bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and Safety of Cyclosporine versus Methotrexate in Severe Psoriasis: A Study from North India
Authors: Sandhu Kamaldeep , Kaur Inderjeet , Kumar Bhushan , Saraswat Abir
Published: July 2014

Treatment of patients with severe psoriasis is difficult. Among the number of systemic drugs that are available, methotrexate has long been used, but cyclosporine has been recently recommended for the management of severe psoriasis. The purpose of this study was to compare the efficacy and safety of daily cyclosporine with weekly methotrexate in the management of severe psoriasis. Thirty consecutive patients with severe psoriasis were randomly assigned to treatment with cyclosporine or methotrexate. The initial dose of cyclosporine was 3 mg/kg/day, which was increased to a maximum of 4 mg/kg after two weeks of therapy when the response was not adequate. Methotrexate was administered weekly at a dose of 0.5 mg/kg. Clinical response was assessed by calculating PASI score in all patients at biweekly intervals. Patients were followed up fortnightly up to a maximum of 12 weeks. The doses of both drugs were gradually tapered once >75% reduction in disease severity was attained. Marked improvement (>75%) reduction in PASI was noted in all patients except for one in the cyclosporine group. The median time for marked improvement was 5.3 weeks with methotrexate and 6.8 weeks with cyclosporine. Patients on methotrexate were found to have more rapid and complete clearance than those on cyclosporine. Both drugs were well tolerated. Side effects in both the treatment groups were minor, transient, and manageable. At doses with comparable safety profiles, methotrexate resulted in more rapid and cost effective clearance of patients with severe psoriasis. Cyclosporine can provide an effective and safe alternative.
Acetylator Phenotype in Behçet's Disease
Authors: Najim Rafid A. , Sharquie Khalifa E. , Al‐Janabi Mahmood H.
Published: July 2014

The purpose of this study was to determine the acetylator status in Behçet's disease (BD) patients and compare it to a matched group of normal individuals. Thirty‐seven healthy volunteers and forty‐one BD patients were included. Detailed history was taken from the patients. HLA‐B51 was determined in the BD patients. In addition, the Clinical Manifestation Index (C.M.I.) was determined for each patient. Pathergy test was also done. After an overnight fast, each control subject and patient received a single oral dose of 100 mg of DDS. A blood sample was collected after 3 hours and the plasma was separated for determination of dapsone/monoacetyldapsone by HPLC. The frequency of slow acetylators in healthy individuals was 70.2%, while the frequency of rapid acetylators was 29.8%. The frequency of slow acetylators in BD patients was 53.7%, while the frequency of non‐acetylators (undetected monoacetyldapsone MADDS in plasma) was 46.3%. There were no rapid acetylators among the BD patients. There was a strong negative association between the acetylator status and the severity of BD. In addition, acetylator status correlated with HLA‐B51, in that BD patients with positive HLA‐B51 were characterized by a very slow or non‐acetylator status. Slow or non‐acetylators had more severe BD. We conclude that BD patients have a unique acetylator status. This finding may have implications for the theories for the pathogenesis of the disease as well as for therapeutic aspects.
Cutaneous Metaplastic Synovial Cyst
Authors: Choonhakarn Charoen , Tang Songyos
Published: July 2014

Metaplastic synovial cyst of the skin is a recently recognized entity characterized by an intradermal nodule that usually occurs at the site of previous surgical trauma. Histologically, the lesion demonstrates a cystic structure with villous‐like projections and a lining resembling hyperplastic synovium. We have studied two patients with rheumatoid arthritis, aged 46 and 55 years, who presented with cystic nodules localized on the thumb and great toes, respectively, without any history of previous trauma or surgical procedures performed in the areas. The presence of vimentin and CD 68 positivity of the cells lining the cyst walls supports the similarities between normal and metaplastic synovium. We hypothesize that constant pressure on the great toe, repeated manipulation of the finger, and chronic inflammation around the affected joints may have played roles in the pathogenesis of the lesions in our patients.
Disseminated Mycobacterium chelonae Cutaneous Infection: Recalcitrant to Combined Antibiotic Therapy
Authors: Kullavanijaya Preya , Rattana‐Apiromyakij Niramol , Sukonthapirom‐Napattalung Palachart , Sirimachand Supreeya , Duangdeeden Imelda
Published: July 2014

A 25‐year‐old Thai housewife had a history of tuberculosis of the lymph nodes for six years that had been successfully treated with a course of anti‐TB drugs. She developed several red, circumscribed, infiltrative plaques composed of umbilicated papules and pustules on her face and upper part of the body with cervical lymphadenopathy six months later. A pus smear from the lesion grew acid fast bacilli (AFB). Histopathological examination showed a mixed cell granuloma suggestive of infection. A T cell study showed a low CD4 count, and multi skin tests indicated cutaneous anergy. Culture from a biopsy specimen taken from the skin lesion grew M.chelonae; the cultures from blood, urine, and bone marrow. The lesions were not responsive to an anti TB drug given for 2 months based upon the results of the AFB positive pus smear before the culture and sensitivity reports were obtained. Since then the patient was treated with antibiotics according to the results of the sensitivity tests. A combination of amikacin and clarithromycin was started and hyperthermic therapy was later added with a partial response. Based upon the sensitivity test, kanamycin was introduced but had to be stopped because of ototoxicity. Sparfloxacin was used with an effective result but was discontinued for economic reasons. Finally, clarithromycin in combination with clofazimine and cryotherapy were given for a year before the lesions healed completely. It took a three years duration for the total course of treatment for this patient. She is still in remission after two years of follow‐up period. This extensive cutaneous M.chelonae infection needed a prolonged combination of antibiotics with the addition of cryotherapy for the non‐responsive lesions.
A Case of Antiphospholipid Syndrome with Cutaneous Ulcer and Intrauterine Fetal Growth Retardation
Authors: Nakano Junji , Nakamura Mitsutaka , Ito Takehisa , Murata Masako , Fujiyama Jun‐ichi
Published: July 2014

A 28‐year‐old patient presented with severe intrauterine fetal growth retardation (IUGR) at 34 weeks' gestation. There was a prior history of a recurrent cutaneous ulcer on the left thigh. Serological tests for IgG anticardiolipin antibody were positive. A live premature male infant was delivered by an urgent cesarean section because of fetal distress. Histopathological examination revealed that the causes of the cutaneous ulcer and IUGR were thrombosis of the small blood vessels and placental infarction, respectively. Early diagnosis and proper treatment are important in the management of the antiphospholipid syndrome.
Steatocystoma Multiplex in Four Successive Generations
Authors: Kaur Tejinder , Kanwar Amrinder Jit
Published: July 2014

A 16‐year‐old girl presented with multiple, yellowish, elastic, non‐tender cysts on the face, trunk, arms and axillae for the last 3–4 years. On pricking, yellowish fluid could be expressed from the lesions. Clinically and histopathologically, the lesions were suggestive of steatocystoma multiplex. There was a family history of similar lesions in five members over four generations.
Expression of Double‐Stranded RNA‐Activated Protein Kinase in Keratinocytes and Keratinocytic Neoplasia
Authors: Kuyama Michiyo , Nakanishi Gen , Arata Jirô , Iwatsuki Keiji , Fujimoto Wataru
Published: July 2014

Double‐stranded RNA‐activated protein kinase (PKR) is a interferon‐induced protein initially known for its inhibitory effects on cellular and viral protein synthesis. In recent studies, PKR has been shown to be an important participant in a broad array of cellular processes, including signal transduction, differentiation, apoptosis, cell growth, and tumorigenesis. The expression of PKR in normal human keratinocytes (NHEK) was examined, and its expression in several skin lesions was compared immunohistochemically with that of proliferating cell nuclear antigen (PCNA). Expression of PKR mRNA was detected in NHEK without IFNγ treatment; the level of PKR mRNA increased with IFNγ treatment for two hours. Immunoblot analysis revealed that the monoclonal anti‐PKR antibody reacted specifically with a 68kDa PKR protein in extracts from NHEK. Immunohistochemistry revealed that PKR protein was expressed in normal epidermis and mucosa. PKR expression was not restricted only to suprabasal cells but was also observed in basal cells positive for PCNA. In psoriatic plaques, PKR expression was lower in basal and parabasal keratinocytes and comparable in suprabasal keratinocytes to the levels in normal skin. PKR was partially detected in atypical cells in non‐invasive keratinocytic neoplasia but was completely absent from undifferentiated tumor cells of squamous cell carcinoma. The present study demonstrated that PKR protein is constitutively expressed in epidermal and epithelial keratinocytes of normal skin and mucosa and indicated that a loss of PKR is not associated with the malignant transformation itself but with the increased cell proliferative activity and the altered differentiation of keratinocytes.
Topical Antibacterial Agents in Dermatology
Authors: Singal Anjum , Thami Gurvinder P.
Published: July 2014

Topical antibacterials are being widely used for the treatment or prevention of superficial bacterial infections. Emergence of drug resistant mutant strains of microorganisms and development of irritant and allergic contact dermatitis is a common problem with many of the topical antibacterials. Topical antibacterials are being reviewed with special emphasis on their spectrum of activity, resistance patterns, contact sensitivity potential and clinical uses. Factors which help the physician to choose a particular antibacterial for the specific indication in order to have the maximum efficacy and minimum adverse effects are discussed.
Structural Changes in the Glycosaminoglycan Chain of Rat Skin Decorin with Growth
Authors: Nomura Yoshihiro , Abe Yoshiko , Ishii Yasuhiro , Watanabe Mutsuto , Kobayashi Miya , Hattori Akira , Tsujimoto Masafumi
Published: July 2014

Decorin controls collagen fibrilogenesis in skin, and its molecular weight changes in wound healing and with age. In this report, the quantitative and structural changes of decorin were investigated with growth in rat skin from the fetus to the young adult. A northern blot analysis showed that the highest level of skin decorin mRNA was at post partus 0.5 days; this level was about 3.7 times the level at embryo 16.5 days. The mRNA level in the rat skin decreased by 1/5 from post partus 0.5 days until 90 days of age. Western blotting showed that the amount of decorin increased with age in protein level. The molecule size of decorin at embryo 18.5 days was about 110 kDa, and that at post partus 90 days was about 70 kDa. There were no changes in molecular size of its core protein, so the reduction in the size of decorin was dependent on the size of the glycosaminoglycan (GAG) as shown by western blot analyses. Electron micrography of the rat skin with cupromeronic blue staining showed that the length of GAG at embryo 18.5 days was about 78.58 ± 13.94 nm, and that at post partus 90 days was about 54.05 ± 4.79 nm. The reduction in length of decorin GAG with age shrunk the distance between the collagen fibrils. We suggested that decorin changes the GAG length in order to control skin reconstruction in response to inflammation and injury.
Skin Graft Fixation with Negative‐Pressure Dressings
Authors: Isago Tsukasa , Nozaki Motohiro , Kikuchi Yuji , Honda Takashi , Nakazawa Hiroaki
Published: July 2014

The tie‐over bolster dressing is the most commonly used method for securing skin grafts. However, it requires surgical skill and experience to make a skin graft adhere closely to a grafting site when the site has a complicatedly curved surface. The lack of appropriate tension and pressure on the skin graft may produce hematoma, dislocation, or wrinkles in the graft. The grafting site for the dorsum of a hand is particularly complicated and irregular and requires delicate changes in pressure when the tie‐over bolster dressing is used for sites supported and not supported by bones. We have obtained a high survival rate at such difficult sites by managing skin grafts with negative‐pressure dressings. This paper describes the details of the technique with case reports. We have used this technique for skin graft fixation in 10 patients and confirmed its high utility as evidenced by a survival rate of 95% or higher of the grafted areas. Unlike existing techniques that apply pressure on skin grafts, this technique applies a negative pressure to the space between the skin graft and the grafting site to remove hematomas and pull the whole skin graft onto the grafting site with uniform force for adhesion.
Multicentric Castleman's Disease Associated with Inherited Epidermolysis Bullosa
Authors: Kawakami Yoshio , Nishibu Akiko , Kikuchi Satoshi , Ohtsuka Mikio , Nakamura Koichiro , Nozawa Yoshihiro , Abe Masafumi , Iwatsuki Keiji , Kaneko Fumio
Published: July 2014

Multicentric Castleman's disease (MCD) is a rare disorder characterized by fever, polyclonal hypergammaglobulinemia, and generalized lymphadenopathy. It has three histological characteristics: a recognizable architecture, germinal center abnormalities, and plasmacytosis. Inherited epidermolysis bullosa (EB) is also a rare disorder caused by a genetic defect. We report a 43‐year‐old patient with dystrophic EB, non‐Hallopeau‐Siemens recessive type or dominant type, displaying clinicopathologic features of MCD. In addition, his serum interleukin‐6, which is thought to be responsible for the clinical symptoms in MCD, was elevated.
Bullous Scabies Mimicking Bullous Pemphigoid
Authors: Brar Balvinder Kaur , Pall Anuj , Gupta Rajesh Rani
Published: July 2014

Scabies is an infestation caused by Sarcoptes scabiei and characterised by polymorphous lesions that may include burrows, papules, nodules, excoriation and crusts. Vesicular and bullous lesions are rather rare. Several diseases may be confused with scabies. We report a case of bullous scabies which, on the basis of the clinical and histopathological picture, mimicked bullous pemphigoid. Direct and indirect immunofluorescence were negative. Bullae recurred and persisted despite systemic corticosteroids. The patient was successfully treated with 5% permethrin and remained disease free for up to 12 months of follow‐up.
Residual Washing Detergent in Cotton Clothes: A Factor of Winter Deterioration of Dry Skin in Atopic Dermatitis
Authors: Kiriyama Takashi , Sugiura Hisashi , Uehara Masami
Published: July 2014

Although it is well known that the skin in patients with atopic dermatitis becomes drier in winter, the mechanisms of winter deterioration of dry skin are not fully understood. Our purpose was to determine whether residual washing detergent in cotton clothes plays a role in the winter deterioration of atopic dry skin. We studied 148 Japanese patients with atopic dermatitis who visited our dermatology clinic during winter months. They wore cotton underwear, which they had washed in cold tap water. We examined the distribution of dry skin on their trunks. We then asked them to stop washing their clothes with common anionic, additive‐enriched detergents, and to use a nonionic, additive‐reduced detergent for a period of two weeks. Photographs of 2 or 3 representative dry skin sites on the trunk were taken before and after the trial. By comparing the before‐after trial photographs, the severity of dry skin at the end of the trial was assessed on a 5‐point scale ranging from markedly improved to worsened. Of the 148 patients examined, 115 (78%) had widespread or localized dry skin on the trunk. The dryness of the skin was prominent around the shoulders. Of these 115 patients, 87 (76%) showed marked or moderate improvement of dry skin after the two‐weeks of use of the nonionic, additive‐reduced washing detergent. No patient showed worsening of the dry skin. These results suggest that residues of common washing detergents in cotton underclothes play an important role in the winter deterioration of dry skin in patients with atopic dermatitis who use cold tap water for washing their clothes.
Localized Cutis Marmorata Telangiectatica Congenita on the Back of a Young Man
Authors: Takenaka Hideya , Yasuno Hirokazu , Kishimoto Saburo
Published: July 2014

We report the clinical and light microscopic features of a case of cutis marmorata telangiectatica congenita with a painful refractory ulcer that was found on the back of a young Japanese man. The ulcer was positioned on the upper back over the spinal bone. In addition to the anatomical location of the ulcer, the vascular ectases may have played a part in the refractory ulceration.
Pulse Therapy with Amikacin and Dapsone for the Treatment of Actinomycotic Foot: A Case Report
Authors: Sharma Neelu , Mendiratta Vibhu , Sharma Ravi Chandra , Hemal Upma , Verma Monica
Published: July 2014

Actinomycetoma is a chronic disease caused by aerobic actinomycetes and affecting the skin, subcutaneous tissue, and bones. It causes significant morbidity and clinically manifests as abscesses and sinus/fistulae with or without granules. Early diagnosis is based on the color, size, histopathology of the granules; culture and metabolic studies are used for further species differentiation. Although sulfamethoxazole‐trimethoprim alone or in combination with dapsone for a variable period of time are used as first line agents for treatment, slow response to the therapy and high relapse rates have led to increasing usage of alternative agents like gentamycin, amikacin and cefotaxime. We report a case of actinomycetoma foot who had complete treatment failure with a sulfamethoxazole‐trimethoprim‐dapsone combination and was successfully treated with combination therapy of amikacin and dapsone without any side effects.
Acute Allergic Contact Dermatitis Due to Para‐Phenylenediamine after Temporary Henna Painting
Authors: Nawaf Al‐Mutairi , Joshi Arun , Nour‐Eldin Osama
Published: July 2014

The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, Middle East, and North Africa, and the fad is spreading in other parts of the world. Several cases of para‐phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17‐year‐old girl with blisters over her hands of five‐days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completerly over the next four weeks leaving post‐inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3+ reaction to PPD at 48 hours. No reaction was seen at the natural henna site. Awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted.
A Case of Generalized Pustular Psoriasis Associated with Turner Syndrome
Authors: Kawakami Yoshio , Oyama Noritaka , Kishimoto Kazuhiro , Yamazaki Keiji , Nishibu Akiko , Nakamura Koichiro , Hoshi Satoshi , Kaneko Fumio
Published: July 2014

We report a 27‐year‐old Japanese woman with Turner syndrome who had generalized pustular psoriasis of the von Zumbusch type. She developed a febrile diffuse erythema and pustular eruption without any history of preceding psoriasis vulgaris or drug ingestion. Oral treatment with 3.2 mg/kg cyclosporin per day successfully resulted in rapid improvement, followed by a complete remission. To our knowledge, this is the first report describing the unusual coexistence of these two systemic disorders. We discuss a hormone imbalance that might have contributed to the predisposition to pustular psoriasis and difficulties in the management of the patent's treatment.
Polypoid Basal Cell Carcinoma on the Perianal Region: A Case Report and Review of the Literature
Authors: Misago Noriyuki , Narisawa Yutaka
Published: July 2014

We report the case of an 88‐year‐old Japanese woman with polypoid BCC on the perianal region. The basaloid, solid aggregations of BCC were limited to the upper to middle part of the polypoid area. A review of the English and Japanese literature that excluded cases of fibroepithelioma of Pinkus found 21 total cases in which the polypoid BCC could be recognized as a variant of nodular BCC. The following points were used to categorize the lesions: 1) characteristic polypoid appearance that often mimics clinically benign or malignant adnexal neoplasms, melanocytic nevus, or malignant melanoma; 2) the peculiar favorable locations such as scalp (23.8% of the 21 cases), genital area (23.8% of the cases), and back‐buttock areas (19% of the cases). These areas suggest that etiologic factors other than ultraviolet radiation exposure are involved in such cases. These characteristic locations may also be the main reason why fibroepithelioma of Pinkus type BCCs frequently manifest with a polypoid appearance, because these types of BCCs also have similar preferred sites such as the back‐buttock and genital areas. Polypoid BCCs appear to affect more women than men than do nodular BCCs (7 men and 14 women). Although the polypoid BCCs have a large average size, they are not considered aggressive because the lesions are well‐circumscribed and the growth patterns are non‐infiltrative.
Delayed Diagnosis in a Case of Lupus Vulgaris with Unusual Localization
Authors: Ceylan Can , Gerceker Bengu , Ozdemir Fezal , Kazandi Alican
Published: July 2014

Lupus vulgaris is the most common form of cutaneous tuberculosis, and the usual sites of involvement are the head and neck. We present a forty‐six‐year‐old woman with lupus vulgaris on the external surface of the left leg and foot, an unusual site. Based on histopathological and clinical features, this case was diagnosed as lupus vulgaris with unusual localization.
Distal Phalangeal Metastasis of Extramammary Paget's Disease
Authors: Umebayashi Yoshihiro
Published: July 2014

A rare case of phalangeal metastasis of extramammary Paget's disease in a 68‐year‐old man is described. The patient developed an erythematous, slightly elevated area in the pubic region. A biopsy specimen demonstrated numerous, large, rounded cells with ample pale‐staining cytoplasm proliferating in the epidermis. With a diagnosis of ***extra‐mammary Paget's disease, he underwent wide local excision and inguinal node dissection. Eleven months postoperatively, the patient developed a tender, red, swollen right ring finger. Bone X‐ray showed that the distal phalanx of the ring finger had completely dissolved. Histopathological examination demonstrated proliferation of tumor cells in the adipose tissue. They had poorer and darker cytoplasm than the Paget's cells in the epidermis of the pubic region. Immunohistochemically, these cells showed the same staining pattern as did the Paget's cells at the primary site. Accordingly, the patient was diagnosed with distal phalangeal metastasis of extramammary Paget's disease. Two weeks after the appearance of the distal phalangeal metastasis, the patient died of cancerous pleurisy. It has been reported that patients with phalangeal metastasis have a very poor prognosis.
Calcium Dobesilate (Cd) in Pigmented Purpuric Dermatosis (PPD): A Pilot Evaluation
Authors: Agrawal Subhav Kumar , Gandhi Vijay , Bhattacharya Sambit Nath
Published: July 2014

Pigmented purpuric dermatosis (PPD) is a chronic disorder of unknown etiology. It is quite common, and no therapy is significantly effective. Calcium dobesilate (Cd) has been tried successfully in many vascular disorders. The aim of this study was to evaluate the usefulness and efficacy of Cd in PPD. Nine male patients (7 with Schamberg's and 1 each with lichenoid dermatosis of Gougerot and Blum and lichen aureus) were given Cd 500 mg twice daily for two initial weeks and then 500 mg once daily for a total period of three months. All the patients were followed up for one year after cessation of therapy. The improvement was moderate in 11.11% and mild in 66.67% of cases; 22.22% did not show any improvement. New lesions stopped appearing in two weeks in all patients, and itching also improved in symptomatic cases without any significant side effects. Based upon the results of this pilot study we recommend Cd as the first line therapy for PPD.
Unilateral Nevoid Telangiectasia
Authors: Karakaş Mehmet , Durdu Murat , Sönmezoğlu Selma , Akman Ayşe , Gümürdülü Derya
Published: July 2014

Unilateral nevoid telangiectasia is a cutaneous condition consisting of congenital or acquired patches of superficial telangiectases in a unilateral linear distribution. Unilateral nevoid telangiectasia has been associated with elevations of blood estrogen levels and/or an increased number of estrogen receptors in the involved skin. We present a hepatitis‐B carrier case with unilateral nevoid telangiectasia on the face and the right side of the neck; she had normal blood estrogen and a normal number of estrogen receptors in the involved skin.
Bilateral Lichen Striatus
Authors: Kurokawa Motoki , Kikuchi Hidezumi , Ogata Katsumi , Setoyama Mitsuru
Published: July 2014

We describe a very rare case of bilateral lichen striatus on the lower extremities with a history of more than ten years. Histopathologically, the lesions demonstrated a lichenoid tissue reaction with foci of spongiosis and perivascular inflammatory cell infiltration. In addition, the finding of lymphocytic infiltrations around the eccrine duct was observed. They were treated successfully with topical application of corticosteroid ointment. To the best of our knowledge, no other lichen striatus case has been reported with bilateral distribution and such long‐term persistence.
Idiopathic Unilateral Hyperhidrosis with Holmes‐Adie Syndrome: Case Report
Authors: Coskun Basak Kandi , Saral Yunus , Belirgen Sait , Öztürk Perihan
Published: July 2014

Hyperhidrosis is a disease that is characterized by excessive sweating due to hyperactivation of eccrine sweat glands. It may be localized or generalized form. Holmes‐Adie syndrome is an idiopathic disease with unilateral pupil dilatation and loss of deep tendon reflexes. We present a 37‐year‐old female patient diagnosed with unilateral hyperhidrosis coincident with Holmes‐Adie syndrome because of this unusual presentation.
Bednar Tumor: A Report of Two Cases
Authors: Yagi Yoichi , Ueda Koichi , Maruyama Seichi , Noborio Reiko
Published: July 2014

We have recently treated two Japanese with Bednar tumor, pigmented dermatofibrosarcoma protuberans. The tumors were multilobular with brown‐pigmentation and an irregular surface. Firm nodules were growing into the deep subcutaneous tissue, but they were movable over the underlying tissue. Histopathological examination and immunohistochemical studies showed the typical features of Bednar tumor and positive staining for CD34, which is known to be expressed in dermatofibrosarcoma protuberans. Bednar tumor is thought to be a variant of dermatofibrosarcoma protuberans and to have intermediate malignancy.
Report of an Infant with Noma (Cancrum Oris)
Authors: Yuca Köksal , Yuca Sevil Arı , Çankaya Hakan , Çaksen Hüseyin , Çalka Ömer , Kırış Muzaffer
Published: July 2014

Noma (cancrum oris) is an infectious disease that destroys the oro‐facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero‐necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2–16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, HIV infection, and immune compromise conditions. Poverty is the most important risk factor. We report the case of a 6‐month‐old child with noma and review the characteristic features of this disease.
Cutaneous Sporotrichosis with Refractory and Reinfectious Lesions in a Healthy Female
Authors: Shinogi Taro , Misago Noriyuki , Narisawa Yutaka
Published: July 2014

We report a 71‐year‐old Japanese healthy female with an unusual clinical course of sporotrichosis; she developed infectious lesions on the face and the left upper limb at different periods. The initial lesion appeared on her right cheek and nose in 1992. Histopathologic and fungal examinations comfirmed the diagnosis of sporotrichosis. She was treated with oral potassium iodide and/or itraconazole and topical heat therapy. She had three recurrences and her facial plaque, which was resistant to several conventional treatments, was eventually excised and then grafted in 1996. After the surgical procedure, oral medication was continued for two months. In 2001, new lesions appeared on her left hand and forearm, which were anatomically different from the former lesions. Based on histopathologic and mycological findings, we confirmed reinfection with sporotrichosis. She was again treated with potassium iodide. The cutaneous lesions completely resolved after 26 weeks without surgical treatment.
Acute Generalized Exanthematous Pustulosis in a Six‐Year‐Old Boy
Authors: Lee Un Ha , Yang Jung Hun , Choi Jung Chul , Chun Duk Kyu
Published: July 2014

Acute generalized exanthematous pustulosis (AGEP) presents with an abrupt onset of widespread pustules on erythematous base and rapid spontaneous healing. AGEP may have a variety of causative factors such as drugs, viral infection and exposure to mercury. We report a case of AGEP in a 6‐year‐old boy who presented with acute onset of fever and widespread pustular eruption on erythematous bases. Histologic examination showed neutrophilic subcorneal spongiform pustule. It is an uncommon condition in children.
Elevated Serum Antimelanocyte Antibody Level in Cerebriform Intradermal Nevus with Vitiligo
Authors: Lee Chih‐Hung , Yu Hsin‐Su
Published: July 2014

We describe a rare, but typical case of cerebriform intradermal nevus associated with vitiligo. A 45‐year‐old man had a patch of alopecia over his vertex scalp for 15 years. The microscopic findings of the biopsy revealed a typical deep‐seated intradermal nevus and neuroid differentiation with a few pigments. Three hypopigmented patches developed on the forehead, cheek and index finger five years after the scalp lesion, with loss of both melanocytes and melanins. In addition, no dopa reactions were present. Compared to normal controls, the serum antimelanocyte antibody level in the patient was elevated as determined by cellular enzyme‐linked immunosorbent assay (cellular ELISA). This is the first reported case with elevation of serum antimelanocyte antibody level of cerebriform intradermal nevus with vitiligo. This antibody's presence may be related to the occurrence of the vitiligo in patient with cerebriform intradermal nevus.
Lupus Panniculitis with Combined Features of Dermatomyositis Resulting in Severe Lipoatrophy
Authors: Yoo Jong Yeop , Jo Seong Jin , Cho Kwang Hyun
Published: July 2014

An 11‐year‐old girl presented with a one‐year history of multiple, hard, slightly painful subcutaneous nodules on her right cheek, upper arms, and buttock. Histology of a skin biopsy specimen showed a lobular panniculitis. Laboratory studies revealed positive ANA, anti‐double strand DNA, and elevated muscle enzymes. She was diagnosed as having lupus panniculitis. During hydroxychloroquine treatment, erythema over knuckle joints developed. These unusual clinical and laboratory findings of panniculitis associated connective tissue diseases made it difficult to make a precise diagnosis. We report this unusual case of lupus panniculitis with combined features of dermatomyositis resulting in severe lipoatrophy.
High‐Frequency Ultrasound as a Useful Device in the Preliminary Differentiation of Lichen Sclerosus et Atrophicus from Morphea
Authors: Chen Hsin‐Chi , Kadono Takafumi , Mimura Yoshihiro , Saeki Hidehisa , Tamaki Kunihiko
Published: July 2014

High‐frequency ultrasound diagnostic equipment (HFUS) using probes with frequencies above 15‐MHz has been utilized conventionally in preoperative assessments and postoperative follow‐up of skin tumors. The advent of probes with even higher frequencies (up to 30‐MHz) has widened the clinical applications of HFUS to inflammatory dermatoses which are histologically confined to the epidermis and upper dermis, such as psoriasis and atopic dermatitis. Ultrasound imaging has the advantage of being a noninvasive and relatively inexpensive technology that is quick and easy to perform. In addition, information obtained from HFUS is unique and useful for clinical diagnosis and evaluation for various skin disorders. We believe that HFUS has the potential to become a powerful tool for either clinical or investigative dermatology. Herein, we present a case of lichen sclerosus et atrophicus (LSA) to which we applied HFUS before skin biopsy and obtained substantial information for the differential diagnosis from morphea, and we reemphasize the usefulness of HFUS in studying the inflammatory skin disorders.
Clinico‐Histopathological Correlation of Skin and Nerve in Leprosy
Authors: Khan Anamita , Koranne Ravinder V. , Bajaj Pramila , Ravi Bina
Published: July 2014

The histopathological features of skin tissue sections in patients clinically diagnosed as leprosy were correlated with the histopathological features of nerve specimens obtained from the same patients. Fifty untreated leprosy patients attending the Outpatient Department of the Department of Dermatology and Sexually Transmitted Diseases of Smt. Sucheta Kriplani and Kalawati Saran Children's Hospitals, New Delhi, India were included in the study. On correlating the histological features of skin and nerve tissue sections, concordant findings were found in 24 out of the 50 patients (48%) but discordance between the histopathological features of skin and nerve tissue sections were found in 26 out of 50 cases (52%). Of these 26 cases, the nerve tissue histology when compared with the skin histology showed features lower down the disease spectrum in 17 (34%) cases. Seven of the 50 patients (14%) showed histological features of leprosy higher in the disease spectrum in the nerve tissue sections than in the skin biopsy sections. One patient clinically LL leprosy demonstrated histopathological features of Histoid leprosy in the skin sections and LL in the nerve sections. The remaining one patient had features of TT leprosy in the skin tissue sections while the nerve tissue histopathology showed non‐specific changes. Histological features of the skin tissue sections were consistent with the clinical diagnosis in 33 out of 50 cases (66%). When the clinical groups were correlated with the histological features of the nerve tissue sections, concordance was found in 30 of the 50 cases (60%). On comparison of the histological features of skin and nerve tissue sections with the clinical diagnosis, concordance was still lower i.e., 19 out of 50 cases (38%). Thus the histological features of the skin tissue sections correlated more frequently with the clinical diagnosis than did those of the nerve sections. The importance of neural histology lies in the fact that it shows a higher BI and a lower histological grading in some cases and if not performed the lapse can result in inadequate treatment, drug resistance and even relapse.
Urticarial Erythema Associated with IgA Myeloma
Authors: Zhang Yan , Morita Eishin , Matsuo Hiroaki , Ueda Daizo , Dekio Satoshi
Published: July 2014

We report a case of atypical urticaria associated with IgA multiple myeloma. A 79‐year‐old man presented with a two‐month history of wheal‐like erythema, which lasted approximately one week without any response to anti‐histamines. Histological examination of a lesion revealed leukocytoclasia as well as perivascular leukocytic infiltration, being consistent with urticarial erythema. Laboratory investigation showed markedly elevated serum IgA concentration and M‐protein in serum protein electrophoresis. A bone marrow examination led to a diagnosis of myeloma. An immunofluorescence study failed to detect any IgA deposit in the lesion. However, the wheal‐like eruptions disappeared when the IgA myeloma was treated and reappeared when it relapsed. We conclude that this long lasting urticaria was the cutaneous manifestation of IgA myeloma.
Erythema Nodosum and Granulomatous Lesions Preceding Acute Myelomonocytic Leukemia
Authors: Anan Takashi , Imamura Tomoyuki , Yokoyama Shigeo , Fujiwara Sakuhei
Published: July 2014

A 65‐year‐old female with a one‐month history of painful eruptions on her lower extremities was admitted to our hospital. Histological examination revealed erythema nodosum (EN), and the patient was treated with oral prednisolone (PSL; 20 mg daily). The eruptions subsided in two weeks. One month later, painful reddish eruptions recurred on her upper limbs and abdomen in addition to her lower extremities. A skin biopsy from an abdominal erythematous plaque revealed a non‐caseating granuloma without microorganisms or foreign‐body materials. These eruptions also disappeared with treatment with oral PSL (20 mg daily). No underlying disease, including sarcoidosis, diabetes mellitus, or rheumatoid arthritis, was found. However, five months later, the patient developed conspicuous leukocytosis. She was diagnosed with acute myelomonocytic leukemia (M4) and treated with chemotherapy. After complete remission had been achieved, the EN reappeared, in association with an increase in blastic cells in the bone marrow. Serum levels of tumor necrosis factor‐alpha and interleukin‐1 beta, which are thought to be essential for granuloma formation and induction of EN, were markedly elevated. Physicians must remember that recurrent EN and granulomatous lesions can be a prodromal sign of leukemia.
Clinical Usefulness of a Long‐Term Treatment with an Antithyroid Drug for Psoriasis Vulgaris
Authors: Hasegawa Michiko , Abe Masatoshi , Ohnishi Kazunori , Shoji Chizuru , Ishikawa Osamu
Published: July 2014

We have previously reported that an antithyroid thiourethylene, thiamazole, can bring about significant clinical improvement in patients with psoriasis vulgaris. Although the efficacy of antithyroid thiourethylenes had been reported earlier, few studies have evaluated the safety of its long‐term use. In this study, we aimed to study whether or not long‐term thiamazole administration is complicated by any adverse effects. Eight patients with psoriasis vulgaris were enrolled in this study after informed consent was obtained. Each patient was administered thiamazole orally at 30 mg/day for 12 weeks. Two patients achieved complete clearance of psoriatic lesions. Four patients showed a significant improvement, and two patients did not reach satisfactory improvement. Some adverse effects developed in five patients; serum TSH levels elevated above the normal range in three patients and fell below the normal range in one patient. However, serum free‐ T3 and free‐ T4 levels remained within normal ranges during the treatment in all patients, and none of the patients developed clinical hypothyroidism. This preliminary study suggests that thiamazole administration is an effective and relatively safe treatment for patients with psoriasis vulgaris.
Unilateral Syringoma of the Face Associated with Hyperthyroidism
Authors: Aliagaoglu Cihangir , Atasoy Mustafa , Yildirim Umran , Balik Özgül , Koca Timur , Erdem Teoman
Published: July 2014

Syringomas are benign tumors derived from the intraepidermal portion of eccrine sweat ducts. They usually occur on the periobital area, but have also been found on the scalp, forehead, cheeks, axillae, abdomen, extremities, genitalia, and buttocks. We describe a patient with an unusual presentation of unilateral syringoma of the face associated with hyperthyroidism.
A Case of Multiple Cavernous Hemangiomas with Skin and Central Nervous System Involvement
Authors: Ebara Naoki , Asada Hideo , Miyagawa Sachiko
Published: July 2014

A 47‐year‐old woman presented with multiple bluish subcutaneous nodules on the trunk and upper extremities. The histological diagnosis of a subcutaneous nodule was cavernous hemangioma. Multiple cavernous hemangiomas were also found in her cerebrum, cerebellum, and medulla oblongata on magnetic resonance imaging examination. We did not detect any mutations in the two loci of the TIE2 gene that have been reported in familial venous malformations.
Postoperative Alopecia in Five Patients after Treatment of Aneurysm Rupture with a Guglielmi Detachable Coil: Pressure Alopecia, Radiation Induced, or Both?
Authors: Lee Won‐Soo , Lee Se‐Won , Lee Sanghoon , Lee Jin Wook
Published: July 2014

Postoperative pressure alopecia is an uncommon complication of long anesthetic surgical procedures, typically affecting the occiput and resulting from pressure‐induced tissue hypoxia. Generally, it develops after procedures of long duration, of more than four hours. Most alopecia is transient, but a few cases are permanent. Guglielmi detachable coil (GDC) coiling is a procedure guided by fluoroscopy that fills an intracranial aneurysm. Our cases were characterized by an unusual distribution of alopecia, short duration of procedure, and radiation exposure. The alopecic lesions of our patients were located on the temporal scalp as well as the occipital scalp. The total time of anesthesia was relatively short, two to three hours. During the procedure, these patients were exposed to ionizing radiation (over 2Gy). These cases are different from previous reports in that the duration of the procedure was short, the temporal scalp was affected in addition to the occipital scalp, and the pathology occurred after GDC coiling.
A Comparison of Dermoscopic Features among Lentigo Senilis/Initial Seborrheic Keratosis, Seborrheic Keratosis, Lentigo Maligna and Lentigo Maligna Melanoma on the Face
Authors: Şahin Mustafa Turhan , Öztürkcan Serap , Ermertcan Aylin Türel , Güneş Ali Tahsin
Published: July 2014

Clinical differentiation of facial lentigo senilis/initial seborrheic keratosis (LS/ISK), seborrheic keratosis (SK), lentigo maligna (LM), and lentigo maligna melanoma (LMM) can be difficult. Dermoscopy improves the diagnoses in pigmented skin lesions (PSLs), but it is not helpful for the sun‐exposed face because of the flat rete ridges without network‐derived features. Therefore, development of new diagnostic criteria for this particular localization is a current issue of dermatology. In this retrospective study, dermoscopic slides of facial pigmented skin lesions of 66 patients referred to two clinics in Turkey were evaluated. Our aim was to determine the reliability of dermoscopy in the differentiation of these entities. The facial PSLs of 66 patients (34 males and 32 females) (median age: 58.2) were photographed with a Dermaphot (Heine, Hersching, Germany) over a five year period from November of 1995 to May of 2000. All of the dermoscopic slides were analysed according to 27 dermoscopic criteria developed by Schiffner et al. This data set contained 22 histologically proven malignant (14 LM, 8 early LMM) and 44 benign (18 SK, 26 LS/ISK) PSLs. In general, asymmetric pigmented follicular openings, dark streaks, slate‐gray streaks, dark globules, slate‐gray globules, dark dots, dark rhomboidal structures, light brown rhomboidal structures, dark homogeneous areas and dark pseudonetworks were statistically significant for malignant growth. On the other hand, milia‐like cysts, pseudofollicular openings, cerebriform structures, light brown globules, light brown dots, light brown homogeneous areas, yellow opaque homogeneous areas, and light brown pseudonetworks were statistically significant for benign growth. This research emphasizes that dermoscopic features on the face differ from criteria used in other locations of the body. Analysis of the data suggests that dermoscopy can be used in the differentiation of LS/ISK, SK, LM and LMM from each other.
A Study of Leprosy Reactions in a Tertiary Hospital in Delhi
Authors: Sharma Neelu , Koranne Ravindra V. , Mendiratta Vibhu , Sharma Ravi Chandra
Published: July 2014

A retrospective study of 531 leprosy patients was undertaken to study the profile of reactions in the post Multi‐Drug‐Therapy period in a tertiary hospital in Delhi. BT was the most common group. The prevalence of reactions was found to be 8.09% for the Type 1 and 4.70% for the Type 2 reactions for a male:female ratio of 2.2. The Type 1 reaction was most frequently observed in the BB group followed by BL, BT and LL groups respectively. More than half of the patients had reactions at the time of presentation. In only 39.8% of the patients did reaction follow Multi‐Drug‐Therapy. In 4.5% of the patients with Type 1 reactions (T1R), concomitant infections were noted. The most common presentation of T1R was cutaneous lesions (74.41%) followed by cutaneous lesions and neuritis (53.6%), neuritis alone (12.1%), and only edema of hands and feet (7.31%) respectively. The Type 2 reactions (T2R) presented chiefly as papulo‐nodular (92%) lesions followed by pustulonecrotic (8%) lesions. Associated neuritis was found in 40% and periosteitis and iritis in 8% and 4%, respectively. In 8.6% of the patients with T2R, precipitating factors could be observed. The prevalence of deformities in patients with reaction was 25%, and was more common in females. Deformities were observed in 23.25% of the T1R patients and 28% of the T2R patients.
β‐Mannosidosis with Angiokeratoma Corporis Diffusum
Authors: Suzuki Nuiko , Konohana Izumi , Fukushige Tomoko , Kanzaki Tamotsu
Published: July 2014

β‐mannosidosis is a lysosomal disorder which is caused by a deficiency of β‐mannosidase. This disorder was first described in goats. Twelve human cases have already been reported. We present the first case in Japan in whom the diagnosis was reached from angiokeratoma corporis diffusum. Futhermore, mental retardation, hearing loss, and renal failure were also detected. Pseudoxanthoma elasticum was also present, but whether it is a complication of β‐mannosidosis or not remains unknown. The activity level of β‐mannosidase in the patient's plasma was only 2% of the normal range, while that in the patient's mother was 40%. We suggest that β‐mannosidosis should be one of the differential diagnoses when lysosomal enzyme disorders are suspected in cases of angiokeratoma corporis diffusum.