bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy, safety and tolerability of terbinafine for Tinea capitis in children: Brazilian multicentric study with daily oral tablets for 1, 2 and 4 weeks
Authors: Filho S. Talarico , Cucé L.C. , Foss N.T. , Marques S.A. , Santamaria J.R.
Published: September 2006

Background

Tinea capitis is a common skin disease seen predominantly in children. The standard therapies for this disease are griseofulvin and ketoconazole. Nevertheless, these drugs have drawbacks in that they are only fungistatic and require treatment for at least 6 weeks. Previous studies with oral terbinafine for the treatment of Tinea capitis have shown that this agent is effective when given for 4 weeks, comparable to an 8‐week regimen with griseofulvin. To date there is no data on the use of oral terbinafine in Brazilian children.

Objectives

To assess the efficacy, safety and tolerability of oral terbinafine in short‐term treatments (1‐, 2‐ and 4‐week treatment) of Tinea capitis in children.

Patients and methods

One hundred and thirty‐two children aged 1–14 years were enrolled in this study, but only 107 were considered for the final efficacy analysis. Diagnosis included clinical assessment and examination by Wood's light. Confirmation was obtained by direct microscopy and culture for fungus. Terbinafine dosage (125 or 250 mg/day) was adjusted according to patient weight. Efficacy was evaluated both by clinical and mycological assessment. Safety and tolerability variables included data on adverse reaction and clinical laboratory evaluations.

Results

Mycological evaluation in the follow‐up visit at week 12 showed negative direct microscopy and culture results in 48.6, 60.5 and 69.7% patients in groups 1‐, 2‐ and 4‐week, respectively (n.s.). At week 12, 84.8% patients in group 4‐week achieved clinical cure with a significant difference compared to groups 1‐ and 2‐week, 54.3 and 60.5%, respectively (P < 0.01). Adverse reactions were present in 4.8, 6.8 and 10.9% of patients in groups 1‐, 2‐ and 4‐week, respectively, terbinafine was not associated with clinically relevant increases in liver function tests.

Conclusions

Terbinafine is an effective, well tolerated and safe antifungal agent for the treatment of Tinea capitis in children. The shorter duration of treatment resulted in lower cure rates. However, it is important to note that depending on the severity of the disease, a 1‐week‐only treatment can also be effective in this indication.
Small malignant melanoma in patients with mycosis fungoides
Authors: Amichai Boaz , Grunwald Marcelo H. , Goldstein Jed , Finkelstein Eve , Halevy Sima
Published: September 2006

An increased risk for a second malignancy has been reported in patients with mycosis fungoides. We describe two subjects with mycosis fungoides who developed small malignant melanoma after topical application of nitrogen mustard.
Effective treatment of persistent papular acantholytic dermatosis with cyclosporine
Authors: Avci Oktay , Lzler Fatih , Pabuçcuoǧlu Uǧur , Şahin Turhan , Guneş Ali Tahsin
Published: September 2006

We describe a patient with persistent papular acantholytic dermatosis provoked by phototoxic reaction to his usual perfumed soap and shaving foam. Therapy with systemic and topical corticosteroids failed to improve the patient. Treatment with cyclosporine was found to be effective.
Antibodies to desmoplakin in a patient with pemphigus foliaceous
Authors: Jiao Diane , Bystryn Jean‐Claude
Published: September 2006

Background

Antibodies to desmoplakins have been associated with paraneoplastic pemphigus. Here, we report a case of non‐neoplastic pemphigus foliaceous with antibodies to desmoplakins.

Observation

A 61‐year‐old woman with pemphigus foliaceous by clinical, histological and immunofiuorescent criteria was found to have circulating antibodies to 250 and 215 kDa antigens identified as desmoplakin I and II by immunoblotting and immunoprecipitation. The patient had no evidence of cancer during a follow‐up period of 3 years.

Conclusion

Although antibodies to desmoplakin I and II have previously been associated with paraneoplastic pemphigus, their occasional finding in erythema multiforme and bullous pemphigoid indicates that they can also occur in non‐neoplastic pemphigus.
Immunomodulatory effects of tretinoin in combination with clindamycin
Authors: Wauben‐Penris Paulette J.J. , Cerneus Dirk P. , van den Hoven Wil E. , Leuven Peter J.M.J. , den Brok Jan H.A.M. , Hall David W.R.
Published: September 2006

Background

Since acne is a multifactorial skin disease, therapies affecting several etiologic factors can have a higher than expected effectiveness. A combination of the antibiotic clindamycin phosphate and the retinoic acid tretinoin was developed.

Objective

Anti‐inflammatory and immunomodulatory effects of tretinoin in vitro were studied on human keratinocytes and peripheral blood mononuclear cells (PBMCs). Effects of clindamycin phosphate on tretinoin effects were studied.

Methods

Anti‐inflammatory effects on keratinocytes were assessed using an in vitro model with PMA (phorbol ester)‐stimulated A431 cells (human epidermoid carcinoma). Immunomodulatory effects were measured on superantigen (SEB) stimulated PBMCs.

Results

Tretinoin showed very potent inhibition of PMA‐stimulated IL‐6 (interleukin 6) release by A431 cells. The addition of clindamycin phosphate did not interfere with this effect. Tretinoin very potently stimulated IL‐5 release, and inhibited IFNγ release by SEB‐stimulated human PBMCs. This indicates an immunomodulatory effect, stimulating Th2, and inhibiting Thl dominated responses. These features have been related to the healing of acne lesions. The addition of clindamycin phosphate did not interfere with the immunomodulatory effects of tretinoin.

Conclusion

The combination of tretinoin and clindamycin phosphate can be expected to be very effective in acne therapy.
Use of recombinant pemphigus vulgaris antigen in development of ELISA and IB assays to detect pemphigus vulgaris autoantibodies
Authors: Bhol Kailash , Tyagi Shivraj , Natarajan K. , Nagarwalla Neville , Ahmed A. Razzaque
Published: September 2006

Aim/Objective The objectives of this study are: (1) to measure the titers of pemphigus vulgaris (PV) autoantibody in the sera of patients with active disease, using three different assays: (a) Indirect immunofluorescence (IIF) using monkey esophagus as a substrate, (b) immunoblot (IB) and, (c) enzyme‐linked immunosorbent assay (ELISA) using recombinant PV antigen (rPVA). (2) To compare the sensitivity of these three assays.

Background The titer of PV autoantibodies and disease severity and extent do not always correlate. This could be due to the lack of consistency and specificity of the substrate. Different results are obtained using different substrates. A standard substrate with uniformly controlled source of antigen would be more useful and clinically beneficial.

Methods In this study we studied 25 PV patients, six each with bullous pemphigoid (BP), ocular cicatricial pemphigoid (OCP), mucous membrane pemphigoid (MMP), and herpes gestationis (HG), and sera from 16 normal subjects. IIF was used to determine the PV autoantibody using monkey esophagus. IB assay was used according to standard protocol using normal human epidermis and rPVA as substrates. ELISA was performed using rPVA as antigens expressed in E. coli.

Results Sera of all 25 PV patients showed binding to the rPVA, normal human sera and the sera from the six BP, six OCP, six MMP, and six HG patients did not show any binding. In addition, we used antisera from rabbits immunized with PVA peptides (Bos‐1, Bos‐6) which also showed binding to rPVA, whereas normal rabbit sera did not show any reactivity. ELISA and IB titers in all the patients were 2.5 to 160 times higher than with the conventionally used IIF assay. The titers of the PV specific autoantibody measured using the rPVA did not show statistically significant differences between the ELISA and IB assays.

Conclusions IB and ELISA are superior to IIF in evaluating the antibody levels in PV patients. ELISA is more practical and is preferable to IB and is recommended for clinical use.
Cutaneous infection due to acremonium
Authors: Grunwald M.H. , Cagnano M. , Mosovich M. , Halevy S.
Published: September 2006

We report an immunocompromised patient who developed a cutaneous infection caused by acremonium which is a rare opportunistic fungi. With the increasing number of immunocompromised patients opportunistic fungal infection can cause serious diseases and early recognition is mandatory.
Subcutaneous T‐cell lymphoma: report of two cases
Authors: Wąsik Feliks , Kołodziej Tomasz , Jeleń Michał , Pejcz Jerzy
Published: September 2006

We have seen two patients, a 24‐year‐old man and a 15‐year‐old girl, with subcutaneous nodules and fever. The histo‐pathological findings in both cases showed a lobular, histiocytic panniculitis with ‘bean bag’ cells and lymphoid cells identified as immature T‐cells. This picture was consistent with subcutaneous T‐cell lymphoma associated with cytophagic histiocytic panniculitis. The girl died after 5 months of disease with florid hemophagocytic syndrome; the man was subjected to a course of treatment (CHOP; cyclophosphamide/doxorubicin/vincristine/prednisone) and after 6 months observation his symptoms of nodules and fever disappeared.
Hypomelanosis of Ito: a case report with clinical and ultrastructural data
Authors: Cellini Andreina , Morroni Manrico , Simonetti Oriana , Offidani Annamaria
Published: September 2006

Hypomelanosis of Ito (HI) is an uncommon skin disorder characterized by the presence of hypochromic areas associated with visceral abnormalities, the most common being neurological, muscular, skeletal and ocular. The authors describe a typical case of hypomelanosis of Ito in a 7‐year‐old child. The patient was obese, suffered from scoliosis, flat feet and had a bilateral genu valgus. No neurological, ophthalmological or dental malformations were noted. An electron microscopic study of a hypomelanotic area showed decreased functional activity in the melanocytes, which contained only a few rudimentary cytoplasmatic projections and poorly developed organelles. In addition, there was a reduction in the number of mature melanosomes.
African histoplasmosis: therapeutic efficacy of itraconazole
Authors: Velho G.C. , Cabral J.M. , Massa A.
Published: September 2006

A patient with African form of histoplasmosis was treated for 7 years with ketoconazole, with no response; after a 9‐month daily treatment with 100 mg of itraconazole the patient was successfully cured. No evidence of relapse was observed during the 3‐year follow‐up period.
Pathophysiology of scleroderma: an update
Authors: Haustein U.‐F. , Anderegg U.
Published: September 2006

Objectives To review the pathophysiological background of systemic sclerosis in relation to the main, components involved: microvascular system, immunological system and fibroblasts of the connective tissue.

Background Although many particular aspects of the pathophysiology of systemic sclerosis have been investigated in recent years, the complexity of the pathogenesis and the important links between the components involved remain unclear.

Methods Literature review.

Results and conclusion Scleroderma is a connective tissue disorder resulting in a progressive fibrosis of skin and internal organs. The genetic background is not clear. The microvascular system is one of the first targets involved (damage of capillaries, enhanced expression of adhesion molecules interacting with lymphocytes, perivascular infiltrates as starting points for tissue fibrosis). The immune system is unbalanced (selection of T‐cell subpopulations, elevated serum levels of several cytokines, occurrence of autoantigens to topoisomerase I, centromeric proteins and RNA polymerases). As far as autoimmunity is concerned the triggering autoantigen is still unknown. Development of connective tissue fibrosis is prominent (sub‐populations of fibroblasts with disturbed regulation of collagen turnover by TGF‐β, CTGF and collagen receptors (α1β1, α2β2)). Investigation of pathophysiology of scleroderma is effected by monitoring the serum levels for soluble mediators, by cell culture studies of affected and non‐affected fibroblasts and EC, by studying environmentally induced forms of scleroderma and by studies using animal models.
Aspergillus versicolor as cause of onychomycosis: report of 12 cases and susceptibility testing to antifungal drugs
Authors: Torres‐Rodríguez J.M. , Madrenys‐Brunet N. , Siddat M. , López‐Jodra O. , Jimenez T.
Published: September 2006

Background Onychomycoses caused by opportunistic moulds are not well understood, and many are due to Scopulariopsis brevicaulis and other species. Aspergillus versicolor is not documented as an etiological agent in most studies. We have found an increasing prevalence of this species which is involved in 5.8% of all fungal infections of toe nails.

Objective To study the clinical and mycological characteristics of the onychomycosis caused by A. versicolor and the in vitro susceptibility of this mould to antifungal agents.

Results Onychomycosis due to A. versicolor is mainly seen in people over 60 and presents with chronic involvement of the big toe nails. Predisposing factors are not always present and the infection does not respond to conventional topical antifungals. In vitro, A. versicolor has been shown to be resistant to griseofulvin and fluconazole as well as to amphotericin B, whereas MICs for itraconazole and ketoconazole are variable but within a range of 0.50–4.0 μ g/ml; on the contrary, MICs for terbinafine are very low (<0.125 μ g/ml).

Discussion Aspergillus versicolor could be considered as an emergent pathogen causing toenail onychomycosis. Local treatment seems not to be effective. Of the various systemic antifungal agents studied terbinafine appears to be the most effective in treating onychomycosis.
Trichorhinophalangeal syndrome type I
Authors: George Soshamma , Pulimood Susanne , Korah Ipeson
Published: September 2006

A 32‐year‐old short statured woman with alopecia, typical facies, shortened angulated fingers and toes with Trichorhinophalangeal syndrome type I (TRPS I) is reported. The absence of exostosis and mental retardation rule out TRPS II. The absence of generalized shortness of all phalanges, metacarpals and metatarsals distinguish it from TRPS III. Possibly the various types of Trichorhinophalangeal syndrome are genetically identical but have a varied clinical spectrum.
Clinical implications of the molecular biology of erythropoietic protoporphyria
Authors: Todd David J.
Published: September 2006

AimTo review our present knowledge about the molecular genetics of erythropoietic protoporphyria.

MethodsLiterature review.

ResultsErythropoietic protoporphyria (EPP) is caused by decreased activity of the enzyme ferrochelatase and is characterized by distressing photosensitivity commencing in childhood. For reasons that are not yet fully understood, some patients develop potentially fatal acute hepatic failure. The gene for ferrochelatase has been cloned, sequenced and mapped to the long arm of chromosome 18. Subsequent molecular analysis has shown EPP to be very genetically heterogeneous, and 28 different mutations in 31 unrelated patients have been published. No mutation(s) in the ferrochelatase gene or elsewhere in the genome, or environmental factors have been conclusively associated with the development of protoporphyric hepatic failure. The complex inheritance of EPP has now been partially resolved. In the majority of families co‐inheritance of a mutant ferrochelatase allele from one parent and a low‐output ‘normal’ ferrochelatase allele from the other parent is required for disease expression. Gene therapy experiments have been completed in‐vitro and are in progress in an animal model of EPP.

ConclusionEPP is a good example of how advances in molecular biology have led to a greater understanding of the pathogenesis and inheritance of disease. The most urgent need is to discover why some EPP patients develop hepatic failure. Gene therapy of EPP patients should become possible in the future.
The efficacy, tolerability and safety of a new oral formulation of Sandimmun®‐Sandimmun Neoral® in severe refractory atopic dermatitis
Authors: Atakan Nilgün , Erdem Cengizhan
Published: September 2006

Aim To investigate the efficacy, tolerability and safety of a new oral formulation of Sandimmun®‐Sandimmun Neoral® in severe refractory atopic dermatitis in an open, multicenter study.

Methods The study was conducted in three parts. After 2 weeks of screening, Sandimmun Neoral® was commenced at a dose of 3 mg/kg per day and continued until remission or for a maximum of 8 weeks, after which the dose was reduced by half and continued for another 2 weeks and then discontinued. After the treatment period, patients were followed up first for 8 weeks and then until relapse or for a maximum of 24 weeks.

Subjects Twenty‐three patients with severe refractory atopic dermatitis (15 females, eight males) mean age 27.2 ± 14.6 years (range 13–70 years) entered and 22 patients completed the study (one drop‐out due to withdrawal of consent).

Results After the end of the full‐dose (mean duration 6.5 weeks) and half dose treatment periods, the SCORAD index decreased by 82 and 90%, respectively. Improvement started as early as at 2 and 4 weeks of treatment (mean reduction in SCORAD: 37.5 and 71.7%). At the end of the treatment phase, reductions in EDS, intensity of disease, DSS, pruritus, and sleep loss were 85, 88, 79, 85 and 96%, respectively. The overall efficacy was assessed as very good or good in 96 and 100% of the patients at the end of treatment and after 8 weeks follow‐up, respectively. During the follow‐up of 24 weeks after treatment, 73% of the patients had a relapse, whereas 27% were still in remission at the end of 24 weeks. In the 22 patients who completed the study, no adverse events were noted which would have necessitated dose reduction or drug withdrawal. Tolerability was assessed as very good or good in 91 and 96% of the patients, at the end of treatment and after 8 weeks follow‐up, respectively. Adverse events observed were: nausea (18%), hirsutism (9%), headache (4.5%), epigastric pain (4.5%), paresthesia (4.5%), furuncle (4.5%), and herpes labialis (4.5%). No significant changes in vital signs, hematological and biochemical parameters and serum creatinine were observed during the study except eosinophilia which was reduced by 40% towards the end of treatment.

Conclusions Our results suggested that short‐term (8 weeks), low dose (3 mg/kg per day) Sandimmun Neoral® treatment is an effective, safe, and well‐tolerated treatment for atopic dermatitis refractory to conventional treatment modalities and can lead to long‐term remission of the disease in some patients. However, a double‐blind, placebo controlled, long‐term follow‐up study would be necessary to confirm these results.
Concentration of an epidermal growth factor in blood serum of males during topical treatment of psoriasis
Authors: Pietrzak Aldona , Miturski Roman , Krasowska Dorota , Postawski Krzysztof , Lecewicz‐Toru Barbara
Published: September 2006

Epidermal growth factor (EGF) is a mitogen that stimulates cell division of various cells of epidermal origin. The present study was undertaken to clarify whether the serum level of EGF is correlated with the disease activity during local therapy with dithranol in psoriasis. We examined serum EGF concentrations in acute and chronic psoriasis before and after topical treatment with dithranol and the correlation with Psoriasis Activity and Severity Index (PASI). Male patients were divided into two groups: acute psoriasis (AP, 18 cases) and chronic psoriasis (CP, 17 cases). A control group C consisted of 20 healthy male volunteers. Radioimmunoassay of EGF was performed using the reagent pack (Amersham, UK). In the CP group mean EGF was higher before treatment than in the AP and C groups, but not significantly. EGF concentration after local treatment was higher in the CP group than the AP group (P < 0.02); the AP group, however, showed statistically significant decrease of EGF after the treatment (P < 0.04). No correlation between EGF and PASI was found. Serum EGF concentration increased in 19/35 treated patients.
Characterization of [3H]substance P binding sites in human skin
Authors: Bianchi Beatrice , Matucci Rosanna , Danesi Alessandro , Rossi Riccardo , Ipponi Pierluigi , Giannotti Benvenuto , Johansson Olle , Cappugi Pietro
Published: September 2006

Radioligand binding experiments were performed with crude homogenates from normal human skin in order to investigate substance P receptor density. Binding of [3H]substance P ([3H]SP) reached equilibrium after 20 min and was saturable; analysis of saturation curves gave a significantly better fit using two‐site binding compared to the single‐site model. Competition studies employing some selective agonists for NK1, NK2 and NK3 receptors have demonstrated that only the NK1 selective agonist, [Sar9, Met(O2)11]‐SP, was a competitor for [3H]SP binding. In addition, the non‐hydrolyzable guanosine 5′‐0‐(3‐thiotriphosphate) altered the dissociation of SP from NK1 receptors by increasing the number of low‐affinity sites. These data show that in the skin [3H]SP binds to a single population of substance P high‐affinity sites, which represent NK1‐type receptors.
Umbilical endometriosis
Authors: von Stemm Andrea M.R. , Meigel Wilhelm N. , Scheidel Peter , Gocht Andreas
Published: September 2006

Cutaneous endometriosis is a well known but rare phenomenon. We present a case of spontaneous umbilical endometriosis. The patient revealed a polypoid, brown‐blue nodule within the umbilical depression with the typical history of monthly bleeding from the umbilicus. The differential diagnoses are summarized.
Keratosis palmoplantaris varians of Wachters
Authors: Paoli S. , Mastrolorenzo A.
Published: September 2006

We report a case of hereditary palmoplantar keratosis (HPPK) causing a progressive reduction of the prehension capacity of the fingers due to the presence of hyperkeratotic lesions which had appeared approximately 25 years earlier. These lesions, also involving the soles, appeared yellowish in color, linear or round in shape, symmetrical and often confluent, developed prevalently at the pressure points displaying a non‐transgrediens pattern. The histological examination, clinical picture and careful analysis of the literature enabled us to define this form as ‘keratosis palmoplantaris varians of Wachters'. As a contribution to a conclusive HPPK classification we discuss the differential diagnosis of this disorder most commonly identified through nummular‐linear keratoses also known as Siemens’ syndrome.
Stress‐induced SAPHO syndrome
Authors: Orion Edith , Brenner Sarah
Published: September 2006

We describe the case of a woman with the classic combination of features of synovitis‐acne‐pustulosis‐hyperostosis‐osteitis (SAPHO) syndrome, including pustulosis palmo‐plantaris and anterior chest wall involvement. The varying symptomology, etiology and pathogenesis of this syndrome and the contribution of stress are discussed. The authors ascribe the dearth of reported cases to lack of awareness and recognition of SAPHO, and not to the real incidence of the syndrome.
Familial primary cryofibrinogenemia
Authors: van Geest A.J. , van Dooren‐Greebe R.J. , Andriessen M.P.M. , Blomjous C.E.M. , Go I.H.
Published: September 2006

Background

To our best knowledge this is the second case ever described of familial primary cryofibrinogenemia (CFG).

Patients

A 29‐year‐old Moroccan female and two of her three children suffered from painful purpura, slow healing small ulcerations and edema of both feet during the winter season. Laboratory investigations revealed the presence of cryofibrinogen in their blood plasma. All three patients were otherwise healthy and no associated disease could be demonstrated.

Conclusions

The diagnosis of CFG has to be considered in patients with livedo reticularis, edema, painful purpura and slow healing ulcera after cold exposure. Cryofibrinogen‐precipitates in the blood plasma have to be determined. Because secondary CFG occurs much more frequently than the primary form, it is important to rule out associated diseases through extensive physical examination and laboratory investigations. This communication also stresses the importance of a thorough family history of patients with CFG. An autosomal dominant mode of inheritance is supposed.
Systemic sarcoidosis presenting with multiple tattoo granulomas and an extra‐tattoo cutaneous granuloma
Authors: Papageorgiou P.P. , Hongcharu Wichai , Chu A.C.
Published: September 2006

We describe a 29 year old Caucasian man who developed cutaneous sarcoidosis manifesting itself as a tumour at the left outer canthus clinically mimicking a basal cell carcinoma and nine tattoo granulomas. Subsequent investigation revealed that the patient was also suffering from systemic sarcoidosis.
Congenital poikiloderma with unusual hypopigmentation and acral blistering at birth
Authors: Ogunbiyi Adebola O. , Ogunbiyi J. Olufemi , Baiyeroju‐Agbeja Aderonke M.
Published: September 2006

Congenital poikiloderma is an uncommon hereditary disorder. It has been reported in association with various syndromes. No case has previously been reported from this environment. We report a case of congenital poikiloderma in a two and a half year old female Nigerian associated with unusual generalised hypopigmentation and acral blisters at birth. The child subsequently developed macular hyperpigmentation on an erythematous background and atrophy of the skin. Although she had some features which were suggestive of Rothmund‐Thomson syndrome (RTS), the presence of hypopigmentation at birth, along with acral blistering, was noted to be peculiar to this child. We, therefore, feel that this case presents a distinct variant of congenital poikiloderma that has not been described previously.
The new oral antifungal agents for onychomycosis of the toenails
Authors: Gupta Aditya K. , Shear Neil H.
Published: September 2006

Objective

To review the use of the new oral antifungal agents, itraconazole, terbinafine and fluconazole for the treatment of onychomycosis of the toenails.

Background

Until about 10 years ago the two oral agents available to treat onychomycosis were griseofulvin and ketoconazole. Since then the new oral antifungal agents have superseded the traditional oral agents for the management of toenail onychomycosis.

Methods

Literature review.

Results and conclusion

Itraconazole, terbinafine and fluconazole have been used approximately 100 million times to treat superficial mycoses. These agents are more effective than the traditional antimycotics for the treatment of pedal onychomycosis; furthermore, the new agents have a broader spectrum of action than griseofulvin. In general, itraconazole, terbinafine and fluconazole have a favorable adverse‐effects profile with drug interactions that are usually predictable and manageable. The new oral antifungal agents have a high benefit‐to‐risk ratio when used to treat toenail onychomycosis.
Psychological and sympatho‐adrenal status in patients with cystic acne
Authors: Schulpis Kleopatra , Georgala Sophia , Papakonstantinou E.D. , Michas T.
Published: September 2006

Background

Patients with cystic acne (CA) frequently report feeling self conscious, anxiety and social isolation.

Methods

Mood characteristics as well as self‐esteem scores of 38 patients with CA were evaluated before and after 30 days treatment with isotretinoin. A high pressure, liquid chromatography method was used for the evaluation of catecholamines (epinephrine (E) and nor‐epinephrine (NE)) in the blood of the patients at the time of the study and in controls (n= 30) after their psychological testing. Moreover, E and NE were measured in the blood of eight healthy volunteers before and after 1 month ‘treatment’ with the drug.

Results

The CA subjects evidenced anxiety and high catecholamine plasma levels (E = 98.0 ± 0.8 pg/ml, NE = 250.8 ± 56.6 pg/ml) before treatment compared to controls (E = 71.8 ± 23.0 pg/ml, NE = 190.0 ± 52 pg/ml, P < 0.006), and these levels were lower (E = 75.4 ± 21.4 pg/ml, NE = 202.0 ± 49.9 pg/ml, P < 0.001) when their psychological status returned to normal after treatment. No differences were observed in E and NE levels in the eight healthy volunteers who received the same dose of the drug at the same time of study.

Conclusions

It is suggested that not only the psychological status is influenced in subjects with CA but also their sympathoadrenal system.
The effect of proteolytic enzymes on hair follicles of transgenic mice expressing the lac Z‐protein in cells of the bulge region
Authors: Protopapa E.E. , Gaissert H. , Xenakis A. , Avramiotis S. , Stavrianeas N. , Sekeris C.E. , Schenkel J. , Alonso A.
Published: September 2006

Objective

To study the effects of proteolytic enzymes on mice hair follicles, particularly on cells of the bulge area regarded as follicle stem cells.

Background

Previous application by iontophoresis of proteolytic enzymes on guinea pig skin resulted in degenerative effects on hair follicles and the hypothesis was proposed that some of the affected cells could be stem cells.

Methods

To mark putative stem cells transgenic mice were produced carrying the lac‐Z gene fused to the Upstream Regulatory Region (URR) of Human Papilloma Virus 11 (HPV11), as they express this gene specifically in the cells of the bulge area. Chymotrypsin and papain were applied on skin by iontophoresis, trypsin in the form of liposomes.

Results

Enzyme application, both by electrophoresis and as liposomes, led to intense degenerative effects of the hair follicle, such as detachment of the inner root sheath, cystic dilation of the hair shaft and presence of epithelial cells within the lumen. Some of these cells represent hair follicle stem cells expressing β‐galactosidase (β‐gal), having been detached from the bulge area as a result of enzyme treatment, implying impairment of their function.
A multidisciplinary vulva clinic: the role of genito‐urinary medicine
Authors: Sullivan A.K. , Straughair G.J. , Marwood R.P. , Staughton R.C.D. , Barton S.E.
Published: September 2006

Objectives

To characterise the new patient referrals to a combined vulva clinic and to assess the role of genitourinary services within the clinic.

Methods

A case note review of all new patients attending a monthly, multidisciplinary vulva clinic over a 12‐month period.

Results

The mean age of the 135 women was 43 years (range 18–86 years). The majority of patients, 64 (47%), were referred by their general practitioner (GP). Using nurse and physician triage 85 (63%) patients were seen by a dermatologist, 55 (41%) by a genitourinary medicine physician, 38 (28%) by a gynaecologist and six (4%) by a psychosexual physician. Fifty‐one (38%) women required a consultation by at least two specialties. Itch was the most frequent presenting symptom (70%) and 59 (44%) women had experienced symptoms for between 6 months and 2 years. A previous STD screen had been performed in only 57 (42%), which was negative in 45 (79%). The most frequent initial clinical diagnoses were lichen sclerosus (35, 26%), vaginal candidiasis (21, 16%), vulvodynia (16, 12%), lichen simplex chronicus (13, 10%) and Bowenoid papulosis (13, 10%). Thirty‐eight (28%) women had microbiological investigations revealing 13/135 (10%) had vaginal candidiasis and two (2%) bacterial vaginosis, all symptomatic. A biopsy was performed in 32 (24%) confirming the initial diagnosis in 20 (63%) cases. Treatment was initiated in 101 (75%) women: 62 (46%) were prescribed steroid cream, 46 (34%) emollient cream and 22 (16%) treatment for Candida infection. Fifty‐three (39%) women received more than one treatment. 94 (70%) patients were followed‐up in the vulval clinic, five (4%) in the genitourinary clinic and 12 (9%) by their GP.

Conclusions

Despite having genitourinary symptoms less than half the patients had been tested for infection prior to attending the clinic. More than a third of the patients, 46 (34%), were diagnosed with a genitourinary infection. There is a significant role for genitourinary services in the diagnosis, management and ongoing care of patients in a vulva clinic.
Scleroderma‐like lesions in insulin‐dependent diabetes mellitus
Authors: Haustein U.‐F.
Published: September 2006

We report on two patients (one female 42 years, one male 47 years) suffering from insulin‐dependent diabetes mellitus (IDDM) for more than 20 years. Both patients exhibited sclerodactyly and sclerosis of the hands and lower arms as well as swelling and slight contracture of the distal interphalangeal joints. Interestingly, internal organs were not involved and auto‐antibodies characteristic for scleroderma were missing. Poor utilization and excess of glucose seem to be responsible for the activation of fibroblasts to produce abundant matrix proteins in the skin. Significant therapeutic improvement of the glucose metabolism was able to improve joint contractures or at least to stop the progression of skin changes in our patients. These skin changes should not be misdiagnosed as systemic sclerosis.
Clinical trial of the efficacy and safety of oral etretinate with calcipotriol cream compared with etretinate alone in moderate‐severe psoriasis
Authors: Giannetti Alberto , Coppini Maurizio , Bertazzoni Maria Grazia , Califano Adalberto , Altieri Ermete , Pazzaglia Alberto , Lega Mario , Lombardo Maurizio , Pelfini Carlo , Fornasa Cleto Veller , Rabbiosi Giacomo , Cespa Maddalena
Published: September 2006

Background

The aim of this clinical trial was to assess the efficacy and safety of calcipotriol cream associated with oral etretinate compared with etretinate alone in the treatment of moderate‐severe psoriasis.

Methods

This controlled multicenter trial, within patients (hemiparts), enrolled 86 in‐ or out‐patients (62 males, 24 females), mean (±SD) age 57.1 ± 14.2 years, with psoriasis vulgaris on both sides of the body, and mean (±SE) baseline PASI score (Psoriasis Area and Severity Index) 30.7 ± 0.9. All patients took oral etretinate 50 mg/day and applied calcipotriol cream (50 μg/g) on one half of their body twice a day. Treatment was continued for 9 weeks, and patients were seen every 3 weeks.

Results

At the end of the first 3 weeks the PASI score indicated a significant clinical difference between the two sides of the body (P < 0.001, ANOVA), with a reduction of 50.7% in the score for the calcipotriol‐treated half, compared with a 39% reduction for the untreated half. By the 9th week of treatment the PASI score was 81.4% lower on the treated half, and 70.3% on the untreated side (P < 0.001, ANOVA).

Conclusions

These findings suggest that patients with moderate‐severe psoriasis might benefit from treatment with etretinate plus calcipotriol, with the aim of achieving a faster response and an overall smaller total dose of etretinate.
Plasma antioxidant defense in actinic keratosis and basal cell carcinoma
Authors: Vural Pervin , Canbaz Mukaddes , Selçuki Dilek
Published: September 2006

Background

Reactive oxygen species and lipid peroxides have been implicated in the pathogenesis of a variety of diseases, particularly cancer. There may be an inverse correlation between lipid peroxidation and antioxidant defense mechanisms. The aim of this study was to investigate whether certain plasma antioxidants (ascorbic acid, α‐tocopherol, total thiol groups, ceruloplasmin, urate, albumin and erythrocyte glutathione) are altered in actinic keratosis (AK) and basal cell carcinoma (BCC).

Methods

Plasma samples and red blood cells (RBC) of 13 patients with AK, 12 with BCC and 16 healthy controls were investigated.

Results

Data analysis indicates significant decrease of ascorbic acid (P < 0.001), α‐tocopherol (P < 0.05 and P < 0.001), total thiol groups (P < 0.001), ceruloplasmin (P < 0.001 and P < 0.05), and RBC glutathione (P < 0.05) values in both AK and BCC groups compared to controls. Comparison of AK and BCC groups evidenced a significant decrease of α‐tocopherol and RBC glutathione (P < 0.05) in BCC patient.

Conclusion

Plasma antioxidants are decreased in the AK and BCC, probably due to the long exposure to UV irradiation which is one of the most important factors in the etiology of AK and BCC and α‐tocopherol and RBC glutathione (P < 0.05) are most altered in BCC.
Coexistence of morphea and psoriasis responding to acitretin treatment★
Authors: Bilen Nilgün , Apaydin Rebiay , Erçin Cengiz , Harova Gökhan , Başdaş Füsun , Bayramgürler Dilek
Published: September 2006

A large number of dermatoses associated with either morphea and psoriasis have been reported. However, to the best of our knowledge there is only one report in the literature about coexistence of morphea and psoriasis. Here we report a case of morphea and psoriasis that improved with acitretin treatment. The concomitant occurrence of these two dermatoses may be explained by immunological factors or trauma. We think that the improvement of the morphea lesions may be due to an immunomodulatory effect of the drug or a decrease in collagen production by dermal flbroblasts due to retinoic acid.
Lesion topography in two cases of nifedipine‐related pemphigus
Authors: Brenner Sarah , Golan Haim , Bialy‐Golan Anat , Ruocco Vincenzo
Published: September 2006

Similar lesion topography which resembled an inverted fir tree in two patients with nifedipine‐related pemphigus vulgaris is described. The possible relation of the lesion pattern to the offending drug is discussed.
Extracoporeal photochemotherapy in cutaneous lupus erythematosus
Authors: Wollina U. , Looks A.
Published: September 2006

We report two female subjects with therapy‐resistant cutaneous lupus erythematosus (LE), one with subacute cutaneous and the other chronic discoid LE, both treated with extracorporeal photochemotherapy (ECP). The responses after six and eight cycles of ECP led to a prolonged remission of 18 and 11 months, respectively. ECP seems to be a treatment option for patients not responding to or showing unwanted side‐effects during conventional standard therapy.
Reducing AIDS risk among inner‐city women: a review of the Collectivist Empowerment AIDS Prevention (CE‐AP) Program
Authors: MacKenzie Jean E. , Hobfoll Stevan E. , Ennis Nicole , Kay Jennifer , Jackson Anita , Lavin Justin
Published: September 2006

We discuss the process underlying our HTV‐prevention project for young inner‐city women. Health interventions are almost uniformly based on individualistic models of health and behavior. In contrast, AIDS and AIDS prevention, by their very social nature, may require more collectivist principles of disease, health, and intervention. We conducted a behavioral intervention, the Collectivist Empowerment AIDS Prevention (CE‐AP) Program, with young, inner‐city women to deal with this critical health issue. Our primary intervention goal was to promote women's sense of owning and making healthy choices about their bodies. We attempted to accomplish this by emphasizing the concepts of empowerment, collectivism (as opposed to individualism), and culturally sensitive skill building. Collectivism is emphasized to encourage women to involve others in their behavioral health decisions and to gain power through social joining and coalition building. A woman's behavioral decisions affect many others in her life. Thus, involving others in decision making emphasizes the connection between an individual's actions and their impact on interpersonal relationships. CE‐AP was found to be effective in changing safer‐sex behavior and we review our findings and future directions.
Comparative chemical evaluation of two commercially available derivatives of hyaluronic acid (Hylaform® from rooster combs and Restylane® from streptococcus) used for soft tissue augmentation
Authors: Manna F. , Dentini M. , Desideri P. , De Pità O. , Mortilla E. , Maras B.
Published: September 2006

Hyaluronic acid (HA) derivatives have been developed to try to enhance Theological properties of this molecule to make it suitable for various medical applications. The main dermatological application of HA derivatives is the augmentation of soft tissues, via injection into the dermis. HA derivatives are indicated for the correction of cutaneous contour deficiencies of the skin, particularly in cases of ageing or degenerative lesions or to increase lips. Two HA derivatives have been evaluated: Hylaform® Viscoelastic Gel (Hylan B), derived from rooster combs and subjected to cross‐linking, and Restylane®, produced through bacterial fermentation (streptococci) and stabilized, as declared by the producer. In both cases the purpose is to improve HA rheological characteristics and slow down its degradation once it is in contact with biological structures. Distribution of particle dimensions, pH, protein concentration and rheological properties have been investigated in order to evaluate their reliability as fillers for soft tissue augmentation. The results of the analyses showed that there are differences between Restylane® and Hylaform®. Especially as far as rheological characteristics are concerned, the results outline different structures of the products: Hylaform® behaves as a strong hydrogel, Restylane® as a weak hydrogel; theologically Hylaform® is clearly superior to Restylane®. Hylaform® contains a definitely minor quantity (about a quarter) of cross‐linked hyaluronic acid than Restylane®. Furthermore, although not declared by the manufacturer, Restylane® contains protein, resulting from bacterial fermentation or added to enable cross‐linking reaction; the quantity of proteins contained by Restylane® can be as much as four times the quantity contained by Hylaform®, for the same volume (1 ml). It is evident that Hylaform® offers higher safety margin than Restylane®. Furthermore, wide literature and 20 years of clinical experience on hyaluronan derived from rooster combs confirm the reliability of this derivative while we did not find evidence regarding about the safety of HA obtained from streptococcus.
Simultaneous occurrence of multiple melanoma in situ on sundamaged skin (lentigo maligna), solar lentigo and labial melanosis: the value of dermoscopy in diagnosis
Authors: Massi Daniela , Nardini Paolo , De Giorgi Vincenzo , Carli Paolo
Published: September 2006

We report on a patient developing simultaneous occurrence of lentigo maligna lesions, solar lentigines and an extensive melanosis of the oral mucosa. Diagnostically, epiluminescence microscopy had a relevant role in the preoperative assessment and selection of suspicious pigmented lesions, as the lesions histologically labelled as lentigo maligna and solar lentigo were clinically indistinguishable. We review the clinical, dermoscopic and histopathologic differential diagnosis of solar lentigo, malignant lentigo and mucosal melanosis with other melanocytic and keratinocytic lesions and discuss the possible relationship between these entitles.
Squamous cell carcinoma secondary to recessive dystrophic epidermolysis bullosa: report of eight tumours in four patients
Authors: Bosch RJ. , Gallardo M.A. , del Portal G. Ruiz , Snchez P. , Arce M.F. , Herrera E.
Published: September 2006

Background

The development of squamous cell carcinomas is the main cause of death of patients with Dystrophic epidermolysis bullosa. We think it is of interest to know their clinical characteristics and the treatment difficulties they cause.

Methods

We followed the clinical evolutions and carried out histopathological studies of eight primary cutaneous squamous cell carcinomas on three males and one female with recessive dystrophic epidermolysis bullosa. Patient ages ranged from 16 to 34 years (mean 27).

Results

Two patients had two tumours and one three, all were in characteristically scarred skin; four on upper limbs; four on lower. Maximum tumour dimensions ranged from 2 to 28 cm (mean 13), and represented 6 or more months of evolution. In three cases the affected limb must be amputated. Five tumours were well differentiated, three were moderately differentiated.

Conclusions

The patients consulted too late and their large lesions needed aggressive treatment. Appropriate information and regular examination of patients with RDEB helps early diagnosis of tumours and may avoid disabling operations.
Treatment of cutaneous leishmaniasis with 20% paromomycin ointment
Authors: Stanimirović A. , Stipić T. , Skerlev M. , Basta‐Juzbašić A.
Published: September 2006

Cutaneous leishmaniasis is an infectious disease caused by flagellate protozoa of the genus Leishmania. In Mediterranean countries, the most common causative agents are Leishmania (L.) major, L. infantum and L. tropica. In Croatia, cutaneous leishmaniasis is a rare disease, the last case being reported in 1988. Our patient was a 5‐year‐old boy with a left cheek skin lesion in the form of papule with central exulceration, hyperkeratotic crust and erythema of a 6‐month duration. The diagnosis of cutaneous leishmaniasis was based on history data (stay in the southernmost region of Croatia and multiple mosquito bites), light microscopic histology (dense infiltrates of large histiocytes with extracellular bodies), and positive Montenegro (leishmanin) test. A new therapy with aminosidine (paromomycin), an aminoglycoside antibiotic, in the form of ointment at a concentration of 20%, was for the first time used in Croatia. Four‐week therapy resulted in complete regression of the skin lesions with residual hyperpigmentation. During therapy, no local or systemic side effects were observed. Thus, topical therapy with paromomycin could be considered an efficient therapeutic alternative in the management of cutaneous leishmaniasis.
Tobacco smoking contributes little to facial wrinkling
Authors: O'Hare Patricia M. , Fleischer Alan B. , D'Agostino Ralph B. , Feldman Steven R. , Hinds Martha A. , Rassette Sheila A. , McMichael Amy J. , Williford Phillip M.
Published: September 2006

Background

The potential detrimental effects of tobacco smoking have been widely cited. Tobacco smoking has been linked with facial wrinkling, but some previous studies have failed to take into account a number of potential confounders or were unblinded and thus subjective to bias.

Objective

This study was designed to determine if there was increased facial wrinkling in smokers directly associated with tobacco usage after controlling for solar risk behavior.

Subjects

Eighty‐two smokers (<10 cigarettes per day) and 118 non‐smokers (<100 lifetime cigarettes) were recruited. Caucasian participants completed a questionnaire designed to assess demographic variables and other suspected factors related to wrinkling.

Methods

Three dermatologists, blinded to demographic information, reviewed three photographs of each subject and rated the wrinkling on a 100 mm visual analog scale. Stepwise linear regression was performed on all variables which attained a P < 0.1 level of independent significance.

Results

Overall the model accounted for 75.4% (P= 0.0001) of the variance in wrinkling, and predictive variables (P < 0.02) included age (partial R2= 0.69), smoking pack years (R2= 0.04), hours of outdoor work (R2= 0.008), freckling (R2= 0.007), and eye color (R2= 0.004). A second model was created excluding age which accounted for 37.8% of the variance. The predictive variables in the second model (P < 0.08) included education (partial R2= 0.08), smoking pack years (R2= 0.05), hours of outdoor work (R2= 0.03), weight change (R2= 0.02), female sex (R2= 0.02), hours of lifetime sun (R2= 0.03), tanning bed use (R2= 0.01), and sunscreen use (R2= 0.02).

Conclusions

Smoking may significantly contribute to facial wrinkling, but accounts for only 6% of the explained variance. If there is a role for tobacco smoking in causing wrinkling, this role is a minor one.
Livedo reticularis and cerebrovascular accidents (Sneddon's syndrome) as a clinical expression of antiphospholipid syndrome
Authors: Gantcheva M. , Tsankov N.
Published: September 2006

We present two patients with livedo reticularis and cerebrovascular accidents (Sneddon's syndrome) and positive antic‐ardiolipin antibodies. We suggest that these antibodies may be pathophysiologically related to the clinical manifestation observed in some patients with this syndrome. When Sneddon's syndrome is associated with positive anticardiolipin antibodies it could be regarded as antiphospholipid syndrome and fall into this category of nosological entity.