bluuebunny/crossref_metadata_2025 huggingface dataset:
Follicular Mycosis Fungoides: Variability of a Rare Entity
Authors: Roeschm Alexander , Schleyer Verena , Landthaler Michael , Vogt Thomas
Published: June 2007

Objective. Three patients with follicular mycosis fungoides (FMF), a rare variant of folliculotropic cutaneous T‐cell lymphoma, are discussed. Follicular involvement in cutaneous T‐cell lymphoma commonly presents clinically with alopecia, follicular cysts, or comedo‐like lesions usually associated with follicular mucinosis and strong epidermotropism. In contrast, FMF, in a strict sense, has been defined as a lymphocytic infiltration of hair follicles in the absence of both epidermal invasion and follicular mucin.

Discussion. Case 1 shows a clinically stable form of FMF characterized by circumscribed alopecia and its persistent resistance to topical therapeutic approaches. In contrast, Cases 2 and 3 demonstrate that classic mycosis fungoides lesions and FMF can occur simultaneously and that transitions occur from mycosis fungoides to FMF and vice versa. These observations strengthen the concept that FMF and mycosis fungoides represent just two variants of one entity of cutaneous T‐cell lymphoma. In Case 3, rapid progression into tumor‐stage mycosis fungoides and the follicular infiltration was controlled with bexarotene.

Conclusions. Because it was previously suggested that FMF may have a worse prognosis compared with classic mycosis fungoides, this impressive response to bexarotene is of great clinical interest and may spark new studies employing this novel retinoid for FMF treatment.
Lupus Miliaris Disseminatus Faciei Part I: Significance of Histopathologic Undertones in Diagnosis
Authors: Virendra N. Sehgal , Govind Srivastava , Ashok K. Aggarwal , Vishwanath Reddy , Sonal Sharma
Published: June 2007

Background. Since its clinical discovery, lupus miliaris disseminatus faciei has sporadically been reported to have different modes of clinicopathologic expression.

Objective. The purpose of this study was to work up a list of histopathologic undertones and to project and propagate lupus miliaris disseminatus faciei as an exclusive entity. An upcoming Part II of this study will present an overview of the disease.

Methods. All patients visiting the outpatient clinic conforming to hitherto accepted clinical features were included to study patients' age and sex, duration of the disease, and above all, conduct a detailed histopathology review. Using the detailed information obtained, an endeavor was made to organize the disease into early, fully developed, and late lesions.

Results. The details of the various parameters were of great help in evolving this modus operandi. The clinical as well as histopathologic features of lupus miliaris disseminatus faciei are fairly distinct and facilitate visualizing the entity as a spectrum comprising early, fully developed, and late lesions. Further studies are called for.
Lupus Miliaris Disseminatus Faciei Part II: An Overview
Authors: Virendra N. Sehgal , Govind Srivastava , Ashok K. Aggarwal , Vishwanath Reddy , Sonal Sharma
Published: June 2007

Lupus miliaris disseminatus faciei, a chronic inflammatory disorder, is a controversial and enigmatic diagnostic/therapeutic entity. Multiple, discrete, smooth 1–3 mm brown/red or brown‐to‐yellowish dome‐shaped papules (sometimes with mild scaling) are its clinical characteristics. The lesions are usually located on the central and lateral side of the face. The condition is most often seen in young adults of both sexes, and diascopy may reveal apple‐jelly nodules. Lupus miliaris disseminatus faciei has clearly been defined into four histopathologic groups: epithelioid cell granuloma with central necrosis; epithelioid cell granuloma without central necrosis (sarcoid/foreign body reaction); epithelioid cell granuloma with abscesses; and nongranulomatous, nonspecific inflammatory infiltrate. While in early lesions granuloma is absent and lymphocytes and a few neutrophils surround the follicles, fully developed lesions show well formed granuloma surrounding ruptured hair follicles, often with large numbers of neutrophils. Lupus miliaris disseminatus faciei must be differentiated from other conditions; to facilitate this, in Part I of this paper the histopathologic undertones were delineated into early, intermediate (first stage, second stage, and third stage), and late stages. This part of the article presents an overview of lupus miliaris disseminatus faciei.
Lyell's Syndrome
Authors: Baroni Adone , Ruocco Eleonora
Published: June 2007

Lyell's syndrome, or toxic epidermal necrolysis, is a rare, potentially life‐threatening mucocutaneous disease, usually provoked by the administration of a drug and characterized by acute necrosis of the epidermis. The drugs most frequently incriminated are nonsteroidal anti‐inflammatory drugs, chemotherapics, antibiotics, and anticonvulsants. An immunologic response to immunocomplexes formed by metabolites of the causal drug and the common tissue antigens is thought to be responsible for this disorder. Preceded by fever, general malaise, and other flu‐like symptoms, bullous and erosive lesions involve oral, ocular, and genital mucosae; and vast areas of the skin with extensive dermoepidermal detachments. The loss of fluid and electrolytes and supervening infections lead to a severe general condition, often with fatal outcome. Treatment is based on the administration of fluids, electrolytes, and albumin. The use of systemic corticosteroids is controversial. Plasmapheresis and hyperbaric oxygen proved to be useful. The employment of high doses of IV immunoglobulins is a novel, valid, and promising treatment.
Patch Testing: A Retrospective Analysis of 103 Patients With Emphasis on Practical Aspects for the Clinician
Authors: Mohammad Al‐Helalat , Cohen Steven , Hadi Suhail
Published: June 2007

Background. Allergic contact dermatitis is a common dermatologic disorder caused by small chemical molecules that can penetrate the skin barrier. Thousands of chemicals capable of inducing allergic contact dermatitis have been identified. To cure allergic contact dermatitis, the allergen should be identified and eliminated from the environment of the patient. Patch testing, utilizing a variety of standard panels of the most frequent allergens, is used to identify the allergen in question. Patch testing is still the gold standard tool used to identify one or more substances that may contribute to the etiology of allergic contact dermatitis.

Objective. To determine the frequency of patch test positivity and to identify the most common allergens in patients with suspected allergic contact dermatitis.

Methods. A retrospective analysis of files of 103 patients who have been clinically diagnosed to have allergic contact dermatitis and have been patch tested using a standard technique with a Northern American Contact Dermatitis Group series.

Results. Sixty‐two patients (60.2%) showed positive reactions to one or more substance. The most common allergens were nickel sulfate, fragrance mix, and neomycin sulfate. There was an increased frequency of positive reactions to fragrance mix and a significant decrease of frequency of thimerosal positive reactions.

Conclusions. Increased awareness of allergens and their potential sources may help to limit the usage of these chemicals in manufacturing consumer products. This may have contributed to decreased prevalence rates of certain allergens such as thimerosal and paraphenylenediamine.
Inoculation Herpes Barbae
Authors: LCDR Eric C. Parlette , LCDR James M. Polo
Published: June 2007

A 21‐year‐old white man in otherwise excellent general health was referred for a painful, progressive, facial eruption with associated fever, malaise, and cervicofacial lymphadenopathy. The patient reported that a vesicular eruption progressed from the left side of his face to also involve the right side of his face over the 48 hours preceding his clinic visit. He also reported some lesions in his throat and the back of his mouth causing pain and difficulty swallowing. Four to 7 days before presentation to us, the patient noted exposure to his girlfriend's cold sore. Additionally, he complained of a personal history of cold sores, but had no recent outbreaks. Physical examination revealed a somewhat ill man with numerous vesicles and donut‐shaped, 2–4 mm, crusted erosions predominantly on the left side of the bearded facial skin. There were fewer, but similar‐appearing lesions, on the right‐bearded skin. The lesions appeared folliculocentric (Figure). Cervical and submandibular lymphadenopathy was present. Oral exam showed shallow erosions on the tonsillar pillars and soft palate. Genital examination was normal. The remainder of the physical exam was unremarkable. A Tzanck smear of vesicular lesions was positive for balloon cells and many multinucleated giant cells with nuclear molding. A viral culture was performed which, in several days, came back positive for herpes simplex virus. The complete blood cell count documented a white blood cell count of 8000/mm3 with 82.6% neutrophils and 9.0% lymphocytes. Based on the clinical presentation and the positive Tzanck smear, the patient was diagnosed with herpes simplex barbae, most likely spread by shaving. The patient was started on acyclovir 200 mg p.o. five times daily for 10 days. Oxycodone 5 mg in addition to acetaminophen 325 mg (Percocet; Endo Pharmaceuticals, Chadds Ford, PA) was prescribed for pain relief. A 1:1:1 suspension of viscous lidocaine (Xylocaine; AstraZeneca Pharmaceuticals LP, Wilmington, DE), diphenhydramine (Benadryl; Pfizer Inc., New York, NY), and attapulgite (Kaopectate; Pfizer Inc., New York, NY) was given as a swish and spit to relieve the oral discomfort. Good hygiene, no skin‐to‐skin contact with others, and no further shaving to prevent autoinoculation were stressed. He was advised to discard his old razor.

Multiple folliculocentric vesicles and 2–4 mm crusted erosions on an erythematous base

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Past and Future: Porphyria and Porphyrins
Authors: Norman Robert A.
Published: June 2007

Porphyria is a compelling disease—disrupted enzyme pathways, heightened sensitivities, and a fascinating history tied in with tales of Dracula. This review discusses the history, pathophysiology, classification, and treatment of porphyria. It further discusses the way in which research on the etiologies of the various porphyrias has led to the development of porphyrin‐based photodynamic therapy, which shows great promise in targeted therapy for a variety of serious pathologies.
An Unusual Complication of Erythema Multiforme and Its Treatment
Authors: Yelda Karincaoglu , Basak Kandi Coskun , Muammer Seyhan
Published: June 2007

A 16‐year‐old boy came to our polyclinic complaining of an eruption on the face and limbs. His history showed that, initially, a blistering eruption developed on the side of his nose, which was followed about 10 days later by mildly painful red lesions that showed a pale center (targetoid lesions) on the face, lips, hands, arms, and feet. The patient stated that he had a similar attack about a year ago, when lesions that developed on his lips crusted after the attack and lip adhesions followed. Dermatological examination showed a large number of papules of 0.5–1 cm diameter with an erythematous periphery and a pale erythematous center on the face, ears, forearm, back of the hand, and palm. Some of the papules had purpuric “targetoid” lesions at the center. Lesions on the lips were papulovesicles and vesicles. In addition, there were adhesions on the commissures of both lips, which limited mouth opening to 25 mm. Clustered erosions with a dry surface were seen on the side of his right nostril (Figure 1). Histopathological investigation of the excisional biopsy taken from the forearm revealed necrotic keratinocytes in the epidermis, vacuolization in basal keratinocytes, and subepidermal blistering. The patient was clinically and histopathologically diagnosed as erythema multiforme. Symptomatic treatment was started and oral acyclovir prophylaxis was given to prevent recurrent nasolabial herpes simplex virus infections. The lesions completely resolved in 2 weeks. After 3 weeks, the patient returned for bilateral labial adhesion surgery. Local anesthesia was induced in upper and lower edges of the lips with lidocaine HCl. Adhesions were separated by a lancet, spare tissues were excised, and both sites were sutured by catgut (Figure 2). Total recovery was achieved, and no adhesion recurrence was observed at 1‐month follow‐up.

A large number of papules with an erythematous periphery and a pale erythematous center; adhesion on the edges of both lips

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After treatment

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Cytokeratins and Dermatology
Authors: Jacques Claudio , De Aquino Adriana Moura , Ramos‐e‐Silva Marcia
Published: June 2007

Cytokeratins are fibrous intermediate‐filament protein polymers present in almost all animal cells. Their function is related to epithelium structural maintenance, protection from mechanical trauma, and possibly communication between adjacent cells or cytoplasm components. Today there are 20 known cytokeratins, classified according to their molecular weight and pH as type I or acidic (cytokeratins 9–20) and type II or neutral‐basic (cytokeratins 1–8). Cytokeratins are always expressed in specific pairs for each type of tissue, composed of one unit of type I and one unit of type II. Primary structural defects of cytokeratins are associated with various keratinization impairments. Two of the better characterized defects are bullous epidermolysis and epidermolytic hyperkeratosis. Anti‐cytokeratin monoclonal antibodies are being used for diagnostic purposes to characterize the origin of poorly differentiated tumors and metastatic solid tumors.
Pigmentary Mosaicism of Hyperpigmented Type in Two Sisters
Authors: Ahmad Al Aboud , Khalid Al Aboud , Khalid Al Hawsawi , Daifullah Al Aboud , V. Ramesh
Published: June 2007

A 17‐year‐old girl and her 15‐year‐old sister presented with progressively increasing streaks of reticulate hyperpigmented macules arranged in a whorled pattern over the trunk and extremities (Figure), which appeared soon after birth. The face, palms, soles, eyes, and mucous membranes were spared. Both parents were unrelated Saudis. There was no history of any preceding eruption or any associated systemic abnormality, except for recurrent oral ulcers in both patients for several years. The younger one also had one episode of genital ulcers. Dermatological examination of both parents and the patients' three brothers and one sister were normal with no history of oral ulceration. Examination revealed few aphthous ulcers in either cases, but no joint or eye symptoms. Pathergy testing in both cases was negative. Ophthalmological examination and consultation revealed no signs of Behçet's disease. Routine blood tests did not show any abnormalities. Skin biopsies were taken from pigmented and normal skin in both patients. Histopathological examination of pigmented skin in both cases revealed basal cell hyperpigmentation with pigmentary incontinence. Similar features but in milder form were seen in the biopsies of normal skin in both cases.

Sisters with linear and whorled nevoid hyper‐melanosis

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Community‐Acquired Methicillin‐Resistant Staphylococcus Aureus: Skin Infection Presenting as an Axillary Abscess With Cellulitis in a College Athlete
Authors: Cohen Philip R.
Published: June 2007

A healthy 19‐year‐old black man without any methicillin‐resistant Staphylococcus aureus risk factors developed axillary boils after he began lifting weights at the university gym in Houston, TX. He presented with a large tender erythematous fluctuant abscess of his right axillae and a superiorly located smaller painful red indurated nodule; the surrounding cellulitis extended into the adjacent tissue (Figure). The abscess was incised, drained, and cultured. Empiric treatment with cephalexin 500 mg q.i.d. was given for 7 days. The culture grew methicillin‐resistant S. aureus. Susceptibility testing of the S. aureus isolate was performed by Laboratory Corp. of America (Houston, TX); the Vitek system (Biomerieux, Hazelwood, MO) was used, and the specimen was incubated for 8 hours. Confirmation of methicillin resistance was performed using a methicillin‐resistant S. aureus plate and the specimen was incubated for 24 hours. In addition to resistance to methicillin, the bacterial isolate was also resistant to ciprofloxacin, erythromycin, and penicillin. The S. aureus strain had intermediate susceptibility to levofloxacin and was susceptible to clindamycin, gentamicin, rifampin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin. The infection persisted and the antibiotic was changed to double strength trimethoprim/sulfamethoxazole, taken twice daily for 15 days. In addition, topical care included lesional and intranasal application of mupirocin 2% ointment and daily cleaning of the area with 10% povidone‐iodine liquid soap. The skin infection completely resolved without recurrence within 2 weeks.

The right axilla of a weight lifter shows cutaneous community‐acquired methicillin‐resistant infection presenting as a tender red abscess inferiorly with a painful erythematous nodule superiorly and cellulitis of the adjacent tissue.

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Arthritis and Skin Disease
Authors: Angotti Chiara
Published: June 2007

Skin lesions are frequently a harbinger of an underlying rheumatic disease or may be of great help in achieving the diagnosis of an underlying joint or connective tissue disease. For this reason, the evaluation of the skin is mandatory for the rheumatologist. In fact, the skin is the most accessible organ and often provides valuable diagnostic clues. Pattern recognition of skin lesions is based upon the type, configuration, distribution, and evolution of the lesions; selective laboratory techniques may further assist the diagnosis. This article focuses on the most relevant cutaneous disease in patients with rheumatic disease and emphasizes those characteristic features that will allow the clinician to identify cutaneous lesions that are commonly associated with musculoskeletal syndromes.
Syphilis 2005: Key Issues
Authors: Waugh Michael
Published: June 2007

I have a passion for old medical books. While recently in Vienna, Austria to honor a dermatologist friend, Angelika Stary, I came across an early twentieth‐century copy of Syphilis by the celebrated dermato‐venereologist Ernest Finger (1856–1939). I now regret that I did not have an overwhelming desire to purchase the book at the time, but it served to remind me that syphilis is just as newsworthy as it was 100 years ago.
With This Eruption, There Is Not a Second to Lues
Authors: Steven D. Burdette , Jill S. Waibel , Jack M. Bernstein , Julian J. Trevino
Published: June 2007

A 28‐year‐old white man presented to the Emergency Department with a 24‐hour history of an eruption on his extremities, trunk, and face. The patient was known to be HIV positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. Physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figure 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink‐red oval macules and papules 1–2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin‐Starry and Steiner methods demonstrated spirochetes at the dermal‐epidermal junction and in vessel walls, consistent withTreponema pallidum (Figure 4). Rapid plasma reagin and fluorescentTreponema antibody were both reactive with a Venereal Disease Research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch‐Herxheimer reaction.

Maculopapular eruption on face

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Maculopapular eruption on forearm

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Subsequent palmar eruption

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Spirochetes at dermal‐epidermal junction and in vessel walls, consistent with Treponema pallidum, Warthin‐Starry stain; original magnification × 100

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Condyloma With Lichen Nitidus
Authors: Noah S. Scheinfeld , Daniel Lehman
Published: June 2007

A 32‐year‐old black man presented with two separate eruptions on his penis (Figure). He has had a 10‐year history of asymptomatic 1–3 mm shiny papules on the shaft of his penis. He also has had one asymptomatic verrucous brown plaque 1.5 cm in diameter on his penis. A small shave biopsy was performed for each process. The former showed lymphocytes and histocytes in the papillary dermis in a “ball‐in‐claw” relation to the rete ridges of the epidermis. The latter showed an acanthotic epidermis with papillomatosis. Diagnoses of lichen nitidus and condyloma acuminata were respectively made. As the shiny papules did not bother the patient, but he wanted to be rid of the verrucous plaque, only the latter was treated. Liquid nitrogen was applied to the plaque. The patient was also given podofilox 0.5% gel to apply to the condyloma overnight on Monday, Tuesday, and Wednesday, with a 4‐day respite. This cycle was to be repeated for 3 more weeks. He was examined several more times and treated with cryotherapy and podofilox gel with the near disappearance of the condyloma over 4 months.

Lichen nitidus and condyloma acuminata occurring together on the patient's penis

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Delicate Skin Cutting: Management Beyond the Skin and Implications of Superficial Habitual Self‐Mutilation
Authors: Jesleen Ahluwalia , Eve J. Lowenstein
Published: June 2007

A 16‐year‐old girl accompanied by her mother was noted to have several thin, well healed brown lines on the distal third of her left flexural forearm (Figure). She admits to having recently made these marks by skin cutting. She feels depressed and at times feels life “is not worth living.” She denies alcohol or substance abuse or true suicidal ideation, plan, or intent. Her mother describes her as previously well adjusted and a good student who has become erratic and moody in the past 6 months, with worsening school performance. Her father had a history of depression and alcoholism and died 3 years ago. She is undergoing psychotherapy and pharmacotherapy with sertraline with good results. She has not cut her skin in 3 months. Her mood and behavior have improved.

Distal forearm with hyperpigmented linear scars from delicate skin cutting

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Skin Disease in a Primary Care Practice
Authors: Sari Fieri , Brian Berman , Brian Magrane
Published: June 2007

Objective. Family medicine physicians treat a large amount of skin disease. Yet, information is lacking regarding which dermatologic disorders are more likely to present to a family medicine physician. Therefore, we performed a chart review at a family medicine private practice in Islamorada, FL, to determine the percentage of patients presenting with dermatologic disease and to identify the most common diseases encountered.

Discussion. On 12 office days in May 2004 to June 2004, 21% of patients seen by a family medicine physician had at least one skin problem, which was the chief complaint 72.2% of the time.

Conclusions. Infectious etiology and inflammatory conditions accounted for the majority of skin disease diagnosed by the physician. Geography and demographics are of great importance when considering which dermatologic diseases are most likely to present to a given physician.
Derm Lite II: An Innovative Por Table Instrument for Dermoscopy Without the Need of Immersion Fluids
Authors: Peter Arrazola , Nizar A. Mullani , William Abramovits
Published: June 2007

The DermLite II is an improvement on a previous instrument allowing for dermoscopy to be carried out without the need of immersion oil. It consists of a magnifying lens encircled by light‐emitting diodes that can be adjusted for polarization or can be customized by the manufacturer to produce colors of specific wavelengths for visualizing pigmentation and structures of various dermal depths. This new version of the DermLite makes it very convenient for the evaluation of not just pig‐mented lesions, but nonpigmented skin cancers, scalp disease, and vascular patterns. It can be attached to a camera to record images and has a retractable faceplate for use with immersion oil.
Cheilitis Glandularis in an African‐American Woman: Response to Antibiotic Therapy
Authors: Matthew M. Bender , Melissa Rubenstein , Ted Rosen
Published: June 2007

A 52‐year‐old black woman presented with a 2‐day history of lower lip swelling 5 days after starting a new medication, lisinopril. She had never experienced similar episodes in the past. She denied shortness of breath, tightening of the throat, swelling of the tongue, generalized cutaneous eruption, urticaria, or pruritus. She also denied symptoms consistent with facial paresis. Her past medical history was significant for hepatitis C infection, coronary artery disease, and hypertriglyceridemia. She had a 15 pack‐year smoking history and denied both alcohol and drug abuse. She had never received a blood transfusion and was HIV negative. Physical examination disclosed a tender, swollen, and erythematous lower lip with induration, oozing, and crusting (Figure 1). Pinpoint openings evident throughout the lip surface exuded a clear, sticky, mucoid secretion. Tongue, parotid glands, and regional lymph nodes were normal. The working diagnosis was angioedema secondary to lisinopril. The presumptive offending drug was discontinued, and conservative therapy (topical clobetasol ointment, oral ranitidine, and oral fexofenadine) was initiated. Despite treatment, signs and symptoms persisted unabated. One week after initial presentation, a punch biopsy of her lower lip was taken to rule out granulomatous cheilitis and sarcoidosis. Histopathology included diffuse lymphohistiocytic infiltrate, minimal microabscess formation, and notable absence of granulomata. There was neither hypertrophy nor detectable abnormality of the salivary glands, with the exception of infiltrating mononuclear cells. Based on the clinical history and compatible pathologic findings, a diagnosis of cheilitis glandularis was made. Specifically, crusting and erosion clinically suggested a diagnosis of the superficial suppurative subtype of cheilitis glandularis. The patient received oral penicillin (dicloxacillin, 1.0 g/d) combined with oral fluoroquinolone (ciprofloxacin, 1.0 g/d). Within 2 weeks of starting the antibiotics, the lip swelling significantly decreased (Figure 2) and the patient was left with a mildly indurated nodule at the labial commissure. Following a 4‐week course of continued antibiotic treatment, the lip returned to near baseline state. At both 6‐month and 1‐year follow‐up visits, the lip remained normal.

Lip at the time of initial presentation. Note marked swelling and crusting

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Lip after 2 weeks of antibiotic therapy

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Photoprotection in Adolescence
Authors: Cristiane Benvenuto‐Andrade , Tania Ferreira Cestari , Mota Adriana , Poziomczyk Claudia , Marcia Ramos‐e‐Silva
Published: June 2007

Physical changes and the establishment of personal values are characteristics of adolescence. Despite being well informed regarding sun protection and the skin cancer risks related to sun exposure, teenagers usually make little use of sunscreens and remain out in the sun for long periods. Besides the social appeal and the impression that a nice tan provides a healthy appearance, the tendency to deny long‐term risks seems to influence sun exposure behaviors in this life period. Due to the strong relation between skin cancer and sun exposure in childhood and adolescence, it is important to encourage the adoption of photoprotection measures early in life. Adolescents have difficulty accepting guidance through official educational messages, and very few of them follow family recommendations. Celebrities, fashion, and the entertainment industry exert a greater influence on their choices. Thus, it is fundamental to incorporate photoprotection counseling into the medical routine, in an adolescent‐driven way. This article reviews peculiarities of sun protection in adolescence and discusses the type of advice to be given to patients in this age group.
Improvement in Psoriasis With Rosiglitazone in a Diabetic and a Nondiabetic Patient
Authors: Harrihar A. Pershadsingh , Stephen C. Benson , Charles N. Ellis
Published: June 2007

The authors conducted a prospective, open‐label, pilot trial of the effects of the antidiabetic thiazolidinedione (TZD) rosiglitazone in two patients with moderate to severe plaque psoriasis. Case 1: A lean, euglycemic 43‐year‐old nondiabetic man with a 2‐year history of plaque psoriasis presented with lesions involving 10% of his body surface (Figures 1A, 1B, 1C). He had no other chronic or acute medical problems. He had previously been managed sporadically with topical triamcinolone acetonide, an intermediate‐strength glucocorticoid, and was off antipsoriatic medication for 5 months. He was started on rosiglitazone p.o., 8 mg q.d. After 10 weeks on rosiglitazone, the lesions developed increased erythema, spreading, and shedding of scale (Figures 2A, 2B, 2C). After an additional 26 weeks, the lesions had largely disappeared (Figures 3A, 3B, 3C). The patient remained euglycemic throughout the study. His liver function enzymes (alanine transferase [ALT] and aspartate transferase [AST]) remained normal throughout the study: ALT, 23 IU/L; AST, 47 IU/L before treatment; ALT, 25 IU/L; AST, 33 IU/L after treatment. There were no adverse events. Case 2: An overweight 68‐year‐old woman (body mass index, 29 kg/m2; with a 12‐year history of type 2 diabetes and 5‐year history of psoriasis presented with generalized plaque psoriasis over 20% of her body, including two large, thick, silvery plaques with the texture of leather over the lower part of the back (Figure 4A). She was given rosiglitazone p.o., 4 mg b.i.d. for 24 weeks, which resulted in significant improvement in psoriasis (Figure 4B). After an additional 26 weeks on rosiglitazone, the plaques had cleared on her back (Figure 4C) and over her entire body, including scalp, ears, and posterior forearms (not shown). Her glycemic control improved (hemoglobin A1c decreased from 7.7% to 7.2%) and liver function remained normal throughout the study (ALT, 24 IU/L; AST, 14 IU/L before treatment; and ALT, 26 IU/L; AST, 15 IU/L after treatment). There were no adverse events.

Oral administration of rosiglitazone (4 mg twice daily) improved large psoriatic plaque lesions on the thoracolumbar region of the back in a patient with longstanding type 2 diabetes. A) Before therapy; B) after 24 weeks of therapy with rosiglitazone; C) after an additional 26 weeks' therapy.

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Cosmeceuticals: Separating Fact From Voodoo Science
Authors: Thornfeldt Carl R.
Published: June 2007

The number of cosmeceutical companies, products, and ingredients has been exploding since the advent of retinoids and hydroxy acids. The clinical effects of these two classes of compounds proved that nonprescription topically applied products could produce visible improvement in one or more signs of extrinsic aging. Simply mixing any ingredient into a topical formulation and then applying it does not ensure clinical success. The complexity of the skin does not allow it in most cases. This discussion will include the requirements for an effective product and how to document efficacy and safety. The evidence base of marketed cosmeceutical products presented in major English language forums will be presented. Moreover, it will provide a framework for how to distinguish fact from fiction in today's slick marketing campaigns.
Activation of human platelet‐rich plasmas: effect on growth factors release, cell division and in vivo bone formation
Authors: Roussy Yanik , Bertrand Duchesne Marie‐Pierre , Gagnon Guy
Published: June 2007

Objectives: Aims of this controlled study were to determine the effects of activated human platelet‐rich plasmas (PRPs) on early and mature bone formation in vivo, and to characterize the effect of PRP activation on growth factors release and endothelial cell division in vitro.

Material and methods: PRPs were prepared from four volunteers with the platelet concentrate collector system (PCCS) system and activated with three concentrations of calcium and thrombin. Platelet‐derived growth factor (PDGF)‐BB, vascular endothelial growth factor (VEGF), transforming growth factor β (TGF‐β) and interleukin‐1β (IL‐1β) levels released in supernatants were measured by ELISA, at time 0, 1h, 24h and 6 days following PRP activation. Mitogenic potential of PRP supernatants were tested on endothelial cells in vitro, and the effects of activated human PRPs on bone formation in vivo were measured in athymic rats by micro‐CT analyses.

Results: Activation of PRPs with calcium and thrombin triggered an immediate release of VEGF, PDGF‐BB and TGF‐β and a delayed release of IL‐1β in PRP supernatants. Higher endothelial cell division was observed with supernatants from activated PRPs than from non‐activated PRPs. Positive correlations were observed between VEGF levels and endothelial cell division and bone formation. A negative correlation was also found between PDGF‐BB concentration and bone formation. However, early and mature bone formations with activated PRPs did not significantly differ from the ones obtained in the control group.

Conclusions: Activation of PRPs with calcium and thrombin regulates growth factors release and endothelial cell division in vitro. However, activated PRPs does not improve the early or mature bone formations in vivo in this athymic rat model.
CVAK104 is a Novel Regulator of Clathrin‐mediated SNARE Sorting
Authors: Borner Georg H. H. , Rana Amer A. , Forster Rebecca , Harbour Michael , Smith James C. , Robinson Margaret S.
Published: June 2007

Clathrin‐coated vesicles (CCVs) mediate transport between the plasma membrane, endosomes and the trans Golgi network. Using comparative proteomics, we have identified coated‐vesicle‐associated kinase of 104 kDa (CVAK104) as a candidate accessory protein for CCV‐mediated trafficking. Here, we demonstrate that the protein colocalizes with clathrin and adaptor protein‐1 (AP‐1), and that it is associated with a transferrin‐positive endosomal compartment. Consistent with these observations, clathrin as well as the cargo adaptors AP‐1 and epsinR can be coimmunoprecipitated with CVAK104. Small interfering RNA (siRNA) knockdown of CVAK104 in HeLa cells results in selective loss of the SNARE proteins syntaxin 8 and vti1b from CCVs. Morpholino‐mediated knockdown of CVAK104 in Xenopus tropicalis causes severe developmental defects, including a bent body axis and ventral oedema. Thus, CVAK104 is an evolutionarily conserved protein involved in SNARE sorting that is essential for normal embryonic development.
Examples for the importance of radiophysical measurements in clinical phototherapy
Authors: Schneider Lars Alexander , Wlaschek Meinhard , Dissemond Joachim , Scharffetter‐Kochanek Karin
Published: June 2007

Background: Optimal UV therapy requires regular surveillance of the variables that influence therapeutic success. In daily practice, phototherapy equipment is often operated with an attitude of “autocontrol.” This implies that thorough control measurements of the emission spectra and calibration of UV fluences are not routinely performed. For both quality control and patient safety, it is essential to regularly check whether a UV source is providing the right target spectrum with the correct dose to the skin.

Methods: We have exemplarily taken three UV sources currently used in clinical practice and performed radiophysical measurements, i. e. determined emission spectra, radiation output and correctness of dose calculation.

Results: All three sources revealed either a largely inhomogeneous distribution pattern of radiation intensity, variation of radiation intensity over time or insufficient filtering of the UV lamp emission spectrum. Furthermore the dose calculation procedures had to be revised because of significant differences between the estimated and the administered UV doses.

Conclusions: Radiophysical measurement of all UV‐equipment in clinical use is a simple and effective way to improve the safety and reliability of phototherapy. Such measurements help to uncover technical flaws in radiation sources and prevent unnecessary side effects and UV exposure risks for the patient.
Shampoos: Ingredients, efficacy and adverse effects
Authors: Trüeb Ralph M.
Published: June 2007

Shampoos are the most frequently prescribed treatment for the hair and scalp. The different qualities demanded from a shampoo go beyond cleansing. A cosmetic benefit is expected, and the shampoo has to be tailored to variations associated with hair quality, age, hair care habits, and specific problems related to the condition of the scalp. The reciprocal relationship between cosmetic technology and medical therapy is reflected in the advances of shampoo formulation that has made applications possible that combine benefits of cosmetic hair care products with efficacy of medicinal products. A shampoo is composed of 10 to 30 ingredients: cleansing agents (surfactants), conditioning agents, special care ingredients, and additives. Since the cleansing activity depends on the type and amount of surfactants utilized, shampoos are composed of a blend of different surfactants, depending on the requirements of the individual hair type. Development time from the concept to the commercial shampoo may take longer than a year. Much effort is invested in the development of conditioning agents, which impart luster, smoothness, volume and buoyancy. Another prerequisite is a scalp free of scaling. Current anti‐dandruff agents primarily have an antimicrobial mode of action, and inhibit growth of Malassezia spp. Recent developments in shampoo technology have led to increased efficacy of anti‐dandruff agents, allowing shorter contact time, and reducing irritation.
Comparative Development of Lint and Fuzz Using Different Cotton Fiber‐specific Developmental Mutants in Gossypium hirsutum
Authors: Zhang Da‐Yong , Zhang Tian‐Zhen , Sang Zhi‐Qin , Guo Wang‐Zhen
Published: June 2007

A series of fiber‐specific mutants, or germplasms, have been recently used in the study of fiber development. In the current study, scanning electron microscopy (SEM) was used to investigate developmental differences in lint and fuzz initiation in different genotypes (Gossypium hirsutum) of upland cotton. These fiber mutants included dominant naked seed N1, recessive naked seed n2, Xuzhou‐142 lintless‐fuzzless (XZ142WX), Xinxiangxiaojilintless‐fuzzless (XinWX), Xinxiangxiaojilinted‐fuzzless (XinFLM), with TM‐1, the cytogenetic and genetic experimental standard stock, as the control. Characteristics of fiber initiation were analyzed from –1 to +1 days post anthesis (dpa) and at 4 and 5 dpa for fuzz initiation. Our data suggested that lint initiation centered on day of anthesis (0 dpa), and elongated significantly at 1 dpa, while fuzz initiation began at 4 dpa, although the shape of fuzz protrusions differed from that of lint fibers. Fiber initiation occurred first on the ovule funicular crest. Compared to TM‐1, there was a noted retardation in development and fiber protrusion in N1 and XinFLM. Microscopy data also demonstrated that lintless‐fuzzless mutants (XZ142WX and XinWX) developed irregular protrusions during early developmental stages, which were unable to grow into fiber.
Effect of Salinity on the Composition, Number and Size of Epidermal Cells along the Mature Blade of Wheat Leaves
Authors: Hu Yuncai , Schmidhalter Urs
Published: June 2007

Salinity inhibits leaf growth in association with changes in cell size. The objective of this study was to determine the spatial distributions of the composition, number and dimensions of epidermal cells in the mature blades of leaf four of wheat seedlings under saline conditions. Plants were grown in loamy soil either with or without 120 mmol/L NaCl in a growth chamber, and harvested after leaf four was fully developed. The results of the spatial distribution analyses of width along the blade showed that salinity not only reduced the width of the leaf blade, but that it also altered the distribution pattern of blade width along the leaf axis. The reduction in the final size of the leaf blade was associated with a reduction in the total number of epidermal cells and in their widths and lengths. This study also revealed the spatial effects of salinity on the blade and epidermal cell dimensions along the leaf axis. In particular, salinity inhibited the total cell number for interstomatal, sister and elongated cells, implying that cell division in wheat leaves is inhibited by salinity. However, the lengths of interstomatal cells were not affected by salinity (unlike those for the sister and elongated cells), suggesting the relative contributions of cell length and numbers to the reduction in the final length of the blade under salinity is dependent on cell type.
Terpenoid Indole Alkaloids Biosynthesis and Metabolic Engineering in Catharanthus roseus
Authors: Liu Dong‐Hui , Jin Hong‐Bin , Chen Yu‐Hui , Cui Li‐Jie , Ren Wei‐Wei , Gong Yi‐Fu , Tang Ke‐Xuan
Published: June 2007

Catharanthus roseus L. (Madagascar periwinkle) biosynthesizes a diverse array of secondary metabolites including anticancer dimeric alkaloids (vinblastine and vincristine) and antihypertensive alkaloids (ajmalicine and serpentine). The multi‐step terpenoid indole alkaloids (TIAs) biosynthetic pathway in C. roseus is complex and is under strict molecular regulation. Many enzymes and genes involved in the TIAs biosynthesis have been studied in recent decades. Moreover, some regulatory proteins were found recently to control the production of TIAs in C. roseus. Based on mastering the rough scheme of the pathway and cloning the related genes, metabolic engineering of TIAs biosynthesis has been studied in C. roseus aiming at increasing the desired secondary metabolites in the past few years. The present article summarizes recent advances in isolation and characterization of TIAs biosynthesis genes and transcriptional regulators involved in the second metabolic control in C. roseus. Metabolic engineering applications in TIAs pathway via overexpression of these genes and regulators in C. roseus are also discussed.
Lanthanum Prevents Salt Stress‐induced Programmed Cell Death in Rice Root Tip Cells by Controlling Early Induction Events
Authors: Li Jian‐You , Jiang Ai‐Liang , Chen Hai‐Yan , Wang Ying , Zhang Wei
Published: June 2007

In a previous study, a salt stress‐induced programmed cell death (PCD) model was established in rice root tip cells. Here, by using Wuyunjing 8th rice seedlings, the effects of lanthanum on salt stress‐induced PCD early events were studied. The results indicated that low concentrations (10 μmol/L), but not high concentrations (100 μmol/L) of LaCl3 could effectively prevent salt stress‐induced PCD. Further study demonstrated that in the early stages of salt‐induced PCD process, 10 μmol/L of La3+ could prevent the increase of cytoplasmic calcium levels, inhibit reactive oxygen species (ROS) production, and enhance the ROS‐scavenging enzyme activities such as superoxide dismutases (SOD) and ascorbate peroxidase (APX). Imidazole (20 mmol/L), the inhibitor of nicotinamide adenine dinucleotide phosphate‐oxidase (NADPH oxidase), could alleviate the occurrence of PCD obviously, and such alleviation could be enhanced by the addition of La3+, indicating the involvement of NADPH oxidase in the salt stress‐induced PCD process. Taken together, lanthanum could prevent salt stress‐induced PCD occurrence in the rice root tip cells by blocking the calcium influx under stress, which was followed by inhibiting calcium‐dependent NADPH oxidase activity to prevent O2 •− production and, enhancing the cytosolic antioxidative enzyme activities to scavenge the reactive oxygen species.
Two‐Dimensional Electrophoretic Analysis of Soluble Leaf Proteins of a Salt‐sensitive (Triticum aestivum) and a Salt‐tolerant (T. durum) Cultivar in Response to NaCl Stress
Authors: YILDIZ Mustafa
Published: June 2007

In this research, 3‐day‐old etiolated wheat seedlings of Triticum aestivum L. cv. Ceyhan‐99 (salt‐sensitive) and T. durum Desf. cv. Fırat‐93 (salt‐tolerant) were grown in control and salt (150 mmol/L NaCl) treatments at a 15/25 °C temperature regime in the light for 12 days. Soluble proteins extracted from the first leaf tissues of two cultivars were analyzed by two‐dimensional (2‐D) electrophoresis in order to detect NaCl‐induced changes. The soluble leaf protein profiles of cultivars were observed to be similar. However, quantitative differences in 74 proteins were detected in the salt treatment group, compared to the control. Among the 74 protein spots, 14 were common for two cultivars. As a result of NaCl treatment, two low‐molecular‐weight (LMW) proteins (28.9 and 30.0 kDa) and one intermediate‐molecular‐weight (IMW) protein (44.3 kDa) in cv. Ceyhan‐99 and six LMW proteins (18.6, 19.4, 25.7, 25.9, 26 and 27.6 kDa) in cv. Fırat‐93 were newly synthesized. The newly synthesized proteins were specific to each cultivar. In the Fırat‐93 cultivar, four proteins with LMW (24.8–27.9 kDa) were completely lost in NaCl treatment. Moreover, these four protein spots were not observed in both protein profiles of cv. Ceyhan‐99. Most of these proteins were in acidic character (pl <6.0–6.9) and low molecular weight (<31.6 kDa). It is suggested that the newly synthesized or completely lost LMW proteins may be important for cultivars differing in sensitivity towards NaCl.
RNA Interference‐mediated Silencing of Phytochelatin Synthase Gene Reduce Cadmium Accumulation in Rice Seeds
Authors: Li Jiang‐Chuan , Guo Jiang‐Bo , Xu Wen‐Zhong , Ma Mi
Published: June 2007

Phytochelatins (PCs) play an important role in heavy metal resistance and accumulation. To reduce the accumulation of cadmium (Cd) in rice seeds, the expression of phytochelatin synthase (PCS) gene OsPCS1 was suppressed by RNA interference (RNAi). A hairpin construct of a PCS fragment was designed in the pRNAi‐OsPCS1 under the control of ZMM1, a seed‐specific promoter from maize. The construct was introduced into rice (japonica) through Agrobacterium tumefaciens. The RNAi rice plantlets were selected and cultivated in pots exposured to 10 mg/kg Cd. The transcriptional level of OsPCS1 declined in seeds of some RNAi rice compared to the wild type. As a result Cd accumulation was reduced by about half in the seeds of RNAi rice. As expected, no apparent difference of growth appeared between RNAi and wild‐type plants. The results suggest that this new approach can be used to control heavy metal accumulation in crops.