bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Necrosis and Lupus-Like Syndrome Preceeding Ovarian Carcinoma
Authors: Chtourou M. , Aubin F. , Savariault I. , Chabot P. , Manchet G. , Montcuquet Ph. , Humbert Ph.
Published: April 2003

Since 1967, about 40 cases of digital necrosis associated with neoplasia have been reported. We report a new case of digital necrosis associated with an ovarian carcinoma and with a lupus-like syndrome. Immunologic cross-reactivity to tumoral antigen could explain the lupus-like syndrome.
c-myc Is Not Useful as Prognostic Immunohistochemical Marker in Cutaneous Melanoma
Authors: Böni R. , Bantschapp O. , Müller B. , Burg G.
Published: April 2003

Background: Several studies indicate that immunohistochemical detection of the c-myc oncogene might serve as an additional prognostic marker in malignant melanoma. Objective: To study c-myc expression in paraffin-embedded cutaneous melanoma and to correlate to metastatic potential and onset of metastases. Methods: Cytoplasmic c-myc protein expression was visualized using the APAPP method, and reactivity (percent total tumor cells stained) was assessed in 62 formalin-fixed paraffin-embedded primary cutaneous melanomas (21 not metastasizing, mean Breslow 3.0 ± 2.9 mm, 41 metastasizing, mean Breslow 3.1 ± 3.0 mm) and 24 metastases of the same patients. Results: There was no significant difference of c-myc reactivity in cutaneous melanoma who did not metastasize (n = 21, c-myc reactivity 32.7 ± 19.3%, follow-up 10.6 ± 1.8 years) and primaries who metastasized (n = 41, c-myc reactivity 27.7 ± 22.4%, p = 0.29). This finding was independent of the thickness of the primary and was found within thin cutaneous melanoma with a Breslow <0.75 mm (range 0.24–0.65 mm, n = 20, c-myc reactivity 29.1 ± 15.7%, p = 0.32) or within thick cutaneous melanoma with a Breslow >1.5 mm (range 1.6–11 mm, n = 41, c-myc reactivity 29.6 ± 23.8%, p = 0.46). No correlation of c-myc expression between thin cutaneous melanoma, thick cutaneous melanoma (p = 0.83) or metastasizing primaries and their metastases (n = 24, c-myc reactivity 29.3 ± 22%) was found (p = 0.64). The time period until development of first metastasis did not correlate with the percentage of cells expressing c-myc in the primary (p = 0.56). Conclusion: c-myc expression is independent of metastatic potential and onset of metastases and, therefore, does not serve as a prognostic immunohistochemical marker in primary cutaneous melanoma.
Polythelia pilosa: A Particular Form of Accessory Mammary Tissue
Authors: Camacho F. , González-Cámpora R.
Published: April 2003

Background: The old Kajawa classification which considered eight possible forms of aberrant mammary tissue has been recently modified into a simpler one that considers this condition only when there is glandular parenchyma or when the aberrant tissue is not a glandular tissue but a nipple, an areola or both. This new classification disregards ‘polythelia pilosa’ defined as an ‘isolated patch of hairs only’. Objective: To demonstrate that polythelia pilosa is at least a marker of subjacent accessory mammary tissue and, consequently, that the term should be incorporated into the current classification. Methods: Among 72 cases of aberrant or accessory mammary tissue, we have studied 14 cases (7 men and 7 women) that were clinically diagnosed as ‘visible isolated patches of hairs, apparently without pigmentation nor structures of areola or nipple’. We excised such isolated patches in 3 women. Results: The histopathological examination showed an acanthotic and hyperpigmented epithelium with central depression closed by keratin plugs; in the dermis there were follicles with hairs surrounded by hypertrophic sebaceous glands. In the deepest portion, abundant secretory glomerules and excretory ducts of apocrine gland type could be observed. Conclusion: Since the biopsy of isolated patches of hairs demonstrated structures of either areolar or apocrine glandular tissue, we think that the term ‘polythelia pilosa’ should be reinstated into the classification as it is at least a marker of true aberrant mammary structures in men and hirsute women.
Hypomelanosis of Ito
Authors: Haenen I. , Vanquickenborne L. , Kerre S. , Degreef H.
Published: April 2003

We report two patients with hypomelanosis of Ito, one whose afflictions were limited to the pigmentary skin abnormalities and another with systemic involvement of the neurological and gastrointestinal system. These case reports give support to the importance of establishing hypomelanosis of Ito as occurring with or without systemic involvement.
Hypercalcemia in a Patient with Malignant Melanoma Arising in Congenital Giant Pigmented Nevus
Authors: Matsui T. , Kageshita T. , Ishihara T. , Tomiguchi S. , Takahashi M. , Ono T.
Published: April 2003

We describe a 43-year-old Japanese female who developed hypercalcemia associated with malignant melanoma. The patient underwent three resections of tumors on her groin and buttock secondary to a bathing trunk congenital nevus, and the histopathological findings showed benign congenital nevi. At the age of 42 years, she developed a malignant melanoma under the giant pigmented nevus in her groin. Fourteen months after the diagnosis of melanoma, she developed metastases to the lung, para-aortic lymph nodes and bones accompanied by hypercalcemia resulting from a remarkable increase in the serum level of parathyroid hormone-related protein (PTHrP). The patient died from acute renal and respiratory failure. In addition, we analyzed serum levels of calcium and PTHrP in 19 patients with advanced malignant melanoma. Seven patients had hypercalcemia, and 3 had increased serum levels of PTHrP.
Elastofibroma dorsi
Authors: Ohtake N. , Setoyama M. , Kanzaki T.
Published: April 2003

Elastofibroma dorsi is a rare benign soft-tissue tumor which is solid, ill-defined and marked by slow growth. It is usually found in the subscapular region of older individuals. We report here the case of a 56-year-old Japanese man with elastofibroma dorsi which was located in the left subscapular region and measured 50 × 70 mm in size. The mass was very similar to tumors previously reported, both clinically and histologically. This entity has only rarely been described in the dermatological literature, but it should be considered in the differential diagnosis of subscapular complaints elderly patients.
Opposing Effects of Glycerol on the Protective Function of the Horny Layer against Irritants and on the Penetration of Hexyl Nicotinate
Authors: Bettinger J. , Gloor M. , Peter C. , Kleesz P. , Fluhr J. , Gehring W.
Published: April 2003

Background: It is known that glycerol in an oil-in-water emulsion has a protective effect against irritating substances. Objective: To answer the question: is the protection effect of glycerol based on a regenerative process? Methods: Upon irritation by either tape stripping or acetone treatment, we applied glycerol to the skin surface under an occlusive dressing to create transepidermal water movement. As a control we used water under the occlusive dressing on the contralateral forearm. After 5 h we compared the barrier function using biological tests. Results: A significant improvement of the protective barrier function was observed in the glycerol-treated areas, as shown by the alkali resistance and by the irritant effect of dimethyl sulfoxide (DMSO) as well as sodium lauryl sulfate. Surprisingly, at the same time penetration of hexyl nicotinate improved on the glycerol-treated areas. A direct physicochemical protection effect on the surface of the skin was ruled out in additional studies using NaOH and DMSO. Conclusions: Under the given conditions glycerol leads to a more rapid reconstitution of the protective skin barrier and initiates a regenerative skin protection. In contrast to that, it is acting as a penetration enhancer.
Evaluation of Topical Drug Treatment in Psoriasis
Authors: van de Kerkhof P.C.M. , Steegers-Theunissen R.P.M. , Kuipers M.V.
Published: April 2003

Background: During the last decade important innovations in the topical treatment of psoriasis have been accomplished, and important investments in new drug development for psoriasis are planned. Methods: A survey was conducted among psoriatic patients in order to quantify the present mode of use of topical drugs by the patients, the mode of prescription by their doctors and the compatibility of actual use and instructions to the patients. Results: Major observations are: The distribution of lesions, in particular on the scalp and soles, justifies major investments in the development of a treatment at these locations. Calcipotriol and topical corticosteroids (classes III and IV) are by far the most frequently prescribed topical drugs. Although at the time of investigation, calciopotriol was only available as ointment in the Netherlands, it is prescribed twice as often as clobetasol which is both available as an ointment and cream. Dermatologists are responsible for approximately 2/3 and general practitioners for 1/3 of the prescriptions. The prescription by general practitioners also comprises the continuation of prescriptions by the dermatologist. The duration of topical treatment is unrestricted in the majority of patients. However, use of up to 8 weeks is only seldom practised. Therefore, long-term safety and efficacy data of these drugs are mandatory for any topical treatment. Although twice daily treatment was advised in 50% of all patients, this treatment frequency was followed in only 33% of them. Greasiness accounted for non-compliance in 11% of the patients. Less frequent applications were desired by 38% of the patients, including patients on a once-a-day regimen. Most patients preferred the cream formulation. However, the variability of the expression of psoriasis (dry cracked exudative or superficially scaling lesions) required the availability of both cream and ointment formulations. Conclusion: An optimal treatment of psoriasis requires a spectrum of topical drugs and their formulations in different vehicles.
Application of Argon Plasma Coagulation in Skin Surgery
Authors: Brand C.U. , Blum A. , Schlegel A. , Farin G. , Garbe C.
Published: April 2003

Background: Argon plasma coagulation (APC) is a noncontact electrosurgical technique which has been used in open surgery for about 20 years and in endoscopy for about 5 years. Objective: The aim of the present study was to provide preliminary results on the effect of this method in skin surgery. Methods: The effects of variations in gas flow, output power and coagulation times on the extent of the resulting skin coagulation zone were tested in a pig skin model. Furthermore, preliminary results were obtained from 48 patients. Results: The depth of the coagulation zone, which depends on the output power of the high-frequency (HF) generator and the application time, was examined clinically and histologically in 150 different pig skin coagulations. The maximum depth of the coagulation zone was 4 mm. Coagulation zones below 4 mm can be maintained by controlling the output power of the HF generator and/or the duration of application. Variations of argon flow did not influence the depth of the coagulation zone significantly. In preliminary clinical tests, 48 patients with common warts, senile hemangiomas and actinic keratoses were treated with APC. In all cases, APC was highly effective and easy to perform. No severe problems or complications were observed. The skin lesions were destroyed with minimal or no scarring and without damaging the surrounding tissue. Conclusion: In the present preliminary study, APC proved to be an effective treatment with well-controlled tissue destruction. Further clinical studies are required to evaluate the suitability and the indications of this method in the treatment of cutaneous lesions.
Flagellate Mushroom (Shiitake) Dermatitis and Photosensitivity
Authors: Hanada K. , Hashimoto I.
Published: April 2003

Flagellate skin lesions occur in some patients after eating the mushroom Lentinus edodes, and they are called shiitake dermatitis in Japan. We describe a 44-year-old man with such skin lesions on his trunk after eating L. edodes, who developed as well photosensitive skin lesions on exposed areas. Skin phototesting with UVB did not show a decreased minimum erythema dose; UVA irradiation provoked an erythematous lesion with nonspecific histological changes. Analysis of the case histories of 94 Japanese patients with shiitake dermatitis revealed that 44 (47%) also developed dermatitis on the skin exposed to sunlight. UVA photodermatitis has not been emphasized in previous reports. The relationship to bleomycin flagellate dermatitis is discussed.
Genodermatosis with Reticulate, Patchy and Mottled Pigmentation of the Neck – A Clue to Rare Dermatologic Disorders
Authors: Itin P.H. , Lautenschlager S.
Published: April 2003

Reticulate pigmentation of the neck is a common finding in numerous genodermatoses and acquired diseases. As the neck is readily accessible to medical inspection, it may serve as a diagnostic window for various dermatoses. Several entities out of the spectrum of ectodermal dysplasia present with reticulate or mottled pigmentation on the upper trunk and neck. The most impressive genodermatoses with punctate and reticulate pigmentation affecting the neck are the Naegeli-Franceschetti-Jadassohn syndrome, dermatopathia pigmentosa reticularis and dyskeratosis congenita. Reticulate pigmented anomaly of the flexures and lentiginosis, disorders of cornification and related entities are further genodermatoses which may involve the neck. In our review we have integrated inherited dermatoses which do not obligatorily affect the neck but have been well documented to do so. Our work should give the clinician a checklist on genodermatoses which may produce reticulate and mottled pigmentation on the neck.
Immunopathogenesis of Psoriasis: News in an Old Concept
Authors: Guilhou J.-J.
Published: April 2003

Twenty years ago, a concept of psoriasis pathogenesis was proposed in which epidermal proliferation of psoriatic lesions was the consequence of immunological abnormalities. This concept has subsequently been supported by the remarkable efficacy of immunosuppressive drugs. Moreover, recent experimental data indicate that activated psoriatic lymphocytes are capable of inducing keratinocyte proliferation. However, we have still to explain the mechanism by which lymphocytes act on keratinocytes and to find out what antigenic material could be responsible for their activation.
Psychosocial Stress of Patients with Port Wine Stains and Expectations of Dye Laser Treatment
Authors: Augustin M. , Zschocke I. , Wiek K. , Peschen M. , Vanscheidt W.
Published: April 2003

Background: Port wine stains can be treated successfully with the dye laser in most cases. The indication for treatment is made on the basis of the emotional stress arising from the port wine stain. Studies of the extent of psychosocial stress to date have led to contradictory results. Objective: To address the question how many patients with port wine stain suffer psychosocial stress and how this group can further be characterized. Moreover, the specific expectations of treatment were to be elucidated. Methods: During dye laser treatment, 76 patients with port wine stains were evaluated by questionnaires regarding (a) emotional well-being, (b) quality of life, (c) body perception and (d) disease-specific stress and expectations of therapy. Results: Patients with port wine stains showed significantly higher emotional stress than healthy controls. They were particularly impaired in quality of life with respect to their social life and felt less attractive than a healthy control group. Patients with high emotional stress placed high hopes on the laser therapy with regard to chances of employment and social contacts. Conclusion: The data point to the need for thorough patient consultation prior to laser therapy in order to avoid excessive expectations. Psychological consultation is recommended for emotionally labile PWS patients.
Tinea capitis Dermatophytes: Susceptibility to Antifungal Drugs Tested in vitro and in vivo
Authors: Mock M. , Monod M. , Baudraz-Rosselet F. , Panizzon R.G.
Published: April 2003

Background: Tinea capitis is a worldwide-spread infection of the scalp caused by dermatophytes and is predominantly seen in children. The clinical manifestations range from mild scaling lesions to widespread alopecia or highly inflammatory suppurating lesions. Terbinafine and itraconazole seem to be promising therapies with shorter treatment durations than griseofulvin. Objective: The objective of the present study was to test the sensitivity of different species of dermatophytes towards terbinafine and itraconazole, and to compare the results with a retrospective study on 35 immunocompetent patients with tinea capitis who were treated with terbinafine (Lamisil®). Methods: Minimal inhibitory concentrations (MIC) were measured with an agar dilution method. Results: Each tested species of dermatophyte was sensitive to terbinafine and itraconazole at different concentration ranges. The MIC for terbinafine ranged from 0.005 to 0.5 μg/ml and for itraconazole from 40 to 80 μg/ml. Microsporum canis was the dermatophyte least sensitive to terbinafine. Our retrospective study showed that the cure rate was excellent for Trichophyton violaceum and T. soudanense, variable for T. mentagrophytes and poor for M. canis and M. langeronii. Conclusions: (i) Regarding the results of susceptibility tests obtained with species involved in tinea capitis, clinical efficacy is not related to MIC measured in vitro; (ii) identification of the isolated dermatophyte from tinea capitis seems to be important for choosing the appropriate treatment.
Decrease in Enkephalin Levels in Psoriatic Lesions after Calcipotriol and Mometasone Furoate Treatment
Authors: Nissen J.B. , Avrach W.W. , Hansen E.S. , Stengaard-Pedersen K. , Kragballe K.
Published: April 2003

Background: Enkephalins are opioid peptides that can modulate immune responses and inflammatory processes. Furthermore, they inhibit keratinocyte proliferation/differentiation in vitro. Previously, we have shown that enkephalins are present in increased amounts in lesional psoriasis. Objective: To determine the effect of topical treatment with the vitamin D analogue calcipotriol and the corticosteroid mometasone furoate on the level of methionine-enkephalin (enk) in psoriatic lesions. Methods: Twelve psoriatic patients were treated with calcipotriol and mometasone furoate for 14 days without or with hydrocolloid occlusion. Keratome biopsies were obtained from treated and untreated skin, and the extracted enk was quantified by radioimmunoassay. Furthermore, punch biopsies were obtained for immunohistochemical analysis. Results: Clinically, both calcipotriol and mometasone furoate improved psoriasis to the same degree, the effects being more pronounced after occlusion. Histologically, treatment with mometasone furoate without occlusion decreased both the epidermal thickness/parakeratosis and the number of dermal immunocompetent cells (CD3- and CD68-positive cells). In contrast, treatment with calcipotriol without occlusion reduced the epidermal thickness and the degree of parakeratosis but decreased the number of CD3- and CD68-positive cells only slightly. The mean enk level was decreased by 26 and 86% by calcipotriol without and with occlusion and by 16 and 63% by mometasone furoate without and with occlusion, respectively. The decreases in the enk levels corresponded to the degree of clinical improvement but not to the histological changes. Conclusion: The increased levels of enk in psoriatic lesions are reduced in parallel with the clinical improvement induced by a topical vitamin D analogue and a corticosteroid. Because enkephalins can modulate epidermal differentiation and inflammatory processes, the findings indicate that enkephalins may play a role in the pathogenesis of psoriasis.
Decreased Nitric Oxide Production in Patients with Behçet’s Disease
Authors: Örem A. , Vanizor B. , Çimşit G. , Kıran E. , Değer O. , Malkoç M.
Published: April 2003

Background: Behçet’s disease is a chronic multisystemic disorder which is characterized by a relapsing systemic inflammatory process. One of the features of Behçet’s disease is endothelial dysfunction resulting from many factors. Objective and Methods: We conducted this study to show if there is any change of plasma nitrite and nitrate levels by using the enzymatic-spectrophotometric method as an indicator for nitric oxide (NO) production, considering the disease activity in patients with Behçet’s disease. The study group consisted 21 patients and 20 healthy control subjects. We measured plasma nitrite and nitrate levels, and some acute-phase reactants including erythrocyte sedimentation rate, alpha-1-antitrypsin, alpha-2-macroglobulin and the neutrophil count. Blood samples were drawn before and after treatment of the patients. Results: Nitrite, nitrate and nitrite + nitrate levels in the active period of the disease were found to be decreased compared to the inactive period and the control group. No significant differences were observed in plasma nitrite and nitrate levels between the inactive period and the control group. Conclusion: It was concluded that decreased NO production in patients with Behçet’s disease may have critical biological activities relevant to pathologic events in the active period of the disease.
Generalized Pustular Psoriasis of Pregnancy (Impetigo herpetiformis)
Authors: Breier-Maly J. , Ortel B. , Breier F. , Schmidt J.B. , Hönigsmann H.
Published: April 2003

A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj’s spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. Serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.
Pleomorphic Sclerotic Fibroma
Authors: Martín-López R. , Feal-Cortizas C. , Fraga J.
Published: April 2003

We report the clinical and histologic features of 2 cutaneous tumors demonstrating many of the usual features of sclerotic fibroma, an entity that is well described in the literature. Our cases differed from the usual form of sclerotic fibroma in that they demonstrated marked focal cellular pleomorphism without increased mitotic activity. We suggest the term pleomorphic sclerotic fibroma for these lesions.
Bone Involvement in a Case of Kaposi Sarcoma
Authors: Ritz-Quillac L. , Machet L. , Machet M.C. , Vedere V. , Vaillant L. , Lorette G.
Published: April 2003

Background: Extracutaneous involvement is rare in the classical form of Kaposi sarcoma (KS). Observation: We report a case of bone involvement revealed by bone pain. Magnetic resonance (MR) images demonstrated the local invasion of bone from cutaneous lesions. Bone biopsy confirmed bone involvement. The patient was treated with vindesine. Bone pain progressively disappeared. Conclusion: Bone involvement has rarely been reported in classical KS though 4.5% of the patients were affected when it was systematically sought. Treatment of symptomatic lesions requires radiotherapy or chemotherapy.
Systemic Hyalinosis of Delayed Onset
Authors: Horiuchi Y. , Mukosaka K. , Fujimaki T.
Published: April 2003

We report a 46-year-old Japanese male with systemic hyalinosis. The condition had not been present during youth but was clearly evident in the patient’s forties. The present case is remarkable because of a delayed onset.
Cutaneous Nocardiosis Caused by Nocardia brasiliensis after an Insect Bite
Authors: Paredes B.E. , Hunger R.E. , Braathen L.R. , Brand C.U.
Published: April 2003

We report the case of a primary lymphocutaneous nocardiosis occurring on the right calf of a healthy 56-year-old man after an insect bite. Analysis of the purulent exudate obtained from the nodule revealed Nocardia brasiliensis. The initial therapy with trimethoprim-sulfamethoxazole had to be stopped due to a drug eruption. However, with minocycline treatment the patient recovered within 5 weeks. Superficial (sporotrichoid) infections and a history of outdoor injury should be considered suspicious for cutaneous nocardiosis.
Elastic Nevus With Normal Expression of Elastin and Elastin-Related Proteins mRNAs
Authors: Ohnishi Y. , Akiyama M. , Tajima S. , Ishibashi A. , Seyama Y.
Published: April 2003

A 3-year-old Japanese girl presented with disseminated white papules on the trunk. A biopsied specimen of the lesional skin revealed a focal accumulation of elastic fibers in the mid to deep dermis. No skeletal involvement was detected. This case was considered to be elastic nevus without systemic involvement. Since an elevated elastin expression in the fibroblasts of typical Buschke-Ollendorff syndrome (BOS) has been reported, elastin and elastin-related protein mRNA levels in the cultured patient fibroblasts were determined. There were no significant differences of steady-state levels of elastin, fibrillin 1 and microfibril-associated glycoprotein 1 mRNAs between patient and matched control fibroblasts. Elastic nevus without skeletal involvement may be etiologically different from typical BOS.
In vivo Enalapril-Induced Acantholysis
Authors: Lo Schiavo A. , Guerrera V. , Cozzani E. , Aurilia A. , Ruocco E. , Pinto F.
Published: April 2003

Enalapril is a widely used antihypertensive drug with a very powerful in vitro acantholytic effect. It has been known to potentially induce pemphigus in genetically predisposed subjects. The action mechanism is complex and still only partially understood. We describe the case of a 66-year-old man, affected with intermediary basal cell carcinoma, in whom the histological examination showed suprabasal acantholytic clefts in the perilesional epidermis. Surprisingly a second biopsy taken from the apparently healthy skin of his back confirmed the presence of acantholytic changes. Clinical signs of pemphigus were absent. The patient’s history did not reveal any relevant data but a mild arterial hypertension that had been treated for 1 year with 10 mg enalapril. Taking into account the patient’s history (enalapril long-term administration), the absence of any bullous or erosive lesions and the histological findings, a diagnosis was made of in vivo enalapril-induced acantholysis.
Nevus anemicus
Authors: Ahkami R.N. , Schwartz R.A.
Published: April 2003

Nevus anemicus (NA) is a congenital localized cutaneous anomaly most often seen on the trunk. It represents a pale-colored irregularly shaped patch of histologically normal-appearing skin in which the pharmacological response to certain mediators may be aberrant, with sympathetic vasoconstriction likely responsible for the pallor. Hence, it has been called a pharmacological nevus. NA may be linked with certain genodermatoses, including neurofibromatosis and phakomatosis pigmentovascularis.
The Ultrastructural Patterns of Mast Cell Degranulation in Kimura’s Disease
Authors: Aoki M. , Kawana S.
Published: April 2003

Background: Although Kimura’s disease has been considered an atopic disease because of the association of peripheral blood eosinophilia and elevated serum IgE, the mechanisms of these phenomena are still unknown. Objective: It is now established that mast cells are a source of cytokines that are involved in eosinophil recruitment or IgE production. In order to understand the role of mast cells in Kimura’s disease, we conducted ultrastructural studies. Method: The 45 mast cells obtained from 2 patients with Kimura’s disease were classified into two subgroups: S type, with a predominance of scroll or crystal subelements in their granules, and P type, predominantly possessing a particulate or filamentous substructure. Results: We observed numerous P type mast cells with focal losses of granule contents in the absence of granule extrusion in Kimura’s disease. Conclusion: These results indicate the possibility that slow release of mediators or cytokines from mast cells by piecemeal degranulation may contribute to the pathomechanism of Kimura’s disease.
Overexpression of p53 Protein Associated with Proliferative Activity and Histological Degree of Malignancy in Solar Keratosis
Authors: Shimizu T. , Oga A. , Murakami T. , Muto M.
Published: April 2003

Background: Overexpression of p53 protein has frequently been demonstrated in human epithelial neoplasms including squamous cell carcinoma (SCC) and solar keratosis (SK). SK is a precursor lesion of SCC. In SCC of the skin, we have already reported that overexpression of p53 protein is associated with the proliferative activity, which is indicated by the percentage of Ki-67-positive cells. In SK, however, the significance of p53 overexpression is still unclear. Objective: The aim of the present study was to clarify the relationship between p53 overexpression and proliferative activity, and between p53 overexpression and histological degree of malignancy in SK. Methods: Sixty-eight cases of SK were divided into four grades according to the proportion of atypical cells in the epidermis (in grade I, up to 25% of the epidermal cells are atypical, in grade II 25–50%, in grade III 50–75%, in grade IV more than 75%) and were immunohistochemically analyzed for the expression of p53 protein and Ki-67 antigen. Results: p53 overexpression was detected in 58 out of the 68 cases of SK. The percentage of p53-protein-positive cells (DO-7 index) ranged from 0 to 78.8 (mean ± SD = 20.6 ± 21.6). Mean DO-7 indices were 7.9 in grade I, 26.7 in grade II and 38.3 in grade III. The differences in mean DO-7 index between grades I and II and between grades I and III were statistically significant (p < 0.001). The percentage of Ki-67-antigen-positive cells (MIB-1 index) ranged from 0.8 to 38.2 (mean ± SD = 10.5 ± 9.0). Mean MIB-1 indices were 5.9 in grade I, 10.7 in grade II and 20.5 in grade III. The differences in the mean MIB-1 index between grades I and II and between grades II and III were statistically significant (p < 0.01). Cases with higher DO-7 indices tended to show higher MIB-1 indices, and the relation was statistically significant [y = 0.272x + 4.8; correlation coefficient r = 0.59 > r (n – 2, 0.01) = 0.31]. Conclusion: Overexpression of p53 protein was related to cell proliferation as well as histological degree of malignancy in SK. Dysfunction of p53 protein might be implicated in skin carcinogenesis.
Reactivity at Edges of Corticosteroid Patch Tests May Be an Indicator of a Strong Positive Test Response
Authors: Bjarnason B. , Flosadóttir E. , Fischer T.
Published: April 2003

Background: The importance of the reactivity at the edges of corticosteroid patch tests is unknown. Objective: To study the clinical importance of edge reactivity in budesonide patch tests. Methods: Ten subjects previously positive for budesonide patch tests were retested with 0.1% budesonide in Finn Chambers® and with budesonide-printed polyester squares in serial doses (150–0.074 μg/cm2). Six exposure periods were used for each polyester square dose (3 h to 4 days). Tests were followed up to 11 days. Doubtful or weakly visible reactivity at the test edges was assessed additionally by test perfusion assessments. Results: Nine of 10 subjects reacted with some edge reactivity and later exhibited positive reactions. Perfusion assessments helped to confirm early edge reactivity. Some allergic subjects showed edge reactivity only at high doses, while longer applications were required for weaker doses. Conclusion: Edge reactivity may be an indicator of a strong suppressed test response.
Helicobacter pylori and Behçet’s Disease
Authors: Avcı O. , Ellidokuz E. , Şimşek I. , Büyükgebiz B. , Güneş A.T.
Published: April 2003

Background: Recent investigation of the etiology of Behçet’s disease (BD) has focused on heat shock proteins (HSP) which belong to the HSP 60 family. Both the gastric pathogen Helicobacter pylori (HP) and BD may cause ulcers in the gastrointestinal tract and, HP expresses HSP 60. Objective: Whether HP is linked to the pathogenesis of BD or not, and to investigate the influence of HP eradication on clinical parameters of BD. Methods: Patients with BD were divided into two groups. Group I comprised 49 patients and was investigated for HP seroprevalence and compared with age- and sex-matched controls. Group II comprised 20 patients with BD and HP infection diagnosed by serological and endoscopic examinations as well as the rapid urease test (RUT). A 1-week eradication therapy was administered for HP infection. Patients were examined for the course of BD at monthly intervals. Two months after the eradication therapy, patients underwent an endoscopic examination and RUT for eradication control. Seven patients were excluded because of eradication failure. Thirteen patients were evaluated for the influence of HP eradication on clinical manifestations of BD. The number and size of oral and genital ulcers before the eradication and at the end of the follow-up period were compared statistically. Results: HP seroprevalence between patients with BD and controls did not show significant difference. In 13 patients with BD, the number and size of oral and genital ulcers diminished significantly and various clinical manifestations regressed after the eradication of HP. Conclusion: HP may be involved in the pathogenesis of BD.
A Laugier-Hunziker Syndrome Associated with Esophageal Melanocytosis
Authors: Yamamoto Osamu , Yoshinaga Kentaro , Asahi Masakazu , Murata Ikuo
Published: April 2003

A 62-year-old Japanese woman came to our clinic because of melanotic macules on the lip, palatoglossal arch, lingual margin and palm. Endoscopic examination revealed a melanotic macule on the midesophageal mucosa but no polyposis in the gastrointestinal tract. Histologically, the specimens taken from the labial, esophageal and palmar lesions showed an acanthosis and basal hyperpigmentation in the epithelium. The patient had not taken any medication which could lead to pigmentation. As far as we know, this is the first case report of an esophageal melanocytic macule which occurred in a patient with Laugier-Hunziker syndrome. When confronted with an isolated pigment spot, we emphasize the necessity of systematic examinations for others. Because the pathologic relationship between Laugier-Hunziker syndrome and the esophageal melanocytic lesion is not proven, further studies should clarify this issue.
Double-Lined Frontoparietal Scleroderma en coup de sabre
Authors: Itin Peter H. , Schiller Peter
Published: April 2003

We describe a rare case of double-lined frontoparietal scleroderma en coup de sabre. The relationship to the distribution following the lines of Blaschko is discussed. In addition, we present a genetic hypothesis which is based on a mosaic state induced by postzygotic mosaicism. A patient with scleroderma en coup de sabre has a mosaic state for genes which predispose to susceptibility for linear scleroderma.
Assessing Hair Shedding in Children
Authors: Rampini Paolo , Guarrera Marcella , Rampini Enrico , Rebora Alfredo
Published: April 2003

Background: The wash test is currently used to assess hair shedding, though it lacks a cut-off point of normality and any evidence of being reliable. The aim of this study is to provide data to fulfil those needs. Methods: The wash test was employed in a standardized way on 31 children aged 3–11 years. Results: The test yielded 10.68 ± 3.91 hairs, a figure which may be considered as ‘normal’ for children of that age. The χ2 test granted the validity of the method. The number of shed hairs counted in the washing basin increased with the age of the subjects. Comment: The wash test proved to be reliable and to be a useful tool for monitoring hair shedding. The increasing trend with age may suggest a possible prepubertal onset of androgenetic alopecia.
Successful Treatment of Progressive Vitiligo with High-Dose Intravenous Methylprednisolone ‘Pulse’ Therapy
Authors: Seiter S. , Ugurel S. , Pföhler C. , Tilgen W. , Reinhold U.
Published: April 2003

We report on the successful therapy of rapid progressive generalized vitiligo in a 24-year-old woman. After intravenous injection of 500 mg of methylprednisolone on 3 consecutive days, the disease progression was stopped and repigmentation was induced. The treatment was repeated monthly and after 6 cycles, repigmentation was achieved on vast parts of most vitiligo lesions. The treatment was well tolerated by the patient, and no side effects were noted. We conclude that high-dose glucocorticoid pulse therapy may represent a therapeutic alternative in selected patients with generalized rapid progressive vitiligo.
Nevus comedonicus
Authors: Lefkowitz A. , Schwartz R.A. , Lambert W.C.
Published: April 2003

The nevus comedonicus (NC) is an uncommon variant of adnexal hamartoma which appears clinically as linear groups of open comedones. Its name may be a misnomer since, according to some, true comedones are not present. NC usually occurs by itself but may be linked with a variety of systemic findings such as skeletal or ocular anomalies. Although the nevus comedonicus is viewed by many as a hamartoma arising from a defective mesoderm, others consider this lesion to be an epidermal nevus involving the hair follicle or an appendageal nevus of sweat ducts.
Receptor Tyrosine Kinase and p16/CDKN2 Expression in a Case of Tripe Palms Associated with Non-Small-Cell Lung Cancer
Authors: Krähn G. , Greulich K.M. , Bezold G. , Dieterle C. , Wolff H. , Peter R.U.
Published: April 2003

Background: Tripe palms is a descriptive term for a cutaneous paraneoplastic keratoderma. Tripe palms are frequently associated with gastric and pulmonary carcinoma. The pathogenetic mechanism remains unknown. Objective: To determine the influence of receptor tyrosine kinases, which are both expressed in pulmonary carcinomas and in human skin, we performed expression studies on epidermal growth factor receptor (EGFR), HER2, HER3 in a skin sample of tripe palms obtained from a patient with non-small-cell lung cancer with lymph node involvement. Two months after diagnosis, the patient had developed palmoplantar ‘tripe palms’. Additionally, the expression of SRC, c-myc and p16/ CDKN2 were studied. Method: Conventional reverse-transcription polymerase chain reaction was performed on a tissue sample of tripe palms. Results: Weak expression of HER2 and of p16/CDKN2 was found. EGFR, HER3, c-myc and SRC were not expressed. Conclusion: Receptor tyrosine kinases of subclass I, the tyrosine kinase SRC and the oncogene c-myc play no major role in the pathogenesis of this case of tripe palms.
Interleukin 11 Reduces Apoptosis in UVB-Irradiated Mouse Skin
Authors: Scordi Irini A. , Nassiri Mehdi , Hanly Andrew J. , Vincek Vladimir
Published: April 2003

Background: UVB radiation, the major cause of skin cancer, causes apoptosis in the skin, characterized by the appearance of ‘sunburn cells’. Interleukin 11 (IL-11) has been shown to protect cells in the gastrointestinal system from chemotherapy and radiation-induced death. Objective: To determine whether exogenous IL-11 has any effect on the UVB-induced apoptosis of cutaneous tissues. Methods: Mice were injected with IL-11 or vehicle control prior to irradiation, and TUNEL assays were performed on paraffin-embedded tissue sections at various times after irradiation. Results: Exogenous IL-11 protects epidermal keratinocytes, epithelial cells of the hair follicles inflammatory cells and fibroblasts in the dermis from UVB-induced apoptotic death. Conclusion: These findings suggest that IL-11 may play a role in the general homeostasis of the skin.
Acute Monocytic Leukemia Presenting as Cutaneous Involvement
Authors: Nakano Kazu , Kusakabe Hidenari , Kiyokane Kimihiro
Published: April 2003

Specific cutaneous lesions appearing during acute monocytic leukemia (AMoL) are more frequent than those associated with other types of leukemia. However, skin involvement preceding the presence of leukemic cells in the peripheral blood is quite rare. In this paper, we describe a case where a 25-year-old male had multiple infiltrative erythemas and nodules on his arms. Histologically, the nodules were formed by masses of tumor cells in the dermis. Peripheral-blood tests revealed no abnormalities, but bone marrow aspiration from the sternum led to a diagnosis of AMoL. The diagnosis of specific cutaneous lesions of AMoL was confirmed by the results of cytochemical studies of bone marrow smears, and cutaneous nodules of cutaneous biopsy specimens led to early diagnosis. Complete remission was achieved with combination chemotherapy and peripheral blood stem cell transplantation.
A Cancer-Registry-Assisted Evaluation of the Accuracy of Digital Epiluminescence Microscopy Associated with Clinical Examination of Pigmented Skin Lesions
Authors: Stanganelli Ignazio , Serafini Monica , Bucch Lauro
Published: April 2003

Background: The accuracy of digital epiluminescence microscopy (D-ELM) as an adjunct to clinical examination for the diagnosis of pigmented skin lesions (PSLs) has seldom been evaluated. Objective: To compare the accuracy of the combined clinical/D-ELM (C/D-ELM) examination with that of the clinical examination alone. Methods: A total of 3,372 PSLs from 1,556 consecutive patients referred to a skin cancer clinic underwent clinical examination and a combined C/D-ELM examination. The reference diagnosis was established using the histology report of known surgical excisions plus a cancer-registry-based follow-up (duration 18 months) of benign C/D-ELM diagnoses. The two diagnostic approaches were compared for sensitivity, predictive value and false-positive rate. Results: The series included 55 melanomas and 43 basal cell carcinomas. About 50% of malignant misdiagnosed cases were identified solely through the cancer registry. The C/D-ELM diagnosis showed a greater sensitivity for melanoma <0.76 mm thick (83 vs. 46% for clinical examination alone; ratio, 1.82) and basal cell carcinoma (79 vs. 49%; ratio, 1.62), a greater predictive value for melanoma (81 vs. 53%; ratio, 1.53) and a reduced total false-positive rate (0.3 vs. 0.9%; ratio, 0.31). Conclusion: D-ELM showed a potential to improve the clinical diagnosis of PSL.
Recurrent Intravascular Papillary Endothelial Hyperplasia of the Toes
Authors: Yamamoto Tetsuji , Marui Takashi , Mizuno Kosaku
Published: April 2003

We report on the rare case of a 50-year-old male with intravascular papillary endothelial hyperplasia (IPEP) in the left toes. The patient noticed a small tender mass in the left toes and underwent surgery in November 1997. The tumor recurred twice after surgery. Histopathological examination revealed a pure form of IPEP without underlying benign vascular lesions.
Late Cutaneous Schistosomiasis Representing an Isolated Skin Manifestation of Schistosoma mansoni Infection
Authors: Kick G. , Schaller M. , Korting H.C.
Published: April 2003

Ectopic late cutaneous schistosomiasis is usually preceded or accompanied by visceral schistosomiasis infection. Our patient presented the very rare case of late cutaneous schistosomiasis as an isolated skin manifestation. Perigenital lesions occurred 1 year after contact with infested water. Identification of the few eggs remaining in the late lesion among the dense cellular infiltrate was difficult. Electron-microscopic studies clearly demonstrated the characteristic eggshell ultrastructure.
Diffuse Calcinosis cutis in a Patient with Congenital Leukemia and Leukemia cutis
Authors: Lestringant Giles G. , Masouyé Isabelle , El-Hayek Mohammed , Girardet Christophe , Révész Tom , Frossard Philippe M.
Published: April 2003

We report an unusual case of congenital leukemia with leukemia cutis (LC) and diffuse calcinosis cutis. A newborn girl presented with widespread dusky red and yellowish cutaneous nodules and papules. Bone marrow morphology was consistent with the diagnosis of acute monocytic leukemia of the FAB M5 type. Skin biopsy specimens confirmed the presence of a leukemic infiltrate and revealed calcium salt deposition in the papillary and reticular dermis. Calcinosis was diffuse in the whole skin but spared other organs. Vascular calcification was not present. Serum calcium levels oscillated between 2.5 and 2.86 mmol/l, and phosphorus, parathyroid hormone and 25-hydroxyvitamin D3 levels were normal. There were diffuse osteoporosis and spontaneous fractures of small tubular bones. The patient responded to chemotherapy but, following consolidation treatment, developed sepsis and died at 120 days of age. Congenital leukemia is rare and LC is uncommon. Hypercalcemia may be a complication of leukemia, which leads to multiorgan metastatic calcification. Despite the absence of frank hypercalcemia, the presence of bone lesions suggests that the patient’s calcinosis cutis was of the metastatic type. However, the cutaneous leukemic infiltrate may also represent a triggering factor for calcium deposition in the skin.
Elevated Serum KL-6 Levels in Patients with Systemic Sclerosis: Association with the Severity of Pulmonary Fibrosis
Authors: Sato S. , Nagaoka T. , Hasegawa M. , Nishijima C. , Takehara K.
Published: April 2003

Background: Serum KL-6 has been suggested to be a useful marker for the evaluation of interstitial lung disease activity. Objective: To determine the correlation between serum KL-6 levels and pulmonary fibrosis in patients with systemic sclerosis (SSc). Methods: Serum samples from patients with limited cutaneous SSc (lSSc; n = 19), diffuse cutaneous SSc (dSSc; n = 26) and normal individuals (n = 15) were examined by ELISA. Results: Serum KL-6 levels in SSc patients were significantly higher than those in normal controls. KL-6 levels in dSSc patients were significantly elevated compared with those in lSSc patients. Elevated KL-6 levels were associated with the presence of pulmonary fibrosis in SSc patients or dSSc patients. Furthermore, KL-6 levels inversely correlated with percentages of diffusion capacity of carbon monoxide and vital capacity in SSc patients or dSSc patients. Conclusion: KL-6 may be a simple, serologic indicator for the severity of pulmonary fibrosis in SSc.
Apoptosis in Established and Healing Psoriasis
Authors: Laporte M. , Galand P. , Fokan D. , de Graef C. , Heenen M.
Published: April 2003

Background: Previous studies have described apoptosis in the stratum granulosum and in the stratum corneum, but not in the germinative compartment in normal skin. In psoriasis, an increased epidermal apoptosis has been observed in the differentiated compartment, suggesting that apoptosis has a key role in the pathogenesis of psoriasis, as a counteracting factor to the overproduction of cells. Little is known on apoptosis in the germinative compartment. Methods: Apoptosis was studied on biopsies of normal skin, established lesions of psoriasis and PUVA-treated psoriasis using the transferase-mediated uridine nick end labelling method, which detects fragmented DNA, and electron microscopy. Counting of apoptotic cells was restricted to the germinative compartment as defined by Mib1 staining to evaluate the impact of cell loss on cell production and tissue architecture. Results: The apoptotic index was 0.12% in normal epidermis, 0.035% in established psoriasis and 0.31% in regressive psoriasis. Conclusion: These results have three implications: (1) they show the physiological presence of apoptosis in the germinative compartment in normal epidermis; (2) they suggest that induction of apoptosis is involved in the regression of psoriatic hyperplasia after PUVA therapy; (3) the decrease of physiological apoptosis in the psoriatic lesion suggests that this phenomenon could play a role in the induction of psoriatic hyperplasia.