bluuebunny/crossref_metadata_2025 huggingface dataset:
TREATMENT OF ROSACEA: TOPICAL CLINDAMYCIN VERSUS ORAL TETRACYCLINE
Authors: WILKIN JONATHAN K. , DeWITT SUELLEN
Published: May 2007

Background. A new topical antibiotic preparation, clindamycin in a lotion base, was compared with oral tetracycline in the treatment of rosacea. Forty‐three patients clinically diagnosed as having rosacea were examined in an investigator‐blinded study.

Methods. Patients used topical clindamycin lotion applied twice daily or the usual oral dose of tetracycline hydrochloride (250 mg four times a day for 3 weeks, then 250 mg twice a day for the remaining 9 weeks). Patients’lesions were examined clinically at 3‐week intervals over a period of 12 weeks.

Results. Topical clindamycin treatment produced similar clinical results to oral tetracycline and was superior in the eradication of pustules.

Conclusions. These results show topical clindamycin in a lotion base to be a safe and effective alternative to oral tetracycline therapy in the treatment of rosacea.
EFFECT OF TOPICAL PAROMOMYCIN ON CELL‐MEDIATED IMMUNITY DURING CUTANEOUS LEISHMANIASIS
Authors: FRANKENBURG SHOSHANA , GROSS ANAT , JONAS FLORY , KLAUS SIDNEY
Published: May 2007

Background. The aim of this study was to evaluate the effect of topical paromomycin treatment on the development of immunity during cutaneous leishmaniasis.

Methods. Three parameters of immunity were measured in the course of the disease: leishmanicidal effector activity, lymphocyte proliferation (cell‐mediated immunity), and antibody levels (humoral immunity). Peripheral blood specimens of 55 treated and 36 untreated patients were tested.

Results. The main results of this study showed that there was a significant delay in the development of leishmanicidal effector activity and to a lesser extent also a delay in the development of antigen‐specific proliferative response in the treated compared with the untreated group. No difference was observed between the groups regarding the values achieved in the various tests.

Conclusions. These results suggest that topical paromomycin treatment delays the development of cell‐mediated immunity but does not affect the levels of immunity that are eventually achieved.
IMMUNOHISTOLOGIC LOCALIZATION OF RAS P21 IN NORMAL, HYPERPLASTIC, AND NEOPLASTIC EPIDERMIS
Authors: INOHARA SHINICHI , KITANO YUKIO , SAGAMI SEICHIRO
Published: May 2007

Background. Ras p21, a ras oncogene product, plays an important role in tumorigenesis, proliferation, and differentiation in various tissues and cells.

Methods. Using a monocolonal antibody raised against ras p21 (RASK 4), localization of ras p21 in normal epidermis and involved epidermis of various skin diseases was examined immunohistologically.

Results. Ras p21 was not present in basal cells of normal epidermis or basaloid cells of basal cell epithelioma but was found almost evenly in the cytoplasm of squamous cells and granular cells. This suggests that ras p21 is concerned with differentiation of epidermal cells. The mode of distribution of ras p21 differed from one cell to another in epidermal cells that turned to malignancy. The distribution was uneven and irregular in the tumorous region on the whole.

Conclusions. This result might possibly represent abnormal differentiation of epidermal cells that turned to malignancy, deviating from the regular mode of the distribution of ras p21, which is necessary for normal differentiation.
ACQUIRED PERFORATING DISEASE: REPORT OF NINE CASES
Authors: CHANG PATRICIA , FERNANDEZ VICTOR
Published: May 2007

Background. A study of nine Guatemalan patients with acquired perforating disease associated with chronic renal failure, diagnosed at the Guatemalan Social Security Institute, General Hospital, during the period of January 1990 to March 1993, is presented (Table 1).

Methods. A dermatological examination and skin biopsy were done on all patients.

Results. Six of the patients were men and three were women; one case was associated with diabetes mellitus. Three of the patients were diagnosed as Kyrle‐like acquired perforating disease, and the other six as perforating folliculitis. The lesions were predominantly located in the lower extremities with hyperkeratotic papules and nodules; some of these were accompanied by pruritus and Koebner's phenomenon.

Conclusion. The acquired perforating disease is a clinical cutaneous manifestation of chronic renal failure with or without treatment. The lesions can disappear spontaneously with stabilization of the renal damage.
BOOK REVIEW
Authors: BEERMAN HERMAN
Published: May 2007

Dermatology: An illustrated Color Text.
David J. Gawkrodger, M.D., M.R.C.P.
MULTIPLE BOWEN'S DISEASE OF THE FINGERS ASSOCIATED WITH HUMAN PAPILLOMA VIRUS TYPE 16
Authors: McGRAE JOHN D. , GREER CATHERINE E. , MANOS M. MICHELE
Published: May 2007

Background. The occurrence of multiple Bowen's disease (bd) in skin away from the anogenital area is rare. In contrast, multiple lesions of bd involving the anogenital skin (bowenoid papulosis) are not so rare and have been found to associated with human papilloma virus (hpv) usually type 16. We encountered a patient with multiple BD of the fingers and endeavored to detect hpv in his lesions.

Methods. Separate bd lesions from 3 fingers of the patient were investigated for the presence of hpv by means of the polymerase chain reaction, followed by dot blot hybridization. Other cases of bd with coexistent HPV infection excluding the anogenital area were collected from the literature for comparative study.

Results
hpv type 16 was detected in each of the three finger lesions of bd. Twenty cases of hpv related bd involving sites other than the anogenital area were found in the literature. Three of these cases had multiple lesions.

Conclusions. Review of the 4 cases with multiple hpv related nonanogenital bd and the 17 others with solitary lesions reveals predilection for the hands and feet (90%) and affinity for type 16 infection (81%). The lesions usually present as verrucous plaques.
SIGNIFICANCE OF PRE‐EXISTENT CONDITIONS IN BASAL CELL CARCINOMA ON THE LOWER EXTREMITIES
Authors: NOGITA TOSHITATSU , KAMIKAWA TOMOYUKI , KAWASHIMA MAKOTO
Published: May 2007

Background. Basal cell carcinoma (BCC) rarely appears on the lower extremities; over 85% appear on the head and neck.

Case Reports. Five patients had BCC on the lower extremity. Histologically, this was of the superficial type. One patient developed a lesion of actinic keratosis.

Results. The presence of pre‐existent cutaneous changes of BCC arising on the lower extremities was studied. Among 40 tumors reported in Japan, 10 cases (25%) had pre‐existent cutaneous changes. This value is significantly higher than those of BCC over the whole body in both Japanese and Caucasian.

Conclusions. Pre‐existent cutaneous changes, thus, are thought to be a possible etiologic factor in the pathogenesis of BCC on the lower extremities.
COSMETIC TATTOOING AS A TREATMENT OF PORT‐WINE STAINS
Authors: van der VELDEN EDDY M. , de JONG BERT D. , van der WALLE HENK B. , STOLZ ERNST , NAAFS BEN
Published: May 2007

Background. Medical treatment for port‐wine stains frequently is cosmetically unsatisfactory. An alternative possibility is cosmetic medical tattooing.

Methods. By means of a traditional Japanese tattooing technique, five patients were treated in multiple sessions until the color of the lesion matched that of the surrounding skin.

Results. The results were excellent, the skin texture remained normal, and the patients could discontinue cosmetic camouflage.

Discussions. Cosmetic medical tattooing when carefully done is a valuable addition to the medical armamentarium and may replace more aggressive techniques.
CUTANEOUS B‐CELL LYMPHOMA CONSISTING OF LARGE CLEAVED CELLS WITH MULTILOBATED NUCLEI
Authors: NAGATANI TETSUO , MIYAZAWA MEGUMI , MATSUZAKI TOSHIKO , HAYAKAWA HIROKI , IEMOTO GAIJIRO , KIM SHU‐TAKU , ICHIYAMA SHINICHI , NAITO SHIZUO , BABA NAOKO , SUGIYAMA ASAMI , AIHARA MICHIKO , MIYAMOTO HIDEAKI , NAKAJIMA HIROSHI , SHIMOYAMA KIYOSHI
Published: May 2007

A 65‐year‐old man was seen at the Ushioda Hospital in Au‐gust 1989, because of a 1‐month history of a tumor on the scalp. The tumor was excised and the diagnosis was malig‐nant lymphoma. The patient was then referred to our de‐partment in September 1989. Several nut‐sized lymph nodes wvepa‐b and m‐fepa for 2 months. Since then, the patient has been free of disease up to the time of writing, July 1992, a period of 2.5 years.

Biopsy samples taken from the tumor on the scalp showed a monomorphous infiltrate of large lymphoid cells throughout the entire dermis and subcutis, with a definite clear zone (Fig.1). A high‐power view showed diffuse large lymphoid cell infiltration. Numerous mitotic figures were also seen. The lymphoid cells had multilobated nuclei and distinct nucleoli (Fig. 2).

Monoclonal antibodies such as Leui (CD5), Leu2a (CD8), Leu3a (CD4), Leu4 (CD3), MT‐1 (CD43), Leu14 (CD22), LN1 (CDw75), and Leu26 (CD20), and polyclonal antibodies such as anti‐kappa, anti‐lambda, anti‐IgG, anti‐lgA, anti‐IgM, and anti‐lgD were purchased from commercial sources. Optimal dilutions of the monoclonal antibodies and heteroantisera were assessed beforehand by titration on suitable tissue samples. The antigens recognized by the monoclonal anti‐bodies and heteroantisera were investigated by either the avidin‐biotin peroxidase complex (ABC) method on cryostat sections or the peroxidase‐antiperoxidase complex (PAP) method on paraffin sections, as described elsewhere.1

The immunologic properties of the infiltrating cells were determined using skin biopsied in August 1989, and October 1989. Large lymphoid cells, which formed the major popu‐lation of infiltrating cells, were positive for CD20, CD22, and HLA‐DR and negative for CD3, CD4, CD43, and CD45RO.

From these findings the patient was diagnosed as hav‐ing primary cutaneous B‐cell lymphoma, diffuse large non‐cleaved cell type, as classified by the Working Formulation.2
MALIGNANT MELANOMA IN TURNER'S SYNDROME
Authors: GARE MEIR , ILAN YARON , SHERMAN YOAV , BEN‐CHETRIT ELDAD
Published: May 2007

A 45‐year‐old woman presented with a 2‐week history of weakness with rapidly progressing abdominal distention. Two weeks previously she had an abdominal ultrasound that showed no evidence of ascites or malignant changes.

The patient was known to suffer from Turner's syn‐drome 45XO/46XX and Hashimoto's thyroiditis for which she was treated with L‐thyroxine. She also had numerous nevi, some of which were biopsied recently and interpreted as having no malignant features.

On admission, the patient complained of weakness and abdominal discomfort. She was of short stature and was pale. Her secondary sexual characteristics were fully devel‐oped. Many pigmented nevi were scattered over her skin, without clinical signs of malignant transformation. Fundo‐scopy showed no signs of malignancy in the choroid layer. The abdomen was tense and edematous. Breast examina‐tion was normal. An ECG and chest x‐rays were also within normal limits. Computerized tomography showed a large amount of fluid with small masses spreading in the peri‐toneal cavity. Aspiration of the abdominal fluid revealed ma‐lignant cells that stained positively with S‐100, melanoma‐specific antigens, and with Masson‐Fontana (Fig. 1).
IN SITU POROCARCINOMA: A CASE WITH MALIGNANT EXPRESSION IN CLEAR TUMOR CELLS
Authors: MIYASHITA MITSUO , SUZUKI HIROYUKI
Published: May 2007

A healthy 84‐year‐old man visited our clinic with elevated lesions on the dorsal aspect of the left hand (Fig. 1). The previous year, he had been in a traffic accident in which he had received an injury to the hand. This injury had since repeatedly shown erosion, but the present lesions had appeared a month before the first clinic visit. These lesions consisted of a tumor, about 2 × 3 cm in size, with neighboring satellite nodules. They were asymptomatic, slightly reddish and yellowish, and had scales.

Histopathologic examination revealed the following features: (1) a tongue‐like tumor mass connected to the epidermis. The tumor foci were localized in the epidermis, from which they were sharply demarcated. Cell infiltration and senile elastosis were found in the stroma. (2) The tumor consisted of deeper layers of basaloid cells and of superficial layers of large cells with clear cytoplasm (Fig. 2A). The clear tumor cells showed prominent cellular and nuclear atypia: they were disordered, of unequal size, had irregular chromatin straining, and were marked by mitotic figures and cell clumping (Fig. 2B). The basaloid cells showed nuclei that stained intensely with hematoxylin and displayed less prominent atypia than the clear cells. (3) On PAS staining of clear cells, PAS‐positive granules were digested with diastase. (4) Several duct‐like structures were seen in the tumor nests. The tumor cells seemed to be proceeding from outer cells around the lumen of these structures. (5) The basement membrane between the tumor and the dermis was intact. No invasion by tumor into the dermis was seen. These findings were all consistent with porocarcinoma in situ.

Immunohistochemically, epithelial membrane antigen (EMA) was strongly positive in the cell membrane of the clear cells. However, staining of basaloid cells was only weakly positive or negative (Fig. 3). These results and the previously reported results of EMA staining4 suggest that the appearance of the clear tumor cells in porocarcinoma indicate malignancy.
ORAL MINI‐PULSE THERAPY WITH BETAMETHASONE IN VITILIGO PATIENTS HAVING EXTENSIVE OR FAST‐SPREADING DISEASE
Authors: PASRICHA J. S. , KHAITAN BINOD K.
Published: May 2007

Background. Systemic corticosteroids can arrest the progression of vitiligo and lead to repigmentation in a significant proportion of patients, but may also produce unacceptable side effects. To minimize the side effects, we tried a new approach using mini‐pulse therapy with betamethasone.

Methods. Forty patients having extensive and/or fast‐spreading vitiligo were given 5 mg betamethasone/dexamethasone as a single oral dose after breakfast on 2 consecutive days per week. The response to treatment was evaluated by photographs taken every 2–4 months and recording the side effects.

Results. Within 1–3 months, progression of the disease was arrested in 89% of the 36 patients having active disease, while 2 patients needed an increase in the dose to 7.5 mg per day to achieve complete arrest of lesions. Within 2–4 months, 80% of the patients started having spontaneous repigmentation of the existing lesions which progressed with continued treatment. The extent of repigmentation varied in different patients and even in different lesions in the same patient. It was less than 10% in 14 (35%) patients and almost complete (>90%) in three patients. The side effects included weight gain of 5 and 7 kg in two patients, mild headache in two patients, transitory general weakness for 2 days after the pulse in two patients, and bad taste in the mouth in three patients; 23 patients, including six children, had no side effects.

Conclusions. Oral mini‐pulse therapy with betamethasone/dexamethasone seems to be an effective treatment modality to arrest the progression of vitiligo. It also induces spontaneous repigmentation. It deserves to be tried on a large scale to evaluate its advantages over the currently available methods of treatment.
SUBCUTANEOUS CYSTICERCOSIS OF THE TONGUE MIMICKING A TUMOR
Authors: PUPPIN DOUGLAS , CAVEGN BRIGITTA MARIA , DELMAESTRO DÉLIO
Published: May 2007

A 12‐year‐old Brazilian girl was seen in our department with a single asymptomatic nodule on the dorsum of the tongue (Fig. 1). The nodule had been present for approxi‐mately 4 years. It measured 1–2 cm in diameter, was firm, flesh‐colored, nontender, nonpulsatile, and slightly mobile. The patient acknowledged that she had been treated for tapeworms 3 years previously, but she could not specify the treatment. Physical examination was otherwise unre‐markable. A clinical diagnosis of lipoma, cyst, or granular cell tumor was suspected. Biopsy of the nodule was per‐formed. Histopathologic examination revealed a cysticercus of Taenia solium in a “bladder cyst” (Fig. 2) surrounded by a discrete inflammatory reaction. Laboratory tests included stool examination that was negative for ova and parasites and a normal complete blood cell count. Chest roentgeno‐gram, EEG, ECG, and brain, liver, spleen, and bone scans were normal. The patient was seen 2 years later and had no evidence of cysticercosis.
TRICHOTILLOMANIA: A TRICHOTILLOSIS, A TRICHOTILLOTIC, OR A TIC TRICHOTILLOSIS
Authors: ALJABRE SALIH H.M.
Published: May 2007

A 35‐year‐old Pakistani man working in Saudi Arabia was referred to the Dermatology Clinic, King Fahd Hospital, AlBaha for the evaluation of patches of hair loss from the beard and moustache (Fig. 1). The patches were of 4 years' duration and asymptomatic. The patient was married and had one child. His family was living in Pakistan, but there were no relevant problems, marital or otherwise, and he was happy at work. He spent his vacations back at home with his family. Past history of hair loss was negative. He appeared stable, relaxed, and reasonably dressed and did not manifest psychotic or psychoneurotic features. On the chin there was a well‐demarcated patch of alopecia on which broken‐off hair and hair of varying lengths were present. There was no scarring or inflammatory signs. Similar patches were seen on the peripheral parts of the moustache. The nails and rest of the skin were normal. A diagno‐sis of trichotillomania was made and discussed with the patient. He acknowledged the self‐induced nature of his hair loss and admitted to be habitually indulging in it.
LIMITED APPLICATION OF MOMETASONE FUROATE ON THE FACE AND INTERTRIGINOUS AREAS: ANALYSIS OF SAFETY AND EFFICACY
Authors: LEBWOHL MARK , PEETS EDWIN , CHEN VIRGINIA
Published: May 2007

Forty patients with moderate to severe psoriasis or atopic dermatitis were enrolled in a study to determine the safety and efficacy of mometasone furoate. Patients were instructed to apply mometasone furoate ointment 0.1% once daily for 2 weeks. Treatments were applied by the patients to an individual target area that was preselected for evaluation of change in disease signs and symptoms. Psoriatic lesions were graded by evaluating the extent of erythema, plaque thickness, scaling, and pruritus. In patients with atopic dermatitis, erythema, lichenification and pruritus were measured. Each of these parameters was assessed on a scale from 0 to 3: 0 = normal, 1 = mild, 2 = moderate, 3 = severe. Half values were permitted. Evaluations of treated areas were made upon entry into the study and at days 2, 3, 4, 8, and 15. Examinations for signs of skin atrophy and telangiectasia were also made at each visit.
HELISTAT ABSORBABLE COLLAGEN HEMOSTATIC SPONGES IN CUTANEOUS SURGERY IN HIV–1+ PATIENTS
Authors: SKELTON HENRY G. , SMITH KATHLEEN J. , TURIANSKY GEORGE , COUZZO DANIEL , LINDSTROM JILL , WELCH MARK L. , YEAGER JOSEF , WAGNER KENNETH F.
Published: May 2007

Background. While biopsies are often required for adequate diagnosis of skin lesions in HIV–1 infected patients, these procedures result in the possible exposure of medical personnel to blood and contaminated instruments. To reduce exposure of medical personnel to contaminated needles we have used collagen sponges instead of sutures to control bleeding from punch biopsy sites in HIV–1 infected patients.

Methods. A collagen sponge was placed in all punch biopsy sites in HIV–1 infected patients. In cases where there was clinical evidence of local infection the sponges were removed 5–6 minutes after hemostasis was obtained.

Results. In over 500 biopsies in which Helistat collagen sponges were used, there have been no cases of secondary infection, and there have been no delays in healing.

Conclusions. We believe that the use of these sponges provides a high degree of safety for the physician, which may assure that the commonly atypical clinical lesions seen in HIV–1 disease are biopsied. In addition, these sponges provide hemostasis, particularly significant in this patient population, and convenience, without a significant risk of secondary infection, and may provide some benefit in healing.
CUTANEOUS MYIASIS CAUSED BY LARVAE OE CORDYLOBIA ANTHROPOPHAGA (BLANCHARD)
Authors: VERALDI STEFANO , BRUSASCO ALBERTO , SUSS LUCIANO
Published: May 2007

Background. Cordylobia anthropophaga (Blanchard) is a nonhematophagous dipteron belonging to the Calliphoridae family. It produces a mylasis called “tumbu fly” or “ver de Cayor” or “mango fly” or “skin maggot fly.”

Case Reports. We describe two women, 24 and 23 years of age, affected by cutaneous myiasis caused by the larva of Cordylobia anthropophaga. In both cases the myiasis was contracted in Senegal and was characterized by a single lesion localized to the flank and the thigh respectively. From each of these lesions a single larva was extracted.

Discussion. This myiasis represents a typical example of tropical disease that In the past was unknown to Western dermatologists.
TOPICAL PHENYTOIN IN WOUND HEALING
Authors: PENDSE ARVIND K. , SHARMA AKHILESH , SODANI ASHA , HADA SUMAN
Published: May 2007

Background. Phenytoin, introduced in 1937 as an antiseizure medication, has since been reported to promote wound healing when applied as a topical agent. This study was undertaken to evaluate its effectiveness in chronic skin ulcers.

Methods. Seventy‐five inpatients with chronic skin ulcers were included in this controlled trial. Forty patients were treated with topical phenytoin, and 35 patients with conventional saline dressings. Assessment of the wounds included wound area, bacteriologic cultures, and clinical assessment by blind observers at baseline and every 7 days thereafter over the 4‐week treatment period.

Results. Wound area reduction was greater in the phenytoin group than in controls. Fifty percent of phenytoin‐treated wounds had negative cultures by day 7, compared to 17% of controls. Healthy granulation tissue appeared earlier with phenytoin. At the end of the fourth week, 29 of 40 phenytoin‐treated ulcers had healed completely versus 10 of 35 controls.

Conclusions. Topical phenytoin appears to be an effective, inexpensive, and widely available therapeutic agent In wound healing. Further clinical use and evaluation is merited.
MAURICIO GOIHMAN‐YAHR, M.D., PH.D., EDITOR
Authors: Roca‐Tey Ramón , Garcia Antonio Segura , Atienza Juan Gonzalez , Ingles Mireia Morera , Aguilar Jesus Luelmo , Lliteras Jorge Vidal
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general in‐terest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33 102.
EXTRACORPOREAL PHOTOCHEMOTHERAPY IN PROGRESSIVE SYSTEMIC SCLEROSIS
Authors: DI SPALTRO FRANCIS X. , COTTRILL CAROLYN , CAHILL CAROL , DEGNAN EILEEN , MULFORD GREGORY J. , SCARBOROUGH DWIGHT , FRANKS ANDREW J. , KLAINER ALBERT S. , BISACCIA EMIL
Published: May 2007

Background. Extracorporeal photochemotherapy, an immune‐modulating form of therapy, has been shown to be effective in the treatment of autoimmune diseases. We evaluated the effects of extracorporeal photochemotherapy in the treatment of patients with progressive systemic sclerosis (pss).

Methods. Nine patients with active progressive systemic sclerosis were treated with extracorporeal photochemotherapy on 2 successive days monthly. The duration of therapy ranged from 6 to 21 months.

Results. A significant improvement was noted in the skin, musculoskeletal system, functional index, and symptoms including Raynaud's phenomenon, dyspnea, fatigue, dysphagia, and arthralgias, as well as improvement of cutaneous ulcers. Stabilization of the pulmonary function studies was also noted in the majority of patients over the course of therapy. No serious side effects were noted throughout the course of therapy in the 9 patients.

Conclusions. The results suggest that photopheresis may be beneficial in selected early cases of progressive systemic sclerosis.
PHARMACOLOGY AND THERAPEUTICS ETRETINATE THERAPY FOR PSORIASIS AND OTHER KE RATINIZING DISORDERS: A 10‐YEAR RETROSPECTIVE STUDY IN SINGAPORE
Authors: SHAHIDULLAH MOHAMMAD , THAM SIEW‐NEE , GOH CHEE‐LEOK
Published: May 2007

Background. Etretinate, a second generation retinoic acid, has been reported to be useful in the treatment of psoriasis and other keratinizing disorders. The effectiveness of etretinate for these disorders are studied in a 10‐year retrospective study of all patients treated with etretinate in a skin clinic in Singapore.

Methods. The case records of 190 cases of psoriasis and other keratinizing disorders treated with etretinate were analyzed. Information collected included demographic data, dosage of etretinate taken, response and side effects, clinical follow‐up, and relapse.

Results. Most of the cases (72.6%) had psoriasis (138/190). The others had different keratinizing disorders. The dose of etretinate used was 0.15 to 1 mg/kg/day (median 0.36 mg/kg/day), and the duration of the treatment varied from 1 to 120 months (median 6 months). Etretinate was coadministered with UVB (ReuvB) or PUVA (RepuvA) in 89 (46.8%) patients. In psoriasis, the response to treatment was excellent in 41.3% (57/138), good in 36.2% (50/138), fair in 15.9% (22/138), and poor in 6.5% (9/138) of the cases. Patients with plaque‐type psoriasis did better with combination therapy than with monotherapy. Those with keratinizing disorders showed excellent, good, fair, and poor responses in 32.7% (17/52), 32.7% (17/52), 25.0% (13/52), and 9.6% (5/52) respectively. Adverse effects were noted in 102 (53.7%) cases and were generally mild and tolerable. Etretinate was discontinued in 24 (12.6%) patients due to significant toxicity.

Conclusions. Etretinate is effective for treating psoriasis and other keratinizing disorders. Combination therapy is preferred in chronic plaque psoriasis. Adverse effects are common, but mild and tolerable.
BOOK REVIEWS
Authors: BEERMAN HERMAN
Published: May 2007

Book reviewed in this article:

Challenge Dermatology‐Vienna 1841–1992. Karl Holubar, M.D., Cathrin Schmidt, M.D., and Klaus Wolff, M.D.

Cutaneous Cryosurgcry. Rodney Dawber, Graham Colver, and Arthur Jackson.

Veterinary Dermatology. Thelma Lee Gross, Peter J. Ihrke, and Emily J. Walder.
HEPARIN‐ASSOCIATED THROMBOCYTOPENIA AND THROMBOSIS (HATT) PRESENTING WITH LIVEDO RETICULARIS
Authors: GROSS ALEXANDER S. , THOMPSON FOREST L. , ARZUBIAGA MARIA DEL CARMEN , GRABER STANLEY E. , HAMMER RICHARD D. , SCHULMAN GERALD , ELLIS DARREL L. , KING LLOYD E.
Published: May 2007

Background. Heparin‐associated thrombocytopenia and thrombosis (HATT) is an infrequently encountered syndrome characterized by ischemic necrosis of soft tissue and vital organs following anticoagulation with heparin. The syndrome is thought to be due to heparin‐dependent platelet aggregation and thrombosis, which is mediated by pathologic immunoglobulins.

Case Report. A 60‐year‐old man developed truncal livedo reticularis and ischemic necrosis of the left foot associated with thrombocytopenia, disseminated intravascular coagulopathy (Die), and microangiopathic hemolytic anemia during intravenous heparin therapy. Skin biopsy from an area of livedo reticularis revealed fibrin thrombi in dermal blood vessels, which is characteristic of HATT. The diagnosis of HATT prompted discontinuation of heparin and a resulting rapid resolution of the livedo reticularis and hematologic abnormalities. No other potential causes of Die were identified, and, other than stopping heparin, no specific therapy was employed.

Conclusions. Periodic monitoring of platelets should be performed on all patients receiving treatment with heparin, as early detection of heparin‐induced thrombocytopenia followed by discontinuation of the drug may prevent life threatening thrombotic complications. HATT should be included in the differential diagnosis of patients with livedo reticularis that occurs during heparin therapy.
PSYCHOSOCIAL CONSEQUENCES OF REJECTION AND STIGMA FEELINGS IN PSORIASIS PATIENTS
Authors: GINSBURG IONA H. , LINK BRUCE G.
Published: May 2007

Background. Many studies as well as clinical experience indicate that patients often feel stigmatized by their psoriasis and may experience rejection due to their skin disease.

Methods. In this study of connections between feelings about having psoriasis, rejection by others, and the impact on work experience, alcohol use, and psychiatric help‐seeking, 100 adults with moderate to severe psoriasis responded to a specially designed questionnaire. Multiple regression analysis is used to determine whether, and how, rejection experience and stigma feelings are associated with the three psychosocial outcomes after controlling for psoriasis severity.

Results. Nineteen percent of the subjects experienced 50 episodes of gross rejection as a result of their psoriasis, most often from a gym, pool, hairdresser, or job. Rejection experience leads to feeling stigmatized, which is then associated with help seeking and, to some degree, with interference with work. Rejection can lead to feeling stigmatized and to increased alcohol consumption, but the data show that patients may drink without conscious awareness of their feelings.

Conclusions. When patients experience psoriasis‐related rejection, they may feel stigmatized and suffer further adverse effects on their emotional and occupational life. It is urgent that ways of helping people deal with the impact of psoriasis, its stigmatizing potential, and the consequences of psoriasis‐induced rejection be emphasized.
STATISTICAL DEFINITION OF NAILFOLD CAPILLARY PATTERN IN PATIENTS WITH PSORIASIS
Authors: OHTSUKA TSUTOMU , YAMAKAGE AKIO , MIYACHI YOSHIKI
Published: May 2007

Background. The microvasculature plays an important role in the pathogenesis of psoriatic skin lesions. Our purpose was to try to define a psoriatic pattern in the nailfold capillary, to clarify the relationship between nailfold capillary microscopic changes and nail involvement and to note the general clinical features of psoriasis.

Methods. Image analysis of nailfold capillaries was performed in 62 patients with psoriasis. The capillary pattern was defined statistically comparing it with that of 51 healthy volunteers. We attempted to differentiate the psoriatic pattern from normal controls with “canonical discriminant analysis.”

Results. Forty‐nine of 62 patients with psoriasis could be differentiated from normal controls by our definition of psoriatic pattern that was significantly correlated with periungual psoriatic plaque, nail pitting, onycholysis, and the extent of the involved area.

Conclusions. Our data suggest that nailfold capillary changes reflect microvascular changes of psoriasis and that the nailfold capillary pattern is a useful tool in evaluating nail involvement and the severity of psoriasis.
INDUCTION OF PSORIASIFORM CHANGES IN GUINEA PIG SKIN BY PROPRANOLOL
Authors: WOLF RONNI , SHECHTER HADAR , BRENNER SARAH
Published: May 2007

Background. The ability of β‐adrenergic blocking agents to induce psoriasis as an adverse effect prompted us to use such an agent to induce psoriasis in guinea pigs.

Methods. Thirty female albino guinea pigs were divided into four groups. Group 1 received propranolol, 0.1 mg/day, dissolved in 2 mL of normal saline, orally by gavage for 30 days. Group 2 was given the same treatment, but in addition intradermal injections of propranolol with Freund's complete adjuvant, injected at weekly intervals. Group 3 (five animals) received 2 mL saline, and group 4 additional injections of adjuvant without propranolol. Groups 3 and 4 served as normal controls.

Results. All animals of group 2 (which received propranolol orally and in addition intradermal injections of adjuvant) developed psoriasiform epidermal hyperplasia with acanthosis. Parakeratosis, papillomatosis, and formation of microabscesses, all characteristic signs of psoriasis, have not been seen in any of the skin samples of this group. Skin samples from group 1 animals receiving propranolol orally showed normal epidermis and dermis. They showed exactly the same histologic picture as the control groups 3 and 4.

Conclusions. Beta‐blockers given orally for 30 days do not cause any significant skin changes in guinea pigs. When given with a weekly intradermal injection of Freund's complete adjuvant, they cause psoriasiform epidermal hyperplasia. Although the overall histologic appearance of the skin of group 2 resembled psoriasis, it lacked important histologic features characteristic of this disease. It seems, therefore, that the model, per se, does not fulfill the initial expectations as an experimental model for psoriasis; however, this model has potential in the study of adverse drug reactions. Perhaps by introducing modifications to the experimental protocol, we may succeed also in developing a better model for experimental psoriasis.
CORRESPONDENCE
Authors: GOIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subject of general interest such as dermatologic training, relations between dermatologyists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publishers, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihrman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, fl33102.
TINEA CAPITIS IN LAHORE, PAKISTAN
Authors: HUSSAIN I. , AMAN S. , HAROON T.S. , JAHANGIR M. , NAGI A.H.
Published: May 2007

Background. The causative fungi of tinea capitis vary with geography and time. This study was planned to identify the etiologic agents and determine clinicoetiologic correlations of tinea capitis in Lahore, Pakistan.

Methods. From clinically suspected cases of tinea capitis, skin scrapings and hair samples were taken and subjected to microscopy and culture.

Results. Of 180 evaluable patients, 95% were children below 12 years of age with equal sex incidence. Noninflammatory lesions were seen in 62.2% of cases. Trichophyton violaceum was the most common etiologic agent responsible for 69.4% of infection, followed by T. tonsurans (16.7%), T. verrucosum (10%), Microsporum audouinii (2.2%), and T. mentagrophyte (1.7%).

Conclusions. T. violaceum is the predominant pathogen causing tinea capitis in children and adults in this part of the world and gives rise to a varied clinical picture. Our findings agree with data from other parts of Pakistan and many countries abroad.
PROLIFERATIVE ACTINIC KERATOSIS
Authors: GOLDBERG LEONARD H. , JOSEPH AARON K. , TSCHEN JAIME A.
Published: May 2007

Background. Solar/actìnic keratoses (AKS) are premalignant lesions, usually less than 1 cm in diameter, that appear on chronically sun‐damaged skin.

Methods. We describe four patients with a form of AK that enlarged and recurred despite standard treatment. Histologic examination revealed a single and multilayered sheet of anaplastic cells along the undersurface of the epidermis extending down hair follicles and present over a large area.

Results. Three of the patients developed either a squamous cell carcinoma (sec) or basal cell carcinoma (see) within the area encompassed by the AK.

Conclusions. These cases represent an insidious, proliferative form of AK with an increased tendency to develop into skin cancer.
EXPRESSION OF CLASS II MAJOR HISTOCOMPATIBILITY ANTIGENS BY KERATINOCYTES IN CUTANEOUS T CELL LYMPHOMA
Authors: WOOD GARY S. , MICHIE SARA A. , DURDEN FAITH , HOPPE RICHARD T. , WARNKE ROGER A.
Published: May 2007

Background. Expression of various class II MHC antigens by lesional keratinocytes may play an important role in the pathophysiology of a wide variety of human dermatoses including cutaneous T cell lymphoma (CTCL). Nevertheless, there is relatively little information available concerning the concurrent expression of HLA‐DR, ‐DP, and ‐DO class II MHC antigens in CTCL. Therefore, our aim in this study was to determine the prevalence, localization, extent, temporal sequence, and consistency of class II MHC antigen expression by lesional keratinocytes in CTCL.

Methods. We used a semiquantitative immunohistologic analysis to analyze HLA‐DR, ‐DP, and ‐DO. expression by lesional keratinocytes in 66 skin biopsies obtained from 39 patients with CTCL.

Results. Class II MHC antigen expression by keratinocytes was observed in 77% of cases. Expression was detected on the cytoplasmic membrane and within the cytoplasm. It varied among cases from focal to confluent. There was a hierarchy of antigen expression in terms of both extent and time course. HLA‐DR was expressed first and most extensively, followed by HLA‐DP and then HLA‐DQ. Comparative studies of multiple serial or concurrent active lesions from 13 cases indicated that the overall pattern and extent of antigen expression was relatively constant within individual patients.

Conclusions. There was no apparent correlation between class II MHC antigen expression and the clinical stage of disease, the type of CTCL skin lesion, or the overall density of the lesional T cell infiltrate. The hierarchy of keratinocyte class II MHC antigen expression observed in this study paralleled that noted in earlier studies of cultured keratinocytes exposed to recombinant interferon‐γin vitro. This suggests that lesional cytokine levels may be the critical factor governing class II MHC antigen expression by lesional keratinocytes in CTCL.
CONTACT DERMATITIS DUE TO BUDESONIDE: REPORT OF FIVE CASES AND REVIEW OF THE JAPANESE LITERATURE
Authors: OKANO MASAKI
Published: May 2007

Background. Contact allergy to corticosteroids has recently gained increased attention.

Methods. Five cases of contact dermatitis due to budesonide, a nonhalogenated steroid, are described. The Japanese literature was reviewed for reports on this allergy, and the occurrence due to budesonide was compared with that of other dermocorticosteroids.

Results. Budesonide use can cause contact dermatitis.

Conclusions. Although budesonide may be beneficial because of its anti‐inflammatory effects, clinicians should be alert to its potential for causing contact dermatitis.
DISK DIFFUSION SUSCEPTIBILITY TESTING OF DERMATOPHYTES WITH ALLYLAMINES
Authors: VENUGOPAL PANKAJALAKSHMI V. , VENUGOPAL TARALAKSHMI V.
Published: May 2007

Background. Allylamines are a newly developed group of drugs possessing a broad spectrum of activity against a wide range of fungi. With the advent of new antifungal drugs, susceptibility testing of fungi is receiving increased attention as important laboratory procedures for aiding in the selection of appropriate drug therapy.

Methods. In vitro susceptibility testing of 43 clinical isolates of dermatophytes which included Microsporum sp., (18) Trichophyton sp., (23) and Epidermophyton floccosum (2) were carried out against the two allylamine derivatives, naftifine and terbinafine, by agar dilution and disk diffusion methods.

Results. Terbinafine was found to be more active minimal inhibitory concentration (mic range ≤ 0.0001–0.1 μg/mL), inhibiting 50% (MIC 50) and 90% (MIC 90) of the isolates at 0.01 and 0.1 μg/mL, respectively. The MIC 50S and MIC 90S of naftifine were 0.1 μg/mL (MIC range 0.001–0.5 μg/mL). Both the drugs showed good correlation between the MIC and sizes of zones of inhibition around the disks. Regression analysis was used to measure the degree of correlation between the MIC values and matched averaged zones of inhibition; the correlation coefficients for both terbinafine and naftifine were −0.6841 (P < 0.001) and −0.5455 (P < 0.001), respectively.

Conclusions. The allylamines, naftifine and terbinafine, could be used successfully for susceptibility testing of dermatophytes by the disk diffusion method. With proper standardization of the test conditions, in vitro susceptibility testing of filamentous fungi by disk diffusion would become a useful laboratory procedure in the near future for determining the best drug therapy.
EFFECTS OF SOFTFNFD AND UNSOFTFNED FABRICS ON INFANT SKIN
Authors: PIÉRARD GERALD E. , ARRESE JORGE E. , DOWLATI AFSHIN , DASKALEROS PANAGIOTIS A. , RODRIGUEZ CARLOS
Published: May 2007

Background. The effects of softened and unsoftened fabrics on the skin of infants of 1–12 months of age were evaluated under real life conditions of skin contact with fabrics.

Methods. During 4 weeks, 24 infants wore cotton fabrics washed with a granular detergent on one side of their lower back, and on the other side, cotton fabrics washed with the same detergent and softened with a liquid fabric softener. Skin effects were evaluated by visual grading for redness, dryness, and smoothness, by skin stripping and measuring of Chroma C* (squamometry), by measurements of elasticity and bioelastic ratio, and by instrumental measurements of skin parameters (pH, capacitance, transepidermal water loss (TEWL), and erythema by colorimetry).

Results. No deleterious effects were observed in any infant. A decrease in squamometry (Chroma C*) and an increase in capacitance were detected in skin exposed to softened fabrics relative to unsoftened ones. Values of pH tended to be higher in the sites treated with softened versus unsoftened fabrics (pH 6.06 and 5.87, respectively, at end of study). All other parameters showed no significant differences in the two treatment groups.

Conclusions. Neither softened nor unsoftened fabrics produced any adverse effects on the skin of infants after continuous wearing during 29 days. A slight beneficial effect on the infants' skin was observed with softened relative to unsoftened fabrics. Methods measuring the structure and function of the stratum corneum were more sensitive discriminators of the effects of fabrics on the skin than traditional methods of visual clinical evaluation.
SUBEPIDERMAL CALCIFIED NODULE OF THE EAR IN A CHILD WITH HAIR FOLLICLE NEVUS
Authors: WON JIN HYOUNG , AHN SUNG KU , LEE SEUNG HUN
Published: May 2007

A 9‐year‐old Korean boy visited the Department of Dermatology, Yonsei University Wonju College of Medicine, with a nodule on the right earlobe with pruritus for 6 months. His past medical history and family history were unremarkable. Physical examination revealed a 5 mm diameter, oval, firm, erythematous nodule on the helix of his right earlobe (Fig. 1). He denied any antecedent trauma. Histopathologic examination of an excisional biopsy specimen showed epidermal hyperplasia and focal parakeratosis. In the upper dermis there were focal collections of deep blue staining calcified material surrounded by some lymphocytes and histiocytes (Fig. 2). The surrounding dermis contained numerous small, well‐differentiated hair follicles with thick fibrous root sheaths and some sebaceous glands connected with the hair follicles (Fig. 3). Von Kossa stain confirmed the impression that the nodules consisted of calcium. Serum calcium and phosphorus levels were normal.
TINEA CAPITIS IN NORTHWESTERN EUROPE 1963–1993: ETIOLOGIC AGENTS AND THEIR CHANGING PREVALENCE
Authors: KORSTANJE MARINUS J. , STAATS CAREL C.G.
Published: May 2007

Background. Although tinea capitis is endemic in many countries, its prevalence in Northwestern Europe (Belgium and the Netherlands) has not been established.

Materials and Methods. Scales, pus, and hair were examined from 435 cases of tinea capitis for etiologic agents and their relative percentages calculated for 5‐year periods between 1963 and 1992.

Results. There was a change in organisms associated with tinea capitis in the Netherlands from Trichophyton schoenleinii to Trichophyton violaceum. Increased immigration from the Mediterranean is held partly responsible for the increased prevalence of T. violaceum infections. Infection with zoophilic dermatophytes, such as T. canis, has also become more frequent in the Netherlands.

Conclusions. The zoophilic dermatophytes have supplanted the anthropophilic dermatophytes as the cause of tinea capitis in the Netherlands.
TICK BITES IN KOREA
Authors: CHO BAIK KEE , RANG HOON , BANG DONGSIK , KIM SOO NAM , HWANG SUN WOOK , SONG EUN SUP
Published: May 2007

Background. Tick bites are dermatoses not commonly encountered in Korea. Recognizing their clinical signs as well as their histopathologic findings is important In making a diagnosis of tick‐related dermatoses. The incidence and causative species are different depending on the geographic areas. The histopathologic findings of tick bites are known to be a variable depending on the species of ticks involved and the duration of their bloodsucking.

Methods. Five ticks were collected from five patients and three of them were identified as Ixodes (/.) nipponensis.

Results. Histopathologic findings of panniculitis were prominent in four of five cases; septal panniculitis in two cases, and lobular panniculitis in the other cases.

Conclusions. Ixodes nipponensis was the most common causative species of ticks responsible for tick bites in Korea, and tick bite panniculitis must be considered in the differential diagnosis of panniculitis which is mainly composed of neutrophils.
BIOLOGIC CHARACTERISTICS OF CULTURED HUMAN VITILIGO MELANOCYTES
Authors: IM SUNGBIN , HANN SEUNG KYUNG , KIM HYUNG IL , KIM NAM SOO , PARK YOON‐KEE
Published: May 2007

Background. Vitiligo is a pigmentary disorder of unknown cause characterized by depigmented patches due to destruction of melanocytes. Recently, the inherent cellular defect theory has been discussed. To investigate the biologic characteristics of cultured melanocytes from normal and vitiligo subjects, this study had the purpose to examine the functional and ultrastructural characteristics of these melanocytes and to observe the morphologic and functional changes of melanocytes in response to ultraviolet B irradiation.

Methods. Melanocytes were isolated and cultured from foreskin and arm skin of normal and vitiligo subjects. The DNA synthesis, tyrosinase activity assay, transmission and scanning electron microscopic examination, and the effects of ultraviolet B(uvB)‐irradiation on cultured melanocytes were studied.

Results. Vitiligo melanocytes showed no significant differences in DNA synthesis and tyrosinase activity compared with normal melanocytes, but the vitiligo melanocytes contained dilated and/or circular rough endoplasmic reticulum (RER) on transmission electron microscopic examination. Exposure of the cultured melanocytes to UVB resulted in increased protein synthesis and tyrosinase activity. Morphologic alterations and changes in DNA synthesis were also noted. Compared with normal melanocytes, the responses of vitiligo melanocyte to UVB showed no significant difference.

Conclusions. Normal and vitiligo melanocytes showed similar biologic characteristics except in the changes of RERS in the vitiligo melanocytes. The ultrastructural aberrations in vitiligo subjects do not seem to be directly related to the biologic characteristics and the responses to UVB irradiation in vitiligo melanocytes.