bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Efficacy of Various Treatment Regimens for Androgenetic Alopecia in Men
Authors: Khandpur Sujay , Suman Mansi , Reddy Belum Sivanagi
Published: July 2014

Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel‐group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side‐effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.
KID Syndrome: Response to Acitretin
Authors: Sahoo Bijaylaxmi , Handa Sanjeev , Kaur Inderjeet , Radotra Bishan Das , Kumar Bhushan
Published: July 2014

KID syndrome is rare. We report a 17‐year‐old girl who presented with universally ichthyotic red hue on the face, trunk, and extremities along with deafness and keratitis since childhood. She was diagnosed with KID syndrome. Treatment with acitretin cleared the hyperkeratotic ichthyotic lesions with little effect on the cornea or hearing. Acitretin seems to be a promising new treatment in KID syndrome.
Isolated Plantar Collagenoma: A Case Report
Authors: Altinyazar H. Cevdet , Kargi Eksal , Gün Banu Doğan , Koca Rafet , Tekin Nilgün Solak
Published: July 2014

Collagenoma is a hamartomatous lesion consisting of proliferation of normal collagen tissue. We describe a 19‐year‐old girl with a firm, elastic 3 × 2 cm nodule located on her right plantar fossa. Histopathologically, dense, coarse, thick collagen fibers were located in the dermis. In addition, the number of elastic fibers was slightly decreased. Based on these findings, the case was diagnosed as isolated plantar collagenoma.
Two Brazilian Cases of IgA Pemphigus
Authors: de Oliveira Juliana Pedroso , Gabbi Tatiana Villas Boas , Hashimoto Takashi , Aoki Valéria , Santi Cláudia G. , Maruta Celina W. , Rivitti Evandro A. , Reis Vitor M.S.
Published: July 2014

IgA pemphigus is a rare, neutrophilic, acantholytic skin disorder with approximately 70 cases described in the literature. We report two patients with the subcorneal pustular dermatosis (SPD) type of IgA pemphigus. Initially, both patients were misdiagnosed as subcorneal pustular dermatosis of Sneddon and Wilkinson. The correct diagnosis was only made after detecting intercellular IgA depositions in the epidermis by direct immunofluorescence. Immunoblotting (IB) of normal human epidermal extracts, performed on both sera, was negative for Dsg 1, Dsg 3, BP 230, BP 180, 210 kDa envoplakin, and 190 kDa periplakin. ELISA for desmogleins (Dsg 1 and Dsg 3) showed that neither of the cases had IgA antibodies to Dsg. The c‐DNA transfection test for desmocollins (Dsc) revealed that the IgA antibodies of both patients reacted with desmocollin 1. This result supports the hypothesis that the autoantigen in SPD type IgA pemphigus is desmocollin 1.
Tinea Barbae (Tinea Sycosis): Experience with Nine Cases
Authors: Bonifaz Alexandro , Ramírez‐Tamayo Teresa , Saúl Amado
Published: July 2014

Tinea barbae is a rare dermatophytosis that affects the hair and hair follicles of the beard and mustache. This paper presents 9 cases of tinea barbae observed over an 18‐year period of time and classified as follows: 1 was superficial and 8 were deep (6 folliculitis‐like and 2 kerion‐like). Most of the cases (4) were associated with topical steroid therapy, others with pet contact (3 cases) and one with diabetes. The causal agents isolated were: Trichophyton rubrum in 3; Microsporum canis in 3; Trichophyton mentagrophytes in 2; and Trichophyton tonsurans in one. The involvement of the hair was observed and classified in all cases. The trichophytin skin reaction was positive in all 9 patients. All the patients were treated with systemic antimycotics, 3 cases with griseofulvin, 1 with ketoconazole, 3 with itraconazole, and 2 with terbinafine. Clinical and mycologic cures were achieved at 6 to 8 weeks of treatment at the usual doses.
Non‐Melanoma Skin Cancers between the Years of 1990 and 1999 in Izmir, Turkey: Demographic and Clinicopathological Characteristics
Authors: Ceylan Can , Oztürk Günseli , Alper Sibel
Published: July 2014

The incidence of nonmelanoma skin cancers (NMSCs) has been rapidly increasing in epidemic proportions all over the world. The purpose was to evaluate the demographic and clinico‐pathological patterns of skin cancers in Izmir, a region with high ultraviolet light exposure. The study was retrospective and hospital‐based. The data related to all NMSC patients registered from January 1, 1990, to December 31, 1999, in the Dermatology Department of Ege University Medical School in Izmir, were collected and analyzed according to the personal statistics, anatomic location, dimensions of the lesion and clinical and histopathological type of skin cancer. A total number of 2,879 patients, aged between 20 and 96 years, were included in the study; among them 1,633 were men and 1,246 were women. The mean age of the patient population was 62.81 years, with a standard deviation of 12.50 years. Among the tumour patients, there were 2,062 basal cell carcinomas (BCCs), 746 squamous cell carcinomas (SCCs) and 71 both BCC and SCC; the total number of lesions was 3,186 (2,339 BCCs, 847 SCCs). Of all the NMSC lesions studied, the highest percentage (46.6%) were located on the face. For the BCCs, the most frequent histopathological subtype was the solid pattern (50.74%). The mean male: female ratios for SCC and BCC lesions were 2.86 and 1.01, respectively. Nodular and ulcerative forms (69.8%) were the most commonly found clinical types. Of all NMSCs, 78.4% had diameters in the 11 to 20 mm. BCC is the most common type of skin cancer diagnosed in our region. Among the NMSC patients, farming was the most widespread and risky job. The majority of SCC tumors were observed mostly in men 60 years old or above. This is the first comprehensive description of NMSCs in our region.
Coexistence of Riehl's Melanosis and Lichen Planus
Authors: Seike Masahiro , Hirose Yasuaki , Ikeda Mitsunori , Kodama Hajime
Published: July 2014

A 61‐year‐old man presented with purple‐red papules and plaques. These lesions on the nape and dorsal aspects of both hands displayed the histological findings characteristic of lichen planus. Riehl's melanosis, which is synonymous with pigmented contact dermatitis, was present on the forehead and bald scalp. Riehl's melanosis typically appears on the face and is induced by cosmetics. Causative factors in this case, however, remained undefined. The coexistence of lichen planus and Riehl's melanosis at separate sites in a single patient suggests that the two diseases represent manifestations of specific immune responses characteristic of lichenoid tissue reaction and situate in the same spectrum. The differences in the skin manifestations of lichen planus and Riehl's melanosis might depend on the severity of immune responses against intrinsic or extrinsic antigens. In addition, the skin manifestations of lichenoid tissue reaction might depend on the disposition of the lesion sites.
PUVA‐Induced Lichen Planus
Authors: Nanda Soni , Grover Chander , Reddy Belum Siva Nagi
Published: July 2014

A 28‐year‐old male with histologically proven psoriasis vulgaris was administered oral 8‐methoxypsoralen UVA therapy (PUVA). The plaques of psoriasis gradually responded to treatment, however numerous pruritic, violaceous papules over the right forearm and left thigh developed 5 months after starting PUVA (45 sittings with a cumulative dose of 156 J/cm2). Histopathologic examination of these lesions was compatible with the diagnosis of lichen planus (LP). On stopping PUVA therapy, the lesions subsided in one month. This case emphasizes the hypothesis that cell injury caused by PUVA therapy could expose some sequestered antigens to autoreactive lymphocytes and induce lichen planus.
Effects of Recombinant Human Tissue Inhibitor of Metalloproteinases‐2 (rh‐TIMP‐2) on Migration of Epidermal Keratinocytes In vitro and Wound Healing In vivo
Authors: Terasaki Kenjiro , Kanzaki Tamotsu , Aoki Takanori , Iwata Kazushi , Saiki Ikuo
Published: July 2014

Tissue inhibitors of metalloproteinases (TIMP), common inhibitors of matrix proteinases, have cell‐promoting activity. We studied the effects of recombinant human tissue inhibitor of metalloproteinases‐2 (rh‐TIMP‐2) on the migration of normal human epidermal keratinocytes (NHEK). An in vitro migration assay revealed that rh‐TIMP‐2 enhanced random migration (up to 170%, p<0.05) in a dose‐dependent manner. When we applied rh‐TIMP‐2 solution (20 μg/20 μl/wound) daily to full‐thickness wounds made with an 8‐mm punch on the backs of healthy (n=8), aged (n=9), and diabetic (n=15) rodents, we observed faster wound closure (p<0.05) than in vehicle‐treated controls. Accelerated wound closure was dose‐dependent (0–20 μg/wound) in diabetic mice (n=6), and the optimal concentration was 10–20 μg of rh‐TIMP‐2/wound. Histological examinations performed on days 0, 5, 10, 15, and 20 in diabetic mice revealed faster migration of epidermal keratinocytes from wound edges. These results suggest that rh‐TIMP‐2 plays an important role in wound healing.
The Expression of Matrix Metalloproteinase‐1 mRNA Induced by Ultraviolet A1 (340–400 nm) Is Phototherapy Relevant to the Glutathione (GSH) Content in Skin Fibroblasts of Systemic Sclerosis
Authors: Yin Lei , Yamauchi Ritsuko , Tsuji Takuo , Krutmann Jean , Morita Akimichi
Published: July 2014

The excessive deposition of collagen in systemic sclerosis (SSc) is thought to be due to an abnormal function of fibroblasts, which may be the result of an immune dysregulation in skin. Ultraviolet A1 (UVA1) irradiation has been shown to be an effective therapy. This is thought to be due to its capacity to induce matrix metalloproteinase‐1 (MMP‐1) expression in human dermal fibroblasts. In the present in vitro study, the effect of UVA1 irradiation on MMP‐1 was studied using skin fibroblasts from healthy controls (n=5) and patients with systemic sclerosis (n=5). In vitro irradiation studies showed that gene expression for MMP‐1 after UVA1 irradiation (p<0.05) was induced in all the fibroblasts studied, but that the induction rate was greater in SSc fibroblasts than in normal ones (p<0.05). The glutathione (GSH) level was lower in SSc fibroblasts than in controls before UVA1 irradiation. However, after UVA1 irradiation, GSH levels were increased and equivalent between normal and SSc fibroblasts. These findings indicated that the relatively stronger increase in MMP‐1 expression in SSc fibroblasts was due to the lower antioxidant capacity. These data support the concept that clinical responses to UVA1 radiation are influenced by the antioxidative state of the patients' skin.
Gamma Interferon Gene Transfection Efficiently Inhibits Proliferation of Neurofibroma Cell Lines In vitro
Authors: Nakayama Juichiro , Tanaka Toshihiro , Arakawa Fumiko , Terao Hiroshi , Shimura Hideo , Ikeda Seiyo , Kuroki Masahide
Published: July 2014

Primarily isolated neurofibroma cell lines and a human dermal fibroblast cell line were transfected with human gamma interferon gene in vitro, and changes in the cell proliferation rates were investigated. The proliferation rates of both cell lines were remarkably suppressed after the gene transfection. In particular, the neurofibroma cell lines almost stopped proliferating five days after gene transfection. The tritium thymidine uptake of the fibroblast cell line was almost abolished three days after gene transfection. The culture media from both of the gene‐transfected cell lines contained a measurable gamma interferon concentration as late as five days after transfection, this was detected by an enzyme‐linked immunosorbent assay. These data suggest that gamma interferon gene therapy might be a possible treatment for intractable or inoperable neurofibromas in patients with von Recklinghausen's disease in the future.
Free Residual Chlorine in Bathing Water Reduces the Water‐Holding Capacity of the Stratum Corneum in Atopic Skin
Authors: Seki Taisuke , Morimatsu Susumu , Nagahori Hidefumi , Morohashi Masaaki
Published: July 2014

Some patients with atopic dermatitis (AD) develop dry skin or exacerbated cutaneous inflammations with frequent swimming in public pools or after bathing. We examined the effects of residual chlorine in bathing water on the function of the stratum corneum (SC) in patients with AD and determined the lowest chlorine concentration showing an effect. In addition, we investigated the relationship between the free residual chlorine concentration in bathing water and the water‐holding capacity of the SC in patients with AD. Twenty patients with AD and 10 normal control (NC) subjects were included in this study. The hydration status of the SC on the flexor surface of the forearm was measured with a corneometer before and after the subject's arms were immersed in tubs filled with comfortably hot water (40°C) containing residual chlorine at concentrations of 0, 0.5, 1.0 and 2.0 mg/L for 10 minutes in a room maintained at normal temperature (24°C) and relative humidity (55%). The water‐holding capacity of the SC after immersion was calculated by integration of the hydration status determined every 30 seconds over a period of 10 minutes. In the patients with AD, the average SC hydration status after immersion in comfortably hot water containing residual chlorine at 1.0 and 2.0 mg/L was significantly lower than that following immersion in water containing a negligible concentration of residual chlorine (i.e., less than 0.03 mg/L)(p <0.05). In the NC subjects, significant differences were observed only between the 2.0 mg/L and the negligible residual chlorine groups (p <0.05). The water‐holding capacity of the SC was significantly decreased with a residual chlorine concentration of 0.5 mg/L or higher in the patients with AD (p <0.01). However, in the NC subjects, a significant decrease in water‐holding capacity was observed only at a residual chlorine concentration of 2 mg/L (p <0.01). These results indicate, first, that the water‐holding capacity of the SC in patients with AD is more sensitive to free residual chlorine exposure than that in NC subjects without AD. Second, these results suggest that free residual chlorine exposure in patients with AD may play a role in the development or exacerbation of AD.
Klippel‐Trenaunay Syndrome with a Life‐Threatening Thromboembolic Event
Authors: Aggarwal Kamal , Jain Vijay K. , Gupta Sanjeev , Aggarwal Hari K. , Sen Jyotsna , Goyal Vishal
Published: July 2014

Klippel‐Trenaunay syndrome is a congenital disorder characterised by the triad of cutaneous vascular nevi, soft tissue or bony hypertrophy, and varicose veins or venous malformations involving one or more extremities. An incidence of venous thromboembolism of up to 22% has been reported in this disorder. Also reported but rare is the development of trophic changes. Herein, we report the case of a male with Klippel‐Trenaunay syndrome, deep vein thrombosis, venous ulceration, and death due to recurrent pulmonary embolism.
Pityriasis Rosea‐Like Eruption Due to Pneumococcal Vaccine in a Child with Nephrotic Syndrome
Authors: Sasmaz Sezai , Karabiber Hamza , Boran Cetin , Garipardic Mesut , Balat Ayse
Published: July 2014

A pityriasis rosea‐like eruption can occur as a consequence of treatments with gold compounds and captopril. It has rarely been reported to have an association with vaccinations such as smallpox, BCG, hepatitis B, and diphtheria toxoid. It has not previously been documented to develop after pneumococcal vaccination. We report a case of pityriasis rosea‐like eruption that developed following pneumococcal vaccination in a child with nephrotic syndrome.
Long‐Term Continuous versus Intermittent Cyclosporin: Therapy for Psoriasis
Authors: Ohtsuki Mamitaro , Nakagawa Hidemi , Sugai Junichi , Ozawa Akira , Ohkido Muneo , Nakayama Juichiro , Hanada Jiro , Morimoto Yosuke , Jimbow Kowichi , Horikoshi Takashi , Kitahara Hiroto , Tamaki Kunihiko , Urabe Kazunori , Hori Yoshiaki
Published: July 2014

A multicenter randomized controlled study was conducted to assess the long‐term efficacy and safety of cyclosporin A therapy for psoriasis using either a continuous or an intermittent regimen. Initially, both regimens consisted of 3–5 mg/kg/day administration of CyA. Once remission was obtained, CyA dose was maintained between 0.5 and 3 mg/kg/day under the continuous regimen, while under the intermittent regimen, CyA dose was tapered off and, when necessary, topical corticosteroids were used until relapse occurred. Thirty‐one patients were followed for at least 48 months (mean follow‐up period: 55.9 ± 4.6 months): 15 received continuous therapy, and 16 received intermittent therapy. With both regimens, the PASI (Psoriasis Area and Severity Index) score was maintained at 5–12 points throughout the follow‐up period. The score was decreased by more than 70% from baseline with both regimens: the responses between them were not significantly different. However, overall control of psoriasis, as assessed from the averaged PASI score, was better in the patients receiving continuous therapy. Although the overall frequency of adverse reactions was similar for the two regimens, cancer occurred in two patients on continuous therapy (gastric cancer and hepatocellular carcinoma in one patient each). We could not, however, definitely attribute the cancers in the two patients to continuous therapy itself. There was a significantly higher incidence of renal impairment in elderly patients receiving either regimen when compared with younger patients. In conclusion, CyA administered to psoriasis patients under both regimens exhibited long‐term efficacy and tolerability. Despite a lower overall efficacy, it seems proper to conclude that intermittent therapy is more useful than continuous therapy due to the occurrence of malignancies with continuous therapy. Further investigation is required to determine whether intermittent therapy is really safer than continuous therapy, and, if so, how it should be designed to minimize long‐term adverse reactions and achieve overall control comparable to that of continuous CyA therapy.
Sexually Transmitted Diseases in Children
Authors: Pandhi Deepika , Kumar Sanjeev , Reddy Belum Siva Nagi
Published: July 2014

Sexually transmitted diseases (STDs) cause considerable morbidity among their victims. This is true even for children. Unfortunately, this aspect has not received due attention and remains a relatively ignored field. We carried out a study of the clinico‐epidemiological profile of STDs among the pediatric patients who attended the STD clinic of a tertiary care hospital. Pediatric patients who presented with STDs from January of 1995 to February of 2001 constituted the subject material of this study. A detailed clinical examination and relevant laboratory investigations were carried out in all patients. A total of 15,453 STD patients were seen during this period, out of which 127 were children, giving a prevalence of 0.82% pediatric STD cases. The peak incidence of STDs was seen in the age group of 10–14 years (66.1%). Most of them were illiterate (61.4%) and from low socio‐economic backgrounds (70.9%). Notably, 17.3% were from remand homes. The predominant STDs observed among these children were syphilis (25.2%), including six cases of congenital syphilis, vulvo‐vaginal candidiasis (11.8%), condyloma‐acuminata (14.2%), herpes progenitalis (8.7%) and traumatic lesions (7.9%). Histories or signs of abuse were present in 74% of the patients. Only two cases during the span of the study were HIV positive. Pediatric STDs remain a hidden and neglected problem. Children constituted 0.82% of all STD patients in our series. This may represent only the tip of the iceberg, because several features, including some operational problems, are responsible for underdiagnosis of pediatric STDs. If not treated promptly and adequately, they may result in significant physical and emotional sequelae in children. Thus, it is essential to develop strategies to prevent sexual abuse and to have adequate counselling measures, especially in juvenile delinquents.
Palmoplantar Lichen Planus Presenting with Vesicle‐Like Papules
Authors: Gündüz Kamer , Inanir Isil , Türkdogan Peyker , Sacar Handan
Published: July 2014

Palmoplantar lichen planus is a rare, localized variant of the disease that may create difficulty in diagnosis if it is present as an isolated finding. Although several morphological patterns may be seen, plaques or small papules with compact hyperkeratosis are usually observed. We present a 25‐year‐old woman with a one‐month history of slightly pruritic, red papules on her palms and soles. Dermatologic examination revealed numerous, asymptomatic, unscaly, red papules on her palms and soles, some of them resembling vesicles and white reticulate plaques on both sides of the buccal mucosa. The diagnosis was established by the typical histopathological features of lichen planus. Although resistant to topical corticosteroids, she responded well to systemic corticosteroid therapy, and no recurrence was observed during the follow‐up period of one year.
Retinoids: Fascinating Up‐and‐Coming Scenario
Authors: Sardana Kabir , Sehgal Virendra N.
Published: July 2014

Retinoids have been in sharp focus ever since their introduction 30 years ago. They include any drug (s) that bind to retinoid receptors and elicit a biological response. Enormous information on the subject seems to embroil the recent literature. Practically it is impossible to clearly comprehend the undercurrents. The meticulously dispensing text envisages surmounting the perspective reader's predicaments. Accordingly, retinoids and their related facets namely retinoid receptors, classification, mode of action, and the pharmacological diversity have been precisely defined. Commonly used systemic retinoids too have been given a substantial fresh look along with their monitoring. Overall, adverse effects and relative and absolute contraindications have been scrupulously incorporated. Human immuno deficiency virus (HIV) and isoretinoid for acne, in particular, have been highlighted. Micronized isotretinoin formulations have also been taken care so also commonly used topical retinoids. Tretinoin and their newer formulation have also been accounted for along with tretinoin polymer cream. Adapalene, a new chemical entity possessing a unique physico‐chemical activity similar to that of tretinoin has also been dealt with. Newer retinoids are likely to be a subject of intrigue. A focus on future potentials of retinoids is its special ingredient. The inclusion of details of rexinoid the most recent introduction in their purview is likely to invoke interest to further consolidate its reckoning in future. All in all the text of the paper should provide an insight into the current rumbling around retinoids.
Phakomatosis Pigmentovascularis II A and II B: Clinical Findings in 24 Patients
Authors: la Cruz Helena Vidaurri‐de , Tamayo‐Sánchez Lourdes , Durán‐McKinster Carola , Orozco‐Covarrubias Ma. de la Luz , Ruiz‐Maldonado Ramón
Published: July 2014

Nearly 200 cases of phakomatosis pigmentovascularis (PPV) have been reported worldwide, most of them of Japanese origin. There are 5 types and 10 subtypes of PPV. Its etiology might be explained by the twin spotting phenomenon. The relative frequency of PPV at the National Institute of Pediatrics was 5.8 per 100,000 pediatric patients and 0.634 per 100,000 dermatological patients. We report 24 cases of PPV with an average follow up of 5 years and the following findings: PPV type II A in 4 male and 2 female patients with melanosis bulbi in 3 and glaucoma in 1. PPV type II B in 7 male and 11 female patients, with melanosis bulbi in 9, glaucoma in 9, iris mammillations in 2, Sturge Weber syndrome in 6 female patients, and Klippel‐Trenaunay syndrome in 2 males, hemifacial, hemicorporal, or limb hypertrophy without venous insufficiency in 6 female and 4 male patients. During the follow‐up time of 60 months, progressive fading of melanotic and vascular macules were observed in 7 patients. No other types of PPV were found. Systemic involvement in PPV was related to the body surface area affected by the vascular macules. Ectodermal and mesodermal migration disorders might be involved in the pathogenesis of PPV.
The Clinical Course of Behçet's Disease in Pregnacy: A Retrospective Analysis and Review of the Literature
Authors: Uzun Soner , Alpsoy Erkan , Durdu Murat , Akman Ayse
Published: July 2014

Although Behçet's disease is mainly diagnosed during the reproductive periods of life, we know little about the influence of pregnancy on the clinical course of Behçet's disease. Therefore, we analyzed the relationship between Behçet's disease and pregnancy retrospectively, in order to detect any possible interaction between the two multisystemic processes, particularly in regard to the influence of pregnancy on the clinical course of Behçet's disease. We studied 44 pregnancies in 28 women with Behçet's disease. The diagnoses were made according to the criteria of the International Study Group for Behçet's disease. The patients were observed during pregnancy and puerperium periods at monthly intervals. The existence and incidence of symptoms were recorded during these periods. There was remission of Behçet's disease during 23 (52.3%) pregnancies, although the disease had been in a stage of exacerbation before pregnancy. The disease became exacerbated during 12 (27.3%) pregnancies, although it had been in a stage of remission before pregnancy. There were no changes in the clinical course of Behçet's disease in 9 (20.4%) pregnancies. The most frequent manifestations of the clinical exacerbation were increases in the intensity and severity of outbreaks of oral ulcers during pregnancy. Outbreaks of genital ulcers, eye inflammations, and arthritis were other signs of exacerbation. Other than spontaneous abortion in three patients, we did not observe maternal or fetal complications. Although Behçet's disease tends toward remission during pregnancy, the influence of pregnancy on its clinical course is quite variable between patients and even during different pregnancies in the same patient. On the basis of our and previous results, we speculate that pregnancy in general does not seem to markedly affect the natural course of Behçet's disease.
Recalcitrant Oral Pyoderma Gangrenosum in a Child Responsive to Cyclosporine
Authors: Park Hyang‐Joon , Han Bong‐Gyun , Kim You‐Chan , Cinn Yong‐Woo
Published: July 2014

We report a case of recalcitrant pyoderma gangrenosum which developed on the tongue of an 8‐year‐old, previously healthy boy without any systemic associated disease. The lesion was confined to the tongue and was not responsive to conventional treatment with prednisolone and sulfa drug, but it showed dramatic improvement with oral cyclosporine therapy. In addition, the histopathology of the lesion included many eosinophils, which caused difficulties in diagnosis to differentiate this condition from other oral ulcerative diseases showing tissue eosinophilia including eosinophilic ulcer of the tongue.
Pansclerotic Morphea Treated with UVA: A Case Report
Authors: Yildirim Mehmet , Baysal Vahide , Aridogan Buket Cicioglu , Kesici Demet , Erturan Ijlal
Published: July 2014

We present an 8‐year‐old girl with pansclerotic morphea of childhood, a rare, severe variant of localized scleroderma. Various systemic agents and PUVA are used in the treatment of this disease. We used UVA therapy in the treatment of this case.
Blue Lunula Due to Hydroxyurea
Authors: Jeevankumar Balasubramanian , Thappa Devinder Mohan
Published: July 2014

Alteration in the color of lunula can be an indication of either a cutaneous or systemic disorder or a systemic drug side effect. Hydroxyurea, an antitumor systemic agent (a ribonucleoside diphosphate reductase inhibitor) used in the treatment of refractory psoriasis as well as in the variety of neoplastic disorders is known to cause brownish pigmentation of the nails but hydroxyurea induced blue lunula is very rare. It is being reported in a 45‐year‐old man with chronic recalcitrant plaque psoriasis on oral hydroxyurea 500 mg twice daily. Lunular pigmentation in finger and toenails developed two weeks later. During follow up, pigmentation remained localized to the proximal portion of nails.
Cutaneous Type of Adult T Cell Leukemia/Lymphoma: A New Entity among Cutaneous Lymphomas
Authors: Yagi Hiroaki , Takigawa Masahiro , Hashizume Hideo
Published: July 2014

Adult T cell leukemia/lymphoma (ATL) is a malignancy of CD4+ T cells that is endemic in certain areas in Japan. Two types of cutaneous ATL thought to originate from skin include cutaneous tumor and erythematopapule types. Patients with cutaneous ATL show neither leukemic involvement nor invasion of tumor cells into the lymph nodes for at least six months. The differential diagnosis between cutaneous ATL and mycosis fungoides is often difficult. The presence of monoclonal integration of human T lymphotropic virus‐I proviral DNA in skin samples is of definitive diagnostic value in cutaneous ATL.
Pattern of Contact Sensitivity in Indian Patients with Hand Eczema
Authors: Suman Mansi , Reddy Belum Siva Nagi
Published: July 2014

One hundred consecutive patients with hand eczema were patch tested with the Indian Standard Series and indigenous antigens after a detailed history and clinical examination. Both sexes were involved and the majority of them were in the age group between 20–39 years (56%). Their occupational profile varied in order of frequency from household work (37%), to masons (14%), students (11%), factory workers (7%), and others (31%). Itching was the most common presenting complaint (93%). A history of atopy was found in 36% of the patients. The predominant sites involved were the palms (43%), followed by fingers (32%), dorsum (17%), and the entire hand (8%). Dry, scaly skin was the most common morphological picture, followed by hyperpigmentation, fissuring, and lichenification. Based on history, clinical examination and patch test results, the diagnosis was made as allergic contact dermatitis in 67% of cases and irritant contact dermatitis in 15% of cases. Positive patch tests with one or more allergens were noted in 67% of the patients. Vegetables (21%) were found to be the most common sensitizers, followed by nickel sulphate (20%), potassium dichromate (18%), and others. Wet work, soaps, and detergents were found to be the most offending irritants. The present study confirmed the fact that hand eczema is a multifactorial disease caused by both irritants and allergens.
Reticulate Acropigmentation of Dohi: First Case Reports from Nepal
Authors: Agarwalla Arun , Agrawal Sudha , Rijal Arpana , Barman Krishna Deb , Bhattarai Sabeena
Published: July 2014

Acropigmentation of Dohi is a rare acropigmentary disorder. We report two cases of reticulate acropigmentation of Dohi from Nepal. To the best of our knowledge, these two cases represent the first case reports from Nepal.
Basal Cell Carcinomas of the Areola‐Nipple Complex: Case Reports and Review of the Literature
Authors: Betti Roberto , Martino Patrizia , Moneghini Laura , Vergani Raffaelle , Tolomio Elena , Crosti Carlo
Published: July 2014

Two white men 57 and 39 years old, and a 47‐year‐old white woman were seen with slowly developing papulo‐nodular lesions of the areola‐nipple complex. None of the patients presented with regional lymphadenopathy, history of trauma, or relevant sun‐exposure. After excison of the mass, the histologic diagnosis of basal cell carcinoma was made. At two years of follow‐up, no recurrence was evident. The low incidence of basal cell carcinoma in this particular site allows us to consider the areola‐nipple complex location as unusual. Moreover, literature reports do not suggest that these BCCs have an increased potential for malignancy. The treatment options depend on the extension of the tumor and on the possible involvement of the areola‐nipple complex and mammary tissue.
Unilateral Angiokeratoma Scroti: A Rare Manifestation of a Vascular Tumor
Authors: Bechara Falk Georges , Altmeyer Peter , Jansen Thomas
Published: July 2014

A 21‐year‐old patient with a six‐year history of asymptomatic papular lesions on his scrotum is reported. The lesions were limited to one half of the scrotum and associated with subclinical varicocele on the same side. The clinical and histopathological findings were consistent with a diagnosis of angiokeratoma scroti. Increased venous pressure caused by the varicocele may have been responsible for the unilateral development of angiokeratoma in this patient.
Primary Tuberculosis Cases Presenting with Erythema Nodosum
Authors: Mert Ali , Ozaras Resat , Tabak Fehmi , Ozturk Recep
Published: July 2014

Erythema nodosum (EN) is seen only in the primary tuberculosis (TB) form of tuberculous diseases. Among the etiologies of EN, TB is the most frequent disorder in developing countries. We aimed to assess our patients with EN in reference to primary TB. We evaluated 335 patients with the diagnosis of TB during last 20 years; retrospectively 61 (18%) of these cases had pulmonary and 274 (82%) had extrapulmonary TB. Ten (16%) of the pulmonary TB cases were primary. All 10 patients with primary TB presented with EN. Among 50 patients with EN diagnosed and followed during the last 10 years, the etiology was determined in 56%, and primary TB was the most frequent: 20%.
Computer‐Aided Diagnosis of Genodermatoses
Authors: Aksungur Varol Lütfü , Maraklı Selma Sönmezoğlu , Akman Ayşe , Homan Seydo
Published: July 2014

Genodermatoses are not usually easily diagnosed by inexperienced physicians. We developed a computer program to aid their clinical diagnoses and compared its accuracy rate to those of five residents in dermatology. The database of the program contained the clinical findings of 100 genodermatoses. Findings related to the skin, its appendages, mucous membranes and physiognomy were recorded in detail; but the involvements of other organs, only as headings. Twenty test cases were prepared from previously published reports. Their clinical findings were evaluated both by the program and five residents, who were at the end of the third year of their training in dermatology. The program gave the correct diagnosis in all of the test cases, but the residents failed to do so in one to seven cases. The high accuracy rate of the program suggests that it can aid inexperienced physicians in their clinical diagnosis of genodermatoses.
A Giant Malignant Fibrous Histiocytoma on the Scalp
Authors: Kim Hyoung‐Hun , Chang Sung‐Eun , Choi Jee‐Ho , Moon Kee‐Chan , Koh Jai‐Kyoung
Published: July 2014

Malignant fibrosis histiocytoma (MFH) is one of the most common soft tissue sarcomas of adult life. The most common sites of origin are the proximal extremities, particularly the thigh and buttock. The tumors are multilobular fleshy masses, often apparently circumscribed on gross examination. We report a case of a MFH of the head in a 57‐year‐old woman. Our case is clinically unusual in that the tumor rapidly grew up to 15 cm in a very short time.
Negative Feedback Regulation of Phosphatidylinositol 3‐Kinase/Akt Pathway by Over‐Expressed Cyclooxygenase‐2 in Human Epidermal Cancer Cells
Authors: Takeda Koichiro , Kanekura Takuro , Kanzaki Tamotsu
Published: July 2014

While enhanced expression of cyclooxygenase (COX)‐2 has been observed in human skin epidermal cancer, the mechanisms underlying COX‐2 expression have not been completely elucidated. Recently, a role for the phosphatidylinositol‐3 (PI3) kinase pathway in COX‐2 expression has attracted attention. We investigated COX‐2 expression, PI3 kinase activity, and the phosphorylation level of Akt, a downstream effector of PI3 kinase, in the human skin cancer cell line HSC‐5. Compared to the nontumorigenic keratinocyte HaCaT, in HSC‐5 cells, COX‐2 protein expression and PI3 kinase activity were increased. The PI3 kinase inhibitor LY294002 reduced COX‐2 expression in HSC‐5 cells and, contrary to our expectation, the phosphorylation of Akt was significantly decreased. The expression of Bcl‐2, which is regulated by Akt, was reduced, and apoptosis was induced in HSC‐5 cells compared to HaCaT cells. COX‐2 inhibitor NS398 up‐regulated Akt phosphorylation. These results imply that constitutively over‐expressed COX‐2 down‐regulates the Akt phosphorylation through a negative feedback mechanism.
Two Cases of Multiple Eccrine Spiradenoma with Linear or Localized Formation
Authors: Yoshida Aki , Sato Toshiki , Sugawara Yuki , Matsuta Mayumi , Akasaka Toshihide
Published: July 2014

We report two rare cases of recurrent, multiple eccrine spiradenoma. Both cases presented with extensive lesions comprised of multiple red papules of various sizes and a soft blue‐red nodule. The first case was a 30‐year‐old woman. Her lesions followed a linear arrangement on her chin, and extended down the right side of the neck with spontaneous pain. The second case was a 57‐year‐old woman with tumors in a localized group on the left occipital region without pain. A search of the literature revealed only 15 reported cases of linear/zosteriform/nevoid multiple eccrine spiradenoma. Both cases were treated by surgical excision. Most of the red papules displayed typical histological features including two cell types: large clear cells with low‐density cytoplasm; and small dark cells with high‐density cytoplasm. The large soft tumors exhibited a variable histological appearance. In the first case, the cystic tumors displayed an homogeneous structure comprised of eosinophilic material. In the second case, the cystic tumors included abundant interstitial tissue.
Skin Aging and Dry Skin
Authors: Hashizume Hideo
Published: July 2014

Skin aging appears to be the result of both scheduled and continuous “wear and tear” processes that damage cellular DNA and proteins. Two types of aging, chronological skin aging and photoaging, have distinct clinical and histological features. Chronological skin aging is a universal and inevitable process characterized primarily by physiologic alterations in skin function. In this case, keratinocytes are unable to properly terminally differentiate to form a functional stratum corneum, and the rate of formation of neutral lipids that contribute to the barrier function slows, causing dry, pale skin with fine wrinkles. In contrast, photoaging results from the UVR of sunlight and the damage thus becomes apparent in sun‐exposed skin. Characteristics of this aging type are dry and sallow skin displaying fine wrinkles as well as deep furrows, resulting from the disorganization of epidermal and dermal components associated with elastosis and heliodermatitis. Understanding of the functions of the skin and the basic principles of moisturizer use and application is important for the prevention of skin aging. Successful treatment of dry skin with appropriate skin care products gives the impression of eternal youth.
A Case of Refractory Bullous Pemphigoid with Plasmapheresis‐Associated Thrombopenia: Efficacy of Pulsed Intravenous Cyclophosphamide Therapy
Authors: Ogawa Yasushi , Adachi Ayumi , Okamoto Miyako , Hashimoto Takashi , Tomita Yasushi
Published: July 2014

We present a 69‐year‐old woman with refractory bullous pemphigoid successfully treated with pulsed intravenous cyclophosphamide therapy. Because various other early treatments including 4,4'‐diaminodiphenylsulphone (DDS), minocycline/nicotinamide, cyclosporin, azathioprine, high‐dose oral prednisolone, and methylprednisolone pulse therapy were either ineffective or intolerable, she was treated with double filtration plasmapheresis, but she responded poorly with the rare complication of severe transient thrombopenia. Finally, she gradually recovered with pulsed intravenous cyclophosphamide therapy.
Treatment of Confluent and Reticulated Papillomatosis with Azithromycin
Authors: Atasoy Mustafa , Özdemir Şevki , Aktaş Akın , Aliağaoğlu Cihangir , Karakuzu Ali , Erdem Teoman
Published: July 2014

Confluent and reticulated papillomatosis (CRP) is a relatively rare disorder of unknown origin, mostly affecting young female adults. We here present the case of a 21‐year‐old male patient with confluent and reticulated papillomatosis. Skin examination revealed brownish, verrucous, hyperkeratotic, 2 to 5 mm papules, which formed confluent patches and plaques with a reticulate network on the interscapular area. The patient was initially treated with ketoconazole cream for two weeks without improvement. The disease can be rather persistent and resistant to topical therapy. Our case showed a satisfactory response to treatment with azithromycin. Although this treatment is known to be effective in some cases, the action mechanism of azithromycin on CRP is not fully understood.
Skin Infiltration of Juvenile Myelomonocytic Leukemia
Authors: Matsumoto Kazuhiko , Miki Jun , Matsuzaki Satoshi , Koike Kenichi , Saida Toshiaki
Published: July 2014

We described a two‐year‐old boy who developed a skin infiltration from JMML. Several indurated erythematous lesions were seen on his back on his first visit to our department. Edematous erythemas had repeatedly appeared on his auricles and feet for the previous six months. He had had a high fever for a month. Hepatosplenomegaly and superficial lymphadenopathy were recognized. Laboratory investigation showed leukocytosis and anemia. The diagnosis of JMML was confirmed by the findings of myeloid hyperplasia in his bone marrow and the spontaneous colony formation and GM‐CSF hypersensitivity in a culture of bone marrow cells. Histopathologically, large atypical mononuclear cells were infiltrated throughout the dermis in a perivascular and interstitial distribution in a skin biopsy specimen. These cells were CD3 (–), CD20 (–), CD45 (+), CD68 (+) and myeloperoxidase (+). Bone marrow transplantation and then cord blood stem cell transplantation were performed but soon rejected. The indurated erythematous lesions appeared again soon after the relapse of JMML. There are other reported cases of JMML with skin infiltration that preceded any other manifestations of the disease. JMML cells in some patients, including our case, seem to have a great affinity for the skin, and skin biopsy aids in early detection of this disease.
Lichen Planus Showing Columnar Epidermal Necrosis
Authors: Yoon Tae Young , Lee Gu Chang , Kim Young Gi , Kim Mi Kyeong , Kim Chi Yeon
Published: July 2014

We describe a 9‐year‐old boy who presented with very itchy papules and plaques on both knees. Histologically, focal columnar epidermal necrosis was seen associated with features of classic lichen planus. A literature search using PubMed revealed that only two cases of transfusion‐associated lichenoid graft‐versus‐host reaction showing columnar epidermal necrosis have been previously reported. Our case is the first of lichen planus showing columnar epidermal necrosis. In that lichenoid graft‐versus‐host reaction is a special form of lichen planus, it is possible to speculate that columnar epidermal necrosis may be a unique feature of lichen planus.
Correlation of Serum Total IgE, Eosinophil Granule Cationic Proteins, Sensitized Allergens and Family Aggregation in Atopic Dermatitis Patients with or without Rhinitis
Authors: Lee Chih‐Hung , Chuang Hung‐Yi , Shih Chia‐Chi , Jee Shiou‐Hwa , Wang Li‐Fang , Chiu Hsien‐Ching , Chang Chung‐Hsing , Wu Chieh‐Shan , Yu Hsin‐Su
Published: July 2014

Atopic dermatitis (AD) is a complex disease with both a genetic background and environmental interactions. Although multiple linkage‐analyses about AD have been studied, there have been only a few family aggregation tests of AD or perennial allergic rhinitis (AR) to date. The association of allergen‐specific IgE in AD and atopic dermatitis with allergic perennial rhinitis (ADR) have also been seldom discussed. The purpose of this study was to evaluate family aggregation and assess allergen‐specific IgE in patients with AD and ADR. We also planned to investigate the effect of family history of AD on the prevalence of allergen‐specific antibodies. The serum levels of IgE, eosinophil cationic protein (ECP) and major basic protein (MBP) were measured and compared in patients with AD and those with ADR. Proportional analysis compared allergen‐specific IgE between AD and ADR. The family aggregation was conducted to estimate the odds ratio for various atopic diseases in different family members. Total IgE and allergen‐specific antibodies in serum were compared between those patients who had AD with AR and those without. The result revealed that allergic rhinitis is the most common concomitant atopic disease associated with AD. The ADR group was more likely to have serum mite‐, cockroach‐, and feather‐specific IgE. The positive rates for wheat, peanut and soybean were higher in those AD without rhinitis. In the family aggregation of AD, the odds ratio for siblings was higher than for parents, the ratios for brother and sister were 9.91 and 8.75, respectively. However, the odds ratio for parents of ADR was higher than siblings; the ratios for father and mother of ADR were 8.22 and 2.94, respectively. AD patients with family histories of AD were more likely to have mite‐, soybean‐, and peanut‐specific antibodies in their serum. We concluded that aeroallergens are the most important allergens aggravating atopic diseases in Taiwan. Food plays an important role in the pathogenesis of AD. Measurement of serum total IgE combined with the MAST‐CLA test could be helpful in the diagnosis of atopic diseases. The differential aggregation tendency for AD and ADR implicated the complexity of the gene‐environment interaction in these atopic diseases.