bluuebunny/crossref_metadata_2025 huggingface dataset:
LEUKOCYTE‐EXTRACELLULAR MATRIX INTERACTIONS IN PSORIASIS
Authors: EL‐SHERIF ABDALLA I. , KRUPINSKI ARKADIUSZ , MAJEWSKI SLAWOMIR , JABLONSKA STEFANIA
Published: May 2007

Background. The basic phenomenon in psoriasis appears to be a directed leukocyte migration that in a great part, depends on the cell‐extracellular matrix (ECM) interactions.

Methods. To evaluate the leukocyte‐ECM interactions in psoriasis, we investigated the adherence of peripheral blood mononuclear cells (PBMC) and polymorphonuclear leukocytes (PMNL) to ECM components (collagen type I, IV, laminin, and fibronectin), using crystal violet staining and measuring absorbance at 570 nm.

Results. In the most active cases of psoriasis (pin‐point and guttate type) of short duration, we found a decreased adherence of PBMC to collagen type IV. In a majority of cases of actively spreading plaque psoriasis of large extent and longer duration, there was decreased adherence to all ECM components, especially to collagen type IV and laminin. The adhesion of PMNL to collagen type IV (but not to other ECM components) was increased only in cases of short duration. Preliminary data suggest that etretinate treatment may modulate leukocyte adherence to the ECM components in patients with psoriasis.

Conclusions. The decreased in vitro adherence of PBMC to ECM components, especially those of the basement membrane, may reflect their in vivo activation and migration to the epidermis, which is a basic phenomenon in psoriasis that could be affected by etretinate therapy.
IMMUNOLOGIC PARAMETERS IN SYSTEMIC SCLEROSIS
Authors: BRUNS MARCO , HERRMANN KONRAD , HAUSTEIN UWE‐FRITHJOF
Published: May 2007

Background. Immunologic abnormalities seem to play an important role in systemic sclerosis (SSc).

Methods. We studied the following immune parameters to get more insight into SSc: autoantibodies (antinuclear antibodies (ana), anti‐Scl‐70, anticentromere antibodies (aca) subsets of lymphocyte subpopulations and markers of their activation, as well as serum levels of il‐2, the soluble il‐2 receptor (sil‐2r), il‐6 and its correlation to N‐terminal procollagen‐Ill propeptide (piiip), and finally, the il‐6 production by SSc and normal dermal fibroblasts.

Results. In patients with active SSc, we found a reduced number of cd2+ T‐lymphocytes and an increase in the expression of T‐lymphocyte activation markers such as cd25+ and cd71+, hla‐dr la, as well as elevated serum levels of sil‐2lr and il‐6. SSc fibroblasts did not produce more il‐6 than normal fibroblasts in monolayer cultures.

Conclusions. Our data show that a wide range of immunologic parameters are altered in SSc. In general, T‐helper (th) lymphocytes are activated possibly because of reduced T‐suppressor (ts) and natural killer (nk)‐cell levels, TH may polyclonally stimulate B cells, which in turn produce higher amounts of autoantibodies. Our findings support the concept that TH cell‐derived cytokines/growth factors stimulate matrix protein synthesis by fibroblasts, resulting in generalized fibrosis.
CIGARETTE SMOKING IS NOT A RISK FACTOR IN ATOPIC DERMATITIS
Authors: MILLS CAROLINE M. , SRIVASTAVA EMANUEL D. , HARVEY IAN M. , SWIFT GILLIAN L. , NEWCOMBE ROBERT G. , HOLT PETER J.A. , RHODES JOHN
Published: May 2007

Background. In recent years several diseases have been shown to have a relationship with smoking. Psoriasis is largely a disease of smokers, whereas acne appears to be associated with not smoking.

Methods. One hundred and fifty patients with atopic dermatitis were sent a postal questionnaire on smoking habits and the results were compared with those from matched controls in the local community.

Results. One hundred and twenty‐seven patients (85%) completed the questionnaire. There was no apparent difference in the prevalence of current smokers amongst atopic dermatitis patients compared with controls (odds ratio = 1.1, 95% confidence limits 0.65–1.86, P = 0.8).

Conclusions. There was no significant difference between the smoking prevalence of patients with atopic dermatitis and matched controls.
RHINOPHYMA IN JAPAN
Authors: FURUKAWA MASAYOSHI , KANETOU KIMIKO , HAMADA TOSHIO
Published: May 2007

Background. Rhinophyma is an end stage of acne rosacea. It results in a large nose due to a proliferation of sebaceous glands and fibrous tissue. Many cases of rhinophyma have been reported in the Western world; however, in Japan, rhinophyma has been an uncommon disease.

Methods. We present two patients associated with rhinophyma who were treated by cross‐shaped full‐thickness excision followed by direct closure and compare the rhinophyma in Japan with that in the West.

Results. To date, only 20 rhinophyma cases including our 2 cases have been reported in Japan. Epidemiologic factors of rhinophyma between the West and Japan do not differ except for location, malignancy and surgical treatment.

Conclusions. In Japan, almost all cases are located on the lower half of the nose, treated by full‐thickness excision followed by application of either skin grafts or direct closure. None have been malignant.
EPIDEMIC CUTANEOUS SPOROTRICHOSIS
Authors: CAMPOS PABLO , ARENAS ROBERTO , CORONADO HELIODORO
Published: May 2007

Background. Sporotrichosis is a subcutaneous fungal infection. Lymphocutaneous and fixed sporotrichosis are the most common forms; cases of disseminated sporotrichosis are rare. There have been isolated reports and some epidemic familial outbreaks of the infection.

Methods. We studied four members of two families who contracted sporotrichosis after sleeping in an old and rust‐stained camping tent.

Results. All cases presented with polymorphic lesions, three of them with multiple sites of inoculation. The camping tent was shown to be the source of infection.

Conclusions. We report an epidemic of sporotrichosis in a family. In three cases disseminated cutaneous sporotrichosis occurred in nonimmunodeficient patients. The isolate of Sporothrix schenckii from a camping tent is extremely rare.
ISOTRETINOIN THERAPY IN ACNE VULGARIS: A 10‐YEAR RETROSPECTIVE STUDY IN SINGAPORE
Authors: SHAHIDULLAH MOHAMMED , THAM SIEW NEE , GOH CHEE‐LEOK
Published: May 2007

Background. The use of isotretinoin, a first generation synthetic retinoid, in the treatment of patients with severe acne vulgaris was a major therapeutic advance in dermatology. This 10–year retrospective study reviews the effectiveness of isotretinoin in patients with acne vulgaris seen in a skin clinic in Singapore.

Methods. The case records of 250 cases of severe inflammatory and nodulocystic acne treated with isotretinoin were analyzed with reference to the demographic data, response to isotretinoin, dosage and cost of isotretinoin used, adverse effects, clinical follow‐up, and relapse.

Results. Two hundred and fifty patients, 171 men (68.4%) and 79 women (31.6%), with different types and grades of acne vulgaris were studied. The dose of isotretinoin used ranged from 0.33 to 1.0 mg/kg/day (median 0.5 mg/kg/day) for a period ranging from 1 to 12 months (median 4 months). Response was excellent in 127 (50.8%) patients, good in 86 (34.4%), fair in 30 (12.0%) and poor in 7 (2.8%). Relapse occurred in 14 (5.6%) patients over a 6–month follow‐up period. Adverse effects were noted in 140 (56.0%) patients and were mild in most cases. Eighteen (7.2%) patients had to discontinue the drug due to significant side effects.

Conclusion. This study confirms that isotretinoin is very effective for severe acne, and complete remission can be induced in more than 90% of cases even with lower dosage regimens. Significant clinical improvement can be achieved with the use of lower doses (mean 0.5 mg/kg/day) for an average of 4 months of treatment with lower risk of adverse effects.
LOCALIZED LEPROMATOUS LEPROSY AND ITS RESPONSE TO CHEMO‐IMMUNOTHERAPY
Authors: BEENA K. R. , ZAHEER S.A. , GULERIA I. , MUKHERJEE R. , TALWAR G.P. , MUKHERJEE A. , RAMESH V. , MISRA R.S.
Published: May 2007

Background. This is an unusual presentation of lepromatous leprosy (ll) in a young boy, 12 years of age. The study forms part of a large scale immunotherapeutic trial with Mycobacterium w (M.w) antileprosy vaccine. The trial is being conducted in two major hospitals in New Delhi, India.

Materials and Methods. This patient presented with three lesions: one on each forearm and the third on the left leg. He was classified initially as borderline tuberculoid leprosy. Slit‐skin smears and histopathology from the lesions proved the diagnosis to be lepromatous leprosy with a bacterial index (bi) 6+. The initial lepromin test was negative. The patient was treated with chemo‐immunotherapy (standard multidrug therapy and immunotherapy with Mycobacterium w vaccine).

Results. Investigations after 1 year (15 months) of multidrug therapy and three doses of vaccine, showed a remarkable fall in the bi from 6 to 0 in the lesions, a lepromin positivity of 5 mm, and a histological upgrading from lepromatous leprosy to borderline tuberculoid. Immunologic studies at 15 months revealed a good LTT response and high levels of cytokines, specifically IL‐2 and IFN‐γ.

Conclusions. This report presents an LL patient with disease limited to a few sites. It stresses the importance of slit‐smear and biopsy in all patients of leprosy, and it highlights the upgrading observed on administration of chemo‐immunotherapy.
CLINICAL AND HISTOPATHOLOGIC SPECTRUM OF PILOMATRICOMAS IN ADULTS
Authors: KADDU STEVEN , SOYER H. PETER , CERRONI LORENZO , SALMHOFER WOLFGANG , HÖDL STEFAN
Published: May 2007

Background. Pilomatricomas are benign cutaneous neoplasms with differentiation toward hair matrix. Although previously reported to occur mostly in children and young adults, Taaffe et al. recently observed a second onset peak in adults and the elderly.

Methods. To study the clinical and histopathologic features of pilomatricomas in adults we analyzed files and histologic sections of all cases of pilomatricomas seen at the Department of Dermatology, University of Graz, Graz, Austria, between January 1980 and December 1990.

Results. A total of 118 patients were identified, 58 of whom were >45 years of age. The clinical features of patients >45 years of age were generally similar to those of patients <45 years of age. Differential diagnoses in both groups were also comparable except in some cases of the older study‐group where differential diagnoses included basal cell carcinoma, keratoacanthoma, and metastasis. Recurrence of the lesions after simple excision was observed in one patient >45 years of age. Histopathologically, lesions in both age groups showed similar features except in four lesions of the older patients where “atypical” features were present. The histopathologic differential diagnosis of the lesions with “atypical” features included pilomatrical carcinoma, basal cell carcinoma with matrical differentiation, and matricoma.

Conclusions. Our study reveals the relatively frequent occurrence of pilomatricomas in adults and the elderly. Pilomatricoma should be considered along with other benign and malignant conditions in the clinical differential diagnosis of solitary, firm skin nodules presenting in adults and the elderly, especially on the head and neck.
PHOTOGRAPHY WITHOUT FILM: LOW‐COST DIGITAL CAMERAS COME OF AGE IN DERMATOLOGY
Authors: SASSON MARVIN , SCHIFF THEODORE , STILLER MATTHEW J.
Published: May 2007

Background. Photography is integral to the practice of dermatology. Digital imaging techniques have only recently been used to assess cutaneous disorders. Previously reported imaging systems have been both expensive and cumbersome. Consequently, they have failed to gain widespread acceptance.

Methods. We describe our experience using an inexpensive digital camera. Photographs taken with this portable digital camera (FotoMan) compare favorably to those obtained with conventional 35 mm cameras.

Results. This inexpensive digital camera provides photographs of acceptable quality for a variety of dermatologic applications. Images created with this system are available within minutes and are less expensive than traditional photographs.

Conclusions. Digital imaging is a new and exciting development. The digital camera described is simple to operate and provides a useful alternative or adjunct to conventional photography.
AN OUTBREAK OF PHYTOPHOTODERMATITIS DUE TO CELERY
Authors: FINKELSTEIN EVE , AFEK UZI , GROSS ELLIS , AHARONI NEHEMIA , ROSENBERG LIOR , HALEVY SIMA
Published: May 2007

Background. Celery is known to contain psoralens, a group of substances that cause a toxic dermal reaction on exposure to ultraviolet A rays (uva). An outbreak of phytophotodermatitis amongst 11 workers in a celery harvest in southern Israel is reported.

Methods. Analysis of the trigger factors was carried out. The patients were questioned regarding their working conditions. Samples of the celery that the workers had been harvesting were analyzed for levels of total psoralens by means of high performance liquid chromatography (hplc). Levels of uva were measured.

Results. It was found that the celery harvested in the south of the country contained 84 μg/g fresh weight (f.wt.) total psoralens as compared to 35 μg/g f.wt. in celery harvested in the north of the country at the same time. The following year the celery harvested in the south contained only 26 μg/g f.wt. total psoralens.

Conclusions. Multiple factors contributed to the outbreak of phytophotodermatitis. A late harvest in the south of the country is incriminated as the cause of the unusually high levels of psoralens in the celery of that year.
HYALURONIC ACID IN CUTANEOUS INTRINSIC AGING
Authors: GHERSETICH ILARIA , LOTTI TORELLO , CAMPANILE GRAZIA , GRAPPONE CECILIA , DINI GERMANA
Published: May 2007

Background. In elderly individuals all components of the skin and subcutaneous tissue undergo histologic and ultra‐structural changes. The turgidity of the dermis appears decreased, presumably due to altered patterns and levels of glycosaminoglycans (GAGS), especially hyaluronic acid and dermatan sulfate that are the most common. A linear, age‐related decrease in the content of GAGS (mainly hyaluronic acid) has been hypothesized in human aged skin.

Methods. We used the cationic dye Alcian Blue to selectively stain hyaluronic acid within the dermis in old and young subjects to compare ultrastructurally its topography and variations with age.

Results. We demonstrated a progressive reduction in the number of electron‐dense granules of hyaluronic acid and of their filaments until they were completely absent in subjects aged 60.

Conclusions. We propose that the variations of the levels of hyaluronic acid in the dermis in aging could account for some of the most striking alterations of the aged skin, including decreased turgidity, less support for microvessles, wrinkling, and altered elasticity.
BOOK REVIEWS
Authors: Maguire Henry , Ruocco Vincenzo
Published: May 2007

Malignant Melanoma. E. Holzle, P. Kind, G. Plewig, and W. Burgdorf.

Differential Diagnosis in Dermatology. 2nd Edition. Richard Ashton and Barbara Leppard.
ABSENCE OF MERKEL CELLS IN LESIONAL SKIN
Authors: BOSE SUMIT KUMAR
Published: May 2007

Background. In vitiligo, other than loss of melanocytes and melanin pigment in the lesional skin, keratinocytes are also Involved. Human fetal Merkel cells are now generally considered to be derived from the epidermis.1 To date, no observations on Merkel cells in lasional skin of active vitiligo have been reported.

Methods. Merkel ceils were identified by indirect immunofluorescence microscopy using the monoclonal antibody TR0MA1.

Results. No TROMA 1‐positive cells were observed in the vitiliginous skin lesions in any of the specimens examined, whereas normal numbers of these cells were seen in the adjacent pigmented skin.

Conclusions. This finding suggests that the processes that lead to damage of keratinocytes in vitiligo also involve other keratin‐expressing cells such as the Merkel ceils.
IN VITRO INTERACTIONS OF NEOMYCIN SULFATE, BACITRACIN, AND POLYMYXIN B SULFATE
Authors: BOOTH JANE H. , BENRIMOJ SHALOM I. , NIMMO GRAEME R.
Published: May 2007

Background. Neomycin sulfate, bacitracin, and polymyxin B sulfate have been combined in topical preparations to provide a complementary antimicrobial spectrum for the prevention of minor wound infections. The advisability of the inclusion of neomycin sulfate has been questioned since it may cause contact sensitization.

Methods. To assess the value of neomycin, microdilution checkerboard titrations were used to determine the in vitro interactions between two‐antibiotic and three‐antibiotic combinations against reference strains of bacteria commonly associated with wound infections. Using Fractional Inhibitory Concentration (FIC) indices (< 0.5 indicates synergism with two‐drug combinations), the combination of neomycin/bacitracin was synergistic for both S. aureus and Ps. aeruginosa; neomycin/polymyxin B was synergistic for E. faecalis, and the bacitracin/polymyxin B combination was synergistic against Ps. aeruginosa. A three‐drug combination of neomycin/bacitracin/polymyxin B had FIC values of < 1 for all organisms, indicating synergy and substantiating the clinical role of neomycin sulfate in current topical formulations.

Results. Neomycin has the lowest safety profile of the drugs in this combination. A replacement agent should ideally have similar or superior synergistic capabilities with the remaining drugs and contribute to the therapeutic efficacy of the preparation. Additionally, because of the strongly synergistic tendencies displayed by the three‐drug combination, it may be possible to reduce the antibiotic concentrations present in current formulations.

Conclusion. By developing this concept, there is potential for the formulation of topical preparations to be based on a sound theoretical and clinical rationale.
VERRUCOUS CARCINOMA OF THE LIP ORIGINATING ON THE VERMILION BORDER
Authors: FLORIN ELIZABETH H. , KOLBUSZ ROBERT V. , GOLDBERG LEONARD H.
Published: May 2007

A 57‐year‐old white man with a long history of smoking presented with a warty growth on his lower lip that had been slowly enlarging for several years. The tumor had replaced the entire vermilion border of the lip but did not appear to invade the deeper tissues or the mucosa (Fig. 1). A biopsy was consistent with verrucous carcinoma. Excision via Mohs micrographic surgery was performed and examination of the tissue confirmed the diagnosis of verrucous carcinoma (Fig. 2).
ERYTHROMELANOSIS FOLLICULARIS FACIEI ET COLLI
Authors: SODAIFY MANOUCHEHR , SODAIFY SODAIFY , HANDJANI FARHAD , SOTOODEH MASOOD
Published: May 2007

Three Iranian men of light complexion, aged 15, 18, and 28, were seen in 1992. All three patients were referred with the chief complaint of increasing pigmentation over both cheeks since childhood. The pigmentation had gradually extended to involve the preauricular areas bilaterally. There was no history of pruritus or discomfort. Two patients related an increase in pigmentation to extremes of temperature, and one patient also complained of a burning sensation when exposed to sunlight. The third patient cited no change at different temperatures. All three patients had visited a few local physicians and had received sunblocks and topical steroids with no definite diagnosis. No improvement was noticed by use of the prescribed medications. Family history of pigmentary disturbance was negative in all three cases. Examination in all three cases revealed a well‐demarcated reddish‐brown pigmentation over both cheeks extending to the preauricular area (Fig. 1). In one patient part of the auricle was also involved. No extension to the neck area was seen in any of the cases. Pinhead sized white follicular papules producing a granular texture were clearly evident over the involved areas (Fig. 2). Vellus hair growth was affected in all three cases. No evidence of scar formation or atrophy was noted. Diascopy in all three patients revealed blanching of the erythematous component of the pigmentation with no change in the brown discoloration. Keratosis pilaris was evident over both arms in all three patients, and in one patient mild keratosis pilaris was also noted on the legs. A biopsy was performed in two patients.

Histopathologic examination of both biopsy specimens revealed a similar picture. There was slight hyperkeratosis with no parakeratosis and only mild acanthosis. Follicular hyperplasia and plugging were evident. Fontana staining revealed intense melanin pigmentation of the basal layer. Mild perivascular mononuclear cell infiltration was observed in the upper dermis (Fig. 3).
PHARMACOLOGY AND THERAPEUTICS RECONSTRUCTION OF THE NOSE UTILIZING A BILOBED FLAP
Authors: MOY RONALD L. , GROSSFELD JODI S. , BAUM AXINE , RIVLIN DAN , EREMIA SOREN
Published: May 2007

Background. Defects of the distal nose are particularly challenging to reconstruct because of this area's unique texture, lack of elasticity, and possible distortion of the alar rim. The bilobed flap has been criticized for having a high incidence of “trapdooring,” flap necrosis, dog ears, and prominent suture lines.

Methods. Patients who underwent bilobed flap repairs of the distal nose (n = 171) were reviewed for complications and cosmetic results. The modifications from the traditional design include minimizing the angle of transposition between lobes, thinning of the flap, basing the pedicle on the lateral aspect of the nose, and creating the lobes of the flap to be of equal diameter to the defect.

Results. There was a 3% incidence of infection, 7% incidence of partial flap necrosis, and 5% incidence of “trapdooring” and contour distortion. Color match and contour were excellent for all other patients.

Conclusions. The modified bilobed flap is an excellent choice for reconstruction of defects of the lower nose because of the good skin match and low incidence of complications.
NONMELANOMA SKIN CANCER: NUMBER OF CANCERS AND THEIR DISTRIBUTION IN OUTPATIENTS
Authors: CZARNECKI D. , O'BRIEN T. , MEEHAN C.J.
Published: May 2007

Background. Nonmelanoma skin cancer (NMSC) is increasing in incidence and more are developing on the trunk and limbs. The objectives were to determine how many outpatients have more than one NMSC at the time they present for treatment and to determine the anatomical distribution of the cancers.

Methods. All outpatients with histologically confirmed NMSC visited by the authors during 1992 received a total body examination and the number and sites of NMSC were recorded.

Results. A total of 952 outpatients were seen. A single NMSC was present in 69.4%, two in 16%, three in 6.4%, four in 3.5%, five to nine in 4.2%, and 0.5% had ten or more. Of the 291 patients with more than one NMSC, one anatomical region was involved in 53.4%, two were involved in 38.4%, and 8.2% had three or more regions involved.

Conclusion. Patients with NMSC required a total body examination to detect unsuspected skin cancers.
PIGMENTED MACULES ON PALMS AND SOLES IN PUERTO RICANS
Authors: MARTÍN RAFAEL F. , SÁNCHEZ JORGE L. , VÁZQUEZ‐BOTET MIGUEL , LUGO AÍDA
Published: May 2007

Background. One‐third of melanomas in Puerto Ricans occur on the skin of palms and soles. This is a study to define the characteristics of melanocytic nevi in those locations.

Background. One‐third of melanomas in Puerto Ricans occur on the skin of palms and soles. This is a study to define the characteristics of melanocytic nevi in those locations.

Methods. A sample of 1,039 patients were randomly examined for pigmented macules on the palms and soles. After informed consent, biopsies of these lesions were done on 67 patients.

Results. Among the patients, 13% were found to have pigmented macules on the palms and soles. Volar melanocytic macule was the most frequent lesion.

Conclusions. Melanocytic nevi occur frequently on volar skin. The criteria for removal of these lesions should not be different from those lesions at other locations.
ACROANGIODERMATITIS: A STUDY OF TEN CASES
Authors: RAO BABAR , UNIS MARK , POULOS EVANGELOS
Published: May 2007

Background. Acroangiodermatitis is a benign vesicular process encountered on the lower extremities that histologically resembles the superficial form of stasis dermatitis, but is clinically characterized by circumscribed violaceous, brown or dusky macules, papules, or plaques. Furthermore, unlike stasis dermatitis, acroangiodermatitis is usually associated with minimal epidermal changes and eosinophils in the inflammatory infiltrate in the dermis. Kaposi's sarcoma, pigmented purpura, vasculitis, and lichen planus are other conditions that should be considered when making a diagnosis of acroangiodermatitis.

Methods. Ten patients with acroangiodermatitis were referred to us by area physicians. Hematoxylin and eosin, periodic acid‐Schiff, Pearl's (an iron stain), and an immunoperoxidase stain for Factor VIII were performed on routinely embedded paraffin sections.

Results. All cases showed new vessel proliferation, perivascular inflammation of superficial and mid‐dermis, consisting of lymphocytes, histiocytes, eosinophils, occasional plasma cells, extravasation of red blood cells, and hemosiderin pigment deposition. Dermal fibrosis was observed in all cases. None of the patients showed changes of vasculitis or Kaposi's sarcoma. Only one patient displayed significant epidermal changes of spongiosis and mild acanthosis.

Conclusions. Acroangiodermatitis is an uncommon entity with peculiar clinical and histologic features and should be confirmed by histologic tests.
SOLAR (BRACHIORADIAL) PRURITUS—RESPONSE TO CAPSAICIN CREAM
Authors: KNIGHT TIMOTHY E. , HAYASHI TAKUJI
Published: May 2007

Background. Solar (brachioradial) pruritus is an enigmatic condition affecting the lateral aspects of the arm(s) and is primarily seen in Caucasian people living in the tropics or subtropics.

Methods. Over a 5‐year period we prospectively evaluated 68 patients with solar pruritus seen in an outpatient dermatology clinic. Clinical, biochemical, and microscopic and ultramicroscopic studies were performed. An open‐label trial of capsaicin cream application was initiated in 15 patients.

Results. An almost equal number of men and women were seen with an average age of 44 years. Brown‐eyed and blue‐eyed patients were seen with equal frequency. Most patients (86%) had outdoor occupations or avocations. The pruritus was intense, usually bilateral (72%) and invariably affected the lateral (as opposed to medial) aspects of the arm(s) in the absence of primary lesions. The most commonly affected area was the elbow area superficial to the brachioradialis and extensor carpi longus muscles, but extension of the pruritus to include the forearm and/or upper arm was common. Biopsy specimens (stained with hematoxylin and eosin) were normal or showed mild actinic elastosis in 15 patients tested. Ultramicroscopy showed myelin sheath splitting in all four patients studied. This is a nonspecific finding that may also be found in diabetic or alcoholic neuropathy.

Ten of thirteen patients completing the capsaicin‐cream study found significant relief (itching much improved or gone) after 3 weeks compared with the untreated control arm.

Conclusions. The cause of solar pruritus remains unknown, but circumstantial evidence implicates chronic exposure to solar radiation. Capsaicin may offer relief to these patients, but the patients need to be cautioned about the burning sensation that occurs with capsaicin cream.
VITAMIN E ADDED SILICONE GEL SHEETS FOR TREATMENT OF HYPERTROPHIC SCARS AND KELOIDS
Authors: PALMIERI BENIAMINO , GOZZI GLAUCO , PALMIERI GASPARE
Published: May 2007

Background. Trauma of various origins can induce a connective tissue disorder that leads to keloids. This condition has yet not been clearly distinguished from scars and hypertrophic scars. Only electronmicroscopic and biochemical data can help to do this. Among some more or less therapeutic approaches, the use of silicon (polydimethylsiloxane) plates, wrapped on the keloid surface, has been reported effective by some authors. These authors also demonstrated that it is not the mechanical pressure that is the mechanism of action, but a direct action on fibroblasts and a hyperhydration of subcutaneous tissue.

The authors of this study conceived that the silicon plate may be able to improve the transdermal penetration of a compound such as vitamin E. This vitamin is capable of preserving some important morphologic and functional features of biological membranes by means of its phytilside chain of the molecule acting as a stabilizer of lysosomal membranes.

Materials and Methods. Eighty patients of both sexes, aged between 18 and 63 years, who had hypertrophic scars and keloids, were admitted to the trial. The patients were randomized to two groups in a simple‐blinded study. Group A: Forty patients whose scars have been covered with silicon plates with added vitamin E. Group B: Forty patients treated with simple silicone gel sheets. No pressure bandages were used, only tape fixing the sheet for 10 hours overnight. The trial lasted for 2 months. The results were recorded at 4 and 8 weeks, evaluating the improvement according to a Scott‐Husskinson scale. For objective assessment photos were taken. The results were analyzed by the chi‐square test.

Results. At the end of the first month, group A had improved by more than 50% in 85% of cases, whereas the improvement in group B was 55% (P < 0.01). At the end of the second month, 95% of patients in group A had improved by 50%, whereas 75% had improved by 50% in group B (P < 0.05).

Conclusions. Vitamin E added to the silicon plate scored better than the simple silicon plate at the end of both periods. We have reported the successful combined action of vitamin E and silicone gel sheets in scar treatment, especially in the short‐term prophylaxis of hypertrophic scars or keloids.
PHARMACOLOGIC MODULATION BY CETIRIZINE OF SOME ADHESION MOLECULES EXPRESSION IN PSORIATIC SKIN LESIONS
Authors: CAPRONI MARZIA , MARIA PALLESCHI GIOVANNI , FALCOS DIMITRIOS , PAPI CATERINA , LOTTI TORELLO
Published: May 2007

Background. Adhesion molecules play a major role in the pathogenesis of inflammatory skin diseases by regulating lymphocyte trafficking and homing in an inflamed area.

Methods. The expression of the lymphocyte function‐associated antigen‐1 (LFA‐1) and of its ligand, the intercellular adhesion molecule‐1 (ICAM‐I) has been studied in psoriatic skin lesions of 10 patients with guttate, nummular, and palmoplantar psoriasis. In addition, the peculiar immunophenotype of infiltrating cells (CD3, CD4, CD8, CD25) and their correlation with HLA‐DR expression before and after treatment with oral cetirizine, a highly selective, third generation H1‐receptor antagonist has been examined using the labeled avidin biotin (LAB) system.

Results. Cetirizine treatment modulated in vivo the expression of adhesion molecules LFA‐I/ICAM‐1 as shown in all cases by decreased levels of their expression on keratinocytes and on dermal endothelial cells (P < 0.001). The expression of HLA‐DR on keratinocytes and endothelial cells was also inhibited after treatment. The numbers of infiltrating CD3–, CD4–, CD8–positive cells were reduced, whereas there was no significant modification of CD25–positive cells within the epidermis and the dermis.

Conclusion. This open clinical trial suggests that cetirizine could be effective in treating psoriasis: (1) for its symptomatic control on itching; (2) for its immunopharmacologic modulation of leukocyte integrins and on the immunophenotype pattern of infiltrating and resident cells, and (3) for contributing to the clearing of the lesions clinically.
IMMEDIATE NONALLERGIC PSYCHOTIC REACTION TO INTRAMUSCULAR PROCAINE PENICILLIN
Authors: EINTERZ ELLEN M. , EINTERZ ROBERT M.
Published: May 2007

Background. Though little known by medical personnel, an immediate nonallergic psychotic reaction to intramuscular procaine penicillin has been reported occasionally from many countries since 1951.

Materials and Methods. A case report describes a patient whose violent behavior, provoked by this reaction, resulted in legal action taken against him. Two other nonviolent cases are presented and are followed by a review of the literature.

Results. Signs and symptoms of this reaction that appears to be to the procaine component resemble a pressor response and are therefore contrary to the signs and symptoms of an anaphylactic reaction. Anxiety, hallucinations, hypertension, and tachycardia are characteristic. The reaction is self‐limited. Long‐term psychologic sequelae might be averted by adequate reassurance.

Conclusions. The importance of procaine penicillin as an essential drug in many parts of the world should not be diminished; however, recognition of acute nonallergic psychotic reactions is of paramount importance to assure proper patient management and to avoid misinterpretation of aggressive behavior.
DETECTION WITH THE POLYMERASE CHAIN REACTION OF HUMAN PAPILLOMAVIRUS DNA IN CONDYLOMATA ACUMINATA TREATED WITH CO2LASER AND MICROWAVE
Authors: LI HONG‐XIA , ZHU WEN‐YUAN , XIA MING‐YU
Published: May 2007

Background. The recurrence rates of condyloma acuminata are high. The reasons for the relatively high relapse rates with different treatments are unknown.

Methods. Twelve specimens of condylomata acuminata of the vulva were excised from 12 patients and divided into three parts. One part was untreated, the second and the third parts were treated with CO2laser and microwave, respectively.dnawas then extracted from tissue by proteolytic digestion and amplified by the polymerase chain reaction. Dot blots were performed with the use of radiolabeled consensus and human papilloma virus (hpv) type‐specific probes.

Results.hpvdnawas amplified in 100% of untreated specimens (6‐hpv6; 6‐hpv11), and in 83.3% and 50% of specimens treated with CO2laser and microwave, respectively. There was a significant difference in detection between untreated and microwave‐treated specimens (χ2= 4.18, P < 0.05).

Conclusion. Microwave damageshpvdnamore effectively than CO2laser.
ANTIDERMATOPHYTIC ACTIVITY OF GARLIC (ALLIUM SATIVUM) IN VITRO
Authors: VENUGOPAL PANKAJALAKSHMI V. , VENUGOPAL TARALAKSHMI V.
Published: May 2007

Background. Interest in herbal medicine is enjoying a renaissance at present. Garlic (Allium sativum) is an intriguing herb with a long history of medicinal use for a variety of diseases including ringworm infections.

Methods. Antidermatophytic activity of the aqueous extract of garlic (A. sativum) was investigated against 88 clinical isolates of dermatophytes by an agar dilution technique. The isolates included Microsporum canis (50), M. audouinii (5), Trichophyton rubrum (6), T. mentagrophytes (5), T. violaceum (12), T. simii (5), T. verrucosum (1), T. erinacei (1), and Epidermophyton floccosum (2).

The results were compared with the minimal inhibitory concentrations of ketoconazole.

Results. The aqueous extract of garlic, diluted 1:150 and 1:100, had inhibited 50 and 90% of the isolates tested, whereas the respective values for ketoconazole were 1 and 2.5 μg/mL.

Conclusions. Garlic (A. sativum) could be used as an effective antidermatophytic agent. Further purification and extraction of the active principle of garlic would give a true antidermatophytic activity comparable to standard antifungal drugs.
EFFECT OF ORALLY ADMINISTERED ANTITHYROID THIOUREYLENES ON PCNA AND P53 EXPRESSION IN PSORIATIC LESIONS
Authors: ELIAS ALAN N. , BARR RONALD J. , ROHAN MARY KATE , DANGARAN KAROL
Published: May 2007

Background. Antithyroid thioureylenes are effective agents in the oral and topical treatment of patients with chronic plaque psoriasis.

Method. The effect of oral treatment with 6‐n‐propyl 2‐thiouracil (propylthiouracil, ptu) and 2‐mercapto 1‐methyl imidazole (methimazole, mmi) on proliferating cell nuclear antigen (pcna), and p53 protein expression was studied in patients with stable plaque psoriasis.

Results. Following treatment with ptu and mmi, pcna staining in psoriatic epidermis was significantly decreased. P53 was minimally expressed in untreated lesions, and treatment with PTU and MMI did not enhance P53 expression in the psoriatic lesions.

Conclusions. Since pcna is a marker of cellular proliferation and p53 inhibits cellular cycling, some of the beneficial effects of ptu and mmi in psoriasis may depend on the ability of the drugs to impair cellular turnover, perhaps by binding to the triiodothyronine (T3) receptor. These effects may be in addition to the previously described effects of ptu and mmi as immune modulators and free radical scavengers.
CEREBRAL AND SUBCUTANEOUS CYSTICERCOSIS TREATED WITH ALBENDAZOLE
Authors: SCHMIDT DIETER K. T. , FRANCOIS JORDAAN H. , SCHNEIDER JOHAN W. , CILLIERS JACQUES
Published: May 2007

Background. Cysticercosis is the most common parasitic disease of the central nervous system in the world, but cysticercosis cutis has been reported much less frequently. Because 54% of patients present with subcutaneous nodules, we report here the association of cysticercosis cutis in a patient with neurocysticercosis and review the literature and treatment options.

Case Report. The patient presented with multiple, asymptomatic subcutaneous nodules over the trunk and the extremities, associated with central nervous system involvement. Examination of an excised nodule by light microscopy revealed a larval cyst in the deep dermis surrounded partly by a fibrous pseudocapsule. Computed tomographic scanning of the skull showed multiple, nonenhancing, and calcified cysts in both cerebral hemispheres. Treatment with albendazole, 15 mg/kg/day for 30 days, was highly effective. At follow‐up 6 months later, most subcutaneous nodules had disappeared or were markedly reduced in size, and the cerebral lesions had much improved.

Conclusions. Albendazole, a newer paracidal drug, seems to be more effective and less expensive than some other drugs in use for the treatment of neurocysticercosis.
EFFECT OF TOPICAL TRETINOIN ON EPIDERMAL LANGERHANS’CELLS IN PHOTODAMAGED SKIN
Authors: BARNADAS MARIA A. , CURELL ROMÁN , DE MORAGAS JOSÉ M.
Published: May 2007

Background. Topical tretinoin has been successfully applied to treat photoaging; however, a decrease in the number of Langerhans’cells (LC) has been reported after its topical application in Macaque skin. A study was performed to evaluate the possible effect of topical tretinoin on the number of LC in human beings.

Methods. Eight patients were studied. Topical tretinoin was applied in progressively increasing concentrations: 0.025% for 1 month, 0.05% for one month and 0.1% for 4 months. A skin biopsy from the malar area was taken before this therapy and 6 months later. To study LC, 4 p frozen sections were stained with the anti‐CD1 antibody.

Results. The number of CD1+ cells did not change when they were counted per unit of epidermal length, but they decreased when they were counted per unit of epidermal surface.

Conclusions. These results indicate that topical tretinoin might damage epidermal Langerhans’cells, when it is applied for long periods of time; future studies are necessary to clarify this point.
SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS DIAGNOSED WITH TREATMENT‐RESISTANT ACNE
Authors: MOTEL PETER J. , BERNSTEIN ERIC E. , FAZIO MICHAEL , HUMENIUK HARRY , KAUH YOUNG C.
Published: May 2007

Background. Systemic lupus erythematosus (SLE) may involve any number of organ systems and varies greatly in the severity and type of involvement. Cutaneous manifestations of SLE are equally numerous and varied throughout the course of the disease within an individual, as well as varying between patients. Cutaneous manifestations of SLE are frequently the presenting symptoms, typically noted in the classic malar “butterfly” rash; however, other cutaneous patterns are frequently observed.

Methods. We present here two patients who presented with what was thought to be acne refractory to treatment.

Results. These patients actually were found to have a facial eruption associated with SLE as confirmed by skin biopsy.

Conclusions. The importance of investigating atypical or treatment‐resistant eruptions, especially in patients experiencing other symptoms, is emphasized.
DISCOID LUPUS ERYTHEMATOSUS LESIONS DEVELOPED ON LUPUS ERYTHEMATOSUS PROFUNDUS NODULES
Authors: CAPRONI MARZIA , PALLESCHI G.M. , PAPI C. , FABBRI P.
Published: May 2007

We describe this case of LEP for its unusual way of presentation. It first appeared with a LEP pattern, followed by a typical DEE of the skin, overlying the nodules only. Moreover, our histologic findings showed the typical pattern of lymphocytic lobular panniculitis, with hyaline necrosis of fat, the lymphoid nodule, and even the lymphocytic nuclear “dust.” The epidermal changes, with the liquefaction degeneration of the basal cell layer, a moderate follicular hyperkeratosis, and a perivascular and periappendeal lymphocytic infiltrate, were also observed in the abdominal lesion that developed last without clinically evident DLE.
CUTANEOUS TUBERCULOSIS IN HONG KONG: A 10‐YEAR RETROSPECTIVE STUDY
Authors: CHONG LAI‐YIN , LO KUEN‐KONG
Published: May 2007

Background. Cutaneous tuberculosis was once a relatively common skin disease in Hong Kong. Tuberculosis verrucosa cutis was the commonest type. Because the last survey was carried out 25 years ago, it was thought necessary to find out the new incidence and pattern of this important disease in this locality.

Methods. A 10‐year (1983‐1992) retrospective survey on the epidemiologic and clinicobacteriologic aspects of cutaneous tuberculosis had been done in the public sector of Hong Kong. The records of the confirmed cases were retrieved for statistical analysis.

Results. A total of 176 cases are included in the final analysis. This represents 0.066% of all new skin cases seen during the 10‐year period. Among these, 79.5% are erythema induratum, 6.3% lupus vulgaris, and 4.5% tuberculosis verrucosa cutis. They are further divided into true cutaneous tuberculosis (14.8%, n=26) and the tuberculide (85.2%, n=150). Among the patients with true tuberculosis, 42.3% had lupus vulgaris, 30.8% had tuberculosis verrucosa cutis, and 26.9% had scrofuloderma. Among the tuberculides, erythema induratum accounted for 93.3%.

Conclusions. Cutaneous tuberculosis is now uncommon in Hong Kong. Tuberculosis verrucosa cutis is no longer the commonest type in Hong Kong as described in some textbooks. Erythema induratum is now the most common among the total cases and lupus vulgaris is the most common among the true cutaneous forms of tuberculosis.
ACQUIRED PORT‐WINE STAINS
Authors: DINEHART SCOTT M. , PARKER RAY K. , HERZBERG ARLENE J. , PAPPAS ALEX J.
Published: May 2007

Background. An acquired port‐wine stain is a rarely reported vascular lesion that mimics a congenital port‐wine stain clinically, but is acquired after birth.

Methods. Clinical and histologic information concerning ten patients with acquired port‐wine stains was recorded. Stains of seven of these patients were treated with either the copper vapor or pulsed dye laser.

Results. Collected information suggests that many acquired port‐wine stains are idiopathic in nature. Light microscopic examination of tissue showed vascular dilation identical to that seen in congenital port‐wine stains. Results of laser treatment were excellent in four patients, good in one patient, and poor in two patients.

Conclusions. Although some differences exist, acquired port‐wine stains are similar to congenital port‐wine stains in their clinical morphology, histologic findings, and response to laser treatment.
SKIN CANCERS AT TERTIARY REFERRAL SKIN HOSPITAL IN SINGAPORE
Authors: TAN SUAT HOON , THAM SIEW NEE , GOH CHEE LEOK
Published: May 2007

Background. Skin cancer is the seventh most common cancer in Singapore. This study was performed to determine the pattern of skin cancers seen in a tertiary referral skin hospital.

Methods. Histologically confirmed skin cancers, seen between 1980 and 1991, were analyzed according to age, sex, race, site, and presence/absence of preexisting skin conditions.

Results. Of a total of 520 patients, the commonest skin cancer was basal cell carcinoma (bcc) (36.5%), followed by squamous cell carcinoma (scc) (24.4%), Bowen's disease (16.7%), and mycosis fungoides (9.0%). Malignant melanomas (2.7%) were rare. The sharp increase (26.2%) in bcc in the recent 3 years was largely contributed by a fivefold increase of nonresident Caucasian patients with bcc. All types of skin cancers were more common in Chinese (78.1%) and less frequent in the more pigmented races (9.4%). The men to women ratio was 1.72:1. The peak age distribution was in the 51–70‐year group, with the exception of mycosis fungoides (31–50 years). The commonest site involved in bcc was the head and neck (67.0%) and in Bowen's disease the trunk (33.3%). Squamous cell carcinoma was found on the head and neck and the lower extremities with equal frequency (29.3%) and 46.2% of all sec on the lower extremities occurred in leprosy patients with chronic trophic ulcers. Of patients with Bowen's disease involving the nonsunexposed parts (trunk and upper extremities), 42.6% had probable arsenic exposure evident either from the history or clinical examination. Malignant melanomas were commonly located on the foot (71.4%).

Conclusions. The commonest skin cancers seen were bcc, sec, Bowen's disease, and mycosis fungoides. There were differences in the site distribution of sec, Bowen's disease, and malignant melanomas in our study when compared to studies in Caucasians.
IMMUNOHISTOCHEMISTRY IN HISTOID LEPROSY
Authors: KONTOCHRISTOPOULOS GEORGE J. , ARONI KYRIAKI , PANTELEOS DEMETRIOS N. , TOSCA ANDRONIKI D.
Published: May 2007

Background. Histoid leprosy is a rare form of multibacillary leprosy as the result of secondary or even primary resistance to dapsone. The etiopathogenesis has not been clarified up to now.

Methods. An immunohistochemical study was carried out for the expression of various markers on epidermal and dermal cell populations using sections of frozen skin specimens from 5 patients with histoid leprosy as compared to specimens from 7 tuberculoid and 7 lepromatous patients.

Results. Dendritic epidermal cells, identified by monoclonal antibodies against CD1, hla‐dr, CD45, and CD36, were found reduced in histoid leprosy as compared to both tuberculoid and lepromatous groups. A gradual reduction of keratinocytic hla‐dr expression from tuberculoid to lepromatous to histoid leprosy was observed. The pattern of CD36, CD4, and CD8 expression of lymphomonocytic cells in the dermis of histoid lesions was similar to that of tuberculoid leprosy, but without the formation of an organized granuloma. CD45+ cells as well as activated lymphocytic cells, expressed by the activation immunophenotype (CD1, hla‐dr, CD25, CD71, egf‐r) were found frequently in all groups.

Conclusions. The in situ immunohistochemical findings support a modified hypersensitivity reaction of the cellular type that results in an inhibition of the lesional expansion, but not in the destruction of the bacilli within the histoid lesion.