bluuebunny/crossref_metadata_2025 huggingface dataset:
Dose-Dependent Shift of Apoptotic and Unaltered Melanocytes into the Dermis after Irradiation with UVA 1
Authors: Bacharach-Buhles M. , Lubowietzki M. , Altmeyer P.
Published: April 2003

Background: Intense UVA irradiation induces an increase in number, size and activity of intraepidermal melanocytes. The number of melanocytes and the activity of melanogenesis return to normal after cessation of irradiation. Objective: In this study, we aimed to clarify the mechanism of reduction of melanocytes by apoptosis to prevent an uncontrolled increase in melanocytes within the epidermis. Methods: The position of the melanocytes before and after UVA 1 irradiation was controlled by electronmicroscopy and histochemistry using Fontana-Masson staining. The status of apoptosis was demonstrated immunohistologically by the use of p53 and bcl2. Results: A dose-dependent shift of melanocytes into the corium could be demonstrated. At low irradiation doses (20 J/cm2) pendulous melanocytes protrude into the dermis without losing contact to the dermoepidermal basement membrane. Higher irradiation doses (60 J/cm2) lead to a total elimination of fibrillary degenerated, apoptotic or even morphologically intact melanocytes into the corium. Once transported into the corium, the melanocytes can be detected there for more than 4 years. Conclusion: This shift mechanism seems to regulate and control UV-induced proliferation of epidermal melanocytes.
Malignant Fibrous Histiocytoma and Atypical Fibroxanthoma in Renal Transplant Recipients
Authors: Hafner J. , Künzi W. , Weinreich T.
Published: April 2003

Background: Allograft recipients are at increased risk for skin cancer. The incidence of cutaneous squamous cell carcinoma is 50–250 times higher than in the age-matched control population, and basal cell carcinoma is about 10 times more frequent. The incidence of Kaposi’s sarcoma is increased 400 to 500 times over that in a control population of the same ethnic origin. However, the incidence of other types of cutaneous sarcoma in organ allograft recipients is largely unknown. Clinical Observation: Within a 2-year-period, we observed 2 patients with cutaneous malignant fibrous histiocytoma and 1 patient with atypical fibroxanthoma among a cohort of 642 renal transplant recipients. For comparison, the incidence for dermatofibrosarcoma protuberans which is the commonest type of cutaneous sarcoma, is 0.45/100,000 persons/year in the non-immunocompromised population. Our observation represents an incidence of 156/100,000/ year (95% confidence intervaI Cl 28–489/100,000/year) for cutaneous malignant fibrous histiocytoma and of 78/100,000/year (95% CI 4–368/ 100,000/year) for atypical fibroxanthoma. Conclusion: To our knowledge, this is the first report on an elevated incidence of cutaneous malignant fibrous histiocytoma and of atypical fibroxanthoma in renal transplant recipients. Future cohort studies on malignancies in organ allograft recipients should aim at defining this risk more exactly.
Systemic Sclerosis Revealing T-Cell Lymphoma
Authors: Hasegawa M. , Sato S. , Sakai H. , Ohashi T. , Takehara K.
Published: April 2003

We describe a case of systemic sclerosis (SSc) occurring together with malignant lymphoma. A 43-year-old man, who had noticed sclerodactyly 1 month before consultation, was admitted for progressive skin sclerosis on his forearms and chest. SSc was diagnosed. Immediately after admission, skin sclerosis rapidly extended to the neck and trunk, and subcutaneous tumors developed on the neck, chest and back. Skin sclerosis was prominent at the sites where subcutaneous tumors were present. The tumors were diagnosed as non-Hodgkin’s lymphoma of T-cell phenotype derived from soft tissue. Following 4 cycles of chemotherapy, he had complete remission and the skin sclerosis remarkably improved. It is possible that cytokines produced by T-cell lymphoma cells were responsible for the development of skin sclerosis in this case.
Incomplete Sjögren-Larsson Syndrome in Two Japanese Siblings
Authors: Kawakami T. , Saito R. , Fujikawa Y. , Kazama H. , Shinomiya N. , Yamaguchi K. , Yamaguchi Y. , Aoki T. , Kobayashi T.
Published: April 2003

Sjögren-Larsson syndrome (SLS) is a rare, autosomal recessive disorder characterized by ichthyosis, spastic diplegia and mental retardation. Biochemical studies have pinpointed the pathogenesis resulting in the deficiency of the fatty aldehyde dehydrogenase (FALDH) component of the fatty alcohol NAD+ oxidoreductase complex. Histochemical analysis revealed a reduction in alcohol dehydrogenase (AD) activity in the skin. SLS patients have been categorized biochemically into two groups: complete and incomplete reduction according to the degree of FALDH deficiency. Our patients demonstrated incomplete clinical features, including a 1/3 reduction in FALDH activity, and decreased AD activity in the ichthyotic lesion. The phenotypical differences between our cases and classic SLS are probably due to the partial FALDH deficiency.
Helicobacter pylori as a Possible Bacterial Focus of Chronic Urticaria
Authors: Wustlich S. , Brehler R. , Luger T.A. , Pohle T. , Domschke W. , Foerster E.-C.
Published: April 2003

Background: Chronic urticaria is one of the most frequent skin diseases. Its cause, however, remains unsolved in a large number of cases. Recent investigations pointed to a potential role of Helicobacter pylori infection of the upper gastrointestinal tract as a possible causative agent in chronic urticaria. Objective: The aim of this study was to examine the effect of a 14-day eradication therapy on chronic urticaria. Methods: Thirty patients with chronic urticaria and confirmed H. pylori infection were treated with amoxicillin and omeprazole. Follow-up was conducted over a period of 6 months concerning eradication of H. pylori and remission of urticaria. Results: Only 8 out of 30 patients (26.7%) showed clinical improvement or disappearance of their urticarial symptoms. Conclusion: Though our results do not support the preliminary data of previous studies, the role of H. pylori as a possible bacterial focus of chronic urticaria has to be further investigated.
Treatment of Stable and Recalcitrant Vitiligo by Autologous Miniature Punch Grafting: A Prospective Study of 1,000 Patients
Authors: Malakar S. , Dhar S.
Published: April 2003

Background: Stable and refractory vitiligo may be unresponsive to medical therapy. Melanocyte transplantation by punch grafting (PG) can restore the normal pigmentation. Objective: To evaluate the efficacy of PG on repigmentation of vitiligo patches. Methods: Autologous miniature PG was undertaken in 1,000 patients with stable and recalcitrant vitiligo. Test grafting (TG) was done in all the patients. Those who showed negative TG results were excluded from the study. Results: Of the 1,000 patients, 880 (88%) showed positive TG results. In 656 (74.55%) patients, 90–100% repigmentation was achieved. In 93 (10.57%) patients, there was no spread of pigment, while in 21 (2.39%) patients depigmentation of the graft(s) was notices. Of various complications, polka dot appearance (43.98%) and colour mismatch (34.32%) were most frequent. Conclusion: Partial to near – total repigmentation of a vitiligo patch can be achieved by PG.
Cutaneous Granulomatous Lesions in Common Variable Immunodeficiency: Complete Resolution after Intravenous Immunoglobulins
Authors: Pujol R.M. , Nadal C. , Taberner R. , Diaz C. , Miralles J. , Alomar A.
Published: April 2003

A 64-year-old man with common variable immunodeficiency developed a persistent papulonodular ulcerative eruption on the right leg. Histopathological examination disclosed a chronic inflammatory infiltrate with central necrosis and palisading granuloma. Repeated microbiological (bacteriological, mycological and mycobacteriological) studies failed to isolate any microorganism. After treatment with intravenous immunoglobulins, a progressive resolution of the skin lesions was observed with a complete clearing after 10 months. Clinicopathological features and therapeutic approaches of sterile granulomatous lesions associated with primary immunodeficiencies are reviewed.
Three Cases of Darier’s Disease in a Family Showing Marked Heterogeneous Clinical Severity
Authors: Inada M. , Shimizu H. , Yamada S. , Sasaki Y. , Nishikawa T.
Published: April 2003

We report a Japanese family in which two sisters and their mother with Darier’s disease showed apparent heterogeneous clinical severity. The elder sister had extensive skin lesions typical of Darier’s disease on the scalp, face, neck, axillae and chest. The skin lesions of the younger sister were less severe. The mother had had skin lesions due to Darier’s disease with moderate severity since her teenage years. The lesions had gradually involuted as she grew older, leaving only postinflammatory pigmentation around the neck. Thus, spontaneous remission of skin lesions, rare in Darier’s disease, and heterogeneous clinical severity between and within generations were noted in this family.
Split-Face Clinical and Bio-Instrumental Comparison of 0.1% Adapalene and 0.05% Tretinoin in Facial Acne
Authors: Piérard-Franchimont C. , Henry F. , Fraiture A.L. , Fumal I. , Piérard G.E.
Published: April 2003

Background: Adapalene and tretinoin are topical compounds active for treating acne. Objective: To compare the efficacity and safety of adapalene 0.1% gel and tretinoin 0.05% gel in moderately severe facial acne using clinical and objective biometrological assessments. Such information is currently lacking in the literature. Methods: The split-face method was used in 25 acne volunteers for a 6-week treatment. In addition to clinical counts of lesions, the amount of comedones was assessed using computer-assisted morphometry of cyanoacrylate follicular biopsies. The erythema index and squamometry values were used to quantitate skin irritation. Results: The tretinoin formulation brought better comedolysis and clinical improvement than the adapalene formulation. Erythema was transiently more pronounced on the tretinoin-treated side. Squamometry yielded no significant difference between both products. Conclusion: Tretinoin 0.05% gel exhibits a greater anti-acne efficacy than adapalene 0.1% gel, although with temperate tolerability.
Comparative Analysis of Severe Aphthosis and Behçet’s Disease: 104 Cases
Authors: Verpilleux M.-P. , Bastuji-Garin S. , Revuz J.
Published: April 2003

Background: The nosologic field of aphthosis is not well defined. While criteria for Behçet’s disease (BD) are lacking in severe unipolar or bipolar aphthosis, these disorders however lead to an important impairment of quality of life. The aim of this study was to assess the relationship between severe aphthosis and BD. Methods: Records of all patients hospitalized for aphthosis or BD during a 20-year period were reviewed. Results: According to clinical data, cases (n = 104) were classified as unipolar aphthosis (group I, n = 53), bipolar aphthosis (group II, n = 30) or BD (group III, n = 21). The characteristics of aphthae (number, localization, recurrences, presence of scars) were similar in all groups. Specific cutaneous manifestations (erythema nodosum, pseudofolliculitis, papulonodules) were present in 15, 17 and 95% of patients of groups I, II and III. Cutaneous puncture hypersensitivity was present in 14 out of 18 patients of group III and no patient of the two other groups. At least one extramucous specific manifestation (cutaneous, ophthalmologic, neurologic, articular, vascular) was present in 43% of patients of group I and II, and 100% in group III. Conclusion: These data support the hypothesis of a continuous spectrum linking severe aphthosis to BD.
Solar Urticaria: A Consideration of the Mechanism of Inhibition Spectra
Authors: Watanabe M. , Matsunaga Y. , Katayama I.
Published: April 2003

Background: Solar urticaria is a rare disorder characterized by pruritus, erythema and wheal upon sunlight exposure. Inhibition spectra (IS), which prevent wheal formation, have been found mainly in Japanese patients and lie mostly in longer wavelengths than the action spectrum (AS). The exact mechanism of AS and IS has not been clarified. Patients and Methods: To elucidate the mechanism of AS and IS, we conducted photobiological studies including in vitro irradiated serum injection tests and measurements of plasma histamine levels in 3 patients with IS. Results: All patients had AS ranging between 400 and 490 nm and IS ranging between 520 and 610 nm. A wheal reaction appeared soon after the termination of IS irradiation. The patients developed no wheal or erythema upon intradermal injection of preirradiated serum. Plasma histamine levels were not elevated during irradiation with slide projector light, but marked elevation of histamine was observed when wheals developed after the termination of inhibitory irradiation. Conclusion: These results suggest that the IS in our cases might inactivate photoallergens produced by AS and, additionally, stabilize mast cell degranulation.
Diabetic Neuropathic Foot Ulcer: Successful Treatment by Low-Intensity Laser Therapy
Authors: Schindl A. , Schindl M. , Pernerstorfer-Schön H. , Kerschan K. , Knobler R. , Schindl L.
Published: April 2003

Objective: To evaluate the efficacy of low-intensity laser irradiation for the induction of wound healing of a diabetic neuropathic foot ulcer. Case: We report a case of a man with insulin-dependent diabetes mellitus, sensory neuropathy, macroangiopathy and microangiopathy who had been suffering from an ulcer of his first left toe accompanied by osteomyelitis for 6 weeks. Results: After a total of 16 sessions of low-intensity laser therapy using a 670-nm diode laser administered within a 4-week period the ulcer healed completely. During a follow-up period of 9 months, there was no recurrence of the ulcer even though the patient’s metabolic condition remained unstable. Conclusions: Although laser therapy was not applied as a monotherapy, the present observation suggests that it might constitute a useful side-effect-free alternative treatment modality for the induction of wound healing of neuropathic ulcers in diabetic patients. Therefore large properly controlled randomized studies seem justified.
Is Occupational Irritant Contact Dermatitis Predictable by Cutaneous Bioengineering Methods? Results of the Swiss Metalworkers’ Eczema Study (PROMETES)
Authors: Berndt U. , Hinnen U. , Iliev D. , Elsner P.
Published: April 2003

Background: Since identification of subjects with high eczema risk by screening tests is desirable, different skin bioengineering methods were studied for their validity as predictive measures for the development of hand eczema. Methods: 205 metalworker trainees were followed up over 2.5 years from the beginning of their apprenticeship to observe the occurrence of hand eczema. Within the first weeks of their training they underwent a number of noninvasive biophysical tests. Transepidermal water loss, skin moisture and skin roughness were measured, and irritation tests with dimethyl sulfoxide (DMSO), sodium hydroxide (NaOH) and sodium lauryl sulfate were conducted. Sensitivity, specificity and predictive values of the performed tests and test combinations were calculated. Results: None of the observed single biophysical methods can be considered a valid screening test. Conclusion: A combination of short irritation tests (DMSO and NaOH tests) and the measurement of skin moisture, however, allows to identify individuals at high risk for hand dermatitis with a high sensitivity, though low specificity.
Leopard Syndrome Associated with Hyperelastic Skin: Analysis of Collagen Metabolism in Cultured Skin Fibroblasts
Authors: Ohkura T. , Ohnishi Y. , Kawada A. , Tajima S. , Ishibashi A. , Ono K.
Published: April 2003

We present a patient with Leopard syndrome and hyperelastic skin. Biochemical analysis using cultured skin fibroblasts showed normal type III and V collagen synthesis, lysyl hydroxylation level of type I procollagen and processing of pro-α1 and α2(I). Our results suggest that molecular defects of hyperelasticity in Leopard syndrome are not related to abnormal collagen metabolism, although not all steps of collagen synthesis have been investigated.
The Immunoglobulin A Antibody Response in Clinical Subsets of Mucous Membrane Pemphigoid
Authors: Egan C.A. , Taylor T.B. , Meyer L.J. , Petersen M.J. , Zone J.J.
Published: April 2003

Background: Mucous membrane pemphigoid (MMP) is an immunobullous disease. In MMP there is frequently a mixed antibody response with the presence of IgA and/or IgG antibodies directed toward basement membrane zone antigens. The IgG antibody response in MMP has been studied, but the antigens to which the IgA antibodies react have not been studied. Objective: To determine the IgA autoantibody reactivity profiles in patients with MMP. Methods: Patients who had both ocular and oral MMP were compared with patients who had ocular or oral MMP and with patients who had cutaneous linear IgA disease (LABD) by Western immunoblot studies. Results: Five of 15 MMP patients and 1 of 5 LABD patients had IgA antibodies reactive with the 180-kD bullous pemphigoid antigen. Seven of 15 MMP patients had IgA antibodies reactive with the 97-kD LABD antigen. Conclusion: Major antigens in IgA MMP are the 180-kD bullous pemphigoid antigen and the 97-kD LABD antigen.
Drug-Induced Linear IgA Bullous Dermatosis Associated with Ceftriaxone- and Metronidazole-Specific T Cells
Authors: Yawalkar N. , Reimers A. , Hari Y. , Hunziker T. , Gerber H. , Müller U. , Pichler W.
Published: April 2003

Background: Previous reports indicate that various drugs may induce linear IgA bullous dermatosis (LABD). The role of T cells and T-cell-derived cytokines in the pathomechanism of such skin lesions, however, has remained unclear. Objective: To describe a case of LABD induced by ceftriaxone and metronidazole in an 80-year-old female suffering from cholelithiasis with concomitant cholecystitis and provide evidence that drug-specific T cells and their cytokines may contribute to the development of LABD lesions. Methods: We performed flow cytometry analysis of peripheral blood T cells during LABD, epicutaneous testing (scratch-patch) and lymphocyte proliferation analysis (LTT) with the suspected drugs, routine histological and immunohistochemical examination of the acute skin lesions during LABD as well as of the positive epicutaneous test reactions and measurement of cytokines (IL-4, IL-5, IL-10, TNF-á, IFN-ã) in the supernatant of the LTT cultures. Results: An increased number mainly of activated CD8+ cells was detected in the peripheral blood during LABD. T cell sensitization to ceftriaxone and metronidazole was confirmed by epicutaneous testing and LTT, indicating that these methods may be useful in identifying the causative drugs. Enhanced cytokine levels, particularly of IL-5, were found in the supernatant of the LTT stimulated with ceftriaxone and metronidazole. Furthermore, in situ expression of IL-5 was confirmed in the patient’s skin lesions by immunohistochemistry. Conclusion: Our findings suggest that in addition to IgA antibodies drug-specific T cells and their subsequent release of cytokines may play an important role in the pathogenesis of drug-induced LABD.
Prevalence of Superficial Dermatomycoses in 73 Renal Transplant Recipients
Authors: Virgili A. , Zampino M.R. , La Malfa V. , Strumia R. , Bedani P.L.
Published: April 2003

Background: Because of chronic immunosuppressive therapy, the skin of renal transplant recipients (RTR) is considered more liable to fungal infections. Aim: The aim of the study was to analyze the prevalence of superficial dermatomycoses in a chronically immunosuppressed group of RTR who live in northern Italy and to verify the eventual relationship between the onset of mycoses, the immunosuppressive regimen and the interval of time elapsed after the transplantation. Methods: 73 RTR were submitted to a complete dermatological examination for fungal infection. Skin scrapings were taken from the upper back, from the 4th toe web of all patients and from any suspicious lesion. Results: 31 patients (42.5%) were affected by dermatomycosis. Pityriasis versicolor (PV) was present in 20 RTR (27.4%), fungal infection of the 4th toe web in 10 patients (13.7%) and onychomycosis in 9 RTR (12.3%). Trichophyton mentagrophytes was the most common dermatophyte. The prevalence of dermatomycoses was higher in the group of patients treated with azathioprine-cyclosporine-steroids and in those who had received their renal transplant in the previous 1–5 years. Conclusions: PV was the most frequent dermatomycosis and showed a higher prevalence than in the normal population. The prevalence of fungal infection of the 4th toe web and onychomycosis was similar to that found in the immunocompetent population, but the length of interval after transplantation seemed to increase the probability of their occurrence and of mixed or simultaneous fungal infections in the same patient.
Cutaneous T Cell Lymphoma: Update of Treatment
Authors: Zackheim H.S.
Published: April 2003

The state-of-the art therapy of cutaneous T cell lymphoma (CTCL) is reviewed. Commonly used treatments for early-stage (patch/plaque) mycosis fungoides (MF) include topical corticosteroids, mechlorethamine, carmustine, ultraviolet light B and PUVA. Total skin electron beam (TSEB) therapy is indicated for widespread infiltrated plaque and tumor stage disease. Low-dose methotrexate is often useful for resistant patch/plaque MF and erythrodermic CTCL. Interferon α (IFN-α) is indicated for methotrexate failures and recurrent tumors following TSEB therapy. Photopheresis may be helpful for early-stage erythrodermic CTCL but is very costly. Retinoids may be of value for early and moderately advanced CTCL particularly in combination with other agents such as IFN-α and PUVA. Systemic disease usually requires combination chemotherapy such as that used for non-Hodgkin’s lymphoma; however, responses are usually short lived.
A Splicing Mutation of the Tyrosinase Gene Causes Yellow Oculocutaneous Albinism in a Japanese Patient with a Pigmented Phenotype
Authors: Matsunaga Jun , Dakeishi-Hara Miwako , Tanita Muneo , Nindl Margit , Nagata Yoichi , Nakamura Eriko , Miyamura Yoshinori , Kikuchi Kanako , Furue Masutaka , Tomita Yasushi
Published: April 2003

Background: Yellow oculocutaneous albinism (OCA) that is caused by tyrosinase gene mutations shows two characteristics: extreme hypopigmentation at birth and the eventual development of yellow or blond hair. Objective: We studied a Japanese girl who had brown hair, a lighter skin color than her unaffected family and brown eyes at 9 months of age. Methods: We performed direct sequencing analyses of the tyrosinase gene in her genomic DNA. Results: The patient was a compound heterozygote for the +ΔC310 mutation (known to result in absent melanogenic activity) and a second t→a transition at the 3′ end of intron 2. Conclusion: The t→a transition has previously been reported as a splicing mutation in other Caucasian patients with a typical yellow OCA phenotype. However, this patient showed much more pigmentation than that reported in Caucasians. Therefore, we estimate that the mild phenotype results from her genetic pigment background.
Polymorphous Light Eruption
Authors: Watanabe Masahisa , Yamanouchi Hirotsugu , Ogawa Fumihide , Katayama Ichiro
Published: April 2003

Background: Polymorphous light eruption (PLE) is a common form of photodermatosis. The pathogenesis of the disease and the mechanism of the hardening phenomenon, however, have not been clarified. Observation: We report a 62-year-old Japanese woman with PLE. Provocation and hardening induction testing revealed that hardening was induced at the sites irradiated by a sufficient dose of UV for reproduction of the lesion. Topical steroid could prevent a positive reaction but not the hardening induction. The expression of adhesion molecules and CD1a was decreased at the hardening site. Conclusion: From these results, the hardening phenomenon in our case might be due to immunosuppression by UV exposure supported by the down-regulation of cell adhesion molecule expression and partially due to the depletion of endogenous antigens which cause a delayed-type hypersensitivity reaction.
Digital Necrosis Revealing Ovarian Cancer
Authors: Legrain Sylvie , Raguin Gilles , Piette Jean-Charles
Published: April 2003

We describe a 57-year-old woman who developed permanent acrocyanosis of all fingers rapidly leading to distal necrosis, revealing an ovarian cancer (OC). Seven similar published cases are reviewed. Digital ischaemia was bilateral, severe and frequently complicated by digital necrosis. OC was of epithelial origin and disseminated at the time of diagnosis. Initial treatment of OC usually resulted in improvement of digital ischaemia. A possible OC should be looked for in women aged 45 years or more presenting with severe digital ischaemia of recent onset.
A Placebo-Controlled Clinical Trial to Compare a Gel Containing a Combination of Isotretinoin (0.05%) and Erythromycin (2%) with Gels Containing Isotretinoin (0.05%) or Erythromycin (2%) alone in the Topical Treatment of Acne vulgaris
Authors: Glass D. , Boorman G.C. , Stables G.I. , Cunliffe W.J. , Goode K.
Published: April 2003

Purpose: To compare the clinical benefit of isotretinoin (0.05%) and erythromycin (2%) gels alone and in combination (Isotrexin™) in acne patients. Procedure: The study was a randomised placebo-controlled trial in acne patients who should benefit from topical therapy. Results: All treatment groups except placebo produced a time-related reduction in lesion counts, with the combined therapy producing the largest mean decrease. Between-group comparisons showed several significant differences. Conclusion: Isotrexin was significantly better than placebo at all time points for inflamed and total lesions, and was better than isotretinoin at week 4. Side-effects were minimal.
A Baboon Syndrome Induced by Intravenous Human Immunoglobulins: Report of a Case and Immunological Analysis
Authors: Barbaud A. , Tréchot P. , Granel F. , Lonchamp Ph. , Faure G. , Schmutz J.L. , Béné M.C.
Published: April 2003

Following the second series of intravenous human immunoglobulins (IVIg; 0.4 g/kg) prescribed to treat a sensorimotor polyneuritis, a 28-year-old woman developed pompholyx that recurred after each of the following monthly treatments with IVIg. During the administration of the 10th series, the patient developed a typical baboon syndrome. Immunohistochemical studies of a skin biopsy revealed an unexpected epidermal expression of P-selectin, usually expressed by endothelial cells. Patch, prick and intradermal tests performed with IVIg on the back, arms and buttocks gave negative results on immediate and delayed readings. IVIg were re-administered, with the informed consent of the patient, and induced a generalized maculopapular rash. This is the first reported case of baboon syndrome induced by IVIg. Although extensive skin testing was performed, all test sites remained negative. We wonder whether IVIg could reproduce immunological mechanisms involved in the 3 types of systemic contact dermatitis (pompholyx, baboon syndrome and maculopapular rash), including the epidermal expression of P-selectin.
Frontal Mucocele Presenting as a Subcutaneous Tumour on the Forehead
Authors: Akiyama M. , Inamoto N. , Hashigucci K.
Published: April 2003

A 57-year-old Japanese woman had a 3-month history of an asymptomatic subcutaneous tumour on the forehead. The patient presented a slightly elevated, elastic soft subcutaneous mass, 3 cm in diameter, on the mid to left-side forehead. Slight swelling of the left upper eyelid was observed. CT scanning and magnetic resonance images revealed a sharply demarcated cystic mass from the subcutaneous area on the forehead expanding into the frontal sinus and intracranial space. The tumour was diagnosed as a frontal mucocele and combined external and endoscopic approaches were performed. It is rare that a patient with a frontal mucocele is initially referred as a case of a subcutaneous tumour because most of the patients complain primarily of the ophthalmic symptoms. However, the present case reminds us that frontal mucocele is one of the differential diagnoses for a subcutaneous mass on the forehead.
Lipodermatosclerosis – Report of Three Cases and Review of the Literature
Authors: Demitsu T. , Okada O. , Yoneda K. , Manabe M.
Published: April 2003

We report 3 cases of lipodermatosclerosis (LDS) and discuss the nosology of similar disorders caused by venous insufficiency of the legs. These cases are characterized by (1) occurrence in middle-aged or aged woman, (2) painful, indurated erythema with hyperpigmented scleroderma-like hardening on the lower leg, (3) lobular panniculitis with membranocystic fat necrosis and various degrees of septal fibrosis. Although the designation LDS has been used particularly in the UK and in the USA, this entity is not familiar in other countries including Japan. LDS clinically represents a wide spectrum from an acute, inflammatory phase to a chronic, fibrotic state. The clinicopathologic findings of LDS are similar or identical to the disease previously reported as chronic indurated cellulitis, hypodermitis sclerodermiformis, stasis panniculitis or sclerosing panniculitis. These diseases are probably related conditions, which depend upon the various stages.
Successful Treatment of Chronic Hand Eczema with Oral 9-cis-Retinoic Acid
Authors: Bollag W. , Ott F.
Published: April 2003

Background: 9-cis-Retinoic acid (9-cis-RA) has a particular pattern of binding and activating retinoid receptors. Treatment of chronic hand eczema is often refractory to conventional treatment. Objective: Evaluation of oral 9-cis-RA therapy in chronic hand eczema in a pilot study. Methods: Thirty-eight patients with refractory chronic hand eczema were treated in an exploratory open-label study with oral 9-cis-RA. Results: Twenty-one (55%) showed a very good response, 13 (34%) a good response, 2 (5.5%) a moderate response and 2 (5.5%) no response. Side effects were mild. Conclusion: 9-cis-RA is a valuable drug when given at low doses to patients with chronic hand eczema.
Bullous and Pruritic Variant of Disseminated Superficial Actinic Porokeratosis: Successful Treatment with Grenz Rays
Authors: Ricci Claudia , Rosset Anne , Panizzon Renato G.
Published: April 2003

We describe a case of intensively pruritic and partially bullous disseminated superficial actinic prorokeratosis, with acute flare-ups. Histopathological examination showed the characteristic cornoid lamella and subepidermal blister formation in one biopsy. Grenz ray treatment resulted in a marked regression of the skin lesions and pruritus.
Bacterial Interdigital Scaly Erythema (Kitamura): A Possible New Clinical Entity
Authors: Mochizuki Takashi , Kinebuchi Tomoko , Fujii Toshiki , Ishizaki Hiroshi , Kitamura Kiyotaka
Published: April 2003

Four patients with scaly erythema on their finger webs and sides of their fingers during summer are described. These patients were working in either butcher’s shops or a sushi bar, where they handled raw meat, chicken or fish for many hours. The eruptions first appeared as scaly erythema, sometimes accompanied by small pustules, on the second, third and fourth finger webs, and later the erythema extended to the sides of the fingers and palms. Maceration and/or shallow erosion sometimes appeared on the finger webs. Symptoms were usually mild; the patients complained of slight itching, irritation or pain. Direct examination of specimens stained with Parker blue-black ink containing KOH revealed scales containing bacterial granules or filaments. Several species of bacteria were cultured including Corynebacterium sp. Fungus was not detected in either KOH specimens or in cultures. The lesions responded rapidly to topical or oral antibiotics; however, they recurred frequently during hot and humid weather. Hitherto a similar condition has not been described and is possibly a new clinical entity.
Collagen Uses in Dermatology – An Update
Authors: Ruszczak Z. , Schwartz R.A.
Published: April 2003

Collagen-derived materials have been used in medicine for many decades. Sutures, hemostatic devices and matrices which stimulate cell growth and soft tissue augmentation are the major applications. In this update, we discuss the two major applications for collagen in dermatology: tissue augmentation and wound healing.
Calcipotriol Cream Combined with Twice Weekly Broad-Band UVB Phototherapy: A Safe, Effective and UVB-Sparing Antipsoriatric Combination Treatment
Authors: Ramsay Colin A. , Schwartz Brian E. , Lowson David , Papp Kim , Bolduc Alain , Gilbert Martin
Published: April 2003

Background: Calcipotriol has been combined with a number of systemic antipsoriatric treatments, improving efficacy or reducing the systemic treatment required. Although studies on calcipotriol and UVB have also been performed, there are no data on the UVB-saving effect of calcipotriol combined with broad-band UVB to reduce overall UVB exposure, while maintaining efficacy. Objectives: To assess the efficacy and safety of calcipotriol cream (50 μg/g) combined with twice weekly broad-band UVB and to determine if this treatment would require fewer UVB treatments and lower cumulative UVB irradiance when compared to a standard 3 times weekly broad-band UVB regime in patients with extensive psoriasis. Methods: This multicentre, prospective, randomised, parallel-group, vehicle-controlled, single-blind (investigator) study consisted of a 1-week wash-out phase, 12-week treatment phase and 12-week follow-up phase. Broad-band UVB equipment was standardised and calibrated prior to the study. The UVB starting dose was based on the patient’s minimal erythema dose. Assessments included PASI, extent, severity and investigator and patient’s overall assessments of the psoriasis. Results: Fewer exposures (12 vs. 19) and less cumulative UVB irradiance (1,570 vs. 5,430 mJ/cm2) were required by the calcipotriol + twice weekly UVB group to achieve 80% reduction in PASI (p < 0.001). Similarly, fewer exposures (22 vs. 25) and less cumulative UVB irradiance (4,147 vs. 9,670 mJ/cm2) were required by this group to achieve total clearance (p < 0.001). There was no difference in the PASI, patient’s and investigator’s overall assessments and number of adverse events recorded by either group for both the treatment and follow-up phases. Conclusion: Calcipotriol cream + twice weekly broad-band UVB phototherapy is an effective and safe antipsoriatric treatment, resulting in fewer UVB exposures, lower cumulative irradiance and a saving of time.
A Prospective Study of Acute-Onset Steroid Acne Associated with Administration of Intravenous Corticosteroids
Authors: Fung Maxwell A. , Berger Timothy G.
Published: April 2003

Steroid acne (SA) may occur after the administration of topical or systemic corticosteroids. Because of several consultations of spinal injury patients with a very abrupt onset of a uniform papular eruption (i.e. days) initially misdiagnosed as a drug reaction or sepsis, we followed hospitalized patients who received intravenous corticosteroids (IVC) for the development of acute-onset SA in order to determine its incidence. Fifty-one consecutive subjects receiving IVC were followed for the duration of their hospital stay and examined for the development of acneiform lesions. Acute-onset SA occurred in 1 subject (2%). Acute spinal cord injury may represent a high-risk clinical setting for acute-onset SA.
Three Cases of Type 2 Segmental Manifestation of Multiple Glomus Tumors: Association with Linear Multiple Trichilemmal Cysts in a Patient
Authors: Flórez A. , Peteiro C. , Sánchez-Aguilar D. , Fernández-Redondo V. , Pereiro Ferreirós M. , Toribio J.
Published: April 2003

We report 3 cases of congenital multiple glomus tumors seen during the last 5 years. One of them showed autosomal dominant inheritance with male-to-male transmission. The remaining patients had no family history of similar lesions. The clinical and histopathological aspects of our patients support the recently described type 2 segmental manifestation of multiple glomus tumors. One of the cases showed associated multiple and giant trichilemmal cysts with a linear distribution in the scalp.
Humoral Response in a Patient with Cutaneous Nocardiosis
Authors: Hornef Mathias W. , Gandorfer Arnd , Heesemann Jürgen , Roggenkamp Andreas
Published: April 2003

The clinical appearance of infection due to Nocardia spp. varies widely. The low sensitivity of direct microscopy and the slow growth of the organism challenge the laboratory diagnosis. We present the case of a skin abscess in an immunocompetent man caused by Nocardia brasiliensis. Diagnosis was made by cultivation and 16S rRNA sequencing. Using indirect immunofluorescence and Western blot, a strong antibody response to the N. brasiliensis isolate could be demonstrated. Serological tests might therefore be useful for the diagnosis and management of nocardial infections.
Alopecia areata and Coeliac Disease: No Effect of a Gluten-Free Diet on Hair Growth
Authors: Bardella Maria Teresa , Marino Roberta , Barbareschi Mauro , Bianchi Fernando , Faglia Giovanni , Bianchi Paolo
Published: April 2003

Background: An association between alopecia areata (AA) and coeliac disease has recently been reported. Aim: The aim of this paper was to evaluate the possible effect of a gluten-free diet (GFD) on the new growth of hair in 5 alopecic patients with CD. Methods: CD was diagnosed in 5 patients with AA (universalis in 3 cases and patchy in 2 cases). The diagnosis of CD was based on serological and histological standard criteria. Results: In all patients the GFD resolved CD clinically, serologically and histologically but had no effect on the course of alopecia. Conclusion: AA and CD, when associated, present different responses to a GFD and have an independent course.
Segmental Manifestation of Darier Disease
Authors: Itin Peter H. , Büchner Stanislaw A. , Happle Rudolf
Published: April 2003

Darier disease is an autosomal dominant disorder which may occasionally become manifest in a segmental form. Two clinical phenotypes with a different genetic background have been elaborated in recent years. More than 50 patients with isolated linear disease expression have been documented. In this phenotype the skin outside the segmental affection is absolutely normal. Such a phenotype is explained by a postzygotic mutation with somatic mosaicism which was labeled as type 1 manifestation of segmental forms in autosomal skin disorders. A patient with classical type 1 segmental Darier disease is presented. On the other hand, only 3 patients with Darier disease showing a segmental manifestation in combination with a diffuse distribution have so far been observed. These cases correspond to the recently described type 2 manifestation of segmental forms of autosomal dominant disorders. We describe a fourth patient with type 2 segmental Darier disease. The genetic explanation of such a phenotype is possible with the assumption that a germline mutation for the disease exists but, in addition, a postzygotic mutation is needed resulting in loss of heterozygosity. Hence, in a circumscribed region a homozygous or hemizygous state of the mutation is apparent which can explain the enhanced severity of the segmental manifestation.
Male-Pattern Hair Loss in Norwegian Men: A Community-Based Study
Authors: DeMuro-Mercon Carla , Rhodes Thomas , Girman Cynthia J. , Vatten Lars
Published: April 2003

Background: A Norwegian community study was conducted as an add-on to a large general health survey in Trondlag County, Norway, to characterize the cross-sectional relationship of patient perceptions with the degree of hair loss. Methods: All members of the community were invited to participate in the general health survey and male participants, aged 20–50 years (n = 7,250), regardless of their degree of hair loss, were asked to complete a mail-based questionnaire. The questionnaire measured satisfaction with hair appearance, self-reported degree of hair loss, self-assessment of Norwood/Hamilton hair pattern, bother due to hair loss as well as concern about getting older due to hair loss, and included the SF-12 general health status questionnaire. Results: Respondents (n = 4,101) rated their hair loss on a 7-point, textual scale that ranged from ‘a full head of hair’ to ‘I am bald’. The majority (63%) of participants reported at least a little hair loss and 27% reported moderate to severe loss. Using the Norwood/Hamilton hair patterns, participants rated themselves as class II (25.5%), III (8.6%), IV (8.8%) or V or worse (19.5%). Relative to men without hair loss, a greater proportion of men with hair loss reported being bothered (20.5 vs. 2.3%), concerned about growing older (43.4 vs. 10.6%) and dissatisfied with overall hair appearance (22.6 vs. 94%, all p ≤ 0.001). Men with hair loss also reported greater levels of perceived noticeability of hair thinning to others. Conclusions: A high proportion of Norwegian men aged 26–50 years self-reported having at least some hair loss. Results suggest that men who perceive themselves as having greater hair loss are more bothered by their hair loss, more dissatisfied with the appearance of their hair and have greater concern about getting older and losing more hair.
Revival of the Use of Botulinum Toxin: Application in Dermatology
Authors: Böni Roland , Kreyden Oliver Ph. , Burg Günter
Published: April 2003

Botulinum toxins (BTXs) comprise a family of neurotoxins designated as types A–G, which are produced by the anerobic bacterium Clostridium botulinum. BTX-A blocks the cholinergic transmission resulting in flaccid paralysis and autonomous nerve dysfunction. It has become a powerful therapeutic tool in a variety of conditions over the last decades. Primarily used in the treatment of strabism, blepharospasm and hemifacial spasms, BTX has only recently been recognized in dermatology. The use of BTX in dermatology includes the treatment of focal hyperhidrosis, hyperfunctional facial lines as well as paralysis of the anal sphincter in the therapy of anal fissures. The mechanism of action is described and the current literature is reviewed.
Age-Related Alterations of Echogenicity in Japanese Skin
Authors: Tsukahara Kazue , Takema Yoshinori , Moriwaki Shigeru , Fujimura Tsutomu , Kitahara Takashi , Imokawa Genji
Published: April 2003

Background: Ultrasonic methods are commonly used for the noninvasive measurement of skin thickness. The effects of ageing on the skin have been reported to differ between Asians and Caucasians. Therefore, it is possible that the echogenicity of the skin on ultrasonographic images reflects differences in the skin architecture and properties that may vary among races and environments. Objective and Methods: Since there have been a few reports on ageing-related changes in ultrasonic echogenicity in Caucasian skin, but not in Asian skin, we evaluated age-related changes in the echogenicity of ultrasonographic images by the ultrasonic B mode at 3 sites on the face (forehead, eye corners, cheeks) considered as sun-exposed areas and on the ventral forearms considered as weakly sun-exposed areas in 130 Japanese females aged from 18 to 83 years. The dermis was divided into 3 layers (upper, middle, lower), and echogenicity was evaluated in each area. Results: No age-related change in echogenicity was observed in the entire dermis. When the dermis was divided into 3 layers (upper, middle and lower dermis), the echogenicity was decreased in the upper layer and increased in the lower layer with age in all skin areas tested. In contrast, there were no age-related changes of echogenicity in the middle dermis. Conclusion: These findings suggest that, as for Caucasians, echogenicity in the upper and lower dermis is a useful tool for evaluating skin ageing in the Japanese.
Expressions of Various Growth Factors and Their Receptors in Tissues from Neurofibroma
Authors: Kadono Takafumi , Kikuchi Kanako , Nakagawa Hidemi , Tamaki Kunihiko
Published: April 2003

Background: Platelet-derived growth factor BB (PDGF-BB) and transforming growth factor β are known to enhance the growth of neurofibroma-derived cells from neurofibromatosis type 1 (NF-1) patients. Objective: This study aims to elucidate whether these growth factors and their receptors are up-regulated in NF-1 patients. Methods: Tissues and culture cells from neurofibroma in NF-1 patients, nontumor lesions in NF-1 patients, and the skin of normal controls were collected. To evaluate the expressions of growth factors and their receptors, reverse-transcriptase polymerase chain reaction and immunohistochemistry were performed. Results: PDGF-β receptor subunit was expressed in the neurofibroma tissues from NF-1 patients, but not in the nontumorous tissues from NF-1 patients or skin from normal controls. As for the other factors, there were no significant differences among these tissues. Neurofibroma sections also stained positive for the PDGF-β receptor subunit. Conclusions: The interaction of PDGF and PDGF-β receptor subunit may be important in the tumorigenesis of NF-1.
High Body Mass Index, Dry Scaly Leg Skin and Atopic Conditions Are Highly Associated with Keratosis pilaris
Authors: Yosipovitch G. , Mevorah B. , Mashiach J. , Chan Y.H. , David M.
Published: April 2003

Background: In a previous study we have found that young patients with insulin-dependent diabetes mellitus had a higher prevalence of keratosis pilaris (KP) than healthy controls, with a high correlation with body mass index (BMI) and ichthyosiform skin changes of the legs. Objectives: To investigate whether BMI, dry scaly legs and atopic conditions could be associated with KP in a healthy population of adolescents. Methods: A total of 202 Jewish adolescents chosen at random among students undergoing a routine medical examination at school participated in the study. The patients filled in a questionnaire for data on ethnic origin, the presence or history of allergic rhinitis, asthma or atopic dermatitis, the presence of thyroid disease, diabetes or dry skin. A similar questionnaire was sent to the family physician for verification. A general inspection of the skin was made for the presence of KP; the lower legs were also examined for dry scaly skin and ichthyosiform skin changes. Results: KP was present in 33 examinees (16%). Factors significantly associated with were dry scaly skin (p < 0.001, odds ratio, OR = 31.3, with 95% confidence interval, CI, 6.4–153.7), BMI >25 (p < 0.001, OR = 4.9, with 95% CI 2.2–11.2) and atopy (p = 0.001, OR = 4.5, with 95% CI 1.8–11.1). Conclusion: It therefore appears that KP is associated with multiple factors, including high BMI, leg skin dryness and atopic conditions.
New Type of Epidermal Nevus Syndrome
Authors: Gobello Tommaso , Mazzanti Cinzia , Zambruno Giovanna , Chinni Luca Massimo , Happle Rudolf
Published: April 2003

An uncommon type of epidermal nevus characterized by systematized bands of non-epidermolytic hyperkeratosis with increased hairiness and follicular hyperkeratosis was observed in a 16-year-old boy who showed, in addition, hemihypoplasia of limbs, brachydactyly, clinodactyly and onychodystrophy. This case cannot be categorized within the group of presently established epidermal nevus syndromes. Most likely, this combination of anomalies represents a new type of epidermal nevus syndrome.