bluuebunny/crossref_metadata_2025 huggingface dataset:
PYODERMA GANGRENOSUM: ASSOCIATIONS REVISITED
Authors: KO C.B. , WALTON S. , WYATT E.H.
Published: May 2007

Fourteen cases of pyoderma gangrenosum were seen over a period of 24 years at the Hull Royal Infirmary Dermatology Department. Several associated conditions were found. Seven cases were associated with rheumatoid arthritis of which five were sero‐positive, including one with Felty's syndrome. One case was associated with both ulcerative colitis and psoriasis; one with polycythemia rubra vera; two patients had diverticular disease including one who also had rheumatoid arthritis; one had positive syphilis serology. In three cases there was no significant associated disease identified. Ten out of the fourteen cases were women, indicating a female preponderance by a ratio of about 2F:1M; a figure similar to that stated by Seitzinger.1 The age of presentation ranged from 30 to 80 years.
PRIMARY LOCALIZED CUTANEOUS AMYLOIDOSIS
Authors: KIBBI ABDUL‐GHANI , RUBEIZ NELLY G. , ZAYNOUN SHUKRALLAH T. , KURBAN AMAL K.
Published: May 2007

Fifty‐seven patients with primary localized cutaneous amyloidosis (PLCA) were clinically and histopathologically reviewed. Two‐thirds of patients had macular amyloidosis (MA). Intermediate cases having macular lesions with micropapules and/or lichens were identified. A spectrum for the disease is proposed, in which the less itchy classical macular variant occurs at one end and the very pruritic traditional lichen variant at the other. The salient histopathologic findings were similar in the macules, micropapules, and lichens, but were more prominent in the lichens. These consisted of hyperkeratosis, keratinocyte degeneration, satellite cell necrosis, and basal cell destruction. Amyloid deposition in the dermal papillae with transepidermal elimination, dermal melanophages, and superficial perivascular inflammation were also present. These changes represent an interface dermatitis of the vacuolar type, PLCA may be categorized under the group of dermatoses characterized by a lichenoid tissue reaction; inflammation may play a key role in mediating these disorders.
PERIPHERAL T LYMPHOCYTES AND THEIR SUBSETS IN CUTANEOUS TUBERCULOSIS
Authors: SEHGAL VIRENDRA N. , WAGH SUNEITA A. , BHATTACHARYA SAMBIT N. , SHARMA VINAY K.
Published: May 2007

Fifty‐four patients with cutaneous tuberculosis, consisting of 23 with lupus vulgaris,22 with scrofuloderma, and nine with verrucosa cutis, were investigated for cell‐mediated immunity, through estimation of peripheral total T lymphocytes (CD3+), CD4+ (helper/inducer), and CD8+ (cytotoxic/suppressor) lymphocytes, by immunohistochemical staining of peripheral blood smears, using specific monoclonal antibodies and the alkaline phosphatase‐antialkaline phosphatase (APAAP) method. Absolute values of total T lymphocytes (CD3+), and CD4+ and CD8+ subsets, were found to be significantly raised in scrofuloderma, but the percentage values and the CD4+/CD8+ ratio remained unaltered. In tuberculosis verrucosa cutis, only the percentage of the CD8+ subset of T lymphocytes was found to be significantly lowered, and this altered the CD4+/CD8+ ratio. No significant change was observed in the peripheral blood T cells and their subpopulations in patients suffering from lupus vulgaris.
PSEUDODIPHALLIA
Authors: PERIS V. TORRES , CUEVAS E. JORDA , QUILIS L. RAMON
Published: May 2007

Ten years ago, a 17‐year‐old high school student noticed a small growth in the prepuce near the free edge; this elevation (Fig. 1) began to grow progressively until it was 0.5 cm long and 0.3 cm wide (Fig. 2). The base of this tumor was not pediculated, it was lighter in color than the skin around it, and its consistency was half soft.

The upper part of the tumor was covered completely by the skin of the penis. The patient stated that he had never felt pain and that the tumor had not changed in size. He felt a slight sensation of tension in this area only when he had not urinated for many hours and his bladder was full. He also had this sensation in the normal penis.

A careful examination showed that the testes, scrotum, and penis were normal, without hypospadias. On rectal examination, the prostate and seminal vesical were found to be normal. Neither the anus nor the rectum showed any change.

Secretory urographic studies showed two normal kidneys that were somewhat descended and rotated. Neither the lumbosacral region of the spinal column nor the pubis was abnormal. The diphallus was extirpated while the patient was under local anesthesia, and we noticed that there was no connection between the tumor (diphallus) and the normal urethra.

Histologic Examination: The surgical extirpation was divided into several 5‐mm portions. On macroscopic examination, it had a cystic appearance, with creamy contents.

The first portions revealed the presence of a pavement and horny (keratinous) epithelium (Fig 3), with a dilated duct beneath It; this duct was covered by transitional mucus, similar to that covering the normal urethra (Fig. 4).

In the last pieces cut, at low and high magnifications, a urethral cavity was seen that was covered by a pavement epithelium; under this epithelium, numerous groups of erectile fibers were found (Fig. 5).
DEVELOPMENT OF ANTHRALIN SHORT‐CONTACT THERAPY IN PSORIASIS: SURVEY OF PUBLISHED CLINICAL TRIALS
Authors: NALDI LUIGI , CARREL CLAUDE‐FRANCE , PARAZZINI FABIO , D'ORO LUCA CAVALIERI , CAINELLI TULLIO
Published: May 2007

In a survey of clinical trials concerning the efficacy of short‐contact therapy with anthralin in psoriasis vulgaris, focusing principally on methodologic issues, twenty‐four papers published between January 1982 and December 1989, in English, French, and Italian, were selected. Nine of 24 papers reported on more than one trial, giving a total of 37 clinical trials to be evaluated. A great heterogeneity was evident in many aspects of the design and conduct of these trials, making pooling of results impossible. Most trials suffered from flaws in general methodologic aspects such as randomization and blinding. Limitations in general applicability of results were discussed with reference to the popular use of self‐control design and selection of composite indexes (e.g., PASI) as an outcome variable. Published trials are not a reliable guide to clinical decisions concerning short‐contact therapy, and some methodologic observations we made could be of general interest in designing clinical trials of psoriasis.
EOSINOPHILIC PUSTULAR FOLLICULITIS IN PATIENTS WITH ACQUIRED IMMUNODEFICIENCY SYNDROME
Authors: FERRÁNDIZ CARLOS , RIBERA MIGUEL , BARRANCO JUAN CARLOS , CLOTET BONAVENTURA , LORENZO JUAN CARLOS
Published: May 2007

Three patients with aids had an intensely pruritic eosinophilic pustular folliculitis associated with abundant Pityrosporum yeasts in the follicles, demonstrated by direct microscopy. The excellent response to ketoconazole treatment suggests a possible pathogenic role for Pityrosporum.
ACTIVITY OF GENTIAN VIOLET AND BRILLIANT GREEN AGAINST SOME MICROORGANISMS ASSOCIATED WITH SKIN INFECTIONS
Authors: BAKKER PETER , VAN DOORNE HANS , GOOSKENS VINCENT , WIERINGA NICOLIEN F.
Published: May 2007

The antimicrobial activity of gentian violet and brilliant green was tested against various strains of potential skin pathogens, by means of agar diffusion assay. The activity of both compounds was affected by pH. Gentian violet was found to be more active than brilliant green at pH 7.4, particularly against Pseudomonas aeruginosa. The spectrum of activity of gentian violet was not increased by the addition of brilliant green. An aqueous solution of gentian violet 0.5% turned out to be an adequate topical anti‐infective drug. The preparation is particularly suitable for primary health care in tropical developing countries, because it is cheap, chemically and physically stable, and easy to prepare.
TONGUE INVOLVEMENT IN LEPROMATOUS LEPROSY
Authors: SHARMA VINOD K. , KAUR SURRINDER , RADOTRA BISHAN D. , KAUR INDERJEET
Published: May 2007

Background. Involvement of the oral cavity in lepromatous leprosy is well‐documented. The tongue may demonstrate multiple nodules, thickening, and scarring.

Methods. Ten consecutive untreated patients with lepromatous leprosy with a bacteriologic index of 4+ or more were clinically and histopathologically studied for evidence of tongue involvement.

Results. Three patients showed clinical tongue involvement, as a noduloplaque lesion in one patient and fissured tongue (lingua plicata) in two patients. Tongue was clinically normal or showed nonspecific changes in the remaining seven patients. Histologic evidence of tongue involvement by lepromatous process was seen in six patients, including three without clinical involvement.

Conclusions. We conclude from this study that the tongue is as prone to involvement by lepromatous process as buccal and palatal mucosa.
OUTBREAK OF CERCARIAL DERMATITIS IN THAILAND
Authors: KULLAVANIJAYA PREYA , WONGWAISAYAWAN HARN
Published: May 2007

Background. An epidemic of cercarial dermatitis caused by Schistosoma spindale cercaria occurred in November 1988 in a district called Chaiya, Surajthani province, in Southern Thailand.

Case Reports. Fifty‐eight Thai farmers in Chaiya, Surajthani gave a history of itch following immersion in water while planting rice. The area of rice field was flooded for 10 days before farmers started working. The duration of the disease ranged from 2 days to 1 month. Forty‐one patients had the disease for the first time, seventeen had a history of previous manifestations.

Conclusions. This epidemic was caused by S. spindale cercaria, which developed in the Indoplanorbis exustus snail, associated with flooding.
INTRAMUSCULAR LOW DOSE ALPHA‐2B INTERFERON AND ETRETINATE FOR TREATMENT OF MYCOSIS FUNGOIDES
Authors: ALTOMARE GIANFRANCO F. , CAPELLA G.L. , PIGATTO P.D. , FINZI A.F.
Published: May 2007

Background. Mycosis fungoides is a lymphoma of cutaneous origin characterized by a proliferation of cells with a T phenotype.

Methods. In this pilot study, 13 men with mycosis fungoides in various stages were treated with alpha‐2b interferon and etretinate.

Results. In ten of them, such a therapy proved to be effective (7 complete responses, 3 partial responses), sometimes with prolonged remissions (up to 20 months, and still persistent) after suspension of the drugs.

Conclusions. We chose low‐dose interferon administration in order to prevent side effects, which are said to be dose‐dependent. In our experience this is not true, but this drawback seems to be overcome by the very good, sometimes spectacular, response to this combination therapy, particularly in low stage forms of the disease. This fact, compared with results provided by other groups, prompts us to plan new research protocols based on associations of retinoids with different interferon types (or even associations of different interferons), because we believe they will have an important place in treatment of cutaneous T‐cell lymphoma in future.
DETECTION OF MYCOBACTERIUM LEPRAE DNA IN FORMALIN‐FIXED, PARAFFIN‐EMBEDDED SAMPLES FROM MULTIBACILLARY AND PAUCIBACILLARY LEPROSY PATIENTS BY POLYMERASE CHAIN REACTION
Authors: SUNG KYUNG JEH , KIM SUNG BUM , CHOI JEE HO , KOH KYOUNG , NA DOE SUN
Published: May 2007

Background. Diagnosis of paucibacillary leprosy is often difficult. A method that could confirm the diagnosis is the polymerase chain reaction (PCR) of M. leprae DNA. This reaction was applied to biopsied tissues of leprotic patients to determine the suitability and sensitivity of the reaction.

Methods. Biopsy samples were taken from previously untreated patients with multibacillary (5 patients) and paucibacillary (3 patients) leprosy, fixed in formalin, and embedded in paraffin, DNA was extracted from paraffin blocks and PCR applied. The sensitivity of the PCR method was tested by using the serially diluted DNA sample as the template.

Results. All eight patients showed a positive PCR for M. leprae DNA. The sensitivity was such that a single organism of M. leprae, as counted by staining of the acid‐fast bacilli was identified by the PCR.

Conclusions. The PCR method is simple, sensitive, specific, and does not require the use of radioisotopes. It can be applied to the unequivocal diagnosis of paucibacillary leprosy which is difficult by other means. The diagnosis can be obtained within 10 hours.

Int J Dermatol 1993; 32:710–713
CRUSTED SCABIES: AN UNUSUAL CLINICAL MANIFESTATION
Authors: BEZERRA SARITA M.F.M.C. , CANTARELLI DIVAL L.
Published: May 2007

The patient, a 40‐year‐old Brazilian woman, was admitted to the Pernambuco Federal University Hospital with a dry extensive crusted eruption on her skin. She had a history of uterine carcinoma that had been treated by radiotherapy 3 years before. She had been losing weight for the past few years. The patient's husband had ordinary scabies, and the family history revealed other affected members. Her bed linen was always covered with scales.

Physical examination revealed generalized cutaneous erythema and scaling. The palms were markedly hyperkera‐totic (Figs. 1 and 2). This caused discomfort under pressure. There was a mild pruritus and her nails were abnormal. No burrows or vesicles were seen.

Laboratory studies revealed the following: anemia and eosinophilia of 12%. Immunoglobulins were normal. Her cel‐lular immunity was diminished. Sensitivity to dinitrochloro‐benzene and reactivity to intradermal injection of tuberculin, trichophytin, and candidin were negative. Direct light mi‐croscopy of thick scales showed a large number of Sarcoptes mites and numerous eggs. Microscopic examination of a biopsy specimen showed hyperkeratosis, acanthosis, and a chronic inflammatory infiltrate composed predominantly of lymphoid cells. The horny layer was riddled with innumer‐able mites.

The patient was treated with a 20% urea ointment and 1% lindane lotion. The skin condition was significantly im‐proved after a 5‐day treatment with keratolytic ointment (2 times a day) and antiscabic lotion applied at night to the whole skin for a period of 5 days. Throughout the hospital stay she remained in good health and was discharged 10 days after admission with her dermatologic problem com‐pletely cured (Fig. 3).

Four months later the patient died due to a cerebral metastatic carcinoma.
URTICARIAL VASCULITIS DEVELOPED ON THE STRIAE DISTENSAE DURING PREGNANCY
Authors: KWON CHUL WOOK , LEE CHANG WOO , KIM YOUNG TAE , KIM JAE HONG
Published: May 2007

A 23‐year‐old woman (gravida 1, para 0) in her 34th week of pregnancy had urticarial erythema on the legs for a period of 2 weeks. The initial eruptions of erythematous papules, plaques, and urticarial lesions were noted on the calves, at the site of striae distensae. The number of erythematous le‐sions had increased during the last 10 days to cover most of the preexisting sites of striae distensae on the lower legs and thighs, with several satellite lesions (Fig. 1). Individual lesions on the legs were pruritic and persisted longer than 1 day.

The lesions of striae distensae on the legs (with urticari‐al erythema) and on the abdomen (without any overlying urticarial lesions) had occurred during pregnancy over the past 8 months. There was no history of drug use, infection, or any other systemic disorders relevant to the skin dis‐ease. Systemic symptoms such as fever, arthralgia, or malaise were not associated with the evolution of the ur‐ticarial erythema.

Her past medical history and family history were non‐contributory. She was healthy and maintained uncomplicat‐ed normal pregnancy without any remarkable findings on physical examination except for the skin lesions.

A biopsy specimen taken from a satellite lesion showed a moderate degree of perivascular and transmural infiltra‐tion of neutrophils, eosinophils, and lymphohistiocytic cells, with some nuclear dust in the upper dermis. Endothe‐lial swellings and foci of extravasation of red blood cells were also seen (Fig. 2). The direct immunofluorescence study of the same tissue showed deposits of IgM and C3 in the blood vessel walls of the upper dermis (Fig. 2).

The erythrocyte sedimentation rate was elevated to 45 mm/h. Complete blood count with differential, platelet count, urinalysis, and stool test for occult blood were within normal limits or negative.

The pattern of serum protein electrophoresis, total serum hemolytic complement, and levels of human chorionic gonadotropin were all normal. The results of the tests for antinuciear antibodies, cryoglob‐ulin, hepatitis B surface antigen, and VDRL were negative. The skin lesions of urticarial vasculitis in this patient were treated with oral prednisolone (25 mg/d). The pruritic lesions cleared in a week with no evidence of recurrence until the postpartum period.
PRIMARY CUTANEOUS NOCARDIA INFECTION DUE TO NOCARDIA ASTEROIDES
Authors: VOGEL PAULA S. , HEIMER WILLIAM L. , SAU PURNIMA , BENSON PAUL M.
Published: May 2007

A 34‐year‐old white man was admitted to the hospital for treatment of cyclosporine toxicity. He was referred to the dermatology service for the evaluation of two lesions that had been present for 4 weeks on the dorsum of his left hand. The patient stated that he had cut his hand on a fence and later cleaned his aquarium two weeks before the skin lesions appeared. The past medical history was significant for a cadaveric renal transplant in 1984 for renal agenesis of the left kidney and obstructive nephropathy of the right kid‐ney. His oral medications included methylprednisolone, dil‐tiazem, ranitidine, cyclosporine, and ketoconazole. The recent addition of ketoconazole for oral thrush was felt to have caused the cyclosporine toxicity.

The patient was cushingoid in appearance with promi‐nent generalized hypertrichosis. The vital signs and the chest examination were normal. Skin examination revealed a 6‐mm tense vesicle with surrounding erythema with an adjacent 5‐mm firm linear papule (Fig. 1). There was no lymphadenopathy. Both lesions were biopsied, hemisec‐tioned, and sent for routine light microscopy and for fungal, atypical mycobacterial, and bacterial cultures.

Laboratory studies were significant for a blood urea ni‐trogen of 56 mg/dL, creatinine of 2.6 mg/dL, WBC of 13,100/mm13, and a cyclosporine level of 2333 ng/mL (thera‐peutic level 100–300 ng/mL). X‐ray of the left hand showed no abnormality. Chest x‐ray and computerized axial tomog‐raphy scan revealed a widened superior mediastinum sec‐ondary to mediastinal lipomatosis. Tissue cultures grew Nocardia asteroides. Bacterial and mycobacterial cultures, including atypical mycobacteria, were negative.

The biopsy showed a mixed cellular infiltrate with scat‐tered multinucleated giant cells and focal microabscesses. Brown and Brenn stain showed gram‐positive filamentous organisms.

A modified Fite stain (Fig. 2) demonstrated acid‐fast filamentous organisms. The patient was diagnosed as having primary cutaneous nocardiosis with no evidence of dissemination. He was treated with trimethoprim sulfamethoxazole (TMP/SMX), one tablet orally four times daily, with resolution of the skin lesions within 3 weeks, but the patient developed neurolog‐ic toxicity and elevation of his serum creatinine with this therapy. He was unable to tolerate a lower dose of TMP/SMX and the medication was changed to sulfisoxazole 500 mg orally four times daily, with plans to continue the treatment for 12 months.

There has been no recurrence after almost 12 months of therapy.
COMPARISON OF TOPICAL PHENYTOIN WITH NORMAL SALINE IN THE TREATMENT OF CHRONIC TROPHIC ULCERS IN LEPROSY
Authors: BANSAL NIRMAL KUMAR , MUKUL
Published: May 2007

Background. Trophic ulceration, one of the most common complications of leprosy, is disabling, distressing, and demoralizing for the patient.

Methods. The wound healing effects of topical phenytoin powder were compared with those of normal saline in a controlled in‐patient study of 100 patients with 110 trophic leprosy ulcers of varying chronicity, over a 4‐week study period. Fifty patients were assigned to the topical phenytoin group and 50 to saline therapy group. Ten patients had two ulcers each, and, in these cases, one ulcer was treated with phenytoin and the other with saline.

Results. Over the 4‐week treatment period healthy granulation tissue appeared earlier, and mean percentage of ulcer volume reduction was greater, in the phenytoin group (72.1 ± 19.9% versus 55.5 ± 21.6%) compared with the control group.

Conclusions. This difference was statistically significant at the level of P < 0.001. Phenytoin appears to be a useful agent for the promotion of healing of trophic leprosy ulcers.
TUMOR NECROSIS FACTOR: STATUS IN REACTIONS IN LEPROSY BEFORE AND AFTER TREATMENT
Authors: SEHGAL VIRENDRA N. , BHATTACHARYA SAMBIT N. , CHATTOPADHAYA DEBASISH , SAHA KUNAL
Published: May 2007

Background. Tumor necrosis factor‐alpha (TNF) is an important mediator of immunologic responses to chronic infections.

Method. Sera from 25 patients with acute reactions (6 with type 1 upgrading, 8 with type 1 downgrading, and 11 with type 2 reaction) were assayed for TNF before treatment and after clinical remission of the acute episode. The results were compared with serum TNF levels in healthy controls and fresh pauci‐and multibacillary leprosy patients.

Results. TNF levels in acute reactions were higher than in the control groups (significant only in upgrading reaction). In type 1 reaction, serum TNF concentrations fell to approximately the levels of the control patients following treatment and clinical remission. In type 2 reaction, however, levels of TNF were seen to rise further (became statistically significant) as a result of therapy induced clinical remission.

Conclusions. The rise in TNF‐A level in reactions in leprosy is significant and indicates its active role in immunopathogenesis. The corresponding decline in TNF‐a levels seen following regression of type 1 (lepra) reactions was not observed in the case of type 2 (ENL) reaction. This probably reflects the enhancement of cellular immunity in such cases and/or an attempt by the immunologic process to overcome specific inhibitors.
OVERHEATING IN BED AS AN IMPORTANT FACTOR IN MANY COMMON DERMATOSES
Authors: MOLLOY HUGH F. , LAMONT‐GREGORY ERIC , IDZIKOWSKI CHRIS , RYAN TERENCE J.
Published: May 2007

Background. Extensive questioning of patients with a wide variety of skin disorders led to the impression that nocturnal overheating was probably an important factor in the initiation and the perpetuation of many skin disorders.

Methods. In order to test the hypothesis, 12 “clean‐skinned” subjects (6M/6F) aged 18 to 45 years were monitored electronically every 30 seconds during an 8 hour sleep period (2300 to 0700 hours), sleeping under a standard 10 tog duvet.

Results. All the subjects were too hot by 3 to 4°C. All showed changes in their EEG patterns with reduced REM sleep, increased awakenings, and all showed changes in their sleep stage patterns. In addition, they all showed evidence of increased sweating in the “heat‐sink” area.

Conclusions. The mechanisms where by such changes could be implicated in the precipitation and perpetuation of skin disease are discussed. “Lifestyle” modification as a very effective, noninvasive, therapeutic regime is recommended. Further research along these lines would probably be very valuable and instructive.
TREATMENT OF ORAL PEMPHIGUS VULGARIS
Authors: CHRYSOMALLIS FOTIS , IOANNIDES DEMETRIS , TEKNETZIS ANGELOS , PANAGIOTIDOU DESPINA , MINAS ARISTIPPOS
Published: May 2007

Background. Oral pemphigus is considered to represent either an initial stage of pemphigus vulgaris that should be treated with high doses of immunosuppressive drugs to prevent its spread to the skin or a variety of the disease that does not need aggressive treatment. The absence of a widely accepted therapeutic method and the obscure nature of this disease prompted this study.

Methods. Twenty‐eight patients with oral pemphigus were randomly divided into three groups. The first group received only steroids at a dose of 40 mg of prednisone equivalent. In the other two groups the same dose of steroids was administered, but combined with either 100 mg of cyclophosphamide or 5 mg/kg of cyclosporine as an adjuvant. Direct immunofluorescence studies were performed on specimens obtained from both buccal mucosa and oral skin.

Results. There was no significant difference in the duration of treatment required to achieve remission and in the relapse rate among the three groups. The incidence of complications was higher with combination treatment. Deposited immunoreactants were detected with equal frequency in specimens obtained from the buccal mucosa and normal skin.

Conclusions. Oral pemphigus most likely represents an initial stage of a disease that can become generalized. Administration of moderate doses of steroids alone is effective in controlling the disease.
TINEA VERSICOLOR AND VISCERAL LEISHMANIASIS
Authors: HASHIM FAISAL A. , ELHASSAN AHMED M.
Published: May 2007

Background. Visceral leishmaniasis (VL) is endemic in several areas in the Sudan. The disease is associated with depressed cellular immunity. Tinea versicolor is a normal commensal of the skin which can become pathogenic particularly in patients with depressed cell‐mediated immunity. Patients with VL have a high prevalence of tinea versicolor.

Methods. One hundred and thirty patients with parasitologic confirmation of VL were screened for tinea versicolor infection. In the suspected cases the diagnosis was made by demonstrating the fungal hyphae and spores in skin scrapings. All patients were treated with sodium stibogluconate.

Results. Of the 130 patients with VL, 10.8% were found to have severe tinea versicolor. The fungal infection developed or became worse with the start of VL. After successful treatment of VL, the tinea lesions disappeared completely or decreased in severity.

Conclusions. Depressed cell‐mediated immunity that is a feature of VL is the probable underlying cause for fungal infection. Tinea infection during the course of VL is to be distinguished from lesions of post‐kala‐azar dermal leishmaniasis.
MAST CELL TRYPTASE AND CHYMASE ARE POTENTIAL REGULATORS OF NEUROGENIC INFLAMMATION IN PSORIATIC SKIN
Authors: NAUKKARINEN ANITA , HARVIMA ILKKA T. , AALTO MARJA‐LEENA , HORSMANHEIMO MAIJA
Published: May 2007

Background. Tryptase and chymase are proteinases present only in mast cells. In psoriatic lesions, mast cells are increased in number. Certain neuropeptides are also more abundant in lesional than nonlesional psoriatic skin. Based on some earlier results as well as the results of the present study, a hypothesis is presented concerning the regulatory action of mast cell tryptase and chymase on neuropeptides in psoriatic inflammation.

Methods. Forty patients were biopsied, 13 for a mature psoriatic plaque and 9 patients of 27 for a developing (1–3 weeks) psoriatic lesion induced by tape stripping (Koebner reaction). Each lesion had its nonlesional control from the same patient. Mast cell tryptase and chymase, and the neuropeptides Substance P (SP) vasoactive intestinal polypeptide (VIP), and calcitonin‐gene‐related peptide (CGRP) were stained by enzyme‐and immunohistochemical methods. Morphological contacts between mast cells and neuropeptides were visualized using double stains and quantitated in the upper dermis.

Results. As the lesion aged, MCTC mast cells displaying tryptase activity increased in number, whereas chymase activity in these cells decreased. All neuropeptides showed some increase along with the development of the lesion, but SP was most abundant in mature lesions. Substance P‐positive nerves had also more contacts with mast cells compared to VIP‐ or CGRP‐containing fibers, the contact count being highest in mature lesions.

Conclusions. Tryptase is known to degrade VIP and CGRP, but not SP. Chymase is capable of cleaving both SP and VIP, but is rendered partially inactive in psoriatic skin. These data together with the results of the present study strongly suggest that SP has potency to act as an important mediator in different stages of the psoriatic inflammation.
BOOK REVIEWS
Authors: Parish Lawrence Charles
Published: May 2007

M.W. Locke. Robert Jackson.
CEPHALIC PYODERMA GANGRENOSUM (PG)‐LIKE LESIONS AS A PRESENTING SIGN OF WEGENER'S GRANULOMATOSIS
Authors: MICALI GIUSEPPE , COOK BRIAN , RONAN SALVE , YADGIR JOHN , SOLOMON LAWRENCE M.
Published: May 2007

Background. Pyoderma gangrenosum (PG)‐like lesions can be associated with Wegener's granulomatosis (WG); in rare instances, they could be the presenting sign of WG. The purpose of this study was to elucidate the relationship between these two disorders.

Methods. The clinical and histologic data from a case of WG with primary ulcerative lesions of the face were compared with five other cases previously reported in the literature.

Results. A predominance among young men was noted. In three patients the histology of the skin ulcerations was suggestive of WG, in the remaining three, including the case described, it was nonspecific. Two cases developed pulmonary WG after the skin lesions cleared, showing that the extent and severity of skin lesions do not necessarily correlate with the systemic disease.

Conclusions. When the histology of the skin is nonspecific, the diagnosis of PG or PG‐like lesions of the head and neck should not be considered definitive and the patients should be carefully monitored to rule out the possible presence of WG.
ONYCHOMYCOSIS IN CHILDREN
Authors: CHANG PATRICIA , LOGEMANN HEIDI
Published: May 2007

Background. Onychomycosis is the most common nail disease in adults. During recent years an increase in its frequency has been reported in children.

Materials and Methods. Children under 12 years were examined and a clinical diagnosis of onychomycosis was made (Figs. 1–4). Potassium hydroxide (KOH) preparations were made and a fungus culture was done in each case.

Results. Twenty‐six children with onychomycosis are reported; 16 boys (61.4%) and 10 girls (38.6%). The average age was 8 years. The most frequent variety was distal subungual onychomycosis (88.5%) and the earliest sign was distal subungual hyperkeratosis. The agent most frequently isolated was Trichophyton rubrum which was found in 18 cases (69.2%).

Conclusions. Onychomycosis in children is not exceptional. Attention should be given to any sign during physical examination to avoid dystrophy of the nails and also to eliminate any source of infection.
MULTIPLE ANGIOKERATOMAS WITH ZOSTERIFORM DISTRIBUTION IN TWO SISTERS
Authors: EIZAGUIRRE XABIER , LANDA N. , RATÓN J.A. , DÍAZ‐PÉREZ J.L.
Published: May 2007

Case 1: At the age of 12 years a 28 year‐old woman noticed multiple reddish papular lesions on the left buttock and thigh. The lesions gradually spread to involve her left thigh towards the knee. The patient had no systemic symptoms, Examination of the skin revealed 23 well‐circumscribed, purplish verrucous lesions each of 2–3 mm diameter, located over the left buttock and extending in a linear fashion to the popliteal flexure (Fig. 1). General examination and routine laboratory studies were normal.

Case 2: A 27‐year‐old woman, sister of the previous patient, noticed at the age of 10 years a steadily increasing number of purple lesions on her left buttock that gradually extended to the left posterior thigh. The lesions were asymptomatic, although the patient noticed occasional bleeding with trauma. The lesions of the thigh had disappeared spontaneously without scarring during the previous 4 years. When we first examined this patient, at the age of 27, she had eight reddish papular hyperkeratotic lesions, 2–3 mm in size, with a linear zosteriform distribution over the left buttock. She was healthy and symptom free. Routine laboratory studies were normal.

An excision biopsy was taken from each sister. The histopathologic examination revealed similar findings in both lesions. Hyperkeratosis with slight acanthosis and papillomatosis was present. Greatly dilated capillaries were seen in the upper and middermis. The capillary walls were lined by flattened endothelium. In one area of the lesion from the second patient there was intravascular thombosis (Fig. 2).
PREVALENCE OF EYELID DERMATITIS IN PRIMARY SJÖGREN'S SYNDROME
Authors: KATAYAMA ICHIRO , KOYANO TAEKO , NISHIOKA KIYOSHI
Published: May 2007

Background. The eyelid dermatitis seen in elderly patients is a relatively heterogenous and troublesome disease. Most cases seem to be idiopathic and show resistance to standard dermatologic therapy.

Methods. Fifty‐two patients with primary definite Sjögren's syndrome (4 men, 48 women, mean age 54 years) were enrolled in this study, and the prevalence of eyelid dermatitis was investigated. Diagnostic criteria for Sjögren's syndrome were based on the criteria proposed by the Japanese Ministry of Health and Welfare. Patch test was performed using ICDRG‐European standard allergens and/or eye drops, hair dye, and cosmetics.

Results. Of the 52 patients, 22 showed eyelid dermatitis. These changes were much more frequent in elderly patients and showed a good correlation with the presence of ocular dry sensation. No significant difference was observed in clinical and other laboratory findings between patients with or without eyelid dermatitis. Although 8 of the 13 patients showed positive patch test reaction to various allergens, no close relationship existed between the use of a suspected substance and the onset or severity of eyelid dermatitis.

Conclusions. These results suggest that the presence of rubbing dermatitis of the eyelid may be one of the cutaneous manifestations of Sjögren's syndrome.
TREATMENT OF COLD URTICARIA
Authors: HUSZ SÁNDOR , TÓTH‐KÁSA I. , KISS M. , DOBOZY A.
Published: May 2007

Background. The etiology of cold contact urticaria is unknown and the therapy is therefore usually rather disappointing.

Methods. This study reports therapeutic data on 42 patients with cold urticaria treated with a combination of terbutaline (3 × 5 mg a week, later 3 × 2.5 mg) and aminophylline‐containing drugs (3 × 150 mg).

Results. Complete remission of the urticarial response was achieved in 37 of the 42 patients.

Conclusions. The therapy was tolerated relatively well and the results are promising.
FAMILY STUDY OF ATYPICAL NEVI WITH INVESTIGATION OF HEPARAN SULFATE PROTEOGLYCAN
Authors: BJARNASON BOLLI , MOONEY ELLEN
Published: May 2007

Background. The epidemiology of atypical nevi (AN) is currently obscure; however the diagnosis must be made early in order to follow these individuals and treat any melanomas that may arise at an early stage, thus preventing premature death.

Materials and Methods. Following the guidelines of the NIH on clinical and histologic features of ANS, 38 adult members in 8 families were investigated. Twenty‐seven were physically examined and 25 biopsied. Biopsies from ANS and junctional nevi from unrelated persons were also stained with antibodies against heparan sulfate proteogly‐can (HSPG).

Results. At least 21 of 38 members had ANS. Staining with HSPG antibodies did not differentiate between ANS and benign junctional nevi, all showing slightly irregular staining. In seven of eight families, two or more family members were affected by ANS.

Conclusions. Although it is not known whether or not HSPG plays a role in melanomas becoming invasive, or the potential of melanoma developing in ANS there were no differentiating features of staining in ANS, and junctional nevi to help in the differential‐diagnosis of the two.
THE ROLE OE MAST CELLS IN TREATMENT OE SCABIES
Authors: AMER MOHAMMED , MOSTAFA FAWZIA FARAG , NASR AWATIF NAGIB , EL‐HARRAS MONA
Published: May 2007

Objective. The purpose of this study was to recognize the role of mast cells in the pathogenesis of scabies.

Methods. One hundred and fifty patients and 10 controls were included in the study. Group 1 included 20 patients without previous treatment. In group 2, 80 patients were treated with antiscabietic drugs. Group 3 had 50 patients who received an antiscabietic drug followed by 3 days of crotamiton. Diurnal and nocturnal skin biopsies were taken from group 1. In groups 2 and 3, the biopsies were taken after 2 weeks of treatment. Sections were cut and stained by hematoxylin and eosin and Giemsa stains.

Results. Mast cells were increased in diurnal and nocturnal biopsies. Evident degranulation of mast cells was detected in nocturnal biopsies. The mast cell number decreased to half its pretreatment number in patients treated with antiscabietic drugs and to its normal number in patients treated with antiscabietic drugs followed by 3 days with crotamiton.

Conclusion. The number of mast cells are increased in scabietic lesions. This plays a role in the pathogenesis of the clinical and histologic picture of scabies. We recommend that an antiscabietic drug should be followed by 3 days of crotamiton in the treatment of scabies.
LOW‐DOSE CYCLOSPORINE A IMPROVES SEVERE DISABLING PSORIASIS IN LATIN AMERICA
Authors: HONEYMAN JUAN F. , SÁNCHEZ LEONARDO , VALDÉS PILAR
Published: May 2007

Background. Severe forms of psoriasis have been treated successfully with cyclosporine A (cyA) in Europe and North America. The aim of the present investigation was to record and evaluate this drug treatment in Latin American patients with severe psoriasis in a multicenter controlled dose‐efficacy study.

Patients and Methods. One hundred and fifty‐two patients from 10 Latin American countries had on entry to the study a Psoriasis Area Severity Index (PASI) of 18 or more. Initial treatment was with cyA, 2.5 mg per kg per day for 6 weeks. At week 6, 27 patients with a baseline PASI score reduction of < 33% had the dose increased to 4 mg/kg/day. At week 12, 48 patients, who had not improved their baseline PASI scores by 66% or more, had their dose increased to 4 or 5 mg/kg/day, respectively. At the end of the study, 74 patients (56%) received cyA 2.5 mg/kg/day, 41 patients (31%) received 4 mg/kg/day, and 16 patients (12%) received 5 mg/kg/day.

Results. Cyclosporine A treatment was considered successful in 84.7% of the patients, who reduced their initial PASI score by 66% or more at the end of treatment at week 18. Adverse effects were seen in 29 patients (19%). Hypertension occurred in 27% and an increase of serum creatinine level above 30% of the initial value in 40% of patients. Among other side effects were gastrointestinal complaints (5.1%), hirsutism (4.3%), muscle pain (2.2%), joint pain (2.2%), respiratory infections (2.2%), headache (1.4%), and hemorrhagic gingivitis (0.7%). Twenty‐one patients (13.8%) were withdrawn from the study for various reasons: adverse events in five cases (3.3%), noncompliance in five cases (3.3%), lack of efficacy in three cases (2%) and nonrelated diseases in two cases (1.3%). There were also six patients of a group that finished earlier than planned. A follow‐up at 8 weeks after treatment was performed in 106 patients; in this phase 60 patients (56.5%) continued with their previous successful PASI reduction. Relapses (i.e., PASI increasing by more than 50% over baseline) were seen in 22.6% of cases.

Conclusions. Cyclosporine A is an effective and well‐tolerated treatment for severe psoriasis. An initial dose of 2.5 mg/kg/day is recommended. Most of the patients have a good response to this dose.
NEW TREATMENT OF ATROPHIC ACNE SCARS BY IONTOPHORESIS WITH ESTRIOL AND TRETINOIN
Authors: SCHMIDT J.B. , BINDER M. , MACHEINER W. , BIEGLMAYER CHRISTIAN
Published: May 2007

Background. Common treatment of atrophic acne scars consists of invasive methods such as dermabrasion, chemo‐peeling, or implantation of bovine collagen. In our study a new noninvasive treatment method consisting of local iontophoresis is demonstrated. Local iontophoresis was performed with either estriol—a mainly topically active estrogen—or with tretinoin.

Patients and Methods. Eighteen women were treated with estriol iontophoresis twice weekly for a period of 3 months. In addition to photographic and clinical documentation of the skin, venous blood for determination of serum levels of prolactin and estradiol according to standard radioimmunoassay methods was obtained monthly. Tretinoin iontophoresis was performed according to the same time schedule in 28 patients (19 women and 9 men) with atrophic acne scars.

Results. Improvement of acne scars was observed in 93% of patients treated with tretinoin iontophoresis and in 100% of the group treated with estriol iontophoresis. No hormonal changes were noted in the estrogen group. Side effects involving the skin appeared in the tretinoin group in 4 cases and consisted of increased dryness and of retinoid dermatitis.

Conclusion. Both treatments were shown to be clinically effective in decreasing acne scars and persistence of effects. This promising new therapeutic approach may thus replace invasive treatment methods in many patients.
HYDROALCOHOLIC HUMAN PLACENTAL EXTRACT: SKIN PIGMENTING ACTIVITY AND GROSS CHEMICAL COMPOSITION
Authors: PAL PRAJNAMOY , ROY RABINDRA , DATTA PIJUSH K. , DUTTA AJIT K. , BISWAS BANASRI , BHADRA RANJAN
Published: May 2007

Background. Vitiligo is a pigmentary disorder of the skin of unknown etiology. It is thought to be of autoimmune origin after demonstration of antibody‐mediated destruction of melanocytes. Photochemotherapeutic PUVA therapy is widely used in vitiligo with about 33% success. Aqueous or hydroalcoholic extracts of human placenta of ill‐defined composition have also been used therapeutically for vitiligo. A hydroalcoholic human placental extract has been developed by us with pigmenting activity based on experimental therapies. Its chemical analysis was the primary objective of this study.

Methods. For the guinea pig experiment, 20 drops of the extract or vehicle (60% alcohol) as control was topically applied around the nipples covering the areola zones of male immature white guinea pigs (wt. 175–250 g) daily for 60 days with 15 minutes infrared (IR) exposure used for vascular dilatation and enhancement of the absorption of the extract. Standard methods have been followed for all chemical analyses.

Results. The guinea pig experiment showed clear pigmentation and hypertrophy of the experimental nipples to varying degrees. Chemical analysis of the extract revealed the presence of small‐molecular‐weight proteins/peptides, lipids (including glycosphingolipids), carbohydrates, sialic acids, cholesterol, triglycerides, high density lipoproteins (hdl), and others, including amino acids, nucleotides, carotenes, vitamins, etc.

Conclusion. Glycosphingolipids, known modulators of B and T cells, were reported capable of inducing adhesion, spreading, and motility of melanoma. It is present in the extract and, therefore, may lead to skin pigmentation through induction of melanocytes. Endothelin, a 21‐amino acid pep‐tide, detected in human placenta and possibly extractable by our process, has been reported to be indispensable for melanocyte growth.
REVISIT TO KAPOSFS VARICELLIFORM ERUPTION: ROLE OF IL‐4
Authors: RAYCHAUDHURI SIBA P. , RAYCHAUDHURI SMRITI K.
Published: May 2007

Background. Kaposi's varicelliform eruption (KVE) is characterized by disseminated cutaneous eruptions usually caused by infection with herpes simplex virus (HSV). Kaposi's varicelliform eruption is commonly observed among patients with atopic dermatitis (AD). Why AD patients are prone to HSV infections is still an enigma. Recent findings suggest that an increased number of IL‐4‐secreting cells can be cloned from lesions of AD. Because IL‐4 is a known Th1 cell inhibitor, theoretically, by inhibiting the Th1 cells, it could downregulate the immune response against HSV. In this study, we have evaluated the role of IL‐4 on HSV replication.

Methods. Peripheral blood mononuclear cells (PBMC) from 10 HSV seronegative and five seropositive healthy individuals were stimulated with PHA, recall antigen (tetanus toxoid), and HSV antigen in combination with IL‐4 and anti‐IL‐4. Supernatants were assessed for interferon (IFN) gamma, IL‐4 by enzyme‐linked immunosorbent assay (ELISA), and for anti‐HSV effect. Anti‐HSV effect was assessed by measuring inhibition of the cytopathic effect (CPE) of HSV on a Vero cell line.

Results. Both seropositive and seronegative groups showed significant inhibition of IFN‐gamma secretion with addition of IL‐4 (P < .001, Wilcoxon rank sum test) and this effect could be neutralized by anti‐IL‐4. There was a direct relationship between the IFN‐gamma concentration and the HSV cytopathic effect and an inverse relationship between IL‐4 concentration and HSV CPE.

Conclusions. This study provides evidence that IL‐4 can enhance HSV infection. Therefore, it is conceivable that patients with conditions of increased activity of IL‐4, as in ad, would be prone to extensive forms of HSV infection.
EFFICACY OF DEXAMETHASONE PULSE THERAPY IN PROGRESSIVE SYSTEMIC SCLEROSIS
Authors: PAI BALLAMBAT SATHISH , SRINIVAS CHAKRAVARTHI R. , SABITHA LAKSHMINARAYANAN , SHENOI SHRUTAKIRTHI D. , BALACHANDRAN CHANDRASEKHARAN N. , ACHARYA SANDHYA
Published: May 2007

Background. Systemic sclerosis is a disease of unknown etiology for which no specific treatment is effective. Pulse therapy with corticosteroids has been tried for various autoimmune disorders with minimal side effects. We undertook this study to determine the efficacy of dexamethasone pulse therapy in progressive systemic sclerosis (PSS).

Methods. Five women with PSS between the ages 30 and 60 years, received 100 mg dexamethasone in 500 mL of 5% dextrose by slow intravenous infusion over 3 hours for 3 consecutive days, once a month.

Results. All patients had symptomatic and clinical improvement. The vital capacity improved in three and posttreatment histopathologic regression was seen in two patients.

Conclusions. Dexamethasone pulse therapy may provide an additional option for treating systemic sclerosis.
SKIN LESIONS IN HIV‐POSITIVE AND HIV‐NEGATIVE PATIENTS IN SOUTH INDIA
Authors: RAJAGOPALAN BISHAKHA , JACOB MARY , GEORGE SOSHAMMA
Published: May 2007

Background. Various dermatologic conditions have been reported to occur with increased frequency in human immunodeficiency virus (HIV)‐positive individuals, but there are only a few studies comparing the prevalences of skin diseases in HIV‐positive patients with those in matched HIV‐negative controls.

Methods. Skin lesions in 129 HIV‐positive patients and 258 HIV‐negative controls were studied prospectively over an 18‐month period from October 1991 to March 1993.

Results. Oral Candida, tinea cruris, and ichthyosis were significantly more common in HIV‐positive patients compared to controls. Several other dermatologic conditions were found only in the HIV‐positive group.

Conclusions. The pattern of skin lesions in Indian patients with HIV infection may be different from that in the West.
HLA AND LEPROSY: SEGREGATION AND LINKAGE STUDY
Authors: DESSOUKEY MOHAMMED WAGDY , EL‐SHIEMY SALEH , SALLAM TARIF
Published: May 2007

Background.The presence of a genetic factor in the determination of leprosy has long been debated. This study tests whether the HLA‐linked control of susceptibility to leprosy and/or for the types of leprosy could be confirmed.

Materials and Methods.In 15 multicase families, the method of DeVries et al., 1976, was used to detect nonrandom segregation of parental HLA haplotypes in their affected and healthy siblings. Linkage analyses, for two and three alleles were performed by the computer program LIPED.

Results.For the affected siblings, the segregations of the parental HLA haplotype were significantly nonrandom from the healthy parents and random from the affected parents, indicating that affected siblings were sharing their HLA haplotypes (segregated from the healthy parents) more than expected. The segregations to the healthy siblings from both the healthy and affected parents were random. Healthy siblings inherited the haplotypes shared among the leprosy siblings randomly as expected. There were excess DR2/DR2homozygote individuals among tuberculoid siblings. The highest lod score was achieved when we considered our suggested three‐alleles model for the susceptibility to the different types of leprosy.

Conclusions.A closely HLA‐linked gene on chromosome number 6 with multiple alleles (3 or more) in recombination fraction between 0.05 and 0.1 with 70 to 100% penetrance may be responsible for the susceptibility to the different types of leprosy, whereas the susceptibility to leprosy per se maybe the responsibility of non‐HLA linked gene/s. DR2/DR2homozygote individuals may be relatively at high risk of developing leprosy or tuberculoid leprosy.