bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of vitiligo. Results of a questionnaire among dermatologists in The Netherlands
Authors: Njoo M. David , Bossuyt Patrick M. M. , Westerhof Wiete
Published: March 2003

Background Several therapeutic options are available for the treatment of vitiligo. Concern exists that there is no uniform approach towards the management of vitiligo among Dutch dermatologists.

Methods A written survey concerning the management of vitiligo was sent to 332 dermatologists in The Netherlands.

Results The response rate was 86%. “Giving information and reassurance concerning the nature of disease” was regarded by most dermatologists (68%) as being the most important goal in the management of vitiligo. Only 16% of the dermatologists aimed for active treatment in vitiligo. The reported therapy choices in children resembled those of adults, except that slightly more dermatologists did not prescribe active therapy in children. Nine different therapeutic modalities were mentioned as first choice therapies. Topical corticosteroids were indicated by most dermatologists as first choice therapy (241 out of 266, i.e. 91%); however, only 2% indicated that 50% or more of the patients achieved a successful treatment; 66% found that less than 25% of the patients were successfully treated with topical corticosteroids. Only 15% of the respondents reported that 50% or more of the patients were treated successfully with narrow‐band UVB. The observed response profile to broad‐band UVB therapy was found to be comparable with that of narrow‐band UVB. The classical therapy with oral psoralen plus UVA (PUVA) was prescribed as first choice therapy by only 12% (32 out of 266) of the dermatologists. Only 6% of these respondents observed that 50% or more of the patients achieved successful therapy using oral PUVA. The recommended maximum treatment duration for topical corticosteroids, oral PUVA, and UVB therapy was found to vary from 3 to 12 months.

Conclusions Most dermatologists in The Netherlands do not offer active treatment in vitiligo, probably because the estimated effectiveness of (nonsurgical) repigmentation therapy is low. In cases where treatment is prescribed, there appears to be no consensus on the choice of therapies and treatment strategies. The development of practice guidelines may be helpful in reducing inappropriate care and improving treatment outcome.
Dissemination in cutaneous leishmaniasis due to Leishmania major in different ethnic groups in Saudi Arabia
Authors: Al‐Qurashi Abdul Rahman , Ghandour Ahmed Mohamed , Osman Mirghani , Al‐Juma Mariam
Published: March 2003

Abstract

Background  Dissemination in patients with cutaneous leishmaniasis has previously been recorded in human infection with Leishmania major and L. tropica. In this study, the potential for dissemination in different ethnic groups in Saudi Arabia was compared.

Methods  The data were recorded from a group of 73 patients with suspected cutaneous leishmaniasis (43 Saudi and 30 non‐Saudi) attending the Dermatology Clinics at King Fahd Hospital of the University and Al‐Khobar Government Hospital at Al‐Khobar, Eastern Region of Saudi Arabia. The patients were of various age groups (all male) between 1 and 55 years. The diagnosis of cutaneous leishmaniasis was confirmed clinically and by smear and skin biopsy. The following data were recorded for each patient: type, number, and anatomic sites of disseminative lesions and the frequency of co‐occurrence of more than one type of lesion.

Results  Three types of disseminative lesions due to zoonotic cutaneous leishmaniasis were recorded in 16 patients (21.92%): subcutaneous nodules, satellite papules, and subcutaneous induration. The percentage of disseminative lesions in non‐Saudi patients (36.66%) was higher than in Saudi patients (11.63%). This was also true for the number of lesions: a mean of 12.27 ± 10 and 6.4 ± 3, respectively. The coexistence of more than one type of disseminative lesion was higher in non‐Saudi patients (63.63%) than in Saudi patients (20.0%), as well as the occurrence of lesions on more than one body site: 36.4% in non‐Saudi patients and 20.0% in Saudi patients.

Conclusions  The potential for dissemination due to cutaneous leishmaniasis was significantly higher in the nonindigenous population than in the indigenous population in Saudi Arabia. Disseminative lesions must be clinically differentiated from other skin diseases and appropriately treated by avoiding the use of intralesional drugs or physical therapy.
A century of the synthesis of dapsone: its anti‐infective capacity now and then
Authors: Wolf Ronni , Orni‐Wasserlauf Ruth
Published: March 2003

Background  Although dapsone was first synthesized in 1908, a quarter of a century was to pass before it was used in the treatment of bacterial infections. Dapsone was, however, too toxic for humans (because of the excess dosage which was administered at that time) and was thus considered to be of no value in the treatment of common bacterial infections. Since the early 1950s, dapsone has been recognized as being uniquely effective against a number of noninfectious, inflammatory diseases and, today, this is its main indication. Thus, the reason why dapsone was first introduced into medicine, namely the treatment of bacterial infections, has been set aside and its main current applications are the treatment of noninfectious, inflammatory, autoimmune, and bullous diseases.

Objective  To study the anti‐infective capacity of dapsone against common bacterial infections. As many patients who receive dapsone for the treatment of noninfectious, inflammatory diseases have a concomitant bacterial infection or a superinfection of their skin disease, we thought that, if dapsone proved to be effective against common bacterial infections, it may obviate the need for an additional antimicrobial drug in these patients.

Methods  Three bacterial ATCC> strains (Streptococcus pyogenes, Staphylococcus aureus, and Escherichia coli) were tested by a macrodilution minimal inhibitory concentration (MIC) test for dapsone. Dapsone concentrations were between 0.06 and 1125 μg/mL.

Results  Even the highest concentration of dapsone of 1125 μg/mL did not inhibit bacterial growth.

Conclusions  Our results indicate that dapsone has no antibacterial effects whatsoever. Even at very high concentrations, it does not suppress the growth of most susceptible strains of bacteria. The story of dapsone (i.e. the long time that elapsed between its synthesis to its use for the chemotherapy of infectious diseases) will not repeat itself this time.
Degos' disease
Authors: Güven Füsun Özder , Bozdağg Kübra Eren , Ermete Murat , Karaman Ahmet
Published: March 2003

A 47‐year‐old woman presented with slightly pruritic, burning lesions on her submammary area and legs of 3.5 years' duration. Similar lesions had appeared on her arms and feet. She was hospitalized at the Pulmonary Diseases Hospital, İzmir, with a complaint of thoracic pain, and was diagnosed with nonspecific pleuritis by pulmonary X‐ray, thoracic computed tomography (CT) scanning, bacterial cultures of phlegm, and pleural biopsy examination. Fifteen days after leaving hospital, she was admitted to the Surgical Clinic of Atatürk Training Hospital, İzmir, with a complaint of severe abdominal pain, and diagnosed with nonspecific peritonitis.

On dermatologic examination, she had multiple, scattered papules (2–3 mm in diameter), with a typical, central, white, porcelain‐like zone of atrophy, on the trunk ( Fig. 1), legs (
Fig. 2), and arms. The lesions were encircled by a slightly raised erythematous border. Some of the lesions had coalesced giving polycyclic atrophic areas and ulcerations.

Papules with a typical, central, white, porcelain‐like zone of atrophy, encircled by a slightly raised erythematous border

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Typical papules on the legs

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Histopathologic examination of the skin biopsy specimen showed hyperkeratosis, epidermal atrophy, dermo‐epidermal separation, edema, and necrosis in the papillary dermis ( Fig. 3). Fibrinoid necrosis and thrombosis were seen in the papillary dermis and in the vessels below the lesions.

Hyperkeratosis, epidermal atrophy, dermo‐epidermal separation, edema, and necrosis in the papillary dermis and fibrinoid necrosis of the blood vessels

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The patient was diagnosed with Degos' disease from these clinical and histopathologic findings. She was treated with anti‐inflammatory drugs. One year later, the patient was hospitalized at the Department of Internal Medicine of Atatürk Training Hospital, İzmir, with a diagnosis of pericarditis and pleuritis.
Microcystic adnexal carcinoma induced by multiple radiation therapy
Authors: Schwarze Hardy P. ,   md, Loche François ,   md, Lamant Laurence ,   md, Kuchta Johannes ,   md, Bazex Jacques ,   md
Published: March 2003

We present an 84‐year‐old Caucasian man (Fitzpatrick classification: skin type II) with microcystic adnexal carcinoma (MAC) on his left cheek and a 15‐year history of recurrent squamous cell carcinoma (SCC) of the head, treated with numerous surgical interventions and multiple palliative 60‐Gy radiation therapy.

In 1996, the patient developed a nontender, indurated, irregularly marked, erythematous lesion on his left cheek (1.5 × 1 cm). Furthermore, the patient suffered from radiodermatitis due to previous radiotherapy ( Fig. 1). Punch biopsy and a subsequent wedge excision showed features of both SCC and eccrine carcinoma. Histopathologic and immunohistochemical tests of the tumor revealed a diagnosis of MAC. The patient underwent Mohs' micrographically controlled surgery to obtain tumor‐free peripheral soft tissue margins. There was no evidence of any lymphatic invasion or distant metastasis in the physical and laboratory examination. So far, the patient has not developed any recurrences.

Clinical picture of MAC showing features of radiodermatitis

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Following excision, the biopsy specimen (4 × 2.6 × 1 cm) was fixed in Dubosq‐Brazil and routinely processed for staining with hematoxylin and eosin. The neoplasm extended into the subcutaneous tissue with rare connection to the overlying epidermis ( Fig. 2). Follicular cysts with amorphous eosinophilic keratin and comma‐like tails of aggregates of epithelial cells were a prominent feature (
Fig. 3). Perineural invasion was evident, but there were only a very few mitotic figures. Immunohistochemistry on paraffin‐embedded tissue blocks was performed, showing strong labeling on dilated ducts for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) in the lumina of tumor cells, and positive staining for anticytokeratin KL1 (55–57 kDa) and S‐100 protein. The latter was negative in ductal structures, but stained dendritic cells.

Panoramic view of the tumor demonstrating poorly circumscribed and deeply infiltrative growth patterns. Rare connection of the tumor with epidermal structures is evident (hematoxylin and eosin, × 40)

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Comma‐like tails of aggregates of epithelial cells and follicular cysts with amorphous eosinophilic keratin (hematoxylin and eosin, × 150)

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Cutaneous and neurologic manifestations of biotinidase deficiency
Authors: Navarro Paloma Cornejo ,   md, Guerra Aurora ,   md, Alvarez J. Gregorio ,   md, Ortiz F. Javier ,   md
Published: March 2003

A male newborn with no obstetric or familial antecedents, except that his parents were cousins, developed hypotonia, lethargy, and feeding problems from birth. Analysis revealed a marked metabolic acidosis and hyperammonemia. Three weeks later, he was admitted to hospital in order to receive parenteral nutrition and to undertake a study for metabolic diseases.

The boy did not improve in spite of the use of parenteral nutrition and began to present with inspiratory stridor and tachypnea. One week later, he presented with an erythematous scaling eruption, which was especially intense in the lumbosacral region (Fig. 1a,b).The scalp was only slightly affected.

Erythematous scaling eruption, more intense in the lumbosacral region

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Laboratory findings were compatible with biotinidase deficiency diagnosed by demonstrating absent enzyme activity. His parents were also studied and they were found to have partial biotinidase deficiency (30% of enzyme activity).

After 37 days of life, the baby was given a treatment consisting of 20 mg of biotin per day intravenously. Biochemical and neurologic alterations improved quickly.

Meckel's diverticulum and a duodenal membrane were detected at the second month of life after a gastroduodenal survey, and both were operated on. The skin lesions did not improve, however, and intravenous biotin had to be increased to 40 mg/day. The eruption disappeared after 10 days.

On his first birthday, he remained asymptomatic with 40 mg of oral biotin.
Successful treatment of tinea capitis with 2% ketoconazole shampoo
Authors: Greer Donald L.
Published: March 2003

Background Oral antifungal drugs are required for effective treatment of tinea capitis. Topical antifungal shampoo's, namely ketoconazole 2% shampoo or products with selenium sulfide or salicylic acid are recommended as adjunctive therapy. Topical antifungal monotherapy has not been successful in the treated of tinea capitis. The purpose of this open study was to evaluate ketoconazole 2% shampoo as a monotherapy for the treatment of tinea capitis.

Method A total of 16 black children, aged 3–6, all with proven tinea capitis caused by Trichophyton tonsurans, were treated daily for 8 weeks with 2% ketoconazole shampoo for a total of 56 treatments. Clinical and mycologic examinations were performed every 2 weeks and again at 4 weeks following treatment. The number of colonies were counted on each plate after each visit. Patients with positive cultures after 8 weeks were placed on oral griseofulvin; those with negative cultures were followed monthly by culture for an additional 12 months.

Results Marked clinical improvement occurred in all patients within 2 weeks and absence of pruritus was noted by the patients as early as 2–6 days. After 8 weeks of shampoo, 14 of the 15 (93%) children were clinically healed. Mycologically, the cultures dropped from a confluent growth of T. tonsurans to less than 100 colonies within 2 weeks; fewer than 50 at week 4 and 20 colonies or fewer after week 6. At 8 weeks of treatment the number of colonies remained at 20 or fewer. Six of the 15 children (40%) had negative cultures after 2, 4, and 6 weeks. One child relapsed at the first 4‐week follow‐up visit. Five of 15 (33%) of the children remained culturally negative for 12 months post‐treatment.

Conclusions Ketoconazole 2% shampoo alone reduces the number of viable arthroconidia in children with tinea capitis thus reducing the transmissibility and contagious nature of the disease. Unexpectedly, complete cure was obtained in 5/15 (33%) of the children. The children remained clinically and mycologically clear as long as one year after treatment.
American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics
Authors: De Oliveira‐Neto Manoel P. ,   phd, Mattos Marise S. , Perez Mauricio A. , Da‐Cruz Alda M. ,   phd, Fernandes Octavio ,   phd, Moreira João , Gonçalves‐Costa Sylvio C. ,   phd, Brahin Lúcia R. ,   msci, Menezes Claudio R. ,   Msci, Pirmez Claude ,   phd
Published: March 2003

Background Rio de Janeiro State in Brazil is an endemic area of American tegumentary leishmaniasis (ATL) induced by Leishmania (Viannia) braziliensis.

Objective Our purpose was to describe the main clinical and epidemiologic characteristics of the disease in Rio de Janeiro State.

Methods Patients from endemic areas of Rio de Janeiro State attending the Evandro Chagas Hospital were included in the study. A general physical, dermatologic, and otorhinolaryngologic examination was performed in all patients, as well as a Leishmanin skin test. Skin biopsy specimens were obtained and utilized for touch preparations (stained with Leishman dye), culture in special media (Nicolle, Nevy and McNeal; NNN), and histopathologic examination after hematoxylin and eosin stain. Positive cultures were identified with regard to species by the isoenzyme technique. Therapy with pentavalent antimonial compounds was employed in all cases. Eco‐epidemiologic characteristics were studied through regular field visits to endemic foci.

Results Cutaneous disease was present in 87.2% of patients, and mucosal disease in only 12.7%. A single ulcerative cutaneous lesion was the most common clinical presentation. Demonstration of the parasite was always difficult and culture in special media gave the best results for diagnosis. The species involved in transmission was Leishmania (Viannia) braziliensis. Vectors included phlebotomine sand flies (Diptera: Psychodidae) of the genus Lutzomyia, and the most common species was Lutzomyia intermedia, captured mainly on the external walls of houses.

Conclusions ATL in Rio de Janeiro is mostly a cutaneous disease. In general, the cases showed great sensitivity to antimony. A pattern of peridomestic transmission seems to be the rule.
Madurella infection in an immunocompromised host
Authors: Satta Rosanna , Sanna Silvana ,   BD, Cottoni Francesca
Published: March 2003

A 77‐year‐old farmer, born and living in Sardinia, affected by acute myelogenous leukemia and undergoing chemotherapy treatment with cytosine arabinoside, presented at the Institute of Dermatology of Sassari in March 1998 with multiple subcutaneous lesions on the legs (Fig. 1) which had appeared 3 months previously. Scattered crusts were observed, and some nodules were necrotizing and ulcerated with a discharge of serosanguineous fluid. There was no history of trauma. A deep biopsy was performed and histologic examination showed suppurative inflammation in the middle and deep dermis with a mass of hyphae and numerous spores at periodic acid‐Schiff (PAS) reaction (Fig. 2). Culture of a small skin sample at 37 °C on Saboraud's dextrose agar resulted, 7 days later, in the development of flat, brownish, fluffy colonies. The reverse of the colony was black. Microscopically, the culture showed broad, segmented hyphae without conidia and with chlamydospores typical of Madurella. X‐Ray findings of the lower extremities showed no bony involvement.

Red subcutaneous nodule on the leg

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Suppurative inflammation in the dermis with a mass of hyphae and spores

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Oral itraconazole at a dosage of 100 mg twice daily was started and clinical evaluation demonstrated lesion resolution after 12 weeks with no adverse reaction.

The patient had no evidence of relapse at follow‐up 10 months later.
Elevated plasma homocysteine levels in patients on isotretinoin therapy for cystic acne
Authors: Schulpis Kleopatra H. , Karikas George A. , Georgala Sophia , Michas Timos , Tsakiris Stylianos
Published: March 2003

Abstract

Background The use of Isotretinoin (Iso) for cystic acne (CA) therapy includes marked side‐effects such as dyslipidemia, increased liver enzymes, and reduction of biotinidase activity. Moreover, Homocysteine (Hcy), an amino acid, is metabolized in the liver requiring folate, vitamin B6, vitamin B12, and the activity of enzymes, i.e. cystathionine‐β‐synthase. Increased blood levels of Hcy are associated with premature occlusive vascular disease.

Objective The aim of this study was the evaluation of Hcy levels and the responsible vitamins for its metabolism in patients with CA on Iso treatment.

Methods  and Results  Twenty‐eight patients with CA were submitted to laboratory examinations before (Value 1) and after (Value 2) 45 days on Iso (0.5 mg/kg/24 h) therapy. Blood levels of Hcy and vitamin B6 were evaluated by HPLC methods, and folate and vitamin B12 using a commercial Kit. Hcy levels (Value 1 = 7.86 ± 1.6 μmol/L; Value 2 = 13.65 ± 3.3 μmol/L; P < 0.001) were statistically significantly increased in patients on treatment. Vitamins were unaltered, and lipids and liver enzymes increased. Significant correlation between Hcy levels, vitamins, and liver enzymes was found. Methionine loading tests performed in nine patient‐volunteers showed an abnormal response post‐treatment.

Conclusions  It is suggested that the elevated Hcy levels in patients after 45 days on Iso therapy could be due either to the ‘inhibition’ of cystathionine‐β‐synthase by the drug and/or their liver dysfunction. Daily vitamin supplementation along with frequent evaluations of Hcy blood levels are recommended for the prevention of a premature occlusive vascular disease.
Lichen planopilaris
Authors: Sehgal Virendra N. , Bajaj Pramila
Published: March 2003

P, a 20‐year‐old laborer displayed initial symptoms of the disease in question when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritis, and the appearance of slate‐blue eruptions on the scalp and elsewhere on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examination revealed the presence of grayish‐blue acuminate follicular papules, disposed singly and in groups (plaques). The pilo‐sebaceous orifices were conspicuously obliterated and filled by keratin plugs. Perifollicular erythema was a predominant feature on the scalp. The lesions were present over the scalp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male‐type baldness was a salient feature. In addition, it was studded with conspicuous acuminate papules in its center (Fig. 1a). The known nonhairy (glabrous) skin had classic lichen planus lesions (Fig. 1b).

(a) Lichen planopilaris scarring alopecia, depicting slate‐blue acuminate papules. (b) Lichen planus plaque

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Hemotoxylin‐eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of the scalp were simultaneously studied. The former revealed changes in the epidermis comprising of hyperkeratosis, increase in thickness of stratum granulosum, hydropic degeneration of the basal cell layer and band‐like lympho‐histiocytic infiltrate pressing against and invading the epidermis, while the latter revealed uniform atrophy of the epidermis and vacuolization of basal cells. The hair follicles were dilated and were filled with keratin plugs. In addition to fibrosis of the dermis, pigment laden microphages and lympho‐histiocytic infiltrate was prominent. The follicles and the sebaceous glands were absent. However, arrectores pilorum and sweat glands were preserved (Fig. 2a,b).

(a) Lichen planopilaris. Uniform atrophy of the epidermis, basal cell vacuolization, and dilated hair follicle filled with keratin plug. (b) Fibrosis of the dermis sebaceous and sweat glands preserved

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Graves' disease presenting as elephantiasic pretibial myxedema and nodules of the hands
Authors: Cho Soyun , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: March 2003

A 67‐year‐old man presented with a 2‐year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well‐defined, skin‐colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 μg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh‐colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin‐colored, walnut‐to‐egg‐sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid‐stimulating hormone (TSH) had a markedly low titer of < 0.05 μU/mL (normal: 0.4–5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis.

Confluent, firm nodules and plaques on both shins and the dorsa of both feet

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Firm, nonpitting, well‐circumscribed, flesh‐colored masses with orange‐peel appearance of overlying skin and growth of coarse hair on the dorsum of the right hand

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Descriptive epidemiology of skin cancer on Aruba: 1980–1995
Authors: Kennedy Cornelis , Bajdik Chris D.
Published: March 2003

Abstract

Background  An epidemiology unit was established in Aruba in 1994. The primary focus was the development of an infrastructure for both surveillance and health information data systems. This effort resulted in the first analysis of available skin cancer data.

Methods  A retrospective study of cancer and particularly skin cancer cases at the local histopathology laboratory for the period 1980–1995 was performed. All available records with a cancer diagnosis were evaluated.

Results  During the study period, an increase in age‐adjusted rates for both men and women was observed for basal cell carcinomas and squamous cell carcinomas. No temporal trend was discerned for malignant melanoma or other skin cancers because the numbers of cases were small. Lesions were most often seen on the nose, face, and arm. Dermatologists provided the majority of skin cancer diagnoses and demonstrated the greatest diagnostic accuracy.

Conclusions  The presence of a central histopathology laboratory may provide small island states, like Aruba, with important public health data. This first description of Aruba's skin cancer epidemiology provides information that may be utilized for future public health action.
Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction‐restriction analysis length polymorphism of the hsp65 gene
Authors: Ena Pasquale , Sechi Leonardo Antonio , Saccabusi Stanislao , Molicotti Paola , Lorrai Maria Paola , Siddi Massimiliano , Zanetti Stefania
Published: March 2003

Background  Nontubercular mycobacteria (NTM) may cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. This study involved eight patients (four men and four women) with primary cutaneous infections caused by NTM; the skin lesions included dermo‐hypodermal abscesses, suppurative granulomas, and papulonodules localized on the legs, arms, hands, and face. The general condition of the patients was relatively good and they were not immunosuppressed.

Methods  All samples were processed with standard methods and the isolates were identified by pattern restriction analysis after polymerase chain reaction (PCR‐PCA) amplification of the heat shock protein of 65 kDa.

Results  In this way, we were able to identify three Mycobacterium chelonae strains, two Mycobacterium marinum, two Mycobacterium fortuitum, and one Mycobacterium avium. The lesions disappeared in 3 or 4 weeks after treatment with two or more antimicrobials.

Conclusions  For a correct diagnosis of cutaneous infection by NTM, demonstrating the presence of mycobacteria is essential; routinely available techniques lack sensitivity and are extremely tedious; often mycobacteria are not seen after acid‐fast stain. We used PCR‐PCA to identify mycobacteria grown in liquid media; the time of identification of mycobacteria was shortened relative to conventional methods.
A pilot study to determine the effect of tazarotene gel 0.1% on steroid‐induced epidermal atrophy
Authors: Kaidbey Kays , Kopper Scott C. , Sefton John , Gibson John R.
Published: March 2003

Abstract

Background  Repeated applications of a corticosteroid can induce epidermal atrophy. This study was performed to investigate whether the adjunctive use of tazarotene gel 0.1% might help to minimize the development of steroid‐induced epidermal atrophy.

Methods  Each of 24 healthy volunteers received the following six treatments (applied 6 days per week for 4 weeks), which were randomized to each of six sites on their forearms: no treatment, tazarotene vehicle, tazarotene vehicle + tazarotene gel 0.1%, diflorasone diacetate 0.05% ointment, diflorasone diacetate 0.05% ointment + tazarotene vehicle, or diflorasone diacetate 0.05% ointment + tazarotene gel 0.1%.

Results  The mean epidermal thickness was increased by 20% (NS) and 62% (P ≤ 0.0005) after applications of tazarotene vehicle and tazarotene gel 0.1%, respectively. Application of diflorasone diacetate reduced the mean epidermal thickness by 43% (P ≤ 0.0005). Concomitant application of tazarotene gel 0.1% with diflorasone diacetate did not entirely prevent atrophy, but was shown to ameliorate 37% of the epidermal atrophy induced by diflorasone diacetate alone (P ≤ 0.003 compared with steroid monotherapy).

Conclusions  Tazarotene gel 0.1% significantly reduces epidermal atrophy induced by diflorasone diacetate 0.05% ointment.
The incidence of pemphigus in the southern region of Saudi Arabia
Authors: Tallab Talal , Joharji Hanan , Bahamdan Khalid , Karkashan Eman , Mourad Mohammed , Ibrahim Karam
Published: March 2003

Abstract

Background  This is the first epidemiologic study of pemphigus in the southern region of Saudi Arabia.

Methods  Data were collected from patient records in the outpatient and inpatient departments of Asir Central Hospital during the period 1990–99. The diagnosis of pemphigus was based on the clinical, histopathologic, and direct immunofluorescence patterns which were consistent with pemphigus.

Results  The results showed that the mean incidence of the disease in the general population was 0.16/100 000; the mean incidence of the disease in the population above 20 years of age was 0.27/100 000. The prevalence of the disease at the end of the study period was

1.56/100 000 for the total population, and 2.7/100 000 for the population above 20 years of age. The male to female ratio was 2.2 : 1. The age of onset of the disease ranged from 23 to 67 years, except for one case at an age of 9 years, giving an average of 43.1 ± 13.4 years and a median of 40 years. Pemphigus vulgaris was the most commonly encountered type, followed by pemphigus erythematosus (94.7% and 5.3%, respectively). Mucosal involvement occurred in 84.2% of cases. No association with neoplasia was found in the current study.

Conclusions  Pemphigus in the southern region of Saudi Arabia is as common as in other parts of the world, but with higher mucosal involvement.
Mast cell density and IL‐8 expression in nonlesional and lesional psoriatic skin
Authors: Jiang Wen Yue , Chattedee Arka D. , Raychaudhuri Siba P. , Raychaudhuri Smriti K. , Farber Eugene M.
Published: March 2003

Abstract

Background  An important cellular aberration at sites of psoriatic inflammation is an increase in the number of dermal mast cells. Being multifactorial immune effector cells, it is believed that mast cells play an essential role in perpetuating the inflammatory process of psoriasis. However, factors responsible for the infiltration and accumulation of mast cells in psoriatic lesions are largely unknown. Recent studies have demonstrated that Interleukin‐8 (IL‐8) exerts strong chemotactic effects on mast cells in vitro. Overexpression of IL‐8 has also been reported in psoriatic lesions. In this study, we have found a correlation between the expression of IL‐8 and dermal mast cell density in lesional psoriatic skin as compared to nonlesional psoriatic skin.

Methods  Four‐mm punch biopsies were taken from 14 psoriatic patients and eight healthy volunteers. Using immunohistochemical techniques, 8 μm sections of lesional psoriatic, nonlesional psoriatic, and normal control samples were evaluated for dermal mast cell density and the density of IL‐8 expressing keratinocytes.

Results  It was found that dermal mast cell density in lesional psoriatic, nonlesional psoriatic, and normal skin was 105.4 ± 71.2, 42.3 ± 30.1, and 47.5 ± 32.5 mast cells/mm2, respectively. IL‐8+ keratinocyte density in lesional psoriatic, non lesional psoriatic, and normal skin was 171.5 ± 67.1, 25.4 ± 14.9 and 20.6 ± 8.7 IL‐8+ Keratinocytes/mm2, respectively.

Conclusions  The results of this study suggest that increased levels of IL‐8 in the keratinocytes of psoriatic plaques play a contributing role in the migration of mast cells to lesion sites.
Axillary osmidrosis treated by partial removal of the skin and subcutaneous tissue en bloc and apocrine gland subcision
Authors: Fan Yi‐Ming , Wu Zhi‐Hua , Li Shun‐Fan , Chen Qiu‐Xia
Published: March 2003

Abstract

Background  Axillary osmidrosis can be treated with many methods, but local surgery is the treatment of choice.

Methods  Forty‐three patients (32 females and 11 males, average age 20.3 years) were treated by partial removal of the skin and subcutaneous tissue en bloc and follicular clipping of the adjacent area. All operations were performed with local anesthesia in an outpatient setting.

Results  Follow‐up ranged from 2 to 47 months (mean: 13.4 months). Forty‐one patients (95%) had good results, two (5%) were fair, and none were poor. No recurrences were seen. The wound complication rate was 3.5% for axillae and 7% for patients. There were no scar contractures or limitations of arm abduction.

Conclusion  This combined surgical method can eliminate malodor and has a low wound complication and recurrence rate. Though the transient and conspicuous scar is the chief drawback of this method, it is a simple, safe, effective and inexpensive method for treating axillary osmidrosis.
Dermatology practice in primary health care services: where do we stand in the Middle East?
Authors: Al‐Hoqail Ibrahim A. , Gad Ashry , Crawford Richard I.
Published: March 2003

Abstract

Background  There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field.

Objective  The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders.

Material and methods  Physicians at university‐hospital primary‐care clinics were asked to answer a multiple‐choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed.

Results  Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P = 0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04).

Conclusion  PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of health care.
Dyskeratosis congenita with isolated neutropenia and granulocyte colony‐stimulating factor treatment
Authors: Yilmaz Kutluhan , Serhat İnalöz H. , Ünal Bünyamin , Güler Elif
Published: March 2003

A 3‐year‐old Turkish boy with a history of chronic cough, recurrent bronchopneumonia, and a borderline sweat chloride test (40 mEq/L) was referred for further evaluation to our department. He was born at term (2100 g) to a marriage with no consanguinity. His mother and father were 40 and 46 years old, respectively.

Physical examination (Fig. 1) revealed hypopigmented, atrophic, and hyperkeratotic skin lesions surrounded by reticulate hyperpigmentation on the entire body, predominantly on the face, neck, arms, shoulders, and legs, which had been noticed initially at the age of 18 months. Dystrophic toenails, sparse and thin hair, and phimosis were also observed. Laboratory tests disclosed an isolated neutropenia (white blood cell count, 1800/mm3). Bone marrow (BM) aspiration showed a decreased myelopoiesis without myelodysplastic changes, but normal erythropoiesis, megakaryopoiesis, and normal stroma. Lymphocyte subgroups containing CD4, CD5, CD6, CD8, CD19, CD23, and CD25, and immunoglobulin G (IgG), IgM, IgA, and IgE, were in the normal range; hemoglobin F (HbF), 2.8%. Spontaneous and clastogen‐induced chromosome breaks were not increased. A skin biopsy showed increased pigmentation at the basal layer, dyskeratotic epidermal cells, and marked IgM deposition and cytoid bodies and mild IgA and IgG deposits at the dermo‐epidermal junction. Lactate response to glucose challenge, amino acid chromatography, and urine organic acid analysis were normal.

Hypopigmented, atrophic, and hyperkeratotic skin lesions surrounded by reticulate hyperpigmentation involving predominantly the face, neck, arms, shoulders, and legs, dystrophic toenails, and sparse and thin hair

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A diagnosis of dyskeratosis congenita (DC) was made with typical skin lesions, dystrophic toenails, thin and sparse hair, and neutropenia with decreased myelopoiesis in BM. Treatment with granulocyte colony‐stimulating factor (G‐CSF) was considered for the neutropenia. As the increase in neutrophil count at a dose of 5 µg/kg was not adequate, 10 µg/kg G‐CSF was tried (Fig. 2). With 10 µg/kg once to three times a week, a 1.8–4.8‐fold increase in the absolute neutrophil count (ANC) was achieved with no side‐effects. Treatment was more frequent during infection (days 22–28).

Response of absolute neutrophil count (ANC) to granulocyte colony‐stimulating factor (G‐CSF) administration (5 µg/kg on days 1 and 3; 10 µg/kg on days 5, 10, 16, 23, 26, 28, 34, 40, 48, 54)

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A randomized, double‐blind, placebo‐controlled study of clobetasol propionate 0.05% foam in the treatment of nonscalp psoriasis
Authors: Lebwohl Mark , Sherer Daniel , Washenik Ken , Krueger Gerald G. , Menter Alan , Koo John , Feldman Steven R.
Published: March 2003

Background Topical corticosteroids are the primary treatment for mild to moderate psoriasis. Foam preparations of corticosteroids offer potential cosmetic and pharmacodynamic advantages over cream and ointment vehicles. A clobetasol propionate foam product is as effective as clobetasol propionate solution in the treatment of scalp psoriasis.

Aim To evaluate the safety and efficacy of clobetasol propionate foam in the treatment of psoriasis involving sites other than the scalp.

Methods Eighty‐one subjects with mild to moderate psoriasis were randomized in a 3 : 1 ratio to receive clobetasol propionate foam vs. placebo foam treatment in this double‐blind study of psoriasis involving nonscalp sites. The investigator's and subject's global assessment of the response at week 2 (or at the end of treatment) and at week 4 (follow‐up) and the severity of erythema, scaling, and plaque thickness were assessed. Safety was assessed from reported adverse events.

Results After 2 weeks of treatment, there was significantly greater improvement with clobetasol propionate foam compared with placebo foam in both investigator's and subject's global assessment of the response (P < 0.0005). The improvement with clobetasol propionate foam was still present at the 4‐week follow‐up visit. Adverse effects were generally limited to mild to moderate application site reactions. No subjects withdrew because of adverse events.

Conclusions Clobetasol propionate foam is more effective than placebo in the treatment of nonscalp psoriasis. Twice‐daily applications are well tolerated, compliance exceeds 90%, cosmetic characteristics are acceptable, and the medication may eliminate the need for separate scalp and body prescriptions.
Anonychia congenita totalis: a case report and review of the literature
Authors: Al Hawsawi Khalid , Al Aboud Khalid , Alfadley Abdullah , Al Aboud Daifullah
Published: March 2003

A 27‐year‐old man presented with a history of the absence of the nails of all the fingers and toes since birth. His parents were first‐degree cousins and there was no other case in the family. The past medical history was unremarkable. Examination revealed the absence of all the nails of all the toes and fingers (Fig. 1). The teeth and hair were normal and there were no significant skin lesions. Other systemic examinations were normal. X‐Ray of the hands and feet showed the presence of terminal phalangeal bones. The patient was diagnosed with anonychia congenita totalis simplex.

Hands showing the absence of all the fingernails

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Large cell acanthoma
Authors: Mehregan Darius R. , Hamzavi Fasahat , Brown Karl
Published: March 2003

The large cell acanthoma presents as a slightly scaly tan macule on photodamaged skin. Clinically, it may be difficult to differentiate from a lentigo senilis, pigmented actinic keratosis, or a flat and pigmented seborrheic keratosis.

We have studied 19 cases of large cell acanthoma. Large cell acanthomas were identified histologically as having epidermal keratinocytes with nuclei roughly twice the size of adjacent epidermal or adnexal keratinocytes, and as having minimal nuclear pleomorphism.

Histologic findings were compared with actinic keratosis and lentigo senilis. Melanocyte density and cellular proliferation were compared using HMB‐45 staining of melanocytes and proliferating cell nuclear antigen (PCNA) staining of epidermal keratinocytes.

Lentigo senilis and large cell acanthoma both showed increased numbers of melanocytes, as identified by HMB‐45 staining. Actinic keratosis shows a statistically increased proliferation rate, as identified by PCNA staining. On the basis of clinical, histologic, and immunohistochemical staining similarities, we believe that large cell acanthoma should be considered as a reaction pattern, possibly related to lentigo senilis.
Psychological benefits of prostate cancer screening: the role of reassurance
Authors: Cantor Scott B. , Volk Robert J. , Cass Alvah R. , Gilani Jawaria , Spann Stephen J.
Published: March 2003

Objectives  The role of reassurance in decision‐making about screening for health problems is largely unknown. We examined the reassurance value of prostate cancer screening in primary care patients.

Setting and participants  One hundred and sixty eight men, aged 45–70 years, who had no history of prostate cancer, from three family medicine practices in southeast Texas.

Methods  A hypothetical scenario was developed where men were asked to assume they did not have prostate cancer, and then to rank three predefined screening states with regard to reassurance value: (A) unknown (no screening), (B) normal by screening [a prostate‐specific antigen (PSA) test and a digital rectal examination (DRE)] and (C) normal by biopsy (abnormal PSA test and DRE results but a negative ultrasound‐guided prostate biopsy).

Results  Most of the men (96.8%) associated some reassurance value with screening, considering health state A to be the worst possible health state. Results from a multivariate analysis showed that preference for screening state C was associated with a family history of prostate cancer and perceived greater risk for prostate cancer compared with other men.

Conclusion  These findings suggest that prostate cancer screening may have some reassurance value for men, and that increased risk status may explain why some men prefer the added reassurance afforded by screening.
Colony size, social complexity and reproductive conflict in social insects
Authors: Bourke
Published: March 2003

The broad limits of mature colony size in social insect species are likely to be set by ecological factors. However, any change in colony size has a number of important social consequences. The most fundamental is a change in the expected reproductive potential of workers. If colony size rises, workers experience a fall in their chances of becoming replacement reproductives and, it is shown, increasing selection for mutual inhibition of one another's reproduction (worker policing). As workers’ reproductive potential falls, the degree of dimorphism between reproductive and worker castes (morphological skew) can rise. This helps explain why small societies have low morphological skew and tend to be simple in organization, whereas large societies have high morphological skew and tend to be complex. The social consequences of change in colony size may also alter colony size itself in a process of positive feedback. For these reasons, small societies should be characterized by intense, direct conflict over reproduction and caste determination. By contrast, conflict in large societies should predominantly be over brood composition, and members of these societies should be relatively compliant to manipulation of their caste. Colony size therefore deserves fuller recognition as a key determinant, along with kin structure, of social complexity, the reproductive potential of helpers, the degree of caste differentiation, and the nature of within-group conflict.
Evolution of resource allocation between growth and reproduction in animals with indeterminate growth
Authors: Heino  , Kaitala
Published: March 2003

We review the recent theoretical developments explaining the evolution of age-schedules of reproduction in animals with indeterminate growth. Indeterminate growth, i.e. growth that continues past maturation and may continue until the end of life, is characteristic for a large number of invertebrate taxa (e.g. clams, cladocerans and crayfish) and ‘lower’ vertebrate taxa (e.g. fish, amphibians, lizards and snakes). Many plants also exhibit indeterminate growth, and we liberally include studies focused on plants when they can be interpreted in terms of animal life histories. We focus on different measures used to determine the fittest life histories, on indeterminate growth as a problem of resource allocation and on the effects of environment to the evolution of the resource allocation schemes.
The evolution of threshold traits: effects of selection on fecundity and correlated response in wing dimorphism in the sand cricket
Authors: Roff  , Tucker  , Stirling  , Fairbairn
Published: March 2003

The quantitative genetic basis of traits can be determined using a pedigree analysis or a selection experiment. Each approach is valuable and the combined data can contribute more than either method alone. Analysis using both sib analysis and selection is particularly essential when there are likely to be nonlinearities in the functional relationships among traits. A class of traits for which this occurs is that of threshold traits, which are characterized by a dichotomous phenotype that is determined by a threshold of sensitivity and a continuously distributed underlying trait called the liability. In this case, traits that are correlated with the liability may show a nonlinear relationship due to the dichotomy of expression at the phenotypic level. For example, in wing dimorphic insects fecundity of the macropterous (long-winged) females appears in part to be determined by the allocation of resources to the flight muscles, which are almost invariably small or absent in the micropterous (short-winged, flightless) females. Pedigree analysis of the cricket Gryllus firmus has shown that wing morph, fecundity and the trade-off between the two have additive genetic (co)variance. It has also been shown that selection on proportion macroptery produced an asymmetric correlated response of fecundity. The present paper details the results of direct selection on fecundity and the correlated response in proportion macroptery. Selection for increased fecundity resulted in increased fecundity within both wing morphs and a correlated decrease in proportion macroptery. Similarly, selection for decreased fecundity resulted in a decrease within morphs and a correlated increase in the proportion of macropterous females. This provides additional evidence that the trade-off between fecundity and wing morphology has a genetic basis and will thus modulate the evolution of the two traits.