of vitamin B6 under the hypophosphatic condition.
Pharmacoeconomic Evaluation of Calcipotriol (Daivonex®/Dovonex®) and UVB Phototherapy in the Treatment of Psoriasis: A Markov Model for The Netherlands
Authors: de Rie M.A. , de Hoop D. , Jönsson L. , Bakkers E.J.M. , Sørensen M.
Published: April 2003

Background: The high prevalence and chronic nature of psoriasis leads to high costs in relation to the treatment and control of the disease. A number of clinical trials have shown that a combination therapy of calcipotriol cream (Daivonex®/Dovonex®, Leo Pharmaceutical Products) and ultraviolet B phototherapy (UVB) decreases the total number of UVB exposures required compared to UVB treatment alone. From a societal point of view, the addition of calcipotriol to UVB therapy could achieve cost savings due to the fewer UVB treatments needed and the reduced travelling and time off work for patients. Fewer UVB exposures may also have other beneficial effects, i.e., shortened waiting lists and less risk to patients of developing cancer or photoaging of the skin. Objective: To compare the cost-effectiveness of treating psoriatic patients in the Netherlands with calcipotriol cream used daily combined with twice weekly UVB treatments to emollient used daily combined with UVB given 3 times weekly. Methods: Based on the clinical results from a Canadian trial, a decision-analytical model was constructed to simulate treatment outcomes and estimate the costs of managing psoriatic patients in the Netherlands over a period of 20 weeks from initiation of therapy. Unit costs and details of standard treatment protocols were collected from Dutch dermatology centres in hospitals and the community for use in the model. Other therapies, such as topical corticosteroids, tar or dithranol were not investigated in this analysis. Results: The total cost of managing psoriatic patients in the Netherlands over a 20-week period is estimated as EUR 1,175.90 for those treated with calcipotriol and UVB and EUR 1,212.14 for patients treated with emollient and UVB. Thus, the former treatment, adding calcipotriol to UVB phototherapy, provides a minor cost saving of EUR 36.24 (3%) compared to the cost of UVB treatment alone. Sensitivity analyses demonstrated that these results are sensitive to changes in the cost of UVB treatment. Conclusion: Calcipotriol treatment combined with UVB phototherapy is a cost-neutral alternative to UVB phototherapy used with an emollient. The patients achieve treatment success in the same time on both treatments but the former, with calcipotriol, requires less exposure to UVB radiation. The additional drug costs from using calcipotriol are offset by savings from the fewer UVB sessions required. Essential beneficial effects for patients are less inconvenience, less risk of developing photoaging of the skin and less exposure to potentially carcinogenic radiations.
Antiepiligrin Cicatricial Pemphigoid with Autoantibodies to the Beta Subunit of Laminin 5 and Associated with Severe Laryngeal Involvement Necessitating Tracheostomy
Authors: Seo Soo Hong , Kye Young-Chul , Kim Soo Nam , Kim Soo-Chan
Published: April 2003

We report the case of a 67-year-old Korean woman with antiepiligrin cicatricial pemphigoid. The patient’s serum immunoprecipitated polypeptides that comigrated with those identified in serum from a representative patient with antiepiligrin cicatricial pemphigoid, and was reactive with the laminin β3-subunit on immunoblotting. She presented not only with cutaneous, oral and ocular, but also with laryngeal and esophageal involvement. Because the supraglottic stenosis was severe, she had to undergo tracheostomy to maintain airway patency.
Bilateral Corneal Melting in a Patient with Paraneoplastic Pemphigus
Authors: Beele Hilde , Claerhout Ilse , Kestelyn Philippe , Dierckxens Laurence , Naeyaert Jean-Marie , De Laey Jean-Jacques
Published: April 2003

An 80-year-old man, with a solid abdominal tumor and multiple skin lesions, was admitted to the hospital because of a perforated right cornea and an impending perforation of the left. The clinical, histological, immunohistological and immunoprecipitation findings of the skin lesions were consistent with Anhalt’s criteria for paraneoplastic pemphigus (PNP). The underlying malignancy proved to be an incurable peripheral neuronal shaft tumor. Both conjunctivae appeared normal. The right eye revealed a flat anterior chamber, due to a spontaneous, central corneal perforation. The central part of the left cornea had severely thinned, resulting in a descemetocele, which eventually perforated. Multiple surgical interventions were needed to restore the anterior chamber in both eyes. Although a causative association between PNP and corneal perforation could not be demonstrated, we think that corneal melting should be added to the list of ocular complications in patients with PNP.
Microdialysis Can Detect Age-Related Differences in Glucose Distribution within the Dermis and Subcutaneous Adipose Tissue
Authors: Boschmann Michael , Murphy Frank P. , Krueger James G.
Published: April 2003

Background: Intrinsic (chronological) cutaneous aging is a continuous and complex process. Limitation in nutrient supply to the skin could contribute to this process. Objective: Our study focused on the impact of age on glucose supply to human skin and its distribution within the dermis and subcutaneous adipose tissue. Methods: An oral glucose load (100 g) was given to healthy volunteers of two age groups (24 ± 4 and 59 ± 10 years, n = 4 for each group). Dialysate concentrations of glucose and glycerol were monitored by microdialysis in the dermis and adipose tissue. Results: Baseline tissue [glucose] did not differ significantly between the two groups. After the glucose load, dialysate [glucose] of the dermis peaked between 60 and 80 min and between 80 and 120 min in the young and old groups, respectively. In the old group, dialysate [glucose] was significantly higher in the dermis than adipose tissue at 80, 100, 120, 160 and 180 min after the load. The sum of the areas under the curve (dermis + adipose tissue) did not differ significantly between the two age groups. Conclusions: Aging is accompanied by an increased diffusion barrier for glucose between the dermis and adipose tissue.
High-Dose Pulse Corticosteroid Therapy in the Treatment of Severe Alopecia areata
Authors: Seiter Simone , Ugurel Selma , Tilgen Wolfgang , Reinhold Uwe
Published: April 2003

Objective: The present monocenter prospective study was designed to evaluate the efficacy of intravenous high-dose methylprednisolone pulse therapy in patients with severe alopecia areata (AA). Methods: 30 patients (aged 14–56 years) were treated with methylprednisolone (8 mg/kg body weight) intravenously on 3 consecutive days at 4-week intervals for at least 3 courses. Results: 67% of patients with AA plurifocalis showed >50% regrowth of hair. None of the patients with AA totalis or universalis and only 1 patient with ophiasic AA responded to therapy. In patients with AA plurifocalis, higher response rates could be observed in those suffering from long-term disease compared to patients treated during their first episodes of AA (73 vs. 57%). Conclusion: High-dose methylprednisolone pulse therapy is an effective and well-tolerated treatment for patients with severe AA plurifocalis but might be less beneficial for patients with ophiasic AA, AA totalis or universalis.
A Case of Giant Extramammary Paget’s Disease of the Genital Area with Squamous-Cell Carcinoma
Authors: Tanabe H. , Kishigawa T. , Sayama S. , Tanaka T.
Published: April 2003

Extramammary Paget’s disease is a primary carcinoma with apocrine differentiation that begins within the epidermis. Extramammary Paget’s disease and squamous-cell carcinoma (SCC) have different neoplastic origins and are different both clinically and histologically. Until now the concurrence of extramammary Paget’s disease and SCC in the same area has not been reported to our knowledge. We report on a 76-year-old man with extramammary Paget’s disease affecting a large region of the genital area with SCC within the same area. A skin biopsy specimen showed the coexistence of typical Paget’s disease and highly differentiated SCC invading the dermis. Immunohistochemical staining of both cell types was completely different.
The Value of Hair Cosmetics and Pharmaceuticals
Authors: Trüeb R.M.
Published: April 2003

As early as can be traced, written documents testify endeavors shown by humanity to please by means of the hair. Hair care, color and style play an important role in people’s physical appearance and self-perception. Dermatologists should be knowledgeable about the procedures people follow to look their best and should have the competence to provide patients with information on the benefits and hazards of hair cosmetics and pharmaceuticals. Shampooing is the most common form of cosmetic hair treatment. The diversity of qualities expected from a shampoo by today’s consumer surpass the primary function of cleansing. Current shampoo formulations are adapted to the variations associated with hair quality, hair care habit and specific problems related to the superficial condition of the scalp. Hand in hand, test methods are developed to evaluate the efficacy of hair care products so that consumers are offered products that perform as claimed. Through the development of cosmetics with pharmaceutically active compounds, products are evolving that are becoming more similar to topical therapeutic agents (cosmeceuticals). The efficacy of cosmeceuticals that claim to act as hair growth stimulants should be measured by the standards set by the drugs minoxidil and, more recently, oral finasteride. Finally, health hazards associated with the use of hair care products, especially rinse-off products, have been overemphasized by the media and need careful correction by opinion leaders.
Solar Damage in Skin Tumors: Quantification of Elastotic Material
Authors: Moon Jong-Sub , Oh Chil-Hwan
Published: April 2003

Background: The elastotic changes of the dermis are thought to be the primary indicator of the cumulative sun exposure of the dermis. The changes of elastotic material have been evaluated by several previous methods, but these did not quantitatively measure the amount of elastic tissue. Objective: The purpose of this study was to quantify dermal elastosis and to assess the significance of sun exposure in the pathogenesis of nonmelanomatous skin tumors such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and Bowen’s disease (BD). Methods: Ninety-nine sections from biopsy specimens of histopathologically proven BCC, SCC and BD were stained with Verhoeff-van Gieson stains. We studied the amount of elastotic material adjacent to the tumor by image analysis. Results: There was a 3- to 4-fold increase in the amount of elastotic material in BCC and SCC compared to the sun-exposed skin of normal controls (p < 0.0001). The amount of elastotic material was increased 1.3 times in BD as compared with the nonexposed skins of normal controls (p < 0.01). Conclusion: We demonstrated a quantitative relationship between cumulative solar exposure and skin cancer such as SCC, BCC and BD.
Dual Diagnosis of Pemphigus and Pemphigoid
Authors: Sami Naveed , Ahmed A. Razzaque
Published: April 2003

Background: Pemphigus and pemphigoid are two distinct groups of autoimmune blistering diseases. There are many reports of the simultaneous presence of clinical and serological features of both diseases in the same patient. Objective: This study is a retrospective review of the present literature on reports of patients with features of both pemphigus and pemphigoid. We recommend that these patients be considered as having a dual diagnosis. Methods: A review of the English language, peer-reviewed literature was conducted on patients described with features of pemphigus and pemphigoid. Available data on clinical profile, histology, immunopathology, treatment, follow-up and outcome were studied in 30 patients. They were divided into three groups: (1) bullous pemphigoid and pemphigus vulgaris, (2) mucous membrane or cicatricial pemphigoid and pemphigus vulgaris and (3) bullous pemphigoid and pemphigus foliaceus. Results: In all three groups, most patients had a clinical phenotype resembling both diseases. In 17 patients with bullous pemphigoid and pemphigus vulgaris, 83% had a skin biopsy consistent with bullous pemphigoid, 70% had direct immunofluorescence studies typical of bullous pemphigoid and sera of 83% had antibodies typical of pemphigus vulgaris on indirect immunofluorescence. In 10 patients with mucous membrane or cicatricial pemphigoid and pemphigus vulgaris, a histology of mucous membrane pemphigoid was reported in 60% of the patients, direct immunofluorescence studies typical of mucous membrane pemphigoid were reported in 70% of the patients and in 80%, autoantibodies characteristic of pemphigus vulgaris were observed. In 3 patients with bullous pemphigoid and pemphigus foliaceus, the histologies were consistent with bullous pemphigoid, direct immunofluorescence was typical of pemphigus foliaceus and their sera had both autoantibodies. The majority of the 30 patients required long-term high-dose corticosteroids and immunosuppressive agents to control their disease. Three patients with bullous pemphigoid and pemphigus vulgaris (18%) died due to effects of prolonged immunosuppression. Conclusion: We characterize a group of patients who have clinical, histological and immunopathological features of bullous or mucous membrane or cicatricial pemphigoid with serological features of pemphigus. These patients did not achieve a prolonged clinical remission by conventional therapy. It is possible that early identification of these patients may improve their prognosis.
Assessment of the Water Content of the Stratum corneum Using a Sorption-Desorption Test
Authors: Agache P. , Mary S. , Muret P. , Matta A.M. , Humbert P.
Published: April 2003

Background/Aim: Various instruments based on electrical properties of the skin are currently used to assess the stratum corneum (SC) hydration state or water holding capacity. However, no direct relation with the quantity of water measured is provided. The objective of the present study was to calibrate the Corneometer, a device displaying electrical-capacitance-related values (which reflect the skin hydration state), and the amount and behaviour of the water taken up by the outer part of the SC during a sorption-desorption test. Methods: The experiment was performed on the ventral forearms of 20 healthy volunteers after a rest in an environmentally controlled room. Corneometer and transepidermal water loss (TEWL) values were measured at intervals over the desorption process. The areas under the TEWL-versus-time curve provided the absolute amounts of residual sorbed water. Results: The decrease kinetics of both signals after subtraction of prehydration values were very similar and bi-exponential, both showing a rapid, then a slower phase. The absolute amount of water taken up by the SC (hygroscopicity) and the two desorption rates were obtained. The Corneometer values were mono-exponentially related to the amount of water remaining within the SC. This allowed the in vivo calibration of the Corneometer in terms of absolute amount of water over the desorption range. Conclusion: The method may be used to calibrate in vivo other electrical devices aimed at assessing SC hydration during a sorption-desorption test. It may also provide new ways to measure SC water uptake and water holding capacity following application of products.
Swelling of the Proximal Nail Fold Caused by Underlying Warts
Authors: Läuchli Severin , Eichmann Alfred , Baran Robert
Published: April 2003

We report on 2 cases of patients with warts underlying the proximal nail fold which presented as tender erythematous nodules. The remarkable feature in both cases was a significant oedema of the proximal nail fold, resembling a reaction to a foreign body. One patient responded well to mild keratolytic treatment. The second patient was treated surgically with crescentic excision of the distal portion of the proximal nail fold. It is important to recognise this tumour variant in order to avoid unnecessary or excessive intervention.
Persistent Plaques and Linear Pigmentation in Adult-Onset Still’s Disease
Authors: Suzuki K. , Kimura Y. , Aoki M. , Takezaki S. , Tuchida T. , Takano T. , Kawana S.
Published: April 2003

A 25-year-old Japanese man presented with high spiking fever, arthralgia and a skin rash. A pruritic edematous erythema with persistent plaques was found mainly on the trunk; these lesions persisted even when the fever subsided, with prominent linear pigmentation. As marked neutrophilia and a high level of serum ferritin were detected, a diagnosis of adult-onset Still’s disease (AOSD) was made, even though the persistent eruption was not characteristic of the disease. Oral prednisolone, together with low-dose methotrexate, was given with good results. In the literature, a similar atypical rash has been reported in 11 cases in Japan. All of them required high-dose administration of corticosteroids or other immunosuppressive agents. Severe systemic complications were seen in 3 patients, and 2 cases died of the disease. Persistent plaques and linear pigmentation are some of the manifestations of AOSD, which cannot be overlooked. This appearance could be an indication that suggests an increased risk of systemic complications and a prolonged time to clinical remission.
Bazex Syndrome
Authors: Buxtorf Konstantine , Hübscher Eugen , Panizzon Renato
Published: April 2003

Bazex syndrome is a paraneoplastic acrokeratosis appearing mostly at the same time as the underlying neoplasm. We report a typical case with a squamous cell carcinoma of the tongue and classical cutaneous symptoms disappearing with the treatment of the tumour.
Human Herpesvirus 8 DNA in the Skin and Blood of Patients with Mediterranean Kaposi’s Sarcoma: Clinical Correlations
Authors: Boneschi Vinicio , Brambilla Lucia , Berti Emilio , Ferrucci Silvia , Corbellino Mario , Parravicini Carlo , Fossati Silvia
Published: April 2003

Background: Kaposi’s sarcoma is a multifocal lympho-angioproliferative disease that appears in elderly subjects of Mediterranean origin (classical form), young Africans and immunodepressed patients (as a result of organ transplantation or AIDS). In 1994, DNA sequences of a new human herpesvirus, called HHV-8, were detected in skin lesions and peripheral blood of patients with AIDS-related Kaposi’s sarcoma by confirmational display analysis and polymerase chain reaction. Objective: As HHV-8 in peripheral blood mononuclear cells is detected in about 50% of Mediterranean Kaposi’s sarcoma patients and its presence fluctuates in time in the same patient, maybe its detection correlates with the clinical behaviour of the disease. Methods: By using routine and nested polymerase chain reaction we evaluated the presence of HHV-8-specific DNA sequences in the skin lesions, perilesional healthy skin and peripheral blood mononuclear cells of a group of 40 HIV-negative patients with Mediterranean Kaposi’s sarcoma. Results: HHV-8 DNA sequences have been found in 40/40 (100%) lesional skin of Mediterranean Kaposi’s sarcoma, in 35/40 (85%) perilesional apparently normal skin and in 24/40 (60%) peripheral blood monuclear cell samples. The results of polymerase chain reaction on peripheral blood monuclear cells were positive in 41% of the patients with slowly evolving disease as opposed to 74% of those with rapidly evolving disease, and in 47.6% of the patients with stage I–II disease as opposed to 73.6% of those with stage III–IV. Conclusion: The detection of HHV-8 in peripheral blood monuclear cells seems to correlate with the more aggressive stages and the rapid evolution behaviour of Mediterranean Kaposi’s sarcoma.
Safe and Effective Treatment of Refractory Facial Lesions in Atopic Dermatitis Using Topical Tacrolimus following Corticosteroid Discontinuation
Authors: Kawakami Tamihiro , Soma Yoshinao , Morita Eishin , Koro Osamu , Yamamoto Syoso , Nakamura Koichiro , Tamaki Kunihiko , Yajima Kenji , Imaizumi Akiko , Matsunaga Ruri , Murakami Noboru , Kashima Masato , Mizoguchi Masako
Published: April 2003

Background: Topical corticosteroids are commonly applied in atopic dermatitis (AD) treatment. However, their chronic use may be associated with significant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, when application of corticosteroids is discontinued, a rebound phenomenon in the facial lesions can occur within several days. Topical tacrolimus, an immunosuppressant currently used to prevent rejection after solid-organ transplantation, presents a potential alternative therapeutic agent for AD. Objective: The present study is the first trial designed to evaluate the efficacy and safety of topically applied tacrolimus ointment after corticosteroid discontinuation without a washout phase in severe, long-term facial AD. Patients/Methods: Forty-seven patients with facial refractory AD were recruited, of whom 38 had undergone topical corticosteroid treatment for at least 4 weeks before enrollment (group 1) and the other 9 had not received steroid treatment (group 2). All 47 patients received 0.1% tacrolimus ointment, and the severity index and pruritus score were assessed as an AD clinical activity index every week and compared with baseline data. Results: Both the severity index and pruritus score improved significantly in group 1 after 1 and 2 weeks of application (p < 0.01, respectively). Group 2 showed the greatest improvement at 4 weeks (p < 0.05). In this trial, none of the patients experienced a rebound phenomenon associated with tacrolimus treatment. A transient sensation of burning at the application site was the only adverse event in 31 of the 47 (66%) enrolled patients, but this condition improved after several days. Spectrophotometric assessment of the facial lesion following treatment revealed significant improvement in group 1 (p < 0.05). Conclusion: The present results indicate that topical tacrolimus treatment following corticosteroid discontinuation is safe and effective in refractory facial AD.
The Dermatoscopic Pattern of Clear-Cell Acanthoma Resembles Psoriasis vulgaris
Authors: Blum Andreas , Metzler Gisela , Bauer Jürgen , Rassner Gernot , Garbe Claus
Published: April 2003

Background: Dermatoscopy (dermoscopy, epiluminescence microscopy) is used for the early detection of malignant tumors and avoidance of unnecessary excisions of benign skin tumors. Objective: Description of the dermatoscopic pattern of clear-cell acanthoma. Methods: Video dermatoscopy at 20-fold magnification of a clear-cell acanthoma and psoriasis vulgaris. Results: Homogeneous, symmetrically or bunch-like arranged, pinpoint-like capillaries were seen in the clear-cell acanthoma and in psoriasis vulgaris. Conclusion: The dermatoscopic psoriasis-like pattern of clear-cell acanthoma is a diagnostic clue which may help the clinician to identify this benign epidermal tumor and to differentiate it from other benign and malignant tumors of the skin.
Late-Onset Eccrine Angiomatous Hamartoma: Clinical, Histological and Imaging Findings
Authors: Laeng R. Hubert , Heilbrunner J. , Itin Peter H.
Published: April 2003

Eccrine angiomatous hamartoma (EAH) is an exceedingly rare benign tumor-like lesion prevalent in childhood which may produce pain and marked sweating. Although an aggressive treatment is not generally indicated, surgery may be considered in severe cases. In this report we present novel morphological findings by immunophenotyping, document the first MRI findings in EAH and emphasize the importance of preoperative imaging of such lesions.
Topical Metronidazole Does Not Abate UVB-Induced Erythema
Authors: Guarrera Marcella , Brusati Carlo , Rebora Alfredo
Published: April 2003

Background: The capacity of topical metronidazole to reduce erythema severity scores in rosacea has been attributed to its anti-inflammatory activity. Methods: Nine healthy subjects were irradiated on three 1-cm2 areas on their volar forearm with 2 MEDs of UVB. Twenty-four hours later, one of the irradiated areas was treated daily with metronidazole 1% vanishing cream, one with the vehicle only and the third was left untreated (control). The intensity of erythema was measured, at 24, 48, 72 and 96 h after irradiation, by a Chromameter CR200 (Minolta, Japan) and expressed in the L*a*b* system. The a* parameter was taken as the measure of redness. Results: Overall, redness diminished over time in a linear way, but treatments did not influence it significantly. Conclusion: In our vehicle, metronidazole 1% cream failed to abate the UVB-induced erythema. An activity other than the anti-inflammatory one should be suggested to explain the topical metronidazole efficacy in rosacea.
Treatment of Psoriasis with a New Combination of Calcipotriol and Betamethasone Dipropionate: A Flow Cytometric Study
Authors: van Rossum M.M. , van Erp P.E.J. , van de Kerkhof P.C.M.
Published: April 2003

Background: Calcipotriol and corticosteroids are established topical antipsoriatics. Previous studies have shown that combined therapy with calcipotriol and betamethasone dipropionate was more effective than monotherapy. In the present study, a recently developed combination product of calcipotriol and betamethasone dipropionate was compared with both monotherapies and the vehicle. Methods: Twenty-five psoriatic patients were treated twice daily with the combination product, monotherapy or vehicle during 4 weeks. Skin biopsies, taken before and after treatment, were analysed using a multi-parameter flow cytometric method. Parameters of inflammation (vimentin-positive cells), normal differentiation (keratin-10-positive cells) and proliferation (cells in SG2M-phase) were assessed. Results: Flow cytometric analysis showed that the combination product turned out to be more effective in reducing inflammation compared with the other treatments. Restoration of normal differentiation was more advanced in patients treated with the combination product or betamethasone dipropionate compared to the vehicle. The highest number of normally differentiated cells was seen after use of the combination product. All treatments, except for the vehicle, decreased hyperproliferation. Conclusion: This study shows that the combination product is a valuable new approach to the treatment of psoriasis.
Alopecia areata and Affected Skin CRH Receptor Upregulation Induced by Acute Emotional Stress
Authors: Katsarou-Katsari Alexandra , Singh Leena K. , Theoharides Theoharis C.
Published: April 2003

Background: Recent evidence indicates that acute stress can precipitate a number of dermatological conditions, including alopecia areata. This effect may be mediated by corticotropin-releasing hormone (CRH) released locally in the skin from dorsal root ganglia or immune cells. CRH typically acts through activation of specific receptors that are either type 1 or types 2α and 2β. CRH, or related peptides such as urocortin, could have proinflammatory effects directly or through activation of mast cells leading to destruction of the hair root. Objectives: To investigate the expression of CRH receptors on the affected skin of patients who developed alopecia areata following acute emotional stress. Methods: Scalp skin biopsies were obtained from 1 normal volunteer and 3 patients after ring infiltration of the relevant site with lidocaine. The biopsies were frozen and were later processed for in situ hybridization for CRH receptors type 1 or types 2α and 2β. Sections showing positive results were photographed. Results: The skin from the normal volunteer showed weak background expression of all three receptor types. However, skin from the affected sites of all 3 patients studied showed intense expression only on the type 2β receptor around the hair follicles. Conclusion: Acute emotional stress may precipitate alopecia areata by activation of overexpressed type 2β CRH receptors around the hair follicles leading to intense local inflammation.
Polishing-Paste-Induced Silica Granuloma of the Gingiva
Authors: Lombardi T. , Kuffer R. , Dubrez B.
Published: April 2003

Polishing-paste-induced silica granuloma of the gingiva, an uncommon condition, may mimic various local or systemic pathological entities. A 33-year-old woman and a 42-year-old man were referred for a localised refractory gingival inflammation. Clinical diagnoses included allergy, lichen planus and herpes. Biopsy showed well-demarcated non-caseating granulomas, associating epithelioid and Langhans giant cells. Special bacterial and mycological stains were negative. Systemic examination and laboratory tests ruled out sarcoidosis and Crohn’s disease. Polarised light revealed birefringent crystalline foreign material. A diagnosis of silica granuloma was made. Both patients had frequent dental hygiene treatment including polishing with abrasive paste, suggesting an iatrogenic implantation of the foreign bodies. Gingival damage can result from the use of some dental materials containing silica. Often asymptomatic, sometimes producing visible lesions, granulomatous gingivitis may mislead into wrong diagnosis and treatment. Old silica granulomas may become symptomatic if the patient contracts sarcoidosis.