bluuebunny/crossref_metadata_2025 huggingface dataset:
TUBERCULOSIS VERRUCOSA CUTIS ASSOCIATED WITH LUPUS VULGARIS
Authors: PRAMATAROV KYRILL , BALABANOVA MARIA , MITEVA LIUBKA , GANTCHEVA MERY
Published: May 2007

A 68‐year‐old peasant had an 8‐year history of tuberculosis verrucosa cutis. After an injury the patient developed a pustule, which extended slowly and formed a plaque. New lesions appeared and increased in number and size. He was treated with various antibiotics without any significant effect. Three months previously a dull‐red plaque developed on the chin without any complaints from the patient.

The patient denied any history of tuberculous infection. The examination of the left foot revealed a verrucous plaque over the medial surface. There were firm, raised, and verru‐cous papules, which exuded yellow pus. Similar lesions were present on the edge of the sole. The plaque was re‐stricted by a margin of crusted papules. The affected nails were thick, keratotic, and damaged (Fig. 1). On the skin of the chin a single lesion was present, 1 × 2 cm in size, flat, irregular, dull‐red in color and firm, without any secretion or accompanying symptoms (Fig. 2).

Histology from the lesion of the foot revealed: necrosis in the superficial stratum corneum with numerous spongio‐form pustules around and beneath the necrotic areas; marked acanthosis reaching pseudocarcinomatous hyperplasia and papillomatosis; and pronounced mononuclear infiltrate without tuberculid structures. Ziehl‐Neelsen staining for mycobacteria was negative (Fig. 3).

Histology from the lesion of the skin revealed: crusted parakeratosis and acanthosis and pronounced band‐like infiltrate in the upper and middermis with well‐formed tuberculoid structures and numerous giant cells. In the deep dermis the infiltrate was predominantly perivascular and periadnexial with tuberculoid structures in some areas. The collagen bundles were hyalinized (Fig. 4). The fluorescent staining with auramine revealed mycobacteria. (Fig. 5).

The routine laboratory findings were within the normal limits except for a mild elevated ESR of 45 mm. Mantoux‐test with 10 Ul of PPD showed induration with purple red surface (Fig. 6). The patient was x‐rayed, but another tuberculous focus could not be detected. Treatment with isoniazid and rifampin was applied with rapid results (Fig. 7).
CIGARETTE PAPER ATROPHY
Authors: ISSAC FLORENCE
Published: May 2007

A 40‐year‐old West African woman was referred to me with a 12‐month history of an asymptomatic patch over the right loin that had been gradually increasing in size. The patient was otherwise in good health, and the family history was negative. The lesion was linear, 7 cm long and 4 cm wide, porcelain‐white, well‐demarcated, and had a raised hyperpigmented border. The overlying skin was atrophic and wrinkled (Fig. 1). The patch also showed a central depression and a few dilated pilosebaceous duct orifices. She had no lesions elsewhere on her body. Laboratory studies showed no particular abnormalities. Histopathologic examination showed thinning of the epidermis, hyperkeratosis, and prominent follicular plugs. There was a band of hyalinized collagen below the epidermis and a zone of lymphocytic infiltrate below the zone of hyalinization. The above histopathologic features were highly diagnostic of lichen sclerosis et atrophiens (LSA).
LEPROSY IN CHILDREN: A PROSPECTIVE STUDY
Authors: SEHGAL VIRENDRA N. , CHAUDHRY ANUP K.
Published: May 2007

Background. Leprosy has been identified as an important health problem in the pediatric age group. The study of leprosy in children is imperative as it may unravel the missing links in the natural evolution of the disease and dispel the uncertainty of the precise incubation period.

Methods. The study was undertaken on patients attending the Urban Leprosy Centre. There were 161 children in the age group of 0 to 14 years, amongst 3184 cases of leprosy, detected between 1981 and 1991. The diagnosis in each was formed after meticulously recording the clinical features, slit‐skin smear examination, and histopathologic characteristics. In addition, a detailed history of duration of the disease was elicited by complement recall method.

Results. The study revealed an incidence of 5.06% amongst leprosy patients, in an urban setting. The boys:girls ratio was 2.6:1. The mean duration of the disease was 1.2 years in paucibacillary and 2.8 years in multibacillary. History of intra‐ or extrafamilial contact was elicited in 8.7%. The typical lesion was a “hypopigmented macule,” either of indeterminate, tuberculoid, borderline tuberculoid, or borderline borderline leprosy. Borderline lepromatous, lepromatous, and polyneuritic leprosy were uncommon.

Conclusions. Leprosy in children is a well‐established distinct entity. Any hypopigmented macule in pediatric age group should arouse suspicion of leprosy. The diagnosis is clinical. Other investigative parameters, namely slit‐skin smear, and histopathology may supplement but not supplant the diagnosis.
ERUPTIVE SYRINGOMA IN A CHINESE BOY
Authors: AKARAPHANTH RUTSANEE , GIAM Y.C.
Published: May 2007

An 8‐year‐old Chinese boy was referred to the National Skin Centre (NSC) for evaluation of multiple white asymptomatic papules of 2 weeks duration. These lesions appeared suddenly on the face, neck, trunk, and extremities. There was no family history of a similar papular eruption. He was otherwise in good health.

Physical examination revealed numerous discrete whitish domeshaped papules measuring 1 to 2 mm in diameter. These were of a bilateral and symmetrical distribution on the lower eyelids, posterior auricular area, neck, dorsal and ventral aspects of the arms (Figs. 1 and 2) and legs, chest, abdomen, and back. Most of the lesions were soft, some firm, smooth surfaced, noncrusted papules. Our first impressions were epidermal cyst, lichen nitidus, milia, histocytic lesion, or rare case of eruptive syringoma.

The first skin biopsy was done from a firm papule on the right arm. Hematoxylin and eosin staining revealed cystic structures filled with bluish material in the upper dermis and a few basophilic epithelial cords in the surrounding connective tissue stroma. Von Kossa stain showed the presence of calcium in the cyst.

On the second visit, we noticed new crops of papular lesions, which were smaller and softer than previous ones. The second biopsy was done from the right forearm, at this time we saw basophilic cells in cords and in tadpole‐like configuration with a normal connective tissue stroma; this confirmed syringoma (Fig. 3).
AMOXICILLIN AND CLAVULANIC ACID IN THE TREATMENT OF ACTINOMYCETOMA
Authors: GOMEZ ALBERTO , SAUL AMADO , BONIEAZ ALEJANDRO , LOPEZ MAVI
Published: May 2007

Background. Mycetoma is a relatively frequent disease in tropical countries. Drugs commonly used need a long period of treatment, and some cases are resistant to these drugs, especially those with bone or visceral involvement. The combination of amoxicillin‐clavulanic acid has shown effectiveness against strains of Nocardia brasiliensis in vitro.

Methods. We have used this combination in two cases of mycetoma caused by N. brasiliensis, both with bone involvement and resistance to the drugs usually used. A dose of three tablets a day for 5 to 6 months was given (each tablet contains 500 mg of amoxicillin and 125 mg of clavulanic acid).

Results. Clinical and mycologic amelioration was observed in the two cases after completing the treatment. There were no side effects or relapses after 3 to 6 months of follow‐up after treatment.

Conclusions. We propose this antibiotic as a new option for the treatment of some special cases of actinomycetoma with bone or visceral involvement or resistance to the drugs commonly used in this disease.
CORRESPONDENCE
Authors: GOIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange ahout subjects of general in‐terest 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. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M–154, P.O. Box 020010, Miami, FL 33 102.
MYCOBACTERIUM MARINUM CUTANEOUS INFECTIONS ACQUIRED FROM OCCUPATIONS AND HOBBIES
Authors: KULLAVANIJAYA PREYA , SIRIMACHAN SUPRIYA , BHUDDHAVUDHIKRAI PRECHA
Published: May 2007

Background. Nontuberculous mycobacterial (NTB) infections are not commonly diagnosed in Thailand. The dissertation of reported cases among 10 published reports of 44 cases within 20 years revealed only six cases of cutaneous infections in which M. marinum was not included.

Methods. The proven cases of M. marinum infection were studied at the Institute of Dermatology, Bangkok from 1981 to 1990. The clinical data, histopathology, tuberculin test, chest x‐ray, and treatments were recorded.

Results. M. marinum skin infection accounted for 18 cases (81.8% of NTB skin infection), 10 men and 8 women. A history of preceding trauma occurred in 11 cases (61.1%), most of which were negligible wounds or minor abrasions. Twelve cases (66.7%) were in contact with organisms in their occupations and hobbies associated with fish and water exposure.

Conclusions. Eighteen cases of M. marinum cutaneous infection acquired from occupations and hobbies were reported. The term “M. marinum cutaneous infection” or “M. marinum granuloma” instead of swimming pool granuloma or fish tank granuloma was proposed. According to this study, cotrimoxazole was the most appropriate drug for the treatment of M. marinum cutaneous infection.
CONCURRENT HPV‐16 INFECTION OF THE NIPPLE AND PERI ANAL AREA IN AN HIV‐1+ PATIENT
Authors: SMITH LTC KATHLEEN J. , SKELTON CDR HENRY G. , HAWKS LTC CLIFFORD , YEAGER CDR JOSEF , WAGNER KENNETH F.
Published: May 2007

Background. In patients with HIV‐1 disease there has been an increasing association with human papilloma virus (HPV) infections in multiple locations as well as an increase in associated tumors. In addition, there has been increased recovery of HPV in individuals with decreasing T4 cell counts.

Case Report. Recently we have seen an HIV‐I+ patient with a cutaneous lesion on the nipple, as well as multiple perianal lesions in which HPV‐16 was demonstrated by in‐situ hybridization. Although these lesions contained the same subtype of HPV virus, they had very different clinical and histopathologic morphologies, and this represents the first reported association of HPV‐16 in a nipple lesion.

Discussion. Our patient illustrates that in HIV‐I disease, HPV infections may present in more diffuse and atypical locations. In addition, the diffuse staining with the in‐situ probe for HIV‐16 within the lesions, tends to support the findings of others, that viral recovery increases with the immune suppression induced by HIV‐I.
MULTIPLE AGMINATED PIGMENTED SPITZ NEVI (MIMICKING ACRAL LENTIGINOUS MALIGNANT MELANOMA AND DYSPLASTIC NEVUS) IN AN AFRICAN‐AMERICAN GIRL
Authors: ABRAMOVITS WILLIAM , GONZALEZ‐SERVA ALDO
Published: May 2007

Background. Reed's nevi are distinguished from Spitz tumors by their significant melanogenesis and growth pattern. They may be confused with melanoma on clinical and histologic grounds.

Case Report. An unsual case in which multiple agminated Reed's nevi mimicked acral lentiginous malignant melanoma in an African‐American girl is presented. A critical review of the literature is presented to assist in the diagnosis.

Conclusions. Awareness of this entity and of its possible clinical presentations and judicious application of conventional hematoxylin‐eosin microscopic criteria remain the most useful methods to bring the correct diagnosis in most instances. Mutilating or excessive surgery may be avoided for most cases of pigmented spindle and epithelioid cell nevus.
PERIPHERAL BLOOD LYMPHOCYTE IMBALANCE IN KOREANS WITH ACTIVE VITILIGO
Authors: HANN SEUNG KYUNG , PARK YOON‐KEE , CHUNG KEE‐YANG , KIM HYUNG IL , IM SUNGBIN , WON JIN HYUNG
Published: May 2007

Background. An immune‐mediated destruction of melanocytes is the most popular current theory of vitiligo. There have been a few published reports on the assessment of lymphocyte population in vitiligo, and they showed mixed results. The purpose of our investigation was to assess peripheral lymphocyte subpopulations in Koreans with actively spreading vitiligo.

Methods. Fifty patients with actively spreading vitiligo and 30 normal persons were studied for peripheral blood lymphocyte imbalance using flow cytometry. The percentages of total T‐lymphocytes, B‐lymphocytes, helper T cells, suppressor T cells, and natural killer cells were evaluated with the use of CD3, CD19, CD4, CD8, and CD16 monoclonal antibodies, respectively.

Results. The mean value of helper T cells showed a significant difference between the two groups with the value being 38.2% in patients and 43.5% in control subjects. Seventeen of the 50 patients showed reversed helper/suppressor T cell ratio, whereas only 1 of 30 control subjects showed reversed ratio. There was a statistically significant difference in the mean percentage of helper T cells and suppressor T cells between generalized vitiligo patients and control subjects. The percentage of B cells in patients with recent onset less than 1 year was higher than control subjects and patients with late onset. The mean percentage of natural killer cells was increased significantly in patients with negative autoantibody test.

Conclusions. The present data show that immunologic abnormalities, both cellular and humoral, are involved in the pathogenesis of vitiligo.
MARGIN ASSESSMENT OF SELECTED BASAL CELL CARCINOMAS UTILIZING LASER DOPPLER VELOCIMETRY
Authors: KIRSNER ROBERT S. , HAIKEN MICHAEL , GARLAND LARRY D.
Published: May 2007

Background. Basal cell carcinomas (BCC) have increased vasculature, therefore, blood flow within the tumor may be greater than normal surrounding skin. We attempted to detect the difference in blood flow between the tumor and uninvolved surrounding skin utilizing laser doppler velocimetry (LDV).

Methods. Ten patients with 14 BCC were studied. Using LDV, we calculated the size of the tumor based on margin assessment as predicted by the measured difference in blood flow and compared this size with the clinically predicted size and the size of the defect after Mohs micro‐graphic surgery (MMS).

Results. Clinical evaluation of tumor size prior to MMS did not correlate with the size of the surgical defect after MMS; however, correlation was found between the predicted size of the tumor as determined by LDV and the defect after MMS.

Conclusions. Tumor size of BCC as predicted by measured differences in blood flow using LDV correlated with the size of the surgical defect after MMS. This suggests that LDV was able to detect the difference in blood flow between the tumor and uninvolved surrounding skin.
INTRALESIONAL TREATMENT OF CUTANEOUS LEISHMANIASIS WITH SODIUM STIBOGLUCONATE ANTIMONY
Authors: PARIS RAJAB M. , JARALLAH JAMAL S. , KHOJA TAWFIK A. , AL‐YAMANI MOHAMMAD J.
Published: May 2007

Background. Cutaneous leishmaniasis represents a difficult disease to manage in endemic areas. Systemic treatment is hampered by both expense and compliance. Side effects may play a major role in this aspect as well.

Methods. The effectiveness of intralesional treatment of leishmaniasis was investigated. Seven hundred and ten patients were treated with injections of sodium stibogluconate intralesionally. The clinical diagnosis was confirmed by demonstrating the parasite in the smears obtained from the lesion. Fine insulin needle was used to infiltrate the lesion with sodium stibogluconate (0.5 to 1.0 ml).

Results. Generally eight injections were sufficient, but some of the complicated lesions needed up to 24 injections. Sixty‐two percent of patients were men. The majority of the study population (64%) were children below 15 years of age. The results showed that 72% of lesions healed completely, 23.9% showed some improvement, while 4.1% showed some deterioration. Lesions of the lips, cheeks, chin, and neck healed faster than lesions in other parts of the body. Side effects were mild and limited to pain at the site of the injection and hyperpigmentation in those who were treated by folk medicine.

Conclusions. Intralesional treatment is as effective as the standard systemic antimonials. It offers a less expensive alternative and a low side effects profile. Our findings confirmed the findings of earlier workers. It is recommended for treatment of cutaneous leishmaniasis in endemic areas.
NEUROPEPTIDES IN PSORIASIS: POSSIBLE ROLE OF BETA‐ENDORPHIN IN THE PATHOMECHANISM OF THE DISEASE
Authors: GLINSKI WIESLAW , BRODECKA HALINA , GLINSKA‐FERENZ MARIA , KOWALSKI DARIUSZ
Published: May 2007

Background. An increased concentration of neuropeptides in psoriatic lesional skin may be responsible for alterations in the neurogenic erythematous response and transmission of stimuli through sensory nerve fibers (sensation of pruritus).

Methods. Increasing doses of capsaicin from 0.125 to 4 μg/ cm2 were applied to nonlesional psoriatic skin to establish the minimal dose that induced the substance P‐mediated neurogenic response in 30 patients with psoriasis. Plasma beta‐endorphin was quantitated in 71 psoriatics by radioimmunoassay using NEN 1251‐RIA kit.

Results. The mean beta‐endorphin concentration was increased about 2‐fold compared to normals, whereas doses of capsaicin needed to induce erythema were higher (1–4 μg/ cm2) in psoriatics (mainly in patients with type II psoriasis) than in healthy subjects (0.125–0.25 ug/cm2).

Conclusions. The data indicate that increased beta‐endorphin in psoriatic skin might affect both substance P‐mediated neurogenic inflammation and transmission of sensory stimuli due to local antinociceptive effects of this opioid. The differences in the neurogenic response in type I and II psoriasis may be related to the degradation of substance P and beta‐endorphin by neutral proteinases in the lesional skin.
MONOCYTE ADHESION TO FIBRONECTIN IN PSORIASIS
Authors: REIN GLEN , ABRAHAM ANIL , RAYCHADAURI SIBA P. , WELTMAN HELENA
Published: May 2007

Background. After vascular extravasation, mononuclear cells (MNC) undergo chemotaxis and adhesion to extracellular matrix proteins, resulting in their differentiation into macrophages. Although endothelial adhesion and chemotaxis are altered in psoriasis, MNC adhesion to extracellular matrix proteins has not been previously studied in the disease. Since MNC adhesion to endothelial cells is abnormally regulated in psoriasis by TGF‐beta, we tested they hypothesis that in psoriasis substance P also regulates the adhesion of monocytes to the extracellular matrix protein fibronectin.

Methods. Monocytes from 16 normal controls and 11 psoriatic individuals were isolated and purified using a two‐step gradient centrifugation procedure. Adhesion to fibronectin was studied by plating monocyte suspensions onto fibronectin‐precoated microtiter plates. The number of adherent cells was quantified by measuring their hex‐osaminidase activity.

Results. Although statistically significant differences in the basal (unstimulated) adhesion or in the substance P‐stimulated adhesion between normal control monocytes and those obtained from psoriatic individuals were not observed, a subpopulation of psoriatics was identified who responded to substance P. Furthermore, this in vitro response to substance P was correlated with the clinical status of the subpopulation which was characterized by unstable psoriasis triggered by stressful life events.

Conclusions. The results of this study indicate that priming of monocytes by the extracellular matrix protein fibronectin or by elevated levels of substance P are not critical steps in the pathogenesis of stable, chronic psoriasis. Substance P may contribute to the appearance of new lesions in some individuals with unstable psoriasis.
HISTOLOGIC GRADING SYSTEM FOR PSORIASIS VULGARIS
Authors: TROZAK DANIEL J.
Published: May 2007

Background. Psoriasis vulgaris is a disease of substantial clinical and microscopic diversity and the histologic diagnosis depends upon an aggregate of histologic criteria, some characteristic of psoriasis and others shared with other dermatoses. While involved in drug testing with micromolar concentrations of active agents on small psoriatic plaques, this grading system was developed to quantify as objectively as possible the degree of psoriatic change present at the time of biopsy.

Methods. Using established references of dermatopathology and a review of the pertinent literature, the salient histologic features of psoriasis were listed and assigned value scores from 1 to 3. The highest score was given to those microscopic criteria most characteristic of the disease. The cumulative score of all features present then gives a mathematical score for each biopsy.

Conclusions. This paper presents an uncomplicated mathematically weighted system of grading biopsy specimens from a disease process that shows a spectrum of microscopic features, but is often not diagnostic. The schema offers a method of grading change that can be especially important in studies of therapeutic agents.
IN VITRO EVALUATION OF GRISEOFULVIN, KETOCONAZOLE, AND ITRACONAZOLE AGAINST VARIOUS DERMATOPHYTES IN SINGAPORE
Authors: GOH CHEE‐LEOK , TAY YONG KWANG , BIN ALI KAMARUDIN , KOH MONG TECK , SEOW CHEW SWEE
Published: May 2007

Background. Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (mic) obtained may give an indication of the in vivo potency of the drugs.

Methods. One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The Mies were determined using the broth dilution method.

Results. The age range was 1–76 years. The most common diagnosis was tinea corporis (36%), followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%), followed by E. floccosum (14%), and T. mentagrophytes (10%).

The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of < 0.25 μg/mL. For T. rubrum, there were four isolates that had an mic of 64 μg/mL to griseofulvin, seven isolates and nine isolates with an mic > 64 g/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an mic 4 μg/mL with griseofulvin, one of seven isolate with an mic 64 μg/mL with ketoconazole, and three of seven isolates with an mic 32 μg/mL with itraconazole.

Conclusions. The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the first‐line drug for treating such infections in Singapore.
ITRACONAZOLE VERSUS GRISEOFULVIN IN THE TREATMENT OF TINEA CAPITIS: A DOUBLE‐BLIND RANDOMIZED STUDY IN CHILDREN
Authors: LÓPEZ‐GÓMEZ SARA , DEL PALACIO AMALIA , VAN CUTSEM JAN , CUÉTARA MARIA SOLEDAD , IGLESIAS LUIS , RODRIGUEZ‐NORIEGA ANTONIO
Published: May 2007

Background. Tinea capitis is a fungal infection in which topical therapy is often unsuccessful. Griseofulvin has been considered to be a first‐line therapy. Other antifungal agents are the azole derivatives. Among these, itraconazole was compared with griseofulvin in children in a double‐blind study.

Patients and Methods. Thirty‐four children and one adult with clinical signs and symptoms of tinea capitis and with positive culture and microscopy for dermatophytes have been included in a double‐blind comparison between itraconazole, 100 mg daily, and ultramicronized griseofulvin, 500 mg daily. Both drugs were given for 6 consecutive weeks. The final evaluation was made 8 weeks after the end of treatment to allow the hairs to regrow. Seventeen itraconazole‐ and 15 griseofulvin‐treated patients received the complete 6‐week treatment course. Fifteen of these 17 itraconazole patients and 14 of the 15 griseofulvin patients had infections caused by Microsporum canis.

Fifteen of 17 patients were cured by itraconazole (88%) and 15 of 17 patients by griseofulvin (88%). One of the patients who discontinued griseofulvin therapy after 4 weeks was clinically and mycologically cured. Two of the original 17 griseofulvin patients discontinued therapy because of vomiting. None of the itraconazole‐treated children experienced side effects.

Conclusions. Itraconazole is the first azole derivate that matches griseofulvin for the treatment of tinea capitis in children. The drug also appears to be better tolerated than griseofulvin.
PAPULONECROTIC TUBERCULID SECONDARY TO DISSEMINATED MYCOBACTERIUM AVIUM COMPLEX
Authors: WILLIAMS J. TODD , PULITZER DONALD R. , DeVILLEZ RICHARD L.
Published: May 2007

Background. Papulonecrotic tuberculid is a rarely reported cutaneous reaction to the mycobacterium bacillus. It is most often encountered in association with tuberculosis. The clinical and histologic picture of the entity is a distinctive one, but the etiology of the disease process is uncertain. Therapy directed against the causative organism is dramatically successful.

Methods. A 35–year‐old white man with AIDS was referred to the Dermatology clinic for evaluation of a widespread skin eruption. The skin lesions were biopsied for histopathology and culture. From the cutaneous cultures Mycobacterium avium complex (MAC) organisms were grown.

Results. We report the first case of papulonecrotic tuberculid manifestation in an AIDS patient with disseminated MAC. Unusual features seen in this case include the predominance of pruritic eschars rather than asymptomatic papules and the confirmation by special stains of mycobacterium organisms within the skin biopsy. Papulonecrotic tuberculid has not been previously associated with either MAC or AIDS.

Conclusions. Papulonecrotic tuberculid should be a diagnostic consideration in immunocompromised patients with MAC whose clinical and histologic features are compatible with this rare entity.
RETROLUMBAR SUBCUTANEOUS EPENDYMOMA AND GIANT BATHING‐TRUNK NEVOCELLULAR NEVUS
Authors: BOURLOND JEAN , BOURLOND ANDRE , ROUSSEAU CATHERINE
Published: May 2007

Background. Subcutaneous ependymomas have been reported rarely in dermatologic reviews and, apparently, were never associated with other cutaneous malformations.

Methods. A 60‐year‐old woman with a retrolumbar subcutaneous ependymoma and a giant bathing‐trunk nevocellular nevus submitted to thorough dermatologic and neurologic investigation. The surgical material was extensively analyzed with light and electron microscope. The literature was reviewed.

Results. The tumor fits exactly the classical prerequisites of the clinical and pathologic diagnosis.

In contrast with the literature, it developed at 53 years, apparently after a trauma, within a congenital giant nevocellular nevus, at the retrolumbar level; it proved unrelated to any spinal cord alteration and so far appeared quite benign.

Conclusions. The observation of a retrolumbar subcutaneous ependymoma is reported with detail; this tumor exceptionally recognized by dermatologists must be included in the differential diagnosis of lumps arising in the retro‐lumbar‐retrosacral area.

The most peculiar feature was its development within a giant bathing‐trunk nevocellular nevus; such a fascinating association of two neurectodermal defects, as far as known, is presented for the first time.
THE PERFECT STATE OE TRICHOPHYTON VIOLACEUM
Authors: TAHA MOHAMED , AMER MOHAMED , SALEM AHMED , HARRAS MONA EL
Published: May 2007

Background. Trichophyton violaceum is the most common etiologic agent causing dermatophytosis in Egypt. This report deals with attempts to produce the perfect state of T. violaceum that may play a role in the epidemiology of T. violaceum.

Materials and Methods. Ten strains of T. violaceum were inoculated on hair soil culture and on rice agar media.

Results. Cultures on hair soil media failed to produce the ascogenous form of the fungus, but after 6 weeks of culture on rice agar media, fertile cleistothecium were seen and 2 weeks later separate asci appeared.

Conclusion. This is the first report on the production of the perfect (sexual) state of T. violaceum. Details of the ascogenous form of this dermatophyte should be studied in the future.
TREATMENT OE A RECURRENT KERATOACANTHOMA WITH ORAL ISOTRETINOIN
Authors: WONG WINONA Y.L. , KOLBUSZ ROBERT V. , GOLDBERG LEONARD H. , GUANA ADRIANA
Published: May 2007

Background. Keratoacanthoma is a benign epithelial tumor that occurs on the sun‐exposed skin of elderly people. Development of KAS on functionally and cosmetically important areas such as the face poses the therapeutic challenge to minimize functional and cosmetic damage. Oral isotretinoin (Accutane, Roche Laboratories) has been reported to be an effective treatment of multiple as well as solitary keratoacanthomas.

Case Report. A 45‐year‐old man with a large keratoacanthoma on the nasal ala, recurrent after surgical excision, was treated with 1 mg/kg/day (80 mg/day) oral isotretinoin (Accutane). Cessation of tumor progression was evident within 1 week after initiation of therapy, and tumor regression was evident within 2 weeks. Tumor size diminished rapidly over the ensuing weeks and complete resolution at 12 weeks was confirmed by biopsy.

Conclusion. An initial trial of oral isotretinoin is an alternative to immediate surgical excision for the treatment of large keratoacanthomas in instances when tumor removal would cause considerable cosmetic deformity.
CLINICAL STUDY OF A NEW PREPARATION OF 8‐METHOXYPSORALEN IN PHOTOCHEMOTHERAPY
Authors: EL‐MOFTY ABDEL MONEM , ELSAWALHY HUSSEIN , EL‐MOFTY MEDHAT
Published: May 2007

Background. Oral 8‐methoxypsoralen is the drug of choice In photochemotherapy of several dermatoses, e.g., vitiligo and psoriasis. The aim of this trial is to produce a new preparation of the drug, which is able to overcome the difficulties met with the oral use of the older preparations.

Methods. A new preparation containing ultramicronized methoxypsoralen (8‐MOP) in 10 mg capsules was tried in an open trial. The trial included 53 patients (15 psoriasis, 26 vitiligo, and 12 tinea versicolor). Light testing showed that the strongest erythema appeared 30 minutes after ingesting the capsules. Patients were exposed to UVA after that period. Laboratory studies were also performed using high performance liquid chromatography to assay the serum concentrations of the drug on normal individuals.

Results. Thirteen of the 15 psoriasis patients (87%) showed an excellent response (a remission) after 30 sittings. Twenty‐two of the 26 vitiligo patients (85%) showed an excellent response (acceptable repigmentation) after 70 sittings. The 12 patients with tinea versicolor (100%) showed complete repigmentation after 12 sittings. The laboratory studies showed the optimum time to be between 35 to 55 minutes, verifying the clinical observation.

Conclusions. The therapeutic effective dose was found to be 0.25 mg/kg. This new preparation of 8‐MOP proved to be well tolerated by the patients, causing no epigastric discomfort, nausea, or vomiting, overcoming the biggest obstacle of oral 8‐MOP therapy. It was also well tolerated by patients known to be sensitive to oral and/or topical 8‐MOP therapy.
DERMATOGLYPHICS IN DARTER'S DISEASE
Authors: SHAMAI‐LUBOVITZ ORNA , TRATTNER AKIVA , KATZNELSON MARIASSA BAT‐MIRIAM , SANDBANK MIRIAM
Published: May 2007

Background. Darier's disease is an acantholytic dyskeratotic genodermatosis with autosomal dominant inheritance. A predictive diagnostic marker for this disorder would be beneficial because of the relatively late onset and the large number of sporadic cases of the disease. The dermatoglyphic features of patients with Darier's disease were examined to determine whether they have a common pattern.

Methods. Ink prints of fingers and palms obtained from 11 patients of both sexes with sporadic and familial Darier's disease were analyzed and compared with those of normal subjects.

Results. No significant quantitative or qualitative differences were found between the dermatoglyphic features of our patients and those of a healthy population, except for punctate interruptions of the skin ridges that indicate pitting, a well‐known manifestation of Darier's disease.

Conclusions. These results refute the conclusions of a previous publication claiming that there is a common characteristic dermatoglyphic feature in patients with this dermatosis.
CUTANEOUS INVOLVEMENT IN CHRONIC MYELOMONOCYTIC LEUKEMIA
Authors: O'CONNELL DAVID M. , PAGAN WAYNE A. , SKINNER STEVEN M. , PULITZER DONALD R. , DEVILLEZ RICHARD L.
Published: May 2007

Background. Chronic myelomonocytic leukemia has been associated with various nonspecific cutaneous manifestations. Rarely has the leukemia been reported to directly affect the skin.

Methods. This case documents the progression of a patient who ultimately developed chronic myelomonocytic leukemia, by clinical examination, hematologic parameters, dermatopathology, and bone marrow pathology.

Results. The skin showed nonspecific cutaneous involvement, progressing to specific leukemic lesions parallel with increasing systemic and hematologic involvement.

Conclusions. Chronic myelomonocytic leukemia can manifest with lesions of leukemia cutis. The possibility of nonspecific cutaneous involvement in the preleukemic phase exists.
DIFFUSE INTRAEPIDERMAL DEPOSITION OF IMMUNOREACTANTS ON DIRECT IMMUNOFLUORESCENCE: A CLUE TO THE EARLY DIAGNOSIS OF EPIDERMAL NECROLYSIS
Authors: KING THEODORE , HELM THOMAS N. , VALENZUELA RAFAEL , BERGFELD WILMA F.
Published: May 2007

Background. Toxic epidermal necrolysis is a distinctive disorder that is readily identified clinically and histologically in advanced cases. Early on, however, toxic epidermal necrolysis may be difficult to identify. Some consider fixed drug eruption a limited form of toxic epidermal necrolysis.

Methods. Direct immunofluorescence was performed on biopsy material of erythematous skin lesions.

Results. Diffuse deposition of immunoreactants in the midmalpighian layer was noted. This finding has not been encountered in other disorders studied in our immuno‐pathology laboratory.

Conclusions. Diffuse immunoreactant deposition in the mid‐epidermis should suggest a diagnosis of epidermal necrolysis either from toxic epidermal necrolysis or fixed drug eruption. Additional cases will need to be assessed to document the usefulness of this pattern for prospective diagnosis.
LICHEN PLANUS SUBTROPICUS: DIRECT IMMUNOFLUORESCENCE FINDINGS AND THERAPEUTIC RESPONSE TO HYDROXYCHLOROQUINE
Authors: ALBERS SHARON E. , GLASS L. FRANK , FENSKE NEIL A.
Published: May 2007

A 32‐year‐old black woman presented with the complained of a l‐year history of asymptomatic “dark areas” on her face and neck. New lesions developed throughout this time and, once present, slowly increased in size and persisted. She denied systemic symptoms, including arthralgias and myalgias. Her occupation as a real estate agent involved frequent outdoor work. The family history was noncontributory.

On physical examination there were multiple hyperpig‐mented round‐to‐oval macules and papules measuring from 0.5 to 2.0 cm in diameter and located over the photoexposed lateral aspects of the face and neck (Figs. 1 and 2). New lesions were papules characterized by a subtle, raised “thread‐like” border (Fig. 1, arrow). Older lesions were mac‐ular, some with a slightly atrophic, hypopigmented center (Fig. 1, Flesh‐colored polygonal papules were present in the V‐shaped area on the anterior neck (Fig. 2). The remainder of the cutaneous examination, including the oral mucosa, was unremarkable.

Histopathologic examination of a flesh‐colored papule viewed on low power revealed a bandlike lymphohistiocytic infiltrate that focally obscured the dermoepidermal junction. Numerous homogenous eosinophilic bodies (Civatte bodies, cytoid bodies, apoptotic cells) and scattered melanophages were identified. In addition, there was epidermal hyperplasia, overlying orthokeratosis, and V‐shaped hyper‐granulosis. The rete was jagged and possessed a slightly eosinophilic hue (Fig. 3).

Hyperpigmented, oval macules had a more patchy lichenoid infiltrate, less epidermal hyperplasia, but possessed a greater number of melanophages in the papillary dermis than new lesions.

Periodic acid‐Schiff (PAS) stained sections of either type of specimen were negative for basement membrane thickening and also negative for dermal mucin using the colloidal iron reagent.

No deposits of immunoglobulin or complement were identified at the dermoepidermal junction by direct immunofluorescence microscopy, but numerous immunoglobulin‐coated cytoid bodies were present.

Laboratory testing was significant for a negative antinu‐clear antibody (ANA) reaction and RPR. A complete blood cell count, results of serum chemistry, and the angiotensin converting enzyme level were within normal limits. Chest roentgenogram revealed no active cardiopulmonary disease.

Based on the distinctive histopathology and the impressive, characteristic clinical presentation, the diagnosis of lichen planus subtropicus was made. Therapy with hydroxy‐chloroquine 200 mg per day, topical hydrocortisone valerate 0.2% cream b.i.d. to inflammatory lesions, 3% hydroquinone solution b.i.d. to hyperpigmented lesions, and photoprotection were initiated. Partial resolution of the lichenoid lesions has occurred, new lesions have ceased to appear, and the hyperpigmentation has slightly improved.
ECCRINE ANGIOMATOUS HAMARTOMA
Authors: NAIR LAXMI V. , KURIEN ANIL M.
Published: May 2007

A g‐year‐old girl was seen at our outpatient department with a 5‐year history of a slowly enlarging hyperpigmented area with increased sweating on the right upper chest and back. There was no history of pain or tenderness over the lesion. She was the second child of a nonconsanguineous marriage. The older sibling was healthy and there was no family history of similar complaints. Dermatologic examination revealed a large hyperpigmented plaque involving the right upper chest, extending over the right shoulder to the back (Fig. 1). The margins were well defined with raised borders on the upper part; elsewhere it gradually merged with the adjacent normal skin. Two other well‐defined hyper‐pigmented plaques were seen, one 3 × 3 cm over the nape of neck and another 3 × 1 cm over the right supraclavicular fossa. The lesions were nontender and noncompressible. There was increased sweating on the plaque following physical exertion and the plaque could be mapped out with starch and iodine (Fig. 2). Systemic examination of the child was within normal limits. Routine blood and urine examination was normal. Histologic sections showed an increased number of cross‐sections of sweatglands interspersed with dilated vascular spaces, filled with blood, in the mid and lower dermis (Figs. 3 and 4).
ULTRASTRUCTURAL STUDY OF HYALURONIC ACID BEFORE AND AFTER THE USE OF A PULSED ELECTROMAGNETIC FIELD, ELECTRORYDESIS, IN THE TREATMENT OF WRINKLES
Authors: GHERSETICH ILARIA , TEOFOLI PATRIZLA , BENCI MAURIZIO , LOTTI TORELLO
Published: May 2007

Background. Treatment of wrinkles has become an increasing problem for dermatologists. Hyaluronic acid is a component of the family of glycosaminoglycans (GAGS, substances known for their property of retaining water), that significantly decreases with aging and in wrinkles. A new technique that uses a specific pulsed electromagnetic field, electrorydesis, has been introduced in the treatment of wrinkles associated with aging. The treatment is based on the reported in vitro effects of specific electromagnetic fields on fibroblast cultures (e.g., an increase in DNA synthesis and in the production of collagen and presumably also of GAGS).

Methods. The in vivo effects of the electromagnetic field on aged skin (3 subjects aged 50, 56 and 60 years), with particular focus on the ultrastructural modifications and GAGS amount before and after the treatment, were evaluated by electron microscope.

Results. The ultrastructural study (tissue stained with al‐cian blue) showed after treatment a significant increase (p < 0.005) of the electron‐dense granules (corresponding to hyaluronic acid), located in collagen elastic fibers, and in the soluble matrix. This presumably leads to subsequent edema that was clinically evident after the treatment.

Conclusions. These data suggest that the increased levels of GAGS and the subsequent edema of the dermis could explain at least in part the clinical changes observed after electrorydesis treatment (e.g., swelling and “disappearance” of the wrinkle).
MAURICIO GOIHMAN‐YAHR, M.D., PhD., EDITOR
Authors: Katayama Ichiro , Sawada Yasuyuki , Yokozeki Hiroo , Nishioka Kiyoshi , Akiba Takasi
Published: May 2007

The correspondence Section serves as a forum for opinion exchange about subjects of general interest such as deratologic training, relations between dermatologists and pharmaccutical houses, govermmental control of deramatology 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. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
SWEET'S SYNDROME: CLINICOPATHOLOGIC STUDY OF ELEVEN CASES
Authors: HENG‐LEONG CHAN , LEE YU‐SHUNG , KUO TSENG‐TONG
Published: May 2007

Background. The clinicopathologic manifestations of Sweet's syndrome associated with malignancy have been rarely studied in a large series.

Methods. We describe the clinical features of Sweet's syndrome in 11 patients seen during the past 12 years. Histopathologic findings of these patients are discussed. The clinicopathologic manifestations of 249 cases of Sweet's syndrome reported in the literature were reviewed.

Results. The clinicopathologic manifestations of Sweet's syndrome associated with hematologic disorders (HSS) were more severe and characterized by bullous pyoderma with more pronounced epidermal changes and ulceration, anemia, giant platelets and abnormal platelet counts. Approximately 40% of the Sweet's syndrome reported in the literature were associated with hematologic malignancy, and the other 7% of patients had solid tumors.

Conclusions. Sweet's syndrome can be classified into three types: (1) association with hematologic disorders (HSS); (2) association with solid tumors (SSS); and (3) idiopathic or associated with various other disorders (ISS).
EOSINOPHILIC PUSTULAR FOLLICULAR REACTION: A PARADIGM OF IMMUNE DYSREGULATION
Authors: MAGRO CYNTHIA M.J. , CROWSON A. NEIL
Published: May 2007

Background. We encountered 10 patients whose biopsies showed an eosinophilic pustular follicular reaction, a histomorphology alleged to be pathognomonic of eosinophilic folliculitis (EF). Only seven of these patients fell within the clinical spectrum of EF. Seven patients had conditions associated with immune dysfunction, including three patients with an atopic history. Potential antigenic stimuli could be elicited in six cases.

Methods. Formalin‐fixed biopsy specimens from all 10 patients were available for examination. Hematoxylin and eosin‐, alcian blue‐periodic acid‐Schiff (PAS)‐ and PAS‐diastase‐stained sections cut from paraffin‐embedded tissue were examined by light microscopy. Immunoperoxidase preparations with antibody to IgE were performed on paraffin sections and the number of IgE‐decorated cells quantitated in each case. Four patients also had biopsy material submitted in Michel's medium, on which direct immunofluorescent studies were conducted.

Results. IgE‐coated mononuclear cells were present in patients whose lesions would logically be expected to derive from dominant type I hypersensitivity mechanisms and absent or minimal in biopsies from those patients in whom the pathogenetic basis of lesions derived principally from cell‐mediated immunity.

Conclusions. The eosinophilic pustular follicular reaction, while characteristic of EF, is not exclusive to that entity. It represents an expression of an excessive immediate or delayed‐type hypersensitivity reaction to various auto‐, epicutaneous, or ingested stimuli. A background of immune dysregulation may be contributory.
BURNING MOUTH SYNDROME
Authors: GRINSPAN DAVID , FERNÁNDEZ BLANCO GRACIELA , ANGEL ALLEVATO MIGUEL , STENGEL FERNANDO M.
Published: May 2007

Background and Objectives. Burning mouth syndrome (BMS) is a frequent process that produces marked oral dysesthetic symptoms. There is controversy over its etiopathogenesis and diagnosis. Therapeutic results are unsatisfactory. The objectives of this study were: (1) to analyze a possible agreement on the definition of BMS; (2) to analyze its cause; (3) to propose a therapeutic scheme that has been shown to be highly effective in our experience and has not been previously reported.

Methods. Five hundred patients with symptomatology of BMS were retrospectively evaluated with a study protocol, specially designed for this disease. Patients with local or general disease processes that could cause secondary asymptomatic stomatodynia were excluded from the study.

Results. Most of the patients evaluated were women over 60 years of age with oral symptoms, including a sensation of heat and burning, and pain, lasting for months or years, and a history of multiple unsuccessful treatments. The patients showed depression associated with anxiety, with evidence of psychiatric disorders in the family. Based on these findings and eliminating symptomatic painful conditions of the mouth that may simulate this syndrome, we diagnosed a genuine or basic BMS of psychosomatic origin. Therapies used in the treatment of these neurotic conditions were not always useful. Tranylcypromine associated with anxiolytics and hypnotics in low doses plus the support of psychotherapy by the stomatologist were the most effective treatments.

Conclusions. The BMS should be defined as a psychosomatic process causing oral dysesthesias for months or years.
DERMATOFIBROSARCOMA PROTUBERANS
Authors: KOH CHUAN K. , KO CHUNG B. , BURY HENRY P. R. , WYATT EDWARD H.
Published: May 2007

Background. Dermatofibrosarcoma protuberans (dfsp) is an uncommon malignant tumor of the skin, the diagnosis of which can be difficult not only clinically but also histologically. The tumor has a low metastatic potential, but tends to recur locally if removal is incomplete.

Methods. We reviewed the clinical and histologic features of 19 cases of dfsp, seen at the Department of Dermatology (14 cases) and Department of Surgery (5 cases) at the Hull Royal Infirmary between 1975 and 1992.

Results. There were only 19 cases of dfsp diagnosed from a population of 500,000 over a period of 17 years. None of the cases were diagnosed clinically prior to histologic diagnosis. The highest incidence was in the 4th decade of age. The most frequent site was on the head and neck. None of the lesions metastasized but there were a total of eight incidents of local recurrence in five patients. Histologically all the cases showed presence of storiform‐pattern spindle‐shaped cells and new collagen formation.

Conclusions. Dermatofibrosarcoma protuberans is a soft tissue tumor that is often not recognized clinically due to its rarity and variable appearance. Local recurrence is frequent. A wide surgical excision is the treatment of choice.