bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychologic Characteristics of Men with Alopecia Androgenetica and Their Modification
Authors: van der Donk J. , Passchier J. , Dutree‐Meulenberg R.O.G.M. , Stolz E. , Verhage F.
Published: May 2007

ABSTRACT: Psychologic characteristics were studied in a sample of 168 men with alopecia androgenetica who participated in a clinical trial on the efficacy of minoxidil gel. In general, no evidence of psychologic malfunctioning was found. Instead, a slightly more adequate psychologic state was indicated. However, specific problems associated with hair loss were reported by a substantial number of men. Responders with cosmetic improvement in the group over 35 years of age improved more regarding general psychologic maladjustment, inadequacy, and self‐evaluation than those who did not respond. A reverse trend was, however, found in the group younger than 35 years of age, where the nonresponders improved more. An explanation for these findings is derived from the theory of cognitive dissonance.
Latent Herpes Simplex Virus Reactivation in the Guinea Pig
Authors: Bobrowski Paul J. , Capiola Richard , Centifanto Ysolina. M.
Published: May 2007

ABSTRACT: The purpose of this investigation was to establish an animal model by which latent herpetic disease could be mechanically reactivated, yielding an adequate number of recurrent clinical lesions in the guinea pig. To determine strain virulence, hairless guinea pigs were inoculated with three different strains of herpes simplex virus (HSV) using a spring‐loaded multiple puncture apparatus. HSV‐1 strains SC‐16 and McKrae produced an average of 21 and 8 lesions per infected area, respectively. The HSV‐2 strain (333) produced the lowest number at an average of 3 lesions per site. Following the determination of strain virulence, a larger number of guinea pigs, Hartley and hairless, were inoculated with the same HSV strains in a similar fashion as previously described. The primary infection was evident from 6 to 12 hours postinfection (PI) by the initial appearance of small pustules, which peaked by day 2, seen as dome‐shaped fluid‐filled sacs. These initial lesions burst, crusted (day 6 PI), and had resolved and flattened between days 9 and 12 PI. At 4‐6 weeks PI the inoculated areas were stripped 6 times per area with cellophane tape. Recurrent lesions were seen in the majority of the stripped areas (89–100%). The best results were achieved with the HSV‐1 (SC‐16) strain in hairless guinea pigs, which peaked on day 3 poststripping, producing an average of 12.25 lesions per area. The hairless guinea pig is ideal for this type of experiment because its use eliminates the trauma associated with denudation, a procedure necessary when using haired (Hartley) animals. Using our model for recurrent cutaneous HSV, the number of lesions produced allows this method to be suitable for quantitive analysis.
GRANULOMA INGUINALE: THREE CASES DIAGNOSED IN TORONTO, CANADA
Authors: HACKER PETER , FISHER BENJAMIN K. , DEKOVEN JOEL , SHIER R. MICHAEL
Published: May 2007

Granuloma inguinale (GI) is a sexually transmitted disease seldom seen in the United States and Canada. We are reporting three cases recently seen in Toronto, Ontario, two in immigrants, and one in a native born Canadian who had an intimate relationship with a foreign visitor. The basic features of the disease are discussed.
RECESSIVE DYSTROPHIC EPIDERMOLYSIS BULLOSA TREATED WITH PHENYTOIN
Authors: ABAHUSSEIN ABDULAZIZ A. , AL‐ZAYIR AHMAD A. , MOSTAFA WEDAD Z. , OKORO ANEZI N.
Published: May 2007

Three patients with severe recessive dystrophic epidermolysis bullosa were treated with oral phenytoin and palliative and supportive measures for variable periods. Their progress was compared with that of three milder cases managed only with palliative and supportive measures. The phenytoin‐treated group showed marked decrease in blister count, increase in trauma tolerance, a rise in hemoglobin level, and considerable weight gain. The results support earlier reports that collagenase inhibitors are useful in controlling blister formation in recessive dystrophic epidermolysis bullosa.
CORRESPONDENCE
Authors: GOIHMAN‐YAHAR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
POST‐KALA‐AZAR DERMAL LEISHMANIASIS IN THE SUDAN: PERIPHERAL NEURAL INVOLVEMENT
Authors: ELHASSAN AHMED M. , ALI MOHAMED S. , ZIJLSTRA EDWARD , ELTOUM ISAM A. , GHALIB HASHIM W. , AHMED HYDER M.A.
Published: May 2007

Four patients developed post‐kala‐azar dermal leishmaniasis and neuritis (PKDL) 1 to 6 months following apparently successful treatment of kala‐azar. The duration of the lesion varied between 1 month and nearly 5 years. The lesions were macules, papules, or nodules affecting the face, extremities, and trunk. The diagnosis was made by demonstration of the parasite in slit smear and biopsies and by a positive direct agglutination test (DAT). Histologically, the patients were found to have neuritis affecting the cutaneous nerves in the lesion only. The nerves showed a lymphohistiocytic infiltration and occasionally parasites. There was no impairment of sensation. Response to sodium stibogluconate was good. PKDL may simulate leprosy both clinically and pathologically.
WORLDWIDE STRATEGY FOR SKIN HEALTH CARE IN A FINANCIAL STRAIT‐JACKET
Authors: RYAN TERENCE J.
Published: May 2007

In consideration of the year 2000, dermatologists must take up the challenge of “Health for All.” This paper draws attention to the scope of dermatology, the nature of its work force, the qualifications that are desirable, and the deficiencies and impediments that characterize dermatologic solutions worldwide. It suggests that the future of dermatology depends on achieving appropriate and essential staffing, technology, drugs, and learning materials, within available financial resources. To achieve this, dermatologists must talk more persuasively to those who govern and some centralization of resources into regional training centers may be desirable. Delegation of skin care to purpose‐trained auxiliaries, nurses, or medical assistants is essential if costs are to be contained while enlarging the work force.
Hyperkeratosis Nigricans
Authors: GOIHMAN‐YAHR MAURICIO
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, government control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should confirm to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐yahr, M.D., Ph.D., Editor, Jet Internationsl M‐154, P.O. Box 020010, Miami, FL 33102.
CHRONIC CUTANEOUS LEISHMANIASIS: LEISHMANIA PARASITES IN BLOOD
Authors: NUWAVRI‐SALTI NUHA , MU'ATASSEM DIA , SALMAN SALAH , IZZEDINE NAZIK , GHANI KIBBI ABDEL
Published: May 2007

Two patients with chronic cutaneous leishmaniasis had positive blood cultures. The diagnosis was established by the clinical picture, skin biopsy, and culture for Leishmania major and tropica.
MALIGNANT ATROPHIC PAPULOSIS (DEGOS' SYNDROME)
Authors: DEMITSU TOSHIO , NAKAJIMA KAZUYUKI , OKUYAMA RYUHEI , TADAKI TAKAYOSHI
Published: May 2007

A 29‐year‐old Japanese man with malignant atrophic papulosis had a 1‐year history of scattered, asymptomatic, whitish or skin‐colored papules, as well as erythematous papules with central atrophy showing a porcelain‐like appearance on the trunk and extremities. Histologic examination revealed lymphocyte‐mediated necrotizing vasculitis with considerable deposition of mucin in the dermis. The wedge‐shaped necrosis of the dermis was not detected. Based on a review of the literature we think that this case represents the histologic features of the early skin lesions of malignant atrophic papulosis.
ACQUIRED PERFORATING DISEASE ASSOCIATED WITH CHRONIC RENAL FAILURE
Authors: CHANG PATRICIA , FERNANDEZ VICTOR
Published: May 2007

A 48‐vear‐old man, in a chronic hemodialysis program, had numerous skin lesions develop that consisted of follicular papules and small hyperkeratotic nodules, located on the trunk, hips, and upper and lower extremities (where the lesions were more numerous). The nodules measured 3 to 5 mm and had a dark discoloration (Figs 1 and 2). Four months previously, the patient noticed the appearance of disseminated papular and pruritic lesions. The lesions did not improve with the prescribed local nonspecific treatment.

The patient had chronic renal failure during the previous 10 years, secondary to renal vein thrombosis. As a result, he has had periodic hemodialysis for 18 months. The clinical diagnosis of the skin lesion was Kyrle disease, and a skin biopsy was performed on a nodular lesion from the thigh. The histologic sections showed skin with hyperkeratosis, an invagination of the epithelium filled with keratin and amorphous material. In some sections, the invagination appeared to be a cyst, which in serial sections, showed partial rupture of the lateral wall. No evidence of hair was found inside the invagination.
IMMUNOHISTOCHEMICAL STUDY ON THE PATTERN OF 50 KD CYTOKERATIN IN PSORIASIS
Authors: FEDI ANNA MARIA , LOTTI TORELLO , MEO ANNA LAURA , RIZZO ANGELA , LEONCINI PAOLO
Published: May 2007

Three biopsies of normal skin and 15 biopsies collected from patients with psoriasis vulgaris were analyzed for the expression of the 50 kd cytokeratin using direct immunofluorescence and ABC technique before and after local treatment with anthralin 0.1% in a petroiatum base, with 0.05% betamethasone dipropionate cream, and finally, after PUVA treatment. Antiserum against the 50 kd anticytokeratin reacted with tissue sections of normal skin, staining cells in the basal layer, while the psoriatic skin sections before the various treatments showed a staining concerning the whole thickness of the epidermis. After the various therapies, the 50 kd cytokeratin immunoreactivity was observed only in the basal layer of those psoriatic skin sections that showed complete clinical clearing, while it was observed in the whole thickness of psoriatic patches that did not clear. These data suggest that the normalization of the 50 kd cytokeratin expression pattern can be considered as a marker of clinical remission of psoriasis.
DIFFERENTIATION OF BULLOUS PEMPHIGOID FROM EPIDERMOLYSIS BULLOSA ACQUISITA ON FROZEN SKIN BIOPSIES
Authors: VALESKI J. EDWARD , KUMAR VIJAY , BEUTNER ERNST H. , CARTONE CARMELA , KASPRZYK KATHERINE
Published: May 2007

Patients with bullous pemphigoid and epidermolysis bullosa acquisita may have similar clinical, histologic, and routine immunohistologic features. These two diseases can be distinguished by routine diagnostic studies either on a patient's serum tested by indirect immunofluorescence on salt‐split normal skin or by obtaining a fresh perilesional skin biopsy, inducing a split at the lamina lucida, and testing for the site of IgG deposition by direct immunofluorescence. Often the serum studies are negative, while direct immunofluorescent studies yield the characteristic linear IgG staining of the basement membrane zone. To eliminate the need for a repeat biopsy to make a laboratory differential diagnosis, we studied the efficacy of salt‐splitting perilesional skin biopsies that had been previously submitted and frozen for routine direct immunofluorescent studies. The biopsies were thawed, salt‐split, and processed for direct immunofluorescence. Three epidermolysis bullosa acquisita biopsies and seven bullous pemphigoid biopsies examined demonstrated IgG staining at sites consistent with their respective diagnoses. The IgG appeared in the dermal side of the split biopsies in epidermolysis bullosa acquisita and predominantly, or exclusively, in the epidermal side in bullous pemphigoid. Thus the direct immunofluorescent study of previously frozen and subsequently salt‐split skin biopsies may be used for the differential diagnosis of bullous pemphigoid from epidermolysis bullosa acquisita. In most cases, it may eliminate the need for a repeat biopsy.
PEMPHIGUS VULGARIS FOLLOWING A CUTANEOUS THERMAL BURN
Authors: HOGAN PETER
Published: May 2007

Pemphigus vulgaris developed in a 59‐year‐old man following a cutaneous thermal burn. This is an example of induced pemphigus and should be included with the small number of cases where this sequence has been reported.
CUTANEOUS ALTERATIONS IN PATIENTS WITH CHRONIC RENAL FAILURE
Authors: PICÓ MARÍA R. , LUGO‐SOMOLINOS AÍDA , SÁNCHEZ JORGE L. , BURGOS‐CALDFRÓN RAFAEL
Published: May 2007

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One‐hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half‐and‐half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.
CURATIVE EFFECT OF DEXAMETHASONE‐CYCLOPHOSPHAMIDE PULSE THERAPY FOR THE TREATMENT OF PEMPHIGUS VULGARIS
Authors: PASRICHA J.S. , DAS SIDDHARTHA S.
Published: May 2007

In 1982, five patients having pemphigus vulgaris, four men and one woman, ranging in age between 16 and 48 years, were treated with an arbitrary regimen designed by us. The regimen consisted of giving 100 mg dexamethasone in 500 mL of 5% glucose by a slow intravenous infusion on three consecutive days, along with 500 mg cyclophosphamide on one day only. Such dexamethasone‐cyclophosphamide pulses (DCP) were meant to be given once a month, but most patients were not regular in this treatment. In between these pulses the patients received only 50 mg cyclophosphamide orally per day. Oral corticosteroids were given only when necessary. After having received a total of 14 to 48 DCPS, further treatment for pemphigus was withdrawn. All the patients are in continuous clinical remission for the last 4 to 9 years and without any treatment for 2 to 7 years. Further studies on more pemphigus patients have yielded similar results suggesting that it may be possible to cure pemphigus.
CUTANEOUS LUPUS ERYTHEMATOSUS: DIRECT IMMUNOFLUORESCENCE AND EPIDERMAL BASAL MEMBRANE STUDY
Authors: SUGAI SOLEDAD A. , GERBASE ANDREA B. , CERNEA SELMA S. , SOTTO MIRIAN N. , OLIVEIRA ZILDA N.P. , VILELA MARIA A.C. , RIVITTI EVANDRO A. , MIYAUCHI LUCY M. , SAMPAIO SEBASTIÃO A.P.
Published: May 2007

Biopsy specimens of cutaneous discoid lesions of 71 patients with cutaneous lupus erythematosus (CLE) were studied. The material was examined by direct immunofluorescence (DIF) to establish positivity and morphologic patterns of immunoglobulins and complement deposits in the basement membrane zone (BMZ). A correlation between DIF results and thickening of the epidermis basement membrane (BM) stained by periodic acid‐Schiff (PAS), obtained from 31 matched biopsy specimens, also is presented. Direct immunofluorescence had positive results in 66.20% of the 71 examinations and 70.97% of the matched examinations, whereas PAS showed BM thickening in 100% of the specimens. This observation stresses the importance of such histopathologic findings in the diagnosis of discoid lesions in CLE. There was no correlation between DIF patterns and PAS‐stained BMZ thickening. These findings merit additional study. In conclusion, an accordance between PAS‐stained BM thickening and immunoglobulin deposits has occurred in 70.97% of cases. This phenomenon does not depend on the presence of immunocomplexes, for it occurs even in cases in which immunocomplex deposits were not detected.
HEPATOCELLULAR CARCINOMA INVASIVE TO CHEST WALL
Authors: KNIGHT TIMOTHY E. , WOO A. STEPHEN , BLAISDELL JODI MATSUURA
Published: May 2007

An 88‐year‐old white man developed hepatocellular carcinoma forming a large subcutaneous mass by direct invasion of the posterior chest wall. Forty‐seven cases of cutaneous metastases from primary liver cancer have been reported. These cutaneous metastases showed protean morphologic features with the face and scalp being the most common sites of involvement. The metastatic lesions may be the presenting sign of the cancer. Average survival, after development of a skin metastasis, was 5 months. Skin metastases from primary liver cancer are being reported more frequently. This is due, in part, to more prolonged survival of liver cancer patients, which allows development of skin metastases, and also due to increased awareness by the clinician.
PROFILE OF ALOPECIA AREATA: A QUESTIONNAIRE ANALYSIS OF PATIENT AND FAMILY
Authors: SHELLOW WILLIAM V.R. , EDWARDS JOEL E. , KOO JOHN Y.M.
Published: May 2007

Eight hundred patients with alopecia areata (AA) responded to a detailed questionnaire that was compiled, distributed, and analyzed by Help Alopecia International Research, Inc. (hair). Among those responding, 28% were men and 72% were women. Fifty percent had localized alopecia, 30% had alopecia totalis, and 20% had alopecia universalis. Forty‐eight percent developed their initial onset before the age of 20. A very strong family history of 42% was found. There were 333 additional family members with AA. Many patients and relatives had concurrent atopic diseases (seasonal rhinitis, bronchial asthma, and atopic dermatitis). Associated autoimmune diseases including vitiligo, thyroid disease, and collagen vascular disease in patients and relatives appeared consistent with previous reports. Insulin dependent diabetes mellitus (IDDM) was not increased in patients but greatly increased in relatives. Additional analysis suggests a genetic association between the two diseases where expression of AA may prevent the development of IDDM.
PREVALENCE OF DYSPLASTIC NEVI IN HEALTHY YOUNG MEN
Authors: PETER RALF U. , WORRET WOLF I. , NICKOLAY‐KIESTHARDT JUTTA
Published: May 2007

Young white men (1176 men, mean age 20 years, age range from 18 to 26 years) were examined for dysplastic nevi. In 78 patients (6.63%), 107 clinically dysplastic nevi were observed, demonstrating all three NIH criteria (diameter >5mm, irregularities of border, irregularities of color) suggestive for clinically dysplastic nevi. Of these, 71 nevi in 52 patients were excised and examined histologically, 46 nevi in 26 patients were not excised due to lack of patients’consent. Fifty‐two of 78 (66.6%) patients with clinically dysplastic nevi agreed to excision. In these, seven nevi (13.5% of patients or 9.86% of all nevi excised) were confirmed by histology. According to these data, three additional patients with dysplastic nevi would have been expected among the 26 patients who refused surgery. Referring to the entire study group, the prevalence of dysplastic nevi in young white men is expected to be 0.85%.
DYSPLASTIC NEVI, CUTANEOUS MELANOMA, AND GYNECOLOGIC DISORDERS
Authors: FRISCH ROSE E. , WYSHAK GRACE , ALBERT LEE S. , SOBER ARTHUR J.
Published: May 2007

We compared the frequency of reproductive system diseases and disorders among 206 female patients with dysplastic nevi (DN), and/or melanoma, in comparison with random samples of women of comparable age without melanoma. The highest odds ratio (OR) for these age‐related diseases and reproductive disorders occurs among the youngest age group of the patients with DN alone (mean age 35.1 ± 1.2 yr): 44.2% of the DN subjects had one or more reproductive disorders compared with 19.8% of the random sample (OR 3.2, 95% CL (1.6, 6.5), P < 0.001). The patients with melanoma and DN (mean age 41.5 ± 1.4 yr) also had a significantly greater percentage of subjects with one or more reproductive disorders, though less so than the DN subjects: 49.4% compared to 33.7% (OR 1.9, 95% CL (1.1, 3.3), P = 0.02).
LACK OF PREDICTIVE FACTORS IN LATE RECURRENCE OF STAGE I MELANOMA
Authors: TAHERY DAN P. , MOY RONALD L.
Published: May 2007

Through the UCLA tumor registry, patients treated for late‐relapse malignant melanoma (after a 10–year disease‐free interval) were identified and studied retrospectively. The patients were studied in regards to age, sex, primary site of the lesion, the disease‐free interval, elective lymph node dissection, mode of recurrence and survival time following relapse. The histologic characteristics studied included the maximal tumor thickness, Clark's levels, rate of mitoses, and presence of ulceration. Based on the 0.84% incidence of late‐relapse, the recommendation for annual life‐time follow‐up examinations for all patients with malignant melanoma is supported.
HUMAN TEST MODELS FOR BIOEQUIVALENCE OF TOPICAL CORTICOSTEROIDS: A REVIEW
Authors: OLSEN ELISE A
Published: May 2007

It would be useful to have a safe, reliable, reproducible, and inexpensive human test model to determine the potency of topical corticosteroids and the bioequivalence of generic agents. Existing human test systems include erythema or inflammation induced by irritants or other stimuli, experimentally induced cutaneous disease‐like states, and bioassays in patients with psoriasis. None of these systems is currently reliable enough to warrant general use. Among the shortcomings of existing test systems are the difficulty of producing a uniform, steroid‐responsive test condition, the requirement to use occlusion in several of the systems, and the lack of agreement among the results of different tests. Despite these shortcomings, some of the tests may prove useful in comparing innovator and generic topical corticosteroids and in screening the potency of new agents.
TOXIC EPIDERMAL NECROLYSIS
Authors: PARSONS JEROME M.
Published: May 2007

Toxic epidermal necrolysis is a severe mucocutaneous reaction pattern characterized by fever, systemic toxicity, tenderness, erythema, and widespread exfoliation. Lyell1 of Glasgow, Scotland, and Lang and Walker2 of Cape Town, South Africa, independently described this syndrome in 1956. Lyell was responsible for coining the term “toxic epidermal necrolysis.” Toxic referred to a presumed circulating toxin responsible for producing both the prodrome and the eruption. Epidermal referred to the presence of significant epidermal damage with comparatively slight dermal reaction. Necrolysis was a neologism combining the pathologic finding of necrosis with the clinical finding of epidermolysis.1,3,4
LEPROMATOUS LEPROSY TREATED WITH RECOMBINANT INTERFERON GAMMA: CUTANEOUS HISTOLOGIC CHANGES
Authors: BOTTASSO OSCAR , BESUSCHIO SANTIAGO , MERLIN VICTOR , MORINI JULIO C. , BERNABO JORGE , FALCOFF REBECA , FALCOFF ERNESTO
Published: May 2007

We report on the histologic changes occurring in single cutaneous lesions, from six active lepromatous patients, 1 week following the administration of three daily intradermal injections, 35 jag each, of recombinant interferon gamma (nFN‐γ). Except for a strong induration at the injection site, nFN‐γ produced no adverse systemic reactions and was able to promote a remarkable influx of T‐lymphocytes, mononuclear phagocytes with large nuclei, nonvacuolated cytoplasm, and reduced lysozyme reactivity. Furthermore, despite no clear‐cut reduction of mycobacterial dermal burden, bacilli showed a clear increase in the granular appearance. Present findings provide a basis for further elucidation of nFN‐γ as an additional tool for leprosy treatment.
PARANEOPLASTIC PEMPHIGOID‐PEMPHIGUS? SUBEPIDERMAL BULLOUS DISEASE WITH PEMPHIGUS‐LIKE DIRECT IMMUNOFLUORESCENCE
Authors: RONGIOLETTI FRANCO , TRUCHETET FRANÇOIS , REBORA ALFREDO
Published: May 2007

Background. Paraneoplastic pemphigus is a recently described variant of pemphigus, in which classic immunologic features of pemphigus are associated with subepidermal erythema multiforme‐like bullae.

Case Reports. Two patients with underlying malignant neoplasm had a bullous disease, which had clinical and histologic features suggestive of bullous pemphigoid while direct immunofluorescence revealed intercellular deposits of IgG and C3 throughout the malpighian layer of epidermis, a pattern usually diagnostic for pemphigus. Indirect immunofluorescence studies were negative. One mg/kg/day prednisone was enough to cure the eruption in a couple of weeks without any recurrence.

Conclusions. The disease differs from the recently reported paraneoplastic pemphigus and from other bullous diseases associating circulating pemphigus‐like antibodies with clinical, histologic, and often even immunologic features of bullous pemphigoid.
PITYRIASIS ALBA: A HISTOLOGIC STUDY
Authors: VARGAS‐OCAMPO FRANCISCO
Published: May 2007

Background. Pityriasis alba is a common dermatitis, but only a few histologic studies have been reported and most of these maintain that its microscopic features are those of a chronic nonspecific dermatitis.

Methods. A retrospective light microscopic study was performed on biopsy specimens taken from 39 patients with localized pityriasis alba on face, arms and forearms without signs of atopy. Thirty‐two patients were girls or women and seven were boys or men, with ages ranging from 7 to 37 years. The duration of illness varied from 1 month to 10 years. The clinical picture was characterized by three clinical stages: papular erythematous, papular hypochromic, and smooth hypochromic.

Results. The histologic study revealed features that were suggestive, though not pathognomonic, of the diagnosis. The most remarkable changes involved the pilary apparatus, which showed horny plugs, spongiotic edema, and atrophic sebaceous glands. There was also a disturbance of melanization secondary to epithelial damage. The tissue reaction was more conspicuous in the skin lesions with follicular papules.

Conclusions. A histopathologic diagnosis of pityriasis alba may be proposed when the following features are seen in a biopsy specimen taken from a skin lesion with follicular papules: (1) irregular pigmentation by melanin of the basal layer; (2) follicular plugging; (3) follicular spongiosis; and (4) atrophic sebaceous glands.
BOOK REVIEWS
Authors: BEERMAN HERMAN
Published: May 2007

Book reviews in this article:

Eczema. Ronald marks.
MICROCYSTIC ADNEXAL CARCINOMA: IN VITRO GROWTH CHARACTERISTICS AND EFFECT ON STROMAL COLLAGEN PRODUCTION
Authors: MOY RONALD L. , TAHERY DAN P. , HOWE KENNETH
Published: May 2007

Background. Microcystic adnexal carcinoma (mac) is a locally aggressive cutaneous neoplasm, which is characterized by follicular and sweat gland differentiation and a stroma of dense collagen.

Methods. mac cells were studied and characterized in vitro through phase microscopy and proliferation assays. Additionally, to delineate a possible role of soluble mediators in bringing about the dense stromal collagen seen in association with these tumors, the effect of conditioned media derived from the tumor cells on the level of collagen production by normal fibroblasts was examined.

Results. A significant morphologic difference between the mac cells and normal keratinocytes was not noted. Proliferation assays demonstrated a significantly slower rate of growth of the MAC cells in comparison to controls. Media conditioned by mac cells did not induce an increase in collagen synthesis by cultured fibroblasts, but rather, there appeared to be an inhibitory effect on the level of collagen synthesis.

Conclusions. The increased stromal collagen seen in mac histologically is not the result of growth factors or cytokines produced by the mac cells.
SPITZ NEVUS
Authors: KO CHUNG B. , WALTON SHERNAZ , WYATT EDWARD H. , BURY HENRY P.
Published: May 2007

Background. The Spitz nevus is a rare form of benign nevus, which may be confused with malignant melanoma.

Methods. We reviewed the clinical and histologic features of 29 cases of Spitz nevus, of which 20 were dealt with by our department of dermatology at the Hull Royal Infirmary between 1969 and 1990. The other nine cases were from the records of our pathology department dated between 1979 and 1991, of which seven of the lesions were excised by the surgeons and two by the general practitioners.

Results. In all the cases, the final diagnosis was established histologically. In three cases, there were difficulties histologically in excluding the diagnosis of malignant melanoma. All the lesions were solitary, and none of the lesions recurred following excision despite the possibility of incomplete excision in some cases.

Conclusions. We found the size of the lesion and the age of the patient important factors to consider in the diagnosis of Spitz nevus. The small number of cases we encountered over a period of 22 years in a department that serves a population of around 500,000 emphasises the rarity of the condition.
Linear and Whorled Nevoid Hypermelanosis
Authors: GOIHMAN‐YAHR MAURICIO , Kanwar A.J. , Dhar Sandipan , Ghosh Srabani , Kaur Surrinder
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Contributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
CLINICAL, BIOCHEMICAL AND MORPHOLOGIC FEATURES OF ACNE KELOIDALIS IN A BLACK POPULATION
Authors: GEORGE ADEKUNLE O. , AKANJI ABAYOMI O. , NDUKA EBERE U. , OLASODE JOSIAH B. , ODUSAN OLATUNJI
Published: May 2007

Background. Acne keloidalis (AK) is an important cause of morbidity In Nigeria and accounts for 1.3% of patients with skin conditions in a Nigerian dermatology clinic. Treatment is usually unsatisfactory because the etiopathogenesis is unclear.

Methods. A prospective clinico‐pathological study was carried out to identify predisposing factors, viable treatment modalities, and prognostic indicators.

Results. The study suggested that AK is associated with the male gender seborrheic constitution, early reproductive years, and increased fasting blood testosterone concentration. Features that may predispose to the vastly predominant occipital location of the lesions include increased mast cell density and dilatation of dermal capillaries.

Management. The main aims are diagnosis of early papules and avoidance of physical and chemical traumatizing agents. Retinoic acid analogs and antiandrogens may be helpful.

Conclusions. The widespread use of irritating physical and chemical traditional treatment remedies and delay in seeking medical attention—AK is typically asymptomatic—contribute to the relatively advanced nature of the disease at the time of presentation to the specialist.
NAIL AND SKIN HYPERPIGMENTATION ASSOCIATED WITH HYDROXYUREA THERAPY FOR POLYCYTHEMIA VERA
Authors: GROPPER CHARLES A. , DON PHILIP C. , SADJADI MANIJEH M.
Published: May 2007

A 63‐year‐old black woman presented with a complaint of nail and skin darkening for 5 months. Past medical history included polycythemia vera, hypertension, angina, and hi‐atal hernia. For several years the patient's medications had included isosorbide dinitrate, iron sulfate, propranolol, and sucralfate. The only recent new medication was hydrox‐yurea (500 mg to 1.5 g daily), which the patient had started for polycythemia vera 8 months prior to presentation. She now complained of asymptomatic hyperpigmentation of the finger and toenails, which had begun proximally and extended distally over time. She also noted increased pig‐mentation of her face, neck, arms, and buccal mucosa.

Physical examination revealed pigmentary changes in all the nails. Dyschromia varied from blue‐grey to brown‐black. Three different patterns of pigmentation were noted: trans‐verse and longitudinal bands that alternated with areas of lighter discoloration (Fig. 1) and diffuse hyperpigmentation (Fig. 2). The nail plates and the proximal and lateral nail folds had a normal morphology aside from the color changes. Macular brown pigmentation was present on the patient's face, neck, lower arms, palms, and buccal mucosa (Fig. 3). The patient noted that the pigmentation in all of these areas began after the hydroxyurea was started; those areas of skin and mucosa had previously been normal. Lab‐oratory results were significant for a mild anemia, hemoglo‐bin 11.4 g/dL, and hematocrit 35.2%. The patient refused nail or skin biopsy. The patient also noted increased “hardness” of the nails, which made it difficult for her to cut them.

Microscopic observation of sections prepared from nail clippings revealed a keratinjzed layer with scattered finely granular brownish pigment. Fontana Masson and Schroml's stains for melanin were positive, and Pearl's stain for iron was negative.
BLACK DOT TINEA CAPITIS IN A MAN
Authors: HAYES ANNE G. , BUNTIN DENISE M. , WIBLE LINDA O.
Published: May 2007

A 52‐year‐old healthy man presented with scalp alopecia, which had progressed over a period of several weeks. The patient stated that he was unemployed and lived at home alone without pets. He recalled that a neighbor who routine‐ly cut his hair in her home also cut the hair of many local children, some of whom had recently had scalp ringworm.

Physical examination revealed a patchy noncicatricial alopecia with numerous short hair stubs (i.e., black dots) in the frontal, parietal, and temporal areas of the scalp (Fig. 1). There was minimal scaling, but no pustulation, kerion forma‐tion, or adenopathy. Glabrous skin and nails were normal. Potassium hydroxide (KOH) preparation of a black dot hair showed multiple arthroconidia within the hair shaft, typical of endothrix hair invasion. Fungal culture on Sabouraud's media later revealed growth consistent with Trichophyton tonsurans. In addition, a culture mount showed abundant microconidia of variable size and shape with occasional macroconidia and chlamydospores, characteristic of T. ton‐surans (Figs. 2 and 3).

The patient was subsequently treated with 500 mg of griseofulvin par day for 2 months. At the completion of therapy, there was healthy regrowth of hair.
DERMATOPHYTOSIS OF CHILDREN IN KUWAIT: A PROSPECTIVE SURVEY
Authors: AL‐FOUZAN ABDULWAHAB S. , NANDA ARTI , KUBEC KAREL
Published: May 2007

Background. Tinea capitis in children is widely reported, whereas there have been only isolated reports on involvement of sites other than the scalp. The purpose of this study was to examine the epidemiological features and treatment responses of dermatophytosis of children in Kuwait.

Methods. Epidemiological features and the treatment responses of 202 consecutive children with dermatophytosis were studied.

Results. The 202 children constituted 44% of the total dermatophytic infections seen during a period of 1 year. Tinea capitis was the most commonly encountered infection (78%), followed by tinea corporis, tinea faciei, tinea cruris and manus, respectively. Microsporum canis was the most prevalent species (96%) in this region. A history of pets at home could be elicited in 52% of the cases. A familial occurrence of similar infections was seen in 56% of the patients. In patients with tinea capitis, addition of topical clotrimazole or ketoconazole to oral griseofulvin produced better therapeutic results compared to griseofulvin alone or in combination with selenium sulfide shampoo.

Conclusions. Tinea capitis is the most common dermatophytic infection in children. Thirty percent of the children may have dermatophytosis at sites other than the scalp. A combination of topical clotrimazole or ketoconazole with oral griseofulvin is superior to griseofulvin alone or in combination with selenium sulfide shampoo in the treatment of tinea capitis.
EPIDERMODYSPLASIA VERRUCIEORMIS IN AFRICANS
Authors: JACYK WITOLD K. , VILLIERS E.M. DE
Published: May 2007

Background. Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder characterised by persistent, refractory infection with human papillomaviruses (HPV). Although EV does not seem to have racial or geographic preference, there is a scarcity of reports on its occurrence in Africans.

Methods. Twenty Africans with EV were studied, and the literature on this condition in Africans was reviewed. Virologic studies were performed on 10 patients.

Results. Three types of lesions were observed: flat warts, pityriasis versicolor‐like macules, and seborrheic keratosis‐like changes. Malignant transformation occurred in only one patient, HPV–3 was isolated only from flat warts, HPV–5 and HPV–17 were isolated only from pv‐like lesions, whereas an Hpv–5‐related type was found in all three types of changes, HPV–5‐related type revealed DNA that was related but not identical to any of the viruses in the HPV–5 group. This particular type was isolated from all five South African patients with EV in whom virologic studies were performed.

Conclusions. The benign nature of EV in dark‐skinned Africans has been confirmed. Four HPV types have been isolated, of which HPV‐related type was found in all South African patients with EV and in all types of skin changes, regardless of their morphology. African patients with EV frequently present seborrheic keratosis‐like changes.
CREEPING DISEASE DUE TO LARVA OE SPIRUROID NEMATODA
Authors: OKAZAKI AIKO , IDA TAKASHI , MURAMATSU TSUTOMU , SHIRAI TOSHIHIKO , NISHIYAMA TOSHIMASA , ARAKI TSUNEZI
Published: May 2007

A 31‐year‐old man visited our hospital in May 1991, com‐plaining of an abdominal serpiginous eruption with pruritus (Fig. 1). He had eaten raw “firefly squid” (Watasenia scintil‐lans) 2 weeks before the onset of the disease, and the erup‐tion had grown to about 30 cm in length in 2 weeks. The laboratory findings included a leukocyte count of 6100/mm3 with 10% eosinophils and a serum IgE level of 134 U/mL (normal < 303 U/mL). The front of the eruption was excised. Seven parasitic sections were observed in the dermis (Fig. 2). The diameter of the sections were about 0.08 mm. The mus‐cle layer was of the polymyarian coelomyarian type. In the body cavity of the parasite, there was a glandular part of the esophagus composed of vacuolated cells with many nuclei and a narrow esophageal lumen. Well‐developed lateral nerve chords were also visible in these sections. Two of the parasitic sections showed intestine composed of cuboidal cells with a round lumen and lateral nerve chords of both sides touching each other in the center of body cavity.

These findings indicate the characteristics of larval Spiruroidea. The morphologic appearance of the sectioned worm closely resembled the type × larva of the superfamily Spiruroidea of Hasegawa.1
TRICHOMONAL ABSCESS OF THE MEDIAN RAPHE OF THE PENIS
Authors: PAVITHRAN K.
Published: May 2007

A 32‐year‐old man presented with a painful swelling on the skin of the penis of 3 weeks' duration. He had frequent unprotected, sexual intercourse with a woman co‐worker, the last contact being 2 weeks before the development of the penile lesion. He denied acquiring any sexually transmitted disease (STD) in the past. There was no previous history of urethral discharge or dysuria and he had not received any antibiotic therapy recently.

Examination revealed a pea‐sized, hour‐glass‐shaped, slightly erythematous, warm, tender, and fluctuant abscess on the distal part of the median raphe of the penis (Fig. 1).

There was a small opening on the distal end of the abscess through which mucopurulent discharge could be readily expressed. The abscess was not attached to the underlying structures. There was no lymphadenopathy or urethral discharge. The prostate, seminal vesicles and Tyson's glands were normal. The rest of the physical examination was normal.

Results of routine laboratory tests on blood and urine were normal. Gram‐stained smears and culture of pus from the abscess did not reveal gonococci or other bacteria. Wet preparations of the pus revealed numerous trichomonads which were identified by their characteristic movement and presence of undulating membrane and flagellae. A venereal disease research laboratory (VDRL) slide test of blood was nonreactive. Examination of urethral scrapings and of the prostatic fluid did not show gonococci or Trichomonas vaginalis.

The patient was diagnosed as having a trichomonal abscess of the median raphe and was treated with oral metronidazole, 200 mg thrice daily for 7 days, and by repeated aspiration of pus from the abscess through the opening at its distal end. The discharge disappeared on the fourth day and the swelling regressed completely by the tenth day, but the distal opening where the swelling was persisted, through which a thin probe could be passed for about 15 mm into the median raphe. To prevent reinfection, the affected area containing the opening and the tract in the median raphe were excised. Histopathological study of the excised tissue revealed a canal lined by squamous epithelium and surrounded by inflammatory cells. The patient made an uneventful recovery and when seen 1 month after the surgery, the lesion had completely subsided. Investigation of his sex partner, who was asymptomatic, disclosed the presence of Trichomonas vaginalis in her vagina. She was also treated with oral metronidazole, 200 mg thrice daily for 7 days.
UNUSUAL MANIFESTATION OF DEMODICIDOSIS IN A CHILD
Authors: WON JIN HYOUNG , AHN SUNG K. , LEE SEUNG HUN
Published: May 2007

A 14‐month‐old male infant was brought to the Department of Dermatology, Yonsei University Wonju College of Medicine, with a scaly pruritic skin rash on the glabella area that had been present for 3 weeks. Physical examination showed a coin‐sized erythematous scaly patch on the glabella (Fig. 1). There had been no response to the application of topical corticosteroid (Vaspit). The medical history and the results of physical examination were otherwise unremarkable. The diagnosis at the time was atopic dermatitis. A fungal study to rule out tinea faciei showed no fungal spores or hyphae, but many scattered Demodex mites (D. foiiicuiorum) were seen in a 10% potassium hydroxide preparation of skin scrapings (Fig. 2). The patient's lesion cleared with the appli‐cation of crotamiton cream on three consecutive nights.
MAURICIO GOIHMAN‐YAHR, M.D., PH.D., EDITOR
Authors: Vignale Raul , Espasandin José , Deneo Hugo , Gonzalez Victoria
Published: May 2007

The Gorrespondence Section serves as a forum for opinion exchange about subjects of general in‐terest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readership might have. Gontributions are welcome and should conform to the usual format for correspondence. Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
EFFECTIVENESS OF A DAPSONE COMPLIANCE PROGRAM IN LEPROSY
Authors: PISCITELLI STEPHEN C. , DANZIGER LARRY H. , HILL CARLOTTA , SLAJCHERT ARLENE A. , WEST DENNIS P. , FISCHER JAMES H.
Published: May 2007

Background. Long‐term effectiveness of a dapsone compliance program was assessed in patients with leprosy.

Methods. The monitoring program consists of urine dap‐sone/creatinine ratio determination at each visit with subsequent patient feedback and education. Eighty‐eight patients receiving dapsone and seen in a leprosy clinic from 1985–1990 were included.

Results. The proportion of patients compliant with dapsone during a given year ranged from 70.0% (1987) to 94.4% (1989). Overall compliance for the 6‐year period was 81.6%. This level of compliance was significantly different (P < 0.05) than the baseline compliance in the leprosy clinic of 46.7%.

Conclusions. Compliance monitoring, combined with active patient involvement, was effective in sustaining high compliance over a 6‐year period.
FRICTION AMYLOIDOSIS: A VARIANT OR AN ETIOLOGIC FACTOR IN AMYLOIDOSIS CUTIS?
Authors: SUMITRA S. , YESUDIAN PATRICK
Published: May 2007

Background. During a study of cutaneous annyloidosis, it was noticed that a significant number of patients gave a history of friction of some kind or other, which when analyzed could be clearly related to their cutaneous pigmentation. A common feature in all these patients was the relative lack of itching when compared with others who did not give a history of friction.

Methods. We studied the role of friction in 65 patients with amyloidosis cutis and found that in 20 patients, frictional factors could be attributed to their cutaneous condition, and these latter were taken up for further study.

Results. Histologic examination of the affected area of skin showed amyloid deposits, which could be detected by light microscopy with hematoxylin and eosin stained sections and confirmed by special stains.

Conclusions. The role of friction in the causation of lesions that resemble amyloidosis cutis morphologically is discussed.
EFFECT OF PROPYLTHIOURACIL AND METHIMAZOLE ON SERUM LEVELS OF INTERLEUKIN‐2 RECEPTORS IN PATIENTS WITH PSORIASIS
Authors: ELIAS ALAN N. , GOODMAN MATTHEW M. , ROHAN MARY‐KATE
Published: May 2007

Background. We have previously reported clinical improvement in patients with psoriasis who received orally administered antithyroid thioureylenes, propylthiouracil (PTU), and methimazole (MMI). The antithyroid drugs are believed to exert immunomodulatory effects based on the results of studies in patients with Graves’ disease, the only disease in which they are clinically used. The potential of these drugs to mediate clinical improvement in patients with psoriasis by reducing expression of the interleukin‐2 receptor (IL2R), a marker of early T and B cell activation, was addressed in the present study.

Methods. Baseline serum concentrations of IL2R were measured by an enzyme‐linked immunosorbant assay (EUSA) in 15 patients with stable plaque psoriasis and in the same patients after 8 weeks of oral therapy with either 300 mg of propylthiouracil (n=7) or 40 mg methimazole (n=8) given daily. Baseline values were compared with normal controls.

Results. Serum IL2R concentrations in the psoriatic patients were significantly higher than in normal controls. After treatment with PTU or MMI, IL2R serum concentrations were not significantly reduced either in the group as a whole or separately in the PTU and MMI treated patients.

Conclusions. Since elevated serum concentrations of IL2R often reflect T and B cell activation, and elevated IL2R serum levels are seen in several autoimmune diseases, it is speculated that the beneficial effect of thioureylenes in patients with psoriasis is mediated by some mechanism(s) other than reduction of IL2R expression in activated lymphocytes.