bluuebunny/crossref_metadata_2025 huggingface dataset:
Perineal Lipoma in a Neonate
Authors: Ogasawara Yumie , Ichimiya Makoto , Nomura Sadahiro , Muto Masahiko
Published: July 2014

Although lipoma is a subcutaneous tumor most commonly found on the trunk in adults, it is very rare in neonates. The histopathological findings show an encapsulated tumor containing normal fat cells. We report a 3‐month‐old female newborn with lipoma in the perineal region. The tumor was 4 cm in diameter, which histopathologically showed non‐encapsulated lobules composed of fat cells without cellular atypia. There were no genital abnormalities. The tumor was easily removed while the patient was under general anesthesia.
Skin Metastasis of Neuroendocrine Carcinoma Derived from the Mediastinum
Authors: Yoshimasu Takashi , Yamamoto Yuki , Uede Koji , Furukawa Fukumi
Published: July 2014

We report a 46‐year‐old Japanese man with a metastatic skin tumor on his left palmar region. He underwent resection for a mediastinal neuroendocrine carcinoma in February of 1998. After the operation, he immediately noticed an elevated tumor on his left palm. In September 1999, a brain tumor was discovered. The skin and brain tumors were subsequently removed surgically. Neuron specific enolase (NSE) in the serum was elevated to 25 ng/ml. A skin biopsy specimen from the left palmar site revealed multiple tumor nests which showed the same histological features as the primary mediastinal tumor. Immunostaining was positive for chromogranin, synaptophysin, and NSE but negative for S‐100 protein and CD57. To our knowledge, this is the first report of cutaneous metastasis of a neuroendocrine tumor derived from the mediastinum.
A Specific Thrombin Inhibitor, Argatroban, Alleviates Herpes Zoster‐associated Pain
Authors: Fujii Kimio , Kanno Yuko , Konishi Kenji , Ohgou Noriko
Published: July 2014

We report the result of a randomized, controlled, open trial of anti‐thrombin therapy for herpes zoster‐associated pain. Fifty‐five herpes zoster patients within 8 days after the onset of skin lesion were enrolled in the trial. Patients were treated with an optimal dose of oral acyclovir (4000 mg/day for 7 days) with or without intravenous administration of a specific anti‐thrombin agent, argatroban (10 mg/day, three times a week). Administration of argatroban reduced pain intensity at the 4th through 21st day after the initiation of treatment as determined by visual analogue scale (Mann‐Whitney U test, p<0.05). It also shortened the median time to cessation of analgesic use (14 days vs. 24 days, p=0.02, logrank test), although it did not significantly reduce the median time to cessation of pain (21 days vs. 43 days, p=0.07, logrank test). None of the enrolled patients showed evidence of adverse effects including hemorrhagic diathesis. The results suggested that relatively low doses of argatroban are effective in reducing herpes zoster‐associated pain. Up‐regulation of prothrombin expression by the vascular endothelial and sweat gland epithelial cells in the active skin lesion and transient elevation of plasma thrombin‐antithrombin III complex levels in a proportion of patients suggest a lesional generation of thrombin in herpes zoster. This may be relevant to the beneficial effects of the anti‐thrombin treatment on the resolution of herpes zoster‐associated pain.
A Suspected Case of Primary Cutaneous Actinomycosis on the Buttock
Authors: Sardana Kabir , Mendiratta Vibhu , Sharma Ravi C.
Published: July 2014

Primary cutaneous actinomycosis is rare and can mimic mycetoma, tuberculosis and nocardiosis. The results of cultures (aerobic and anaerobic) are not always positive. A high degree of clinical suspicion should be entertained and a combination regimen of penicillins with sulphonamides should be used for treatment. We report a patient with primary cutaneous actinomycosis over the buttock, who was successfully treated with amoxycillin and sulphonamides.
Stanozolol in Chronic Urticaria: A Double Blind, Placebo Controlled Trial
Authors: Parsad Davinder , Pandhi Roma , Juneja Archana
Published: July 2014

H1‐type antihistamines drugs are mainstays in the management of chronic urticaria. For patients with refractory, chronic, idiopathic urticaria who have failed to benefit from conventional therapy, other safe therapeutic modalities are required. To evaluate the role of stanozolol as an adjunctive therapeutic agent with H1‐antihistamine in refractory chronic idiopathic urticaria, we conducted this study. Fifty‐eight patients with chronic refractory urticaria were enrolled in this trial and were randomly assigned to two groups (A and B). Patients in group A received 2 mg stanozolol twice daily along with cetrizine 10 mg daily. Patients in group B received cetrizine 10 mg daily and placebo tablets twice daily. The improvement was monitored by estimation of severity score. Of the 58 patients, 26 in group A and 24 in group B could be evaluated. At the end of 12 weeks, 17 patients in group A showed marked to complete resolution as compared to 7 patients in group B (chi‐square p<0.01). The intention to treat analysis p value was a found to be <0.007. There was a highly significant decrease in mean severity score at 12 weeks (p<0.001) in group A patients. The present study demonstrated that stanozolol is an effective and safe adjuvant therapy for treatment of chronic refractory urticaria.
Decreased Total Numbers of Peripheral Blood Lymphocytes with Elevated Percentages of CD4+CD45RO+ and CD4+CD25+ of T‐Helper Cells in Non‐Segmental Vitiligo
Authors: Mahmoud Fadia , Abul Habib , Haines David , Al‐Saleh Casem , Khajeji Mehdi , Whaley Keith
Published: July 2014

Vitiligo is a disorder involving progressive skin depigmentation caused by host mediated destruction of melanocytes. Its pathogenesis is known to correlate with elevated levels of activated skin‐infiltrating T lymphocytes and is presumed to be autoimmune in nature. In the present study, we characterize the immunophenotype of peripheral blood T cells from vitiligo patients, with the objective of developing an investigative and diagnostic tool for the disease, using analysis of peripheral blood. Subjects for this investigation included 32 patients diagnosed with non‐segmental vitiligo and 28 age‐and gender‐matched, normal, healthy control participants. Whole venous blood taken from each subject was analyzed using 2‐color flow cytometry for immunologically‐relevant lymphocyte subsets. When compared with healthy control subjects, peripheral blood from individuals with vitiligo was found to have lower total numbers of lymphocytes (p<0.039). Vitiligo patients also had elevated percentages of memory (CD4+CD45RO+) T cells; (p<0.05), but NK‐T cells (CD3+CD16+CD56+) and naive T cells (CD4+CD45RA+) were present at lower total numbers and percentages than in healthy controls (p<0.01 and 0.05 respectively). Blood from severely afflicted subjects exhibited elevated CD3+HLADR+ and CD4+CD45RO+ as well as lower percentages of NK‐T cells (p<0.05) when compared with mild cases. In conclusion, disease‐associated, peripheral blood lymphocyte immunophenotypic profiles of vitiligo patients are consistent with the hypothesis of T cell activation as a major feature of the disorder. These include elevated memory and reduced naive T cell percentages and increased expression of the activation‐associated surface antigen CD25. These changes presumably reflect increased antigen‐mediated activation. Moreover, because a corollary effect is increased activation‐induced cell death (AICD), lower overall lymphocyte counts observed in vitiligo‐afflicted subjects is also expected.
Actions of Gluco‐Oligosaccharide against Staphylococcus aureus
Authors: Akiyama Hisanori , Oono Takashi , Huh Wook Kang , Yamasaki Osamu , Akagi Yukie , Uemura Hideto , Yamada Tetsumasa , Iwatsuki Keiji
Published: July 2014

Heavy colonization of atopic dermatitis (AD) with Staphylococcus aureus is well documented. The purpose of the present study is to examine the actions of gluco‐oligosaccharide (G‐OS) against S. aureus for the control of AD skin lesions infected with S. aureus. The colony counts of S. aureus cells in 0.5% sodium chloride solution supplemented with 5% G‐OS (pH 4.8) were about 10‐fold lower than those in 0.5% sodium chloride solution (pH 6.6; control) after incubation for 24 hours. The colony counts of S. aureus cells attached on the coverslips (pre‐treatment with 1% and 5% G‐OS/PBS and following treatment with plasma) were about 10‐fold lower than those on the coverslips (pre‐treatment with PBS and following treatment with plasma; control) in PBS after incubation for 24 hours. The materials (sugars, probably glycocalyx) that stained positively for fluorescein‐isothiocyanate (FITC) ‐concanavalin A and were consistent with the presence of S. aureus cells were reduced when S. aureus cells attached to the coverslips treated with 5% G‐OS. In conclusion, G‐OS is a promising agent that can be applied topically in a cream to clear adherent S. aureus cells from skin lesions of AD in order to prevent its exacerbation. Further, 5% G‐OS can inhibit glycocalyx production by S. aureus cells and consequently have some suppressive effect on the colonization of S. aureus on the horny cells of AD lesions.
Notalgia Paresthetica with a Significant Increase in the Number of Intradermal Nerves
Authors: Inaloz H. Serhat , Kirtak Necmettin , Erguven H. Gulcin , Karakok Metin , Inaloz Serap S.
Published: July 2014

Notalgia paresthetica is an isolated mononeuropathy involving the skin over or near the scapula. The cause remains unknown. We histologically observed a significant increase in the number of dermal nerves in a case of notalgia paresthetica. Immunohistochemical examination using a neural marker, S‐100, positively stained the nerves. Interestingly, a biopsy from perilesional skin also showed an abnormal nerve proliferation.
Patch Testing in Discoid Eczema
Authors: Khurana Sandeep , Jain V.K. , Aggarwal Kamal , Gupta Sanjeev
Published: July 2014

Fifty patients of both sexes with clinically suspected discoid eczema were patch tested with the Indian Standard Patch Test Battery approved by the Contact and Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20 and 39 years old, with a mean age of 36 years. The mean duration of symptoms was 2 1/2 years. The occupational profiles of the patients included farmers (24%), housewives (18%), students (14%), housewives engaged in farming (12%), shopkeepers (10%), and laborers (8%). The miscellaneous group, including technicians, drivers, cable operators, office workers, and computer operators, accounted for the remaining 14%. The common clinical patterns of presentation of discoid eczema included hands and feet (44%), hands and forearms' (30%), legs and feet (12%) and trunk and limbs (12%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 28 (56%) reacted to one or more allergens. Potassium dichromate was the most common allergen (20%), followed by nickel (16%), cobalt chloride, and fragrance (12% each) in decreasing order of frequency. Hence, it may be concluded that patch testing should be considered for all patients with severe or persistent discoid eczema because allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to the patients.
A Case of Primary Cutaneous Histoplasmosis in a Patient with Diabetes and Multi‐Infarct Dementia
Authors: Krunic Aleksandar L. , Carag Henry , Medenica Maria M. , Lorincz Allan L.
Published: July 2014

We report a case of primary cutaneous histoplasmosis in a fifty‐year‐old African‐American woman with diabetes and multi‐infarct dementia. The patient developed fever and crusted, nodulo‐ulcerative lesions of the skin after accidental superficial trauma to the forehead. The biopsy revealed suppurative granulomatous inflammation with intracellular and extracellular yeast‐like cells with associated clear halo measuring 3–4 μm in size. Systemic involvement was not found. The lesions cleared after treatment with itraconazole 200 mg twice a day for 3 weeks. The medication was continued for a total period of 3 months, with no signs of recurrence after one‐year of follow‐up.
Short‐Term Etretinate Therapy for Prurigo Chronica Multiformis
Authors: Fujii Kimio , Kanno Yuko , Konishi Kenji , Ohgou Noriko
Published: July 2014

Prurigo chronica multiformis is an intensely pruritic, chronic cutaneous disorder of unknown etiology without any effective treatment. This is a report on the results of using etretinate therapy to treat prurigo chronica multiformis. Thirty‐seven patients (average age; 69.1 ± 11.5 year‐old) were treated with 30 mg/day etretinate along with topical steroids (very strong classes) and oral antihistamines. Etretinate was discontinued as soon as remission was achieved. Thirty‐six patients were followed up for at least four weeks. The number of patients who achieved remission increased progressively after the initiation of etretinate therapy; 18 patients were totally and 14 were partially free of active skin lesions within four weeks. Eventually, 27 patients achieved remission with an average duration of 4.4 ± 3.1 weeks etretinate treatment (range; 1–14 weeks), and five achieved partial remission. Four patients discontinued etretinate within two weeks because of the absence of clinical response (two cases) or exacerbation of the skin lesion (two cases). Among the 27 patients who had achieved remission, 23 had recurrence after the cessation of etretinate. The remission period ranged from 1 to 32 weeks with an average duration of 5.7 ± 6.7 weeks. Combined treatment with topical steroids and oral antihistamines did not achieve remission in the recurrent cases but re‐administration of 30 mg/day etretinate did. Our observation suggests that a moderate dose of etretinate is a safe and effective therapy for prurigo chronica multiformis, which is often resistant to conventional treatment using topical steroids and oral antihistamines.
Palisaded and Verocay Body Prominent Leiomyoma of Deep Soft Tissue
Authors: Lee Mi Woo , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: July 2014

Leiomyoma of deep soft tissue is a very rare tumor, which is sometimes confused with leiomyosarcoma, histopathologically. We describe a case of palisaded and Verocay‐body prominent leiomyoma of deep soft tissue. The lesion was characterized by areas of nuclear palisading with Verocay‐body like formation in addition to the features of leiomyoma.
Ocular Scrofuloderma with Unilateral Proptosis
Authors: Sardana Kabir , Koranne R. V. , Langan Usha , Sharma R. C. , Bhatnagar Shishir Kumar
Published: July 2014

Proptosis due to an extraconal orbital abscess of tubercular origin with lacrimal gland involvement, representing ocular scrofuloderma, is a rare entity. This association has not been reported earlier in the literature. We describe a 7‐year‐old boy who presented with nodulo‐ulcerative lesions of tubercular etiology with discharging sinuses on right side of the face and a similar lesion on the right lower eyelid along with proptosis of 4 months duration. Computerized tomography (CT) scan of the head confirmed the extraconal, intraorbital, hyperdense, homogeneously enhancing mass separated from the lateral rectus muscle and further revealed involvement of lacrimal gland along with erosion of the temporal bone. The patient showed marked improvement of his dermatological and ophthalmological lesions with anti‐tubercular treatment. Subsequent ultrasound examinations of the orbit revealed regression in the size of the abscess from 10.7 mm to 5.0 mm and then complete disappearance of the abcess obviating surgical intervention.
A Case of Multiple Disseminated Eruptive Spitz Nevi
Authors: Rim Jong‐Hyun , Won Chong‐Hyun , Lee Jong‐Suk , Cho Kwang‐Hyun
Published: July 2014

Spitz nevus is usually a solitary lesion. However, multiple Spitz nevi do arise and can be divided into two variants, agminated (grouped) or disseminated. We report an interesting case of multiple disseminated eruptive Spitz nevi with an unusual feature. The apperance of most of the nevi resembled that of melanocytic nevi, and clinically it was impossible to distinguish these multiple disseminated eruptive Spitz nevi from eruptive melanocytic one.
Hyperpigmentation Due to Pyrimethamine Use
Authors: Ozturk Recep , Engin Aynur , Ozaras Resat , Mert Ali , Tabak Fehmi , Aktuĝlu Yildirim
Published: July 2014

Pyrimethamine is used for the treatment of toxoplasmosis and the prophylaxis of malaria. Among the well‐documented side effects are megaloblastic anemia, leukopenia, thrombopenia, rash, vomiting, and diarrhea. Hyperpigmentation is a very rare side effect. In some patients, associated HIV infection makes it difficult to distinguish the reasons for the etiology. We herein describe an HIV‐negative patient who developed hyperpigmentation after pyrimethamine use.
Immediate and Delayed‐type Reactions in Caterpillar Dermatitis
Authors: Natsuaki Masaru
Published: July 2014

The mechanism of dermatitis induced by Euproctis caterpillars has not been fully clarified, although mechanical stimulation by the spicules as well as chemical irritation by venomous components from spicules have been suggested to be involved. In this study, skin tests using venomous spicules and the venomous extract from the caterpillar of E. pseudoconspersa were carried out on a subject. The test site developed both immediate and delayed‐type reactions. Next, the crude extract was separated into 8 fractions (No. 1–8) using gel filtration HPLC, and a skin test using each fraction was performed in the same subject. The result showed that only fraction No. 3 caused reactions similar to those in crude venom extract. Then skin tests using the crude venom and fraction No. 3 were performed in 10 healthy volunteers. The skin reaction caused by crude venom was similar to that caused by fraction No. 3 in each subject. Two volunteers showed neither immediate nor delayed‐type reactions, 4 volunteers showed a delayed‐type reaction, and the other 4 showed both immediate and delayed‐type reactions. These results indicate that allergic reactions against venom released by the spicules play a role in the induction of dermatitis by E. pseudoconspersa caterpillars. Variations in the clinical course of individual patients may be attributable to differences in the state of sensitization to the venomous components.
A Novel Liposomal Formulation of Dithranol for Psoriasis: Preliminary Results
Authors: Agarwal Ravindra , Saraswat Abir , Kaur Inderjeet , Katare Om Prakash , Kumar Bhushan
Published: July 2014

We have prepared a novel, aqueous gel‐based, liposome‐entrapped formulation of dithranol. Herein, we report preliminary observations on its efficacy, tolerability, and cosmetic acceptability in treating stable plaque psoriasis. Nineteen plaques of psoriasis in nine adult patients were treated for six weeks in a prospective, open‐label trial. In five patients, there was total clearance of lesions, with more than 50% subsidence in a further two patients. Significantly, there were no reports of lesional or perilesional irritation, and only one patient showed faint brown staining of the skin, which was completely and rapidly reversible. These preliminary results indicate that our liposomal dithranol gel has potential advantages over presently available preparations of dithranol; these may translate into enhanced acceptance of this useful drug by patients and physicians.
Cutaneous Toxicity of Chemical Irritants on Hairless Guinea Pigs
Authors: Sueki Hirohiko , Kligman Albert M.
Published: July 2014

To evaluate the toxicity of irritant chemicals on animal skin, investigators have frequently had to apply high concentrations, owing to the fact that its susceptibility is less than that of human skin. High concentrations are so damaging to tissue that specific effects are obscured on the various layers. The aim of the present study was to elucidate the effects of a variety of irritating chemicals on the skin of hairless guinea pigs. Graded concentrations of these irritating substances were applied to the back for varying periods. Histologic changes were analyzed by light and electron microscopy. The structural alterations varied greatly among the chemicals, reflecting quite different mechanisms of action. Hairless guinea pigs are quite susceptible to chemical injury, especially to their hair follicles and dermal components. The hairless guinea pig appears to be an advantageous model to assess the acute and chronic effects of chemical irritants.
Three Cases of ‘Mechanic's Hands’ Associated with Interstitial Pneumonia: Possible Involvement with Foot Lesions
Authors: Shibuya Hiromi , Arakawa Shoko , Kai Yoshitaka , Hatano Yutaka , Okamoto Osamu , Takayasu Susumu , Fujiwara Sakuhei
Published: July 2014

We describe three cases of the rare combination of lateral erythema and hyperkeratosis of the fingers that typify a condition known as ‘Mechanic's Hands’. The first and the third cases were unusual in that the condition was associated with cutaneous involvement of the feet and interstitial pneumonia but not with myositis, or with only mild muscular involvement, while the second case was typical, being accompanied by myositis and detectable antibodies against histidyl transferase. We propose that Mechanic's Hands can occur in association with foot lesions and interstitial pneumonia, even if it is not accompanied by myositis.
Treatment of Bullous Pemphigoid
Authors: Fontaine Juliette , Joly Pascal , Roujeau Jean‐Claude
Published: July 2014

Bullous pemphigoid (BP) is the most frequent auto‐immune blistering skin disease. Up to recently, it was treated with oral corticosteroids. High dose steroids are poorly tolerated in the elderly and probably contributed to the high mortality rates observed in several cohorts. For years, efforts have been devoted to looking for steroid sparing agents including immunosuppressive drugs, plasma exchanges, intravenous immunoglobulins, tetracycline. Many seemed useful in open series but proved ineffective or marginally effective when tested in randomized controlled trials. An important breakthrough was the demonstration by a large randomized trial that a “super‐potent” topical corticosteroid (clobetasol propionate) was not only associated with a significant decrease in severe complications and mortality of BP patients but was also more effective than oral prednisone. New strategies for BP should include topical clobetasol propionate as the first line treatment and consider adjuvant therapy only in the very rare cases that are either resistant to or intolerant of this treatment.
Role of Neutralizing Antibody in the Pathogenesis of Zoster and the Correlation of Severity with Anti‐gE: gI Antibody Response
Authors: Matsuo Koma , Honda Mariko , Shiraki Kimiyasu
Published: July 2014

Antibody response to varicella‐zoster virus glycoproteins and neutralizing antibodies were examined to correlate them with the severity of the zoster. Antibody rise to whole viral antigen was observed in 17 of 19 patients, that to gE: gI was not increased in 7 patients, and antibody to gE: gI in severe cases was significantly lower compared with mild cases in the convalescent phase than in the acute phase (p<0.05 Fisher's exact test). Antibody rise to gE: gI was well correlated with limited development of zoster lesions and, in contrast, antibody titer without rise was associated with increased severity and wider development of zoster lesions. As gE is the most abundant glycoprotein in the infected cells, the antibodies may be consumed in severe and widespread lesions, resulting in an antibody response to gE: gI without a rise. When the ratio of neutralizing antibody to anti‐gE: gI antibody titers in the acute phase was compared with that in the recovery phase, the former was significantly lower in the severe cases than the latter (p=0.0082 Student t‐test). This suggested that neutralizing antibody was specifically consumed in the acute phase of zoster among the anti‐VZV antibodies. The role of humoral immunity in the pathogenesis of zoster might have been reflected in the antibody response to the neutralizing antibody in the acute phase and antibody to gE: gI in the severe cases.
A Case of Syringocystadenocarcinoma Papilliferum In situ Occurring Partially in Syringocystadenoma Papilliferum
Authors: Arai Yasuhiro , Kusakabe Hidenari , Kiyokane Kimihiro
Published: July 2014

We report a case of syringocystadenocarcinoma papilliferum in situ associated with syringocystadenoma papilliferum. The patient was a 64‐year‐old man with a red tumor that arose on top of his head two years before he consulted our department. The histological findings revealed a papillomatous growth on the epidermis forming several invaginations. Numerous papillary projections, lined by a two‐layered epithelium with a benign appearance and decapitations on the luminal surface of the cells, extended into the lumens of the invaginations. Some projections showed a disorderly arrangement of multilayered cells with atypical nuclei. No differences between findings in the syringocystadenocarcinoma papilliferum in situ and those in the syringocystadenoma papilliferum were observed histochemically (PAS) or immunohistochemically (cytokeratin, CEA, CA 19–9, S‐100, gross cystic disease fluid protein, lysozyme and Leu M1).
Nonspecific Cell‐Mediated Immunity in Patients with Epidermodysplasia Verruciformis
Authors: de Oliveira Walmar Roncalli Pereira , Carrasco Solange , Neto Cyro Festa , Rady Peter , Tyring Stephen K.
Published: July 2014

Epidermodysplasia verruciformis (EV) is a rare disease that usually begins in childhood and is characterized by a generalized infection by human papilloma virus (HPV), frequent associations with cutaneous carcinomas, and abnormalities of cell‐mediated immunity (CMI). We studied nonspecific CMI in 13 patients with EV by bacterial skin tests, allergic reactions to dinitrochlorobenzene (DNCB), measurement of responses to phytohemagglutinin (PHA), and quantification of T lymphocytes and T lymphocytes subsets in peripheral blood. Impairment of CMI was manifested by the cutaneous anergy to a variety of common skin antigens and, by the reduction of the lymphocyte transformation to PHA. There were no correlation between the severity of cases and abnormalities of CMI in our patients, however; the impairment of CMI was lower in cases of short duration, suggesting that the impairment of CMI in EV might reflect a long period of disease.
Epidermolysis Bullosa Acquisita in Childhood
Authors: Trigo‐Guzmán Fanny X. , Conti Adriana , Aoki Valéria , Maruta Celina W. , Santi Cláudia G. , Silva Claudia M. Resende , Gontijo Bernardo , Woodley David T. , Rivitti Evandro A.
Published: July 2014

Epidermolysis bullosa acquisita (EBA) is a subepidermal autoimmune blistering disease that is rarely reported in childhood. We describe a nine‐month‐old mulatto boy presenting with multiple, annular, widespread, tense blisters and oral lesions. The diagnosis of EBA was confirmed by histopathology, immunofluorescence, and immunoblotting analysis. The patient was successfully treated with systemic steroids (prednisone) and dapsone. After 20 months of initial treatment, clinical remission was observed, and dapsone remains as the current treatment. This case report emphasizes the rarity of EBA in childhood and the difficulties in reaching the final diagnosis.
Circulating CD14+ CD16+ Monocytes Are Expanded in Sarcoidosis Patients
Authors: Okamoto Hiroyuki , Mizuno Kana , Horio Takeshi
Published: July 2014

Sarcoidosis is a systemic disease of unknown etiology characterized by noncaseating granulomas, consisting mainly of epithelioid cells and multinucleated giant cells derived from monocyte‐macrophage lineage cells. Monocytes fall into subpopulations comprising CD14++ CD16−, and CD14+ CD16+ cells, and expansion of the later monocytes has been reported under some pathological conditions. In this study, we examined the immunophenotype of blood monocytes in patients with sarcoidosis using two‐color immunofluorescence flow cytometry. In healthy controls CD14+ CD16+ monocytes account for 5.8 ± 2.8% of monocytes. The percentage of CD14+ CD16+ monocytes was significantly higher (p <0.02) in the sarcoidosis patients (11.8 ± 4.9%) compared with those in healthy control subjects. The serum ACE levels were significantly correlated with the percentage of CD14+ CD16+ monocytes (p <0.05). In contrast, the percentage was not correlated with purinergic receptor expression of monocytes as estimated by LDH release from BzATP‐stimulated monocytes. These findings suggest that CD14+ CD16+ monocytes represent a sensitive marker for the disease activity of sarcoidosis.
Basal Cell Carcinoma with Sarcomatoid Features (Sarcomatoid Carcinoma): Report of a Case and Review of the Literature
Authors: Gómez‐Espejo Carmen , Herrera‐Sabal Alberto , Ríos‐Martín Juan José , Camacho‐Martínez Francisco
Published: July 2014

We report a new case of sarcomatoid carcinoma, which showed cellular features of basal cell carcinoma and malignant fibrous myxoid histiocytoma. For this new case and rare neoplasm, we propose the designation of sarcomatoid basal cell carcinoma, as both components were intimately intermingled, the spindle cells seemed to arise from epithelial cells, and both tumoral components showed the same immunohistochemistry expression, cytokeratin and P53 protein, suggesting a monoclonal origin. The epithelial component, a basal cell carcinoma, may have been the first component in the carcinogenesis process.
Serum Levels of IL‐4, IL‐10, IL‐12, IL‐13 and IFN‐Gamma in Behçet's Disease
Authors: Aridogan Buket Cicioglu , Yildirim Mehmet , Baysal Vahide , Inaloz H. Serhat , Baz Kiymet , Kaya Selcuk
Published: July 2014

Behçet's disease (BD) is an inflammatory disease of unknown etiology. Although its pathogenesis is not fully understood, recent studies have suggested that immunological abnormalities and neutrophil hyperfunction may be involved in its etiology and pathophysiology. The immune system in BD can be characterized as a divergent cytokine production profile of the mixed Th1/Th2 cell type. In this study, we investigated the levels of interleukin (IL)‐4, IL‐10, IL‐12, IL‐13 and interferon‐γ in the sera of patients with BD, in comparison with recurrent aphthous stomatitis and healthy controls, to determine the Th1/Th2 profile of the disease. The levels of IL‐4, IL‐10 and IL‐13 were found to be high in active BD patients, and IL‐12 and interferon‐γ levels were lower in active BD patients than in inactive BD, recurrent aphthous stomatitis, and control patients.
Three Cases of Malignant Melanoma Arising on Burn Scars
Authors: Kikuchi Hidezumi , Nishida Takaaki , Kurokawa Motoki , Setoyama Mitsuru , Kisanuki Atsushi
Published: July 2014

It is well known that up to 2% of chronic burn scar lesions can transform into malignant tumors. Most of them are squamous cell carcinoma (SCC) and, more occasionally, basal cell carcinoma (BCC). The incidence of malignant melanoma (MM) is extremely low. To the best of our knowledge, there are only 23 such cases reported in the literature. We report here three cases of MM arising on burn scars and analyze the 23 cases reported previously. Case 1: A 74‐year‐old Japanese man sustained a burn injury on about 54% of his whole body surface when he was accidentally bathed in boiling oil at the age of 37 years old. Some small tumors developed on the burn scar on his right lumbar region. A wide excision of the tumor was performed. Case 2: A 51‐year‐old Japanese woman was injured on her right forearm and face by deep burns from a flame when she was 7 months old. She presented with a rapidly growing, painless black nodule on the dark skin lesion on her right forearm. She was treated with a wide excision followed by a full‐thickness skin graft. Intravenous administration of one unit of OK‐432 every week has been continued. Case 3: A 73‐year‐old Japanese woman was burned on her left leg and hand from a flame when she was 6 years old. A nodular lesion appeared within the ulcer two months previously and it was growing rapidly. This lesion was ulcerated on the top of its central area and was slightly reddish without any pigmentation. The patient was treated with a wide excision and a split‐thickness skin graft. The 5‐year survival rate of MM in an old burn scar is 53.6%. It is suggested that the prognosis of burn scar carcinoma is not worse than that of non‐burn scar carcinoma.
The Expression of Melanogenic Proteins in Korean Skin after Ultraviolet Irradiation
Authors: Kim Tae Jin , Cho Moon Keun , Lee Jong Suk , Whang Kyu Uang , Jin So Young , Hoshino Taku
Published: July 2014

For proper melanin production, several specific enzymes such as tyrosinase, tyrosinase‐related protein 1 (TRP‐1) and dopachrome tautomerase are required. Their expressions are increased after exposure to UVB. However, it is not known how long tyrosinase and TRP‐1 activities continue after UV irradiation in vivo. The purpose of this study is to measure the changes in expressions of tyrosinase, TRP1, and MITF after exposure to UV on skin in a Korean population. We established an immunohistochemical staining protocol for specimens which were obtained from UV‐irradiated skin in five healthy Korean males on the 2nd, 5th, 7th, 28th, and 56th days after UV irradiation. Tyrosinase, TRP‐1, and MITF expressions increased until 7 days after UV irradiation and then dropped to the basal constitutive level 4 and 8 weeks later. Interestingly, tyrosinase increased prior to TRP‐1. This study reveals the time‐sequence of melanin‐synthesized enzymes and provides important information for the clinical evaluation of the effectiveness of whitening agents.
Immediate and Delayed Complications of Dexamethasone Cyclophosphamide Pulse (DCP) Therapy
Authors: Jain Rajesh , Kumar Bhushan
Published: July 2014

Dexamethasone‐cyclophosphamide pulse (DCP) is the prefered mode of therapy in pemphigus in India because it is relatively free from the side effects seen with heavy doses of daily oral steroids. One hundred forty‐six pemphigus patients treated with DCP were observed for side effects of this regimen. One hundred forty mg of dexamethasone was administered IV in 200 ml of 5% dextrose over a period of 60–90 minutes on 3 consecutive days. Five hundred mg of cyclophosphamide was added on first day of the pulse and 50 mg given orally daily in the intervening period. DCP was repeated every 4 weeks and continued for 6 months after subsidence of the disease (no new lesions). Flushing over the face was the most common event recorded during the adiministration in 78 subjects followed by palpitations in 11, hiccups in 9, and numbness of feet in 6. Fourteen patients had polyurea, and 3 developed skin rash. Shivering, shooting pains along thighs, breathlessness, seizure and unilateral limb edema were observed in one patient each. Generalized weakness/malaise was the most troublesome delayed side effect in 81 (55.4%) patients; it lasted for 8–15 days after the pulse. Thirty‐six (24.6%) had inadequate sleep syndrome, 23 (15.7%) had headache, 21 (14.3%) complained of arthralgias, 19 (13%) experienced alteration in taste, and 13 (9%) had diffuse hair loss. 28 females developed menstrual disturbances, and 14 (9.5%) had blurring of vision (glaucoma in 3 and posterior subcapsular cataract in 1). Thirteen of eighteen diabetics had an increase in blood sugar requiring higher doses of insulin. Five NIDDM patients needed insulin. Four (2.7%) developed hypertension. Pulse therapy is not absolutely free from side effects. Hypertension and diabetes occur less frequently as compared to conventional steroid therapy. Generalized weakness, flushing, headache and taste alteration occur exclusively with pulse therapy.
Successful Treatment of Multiple Premalignant and Malignant Lesions in Arsenical Keratosis with a Combination of Acitretin and Intralesional 5‐Fluorouracil
Authors: Khandpur Sujay , Sharma Vinod K.
Published: July 2014

A case of arsenical keratosis with multiple lesions of Bowen's disease and squamous cell carcinoma is described. The patient was successfully treated with a combination of acitretin and intralesional 5‐fluorouracil. All the lesions resolved after three months of therapy with no side effects and no recurrence during four months of follow‐up.
Ultraviolet‐B Phototherapy Is Successful in Japanese Patients with Early‐Stage Mycosis Fungoides
Authors: Abe Masatoshi , Ohnishi Kazunori , Kan Chie , Ishikawa Osamu
Published: July 2014

UVB phototherapy is widely used for the treatment of psoriasis and atopic dermatitis, however, only limited reports evaluate its usefulness in the treatment of mycosis fungoides. We introduced UVB phototherapy to five patients with early‐stage mycosis fungoides. All of them were classified as stage IB (erythematous stage), and none had obtained a satisfactory response to other therapies. After initial treatment with UVB phototherapy, all the patients obtained significant improvement in their skin lesions leaving pigmentary changes. After this satisfactory response was achieved, the same dose of UVB was administrated as a maintenance therapy with longer intervals between exposures. Histopathological examination of three patients revealed decreased numbers of inflammatory cells in both the epidermis and the dermis after the treatment. Immunohistochemical study showed that CD1a+/HLA‐DR+ dendritic cells were present throughout the lesional epidermis before the treatment. In contrast, after the treatment, the dendritic cells in the epidermis were CD1a+/HLA‐DR−. Although it remains unclear why only the expression of HLA‐DR antigen was eliminated after treatment, we presume that this loss of HLA‐DR antigen expression by epidermal Langerhans cells was, in part, responsible for the improvement of skin lesions. This preliminary study suggests that UVB phototherapy is an effective treatment for patients with early‐stage mycosis fungoides.
The Successful Use of Topical Tacrolimus Treatment for a Chronic Actinic Dermatitis Patient with Complications of Idiopathic Leukopenia
Authors: Ogawa Yasushi , Adachi Ayumi , Tomita Yasushi
Published: July 2014

Chronic actinic dermatitis (CAD) is a photosensitivity disorder marked by severe eczematous lesions on exposed areas. Although associations with contact dermatitis, atopic dermatitis, and human immunodeficiency virus (HIV) have been suggested, its pathogenesis remains unknown. CAD is often refractory, and systemic administration of cyclosporin A has been the treatment of choice. Recently, topical tacrolimus therapy has been reported to be effective. We report the efficacy of topical tacrolimus treatment in a CAD patient who also had the complication of idiopathic leukopenia. A phototest showed marked suppression of erythema formation in the skin pre‐treated with tacrolimus before UVB radiation but not in the skin treated after the irradiation. Therefore, it is suggested that tacrolimus may prevent UV‐B induced erythema by suppressing a very early phase of the inflammatory process in CAD.
X‐Linked Dominant Inheritance in Palmoplantar Keratoderma with Leukokeratosis: A Study of the Pedigree of Two Cases
Authors: Sharma Prafulla Kumar , Rath Namita , Chauhan Ruchi , Sharma Suresh Kumar , Kar Hemant Kumar
Published: July 2014

Keratoderma of the palms and soles is not of rare occurrence. Its association with leukokeratosis of the mouth is well recognized. We describe two siblings having callosities like keratoderma over the weight bearing areas of soles, pressure areas of palms and palmar creases with leukokeratosis of cheeks. On study of the pedigree of these probands we could trace the trait transmission by a rare X‐linked dominant mechanism.
Glomangiosarcoma of the Hand: A Case Report and Review of the Literature
Authors: Park Jung‐Hun , Oh Seok‐Hun , Yang Moon‐Ho , Kim Nack‐In
Published: July 2014

Glomangiosarcomas, or malignant glomus tumors, are very rare, cutaneous, soft tissue tumors. Despite having histologic features of malignancy, these tumors usually do not metastasize. We describe a 74‐year‐old woman with a glomangiosarcoma on her hand and review the literature. The woman presented with a five month history of a painful mass on the right palm. An excisional biopsy of the mass was undertaken. Histologically, the tumor was composed of uniform, round cells and numerous vascular components. The tumor cells were pleomorphic and had large nucleoli. Frequent mitotic figures were identified. Immunohistochemical stains showed strong positivity for vimentin and weak, focal positivity for smooth muscle actin. Ultrastructurally, the tumor cells were characterized by pinocytic vesicles, well formed basal lamina, and scattered junctional complex of the plasma membrane.
Sphingosine May Have Cytotoxic Effects via Apoptosis on the Growth of Keloid Fibroblasts
Authors: Chang Sung‐Eun , Kim Kyoung‐Jin , Ro Kyoung‐Hyun , Lim Young‐Jin , Choi Jee‐Ho , Moon Kee‐Chan , Sung Kyung‐Jeh
Published: July 2014

Keloids are often resistant to treatment, causing much suffering to the patient. Our previous work found that ceramide (Cer) inhibits growth of fibroblasts via apoptosis. However, when compared to normal fibroblasts (NFs), which are quiescent, keloid fibroblasts (KFs) rapidly proliferate and are reported to be resistant to apoptosis via Cer. Sphingosine (Sph) is a metabolite product of ceramide that has some different biochemical properties. Thereofore, we investigated the cytotoxic effects of Sph on cultured fibroblasts from keloid lesions and normal skin in order to evaluate the possibility of using Sph in the treatment of keloid. We used the lactic dehydrogenase (LDH) method, MTT method, and propidium iodide (PI) method. Sph had cytotoxic effects via apoptosis on both the KFs and NFs. Our results indicate that Sph may be applicable to the future treatment of keloid.
Brooke‐Spiegler Syndrome Associated with Cylindroma, Trichoepithelioma, Spiradenoma, and Syringoma
Authors: Uede Koji , Yamamoto Yuki , Furukawa Fukumi
Published: July 2014

Brooke‐Spiegler syndrome is a rare, autosomally dominant disease characterized by the development of multiple cylindromas, trichoepitheliomas, and occasional spiradenomas. We report herein a case of Brooke‐Spiegler syndrome in a 55‐year‐old woman associated with multiple cylindromas, spiradenomas, trichoepitheliomas, and syringomas that developed on her face. Her 52‐year‐old sister also suffered from multiple trichoepitheliomas. Although there is variable clinical and histological expression in Brooke‐Spiegler syndrome, all of the tumors encountered in our case were related to folliculosebaceous‐apocrine units.
A Case of a Large Dermatofibrosarcoma Protuberans Successfully Treated with Radiofrequency Ablation and Transcatheter Arterial Embolization
Authors: Imai Yasutomo , Habe Koji , Imada Mika , Hakamada Arata , Isoda Ken‐ich , Yamanishi Kiyofumi , Uchida Atsumasa , Mizutani Hitoshi
Published: July 2014

We present a large dermatofibrosarcoma protuberans on a 52 years‐old woman's back that was successfully treated with transcatheter arterial embolization and radiofrequency ablation. The tumor developed on her back at the age of 14. Surgical treatment was not complete, and it relapsed at age 17 and again at age 24. The tumor enlarged to over 20 × 20 × 10 cm and flooded intermittently. The tumor cells with atypical nuclei were CD34 positive and proliferated in a storiform pattern. These findings were compatible with dermatofibrosarcoma protuberans. She was treated with blood transfusion for severe anemia. Two large feeding arteries were embolized, and the bottom of the tumor was treated with radiofrequency ablation. The tumor reduced in volume by more than 50%. It was then surgically removed and reconstructed with a free mesh skin graft. The combination pretreatment enabled radical resections of a large DFSP without severe complications.
Two Cases of Angiosarcoma of the Face
Authors: Kikuchi Hidezumi , Kurokawa Motoki , Setoyama Mitsuru
Published: July 2014

Angiosarcoma is a rare vascular malignant tumor most commonly seen on the scalp of elderly people. We report here two cases of angiosarcoma of the face in 74‐ and 75‐year‐old males. It is very unusual to find the development of an angiosarcoma with a rosacea on the face. To the best of our knowledge, only three such cases have been reported.
T Cell Subpopulations and IL‐2R in Vitiligo
Authors: Gunduz Kamer , Ozturk Gunseli , Terzioglu Ender , Sebik Filiz
Published: July 2014

Immunological alterations have been implicated in the etiopathogenesis of vitiligo. The aim of this study was to determine peripheral lymphocyte subpopulations and interleukin‐2 receptor (IL‐2R) in patients with vitiligo. Forty‐five vitiligo patients (24 female, 21 male) and 34 healthy controls (11 female, 23 male) were included into the study. Eight (17.8%) of the patients had the segmental type, and 37 (82.2%) had generalized vitiligo. The disease was active in 25 (55.6%) patients; the other 20 (44.4%) patients had static vitiligo. Flow cytometry was used to determine the percentages of total T‐lymphocytes, B‐lymphocytes, helper/inducer T cells, suppressor/cytotoxic T cells, natural killer (NK) cells, activated T cells and interleukin‐2 receptor (IL‐2R) with the use of CD3, CD19, CD4, CD8, CD16, HLA‐DR and CD25 monoclonal antibodies, respectively. The mean value of helper T cells showed a significant difference (p=0.01) between the two groups with the value being 32.5% in patients and 38.1% in control subjects. CD4/CD8 was significantly lower in vitiligo patients (p=0.04). There was also a statistically significant difference in the mean percentage of activated T cells between vitiligo patients and control subjects (4.7 and 8.1, respectively; p=0.001). No statistically significant differences were found when the values were compared between segmental and generalized vitiligo patients, or between active and static cases. In conclusion, T helper/inducer cells, CD4/CD8 ratio and activated (HLA‐DR+) T cells are decreased in vitiligo patients, suggesting a role for changes in cellular immunity.
Morbihan's Disease: Treatment with CO2 Laser Blepharoplasty
Authors: Bechara Falk Georges , Jansen Thomas , Losch Rüdiger , Altmeyer Peter , Hoffmann Klaus
Published: July 2014

Morbihan's disease is a rare condition characterized by chronic persistent erythema and edema of the upper half of the face. Therapeutic regimens such as X‐ray irradiation, lymphatic massage, interferon gamma injections, antihistamines, and high‐dose antibiotics are often unsatisfactory. Promising results in some patients have been achieved by a systemic combination therapy of isotretinoin with ketotifen or clofazimine. Excision of redundant edematous tissue may be an alternative. We present a 67‐year‐old Caucasian patient with a two‐year history of right lower and upper eyelid swelling and erythema. Systemic therapies with corticocosteroids and antibiotics were not successful, but CO2 laser blepharoplasty led to good cosmetic results with marked improvement of visual impairment and no recurrence during the six‐month follow‐up period.
A Case of Multifocal Lupus Vulgaris that Preceded Pulmonary Tuberculosis in an Immune Compromised Patient
Authors: Hamada Manabu , Urabe Kazunori , Moroi Yoichi , Koga Tetsuya , Takeishi Masaaki , Fujita Masaki , Nakanishi Yoichi , Furue Masutaka
Published: July 2014

We describe the rare case of a Japanese male with multifocal lupus vulgaris that preceded asymptomatic pulmonary tuberculosis and adult T‐cell leukemia/lymphoma (ATL). He visited our hospital with multiple reddish plaques and erythema of 4–12 months duration. A skin biopsy revealed non‐caseating epithelioid granulomas. Mycobacterium tuberculosis was detected by polymerase chain reaction (PCR)‐hybridization from a skin biopsy specimen and was also isolated from a culture of the skin biopsy sample. The result of chest roentogenography was compatible with pulmonary tuberculosis. In addition, the diagnosis of ATL was based upon the presence of atypical lymphocytes with convoluted nuclei in his peripheral blood and a positive anti‐ATL antibody reaction. Cases of cutaneous tuberculosis presenting with unusual clinical features may be on the increase, accompanying the spread of tuberculosis in immunosuppressed patients, including those with ATL and acquired immunodeficiency syndrome (AIDS).