bluuebunny/crossref_metadata_2025 huggingface dataset:
Isotype determination of circulating autoantibodies in canine autoimmune subepidermal blistering dermatoses
Authors: Favrot Claude , Dunston Stanley M. , Paradis Manon , Olivry Thierry
Published: March 2003

Abstract The three most common canine autoimmune blistering skin diseases (AISBD), bullous pemphigoid (BP), mucous membrane pemphigoid (MMP) and epidermolysis bullosa acquisita (EBA) have recently been separated based on clinical, histological and immunological grounds. The objectives of this study were to determine the isotype profiles of circulating autoantibodies in these dermatoses. Serum was collected from 5 dogs with BP, 15 with MMP and 11 with EBA. All sera were tested using an indirect immunofluorescence method using salt‐split canine gingiva as substrate. Anti‐basement membrane IgG autoantibodies were detected in all patients. Among the IgG autoantibodies, IgG1 and IgG4 were encountered most frequently, while IgG2 and IgG3 were uncovered in some dogs. IgE autoantibodies were detected more often than IgA or IgM autoantibodies in any of the three entities. The predominance of IgG1, IgG4 and IgE autoantibody isotypes in dogs with AISBD is very similar to the situation found in humans with the homologous diseases.
Competition between maize and Datura stramonium in an irrigated field under semi‐arid conditions
Authors: Cavero  , Zaragoza  , Suso  , Pardo
Published: March 2003

Crop growth of maize (Zea mays L.) and Datura stramonium L. in monoculture and competition was studied over 4 years in a flood irrigated field in Zaragoza (Spain). Plant density was 8.33 m–2 for maize and 16.66 m–2 (1994 and 1995) and 8.33 m–2 (1996 and 1997) for D. stramonium. Maize yield was decreased by 14–63% when competing with the weed. Yield reduction increased as the time between crop and weed emergence decreased. The development of leaf area per plant during the exponential growth phase was faster in maize primarily because the leaf area of maize seedlings at emergence time was greater than that of the weed. The faster growth of maize in leaf area and height reduced the photosynthetically active radiation received by the weed. Datura stramonium had a lower radiation use efficiency (RUE) than maize. Competition from the weed slightly decreased the maximum leaf area index (LAI) of the crop, and leaf senescence of maize was accelerated. The weed competed with the crop late in the season reducing crop growth rate, grain number per ear and grain weight. Competitive ability of D. stramonium for light was mainly due to its growth habit, with the leaves concentrated in the upper part of the canopy (more than 75% of LAI in the upper 25% of its height), its higher light extinction coefficient (0.89) and its indeterminate growth habit. The N plant content of maize was not influenced by the presence of the weed. The weed had a higher N plant content than the crop throughout the season and took up more N in monoculture.
Weed competition in willow coppice crops: the cause and extent of yield losses
Authors: Sage
Published: March 2003

Growth in 2‐year‐old willow Salix spp., grown in the short‐rotation coppice (SRC) system on agricultural land, was compared in 30 weeded and 30 unweeded plots in each of 2 years after cutting. Non‐destructive assessment methods of both crop and weed biomass were used. Coppice growth in year I was greater in the weeded plots than in the unweeded plots. In year II, coppice growth was not different between plots so that, over the 2‐year study period, the coppice yield reductions with weeds reflected the losses in year I only. There was considerable variation in the amount of weeds in the unweeded plots. The relationship between the volume of weeds present and the extent of the coppice yield reduction over 1 and 2 years after cutting are described by linear models. Soil moisture and nutrient content, when measured in mid‐summer, were not different between plots in either year. In year I, mid‐summer coppice height was greater in the weedy plots, while stem numbers in both years and canopy density in year II were lower in the weedy plots. These results indicate that tall weeds competing for light and space in the first year of growth, rather than moisture or nutrient stress, caused fewer (and taller) stems to grow from the coppice stools, leading to the observed reductions in biomass.
Biological control of weeds in European crops: recent achievements and future work
Authors: Müller‐Schärer  , Scheepens  , Greaves
Published: March 2003

Approaches to the biological control of weeds in arable crops and integration of biological weed control with other methods of weed management are broadly discussed. Various types of integrative approaches to biological control of weeds in crops have been studied within the framework of a concerted European Research Programme (COST‐816). During the period 1994–99, some 25 institutions from 16 countries have concentrated on five target weed complexes. Some major scientific achievements of COST‐816 are: (i) combination of the pathogen Ascochyta caulina with an isolated phytotoxin produced by this fungus to control Chenopodium album in maize and sugar beet; (ii) the elaboration and preliminary field application of a system management approach using the weed:pathogen system Senecio vulgaris:Puccinia lagenophorae to reduce the competitiveness of the weed by inducing and stimulating a disease epidemic; (iii) combination of underseeded green cover with the application of spores of Stagonospora convolvuli to control Convolvulus species in maize; (iv) assessment of the response of different provenances of Amaranthus spp. to infection by Alternaria alternata and Trematophoma lignicola, the development of formulation and delivery techniques and a field survey of native insect species to control Amaranthus spp. in sugar beet and maize; (v) isolation of strains of different Fusarium spp. that infect all the economically important Orobanche spp. and development of novel, storable formulations using mycelia from liquid culture. Although no practical control has yet been reached for any of the five target weeds, potential solutions have been clearly identified. Two major routes may be followed in future work. The first is a technological approach focusing on a single, highly destructive disease cycle of the control agent and optimizing the efficacy and specificity of the agent. The second is an ecological approach based on a better understanding of the interactions among the crop, the weed, the natural antagonist and the environment, which must be managed in order to maximize the spread and impact of an indigenous antagonist on the weed.
A qualitative quick‐test for detection of herbicide resistance to tribenuron‐methyl in Papaver rhoeas
Authors: Cirujeda A , Recasens J , Taberner A
Published: March 2003

A qualitative seed‐based method useful for the detection of resistance to the herbicide tribenuron‐methyl in Papaver rhoeas L. is described. Seeds were germinated on 35 mL of a 1.3% agar medium containing 2 g KNO3 L–1 in 8.5 cm Petri dishes in a growth chamber under 20 μmol s–1 m–2 of fluorescent light. When 0.24 μM tribenuron‐methyl or more was added, growth in susceptible plants stopped after the cotyledon stage and they turned chlorotic. The resistant plants continued developing new leaves. The same effect was achieved when 0.2 g gibberellin (GA3) L–1 and 7.68 μM tribenuron‐methyl or 0.5 g GA3 L–1 and 61.44 μM tribenuron‐methyl were added. Germination percentage rose with gibberellin in the presence or absence of the herbicide. Plants developed rapidly, with only about 14 d needed to finish the test but sometimes root growth was reduced because of the addition of gibberellin. In the absence of gibberellin but in the presence of the herbicide, plants grew more slowly and developed smaller leaves with a 17‐d evaluation period requirement. The test was validated with pot experiments in a greenhouse and also with field trials. The best combination was found to be 0.2 g GA3 L–1 and 7.68 μM tribenuron‐methyl, assuring homogenous germination and testing of dormant seeds but avoiding root inhibition associated with too much gibberellin.
Comparative ecophysiology of grain sorghum and Abutilon theophrasti in monoculture and in mixture
Authors: TRAORÉ S , LINDQUIST J L , MASON S C , MARTIN A R , MORTENSEN D A
Published: March 2003

Selection of crop genotypes that are more competitive with weeds for light interception may improve crop yield stability in the presence of weeds. The effects of interference on ecophysiological characteristics of Abutilon theophrasti Medic. and three morphologically diverse grain sorghum hybrids was evaluated to determine the relative tolerance and suppressive ability of the three hybrids and specific traits that may contribute to those differences. A tall hybrid was more tolerant to A. theophrasti interference than two medium stature hybrids. Early leaf area growth of two medium‐stature sorghum hybrids was reduced by A. theophrasti interference, whereas early growth of a tall hybrid was unaffected. The height of A. theophrasti was greater than two moderate‐stature hybrids but lower than the tall hybrid. Greatest leaf area density (LD) of the tall sorghum hybrid was above that of A. theophrasti, whereas greatest LD of medium‐stature hybrids was below that of the weed. In monoculture, the partitioning of new biomass to various plant organs was similar among sorghum hybrids, whereas the tall sorghum hybrid partitioned less biomass to leaves and more to stems than medium hybrids in mixture. The results indicate that the three hybrids differ in their susceptibility to A. theophrasti competition. Crop traits that may contribute to greater crop competitiveness include greater maximum height and its growth rate and greater height of maximum leaf area distribution.
Non‐deep simple morphophysiological dormancy in seeds of the weedy facultative winter annual Papaver rhoeas
Authors: Baskin C C , Milberg P , Andersson L , Baskin J M
Published: March 2003

Embryos in freshly matured seeds of the facultative winter annual Papaver rhoeas are underdeveloped and physiologically dormant; thus, seeds have morphophysiological dormancy (MPD). Seeds lost physiological dormancy during 12 weeks of burial in moist soil at 12 h/12 h daily alternating temperature regimes of 15/5°C, 20/10 °C and 25/15 °C but not at 1 °C. Physiological dormancy was not broken in seeds stored dry at room temperature for 12 weeks. After physiological dormancy was broken, seeds required light for embryo growth (i.e. for loss of morphological dormancy) and consequently for germination. After a 12‐week period of burial in soil at 25/15 °C, seeds that matured in 1997 germinated to 100% in light at 25/15 °C, demonstrating that cold stragification temperatures (≈ 0.5–10 °C) are not required for embryo growth. Thus, seeds have non‐deep simple MPD. During exposure to low winter temperatures (5/1 °C, 1 °C), 52% of the seeds with physiologically non‐dormant embryos entered conditional dormancy and thus lost the ability to germinate at 25/15 °C but not at 15/5 °C or 20/10 °C. The peak of germination for seeds sown in southern Sweden was in autumn, but some also germinated in spring. A higher percentage of seeds that matured in a relatively warm, dry year (1997) came out of MPD and germinated than did those that matured in a relatively cool, wet year (1998) at the same site.
The significance ofDemodex folliculorumdensity in rosacea
Authors: Erbagˇci Zülal , Özgöztaşi Orhan
Published: March 2003

BackgroundDemodex folliculorumhas been reported in rosacea in a number of clinical studies. As theDemodexmite is also present in many healthy individuals, it has been suggested that the mite may have a pathogenic role only when it is present in high densities. Moreover, some authors have proposed that a mite density above 5/cm2may be a criterion for the diagnosis of inflammatory rosacea. In this study, the possible role ofD. folliculorumand the importance of mite density in rosacea were investigated using a skin surface biopsy technique.

MethodsThirty‐eight patients with rosacea and 38 age‐and‐sex‐matched healthy subjects entered the study. With the skin surface biopsy technique, we obtained samples from three facial sites. We then determined the mite positivities, the mean mite counts in both study groups, the mean mite densities at each facial site and in the rosacea subgroups, and the mite densities above 5/cm2.

ResultsThe mean mite count in the rosacea group (6.684) was significantly higher than that in controls (2.868;p< 0.05). The cheek was the most frequently and heavily infested facial region. Ten rosacea patients and five normal subjects had mite densities over 5/cm2; the difference was not statistically significant (p> 0.05).

ConclusionsRosacea is a disease of multifactorial origin, and individual properties may modify the severity of the inflammatory response toDemodex. We suggest that a certain mite density is not an appropriate criterion in the diagnosis of the disease; nevertheless, large numbers ofD. folliculorummay have an important role in the pathogenesis of rosacea, together with other triggering factors.
Value of routine diagnostic criteria of bullous pemphigoid
Authors: Chaidemenos MD George Ch. , Maltezos MD Efstratios , Chrysomallis MD Fotis , Kouskoukis MD Konstantinos , Kapetis MD Evangelos , Mourellou MD Olga , Gotsis MD Nikos
Published: March 2003

Background and designThe clinical, histologic, and direct (DIF) and indirect (IIF) immunofluorescence findings are used in a critical, although arbitrary, manner in the routine diagnostic process of bullous pemphigoid (BP). Our purpose was to estimate their relative value. In the present retrospective study, a follow‐up of at least 18 months was used as a prerequisite for the final diagnosis of BP (63 patients) and controls (n = 159).

ResultsThe clinical, histologic, DIF, and IIF diagnostic criteria of BP were found to vary independently of each other. Positive DIF was the most sensitive (90.5%) typical for BP histology and positive IIF were the most specific (99%). Immunopathologic tests were the most valuable, especially in the atypical varieties of BP. Nearly 25% of patients in this group would have been misdiagnosed if IF tests had not been performed. Atypical cases (40%) seemed to represent a clinical continuum over the whole spectrum of the disease. Patients with exclusively immunoglobulin G (IgG) and C3 basal membrane zone (BMZ) deposits were significantly more often seropositive than the rest of the DIF‐positive cases; however, the class of BMZ immunoreactants varied according to the site of biopsy. C3 was almost invariably deposited at the BMZ of DIF‐positive patients. When Igs were also present, they were only exceptionally (5% of cases) of greater fluorescence intensity than C3.

ConclusionsThe combination of clinical data plus one positive immunopathologic test provide the best combination of sensitivity and specificity (98%), and seem to be most appropriate in defining patient populations for study purposes. The relationship between the classes of immunoreactants should be better evaluated with reference to the site of skin biopsy. It may be suggested, however, that the likelihood of BP existence is very low when in vivo C3 is absent or of lower intensity of fluorescence than the concomitant Ig(s).
Etiologic aspects of chronic urticaria
Authors: Liutu Mervi , Kalimo Kirsti , Uksila Jaakko , Kalimo Hannu
Published: March 2003

Background Urticaria is a common disease that is always a challenge to the dermatologist due to its evasive etiology.

Patients and methods One hundred and seven chronic urticaria patients were studied. Routine laboratory investigations were performed and Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody determinations, autoimmune reactivity, infections, allergies, and hyperreactivities were investigated.

Results Pathologic findings were seen in 92 patients. Concomitant diseases suggesting autoimmune reactivity were detected in nine patients and, in 16 patients, infections including maxillary sinusitis, streptococcal tonsillitis, and tooth infection were found. Elevated total IgE level was detected in 37 out of 75 patients and positive skin prick test results in 47 out of 91 patients. Fifty‐five patients had a history of recent dyspeptic symptoms. A diagnosis of adult celiac disease was made in two patients and, additionally, IgA antigliadin antibodies were seen in four patients. H. pylori IgG antibodies were found in 40 out of 107 patients. Active gastritis was verified by esophagogastroduodenoscopy in 30 out of 32 patients with positive Helicobacter staining in 24 samples. An elevated IgE level was detected in 64% of H. pylori‐positive and in 39% of H. pylori‐negative patients.

Conclusions In this study, several findings suggesting aberrant immunologic activation were detected in chronic urticaria patients. Inflammation in the gastrointestinal tract, e.g. caused by H. pylori infection, may have an important role in the etiology of chronic urticaria.
Eccrine angiomatous hamartoma
Authors: Kwon Oh‐Chan , Oh Shin‐Taek , Kim Sung‐Wook , Park Gun‐Su , Cho Baik‐Kee
Published: March 2003

A 50‐year‐old Korean man had an erythematous patch on the left side of his chest since birth ( Fig. 1). We first regarded this lesion as nevus flammeus because of the resemblance of the lesion to an erythematous patch that blanched with pressure. Physical examination revealed an 8×5 cm erythematous patch with a central profuse sweating zone surrounded by a flame‐like non‐sweating zone (
Fig. 2). The patch was sharply demarcated from the normal skin. Sweating was evoked by physical exercise or emotional stress. There was no history of pain or tenderness for the lesion. The patient had no history of any other vascular disease. Histopathologic examination of the central zone showed an increased number of eccrine glands in the mid and deep dermis. Some dilated vascular channels that were not associated with the eccrine glands were present in the upper dermis and subcutaneous tissue (
Fig. 3). Immunohistochemical stain with anti‐factor VIII‐related antigen showed reactivity on the endothelia of the vascular elements which were not associated with eccrine glands in the upper dermis. Histopathologic examination of the surrounding zone showed non‐specific findings, except for the dilated vascular channels in the upper dermis.

(A) hyperhidrotic erythematous patch on the left side of the chest

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(A) sharply demarcated 8×5 cm erythematous patch with a central profuse sweating zone surrounded by a flame‐like non‐sweating zone

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Several eccrine angiomatous lobules in the mid and deep dermis, and hyperplasia and dilation of vascular structures in the upper dermis and the subcutaneous fat (hematoxylin and eosin, ×100)

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Oral lichen planus and HCV infection: a clinical evaluation of 263 cases
Authors: Mignogna Michele D. , Lo Muzio Lorenzo , Favia Gianfranco , Mignogna Roberto E. , Carbone Roberto , Bucci Eduardo
Published: March 2003

Background Hepatitis C virus (HCV) infection induces variable dermatologic manifestations. Our purpose was to determine whether there is an association between HCV infection and oral lichen planus (OLP).

Methods Antibodies to HCV were determined in patients with OLP (263 patients; 156 women and 107 men, with a mean age of 55.5 years) and in a control population.

Results Seventy six cases (28.8%) were positive for HCV antibodies with the second‐generation enzyme‐linked immunosorbent assay (ELISA II) test. All of these cases were confirmed with the second‐generation recombinant immunoblot assay (RIBA II) test. In 61 cases (23.1%), high levels of serum transaminase were found. Positivity for hepatitis B virus (HBV) markers was found in 31 patients (11.7%) and for hepatitis A virus (HAV) markers in 43 patients (16.3%). None had positivity for hepatitis D virus (HDV) markers. As a control group, we used 100 patients (58 women and 42 men, with a mean age of 55.3 years) referred to the School of Dentistry of the University of Naples “Federico II,” and treated for general dental caries. In the control group, HCV antibody positivity was found in three cases.

Conclusions The high prevalence of HCV antibody in this group of patients with OLP, higher than in the healthy population, suggests a link (p = 1.423 × 10–7, chi‐squared test) between these two diseases. These findings stress the importance of liver examination in OLP patients, and the need for other studies on the high susceptibility to hepatitis viruses in the population in the southern part of Europe.
Microbiology of perianal cellulitis in children: comparison of skin swabs and needle aspiration
Authors: Brook Itzhak
Published: March 2003

Objective To establish the aerobic and anaerobic microbiology of perianal cellulitis in children, comparing skin swab and needle aspirate methodology.

Method Swabs of involved skin and needle aspirates of cellulitis were studied for aerobic and anaerobic bacteria.

Results Specimens obtained from 10 patients with perianal cellulitis showed bacterial growth. Polymicrobial aerobic–anaerobic flora was found in all skin surface cultures, where the predominate isolates were Peptostreptococcus spp., Escherichia coli, and alpha hemolytic streptococci. The number of isolates in needle aspirates varied between one and two. The predominant ones were E.coli (3), Peptostreptococcus spp. (3), Staphylococcus aureus (2), and Bacteroides fragilis group (2). Complete or partial concordance in microbiology between skin swabs and needle aspirates was present in six instances. In four instances, isolates recovered from needle aspirates were not isolated from the skin surface.

Conclusions This study demonstrates the diversity of aerobic and anaerobic organisms isolated from perianal cellulitis, and the superiority of needle aspirates in establishing the microbiology of the infection.
Double‐labeled immunofluorescence study of cutaneous nerves in psoriasis
Authors: Jiang Wen‐Yue , Raychaudhuri Siba P. , Farber Eugene M.
Published: March 2003

Background and objective In recent years, many reports have suggested an active role of neuropeptides in the pathogenesis of psoriasis. Increased numbers of neuropeptide‐containing nerves positive for substance P (SP), vasoactive intestinal polypeptide (VIP), and calcium gene‐related peptide (CGRP) have been reported in psoriatic tissue. As psoriatic epidermis has a larger mass/volume, however, it is expected to have more nerves and a higher number of neuropeptergic fibers. Therefore, instead of demonstrating a larger number of neuropeptergic fibers, a more significant study is to investigate whether the neuropeptergic fibers are denser in psoriatic tissue. In this study, we applied a double labeled immunofluorescence technique. This method allows the identification of the total number of nerve fibers and the number of nerves positive for specific neuropeptides.

Materials and methods We obtained biopsies from nine lesional and seven non‐lesional psoriatic skins and six normal controls. Biopsies were snap frozen and then cut into 14 μm cryosections. The tissues were first treated with anti‐microtubule associated protein (MAP)2 antibody to stain the nerves. This was followed by a second set of stainings for SP, VIP, and CGRP. Primary antibodies were used in dilutions of 1 : 200 for anti‐MAP2, 1 : 200 for anti‐SP, 1 : 800 for anti‐VIP, and 1 : 400 for anti‐CGRP.

Results We found that the percentage of SP‐positive fibers was twofold greater and the percentage of CGRP‐positive fibers was 2.5 times greater in the psoriatic epidermis than in the epidermis of normal skin. Psoriatic epidermis had 30.1 ± 3.9% SP‐positive nerve fibers compared with 15.7 ± 3.7% in the normal control. The corresponding values for CGRP‐positive nerve fibers were 30.1 ± 3.9% and 12.0 ± 4.2%.

Conclusions The results of our study suggest that SP‐ and CGRP‐containing neuropeptide nerve fibers are more dense in the psoriatic epidermis. Both SP and CGRP are chemotactic to neutrophils and mitogenic to keratinocytes and endothelial cells. In addition, SP activates T lymphocytes and induces adhesion molecules on the endothelial cells. Our observations suggest that neuropeptides may play a significant role in the inflammatory and proliferative process of psoriasis.
The efficacy of low‐dose oral corticosteroids in the treatment of vitiligo patients
Authors: Kim Soo Min , Lee Han‐Seung , Hann Seung‐Kyung
Published: March 2003

Background One of the most probable pathogeneses of vitiligo is autoimmunity. Systemic corticosteroids suppress immunity and may arrest the progression of vitiligo and lead to repigmentation. The clinical efficacy of low‐dose oral corticosteroids was assessed to minimize the side‐effects in actively spreading vitiligo patients.

Methods Eighty‐one patients with vitiligo were evaluated. The patients took daily doses of oral prednisolone (0.3 mg/kg body weight) initially for 2 months; the dosage was then reduced to half of the initial dose for the third month and was halved again for the fourth and final month. The effects of treatment were evaluated using photographs of before and after the study. Side‐effects were assessed at the first, second, third and fourth month of treatment.

Results Arrested progression of vitiligo and repigmentation were noted in 87.7% and 70.4% of patients respectively. Male sex, a patient age of 15 years or under, and a duration of disease of 2 years or less showed increased repigmentation with statistical significance. The side‐effects of treatment were minimal and did not affect the course of treatment.

Conclusions Low‐dose oral corticosteroids are effective without serious side‐effects in preventing the progression and inducing repigmentation of actively spreading vitiligo, which is difficult to treat with topical corticosteroids or photochemotherapy.
Allergic contact dermatitis in the United Arab Emirates
Authors: Lestringant Gilles G. , Bener Abdulbari , Sawaya Maha , Galadari Ibrahim H. , Frossard Philippe M.
Published: March 2003

Background No data exist on allergic contact dermatitis (ACD) in the United Arab Emirates (UAE).

Aim Our aim was threefold: (i) to determine the incidence of ACD; (ii) to identify responsible allergens using the European Standard Series, TRUE TEST, and other substances; (iii) to tentatively explore population‐specific reactions in Al Ain, UAE.

Design This is a prospective, descriptive, hospital‐based, study.

Setting Tawam Hospital, Al Ain Medical District, UAE.

Patients During the years 1989–1996, 373 patients (male : female = 2 : 3), presenting with cutaneous manifestations possibly related to contact allergy, were patch tested.

Results 93.8% of patients presented with dermatitis affecting mostly the hands (45.1%), feet (21.4%), face (12.6%), and legs (4.6%). Two hundred and twenty‐four patients (60%) (male : female = 1 : 2) tested positive for at least one substance. Nickel was the commonest sensitizer (15%) in both genders. “Fragrance mix” (8%), p‐tertiary butylphenolformaldehyde (p‐TBPF) resin (7.5%), thiomersal (7.5%), chromium (7.2%), cobalt (6.4%), ethylenediamine (6.4%), neomycin (5.1%), and parabens (5.1%) were prominent allergens. Glutardialdehyde, an additional substance tested together with the European Standard Series, scored significantly (4.8%). Variations from the results reported from other countries may be explained by the specific lifestyles and customs of the UAE population.

Conclusions Substances contained in the TRUE TEST, plus glutardialdehyde, may be considered as the standard series for patch testing in the UAE population.
Fluconazole vs. Itraconazole in the treatment of tinea versicolor
Authors: Montero‐Gei Fernando , Robles Miguel Eduardo , Suchil Patricia
Published: March 2003

Ninety patients with tinea versicolor were randomly assigned to treatment with either a single 450‐mg dose of fluconazole, two 300‐mg doses of fluconazole given 1 week apart, or itraconazole 200 mg daily for 7 days. At the end of treatment, the cure rate for itraconazole (20%) was significantly higher (P = 0.024) than that for fluconazole 450 mg (0%). When cure plus improvement was considered, response rates among the three treatment groups were comparable (97, 100, and 97% for fluconazole 450 mg, fluconazole 300 mg, and itraconazole, respectively). Failure rates at the end of treatment were low (0–3%). Clinical response rates achieved at the end of treatment generally were maintained at 1 month, but tended to decrease at 2 months. Eradication at the end of treatment was not significantly different among the treatment groups (17, 33, and 38% for fluconazole 450 mg, fluconazole 300 mg, and itraconazole, respectively). At 1 month, the eradication rate was significantly higher (P = 0.012) for the two‐dose than the single‐dose fluconazole treatment group (97 and 70%, respectively). At 2 months, reinfection rates were 21, 20, and 4% for fluconazole 450 mg, fluconazole 300 mg, and itraconazole, respectively. No clinical adverse events occured, and no patients were withdrawn for laboratory abnormalities.
Elephantiasis nostras verrucosa
Authors: Vaccaro Mario , Borgia Francesco , Guarneri Fabrizio , Cannavò Serafinella P.
Published: March 2003

A 62‐year‐old white man was referred to our department in May 1998 because of the progressive development of chronic lymphedema on the lower extremities; since the age of 58 years, he had noted recurrent swelling with bilateral edema involving, at first, the dorsum of the feet and, later, both the front and the back of the legs, leading to the advancing deformation of the entire extremities.

His medical history was significant for congestive heart failure and severe obesity; anamnestic investigation was negative for filariasis and familial Milroy's disease.

Physical examination revealed a man in poor health with diffuse thickening of both feet and legs, accompanied by profound, nonpitting edema, generalized lichenification, and cobblestone‐like skin surface. Severely malodorous verrucous plaques were present on the calves; ulcerative lesions were also noted on the medial malleolus of the left extremity

( Fig. 1). The toes of both feet showed marked pachyonychia and signs of onycogryphosis.

Physical examination shows nonpitting edema, generalized lichenification, and cobblestone‐like skin surface with ulcerative lesions

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Posterior tibial and dorsal pedis pulses were not palpable bilaterally. Laboratory tests revealed slightly elevated serum levels of sugar, triglycerides, and cholesterol. Repeated cultures from lesional areas showed Trichophyton rubrum, Candida albicans, and β‐hemolytic Streptococcus group A.

A surgical biopsy specimen obtained from the edge of the ulcer showed hyperkeratosis with parakeratosis and acanthosis of the epidermis; diffuse edema and multiple dilated lymphatic spaces throughout the papillary and reticular dermis were observed. There was no sign of neoplastic change ( Fig. 2).

Histology shows hyperkeratosis with parakeratosis and acanthosis, and diffuse dermal edema with multiple dilated lymphatic spaces (hematoxylin and eosin stain; original magnification, × 40)

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The patient was given oral itraconazole 200 mg/day and amoxicillin plus clavunalate 1 g twice daily, but treatment was stopped because of the increased cardiac decompensation and subsequent death.
Pattern of skin diseases at the University Teaching Hospital, Addis Ababa, Ethiopia
Authors: Shibeshi Dagnatchew
Published: March 2003

Abstract

Background and objective  Skin diseases are among the leading causes of hospital visits in Ethiopia. An analysis was performed to describe the pattern of skin diseases at a teaching hospital in Addis Ababa, Ethiopia.

Patients and methods  All consecutive new patients seen at the dermatologic referral clinic of Black Lion Teaching Hospital (BLH) from June 1995 to July 1997 were included in this prospective analysis. The clinical examinations were performed by the author, so that uniformity of diagnosis and classification is assured.

Results  A total of 1505 patients were assessed; 1093 (72.6%) were in the age group 21–40 years, and the female to male ratio was 1.2 to 1. The most common skin diseases were allergic skin diseases (25.5%), infections (25.4%), the photodermatoses (22.9%), followed by papulosquamous diseases (11.4%) and pruritis of unknown origin (3.3%). Skin manifestations of collagen diseases were less common findings (0.7%).

Conclusions  The pattern of skin diseases observed in this analysis shows that allergic and infectious causes account for three‐quarters of skin problems. Emphasis should be given to this group of common skin diseases at all levels of health care so that proper diagnosis, treatment, and referral can be practiced.
Eccrine poroma of the heel
Authors: Lemont Harvey ,   DPM, Snyder Heather ,   DPM
Published: March 2003

A 67‐year‐old African–American woman had a tender red nodule on the posterior aspect of her left heel of 20 years' duration. The lesion had initially grown quickly to its present size, but subsequently remained unchanged through the years. No previous history of trauma to the area could be elicited. The lesion was not tender or painful, although the patient related some recent discomfort when wearing shoes with high heel counters. Examination revealed a soft, multilobulated, skin‐colored nodule, measuring approximately 1.1 cm at its greatest diameter ( Fig. 1), with a rim space or moat (
Fig. 2) surrounding the lesion. Biopsy of the lesion demonstrated a uniform proliferation of basaloid cells exhibiting a sharp demarcation between the adjacent normal epidermis (
Fig. 3). No horn cysts were present. The papillary dermis demonstrated multiple ectatic blood vessels (
Fig. 4) which may be responsible for its reddish appearance.

red, granulating lesion on the posterior heel

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the characteristic ‘‘moat’' surrounding the lesion

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reveals a proliferation of uniformly small cuboidal cells sharply demarcated from the adjacent normal epidermal cells

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vessel dilatation most likely responsible for the reddish color of the lesion

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Suction blister grafting for stable vitiligo using pulsed erbium:YAG laser ablation for recipient site
Authors: Sachdev Mukta , Krupashankar Devasthanam Sundara Rao ,   DVD
Published: March 2003

Background Suction blister grafting was performed via a modified simple technique using a 20‐mL syringe to create the donor graft and pulsed erbium:YAG laser ablation of the recipient site.

Methods Two patients with stable vitiligo and one with postinflammatory depigmentation were studied.

Results The grafts took well in all three patients and pigmentation was retained at 20 weeks. No complications occurred.

Conclusions The erbium:YAG laser is an ideal tool for creating graft recipient sites, given its precision in terms of width and depth of ablation. A 20‐mL syringe can be used to create a blister of adequate size.
Prurigo in a patient with intestinal strongyloidiasis
Authors: Albanese Giancarlo , Venturi Caterina , Galbiati Giuseppe
Published: March 2003

A 22‐year‐old Senegalese man, who had been in Italy for 2 years, in a good general state of health and with an unremarkable medical history, had been suffering for an unspecified length of time from widespread itching, along with the gradual appearance of numerous keratotic nodular lesions, sometimes interspersed with areas of lichenification in a picture of progressive xerosis ( Fig. 1). During a previous stay in our hospital department, he had suffered a serious attack of asthma, with hypereosinophilia (19%) and an increase in serologic immunoglobulin E (IgE) (2000 IU/mL).

Clinical view of the lesions on the left leg

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A histologic examination of a lesion removed from the patient's back revealed the presence of slight acanthosis and an inflammatory infiltrate in the surface and middle dermis, mainly consisting of lymphocytes and a few eosinophils ( Fig. 2).

Histologic view of a lesion (hematoxylin and eosin, × 250)

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A parasitologic examination of the feces revealed the cause of the clinical picture, and led to the identification of Strongyloides stercoralis (
Fig. 3). The patient was subjected to a short cycle of treatment with albendazole, 400 mg/day for three consecutive days.

Parasite isolated from the feces (direct examination, × 100)

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The patient was kept under observation for the next 6 months, and his clinical picture and symptomatology slowly but gradually improved. Examination of the feces gave a negative result.
Poroid hidradenoma
Authors: Cho Soyun , Kim Ji‐Sook , Shin Joung‐Hyun , Kim Jin‐Hyoung , Kim Hyun‐Joo , Whang Kyu‐Kwang , Hahm Jeong‐Hee
Published: March 2003

A 36‐year‐old Korean man presented with a nodular lesion on the buttock. It was a walnut‐sized, tender, soft, and movable nodule covered by normal skin which had been enlarging steadily over a period of one year ( Fig. 1). Surgical exploration revealed the tumor to be a cyst containing serous, brownish fluid. It was totally excised. Histological examination showed a well‐demarcated, 1.3 × 0.9 cm tumor with cyst formation in the center and surrounded by a zone of connective tissue in the middle and lower dermis, without any connection to the overlying epidermis (
Fig. 2a). The cystic wall was composed of tumor cells. Variably sized tumor lobules protruded into the cystic space. The tumor nests consisted of two cell types: smaller, darker poroid cells and larger, paler cuticular cells. Mitotic figures were not present. Vacuolar spaces were seen within the cytoplasm of some cuticular cells, which were thought to represent early stages of ductal differentiation. Ductal structures lined by eosinophilic cuticle were present in some tumor lobules (
Fig. 2b). Peripheral pallisading was occasionally observed, but it was not a prominent feature] the cells at the edges of the lobules tended to be rather flattened. Periodic acid‐Schiff stain with diastase demonstrated variable amounts of glycogen within the cytoplasm of some tumor cells. Carcinoembryonic antigen (CEA) immunostaining was positive in the luminal border of the cystic space, which appeared as a sensitive marker of ductal differentiation. Epithelial membrane antigen also showed a positive reaction in luminal borders of the cystic space. Tumor cells were positive for vimentin, but negative for S‐100 protein] however, many dendritic cells scattered throughout the neoplasm were positive for S‐100 protein.

A  walnut‐sized, tender, soft, movable nodule covered by normal skin is seen on the buttock.

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(a)  A well‐demarcated tumor with cyst formation in the center is surrounded by a zone of connective tissue in the middle and lower dermis, without any connection to the overlying epidermis. Solid parts protrude into the cystic space (hematoxylin and eosin; original magnification × 40). (b)  Ductal structure lined by eosinophilic cuticle is surrounded by cuticular tumor cells (hematoxylin and eosin; original magnification × 200).

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Human cowpox infection in Sharkia Governorate, Egypt
Authors: Amer Mohamed , El‐Gharib I. , Rashed A. , Farag F. , Emara M.
Published: March 2003

Abstract

Background and objective  In the last few years, outbreaks of an apparently specific dermatosis occurred during the months of late summer and early autumn in our locality. Our aim in this study was to reveal the underlying etiology of this dermatosis.

Subjects and methods  Sixty patients with the disease were studied clinically, epidemiologically, histopathologically, and ultrastructurally.

Results  The results of all methods suggest that the dermatosis is most probably a human cowpox infection. Electron microscopy showed unenveloped cowpox virons.

Conclusions  This apparently specific dermatosis is due to human cowpox infection. Future investigations will be needed to better define this important zoonosis frequently passed by cats to humans and carried by rodents.
Familial koilonychia
Authors: Gao Xing‐Hua , Li Xiaodong , Zhao Yuming , Wang Yakun , Chen Hong‐Duo
Published: March 2003

A 2‐year‐old boy with flat and spoon‐shaped nail plates was referred to us. His mother had noticed that his fingernails were quite soft when he was born. After 2 months, the nails became flat or spoon‐shaped; the toenail plates also became rough and flat. Systemic examination revealed nothing unusual. All his fingernail plates were quite thin, and had concave surfaces; the distal edges of some nail plates were rough and darkened (Fig. 1). His great, second and middle toenails on both sides showed the same abnormalities as the fingernails. Routine laboratory tests were normal; serum levels of iron, zinc, calcium, and magnesium were within normal limits. Repeated microscopic examination and culture of fungi from both fingernails and toenails were negative. Histologic examination of the distal edges of some of his fingernail plates was basically normal.

The proband has concave fingernail plates with rough and light brown distal edges

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When checking members of the family, we noticed that the boy's mother and maternal grandmother had similar nail problems (out of 14 members of three generations), although no systemic or other skin disorders were noticed. All the fingernails of the boy's mother were lusterless and concave with darkening of the distal edges (Fig. 2). All her toenails were rough, lusterless, and brown; some of them had longitudinal ridges. His maternal grandmother had light brown colored fingernail plates with concave profiles (Fig. 3), and dark brown or even blackish colored toenails. Both the mother and maternal grandmother acknowledged that their nails were abnormal from early childhood. Repeated microscopic examination and culture of fungi from both fingernails and toenails were negative. Several distal portions of the nail plates were collected for histologic examination. The fingernail plates of the boy's mother showed numerous parakeratotic cells in the middle zone, and those of his maternal grandmother showed diffuse parakeratotic cells; melanin granules were not found in those nail plates that were checked. Taken together, a diagnosis of familial koilonychia was established.

The boy's mother has concave fingernail plates with brown colored distal halves

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The boy's maternal grandmother has concave fingernail plates with a dark brown color

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Metastatic cutaneous leiomyosarcoma from primary neoplasm of the mesentery
Authors: Kim Kyoung Jin , Lee Won Sin , Chang Sung Eun , Choi Jee Ho , Sung Kyung Jeh , Moon Kee Chan , Koh Jai Kyoung
Published: March 2003

A 31‐year‐old South Korean woman was referred to the dermatology department from the oncology department for the evaluation of a subcutaneous nodular lesion on the back. Three years before, she noted a palpable, fingertip‐sized, nontender mass on her right lower abdomen. The mass had increased in size slowly. One year ago, she visited a local clinic and physical examination revealed a 7 × 8 × 7 cm, slightly tender, deep‐seated mass on the right lower quadrant of the abdomen. The mass on the ilial mesentery was resected by surgical exploration and tissue examination revealed leiomyosarcoma. She refused adjuvant chemotherapy.

Approximately 3 months later, she re‐visited the clinic with a tender, subcutaneous nodule on the back. Cutaneous examination revealed a solitary, 2 × 2 cm, well‐defined, hard, movable, subcutaneous nodule on the upper back without skin color change (Fig. 1). She complained of tenderness on touching the lesion. Histologic examination of a biopsy specimen showed irregularly arranged spindle cells scattered throughout the dermis. They were arranged in haphazardly oriented or interweaving fascicles. Most of the spindle cells possessed elongated nuclei with blunt ends and some cells had a polygonal outline with irregularly shaped nuclei (Fig. 2). There were many mitoses: 3–4 per high‐power (× 400) field. Immunohistochemically, smooth muscle actin and desmin were positive in most of the tumor cells (Fig. 3). S‐100 reactivity was not observed. A diagnosis of metastatic leiomyosarcoma was made. About 1 month later, computed tomography showed two, ill‐defined, heterogeneous, low attenuation masses in the right lobe of the liver, suggesting liver metastasis. The patient was treated with chemotherapy for 2 months and remains in good condition.

2 × 2 cm, solitary, well‐defined, hard, movable, subcutaneous nodule without any overlying skin change

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(a) Characteristic findings of cutaneous leiomyosarcoma with markedly high cellularity and densely packed transverse and longitudinal fascicles of cells (hematoxylin and eosin, × 40). (b) High magnification of the neoplasm revealing spindle cells with blunt‐ended nuclei, pleomorphism, and mitotic figures (hematoxylin and eosin, × 200)

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Dense cytoplasmic reactivity for smooth muscle actin is apparent (smooth muscle actin, × 200)

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Three cases of cutaneous sparganosis
Authors: Kim Soo Hong , Park Kyungho , Lee Eil Soo
Published: March 2003

Case 1 A 64‐year‐old man visited our clinic complaining of an asymptomatic nodule on his right thigh, detected 10 days previously. Physical examination revealed a solitary subcutaneous nodule, 1.5 cm in diameter on his right thigh. Twenty years previously the patient had undergone surgery to remove a ‘‘worm’' from his leg. The patient stated that he enjoyed eating raw snakes. On performing excisional biopsy of the lesion, the white, flat, shiny sparganum was detected and removed (Fig. la). The histopathological study of the biopsy specimen showed several encapsulated, mummified sparganum pieces and dense lymphohistiocytic infiltration along with neutrophils and eosinophils (Fig. lb).

(a) A flat, band‐like, white glistening sparganum being removed from the right thigh of case 1. (b) An encapsulated, mummified sparganum piece showing degenerated internal organs (hematoxylin and eosin × 40)

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Case 2 A 53‐year‐old woman was noted to have an asymptomatic nodule on her inguinal area for over 3 years. Although the lesion was asymptomatic the patient dubiously described the lesion as creeping upward in a linear pattern at negligible speed. The patient denied ingesting snakes or any kind of exotic food, yet admitted to drinking from springs occasionally as she climbed mountains. On physical examination, a relatively ill‐defined soft nodule was detected on her left inguinal area. While performing excisional biopsy of the lesion, an 8 cm sized white, flat sparganum was noticed and removed (Fig. 2). The histopathological study revealed a panniculitis infiltrated with eosinophil and lymphohistiocytes.

An 8‐cm white, flat larva from case 2

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Case 3 A 41‐year‐old man presented with an asymptomatic nodule on his right thigh detected 3 years previously. The patient had eaten raw snakes about 10 years earlier. The clinical feature of the lesion was a solitary pea‐sized nodule without any change in color on overlying skin. The biopsy from the lesion disclosed fragments of a larval cestode with morphologic features of sparganum (Fig. 3).

Cross section of Sparganum, shows tegument (T), numerous smooth muscle fibers (M), excretory ducts (E) and calcareous bodies (C) (hematoxylin and eosin × 100)

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