bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of keratinocyte muscarinic acetylcholine receptors reverses pemphigus acantholysis
Authors: Grando Sergei A. , Dahl Mark V.
Published: July 2006

We studied neuroendocrine mediator regulation of adhesion and motility of human epidermal keratinocytes (EK) and found that cholinergic compounds control EK cell‐matrix and cell‐cell attachment. In this study, we tested the anti‐acantholytic activity of muscarinic agonists in pemphigus and non‐pemphigus acantholysis, and investigated the effects of pemphigus antibody (Pab) on the the keratinocyte muscarinic acetylcholine receptors (mAChR). Acantholysis produced by Pab from two patients with pemphigus vulgaris was compared with acantholysis induced by the serine protease trypsin. the calcium chelator EOT A or the muscarinic antagonist atropine. Trypsinized EK first lost contact with microplate surface and then retracted their intercellular filaments. EDTA‐treated cells first detached from each other and then from the dish. EK cultures treated with Pab or atropine rounded up and retracted their intercellular filaments simultaneously, although it took hours to obtain acantholysis with Pab treatment compared to several seconds with atropine treatment. Addition of acetylcholine or other muscarinic agonists (bethanechol. carbachol or methacholine) to acantholytic cultures reversed both pemphigus and non‐pemphigus acantholysis. Acantholysis induced by atropine reversed spontaneously. Short‐term preexposure of EK to Pab significantly increased, and long‐term preexposure significantly decreased, the [3H]atropine binding to keratinocyte mAChR. We conclude that muscarinic agonists reverse various types of acantholysis. including acantholysis induced by Pab, and that binding of Pab to EK may affect the ability of keratinocyte mAChR to bind its ligands.
Alcohol and skin disorders*
Authors: Rothenborg Hans W. , Andersen Helene Bryde
Published: July 2006

Background Little is known about skin changes associated with or caused by alcohol intake.

Patients and methods In this open study, 65 patients affected with rosacea, rubeosis faciei, pruritus, eczema, non‐healing ulcers and psoriasis were examined for signs of high alcohol intake. Thirty‐two had elevated aspartate aminotransferase (ASAT) and/or gamma glutamyl transferase (GGT) levels. These patients were interviewed about their drinking habits. As ASAT and/or GGT had been found elevated, it was suggested that they abstain from alcohol. Of the 32 patients with a confirmed regular alcohol intake eight dropped out. The remaining 24 accepted the suggestion and came back for monthly clinical and laboratory controls. Their laboratory values normalized in 2‐3 months parallel with healing or improvement of skin symptoms. The 32 patients with dermatoses associated with high alcohol intake were found in a series of 900 consecutive new patients, i.e., over 3%.

Conclusions Dermatological patients with increase of ASAT and/or GGT of unknown origin should be suspected to have a high alcohol intake. These patients should be persuaded to try total abstinence for at least 2 months before initiating any dermatological treatment.
High doses and low doses of α2‐interferon plus Zidovudine in the management of Kaposi's sarcoma associated with human immunodeficiency virus infection
Authors: Hernåndez Dimas E.
Published: July 2006

Background α‐2‐lnterferon (α2‐IFN) is recommended as an effective agent for the treatment of epidemic Kaposi's sarcoma (EKS).

Objective Trial of efficacy of low dose α2,‐IFN plus Zidovudine (AZT) for the treatment of EKS.

Study design Non‐randomised study.

Subjects Ten homosexual or bi‐sexual male patients with cutaneous lesions of Kaposi's Sarcoma, divided into two equal groups.

Intervention High doseα2‐IFN (10‐30 million units/three times per week) alone, or combination of low doseα2‐IFN (5 million units three times per week) with AZT (500 mg/day).

Results High dose, IFN: 3 stable disease and 2 disease progression. Low dose, IFN plus AZT: 1 complete remission, 2 partial remissions and 2 stable disease.

Outcome Preliminary results suggest the usefulness of low dose α2‐IFN plus AZT in the treatment of cutaneous lesions of EKS without visceral involvement.
Acyclovir‐resistant herpes simplex virus infection in HIV‐infected patients: a report of three cases and a review of management
Authors: Murphy M. , Monteiro E.
Published: July 2006

Case reports Three cases of acyclovir‐resistant ano‐genital HSV infection.

Management review Acyclovir‐resistant mucocutaneous herpes simplex virus (HSV) infections are increasingly seen in patients with advanced HIV disease. The primary mechanism of resistance is deficiency of virus specific thymidine kinase. Foscarnet, a pyrophosphate analogue, which directly inhibits HSV DNA polymerase is an effective therapeutic alternative to acyclovir, and is commonly used. Topical trifluridine recently has been useful as a non‐toxic alternative to foscarnet. Management of recusrrent episodes of acyclovir‐resistant HSV infection following successful inital or induction therapy with foscarnet requires development of a clear strategy for effective suppressive therapy.
Reticular erythematous mucinosis
Authors: Lotti T. , Benci M. , Lorusso B.
Published: July 2006

Reticular erythematous mucinosis is a rare syndrome which can be misdiagnosed as seborrhoeic dermatitis. This long‐lasting skin disease, which is characterized by the histological presence of deposits of mucin in the dermis, usually responds to treatment with per os hydroxychloroquine, 400 mg/day, for 3 months.
Treatment of anogenital warts
Authors: Handley J. , Dinsmore W.
Published: July 2006

This article critically reviews both established and experimental treatment modalities for anogenital (AG) warts. Efficacy, cost, safety, advantages and disadvantages of each therapy are directly compared and treatment algorithms are suggested. Treatment of AG warts in pregnant women and prepubertal children is discussed. As AG warts are a sexually transmitted disease (STD) prevention of infection and the need to screen and treat patients and their sexual partners for other concurrent infections is stressed. The majority of patients with AG warts also have subclinical or latent HPV infection/associated disease of the AG tract. In this regard alt such women should be screened for the presence of cervical intraepithelial neoplasia (CIN).
Pilomatricoma. A clinical, histopathologic and histochemical study of 22 patients
Authors: Galadari Ibrahim , Helmy Mohamed M. , Abdul Gamal M.
Published: July 2006

We have studied the clinical, histopathologic and histochemical features of pilornatricoma in a series of 22 cases. In early lesions, basophilic cells constituted the main tumor cell population and underwent four ways of maturation. Calcification was observed in 16 cases and ossification in two lesions. Melanin pigment was found in seven specimens and hemosiderin in six. Glycogen granules were present in most tumor parenchyma and less frequently in the stroma. Mitotic figures were frequent but cellular atypia was not observed.
Food‐induced contact urticaria syndrome (CUS) in young children with atopic dermatitis: practical consequences
Authors: Oranje Arnold P. , de Waard‐van der Spek Flora B. , van Oostende Lianne , Aarsen Roland S.R. , van Toorenenbergen Albert W. , Dieges Paul H.
Published: July 2006

Eight children, aged less than 5 years, with atopic dermatitis (AD) and food‐induced contact urticaria are described. These cases illustrate the clinical importance of food‐induced contact urticaria. The symptoms can be easily provoked and imitated in children under 4 years of age using the ‘Skin Application Food Test’ (SAFT). This test includes the application of foods on the skin, in the form they are consumed. The clinician should pay attention to clinical symptoms of immediate‐contact reactions, easy to recognize. The common skin symptoms are swollen face, in particular the lips, and itching or pain in the mouth and (contact) urticaria. Another dominating symptom is evident refusal of foods. Non‐immunological irritation reactions are also common in these children. Confusion with irritation reactions is first avoided of all by strict selective interpretation of the history told by the mother; and second, both the SAFT and the CAP RAST are positive only in immune‐mediated processes.
The dermatological spectrum of Turner syndrome
Authors: Borroni G. , Larizza D. , Vignati G. , Zaccone C. , Zanetta R. , Vignoli G.P. , Brazzelli V. , Bobba C. , Rabbiosi G.
Published: July 2006

Turner syndrome, characterized by monosomy of X chromosome, has a peculiar phenotype, including short stature, sexual infantilism, cardiovascular, renal, skeletal and skin abnormalities (in particular melanocytic naevi and skin appendage abnormalities). Fifty‐four patients affected by Turner syndrome were investigated. The skin and adnexal changes of Turner syndrome patients were analysed and their frequency was correlated with two karyotype groups (45, X and mosaicism group). A wide spectrum of skin findings was observed in Turner syndrome; in particular melanocytic naevi and pterygium colli were the most frequent findings. Pterygium colli was more frequent in patients with X monosomy than in those with other karyotypes (P < 0.05). The frequency of congenital/congenital‐naevus‐like naevi (CN/CNLN) and acquired melanocytic naevi (AN) (81.6%) was higher in Turner syndrome subjects, independently of their karyotype, than in the general Caucasian population. However, there was an unexpectedly high frequency of ichthyotic changes, café‐au‐lait spots and halo naevi. Hypertrichosis, nail changes and keloid formation were also seen. No significant correlation was found between these dermatological findings and the two karyotype groups considered.

Although there are no reports on the occurrence of melanoma in Turner syndrome, given the high prevalence of both small congenital and acquired naevi, these patients should also be considered for melanoma prevention.
Congenital linear psoriasis: case report and differences with ILVEN
Authors: Loòpez‐Avila A. , Diíaz E. Rodriíguez , Vicente I. Hernaández , Armesto S. , Armijo M.
Published: July 2006

We report the case of a 5‐year‐old child who from birth had five erythemato‐desquamative papulous lesions with a verrucose surface and linear distribution in the proximal region of the lower left leg not following the lines of Blashko. The morphological aspect and the evolution of the lesions, data from physical exploration of the skin and adnexa, the characteristics of the histopathology and its association with HLA Cw6 led us to diagnose congenital linear psoriasis. Differential diagnosis was established basically with ILVEN since distinction between the two entities is now traditional. We took into consideration the fact that linear psoriasis is a particular entity and can occur congenially, as in the case reported; although this is an exceptional occurrence.
Pseudoxanthoma elasticum and β–δ thalassaemia
Authors: Rodriguez–Cano L. , Luelmo‐Aguilar J. , Mieras‐Barceló C. , Salvador‐Rodriguez F. , Castells‐Rodellas A.
Published: July 2006

A case of β–δ thalassaemia and pseudoxanthoma elasticum without angioid streaks is reported. To the best of our knowledge, this association has not been reported previously. The possible pathogenic mechanisms of pseudoxanthoma elasticum in relation to chronic hemolytic diseases are discussed.
Spiney hyperkeratosis with hair shaft alterations, keratitis and deafness
Authors: Bosch R.J. , Alcaraz M.V. , Herrera E.
Published: July 2006

Two males and a female in a family of seven children from consanguineous parents showed a generalized ichthyosiform dermatosis characterised by spiney hyperkeratosis. Bilateral neurosensory deafness affected only the older child, aged 10 who, in addition, was totally blind. His 1–year–old brother developed photophobia and severe corneal ulcers, and his 5–year–old sister suffered from dry eyes due to scarcity of tears. The three patients showed hair defects, with different degrees of alopecia and alterations of the hair–shaft, including eliptical cross–section tike woolly–hair. We stress the clear recessive inheritance of this association, its wide clinical variability and the less known hair shaft alterations.
Stress, attachment and skin diseases: a case‐control study
Authors: Russiello Fulvia , Arciero Giampiero , Decaminada Franco , Corona Rosamaria , Ferrigno Luigina , Fucci Monica , Pasquini Massimo , Pasquini Paolo
Published: July 2006

Objectives In this case‐control study we tested the hypothesis of an association between some psychosomatic skin diseases, attachment style and stress.

Patients and methods A total of 177 cases and 194 controls seen between November 1992 and November 1993 at the Istituto Dermopatico dell'lmmacolata (IDD) in Rome, were enrolled into the study. Cases were outpatients with first diagnosis of hyperidrosis, chronic urticaria, generalized pruritus or alopecia areata. Controls were outpatients seen in the same period of time with first diagnosis of pigmenled nevi, keratosis or mycosis. The presence and weight of life stress events were assessed by u standard precoded questionnaire based on the Schedule of Recent Experiences (SRE) and on the Life Experiences Survey (LES). The attachment style was assessed by a modified version of the Shaver and Hazan questionnaire about feelings in a love relationship. We calculated 3 scores for each individual and classified study subjects in 2 groups: 1) "free" (= secure attachment); 2) "not free" (not secure attachment: anxious‐ambivalent or avoidant). Questionnaires were self‐administered in the presence of a trained psychologist. Adjusted odds ratios (OR) were calculated using a multiple logistic function.

Results No association was found between the different stress scores and the skin diseases considered. The crude odds ratio for life stress events in the previous year was 1.4 (95% CI 0.8–2.7). After multiple adjustment for age, sex, marital status and education, the estimated OR was 1.6 (95% CI 0.8–3.0). One significant association emerged between the adult attachment style defined as “not free” and psychosomatic skin diseases: the adjusted OR was 4.0 (95% CI 1.4–12).
Kaposi's sarcoma and rheumatoid arthritis: a possible immunogenic and drug interaction
Authors: Satta Rosanna , Cottoni Francesca , Contu Licinio , Mulargia Marina , Montesu M. Antonia
Published: July 2006

Background In the literature, Kaposi's sarcoma‐rheumatoid arthritis association is reported and it has been suggested that genetic predisposition may play an important role. Numerous studies indicate that immunological deficiency may also have an important role in the pathogenesis of Kaposi's sarcoma, along with a series of others factors.

Patients and methods We present two cases of Sardinian women with rheumathoid arthritis and Kaposi's sarcoma where the relationship between the drugs used for the treatment of the former (particularly gold salts) and Kaposi's sarcoma is highlighted. In addition, their genetic background is delineated.

Conclusion Our findings suggest that genetic background associated with drugs plays a role in the pathogenesis of Kaposi's sarcoma in rheumatoid arthritis patients.
Melasma. Classification and treatment
Authors: Katsambas A. , Antoniou Ch.
Published: July 2006

Melasma is a cosmetic problem that sometimes causes great emotional suffering. The two most important causative factors are sunlight and genetic predisposition. Moreover, natural and synthetic estrogens, the use of certain drugs and the use of cosmetics with certain components have been implicated as etiologic factors. For the treatment of melasma, the elimination of the factors that are associated with the abnormality of pigmentation, is essential (discontinuation of birth control pills, avoidance of sun exposure). From the many medications that have been used in the treatment of melasma, Hydroquinone alone at a concentration of 2‐5%, or in combination with tretinoin or tretinoin and corticosteroids, is now the most widely used preparations. New phenolic compounds and Azelaic acid are also used. Medium depth chemical peeling alone or in combination with other bleaching agents has also been tried with success in some cases. Finally, the use of lasers is discussed.
Ambulatory treatment of metastatic melanoma associating subcutaneous dacarbazine, interferon α and interleukin‐2
Authors: Dréno B. , Cupissol D. , Joly P. , Sassolas B. , Bonneterre T. , Tourani J.M.
Published: July 2006

Background Recent studies have shown that interleukin–2 (IL2) is less toxic when administered subcutaneously than intravenously. Moreover interferon α and Dacarbazine could increase the efficiency of IL2.

Patients and methods Nineteen ambulatory patients with metastatic melanoma (1 stage 111 and 18 stage IV) were treated with an association of dacarbazine 400 mg/m2, interferon α2a (Roferon) 9 × l06 IU 3 times per week administered subcutaneously and recombinant interleukin‐2 (IL–2) (Eurocetus) 3 × 106 IU five days per week for two weeks per month subcutaneously. The treatment consisted of 2 induction cures separated by a one‐month interval followed by evaluation studies.

Results At the end of the induction phase. 2 complete and 3 partial responses (response rate 26.2%) were observed. These responses were obtained in patients with sinus (1 case), skin (3 cases), lymph node (2 cases), bone (1 case) and liver (I case) targets. The mean response period was 10 months for the 2 complete responses. No patients had grade 4 toxicity, and treatment was stopped for only one patient. Painful subcutaneous nodules frequently (23%) formed at the injection site.

Conclusion The association of subcutaneously administered dacarbazine, interferon α and IL2 would thus seem of interest for the treatment of metastatic melanoma. Moreover, toxicity is tolerable and compatible with ambulatory treatment ensuring the patient a decent quality of life.
Recreational sunbeds and climacteric xerosis
Authors: Piérard Gérald E. , Nikkels‐Tassoudji Nazli , Piérard‐Franchimont Claudine
Published: July 2006

Background The influence of menopause on photoaging is largely unknown despite the fact that climacteric xerosis after sun exposure is a common complaint in clinical practice.

Objective The purpose of the study was to determine whether frequent use of recreational sunbeds affects the skin during the perimenopause.

Methods Biometrological evaluations were performed in 172 women who frequently used sunheds and in 79 age‐matched women without this habit. Measurements included capacitance, transepidermal water loss and squamometry performed on the forearms.

Results Compared to controls, women who used sunbeds had an overall lower capacitance without specific age‐related influence. Higher transepidermal water loss and squamometry values were found in the sunbed users, particularly in the perimenopausal group.

Conclusion The UVA‐related changes in the epidermis appear to be more severe during the perimenopause than in other age groups. Altered intercorneocyte cohesion and impaired skin barrier function prove to be important features of climacteric xerosis.
The effect of laundering on the sun protection afforded by a summer weight garment
Authors: Stanford Duncan G. , Georgouras Katherine E. , Pailthorpe Michael T.
Published: July 2006

Aim To determine what effect a period of prolonged washing and drying of a garment would have on the photoprotection afforded by the fabric of that garment.

Materials and Methods Five pure cotton T‐shirts from the same production lot were subjected to 36 consecutive standard washes. The fabric sun protection factors (SPFs) calculated from spectrophotometric UVR transmission data for samples taken from each garment after use were compared with those of control samples taken from the same garment prior to the study.

Results There was a significant increase in fabric SPF after one wash in all shirts with no further change in 4 of 5 shirts after a further 35 washes.

Conclusion The effect on fabric SPF of the first wash can account for most of the effect on fabric SPF of wash and wear in the use of a garment. The SPF rating of a pure cotton garment as new is valid for the standard lifetime of that garment.
Axillary hyperpigmentation with 5‐fluorouracil/cis‐platinum combination therapy
Authors: Thomas P. , Kind P. , Dathe O. , Ruzicka Th.
Published: July 2006

Adverse reactions to chemotherapeutic drugs are usually classified as cytotoxic reactions, hypersensitivity phenomena or reactions related to immunomodulatory drugs. We present a patient with patterned hyperpigmentation in both axillary regions after 5‐fluorouracil/carboplatin combination therapy. From the cutaneous aspect and the histological examination we suspect that this was caused by a toxic effect of the drugs excreted in the sweat. The occluding condition of the axillary region may have acted as aggravating factor.
Disseminated coccidioidomycosis in an American soldier in Europe
Authors: Libow Lester F. , Lum George H. , Jackson Jeffrey L. , Zaenglein James
Published: July 2006

A 25‐year‐old black man had a 7‐month history of draining chest wall abscesses. Potassium hydroxide examination of abscess drainage revealed numerous spherules with doubly refractile walls. Although uncommon, a diagnosis of nonendemic coccidioidomycosis should be considered in cases of atypical cutaneous infections in highly mobile persons.
Continuing medical education: quality assurance and certification by the EADV
Authors: Frentz Gerda
Published: July 2006

The European Academy of Dermatology and Venereology (EADV) prioritises the provision of high quality continuing medical education (CME) to its members.

The European Union of Medical Specialists (LJEMS) is currently establishing European Boards of the individual medical specialities to monitor and ensure high professional standards of European medical specialists and harmonisation among member nations. Within the next Few years, national and supra‐national authorities in Europe are expected to request documentation of participation in continuing medical education from physicians in order to maintain their full specialist competence, analogous to the conditions now pertaining in the US. In Belgium, participation in CME is mandatory for standard appointments with the health insurance.

The EADV has developed procedures for quality assurance of the CME activities for the 3rd EADV congress in Copenhagen 1993, and the Skin Therapy Update Symposium in Crete 1994, using participant evaluation of the scientific programme. Following these meetings the EADV has issued individual certificates to the participants, documenting their CME activities. The results of the programme evaluation indicate a high standard of CME at the above meetings.

The EADV wishes to develop as a competent sponsor of CME activities, to offer extensive membership service in this field, and to administer recognition of EADV‐CME accreditation to other bodies.
New methods in diagnostic and epidemiological research of Chlamydia trachomatis infections: the tide is turning molecular
Authors: Ossewaarde J.M.
Published: July 2006

Objective The aim of this review is to provide a primer on polymerase chain reaction (PCR) technology for the clinical diagnosis of Chlamydia trachomatis infections. Two main applications are reviewed: detection of Chlamydia trachomatis in clinical specimens For diagnosis, and genotyping of Chlamydia trachomatis for epidemiological purposes.

Background Chlamydia trachomatis is one of the major causes of sexually transmitted diseases throughout the world. Laboratory techniques to establish a definitive diagnosis have been hampered by a lack of sensitivity. This review describes the state of the art of the application of polymerase chain reaction based assays to the diagnosis and epidemiology of Chlamydia trachomatis infections.

Results The basic principles of PCR assays are described. General guide‐lines for collecting specimens are reviewed. The application of home‐made PCR‐based assays and of the commercially available Amplieor assay in laboratory diagnosis is described. The first results of the application of LCR assays are mentioned. Comments arc made on the interpretation of the results and on the importance of quality assessment. Finally. PCR‐based techniques for genotyping of clinical isolates in epidemiological studies are described.

Conclusion The introduction of specific DNA amplification methods provides new ways to implement laboratory diagnosis and enhances our insights in the epidemiology of Chlamydia trachomatis infections. At this moment PCR‐based assays are probably the most sensitive assays for detection of Chlamydia trachomatis available. Application of PCR‐based assays might yield higher prevalences of Chlamydia trachomatis infections than currently recognized. Application of PCR‐based genotyping methods will reveal more useful epidemiological data and will unravel more precisely existing sexual networks.
Nucleolus organizer regions as useful proliferation markers in hyperproliferative epidermal lesions
Authors: Heinisch G. , Barth J.
Published: July 2006

Aim To study the suitability of the AgNOR technique for the determination of epidermal proliferative activity in hyperproliferative epidermal lesions.

Background Nucleolus organizer regions are nuclear DNA segments of ribosomal genes, which can he visualized in histological sections by using a silver staining technique. Several studies in different tumors have demonstrated that the determination of AgNOR expression makes it possible to obtain precise information on cellular proliferative activity.

Methods We investigated the epidermal AgNOR behavior in silver‐stained sections of different non‐neoplastic hyperproliferative epidermal lesions by image analysis.

Results Psoriatic lesions showed the highest AgNOR expression, the lowest AgNOR status was found in senile atrophic epidermis. Acute‐exanthematic psoriasis could be distinguished significantly from chronic plaque‐type psoriasis. The AgNOR status of lichen planus and verrucous epidermal naevi corresponded to that of normal epidermis. We found a significant correlation with the values of PCNA expression. For analysis of AgNOR expression the count in the basal cell layer is sufficient.

Conclusions The AgNOR technique is suitable for estimation of epidermal proliferative activity of hyperproliferative epidermal disorders. The method is easy and can he successfully used in paraffin‐embedded tissues.
Topical interferon alpha in atopic eczema
Authors: Cremer Brigitte , Kohlmus Corinna , Czarnetzki Beate M.
Published: July 2006

Background On the basis of experimental and clinical data, interferon α might improve pathological alterations in atopic eczema. Systemic treatment with this drug is however cumbersome and fraught with side effects.

Objective Since most patients with atopic eczema have only localized disease, we have decided to study the effect of topically applied interferon α in this disease.

Design A pilot study was performed on 10 patients, using a single‐blind, within‐patient comparison. An interferon‐α2a gel formulation (150000 IU/g) was studied against triamcinolone acetonide liquor carbonis detergens and bland cremes or gels with a twice daily application to the anticubital fossae over 10 days. Biopsies were taken from 3 patients for evaluation of treatment‐induced histopathological changes.

Results Improvement of eczema occurred most rapidly with triamcinolone whereas interferon α was as effective as other treatments and vehicle alone. No effect on pruritus was noted with any patient. Only two patients considered interferon α better than liquor carbonis detergens or bland cremes respectively. Mast cell numbers were elevated in all patient biopsies and were lower on the triamcinolone‐treated site in only one patient.

Conclusion Short‐term treatment with topically applied interferon α is thus ineffective in atopic eczema.
Longitudinal white streaks of fingernails: a useful clinical marker in genital verrucoid Hailey‐Hailey disease
Authors: Meawad Osama B. , Assaf Hasan M.
Published: July 2006

Among the atypical variants of Familial benign chronic pemphigus (FBCP) is the genital verrucoid variety. This condition is often misdiagnosed as condyloma accuminata. We present a case of a genital verrucoid variant of Hailey‐Hailey disease that was initially mistaken for condyloma accuminata. Multiple asymptomatic white bands in more than one fingernail were the first clue in diagnosing the condition, which was confirmed histopathologically. This nail marker may antedate any other cutaneous manifestation of FBCP. Nail examination for longitudinal leukonychia of fingernails might be of help in diagnosing atypical cases of Hailey‐Hailey disease.
Sexually transmitted diseases and pregnancy
Authors: Dimian C.O. , Bingham J.S.
Published: July 2006

The spectrum of the sexually transmitted diseases (STDs) has expanded over the years. As they occur in the sexually active during reproductive years, they can affect pregnancy and its outcome, maternal health and the neonate. While morbidity affects both mother and child, maternal mortality is rare, but death can result in the baby. Those providing care to pregnant women should be aware of the presence and risks of these infections in pregnancy and consider screening those perceived as being at high risk.
The response to ultraviolet radiation and delayed hypersensitivity in Celts with skin cancer
Authors: Long C.C. , Marks R.
Published: July 2006

Background The reasons for the apparent increased risk of skin cancer in Celts are unclear, but it is possible that Celts possess more risk factors than non‐Celts.

Aims To determine whether Celts differ from non‐Celts with respect of cutaneous response to UVR, and tests of cell mediated immunity.

Methods The MED of UVB, degree of clinical photodamage, pigmentation, numbers of peripheral blood T‐lymphocyte sub‐sets, and response to a battery of infra‐dermal antigens were determined in 18 Celts with a history of BCC and 18 age, sex, and skin type matched non‐Celts with a history of BCC. Each was then exposed to 2MED, and biopsies taken of irradiated and non‐irradiated sites at 24 h.

Results Celts tended to have a thinner epidermis than the non‐Celts. Following irradiation the epidermal thymidine labelling index in Celts had almost doubled, whereas in non‐Celts it fell slightly. We found no differences in photodamage, freckling, pigmentation, MED, the erythema response to 2MED, numbers of peripheral T‐lymphocytes, or tests of cell mediated immunity.

Summary The tendency of Celts to a thinner epidermis and an increased epidermal labelling index following UV irradiation may be a reflection of an increased susceptibility to skin damage following UV exposure.
“Open house” for evaluation of skin tumours. Who seeks advice and for what reasons?
Authors: Bjellerup Mats
Published: July 2006

Objectives To study in detail the characteristics of patients attending a screening campaign for detection of malignant melanoma.

Background Malignant melanoma is the malignant tumour exhibiting the greatest increase in incidence in most countries.

Design On September 15 and 16 1990 an “open house” for evaluation of skin tumours was performed mainly at dermatologic departments throughout Sweden. In the city of Malmö such patients were investigated by dermatologists and oncologists and documented in a more detailed manner than in the national campaign.

Subjects 380 patients.

Methods Ocular whole body examination for premalignant and malignant skin tumours. Registration of patient characteristics concerning sex, age, reason for attending. Registration of therapeutic action and possible differences between dermatologists and oncologists.

Results The median age of attending persons was 67 years probably reflecting the higher prevalence of skin tumours among the elderly. Three quarters of patients sought advice for a specific skin change, in most cases verruca seborrhoica. Several premalignant and malignant non melanoma skin changes were found. Altogether two malignant melanoma were found, both of the thin type and. thus, potentially curable. Dermatologists referred 10.4% of specific skin changes to surgery compared to 30.8% for oncologists.

Conclusions The great number of attending patients reveals a great concern about skin tumours among the public. This indicates the need for permanent, easily accessible skin tumour clinics, preferably run by dermatologists, where patients can be evaluated without delay.
Cutaneous angiosarcoma: a novel therapy with liposomal doxorubicin?
Authors: Ockenfels Hans M. , Brockmeyer Norbert H. , Hengge Ulrich , Goos Manfred
Published: July 2006

The case of a 65 year old patient with a cutaneous angiosarcoma of the head and facial skin is reported. In contrast to preceding chemo‐and radiation therapies which did not induce any tumor regression, our treatment with liposomal doxorubicin HCL (Doxil®) caused considerable tumor regression. This therapy had to be stopped because of accumulated toxic side effects after multiple chemotherapies. The therapy with liposomal doxorubicin is known to yield good results in the therapy of Aids‐related Kaposi's sarcoma and is usually well tolerated. We assume that liposomal doxorubicin could be an effective chemotherapy compared to the conventional and in most cases only palliative therapies.
Purpuras and related conditions
Authors: Lotti Torello , Ghersetich Ilaria , Comacchi Claudio , Panconesi Emiliano
Published: July 2006

Purpuras include a wide spectrum of cutaneous disorders characterized by extravasation of red blood cells into the skin with consequent release of hemoglobin. Various other pigments deriving from heme are subsequently found into the skin within 2‐3 weeks, accounting for the color changes (purple, orange, brown, yellowish, green‐blue) which may occur in most purpuric lesions. Too often the factors leading to these disturbances are obscure. Sometimes they are obscure mainly to the dermato‐venereologist as they are generally considered more pertinent to the field of interest of other specialists, i.e. in hematology or internal medicine. The dermato‐venereologist should be familiar with these cutaneous conditions and, when necessary, cooperate with the hematologist in order to evaluate the cutaneous and extracutaneous signs and symptoms and to schedule the proper systemic and/or topical therapies.

Learning objective At the conclusion of this learning activity, participants should be able to discuss the clinical and histological presentations of purpuric disorders and know which tests should be done to allow proper diagnosis and treatment. The participants should also be aware of the controversies concerning the pathogenesis of some kinds of purpuras (i.e. palpable purpuras), of the evolution of terminology and finally of the different therapeutic options and regimens.
Analysis of the antifungal activity of ketoconazole, zinc pyrithione, and ciclopirox olamine against Pityrosporum ouale. A diffusion assay for cultures in solid media
Authors: Squiquera Luis , Plotkin Lilian , Mathov Irina , Galimberti Ricardo , Leoni Juliana
Published: July 2006

Background Recently dandruff has been associated with a local increment in the number of Pityrosporum yeasts. Due to this fact, several anti‐dandruff shampoos containing antifungals have been marketed.

Objective We studied the sensitivity of Pityrosporum ovale (PO) to three different groups of antimycotics (ketoconazole, Zn pyrithione, and ciclopirox olamine).

Methods /Results The drugs were tested by an inhibition assay in solid medium. Ketoconazole proved to be the most effective drug in inhibiting PO growth in a dose‐dependent fashion. The results of our evaluation revealed that the inhibitory effects of the drugs were ketoconazole > Zn pyrithione > ciclopirox olamine.

Conclusion We postulate that the diffusion assay is a reliable medium for evaluating the effectiveness of antifungals contained in anti‐dandruff shampoos.
Treatment of hyper‐IgE dermatitis with interferon‐γ
Authors: Jemec Gregor B.E. , Heidenheim Michael
Published: July 2006

Background Interferon‐γ has been suggested as causal therapy in both hyper‐IgE syndrome and severe atopic dermatitis.

Aim To investigate the therapeutic effect of short‐term, low‐dose interferon‐γ both as monotherapy and in combination with topical treatment, in a patient with a variant of the hyper‐IgE syndrome.

Method Interferon‐γ was administered subcutaneously (50 μ/m2 X 3 d/w) for 4 weeks. Three regions were studied: hands, flank and feet. The hands were treated with betamethasone‐17–valerate cream and the feet with mupirocin ointment, while the flank was treated only with a moisturizer.

Results All regions showed significant reductions of the clinical scores (0.0001 < P < 0.0280), but hands and feet showed significantly greater reduction than Hank (P < 0.004).

Conclusions The results suggest that short‐term, low‐dose interferon‐γ treatment is a potentially useful therapy in hyper‐IgE syndrome dermatitis when used in combination with topical mupirocin or a steroid.
Undesirable effects from latex gloves in hospital health‐care personnel
Authors: Stingeni Luca , Lapomarda Vincenzo , Lisi Paolo
Published: July 2006

The high incidence of occupational hand dermatitis in hospital employees and the increased number of reports on cutaneous, mucosal and systemic reactions connected with a widespread USE: OF GLOVES induced us to investigate the prevalence of undesirable effects caused by latex gloves and the possible risk factors. We distributed a self‐administered questionnaire, elaborated by us. to 1030 Perugia Monteluce Hospital employees who usually used latex gloves at work. The questionnaire was returned by 922 (476 females and 446 males; mean age. 38.7 years). The subjects who reported atopy and/or undesirable glove reactions were interviewed and clinically examined. Of these, 128 (13.9%) had presented or still had glove problems and therefore were submitted to skin tests (patch and prick tests) and when negative, to use test. Our results showed that the large majority of skin complaints from gloves was caused by irritation rather than by allergy. Predisposing factors of irritant contact dermatitis (CD), which was present in 13.1% of the subjects investigated, were female sex. age under 31 years, cleaning activity mainly when carried out in the Held of internal medicine, and atopie constitution. The most common causative factors, investigated with two substitute latex gloves in 64 of the 120 patients affected by irritant CD, were cornstarch powder and perhaps latex proteins. Even if allergic skin disorders from latex gloves were rare in our unselected group (allergic CD: 0.5%‐, contact urticaria: 0.3%), more attention should be given to IgE‐mediated disorders since they may be a life threatening problem.
A histopathological study of secondary syphilis
Authors: McMillan A. , McQueen A. , McLaren C.
Published: July 2006

Objectives To study the histology of the skin lesions of secondary syphilis.

Background Secondary syphilis is becoming less prevalent in developed countries and clinicians not familiar with the condition may resort to biopsy to elucidate the nature of a rash. It is therefore important that Dermatopathologists are aware of the histological features of secondary syphilis.

Design Patients with secondary syphilis, who attended clinics held by one of us during a 10 year period and who consented to biopsy, were studied.

Subjects Twenty‐eight individuals.

Methods Skin biopsies of representative lesions. Routine histological processing.

Results The most common finding was that of an erythema multiforme pattern of papillary oedema and perivascular lympho‐histiocytic infiltration (19 cases including the 2 men with HIV infection). The tissue reaction was mild in patients with macular lesions. Focal lichenoid tissue reaction (4 cases), a pseudolymphomatous appearance (1 case), and granuloma formation (3 cases) were noted in other patients. The histology of a condyloma latum was typical.

Conclusions Our study serves to emphasise the importance of clinicopathological correlation in the assessment of a skin rash and to remind pathologists of secondary syphilis as an aetiological factor in macular and papular skin lesions. The mimicry of several other conditions confounds the specificity of the changes and shows that syphilis is a theoretical candidate in considering the aetiology of the changes seen. Careful scrutiny of all the histopathological features may permit a relatively refined differential diagnosis to be established and, either prospectively or retrospectively, alert the clinician to the appropriate additional investigative techniques which will allow a sound diagnosis to be attained.
Dyshidrosiform bullous pemphigoid: trigger factors
Authors: Knees‐Matzen S. , Proksch E. , Meigel W.N.
Published: July 2006

This report presents 2 patients with a rare form of bullous pemphigoid on (heir palms and soles. To date, at least 16 cases of dyshidrosiform pemphigoid have been reported. The first case was accompanied by a bacterial fool infection, the second by contact dermatitis. The possibility that dyshidrosiform bullous pemphigoid was induced by these trigger factors is discussed.
Fibrillar IgA deposition may be associated with atypical dermatitis herpetiformis – a report of two cases
Authors: Vaughan Jones S.A. , Bhogal B.S. , Black M.M.
Published: July 2006

We report two cases of known dermatitis herpetiformis (DM) who presented with atypical clinical dermatological features. The first case, a 31‐year‐old woman, presented with an itchy urticated eruption on the abdomen and trunk, while the second case, a 50‐year‐old woman developed a scaly psoriasiform eruption on the extensor aspects of her knees and elbows. In each case, direct immunofluorescence of a perilesional skin biopsy showed a fibrillar pattern of IgA deposition at the basement membrane zone. Pre‐embedding immunoelectron microscopy of these 2 specimens, using a 1 nm gold probe and silver enhancement, showed colloid gold panicle deposition around microfibril bundles in the dermal papillae. Recent studies have shown that fibrillin, a 350 kDa glycoprotein, is also associated with these microfibril bundles.

Serological tissue typing in our first case confirmed the presence of HLA‐B8. B18. DR3 and DQw2 antigens consistent with dermatitis herpetiformis. In the second case, there was a notable absence of the antigens B17 and B27 typically found in psoriasis but HLA‐AI, BX and DQ1 antigens were present, as commonly seen in dermatitis herpetiformis. Our findings would suggest that cases of dermatitis herpetiformis with fibrillar IgA deposition at the BMZ on direct IMF may show an atypical clinical presentation. In addition, our imunoelectron microscopy findings may provide a further clue to an ultrastructural abnormality in this disease.
Marie Unna hypotrichosis: an autosomal dominant hair disorder
Authors: Papadavid E. , Dover R. , Mallon E. , Dawber R.P.R.
Published: July 2006

Hereditary hypotrichosis of Marie Unna type is a rare distinctive syndrome of hair loss which is inherited with an autosomal dominant gene. We report a family with more than half affected individuals in 4 subsequent generations which supports the very strong autosomal dominant pattern of inheritance.
Comedogenicity of cosmetics: a review
Authors: Katoulis A.C. , Kakepis E.M. , Kintziou H. , Kakepis M.E. , Stavrianeas N.G.
Published: July 2006

Adverse reactions associated with the use of cosmetics include comedones and folliculitis that substantiate the potential of cosmetic products to induce, aggravate or prolong acne.

Acne cosmetica is a particular facial variant of acne. It commonly affects young adult women who use cosmetics. Key to the management of acne cosmetica is the avoidance of comedogenic cosmetics. Thus, it is of crucial importance to evaluate cosmetics with respect to their comedogenicity. Methods of assessment include animal models, human models and clinical trials. Among them, the rabbit ear assay, although not ideal, is the best available.

Today, most commercial products are safe. However, dermatologists should remain vigilant and provide the guidelines for beneficial use of cosmetics to acne‐prone individuals.
Herpes immunization—on the threshold
Authors: Stanberry L.R.
Published: July 2006

Objectives To review the history, public health importance and current status of vaccines intended for the prevention and treatment of genital herpes simplex virus infection.

Background Primary and recurrent genital herpes remains a significant public health problem. Prophylactic and therapeutic vaccines offer an important strategy for control of genital herpes.

Methods Literature review.

Results For more than half a century the development of a safe and effective herpes simplex virus (HSV) has remained an elusive goal. Factors complicating vaccine development have included the complex natural history of HSV infection, an intricate viral genome which has made production of simple tissue culture attenuated live viral vaccines impossible, a general lack of understanding regarding what constitutes protective immunity and an excess of poorly conceived and seriously flawed clinical research. Over the past decade prospects for developing an effective vaccine have brightened as advances in basic immunology and molecular biology have increased our understanding of HSV, and as clinical investigators have taken lessons from the mistakes of earlier research. Investigative teams both in academic centers and in industry are now making excellent progress toward the development of HSV vaccines.

Conclusions The combination of increased understanding and focused application is expected to result in the development of safe and effective HSV vaccines which should be available to physicians within this decade. The goal of the prophylactic vaccine will be to prevent symptomatic primary genital infection and reduce the likelihood the patient will establish latent infection and experience recurrent disease. The therapeutic vaccines are designed for patients who experience recurrent infections with the intended benefit of reduced symptomatic and subclincial recurrences.
Extracorporeal photochemotherapy as an effective treatment modality in chronic graft‐versus‐host disease
Authors: Balda Bernd‐Rüdiger , Konstantinow Alexander , Starz Hans , Gnekow Astrid , Heidemann Peter
Published: July 2006

Background In chronic graft‐versus‐host disease (cGvHD) cytotoxic and suppressor T lymphocytes probably play a decisive pathogenetic role. The efficacy of conventional immunosuppressive therapy is often insufficient, and drug side effects may produce further complications. Photochemotherapy with orally administered photosensitizer 8‐methoxypsoralen (8‐MOP) followed by UV‐A irradiation of the skin (PUVA) has been reported as an advantage. Extracorporeal photochemotherapy (ECP) was introduced as an improved method of photochemotherapy compared with PUVA. ECP selectively affects autoreactive as well as malignant T lymphocytes and implies repeated ex vivo UV‐A irradiation of chemically photosensitized leukocytes, followed by reinfusion. The treatment efficacy depends essentially on sufficient plasma levels of 8‐MOP. In cases of considerable gastrointestinal malabsorption, however, therapeutic levels of 8‐MOP are rarely achieved when the drug is administered orally.

Objective In a case of severe cGvHD, ECP was used because of disease progression, despite massive conventional immunosuppressive therapy.

Patient and method After bone marrow transplantation a 13‐year‐old girl developed acute GvHD, which turned later to severe cGvHD with massive involvement of the skin, oral mucosa, liver and gastrointestinal tract. The treatment with prednisolone, cyclosporin A (CsA), azathioprine and thalidomide was without success. When the patient was 15 we started ECP with individually adapted modifications. Especially because of severe gastrointestinal malabsorption, a liquid preparation of 8‐MOP was administered directly into the leukocyte (buffy coat) fraction, received by leukapheresis.

Results After 15 treatment cycles within 12 months immunosuppressive drugs were omitted because of noticeable improvement in cutaneous changes, liver function parameters and general condition (Karnofsky score 85–90% compared with 30–40% at the beginning).

Conclusion It seems to us that this modification of ECP is a very effective and safe treatment modality for cGvHD without any side effects.