bluuebunny/crossref_metadata_2025 huggingface dataset:
REACTION IN LEPROSY: ACUTE PHASE REACTANT RESPONSE DURING AND AFTER REMISSION
Authors: SEHGAL VIRENDRA N. , BHATTACHARYA SAMBIT N. , SHAH YASHODHARA , SHARMA VINAY K. , GUPTA CHANDER K.
Published: May 2007

Sera from 25 patients with type 1 (Lepra), upgrading and downgrading, and type 2 (erythema nodosum leprosum [ENL]) reactions were assayed, during the reaction and after its clinical remission, for changes in levels of alpha‐1–antitrypsin (AIA) and C‐reactive protein (CRP). The results were compared with those from normal healthy adults and patients of leprosy without history and/or clinical evidence of reaction. The AIA levels correlated better with changes in status of type 1 reaction; whereas CRP levels correlated well with alterations in type 2 reactions and were definitely superior to AIA in this situation for monitoring the course of these episodes.
CUTANEOUS MYIASIS: A SIMPLE AND EFFECTIVE TECHNIQUE FOR EXTRACTION OF DERMATOBIA HOMINIS LARVAE
Authors: LOONG PHILIP T. LI , LUI HARVEY , BUCK H. WILLIAM
Published: May 2007

We describe two patients with cutaneous myiasis caused by Dermatobia hominis. Three larvae were removed successfully by a simple technique that involved the injection of each larva with 2 mL of lidocaine, making surgical extraction by incision and exploration unnecessary.
ANIMAL MODELS FOR TESTING TOPICAL CORTICOSTEROID POTENCY: A REVIEW AND SOME SUGGESTED NEW APPROACHES
Authors: PENNEYS NEAL S.
Published: May 2007

Animal models allow for testing the potency of topical corticosteroids by measuring their effects on induced conditions that are analogous to human skin disease. Animal models can examine the anti‐inflammatory, anti‐allergic, antiproliferative, and atrophogenic effects of topical corticosteroids. These test models as they are currently applied are relatively imprecise; however, innovations using newly available histologic, autoradiographic, and biochemical techniques have great potential for precisely quantitating the effects of corticosteroids in animal model systems.
THE VASOCONSTRICTOR ASSAY IN BIOEQUIVALENCE TESTING: PRACTICAL CONCERNS AND RECENT DEVELOPMENTS
Authors: STOUGHTON RICHARD B
Published: May 2007

The vasoconstrictor assay, when properly performed, is a highly reliable method to determine bioequivalence of generic formulations. Recent research has resolved some of the remaining questions concerning the practical application of the assay. Significant vehicle‐related differences have been observed between the potency of different, supposedly equivalent formulations now on the market. Large differences in concentrations of the active agent in similar vehicles usually have not resulted in corresponding differences in vasoconstrictor assay results. Finally, the time course of drug effects may differ among highly potent and less potent corticosteroids. In general, the higher the potency of the topical corticosteroid, the earlier the maximal effect is observed. This finding suggests that short application of highly potent agents might minimize systemic absorption without sacrificing efficacy.
BIOEQUIVALENCE STUDIES OF TOPICAL PREPARATIONS: STATISTICAL CONSIDERATIONS
Authors: HAUCK WALTER W.
Published: May 2007

To be approved for marketing, a potential generic pharmaceutical product must demonstrate bioequivalence, that is, a rate and extent of absorption similar to those of the currently marketed (“innovator”) product. For oral products, design and statistical analysis for studies conducted to determine whether two products are bioequivalent have become reasonably standardized; the design is crossover, and analysis is based on the two one‐sided tests principle. The purpose of this overview is to consider whether the practices for oral products apply to topical products, and where different procedures may be required. The principles behind the practices for oral products are seen, largely, to carry over to topical products.
CLINICAL TRIALS OF TOPICAL CORTICOSTEROIDS IN PSORIASIS: CORRELATIONS WITH THE VASOCONSTRICTOR ASSAY
Authors: CORNELL ROGER C
Published: May 2007

It would be desirable to develop an alternative system to clinical studies to evaluate the potency of generic topical corticosteroids and of new formulations of existing innovator corticosteroids. The vasoconstrictor assay is a reliable method for testing potency; however, its results do not always agree with clinical studies. Psoriasis offers an ideal clinical model to evaluate corticoid potency because the ability to perform within‐patient comparisons of the treatment of bilateral lesions permits meaningful comparisons with a relatively small sample size. The results of bilateral comparisons in psoriasis agreed with those of the vasoconstrictor assay in 20 of 23 comparisons of active agents and in numerous comparisons of active corticosteroids with a placebo. Eczematous dermatoses do not lend themselves well to bilateral paired comparison studies and therefore require parallel treatment studies with relatively large sample sizes to produce statistically significant comparisons.
TREATMENT OF FEMALE ANDROGENETIC ALOPECIA WITH MINOXIDIL 2%
Authors: WHITING DAVID A. , JACOBSON COLEMAN
Published: May 2007

The safety and efficacy of minoxidil 2% for the treatment of female androgenetic alopecia was assessed in a 32‐week double‐blind placebo‐controlled trial. Thirty‐three women aged 22 to 44 years with hair loss classified as Ludwig's grade I or II were enrolled, and 28 completed the trial. Before the administration of treatment, mean nonvellus hair counts were taken within a 1‐cm2 target area of the scalp. For the 15 patients in the minoxidil group, the mean count was 169 hairs compared with 161 hairs for the 13 patients in the placebo group. At the completion of the trial, the patients treated with minoxidil 2% had a mean nonvellus hair count of 195 hairs versus a mean hair count of 177 for patients in the placebo group; 60% (9) of the patients in the minoxidil group showed minimal to moderate hair growth compared with 46% (6) of the patients in the placebo group. No serious side effects were encountered during this study, nor any significant changes in safety parameters. There were no drop‐outs due to medical events related to minoxidil 2%.
CORRESPONDENCE
Authors: Suite Marilyn , Jankey Neville
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic 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 Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
TINEA CAPITIS IN SAUDI ARABIA
Authors: VENUGOPAL PANKAJALAKSHMI V. , VENUGOPAL TARALAKSHMI V.
Published: May 2007

Background. Tinea capitis is a dermatophyte infection of the scalp, eyebrows, and eyelashes caused by species of Microsporum and Trichophyton. The purpose of this study was to discover the incidence and causal agents of tinea capitis in Saudi Arabia.

Methods. Hair roots, skin scrapings, and pus swabs were collected from patients clincially diagnosed with tinea capitis and were processed for fungus.

Results. Of 372 patients with tinea capitis investigated in Saudi Arabia, 240 were found to be positive by direct microscopic examination, and the causal agent was isolated from 237 patients. Tinea capitis accounted for 47.7% of all superficial mycoses, and 97% of it occurred in children below 15 years of age. Inflammatory lesions were found in 35% of cases, and 10 of them presented with kerion celsi. Favus‐type lesion was found in one. Microsporum canis was the most common etiologic agent, responsible for 82.3% of the infections. Trichophyton violaceum was the next most common agent (13.9%), followed by M. audouini (2.2%); T. mertagrophytes, T. rubrum, T. verrucosum, and T. simii were isolated from one patient each. This is the first report of T. simii infection in a Saudi man.

Conclusions. Although none of the patients owned pets, the predominance of M. canis may be explained by the large number of cats in the neighborhood. The disappearance of favus due to T. schoenleinii may be due to improved socio‐economic conditions. Our results agreed with two previous reports.
DETECTION OF EARLY LESIONS OF “UNGUAL” MALIGNANT MELANOMA
Authors: ISHIHARA YOKO , MATSUMOTO KAZUHIKO , KAWACHI SHIGEO , SAIDA TOSHIAKI
Published: May 2007

Background. The nail area is commonly affected by malignant melanoma. The prognosis of malignant melanoma of the nail is poor, becuase at the time of diagnosis most lesions are in the advanced stage. Correct diagnosis of early lesions could improve the prognosis.

Methods. For 3 years, all patients with nail pigmentation at the dermatology clinic were screened for five specific criteria for the diagnosis of early lesions of malignant melanoma. Histologic examination was performed on 10 of 29 lesions.

Results. Five of the 29 lesions were advanced malignant melanoma, easily diagnosed clinically. Two of the remaining 24 lesions fulfilled most of our clinical criteria of early malignant melanoma of the nail apparatus; that is, they appeared as melanonychia striata during adulthood, were wide in breadth measuring 9 and 11 mm, and showed variegated shades of brown. Periungual pigmented macule (Hutchinson's sign) was observed in one of the two cases. Total resection of the lesions was performed, followed by skin grafting.

Conclusions. Histologically, an increased number of atypical melanocytes, mainly arranged as solitary units, were observed only in the epithelia of the nail matrix and of the nail‐bed, confirming that these lesions were “ungual” malignant melanoma in situ. Such an early lesion of malignant melanoma of the nail apparatus can be completely cured with conservative excision, and the phalanx of the affected digit can be preserved.
MOLDS IN ONYCHOMYCOSIS
Authors: RAMANI RAMA , SRINIVAS C.R. , RAMANI ANANTHAKRISHNAN , KUMARI T. GIRIJA RATNA , SHIVANANDA P.G.
Published: May 2007

Background. Onychomycosis is a major cause of nail dystrophy. The causative organisms in onychomycosis are dermatophytes, Candida and molds. A variety of molds have been isolated from nails.

Methods: Nail scrapings and clippings were collected from 100 cases and inoculated on slants containing SDA with cycloheximide 0.5 mg/mL, chloramphenicol 0.05 mg/mL, and SDA with chloramphenicol 0.05 mg/mL.

Results: The culture positivity rate for molds was 22%. The predominant mold isolates were Aspergillus species (86.4%, Fusarium oxysporum (4.5%), Curvularia species (4.5%) and Penicillium species (4.5%).

Conclusion: Primary invasion of nails by molds can cause onychomycosis.
PHYSICALLY INDUCED PEMPHIGUS AFTER COSMETIC PROCEDURES
Authors: KAPLAN RICHARD P. , DETWILER SUSAN P. , SAPERSTEIN HARRY W.
Published: May 2007

Background. Pemphigus is a vesiculobullous autoimmune disease characterized by acantholysis due to antibodies against epidermal antigens.

Case Reports. We report the first two cases of pemphigus in which lesions appeared in areas traumatized by cosmetic procedures. In one case, the patient had a history of pemphigus under excellent control; pemphigus lesions appeared only in her surgical scars 2 months after a reduction mammoplasty and facelift. The other patient presented with an outbreak of pemphigus 4 weeks after a chemical peel.

Conclusions. Physical agents including infrared and ionizing radiation as well as ultraviolet light are known triggers of pemphigus. We suggest that cosmetic procedures can initiate pemphigus and that this change must be differentiated from postoperative wound infections and other reasons for poor wound healing.
PRIMARY MERKEL CELL TUMOR: A CLINICAL ANALYSIS OF EIGHT CASES
Authors: MICALI GIUSEPPE , FERRAÚ FRANCESCO , INNOCENZI DANIELE
Published: May 2007

Background. In recent years, an unusual biologic behavior of Merkel cell tumor (mct) has been noted. In some patients, the tumor was indolent and well controlled by therapy, while in others it was lethal in a few months. Even though the majority of the reported cases are between these two biologic extremes, it seems evident that there is a high variability in the clinical course of the tumor.

Methods. A clinical analysis of eight cases of primary Merkel cell tumor was performed. All the patients presented with similar clinical features: age, tumor staging, duration of the disease, lack of complicating cutaneous or systemic diseases. On the basis of these common findings, which made this group quite homogeneous, our attempt was to identify other clinical signs that could correlate with the local recurrence and/or the onset of metastases. The outcome of our patients, in fact, was quite variable.

Results. The tumor size, the clinical aspect at presentation (single, multiple nodules, or plaque), the histologic pattern (all were of the trabecular type), and immunohistology did not correlate with the outcome.

Conclusions. We report the rare occurrence of mct in the perianal area, which suggests that it should be included in the differential diagnosis of perianal tumors, the very aggressive behavior of the tumor in two patients (death < 6 months from diagnosis), which confirms how the prognosis for mct is unpredictable even if the diagnosis is established at an incipient stage and the tumor promptly removed.
TATTOO REMOVAL: TANNIC ACID METHOD OF VARIOT
Authors: van der VELDEN EDDY M. , van der WALLE HENK B. , GROOTE ALEXANDER D.
Published: May 2007

Background. There are many methods for tattoo removal (e.g., surgery, cryosurgery, laser, dermabrasion), but none can restore the skin to its original state.

Methods. Tattoo removal was obtained with a combination of tattoo machine, tannic acid, and silver nitrate.

Results. This technique proved to be effective for the removal of amateur tattoos of any size. The results with professional tattoos were much less satisfactory. The estimation of the depth of pigment in pretreatment biopsies showed no correlation with the success rate of treatment. No indication of systemic side effects on the liver from tannic acid was found in the concentration and amount used in this study.

Conclusions. This technique is effective for the removal of amateur tattoos of any size and is comparable with cryotherapy, infrared coagulation, and focal salabrasion.
EFFECTIVE DETECTION OF PLANTAR MALIGNANT MELANOMA
Authors: SAIDA TOSHIAKI , ISHIHARA YOKO , TOKUDA YASUTAKA
Published: May 2007

Background: As the sole of the foot is the most prevalent site of malignant melanoma in non‐Caucasians, early detection of the neoplasm at this anatomical site is very important. In our previous study, we proposed a clinical guideline that acquired melanocytic lesions on the sole larger than 7 mm in maximum diameter should be examined histologically.

Methods: Eighty‐one Japanese patients with the complaint of plantar pigmented lesions were screened at our dermatology clinic during 3 years using the 7‐mm criterion.

Results: Of the total 80 melanocytic lesions on the sole, 14 lesions were larger than 7 mm in maximum diameter, excluding congenital lesions. Diagnoses of the 14 “large” lesions were as follows: advanced malignant melanoma, 8 lesions; early malignant melanoma (malignant melanoma in situ), 1 lesion; acquired melanocytic nevus, 4 lesions, and volar melanotic macule, 1 lesion.

Conclusions: The present study confirmed the validity of the 7‐mm criterion for the early effective detection of plantar malignant melanoma.
RETICULATE ACROPIGMENTATION OF KITAMURA: TWO CASE REPORTS
Authors: EREL ARZU , GURER MEHMET ALI , EDALI NACI
Published: May 2007

Background. Reticulate acropigmentation of Kitamura (RAK) is an autosomal dominantly inherited dermatosis.

Case Reports. Two patients are described with the clinical and histopathologic features of reticulate acropigmentation of Kitamura.

Conclusions. We speculate that RAK and the Dowling‐Degos disease (DDD) are the same diseases.
USE OF TOPICAL MINOXIDIL THERAPY FOR ANDROGENETIC ALOPECIA IN WOMEN
Authors: JACOBS JAMES P. , SZPUNAR CHERYL A. , WARNER MICHAEL L.
Published: May 2007

Background. Androgenetic alopecia is the most common cause of hair loss in men and women. Androgenetic alopecia in women begins as a diffuse and progressive thinning of the frontoparietal area of the scalp. In women, hair loss at any age is socially unacceptable and may be the basis of psychiatric illness.

Methods. A 32‐week, double‐blind, placebo‐controlled trial was conducted in 10 European centers to assess the efficacy and safety of 2% topical minoxidil solution for the treatment of androgenetic alopecia in women. Two hundred ninety‐four of the 346 women enrolled (85%) completed the 32‐week trial. Photographic and computer imaging techniques were used at each visit to determine objectively the number of nonvellus hairs present in a 1‐cm2 area selected as the target evaluation site.

Results. In the 2% minoxidil group, the mean increase in nonvellus hair count was 33 hairs, which was significantly greater than that of 19 hairs in the placebo group (P = 0.0001). The investigators observed that 44% of the patients in the 2% minoxidil group achieved new hair growth compared with 29% in the placebo group. When asked to evaluate their own hair growth, 55% of the women in the 2% minoxidil group compared to 41% of the women in the placebo group believed that they had achieved new hair growth. No clinically significant changes in vital signs were observed during the study and no serious or unexpected medical events were reported.

Conclusion. Topical minoxidil solution was significantly more effective than placebo in the treatment of androgenetic alopecia in women.
TOPICAL MINOXIDIL THERAPY FOR ANDROGENIC ALOPECIA IN THE MIDDLE EAST
Authors: KARAM PAULA
Published: May 2007

Background. A 48‐week open label trial was conducted in five Middle‐Eastern countries (Lebanon, Egypt, Saudi Arabia, Jordan, and the United Arab Emirates) to determine the safety and efficacy of 2% minoxidil in the treatment of early androgenic alopecia and to compare the response with Western countries.

Methods. One hundred and ninety‐five men aged between 19 and 47 years were enrolled. The duration of their baldness varied from 6 months to 10 years, and they all showed a type III vertex or type IV of the modified Hamilton scale. Baldness pattern, diameter of the balding area, hair counting within a 2.5 cm bald patch as well as investigator's and patient's evaluation were regularly noted.

Results. No significant changes were observed in vital signs or laboratory parameters. Of the 161 patients considered evaluable at 48 weeks, 80% showed moderate to dense growth. The mean increase in nonvellus hair at 12 months was 234.

Conclusions. The age of the patient and the type of baldness rather than its duration affected the final outcome.
SUCCESSFUL TREATMENT OF A PATIENT WITH RECURRENT FURUNCULOSIS BY VITAMIN C: IMPROVEMENT OF CLINICAL COURSE AND OF IMPAIRED NEUTROPHIL FUNCTIONS
Authors: LEVY RACHEL , SCHLAEFFER FRANCISC
Published: May 2007

Background. Neutrophils play a critical role in host defense against a variety of microbial pathogens. There is much information to suggest a role for vitamin C in the physiology of neutrophils. Thus, the effects of vitamin C treatment were studied in a patient with a history of recurrent furunculosis who showed altered neutrophil functions.

Methods. Superoxide generation was measured by cytochrome C reduction. Phagocytosis of opsonized zymosan by neutrophils and chemotaxis on agarose plates were determined.

Results. Chemotaxis, phagocytosis, and superoxide generation of the patient's neutrophils were significantly lower than those of the matched control. Treatment with vitamin C (500 mg/day) for 30 days caused a dramatic clinical response and a significant improvement of all three neutrophil functions to values similar to those of the controls.

Conclusions. We suggest that the patient described here had a temporary defect in neutrophil functions. The treatment with vitamin C probably prevented neutrophil oxidation, thus contributing to recovery of neutrophil function and arrest of furunculosis.
SUICIDAL IDEATION IN PSORIASIS
Authors: GUPTA MADHULIKA A. , SCHORK NICHOLAS J. , GUPTA ADITYA K. , KIRKBY SUEANN , ELLIS CHARLES N.
Published: May 2007

Background. Psoriasis has been associated with depressive disease and case reports of completed suicide.

Methods. 217 consenting psoriasis patients completed the Carroll Rating Scale for Depression (CRSD), a 52‐item self‐rated scale, with four of the Items directly addressing wishes to be dead and suicidal ideation. The patients also self‐rated the severity of their psoriasis.

Results. 9.7% of patients reported a wish to be dead, and 5.5% reported active suicidal ideation at the time of the study. The death wish and suicidal ideation were associated with higher depression scores (P < 0.0001) and higher patient self‐ratings of psoriasis severity (P < 0,05). Patient self‐reports of psoriasis severity correlated directly with the overall depression scores (r = 0.39), P < 0.0001).

Conclusions. The comorbidity between depressive symptoms, suicidal ideation, and psoriasis severity is in contrast with reports that severe depression and suicidal ideation are mainly a feature of life‐threatening medical disorders such as malignancies. Our finding may have important implications in the management of psoriasis.
LEPROMIN RESPONSES IN RECIPIENTS OE A CANDIDATE ANTILEPROSY BACTERIN VACCINE (WHO‐IMMLEP MYCOBACTERIUM LEPRAE KILLED PREPARATION) IN THE USA
Authors: KROTOSKI WOJCIECH A. , MROCZKOWSKI TOMASZ E. , SHANNON EDWARD J. , MILLIKAN LARRY E. , SANCHEZ RITA M. , HASTINGS ROBERT C.
Published: May 2007

Background. Identification of the nine‐banded armadillo as a potential source of massive numbers of Mycobacterium leprae led to the development of a candidate bacterin vaccine for possible immunoprophylaxis.

Methods. Volunteers were from a leprosy‐hypoendemic, nonBCG‐using area (USA). They had been vaccinated intradermally 3 years earlier with a candidate antileprosy bacterin vaccine of irradiated and autoclaved Mycobacterium leprae obtained from experimental nine‐banded armadillos. They were tested for dermal responsiveness to standard lepromin A.

Results. Values for induration and erythema appeared slightly greater for the vaccinated group; however, the differences were not statistically significant, indicating no appreciable ‘anamnestic’ effect on either Fernandez (early) or Mitsuda (late) reactions after 3 years.

Conclusions. Because previous studies had demonstrated that administration of this bacterin produced no humoral changes, it now appears less probable that laboratory methods will be of much help in assessing even possible effectiveness of such vaccination.
PLICA NEUROPATHICA AFTER USING HERBAL SOAP
Authors: RAMANAN CHERUKOT , GHORPADE ASHOK
Published: May 2007

A 22‐year‐old woman was referred to dermatology from oncology for an opinion regarding the sudden matting of scalp hair of 10 days duration. A case of primary infertility for 7 years, this patient was undergoing chemotherapy with doxorubicin, cyclophosphamide, and cisplatin after operative removal of a papillary cystadenoma (clear ceil type) from her left ovary 40 days previously.

She had noticed a sudden matting of her hair 3 to 4 hours after using a soap containing Acacia concinna for washing her hair. All efforts to disentangle the matted hairs were futile. She was feeling very uncomfortable because of the heavy solid mass of tangled hair. She told of rubbing her wet hair and using a wet towel to cover her hair after use of the soap. She denied earlier use of the soap, shampoo, setting lotions, bleaches, or hair dye. She had not cut her hair since early childhood.

Examination showed a huge, firm almost stony mass of severely tangled hair on her scalp, which was more marked over the vertex and occipital areas (Figs. 1 and 2). The hairs in the frontal area were free, thin, and straight. The skin over the entire scalp was normal. On light microscopy, a few hairs showed features of trichorrhexis nodosa. Routine hematology was normal. The patient was unable to tolerate the pain and discomfort because of the stony hard mass. She shaved her head and offered her hair in a temple, as is a common custom in parts of South India.
PHOTOSENSITIZING POTENTIAL OF OFLOXACIN
Authors: SCHEIFE RICHARD T. , CRAMER WENDY R. , DECKER EDWARD L.
Published: May 2007

Background. The relative phototoxic risk of ofloxacin, one of the newer fluoroquinolones, was compared with that of an active control of known but low phototoxic risk, naproxen.

Methods. A randomized, controlled, open‐label trial was used with a standardized phototoxic assay completed at baseline, midway through, and at the termination of the 12‐day trial. The trial was held at a dermatology research laboratory located at a large tertiary referral and teaching hospital. Thirty healthy volunteers who met the inclusion criteria and met none of the exclusion criteria were enrolled. Twenty‐seven patients completed the trial. Three subjects failed to complete the trail. One subject developed an exaggerated response to the Initial photoexposure and was dropped from the study. The other two subjects failed to return for follow‐up visits.

Results. Both ofloxacin and the active control agent, naproxen, significantly increased the subjects’ response to the tested solar and ultraviolet irradiation. There was, however, no significant difference between the responses observed for ofloxacin versus naproxen at any time.

Conclusions. Ofloxacin possesses a definite but low potential to cause phototoxic reactions in humans. These study data, in concert with surveillance data, suggest a hierarchy of phototoxic risk among the fluoroquinolones: fleroxacin ≫ lomefloxacin, pefloxacin ≫ ciprofloxacin > enoxacin, norfloxacin, ofloxacin. The impact that phototoxicity risk will have on selecting the optimum member of a large drug family appears to be substantial in outpatient and ambulatory settings and minimal in inpatient settings.
FEASIBILITY OF A REGISTRY OF PEMPHIGUS IN ITALY: TWO YEARS EXPERIENCE
Authors: NALDI LUIGI , BERTONI MAURIZIO , CAINELLI TULLIO ,   GRUPPO ITALIANO STUDI EPIDEMIOLOGICI IN DERMATOLOGIA (GISED)
Published: May 2007

Background. There are still unanswered questions about optimal treatment strategies and long‐term prognosis of pemphigus. The Italian Group for Epidemiologic Research in Dermatology (GISED) started to register pemphigus in March 1990.

Methods. The registry is hospital‐based, covering newly diagnosed cases referred to 33 dermatologic centers in the north and the middle‐south of Italy. Serum samples were collected at the time of diagnosis, for centralized storage.

Results. In the period between March 1990 and December 1991, 110 cases were collected, with 105 retained. Median age at diagnosis was 54, and the man to woman ratio was 0.7. The median lag of diagnosis was 4 months. Seventy‐four of 79 patients with pemphigus vulgaris/vegetans and 24 of the 26 with pemphigus erythematosus/foliaceus were given corticosteroid treatment.

Conclusions. A hospital‐based registry is feasible and provides useful information about both clinical aspects and management of pemphigus, serving as a basis for developing ad hoc research programs (e.g., formal epidemiologic studies and clinical research).
STEVENS‐JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS IN THAILAND
Authors: LEENUTAPHONG VICHIT , SIVAYATHORN APICHATI , SUTHIPINITTHARM PUAN , SUNTHONPALIN PATCHAREE
Published: May 2007

Background. Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life‐threatening illnesses that have often been linked to drug exposure.

Methods. We looked retrospectively for all cases of SJS and TEN that were admitted to Siriraj Hospital between 1981 and 1990 to determine the drug etiology.

Results. Fifty‐eight cases of SJS and 20 cases of TEN were identified. Eight patients initially had an SJS‐like aspect, which subsequently evolved into TEN. A culpable drug was determined in 60 patients (77%). The mean time from first drug administration to onset of SJS or TEN was 6.8 ± 6.5 days (range, 1 to 28 days). A longer incubation period was observed with thiacetazone (10.5 ± 5.6 days), phenytoin (12 ± 8.5 days), and carbamazepine (11.3 ± 3.4 days).

Conclusions. The culprit drugs included the following: antibiotics, 32 cases (penicillin, sulfonamides, tetracycline, erythromycin); anticonvulsants, nine (phenytoin, carbamazepine, barbiturates); antitubercular drugs, eight (thiacetazone); analgesics, four (acetylsalicylic acid, fenbufen); sulfonylurea, two; allopurinol, one; and others, four. The most frequent underlying diseases justifying the ingestion of one or more drugs in our patients were infections (52.7%), followed by pulmonary tuberculosis (10.8%), and by seizures (8.1%). The total mortality rate was 14%; 5% for SJS, and 40% for TEN. Mortality was not affected by the type of drug responsible.
MULTIPLE CUTANEOUS GRANULAR CELL TUMORS WITH SYSTEMIC DEFECTS: A DISTINCT ENTITY?
Authors: BAKOS LUCIO
Published: May 2007

Background. The association between cutaneous granular cell tumors and systemic defects Is extremely rare, this being the tenth case reported in the literature. The reported defects in the literature include lentiginosis, face and skull alterations, heart defects, muscular and neural pathologies, among other sporadic defects in other organs. The patients do not present visceral granular cell tumors.

Case Report. An 11year‐old girl had 124 skin granular cell tumors associated with face and skull defects, pulmonary stenosis, EEG and other neurologic alterations, diffuse muscle hypotonia, and an excess of finger joint mobility.

Conclusions. The combination of multiple cutaneous granular cell tumors with repeated alterations in other organs seems to be more than simply coincidental, thus suggesting a syndromic separate entity.
LUPUS MILIARIS DISSEMINATUS FACIEI‐PATHOLOGIC STUDY OE EARLY, FULLY DEVELOPED, AND LATE LESIONS
Authors: EL DAROUTI MOHAMED , ZAHER HESHAM
Published: May 2007

Background. Lupus miliaris disseminatus faciei is a chronic inflammatory disorder, which affects adults of both sexes.

Methods. This study included 25 patients with lupus miliaris disseminatus faciei. Three biopsies, representing early, fully developed, and late lesions, were taken from each patient.

Results. Histopathologic examination of the different lesions revealed that in early lesions, all of them showed superficial perivascular and periappendigeal cellular infiltrate composed mostly of lymphocytes and few histiocytes with occasional neutrophils. The fully developed lesions showed a sarcoidal granuloma only (40%), sarcoidal granuloma with abscess (24%), sarcoidal granuloma around areas of caseation necrosis (20%), and a mixture of sarcoidal and tuberculoid granulomas (16%).

Conclusions. All the late lesions showed extensive fibrosis especially in the perifollicular areas. Scattered lymphocytes, histiocytes and neutrophils were present within the fibrotic areas. A possible explanation of the pathogenesis is discussed.
WIDESPREAD PRIMARY CUTANEOUS INFECTION WITH MYCOBACTERIUM FORTUITUM
Authors: ROTMAN DARRIN A. , BLAUVELT ANDREW , KERDEL FRANCISCO A.
Published: May 2007

Background. Cutaneous infection with Mycobacterium fortuitum, a ubiquitous rapid growing atypical mycobacterium, most often occurs as a postsurgical wound complication or at the site of a penetrating injury to the skin. Rarely, disseminated infection with cutaneous involvement can occur in immunocompromised patients.

Case Report. A 47‐year‐old black woman presented with a 10‐year history of numerous draining abscesses and tender nodules on the back and buttocks unresponsive to oral and intravenous antibiotics. Biopsy showed a granulomatous and suppurative dermatitis and panniculitis and special stains did not reveal organisms. M. fortuitum was cultured from involved skin on two separate occasions. The patient improved with a 2‐week course of intravenous amikacin and cefoxitin combined with oral probenecid followed by a course of doxycycline and ciprofloxacin.

Conclusions. Widespread primary cutaneous infection with M. fortuitum may occur in an immunocompetent patient. Chronic draining skin abscesses unresponsive to routine antibiotics may represent infection with an atypical mycobacterium; tissue cultures of affected skin should be performed to rule out this possibility. Therapy should be directed by culture sensitivity results.
CLARITHROMYCIN IN THE TREATMENT OF SKIN AND SKIN STRUCTURE INEECTIONS: TWO MULTICENTER CLINICAL STUDIES
Authors: PARISH LAWRENCE CHARLES ,   THE CLARITHROMYCIN STUDY CROUP
Published: May 2007

Background. Clarithromycin is a new macrolide analog of erythromycin with activity against a number of dermatologic pathogens.

Methods. The efficacy and safety of clarithromycin, 250 mg bid, were compared with those of reference drugs, cefadroxil and erythromycin, in two multicenter studies: (1) a randomized, double‐blind 45‐center study, in which clarithromycin or cefadroxil 500 mg bid was given for 5–14 days; and (2) a single‐blind 31‐center study, in which clarithromycin or erythromycin, 250 mg qid, was given for ≤ 14 days.

Results. In the first study, efficacy and safety were evaluated in 299 and 538 patients, respectively. In the second study, the numbers were 141 and 261 patients, respectively. Overall, clarithromycin was as effective and safe as cefadroxil and erythromycin.

Conclusions. Clarithromycin provides an alternative therapy to cefadroxil and erythromycin for skin and skin structure infections, especially in beta‐lactam allergic patients.
IN VITRO SUSCEPTIBILITY OF DERMATOPHYTES TO ANTIFUNGAL DRUGS: A COMPARISON OF TWO METHODS
Authors: MACURA ANNA B.
Published: May 2007

Background. There is an evidence that some fungal strains are resistant to certain antimycotic drugs with resulting therapeutic failures. Unlike testing of antibacterial agents, the activity of these drugs against the given fungal strains is not tested routinely. The paper presented is an approach to such a procedure.

Methods. The minimum inhibitory concentration (MIC) values obtained using the dilution method were compared with the diameters of growth inhibition zones using the disk‐diffusion method. Seven antifungal drugs (graiseofulvin, natamycin, naftifine, clotrimazole, bifonazole, miconazole, ketoconazole) were tested with 80 fungal strains, including Trichophyton rubrum, T. mentagrophytes, Microsporum canis, and Epidermophyton floccosum.

Results. The majority of fungal strains were inhibited by griseofulvin at concentrations not exceeding 10 mg/L. The least susceptible was T. mentagrophytes. The most effective drug was naftifine, and the least effective was natamycin. Naftifine inhibited 98.75% of the strains tested at a concentration not exceeding 1.0 mg/L. An increase of the MIC value was accompanied by a decrease in the growth inhibition diameter. The relation was statistically significant.

Conclusions. T. rubrum strains are more susceptible to antifungal drugs than T. mentagrophytes. Naftifine proved to be the most effective drug in dermatophytoses. Natamycin is a useful drug against yeast‐like fungi but not against dermatophytes. The disk‐diffusion method of fungal susceptibility assessment yields data consistent with results obtained from the dilution method and is recommended for routine use because of its simplicity.
ACUTE FEBRILE NEUTROPHILIC DERMATOSIS (SWEET'S SYNDROME)
Authors: SITJAS DOLORS , PUIG LLUIS , CUATRECASAS MIRIAM , DE MORAGAS JOSÉ M.
Published: May 2007

Background. Sweet's syndrome is well recognized and not infrequently diagnosed in Spain; however, the range of clinical and pathologic expression may not have been fully realized.

Methods. We reviewed 30 consecutive Spanish cases of Sweet's syndrome diagnosed in our department from 1979 to 1990, with special attention to clinical and histopathologic findings.

Results. Distinctive clinical features in our series included oral mucosa lesions in four patients (13%), development of pathergy phenomenon in one case, concurrent nodular lesions resembling erythema nodosum on the limbs in nine cases (30%), and lung involvement in two patients. Infectious disease and drug treatment were recorded as possible triggering factors of Sweet's syndrome in eight and seven patients respectively. Associated underlying systemic disorders were present in 15 (50%) of our patients. The most frequent associations were hematologic neoplasia in four patients, solid neoplasia in two, and chronic idiopathic inflammatory bowel disease in three patients. Dressler's syndrome and sicca syndrome were found in one patient each. Histopathologic studies of skin biopsy specimens obtained at presentation disclosed typical features of Sweet's syndrome in all cases. Epidermal involvement, with variable degrees of spongiosis, exocytosis of polymorphonuclear leukocytes and keratinocyte necrosis, was a prominent feature in 83% of biopsy specimens.

Conclusions. Further characterization of the clinicopathologic spectrum of Sweet's syndrome is necessary as the recognition of the full spectrum of this syndrome will improve our diagnostic abilities and provide a solid clinical basis for prospective studies that allow dissection of the intricate pathomechanisms involved in this fascinating disorder.
POST‐KALA‐AZAR DERMAL LEISHMANIASIS: A CLINICAL AND THERAPEUTIC STUDY
Authors: RAMESH VENKATESA , MISRA RADHEY SHYAM , SAXENA UMA , MUKHERJEE ASHOK
Published: May 2007

Background. Post‐kala‐azar dermal leishmaniasis is a condition peculiarly confined to the Indian subcontinent.

Methods. The clinical features and investigations in 18 patients of post‐kala‐azar dermal leishmaniasis were studied.

Results. There was a polymorphic picture from hypopigmented macules to nodules and plaques. Mucous membranes were affected in five, the lips and glans penis being the most frequent sites, Histopathologically, a rich dermal infiltrate was seen in indurated lesions and in macules; it was confined to perivascular foci in the upper dermis. Leishman‐Donovan bodies were seen in 16.

Conclusions. The lesions cleared in 4 to 5 months after treatment with sodium antimony gluconate intramuscularly 20 mg/kg/day up to a maximum of 1 g/day. The drug was well tolerated.
EPIDERMOLYSIS BULLOSA IN THE EASTERN PROVINCE OF SAUDI ARABIA
Authors: ABAHUSSEIN ABDULAZIZ A. , AL‐ZAYIR AHMAD A. , MOSTAFA WEDAD Z. , OKORO ANEZI N.
Published: May 2007

Background. Epidermolysis bullosa is recognized to be rare, but its prevalence in the Eastern Province of Saudi Arabia had not been previously established.

Methods. We reviewed 49,902 dermatology cases seen in our clinic over a 7–year period (1984 through 1990) and carried out a therapeutic trial of oral phenytoin in three severe cases of epidermolysis bullosa dystrophica (Recessive dystrophic type).

Results. Sixteen cases of epidermolysis bullosa were found in this series, ten (62.5%) of which were of the dermolytic type (epidermolysis bullosa dystrophica), and four (25%) of the epidermolytic type (epidermolysis bullosa simplex). Parental consanguinity was established in fourteen (87.5%) of these cases. All ten cases of epidermolysis bullosa dystrophica developed complications. Three severe cases were treated with oral phenytoin and managed with meticulous nursing and nutrition with blended foods and protein and vitamin supplements and responded satisfactorily.

Conclusions. This study confirmed the rarity of epidermolysis bullosa in this province (population 3,000,000), and demonstrated the usefulness of oral phenytoin therapy, meticulous nursing, and good nutrition in the management of epidermolysis bullosa dystrophica.
ELEVATED SERUM NICKEL CONCENTRATION IN PSORIASIS VULGARIS
Authors: SMITH STEVEN A. , AAMIR FARAH , OTIS MICHAEL P. B.
Published: May 2007

Background. Psoriasis vulgaris is a common skin disease afflicting 1–3% of the American population. Its pathogenesis remains unknown despite concerted research efforts. Our purpose was to study baseline serum nickel concentrations in psoriasis vulgaris subjects and in healthy control subjects.

Methods. Sixteen psoriasis vulgaris subjects with active disease (in 14 of moderate to marked severity), and 11 age‐and sex‐matched healthy control subjects were studied. Serum nickel determinations were performed using electrothermal atomic absorption spectrophotometry (ETAAS).

Results. Despite the relatively small sample size, significant elevation of mean serum nickel concentration was found in the psoriasis group compared to the control group (P = 0.019).

Conclusions. Recognition of abnormal nickel homeostasis could point the way to greater understanding of the primary biochemical defect in the psoriatic process. Alternatively, this finding may mark an association without pathogenic significance. Further investigation is needed.
ULTRASOUND IMAGING OF PSORIATIC SKIN: A NONINVASIVE TECHNIQUE TO EVALUATE TREATMENT OF PSORIASIS
Authors: VAILLANT LOIC , BERSON MARCEAU , MACHET LAURENT , CALLENS ANNICK , POURCELOT LÉANDRE , LORETTE GÉRARD
Published: May 2007

Background. The aim of our study was to image psoriasis plaques by ultrasound to assess the changes in psoriasis and to measure and quantify them objectively.

Materials and Methods. Thirty‐one psoriasis plaques were studied in 19 patients. Measurements of skin thickness were obtained with a high resolution B‐mode echographic system.

Results. Some changes were seen in psoriatic skin. A new structural element was observed: a wide subepidermal nonechogenic band. The other changes were a decrease in dermal echoes that were less intense and less dense, and an increase in the epidermal and dermal skin thicknesses. The skin thickness was increased in all psoriasis plaques as compared to apparently normal skin (P < 0.001). The average increase was 67% for whole skin and 200% for epidermis.

Conclusions. Ultrasound imaging of psoriatic skin allowed the identification of different skin changes induced by psoriasis, and particularly, the differentiation between epidermal and dermal alterations. We presume that epidermal thickness reflects epidermal proliferation and desquamation, and the increase in the dermal and whole skin thickness reflects infiltration. We feel that ultrasound imaging of psoriatic skin is a quantitative method that is as easy and noninvasive as the psoriasis area and severity index (PASI). It could be used for following up patients with psoriasis and could achieve widespread use, especially in research protocols.
EFFICACY OF SHORT‐CONTACT THERAPY WITH DITHRANOL IN CHILDHOOD PSORIASIS
Authors: ZVULUNOV ALEXANDER , ANISFELD AMIR , METZKER ARIEH
Published: May 2007

Background. Dithranol is a potent reducing substance and is thought to achieve its effect on psoriasis by reduction of cell turnover. It was shown to be efficacious in adults, but its efficacy has not been documented in children.

Methods. The efficacy of short‐contact therapy, a dithranol cream preparation, was retrospectively evaluated in 58 children with psoriasis. Dithranol cream (0.1‐2%) was applied daily for 30 minutes to affected skin areas. Patients were evaluated at 1‐4‐week intervals.

Results. The median duration of therapy before the onset of remission was 2 months. Remission was achieved in 81% of the children. The median duration of remission was 4 months. Mild adverse skin reactions occurred in 20% of patients, but only one patient had to discontinue therapy.

Conclusion. Short‐contact therapy with dithranol cream preparation is an effective and well‐tolerated treatment for childhood psoriasis. A thorough explanation of the disease and mode of therapy to patients and their parents is essential for good compliance and subsequent success.
EFFECTS OF AZELASTIN ON PRURITUS AND PLASMA HISTAMINE LEVELS IN HEMODIALYSIS PATIENTS
Authors: MATSUI CHIHIRO , IDA MITSURU , HAMADA MASAAKI , MOROHASHI MASAAKI , HASEGAWA MASATSUNE
Published: May 2007

Background. Persistent pruritus is the most common symptom in hemodialysis patients. Its causes are poorly understood and there is no effective treatment. We have studied the effect of azelastin HCL on the plasma histamine concentrations and pruritus in maintenance dialysis patients with or without erythropoietin therapy.

Patients. Twenty‐eight hemodialysis patients were divided into four groups according to the presence or absence of pruritus and whether or not they received erythropoietin therapy.

Results. Histamine concentrations in the patient groups were significantly higher than in healthy volunteers, but a significant difference could not be found among the four groups. The patients with pruritus showed no change in their histamine concentration during treatment with azelastin HCL, but their pruritus scores decreased remarkably.

Conclusions. The present data do not support the thesis that the increased plasma histamine concentration is causally related to pruritus in hemodialysis patients or that the antiallergic drug, azelastin HCL, alleviates the pruritus of dialysis patients by decreasing plasma histamine levels. The possible role of the increased tissue levels of histamine remains to be studied.
CORRESPONDENCE
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 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 Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
IL‐1 ALPHA‐INDUCED EXPRESSION OF ICAM‐1 ON CULTURED HYPERPROLIFERATIVE KERATINOCYTES: SUPPRESSION BY ANTIPSORIATIC DIMETHYL‐FUMARATE
Authors: SEBÖK BELA , BONNEKOH BERND , MAHRLE GUSTAV
Published: May 2007

Background. In the psoriatic plaque both IL‐1 dysregulation and ICAM‐1 expression on keratinocytes have been previously described. Furthermore systemic administration of fumarates has been reported to be effective in psoriasis. We, therefore, studied the effect of dimethyl‐fumarate ester (DMF) on the putative IL‐1‐induced ICAM‐1 expression.

Methods. Hyperproliferative human kertinocytes (HaCaT cell line) were incubated in 10 to 100 U/mL IL‐1 alpha for 24 h with and without preincubation with 0.4–12.0 uM dmf. Expression of icam‐1 was measured by a special ELISA‐APAAP technique.

Results. The exposure to 11‐1 led to a significant dose‐dependent induction of ICAM‐1 expression of from 124 ± 17 to 194 ± 22% (control 100 ± 12%), while proliferation remained unaltered. Pretreatment with > 4 μM DMF resulted in a distinct suppression of ICAM‐1 expression and a slight decrease in proliferation.

Conclusions. The present results show that ICAMI‐1 expression on hyperproliferative keratinocytes may be triggered by il‐i alpha and serve as a molecular target for antipsoriatic DMF.