bluuebunny/crossref_metadata_2025 huggingface dataset:
Subantimicrobial dose doxycycline as an adjunct to scaling and root planing: post‐treatment effects
Authors: Caton J. G. , Ciancio S. G. , Blieden T. M. , Bradshaw M. , Crout R. J. , Hefti A. F. , Massaro J. M. , Polson A. M. , Thomas J. , Walker C.
Published: March 2003

Background/objective: Subantimicrobial dose doxycycline (SDD 20 mg bid) plus scaling and root planing (SRP) significantly improved clinical attachment level (CAL) and reduced probing depth (PD) compared with placebo plus SRP in a double‐blind, placebo‐controlled, multicenter study of patients with adult periodontitis (AP). In a study conducted as a follow‐up, the post‐treatment effects of SDD were assessed in patients who completed the SRP study.

Methods: The SRP study was a 9‐month, active‐treatment study and the follow‐up was a 3‐month, no‐treatment study. In the SRP study, tooth sites in qualifying quadrants were scaled and root planed and patients were randomized to receive twice daily SDD 20 mg or placebo. In the follow‐up, patients received no study drug; investigators and patients remained blinded to the previous treatment group assignments. Efficacy measures included the change in CAL and PD from baseline values determined at the start of the SRP study in tooth sites stratified by baseline PD (i.e., 0–3 mm, 4–6 mm, ≥7 mm). Safety was evaluated using adverse event data and the results of clinical laboratory tests, oral pathology examinations, and microbiological assessments.

Results: Within each disease stratum, the incremental improvements in PD and CAL demonstrated in the SDD group over 9 months of active treatment were maintained through 3 additional months of no treatment. Treatment cessation did not result in an accelerated regression of periodontal health. No differences in the incidence of adverse events (including those related to infection) or laboratory or microbiological parameters were noted between the SDD group and the placebo group.

Conclusions: The administration of SDD 20 mg bid for a period of up to 9 months is not associated with rebound effects or delayed or negative after‐effects for a 3‐month period after cessation of therapy.
Non‐surgical periodontal therapy with adjunctive topical doxycycline: a double‐blind randomized controlled multicenter study
Authors: Eickholz Peter , Kim Ti‐Sun , Bürklin Thomas , Schacher Beate , Renggli Heinz H. , Schaecken Matthijs T. , Holle Rolf , Kübler Alexander , Ratka‐Krüger Petra
Published: March 2003

Aim: Evaluation of the clinical effect of topical application of doxycycline adjunctive to non‐surgical periodontal therapy.

Methods: A total of 111 patients suffering from untreated or recurrent moderate to severe periodontitis at 3 different centers (Heidelberg, Frankfurt, Nijmegen) were treated in this double‐blind split‐mouth study. In each patient, 3 different treatment modalities were assigned randomly to 3 test teeth: scaling and root planing alone (SRP), SRP with subgingival vehicle control (VEH), and SRP with subgingival application of a newly developed biodegradable 15% doxycycline gel (DOXI). At baseline, clinical parameters were measured at all single rooted teeth using a reference splint: PlI, PPD, relative attachment level (RAL‐V), GI. 3 strata were generated according to baseline PPD: (i) 5–6 mm, (ii) 7–8 mm, (iii) 9 mm. Not more than 50% active smokers were allowed to each stratum. 3 and 6 months after therapy re‐examination was performed by examiners blinded to baseline data and test sites. The statistical comparison of RAL‐V gain and PPD reduction between the treatments was based on a repeated measures ANOVA with correction according to Huynh & Feldt. The comparison of SRP versus DOXI was considered as the main study question.

Results: 110 patients finished the 3 months and 108 the 6 months examination. The study did not show adverse effects of VEH or DOXI except for one singular inflammation that occurred 2 months after application of the doxycycline gel. DOXI provided statistically significantly more favorable PPD reduction (SRP: −2.4±1.4 mm, VEH: −2.7±1.6 mm, DOXI: −3.1±1.2 mm; SRP versus DOXI p=0.0001, VEH versus DOXI p=0.0066) and RAL‐V gain (SRP: 1.6±1.9 mm, VEH: 1.6±2.2 mm, DOXI: 2.0±1.7 mm; SRP versus DOXI p=0.027, VEH versus DOXI p=0.038) than SRP and VEH after 6 months.

Conclusions: Adjunctive topical subgingival application of a biodegradable 15% doxycycline gel was safe and provided more favorable RAL‐V gain and PPD reduction than SRP alone and VEH. Thus, by use of topical doxycycline the threshold for surgical periodontal therapy might be moved toward deeper pockets.
Enamel matrix proteins in the regenerative therapy of deep intrabony defects
Authors: Tonetti Maurizio S. , Lang Niklaus P. , Cortellini Pierpaolo , Suvan Jean E. , Adriaens Patrick , Dubravec Dominik , Fonzar Alberto , Fourmousis Ioannis , Mayfield Lisa , Rossi Roberto , Silvestri Maurizio , Tiedemann Christine , Topoll Heinz , Vangsted Tine , Wallkamm Beat
Published: March 2003

Aim: This prospective multicentre randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of enamel matrix proteins (EMD).

Material and methods: 172 patients with advanced chronic periodontitis were recruited in 12 centers in 7 countries. All patients had at least one intrabony defect of 3mm. Heavy smokers (20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, roots were conditioned for 2 min with a gel containing 24% EDTA. EMD was applied in the test subjects, and omitted in the controls. Postsurgically, a strict plaque control protocol was followed. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full‐mouth plaque scores and full‐mouth bleeding scores were assessed. A total of 166 patients were available for the 1‐year follow‐up.

Results: At baseline, 86 test and 86 control patients presented with similar subject and defect characteristics. On average, the test defects gained 3.1±1.5 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5±1.5 mm. Pocket reduction was also significantly higher in the test group (3.9±1.7 mm) when compared to the controls (3.3±1.7 mm). A multivariate analysis indicated that the treatment, the clinical centers, cigarette smoking, baseline PPD, and defect corticalisation significantly influenced CAL gains. A frequency distribution analysis of the studied outcomes indicated that EMD increased the predictability of clinically significant results (CAL gains 4 mm) and decreased the probability of obtaining negligible or no gains in CAL (CAL gains <2 mm).

Conclusions: The results of this trial indicated that regenerative periodontal surgery with EMD offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.
The effect of a fibrin glue on the integration of Bio‐Oss® with bone tissue
Authors: Carmagnola Daniela , Berglundh Tord , Lindhe Jan
Published: March 2003

Background: Bio‐Oss® is a deproteinized bovine mineral used in bone augmentation procedures. The particles are often mixed with a protein product (Tisseel®) to form a mouldable graft material.

Aim: The aim of the present experiment was to study the healing of self‐contained bone defects after the placement of Bio‐Oss® particles alone or mixed with Tisseel® in cylindrical defects in the edentulous mandibular ridge of dogs.

Material and methods: In 4 labrador dogs, the 2nd, 3rd and 4th mandibular premolars were extracted bilaterally. 3 months later, 3 cylindrical bone defects, 4 mm in diameter and 8 mm in depth, were produced in the right side of the mandible. Following a crestal incision, full thickness flaps were raised and the bone defects were prepared with a trephine drill. The defects were filled with Bio‐Oss® (Geistlich Biomaterials, Wolhuser, Switzerland) particles alone or mixed with Tisseel® (Immuno AG, Vienna, Austria), or left “untreated”. A collagen membrane (Bio‐Gide®, Geistlich Biomaterials, Wolhuser, Switzerland) was placed to cover all defects and the flaps were sutured. 2 months later, the defect preparation and grafting procedures were repeated in the left side of the mandible. After another month, the animals were sacrificed and biopsies obtained from the defect sites.

Results: Bio‐Oss®‐treated defects revealed a higher percentage of contact between graft particles and bone tissue than defects treated with Bio‐Oss®+ Tisseel® (15% and 30% at 1 and 3 months versus 0.4% and 8%, respectively). Further, the volume of connective tissue in the Bio‐Oss® treated defects decreased from the 1 to the 3 month interval (from 44% to 30%). This soft tissue was replaced with newly formed bone. In the Bio‐Oss®+ Tisseel® treated defects, however, the proportion of connective tissue remained unchanged between 1 and 3 months.

Conclusion: The adjunct of Tisseel® may jeopardize the integration of Bio‐Oss® particles with bone tissue.
Assessment of periodontal conditions and systemic disease in older subjects
Authors: Persson R. E. , Hollender L. G. , Powell V. L. , MacEntee M. , Wyatt C. C L. , Kiyak H. A. , Persson G. R.
Published: March 2003

Background: Panoramic radiographs (PMX)s may provide information about systemic health conditions.

Aims: i) To study clinical periodontal conditions and collect self‐reported health status in a cohort of 1084 older subjects; ii) to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii) to study associations between study parameters.

Material and methods: PMXs from 1064 adults aged 60–75 (mean age 67.6, SD ± 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self‐reports. Signs of carotid calcification were identified from panoramic radiographs.

Results: The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self‐reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10–0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3–3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9–9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss.

Conclusions: PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self‐reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.
A longitudinal study of young Finnish adults' use of subsidized, private sector dental care, 1986–1997
Authors: Suominen‐Taipale Anna Liisa , Widström Eeva
Published: March 2003

Abstract – Objectives: Finns born after 1956 are now entitled to subsidized private sector dental care, or such persons could be enrolled in the Public Dental Service. Until 1986, eligibility was more restrictive. The purpose of this study was to investigate the use and costs of private dental care and effects of regularity of care on costs and treatment received among young Finnish adults during 1986–1997. Methods: All 1986, 1990 and 1994 recipients of reimbursement for dental care from the Social Insurance Institution were included in the study. Five separate age cohorts were compared. Using their civil registration numbers, individuals were tracked from their first contact with a private dentist in one of the years 1986, 1990 or 1994 until the year 1997. Results: While the total number of young adults who had received reimbursement for private dental care increased from about 53 000 (1986) to 200 000 (1994) due to extended eligibility, the number of users in the youngest group decreased from 53 000 to 23 000. Attending infrequently (1–2 times during the study period) was most common among the youngest adults and frequent attendance (annually) was most common among older adults. The annual mean cost was slightly lower among the frequent attenders in almost every cohort. Variation in the mean number of annual visits was directly correlated with costs. Frequent attenders most often received diagnostic and preventive measures while restorations and surgery were most common for the infrequent attenders. Conclusions: A substantial decline in the demand for private services among the 19–25‐year‐olds and stable demand among 26–34‐year‐olds was detected, indicating falling treatment needs or a preference for the Public Dental Service. All groups had a stable mean number of visits per year and almost constant costs. The mean number of dental visits per year remained steady in all cohorts indicating rigid treatment patterns.
The Common Risk Factor Approach: a rational basis for promoting oral health
Authors: Sheiham Aubrey , Watt Richard Geddie
Published: March 2003

Abstract – Conventional oral health education is not effective nor efficient. Many oral health programmes are developed and implemented in isolation from other health programmes. This often leads, at best to a duplication of effort, or worse, conflicting messages being delivered to the public. In addition, oral health programmes tend to concentrate on individual behaviour change and largely ignore the influence of socio‐political factors as the key determinants of health. Based upon the general principles of health promotion this paper presents a rationale for an alternative approach for oral health policy. The common risk factor approach addresses risk factors common to many chronic conditions within the context of the wider socio‐environmental milieu. Oral health is determined by diet, hygiene, smoking, alcohol use, stress and trauma. As these causes are common to a number of other chronic diseases, adopting a collaborative approach is more rational than one that is disease specific. The common risk factor approach can be implemented in a variety of ways. Food policy development and the Health Promoting Schools initiative are used as examples of effective ways of promoting oral health.
Salivary flow and oral complaints in adult dental patients
Authors: Bergdahl Maud
Published: March 2003

Abstract – Saliva plays an important role in maintaining oral health and functions. In the present study, unstimulated and stimulated whole salivary flow and various oral complaints were surveyed in 1427 individuals, 669 men (47%) and 758 women (53%). These individuals, aged 20 to 69 years and from different socio‐economic backgrounds, were recruited from 2000 randomly selected men and women in the register of the public dental health service in northern Sweden. The unstimulated salivary flow rate ranged from 0 to 2.07 mL/min (mean 0.33±SD 0.26) for men, and from 0 to 1.35 mL/min (mean 0.26±SD 0.21) for women. The stimulated salivary flow rate ranged from 0.17 to 7.3 mL/min (mean 2.50±SD 1.06) for men, and from 0 to 6.40 mL/min (mean 2.02±SD 0.93) for women. Women over 55 years of age had a reduced unstimulated salivary flow (P<0.05). Individuals with many teeth had a higher stimulated salivary flow than those with fewer teeth (P<0.001). Male smokers had a lower unstimulated salivary flow than male non‐smokers (P<0.05). Women with oral lesion complaints had a lower unstimulated salivary flow (P<0.05), and women with burning mouth had a lower stimulated salivary flow (P<0.01). Individuals with subjective oral dryness had reduced salivary flow, both unstimulated (men P<0.01, women P<0.001) and stimulated (P<0.001). Subjective oral dryness was associated with complaints of burning mouth (P<0.001), muscle pain (P<0.01), taste disturbances (P<0.01), and dry eyes (P<0.05). Individuals with subjective oral dryness had fewer teeth than individuals with no such complaints (P<0.001). Information regarding salivary flow rate in adults is important in understanding and evaluating the relationship between salivary flow and various types of oral complaints in patients.
A community trial of fluoridated powdered milk in Chile
Authors: Mariño Rodrigo , Villa Alberto , Guerrero Sonia
Published: March 2003

Abstract – Objective: To demonstrate the effectiveness of a dental caries prevention program on the primary dentition of Chilean rural children, using fluoridated powdered milk and milk derivatives. Methods: Fluoridated milk and milk‐cereal was given to about 1000 preschool children in Codegua, a rural community located in the 6th Region of Chile, using the standard National Complementary Feeding Program (PNAC). The daily fluoride dose from fluoridated powdered milk was estimated at 0.25 mg for infants (0–2 years old), 0.5 mg for children aged 2–3 years and 0.75 for children aged 3–6 years. Cross‐sectional samples of children aged 3–6 years were taken from Codegua (study community) from 1994 to 1999 and from La Punta (control community) from 1997 and 1999. Results: Significant reductions (72%) were observed in the dmfs indices in the 3–6‐year‐old groups in Codegua, when comparing 1999 with 1994 data. In 1999, children in the study community showed significantly lower dmfs than children in the control community (41%). The proportion of caries‐free children in the study community increased after 4 years of program implementation (from 22.0% to 48.4%). Conclusion: Under Chilean rural conditions, fluoridation of powdered milk distributed through the PNAC is an effective caries prevention alternative for areas where water fluoridation might not be feasible.
Cost‐effectiveness of screening for the possible development of cancer in patients with oral lichen planus
Authors: Van Der Meij E. H. , Bezemer P. D. , Van Der Waal I.
Published: March 2003

Introduction: Several authors have expressed the view that patients with oral lichen planus (OLP) are at increased risk of developing oral cancer. Since OLP cannot be effectively treated, regular screening for the possible development of oral cancer might be considered.

Objectives: (i) To calculate costs and effectiveness of screening for oral cancer in OLP patients with a decision model; (ii) to compare the cost‐effectiveness of different screening scenarios; and (iii) to perform a sensitivity analysis of several variables used in this model.

Methods: Costs and effectiveness of a population of 100 000 OLP patients, being either screened or not screened for oral cancer, were calculated for the period of 1 year. Health gain was expressed as quality adjusted live years (QALY's) and equivalent lives saved (ELS). Cost‐effectiveness was expressed as extra costs (costs of screening minus costs of no screening) per ELS. Then, the outcome was compared with the cost‐effectiveness of a different screening scenario. Finally, the effect of varying the variables: (i) costs of cancer treatment; (ii) annual malignant transformation rate (MTR); (iii) sensitivity and specificity of an oral examination; and (iv) proportion of cancers found in stage I on extra costs per ELS were assessed in a sensitivity analysis.

Results: The health gain from screening was 592 QALY's or the equivalent of 23.68 lives saved, costing $1 265 229, meaning that one ELS costed $53 430. Increase of cancer‐treatment costs will significantly decrease the costs per ELS. When the MTR is lower than 0.4% per year, extra costs per ELS will increase exponentially. The effect of sensitivity and specificity of an oral examination in detecting oral cancer on cost‐effectiveness seems to be substantial. When the proportion of cancers found in stage I can be increased from 40% (without screening) up to at least 60% after screening, extra costs per ELS will decrease exponentially.

Conclusions: Screening for oral cancer in OLP patients, based on the presently used model, seems attractive. However, varying the several variables in the decision model has a significant impact on the final costs and effectiveness. Only, when additional information about these variables will become available, a more precise and realistic calculation can be performed.
Contact allergy, irritancy and ‘danger’
Authors: McFadden J. P. , Basketter D. A.
Published: March 2003

Conventional models of the immune response are based on distinguishing self and non‐self. However, we consider that the more recently proposed ‘danger’ model may be an illuminating alternative for studying allergic contact dermatitis. In this model, an antigenic signal on its own would tend to produce tolerance. In contrast, in the presence of a ‘danger’ signal, which, in the case of allergic contact dermatitis, we suggest is usually cutaneous irritancy, the immune system would become activated, leading first to the induction of sensitization and then subsequently to the elicitation of a contact hypersensitivity response. In most cases, both the antigenic signal and irritant signal will come from the hapten, although, e.g., in an occupational setting, traumiterative dermatitis would be the source of the ‘danger’ signal. Typically, the irritant signal tends to be more concentration‐dependent and thus is the overriding factor in the determination of the effective sensitizing and eliciting concentrations of the hapten. A further prediction of this hypothesis is that successful experiments demonstrating low‐dose tolerance with contact allergens may be explained by the loss of the irritant effect at lower dilutions, whilst an antigenic stimulus remains present.
Experimental study on skin sensitization potencies and cross‐reactivities of hair‐dye‐related chemicals in guinea pigs
Authors: Xie Zhenlin , Hayakawa Ritsuko , Sugiura Mariko , Kojima Hajime , Konishi Hiroaki , Ichihara Gaku , Takeuchi Yasuhiro
Published: March 2003

In screening patch testing of hairdressers with occupational contact dermatitis, multiple positive reactions to hair dye‐related chemicals, such as p‐phenylenediamine (PPD), p‐toluenediamine ·  2HCI (PTD) and p‐aminophenol (PAP), a fabric dye p‐aminoazobenzene (PAB), and a tar dye Sudan III, were frequently encountered. To investigate individual skin sensitization potency and the cross‐reactivities among above chemicals, a guinea pig maximization test with the above 5 chemicals was performed. In each group, 6 animals were induced with one of the chemicals at 0.1% concentration by intradermal injection and at 1.0% by topical application. The animals were challenged with all 5 chemicals in concentrations of dilution by 10 from 0.1% to 0.001%. Under the conditions of 0.1% challenges, similar sensitization potencies were observed in PPD (6/6), PTD (6/6), PAP (5/6) and PAB (6/6) groups, but no positive reactions were elicited in the Sudan III group. The cross‐reactivities to PPD were confirmed in the animals challenged with PTD (6/6), PAP (6/6), PAB (6/6) and Sudan III (3/6). In the PTD‐induced group, positive responses to cross‐challenges were elicited by PPD (5/6), PAP (3/6), PAB (5/6) and Sudan III (1/6). The cross‐reactivities to PAP were observed only with PPD (2/5) and PAB (5/5). PAB‐induced animals responded only to PPD (1/6). The results indicate that all these chemicals except Sudan III are strong sensitizers. Their cross‐reactivities are different in sensitized conditions, respectively. The cross‐reactivities to PPD were higher than those to PTD, PAP and PAB.
Contact allergy and hand eczema in Swedish dentists
Authors: Wallenhammar L.‐M. , Örtengren U. , Andreasson H. , Barregård L. , Björkner B. , Karlsson S. , Wrangsjö K. , Meding B.
Published: March 2003

Hand eczema and contact allergy in Swedish dentists were studied in a multidisciplinary project. The aims of the study were to establish diagnoses, to investigate the occurrence of contact allergy, in particular to (meth)acrylates, and to evaluate certain consequences of hand eczema. A postal questionnaire on skin symptoms, atopy and occupational experience was mailed to 3500 dentists aged <65 years, and licensed 1965–1995. The response rate was 88%. Among dentists living in 3 major cities, 14.9% (n=191) reported hand eczema during the previous year. They were invited to a clinical examination, including patch testing with a standard and a dental series. 158/191 (83%) dentists attended, and hand eczema diagnosis was confirmed in 149/158 (94%). Irritant contact dermatitis was diagnosed in 67% and allergic contact dermatitis in 28%. On patch testing, 50% presented at least 1 positive reaction. The most frequent allergens were nickel sulfate, fragrance mix, gold sodium thiosulfate and thiuram mix. 7 (5%) had positive reactions to (meth)acrylates, all to 2‐hydroxyethyl methacrylate and 6 also to ethyleneglycol dimethacrylate. 38% had consulted a physician, 4% had been on sick‐leave and 1% had changed occupational tasks due to hand eczema. No dentist with allergy to acrylates had been on sick‐leave or changed occupation. It is concluded that dentistry is a high‐risk occupation for hand eczema, and that irritant contact dermatitis is most common. The prevalence of contact allergy to acrylates was below 1% in the population of responding dentists, and in most cases did not have serious medical, social or occupational consequences.
A cream containing the chelator DTPA (diethylenetriaminepenta‐acetic acid) can prevent contact allergic reactions to metals
Authors: Wöhrl Stefan , Kriechbaumer Nicole , Hemmer Wolfgang , Focke Margarete , Brannath Werner , Götz Manfred , Jarisch Reinhart
Published: March 2003

Chelating agents in protective barrier creams have often been used in the prevention of allergic contact dermatitis to nickel. In a pilot study, we demonstrated the preventive effect of 10% diethylenetriaminepentaacetic acid (DTPA) in an oil‐in‐water emulsion in nickel‐sensitized patients. Now we reproduced these results in a randomized, double‐blind study. Additionally, we investigated the efficacy of the barrier cream in other clinically relevant metal allergies. Individuals sensitized to various metals had a significant decrease in positive patch test reactions after pre‐treatment with the DTPA‐cream: 2.5% nickel sulfate (24/28 positive without pre‐treatment versus 1/28 with pre‐treatment; p<0.0001), 5% nickel sulfate (30/32 versus 15/32; p=0.0003), 1% cobalt chloride (19/20 versus 6/20; p=0.001) and 5% copper sulfate (13/14 versus 5/14; p=0.02). However, the cream had no protective effect with 1% palladium chloride (17/23 versus 16/23) and with 0.5% potassium dichromate (9/13 versus 7/13). We conclude that the DTPA‐cream clearly abrogates positive patch test reactions in nickel‐, cobalt‐ and copper‐sensitized subjects and that it may therefore be helpful in the management of allergic contact dermatitis.
Irritant contact dermatitis caused by needle‐like calcium oxalate crystals, raphides, in Agave tequilana among workers in tequila distilleries and agave plantations
Authors: Salinas Maria Lorenza , Ogura Tetsuya , Soffchi Luis
Published: March 2003

It was found that needle‐like calcium oxalate crystals, raphides, are found abundantly in all tissues of Agave tequilana plants; thus, 1 droplet (0.03 ml) of juice pressed from leaves contains 100–150 crystals, 30–500 μm in length, sharpened at both ends. In tequila distilleries, 5/6 of the workers who handle the agave stems have experienced the characteristic irritation. In contrast, only 1/3 of workers in agave plantations who harvest agave plants, complain of the irritation. It is confirmed that all the irritation suffered in both distilleries and plantations takes place at bodily locations where the plants come into contact with the worker's skin in the course of their work.
The risk of active sensitization to PPD
Authors: Devos Steven A. , Van Der Valk Pieter G. M.
Published: March 2003

Para‐phenylenediamine (PPD) and para‐aminoazobenzene are strong sensitizers. By the patch test procedure, the patient may be sensitized to these agents. Combined testing of para‐compounds may increase the risk of active sensitization. We studied the % of positive patch test reactions and their relevance. In order to assess the risk of active sensitization, we compared the % of relevant reactions of both early (2/3 days) and late (7 days) reactions. We also compared the percentage of positive patch test reactions to PPD and their relevance if simultaneously tested with para‐aminoazobenzene. We studied the patch test reactions to PPD in the routine series in 2058 patients. In a group of 678 patients we tested PPD and para‐aminoazobenzene simultaneously. 4.3% and 3.1% of the patients reacted to PPD, respectively, with and without simultaneous testing with para‐aminoazobenzene. We estimated the reactions as relevant in 21.1% and 39.7%, respectively, with and without simultaneous testing with para‐aminoazobenzene. We considered none of the late reactions as relevant. We found a high proportion of relevant patch test reactions to PPD, but sensitization to PPD by the patch test procedure is a risk. We state that routine series should not contain PPD. The high number of irrelevant late positive reactions strongly suggests active sensitization. Moreover, PPD is not a ubiquitous allergen and can be tested on a non‐routine basis if industrial exposure to para‐compounds is suspected or if a specific localization (e.g., head or feet) prompts the testing of PPD. Testing PPD combined with para‐aminoazobenzene does lead to a slight increase in positive reactions to PPD (p<0.25) and to an increase in irrelevant reactions (p<0.10).
Adverse effects of gasoline on the skin of exposed workers
Authors: Jia Xiaodong , Xiao Ping , Jin Xipeng , Shen Guangzu , Wang Xiasheng , Jin Taiyi , Nordberg Gunnar
Published: March 2003

Gasoline is widely used as a solvent in industry. To study its adverse effects on the skin and to understand their mechanisms, a matched epidemiological study (1:1, 52 exposed workers and 52 control subjects) was developed. Information about general conditions, history of dermatosis, changes in skin after exposure to gasoline, etc., was obtained. Ceramide, fatty acid and cholesterol collected from the backs of the hands were analyzed by high‐performance thin‐layer chromatography (HPTLC), because stratum corneum lipids play a predominant rôle in maintaining the physiological function of skin. The results showed that prevalences of hyperkeratosis, dryness, onychosis and dermatitis were clearly higher in exposed workers than in the control group, prevalence ratios being 3.33 (p<0.05), 3.00 (p<0.001), 11.25 (p<0.001), 5.00 (p<0.001), respectively. Fissures and onychorrhexis were the common symptoms in exposed workers. The stratum corneum lipid levels of ceramide, fatty acid and cholesterol were significantly lower in the exposed group than in the control group (p<0.05). Findings indicated that prolonged or repeated contact with gasoline could cause fissuring of the skin and nail disorders, and that the mechanism was perhaps depletion of stratum corneum lipids.
Effects of repeated short‐term skin contact with proteolytic enzymes
Authors: Lee Min Young , Park Kyoung Sik , Hayashi Chizuru , Lim Hyung Hee , Lee Kwang Ho , Kwak Inshin , Laurie R. Dana
Published: March 2003

The objective was to investigate effects on the hand of protease used in dishwashing liquids (DWL). A group of 30 Koreans (normal skin) and 24 Japanese (12 atopic and 12 normal) were employed for two different studies, respectively. The 30 Koreans were divided into three groups. Each group immersed their hands for 15 min a day for 9 days into DWL containing 0.005% protease, 0.02% protease, or non‐enzyme DWL. The 24 Japanese immersed their hands for 15 min a day for 4 days into 0.005% protease‐containing or a non‐enzyme DWL. The hand skin was evaluated by measuring overall and dry skin grades, estimated before and after exposures to the test products. The Korean study shows that 0.005% and 0.02% protease‐containing DWL are less irritating to the skin than non‐enzyme control, as measured by better overall skin grades and less dry skin. The Japanese study shows that 0.005% protease‐containing DWL are less irritating to the skin than non‐enzyme control in both atopic and normal subjects. The 0.005% protease use did not cause any adverse dermatological effects to atopic subjects compared with non‐enzyme control. Both studies indicate that 0.005% and 0.02% protease resulted in better skin mildness profile, without causing adverse dermatological complications to the subjects.
Relationship between 2,4‐dinitrochlorobenzene elicitation responses and individual irritant threshold
Authors: Smith H. R. , Kelly D. A. , Young A. R. , Basketter D. B. , McFadden J. P.
Published: March 2003

Contact dermatitis shows significant interindividual variation. We studied the relationship between an individual's irritant threshold and the elicitation of experimentally induced allergic sensitization. The results suggest that there is an association between reactivity to an irritant and the likelihood of positive elicitation reactions to lower hapten concentrations. This novel finding would be compatible with the proposal that contact allergy is best explained using a danger model with cutaneous irritancy determining sensitization. However, the enhanced allergic reactivity of individuals with a lower irritant threshold was not apparent on visual inspection, suggesting that the determinants of skin reactivity to haptens are multifactorial.
Guidelines for visualization of cutaneous blood flow by laser Doppler perfusion imaging
Authors: Fullerton A. , Stücker M. , Wilhelm K.‐P. , Wårdell K. , Anderson C. , Fischer T. , Nilsson G. E. , Serup J.
Published: March 2003

This report reviews how to set up a laser Doppler perfusion imaging system intended for visualization of skin blood perfusion, capture images and evaluate the results obtained. A brief summary of related papers published in the literature within the areas of skin irritant and allergy patch testing, microdialysis and skin tumour circulation is presented, as well as early applications within other fields such as diabetology, wound healing and microvascular research.
Monitoring levels of preservative sensitivity in Europe
Authors: Wilkinson J. D. , Shaw S. , Andersen K. E. , Brandao F. M. , Bruynzeel D. P. , Bruze M. , Camarasa J. M. G. , Diepgen T. L. , Ducombs G. , Frosch P. J. , Goossens A. , Lachappelle J. ‐M. , Lahti A. , Menné T. , Seidenari S. , Tosti A. , Wahlberg J. E.
Published: March 2003

A 10‐year multicentre analysis of the frequency of sensitivity to common preservatives collected in 16 centres in 11 countries has shown stable but persisting high levels of sensitivity to formaldehyde and 5‐chloro‐2‐methyl‐4‐isothiazolin‐3‐one + 2‐methyl‐4‐isothiazolin‐3‐one (MCI/MI). It has also revealed a significant increase in the level of reactivity to methyldibromoglutaronitrile (MDBGN) from 0.7% in 1991 to 3.5% in 2000. The current high level of sensitivity to MDBGN requires an urgent safety re‐evaluation and risk assessment update along with consideration of immediate lowering of use concentrations, especially in leave‐on products.
Three‐dimensional hard tissue palatal size and shape in human adolescents and adults
Authors: Ferrario Virgilio F. , Sforza Chiarella , Colombo Anna , Dellavia Claudia , Dimaggio Francesca R.
Published: March 2003

Hard tissue palatal dimensions and shape in 29 boys and 32 girls (mean age 14 years) and 30 men and 35 women (mean age 20 years), all with a complete permanent dentition including the second molars, and free from respiratory problems, were analyzed. Palatal landmarks were digitized with a computerized 3D instrument, and their coordinates were used to derive a mathematical model of palatal form. Palatal shape (size‐independent) was assessed by a four‐order polynomial in the sagittal and frontal plane projections. Palatal dimensions in the frontal and sagittal planes were computed, and compared between ages and sexes by two‐way factorial analyses of variance. The effect of age on palatal shape was different in the two sexes: while in females the curves in both the frontal and sagittal planes were practically superimposed, in males the youngest subjects had somewhat ‘lower’ curves than the oldest subjects. Sex had a significant (p<0.05) effect for all variables. Age was significant only for palatal slope in the sagittal plane (p<0.01), and for raphe inclination in the horizontal plane (p<0.05). For all variables but palatal length in the sagittal plane, a significant (p<0.01) sex×age interaction was found: while in males all linear variables were larger in adults than in adolescents, the reverse was found in females. Overall, while in adolescent females palatal form appeared to have already attained adult characteristics, in males some modifications between adolescence and young adulthood were measured. These modifications should be taken into consideration as a possible factor of relapse after orthodontic treatment.
Lichenoid, erosive and ulcerated dermatofibromas. Three additional clinico‐pathologic variants
Authors: Sánchez Yus Evaristo , Soria Laura , De Eusebio Esther , Requena Luis
Published: March 2003

On the occasion of a case of dermatofibroma with histological lichenoid features, we reviewed from our files all the cases in which the epidermis, usually hyperplastic in dermatofibroma, was, in some way, partially or completely destroyed. Among a total of 484 dermatofibromas, we found three lichenoid, six erosive and two ulcerated cases. In the three lichenoid cases, the columnar epidermal basal cells were lacking (squamotization of the basal layer) and in two of them there was a cleft between the epidermis and the dermatofibroma. Three of the six eroded cases were large pedunculated dermatofibromas with inflammatory phenomena of variable intensity. One case was in the center of a plaque of lichen simplex chronicus with some eroded area. In the other two cases, as well as in the two ulcerated lesions, neither inflammation nor epidermal changes usually attributed to rubbing or scratching were seen. Only in three of the eleven cases dermatofibroma was proposed (with question mark) as a clinical diagnosis. Both follow‐up and histopathology supported the benign nature of these cases. We may conclude that: i) Lichenoid, erosive and ulcerated changes in dermatofibroma are infrequent phenomena which may make a clinical diagnosis difficult; and ii) in the presence of an otherwise histopathologically typical dermatofibroma, erosion and ulceration should not be considered as suspicious of malignancy.
Cell proliferation in skin tumors with ductal differentiation: patterns and diagnostic applications
Authors: Pozo Lucia , Camacho Francisco , Rios‐Martin Juan J. , Diaz‐Cano Salvador J.
Published: March 2003

The kinetic features of skin tumors with ductal differentiation (TDD) remain mainly unknown. We selected 88 skin TDD (D‐PAS‐positive cuticles) classified according to Murphy and Elder's criteria. Tumors studied included 13 poromas, 12 nodular hidradenomas, 10 cylindromas, 6 spiradenomas, 9 syringomas, 9 chondroid syringomas, 7 porocarcinomas, 15 malignant nodular hidradenomas, and 7 not otherwise specified carcinomas. The same tumor areas were evaluated for mitotic figure counting (MFC) and proliferation rate (PR=MIB‐1 index), screening 10 consecutive high‐power fields (HPFs) in the most cellular areas. Results were recorded by HPF and tumor cellularity, considering both average and standard deviation. Differences were analyzed by Student's t‐test and analysis of variance (ANOVA) and considered significant if p<0.05. PR was significantly higher in malignant (23.29±12.49) than in benign tumors (3.86±4.44) and in poroma‐nodular hidradenoma (4.99±3.34) than in spiradenoma‐cylindroma‐syringoma (1.91±1.67), but not by malignant tumor type. MFC was significantly higher in malignant (25.52±4.10) than in benign tumors (1.57±0.38), showing porocarcinomas the biggest MFC/10 HPF and malignant nodular hidradenomas the highest MFC/1000 cells. PR and MFC are useful malignancy criteria in skin TDD and should be evaluated by tumor cellularity to avoid potential misinterpretations related with tumor heterogeneity.
Silicone granuloma on the entry points of acupuncture, venepuncture and surgical needles
Authors: Yanagihara Makoto , Fujii Toshiki , Wakamatu Nobuhiko , Ishizaki Hiroshi , Takehara Teruaki , Nawate Kiyoshi
Published: March 2003

We describe a case of epithelioid granuloma on the entry points of needles used for acupuncture, venepuncture and for taking skin biopsy. The acupuncture needles used at each session were silicone coated. Silicon was detected in the vacuoles of macrophages and multiple nucleated giant cells by X‐ray microanalysis. To our knowledge, this is the first case of silicone granuloma arising on the entry points of acupuncture, venepuncture and surgical needles.
In vitro characteristics of neonatal hemangioma endothelial cells: similarities and differences between normal neonatal and fetal endothelial cells
Authors: Dosanjh Amarjit , Chang James , Bresnick Stephen , Zhou Lisa , Reinisch John , Longaker Michael , Karasek Marvin
Published: March 2003

Background: Increased angiogenesis and eventual involution are major characteristics of neonatal hemangiomas. The mechanism to explain this transition is not completely understood.

Methods: To determine the nature of these changes, endothelial cells were isolated from eight hemangiomas and the growth characteristics and morphology of these cells were compared to cells isolated from normal fetal and neonatal skin. Three cells lines were further characterized by analyzing protein expression with immunhistochemistry and FACS analysis.

Results: Hemangioma endothelial cells converted to a spindle‐shaped morphology similar to that of fetal endothelial cells whereas neonatal endothelial cells maintained their characteristic epithelioid morphology. While neonatal, hemangioma and fetal endothelial cells continued to express platelet‐endothelial cell adhesion molecule‐1 (PECAM‐1) and von Willebrand factor (vWf), hemangioma and fetal cells expressed both proteins at a lower level and in a distribution distinct from normal neonatal endothelial cells. Neonatal endothelial cells continued to express epithelial specific Type IV collagen, while hemangioma and fetal endothelial cells produced interstitial Type I collagen.

Conclusions: Both cell morphology and protein expression of neonatal hemangioma endothelial cells were more characteristic of embryonic microvascular endothelial cells than that of postembryonic cells demonstrating a similarity in these two cell types and suggesting a dysfunction in the normal growth and maturation of endothelial cells in this tumor.
Sea‐urchin granuloma: histologic profile. A pathologic study of 50 biopsies
Authors: De la Torre Carlos , Toribio Jaime
Published: March 2003

Background: Sea‐urchin granuloma is a chronic granulomatous skin lesion caused by injury with sea‐urchin spines. Frequently these lesions occur on the hands and develop several months after the initial injury. Classified as an allergic foreign‐body reaction, their most common histological pattern resembles sarcoid. The purpose of this study was to evaluate the light microscopic features of biopsies from lesions clinically diagnosed of sea‐urchin granolomas.

Methods: We retrospectively reviewed 50 biopsy specimens corresponding to 35 patients with sea‐urchin granulomas. These lesions were caused by injuries with the spines of the sea‐urchin Paracentrotus lividus. Data were collected between 1990 and 1999 from patients in the seashore of Galicia (NW Atlantic coast, Spain).

Results: The cohort consisted of 35 patients (31 males, 4 females), with a median age of 35 years (range 14–60 years). The median duration of the disease was 7.5 months (range 2–60 months). We identified different histopathologic patterns. A granulomatous reaction was observed in 39 biopsies (78%). In 70% corresponding to 35 biopsies this granulomatous reaction was predominant. Foreign‐body, sarcoidal, tuberculoid, necrobiotic and suppurative granulomas were identified. The remaining 15 biopsies (30%) showed a predominant inflammatory reaction with features of non‐specific chronic inflammation or suppurative dermatitis. A panel of histopathologic features, including epidermal and dermal changes were evaluated. Presence of focal necrosis and microabscesses were common findings. In 50% of our specimens we found umbilication and/or perforation. Additional features included the presence of inclusion epidermoid cysts in four cases and squamous syringometaplasia in one case.

Conclusions: Our observations suggest that sea‐urchin granuloma span a wide morphologic spectrum. A granulomatous inflammatory reaction was predominant, with the foreign body and sarcoidal types the most frequent patterns. Other histopathologic patterns with non granulomatous inflammation can be noted. Some features, such as the frequency of perforation and the presence of necrobiotic granulomas have not previously been recognized in the literature.
Depigmented genital extramammary Paget’s disease: A possible histogenetic link to Toker’s clear cells and clear cell papulosis
Authors: Chen Ya‐Hui , Wong Tak‐Wah , Lee J. Yu‐Yun
Published: March 2003

Background: The histogenesis of extramammary Paget’s disease (EMPD) is still controversial. Benign pagetoid cells of the nipple first described by Toker and the similar clear cells found in white maculopapules of clear cell papulosis (CCP) have been proposed to be potential precursor cells giving rise to EMPD and primary intraepidermal Paget’s disease in the nipple. The observation of a rare case of depigmented EMPD provided us with a chance to examine further the interesting Toker’s clear cell/CCP hypothesis.

Methods: We performed pathologic studies, including Fontana‐Masson stain and immunostaining for AE1/AE3 and S100P, on a new case of depigmented EMPD manifesting a 4×3 cm hypopigmented‐depigmented patch on the root of the penis.

Results: The lesion showed extensive intraepithelial proliferation of atypical pagetoid cells with markedly reduced epidermal melaninization but nearly normal numbers of melanocytes. The tumor cells were strongly positive for AE1/AE3 by immunostaining. Some tumor cells displayed tadpole‐like morphology resembling the pagetoid cells of CCP. Such morphology was not observed in two random examples of non‐depigmented genital EMPD.

Conclusions: The findings of tadpole‐shaped pagetoid cells and depigmentation in the present case suggest that depigmented EMPD may be histogenetically related to CCP. Depigmented EMPD should be considered in the differential diagnosis of vitiligo, depigmented mycosis fungoides and lichen sclerosus located along the milk line.