bluuebunny/crossref_metadata_2025 huggingface dataset:
Ki-67 Immunostaining of Normal Human Epidermis: Comparison with 3H-Thymidine Labelling and PCNA Immunostaining
Authors: Heenen M. , Thiriar S. , Noël J.-C. , Galand P.
Published: April 2003

Background: The size of the germinative growth fraction (i.e. the number of actively proliferating germinative cells) of normal human epidermis is still a subject of debate. Ki-67 antigen and PCNA, an auxiliary protein of d-polymerase, are considered as markers of the growth fraction when used under optimal conditions. Method: In the present work, we have compared Ki-67 expression (detected with MIB1 antibody) with PCNA expression (detected with PC10 antibody) in biopsies of normal human epidermis fixed in neutral formalin and using antigen retrieval by microwave processing. To obtain additional information, such as the percentage of cells in S phase, biopsies were also incubated in 3H-thymidine before immunostaining. Results: Before microwave treatment, 8% of the basal cells were positive for MIB1 antibody and 7.8% were positive for PC10 antibody. The 3H-thymidine labelling index was 2.8%. The proportion of MIB1-positive cells rose to 19% after antigen retrieval by microwave processing. In the same way, the 3H labelling index rose to 9%. In contrast, PC10 became positive in all epidermal nuclei. Conclusion: These results suggest that the growth fraction of the germinative cell population of normal human epidermis is not larger than 20% and is composed of cells with a short cell cycle time.
Is Aberrant Mammary Tissue a Marker for Chronic Alcoholism or Kidney-Urinary Tract Malformations?
Authors: Camacho F.M. , Moreno-Giménez J.C. , García-Hernández M.J.
Published: April 2003

Background: Numerous publications describe the relationship between aberrant mammary tissue (AMT) and kidney-urinary tract malformations, individual/ familial alcoholism and sense organ disorders. Patients and Methods: We investigated these possible associations and reviewed 72 cases observed in our Department during the past 3 years: 30 men and 42 women, 17 of them with bilateral AMT (7 men and 10 women) and 25 patients from 9 families. Diagnosis was made according to Kajawa’s classification. A detailed family history was performed asking for individual or familial alcoholism, especially in the mother, in addition to blood tests and ultrasonographic examination of the abdomen and the kidneys. Results: We only found 1 family history of alcoholism in 3 families, but in the father, never in the mother or the affected subject. No congenital/ hereditary nephrourinary defects or sense organ disorders were found. Conclusions: We believe that in our population AMT is not a marker for alcoholism, kidney-urinary malformations nor sense organ disorders.
Perfluoropolyethers in the Prevention of Irritant Contact Dermatitis
Authors: Elsner P. , Wigger-Alberti W. , Pantini G.
Published: April 2003

Background: Perfluoropolyethers (PFPEs) are non-reactive perfluorinated (no hydrogen atoms) liquid polymers that showed promise as ingredients of protective preparations in occupational dermatology. Objective: The aim of this study was to investigate if oil-in-water (o/w) emulsions containing 0.5, 1.0, 2.0 and 4.0% PFPEs (molecular weight 6,250 D) prevent epidermal barrier disruption induced by a repetitive irritation test (RIT). Methods: PFPE-containing o/w emulsions and the emulsion base alone were evaluated against a set of 4 irritants [10% sodium lauryl sulphate (SLS), 0.5% sodium hydroxide (NaOH), 15% lactic acid (LA), and undiluted toluene (TOL)] in the RIT. Ten subjects were tested on the paravertebral skin of the mid-back. Irritation was assessed by visual scoring, transepidermal water loss (TEWL) and colorimetry. Results: Both the emulsion base and all PFPE-containing preparations significantly suppressed irritation by SLS and NaOH. Against LA and TOL, only the 4% PFPE-containing preparation was significant as assessed by TEWL. Conclusion: A 4% PFPE-containing o/w emulsion significantly inhibits irritation due to a wide spectrum of hydrophilic and lipophilic irritants. o/w emulsions with lower concentrations of PFPE are also effective against SLS and NaOH, but this is also true for the cream base alone. Therefore, further studies are necessary to evaluate if a minimum of 4% PFPE in the base provides additional benefit.
Comparison of the Effects of Cetirizine and Ebastine on the Skin Response to Histamine Iontophoresis Monitored with Laser Doppler Flowmetry
Authors: Leroy T. , Tasset C. , Valentin B. , van Neste D.
Published: April 2003

Background: The administration of histamine with iontophoresis is an alternative method to skin prick tests or intradermal injections. Skin reactions obtained with this method can be recorded with laser Doppler flowmetry (LDF) and previous studies with this method have shown histamine-induced laser Doppler changes in the wheal area. Objective: In order to compare the influence of two H1 receptor antagonists (cetirizine 10 mg vs. ebastine 10 mg) on the skin vascular responses to histamine introduced by iontophoresis, we designed a double-blind, randomized, two-period crossover trial in which 18 volunteers were randomized. Methods: Before and 2, 5 and 7 h after drug administration, iontophoresis (30 s, 1.4 mA/cm2) of histamine 10% was performed and followed by (1) monitoring of skin vascular responses with LDF at the administration site and at 1 cm from it, and (2) wheal and flare area measurements. Results: 2, 5 and 7 h after intake of the antihistaminic drug, there were significant differences between both drugs. Concerning LDF recordings, we noted at the histamine administration site an increase in perfusion unit (PU) values which is an effect known to be in proportion to the degree of inhibition of wheal reaction, and at 1 cm distal to the histamine administration site, there was a decrease in PU values. These changes were more marked under cetirizine. A greater suppressive effect of cetirizine on the wheal and flare reaction was consistently observed at all time points during the study, demonstrating its superior efficacy. Conclusion: We conclude that (1) cetirizine demonstrated a stronger antihistaminic effect compared to ebastine at all time points; (2) iontophoresis appears to be an appropriate method to study specific microvascular changes at the delivery site of histamine and hence to detect the earliest changes occurring at the site of agonist-antagonist competition in the skin.
Treatment of Vascular Lesions Using the VersaPulse® Variable Pulse Width Frequency Doubled Neodymium:YAG Laser
Authors: Dummer R. , Graf P. , Greif C. , Burg G.
Published: April 2003

Background: The flashlamp-pumped dye laser is considered the treatment of choice for vascular lesions including port-wine stains. However, this treatment is associated with an intensive postoperative purpura and considerable pain. Objective: We tested a newly developed laser device with a 532-nm neodymium:YAG laser with variable pulse widths between 2 and 10 ms. Methods: Forty-two consecutive patients from our laser clinics were treated with the new laser system delivering energy through a chilled tip by means of circulating water (cooling temperature was between 4 and 5.5 °C). Forty of them had been pre-treated with an argon laser and an argon-pumped dye laser. Results: Out of the 42 patients, 1 patient had a complete clearing, 11 had an excellent result (more than 80% clearing), 21 patients had a good result (51–75% clearing), weak responses were seen in 9 patients. Significant success was already seen after 1 or 2 treatments. Side effects were rare. There was no purpura after treatment. Local anesthesia was only applied in 6 out of 42 patients. Conclusion: The variable pulse width frequency doubled neodymium:YAG laser seems to be an alternative to the flashlamp-pumped dye laser and deserves to be investigated in comparative trials.
Relapses of Onychomycosis after Successful Treatment with Systemic Antifungals: A Three-Year Follow-Up
Authors: Tosti A. , Piraccini B.M. , Stinchi C. , Colombo M.D.
Published: April 2003

Background: Data about relapses of onychomycosis after treatment with the new systemic antifungals vary among the different studies, with figures ranging from 3 to 20% for terbinafine and from 21 to 27% for itraconazole, depending on the follow-up duration. Objective: To determine the prevalence of relapses of onychomycosis cured by terbinafine compared with that of onychomycosis cured by itraconazole. Methods: We followed up 47 patients whose toenail onychomycosis had been mycologically cured in an open randomized study comparing intermittent itraconazole treatment with continuous terbinafine treatment and intermittent terbinafine therapy. Patients were examined every 3 months for up to 3 years after the end of therapy. At each visit clinical and mycologic (direct microscopy and cultures) evaluations were performed. Results: Eight of the 36 patients (22.2%) who completed the study had a relapse of onychomycosis during the follow-up period, including 2 patients of the terbinafine 250 mg group, 2 patients of the terbinafine 500 mg group and 4 patients in the itraconazole 400 mg group. As the original infection, the relapse was caused in all cases by Trichophyton rubrum. Conclusions: This study shows that 22.2% of patients with onychomycosis successfully treated with systemic antifungals experienced a relapse. The relapse rate increased from 8.3% at month 12 to 19.4% at month 24 and to 22.2% at month 36. Relapses were more common in patients treated with pulse itraconazole (4/11) than in patients treated with continuous (2/12) or intermittent (2/13) terbinafine. Statistical analysis did not reveal any significant difference between relapse rates in the three groups.
Ethanol-Induced Urticaria: Elevated Tryptase Levels after Double-Blind, Placebo-Controlled Challenge
Authors: Emonet S. , Hogendijk S. , Voegeli J. , Eigenmann P.A. , Roux N. , Hauser C.
Published: April 2003

We present a 48-year-old patient who complained for 1 year about urticarial reactions which appeared always when he ingested alcoholic beverages. Skin prick tests with ethanol were negative but positive with 10% acetic acid in the patient. Normal controls tested negative with acetic acid. Skin prick tests to common immediate-type allergens were negative. The patient underwent a double-blind, placebo-controlled challenge test. A few minutes after challenge with ethanol but not with placebo, the patient developed erythema and wheals on the chest and the upper arms. The tryptase serum level rose from undetectable (0.1 U/ml) before challenge to 3.8 U/ml after skin lesions had appeared. This case demonstrates that increased tryptase serum levels can help in the diagnosis of ethanol-induced urticaria.
Effects of Self-Perceived Hair Loss in a Community Sample of Men
Authors: Girman C.J. , Rhodes T. , Lilly F.R.W. , Guo S.S. , Siervogel R.M. , Patrick D.L. , Chumlea W.C.
Published: April 2003

Background: Few studies have quantified the psychosocial effects of hair loss using standardized instruments in men not seeking treatment for hair loss. Objective: Examine self-perception of hair loss and its effects on men from the community. Methods: Men 18–50 years of age recruited without regard to hair loss, from households near Dayton, Ohio, completed a questionnaire assessing self-perception of hair loss, satisfaction with hair appearance, hair-loss-specific effects and general health status. Results: Men with greater hair loss had more bother, concern about getting older, perceived noticeability to others and greater dissatisfaction with their hair appearance than men with less hair loss. These effects decreased with age for men with hair loss, but regardless of age, perceived noticeability of hair loss increased monotonically with degree of hair loss. Conclusions: Men with greater hair loss report more negative effects due to their hair loss across all age groups, but the effects were more pronounced in younger men.
Psychiatric Disorders in Patients Attending a Dermatology Outpatient Clinic
Authors: Aktan Şebnem , Özmen Erol , Şanli Berna
Published: April 2003

Background: Psychiatric comorbidity in patients with skin disorders has been reported. Objective: To find out the prevalence of psychiatric disorders in dermatology outpatients and to investigate the factors that affect the psychiatric symptoms. Methods: 256 patients attending our dermatology outpatient clinic completed a 12-item General Health Questionnaire (GHQ) following their dermatologic examination. A standardized personal interview was performed to establish a psychiatric diagnosis in patients sampled by using a stratified random sampling method. Results: The prevalence of psychiatric disorders was found to be 33.4% in the study group. The mean of the total GHQ scores of the sample group (n = 256 patients) was 3.656. The duration of the dermatologic complaints, sex of the subjects, localization of the lesions, and dermatologic diagnosis did not affect the total GHQ scores of the patients. Conclusion: Psychiatric comorbidity in 33.4% of the dermatology outpatients indicates the need for considering emotional factors for an effective management of the cutaneous disorders.
Establishment of a Tissue Culture System for Hamster Sebaceous Gland Cells
Authors: Ito A. , Sakiguchi T. , Kitamura K. , Akamatsu H. , Horio T.
Published: April 2003

Background: A human sebaceous gland culture system is very useful in studying the functions of the sebaceous glands at the cellular level. On the other hand, the success rates for culture systems and the experimental results from these human culture systems exhibit significant fluctuations, depending on the condition of the donor skin. Objective: The purpose of this study was to establish a stable culture system in order to investigate the functions of the sebaceous glands under uniform conditions. Methods: Sebaceous glands from the auricles of 5-week-old hamsters were isolated and seeded onto a 3T3 cell feeder layer. The proliferation, lipid production and response to androgens of these sebaceous-gland-derived cells (SGDC) were then examined. Results: The SGDC showed outgrowth, formed colonies and became confluent in a 35-mm dish culture after 14 days in primary culture. The amount of intracellular lipids significantly increased following the peak of the cell proliferation. The composition of the intracellular lipids from the hamster SGDC was identical to human SGDC, except that the hamster SGDC did not contain any squalene. Testosterone and 5α-dihydrotestosterone markedly stimulated the proliferation of these SGDC in a dose-dependent manner. Conclusion: This tissue culture system will be a useful tool for the study of sebaceous gland function at the cellular level.
Reticulate, Patchy and Mottled Pigmentation of the Neck
Authors: Lautenschlager S. , Itin P.H.
Published: April 2003

Besides the inherited forms of mottled and reticulate pigmentation, a vast number of diseases and trigger mechanisms can lead to acquired pigmentation of the neck. Nonhereditary variants of reticulate and mottled pigmentation can affect the neck as a typical site and therefore may give a diagnostic clue or it can occur sporadically on the neck as well as on other sites. A well-known and important factor in the pathogenesis is exposure to sunlight. Sun-induced pigmentation often presents on the neck and may result from phototoxic, photoallergic and cumulative actinic damage. Frequent forms comprise berloque dermatitis, Riehl’s melanosis, poikiloderma of Civatte and tanning bed lentigines. Different infections may also lead to this distinct skin alteration as pediculosis capitis, pityriasis versicolor and syphilis II. Treatment-induced irregular pigmentations may occur after applications of topical agents (e.g. diphenylcyclopropenone), systemic medication (e.g. 5-fluorouracil, chlorpromazine), as a complication of laser resurfacing or as a chronic graft-versus-host reaction. Different neoplasms may also involve the neck. Widespread pigmented basal cell carcinoma, cutaneous T-cell lymphoma, syringolymphoid hyperplasia and histiocytic diseases may lead to reticulated pigmentation. Various other infrequent conditions as connective tissue diseases, malnutrition, lichen planus pigmentosus and others are summarized. The neck, a readily accessible site to medical inspection, may have an underestimated value for the diagnosis of different skin diseases.
Onychomycosis due to Trichophyton soudanense in Switzerland
Authors: Ricci C. , Monod M. , Baudraz-Rosselet F.
Published: April 2003

We report 2 cases of onychomycosis of the finger- and toenails due to Trichophyton soudanense with a typical clinical picture different from the hyperkeratosis of T. rubrum subungual onychomycosis.
Monosymptomatic Loa loa Infection
Authors: de Viragh P.A. , Guggisberg D. , Derighetti M. , van Saanen M. , Panizzon R.G.
Published: April 2003

We report the case of a 17-year-old student from Cameroon who presented an atypical, mono-symptomatic form of Loa loa infection, characterized only by rare subcutaneous movements of adult worms.
Electrical Impedance of Nodular Basal Cell Carcinoma: A Pilot Study
Authors: Emtestam L. , Nicander I. , Stenström M. , Ollmar S.
Published: April 2003

Background: Previously, we have explored the use of measurements of electrical impedance and devised 4 physically distinct indices named magnitude index (MIX), phase index, real part index and imaginary part index (IMIX) from the impedance data. Our results indicated that these indices could characterize contact reactions. Objective: The goal of the present study was to use the electrical impedance method for the preoperative assessment of nodular basal cell carcinoma (BCC). Methods: We included 11 patients with a total of 12 nodular BCC, diagnosed clinically and histologically. The noninvasive measurements were performed by transepidermal water loss (TEWL) and electrical impedance. For reference, normal looking contralateral or ipsilateral skin was used. Results: Compared to controls, the mean TEWL of BCC was increased, but this finding was not statistically significant. The electrical impedance measurements of BCC tissue revealed statistically significant changes of the impedance indices MIX and IMIX (p ≤0.001). Conclusion: The results suggest that the measurement of electrical impedance might become useful for investigations of BCC.
Fixed Drug Eruption Presenting as Erythema dyschromicum perstans: A Flare without Taking Any Medications
Authors: Mizukawa Y. , Shiohara T.
Published: April 2003

Fixed drug eruption (FDE) can present as multiple pigmented macules that flare at fixed sites even when the patient has taken no medications. Although this presentation is not characteristic of FDE, it must be borne in mind in order to make a correct diagnosis. We describe such a patient whose condition was initially diagnosed as erythema dyschromicum perstans (EDP). Immunohistochemically intraepidermal T cells were distributed between basal and suprabasal keratinocytes in the lesional skin, a finding suggestive of FDE. A flare occurred not only with exposure to theophylline but also without exposure. A flare has never recurred and pigmented macules faded gradually after avoiding theophylline. On the basis of these findings, we recommend that patients with an EDP-like presentation be examined completely for causes such as drugs before labeling the cutaneous lesions.
Amicrobial Pustulosis of the Folds
Authors: Stefanidou M.P. , Kanavaros P.E. , Stefanaki K.S. , Tosca A.D.
Published: April 2003

Amicrobial pustulosis (AP) is a recently defined entity associated with connective tissue diseases. Few cases have appeared in the literature. We report a case of AP coexisting with a systemic lupus erythematosus-scleroderma overlap syndrome and marked photosensitivity. The patient presented prominent pustular skin lesions and a few discoid lupus ones. No significant differences in the inflammatory infiltrate were found between the two clinical variants. The infiltrate consisted mainly of CD4+ lymphocytes and many neutrophils. CD1a+ dendritic cells were few in both epidermis and dermis. AP introduces a potential source of diagnostic confusion, but increasing experience of this syndrome will improve the awareness and diagnostic potential among dermatologists.
Percutaneous Absorption of Salicylic Acid in Man after Topical Administration of Three Different Formulations
Authors: Schwarb F.P. , Gabard B. , Rufli T. , Surber Ch.
Published: April 2003

Objective: To determine the amount of drug which is absorbed during 1 day following topical application of three different preparations containing salicylic acid. Methods: Ten grams of the formulations, either (a) Kerasal™ 5% ointment, (b) salicylic acid 5% or (c) 10% in petrolatum, were administered consecutively to a 600-cm2 area on alternating sides of the back of healthy volunteers (n = 9). Thirty minutes after application, a skin area of 2.54 cm2 was stripped with D-Squame™ adhesive disks to determine the amount of salicylic acid in the stratum corneum. The entire application site was then covered by a thin gauze bandage and was not washed for the next 24 h. Urine was collected for 26 h following administration, hydrolyzed and assayed by HPLC analysis. Results: The absolute amounts absorbed and excreted were 52.6 ± 29.4 mg (mean ± SD), 127.1 ± 43.9 mg and 208.0 ± 81.7 mg, and the doses absorbed in relation to the doses applied (500 mg salicylic acid in case of formulations a and b and 1,000 mg for formulation c) were 9.3 ± 3.8, 25.1 ± 8.5 and 20.2 ± 7.7%, respectively. The amounts of salicylic acid in the skin 30 min after application were 36.3 ± 16.5, 18.2 ± 11.9 and 31.3 ± 15.4 μg/ cm2 as determined by the tape stripping procedure. Conclusions: Significant differences in the doses absorbed were detected between the two formulations a and b (same concentration) with different vehicles (p value < 0.001) as well as between b and c (same vehicle) with different concentrations (p value = 0.018) using Student’s paired t test. These results demonstrate that salicylic acid is well absorbed by healthy skin.
Granuloma faciale with Extrafacial Lesions
Authors: Roustan G. , Sánchez Yus E. , Salas C. , Simón A.
Published: April 2003

Extrafacial involvement in granuloma faciale (GF) is rather exceptional. We report herein a patient with GF associated with lesions on the trunk and the forearm. Histological studies of facial and extrafacial lesions shared similar characteristics: a mixed inflammatory infiltrate with abundant eosinophils in the superficial and middle dermis with a narrow grenz zone of uninvolved dermis between the epidermis and the infiltrate. Evidence of vasculitis was clearly observed in both biopsy specimens. Treatment with dapsone did not alter the course of the disease. We review the 12 cases of extrafacial GF that have been reported in the English and Spanish literature. In these cases a diagnosis of erythema elevatum diutinum (EED) may be suggested. Although GF and EED may share some pathogenic mechanisms, there are several clinical and histological differences between them that make us consider EED and GF as distinct entities.
Lack of Expression of Interleukin 8 and RANTES in Autoimmune Bullous Skin Diseases
Authors: Bornscheuer E. , Zillikens D. , Schröder J.-M. , Sticherling M.
Published: April 2003

Background: In autoimmune bullous skin diseases, accumulation of neutrophils and/or eosinophils in the affected skin represents a characteristic feature. So far, however, the induction of this granulocyte infiltration has not been elucidated. Objective: Regarding their biological effects, the chemokines interleukin 8 (IL-8) and RANTES (regulated upon activation normal T lymphocyte expressed and secreted) could play a role in this granulocyte accumulation. Methods: Immunohistochemical examination of lesional skin from patients with bullous pemphigoid, pemphigus, dermatitis herpetiformis and linear IgA disease was performed using a set of different antibodies against IL-8 and RANTES. Additionally, blister fluids were screened for soluble RANTES peptide using an ELISA. Results: No difference in chemokine expression was found in lesions of autoimmune bullous diseases compared to normal skin. Conclusion: In contrast to chronic inflammatory diseases like psoriasis and eczema, where keratinocyte IL-8 immunoreactivity was found to differ from normal skin, keratinocyte immunoreactivity is not altered in autoimmune bullous diseases.
Recurrent Pleomorphic Solitary Angiomyxoma of the Face
Authors: Heymans O. , Médot M. , Hermanns-Lê T. , Piérard G. , Fissette J. , Lahaye T.
Published: April 2003

The historical background of solitary and multiple myxoid tumors of the dermis is accompanied by a confusing conglomeration of names. We report a case whose histologic features do not fit exactly with previous classifications. It appeared as a solitary angiomyxoma of the face containing stellate pleomorphic cells and exhibiting a locally infiltrative behavior with tendency for recurrences over more than 25 years. This recurrent pleomorphic solitary angiomyxoma appears to be distinct from cutaneous myxomas that exhibit a very low local recurrence rate and from malignant tumors with myxoid deposits. The treatment consisted of a wide surgical excision.
Would Cyclosporin A Be Beneficial to Mitigate Drug-Induced Toxic Epidermal Necrolysis?
Authors: Paquet P. , Piérard G.E.
Published: April 2003

Drug-induced toxic epidermal necrolysis (TEN) is a rare life-threatening disease whose mortality remains high. The treatment of the disease is badly settled. Several kinds of drugs have been tested, including systemic corticosteroids, cyclophosphamide, pentoxifylline and thalidomide, but without any clear-cut outcome. Cyclosporin A (CsA) has many inhibitory effects on the main cell populations involved in TEN (T lymphocytes, macrophages and keratinocytes). CsA could also act on tumor necrosis factor α metabolism, a cytokine which is important in TEN epidermal destruction. Moreover, apoptosis is the mechanism leading to keratinocyte death and CsA has antiapoptotic properties. CsA has already been used successfully on a limited series of TEN patients. We have reviewed the potential theoretical useful effects of CsA in TEN. We conclude that CsA could be a good candidate to reverse TEN progression.
Autoantibodies against Oxidatively Modified Low-Density Lipoprotein in Patients with Behçet’s Disease
Authors: Örem A. , Çimşit G. , Değer O. , Vanizor B. , Karahan S.C.
Published: April 2003

Background: Change of lipids and lipoprotein metabolism and an imbalance of the oxidant-antioxidant system related to the disease activity have been reported in Behçet’s disease. Therefore, there is a tendency of oxidative modification of lipids and lipoproteins in patients with the disease. Objective: To investigate serum autoantibodies against oxidatively modified low-density lipoprotein (oxLDL) as a marker for the degree of in vivo oxidation of lipoproteins in Behçet’s disease. Methods: Serum autoantibodies against oxLDL, total cholesterol, triacylglycerol, HDL cholesterol, LDL cholesterol, apolipoprotein (Apo) AI, Apo B, α1-antitrypsin, α2-macroglobulin and erythrocyte sedimentation rate were determined in 37 patients and 30 sex- and age-matched healthy volunteers. Autoantibodies against oxLDL were measured by a commercial enzyme-linked immunosorbent assay. Results: Serum autoantibody levels against oxLDL were significantly higher in patients than in controls (425 ± 365 and 187 ± 132 mU/ml, respectively; p < 0.05). The levels of autoantibodies against oxLDL in the patients were found to correlate with total cholesterol, LDL cholesterol, HDL cholesterol and α1-antitrypsin levels (r = 0.38, p < 0.05; r = 0.42, p < 0.05; r = –0.38, p < 0.05; r = 0.42, p < 0.05, respectively). Conclusion: It has been shown in previous studies that high autoantibody titers against oxLDL may be important in diseases with atherosclerosis as seen in systemic lupus erythematosus and rheumatoid arthritis. High autoantibody titers against oxLDL are not specific for Behçet’s disease but probably important for pathologic processes in the disease. We suggest that increased levels of autoantibodies against oxLDL may be a factor responsible for endothelial dysfunction and development of vascular pathology in Behçet’s disease.
Predictive Factors for Failure of Isotretinoin Treatment in Acne Patients: Results from a Cohort of 237 Patients
Authors: Lehucher-Ceyrac D. , de La Salmonière P. , Chastang Cl. , Morel P.
Published: April 2003

Background: The efficacy of oral isotretinoin in acne has been established, though the role of the mean daily dose (MDD) is still unclear. Objective: To determine the predictive factors of resistance to oral isotretinoin and the role of the MDD of isotretinoin on relapse of acne while taking into account patient characteristics and the total cumulative dose (TCD). Methods: Two hundred and thirty-seven patients treated with oral isotretinoin for the first time were enrolled by a single dermatologist. Patients with closed comedonal acne and with hyperandrogenism received adequate therapy prior to isotretinoin. Results: Closed comedonal acne was the only predictive factor of resistance to isotretinoin with an adjusted OR = 2.7 (95% CI: 1.0–7.3). The estimated rates of relapse at 1, 3 and 5 years were 14, 40 and 48%, respectively. Age and grade of facial acne were the only predictive factors for relapse with adjusted relative risks of 0.6 (95% CI: 0.4–0.8) for age ≥ 20 and 1.5 (95% CI: 1.0–2.2) for grade > 3. Conclusion: MDD, TCD, closed comedonal acne and hyperandrogenism that have been adequately treated prior to isotretinoin treatment had no prognostic value for relapse.
Nail Changes Secondary to Docetaxel (Taxotere)
Authors: Correia O. , Azevedo C. , Pinto Ferreira E. , Braga Cruz F. , Polónia J.
Published: April 2003

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer. Skin and nail toxicity are one of the more frequent nonhematologic adverse reactions. Besides dark pigmentations and Beau’s lines, subungual hemorrhage, orange discoloration, acute painful paronychia, onycholysis, subungual hyperkeratosis and transverse loss of the nail plate are described. The type of nail alteration is related with the number of cycles administered and there are no efficacious preventive measures to avoid its development. Clinicians should recognize the clinical picture of these adverse nail reactions because docetaxel is used for several neoplastic disorders.
Metastasizing Porocarcinoma of the Head with Lethal Outcome
Authors: Grimme H. , Petres A. , Bergen E. , Wiemers S. , Schöpf E. , Vanscheidt W.
Published: April 2003

Porocarcinoma is a very rare malignant tumor arising from the duct of eccrine sweat glands. Its prognosis is variable. We report on a patient who developed lymph node and multiple distant metastases, and who died of this malignancy only 6 months after the initial diagnosis.
Increased Fibroblast Elastase Activity in Acquired Cutis laxa
Authors: Bouloc A. , Godeau G. , Zeller J. , Wechsler J. , Revuz J. , Cosnes A.
Published: April 2003

Background: Acquired cutis laxa is a rare disease characterized by sagging skin, premature wrinkling and reduced skin elasticity. Observation: We report a 21-year-old woman, who presented with acquired cutis laxa on the face and the ear lobes. Urticarial papules had preceded for 6 years. There was no systemic involvement. Skin specimens were obtained from lax skin and urticarial papules, and from healthy controls. Histology showed only few perivascular lymphocytes in lax ear skin and a dense inflammatory infiltrate in urticarial skin. In both biopsies elastic fibres were decreased as demonstrated by computerized morphometric analyses. Elastase activities of fibroblasts in culture were evaluated. There was a 2- to 3-fold increase in elastase activity in urticarial skin fibroblasts, contrasting with a normal elastase activity in lax ear skin. Conclusion: Our findings suggest that the inflammatory cells could play a significant role in the destruction of elastic fibres.
Three-Dimensional Reconstruction of Blood Vessels from in vivo Color Doppler Optical Coherence Tomography Images
Authors: Kehlet Barton J. , Izatt J.A. , Kulkarni M.D. , Yazdanfar S. , Welch A.J.
Published: April 2003

Purpose: Current laser treatment for vascular disorders such as port wine stains can have incomplete or unacceptable results. A customized treatment strategy based on knowledge of the patient’s blood vessel structure may effect an improved clinical outcome. Procedure: We tested the feasibility of using color Doppler optical coherence tomography (OCT) and image processing techniques to locate, measure and reconstruct cutaneous blood vessels in rat and hamster skin. OCT is a recent, potentially noninvasive technique for imaging subsurface tissue structures with micrometer scale resolution. Results: Blood vessels were identified in a series of cross-sectional images, then a three-dimensional reconstruction was made. Parameters that can affect optimum laser treatment parameters, such as average blood vessel depth and luminal diameter, were found from the images. Conclusion: This study shows that color Doppler OCT is a potential tool for improving laser treatment of vascular disorders.
Long-Term Extracorporeal Photoimmunotherapy for Treatment of Chronic Cutaneous Graft-versus-Host Disease: Observations in Four Patients
Authors: Dippel E. , Goerdt S. , Orfanos C.E.
Published: April 2003

Background: Chronic cutaneous graft-versus-host disease (GvHD) can arise as a late complication after allogeneic bone marrow transplantation. Patients with extensive disease to date require intensive early and long-term immunosuppression; however, treatment is often insufficient. Since the beneficial effects of phototherapy for chronic cutaneous GvHD are well known, extracorporeal photoimmunotherapy (ECP) was also tried with some success for a few single patients with this disease. Objective: The long-term effect of ECP was evaluated in 4 patients with therapy-resistant severe chronic cutaneous GvHD after allogeneic bone marrow transplantation. Methods: Four patients were treated with monthly sessions of ECP over a period of 16–40 months. Disease severity was assessed by a semiquantitative score adapted from the literature including extent of skin area involved, rigidity of the skin, involvement of joints and immunosuppressive drug consumption. Results: In all patients, a favorable response was observed after 6–12 treatment cycles. One patient had a complete response, 2 patients had a partial response, and 1 patient had a minor response after treatment. In 2 patients, immunosuppressive medication started before initiating ECP could be reduced or completely withdrawn under ECP. Peripheral blood lymphocyte immunophenotyping revealed reduction of CD3+ CD4+ T cells in 3 patients and of elevated CD3+ CD8+ and CD57+ CD8+ T cell subsets in 2 patients. Conclusion: ECP is effective in treating severe chronic cutaneous GvHD. ECP possibly exerts its effects by reducing the number of CD8+ suppressor/cytotoxic T cells, the presumptive effector cells of GvHD. ECP is well tolerated with essentially no side effects and allows reducing the dosage of immunosuppressive agents.
Total Antioxidative Capacity Is Normal in Sera from Psoriasis Patients despite Elevated Bilirubin, Tocopherol and Urate Levels
Authors: Severin E. , Nave B. , Ständer M. , Ott R. , Traupe H.
Published: April 2003

Background: Psoriasis is a chronic inflammatory skin disease. Reactive oxygen species are thought to play a critical role in inflammation and are scavenged by antioxidants. Objective: We wanted to know whether the total antioxidative capacity or single antioxidative components in sera from psoriasis patients are decreased. Material and Methods: Well-known antioxidants of the serum were measured using commercial kits or determined by HPLC in the sera of 33 inpatients with severe psoriasis and in 36 healthy control persons. The total antioxidative capacity was measured using the ability of endogenous antioxidants to scavenge the 2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) radical cation. Results: Several single antioxidative components were slightly elevated when considered groupwise, namely tocopherol (p = 0.001), bilirubin (p = 0.001) and urate which was increased over controls by about 33% (p= 0.01). Other parameters such as total protein and thiol content and ascorbic acid did not differ from controls. Conclusion: To our surprise the total antioxidative activity was normal in sera from psoriasis patients although some components such as urate were even elevated.
Basal Cell Carcinoma in Young Adults: Not More Aggressive than in Older Patients
Authors: Roudier-Pujol Caroline , Auperin Anne , Nguyen Thiem , Duvillard Pierre , Benhamou Ellen , Avril Marie-Fançoise
Published: April 2003

Background: An increased incidence of sporadic basal cell carcinoma (BCC) has been observed in young adults within the last years. It has been hypothesized that these BCC in younger subjects might be more aggressive compared to BCC in the elderly. Objective: To compare BCC recurrence rates between young and older patients. Methods: Retrospective study of patients under the age of 35 years (group 1) with previously untreated BCC and comparison with BCC in patients older than 35 years (group 2). Each patient in group 1 was matched with 2 patients in group 2. Results: 70 patients in group 1 and 140 patients in group 2 were included. The median follow-up was 76 months. In group 1, 13% of the BCC were of the morphea-like type and 9% in group 2 (p = 0.30), respectively. The 5-year recurrence rate was 4.6% in group 1 and 9.8% in group 2. They did not significantly differ between the two groups (log rank test p = 0.48). Conclusion: BCC in young patients are not more aggressive than in older patients.
Metastasis to the Nasal Tip from a Cervical Carcinoma
Authors: Itin Peter H. , Heitzmann Felix , Stamm Bernhard
Published: April 2003

We report on a patient with a red-violaceous swelling of her nasal tip which turned out to be a primary metastasis of a cervical carcinoma. Only 2 patients with metastatic lesions in the nose from cervical carcinoma have been reported. The clinical features are presented, and the differential diagnosis is discussed.
Development and Validation of a Quality of Life Measurement for Chronic Skin Disorders in French: VQ-Dermato
Authors: Grob J.J. , Auquier P. , Martin S. , Lançon C. , Bonerandi J.J.
Published: April 2003

Background: Quality of life (QoL) assessment is crucial to assess the severity of dermatological diseases. Purpose: To construct and validate the first dermatology-specific instrument in French. Methods: Items were generated from the interview of patients. The final self-administered questionnaire, the VQ-Dermato, included 28 questions. Validity in terms of content and construct, reliability in terms of reproducibility and internal consistency, responsiveness and acceptability were tested in a population of 231 patients with 12 categories of chronic skin disorders, who were recruited and followed in hospital and private practice in France. Results: Item analysis revealed that discrimination indices were high. After factor analysis, 7 dimensions were retained, which accounted for 72% of the total variance. Cronbach’s α coefficient ranged between 0.67 and 0.88. A strong correlation was found between dimensions of the VQ-Dermato and the corresponding dimensions of the SF36. Scores were significantly different in each category of chronic skin disease and significantly higher when there was a function restriction or when the lesions were visible to others. The scale was proven to be stable by test-retest correlation. The VQ-Dermato was more responsive to clinical improvement after a 1- or 2-month treatment than the SF36. The percentage of missing responses was under 10 and the time for completing the questionnaire always under 13 min. Conclusion: The VQ-Dermato is the first valid and reliable dermatology-specific QoL instrument in French, and the first based on the concept of ‘chronic skin disorders’. It is acceptable for routine use and has a better responsiveness than a general health instrument.
Acquired Angioedema with C1 Inhibitor Deficiency: Is the Distinction between Type I and Type II Still Relevant?
Authors: D’Incan Michel , Tridon Arlette , Ponard Denise , Dumestre-Pérard Chantal , Ferrier-Le Bouedec Marie-Christine , Bétail Georges , Souteyrand Pierre , Caillaud Denis
Published: April 2003

Background: Acquired angioedemas are divided into type I associated with lymphoproliferation and type II caused by anti-C1-inhibitor antibodies. Recent reports have suggested that this distinction is not so clear-cut, mainly because of the presence of antibodies against the C1 inhibitor in some cases belonging to the type I group. We report herein 2 additional cases of acquired angioedema with anti-C1-inhibitor antibody. Material and Methods: One man and 1 woman had had acquired angioedema for several years. In the man, a monoclonal component had been detected several years before the present study. In the second patient, a monoclonal component was detected during the study. The following data were studied on successive blood samples collected during angioedema manifestations: complement component levels, functional activity of the classical pathway, functional and antigenic C1 inhibitor doses, ELISA test to detect autoantibodies to C1 inhibitor and Western blot analysis of the C1 inhibitor. Results: In both patients, CH50 and C4 activities were decreased, and an autoantibody to C1 inhibitor was detected. In 1 case, the antibody appeared after the monoclonal component; in the second case, it appeared before and belonged to a different immunoglobulin class. Conclusion: Our data suggest that the distinction between type I and type II acquired angioedema is no longer valid because of overlapping in some cases.
Skin Invasion of Hodgkin’s Disease Mimicking Scrofuloderma
Authors: Takagawa Shinsuke , Maruyama Ryuji , Yokozeki Hiroo , Nishioka Kiyoshi , Kobayashi Yasushi , Numano Fujio
Published: April 2003

We report a case of direct skin invasion by Hodgkin’s disease from a left supraclavicular lymph node. Clinical and pathological presentations mimicked infectious disease such as scrofuloderma. The nodule later developed a fistula following a biopsy that never healed despite numerous antibiotic treatments. Ten months later, other nodules with spontaneous fistula formation appeared on the anterior neck. A diagnosis of Hodgkin’s disease was then made. Subsequent COPP cytostatic therapy remarkably improved the skin lesions and lymph nodes achieving comlete remission.
Differentiating Squamous Cell Carcinoma from Keratoacanthoma Using Histopathological Criteria
Authors: Cribier Bernard , Asch Pierre-Henri , Grosshans Edouard
Published: April 2003

Background: Squamous cell carcinoma (SCC) and keratoacanthoma (KA) are sometimes difficult to distinguish by histopathological examination, since cytological features are similar in both tumors. Distinctive criteria – mainly architectural – have therefore been proposed as an aid in diagnosis. Objective: The purpose of this study was to evaluate the reliability of some of the criteria used to make a distinction between SCC and KA. Methods: 296 fully excised tumors previously classified as SCC or KA were randomized and examined independently by two examiners. Fourteen criteria, mainly based on the architecture of the tumors, were determined on the 262 slides for which a consensual diagnosis was made. Results: No single criterion was sufficiently sensitive and specific to allow a clear-cut differential diagnosis. The 5 most relevant criteria were epithelial lip, sharp outline between tumor and stroma in favor of KA and ulceration, numerous mitoses and marked pleomorphism/ anaplasia in favor of SCC. Intraepithelial polymorphonuclear abscesses, intraepithelial elastic fibers, parakeratosis and dyskeratosis and extension more lateral than downward were not distinctive criteria, although they are considered as classic distinctive features. Conclusion: Many of the criteria commonly used for the differential diagnosis of SCC and KA are not reliable. The combination of the 5 most useful criteria does not significantly increase the specificity or sensitivity of the histological diagnosis in difficult cases. Atypical or difficult cases should therefore be considered and treated as SCC, since a clear-cut distinction is not possible even with the aid of the most relevant criteria.
Retinol and Retinyl Ester Epidermal Pools Are Not Identically Sensitive to UVB Irradiation and Anti-Oxidant Protective Effect
Authors: Sorg Olivier , Tran Christian , Carraux Pierre , Didierjean Liliane , Saurat Jean-Hilaire
Published: April 2003

Background: UV irradiation can deplete epidermal vitamin A, thus the hypothesis that UV-induced depletion of vitamin A in sun-exposed skin is involved in the pathogenesis of skin cancers and skin ageing. Objectives: In this study we addressed two questions: (1) Are retinol (ROL) and retinyl esters (RE) – the two predominant forms of vitamin A – equally sensitive to the action of UVB, and (2) could the depletion be prevented by anti-oxidants? Methods: Hairless mice were irradiated with a single UVB dose, corresponding to the maximum of ROL and RE absorption. Retinoid content, enzyme activities catalysing the esterification of ROL (ARAT and LRAT) and the hydrolysis of RE (REH), as well as retinol-binding protein (CRBP-1) expression were determined in the epidermis. Results: A single UVB dose induced a rapid, dose-dependent decrease in both ROL and RE in the epidermis of hairless mice, with partial replenishment after 24 h. The dose-response curve for ROL showed a high sensitivity to UV at doses not exceeding 200 mJ/cm2, followed by a plateau, whereas RE underwent a continuous dose-dependent decrease at UVB doses up to 1 J/cm2. A topical anti-oxidant mixture containing 0.5% ascorbate, 0.25% tocopherol and 0.25% melatonin failed to protect epidermal RE from UVB-induced depletion, whereas it did prevent ROL depletion. ARAT and REH, as well as CRBP-1, were not affected by UVB in these conditions. Conclusion: Vitamin A storage in the epidermis comprises two forms, ROL and RE, that do not show similar sensitivity to acute UVB exposure. ROL stores comprise a UVB-resistant (possibly by CRBP) portion and a UVB-sensitive portion that can be protected by anti-oxidants. RE stores do not show such a pattern.
Treatment and Pain Relief of Ulcerative Hemangiomas with a Polyurethane Film
Authors: Oranje Arnold P. , de Waard-van der Spek Flora B. , Devillers Arjan C.A. , de Laat Peter , Madern Gerard C.
Published: April 2003

Background: Hemangiomas are the most common tumors occurring in young children. The most common complication in the growing phase of hemangioma is ulceration. Aim and Method: We report healing, pain relief and evolutive effects of a polyurethane film in 8 cases with ulcerative hemangiomas. Results: In all 8 infants, prompt pain relief and healing within 1–2 months were observed. An increased regression was also noted within 2–4 months, when the hemangiomas were in the normal proliferative phase. Conclusion: As far as the authors know, there is no explanation for the effectiveness of polyurethane film. Explanations could be the occlusive effects of the film inhibiting proliferation or the decrease in blood flow. As primary initial therapeutic approach in ulcerative hemangiomas, we advocate the application of a polyurethane film. This therapy is painless and suitable for children.
Interferon-Alpha-Associated Development of Bullous Lesions in Mycosis fungoides
Authors: Pföhler C. , Ugurel S. , Seiter S. , Wagner A. , Tilgen W. , Reinhold U.
Published: April 2003

We report a 67-year-old woman with mycosis fungoides (MF) who was receiving subcutaneous injections of recombinant interferon α-2b (IFN-α). After 2 months of IFN-α treatment, bullous lesions appeared on her trunk and extremities. A skin biopsy specimen from the trunk revealed histopathologic features of bullous MF. Bullous lesions with specific infiltrates of MF are very rare; to the best of our knowledge, this is the first case showing specific bullous lesions of MF developed under IFN-α treatment.