bluuebunny/crossref_metadata_2025 huggingface dataset:
Caspase Regulation of Neuronal Progenitor Cell Apoptosis
Authors: D’Sa-Eipper Cleta , Roth Kevin A.
Published: April 2003

Programmed cell death (apoptosis) of both proliferating neuroblasts and postmitotic neurons is essential for normal nervous system development. To study the molecular regulation of apoptosis in neuronal progenitor cells, we developed a flow cytometric assay capable of distinguishing between viable, apoptotic, and necrotic cell populations. Incubation of freshly dissociated telencephalic cells from gestational day 12–13 mouse embryos with either cytosine arabinoside (AraC) or staurosporine caused a marked increase in the percentage of apoptotic cells. Both drugs induced caspase-3 activation, as determined by in vitro cleavage of a caspase-3 substrate and immunocytochemical detection of activated caspase-3. Treatment of telencephalic cells with the broad caspase inhibitor BAF, blocked caspase-3 activation and protected cells against both AraC and staurosporine-induced apoptotic death. These results indicate that neuronal progenitors possess a caspase-dependent apoptotic pathway, the activation of which may regulate neuronal progenitor cell numbers in vivo.
Expression of EphA4, Ephrin-A2 and Ephrin-A5 during Axon Outgrowth to the Hindlimb Indicates Potential Roles in Pathfinding
Authors: Eberhart J. , Swartz M. , Koblar S.A. , Pasquale E.B. , Tanaka H. , Krull C.E.
Published: April 2003

During neural development, spinal motor axons extend in a precise manner from the ventral portion of the developing spinal cord to innervate muscle targets in the limb. Although classical studies in avians have characterized the cellular interactions that influence motor axon pathfinding to the limb, less is known about the molecular mechanisms that mediate this developmental event. Here, we examine the spatiotemporal distributions of the EphA4 receptor tyrosine kinase (RTK) and its cognate ligands, ephrin-A2 and ephrin-A5, on motor neurons, their axons and their pathways to the avian hindlimb to determine whether these molecules may influence axonal projections. The expression patterns of EphA4, ephrin-A2 and ephrin-A5 mRNAs and proteins are highly complex and appear to exhibit some overlap during motor axon outgrowth and pathfinding to the hindlimb, reminiscent of the co-expression of Eph RTKs and ephrins in the retinotectal system. EphA4, similar to the carbohydrate moiety polysialic acid, strikingly marks the main dorsal, but not ventral, nerve trunk after axon sorting at the limb plexus region. Our results suggest that EphA4 RTK and its ligands may influence axon fasciculation and the sorting of axons at the limb plexus, contributing to the correct dorsoventral organization of nerve branches in the hindlimb.
Brain Creatine Kinase and Creatine Transporter Proteins in Normal and Creatine-Treated Rabbit Pups
Authors: Kekelidze Téa , Khait Igor , Togliatti Anthony , Holtzman David
Published: April 2003

Systemic creatine (Cr) supplementation increases brain phosphocreatine (PCr) and prevents hypoxic seizures in 15-day-old rabbits . Between 5 and 30 days of age during normal development, rabbit gray matter mitochondrial creatine kinase (Mi-CK) increases 400% while cytosolic CK (BB-CK) increases 60%. In white matter, both isoenzymes show smaller, similar increases (40%) during this period. The Cr transporter protein decreases 60% between 5 and 15 days in both regions. In vivo CK rate constants measured by 31P nuclear magnetic resonance increase 30% between 10 and 20 days, and then fall 50% between 20 and 30 days in predominantly gray matter slices. Similar maturational changes are seen in predominantly white matter slices. Injecting Cr at 15 days does not significantly change BB-CK or Mi-CK isoenzymes or the in vivo CK reaction rate constants. Thus, the largest change in the CK system associated with suppression of hypoxic seizures in Cr-treated rabbits is increased PCr in gray and white matter.
Acneiform Dermatoses
Authors: Plewig G. , Jansen T.
Published: April 2003

Acneiform dermatoses are follicular eruptions. The initial lesion is inflammatory, usually a papule or pustule. Comedones are later secondary lesions, a sequel to encapsulation and healing of the primary abscess. The earliest histological event is spongiosis, followed by a break in the follicular epithelium. The spilled follicular contents provokes a nonspecific lymphocytic and neutrophilic infiltrate. Acneiform eruptions are almost always drug induced. Important clues are sudden onset within days, widespread involvement, unusual locations (forearm, buttocks), occurrence beyond acne age, monomorphous lesions, sometimes signs of systemic drug toxicity with fever and malaise, clearing of inflammatory lesions after the drug is stopped, sometimes leaving secondary comedones. Other cutaneous eruptions that may superficially resemble acne vulgaris but that are not thought to be related to it etiologically are due to infection (e.g. gram-negative folliculitis) or unknown causes (e.g. acne necrotica or acne aestivalis).
Topical Drug Treatment in Acne
Authors: Gollnick H. , Schramm M.
Published: April 2003

The main part of acne treatment uses the topical route. More than 50% of acne patients belong to the group presenting with acne comedonica and papulopustulosa. Whenever small nodes or scarring occur, systemic comedication is indicated, however. Topical treatment affects at least three of the four main pathogenetic factors responsible for the development of acne, i.e. hyperseborrhea, hyperkeratosis, microbial colonization and inflammation. The agents currently available influence at least one of these factors but often have additional properties. Those which act in a comedolytic and anticomedogenic manner are the retinoids tretinoin, isotretinoin, adapalene and tazarotene and azelaic acid as well, some of the retinoids having additional anti-inflammatory potency. Azelaic acid has strong antibacterial potency without inducing bacterial resistance similar to benzoyl peroxide. Unfortunately, bacterial resistances are beginning to emerge as a significant problem. Propionibacterium acnes resistance to the commonly used erythromycin can also be transferred to clindamycin, whereas no resistance has been reported to nadifloxacin so far. Today, more and more evidence comes up that topical antiandrogenic agents will soon be available to treat the important factor seborrhea, because patients with marked hyperseborrhea frequently relapse. Finally, liposome encapsulation of agents including phospholipids can enhance penetration and efficacy but, particularly with regard to retinoids, can lead to higher absorption and adverse drug reactions.
An Overview of Topical Antibiotics for Acne Treatment
Authors: Toyoda M. , Morohashi M.
Published: April 2003

Topical use of antibiotics is currently a widely accepted effective and safe treatment for acne. A review of the articles published in the past 30 years revealed that topical application of antibiotics such as erythromycin, clindamycin or tetracycline showed clinical effectiveness for mild to moderate inflammatory acne, especially when they are combined with zinc, tretinoin or benzoyl peroxide, while they showed little influence on noninflammatory acne. The main mechanism of action of topical antibiotics for acne treatment is inhibition of inflammation caused by bacteria rather than a direct bactericidal effect. The adverse reactions of topical antibiotics are mostly minor and negligible, while special attention should be given to the risk of development of resistant strains of Propionibacterium acnes. The development of new antibiotics is promising and will provide a wider range of therapeutic options for refractory cases.
Polymorphisms in the Human Cytochrome P-450 1A1 Gene (CYP1A1) as a Factor for Developing Acne
Authors: Paraskevaidis A. , Drakoulis N. , Roots I. , Orfanos C.E. , Zouboulis Ch.C.
Published: April 2003

Cytochromes P-450 are a supergene family of enzymes involved in the metabolism of a wide range of endogenous and foreign compounds. The existing genetic variations of the distinct isozymes lead to interindividually different metabolic capacity. Since vitamin A, endogenous retinoids and their natural metabolites are morphogenic for the sebaceous gland, we investigated the polymorphisms of cytochrome P-450 1A1, as being one of the most active isozymes involved in their interconversion. From the known mutations, two were investigated: an additional cleavage site for MspI in the 3′-flanking region identified as a thymine-to-cytosine transition 1,194 bp downstream of exon 7 (m1) and an adenine-to-guanine transition at position 4889 in exon 7 (m2). We studied 96 acne patients for ml and m2 mutations by restriction fragment length polymorphism and allele-specific polymerase chain reaction, respectively, and compared the results with 408 reference individuals. No statistically significant difference was found in the distribution of m2 alleles; the frequency was 3.13 and 3.06% of the alleles, respectively (odds ratio = 1.02, confidence limits 0.41–2.52, p = 0.96). In contrast, a trend to an overrepresentation of m1 alleles in acne patients was observed; allele frequency was 8.33 in the patients and 6.99% in the control subjects, respectively (odds ratio 1.21, 95% confidence limits 0.68–2.16, p = 0.52). As the m1 mutation might define a marker for alterations on regulatory sites, the biological efficacy of natural retinoids could be greatly impaired by their rapid metabolism to inactive compounds. The resulting deficit of active natural retinoids may lead to abnormal sebocyte differentiation and hyperkeratinization of the follicular canal implicating the development of acne in some patients.
The Human Sebocyte Culture Model Provides New Insights into Development and Management of Seborrhoea and Acne
Authors: Zouboulis Ch.C. , Xia L. , Akamatsu H. , Seltmann H. , Fritsch M. , Hornemann S. , Rühl R. , Chen W. , Nau H. , Orfanos C.E.
Published: April 2003

Seborrhoea and acne are exclusively human diseases and sebaceous gland differentiation is species specific. Therefore, fundamental research on human sebaceous cell function and control requires human in vitro models. The human sebocyte culture model, introduced in 1989, has been used in several studies to elucidate sebaceous gland activity and its regulation at the cellular level. Cultured human sebocytes have been shown to preserve important sebocytic characteristics, although they undergo an incomplete terminal differentiation in vitro. In vitro synthesis of free fatty acids without bacterial involvement and marked interleukin 1α expression at the mRNA and protein levels with no further induction by lipopolysaccharides lead to the assumption that human sebocytes may initiate acne lesions by an intrinsic mechanism. Androgens affected sebocyte activity in vitro in a manner dependent on the localization of the sebaceous glands. In vitro stimulation of sebocyte proliferation by androgens could be completely abolished by spironolactone. Cultured sebocytes strongly expressed type 1 5α-reductase and metabolized testosterone to androstenedione, 5α-androstanedione, 5α-dihydrotestosterone, androsterone and 5α-androstanediol, whereas the levels of 5α-reductase activity were probably not feedback regulated. 4,7β-Dimethyl-4-aza-5αcholestan-3-one, a type 1 5α-reductase inhibitor, induced an early, marked down-regulation of 5α-reductase activity in human sebocytes in vitro, while hydrofinasteride, a type 2 inhibitor, required 103-fold higher concentrations to induce similar effects. Stimulation of sebocyte proliferation by insulin, thyroid-stimulating hormone and hydrocortisone indicates that the hormonal control of the sebaceous gland could be a complex mechanism. Retinoids inhibited sebocyte proliferation in a dose-dependent manner and down-regulated lipid synthesis and sebocyte differentiation in vitro. Isotretinoin was the most potent compound. On the other hand, vitamin A was found essential for sebocyte activity and differentiation in vitro and could be partially substituted by synthetic retinoids. The inhibitory effect of isotretinoin on sebocyte proliferation was barely affected by the presence of vitamin A. The low persistent isotretinoin levels or, more likely, the considerably elevated tretinoin concentrations detected in human sebocytes after treatment with isotretinoin in vitro may be responsible for the inhibitory effect of this compound on sebocyte activity.
Fluconazole in the Treatment of Tinea corporis and Tinea cruris
Authors: Stary A. , Sarnow E.
Published: April 2003

Background: Results of topical dermatomycosis treatment are often unsatisfactory, particularly in patients with extended or multiple infection sites. Objective: Given the high fluconazole concentrations attainable in the stratum corneum and the long elimination half-life of fluconazole, we investigated whether efficacy is satisfactory when using fluconazole at once weekly doses of 150 mg. Methods: In an open, noncomparative study, tinea corporis and cruris patients were treated with once weekly fluconazole 150 mg over 2–4 weeks. Clinical (pruritus, erythema, scaling, burning/pain, vesiculation) and mycologic (culture and microscopy) assessments were performed before treatment, at weekly intervals until the end of treatment and 3 weeks after treatment. All adverse events were recorded. Results: The total severity scores of clinical symptoms were reduced from 7.1 before to 1.5 after treatment (p = 0.001, n = 100 patients). Seven patients experienced adverse events. Conclusions: Fluconazole 150 mg once weekly for 2–4 weeks is an efficacious and safe regimen in the treatment of tinea corporis and cruris.
Primary Cutaneous Nocardia asteroides Infection after Heart Transplantation
Authors: Merigou D. , Beylot-Barry M. , Ly S. , Doutre M.S. , Texier-Maugein J. , Billes P. , Beylot C.
Published: April 2003

Skin diseases due to Nocardia are rare in Europe and usually occur as the secondary localization of a pulmonary lesion in immunocompromised patients. We describe a cutaneous pyoderma and cold abscess due to Nocardia asteroides infection in a cardiac transplant recipient. An insect bite represents the wound of this soil saprophyte belonging to the actinomycetes. Treatment by sulfone and ampicillin-clavulanic acid allowed the regression of lesions without extracutaneous dissemination.
Merkel Cells in Hyperplastic and Neoplastic Lesions of the Skin
Authors: Kanitakis J. , Bourchany D. , Faure M. , Claudy A.
Published: April 2003

Background: Merkel cells are neuro-endocrine cells present in the basal layer of the human epidermis and the outer root sheath of hair follicles. Objective and Method: In order to gain further insight into the as yet ill-defined involvement of Merkel cells in skin diseases, we studied the distribution of these cells in formalin-fixed, paraffin-embedded sections of 165 inflammatory, hyperplastic or tumoral skin lesions of various anatomic locations, with a monoclonal antibody to keratin 20. Results: Lesions with frequently increased Merkel Cell numbers included actinic keratosis, fibrous papules of the face and some conditions with (immature) hair follicle differentiation. Conclusion: These results suggest that Merkel cell hyperplasia is unrelated to epidermal proliferation but that it is rather specific to a limited number of skin diseases.
A Case of Unique Subepidermal Blistering Disease with Autoantibodies against a Novel Dermal 200-kD Antigen
Authors: Kawahara Y. , Matsuo Y. , Hashimoto T. , Nishikawa T.
Published: April 2003

Background: Several autoimmune subepidermal blistering diseases with autoantibodies against the epidermal basement membrane zone (BMZ) have been identified. Each shows distinct immunological findings. Objectives: Our patient showed clinical features which were indicative of bullous pemphigoid or linear IgA bullous dermatosis. In his serum, circulating IgG antibodies binding to the dermal side of skin split with 1 M NaCl were detected. To clarify the immunological character of the patient, we performed further studies. Methods: Western immunoblot analysis using normal human skin extracts and indirect immunofluorescence (IF) with affinity-purified IgG antibodies to the detected dermal protein were done. Results: Western immunoblot analysis demonstrated IgG antibodies reacting with a dermal 200-kD protein. Affinity-purified IgG antibodies to the 200-kD protein reacted to the dermal side of the split by indirect IF. Therefore, this dermal 200-kD protein is believed to be the epidermal BMZ antigen. Conclusion: Our patient showed an immunologically unique subepidermal blistering disease.
Recombinant Interferon Beta Gel as an Adjuvant in the Treatment of Recurrent Genital Warts: Results of a Placebo-Controlled Double-Blind Study in 120 Patients
Authors: Gross G. , Rogozinski T. , Schöfer H. , Jablonska S. , Roussaki A. , Wöhr C. , Brzoska J.
Published: April 2003

Background: Pilot studies of adjuvant therapy with topically applied interferons (IFN) have shown promising results in reducing the recurrence of condylomata acuminata (CA). Objective: The aim of this multicenter placebo-controlled, double-blind study was to confirm the efficacy and safety of topically applied IFN in a large sample of patients. Methods: After removal of CA by CO2 laser surgery, electrocautery or cryosurgery, 120 patients applied either recombinant IFN-β (0.15 or 1.0 × 106 IU/g) or placebo gel to the affected areas 5 times daily for 4 weeks. The patients were followed for a total of 24 weeks or until recurrence of CA was observed, respectively. Results: In the 105 patients evaluated for efficacy after 24 weeks, recurrence rates were 75% (27/36 patients) in the placebo group, 62% (21/34) in the 1.0 × 106 IU/g group (n.s.) and 54% (19/35) in the 0.15 × 106 IU/g group (p = 0.034). Only few mild adverse events were noted, which were almost limited to the application site. Conclusion: Topical application of gel containing 0.15 × 106 IU/g recombinant IFN-β is safe and appears to reduce the recurrence of CA after surgical treatment.
The Effects of UVA and UVB Irradiation on the Viscoelastic Properties of Hairless Mouse Skin in vivo
Authors: Takema Y. , Imokawa G.
Published: April 2003

Background: Age-related changes in the elasticity of the human skin have been demonstrated as well as those due to proto ageing. Aims and Methods: To investigate if UV irradiation causes similar changes in the elastic properties of skin, hairless mice (HR/ICR) were irradiated chronically with suberythemal doses of UVA or UVB. Using a recently designed, commercially available noninvasive in vivo instrument, we compared skin thickness and elasticity after 8 weeks of UV exposure with age-matched control mice. Results: Skin thickness increased significantly after UVB irradiation. Skin elasticity (Ur/Uf) decreased significantly after UVA and UVB irradiation, and the ratio of viscosity to elasticity (Uv/Ue) increased significantly after UVA irradiation. Intrinsic immediate strain (Ue*) and intrinsic delayed strain (Uv*) decreased significantly after UVB and UVA exposure. These changes were similar to those reported previously in an in vivo study on human face skin using the same instrument. Conclusion: This finding suggests that the Ue* and Uv* changes observed in human facial skin are associated with actinic ageing caused by chronic UV exposure.
Shielded Corneosurfametry and Corneoxenometry: Novel Bioassays for the Assessment of Skin Barrier Products
Authors: Goffin V. , Piérard-Franchimont C. , Piérard G.E.
Published: April 2003

Objectives: One of the most frequent occupational and environmental insults to the skin is linked to chronic exposure to weak irritants. There is a need for new predictive tests assessing the efficacy of barrier creams. Methods: Shielded variants of corneosurfametry and corneoxenometry are introduced as novel ex vivo bioassays applicable for comparing protection to surfactants and organic solvents. Results: Both bioassays showed good reproducibility for each offending agent and skin-protective products. Significant differences in efficacy were indicated between the presumptive barrier products. Conclusions: Shielded corneosurfametry and corneoxenometry may be convenient bioassays to compare the protection afforded by topical products against specific offending compounds to the skin. They avoid animal testing and toxicological hazards in human testing. In addition, they are cheap, rapid and reproducible.
Tuberculous Inguinal and Crural Lymph Nodes
Authors: Binet H. , van Vooren J.P. , Thys J.P. , Heenen M. , Parent D.
Published: April 2003

Non-respiratory forms of tuberculosis are frequently described in immigrants from endemic countries and in immunocompromised patients. Among the extrapulmonary forms of tuberculous disease, peripheral lymph node involvements, generally cervical, are the most common. Interestingly, only a few cases of tuberculous inguinal adenitis have been reported in the literature during the last 15 years. We report 2 cases of isolated inguinal inflammatory lymphadenitis observed in immigrant immunocompetent women. The diagnosis of tuberculosis was confirmed by culture obtained by needle aspiration of a lymph node. The lesions completely healed after standard antituberculous therapy.
The Schöpf-Schulz-Passarge Syndrome
Authors: Verplancke P. , Driessen L. , Wynants P. , Naeyaert J.M.
Published: April 2003

The Schöpf-Schulz-Passarge syndrome is a rare genodermatosis with autosomal recessive transmission. It is characterized by palmoplantar keratoderma, eyelid apocrine hydrocystomas, hypodontia, hypotrichosis and hypoplastic nails. Several epithelial tumors have been described in this syndrome. This report describes a case with actinic keratoses, two tumors of the follicular infundibulum and one poroma with follicular differentiation. This is the first report of an association between the Schöpf-Schulz-Passarge syndrome and a poroma with follicular differentiation.
Contact Allergy to Resorcinol Monobenzoate
Authors: Ongenae K. , Matthieu L. , Constandt L. , van Hecke E.
Published: April 2003

Resorcinol monobenzoate is an ultraviolet light absorber used in cellulose plastics and is known to cause allergic contact dermatitis reactions. It is the most important allergen in spectacle frames but can be a potential allergen in shoes as well. We report 7 cases of allergy to resorcinol monobenzoate with different clinical presentations. Our series further illustrates several possible cross-sensitizers.
A Case of Anaphylactoid Purpura with Multiple Blister Formation: Possible Pathophysiological Role of Gelatinase (MMP-9)
Authors: Kobayashi T. , Sakuraoka K. , Iwamoto M. , Kurihara S.
Published: April 2003

A 10-year-old Japanese male with multiple blister formation and palpable purpura in the course of anaphylactoid purpura is described. Histologically, the lesions showed leukocytoclastic vasculitis in the upper dermis with subepidermal clefts. Blister fluid showed matrix metalloproteinase (MMP) 2 and MMP-9 gelatinolytic activities using zymography. These enzymatic reactions, especially that involving MMP-9 derived from polymorphonuclear leukocytes, might play an important role in the pathophysiology of this condition.
Pseudo-Melanoma after Laser Therapy
Authors: Dummer R. , Kempf W. , Burg G.
Published: April 2003

A 44-year-old woman had several congenital melanocytic nevi that were treated with a CO2 laser. Six weeks after the laser treatment one lesion repigmented and was therefore excised. The initial histological diagnosis of malignant melanoma was revised to ‘pseudo-melanoma’ after re-evaluation of the history, the clinical presentation and the histology. We conclude that pseudo-melanoma is a complication of laser therapy that has to be recognised in order to avoid unnecessary surgical procedures.
Uncommon Clinical Presentations of Juvenile Xanthogranuloma
Authors: Caputo R. , Cambiaghi S. , Brusasco A. , Gelmetti C.
Published: April 2003

Two unusual clinical presentations of juvenile xanthogranuloma (JXG), the most common non-Langerhans cell histiocytosis, are described: a flat ‘plaque-like’ and a ‘paired’ form. This report confirms the great variability of JXG. Besides representing a dermatological curiosity, the recognition of these atypical forms of presentation should facilitate the clinical diagnosis of the disorder.
The Acute Effect of Smoking on Cutaneous Microcirculation Blood Flow in Habitual Smokers and Nonsmokers
Authors: Monfrecola G. , Riccio G. , Savarese C. , Posteraro G. , Procaccini E.M.
Published: April 2003

Background: Smoking is known to be a primary cause of chronic harmful effects on the vascular system. It also induces some acute effects on the coronary circulation and on the ophthalmic artery. Objective: The aim of our study was to assess the effect of smoking a single cigarette on cutaneous blood flow in habitual smokers as well as in nonsmokers. Methods: A laser Doppler flowmeter was used to perform measurements of cutaneous microcirculation. Flowmetric data were recorded (i) before smoking, (ii) inhaling from an unlighted cigarette, (iii) during cigarette smoking, (iv) 2 and (v) 5 min after smoking. Results: We could show that smoking a single cigarette acts on the cutaneous microcirculation reducing blood flow in both groups of subjects (38.1% reduction in smokers and 28.1% reduction in nonsmokers; p <0.01). Interestingly, the recovery phase is faster in nonsmoker subjects than in smoker ones; in fact, the recovery is complete 2 and 5 min after cigarette smoking in nonsmokers and in smokers, respectively. Conclusion: Smoking a single cigarette decreases the cutaneous blood flow in habitual smoker as well as in nonsmoker subjects. Moreover, the slower recovery phase of smokers suggests that their microcirculation become inured to smoke.
Understanding the Pathogenesis of HSV-Associated Erythema multiforme
Authors: Aurelian L. , Kokuba H. , Burnett J.W.
Published: April 2003

Erythema multiforme (EM) is a polymorphic, often recurring eruption caused by exposure to medication or various infections, notably herpes simplex virus (HSV). Understanding the pathogenesis of HSV-associated EM (HAEM) is essential for patient management. We suggest that HAEM results from the combination of viropathic effects mediated by HSV proteins, notably DNA polymerase (Pol), and an immunological reaction to viral antigens. Presumably, viral DNA and proteins ingested by macrophages at HSV lesion sites undergo fragmentation and processing for presentation to T cells with HSV memory. HSV DNA is deposited on the skin, where it is expressed. Activated T cells are recruited to the skin site of Pol expression, directly or indirectly resulting in the generation of an inflammatory cascade. Factors potentially involved in the incidence of recurrences, lesion severity and anatomical localization include the identity of the deposited HSV genes, cutaneous capillary size, degree of vasoconstriction and ambient temperature. Evidence in support of this interpretation is reviewed.
Pseudoporphyria cutanea tarda Induced by Furosemide in a Patient Undergoing Peritoneal Dialysis
Authors: Breier F. , Feldmann R. , Pelzl M. , Gschnait F.
Published: April 2003

We report on a 32-year-old female patient undergoing peritoneal dialysis for diabetic nephropathy who developed blisters and cutaneous fragility on the dorsa of the hands. Histopathology of an early lesion showed a subepidermal cleft under a regular epidermis with single necrotic keratinocytes and normal dermal structures. In an advanced lesion, a subepidermal bulla and caterpillar bodies were found in the epidermis. Dermal vessel walls were normal and surrounded by a discrete lymphocytic infiltrate. Direct immunofluorescence revealed perivascular deposits of C3. Uroporphyrin and coproporphyrin levels of serum, urine and dialysate were repeatedly normal, confirming pseudoporphyria. The patient took furosemide (500 mg daily). Replacement of furosemide by ethacrynic acid led to spontaneous healing of the blisters. The patient was free of further lesions at the 1-year follow-up.
Palmoplantar Keratoderma and Leukokeratosis anogenitalis: The Second Case of a New Disease
Authors: Lautenschlager S. , Pittelkow M.R.
Published: April 2003

An increasing number of syndromes with palmoplantar keratoderma (PPK) with associated diseases are being identified, representing a wide spectrum of distinct entities. At present only one case report has described the combination of marked anogenital leukokeratosis with diffuse PPK evolving in a collodion baby. We report a patient with a diffuse, nonprogressive PPK in combination with an intermittently pruritic, slowly progressive anogenital leukokeratosis. Hyperkeratosis of the perineal area was most pronounced and extended to the distal portion of the anal mucosa. The opalescent lesion was also visualized at the margin of the major labia. Vulvar structures were not otherwise involved or dystrophic. There were no signs or symptoms of ectodermal dysplasia. Specifically, the nails were normal and showed no signs of pachyonychia congenita. Other differential diagnoses included dyskeratosis congenita and white sponge nevus, which may be associated with anogenital leukokeratosis, but a keratoderma is not associated with these entities. Keratin immunocytochemistry showed marked expression of suprabasal K17 and absence of K6 and K16. Further examination of the initial case described by Itin and Rufli demonstrated the same expression pattern and supports the contention that these two cases represent the same entity.
Nonepisodic Angioedema Associated with Eosinophilia: Report of 4 Cases and Review of 33 Young Female Patients Reported in Japan
Authors: Chikama R. , Hosokawa M. , Miyazawa T. , Miura R. , Suzuki T. , Tagami H.
Published: April 2003

Background: In 1984, Gleich et al. described 4 patients with episodic angioedema associated with eosinophilia (EAE), which was characterized by recurrent episodes of angioedema and urticaria, eosinophilia, elevated serum IgM, fever, increased body weight and a benign course without involvement of the internal organs demonstrating that it was a clinical entity distinct from the hypereosinophilic syndrome. Thereafter, 37 cases of EAE have been reported in Japan, 33 cases of which, although similar, had a different evolution from classical EAE. Objective: To describe 4 cases and review the cases of angioedema associated with eosinophilia reported in Japan. Results: Four Japanese female patients had persistent angioedema mainly involving the hands and lower legs, and eosinophilia which resolved within a few months. The review of the 37 cases of EAE in the Japanese literature demonstrated that in 33 cases, there were common characteristics which differed from EAE. These included: (1) the absence of recurrent attacks; (2) the predominance of young females (20–37 years, with a mean of 26 years); (3) the localization of the angioedema to the extremities; (4) the absence of increase in the serum IgM level, and (5) the effectiveness of low-dose prednisone or even the occurrence of spontaneous remission. Conclusion: We propose that persistent angioedema with eosinophilia can be classified into 2 types, i.e. one being an episodic (recurrent) type as reported by Gleich and a nonepisodic type as our 4 cases and others found in the Japanese literature.
Scalp Psoriasis, Clinical Presentations and Therapeutic Management
Authors: van de Kerkhof P.C.M. , de Hoop D. , de Korte J. , Kuipers M.V.
Published: April 2003

Background: The scalp is a well-known predilection site for psoriasis. Many patients indicate that scalp psoriasis is both psychologically and socially distressing. Objective: The aim of the present investigation is to provide epidemiological data on the various manifestations of scalp psoriasis, as well as on its therapeutic management. Methods: A questionnaire, targeted on scalp psoriasis, was mailed to patient subscribers of a Dutch journal on psoriasis. In total 1,023 forms were returned and evaluated. Results: Remarkably, a relatively high occurrence of facial psoriasis (25%) and nail psoriasis (40%) was recorded. The dynamics of scalp psoriasis were rather similar to psoriasis at other sites with respect to the total duration of the disease and exacerbations/remissions. In 57% of the patients, psoriasis was psychologically and socially distressing, at least occasionally. Itch and scaling proved to be the leading symptoms, in terms of frequency of occurrence as well as in terms of distress. Therefore, these parameters should be regarded as primary efficacy criteria in the treatment of scalp psoriasis. On average, most patients were seen by the dermatologist 5 times a year. The majority of prescriptions (76%) was given by the dermatologist. The application of topical corticosteroids was by far the most frequent treatment modality. To our surprise, calcipotriol was used by 28% of patients. At the time of investigation calcipotriol was only available as ointment. Tar shampoos were used by 51% of the patients, although the clinical efficacy of such a shampoo has never been demonstrated in a controlled study. A remarkable observation was the lack of instruction on the duration of treatment and the frequency of applications. In fact, 72% of the patients used topical treatments, including topical corticosteroids, for more than 8 weeks, and 42% of the patients used an intermittent schedule of a few applications per week. Conclusions: Based on the present survey, the following profile for an optimal treatment of scalp psoriasis can be constructed: (1) effective applications a few times per week; (2) either a lotion or an emulsion, and (3) safety for long-term use.
Generalized Melanosis in Metastatic Malignant Melanoma: The Possible Role of DOPAquinone Metabolites
Authors: Tsukamoto K. , Furue M. , Sato Y. , Takayama O. , Akasu R. , Ohtake N. , Wakamatsu K. , Ito S. , Tamaki K. , Shimada S.
Published: April 2003

Generalized melanosis occurs very rarely as a complication of malignant melanoma, and the pathogenesis of this condition is still unclear. Histological examination of pigmented skin and measurements of the DOPAquinone metabolites 5-S-cysteinyldopa (5-S-CD) and 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) in the patient’s serum and urine were carried out. Histological examination revealed basal hyperpigmentation, discrete melanoma cells and melanophages around the blood vessels and an unusual melanin deposition within collagen bundles in the dermis. The levels of 5-S-CD and 6H5MI2C were dramatically increased both in the patient’s serum and urine. The deposition of DOPAquinone metabolites secreted by the melanoma cells may contribute to the unusual melanin deposition within collagen bundles in the affected dermis.
Phacomatosis pigmentokeratotica: Speckled-Lentiginous Nevus in Association with Nevus sebaceus
Authors: Langenbach N. , Hohenleutner U. , Landthaler M.
Published: April 2003

We report a case of a congenital nevus sebaceus with numerous brown macules and papules in the left auricular region. In the same lesion, pigmented basal cell carcinomas developed later in life. Additionally, on the left side of the neck, both shoulders and the left arm, features of nevus spilus with melanocytic and blue nevi were present. Such a combination of nevus sebaceus with melanocytic lesions may be explained by the concept of twin spotting and represent another case of phacomatosis pigmentokeratotica.
Sensitization and Development of Allergic Contact Dermatitis Caused by a Single Contact with an Electrosurgical Grounding Plate Containing Acrylates
Authors: Borelli S. , Nestlé F.O.
Published: April 2003

Acrylates are known as potent sensitizers which can cause sensitization even during patch testing. A single exposure to concentrated acrylates can induce primary sensitization and contact dermatitis. Here we describe a 50-year-old man who developed contact dermatitis at the site of an electrosurgical grounding plate 2 weeks after orthopedic surgery. Patch testing revealed positive reactions to the electrosurgical plate and its components hydroxyethyl acrylate and hydroxyethyl methacrylate. As the patient has never had contact with acrylate-containing materials before, there is a high probability of primary sensitization by a single contact with the grounding plate during surgery.
A Case of Lyme Disease with Parotitis
Authors: Kawagishi N. , Takahashi H. , Hashimoto Y. , Miyamoto K. , Iizuka H.
Published: April 2003

A-59-year-old Japanese woman presented a cellulitis-like erythematous skin rash, low-grade fever, and general fatigue, accompanied by a firm swelling of the right parotid gland. She had a history of tick bite on the right lateral neck 2 weeks before. Serum anti-Borrelia burgdorferi antibody was positive by Western blot analysis, and B. burgdorferi was isolated from the skin lesion. Serum amylase level was elevated with predominant salivary gland isozyme; the level returned to normal within 3 weeks following penicillin and tetracycline treatment. Parotitis might be included among the rare complications of Lyme disease affecting the head and neck region.
Low-Salt Water Reduces Intestinal Permeability in Atopic Patients
Authors: Dupuy P. , Cassé M. , André F. , Dhivert-Donnadieu H. , Pinton J. , Hernandez-Pion C.
Published: April 2003

Background: Clinical remission of atopic dermatitis (AD) after intake of a low-salt water has recently been reported. Methods: We here investigated the effects of a low-salt water in AD patients with increased intestinal permeability to lactulose. From an initial group of 75 atopic patients, who undertook a treatment in a medical spa center, 12 were included because of abnormal urinary excretion of lactulose (>0.6%), which is absorbed in the enterocytic interspaces, at baseline. The excretion of mannitol with an extraenterocytic absorption was also studied as control. During 18 days, the patients followed a medical spa treatment course, including topical application and oral ingestion of a low-mineral water. Patients were asked not to modify their usual food regimen during the cure. At the end of treatment (day 18), the determination of the excretion of both sugars in urine was repeated. Results: At baseline, the mean urine excretion of lactulose in the study population was 1.21 ± 0.08 SEM. At the end of treatment (day 18), the lactulose concentration in urine diminished dramatically by 55% (mean 0.55 ± 0.09 SEM, p = 0.0005). Urine mannitol was also found to be reduced over the cure period, although to a lesser extent (30%, p = 0.04). Conclusion: This study indicates that low-mineral water normalizes the intestinal permeability of patients with AD.
The Medusa Stage of the Coronate Scyphomedusa Linuche unguiculata (‘Thimble Jellyfish’) Can Cause Seabather’s Eruption
Authors: Segura Puertas L. , Burnett J.W. , Heimer de la Cotera E.
Published: April 2003

Adult Linuche unguiculata medusae cause seabather’s eruption just like that animal’s larval form. This observation explains the wide seasonal incidence and the fact that lesions can appear on exposed skin.
Panniculitis Caused by Acinous Pancreatic Carcinoma
Authors: Heykarts B. , Anseeuw M. , Degreef H.
Published: April 2003

Subcutaneous fat necrosis is a form of panniculitis associated with pancreatitis or pancreatic carcinoma. The massive release in the bloodstream of lipolytic enzymes such as lipase, amylase and trypsin causes these lesions. As pancreatic disease is often asymptomatic, extensive investigations are mandatory in the presence of panniculitic lesions to search for an underlying disease.
Cutaneous Cancers in the Mosan Region and Ardennes of Belgium
Authors: Piérard-Franchimont C. , Uhoda I. , Piérard G.E.
Published: April 2003

Background: The ratios of basal cell carcinomas (BBC) to squamous cell carcinomas (SCC) and to malignant melanomas (MM) have changed over time in the white population throughout the world. Objective: To evaluate the incidence of skin cancers in the Mosan region and the Belgian Ardennes over the past 6 years. Results: In contrast with epidemiological data reported by the Belgian National Cancer Registry, cutaneous cancers are the commonest malignancies occurring in humans. At the present time, the ratio BCC:SCC roughly equals 4 to 1. When combined, the incidence of BCC and SCC is about 10 times greater than that of MM. Conclusion: The rate of detection of skin cancers does not always correlate with the rate of notification of a national registry.
Evaluation of the Role of Genital Human Papillomavirus in the Pathogenesis of Ungual Squamous Cell Carcinoma
Authors: Theunis A. , André J. , Noël J.-Ch.
Published: April 2003

Human papillomaviruses (HPV), and particulary HPV 16, have been associated with ungual squamous cell carcinoma (USCC). But their role in tumor development remains unclear. In genital carcinoma, where the oncogenic role of HPV is well established, integration of HPV DNA into the host cell genome seems to be important for malignant transformation. To clarify the issue, we have studied the physical state of HPV 16 in 3 cases of in situ USCC by the polymerase chain reaction and by in situ hybridization. HPV DNA was integrated into the human genome in 2 cases and episomal in 1 case. This particular physical state of HPV 16 in USCC, similar to those encountered in anogenital SCC, confirms the probable role of this kind of virus in the pathogenesis of USCC.
Osteoma cutis in Pseudohypoparathyroidism
Authors: Goeteyn V. , de Potter C.R. , Naeyaert J.M.
Published: April 2003

Pseudohypoparathyroidism (PHP) is a hereditary disorder characterized by an end-organ resistance for parathormone. PHP can be classified into different types by biochemical and phenotypic characteristics and the level of the defect in the hormone-receptor complex. PHP is described as Albright’s hereditary osteodystrophy (AHO) when a specific phenotype is present. We report a case of osteoma cutis in a 30-year-old woman with AHO. Successful treatment was obtained by debriding the lesion followed by split-thickness skin grafting.
Fractal Quantification of the Microvasculature Heterogeneity in Cutaneous Melanoma
Authors: Heymans O. , Blacher S. , Brouers F. , Piérard G.E.
Published: April 2003

Background: Recent advances in angiogenesis research have led to the introduction of new prognosis factors. Although the vessel count is effective in breast cancer, the prognosis of primary cutaneous melanoma (PCM) does not seems to be directly influenced by this parameter. However, the microscopic examination of PCM suggests variability in the repartition of the microvasculature. Objective and Method: To explore the possibility of extracting information about the vessel distribution by performing a textural analysis on the grey level of histological sections by means of fractal characterization by both Fourier spectrum and multifractal analysis. Results: Three different patterns of vasculature were identified according to the vessel density and distribution. Conclusion: It is possible to differentiate and quantify clearly the differences in the microvessel profile organization using the fractal and multifractal methods.
Longitudinal Study of a Patient with Herpes-simplex-Virus-Associated Erythema multiforme: Viral Gene Expression and T Cell Repertoire Usage
Authors: Kokuba H. , Imafuku S. , Burnett J.W. , Aurelian L.
Published: April 2003

Background: Erythema multiforme is a polymorphous self-limited, often recurrent eruption that can follow herpes simplex virus (HSV) infection, hereby designated HAEM. Studies of relatively large groups of patients during one recurrent episode indicated that HAEM pathogenesis is associated with HSV gene expression, Vβ2 T cell infiltration of lesional skin and altered T cell receptor (TCR) repertoire usage by HSV-stimulated peripheral blood mononuclear cells (PBMC). However, HAEM recurrences are not always preceded by overt HSV eruptions and virus cannot be isolated from HAEM lesional skin. Therefore, it is unknown whether all HAEM recurrences experienced by a given patient are HSV related. Objective: The studies described in this report were designed to examine whether all HAEM recurrences experienced by a given patient are HSV related. Methods: We describe one patient who was studied longitudinally during 6 HAEM recurrences and in the intervening lesion-free periods. Lesional skin from all HAEM episodes was studied for HSV gene expression and infiltration by Vβ2 and Vβ3 T cells. PBMC obtained at these times were assayed for TCR repertoire usage upon HSV stimulation. Results: Lesional skin from all HAEM episodes was positive for HSV gene expression (RNA and protein) as well as Vβ2 T cell infiltration. HSV-stimulated PBMC obtained at these times had an altered TCR repertoire characterized by a predominance of Vβ2 cells. The duration of viral gene expression, Vβ2 cell infiltration and altered TCR repertoire usage correlated with the duration of clinical symptoms. Conclusion: The data suggest that HSV and a virus-specific immunopathology component are involved in the causation of all HAEM episodes experienced by the patient.
Type 2 Segmental Manifestation of Multiple Glomus Tumors: A Review and Reclassification of 5 Case Reports
Authors: Happle R. , König A.
Published: April 2003

Background: In various autosomal dominant skin disorders, segmental forms reflecting mosaicism have been reported. Recently, two different types of mosaic manifestation have been delineated. Type 1 reflects heterozygosity for the underlying mutation and shows a degree of severity as observed in the corresponding nonmosaic phenotype. Type 2 originates from loss of heterozygosity, shows an excessively severe involvement and is usually superimposed on the disseminated lesions of the ordinary trait. Objective: We wanted to exemplify further the proposed rule of dichotomy. Methods: We have screened the literature on multiple glomus tumors, a trait that follows an autosomal dominant mode of transmission. Results: We found 5 cases of multiple glomus tumors suggesting a type 2 segmental involvement. In all of these cases, a unilateral band-like or patchy arrangement of excessively pronounced glomus tumors was associated with disseminated lesions corresponding to the ordinary phenotype, and in 3 cases other family members were affected with disseminated glomus tumors. The unilateral agminated lesions were reported to be present in early childhood, whereas the disseminated lesions appeared later. Conclusion: Multiple glomus tumors can be added to the list of autosomal dominant skin disorders that may show a type 2 segmental involvement.
Mycosis fungoides with Mucinosis follicularis in Childhood
Authors: Hess Schmid M. , Dummer R. , Kempf W. , Hilty N. , Burg G.
Published: April 2003

Mycosis fungoides is a cutaneous T-cell lymphoma (CTCL) usually observed in mid to late adulthood. It occurs only rarely during childhood. Follicular mucinosis is a chronic dermatosis involving the sebaceous glands and outer root sheaths. It is normally differentiated into a juvenile benign form and an adult form possibly associated with mycosis fungoides. We report a 12-year-old boy who presented with an 8-month history of erythematous mucinous plaques on the scalp. Three months later, he developed erythematous patches and plaques on his whole body, accompanied by cervical lymphadenopathy. A biopsy showed follicular mucinosis and epidermotropism of the lymphocytic infiltrate. Immunophenotyping and a PCR clonality test were consistent with CTCL. The patient received PUVA treatment and local steroids, resulting in partial remission. Mycosis fungoides should be considered in the differential diagnosis of chronic, scaling dermatoses in childhood. Moreover, follicular mucinosis in childhood can be associated with mycosis fungoides.