bluuebunny/crossref_metadata_2025 huggingface dataset:
PRELIMINARY, DERMATOLOGIC EIRST STEP CRITERIA FOR LUPUS ERYTHEMATOSUS AND SECOND STEP CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: BEUTNER ERNST H. , BLASZCZYK MARIA , JABLONSKA STEFANIA , CHORZELSKI TADEUSZ P. , WHITE DONALD , WOLSKA HANNAH , DAVIS BRIAN
Published: May 2007

Background. Comparisons of cases of systemic lupus erythematosus (SLE) with cases of rheumatoid arthritis and other rheumatologic disorders affords the basis of the 1982 revised criteria of the American Rheumatism Association (ARA) for classifying SLE cases. We address three questions: Do comparisons of LE cases with non‐LE cases that have suggestive skin lesions yield criteria for use in dermatology clinics for primary classification of cases with photo distributions of skin lesions? Do comparisons of SLE with cutaneous LE cases yield the same or similar criteria to the revised ARA criteria for SLE? How should subacute cutaneous LE cases be evaluated for signs of significant systemic involvement?

Methods. Discriminant analyses on 168 cases with skin lesions suggestive of LE were performed using data based on the ARA criteria for SLE and study factors for cutaneous LE suggested by the European Academy of Dermatology and Venereology.

Results. These yielded two sets of criteria: (1) The 11 preliminary, dermatologic first step criteria (10 plus 1 for discoid lesions and histology) serve to classify cases as LE or non‐LE. (2) The 11 preliminary, dermatologic second step criteria classify LE cases as cutaneous LE or systemic LE. Interestingly, 5 of 11 of these second step criteria differ from the 11 ARA criteria for systemic LE. These second step criteria afford a useful means of distinguishing between subacute cutaneous LE cases with or without significant systemic involvement.

Conclusions. The study factors included in both the first and the second step criteria fall into three groups, notably clinical criteria, laboratory criteria, and “added study factors.” The latter factors distinguish between the groups compared (LE VS. non‐LE and cutaneous vs. systemic LE) but not as well as the study factors included as “criteria.”
PREVALENCE OF RAYNAUD'S PHENOMENON AND SPECIFIC CLINICAL SIGNS RELATED TO PROGRESSIVE SYSTEMIC SCLEROSIS IN THE GENERAL POPULATION OF JAPAN
Authors: INABA RYOICHI , MAEDA MANABU , FUJITA SETSUYA , KASHIKI NAOKO , KOMURA YOKO , NAGATA CHISATO , YOSHIDA HIDHYO , MIRBOD SEYED MOHAMMAD , IWATA HIROTOSHI , SHIKANO YUKIKO , ICHIKI YOSHIRO , MORI SHUNJI
Published: May 2007

Background. In order to evaluate the prevalence rates of Raynaud's phenomenon (RP) and specific clinical signs related to progressive systemic sclerosis (PSS) in the general population of Japan, inquiries were made concerning RP in the hands and dermatologic examinations were also conducted.

Methods. One thousand and sixty‐three subjects (332 men and 731 women) over 30 years of age who underwent inhabitants' health examinations in 1990 were considered for this study.

Results. The prevalence of RP was 3.0% in men and 3.4% in women. In 8 men and 17 women with RP who received the blood tests, the positive rates of antinuclear antibody (ANA) were 12.5% and 35.3% in men and women, respectively. The prevalence rates of all five specific clinical signs related to PSS, sclerodactyly, pitting scars of the fingers, brown pigmentation of the body, shortened frenulum of the tongue, and flexion contracture of fingers, were under 2% in men and 3% in women. In women with RP the prevalence rates of sclerodactyly, pitting scars of the fingertips, brown pigmentation of the body, and shortened frenulum of the tongue were 16.0, 4.0, 4.0, and 16.0%, respectively. These values were significantly higher than those of persons without RP.

Conclusions. Because some persons with primary RP may become typical cases of PSS within several years, a follow‐up study, particulary for women who have positive titers of ANA with RP, should be carried out to find out whether the persons suffer from PSS or not.
FIBRIN CUFF LYSIS IN CHRONIC VENOUS ULCERS TREATED WITH A HYDROCOLLOID DRESSING
Authors: MULDER GERIT , JONES RICHARD , CEDERHOLM‐WILLIAMS STEWART , CHERRY GEORGE , RYAN TERENCE
Published: May 2007

Background. Pericapillary fibrin cuffs (PFC) are a recognized part of the pathology of venous stasis ulcers. A hydrocolloid dressing capable of lysing wound surface fibrin was tested in venous ulcers for its capacity to lyse pericapillary fibrin below the wound surface.

Methods. Tissue biopsies from the rims of 19 venous ulcers were evaluated for thickness of shallow and deep dermal PFCS before and after treatment with DuoDERM covered by Unna's boot and a compression bandage (DD+UB; n=9) versus the same treatment without the hydrocolloid dressing (UB; n=10). Frozen sections of all biopsies were stained with an immunofluorescent antibody to fibrin for rating of PFC thickness. Separate sections were stained with hematoxylin and eosin to assess capillary frequency, histopathology, and inflammation. All ratings and pathology assessments were performed blinded to treatment conditions.

Results. Both deep and shallow PFCS were reduced in 89% of ulcers treated with DD+UB versus 40% of ulcers treated with UB (α < 0.04). No other significant differences in inflammation, histopathology, or capillary frequency were observed.

Conclusions. Treatment with DD+UB reduced PFCS in twice the number of ulcers than UB alone in 1 week. This is the first scientific documentation that a topical wound dressing could reduce the pathophysiology associated with venous ulcers, beyond the known beneficial effect of graduated compression. Not all hydrocolloid dressings are fibrinolytic, so this effect may not generalize to other dressings.
UPDATE ON NUTRITION AND PSORIASIS
Authors: PRYSTOWSKY JANET H. , OROLOGA APHRODITE , TAYLOR SUSAN
Published: May 2007

Background. It has been established that severe psoriasis may lead to nutrient depletion, especially of protein, folate, and iron. Nutrient loss occurs due to the accelerated loss of nutrients from the hyperproliferation and desquamation of the epidermal layer of skin in psoriasis. We have proposed that nutritional support as a secondary form of therapy may be beneficial in aiding some psoriasis patients return to a state of remission.

Methods. To determine how frequently nutritional abnormalities occur in hospitalized psoriasis patients, a retrospective analysis was done of the nutritional status of 50 patients admitted for the treatment of psoriasis. Chart records were analyzed and laboratory data were interpreted in consideration of concurrent medical problems. Protein status and anemia were the primary nutritional indicators studied.

Results. We found that of those parameters that may be used as indicators of nutritional status, 18% of the patients had a decreased total protein, 16% of the patients had a decreased serum albumin, 38% had an elevated mean corpuscular volume, and 39% had a decreased hematocrit.

Conclusions. Our findings support the concept that widespread psoriasis places the patient at risk to develop minor nutritional abnormalities in protein and folate status even when accounting for confounding medications and coexistent diseases.
PSYCHOSOMATIC STUDY OF SELF‐EXCORIATIVE BEHAVIOR AMONG MALE ACNE PATIENTS: PRELIMINARY OBSERVATIONS
Authors: GUPTA MADHULIKA A. , GUPTA ADITYA K. , SCHORK NICHOLAS J.
Published: May 2007

Background. Studies of the psychosomatic correlates of self‐excoriative behavior in acne have involved mainly women with acne excorieé. Little is written about the psychosomatic factors that affect men with acne. Excessive self‐excoriation of acne lesions is an important clinical factor because it can prolong the course of the disease and exacerbate the deeper inflammatory process with an increase in the severity of scarring.

Methods. Thirteen men (mean ± SE: age: 22.2 ± 1.4 years) with mild to moderate facial acne, whose self‐excoriative behavior was not severe enough to result in acne excoriee, completed a battery of self‐rated questions assessing their self‐excoriative behaviors, the severity of their acne, and various psychologic factors.

Results. Certain aspects of self‐excoriative behavior (e.g., a tendency to pick or squeeze the acne lesions when stressed) correlated directly with depression (brief symptom inventory (BSI)) (Pearson r = 0.64, P = 0.02) and anxiety (BSI) (Pearson r = 0.61, P = 0.03) scores. The dermatologic indices of acne severity such as inflammation (Pearson r = 0.82, P = 0.0004) and pustules (Pearson r = 0.62, P = 0.03) were the strongest correlates of self‐excoriative behavior.

Conclusion. Self‐excoriative behavior in men with acne may be exacerbated by a coexisting depressive or anxiety disorder. In contrast, women with acne excorieé have been reported to suffer from an immature personality where the cutaneous condition may serve as “an appeal for help.” Men who excessively pick their acne will benefit from aggressive dermatologic therapies and should be assessed for underlying depressive and anxiety disorders.
ALOPECIA AREATA AND INCREASED PREVALENCE OF PSYCHIATRIC DISORDERS
Authors: KOO JOHN Y.M. , SHELLOW WILLIAM V.R. , HALLMAN CHRIS P. , EDWARDS JOEL E.
Published: May 2007

Background. The relationship between psychiatric disorders and alopecia areata has not been well studied. Although previous reports have been unable to correlate psychiatric illness with hair loss, a recent study determined that 74% of patients with alopecia areata (AA) under evaluation had one or more lifetime psychiatric diagnoses.

Methods. Two hundred and ninety‐four community‐based patients with alopecia areata responded to a detailed questionnaire distributed by Help Alopecia International Research, Inc. The prevalence of psychiatric disorders was determined using diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IIIR).

Results. Major depression, generalized anxiety disorder, social phobia, and paranoid disorder were all present in patients with alopecia areata at rates significantly higher than in the general population.

Conclusions. Alopecia areata patients are at a higher risk of developing psychiatric comorbidity during their clinical course.
NATURE AND TREATMENT OF DELUSIONAL PARASITOSIS: A DIFFERENT EXPERIENCE IN INDIA
Authors: SRINIVASAN T.N. , SURESH T.R. , JAYARAM VASANTHA , FERNANDEZ M.P.
Published: May 2007

Background. Delusional parasitosis has been described as a rare syndrome, often involving elderly women who respond poorly to treatment except to pimozide.

Method. Nineteen cases of delusional parasitosis given antipsychotic treatment other than pimozide were followed up and the responses assessed in a structured manner.

Results. The frequency of the syndrome was higher than generally reported and the patients were younger and had been ill for a shorter period. There was good response to antipsychotic treatments using trifluoperazine, haloperidol, chlorpromazine, and electroconvulsive therapy, and 11 cases showed complete remission, five of them maintaining the recovery for more than 3 years.

Conclusions. Delusional parasitosis is not as rare as described: it does not need to be chronic, and can involve young patients. Antipsychotic treatments other than pimozide are equally effective in delusional parasitosis especially if the patients are young and seen early in the illness. The frequency and nature of the disorder observed could probably be due to regional cultural factors.
CLINICAL PICTURE OF CUTANEOUS LEISHMANIASIS IN ISFAHAN, IRAN
Authors: MOMENI A.Z. , AMINJAVAHERI M.
Published: May 2007

Background. Cutaneous leishmaniasis caused by Leishmania tropica is endemic in Iran, being the second most prevalent vector‐borne disease in the country (after malaria). From the five most infected provinces, Isfahan is third after Boushehr and Khouzestan.

Methods. To study the clinical picture of this disease, 1250 patients referred to the Leishmaniasis Training and Treatment Center (affiliated with Isfahan University of Medical Sciences) were studied during a 2–year period.

Results. The disease was more prevalent in the age group of 10–15 years. Nonindigenes had more lesions and their lesions were more acute and more severe than those of indigenes. The face was the most frequent site of involvement (39.7%), followed by the upper (32.4%) and lower extremities (19.4%), whereas only 8.1% of the lesions were found on the trunk. No direct relation was seen with age, sex, and clinical features of the lesions except for the erysipeloid cases that were rare and seen only in middle‐aged and elderly women. Noduloulcerative and papular lesions dominated the clinical picture, followed by plaque, impetiginized, and nodular lesions.

Conclusions. The reason why nonindigenous patients have more severe lesions and in greater number is not clear. It can be postulated that nonindigenous people were more exposed to the vector biting since they were living in more infected areas and that during a long period of time, a mild immunity might have developed in indigenous people.
TREATMENT OF SUPERFICIAL MYCOSES IN THE TROPICS: WHITFIELD'S OINTMENT VERSUS CLOTRIMAZOLE
Authors: GOOSKENS VINCENT , PÖNNIGHAUS JÖRG M. , CLAYTON YVONNE , MKANDAWIRE PAUL , STERNE JONATHAN A.C.
Published: May 2007

Background. In tropical primary health care, essential drugs should be safe, effective, and as inexpensive as possible. To treat the very common dermatophyte infections of the skin, one may use inexpensive Whitfield's preparations, more expensive topical imidazole derivatives, or extremely expensive oral antifungals. Because a cream base is felt to be more appropriate than an ointment in tropical conditions, we wanted to compare the effectiveness of Whitfield's cream and a topical imidazole derivative in field conditions in the tropics.

Methods. A double‐blind trial was performed involving 153 patients with a dermatophyte infection of the skin in Karonga District, Northern Malawi, including 25 patients who were Hiv‐i‐seropositive, comparing Whitfieid's cream with clotrimazole cream.

Results. 75 patients were treated with Whitfield's cream and 78 with clotrimazole cream for a period of 6 weeks. Cure rates ranged from 80% to over 90% depending on the definition of cure. If positive cultures after treatment were used as criterion for treatment failure, six were found in each treatment group. One in each treatment failure group was an mv‐i‐seropositive patient.

Conclusions. The great majority of patients in the tropics with a dermatophyte infection of the skin can be cured with a topical antimycotic preparation and do not need expensive oral therapy. This also proved to be valid for HIV‐I‐seropositive patients. Whitfield's cream and clotrimazole cream are both very effective. The lower cost makes Whitfield's cream the treatment of choice in dermatophyte infections of the skin in tropical primary health care.
VULVITIS CIRCUMSCRIPTA PLASMACELLULARIS
Authors: HAUTMANN GIUSEPPE , GETI VINICIO , DIFONZO ELISA MARGHERITA
Published: May 2007

A 56‐year‐old woman reported that an erythematous lesion, accompanied by severe burning, had appeared on the left labium minus about 2 years earlier. She had treated herself with topical deoxymethasone and estrogen topical medications that temporarily relieved the subjective synnptoms, but did little to help the clinical manifestations. The patient's history revealed an adnexectomy and ovariectomy at age 40 after an ectopic pregnancy and a left saphenectomy for ectatic varicose veins at age 54.

We noted a bright red, shiny, almost lacquerlike lesion with clearly defined edges on the left labium minus that started from the external vaginal orifice and extended over half of the labium (Fig. 1). The lesion was not infiltrated and there was no inguinal lymphoadenopathy.

Routine blood chemistry was normal and culture tests for bacteria and fungi were negative. The histologic examination showed a basically healthy epidermis with the exception of a focal reduction of the granular layer, a flattening of the dermoepidermal junction, capillary vasodilatation in the superficial dermis, and an infiltrate consisting of granulocytes, lymphocytes, and numerous plasma cells (Fig. 2).

Direct immunofluorescence (DIF) performed with antigammaglobulin antiserum revealed numerous cell elements that tested positive with anti‐lgA antiserum with cytoplasmatic fluorescence at the dermal and subjunctional level (Fig. 3).

On the basis of the clinical and histopathologic data we diagnosed a chronic circumscribed plasmacellular vulvitis, or Zoon's vulvitis. Excellent results were obtained after 3 months of topical treatment with cyclosporine.
NODULAR FASCIITIS OF THE UPPER LIP MIMICKING A SARCOMA
Authors: CHARTIER SUZANNE , ALLAIRE GUY , TOSCANO MARIE
Published: May 2007

A 39‐year‐old white man in good health noticed a rapidly progressive swelling of his upper lip for which he consulted an otorhinolaryngologist. No pain or other symptoms were mentioned. Physical examination revealed an ill‐defined swelling of the upper lip extending in the region under the nose. This mass was hard and fixed to the underlying tissues. There was no ulceration or discoloration of the overlying skin (Fig. 1).

Complete blood count, liver enzymes, renal function, sinus and chest x‐rays were normal. The patient was sub‐mitted to an excisional biopsy of the tumor.

Histopathologic evaluation revealed an unencapsulated cellular proliferation of spindle‐shape or stellate cells extending into the dermal, fat, and muscular layers. The cells were pleomorphic without atypia, growing haphazardly or in a storiform pattern. There were very few mitotic figures and no abnormal forms, A few multinucleated cells were also present. The stroma appeared edematous or myxoid in the dermis but more densely collagenized In the hypodermis and muscular layer. The proliferation was accompanied by a well‐developed capillary network (Fig. 2).

Clinically, the swelling of the superior lip persisted and another biopsy revealed the same histologic changes.

Since the histopathology was oriented towards a benign condition and a complete excision would require extensive mutilating surgery, a wait‐and‐see policy was justified, A periodic follow‐up was arranged and a slowly progressive resolution of the swelling of the upper lip was noted. Six months after the second biopsy, there was only a discrete residual induration.
GENERALIZED PUSTULAR PSORIASIS PRECIPITATED BY TOPICAL CALCIPOTRIOL CREAM
Authors: GEORGALA SOFIA , RIGOPOULOS DIMITRIOS , ARONI KIRIAKI , STRATIGOS JOHN T.
Published: May 2007

An 18‐year‐old woman had a 3‐year history of previously stable plaque‐type psoriasis that covered most parts of her body, arms, and legs.

In June 1993, she started treatment with calcipotriol cream, which was prescribed by her dermatologist.

Two weeks after starting this treatment, she had an exacerbation of her psoriasis with a generalized pustular eruption and she was admitted to the dermatology unit of “A. Sygros” Hospital.

On admission, the clinical examination revealed a bright red erythema of most of her skin and numerous pinhead‐sized pustules that covered all the psoriasis lesions (Fig. 1).

The eruption covered the patient's body, legs, and arms, whereas flexures and genitalia remained free. She also complained of malaise. The patient's laboratory studies showed the following values: hemoglobin 12.8 g/dL; hematocrit 39%; WBC 14,000/mm3; platelets 28,000/mm3; erythrocyte sedimentation rate 48/h. The blood chemistry surveys were all in the normal range and so were all enzyme studies. Urinalysis was normal. Chest x‐ray showed no abnormality.

Previous treatment

During the 3‐year history, the patient had been using different treatments to control her disease. The last treatment was fluocinamide 0.05% cream, which she had stopped 8 weeks before starting treatment with calcipotriol. On clinical examination no signs of cutaneous atrophy, suggesting the overuse of topical steroid, was found.

Histopathologic Findings

A 4‐mm punch biopsy was taken from a lesion and it revealed the epidermis to be slightly acanthotic and the formation of intraepidermal pustules underneath the stratum corneum with spongiform pustules at the shoulders of the lesion. In the dermis there was a perivascular infiltrate of lymphocytes and a few neutrophils with dilatation of blood vessels (Fig. 2).

Course

Calcipotriol cream was immediately withdrawn and treatment with methotrexate (MTX) was started (25 mg i.m. weekly). The dose was gradually decreased and discontinued 8 weeks later with no relapse of pustules or the plaque‐type psoriasis until now.
PREVALENCE OF THYROID DISEASES IN PATIENTS WITH ALOPECIA AREATA
Authors: PUAVILAI SIRIPEN , PUAVILAI GOBCHAI , CHARUWICHITRATANA SOMYOT , SAKUNTABHAI ANAVAJ , SRIPRACHYA‐ANUNT SUCHAI
Published: May 2007

Background. The prevalence of thyroid disease in patients with alopecia areata previously reported varied from 0 to 28%. These thyroid diseases include Hashimoto's thyroiditis. Graves' disease, simple goiter, and others.

Methods. The prevalence of thyroid diseases was determined in 152 consecutive patients with alopecia areata who presented to the dermatology clinic. A complete history was taken and a physical examination was performed. Thyroxine, triiodothyronine, thyroid‐stimulating hormone, and microsomal antibody levels were measured in every patient. The control group consisted of 152 age‐ and sex‐matched volunteers who had skin diseases other than alopecia areata or autoimmune disorders.

Results. Among 152 patients, age 10–59 years, four cases (2.6%) had a small simple goiter. Microsomal antibodies were detected in seven other patients (4.6%) with liters ranging from 1:100 to 1:1600. None of these seven patients had signs or symptoms of thyroid disease. Five cases (3.3%) of the control group had positive microsomal antibody tests with titers ranging from 1:100 to 1:400. The prevalence of positive microsomal antibodies in the alopecia areata group was not statistically different from the control group (x2= 0.347, df= 1, P = 0.5558).

Conclusions. Among 152 patients with alopecia areata, 4.6% of patients had microsomal antibodies and 2.6% had a small simple goiter. Thus the prevalence of thyroid disease among these patients was 7.2%. The prevalence of positive microsomal antibodies in 4.6% of the patients was not statistically different from that of the control group.
MYCOSIS FUNGOIDES WITH SIGNET‐RING CELLS AND MONOCLONAL GAMMOPATHY
Authors: MISA RICARDO F. DE , AZAÑA JOSÉ M. , BELLAS CARMEN , PEREZ BIBIANA , ROCAMORA ANTONIO , LEDO ANTONIO
Published: May 2007

A 73‐year‐old white woman was admitted to our hospital for evaluation of a chronic dermatitis. Personal history was remarkable only for arterial hypertension and noninsulin‐dependent6 diabetes mellitus. Clinical and histopathologic findings were consistent with a diagnosis of mycosis fundoides (mf and staging procedures including bolld cell counts, serum biochemistry, urinalysis, bone marrow biopsy, Sé zary cell counts in peripheral bolld, computerized tomography (ct scans, abdominal ultrasonography, chest roentgenograms, serum protein electrophoresis, and immunoelectrophoresis disclosed normal or negative results (T2 N0 M0 B0).

After 2 years of standard treatment, the patient's condition had progressively worsened and she presented generalized erythematious plaques and a few, small, red‐bluish tumors (Fig. 1). A biopsy specimen of a tumor showed an intense lymphoid infiltrate composed mainly of large and medium‐sized cells, many of which exhibited clear interacytoplasmic vacuoles (Fig. 2). These vacuoles were negative for periodic acid‐Schiff, alcian blue, and oil‐red‐O staining. Most of the neoplastic cells stained with uchl1 antibody, and none expressed B‐cell markers. Some of the malignant cells reacted wih the Ber‐h2 and mb3 monoclonal antibodies. No evidence of immunoglobulin libht chain production was observed. Negative staining with cd68 monoclonal antibody ruled out a monocyte‐macrophage lineage of the malignant cells.

On physical examination, no palpable lymph nodes were found. The quantitative immunoglobulin study showed an IgG level of 6,950 mg/dL (noral values, 800–1,800 mg/dL), IgA level of 126 mg/dL (normal, 90–450 mg/dL), IgM level of 130 mg/dk (normal, 70–280 gm/dL).Serum immunoelectrophoresis showed an IgG lambda monoclonal protein. Further studies including blood cell count, serum biochemistry, urinalysis, bone marrow biopsy, peripheral blood Sézary cell counts, Bence‐Jones proteinuria, ct scans, abdominal ultrasonography, and chest roentgenograms yielded negaive or normal results. Thus, diagnosis of monoclonal gammopathy of unknown significance (mgus) was made. Despite treatment with systemic chemotherapy, the diesease followed an aggressive course and the patient died from Staphylococcus epidermidis septicemia.
SUCCESSFUL SURGICAL MANAGEMENT AND LONG‐TERM FOLLOW‐UP OF EPIDERMOLYSIS BULLOSA
Authors: IKEDA SHIGAKU , YAGUCHI HITOSHI , OGAWA HIDEOKI
Published: May 2007

Background. Esophageal stenosis and hand deformity are serious complications of recessive dystrophic epidermolysis bullosa that influence the prognosis of patients. To control such complications we have used surgical treatments with favorable results. Additional objectives were to summarize the results of long‐term follow‐up.

Methods. Six patients with esophageal stenosis and nine patients (13 hands) with hand deformity (contracted fingers, mitten‐like deformity) were treated surgically after anemia and malnutrition were corrected by intravenous iron infusion, high‐energy diet, and blood transfusion. As intubation was contraindicated, topical anesthesia was used (eg., lidocaine spray to the nasopharyngeal mucosa for esophageal dilatation and brachial block, ketamine drip, and nitrous oxide inhalation for reconstruction of contracted fingers). We established a new method for esophageal dilatation using a microvasive rigiflex balloon catheter. This catheter was advanced to the stenotic area under radiography and then expanded by injecting contrast medium into the balloon. For reconstruction of hand deformities, the epidermal glove was initially peeled off, and then the combined digits separated carefully by hand, if the release of the contracture was not sufficient, a skin incision was made avoiding injury to nerves and blood vessels. Any skin defects that appeared after the release of the contracture were covered with skin grafts taken from the abdominal wall. K‐wire fixation was used to maintain the extended position of the fingers. Three weeks after the operation, the K‐wires were removed and rehabilitation was commenced.

Results. The esophageal stenosis was successfully dilated with the balloon catheter; in all six cases the dysphagia was relieved immediately. There was no recurrence in any of the patients on long‐term follow‐up. After reconstruction of the hand, daily activity improved in 12 of the 13 hands. The remaining hand was difficult to reconstruct due to severe mutilation and bone deformity. During follow‐up, 6 of the 12 hands maintained successful reconstruction, whereas the remaining 6 hands showed slight to moderate recontraction of the fingers.

Conclusion. Esophageal dilatation with a balloon catheter is safer and has fewer side effects compared to other surgical procedures. This method can provide favorable results and can be carried out repeatedly in a short time. Daily and social activities of patients can be improved upon reconstruction of hand deformities.
THREE CASES OF PEMPHIGUS VEGETANS: INDUCTION BY ENALAPRIL—ASSOCIATION WITH INTERNAL MALIGNANCY
Authors: BASTIAENS MAARTEN T. , ZWAN NEL VERBURGH‐VD , VERSCHUEREN GUY L.A. , STOOF TOM J. , NIEBOER CEES
Published: May 2007

Background. Pemphigus vegetans, a rare form of pemphigus vulgaris, consists of vegetating plaques localized to flexural areas. Two types, the Neumann and the Hallopeau type, are recognized with their own characteristics.

Methods. Three patients with pemphigus vegetans were examined, two with Hallopeau type and one with Neumann type. The microscopic and immunofluorescence findings were recorded.

Results. Two remarkable features were present. In one case pemphigus vegetans was possibly induced by the use of enalapril. Only in three previous cases has enalapril been described in relation to pemphigus. A second case was associated with a malignant lung tumor, a phenomenon which could not be traced in the literature.

Conclusions. Two types of pemphigus vegetans must be distinguished. Induction of pemphigus (also vegetans) is an accepted side effect of captopril. The effect of enalapril on pemphigus is still in debate. To the best of our knowledge, this is the first time that a patient with pemphigus vegetans and a simultaneously occurring internal malignancy is described.
CUTANEOUS LUPUS ERYTHEMATOSUS: COMPARISON OF DIRECT IMMUNOFLUORESCENCE FINDINGS WITH HISTOPATHOLOGY
Authors: RAOUF AL‐SUWAID ABDUL , NAGARAJ VENKATARAM MYSORE , RUDRIAH BHUSHNURMATH SHIVAYOGI
Published: May 2007

Background. Direct immunofluorescence (DIF) is considered to be a major advance in the diagnosis of connective tissue diseases, particularly lupus erythematosus (LE); however, the reliability of the technique depends on several factors, such as age and site of the lesion, type of immunofluorescence, type of immunoglobulin, etc. False positives and false negatives can occur.

Objective and Methods. To determine the diagnostic value of DIF we studied 18 clinically established cases of cutaneous lupus erythematosus (CLE). Lesional biopsies were subjected to routine histopathologic examination and direct immunofluorescence. The results were compared.

Results. Direct immunofluorescence was positive in 72.7% and histopathology in 66% cases. Combination of the two techniques (with one or both methods giving characteristic findings) was positive in 83% cases. The most common antibody was IgG, seen in 77.8% cases. A homogeneous pattern of immunofluorescence, with IgG, was seen in 55.5% of the cases. Although histopathology gave positive or suggestive results in all cases, DIF was negative in two cases of early cutaneous LE.

Conclusion. Although DIF is an extremely useful diagnostic tool, it should always be used in conjunction with histopathology and the combination of the two methods yields the best results.
Burn‐Induced Bullous Pemphigoid
Authors: GOIIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Originality is highly desirable and repetitious contributions or minutiae are discouraged. We wish also to foster submission of hypotheses marked accordingly. These should be based on reality and should stimulate thought. Contributions should conform to the format for correspondence as outlined in, “Notice to Contributors.” Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Section Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
CUTANEOUS MYIASIS: REVIEW OF 13 CASES IN TRAVELERS RETURNING FROM TROPICAL COUNTRIES
Authors: JELINEK TOMAS , DIETER NOTHDURFT HANS , RIEDER NATASCHA , LÖSCHER THOMAS
Published: May 2007

Background. Cutaneous myiasis is frequently reported in patients from tropical countries. Most commonly infestation is due to Cordylobia anthropophaga and Dermatobia hominis, whereas Hypoderma lineatum is less likely to affect humans.

Methods. The clinical and parasitologic aspects in a series of 13 patients with cutaneous myiasis seen in a German travel clinic are reviewed.

Results. Six patients were infected with larvae of the tumbu fly, Cordylobia anthropophaga, six with larvae of the botfly, Dermatobia hominis, and one patient presented with an infection with Hypoderma lineatum. Dermatobia hominis was exclusively acquired in the American tropics and Cordylobia anthropophaga exclusively in Africa, whereas infection with Hypoderma lineatum was acquired in Nepal. The number of larvae removed from the skin was markedly higher in patients infected with the tumbu fly (average of five larvae) compared to the botfly (average of 1.7 larvae), whereas pain was more frequently reported from patients with botfly infestation. Treatment consisted in the removal of the larvae by forceps or surgical incision in tumbu or botfly infection and oral application of infection in infection with Hypoderma lineatum. This led to complete recovery in all patients.

Conclusions. In patients presenting with cutaneous lesions after return from tropical countries, myiasis has to be considered as a differential diagnosis. Simple and effective therapy is available through removal of the maggots.
SERUM EOSINOPHIL CATIONIC PROTEIN (ecp) IN BULLOUS PEMPHIGOID
Authors: CAPRONI MARZIA , PALLESCHI GIOVANNI MARIA , FALCOS DIMITRI , D'AGATA ALBERINO , CAPPELLI GINO , FABBRI PAOLO
Published: May 2007

Background. The importance of eosinophils in the pathogenesis of the major forms of pemphigoid (bullous pemphigoid, cicatricial pemphigoid, herpes gestationis) remains to be confirmed.

Methods. To evaluate the role of eosinophilic Infiltrates in these diseases and to detect the presence and activity of eosinophils, we compared the serum levels of eosinophil cationic protein (ecp), an eosinophil‐derived protein, in 11 healthy subjects and in 10 patients with pemphigoid diseases (8 with bullous pemphigoid, one with cicatricial pemphigoid, and one with herpes gestationis). The serum of two patients with epidermolysis bullosa acquisita (lEBA) and one with linear IgA bullous dermatosis (labd) were utilized as a further control.

Results. There was a significant difference between the mean of serum ecp levels in patients with pemphigoid diseases (25.1 ± 12.3 μg/L, M = SD) and control subjects (2.30 ± 2.41, μg/L ± SD 2.41) (T = 4.272 P < 0.0001). The two patients with EBA (10.8 and 17.7 μg/L) showed contrasting results; the patient with labd had normal ecp serum levels. The serum levels of ecp were not significantly correlated with the blood eosinophil count (R = 0.103; P = 0.777) in any of the cases.

Conclusions. In pemphigoid disease, the serum levels of ecp seem to be correlated with the activated secreting and tissue‐damaging eosinophils found in the dermis, supporting the concept of an active participation of eosinophils in generating cutaneous lesions.
ORAL PHOTOCHEMOTHERAPY IN VITILIGO: FOLLOW‐UP, PATIENT COMPLIANCE
Authors: AL‐ABOOSI MUSTAFA M. , AJAM ZUHAIR A.
Published: May 2007

Background. Vitiligo is a common, acquired condition of unknown etiology. The only practical treatment for patients with vitiligo is psoralen ultraviolet A (puva). NO satisfactory method is available to measure the influence of certain factors on the therapeutic response.

Methods. Twenty‐nine patients with generalized vitiligo were studied for the effectives of puva therapy. The comparative study revealed the importance of certain variables (i.e., the proper dose of psoralen, the regular attendance of the patient, and the duration of the treatment). A scoring system had been designed and employed to evaluate these factors.

Results. The follow‐up of these patients showed that 18 of the 29 completed their treatment. An almost total improvement was obtained in 67% of these patients within 12 months (range 6–18 months). The average number of exposures was 64. A statistically significant difference was obtained between patients with good compliance and those with poor compliance.

Conclusions. The scoring system is a simple practical measure applicable to patients that proved eventually to be very useful for providing more effective treatment and a good response.
SECONDARY SYPHILIS: A CLINICOPATHOLOGIC STUDY
Authors: PANDHI R. K. , SINGH NAVJEEVAN , RAMAM M.
Published: May 2007

Background. With the resurgence of syphilis in the hiv era, a greater awareness of the clinicopathologic features of the disease is desirable. This report describes and correlates the clinical and histopathologic features of secondary syphilis seen at a teaching hospital in Delhi, India.

Methods. Forty biopsies of mucocutaneous lesions from 31 consecutive patients with secondary syphilis, seen between September 1987 and January 1991, were studied and the histopathologic findings correlated with the clinical findings.

Results. A spectrum of histopathologic changes ranging from a minimal infiltrate to granulomatous inflammation throughout the dermis was seen. The pattern of inflammation correlated well with the type of skin lesion, with macules showing the least and nodules the most prominent changes. The predominant cell type in the infiltrate was the mononuclear cell/lymphocyte. Plasma cells were seen infrequently. except in condylomata lata. Endothelial proliferation, the “classical” feature of the histopathology of syphilis was noted infrequently.

Conclusions. The histologic manifestations of secondary syphilis appear to be as varied as the clinical ones. This calls for close interaction between the clinician and the pathologist to correlate the clinical, serologic, and histologic findings to establish the diagnosis of syphilis.
NEVUS SEBACEUS: CLINICAL OUTCOME AND CONSIDERATIONS FOR PROPHYLACTIC EXCISION
Authors: CHUN KEVIN , VÁZQUEZ MIGUEL , SÁNCHEZ JORGE L.
Published: May 2007

Background and Objective. Nevus sebaceus is a hamartoma of the skin with the potential to develop benign and malignant neoplasms. Prophylactic surgical excision has been advocated, usually before puberty, to prevent their occurrence; however, it is the clinical impression of the authors that the development of cutaneous neoplasms is infrequent and, if they develop, they are usually benign and nonaggressive. Our objective was to investigate the clinical outcome and histopathologic findings of every single nevus sebaceus that had been excised in our institution in a five‐year period.

Methods. Two hundred and twenty‐five consecutive cases, coded as nevus sebaceus corresponding to 175 patients were submitted to our institution between September 1987 and May 1992, and were identified among a total of 64,827 specimens. All cases were reviewed histopathologically and clinical information was obtained from the records. Specimens from 10 patients were excluded.

Results. A total of nine benign neoplasms (5.4%) were identified in the 165 patients. Three patients were in their second decade of life, two in their third, two in the fifth and two in the sixth. There were five trichoblastomas, three specimens of syringocystadenoma papilliferum, and one aprocrine cystadenoma. No malignant neoplasms were found. Six of the tumors were removed either for prophylactic or cosmetic reasons and in only three cases were the neoplasms suspected clinically and excised.

Conclusions. If this same tendency prevails in other prospective studies, we strongly believe that prophylactic excision of all nevus sebaceus is not warranted. Excision should be recommended only when benign or malignant neoplasms are clinically suspected or for cosmetic considerations.
TRIVIAL OR TERRIBLE? THE PSYCHOSOCIAL IMPACT OF PSORIASIS
Authors: FRIED RICHARD G. , FRIEDMAN STEVEN , PARADIS CHERYL , HATCH MARJORIE , LYNFIELD YELVA , DUNCANSON CAROL , SHALITA ALAN
Published: May 2007

Background. Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment.

Methods. The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment.

Results. Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well.

Conclusions. Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.
TREATMENT OF RECURRENT CUTANEOUS LEISHMANIASIS
Authors: MOMENI ALI‐Z. , AMINJAVAHERI MALI
Published: May 2007

Background. Cutaneous leishmaniasis is endemic in Iran. One of the clinical pictures of this disease is leishmaniasis recidivans (LR). Most of the drugs used for cutaneous leishmaniasis are ineffective in LR.

Methods and Patients. Twenty‐five patients (13 women and 12 men), who had LR and whose disease had been proved by previous direct smears, were accepted for the study. The duration of disease in all patients was more than 2 years and they had previously been treated for their cutaneous leishmaniasis by different methods. All patients were treated with a combination of allopurinol (AL) (20 mg/kg/day for 30 days) and meglumine antimoniate (MA) (70 mg/kg/day for 15 days). Laboratory tests including hemograms, liver function, and kidney function tests, were done both at baseline and at the end of therapy.

Results. Twenty‐four out of 25 patients (96%) responded well to treatment and after 1 year follow‐up no relapse had occurred. The drugs were well tolerated by the patients producing no side effects nor any significant changes in laboratory values.

Conclusions. A combination of AL and antimoniate is an effective method for the treatment of LR and for patients with cutaneous leishmaniasis who are resistant to the usual treatments.
OPEN RANDOMIZED COMPARISON OE ITRACONAZOLE VERSUS TERBINAEINE IN ONYCHOMYCOSIS
Authors: ARENAS ROBERTO , DOMÍNGUEZCHERIT JUDITH , FERNANDEZ LUISA MA.
Published: May 2007

Background. Onychomycoses are among the most frequent nail diseases. The principal agents are dermatophytes, Itraconazole and terbinafine are two effective and systemic antimycotics. Previous trials have shown, that treatment schedules with effective concentrations for 3 months cause drug deposits in nail plates that persist 6 months after the end of the treatment.

Methods. A comparative, open, prospective study was carried out with random assignment of patients. The first group included 27 patients under treatment with 200 mg of itraconazole once daily for 3 months. The second group included 26 patients treated with 250 mg of terbinafine for 3 months. Both series of patients were followed for 6 additional months.

Results. Both groups were similar in age, sex, and history of onychomycosis, Trichophyton rubrum was the main isolated agent in all patients. The percentage of diseased nails was similar in both groups affecting predominantly the first toenail. Treatment was highly effective and differences between groups were not significant. The rate of adverse events was 21% in the itraconazole group and 47% in the terbinafine group.

Conclusions. Itraconazole and terbinafine are two drugs of choice in dermatophytic onychomycosis.
HISTOLOGIC SPECTRUM OF CUTANEOUS INVOLVEMENT IN PATIENTS WITH MYELOGENOUS LEUKEMIA INCLUDING THE NEUTROPHILIC DERMATOSES
Authors: WONG TAI‐YUEN , SUSTER SAUL , BOUFFARD DANIELLE , FLYNN STUART D. , JOHNSON RICHARD A. , BARNHILL RAYMOND L. , MIHM MARTIN C.
Published: May 2007

Background. Cutaneous manifestations of myeloid leukemia can be specific or nonspecific. The study was designed to determine the prevalence and histologic appearance of cutaneous lesions in patients with myeloid leukemia and various myeloproliferative disorders.

Methods. The histologic changes of cutaneous lesions in 52 patients with myelodysplastic syndrome, polycythemia vera, and myeloid, myelomonocytic, or monocytic leukemia are presented in this study.

Results. Two types of cellular infiltrates were identified. In the first group, the most common pattern was a diffuse involvement by the leukemic cells through the entire dermis with preservation of a “grenz zone” in the superficial dermis. Two cases exhibited a Kaposi's sarcoma‐like pattern, with prominent slit‐like blood‐filled spaces lined by myeloblasts against a fibrocellular stroma. The second group of lesions was characterized by dense, neutrophilic dermal infiltrates resembling acute neutrophilic dermatosis (Sweet's syndrome) or pyoderma gangrenosum. In two of these cases, scattered immature blast cells admixed with the mature neutrophilic elements were identified.

Conclusions. Awareness of these different morphologic features and application of special stains are of value in the evaluation of suspicious cutaneous infiltrates in patients with myeloid leukemia and various myeloproliferative disorders.
SYSTEMIC LUPUS ERYTHEMATOSUS: A CASE‐CONTROL EPIDEMIOLOGIC STUDY IN JAPAN
Authors: NAGATA CHISATO , FUJITA SETSUYA , IWATA HIROTOSHI , KUROSAWA YUTAKA , KOBAYASHI KATSUYOSHI , KOBAYASHI MASAYO , MOTEGI KAZUO , OMURA TOSHITAKA , YAMAMOTO MASAHARU , NOSE TAKAYUKI , NAKAMURA KEN‐ICHI , HASHIMOTO TSUTOMU , NAKAMURA YOSIKAZU , YANAGAWA HIROSHI
Published: May 2007

Background. Systemic lupus erythematosus (SLE) is designated by the Japanese government as one of the intractable diseases and all patients, who suffer from these diseases, are registered to get financial aid for treatment. Using newly registered SLE patients, a case‐control study was conducted to evaluate potential risk factors.

Methods. Two‐hundred and eighty‐two women SLE patients, newly registered to receive financial aid for treatment, and 292 randomly selected health examination participants at public health centers (controls) were surveyed from April 1988 through March 1990. By means of a self‐administered questionnaire, data concerning demographic variables, smoking and drinking habits, past medical and reproductive history, and family history were collected.

Results. Based on unconditional logistic regression analysis, the risk of SLE was significantly increased for current smokers (age‐adjusted odds ratio (OR) = 2.31, 95% confidence interval (CI) (1.34–3.97). Alcohol and milk intake were inversely associated with risk. Family histories of asthma and collagen diseases, including SLE, were associated with significantly elevated risk of SLE (OR = 2.07, 95% ci 1.14–3.77; OR = 5.20, 95% CI 1.08–24.95, respectively). Regarding reproductive function, women with menarche at age 15 or later had significantly higher risk than those, who started menstruating before age 12 (OR = 3.82, 95% CI 1.66–8.81 for menarche at > 15 years and OR = 2.90, 95% a 1.14–7.39 for menarche at 16y).

Conclusions. Our study suggests several risk factors, including smoking, family history, and reproductive history that may increase the risk of SLE.