bluuebunny/crossref_metadata_2025 huggingface dataset:
A mathematical model to predict the population dynamics of Oryza sativa var. sylvatica
Authors: Vidotto F , Ferrero A , Ducco G
Published: March 2003

A mathematical model has been developed for the prediction of the population dynamics of Oryza sativa L. var. sylvatica. The input variables included in the model were the seedbank composition; the number of panicles per plant and seeds per panicle; the rate of shattering; the seed longevity and the number of weed seeds contained in the sown grain; the type of soil tillage (ploughing, minimum and No tillage); the weed control efficacy; and the predation. The output variables were the number of seedlings that emerged from different depths and the seedbank evolution. The model relies on probability matrices that predict the vertical movement of the seeds after different soil tillage practices. Sensitivity analysis showed that the weed control efficacy and number of grains per panicle were the parameters that had the highest influence on the development of the weed population. The model evaluation was carried out by comparing the predicted with the observed seedling emergence at different seedbank values and under different soil tillage conditions. The model performance showed a tendency to overestimate seedling densities. The agreement between the estimated and experimental data was closely related to the accuracy of the input values of the seed distribution along the soil profile.
Nevus depigmentosus and inflammatory linear epidermal nevus – an unusual combination with a note on histology
Authors: Ogunbiyi Adebola O. , Ogunbiyi J. Olufemi
Published: March 2003

An 18‐year‐old woman was seen in the clinic with complaints of a bizarre hypopigmentation of her skin which her mother said had been present from birth and had been asymptomatic, constant, and permanent. She also complained of a rough eruption which had developed at one year of age and had progressed slightly in size over the years. It was first noticed in the left axilla, groin, parasternal area and posteriorly on the neck and was restricted to the left side of the body. It became inflamed and pruritic, was asymptomatic at times, but never cleared although the patient felt some of the lesion had sloughed off. There were no associated systemic symptoms, no history of seizures, and her psychomotor development was normal.

On examination, the main findings were mucocutaneous; she had hypopigmented bands, whorls, and streaks following Blaschko’s lines, the lesions affected the front and the back of her trunk bilaterally, with the arms and thighs also involved. Her face was spared ( Fig. 1a,b). There was no evidence of atrophy or scarring in the hypopigmented lesions.

Hypopigmented whorls, bands, and streaks on both front (a) and back (b) of patient. Note also the one‐sided distribution of the ILVEN (affecting the neck, left parasternal area, and dorsal surface of the hand)

image

The patient also had linear verrucous lesions in left armpit, left hand (dorsal surface), left groin, left parasternal region ( Fig. 2) and posteriorly on the neck (
Fig. 1b). The lesions in some areas were fragile and there was evidence of shedding in some places, leaving hypopigmented lesions; no vesicles were seen. Her hair, nails, and teeth were normal, as were the musculo‐skeletal, ocular, and central nervous system.

Verrucous lesions of ILVEN affecting the left armpit and groin

image

A diagnosis of nevus depigmentosus with inflammatory linear epidermal nevus to rule out incontinentia pigmenti was made. Skin biopsies were taken from the whorled, hypopigmented, and verrucous patches.

The biopsy result of the hypopigmented patch showed an essentially normal looking epidermis and dermis; there was no melanin incontinence. The verrucous patch showed hyperkeratosis, psoriasiform hyperplasia of the epidermis with regular alternation of parakeratotic areas with hypergranulosis and orthokeratosis with a reduction in the granular layer.
Sweet's syndrome without granulocytosis
Authors: Probert, MD Christine , Ehmann, MD W. , Al‐Mondhiry, MD Hamid , Helm, MD J.
Published: March 2003

Background Sweet's syndrome (SS), acute febrile neutrophilic dermatosis, has been linked to hematologic malignancies and presents with characteristic edematous dermal plaques. Peripheral blood neutrophilia is frequently seen in association with SS and is one of the diagnostic criteria.

Objective To report the clinical, laboratory, and hematologic data of four patients with myeloid leukemia who developed SS after chemotherapy. Three of these patients were neutropenic.

Methods A retrospective study of four patients with SS and hematologic malignancies was undertaken. Three patients had de novo acute myelogenous leukemia and one was in the acute blast crisis of chronic myelogenous leukemia.

ResultsSweet's syndrome was not originally suspected in these patients because of the low peripheral white blood cell counts caused by chemotherapy. All of the patients presented with fevers, arthralgias, and an eruption. They had been treated with antibiotics because of a presumed infection. Once the correct diagnosis was made and oral prednisolone was started, a rapid response followed.

ConclusionsSweet's syndrome should be considered in the differential diagnosis when acute myeloid leukemic patients develop skin lesions and unexplained fevers regardless of the peripheral blood counts.
Capillaropathy and capillaroneogenesis in the pathogenesis of rosacea
Authors: Neumann MD Emil , Frithz MD Anders
Published: March 2003

BackgroundDilatation of vascular vessels in rosacea has generally been attributed to yielding to deranged connective tissue. In contrast, in a previous study a degrading effect of insufficient vascular vessels in connective tissue has been demonstrated in connection with diabetic microangiopathy. In yet another paper, it was demonstrated that the fusing of damaged capillaries, which had lost part of their adjacent walls due to functional inadequacy, led to the formation of dilated vessels. These pathogenetic patterns are the main subjects of this study of rosacea.

Methods Punch biopsies from rosacea lesions were examined by light microscopy and immunochemistry in order to identify structural changes leading to the formation of telangiectasias.

Results Deranged connective tissue is secondary to damaged capillaries. The primary damage may be evoked mostly by environmental influences, mainly the sun.

Conclusions Infections, infestations, and granulomatous formations are not primary in the development of rosacea.
Regional ganglionar metastasis 24 years after surgical resection of a malignant melanoma
Authors: Vignale Raul , Brugnini Silvia , Martinez Miguel , Alonso Omar , Fleurquin Fernando
Published: March 2003

A 40‐year‐old woman, with type I skin, came to the Dermatology Clinic after noticing a tumor in the armpit. The physical examination revealed a hard, stretched‐shaped tumoral node with a diameter of 30 mm, located in the left armpit. It moved on the superficial and deeper layers. In addition, the scar of a large graft was found in the homolateral supraclavicular region, where a malignant melanoma had been excised 24 years earlier. At that time, the primary tumoral lesion had the characteristics of an extensive superficial melanoma with an infiltrating core with vertical growth. The pathologic study of the tumor confirmed the diagnosis of a malignant melanoma with a Clark level II and a 1.17 mm Breslow thickness. Surgery had a margin of 3 cm. At present, the patient is in excellent condition and laboratory tests are normal. Immunologic tests performed showed a slight increase in CD4+, CD45A+, DR+ lymphocytes, CD16+, CD56+, NK cells, and a marked increase in tumor necrosis factor‐α (TNF‐α) and γ‐interferon (IFN‐γ) levels (Table 1). Imaging studies (chest X‐rays, abdominal ultrasound, bone scintigraphy) did not show any abnormal signs. Computerized tomography confirmed the ganglionic mass, without any other abnormalities. Tc‐99m methoxy‐isobutyl‐isonitrile (MIBI) scintigraphy was performed, showing a focally increased concentration of radiomarker in the left armpit, indicating a thick adenopathic conglomerate (Fig. 1). No other areas of abnormal uptake were observed, not even in the original area of the primary tumor. The surgical exploration of the axillar contents confirmed the presence of adenopathies. Pathology studies showed metastatic invasion of intensely melanin‐pigmented and pleomorphic cells, with atypical mitosis.
Drug eruptions in Bangkok: a 1‐year study at Ramathibodi Hospital
Authors: Puavilai Siripen , Choonhakarn Charoen
Published: March 2003

Background As new drugs are introduced onto the market, it is important to determine those that can cause cutaneous reactions and with what frequency. In addition, drugs that have been used for a long period of time may cause new types of eruption that have not been observed previously. The purpose of this study was to evaluate the types of drug eruption and the causative agents in a hospital‐based population for a period of 1 year.

Methods All in‐ and outpatients consulting for drug eruptions at the Dermatology Clinic, Ramathibodi Hospital from June 1995 to May 1996 were included in the study. The history and physical examination were performed by one of the authors. In suspected cases, a skin biopsy was carried out to confirm the diagnosis. Rechallenge tests with suspected drugs were performed with informed consent.

Results One hundred and thirty‐two patients were enrolled in the study. The most common types of drug eruption were maculopapular eruption, fixed drug eruption, and urticaria. Antimicrobial agents were found to be the most common causative drugs, followed by antipyretic/anti‐inflammatory agents and drugs acting on the central nervous system.

Conclusions Although the most common type of drug eruption and the most common causative agents were not different from those found in previous studies, the new generation of antibiotics and antifungal agents were found to be a frequent cause of drug eruptions. New types of drug eruption, such as generalized exanthematous pustulosis and acral erythema, were observed in this study.
Bubble hair – a possible explanation for its distribution
Authors: Krasnoff MD Jennifer , Glusac MD Earl , Bolognia MD Jean L.
Published: March 2003

A 23‐year‐old white woman presented with a circumscribed area of shortened hairs along the anterior hairline. Approximately 1 month previously, the involved hairs had broken abruptly following shampooing. She used a hot air blow dryer for hair styling, but did not use electric rollers or a curling iron. Nor did she bleach, dye, or permanently wave her hair. The patient’s hair styling technique involved wrapping hairs of the frontal hairline over a round brush whilst blow drying. There was no personal or family history of alopecia or scalp infections.

On physical examination, an oval‐shaped area of shortened hairs (5–6 cm in length) was noted along the anterior hairline (Fig. 1). The area of involvement measured 5×4 cm and was to the left of the midline. The texture of the affected hairs was coarser than that of the unaffected hairs, and these broken hairs were somewhat crinkled in appearance. There was no erythema, scale, or discrete areas of alopecia on the scalp. By light microscopy, the broken hairs demonstrated multiple bubbles within the hair shafts (Fig. 2). Some of the bubbles led to the distension of the hair shaft. There was no evidence of trichorrhexis nodosa.
The “gauntlet” of pellagra
Authors: Isaac Shaun
Published: March 2003

A 48‐year‐old alcoholic Filipino man presented to the outpatient department with a 2‐year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health.

Dermatologic examination revealed a browny‐red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry (Fig. 1). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion.

“Gauntlet” of pellagra, showing browny‐red discoloration with sharply demarcated erythematous border

image

A clinical diagnosis of pellagra was made based on the morphology, and treatment with nicotinamide 500 mg daily was instituted. The eruption quickly improved and resolved in 2 weeks (Fig. 2).

Two weeks after treatment, showing rapid clearance of the lesions

image
Early repeeling – a matter of time
Authors: Wolf Ronni
Published: March 2003

Background Repeeling after a short interval in medium‐depth or deep peeling is considered by most experts as hazardous, and is generally contraindicated. Most experts recommend an interval of 6 months or more before repeating the same level of peel. The results are presented of four patients who underwent repeeling after a short interval.

Methods and results All four patients were dissatisfied with their first peel (medium‐depth peel performed with trichoroacetic acid (TCA) 35%). Repeelings were performed using two methods: TCA 30–35% (Cases 1–3) and unoccluded Baker phenol peel (Case 4). On three occasions (Cases 1–3), the patients underwent three peelings at short intervals. All four cases gave excellent objective results.

Conclusions The risk of a second peel shortly after the first is not as high as indicated in the literature, and should not be automatically ruled out. In a selected group of patients who, for various reasons, be persuaded to wait, repeeling after a short interval (2–3 weeks) may solve certain problems and may even make the difference between an unhappy patient and a satisfied one. In performing repeeling after a short interval, one should take into consideration that the skin, particularly the keratin layer, is thinner, so that the degree of penetration of the second peel solution and the peel depth will be greater. It is possible that the scarring reported after repeeling is a result of the disregard of this important factor and, consequently, the use of too high a concentration of peel solution in the second peel procedure.
Kasabach–Merritt syndrome in two successive pregnancies
Authors: Singh Girija , Rajendran Chakrapani
Published: March 2003

A 20‐year‐old Indian Hindu woman, a primigravida at 8 months of pregnancy, presented with symptoms of progressively worsening dyspnea and anasarca of 1 month duration. Physical examination showed signs of severe congestive cardiac failure. She had multiple hemangiomas, 5 cm in size, located over the right temporal region, right side of the chin, right side of the nose, left upper part of the abdominal wall, and anterior aspect of the left leg ( Fig. 1). These hemangiomas had been present since birth and had enlarged considerably during pregnancy. The clinical diagnosis was pregnancy—34 weeks—with multiple hemangiomas and congestive cardiac failure.

Hemangiomas

image

Laboratory investigations revealed hemoglobin (Hb) 11 g/dL, total leucocyte count 7000/mm3, differential count P 60 L 40, random blood sugar 110 mg/dL, blood urea (BU) 34 mg/dL, creatinine 0.9 mg/dL, and serum electrolytes: Na, 130 mEq/L; K, 4 mEq/L; Cl, 110 mEq/L. Electrocardiogram (ECG) was normal. Chest X‐ray showed cardiomegaly with congestion. Echocardiogram (ECHO) showed enlarged right atrium and right ventricle.

The patient was refractory to antifailure therapy and went into labor at the end of 35 weeks of pregnancy and delivered a 1.3 kg male baby. The patient developed post partum hemorrhage and was treated with blood transfusion. During labor, the patient developed purpuric eruption and epistaxis. At that time, the bleeding time was more than

15 min and the platelet count was 46,000. At this juncture, a diagnosis of Kasabach–Merritt syndrome was considered. Skin biopsy revealed hemangiomatous changes. After delivery, the patient’s edema and dyspnea decreased considerably and the eruption disappeared. The hemangiomas regressed in size. A platelet count performed 3 days after delivery was 120,000/mm3. The bleeding time was 7 min, and a chest X‐ray showed the reduction of heart size to normal. ECHO repeated 1 week after delivery showed normal‐sized chambers. Follow‐up as an outpatient showed the patient returning to normalcy. She had a similar presentation during her second pregnancy, 1 year later.
Captopril‐triggered linear IgA bullous dermatosis
Authors: Friedman Ilyse S. , Rudikoff Donald , Phelps Robert G. , Sapadin Allen N.
Published: March 2003

A 57‐year‐old African–American woman with a history of long‐standing asthma, hypertension, and congestive heart failure was referred for an intensely pruritic, blistering eruption of 2 months duration. The blistering began 2 weeks after the initiation of captopril for essential hypertension. It was localized predominantly on the thighs and legs, but had recently spread to the upper extremities. Previously, the patient had been treated with albuterol and furosemide. She had been admitted to the hospital with a diagnosis of acute varicella, which was ruled out by a negative Tzanck preparation. Clarithromycin was prescribed upon discharge.

Physical examination revealed multiple healed and crusted erosions ranging in size from 1 to 7 cm on the anteromedial aspect of the thighs and legs (Fig. 1). Discrete and confluent tense vesicles, some forming arciform or rosette‐like patterns, were noted (Fig. 2). Multiple hypopigmented macules and patches were seen. On the flexural aspect of the forearms, there were multiple small erosions, some of which appeared excoriated. There were no urticarial lesions, and the oral mucosa and scalp were spared.

Multiple healed and crusted erosions on the anteromedial aspect of the left thigh. Hypopigmented macules and patches are also evident

image

Confluent tense vesicles in an arciform arrangement

image

A biopsy specimen of lesional skin from the left thigh revealed epidermal detachment at the dermal–epidermal junction with prominent festooning of dermal papillae. A dense, perivascular lymphohistiocytic infiltrate was present in the underlying dermis (Fig. 3). Well‐defined neutrophilic papillary microabscesses were not identified, nor were eosinophils. Direct immunofluorescence (DIF) staining revealed linear deposition of immunoglobulin A (IgA) at the dermal–epidermal junction (Fig. 4). Indirect immunofluorescence studies of the serum were negative for circulating pemphigus and pemphigoid antibodies. On the basis of these findings, a diagnosis of linear IgA bullous dermatosis was made.

(a) Subepidermal blister with prominent festooning of dermal papillae. (b) Dense, perivascular lymphohistiocytic infiltrate in underlying dermis

image

Deposition of IgA in a linear pattern at the dermal–epidermal junction

image

Despite discontinuation of captopril, the patient continued to develop new blisters. Treatment with dapsone was initiated at a dose of 25 mg t.i.d. Because of continued blister formation, the dose was increased to 50 mg t.i.d. and prednisone was added to the regimen. The latter was tapered over a period of 3 months. For the past year, dapsone has been administered at a dosage of 100 mg b.i.d., and the patient has experienced only occasional blister formation.
Acneiform eruptions after facial beauty treatment
Authors: Khanna Neena , Gupta Siddhartha Datta
Published: March 2003

Background Female patients in the post‐adolescent age group presented with predominantly deep‐seated nodules and a few comedones situated mainly on the cheeks. As most of these subjects related the onset of their symptoms to antecedent facial beauty treatment, we decided to study the clinical and histologic profile of these patients.

Methods Thirty seven subjects (36 women and one man) were questioned in detail about their acneiform eruptions. The patients were examined and a biopsy of typical lesions was taken in eight patients.

Results On direct questioning, all patients related the onset of their lesions to facial beauty treatment taken 3–8 weeks previously. The predominant types of lesion were deep‐seated nodules, although a few closed comedones were present in some cases. Most lesions took a long time to heal and, on healing, left behind hyperpigmentation. The cheeks were universally involved in all patients, and the chin and forehead were involved in 14. The histopathologic study revealed a predominantly peri‐appendageal dermal infiltrate consisting of lymphocytes and histiocytes admixed with polymorphs. A granulomatous infiltrate was seen in one‐third of the biopsies.

Conclusions This eruption is unlike the earlier eruption described as acne cosmetica in being inflammatory, indolent, and often occurring after the first cream massage itself.
Erythema multiforme following the exacerbation of hepatitis B virus infection
Authors: Tabata Nobuko , Kato Taizo , Noguchi Kenji , Ueno Yoshiyuki , Tagami Hachiro
Published: March 2003

Japan A 56‐year‐old Japanese woman suffered from chronic persistent hepatitis, which was HBeAg and hepatitis B virus (HBV) DNA positive. In October 1996, her hepatitis deteriorated and was associated with an increase in the HBeAg titer and HBV DNA concentration. The HBeAg titer and HBV DNA concentration were followed on a monthly basis as shown in Table 1. The serum aspartate transaminase (AST), alanine transaminase (ALT), and total bilirubin reached peaks of 1427 IU/L, 1363 IU/L (8–35), and 2.2 mg/dL (0.2–1.2), respectively. Five weeks later, the patient developed symmetric, well‐demarcated, dark, annular, erythematous lesions on the lower and upper extremities and face. The trunk and mucosal surfaces were spared (Fig. 1). We made the clinical diagnosis of erythema multiforme (EM). The eruption cleared spontaneously within 2 weeks. She had no history of a previous eruption, recurrent throat infections, herpes simplex, or drug exposure.

Serologic data showing the exacerbation of hepatitis B virus infection

 
–10 weeks

*

–5 weeks
–2 weeks

HBV DNA (pg/mL)
32
1100
43

HBeAg (cut‐off index)
0.6
41.8
0.05

HBeAb (inhibition, %)
99.9
36.9
99.9

Weeks before the appearance of skin eruptions.

Symmetric, well‐demarcated, dark, annular, erythematous lesions on the lower extremities

image
Effects of gemfibrozil on in vitro cultured normal human skin explants
Authors: Wolf Ronni , Lo Schiavo Ada , Russo Adolfo , De Angelis Francesca , Ruocco Vincenzo
Published: March 2003

Background Several lipid‐lowering agents, when given topically, show a profound effect on skin morphology. Because of low bioavailability of these drugs for keratinocytes, the incidence is extremely low clinically. The most appropriate way to study the effect of hypolipidemic drugs on keratinocytes is by artificial exposure of the skin to high drug concentrations.

Objective To study the effects of gemfibrozil on the morphology of in vitro cultured normal human skin explants. As gemfibrozil induces barrier disruption by inhibiting epidermal sterologenesis, essential for a competent permeability barrier, it is interesting to investigate the morphologic changes associated with this phenomenon. Studying the epidermal changes induced by lipid‐lowering agents is important, not only because it might lead to a better understanding of the effects of these drugs on keratinocytes, but as it might also unlock the door to a wider knowledge of the pathomechanism of disorders of cornification.

Methods Normal human skin from patients undergoing mastectomy was cultured in the presence of 2, 5, and 10 mM of gemfibrozil for 4 days The morphologic changes were evaluated by three blinded observers. Their reports were matched and collated.

Results The cultured skin in the presence of gemfibrozil showed cell crowding of keratinocytes in the lower part of the epidermis, indicating epidermal hyperplasia and increased proliferation. Intercellular edema with the formation of small cavities in the epidermis, intracellular edema, and vacuolar alteration of keratinocytes in the upper portion of the epidermis were also observed. The intensity of these changes tended to parallel the gemfibrozil concentration. Some dermo‐epidermal detachments did not correlate with the gemfibrozil concentration, but rather with tissue characteristics peculiar to each explant.

Conclusions The morphologic changes caused by gemfibrozil to normal human skin were not characteristic of psoriasis, and included intracellular and intercellular edema in the upper portion of the epidermis and cell crowding, indicating epidermal hyperplasia in the lower portion of the epidermis. The present experimental study gives further support to the hypothesis that hypolipidemic drugs cause an initial break in the barrier function of the epidermis, followed by a physiologic epidermal response, aimed at barrier restoration. This rather nonspecific stimulus to epidermal proliferation may trigger psoriasis in predisposed patients.
Benign symmetric lipomatosis in a Chinese man with bullous pemphigoid
Authors: Ho Man Hon , Lo Kuen Kong , Mbbs .
Published: March 2003

Hong Kong[TAB]A 70‐year‐old Chinese man with biopsy proven bullous pemphigoid was treated with oral prednisolone, 60 mg daily, azathioprine, 100 mg daily, and dapsone, 100 mg daily. Changes were observed in his body build within 2 weeks of steroid treatment.

Clinical examination showed multiple, firm, lobulated, fat‐feeling masses distributed symmetrically on the occiput, neck, shoulder girdle, upper trunk, proximal upper extremities, and supraclavicular fossae ( Fig. 1a,b). The deposits on the neck gave a characteristic, peculiar, “horse‐collar” appearance (
Fig. 2). The legs and lower part of the trunk were spared. The overlying epidermis was normal. The overall appearance was pseudo‐athletic instead of Cushingoid. Multiple, mobile, shotty lesions were palpable along the neck, suspicious of cervical lymph nodes.

Anterior (a) and posterior (b) views of the patient showing symmetric deposition of adipose tissue in the upper trunk, supraclavicular fossae, and proximal upper limbs and typical sparing of the distal extremities

image

A close‐up view of the fat deposits on the occiput showing the characteristic “Madelung’s neck”

image

The patient had been drinking alcoholic beverages for 28 years, with an average daily intake of 4 fluid ounces. There was no history of liver disease or other systemic diseases. No family member had a similar problem.

Excisional biopsy of the neck mass was performed to exclude cervical lymph node metastasis and tuberculosis lymphadenitis. The histology revealed mature adipose tissue only. Complete blood counts were normal. Liver function test showed isolated elevation of γ‐glutamyl transferase of 220 U/L (normal, 9–62 U/L) and low serum albumin of 35 g/L (normal, 44–56 g/L). Hepatitis B surface antigen was negative. These changes were secondary to chronic alcoholism. Fasting urate, blood sugar, and triglyceride were within normal limits. Fasting cholesterol was 6.3 mmol/L (normal, 4.1–6.2 mmol/L) which was slightly elevated.

Ultrasonic examination of the abdomen showed a normal sized liver and spleen. Liver parenchymal echogenicity was slightly increased, compatible with fatty change. Chest roentgenogram was normal. A computed axial tomography (CAT) scan of the thorax and abdomen did not reveal any mass lesion or lymph node.

The whole clinical picture and investigations supported the diagnosis of benign symmetric lipomatosis (BSL). At the time of reporting, bullous pemphigoid was well controlled with prednisolone, 15 mg daily, and BSL remained static.

Discussion
Erythroderma with pemphigus immunofluorescence. An erythrodermic variant of pemphigus?
Authors: Cozzani Emanuele , Balestrero Sonia , Parodi Aurora , Rebora Alfredo
Published: March 2003

A 79‐year‐old woman had suffered from a severe pruritic eruption for 2 years which worsened whenever she was given nonsteroidal anti‐inflammatory drugs (NSAIDs). Treatment with itraconazole, 100 mg/day for 16 days, was of no benefit, while partial remission was obtained with methylprednisolone 4 mg/day.

On examination, she was in good general condition and exhibited several pruritic polycyclic urticarial lesions ( Fig. 1). In a week, from their initial localization at the trunk and limbs, her lesions spread centrifugally to eventually involve the whole body. Oral lesions were not present.

Erythematous polycyclic lesions of the leg

image

Routine laboratory tests, including those directed to the detection of a possible neoplasm, were normal. Eosinophils were 800/mL. Three biopsies were taken 1 week apart. All revealed only a mild epidermal hyperplasia and a lymphocytic infiltrate in the superficial dermis, with some neutrophils and eosinophils. No acantholysis or spongiosis was observed.

Direct immunofluorescence (DIF) performed on lesional skin disclosed deposits of both immunoglobulin G (IgG) and C3 in the intercellular spaces (ICS) of the entire epidermis ( Fig. 2), and deposits of both IgM and C3 in the vessel walls. Three serum specimens were taken simultaneously with biopsies to detect anti‐ICS antibodies. Anti‐ICS antibodies were not found in the serum by indirect immunofluorescence (IIF) with monkey esophagus as substrate and by immunoblotting (IB) on epidermal extract.

Deposits of IgG in the intercellular spaces of the epidermis

image

Because of the DIF features, the patient was diagnosed as having pemphigus and given 2 mg/kg/day prednisone. The lesions cleared after 1 month. During disease remission, however, IIF became positive disclosing IgG anti‐ICS antibodies at a serum dilution of 1/40 and, 6 months later, when the patient was taking 5 mg/day prednisone, the IgG titer rose to 1/80. After a further 2 months, when the patient was in clinical remission, IIF was again negative.
Ecthyma gangrenosum
Authors: Güçlüer Hülya , Ergun Tülin , Demirçay Zeynep
Published: March 2003

Case 1. An 18‐year‐old white man with AML‐M3 received allogeneic bone marrow transplantation (BMT) in August 1997. On the seventh day of BMT, he developed chills, fever (39.1 °C), anorexia, and perirectal pain. On physical examination, a hemorrhagic bulla and “punched out” ulceration were observed on the perirectal region. Subsequently, the ulcer was surrounded by a red, swollen, tender, cellulitic plaque (Fig. 1).

The ulceration on the perianal region of the first patient

image

Laboratory analyses showed leukopenia (200/mm3 ) with anemia (hemoglobin (Hb), 10.5 g/dL) and thrombocytopenia (17,000/mm3 ). Tzanck test of the lesion was negative. The direct examination of the ulcer material revealed leukocytes and Gram‐negative bacilli, but no pathogen grew on culture. Blood and catheter cultures revealed Pseudomonas aeruginosa. Intravenous imipenem, 2 g/day, and amikacin, 1 g/day, were started. The lesion resolved within 3 weeks following antibiotic treatment and surgical debridement.
Nevus sebaceous syndrome
Authors: Jang In Gang , Choi Jung Min , Park Kee Woan , Kim Si‐Yong
Published: March 2003

A 10‐day‐old boy presented with an 11‐cm × 7‐cm asymptomatic well‐demarcated alopecic verrucous yellowish plaque on the right temporoparietal area, a 5‐cm × 3‐cm verrucous yellowish plaque on the forehead, and a linear plaque extending from the forehead to the nose ridge present since birth. He also had a 2‐cm pedunculated mass from the right bulbar and tarsal conjunctiva ( Fig. 1). The gestational age was 39 weeks and 5 days and he weighed 4.04 kg at birth. No abnormalities were observed upon physical examination except for the cutaneous and optical findings. An examination of the fundus revealed macular agenesis and peripapillary atrophy (
Fig. 2). No family history was revealed. The results of laboratory tests, including complete blood count, blood chemistry, immunochemical study, screening test for inborn metabolic disorders (methionine, leucine, phenylalanine, galactose, thyroid hormone, thyroid stimulating hormone), and antibody tests to TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes virus), were normal. The results from the chromosomal study, brainstem auditory evoked potential, and visual evoked potential were normal. Chest and skull X‐ray did not show any abnormal signs. Orbit and brain magnetic resonance images showed findings suggesting a lipodermoid cyst from the right eyeball and subdural hygroma or arachnoid cysts in both of the frontal and both of the temporal areas (
Fig. 3). The histopathologic examination of a lesional biopsy specimen revealed hyperkeratosis, papillomatosis in the epidermis, large numbers of sebaceous glands of various sizes, and immature hair structures in the dermis.

Asymptomatic verrucous yellowish alopecic plaque on the right frontal temporoparietal area and linear verrucous yellowish plaque on the nose. Solitary 2‐cm pedunculated mass from right tarsal and bulbar conjunctiva

image

Fundus photograph reveals macular agenesis and peripapillary atrophy

image

Widening of the cerebrospinal fluid (CSF) space is noted at the bilateral anterior temporal fossa and bilateral frontal area, suggesting subdural hygroma or arachnoid cyst

image
Pyloric atresia with junctional epidermolysis bullosa(PA‐JEB) syndrome: absence of detectable β4 integrin and reduced expression of epidermal linear IgA dermatosis antigen
Authors: Kim Jeong Nyun , Namgung Ran , Kim Soo‐Chan , Lee Min Geol , Lee Jin Sung , Lee Chul
Published: March 2003

A newborn girl with pyloric atresia with junctional epidermolysis bullosa (PA‐JEB) developed vomiting and blisters after birth. Radiography revealed pyloric atresia, and a resection of atretic segment and gastroduodenostomy were carried out at 4 days after birth. Physical examination revealed multiple bullae on the trunk and extremities ( Fig. 1). Light microscopy of a skin biopsy specimen showed subepidermal bullae with few inflammatory cells. Electron microscopy showed separation in the lamina lucida and rudimentary hemidesmosomes (
Fig. 2). A direct immunofluorescence (IF) mapping study was negative for immunoglobulin G (IgG), IgA, IgM, C3, and fibrin. To determine the cleavage level, an IF mapping study was performed on 6 μm cryostat sections of a frozen skin biopsy specimen, using bullous pemphigoid (BP) antibody, monoclonal antibody against type IV collagen (Dako, Copenhagen, Denmark), monoclonal antibody (LH 7.2) against type VII collagen (Serotec, Oxford, UK), and epidermolysis bullosa acquisita (EBA) serum. The staining for BP was identified on the epidermal side. The staining for monoclonal antibody against type IV collagen, type VII collagen, and EBA was identified on the dermal side. This pattern was compatible with the diagnosis of JEB. We also performed an IF mapping study using GB3 monoclonal antibody (Sera Laboratory, Cambridge, UK), which recognizes laminin 5 monoclonal antibody against β4 integrin (Chemicon, Los Angeles, CA), and linear IgA dermatosis (LAD) antibody, which binds to the epidermal side of salt‐split skin substrate (
Fig. 3). The patient’s skin has normal laminin 5 expression, but an absence of detectable β4 integrin and reduced epidermal LAD antigen expression. Despite nutritional support with parenteral nutrition and special formula feeding, chronic diarrhea and bloody mucoid stools persisted and malnutrition was not improved.

Photograph of the patient with pyloric atresia with junctional epidermolysis bullosa (PA‐JEB). Multiple bullae are seen on the trunk, shoulder, and areas exposed to pressure and minor trauma. The operation scar for pyloric atresia is seen on the abdomen

image

Electron microscopic findings: reduced number of hemidesmosomes were found at basal cells

image

Immunofluorescence analysis of the patient (right column) compared with normal skin (left column), A, B, GB3 Ab; C, D, β4 integrin; E, F, LAD serum. The skin of the patient has normal laminin 5 expression, but an absence of detectable β4 subunit at reduced LAD antigen expression

image
Squamometry in seborrheic dermatitis
Authors: Piérard‐Franchimont Claudine , Willemaers Valentine , Fraiture Anne‐Laure , Piérard Gérald E.
Published: March 2003

Background Seborrheic dermatitis is a corticosteroid‐responsive condition. Topical corticosteroids exhibit distinct activities according to the type and cellular site of action of the hormone and its vehicle. The latter influences not only drug penetration, but also the structure and function of the horny layer.

Objective The present study compared the early response of seborrheic dermatitis to two topical corticosteroids using objective quantifications of the stratum corneum alterations.

Method Squamometry was used to supplement the clinical assessment of the therapeutic activity of 0.1% hydrocortisone butyrate in an oil‐in‐water emulsion (Locoid Crelo®) and 0.05% betamethasone 17–21 dipropionate lotion (Diprosone® lotion).

Results The hydrocortisone butyrate formulation had a faster onset of efficacy as documented by a greater improvement of lesions after a 1‐week twice‐daily treatment. Clearance or marked improvement was observed in the two treatment groups at completion of the 2‐week trial.

Conclusions As the ranking of the clinical efficacy was not predicted by the intrinsic anti‐inflammatory potency of the steroids, it is suggested that the vehicle contributed itself to the global in vivo efficacy. The anti‐inflammatory action of hydrocortisone butyrate appears to be synergistically implemented by the emollient effect of the specially designed oil‐in‐water emulsion.
Prurigo pigmentosa
Authors: Gürses Leyla , Gürbüz Oya , Demirçay Zeynep , Kotilogˇlu Esin
Published: March 2003

Case 1 A 28‐year‐old woman with skin type 2 was first seen in May 1997 with a 10‐year history of a recurrent pruritic eruption in the intermammary area. Her medical history was not significant regarding a systemic disease or a triggering factor that could have been related to her eruption. Results of laboratory investigations, including peripheral blood cell counts, liver and renal function tests, blood glucose levels, and urinalysis, were within normal limits. Physical examination revealed erythematous papules and reticulated hyperpigmentation in the intermammary area. Histopathologic examination from an erythematous papule showed parakeratosis, mild acanthosis, spongiosis, dyskeratotic keratinocytes, and focal vacuolar degeneration of basal keratinocytes within the epidermis; and perivascular lymphocytic infiltrate and pigment incontinence within the upper dermis
(
Fig. 1). Following an initial treatment with topical corticosteroid for 2 weeks with a partial response, doxycycline was started in 200 mg daily doses for 3 weeks. The eruption resolved leaving marked residual hyperpigmentation within 3 weeks. No recurrence has been observed over the past 6 months.

Biopsy of an erythematous papule revealed parakeratosis, mild acanthosis, spongiosis, necrotic keratinocytes (double arrows), and focal vacuolar alteration of the basal layer (single arrows) (hematoxylin and eosin stain; original magnification, × 100)

image

Case 2 A 23‐year‐old woman with skin type 3 presented in June 1997 with a 2‐month history of a recurrent pruritic eruption on her chest. She denied any provoking factor that could have been responsible for her eruption. Her examination revealed erythematous papules and reticulated hyperpigmentation localized to the inframammary area
(
Fig. 2).Skin biopsy showed focal parakeratosis, minimal acanthosis, spongiosis, and a lymphocytic infiltrate around the blood vessels of the upper dermis. The lesions resolved spontaneously leaving residual reticulated hyperpigmentation within 2 weeks. The following course of her lesions is not known as she was lost to follow‐up.

Reticulated hyperpigmentation in the inframammary area

image
Improvement in psoriasis after intradermal administration of heat‐killed Mycobacterium vaccae
Authors: Balagon Maria V. , Walsh Douglas S. , Tan Paul L. , Cellona Roland V. , Abalos Rodolfo M. , Tan Esterlina V. , Fajardo Tranquilino T. , Watson James D. , Walsh Gerald P.
Published: March 2003

Background New treatments for psoriasis are being developed, but many are associated with limited efficacy, side‐effects, or rapid recurrence after discontinuation. Thus, the aim of new agents is to induce longer term remissions with fewer side‐effects. Preliminary studies have shown that Mycobacterium vaccae, a nonpathogenic organism prepared as a heat‐killed suspension, may induce periods of remission in some psoriasis patients when administered intradermally.

Methods To further assess the efficacy and tolerability of M. vaccae in patients with moderate to severe psoriasis (psoriasis area and severity index (PASI) of 12–35), we conducted an open label study whereby 24 patients received two intradermal inoculations of M. vaccae in lesion‐free deltoid skin, separated by a period of 3 weeks.

Results Twelve weeks after starting treatment, 14 of 24 patients (58%) showed marked improvement in the PASI score (greater than 50% reduction), two had moderate improvement (25–50% reduction), six were unchanged (< 25% reduction), and two had worsened (> 5% increase). By 24 weeks, 11 of 22 patients continued to show greater than 50% improvement. Five patients had complete clearance of skin lesions that lasted for at least 6 months.

Conclusions Intradermal administration of heat‐killed M. vaccae suspension was well tolerated and induced clinically significant improvement in a majority of psoriasis patients in this cohort. Placebo‐controlled testing to further define the efficacy of this treatment is warranted.
Non malignant superior vena cava syndrome
Authors: Musumeci Maria Letizia , De Pasquale Rocco , Tedeschi Aurora , Neri Sergio , Micali Giuseppe
Published: March 2003

A 62‐year‐old woman was admitted to our clinic for the evaluation of 2.5‐year history of progressive exertional facial flushing, and swelling of the head, face, and neck. Three years earlier, she had undergone implantation of a definitive pacemaker with an endocardial ventricular lead for a severe bradycardia. Physical examination revealed facial swelling and erythema including the periorbital areas, distended neck and edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules were present on the ventral upper thoracic wall interspersed with patches of intense flush and large areas of normally colored skin (Fig. 1). There had been no weight loss within the previous months. History of angioedema, allergic reactions, autoimmune diseases, or medication was negative. Enlarged lymph nodes were not detected. Complete blood cell count, fibrinogen, Quick's test for prothrombin, antithrombin III, C‐reactive protein, lipidic profile, renal functions, urinanalysis, and thyroid function test were within normal ranges. Standard X‐ray and sectional radiography of the chest revealed no lung diseases or alterations of the mediastinum. Doppler examination of the supraaortic trunks and chest CT scan showed normal findings. A diagnosis of superior vena cava syndrome (SCVS) was suspected and a cavography was performed, by injecting contrast medium simultaneously through the basilic veins, that revealed marked narrowing of the confluence of the two brachiocephalic veins at the junction of the internal jugular and right subclavian veins with a total obliteration of the right brachiocephalic vein (Fig. 2). The diagnosis of pacemaker‐induced SVCS was confirmed and the woman was referred for angiosurgery.

Presence of edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules on the ventral thorax wall interspersed with patches of intense erythema and large areas of normally colored skin were present

image

Cavography showing obliteration of the right brachiocephalic vein at its confluence with the left brachiocephalic vein

image
Primary cutaneous nocardiosis associated with intra‐articular corticosteroid injection
Authors: Aydıngöz İkbal E. , Candan İnci , Dervent Barış , Hitit Gülden
Published: March 2003

A 65‐year‐old woman presented to our clinic with a 2‐month history of papulopustular lesions on her right hand that had progressively increased in size and number. She had a 15‐year history of psoriasis vulgaris and had developed digital arthralgias within the preceding few months. A diagnosis of psoriatic arthropathy was made and she was treated by multiple intra‐articular steroid injections on the back of the right hand. One month after the last injection, the lesions had developed over the treatment area. The patient had no apparent history of trauma, but had grown flowers for years.

Dermatologic examination revealed three fluctuating, erythematous, superficial, scaling nodules, measuring 0.5‐1.5 cm, on the second and fourth metacarpal bones and on the proximal phalanx of the fourth finger. Many scattered papulopustular lesions were also present on the back of the right hand (Fig. 1).

Nodules and papulopustular lesions found on the back of the right hand on admission

image

Routine laboratory investigations, including urine analysis, complete blood count, sedimentation rate, glucose, liver function tests, renal function tests, total protein, and albumin were within normal limits. Chest X‐ray and right hand roentgenogram were normal. Microbiological examination of the aspiration fluid obtained from the nodules revealed Gram‐positive, acid‐resistant, filamentous bacteria with fine branching. The isolates were grown within a few days in blood agar and within a week in Lowenstein‐Jensen medium. The microorganism was identified as Nocardia brasiliensis.

The patient was given trimethoprim/sulfamethoxazole (160/800 mg) twice daily for 6 weeks. It later became evident that the patient had stopped the treatment within 3 weeks, when a dramatic improvement was observed (Fig. 2). No recurrences were noted at 15 months.

Clinical appearance of the hand after treatment

image
A case of cutaneous lymphangiectasis secondary to breast cancer treatment
Authors: Kaya Tamer Irfan , Kokturk Aysin , Polat Ayse , Tursen Umit , Ikizoglu Guliz
Published: March 2003

A 55‐year‐old woman presented to our outpatient clinic for evaluation of multiple small papulo‐vesicular lesions on the left axillae. She had a history of carcinoma of the left breast in 1997 and had undergone radical mastectomy. One month postoperatively she also received radiation therapy.

Physical examination revealed multiple raised, pinkish‐red, papulo‐vesicular lesions on the left axillae. The lesions were located within the field that received radiation therapy. The lesions were not associated with the mastectomy scar but were located through or parallel to the skin folds, mildly inflamed and their surfaces macerated. Due to the presence of maceration and inflammation, there was a burning sensation in the affected areas. She also had moderate lymphedema of her left arm.

A small cluster of the lesions was excised for microscopic examination and the intertrigo was treated. Hemotoxylin and eosin stained sections of the lesions revealed ectatic lymphatic spaces in the papillary dermis. They were lined by normal endothelial cells. The overlying epidermis was hyperkeratotic. There was a severe, chronic inflammatory cell infiltration in the subjacent dermis (Fig. 1). With these clinical and histological findings the patient was diagnosed as cutaneous lymphangiectasis (CL).

Ectatic lypmhatic spaces in the papillary dermis with subjacent chronic inflammatory cell infiltrate (Hematoxylin and eosin stain, ×100)

image

Multiple lesions were anesthetized and treated with electrodessication. At 1 month follow up, no recurrence was observed. Six months later there was no recurrence at the sites of electrodesicated and excised lesions but new lesions were observed. Oozing of clear fluid was observed from these new lesions (Fig. 2). The lesions were treated with electrodessication and daily massage therapy was advised for the treatment of lymphedema. The patient responded well to massage therapy and the lymphedema regressed gradually. There was no recurrence of the skin lesions after 1 year.

Oozing of clear fluid from papulovesicular lesions on the left axillae

image