bluuebunny/crossref_metadata_2025 huggingface dataset:
Relapsing bullous staphyloderma.
Authors: Brasch J , Mrowietz U , Schubert C , Christophers E
Published: July 2023

Relapsing eruptions of bullae rapidly turning into pustules were seen in a 69-year-old woman of good general health. At different times during several months of observation, strains of S. aureus were grown from various lesions, including one (phage group III) producing enterotoxin C. Systemic involvement except for high BSR was absent and repeated blood cultures were negative. Histopathological findings resembled impetigo. Antibiotic treatment was effective. As this disease does not fit into any of the well-known pustular infectious dermatoses, we suggest calling it relapsing bullous staphyloderma.
Amelanotic acral melanoma masquerading as fibrous histiocytic tumours. Three case reports.
Authors: Hara M , Kato T , Tagami H
Published: July 2023

We report 3 cases of amelanotic melanoma developing on the finger, whose histology disclosed dermal invasion of histiocyte/like tumour cells. One of the 3 cases was subungual melanoma and the other 2 were on the volar surface of the finger tip. Because of the characteristic dense infiltration of large histiocyte/like tumour cells, including many multinucleated giant cells, we initially considered histiocytic tumours. However, there were some histiocyte/like cells that displayed inclusion/like intranuclear invagination of cytoplasm, and almost all tumour cells, including the giant cells, were positive for S/100 protein. In addition, ultrastructural demonstration of premelanosomes within the cytoplasm of the tumour cells established the diagnosis of amelanotic melanoma. These features were distinct histologically from other variants of vertical growth phase amelanotic malignant melanoma, including desmoplastic or neurotropic melanoma. Because we encountered cases 2 and 3 within just a year after the first case, we think that the misdiagnosis of amelanotic "histiocytic" melanoma can be avoided through enhanced clinical awareness and subsequent appropriate histopathologic studies.
Detection of mRNA transcripts for retinoic acid, vitamin D3, and thyroid hormone (c/erb/A) nuclear receptors in human skin using reverse transcription and polymerase chain reaction.
Authors: Törmä H , Rollman O , Vahlquist A
Published: July 2023

Differentiation of keratinocytes involves both non/genomic and genomic events. The genomic effects are regulated by ligand/dependent transcription factors, e.g. the steroid/thyroid super/family of nuclear receptors. In the present study we examined mRNA expression of receptors for retinoic acid, thyroid hormone, and vitamin D3 in normal human skin and cultured keratinocytes using reverse transcription coupled to the polymerase chain reaction. The vitamin D3 receptor and the retinoic acid receptor (RAR) gamma together with the more distantly related RXR alpha were amplified extensively in skin and cultured keratinocytes. RAR alpha was amplified at a lower level, and RAR beta was almost undetectable. The thyroid hormone receptors alpha 1 and beta 1 were weakly amplified, but to comparable levels. Because receptors for retinoic acid, thyroid hormones, and vitamin D3 are all expressed in human epidermis differentiation of keratinocytes is probably regulated at transcriptional level by these molecules. It remains to be seen whether alterations in the expression of the nuclear receptors occur in certain skin disorders.
Dentist's occupational allergic contact dermatitis caused by coconut diethanolamide, N/ethyl/4/toluene sulfonamide and 4/tolyldiethanolamine.
Authors: Kanerva L , Jolanki R , Estlander T
Published: July 2023

Dental personnel are exposed to many sensitizing compounds at work and often develop multiple delayed allergies. Here we report on a dentist who got sensitized to several products that have not, or only seldom, caused sensitization earlier. These products were: coconut diethanolamide from her handwashing liquids, N/ethyl/4/toluene sulfonamide, a resin carrier in dental materials for isolating cavities underneath restorations, and 4/tolyldiethanolamine, an accelerator for inducing polymerization of dental acrylic resins at room temperature. The patient also had allergic patch test reactions to formaldehyde, phenol/formaldehyde resin, fragrance mix, and lauryl monoethanolamide, possibly from occupational exposure.
Inflammatory carcinoma masquerading as erythema annulare centrifugum.
Authors: Reichel M , Wheeland R G
Published: July 2023

A case of inflammatory carcinoma, or carcinoma erysipelatodes, clinically resembling erythema annulare centrifugum is reported. The cutaneous inflammatory carcinoma was due to metastasis by a signet/ring cell adenocarcinoma, probably of gastrointestinal origin. This is the third reported case of inflammatory carcinoma with signet/ring cell infiltration. Cancer patients with atypical or unusual inflammatory dermatoses should be evaluated by skin biopsy because of the possible association with the internal neoplastic process.
Comparative evaluation of scalp hair by phototrichogram and unit area trichogram analysis within the same subjects.
Authors: Rushton D H , De Brouwer B , De Coster W , Van Neste D J
Published: July 2023

Quantitative evaluation of scalp hair requires techniques that are reproducible. The unit area trichogram is such a method but is unsuitable for large/scale clinical trials. An alternative may be the phototrichogram//a non/plucking, non/invasive method. Hair variables were evaluated in 12 Caucasian subjects employing both methods. The mean value for total hair density was significantly underestimated by the phototrichogram (181 versus 237 hairs/cm2) however, no significant difference was found between this phototrichogram value and the number of non/vellus hairs/cm2. Estimates for the percentage of anagen hairs were similar with both methods. Hair diameters from the phototrichogram were too unreliable to be of any practical use. Analysis of the individual hair data revealed that light hair was much more difficult to evaluate than dark hair. Consequently, Caucasian subjects with light hair or dark skin subjects with dark hair should be excluded from studies employing phototrichograms.
Modulation of eicosanoid formation by lesional skin of psoriasis: an ex vivo skin model.
Authors: Fogh K , Iversen L , Herlin T , Kragballe K
Published: July 2023

The purpose of the present study was to develop an ex vivo skin model to determine the capacity of lesional skin of psoriasis to form leukotriene B4 and other eicosanoids. Keratomed skin samples were incubated in the presence of the calcium ionophore A23187 and arachidonic acid for 45 min at 37 degrees C. After extraction of lipids, eicosanoids were determined by quantitative reversed/phase high/performance liquid chromatography in combination with specific radioimmunoassays. We found that stimulation of skin samples with A23187 and arachidonic acid increased the amount of leukotriene B4 4.0/fold. The 12/lipoxygenase product, 12/hydroxy/eicosatetraenoic acid, and the 15/lipoxygenase product, 15/hydroxy/eicosatetraenoic acid, were both increased 2.7/fold. The cyclooxygenase product, prostaglandin E2, was increased 8.0/fold. Similar incubations using psoriatic scales did not result in formation of eicosanoids. Incubations with the 5/lipoxygenase inhibitor RS43179 inhibited the formation of leukotriene B4 and prostaglandin E2 without significantly affecting the formation of 12/hydroxy/eicosatetraenoic acid and 15/hydroxy/eicosatetraenoic acid. These results reveal that lesional psoriatic skin ex vivo has the enzymatic capacity to increase the levels of eicosanoids. This provides an ex vivo skin model to determine whether putative lipoxygenase inhibitors are able to modulate the formation of eicosanoids in psoriatic skin.
Photodynamic properties of Sn/protoporphyrin: clinical investigations and phototesting in human subjects.
Authors: Emtestam L , Angelin B , Berglund L , Drummond G S , Kappas A
Published: July 2023

Pure synthetic metalloporphyrins have been developed for experimental and clinical use as inhibitors of heme oxygenase, the rate limiting enzyme in the catabolism of heme to bilirubin. Tin (Sn)/protoporphyrin is one such compound, which potently suppresses bilirubin production and thus jaundice in animals and man. We have previously reported that this metalloporphyrin in conjunction with UVA might be useful as a treatment for psoriasis. To assess the photodynamic properties of Sn/protoporphyrin, 31 subjects were investigated with regard to photosensitivity. In all subjects, phototesting using UVB, UVA, and visible light as well as photopatch testing was performed. Our investigations revealed that 16 of the 31 individuals treated with Sn/protoporphyrin developed a mild photosensitivity, mainly erythema of the hands and face, and in some cases a mild conjunctivitis. The duration of this sensitivity, which in no case caused discomfort, was dose/dependent and ranged from several weeks to 1/3 months. After administration of Sn/protoporphyrin, lower thresholds were found for both UVA and visible light, but the sensitivity for UVB was normal and photopatch tests were negative. In summary, the photosensitivity observed during Sn/protoporphyrin administration was of limited duration and magnitude and did not occur in all subjects. Thus, the combination of photoactive synthetic metalloporphyrins and artificial light might prove to be useful as a regimen for the treatment of skin disease.
Intensity and area increase of UVB/induced erythema: two variables used for studies of the influence of topically applied drugs.
Authors: Juhlin L , Shroot B
Published: July 2023

The area of UV erythema produced by a small beam head was found to increase with increasing doses. The aim was to investigate whether measurement of the area could be a more useful indicator of UV/induced damage than classic visual grading. Topical pretreatment with all/trans retinoic acid (tretinoin) and betamethasone valerate was used to test the applicability of the method in pharmacological studies. We used a round outlet head (5 mm2) connected by optical fibre to a monochromatic irradiator, and doses ranging from 0.05 to 0.2 Joule of 300 mm UV light were applied to the skin of 6 healthy subjects. Erythemal area was calculated by the measurement of two diameters, and intensity was graded visually (0/6 scale). The area of the erythema correlated with the increase in intensity up to score 6. Area measurement was less subject to intra/investigators' variability than the intensity score. By multiplying intensity by area, a good indicator of UV/induced reactivity was obtained. Pretreatment with betamethasone valerate decreased the area of erythema, as did tretinoin 12 h after irradiation. Thus, area measurement of erythema is a useful adjunct to visual grading of UV/induced skin reactions.
Quantitative and 3/dimensional analysis of Langerhans' cells following occlusion with patch tests using confocal laser scanning microscopy.
Authors: Emilson A , Lindberg M , Forslind B , Scheynius A
Published: July 2023

Quantitative and detailed 3/dimensional (3/D) morphological information can be obtained from the same tissue volume using a confocal laser scanning microscope (CLSM). In the present study, we used CLSM for evaluation of Langerhans' cells (LC) in human skin at 0 h, 24 h and 48 h following occlusion with patch tests for 48 h. The relative volume of epidermal CD1a reactivity was quantified with CLSM on 25 microns thick sections stained with indirect immunofluorescence. No statistically significant difference was found when comparing the values obtained on the biopsy specimens from occluded skin (n = 36) with those from non/occluded skin (n = 9). Nor were any statistically significant changes detected in the number of epidermal CD1a+ cells as determined with immunoperoxidase staining between occluded and non/occluded skin. The occlusion produced a transient mild inflammatory reaction with an induced expression of intercellular adhesion molecule/1 (ICAM/1) on keratinocytes and an increased number of CD3+ epidermal lymphocytes. In addition, 3/D reconstructions revealed spatial information on the distribution of LC dendrites towards the skin surface.
Skin disease in immunosuppressed patients in relation to epidermal Langerhans' cells.
Authors: Bergfelt L , Larkö O , Blohmé I
Published: July 2023

Warts and skin tumours are common in renal transplant recipients (RTR). The increased susceptibility to skin lesions has been attributed to immunosuppressive treatments. The epidermal antigen/presenting Langerhans' cell (LC) is important for cutaneous immunosurveillance. The number of LC is reduced by UV light and by immunosuppressive therapy. One hundred and seventy/three immunosuppressed patients (RTR) were examined for signs of skin disease such as warts, premalignant or malignant skin lesions. The aim of this study was to determine whether the prevalence of these lesions varied between different immunosuppressive protocols and if there was an association between Langerhans' cell density, skin lesions and immunosuppressive therapy. Five years after transplantation, there was no difference in the prevalence of warts or dysplastic lesions in patients with triple drug therapy (cyclosporine, azathioprine and prednisolone) as compared with patients who had been treated with cyclosporine and prednisolone alone. Patients treated with azathioprine+prednisolone for 10/25 years had a higher prevalence of warts as well as dysplastic lesions. Long/term follow/up is needed to determine whether the risk of skin lesions is differently affected by different immunosuppressive therapies. LC density was assessed in 35 patients and in controls. There was a significant reduction in LC number in immunosuppressed patients, with the lowest density in patients on triple drug therapy and in patients on long/term azathioprine treatment. There was no significant difference in LC density between patients with and without skin lesions.
Water and ion distribution profiles in human skin.
Authors: Von Zglinicki T , Lindberg M , Roomans G M , Forslind B
Published: July 2023

Bulk sample x/ray microanalysis (XRMA) of human gluteal skin was performed to provide data on water and ion profiles over the epidermal cross section. All samples were analyzed both in the frozen hydrated state and in the frozen dried state. This allows, for the first time, a quantitative determination of the local water content in different strata of the skin. A steep water gradient was found in the stratum corneum towards the stratum granulosum, while the water content was constant in all deeper layers of the skin, including the papillary dermis. Previously demonstrated distributions over the epidermis of the monovalent ions sodium (Na), potassium (K) and chlorine (Cl) given in concentrations per unit dry weight were confirmed, as were the distributions of phosphorus (P) and sulfur (S). Combining the water and ion distributions, our data indicate the major monovalent ions Na, K and Cl to be in equilibrium between the stratum corneum and the dermis if the assumption is that all monovalent ions are in solution and that all the water of the tissue is available as solvent for the ions. This result does not disprove the existence of an ion transport gradient in the epidermis but sets significant bounds to it.
Initiation of the effects of acrivastine and cetirizine on histamine/induced wheals and itch in human skin.
Authors: Lahti A , Haapaniemi T
Published: July 2023

The initiation of the antihistamine effect of a single dose of acrivastine (8 mg) or cetirizine (10 mg) on wheals and itch induced by histamine dihydrochloride (10 mg/ml) in the prick test was studied in a randomized cross/over design employing 20 healthy medical students. The prick test was performed before ingestion of the drug and after 15, 20, 25, 30, 60 and 90 min and 2, 3 and 4 h. Local symptoms (itching) were recorded on a visual analogue scale. The inhibitory effect of acrivastine on the histamine wheal was first noticed 20 min (p < 0.01) after ingestion of the drug and that of cetirizine after 60 min (p < 0.001). The maximum effect of cetirizine, at 4 h, was greater than that of acrivastine, at 3 h (p < 0.001). The suppression of itching was first noticed 25 min after ingestion with both drugs.
Papillomavirus DNA typing analysis in condyloma acuminatum patients and their consorts.
Authors: Kiss M , Husz S , Soós J , Dobozy A
Published: July 2023

The present study demonstrated human papillomavirus (HPV) infection by means of an in situ HPV DNA hybridization screening test (BIOHIT) in 8 male patients with genital condyloma acuminatum, their asymptomatic female consorts and 6 female patients with vulval condyloma acuminatum. The investigations revealed that all but one of the female consorts were infected by HPV but did not show any clinical sign of papillomavirus infection. HPV DNA typing analyses with the most common HPVs present in the genital tract (HPV 6, 11, 16, 18, 31 and 33) revealed the same HPV types in the consorts as found in their partners. (HPV 6 and/or 11 were detected in 4 pairs, HPV 18 and 31 in one pair each, and HPV 18/31 and 16/31 double infections in one pair each.) All cytological specimens of female patients with condyloma acuminatum were HPV/infected, the most frequent type being HPV 31. In the one patient with vulval condyloma acuminatum and carcinoma epidermoides cornescens, the "high/risk" HPV 18 was identified in both condyloma and carcinoma tissues.
Down/regulation of epidermal growth factor receptors by dithranol.
Authors: Kemény L , Michel G , Arenberger P , Ruzicka T
Published: July 2023

Dithranol is highly effective in the treatment of psoriasis, but the exact mechanism of action is not known. Since persistent expression of epidermal growth factor (EGF) receptors in psoriatic epidermis is assumed to have pathogenetic significance, we have studied the effects of dithranol on EGF binding to the human epidermal cell line SCL/II. After treatment of cells with dithranol or its therapeutically inactive oxidation product, danthrone, radioligand binding assays were performed with 125I/EGF. In therapeutically active concentrations (0.25/1 micrograms/ml) dithranol induced a decrease in EGF binding in a dose dependent manner. Danthrone was inactive. The inhibition occurred after a latency period of 6 h and reached its maximum at 24 h. At the concentration of 1 microgram/ml, the drug led to approximately a 70% decrease in the number of specific high/affinity EGF receptors (Bmax), whereas receptor affinity (Kd) showed no change. The down/regulation of EGF receptors on epidermal cells by dithranol may contribute to its antipsoriatic action.
Scanning electron microscopy of scales from pityriasis amiantacea.
Authors: Batten T L , White M I , Gregory D W
Published: July 2023

The scanning electron microscope has been used to examine scales taken from the scalp of 3 patients with pityriasis amiantacea alone, 3 psoriatic patients with pityriasis amiantacea and one patient with both atopic dermatitis and pityriasis amiantacea. Samples from 2 patients were additionally studied by different fixation techniques and in the frozen hydrated state, but no cementing of the scales could be observed. There was no evidence of an infective agent.
GM1/gangliosidosis type 1 involving the cutaneous vascular endothelial cells in a black infant with multiple ectopic Mongolian spots.
Authors: Tang T T , Esterly N B , Lubinsky M S , Oechler H W , Harb J M , Franciosi R A
Published: July 2023

GM1/gangliosidosis (GM1) is one of the metabolic storage diseases, of which a differential diagnosis requires an array of biochemical assays to determine the enzyme deficiency. This approach is not only time/consuming and costly but also unavailable to most hospital laboratories. However, a presumptive diagnosis of GM1 may be made on the basis of coarse facial feature, foamy endothelial cells in the cutaneous blood vessels and ectopic Mongolian spots, if present. A more definitive diagnosis of GM1 is then made on the demonstration of deficiency of GM1 beta/galactosidase in leukocytes, plasma or cultured skin fibroblasts. Thus, a battery of enzyme tests may be averted.
Quality of life in chronic leg ulcer patients. An assessment according to the Nottingham Health Profile.
Authors: Lindholm C , Bjellerup M , Christensen O B , Zederfeldt B
Published: July 2023

Chronic leg ulcer is a disease of long duration, occurring predominantly in elderly people. Traditionally, little interest has been devoted to the study of the impact of this disease on life quality. In the present study the Nottingham Health Profile (NHP) was used to assess disease influence on six areas of daily life, namely: pain, physical mobility, sleep, energy, emotional reactions and social isolation. Standard questionnaires were distributed to patients with chronic leg ulcers of venous, arterial or mixed venous/arterial origin, treated at the Department of Dermatology. Complete data were obtained from 125 patients. The disease had a marked impact on the patient's subjectively perceived health. Males exhibited remarkably elevated scores, compared to the normative scores for men, especially in the areas of pain, emotional reactions, social isolation and physical restrictions. For women the impact of leg ulcer disease, although obvious, seems much less marked than for males. An exceptionally long median duration of leg ulcer disease was found among shop/assistants. It is possible that preventive measures should be undertaken in this group. The duration of leg ulcer disease did not seem to influence the quality of life. Patients with long disease duration in fact reported fewer problems than those with shorter duration, suggesting adaptive mechanisms. This study indicates that male leg ulcer patients should be more closely observed for symptoms of emotional stress, pain, social isolation and impaired physical mobility. More efforts should be made to alleviate pain. Above all this study underlines the importance of considering not only the ulcer but the whole patient.
Malignant aneuploid spindle/cell transformation in a proliferating trichilemmal tumour.
Authors: Alvarez-Quiñones M , Garijo M F , Fernández F , Val-Bernal J F
Published: July 2023

A case of spindle/cell carcinoma developed on a proliferating trichilemmal tumour (PTT) is presented. The tumour on the scalp of an 84/year/old white woman was excised and histological examination showed typical features of PTT, but with a coexistent malignant spindle/cell tumour with a sarcomatoid appearance. There were some areas of transition between squamous trichilemmal epithelium and the neoplastic mass composed of atypical spindle/shaped cells. Two years later, the patient was well, and neither recurrence nor metastases were observed. We report the second case of PTT with a malignant spindle/cell transformation with a sarcomatoid appearance (spindle/cell carcinoma), and a proven aneuploidy, demonstrated with DNA/flow cytometric analysis.
Leg and foot ulcer prevalence and investigation of the peripheral arterial and venous circulation in a randomised elderly population. An epidemiological survey and clinical investigation.
Authors: Andersson E , Hansson C , Swanbeck G
Published: July 2023

Five thousand one hundred and forty questionnaires concerning leg ulcers were sent to a randomly selected population aged 65 years and older in Gothenburg in April 1989. The response rate was 89%. Ninety/seven individuals answered affirmatively, that they had leg ulcers, which corresponds to a prevalence of 2.15 +// 0.42 per cent. These 97 individuals and the same number of controls were asked to come for a medical examination with tests of the peripheral circulation and an interview. Seventy/five (of the 97) were examined. Thirty/five had leg or foot ulcers caused by vascular insufficiency and/or diabetes and the true prevalence was estimated to be 1.02 +// 0.29 per cent.
Nail changes of punctate keratoderma: a clinical and pathological study of two patients.
Authors: Tosti A , Morelli R , Fanti P A , Cameli N
Published: July 2023

The pathological study of the nail changes of 2 patients affected by punctate keratoderma is described. Both patients presented nail abnormalities that were clinically suggestive of a nail psoriasis. Subungual hyperkeratosis was a prominent feature but onycholysis, splinter haemorrhages and pitting were also present. The pathology of the nail bed revealed sharply limited columns of hyperkeratosis associated with hypergranulosis and depression of the underlying nail bed epidermis. Etretinate therapy produced a significant improvement in the palmoplantar keratoderma, but it was of no apparent value in treating nail keratoderma.
The induction of epidermal ornithine decarboxylase following UV/B irradiation is inhibited by estriol.
Authors: Arnold W P , Pennings B J , Van de Kerkhof P C
Published: July 2023

The induction of epidermal ornithine decarboxylase (ODC) can be partially blocked by corticosteroids, retinoic acid or active vitamin D3. The influence of the other members of this so/called "steroid hormone receptor superfamily", namely the sex/steroids and thyroid hormone, is unknown in epidermis, but they enhance ODC induction in certain other tissues. Here we investigated whether topical estriol leads to a spontaneous and/or enhanced epidermal ODC induction 8 h after UV/B irradiation of 6 postmenopausal women. Contrary to expectation, estriol did not stimulate induction but reduced induction by 44%. This observation raises the possibility that all members of the steroid hormone receptor superfamily may share a common AP/1 binding site.
Streptococcal and staphylococcal superantigens (ETA, SEB): presentation by human epidermal cells and induction of autologous T cell proliferation in vitro.
Authors: Buslau M , Kappus R , Gerlach D , Köhler W , Diehl S , Holzmann H
Published: July 2023

Streptococcal and staphylococcal toxins are responsible for skin/related clinical conditions, e.g. scarlet fever and toxic shock syndrome. Skin involvement may result from a hypersensitivity reaction to these toxins
Topical all/trans retinoic acid rapidly corrects the follicular abnormalities of the rhino mouse. An ultrastructural study.
Authors: Zheng P , Gendimenico G J , Mezick J A , Kligman A M
Published: July 2023

Topical all/trans retinoic acid (RA) has been shown to transform the horn/filled utriculi of the rhino mouse into normal follicles. We studied the early events by light and electron microscopy. Reduction in diameters of the utriculi was quantified by image analysis of whole mounts. Topical RA at 0.05% in ethanol/propylene glycol was applied daily and biopsies were taken after 1, 2, 3 and 6 days of treatment. By electron microscopy, after 3 days of RA treatment there was a great increase in the size and density of laminated membrane coating granules (MCGs) which had fused to the apical membranes of the upper granular cells. Thereafter, corneocytes within the lumina of the utriculi showed fewer desmosomes and a loss of intercellular material, accompanied by detachment from each other. Conversion to normal follicles was complete by 6 days. In whole mounts examined after 3 days of RA, there was a 75% reduction in the mean diameter of the utriculi. These results suggest that extrusion of the contents of enlarged MCGs into the intercellular corneocyte spaces facilitated separation of corneocytes, leading to rapid shedding, perhaps through the action of desmosome/lysing proteases. The conversion to normal follicles is consistent with the established role of retinoids in correcting abnormal differentiation.
Lowered peripheral resistance in arteries of legs with venous ulcer.
Authors: Malanin K , Haapanen A , Havu V
Published: July 2023

In the literature there is disagreement concerning the existence of arteriovenous shunting in legs with venous ulcer(s). The aim of this study was to find out if there are differences in resistance in the arteries of ulcer legs and non-ulcer legs and if it is possible to investigate this with a non-invasive Doppler method. Eleven patients, aged 34-87 years, with venous ulcer only in one leg, were investigated using angiography and duplex scanning. Angiography showed premature venous filling and Doppler examination showed lowered peripheral resistance in the arteries of every ulcer leg. Lowered peripheral resistance was found only in one non-ulcer leg, which, however also had signs of venous stasis. Our results clearly show that there is lowered peripheral resistance in arteries of legs with venous stasis. The possible significance of this phenomenon in the pathogenesis of venous leg ulcer is discussed.
A domain mosaic model of the skin barrier.
Authors: Forslind B
Published: July 2023

The skin barrier primarily protects the body against uncontrolled loss of water and in addition prevents water and matter of the environment from indiscriminately entering the living system. The current concept of the skin barrier suggests that permeability is governed by a hydrophilic and a hydrophobic "channel". To account both for the barrier function and the hydrophilic and hydrophobic pathways through this barrier, we propose a new model, "the domain mosaic model of the skin barrier", which depicts the bulk of the lipids as segregated into crystalline/gel domains bordered by "grain borders" where lipids are in the fluid crystalline state. Such an arrangement provides for an effective "water-tight" barrier that allows a minute and controlled loss of water to keep the corneocytes moistened. In addition the model provides for the necessary mechanical properties permitting bending and stress imposed on the skin surface. Furthermore, the fluid character of the "grain borders" represents areas where lipid and hydrophobic molecules may diffuse through the system on down-hill gradients. It is suggested that in the border areas between the crystalline domains, structural transformations of the lipid organization due to permeation promoters may take place without structural changes in the bulk organization of lipids in the crystalline or gel phase.
Dyschromatosis symmetrica hereditaria associated with idiopathic torsion dystonia. A case report.
Authors: Patrizi A , Manneschi V , Pini A , Baioni E , Ghetti P
Published: July 2023

The authors report a case of a family in which a diagnosis of dyschromatosis symmetrica hereditaria was established by a clinical pattern of cutaneous lesions and by assessment of cellular DNA repair synthesis. The skin lesions were characterized by a mixture of hyperpigmented and hypopigmented macules and were localized on the back of the feet of three patients (two male brothers and one sister). All the patients also had small freckle-like pigmented macules on their face. The father presented large symmetrical hypopigmented vitiligo-like macules. In this patient, mottled pigmentation and depigmentation of the extremities had been present since childhood. In the four patients no cellular abnormalities in DNA repair ability were found. These data exclude a mild form of xeroderma pigmentosum. The daughter, a 9-year-old girl, had since the age of 7 also shown a neurological disorder diagnosed as idiopathic torsion dystonia. The authors emphasize the association of dyschromatosis symmetrica hereditaria, a rare cutaneous disease, with idiopathic torsion dystonia, a rare idiopathic neurological disease, in this young girl.
DF3 (CA15-3) antibody as a marker of cutaneous adnexal tumors.
Authors: Yasui S , Ando I , Kukita A , Hino H , Ohara K
Published: July 2023

DF3(CA15-3) monoclonal antibody detects the 20 amino acid sequence of epithelial mucin. In normal cutaneous tissue DF3 antibody exhibits strong and constant positive reactivity with sebaceous and secretory segments of eccrine and apocrine sweat glands. All epidermal tumors are DF3 negative but poorly differentiated squamous cell carcinoma. Various adnexal tumors such as eccrine hidrocystoma, tubular apocrine adenoma, syringocystadenoma papilliferum, eccrine poroma, eccrine spiradenoma, clear cell hidradenoma, mixed cell tumor, eccrine porocarcinoma, extramammary Paget's disease and adenoid cystic carcinoma are DF3 positive, which indicates epithelial mucin production by these tumors.
Nd:YAG laser hyperthermia in the treatment of recalcitrant verrucae vulgares (Regensburg's technique).
Authors: Pfau A , Abd-el-Raheem T A , Bäumler W , Hohenleutner U , Landthaler M
Published: July 2023

Heat therapy of cutaneous diseases has been used for decades. During the last years several kinds of energy sources, including electromagnetic energy from radiofrequency, microwaves and sonic energy from ultrasound, have been used to produce local hyperthermia. The general principle of this treatment is based on the fact that disease tissue which is being treated is more sensitive to the effects of elevated temperature than normal tissue and thus less able to recover after heat exposure. We report the case of a 54-year-old female patient with recalcitrant verrucae vulgares on the little finger of her right hand and on her left sole, who was treated with Nd:YAG laser hyperthermia. Laser energy was applied twice with an interval of 6 weeks. Laser output power was 10 W, spot size 8 mm and irradiation time up to 20 s. By this technique it was possible to receive a surface temperature of about 40 degrees C for 30 s. After hyperthermia no skin changes like whitish discoloration, blistering or crusting were observed. After the patient had completed the second course a total remission took place. No recurrence was seen in a follow-up period of 3 months. This method could be used in the treatment of recalcitrant warts on the fingers and hands, periungual and other parts of the body including plantar surfaces.
Subcutaneous mucormycosis in a non-immunocompromised patient treated with potassium iodide.
Authors: Verma K K , Pandhi R K
Published: July 2023

A 55-year-old teacher had had painful subcutaneous swellings on both her arms for 6 years, after receiving intramuscular multivitamin injections for generalized weakness. She did not have fever, constitutional or systemic symptoms. Cutaneous examination revealed ill-defined, subcutaneous, firm, globular, indurated, tender swellings with central softening on both the arms. There was no systemic involvement or lymphadenopathy. Aspiration cytology from one of the lesions showed inflammatory exudate with a mucor-like fungus. Skin biopsy revealed granulomatous inflammation with fungal hyphae resembling mucor within the giant cells. The patient was diagnosed as subcutaneous mycormycosis and treated with saturated solution of potassium iodide. Both the lesions completely disappeared within 10 weeks without any side-effect of the therapy.
Proliferating cell nuclear antigen decreases in normal human keratinocytes with differentiation stimuli but not in an HPV immortalised cell line.
Authors: Jones K T , Sharpe G R
Published: July 2023

Proliferating cell nuclear antigen (PCNA) is a co-factor for DNA polymerase delta, which replicates genomic DNA during cell growth and division. Using a monoclonal antibody to PCNA (PC10) and conventional immunofluorescent techniques, we have compared the effect of differentiation stimuli on PCNA expression in normal and HPV immortalised keratinocytes. Two positive nuclear staining patterns were observed, a strong speckled form characteristic of proliferating cells and a weaker diffuse form. Strong nuclear staining was present in 44 +/- 4% (mean +/- SEM) of normal keratinocytes proliferating as a monolayer in 70 microM calcium serum-free medium but decreased to 13 +/- 3% after the differentiation stimulus of 2 mM calcium medium for 2 days. An even greater reduction was observed following other differentiation agents, 1,25 dihydroxyvitamin D3, the phorbol ester TPA and the non-specific protein kinase C inhibitor staurosporine. Transforming growth factor-beta, which slows keratinocyte growth without inducing differentiation, reduced strong staining to 17 +/- 3% of cells, but with an increase in the diffuse pattern of staining from 39 +/- 4 to 57 +/- 3%. HPV immortalised cells were resistant to the above agents except staurosporine, which inhibited growth and reduced the strong nuclear staining from 44 +/- 5% to 15 +/- 2%.
Potentializing effect of ketoconazole on cyclosporin A-induced inhibition of keratinocyte DNA synthesis.
Authors: Amsellem C , Haftek M , Thivolet J , De Doncker P , Schmitt D
Published: July 2023

Keratinocyte growth in vitro and DNA synthesis by epidermal cells in vivo are inhibited by therapeutic doses of cyclosporin A (CsA). This effect may be potentialized by topical treatment with ketoconazole, since this drug has been shown to inhibit CsA metabolism. Normal human skin grafts on nude mice receiving intraperitoneal injections of CsA were treated with ketoconazole cream or its placebo for 3 weeks. The keratinocyte DNA synthesis rate was evaluated through the rates of bromodeoxyuridine (BrdU) incorporation, and the trough blood levels of CsA were checked at the end of the experiment. Counting of the BrdU-labelled nuclei in human tissue sections confirmed a dose-dependent inhibition of BrdU incorporation by keratinocytes exposed to CsA. This CsA-induced inhibition was further increased in the animals treated with ketoconazole cream. This effect was best seen in the groups treated with the low-to-medium doses of CsA (12.5 and 25 mg/kg/day). However, the simultaneous increase in the circulating CsA levels was also observed in these animals. Based on our results, we speculate that the potentializing effect of ketoconazole on CsA-induced inhibition of keratinocyte DNA synthesis is systemic rather than local.
No association with HLA class II alleles in Swedish patients with cutaneous manifestations of Lyme borreliosis.
Authors: Olsson I , Asbrink E , Olerup O
Published: July 2023

The possibility of an association between manifestations of Lyme borreliosis and HLA class II alleles has been investigated with varying results. In the present study, we used genomic typing techniques to determine the DR, DQ and DP allele frequencies in 29 patients with erythema migrans and 36 patients with acrodermatitis chronica atrophicans. We did not find a significant deviation from controls in the distribution of the HLA class II alleles in any of these disease manifestations, nor in the subgroup of 8 patients with acrodermatitis chronica atrophicans and long-standing arthritis. With the additional information obtained by the typing techniques used, our results are thus in accord with those studies where no association between the development of the late disease manifestation acrodermatitis chronica atrophicans and HLA class II alleles has been found.
Non-invasive evaluation of topical calcipotriol versus clobetasol in the treatment of psoriasis.
Authors: Berardesca E , Vignoli G P , Farinelli N , Vignini M , Distante F , Rabbiosi G
Published: July 2023

Topical treatment of psoriasis with calcipotriol has been proven effective. The efficacy of calcipotriol has been compared to that of topical corticoids in a number of studies using subjective visual scoring systems such as the PASI index. The purpose of this study was to compare, with objective data, the efficacy of calcipotriol and clobetasol propionate 0.05% in the treatment of plaque type psoriasis. Transepidermal water loss (TEWL) and laser Doppler velocimetry (LDV) were used to monitor restoration of water barrier and normalization of blood flow, respectively, in psoriatic plaques of the limbs of 24 male patients during 3 weeks of treatment. Data were compared to subjective evaluation using the PASI index of the same areas. Significant differences were recorded during treatment in both groups. The results correlated well with the PASI score. Clobetasol was faster in restoring barrier function than calcipotriol. However, no significant differences were detected between the two groups. The use of vitamin analogues may be effective in the topical treatment of psoriasis by normalizing skin biophysical parameters and minimizing the risks of side-effects induced by potent topical corticoids.
Low anti-streptokinase IgG concentrations following streptokinase-streptodornase treatment of leg ulcer patients.
Authors: Munkvad S , Breuning L , Tvedskov J
Published: July 2023

We have evaluated whether neutralising anti-streptokinase IgG antibodies are produced following streptokinase-streptodornase therapy of leg ulcer patients. Serum anti-streptokinase IgG concentrations in 10 leg ulcer patients were determined before, and 1 week, 2 weeks, and 3 weeks following the treatment. We observed only a negligible increase in neutralizing anti-streptokinase IgG concentrations during the observation period, which was probably of no therapeutical significance.
Vein surgery with or without skin grafting versus conservative treatment for leg ulcers. A randomized prospective study.
Authors: Warburg F E , Danielsen L , Madsen S M , Raaschou H O , Munkvad S , Jensen R , Siersen H E
Published: July 2023

In order for us to evaluate the efficiency of perforator vein surgery and skin grafting in leg ulcer patients, 47 patients were randomized into 3 treatment groups (group A: surgery for incompetent perforators, group B: surgery for incompetent perforators and ulcer excision followed by grafting, group C: control group). All the patients were treated with a compression bandage. When cellulitis was observed, a systemic antibiotic was given eczema was treated with a steroid ointment. Fourty patients were evaluated regularly during one year after entry. There were no differences between the 3 treatment groups considering base-line characteristics, median ulcer size at entry and after one year. According to a review of the initial phlebograms, the occurrence of post-thrombotic changes in the deep veins were recorded in the majority of the legs. Our results suggest that ligation of incompetent perforators and skin grafting, as used in the present study, may not offer an additional advantage for venous ulcer patients with insufficiency of the deep veins when compared to conservative treatment. However, the removal of insufficient superficial veins was not studied.
Diphencyprone is not detectable in serum or urine following topical application.
Authors: Berth-Jones J , Mc Burney A , Hutchinson P E
Published: July 2023

Diphencyprone is a potent contact sensitizer in widespread use for treatment of alopecia areata. It is currently not known whether this compound is absorbed following topical application. This is important, since little is known regarding potential toxicity. We therefore analysed serum and urine samples following application of at least 0.5 ml of a 1% solution of diphencyprone to the scalp of patients under treatment for alopecia areata. Serum samples were obtained over 8 h following treatment and 24-h urine collections were performed. The threshold for detection was 2 ng, and the assay gave an accurate linear response for samples of serum and urine containing known concentrations of diphencyprone. Blood and/or urine samples were obtained from a total of 18 subjects. Diphencyprone was not detected in any sample of serum or urine from the subjects. These data suggest that diphencyprone is not absorbed following application to the skin.
Presence of Epstein-Barr virus in cutaneous lesions of mycosis fungoides and Sézary syndrome.
Authors: Dreno B , Celerier P , Fleischmann M , Bureau B , Litoux P
Published: July 2023

It has been suggested that prolonged antigenic stimulation contributes to the development of epidermotropic cutaneous T cell lymphoma (CTCL), mycosis fungoides and Sézary syndrome, characterized by a cutaneous infiltration of proliferating helper T cells. Since Epstein-Barr virus (EBV) antibodies were increased in CTCL sera, we investigated a possible etiologic role for EBV in epidermotropic CTCL by looking for the EBV genome in 25 cutaneous biopsies of mycosis fungoides or Sézary syndrome and 12 reactional inflammatory skin lesions. The use of a non-isotopic in situ hybridization procedure based on the detection of Epstein-Barr encoded RNAs with biotinylated oligonucleotide probes (EBER) revealed 32% of the lesions with CTCL to be positive for EBV (3 in dermis, 3 in epidermis, 2 both in dermis and epidermis), as compared to no detection of the EBV genome in the reactional inflammatory skin lesions. Moreover, a combined hybridization (EBER probe) and immunochemistry technique (anti-CD3 or anti-Kil monoclonal antibody) permitted the identification of EBV in T cells of dermis and in keratinocytes, respectively. The identification of EBV in epidermotropic CTCL suggests that this virus could play a role in the development of these CTCLs, either as an etiological agent or more probably as a chronic activating agent. Indeed, the infection of keratinocytes by EBV could activate them and so induce the production of in situ cytokines (IL1a, IL6, TNFa) playing a role in the development of tumoral infiltrate.
Dermatitis with an unusual explanation in a welder.
Authors: Bruze M , Hindsén M , Trulsson L
Published: July 2023

Occupational diseases among welders include asthma, acute keratoconjunctivitis, and various skin disorders. A localized cutaneous erythema from UVC radiation is common and does not generally constitute any problem, as its cause is obvious to the welder, the symptoms are slight, and it is transient. In this report a welder with UVC-induced erythema on the cheeks is described. Initially, neither the worker, the physician at the factory, nor ourselves suspected a UVC erythema. Extensive investigations, including factor visits with measurements of UVA, UVB, and UVC irradiance during welding, revealed the cause of the dermatitis to be UVC, most likely reflected from a textile hood used to prevent exposure to dirt.
Familial pachydermodactyly.
Authors: Russo F , Rodriguez-Pichardo A , Camacho F
Published: July 2023

Pachydermodactyly is a rare form of digital fibromatosis. There are only 15 cases reported in the literature, all with a negative family history. Only one of the previously reported cases was a woman. We now report 2 female cases, mother and daughter, who, to the best of our knowledge, are the first patients with familial pachydermodactyly. The histological evolution of this disease over the years had not been previously reported.
Giant spontaneous hematoma of the thoracic wall in a patient with REST syndrome.
Authors: Böhm M , Haas N , Czarnetzki B M
Published: July 2023

We report on a 56-year-old patient with systemic sclerosis of one and a half year's duration who was admitted with an acute soft tissue swelling over the left scapula and a marked reduction of joint mobility of the left shoulder. Over the following days, the swelling extended distally and a hemorrhagic discoloration developed, reaching down to the scrotum. Nuclear magnetic resonance imaging revealed a giant intermuscular hematoma between the serratus anterior and the costal muscles. This is the first report of an extensive spontaneous hematoma of the thoracic wall in a patient with progressive systemic sclerosis. Its development and unusual localization may be explained by both the underlying systemic sclerosis and the patient's previous profession as a trapeze artist. Hemorrhagic complications of systemic sclerosis are rare but should be watched for in these patients.
A pathogenic role for endothelin in Raynaud's phenomenon?
Authors: Bottomley W , Goodfield M
Published: July 2023

Plasma endothelin response to a standardized cold challenge in 7 patients with primary Raynaud's phenomenon and 7 controls using a sensitive radioimmunoassay was measured. There was no difference between resting levels of plasma endothelin in patients with primary Raynaud's phenomenon (2.6 fmol/ml) and controls (2.4 fmol/ml). A decrease in plasma endothelin levels in both groups of patients during the initial phase of the cold challenge was detected this was more pronounced in the patients with Raynaud's phenomenon. These results suggest that there is no persistent stimulus to overproduction of endothelin. The fall in levels in patients with Raynaud's phenomenon during the initial phase of the cold challenge might suggest that a different vasoconstrictive factor is initiating the start of the vasospastic process, with the decreased endothelin levels being a reactive response to increased vasoconstriction produced by this alternative factor.