bluuebunny/crossref_metadata_2025 huggingface dataset:
FATAL CHICKENPOX IN A PATIENT WITH NEPHROTIC SYNDROME
Authors: MATÉ EVA S. , FISHER BENJAMIN K.
Published: May 2007

Background. We report our experience with two patients with adult onset of chickenpox in the setting of longstanding steroid therapy for nephrotic syndrome. Ours is a 430‐bed tertiary care teaching hospital. The Wellesley Hospital, Toronto, Ontario. Both patients presented as self‐referrals to the emergency department.

Methods. The clinical suspicion of chickenpox was rapidly confirmed in both cases by a Tzanck smear preparation, by viral cultures of the vesicle, serology, and skin biopsy. In both patients therapy with high dose acyclovir, 10 mg/kg q8h, intravenously, was instituted based on clinical presentation.

Results. Delay in clinical recognition and treatment in our first case resulted in death due to multiorgan failure (MOF). Improved awareness and rapid treatment of the second patient had a favorable outcome with no sequelae.

Conclusions. Chickenpox is not only a childhood illness. Although rare in the adult population, it is associated even in the nonimmunocompromised host with increased morbidity and mortality. Steroid therapy predisposes to early dissemination and a potentially fatal outcome. Adults with immunosuppression should receive prompt systemic treatment with acyclovir.
LEISHMANIASIS RECIDIVA CUTIS IN AMERICAN CUTANEOUS LEISHMANIASIS
Authors: BITTENCOURT ACHILÉA L. , COSTA JACKSON M.L. , CARVALHO EDGAR M. , BARRAL ALDINA
Published: May 2007

Background. Leishmaniasis recidiva cutis (LRC) consists of active lesions around or inside the scar of classical cutaneous leishmaniasis (CL). In the literature it is considered as an hyperergic form of CL because the patients show a strong response to intradermal testing with leishmania antigen and, histologically, the parasites are scarce or absent; a well‐organized granuloma is always observed.

Methods. Three patients from Bahia (Brazil) with LRC were evaluated by clinical examination, biopsies, skin tests with leishmania antigen, serology, and culture. In addition, a specific lymphocyte blastogenesis test was done and the species of leishmania characterized.

Results. The disease was caused by both L. amazonensis and L braziliensis and serological titers varied from 1/16 to 1/64. The patients presented histologic and immunologic aspects different from those referred to in the literature. From four biopsies obtained only two presented a granulomatous reaction and parasites varied from absent to a parasite index 3. In one patient an absence of T cell response to leishmania antigen was observed in the first evaluation with restoration of the response after cure. In the other two, the degree of the specific proliferative response was lower than that usually observed in patients with classical CL.

Conclusions. These findings indicate that New World LRC can not be considered a hyperergic form of CL. With respect to its clinical aspects and response to treatment, LRC must be considered as an entity different from the classical CL.
AMERICAN CUTANEOUS LEISHMANIASIS: INTERMEDIATE FORM
Authors: HALMAI‐STUPAR OLGA , AROSEMENA‐SARKISSIAN REYNALDO , PAEZ ERICA , WEISS EDUARDO , RONDON ANTONIO
Published: May 2007

A man of Portuguese nationality presented with increased volume of the forehead and multiple pustules, which subsequently ulcerated. The pustules appeared progressively on the rest of the face and in the right scapular region during a period of 2 years.

Physical examination revealed multiple rounded ulcers of different sizes with erythematous and infiltrated borders covered by serosanguineous scabs on the face and right scapular region (Figs. 1 and 2).

The otorhinolaryngologic examination showed an infiltrate of granulomatous aspect in the anterior third of the septum. Posterior rhinoscopy was normal.

When the patient was first seen, complete hematology and hepatic and renal tests were normal. Additional tests included: HIV, nonreactive; venereal disease reference laboratory test, nonreactive; chest x‐ray, normal; Montenegro skin test, 14 mm; purified protein derivative, 0 mm.

The skin biopsy revealed a granulomatous infiltrate with a dense infiltrate composed principally of plasmocytes, with few lymphocytes (Fig. 3).

A skin smear stained with Giemsa and culture of biopsy material in blood agar were positive for the presence of Leishmania. Antibodies against Leishmania measured in an ELISA test were strongly positive, titer 1:6400. Typing of the isolate using absorbed polyclonal antisera revealed Leishmania braziiiensis.

During hospitalization, the patient received systemic immunotherapy with a combined vaccine containing heat‐killed Leishmania mexicana promastigotes and bcg,1,2 as well as chemotherapy with meglumine antimoniate in a dose of 50 mg/kg/day IM, two cycles of 20 days with an in‐terval of 7 days of rest.

The patient presented clinical healing of his lesions without relapse during a 2 year follow up after completion of therapy.
ROLE OF EMOTIONAL FACTORS IN ADULTS WITH ATOPIC DERMATITIS
Authors: GINSBURG IONA H. , PRYSTOWSKY JANET H. , KORNFELD DONALD S. , WOLLAND HENRIETTA
Published: May 2007

Background. The role of anger in the onset or perpetuation of episodes of atopic dermatitis in adults has long been considered an important factor. The objective was to investigate whether atopic patients feel ineffective in dealing with anger and assertiveness when compared with psoriasis patients and control patients.

Methods. Thirty‐four adult patients with atopic dermatitis were compared to 28 patients with psoriasis and 32 controls, dental patients without major skin disease. Standard measures of anxiety, anger, assertion, depression, and locus of control as well as a measure of anger effectiveness, designed for this study, were used.

Results. There were significant differences between atopic dermatitis patients and controls in that atopics felt angry more readily but were less likely to express it, were more anxious and less assertive, and felt less effective in expressing anger. The only difference between psoriasis patients and controls was less ability to express anger. Atopic patients were more chronically anxious than those with psoriasis.

Conclusions. Adult atopic dermatitis patients are often chronically anxious and feel ineffective in handling anger which suggests that psychological interventions may prove helpful.
STUDY OF THE PARTNERS OF WOMEN WITH HUMAN PAPILLOMAVIRUS INFECTION
Authors: KOKELJ FRANCO , BARAGGINO EZIO , STINCO GIUSEPPE , WIESENFELD URI
Published: May 2007

Background. Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases, and it has been identified as a significant risk factor for the development of dysplasia and cancer of the uterine cervix. The possible influence of male HPV lesions on female cervix oncogenesis has not been elucidated so far. In the present study we evaluate the male partners of women with clinical or subclinical HPV infection with particular interest in the clinical features of this infection in both partners.

Methods. We examined 81 male partners of women affected with human papillomavirus infections. Condylomata acuminata were searched for by visual inspection. Subclinical lesions were searched by 5 power optical magnification lens after application of 5% acetic acid.

Results. In men we observed the following percentage of infection: 67% of the partners of women affected with condylomata acuminata, 46% of the partners of women affected with subclinical lesions (acetic acid positive), and 40% of the partners of women with association of HPV and cervical intraepithelial neoplasia.

Conclusions. Our data stress that very often the partners of women with HPV subclinical infection, especially when associated with CIN, do not present lesions, and consequently primary prevention may be very difficult.
XERODERMA PIGMENTOSUM VARIANT: DNA PLOIDY ANALYSIS OF VARIOUS SKIN TUMORS AND NORMAL‐APPEARING SKIN IN A PATIENT
Authors: CHI HYUNG‐IN , KAWACHI YASUHIRO , OTSUKA FUJIO
Published: May 2007

Background. The patient with xeroderma pigmentosum provides an appropriate human model for the evaluation of tumor development and progression.

Methods. We describe a patient with variant‐type xeroderma pigmentosum who developed actinic keratoses, a squamous cell carcinoma, and its metastasis into a lymph node. DNA ploidy was measured and analyzed in cells of these tumors and the patient's sun‐exposed as well as sun‐shielded skin.

Results. The sun‐shielded skin showed a normal diploid dna distribution pattern, while the sun‐exposed skin had an increased number of hyperdiploid cells. The actinic keratosis showed further increased hyperdiploid cells. The squamous cell carcinoma showed a large number of hyperdiploid cells and formed an aneuploid cell fraction. Histographically, the aneuploid cell fraction became more apparent and was revealed to be a major fraction in the metastatic squamous cell carcinoma.

Conclusions. The changes in the DNA ploidy pattern well reflect the clinical and histologic characteristics of the respective skin conditions and likely provide the cellular basis for the sequential or stepwise carcinogenic process in the patient's xeroderma pigmentosum skin. Further studies are necessary to determine whether the present results explain the similar carcinogenic process in sun‐damaged skin of the nonpredisposed general population.
SENILE DRY SKIN TYPE SJÖGREN'S SYNDROME
Authors: ASO KAZUO
Published: May 2007

Background. Elderly patients may show asteatotic dermatitis complicating Sjögren's syndrome (sjs) that we have named “senile dry skin type sjs.” To define the condition further, we have examined a group of patients with sjs and have recorded clinical and laboratory findings in these patients.

Patients and Materials. Of the 36 patients, 11 were men and 25 were women, with a mean age of 72 years. In addition to the subjective sensation of dryness of the eyes and oral cavity and objective signs of dryness revealed by the Schirmer test, the rose bengal test, minor labial gland biopsy, and sialography were carried out, as well as other hematologic and immunologic tests.

Results. The following abnormal laboratory tests were found: elevated erythrocyte sedimentation rate (85%), mild hepatic dysfunction (50%), and anemia (45%), leukopenia (42%), and thrombocytopenia (16%). Immunologic abnormalities were also observed, such as: positive antinuclear antibody (55%), an increase in gamma globulin (28%), and a positive rheumatoid factor (20%). In 11 of the 36 patients (30%), the subjective sensation of dryness was absent and only objective signs of dryness were present.

Conclusions. The present study suggests that dry–skin–dermatitis associated with sjs is rather common in the elderly.
BOOK REVIEW
Authors: BEERMAN HERMAN
Published: May 2007

Book review in this article:

Management and Treatment of Benign Cutaneous Vascular Lesions. Oon Tian Tan
THE RELATIONSHIP BETWEEN FACIAL WRINKLING AND AIRFLOW OBSTRUCTION
Authors: LANGE PETER , SCHNOHR PETER
Published: May 2007

Background. Similar smoking‐related changes in the collagen and elastin could play a role in the pathogenesis of both skin wrinkling and chronic airflow obstruction. The hypothesis was tested by analyzing whether increased facial wrinkling, especially in smokers, is associated with the presence of airflow obstruction.

Methods. An age‐stratified randomized sample of the general population comprising 6034 men and 7152 women between 30 and 80 years of age was analyzed. The recording of wrinkling in the crow's foot area of the right eye was performed according to an earlier described severity score. As an index of airflow obstruction, we used the ratio between forced expiratory volume in 1 s and forced vital capacity in percent (FEV1/FVC%).

Results. Multiple regression analysis comprising current and previous smokers showed that, after controlling for age, subjects with highest wrinkle scores had on average FEV1/FVC% that was 1.2–1.9% lower than in subjects with lower wrinkle scores. No association between facial wrinkling and airflow obstruction was observed among lifetime nonsmokers.

Conclusions. Increased facial wrinkling is independent of age when associated with airflow obstruction in smokers, but not in never‐smokers. The magnitude of this association, however, is small.
MELANOCYTE RESERVOIR IN VITILIGO
Authors: ARRUNATEGUI ADRIANA , ARROYO CESAR , GARCIA LUCY , COVELLI CLAUDIA , ESCOBAR CARLOS , CARRASCAL EDWIN , FALABELLA RAFAEL
Published: May 2007

Background. Dopa‐negative, inactive melanocytes, present in the middle portion of the hair follicle, but also in hair bulbs, have been reported as a source of pigment cells, when repopulation of epidermal melanocytes occurs. A melanocyte reservoir in these anatomical sites has been suggested. Our objective was to investigate the ability of the lower third of the hair follicle (hair bulb) to repigment achromic skin in vitiligo.

Methods. Scalp hair bulbs were transplanted within leukodermic areas in 10 patients with vitiligo.

Results. Repigmentation around the grafts was suitable for evaluation in four cases. Dopa‐positive (+) cells were seen in the epidermal basal cell layer of the repigmented areas.

Conclusions. Although these findings were observed only in a few patients, they suggest that melanocytes from the implanted lower third portion of the hair follicle (hair bulb) act as a reservoir in this anatomic location and are able to migrate and repigment achromic areas in vitiligo.
CHRONIC MENINGOCOCCEMIA IN AN IMMUNOCOMPETENT GIRL
Authors: PENA JOSEFINA , MÉNDEZ‐BUSTELO MARÍA J. , DEL‐RÍO EMILIO
Published: May 2007

A 13‐year‐old healthy girl consulted with a 4‐week history of recurrent fever (39–40°C) and erythematous macules and plaques on the distal parts of her legs and forearms, and the palms and soles, A migrating arthritis developed on the left ankle and, later, on the knees, elbows, wrists, and hand joints. General symptoms included anorexia, malaise, and weight loss.

Physical examination revealed several erythematous macules, plaques, and nodules, 1–3 cm in diameter, located on the anterior and posterior aspects of the legs, soles, forearms, dorsum of the hands, and palms (Fig. 1), Some lesions showed very small petechiae and vesicles in the center. The nodules in acral locations were painful.

A hemogram displayed mild anemia (hemoglobin 11.3 g/dL) and leukocytosis (11,500 WBc/mm3). The erythrocyte sedi‐mentation rate was 63 mm in 1 hour. Serum biochemistry, protein and protein fractions, and fractions of immunoglobu‐lins were within normal limits. Urinalysis showed microhe‐maturia and a few leukocytes. Two serial blood cultures were taken during the first two febrile peaks after admission, but both were negative. A third one (1 week after admission) was positive for group B Neisseria meningitidis. This bacterium was also recovered from pharyngeal samples, but was not isolated in the culture of cerebrospinal fluid.

Antibiotic therapy was established with intravenous cephtriaxone, 100 mg/kg/day for 10 days, with dramatic im‐provement of the fever and arthritis within 3 days. The cu‐taneous lesions disappeared within 1 week.

Some of the components of complement proteins (C3, C4, and C5) were measured to rule out any deficiency, but they were normal. A normal value of CH50 supported the adequate presence of all of the components of the mem‐brane attack complex (C6 to C9) in the serum.

Several relatives of the patient were found to be oropha‐ryngeal carriers of group B Neisseria meningitidis. They were treated successfully with rifampin (20 mg/kg/day for 2 days).
CHRONIC BULLOUS DERMATOSIS OF CHILDHOOD: DIFFERENTIATION FROM OTHER AUTOIMMUNE BLISTERING DISEASES IN CHILDREN
Authors: TSE YARDY , LIM HENRY W.
Published: May 2007

An 8‐year‐old girl presented with a 1‐week history of intensely pruritic vesicles and bullae on the trunk and extremities. The patient was otherwise in good health and was not taking any medications.

Physical examination revealed multiple large, tense bullae on normal‐appearing skin on the trunk, extremities, and pelvic region. Some of the bullae were hemorrhagic, while others were grouped in circular clusters (Fig. 1A, B). The oral cavity and conjunctivae were spared. Complete blood cell count, electrolytes, serum urea nitrogen, creatinine, and liver function studies were normal.

Histopathologic examination of perilesional skin demonstrated a subepidermal blister with neutrophils in the dermal papillae (Fig. 2). Direct immunofluorescence of the specimen showed heavy deposition of IgA in a linear pattern in the basement membrane zone (Fig. 3). Broad but faint deposits of IgM were also present. Blood obtained for indirect immunofluorescence revealed no circulating autoantibodies.

The patient was diagnosed with chronic bullous dermatosis of childhood and treated with dapsone (2 mg/kg) with dramatic improvement. New blister formation and puritis were suppressed within several days. All lesions healed with mild hyperpigmentation but without scarring.
MAURICIO GOIHMAN‐YAHR, M.D., PH.D., EDITOR
Authors: Al‐Aboosi M. , Abalkhail A.
Published: May 2007

riie Correspondence Section serves as a forum for opinion exchange about subjects of general in‐terest such as ciermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihmau‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, PL 33102.
EFFECT OF PROLONGED TREATMENT WITH LEVAMISOLE ON VITILIGO WITH LIMITED AND SLOW‐SPREADING DISEASE
Authors: PASRICHA J.S. , KHERA VIKAS
Published: May 2007

Background. For an effective treatment of vitiligo, it Is as important to arrest the progression of the disease (if it is still active) as it is to induce repigmentation in existing lesions. In patients having limited and slow‐spreading vitiligo, we evaluated the efficacy of levamisole to control the activity of the disease process and to induce repigmentation of the vitiliginous areas.

Methods. Levamisole was given to 64 patients in an oral dose of 150 mg on two consecutive days every week for periods varying from 4–48 months. In 14 patients levamisole was used alone, in 38 patients it was combined with topical 0.1% fluocinolone acetonide acetate ointment massaged on the lesions once a day, and in 12 patients it was combined with topical 0.05% clobetasol propionate used in the same way. There was no other adjuvant therapy.

Results. In 34 of the 36 patients (94%) having active disease, the progression of the disease could be arrested within 2–4 months. A variable degree of spontaneous repigmentation of the vitiliginous areas was seen in 9 patients (64%) treated with levamisole alone, 33 patients (87%) treated with levamisole and topical fluocinolone, and all the 12 patients treated with levamisole and topical clobetasol.

The side effects with levamisole were minimal except in two cases where treatment had to be discontinued. Topical fluocinolone was fairly safe in the Indian patients, but clobetasol frequently produced atrophy and telangiectasia.

Conclusions. Levamisole seems to be a simple, safe, and fairly effective remedy for controlling the activity of the disease process in vitiligo patients who have limited and slow‐spreading disease. Some patients develop spontaneous repigmentation as well. To achieve a faster rate of repigmentation, levamisole can be combined with other treatment methods such as topical corticosteroids.
CORRESPONDENCE
Authors: GOIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general in‐terest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology gjid medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Coihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
ALBERT'S SOLUTION VERSUS POTASSIUM HYDROXIDE SOLUTION IN THE DIAGNOSIS OF TINEA VERSICOLOR
Authors: PAYLE BRUCE , SERRANO LOURDES , BIELEY HARLAN C. , REYES BLAS A.
Published: May 2007

Background. The diagnosis of tinea versicolor can usually be made by clinical examination. Either potassium hydroxide (KOH) or Wood's light fluorescence are used to corroborate the diagnosis. Albert's solution has been reported as a method of visualizing dermatophytes. We compared Albert's solution to KOH in the diagnostic evaluation of tinea versicolor.

Methods. Twenty patients with clinical tinea versicolor were examined for the presence of hyphae and/or spores utilizing Albert's solution or KOH (20%) with dimethyl sulfoxide.

Results. All patients were positive for hyphae and/or spores by both methods. Preparations with Alberts' stains were faster and easier to read.

Conclusions. Albert's solution is an alternate method to stain for fungal elements in patients with tinea versicolor.
FULMINANT HEAD AND NECK CONGESTION IN ADVANCED CUTANEOUS T CELL LYMPHOMA: A POOR PROGNOSTIC INDICATOR
Authors: MCFALLS SUSAN G. , COHEN JONATHAN , BERMAN BRIAN , KERDEL FRANCISCO A.
Published: May 2007

Background. Clinical factors associated with a poor prognosis in patients with cutaneous T cell lymphoma (CTCL) include the extent and type of skin involvement and the presence and extent of lymphadenopathy.

Materials. We report retrospectively the clinical course and survival time of four patients with advanced CTCL after the development of fulminant head and neck congestion.

Methods. All four patients presented with marked erythema and edema of the head and neck with marked cervical adenopathy. Treatment with multidrug chemotherapy and radiation induced only brief remissions. The clinical picture was felt to be due to extensive tumor infiltration of the skin as well as lymphatic compression due to cervical adenopathy rather than venous compression at the level of the mediastinum. Survival from onset of this fulminant head and neck congestion was 1–5 months.

Conclusion. Development of this fulminant head and neck congestion in patients with advanced CTCL heralds a progressively deteriorating clinical course with a poor prognosis.
Sucessful Treatment of Multiple Drug Resistance with Ofloxacin in a Leprosy Patient
Authors: GOIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic traning, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climaic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Originality is highly desirable and repititious contributions or minutiae are discouraged. We wish also to foster submission of hypotheses marked accordingly. These should be based on reality and should stimulate thought. Contributions should conform to the format for correspondence as outlined in, “Notice to Contributors,” Manuscripts will undergo standard etitorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Section Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
TINEA VERSICOLOR OF THE SCALP
Authors: EL‐GOTHAMY ZENAB , GHOZZI MOHAMMAD
Published: May 2007

Background. Tinea versicolor (TV) is commonly described on the trunk without giving attention to involvement of the scalp. We examined cases with dandruff with and without TV on the body to see how frequent Malassezia furfur (M. furfur) is present in dandruff scales.

Methods. A total of 80 patients were examined mycologically using KOH preparation for the presence of M. furfur in dandruff scales.

Results. M. furfur was found in dandruff scales in 7 out of 20 men with TV (35%) and 5 out of 20 women with TV (25%), whereas it was absent in another 40 cases without clinical lesions of TV on the body.

Conclusions. Attention must be paid to TV of the hairy scalp. Cases of dandruff, especially those accompanied with TV of the body, must be examined for the presence of M. furfur because of its prognostic significance. Positive cases should be treated accordingly.
DENSITOMETRY OF PAUTRIER'S MICROABSCESS CELLS IN CUTANEOUS T CELL LYMPHOMA
Authors: ALTOMARE GIANFRANCO , LUIGI CAPELLA GIOVANNI , PIGATTO PAOLO D. , BIONDO BRUNA , LAVEZZI ANNA M.
Published: May 2007

Background. Epidermotropic lymphoid T cell infiltrates are part of a continuous spectrum of lesions ranging from “benign” parapsoriasis to frank cutaneous T cell lymphoma (CTCL, mycosis fungoides). Either the clinical or histologic differentiation between these entities prove often difficult and the prognosis may be difficult to assess.

Patients and Methods. We studied 15 patients, men aged 50 to 81 years, mean ± SD 68 ± 12 years, with patch‐plaque CTCL. Sections from punch biopsies from active lesions were stained with Feulgen reagent, coupled with a “twin” adjacent hematoxylin and eosin (H&E)‐stained section and analyzed with a VIDAS Zeiss‐Kontron Image Analyzer. At least 50 dermal infiltrating cells and 50 epidermotropic Pautrierian cells per specimen were counted and the biopsies were repeated periodically.

Results. Nine patients with aneuploid Pautrierian cell DNA patterns did well after conventional phototherapy (dermal cell ploidy was irrelevant), whereas six patients with euploid Pautrierian cell DNA patterns had to be treated aggressively (IFN + retinoids, COP). Clinical and histopathologic aspects of the first group were comparable to those of the second group.

Conclusions. The classical cytophotometric aphorism seems to be reversed in this sample: “The more abnormal the ploidy of epidermotropic Pautrierian cells, the better the prognosis.” Euploid epidermotropic cell prove more efficient in invading the skin and other areas and this efficiency may be reflected in more aggressive trends in the evolution of the lymphoma. Thus, DSM analysis of epidermotropic cells could prove very useful as an inexpensive tool for routine CTCL grading.
ANTISMOOTH MUSCLE AND ANTIPARIETAL CELL ANTIBODIES IN INDIANS WITH ALOPECIA AREATA
Authors: KUMAR BHUSHAN , SHARMA VINOD K. , SEHGAL SHOBHA
Published: May 2007

Background. Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases.

Methods. A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique.

Results. Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Anti‐smooth‐muscle‐antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata (P< 0.001). Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels.

Conclusion. Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.
HOW RELIABLE IS THE BASEMENT MEMBRANE PHENOMENON IN THE DIAGNOSIS OF SYSTEMIC LUPUS ERYTHEMATOSUS?
Authors: AL‐FOUZAN ABDULWAHAB S. , HASSAB‐EL‐NABY HUSSEIN M.M. , DVORAK RICHARD
Published: May 2007

Background. Although the basement membrane (BM) phenomenon is considered a good test to differentiate between systemic (SLE) and discoid lupus erythematosus (DLE), our observations question its reliability.

Methods. Direct immunofluorescence stain was done to detect immunoglobulins and complement deposits in 10 SLE patients and in 10 healthy controls. Specimens were taken from the normal skin of the dorsa of hands.

Results. The group of SLE patients showed deposits of IgG in 4, IgM in 7, IgA in 1, C3 in 7, and C4 in 1 patient. The group of healthy controls showed IgM in 2, C3 in 5, C4 in 2 cases, but no IgG or IgA deposits.

Conclusion. A positive BM phenomenon test could be found in normal individuals and may be due to the effect of ultraviolet rays. We think that the BM phenomenon has a limited reliability in diagnosing SLE.
ANOTHER “PARABEN PARADOX”
Authors: WOLF RONNI , BRENNER SARAH
Published: May 2007

Background. To test the reliability and reproducibility of the patch test with a paraben mix, we added a second paraben mix allergen to our standard tray and compared the results achieved with these two allergens.

Methods. Two hundred and fifteen consecutive patients, undergoing patch testing with a standard series, were simultaneously tested with an additional paraben mix (i.e., each patient was tested with two paraben mix allergens) supplied by two different companies.

Results. Twelve patients (5.6%) showed a positive reaction to one or two paraben tests. Five patients showed a positive reaction to one paraben test (paraben‐a), and five others to the second paraben test (paraben‐b). Only two patients out of 12 with positive reactions to parabens showed a reaction with both of the two parabens.

The parabens appear to be overrepresented in our study compared to other series. There was no correlation between the results of the tests with the two different parabens used

Conclusions. Patch testing with a paraben mix cannot be considered an appropriate and reliable method for detecting paraben allergies. T is recommended to test routinely with a paraben screening series instead of the paraben mix.
CHEMOTHERAPY FOR AIDS‐RELATED AND ENDEMIC AFRICAN KAPOSI'S SARCOMA IN SOUTHERN AFRICA
Authors: STEIN MOSHE E. , LACHTER JESSE , SPENCER DAVID , BEZWODA WERNER R.
Published: May 2007

Background. Kaposi's sarcoma (KS), either in its endemic (African) form or its AIDS‐related variant, is a common neoplastic disorder seen in Southern Africa. Chemotherapy has been proven to be very effective in advanced or relapsed African Kaposi's sarcoma, but much less so in AIDS‐related, endemic KS.

Patients and Methods. The study consists of a retrospective analysis of the results of chemotherapy alone in 17 patients with African KS (AKS) and in 32 patients with epidemic AIDS‐related KS (EKS), treated at the Johannesburg General Hospital between 1982 and 1992. Single agents included vinblastine, actinomycin D, bleomycin, and vincristine; combined regimens were largely doxorubicin/vincristine/ bleomycin or etoposide/methotrexate. Outcome classifications were: complete remission (CR), partial remission (PR), and treatment failure (TF).

Results. Four of the 17 patients with AKS had CR, 10 a PR, and three were TF and died rapidly from their disease. The combined chemotherapeutic regimens produced marked symptomatic relief and even long‐term remission in AKS. In patients with EKS, the response rate to chemotherapy was very low and of brief duration. No patient had a CR and debilitating side effects were common.

Conclusions. The African type of AKS is a chemo‐sensitive tumor, whereas the endemic type EKS, like its Western counterpart, has a dismal prognosis.
NONMELANOMA SKIN CANCER IN NORTHERN FINLAND
Authors: KOSKINEN ARI , OIKARINEN AARNE
Published: May 2007

Background and Objectives. The incidence of nonmelanoma skin cancers is highest in those geographic areas where light‐skinned people are exposed to large amounts of sunlight. The purpose of this study was to detect differences in nonmelanoma skin cancers diagnosed in Northern Finland compared to those from elsewhere. Another purpose was to estimate whether changes have occurred in clinical diagnosis, site distribution, and recurrence rate during the past 15 years.

Methods. The material included patients treated at Oulu University Hospital in Northern Finiand (64.6°N) during the years 1976—1977 and 1991—1992. Information was collected from files on 334 patients with 428 different, histologically verified skin cancers.

Results. In 1976—1977, the average age of men with basal cell carcinoma (BCC) was 61 years, whereas the women's average age was 66 years. In 1991—1992, the corresponding ages were 69 and 72 years. The site distribution did not show any obvious changes in the 15 years, but the differences between sexes had become more prominent. Men had more BCC on the ears and the trunk, whereas women had more BCC on the nose and the forehead. Most of the squamous cell carcinomas (sec) were on the head and neck similar to BCC, but on the ears of men there occurred relatively more secthan BCC.

Conclusions. The clinical diagnosis of BCC was fairly easy to make, whereas that of sec seemed to be very difficult clinically and was only correct in 10% of the cases. The markedly decreased recurrence rate of BCC between 1976 and 1992 probably occurred because of changes in treatment practices.
BASAL CELL CARCINOMA IN QATAR
Authors: MAHMOUD SOMAIA F. , AZADEH BAHRAM
Published: May 2007

Background. There is an increasing incidence of basal cell carcinoma (BCC) and skin cancer in general among various countries, where the sun is implicated as an important causative factor.

Methods. Results of clinical and histopathologic examination and the incidence rate of BCCS were recorded over a period of 5 years at Hamad Medical Corporation, Doha, Qatar.

Results. Basal cell carcinoma is the commonest skin cancer in Qatar. The average annual incidence per 100,000 residents of working manpower, standardized to the 1986 census, is 9.9 for both sexes and at all ages. Expatriates formed the highest proportion and of these, Europeans were predominant. The tumor was more frequent in men, on sun‐exposed areas, was mostly of the nodular and infiltrative type, and occurred in the 3rd, 4th, and 5th decades. As a whole, persons with relatively heavily pigmented skin constituted 66.7% of the patients.

Conclusions. Intense sunlight exposure during outdoor work and leisure activities in Qatar puts residents at increased risk for nonmelanoma skin cancer, even in persons with relatively pigmented skin.
BOOK REVIEWS
Authors: Camacho Francisco , Parish Lawrence Charles
Published: May 2007

Itch: Mechanisms and Management of Pruritus. Jeffrey D. Benihard.

Pocket Guide to Cutaneous Medicine and Surgery.
Jeffrey S. Dover.
SYRINGOMAS: NEW APPROACH TO AN OLD TECHNIQUE
Authors: KARAM PAULA , BENEDETTO ANTHONY V.
Published: May 2007

Background. Syringomas are common, benign periorbital adnexal tumors that pose a cosmetic dilemma for both patients and physicians alike. Many therapeutic modalities can potentially cause scarring and recurrences are common. The objective was to develop a treatment method that minimizes scarring and subsequent recurrences.

Methods. Each syringoma is treated with short bursts of low voltage electrodesiccation, delivered with an epilating needle that is inserted deeply into the skin at the level of the reticular dermis.

Results. A patient treated by intralesional electrodesiccation of her long‐standing periorbital syringomas remains lesion‐free for over 24 months after therapy.

Conclusions. Intralesional electrodesiccation is a safe, nonscarring and reliable method that can be used to eradicate periorbital syringomas.
REITER'S SYNDROME‐LIKE PATTERN IN AIDS‐ASSOCIATED PSORIASIFORM DERMATITIS
Authors: ROMANÍ JORGE , PUIG LLUÍS , BASELGA EULAILIA , MORAGAS JOSÉ M. DE
Published: May 2007

Background. The prevalence of psoriasiform dermatitis in HIV‐infected patients is similar to that in the general population, but its clinical severity and the immunosuppression in these patients pose special problems of therapeutic management. Furthermore, a distinctive clinical pattern has been reported in some cases. In order to assess these features in our clinical setting, we have done a retrospective study on the clinical records of all human immunodeficiency virus (HIV)‐positive patients with psoriasiform dermatitis requiring systemic treatment.

Methods. The clinical records were reviewed of seven HIV‐positive patients who were referred between 1988 and 1994 to a University Hospital Dermatology Department from an HIV‐clinic because of psoriasiform dermatitis, resistant to topical treatment.

Results. The clinical appearance was rather uniform, with the following common features: facial seborrhea, flexural and acral involvement, with pustulosis of the palms and soles, and frequent arthritis. Lesions appeared in nonterminal stages of acquired immunodeficiency syndrome (AIDS). Three patients developed cutaneous lesions after the diagnosis of HIV infection was made and showed the most severe clinical involvement and arthritis. Etretinate, followed by RePUVA, proved to be the most effective systemic therapy prescribed, with only rare adverse effects. Methotrexate was shown to be effective, but its use was accompanied by hematologic toxicity. Cyclosporine A treatment was moderately effective and was not associated with progression of AIDS.

Conclusions. A characteristic Reiter‐like clinical picture was observed in AIDS‐related psoriasiform dermatitis. Etretinate and RePUVA were effective and safe in controlling the lesions. Physiopathologic mechanisms involved in the development of AIDS‐related psoriasis might provide an explanation for the outstanding similarity of the clinical pattern in those patients.
SUCCESSFUL TREATMENT OF VITILIGO WITH PUVA‐PIGMENTED AUTOLOGOUS EPIDERMAL GRAFTING
Authors: SUGA YASUSHI , BUTT KHALID IQBAL , TAKIMOTO REIKO , FUJIOKA NORIKO , YAMADA HIROMICHI , OGAWA HIDEOKI
Published: May 2007

Background. The methoxypsoralen‐ultraviolet A‐light (PUVA)‐induced pigmented epidermal grafting procedure appears to be a more effective treatment for vitiligo than similar treatments presently available. This finding was based on: 1) a more vigorous and completely homogeneous repigmentation was observed in the vitiliginous area and 2) that the treatment was safe, easy, inexpensive, and not time‐consuming (approximately 3–4 hours), thus making it a suitable outpatient clinic treatment procedure for vitiligo patients.

Patients and Methods. Twenty‐eight patients with amelanotic depigmented lesions that had been refractory to conventional therapy were treated using suction blisters from autologous epidermal sheets. These had 8‐methoxypsoralen (8‐MOP) solution applied and had been exposed to ultraviolet A light (topical PUVA) in order to stimulate melanogenesis.

Results. Successful repigmentation was obtained after transplantation in all patients with segmental and localized vitiligo. The most homogeneous repigmentation was obtained within 3 months after grafting.

Conclusions. This novel procedure is an excellent tool by which to treat segmental and localized vitiligo lesions that have failed to respond to other therapies.
LEPROMATOUS AND TUBERCULOID LEPROSY: CLINICAL PRESENTATION AND CYTOKINE RESPONSES
Authors: OCHOA MARÍA TERESA , VALDERRAMA LILLIANA , OCHOA AUGUSTO , ZEA ARNOLD , ESCOBAR CARLOS E. , MORENO LUIS H. , FALABELLA RAFAEL
Published: May 2007

Objective. This study analyzes the major clinical characteristics of patients with active leprosy in relation to the in vitro immune response to the T‐ lymphocyte activator anti‐CD3.

Methods. Thirty‐eight patients with an established diagnosis of leprosy were classified according to the Ridley and Jopling table. Peripheral blood mononuclear cells from both lepromatous leprosy (LL) and tuberculoid leprosy (TL) patients and healthy controls were used to evaluate lymphocyte proliferation; immunoenzymatic assays were used to evaluate cytokine production (IL‐I, IL‐2, IL‐4, IL‐6, IL‐10, IFN‐gamma).

Results. Peripheral blood mononuclear cells from both LL and TL patients displayed blastogenic responses to anti‐ CD3. The cytokines IL‐1β, IL‐6, IL‐10, and IFN‐γ were detected in culture supernatants. Endogenous production of IL‐1ß was significantly higher in cell cultures from patients with the lepromatous form of the disease compared to those with tuberculoid leprosy. Production of IL‐6 in response to anti CD3 was observed in a significantly higher proportion of LL than TL patients (P = 0.0025). Gamma‐interferon production did not differ between TL and LL, but a direct correlation was observed between time of multidrug treatment and IFN production in vitro (P = 0.016). Interleukin‐10 was detected in culture supernatants of lymphocytes activated by anti‐CD3 from both patient groups, but not from healthy controls.

Conclusions. The findings of this study suggest that patients with the two distinct forms of leprosy are capable of responding to a polyclonal T‐lymphocyte stimulus such as anti‐CD3 and provide evidence suggestive of alterations in the immune responses mediated by cytokines that may contribute to the spectrum of disease and response to treatment.
SEROLOGIC TESTS FOR TREPONEMATOSES IN THE UNITED ARAB EMIRATES
Authors: NSANZE HERBERT , LESTRINGANT GILES G. , AMEEN ABDUL M. , LAMBERT JEAN MARIE , GALADARI IBRAHIM , USMANI MOHAMMED A.
Published: May 2007

Background and Objective. Venereal syphilis is uncommon in the United Arab Emirates (UAE) and other Gulf states in the Middle East. Although nonvenereal syphilis (bejel) has been reported to be endemic in some of these countries, the extent of treponematoses in the UAE is unknown. The objectives were therefore, to investigate those who attended the outpatient clinic of a hospital in the UAE and to establish the seroprevalence of treponematoses and related clinical conditions.

Methods. One thousand and eighty‐four patients were serologically screened with a Rapid Plasma Reagin (RPR) and Treponema pallidum hemagglutination (TPHA) tests. The charts of seropositive and seronegative patients, matched for age and sex, were reviewed and compared for clinical problems.

Results. A total of 47 people tested had antitreponema antibodies. The positivity rates varied considerably and rose with age from 0.36% for persons < 16 years to 8.3% for those > 50 years. Among the seropositive group, there were no obvious clinical signs of bejel on presentation, but osteoarthritis was significantly more common than in the seronegative group.

Conclusions. In the UAE, although venereal syphilis is uncommon, there is a high seropositivity rate in the > 50‐year age range possibly due to old or attenuated bejel.
BLASTOMYCOSIS‐LIKE PYODERMA (PYODERMA VEGETANS) RESPONDING TO ANTIBIOTICS AND TOPICAL DISODIUM CHROMOGLYCATE
Authors: RONGIOLETTI FRANCO , SEMINO MARIATERESA , DRAGO FRANCESCO , BLANGETTI MARIA GRAZIA , REBORA ALFREDO
Published: May 2007

Background. Blastomycosis‐like pyoderma is a disorder of uncertain etiology that has been described in association with a variety of underlying conditions, including inflammatory and neoplastic pathologic conditions and in association with a primary immunodeficiency state. The response to therapy, antibiotics in particular, is said to be variable or poor.

Methods. We examined two patients with blastomycosis‐like pyoderma in whom no underlying pathologic or immunologic abnormalities were found. We treated them with antibiotics according to bacterial resistance tests. In the second case topical disodium chromoglycate was added.

Results. Treatment cleared or markedly improved the lesions.

Conclusions. Antibiotic treatment guided by susceptibility tests is recommended. The addition of topical disodium chromoglycate may be useful.
NECROLYTIC ACRAL ERYTHEMA: A CUTANEOUS MARKER OE VIRAL HEPATITIS C
Authors: EL DAROUTI MOHAMED , ABU EL ELA M.
Published: May 2007

Background. Necrolytic acral erythema (NAE) is a distinctive skin lesion that was found to affect the dorsa of the feet of seven patients having active viral hepatitis C. Necrolytic acral erythema occurs in the form of well circumscribed dusky erythematous areas that develop flaccid blisters in their early stages and a hyperkeratotic surface in their chronic form. Microscopically, lesions of NAE are similar to those of other necrolytic erythemas such as necrolytic migratory erythema, pellagra, and zinc deficiency.

Method. Seven patients with NAE were included in this study. These patients underwent microscopic examination of punch biopsy specimens of the affected skin, abdominal sonography, ct scan of pancreas, and a liver biopsy. Blood samples were obtained for complete blood picture, serum glucose, zinc, amino acids, liver function tests, and markers of hepatitis.

Results. All patients with nae were found to have hepatitis C by elisa and pcr.

Conclusions. Necrolytic acral erythema is a distinctive type of necrolytic erythemas that was observed to occur almost exclusively with viral hepatitis C. Therefore, it should be considered an important cutaneous marker of hepatitis C, particularly in areas showing a high incidence of this form of hepatitis.
SEASONAL VARIATIONS IN THE SEVERITY OF ACNE VULGARIS
Authors: GFESSER MICHAEL , WORRET WOLF‐INGO
Published: May 2007

Background and Objective. The improvement of acne in summertime or the aggravation of acne in winter is a traditional dermatologic opinion. Ultraviolet rays are thought to be beneficial in the treatment of acne. In the existing literature there is no proof of this. The purpose of this study was to find out whether or not acne generally worsens in winter.

Patients and Method. One hundred and thirty‐nine patients were asked if their acne worsens in winter or in summertime, whether it improves seasonally, or if they didn't notice any change with the seasons.

Results. About one‐third of the patients reported an aggravation of their acne in winter, but also approximately one‐third of the patients complained about an aggravation of their acne in summer. Another third did not notice any change.

Conclusions. Sun‐bathing may be beneficial for psychologic reasons and may produce euphoric effects, but we do not see any reason to treat acne with ultraviolet radiation because of all its negative effects on the skin.