bluuebunny/crossref_metadata_2025 huggingface dataset:
Disseminated cutaneous Mycobacterium chelonae infection after injection of bovine embryonic cells
Authors: Valencia Isabel C. , Weiss Eduardo , Sukenik Elizabeth , Kerdel Francisco A.
Published: March 2003

A 50‐year‐old previously healthy white woman developed a tender erythematous draining subcutaneous nodule on her left cheek, 9 months after receiving multiple injections of bovine embryonic cells in different areas of the face, neck, and chest as a skin rejuvenation treatment. Over the subsequent 4 months, multiple similar nodules developed on the injected areas. The lesions, which were initially painful, became asymptomatic as they developed purulent drainage and ruptured onto the skin surface. There were no associated fevers, chills, or sweats. The nodules failed to respond to a 2‐month course of oral prednisone and intralesional triamcinolone acetonide.

Physical examination showed red, firm, subcutaneous nodules some of which were draining a serosanguinous exudate ( Fig. 1). While a presumptive diagnosis of foreign body granuloma was made, the possibility of an atypical mycobacterial infection remained, and therefore tissue was submitted for culture. While awaiting culture results, the patient was started on minocycline, 50 mg twice daily.

Neck with disseminated subcutaneous erythematous nodules due to M. chelonae that developed following injections of “bovine embryonic cells”

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The biopsy showed a collection of chronic and granulomatous inflammatory cells, intermixed with a few areas of polymorphonuclear abscesses within the dermis ( Fig. 2). Doubly refractile foreign material was not detected. Although acid‐fast bacilli were not observed with Ziehl–Neelsen stain, tissue culture grew mycobacterial colonies after 1 week of incubation. The isolate was subsequently identified as Mycobacterium chelonae, and clarithromycin, 500 mg twice daily, was added to the antimicrobial regimen on the basis of the susceptibility profile. There was significant improvement and the lesions resolved clinically over the following 6 weeks.

Skin biopsy specimen from facial nodule shows granulomatous inflammation within the papillary dermis (hematoxylin and eosin, ×40)

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Clotrimazole troche vs. itraconazole oral solution in the treatment of oral candidosis in AIDS patients
Authors: Linpiyawan Rumpa , Jittreprasert Kitti , Sivayathorn Apichati
Published: March 2003

This prospective study was designed to compare the efficacy and safety of itraconazole oral solution with those of clotrimazole troche in the treatment of oropharyngeal candidosis in acquired immunodeficiency syndrome (AIDS) patients. Patients were excluded if they had been treated with any antifungal agents 2 weeks prior to the study entry, were pregnant or nursing, or had significant liver disease. Twenty‐nine patients (20 men and nine women), with a mean age of 32 years (15–62 years), were randomly, observer‐blind treated with clotrimazole troche (10 mg, five times daily) or itraconazole oral solution (100 mg/10 mL, twice daily) for 1 week. Clinical and mycologic assessment were carried out on four consecutive days, in week 1, week 2, and week 4 after the start of treatment. Clinical evaluation was assessed by a scoring method (0–3, absent to severe) as follows: soreness, change in taste, erythema, removable white plaque, and extent of lesions. Mycologic assessment was performed by KOH preparation and fungal culture. Global evaluation, which is a summary of clinical and mycologic assessment at the end of treatment, was classified as cure (all signs and symptoms resolved with no evidence of infection), improvement (decrease in clinical score without complete resolution), or failure (lack of improvement or further deterioration). (Pons V, Greenspan D, Debruin M. Therapy for oropharyngeal candidiasis in HIV‐infected patients: a randomized, prospective multicenter study of oral fluconazole versus clotrimazole troches. J Acquir Immune Defic Syndr 1993; 6: 1311–1316.) Global evaluation at week 2 and week 4 was made in terms of no relapse or relapse. Any intercurrent medical events, whether human immunodeficiency virus (HIV)‐related or not, were recorded. An intention‐to‐treat analysis was employed. Data were analyzed using the chi‐squared test, Mann–Whitney U‐test, and Student's t‐test.
Prevalence of cutaneous manifestations in 200 patients with eating disorders
Authors: Glorio Roberto , Allevato Miguel , De Pablo Ana , Abbruzzese Mario , Carmona Luz , Savarin Mario , Ibarra Monica , Busso Corina , Mordoh Ana , Llopis Carolina , Haas Roxana , Bello Mabel , Woscoff Alberto
Published: March 2003

Background Eating disorders are increasing and show a variety of symptoms. They mainly include anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not specified (EDNOS). They predominate in females and represent an important danger, especially in teenagers. In serious cases, they may be life‐threatening.

Objective To determine the prevalence of cutaneous findings in patients with eating disorders and to compare the results with those found in the literature.

Methods An observational, transverse, and prospective study was performed. Two hundred patients of recent admission to ALUBA (association that fights against BN and AN), a psychiatric unit for eating disorders, were included: 122 BN; 62 AN; 16 EDNOS.

Results Patients with eating disorders show dermatologic manifestations (alopecia, xerosis, hypertrichosis, caries, nail fragility) that are secondary to starvation. Russell's sign, seen as calluses on the dorsal aspect of the hands, is a consequence of self‐induced vomiting and the local trauma of the superior incisors. This sign represents a compensatory behavior to overeating and predominates in the BN group.

Conclusion The recognition of dermatologic signs could be of immense value and could lead to the early diagnosis and treatment of these eating disorders.
Frequency of oral conditions in a dermatology clinic
Authors: Ramírez‐Amador Velia A. , Esquivel‐Pedraza Lilly ,   DDS, Orozco‐Topete Rocío
Published: March 2003

Background Oral mucosal manifestations may be the initial feature, the most florid clinical feature, or the only sign of mucocutaneous diseases.

Methods Sixty adult patients (48 women, 12 men) with oral mucous complaints were referred to and evaluated at a dermatology clinic in a tertiary care hospital in Mexico City between November 1996 and September 1998.

Results The most frequent oral conditions observed were pemphigus vulgaris (18.3%), lichen planus (8.3%), candidiasis (8.3%), recurrent aphthous ulcers (6.7%), herpetic lesions (6.7%), xerostomia (6.7%), and traumatic lesions (6.7%). Oral affection in mucocutaneous conditions was observed in 21 (35%) patients; the diagnosis was based on oral signs in 10 (48%) of these patients. A large number of oral conditions had previously been misdiagnosed.

Conclusions The importance of the diagnosis of oral conditions in dermatology has been underlined in this study due to the frequency and diversity of oral lesions. The benefits of an interdisciplinary approach in the management of patients has been highlighted.
Cutaneous angiosarcoma afflicting the lower aspect of the left leg in an elderly woman
Authors: Huber Margit A. , Weber Lutz , Kaskel Peter , Warszawski Antje , Schmidt Roland , Peter Ralf U. , Krähn Gertraud
Published: March 2003

An 88‐year‐old woman who was generally in good health was referred to the Dermatology Department in August 1997. Three years prior to admission she had first noticed a bluish macule on her left lower leg which had rapidly enlarged over the past 3 months. Other symptoms included intermittent bleeding and pain. On examination, there was an exophytic and partly exulcerated tumor of approximately 9 × 7 cm in diameter, located above the left medial malleolus. The remainder of the lower aspect of the left leg was without pathologic findings. The patient had not undergone surgery or radiotherapy prior to the described symptoms.

Blood hematology, chemistry, immunologic and serologic parameters (including liver function tests) were within the normal range. The alkaline phosphatase decreased from 211 U/L initially to 179 U/L. Magnetic resonance imaging (MRI) of the left lower leg revealed a 10 × 5 × 2 cm tumor mass invading the subcutaneous fat, leaving muscle tissue. Ultrasound of the regional lymph nodes, a chest X‐ray, and a full‐chest computed tomography (CT) scan were normal. A biopsy specimen showed a marked proliferation of cells of undifferentiated morphology in the corium and subcutaneous tissue. Several layers of atypical endothelial cells next to large cuboid cells with pleomorphic nuclei and frequent mitoses were noted, thus facilitating clear differentiation from Kaposi’s sarcoma ( Fig. 1). Immunohistochemical studies were positive for factor VIII‐related antigen, ulex europaeus I, CD31, and CD34. An angiosarcoma was diagnosed.

biopsy specimen showing marked proliferation of atypical endothelial cells in the corium and subcutaneous tissue

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Treatment included a complete surgical excision of the tumor with a wide safety margin of normal tissue. The skin defect was covered with mesh‐graft. At this point, the patient refused consent to adjuvant radiation therapy postoperatively.

In January 1998 and in March 1998 recurrences of the tumor were again treated with local excision and mesh‐graft. Subsequent to multifocal recurrence in June 1998 ( Fig. 2A), the patient finally accepted palliative radiotherapy. Fractionated irradiation (total dose/left lower leg: 50 Gy; single fraction dose/left lower leg: 2 Gy; 6 MV photons) resulted in local control of the lesion for more than 6 months. In January 1999, another local recurrence of the tumor was treated with the cw‐Nd:YAG laser technique as it was not possible to conduct a second course of radiation therapy. Only 1 month later the patient presented again with multifocal spread involving most of the left lower leg (
Fig. 2B). Considering the patient's age and nursing circumstances, an above‐knee amputation of the left leg was performed.

Multifocal recurrence in June 1998. (B) Progression of the disease with ulceration in February 1999

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Frequency of toenail onychomycosis in patients with cutaneous manifestations of chronic venous insufficiency
Authors: Del Mar María , De Ocariz Sáez , Arenas Roberto , Ranero‐Juárez Guadalupe Alejandra , Farrera‐Esponda Fernando , Monroy‐Ramos Elena
Published: March 2003

Abstract

Background Chronic venous insufficiency (CVI) can originate onychopathyper se. We have anecdotally observed nail changes in patients with CVI, but there are few studies which determine the frequency of both onychopathy and onychomycosis in these patients

Objective The aim of the study was to determine the frequency of nail pathology and onychomycosis in patients with CVI

Patients and Methods We included 36 adult patients, both men and women, aged from 18 to 59 years, with clinically documented venous leg ulcers. All patients were examined by a dermatologist and the venous leg ulcers were classified according to severity in three grades. The nail changes were described and a mycological examination was performed. We obtained a small fragment of the nail for histological examination. In 27 patients, we also performed functional studies to determine the type of venous insufficiency.

Results The ratio of women to men was 5 : 1. The mean age of patients was 46.39 ± 8.51 years, men being slightly younger than women. Ten patients had ulcers of grade I severity, 12 had grade II, and 14 had grade III. The overall time of evolution of the cutaneous lesions was 11.02 ± 10.11. Fourteen patients had superficial venous insufficiency, whereas 13 had deep venous insufficiency. Twenty‐two (61.11%) of our patients had nail alterations. These nail changes were related more to the type of vascular affection than with the severity of cutaneous involvement. In more than half of the cases (59.09%), onychomycosis was the cause of the nail changes. The overall frequency of onychomycosis was 36.11%. The etiologic agent of onychomycosis was isolated in 38.46% of the cases, andTrichophyton rubrumwas the most frequent agent. The histologic examination of the nail plate showed a low sensitivity (62%) but a high specificity (100%) in the detection of nail plate parasitization. No clinical differences could be established between the nail changes observed in patients with true onychomycosis and those with nonfungal onychopathy.

Conclusions Nail changes are common in patients with venous leg ulcer, and onychomycosis accounts for slightly more than half of the cases. We therefore recommend a routine mycological examination in patients wit nail changes and cutaneous manifestations of CVI, to diagnose or rule out onychomycosis, and therefore avoid overtreating patients without onychomycosis with antimycotics.
Intravenous pyogenic granuloma
Authors: Song Min Gyu , Kim Hee Joong , Lee Eil Soo
Published: March 2003

A 43‐year‐old man presented with a 1‐month history of a nodule on the left side of the neck. There were no subjective symptoms. He denied any history of trauma.

On physical examination, a round, soft, and movable subcutaneous nodule, approximately 1 cm in size, was detected. The overlying skin was normal.

The nodule was observed to be attached to the wall of the external jugular vein during biopsy. On histopathologic examination, attachment to the external jugular vein was noted to be via a fibrovascular stalk ( Fig. 1a), and a lobular proliferation of capillaries, some of which were embedded in a fibromyxoid stroma, was observed (
Fig. 1b). There were no atypical cells, and a sparse inflammatory cell infiltrate was seen. The endothelial cells of the capillaries were CD31 positive (
Fig. 1c).

(a)  Nodule attached to the wall of the vein (hematoxylin and eosin, × 10). (b)  A lobular proliferation of capillaries, some of which are embedded in a fibromyxoid stroma (hematoxylin and eosin, × 40). (c)  CD31 positivity (× 200)

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Treatment of larva migrans cutanea (creeping eruption): a comparison between albendazole and traditional therapy
Authors: Albanese Giancarlo , Venturi Caterina , Galbiati Giuseppe
Published: March 2003

Abstract

Background  Creeping eruption (CE), which is characteristic of tropical and subtropical regions, is being increasingly frequently observed in Italy. The presence on the beaches of stray animals infected by nematodes of the Ancylostoma species favors contact between human skin and the larva‐infested soil.

Materials and methods  Our experience with 56 patients (13 cryotherapy, one thiabendazole together with cryotherapy, six thiabendazole, two albendazole with cryotherapy, and 34 albendazole) is described.

Results  A prompt and definitive cure was achieved in all 56 patients. The therapeutic effectiveness of the various methods used is therefore equivalent.

Conclusions  We believe that albendazole should be considered the first choice for treatment. It is extremely well tolerated and patient compliance is good.
Multiple eccrine hidrocystomas of the face
Authors: Alfadley Abdullah , Al Aboud Khalid , Tulba Asma , Mazen Mourad Mohamed
Published: March 2003

Abstract

Background  Multiple eccrine hidrocystomas of the face are a rare facial dermatosis for which no recent large series of cases has been reported.

Objective  To describe the clinicopathologic features of five cases of multiple eccrine hidrocystoma and to emphasize their similar characteristics.

Methods  The clinical and histologic features of five women with multiple eccrine hidrocystomas of the face are described.

Results  All cases were middle‐aged women with numerous, asymptomatic, skin‐colored to bluish, papulonodular skin lesions, ranging from 2 to 5 mm in diameter, and mainly centrifacial in distribution. Histopathologically, all cases showed unilocular cysts in the dermis lined by two layers of cuboidal cells. Staining for S‐100 protein was negative in the cyst wall in all cases. One case was treated with topical 1% atropine for 3 weeks with no significant improvement. No systemic side‐effects were observed during this treatment.

Conclusions  Multiple eccrine hidrocystomas are a rare condition which might be confused clinically and histopathologically with apocrine hidrocystomas. To date, no effective treatment has been reported.
Two cases of reactive perforating collagenosis arising at the site of healed herpes zoster
Authors: Lee Hye Nam , Lee Dong Won , Lee Jun Young , Cho Baik Kee
Published: March 2003

Case 1 A 67‐year‐old South Korean woman presented with a painful eruption on the left trunk. Several groups of vesicles with an erythematous and edematous base were situated unilaterally within the distribution of the left T9 dermatome; they had been present for 7 days. A diagnosis of herpes zoster was made, and treatment with acyclovir, analgesics, tranquilizers, and wet dressings produced a moderate response. Two weeks after onset, the lesions appeared to have healed with a scar. Four months later, however, the patient noticed another eruption of papules in the postherpetic area (Fig. 1A,B).

Case 1. (A) Multiple erythematous papules on the left trunk along the T9 dermatome. (B) Multiple erythematous papules with a keratotic central plug

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The biopsy specimen showed a cup‐shaped epidermal invagination filled with a keratotic plug containing basophilic debris and collagen, with perforation of the epidermis. Masson's trichrome stain identified refractile fibers within the epidermis as hyalinized and degenerating collagen. Van Gieson staining for elastic fibers was negative in the epidermis and in the crater. These findings are consistent with reactive perforating collagenosis (RPC).

Case 2 A 66‐year‐old South Korean woman developed herpes zoster of the left neck and shoulder, which resolved after an uncomplicated course. Two months later, a zosteriform, pink, papular eruption developed at the site of the resolved herpes zoster. Examination revealed multiple, erythematous papules with a central umbilication containing a firmly adherent keratotic plug on the left shoulder and neck (Fig. 2A).

Case 2. (A) Multiple erythematous papules on the left neck and shoulder along the C4 dermatome. (B) Cup‐shaped epidermal invagination filled with keratotic plug containing basophilic debris and degenerated collagen, with perforation of the epidermis (hematoxylin and eosin stain, × 100)

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The biopsy specimen showed a dome‐shaped lesion with a central crater that extended from the epidermis to the papillary dermis and contained degenerated collagen in vertical strands (Fig. 2B).
Pigmentary changes of tinea versicolor in dark‐skinned patients
Authors: Aljabre Salih H. M. , Alzayir Ahmad A. A. , Abdulghani Magdy , Osman Osman O.
Published: March 2003

Abstract

Background  Tinea versicolor causes scaly macular lesions which vary in color from white to brown. In patients with dark skin, tinea versicolor is thought to have a tendency to be hypopigmented. This view has not been formally documented.

Objective  Our objective was to determine the pigmentary changes of lesions of tinea versicolor in patients with skin types IV and V.

Methods  One hundred cases of tinea versicolor in persons with skin types IV and V were studied. The pigmentary changes and their correlation with the age and sex of the patients and the duration, recurrence, site, and symptomatology of the lesions were determined.

Results  There was no correlation between the pigmentary variations of tinea versicolor and the type of skin, sex, and age of our patients or the duration, recurrence, site, and symptomatology of the lesions.

Conclusions  In dark‐skinned individuals, tinea versicolor does not tend to be significantly hypopigmented.
Skin diseases in Ghana and the UK
Authors: Doe Prosper T. , Asiedu Alex , Acheampong J. W. , Rowland Payne Christopher M. E.
Published: March 2003

Abstract

Background  Although diseases of the skin have been studied in some African countries, the provision of dermatology services is as yet a relatively underdeveloped aspect of medicine in sub‐Saharan Africa.

Objective  To determine the pattern of skin diseases seen in a sub‐Saharan community and to compare it with that seen in a European community.

Methods  The diagnoses of the principal presenting complaint of 2254 consecutive new patients seen at the dermatology clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, are presented and compared with those of 3383 consecutive new patients seen at the dermatology clinic of The William Harvey Hospital (WHH), Ashford, Kent, UK.

Results  The most common conditions in Ghana were infections (46.3%; UK, 12%). In the UK, the most common conditions were malignant and premalignant diseases of the skin (22.2%; Ghana, 0.5%) and benign tumors (16.8%; Ghana, 0.5%). Dermatitis was common in both countries (Ghana, 18.4%; UK, 16.0%). Psoriasis was more common in the UK (6.2%) than in Ghana (0.4%). In Ghana, fixed drug eruption, mainly due to cotrimoxazole (Septrin), was not rare (27 cases), and complications from cosmetic skin lightening creams were a frequent problem among women (86 cases). No cases of rosacea were found in Ghana, but it was not uncommon in the UK (1.6%).

Conclusions  The patterns of skin diseases are different in the two countries. It is hoped that this study may help to catalyze the further development of dermatology services in Ghana.
Basal cell carcinoma and actinic keratoses: patients' perceptions of their disease and current treatments
Authors: Berman Brian
Published: March 2003

Abstract

Background  The increasing incidence of nonmelanoma skin cancer constitutes a significant worldwide epidemic. Chronic exposure to ultraviolet light is the predominant risk factor for basal cell carcinoma (BCC), which will make up approximately 80% of new cases of skin cancer per year, and for actinic keratoses (AK), an early manifestation of squamous cell carcinoma. BCC and AK are associated with considerable morbidity, which can be decreased if detected and treated early.

Methods  Patients in the United States (US), Australia, Spain and Germany took part in discussion groups in which they were asked about their knowledge of BCC or AK and current diagnosis and treatment processes.

Results  In this study, patients were found to have only a basic understanding of BCC or AK, and furthermore, they were not satisfied with the amount of information provided by their physician about their treatment options, and possible side‐effects such as pain and scarring.

Conclusions  Increased public awareness about BCC and AK may potentially aid in their early detection and treatment.
Ofuji's disease: diagnostic and therapeutic problems. A report of three cases
Authors: Patrone Pasquale , Bragadin Giovanni , Stinco Giuseppe , De Francesco Vincenzo , Frattasio Alfonsina
Published: March 2003

Abstract

Background  Ofuji's disease is an eosinophilic dermatosis affecting mostly male subjects. It is characterized by the appearance of follicular papulopustules, at times on an erytemathous base, which tend to form an annular configuration. The evolution is relapsing remitting. The histopathological examination demonstrates a dense dermal infiltrate with a prevalence of perifollicular and perivascular eosinophilia. Peripheral blood eosinophilia is observed in a high percentage of cases. The pathogenesis is unclear.

Methods  We report three cases of patients affected by Ofuji's disease with presentation on different sites. Our case reports concern three male subjects otherwise in good health and whose hematologic results were normal. Before they came to our observation, an erroneous diagnosis had been made and they had been subjected to improper treatment.

Results  To make a definite diagnosis it was necessary to evaluate the following features as a whole: the clinical aspect, the evolution, the result of the histological examination, the negativity of cutaneous cultures and the lack of response to previous treatments. All three patients were treated with dapsone 100 mg/day with regression of the clinical manifestations. In one case there was a relapse which was treated with isotretinoin 0.5 mg/kg/day.

Conclusions  From our experience we can deduce that in cases of follicular pathologies which do not respond to conventional therapies, it is necessary to take into consideration the possibility of Ofuji's disease and, in that case, patients should be monitored because of the frequent relapses.
Primary malignant melanoma of the oral cavity: case report
Authors: Bongiorno Maria Rita , Aricò Mario
Published: March 2003

An 80‐year‐old‐female patient had a pigmented lesion on: the hard palate, the soft palate, the alveolar mucosa and the vestibolar mucosa of the maxillary gingiva. Pigmented macules and patchs had been persistent and asymptomatic for many years (Fig. 1). The lesion exhibited irregularities of pigmentation, border and surface contour. About 1 year later the patient had noticed an extension of the pigmented macules and plaques; there was also the appearance of nodules of the maxillary gingiva accompanied by swelling. Loosening of teeth as a result of extensive destruction of bone was further noted (Fig. 2).

Pigmented macules and patchs with irregularities of pigmentation, border and surface contour

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About one year: nodules of the maxillary gingiva accompanied by swelling and loosening of teeth

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The histological examination showed a downward streaming in the dermis of the tumor cells and a disintegration and ulceration of the epidermis (Fig. 3). An increased number of large round or polygonal cells resembling atypical epithelioid cells were found on the submucosa. The atypical cells had enlarged, pleomorphic nuclei with prominent and sometimes multiple nucleoli. Mitoses were observed at various tissue levels (Fig. 4). Abundant pigmented melanin was present in the tumor cells (Fig. 5). Many cells had fine, dusty melanin particles. The tumor cells showed great variations in size. Immunohistochemical staining, with S100 protein and HMB45 antibodies, stained many of the spindleshaped cells, indicating that they were melanocytic cells. An inflammatory infiltrate of lymphocytes was seen in a band beneath the invading tumor cells.

An increased number of large round or polygonal cells resembling atypical epithelioid cells were found on the submucosa, the epidermis is atrophic (200×)

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Mitoses were observed at various tissue levels (400×)

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Abundant pigmented melanin was present in the tumor cells (250×)

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Paracoccidioidomycosis: unusual clinical presentation and utility of computerized tomography scanning for diagnosis
Authors: Achenbach Ricardo , Negroni Ricardo , Khaski Silvia , Lococo Liliana , Beresñak Alejandro , Gai Luis
Published: March 2003

A 57‐year‐old white man, born in Chaco in the north of Argentina, who had worked as a cotton picker until 20 years ago when he moved to the city of Buenos Aires, presented with an asymptomatic, 10 cm long, 3.5 cm wide ulcer on the back of the neck, with an erythematous, violaceous border and serosanguinous material in the micronodular center (Fig. 1). No enlargement of the lymph nodes was present and the patient's general condition was good. The results of laboratory tests were within normal values, and candidin and purified protein derivative (PPD) tests were negative; chest X‐ray showed subtle interstitial infiltrates. Histopathologic study of the border and center of the ulcer showed a granulomatous infiltrate with giant cells and large, spherical to oval cells with multiple buds, typical of Paracoccidioides brasiliensis; Grocott stain showed yeast with various blastoconidia and the well‐known image of the “pilot wheel” (Fig. 2). The study of fresh tissue confirmed the existence of yeast (10–40 µm) including buds. Culture was negative. Skin test with Fava Neto antigen (polysaccharides of P. brasiliensis) was positive (17 mm). Tests of contraimmunoelectrophoresis with paracoccidioidin antigen showed two negative and one positive band. As the initial chest X‐ray was not decisive, computerized axial tomography of the lung was carried out. The latter showed a pulmonary interstitial infiltrate of the right inferior lobe and a small infiltrate of the left inferior lobe. (Fig. 3).

Painless ulcer with sharp border and serosanguinous crust

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Grocott stain (× 400). Etiologic agent from the border of the ulcer

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Computerized tomography scan of the chest showing pulmonary involvement

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Once a diagnosis of skin–lung paracoccidioidomycosis had been confirmed, 6 months of treatment with daily oral doses of 100 mg of itraconazole was started, leading to the healing of the skin lesion in 6 weeks (Fig. 4). Pulmonary compromise improved a few weeks after the initiation of treatment.

Ulcer healed after 4 weeks of treatment with itraconazole

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Atopic dermatitis is associated with a decrement in health‐related quality of life
Authors: Kiebert Gwendoline , Sorensen Sonja V. , Revicki Dennis , Fagan Susan C. , Doyle Joseph J. , Cohen Joel , Fivenson David
Published: March 2003

Background Although atopic dermatitis is a chronic skin disease that can have a major impact on a patient’s life, the burden of illness associated with this condition has not been well characterized.

Objective To determine the health‐related quality of life (HRQL) of patients with atopic dermatitis by disease severity and to compare it with that of the general public and of patients suffering from other chronic illnesses or skin disorders.

Methods Two hundred and thirty‐nine atopic dermatitis patients aged 4–70 years completed the Medical Outcomes Study Short Form‐36 Health Survey (SF‐36) and the Dermatology Life Quality Index (DLQI) or the Children’s Dermatology Life Quality Index. These HRQL scores were compared by self‐reported patient disease severity ratings. Health‐related quality of life scores were compared with those of the general population and those of patients with other chronic conditions (clinical depression, hypertension, type 2 diabetes) or skin disease (psoriasis). Dermatology Life Quality Index scores were also compared with those of other skin diseases (such as psoriasis, Darier’s disease, and Hailey‐Hailey disease).

Results Patients with atopic dermatitis had inferior scores on the SF‐36 vitality, social functioning, and mental health subscales compared with individuals in the general population. In seven of eight subscales, individuals reporting more severe disease had inferior DLQI and SF‐36 scores. Patients with atopic dermatitis had inferior mental health scores compared with those with diabetes or hypertension, and inferior social functioning scores compared with patients with hypertension. When compared with a psoriasis cohort, patients with atopic dermatitis had inferior scores in the role‐physical, vitality, social functioning, role‐emotional, and mental health SF‐36 domains. Patients with atopic dermatitis had similar DLQI scores to patients with other chronic dermatologic diseases.

Conclusions These results demonstrate that atopic dermatitis has an impact on HRQL, particularly in social functioning and psychological wellbeing. Patient‐assessed severity of atopic dermatitis correlates with HRQL decrements, indicating greater HRQL impact with greater disease severity. Atopic dermatitis has as large an impact on HRQL as several chronic conditions and other dermatologic conditions.
Rapid initiation of repigmentation in vitiligo with Dead Sea climatotherapy in combination with pseudocatalase (PC‐KUS)
Authors: Schallreuter Karen U. , Moore Jeremy , Behrens‐Williams Stephanie , Panske Angela , Harari Marco
Published: March 2003

Background Low catalase levels and cellular vacuolation in the epidermis of patients with vitiligo support major oxidative stress in this compartment. There is now in vivo evidence for increased epidermal hydrogen peroxide (H2O2) accumulation in this patient group by utilizing noninvasive Fourier Transform Raman spectroscopy (FT Raman). Epidermal H2O2 can be removed with a topical application of narrow band UVB activated pseudocatalase cream (PC‐KUS). (Mn/EDTA‐bicarbonate complex, patent No. EPO 58471 1 A), yielding initiation of repigmentation. Dead Sea climatotherapy is another successful treatment modality for vitiligo, but the mode of action has escaped definition so far.

Methods Epidermal hydrogen peroxide (H2O2) was assessed in vivo before and after 21 days treatment at the Dead Sea using noninvasive Fourier‐Transform Raman spectroscopy. The effectiveness of repigmentation was followed in 59 patients with vitiligo by comparing Dead Sea climatotherapy alone with the combination of Dead Sea climatotherapy/pseudocatalase cream (PC‐KUS) as well as Dead Sea climatotherapy/placebo cream. Clinical repigmentation was documented by standardized black/white photography using non‐UV coated bulbs as flashlight and by color photography.

Results This study on 59 patients who had vitiligo for an average time of 17 years (range 3–53 years) confirmed in vivo H2O2 accumulation in mM concentrations in the epidermis of untreated patients. Furthermore, we demonstrated a pseudocatalase activity after 15 min of Dead Sea bathing, but the decrease of epidermal H2O2 levels was significantly less compared to narrowband UVB activated pseudocatalase cream (PC‐KUS). Initiation of repigmentation was already observed between day 10 and day 16 after a combination of Dead Sea climatotherapy/pseudocatalase cream compared to conventional pseudocatalase monotherapy (8–14 weeks) and Dead Sea climatotherapy alone (5–6 weeks).

Conclusion The results of this study show a significantly faster initiation of repigmentation in vitiligo after a combination of short‐term climatotherapy (21 days) at the Dead Sea in combination with a pseudocatalase cream (PC‐KUS) compared to either conventional climatotherapy at the Dead Sea alone or with placebo cream in combination with climatotherapy. This combined therapy is significantly faster in repigmentation than narrowband UVB activated pseudocatalase cream (PC‐KUS) treatment alone.

The results of this study support the necessity of epidermal H2O2 removal as well as the influence of solar UV‐light in the successful treatment of vitiligo.
Bowen's disease: an uncommon presentation
Authors: Sardesai Vidyadhar R.
Published: March 2003

A 60‐year‐old man presented with a lesion over the abdomen of 12–13 years’ duration. The lesion had been gradually progressing over the years and was asymptomatic. It had been treated by application of 5‐fluorouracil in 1993, which had resulted in partial regression; however, it started to grow again. A similar lesion had occurred over the left thigh, 2 years after the abdominal lesion appeared, and was excised. Past personal and family history was noncontributory. General and systemic examination revealed no abnormality. Dermatologic examination revealed a plaque, 18 cm × 15 cm in size, over the abdomen. It was well defined and erythematous. In places, hyperpigmented, verrucous, firm papules of various sizes were seen at the periphery and center of the lesion. There was no atrophy, ulceration, bleeding, and lymphadenopathy (Fig. 1). A differential diagnosis of hyperkeratotic lupus vulgaris, Bowen's disease, pagetoid type of basal cell carcinoma, squamous cell carcinoma, and superficial spreading melanoma was considered.

Clinical photograph of lesion over the abdomen

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Routine laboratory investigations were normal. Histopathology showed disease extending through the whole thickness of the epidermis. The basal cell layer was intact. Hyperkeratosis and acanthosis were present. Keratinocytes showed a loss of polarity and atypia. Individual keratinocytes were large, rounded, with pyknotic nuclei. Occasional horn pearls were seen. Keratinocytes with large hyperchromatic nuclei and multinucleated cells were present (Fig. 2). A diagnosis of “Bowen's disease” was made, the lesion was surgically excised, and skin grafting was performed.

Photomicrograph of the lesion (hematoxylin and eosin stain; magnification, × 40)

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Short‐term methotrexate therapy in psoriasis: a study of 197 patients
Authors: Kumar Bhushan , Saraswat Abir , Kaur Inderjeet
Published: March 2003

Methotrexate (MTX) is one of the most effective antipsoriatic drugs available. Although it is undeniably hepatotoxic, it can be used safely in most patients with severe psoriasis if established guidelines are followed. Current opinion on the monitoring of hepatic damage is divided, however, and the need for repeated liver biopsies during MTX therapy is being re‐examined. We have used MTX in a short‐term protocol in our patients with psoriasis for the past 20 years, and have recently attempted to minimize or eliminate the need for liver biopsies using this regimen.

Data on 244 psoriatics who were given MTX from 1981 to 2000 have been reviewed. Our protocol entailed the use of weekly oral MTX at the full therapeutic dose during episodes of peak disease activity, with tapering off of MTX when the disease subsided in response to treatment combined with natural/seasonal remission. Intensive topical and heliotherapy were encouraged throughout to facilitate the earliest possible drug withdrawal and the longest possible drug‐free interval before the next relapse. Strict inclusion criteria were applied before starting MTX.

A total of 243 cycles of MTX therapy have been given to 197 evaluable patients. More than 75% improvement occurred in 88% of patients in 8.5 ± 5.1 weeks. The mean cumulative dose was 709.3 ± 369.2 mg and the mean duration of follow‐up was 16.5 ± 9.1 months. Fifteen (6.1%) patients had serious adverse effects requiring the cessation of therapy. Only three patients had deranged liver function tests. Thirty‐four pre‐MTX and 13 post‐MTX liver biopsies were taken, which revealed grade I or II changes that were nonprogressive.

Our experience with short‐term MTX therapy has enabled us to safely administer MTX to our patients with minimal recourse to liver biopsy. In developing countries, where advanced noninvasive methods for the assessment of liver damage are unaffordable or unavailable, this interrupted, short‐term regimen may present an acceptable and safe method of using MTX in carefully selected patients with severe psoriasis.
Detection of human herpesvirus 7 in pityriasis rosea by nested PCR
Authors: Karabulut Ayse A. , Koçak Mukadder , Yilmaz Nezihe , Eksioglu Meral
Published: March 2003

Background Clinical presentation, immunologic, light microscopic, and electron microscopic studies suggest a viral etiology for pityriasis rosea (PR).

Objective To evaluate whether human herpesvirus 7 (HHV‐7) is an etiologic factor for PR.

Patients and methods Twenty‐one PR patients (12 female, nine male) aged between 12 and 52 years, whose diagnoses were confirmed clinically and histopathologically, were included in the study. The duration of the disease was questioned. Tissue samples of 5‐mm punch biopsy material were collected from the patients and from six healthy volunteers (three female, three male) as the controls. Nested polymerase chain reaction (PCR) with specific primers for HHV‐7 DNA sequences (OPERON technologies Inc., HV‐7S/HV‐8A external sences and HV‐10S/HV11A internal sences) was performed on each tissue sample. Polymerase chain reaction products were analyzed by electrophoresis on 2% agarose gels. After molecular weight markers (Haφ174) had been placed and visualized on an ultraviolet transilluminator, the gels were immersed and photographs were taken.

Results The mean age was 29.86 ± 11.77 for the PR patients and 25.33 ± 11.69 for the controls. The mean duration of the disease was 16.28 ± 15.74 days. Human herpesvirus 7 DNA sequences were detected in six of the PR patients (28.57%). The mean duration of the disease was calculated as 11.67 ± 9.85 for the HHV‐7‐positive patients (patient nos. 3, 4, 5, 7, 8, 9) and 18.13 ± 17.05 for the HHV‐7‐negative patients, and there was no statistically significant differences in either of the groups (U = 29.5, W = 50.5, P = 0.2241, using the Mann–Whitney U and Wilcoxon's rank sum W‐tests). Nested PCR was negative for HHV‐7 in all of the specimens from the controls. There was no statistically significant difference for the presence of HHV‐7 DNA sequence between the PR patients and the controls (P = 0.2843, Fisher's exact two‐tail analysis test).

Conclusion Our results failed to support a possible role for HHV‐7 in the pathogenesis of PR.
Imiquimod; an international update on therapeutic uses in dermatology
Authors: Tyring Stephen , Conant Marcus , Marini Mario , Van Der Meijden Willem , Washenik Ken
Published: March 2003

Imiquimod, the first member of a new class of immune response modifiers, is approved for the treatment of external genital and perianal warts. The clinical effect of imiquimod stems from cytokine‐induced activation of the immune system. Topical application of imiquimod elevates the production of cytokines, including the principal cytokine for antiviral activity, interferon‐α. This is the initial event in an immunological cascade resulting in the stimulation of the innate immune response as well as the cell‐mediated pathway of acquired immunity. This immune modification mediates the indirect antiviral, antiproliferative and antitumor activity of imiquimod in vivo. These properties highlight the potential of imiquimod not only as an effective treatment for genital warts, but also as a treatment for other cutaneous viral infections and cutaneous neoplasms.
Cutaneous extramedullary hematopoiesis in idiopathic myelofibrosis
Authors: Rogalski Christina , Paasch Uwe , Friedrich Thomas , Haustein Uwe‐Frithjof , Sticherling Michael
Published: March 2003

A 67‐year‐old German woman presented with a 2‐month history of indolent erythematous macules and livid papulonodules of 0.5–1.5 cm in diameter scattered on her abdomen (Fig. 1). On physical examination, the patient was alert, the liver was palpable 3 cm below the right costal margin, and the spleen was enlarged 3 cm below the left costal margin. There was no lymphadenopathy.

Clinical lesions with extramedullary hematopoiesis on the abdomen

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Laboratory findings disclosed the following abnormalities: hemoglobin, 10.6 g/dL; hematocrit, 32.4%; white blood cell count, 4.600/mm3 myelocytes, with 15.2% lymphocytes, 74.1% neutrophils, 6.7% monocytes, and 3.6% eosinophils. Repeated bone marrow biopsy specimens showed severe myelofibrosis and osteosclerosis.

Histologic examination of an incisional skin biopsy specimen revealed a mixed dermal infiltrate containing numerous histiocytic and myelocytic cells that resembled atypical megakaryocytes. Cells of the erythroid series were absent. The giant cells were labeled with CD61, thereby supporting the megakaryocytic lineage. The naphthol As‐D chloracetate reaction was positive on myelocytic cells of the infiltrate indicating granulocytopoiesis (Fig. 2).

Mixed dermal infiltrate composed of histiocytic, myelocytic, and multinuclear cells. Multinuclear cells were labeled with CD61 (upper right inset) and were negative for naphthol As‐D chloracetate reaction, which detected myelocytic cells (lower left inset)

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The patient had received electron‐beam irradiation 8 months previously, and had been treated with hydroxyurea (Litalir®, 500 mg/day) for 8 months before the manifestation of myelofibrosis on the skin.

Two months after her first visit to our out‐patient clinic, the eruptions expanded, and electron‐beam irradiation was considered, but not performed, because of the progress of the disease. The patient's course was complicated by severe bone pain, the development of anemia (2.6 g/dL), a blast crisis with 80% undifferentiated, myelocytic blasts, and thrombocytopenia (26 × 109/L). Symptomatic treatment, such as several blood transfusions and analgesic agents, did not stabilize the situation. During this stage of the illness, the skin alterations remained unchanged.

Sixteen months after the first diagnosis of myelofibrosis, the patient died due to conversion into chronic myelogenous leukemia, as shown by repetition of the bone marrow aspiration and the peripheral blood count.
Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital‐based study
Authors: Al‐Ameer Ali M. , Al‐Akloby Omar M.
Published: March 2003

Aim To review the demographic features and seasonal variations of acne vulgaris in patients diagnosed at the Dermatology Outpatient Clinic, King Fahad Hospital of the University (KFHU), Al‐Khobar, Saudi Arabia.

Methods Two hundred and twenty cases (142 females, 78 males; mean age, 14.8 and 16.3 years, respectively) seen between January 1, 1999 and December 31, 2000 were studied.

Results Patients suffering from acne vulgaris made up 19.6% of the new cases seen at the clinic. The male to female ratio was 1 : 1.8. The mean age of onset was 16.3 ± 2.1 years for males and 14.8 ± 3.9 years for females (P = 0.003). The largest numbers of patients were seen during the cold months of the year (November to February).

Conclusions Acne vulgaris constituted nearly one fifth of all visits to the dermatologist with female predominance. It appears nearly one and a half years earlier in females than in males. Seasonal variations were observed in acne as the condition exacerbates in winter, while if often improves during the summer months.
Post‐kala‐azar dermal leishmanasis occurring after 10 years of treated kala azar
Authors: Mittal Rachna , Behl Pran N. , Srivastava Govind
Published: March 2003

Post‐kala‐azar dermal leishmaniasis (PKDL) as the name suggests, develops usually after 1–2 years of treated kala azar (KA).1 Infrequently, cases may be seen later than 2 years. A case of PKDL occurring after 10 years of treated KA is herein reported. Such a long disease‐free interval may be forgotten by the patient, and if not carefully elicited in the history, the diagnosis of PKDL may be missed.
Comparing the campaigning profile of maternity user groups in Europe – can we learn anything useful?
Authors: Tyler Suzanne
Published: March 2003

Objective  To compare the extent to which women in three European countries were able to exert influence over the organization and delivery of maternity policy and the factors likely to determine their success.

Design  Semi‐structured interviews used to collect data, which was analysed in a framework that emphasized the importance of contextual environment.

Setting and participants  Representatives of 19 lay maternity user organizations in England, the Netherlands and Germany interviewed during 1996 and 1997.

Variables studied  Each interviewee was asked to provide details of their aims and objectives, activities and networks and perception of success. Four areas of contextual environment were used to account for variations.

Main outcome measure  Self‐reported accounts of success in influencing policy agenda, credibility with opinion formers, campaigning activities and political networking were compared between and across countries.

Results  Marked differences between both the aspirations and the achievements of groups in the three countries.

Conclusions  Understanding the differences between countries in relation to user involvement entails locating research within the social, political and cultural context of health‐care, consumerism and citizen participation.
Exaptation and the evolution of dealation in insects
Authors: Roff Derek A.
Published: March 2003

This paper presents the results of an empirical test of the hypothesis that the evolution of dealation, or self‐inflicted removal of wings, is favored in some insect species by the pre‐existence of a physiological response of enhanced reproduction following dealation. Two Orthopteran species that do not naturally shed their wings are studied, Teleogryllus oceanicus and Gryllus firmus. The hypothesis that enhanced reproduction following dealation is accompanied by histolysis of the wing muscles is also examined. Dealation increases the rate of egg production in both species. However, total fecundity is not increased by dealation. Wing muscle histolysis is increased by dealation and there is a significant correlation between the degree of histolysis and cumulative egg production to days 4 and 7. It is suggested that Orthoptera are “preadapted” for the evolution of dealation and that ecological factors rather than physiological are most important in determining its appearance in various species.