bluuebunny/crossref_metadata_2025 huggingface dataset:
Henoch–Schönlein purpura induced by clarithromycin
Authors: Goldberg Elizabeth I. , Shoji Toru , Sapadin Allen N.
Published: March 2003

An 84‐year‐old Indian woman with no significant past medical history and no known drug allergies had been prescribed clarithromycin (250 mg twice daily) for pneumonia. The patient was receiving no other medications. Ten days after starting treatment, the patient developed a mild fever, eruption, and swelling of the ankles. Several days later, the patient developed a spreading, nonpainful, nonpruritic eruption, joint pain, gastrointestinal bleeding, and general malaise. Skin examination revealed numerous palpable purpuric macules and papules and petechiae on the lower extremities, mostly below the knees, and on the right hand. There were large blistering lesions around both ankles, some of which had ulcerated and had a necrotic center (Fig. 1). Blood streaked stool was noted during rectal examination. Laboratory tests showed a normal white blood cell count, hematocrit, and hemoglobin. Serum urea nitrogen was 22 mg/dL (8–18 mg/dL) and creatinine was normal. Urinalysis revealed proteinuria of 0.9 g/24 h (<0.15 g/24 h) and a microscopic hematuria. Antistreptolysin O, antinuclear antibodies, cryoglobulins, and hepatitis serologies were all negative. Histology of the skin showed leukocytoclastic

Extensive purpura on the distal legs. Overlying the medial malleolus of the left ankle is a large crusted erosion. An ischemic but intact blister roof is apparent at the periphery

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vasculitis of superficial vessels with extravasation of red blood cells (Fig. 2). Direct immunofluorescence revealed immunoglobulin A (IgA) in superficial dermal vessels. Treatment with prednisone (1 mg/kg/day) was started and the arthralgias, hematochezia, and eruption resolved over the next 3 days. Renal function remained impaired, however, and the patient was discharged with a proteinuria of 0.56 g/24 h (<0.15 g/day) on prednisone and omeprazole.

Medium power picture showing fibrinoid necrosis of superficial vessels, neutrophilic infiltrate, and karyorrhectic debris (hematoxylin and eosin, ×100)

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Cutaneous leishmaniasis in Yemen
Authors: Khatri Mishri Lal , Haider Nasser
Published: March 2003

Background Cutaneous leishmaniasis is widespread in the Yemen, but has not been fully documented.

Methods We have studied 42 cases from the Hajjah and Amran Governorates of the Yemen Republic. The clinical profile of these cases was recorded in a special protocol. The diagnosis was based on positive slit skin smear and histopathologic studies when needed.

Results The age of the patients ranged between 1 and 65 years (median age, 19 years) and the duration of the disease ranged between 2 months and 12 years (median duration, 6 months). Most of the patients had a single lesion. Slit skin smear was positive for parasites in 35 cases (highly positive in 15). From the analysis of features, the disease could be classified into dry type (31 patients), wet type (seven patients), and chronic cutaneous leishmaniasis (four patients). Most of the patients required prolonged (4–6 weeks) treatment with sodium stibogluconate; the smear was still positive in eight patients, seven of whom were further treated successfully with a combination of rifampicin and isoniazid for 2–3 months. One who was treated successfully with intralesional injections of sodium stibogluconate.

Conclusions Cutaneous leishmaniasis in this region seems to be endemic, has a long chronic course, shows a highly positive smear even 1–6 years after onset, and gives an inadequate response to prolonged systemic therapy. Further epidemiologic studies and taxonomic differentiation of the species are required.
Congenital self‐healing histiocytosis (Hashimoto–Pritzker)
Authors: Larralde Margarita , Rositto Alicia , Giardelli Margarita , Gatti Carlos F. , Muñoz Andrea Santos
Published: March 2003

Background Congenital self‐healing Langerhans cell histiocytosis (CSHLCH) is a rare condition, initially seen at birth or in the neonatal period, with generalized papules, vesicles, or nodules. Affected infants are otherwise well and the skin lesions tend to involute spontaneously within weeks to months.

Methods Twelve patients with CSHLCH were seen from 1989 to 1998.

Results Eight patients were girls and four were boys and all presented with lesions at birth which disappeared 1–3 months later. The lesions consisted of numerous brownish‐red papules, papulovesicles, crusts, and nodules distributed on the face, limbs, palms, and soles. Two patients had oral mucosal lesions, and one had ulcerated lesions that evolved leaving hypochromic macules. Light microscopy showed a histiocytic infiltrate in the papillary dermis with epidermotrophism. Two cases were studied by electron microscopy: the Langerhans cells showed Birbeck granules and laminated corpus in their cytoplasm. Immunomarking with S100 protein was performed in all 12 patients and was positive. CD1 was also tested in four cases and was positive.

Conclusions Because CSHLCH is a rare condition, we emphasize that, although it is usually a benign, self‐limited entity, careful evaluation for systemic disease must be performed and long‐term follow‐up must be carried out to detect evidence of relapse or progression of the disease; this is essential when treating these patients.
Chromoblastomycosis in India
Authors: Sharma Nand Lal , Sharma Ramesh Chander , Grover Prem Singh , Gupta Manohar Lal , Sharma Ashok Kumar , Mahajan Vikram Kumar
Published: March 2003

Background Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed.

Results These 34 patients ranged in age from 12 to 80 years with a male to female ratio of 5.8 : 1. Onset before the age of 20 years was seen in 24% of cases which was comparatively high. Culture was positive in 72% of cases and sclerotic bodies were observed in 84% of cases. A relatively higher prevalence (15%) of Fonsecaea compacta was observed. Unusual cutaneous sites afflicted were the penile shaft, vulva, and ala of the nose, and unusual extracutaneous spread was seen in the pleural cavity, ileocecal region, laryngotracheal area, and tonsils. Extracutaneous involvement was seen in 24% of cases. Overlapping infection with another fungus, Geotrichum candidum, was seen in one case.

Conclusions Combination therapy with two azoles was attempted with some success for clinical cure.
Use of high‐dose methylprednisolone pulse therapy in patients with progressive and stable vitiligo
Authors: Seiter Simone , Ugurel Selma , Tilgen Wolfgang , Reinhold Uwe
Published: March 2003

Abstract

Background  Although there are several treatment options available for patients with generalized vitiligo, their efficacy is still a matter of debate. Although shown to be effective, corticosteroids applied either systemically or topically carry the risk of significant side‐effects in long‐term therapy. We evaluated the effectiveness of intravenous methylprednisolone (8 mg/kg body weight) administered on three consecutive days in patients with generalized vitiligo.

Materials and methods  A total of 14 patients with progressive or static vitiligo were included in a prospective, open, clinical study.

Results  Eighty‐five per cent of the patients presenting with progressive disease showed cessation of disease progression after the infusion therapy. Repigmentation was observed in 71% of patients with progressive vitiligo. None of the six patients presenting with static disease showed any repigmentation in response to this form of treatment. The therapy was well tolerated in all but one patient who developed intermittent arterial hypertension during therapy.

Conclusions  High‐dose glucocorticoid pulse therapy may represent a therapeutic option in patients with generalized progressive vitiligo, and should be further evaluated in a prospective, randomized, clinical trial.
Demodex folliculorum in pregnancy
Authors: Aydingöz İkbal Esen , Dervent Barış , Güney Osman
Published: March 2003

Abstract

Background  Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS).

Objective  We aimed to determine the influence of pregnancy on the carriage of DF.

Methods  Mite density in 40 pregnant women was compared with that of age‐ and sex‐matched controls. Two standardized skin surface biopsies were taken from each subject.

Results  In pregnant women, DF was found at 0.55/cm2, compared with a mean value of 1.2/cm2 in nonpregnant controls. The difference between the two groups was not statistically significant (Mann–Whitney test, P = 0.22).

Conclusions  Our findings indicate that pregnancy may not have a direct effect on mite density.
Adapalene: an update on newer comparative studies between the various retinoids
Authors: Millikan Larry E.
Published: March 2003

Abstract

Background  Extensive modification of the retinoic acid molecular skeleton has resulted in the development of adapalene, a more stable, less irritating compound with receptor selectivity. Adapalene selectively targets nuclear retinoic acid receptors found primarily in the epidermis. Pharmacologic and preclinical studies have demonstrated excellent follicular penetration, comedolytic activity, and anti‐inflammatory activity.

Methods  Recent comparative trials were reviewed.

Results  Adapalene is a useful new agent because of its tolerability and stability. It is a good therapeutic choice for combination with other topical anti‐acne medications, such as antimicrobials or benzoyl peroxide. Patient compliance with either combination or single‐agent adapalene regimens is likely to be enhanced because of the greater comfort and reduced skin irritation associated with the new compound. Other investigators have confirmed that adapalene gel produces consistent and significantly reduced irritation.

Conclusions  Recent comparative trials on retinoids have provided new data to aid in the selection of the appropriate combination of topical agents for individual patients.
The safety of terbinafine in patients over the age of 60 years: a multicenter trial in onychomycosis of the feet
Authors: Smith Edgar B. , Stein Linda F. , Fivenson David P. , Atillasoy Ercem S.
Published: March 2003

Thirty patients completed this open‐label, multicenter prospective study performed to evaluate the efficacy and safety of terbinafine treatment of onychomycosis of the feet in elderly patients. Inclusion criteria included an age of 60 years or older, a diagnosis of onychomycosis confirmed by positive potassium hydroxide (KOH) preparation at baseline, and toenails capable of regrowth. Patients were excluded from the study if they had received any systemic antifungal therapy within the previous 3 months or topical antifungal therapy within 1 week prior to the start of the study; had psoriasis; had toenail abnormalities interfering with normal toenail appearance; were immunosuppressed or immunodeficient; or had serum hepatic enzyme (serum glutamic‐oxaloacetic transaminase, SGOT; serum glutamic‐pyruvic transaminase, SGPT) values greater than 1.5 times the upper limit of normal at baseline.

Following baseline evaluations, eligible patients received a 12‐week supply of oral terbinafine (250 mg/day) for self‐administration. Compliance was assessed by tablet counts at each visit and defined as the use of at least 80% of the medication prescribed at the first two visits. Follow‐up evaluations were conducted for the next 60 weeks, for a total study period of 72 weeks. These visits occurred at weeks 6, 12, 24, 36, 48, and 72. All follow‐up visits included: (i) the reporting of adverse effects; (ii) assessment of efficacy by KOH preparation, mycologic culture, and investigator evaluation; and (iii) physician and patient global assessments of various quality of life parameters (except for the visit at week 36).

Safety and tolerance were assessed by physical examination at baseline and week 12, by laboratory evaluations (hematology, blood chemistry, and urinalysis) at baseline, week 6 and week 12, and by reporting and evaluation of adverse events throughout the entire study. Investigators assessed the extent of involvement of the target toenail and recorded global assessments of therapeutic efficacy at all visits. Mycologic evaluation was conducted by KOH preparation and a mycologic culture of the target toenail. Because of discrepancies in KOH results between the investigator sites and the central laboratory in early analyses, we chose to use the mycologic culture results to evaluate efficacy. Because all 30 subjects were treated with terbinafine, the entire group was considered for safety evaluation.
Lichenoid and granulomatous dermatitis
Authors: Magro Cynthia M. , Crowson A. Neil
Published: March 2003

Background The prototypic lichenoid eruptions, lichen planus (LP), lichenoid drug eruptions, secondary syphilis, and collagen vascular disease, are defined histologically by a band‐like lymphocytic infiltrate in close apposition to the epidermis. We describe a novel form of lichenoid dermatitis with a granulomatous component.

Design Skin biopsies from 40 patients demonstrating a band‐like lymphocytic infiltrate with concomitant granulomatous inflammation were encountered over 4 years. Clinicians were contacted to elucidate underlying triggers and medical illnesses.

Results A lichenoid dermatitis, a linear eruption, vasculitis, annular erythema, and erythroderma were among the clinical presentations. A drug‐based etiology was implicated in 14 cases: the drugs included antibiotics, lipid‐lowering agents, anti‐inflammatory drugs, antihistamines, hydroxychloroquine sulfate, and angiotensin‐converting enzyme inhibitors. Over one‐third of patients with drug‐related eruptions had other medical illnesses associated with cutaneous granulomatous inflammation, namely rheumatoid arthritis (RA), Crohn’s disease, hepatitis C, diabetes mellitus, and thyroiditis. A microbial trigger was implicated in 12 patients in the context of infective id reactions to herpes zoster, Epstein–Barr virus (EBV), or streptococci, or active infections by Mycobacterium tuberculosis, M. leprae, fungi, and spirochetes. The remainder had hepatobiliary disease and RA without obvious exogenous triggers, cutaneous T‐cell lymphoma (CTCL), and idiopathic lichenoid eruptions (i.e. LP, lichen nitidus, and lichen striatus). One patient with LP had underlying multicentric reticulohistiocytosis. The histiocytic infiltrate assumed one or more of five light microscopic patterns: (i) superficially disposed loose histiocytic aggregates; (ii) cohesive granulomata within zones of band‐like lymphocytic infiltration with or without deeper dermal extension; (iii) a diffuse interstitial pattern; (iv) scattered singly disposed giant cells; and (v) granulomatous vasculitis. Additional features included lymphocytic eccrine hidradenitis in those patients with drug reactions, hepatobiliary disease, and antecedent viral illnesses, tissue eosinophilia and erythrocyte extravasation in drug hypersensitivity, granulomatous vasculitis in patients with microbial triggers, drug hypersensitivity or RA, and lymphoid atypia in lesions of CTCL or drug hypersensitivity.

Conclusions The cutaneous lichenoid and granulomatous reaction may reflect hepatobiliary disease, endocrinopathy, RA, Crohn’s disease, infection, or a drug reaction. One‐fifth of cases represent idiopathic lichenoid disorders. Lymphoproliferative disease or pseudolymphomatous drug reactions must be considered in those cases showing lymphoid atypia.
New topical treatments change the pattern of treatment of psoriasis: dermatologists remain the primary providers of this care
Authors: Feldman Steven R. , Fleischer Alan B. , Cooper Jennifer Z.
Published: March 2003

Background Psoriasis is a common chronic skin disorder that can be debilitating both physically and psychologically. The treatment of psoriasis is complicated by the many manifestations of the disease, different patients’ subjective impression of the disease, and the availability of numerous topical agents, systemic agents, and phototherapy options for the disease.

Purpose The purpose of this study was to characterize how topical psoriasis treatment is changing in the USA.

Methods Data from the National Ambulatory Medical Care Survey (1990–1996) were used to characterize the use of medication at physician office visits for psoriasis vulgaris. Corticosteroid agents in the years 1990–1994 were classified by relative potency.

Results There were 1.0 million yearly visits for psoriasis. Dermatologists were responsible for 95% of these office visits. Topical corticosteroids were the only medication listed at 50% of psoriasis visits, and were used in combination with another medication in an additional 26% of visits. High and superpotent corticosteroid agents accounted for 55% of all topical corticosteroid agents listed. Topical calcipotriene was the most commonly used noncorticosteroid treatment, and its use in combination with corticosteroids increased from 17% to 84% between 1994 and 1996.

Conclusions 80% or more of people with psoriasis do not see a physician for the disease in any given year. A combination of different topical medications is commonly used to treat psoriasis. Patients should be aware of the availability of new therapeutic options and the special expertise of dermatologists in managing complex treatment regimens for psoriasis.

Introduction
The relationship between Helicobacter pylori IgG antibody and autologous serum test in chronic urticaria
Authors: Hizal Müge , Tüzün Binnur , Wolf Ronni , Tüzün Yalçin
Published: March 2003

Background In chronic urticaria, suspicious factors are Helicobacter pylori (HP) infection and autoimmunity, as well as other etiologic agents. Autologous serum injection is the first step to identify autoimmune urticaria. Our study was performed to determine the prevalence of HP infection in patients with chronic urticaria, and to evaluate the results of autologous serum testing in chronic urticaria patients who had HP antibodies.

Methods HP immunoglobulin G (IgG) antibody was defined by an immunochromatographic method in 61 chronic urticaria patients and 15 healthy persons. Autologous serum testing was performed in 32 chronic urticaria patients.

Results HP IgG antibody was found to be positive in 41% of chronic urticaria patients and 26% of healthy controls (χ2 = 7.82, P = 0.005). Autologous serum testing was positive in 40% of chronic urticaria patients who had HP IgG antibody. This ratio was 14.3% in chronic urticaria patients who did not have HP IgG antibody (χ2= 9.23, P = 0.002).

Conclusions In this study, autologous serum testing was found to highly positive in chronic urticaria patients with HP IgG antibody, but the relationship between autoimmunity and HP infection requires further investigations.
A unique variant of Darier's disease
Authors: Peterson Christopher M. , Lesher Jack L. , Sangueza Omar P.
Published: March 2003

A 45‐year‐old black woman presented with a chief complaint of an increasing number of ‘‘light spots’' on her face, upper trunk, and legs. She had a 4‐year history of a pruritic eruption on the dorsum of her hands. The eruption was particularly pruritic in the summer months. Other family members, including her sister and her daughters, reportedly had a similar dermatologic problem. The patient had been previously evaluated and biopsied by another dermatologist. The earlier biopsy was nondiagnostic, however, and she presented for further evaluation of this problem.

On physical examination, the patient had hypopigmented macules along her jawline (Fig. 1), lateral neck, and upper chest. She had similar hypopigmented macules on her thighs. She had hyperkeratosis of the palmoplantar surface of her hands and feet. The dorsum of her hands had numerous coalescing, shiny, flat‐topped, hypopigmented papules (Fig. 2), and several of her fingernails had distal, V‐shaped notching.

Hypopigmented macules on the cheek and along the jawline

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Coalescing, hypopigmented papules on the dorsal aspect of the fingers and hand, with distal notching of the fingernails

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A punch biopsy from a papule on the dorsum of her hand was obtained. The epidermis had corps ronds present with focal areas of acantholysis above the basal layer (Fig. 3). The dermis had sparse, superficial, perivascular infiltrates composed of lymphocytes and histiocytes. These changes were consistent with our clinical diagnosis of Darier's disease (keratosis follicularis).

Corps ronds (large arrow) and focal acantholysis with suprabasal clefts (small arrow) are present in the epidermis (hematoxylin and eosin; original magnification, × 40)

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Generalized lichenoid drug eruption following Blaschko lines
Authors: Krasowska Dorota , Schwartz Robert A. , Lecewicz‐Torun Barbara
Published: March 2003

A 16‐year‐old girl was referred for evaluation of a widespread rash of 1 month duration. Its onset was on the trunk, but it rapidly generalized to cover virtually the entire body. It was intensely pruritic. The girl had a history of recurrent frontal headaches and had been taking ibuprofen 1 month prior to and during the onset of the rash. She was in otherwise good health.

She apeared to be a healthy adolescent with flat topped violaceous papules scattered on her entire body following an arch line unilateral pattern on the right cheek, band‐shaped on the neck and ‘‘S’' shaped lines on the frontal chest and abdomen (Fig. 1). They were ‘‘V’' shaped on the back, and had a linear pattern on all limbs. The nails, scalp, oral and genital mucosa were clear.

Band‐shaped violaceous papules on the neck and arms

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Routine laboratory findings were within normal limits. Serological tests for hepatitis B and C virus infection were negative. Histological features of lichen planus were evident on the skin biopsy specimen: orthokeratosis without parakeratosis, hypergranulosis, liquefactive degeneration of the basal layer, saw‐toothing of the rete ridges, pigmentary incontinence in the superficial dermis, band‐like interface infiltration of lymphocytes and histiocytes, and colloid bodies within the lower dermis and papillary dermis. There were no eosinophils evident in the dermis.

This girl was given cimetidine 400 mg twice daily combined with topical fluticasone proproniate, but after 4 weeks showed no improvement. Methylprednisolone was given 16 mg daily for 2 weeks until remission began, then tapered for another 3 weeks. The pruritus ended after a few days of treatment, whereas the papules slowly resolved leaving behind fading hyperpigmentation, a cosmetic problem. Further treatment involved hydroxyzine and exfoliative ointments, but the hyperpigmentation did not resolve completely (Fig. 2).

Hyperpigmented linear macules on the extremities

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Hard palate perforation: an unusual finding in paracoccidioidomycosis
Authors: Castro Luiz G. M. , Müller Andreas P. , Mimura Maria Angela M. , Migliari Dante A.
Published: March 2003

A 36‐year‐old black man presented to his dermatologist in May 1996 complaining of mucosal lesions in the mouth, as well as perforation of the hard palate. The lesions had started approximately 7 months before and had worsened gradually. Other complaints included odynophagia, dysphagia, mild dyspnea, and dry cough. The patient was in good general health, but reported a 3 kg weight loss over the previous semester. The hard and soft palate presented erythematous ulcers with a finely granulated base and irregular, but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate was seen in the center of the ulcerated region (Fig. 1). Direct examination of 10% KOH cleared specimens showed typical double‐walled, multiple budding yeast structures. Paracoccidioidomycosis (PCM) serologic reactions tested positive for double immunodiffusion (DI), complement fixation (CF) 1 : 256 and counterimmunoelectrophoresis (CIE) 1 : 128. Hematoxylin and eosin‐stained sections of oral lesions showed an ulcer covered by a fibrous leukocytic crust, with a lymphoplasmacytic infiltrate, as well as multinuclear giant cells containing round bodies with a double membrane. Gomori–Grocott staining showed budding and blastoconidia suggestive of PCM. Lung computed tomography (CT) exhibited findings consistent with pulmonary PCM. Diagnosis of the chronic multifocal form of PCM with oral and pulmonary manifestations was established. Drug therapy was initiated with ketoconazole (KCZ) 200 mg twice daily, which led to clinical cure in approximately 2 months. Serum antibody values rose 30 days after institution of therapy (CIE 1 : 256; CF 1 : 512), peaking at day 60 (CIE 1 : 1024; CF 1 : 1024). Three months later the daily dose was reduced to 200 mg and titers declined slowly. The diameter of the perforation remained unchanged (Fig. 2). The hard palate perforation was corrected with a palatoplasty 27 months after initiation of drug therapy (Fig. 3). KCZ was discontinued when serologic cure was achieved after 34 months of treatment (DI weakly positive; CIE 1 : 8; CF not measurable). The patient was discharged 46 months after the first visit.

Ulcers with a finely granulated base on the hard palate with irregular but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate is seen in the center of the ulcerated region

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Clinical aspect after 2 months of oral ketoconazole 200 mg twice daily. Resolution of ulceration was evident, but the diameter of the perforation remained unchanged

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Final result of palatoplasty to cover hard palate perforation

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‘‘Pot‐lid’’ technique for aesthetic removal of small lipoma on the face
Authors: Gupta Somesh , Pandhi Roma , Kumar Bhushan
Published: March 2003

Background  Patients presenting with an asymptomatic subcutaneous facial lipoma desire its removal in order to restore the contour of the face. The standard treatment for lipoma is excision, with the size of the incision being about one‐half of that of the tumor itself. The long linear scar resulting from simple excision may fail to improve the appearance of the patient. The removal of the lipoma through a small incision or a punch hole decreases the size of the resulting scar, but does not eliminate it completely.

Objective  To improve the aesthetic outcome of the commonly used technique for lipoma removal, known as the narrow hole extrusion technique (NHET), by modification.

Methods  Four patients (three men and one woman) with small lipomas on the face (three on the forehead and one on the cheek) were selected for the procedure. A 5‐mm punch was inserted deep into the center of the lesion to create a circular hole. The punched‐out piece of skin was kept in normal saline. The lipoma was extruded with the help of a hemostat and by squeezing pressure. This resulted in the formation of a subcutaneous cavity. After achieving hemostasis, two absorbable buried subcutaneous sutures were placed to create support for the graft. The punched‐out piece of skin was then positioned to cover the defect, like a ‘‘lid on a pot’' and dressed.

Results  The color and texture match of the graft with the surrounding skin were excellent in three of the four patients by the end of 6 months. The graft, which was depressed in the fourth patient, improved through spot dermabrasion.

Conclusion  The proposed modification of the NHET for lipoma removal improves the cosmetic outcome.
A randomized parallel trial of topical aspirin–moisturizer solution vs. oral aspirin for acute herpetic neuralgia
Authors: Balakrishnan Sadasivam , Bhushan Kumar , Bhargava Vinod Kumar , Pandhi Promila
Published: March 2003

Abstract

Background  In this study, the efficacy of oral aspirin vs. topical aspirin in moisturizer (Vaseline Intensive Care Lotion) was studied in an open, randomized, parallel trial in patients with acute herpetic neuralgia.

Methods  Thirty patients were evaluated in the trial, with 15 in each group. The patients were randomized to receive either oral aspirin, 375–750 mg three times a day, or 75 mg topical aspirin/mL of moisturizer (5–10 mL, depending on the extent of involvement), three times a day, for 21 days. Pain was assessed daily by means of a self‐rating visual analog scale and physician assessment. In addition, the skin and plasma levels of aspirin were measured in both groups.

Results  The mean time to onset of pain relief was 44 min with topical aspirin and 110 min with oral aspirin. The mean duration of pain relief after a single application of topical aspirin was 5.4 h, whereas it was 3.5 h with oral aspirin. The mean visual analog scale scores for pain with oral aspirin decreased from 68.2 ± 6.1 on day zero to 43.1 ± 8.7 on day 21, which was not significant compared with the baseline score. With topical aspirin, the baseline pain score was 77.5 ± 3.7 and decreased to 6.8 ± 3 on day 21 (P < 0.001 compared to the baseline score and compared to oral aspirin). The mean plasma and skin levels of aspirin following oral administration were 16.21 ± 1.1 μg/mL and 1.97 ± 0.3 μg/mm2, respectively. After topical administration, the mean plasma level of aspirin was 2.29 ± 0.5 μg/mL (P < 0.01 vs. oral aspirin) and the skin level was 5.96 ± 0.4 μg/mm2 (P < 0.05 vs. oral aspirin). Treatment tolerance was excellent in both groups.

Conclusions  This trial has demonstrated that topical aspirin in moisturizer is clearly superior to oral aspirin in relieving the pain of acute herpetic neuralgia, and that the analgesic activity of aspirin is largely due to its local effect.
Localized linear IgA disease responding to colchicine
Authors: Benbenisty Keith M. , Bowman Paul H. , Davis Loretta S.
Published: March 2003

A 64‐year‐old white woman presented to our clinic with a 3‐month history of multiple blisters on her right breast which had been unresponsive to acyclovir, amoxicillin/clavulanate and fluconazole. She denied taking any antibiotics prior to the eruption. Physical examination revealed grouped vesicles on an erythematous base and shallow ulcerations in an annular pattern localized to the right breast, without areolar involvement (Fig. 1). There were no oral or mucosal lesions. Past medical history was significant only for a distant history of uterine carcinoma which had been successfully treated with hysterectomy/oophorectomy. No history of liver or autoimmune disease was present. Further examination failed to reveal any history of unusual contact allergens. There was no family history of similar eruptions.

Shallow ulcerations and blisters on erythematous bases in an annular pattern

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Punch biopsy specimen from lesional skin revealed a subepidermal blister with a dermal infiltrate consisting of numerous neutrophils and scattered eosinophils (Fig. 2). Direct immunofluorescence of perilesional skin demonstrated the presence of a homogeneous linear band of IgA deposits along the dermoepidermal junction and in dermal microvascular basement membranes (Fig. 3). IgG and C3 immunoreactants were not identified.

Subepidermal blister with a dermal infiltrate consisting of numerous neutrophils and scattered eosinophils (hematoxylin & eosin, × 20)

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Linear deposits of IgA along the dermoepidermal junction and in dermal microvascular basement membranes (direct immunofluorescence of perilesional skin, × 40)

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After starting the patient on oral colchicine, 0.6 mg twice daily, no new blisters appeared, and within 1 week the eruption was nearly resolved. The patient tolerated therapy without any side‐effects, and at a follow‐up visit 5 weeks later had only minimal postinflammatory changes on the skin of the right breast. She then discontinued colchicine and remains free of any recurrence 6 months later.
Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas
Authors: Koh Jae Sook , Kang Hoon , Choi Sung Woo , Kim Hyung Ok
Published: March 2003

Background Despite the obvious relation between smoking and facial wrinkling, grossly undetectable wrinkling and the consequences of smoking on the face have been poorly studied.

Objective To assess the risk factor of cigarette smoking on the development of premature facial wrinkling.

Methods One hundred and twenty‐three nonsmokers, 160 current smokers, and 67 past smokers, aged 20–69 years, were studied. Cigarette smoking status, weight changes, average sun exposure time (recreational and occupational) in 1 month, and past medical and facial cosmetic surgery were quantified by self‐questionnaire. Computerized image analysis of silicone skin replicas was used in addition to clinical visual measurement, and a severity score based on predetermined criteria was assigned to each patient.

Results Current smokers have a higher degree of facial wrinkling than nonsmokers and past smokers. Past smokers who smoked heavily at a younger age show less facial wrinkling than current smokers. In the analysis, which was adjusted for age group, the relative risk of moderate to severe wrinkling for current smokers compared with nonsmokers was 2.72 (confidence interval, CI: 1.32–3.21, P < 0.05). In current smokers, the relative risks associated with more than 19 pack‐years and 11–19 pack‐years of smoking compared with nonsmokers were 2.93 (CI: 1.14–4.1, P < 0.05) and 1.75 (CI: 1.54–3.67, P < 0.05), respectively. On image analysis of facial skin replicas, the mean values of Ra (arithmetic average roughness), Rz (average roughness), and Rt (distance between the highest and lowest values) of current smokers were higher than those of nonsmokers and past smokers in all age groups. This indicates a strong correlation between cigarette smoking and skin wrinkling. In addition, microscopic superficial wrinkling (Ra and Rt) was noted in current smokers in the younger age group (20–39 years).

Conclusions This study suggests that attention should be paid to smoking‐associated facial wrinkling (not evident from a visual assessment) in young people and added to the list of disorders seemingly caused by smoking.
Mycetoma in Yemen: clinicoepidemiologic and histopathologic study
Authors: Khatri Mishri Lal , Al‐Halali Hussein Mohammed , Fouad Khalid Mohammed , Saif Sultan Ahmed , Vyas Mehesh Chandra R.
Published: March 2003

Background Mycetoma is widespread in Yemen, but has not been fully documented.

Methods A prospective study of 70 patients (53 male, 17 female; from different regions of Yemen) was performed. The clinical profile of the cases was recorded in a special protocol. The diagnosis was based on clinical features, examination of grains, roentgenographic studies, and histopathology (44 cases).

Results Fifty cases were diagnosed as eumycetoma and 20 as actinomycetoma. The identification of the causative species was performed in 44 cases by histopathologic studies. Among the cases of eumycetoma, Madurella mycetomatis was recognized in 27 patients, Leptosphaeria senegalensis in two, and pale‐grain fungi in two. Among the cases of actinomycetoma, Streptomyces somaliensis was seen in eight patients, Streptomyces madurae in one, and Nocardia species in four. The treatment of eumycetoma patients with ketoconazole and excision in selected cases controlled the disease activity in the majority. Most of the cases of actinomycetoma were better controlled with drug therapy alone, with a combination of penicillin and cotrimoxazole, or cotrimoxazole alone.

Conclusions Mycetoma is widespread in Yemen, with a higher incidence of eumycetoma and a maximum number of cases from the Hudaida region. A multicenter study is needed to evaluate the exact extent of disease.
Sunburn, sunscreens, and phenotypes: some risk factors for cutaneous melanoma in southern Brazil
Authors: Bakos Lucio , Wagner Mario , Bakos Renato M. , Leite Cristina S. M. , Sperhacke Cristina L. , Dzekaniak Karina S. , Gleisner Ana L. M.
Published: March 2003

Background The risk factors for cutaneous malignant melanoma have been studied in populations from numerous countries around the world. There are no published studies on the risk factors for this malignancy in Brazil, the largest country in South America.

Methods A case–control study of all melanoma patients attending a university hospital in Porto Alegre, Brazil, was conducted over a 3‐year period from 1995 to 1998. Phototype, hair and eye color, solar habits, history of sunburn, use of sunscreens, and the number of nevi were evaluated through a questionnaire and full body skin examination. Bivariate analysis and a logistic regression model were used to evaluate the data.

Results One hundred and three malignant melanoma patients and 206 matched controls were enrolled in the study. The female to male ratio was 2 : 1. Light phototypes were more prone to the development of cutaneous melanoma. Although stronger in the bivariate analysis, in the logistic regression model, phototypes I or II and ephelides emerged only as moderate risk factors; light eye color and light hair color were not independently significant, with adjusted odds ratios (OR) close to zero. Commonly acquired nevi (CAN) showed a significant and strong effect in the bivariate analysis only when the “30 or more” category was compared to baseline. In the logistic regression model, the presence of a large number of CAN showed an association with increased levels of risk, although these findings did not reach classical significance. Dysplastic or atypical nevi seemed to contribute more strongly, although still with a moderate excess of relative risk. When the use of sunscreens was compared to no use at all, it appeared to show progressive protection as the solar protection factor (SPF) increased. Only SPF15 or greater (SPF15+) showed strong and significant protection when compared to baseline. Physical measures offered a weaker level of protection. Nevertheless, there was a significant increase in the risk of melanoma for those with a large number of sunburn episodes. It was found that 30 or more alleged episodes of sunburn showed a very strong OR of 11.4 (95% confidence interval, 2.6–50.5), the most significant in the study.

Conclusions Phototypes I and II, freckles, a large number of acquired nevi, dysplastic nevi, and inadequate photoprotection appeared as risk factors with moderate strength for cutaneous malignant melanoma in the studied population. The color of the eyes and hair showed a very weak statistical significance as a risk factor. Sunscreens showed progressive significance corresponding to an increase in SPF, the best scores in statistical protection being achieved in users of sunscreens with SPF15 or greater. Frequent sunburn episodes appeared as the most important risk factor associated with malignant melanoma in this sample of the white population in southern Brazil.
Safe control of palmoplantar hyperhidrosis with direct electrical current
Authors: Karakoç Yunus , Aydemir Ertuğrul H. , Kalkan M. Tunaya , Ünal Gaye
Published: March 2003

Background Primary (idiopathic) hyperhidrosis is a benign disease of unknown etiology, leading to the disruption of professional and social life and emotional problems. A variety of treatment methods have been used to control or reduce the profuse sweating. In this study, we report the efficacy of direct current (d.c.) administration in the treatment of idiopathic hyperhidrosis.

Methods One hundred and twelve patients with idiopathic hyperhidrosis were enrolled in the study. Initial sweat intensities of the palms were measured by means of the pad glove method. The patients were treated in eight sessions with d.c. administration using a complete regulated d.c. unit based on tap water iontophoresis. The final sweat intensities of responders were determined 20 days after the last treatment. Nonresponders returned earlier than 20 days, with final sweat intensities measured at least 5 days after the last treatment. In 26 responders, plantar hyperhidrosis was also treated. After the first remission period, the second of eight treatments was applied to the palms of 37 responders.

Results This therapy controlled palmar hyperhidrosis in 81.2% of cases. The final sweat intensities of the palms of responders were significantly reduced after eight treatments (P < 0.001). The first average remission period was 35 days. Minimal undesirable effects were noted.

Conclusions This technique appears to control hyperhidrosis on the palms and soles only if regular treatment is applied. Plantar hyperhidrosis appeared to resolve simultaneously when palmar hyperhidrosis was successfully treated.
Severe human urticaria produced by ant (Odontomachus bauri, Emery 1892) (Hymenoptera: Formicidae) venom
Authors: Rodriguez‐Acosta Alexis , Reyes‐Lugo Matias
Published: March 2003

Background Ant sting reactions are becoming an increasing problem in tropical countries. It is important for physicians to be aware of their possible cutaneous and systemic manifestations.

Methods A child with a severe allergic reaction to an ant sting was examined and is discussed. This is the first case described in the literature caused by the ant Odontomachus bauri, and the biology of the ant and the clinical signs in the patient are described.

Results A child developed a strong allergic reaction to an ant sting. The case was not associated with a previous ant sting. Treatment with the systemic antihistamine loratadine (Clarityn®) was favorable in this patient.

Conclusions In tropical areas, ant stings are usually benign, self‐limited pathologic processes. In some cases, however, severe allergic reactions can develop, including urticaria and anaphylactic shock. Physicians should be aware of the possible complications of ant stings.
Epidemiology of onychomycosis in patients with diabetes mellitus in India
Authors: Dogra Sunil , Kumar Bhushan , Bhansali Anil , Chakrabarty Arunaloke
Published: March 2003

Background The number of individuals diagnosed with diabetes mellitus is increasing worldwide. Although onychomycosis is often observed in diabetics, there have been no large studies of its epidemiology in this patient group in India.

Methods We studied the prevalence of onychomycosis in diabetics attending the Diabetes Clinic at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, and compared it with that in a nondiabetic control group. A total of 400 diabetic subjects (237 males, 163 females), aged 48.8 ± 0.5 years (mean ± SD), were evaluated.

Results The prevalence of onychomycosis in the diabetic and control groups was 17% and 6.8%, respectively, the difference being statistically significant (P < 0.001). The presence of onychomycosis was found to correlate significantly with increasing age (P < 0.01) and male gender (P < 0.05) in both diabetic and control groups. From diabetics, yeasts were the most common isolate (48.1%), followed by dermatophytes and nondermatophyte molds in 37% and 14.8%, respectively. In the control group, the distribution of yeasts, dermatophytes, and nondermatophyte molds was 25%, 62.5%, and 12.5%, respectively. After controlling for age and sex, a stepwise logistic regression demonstrated that significant predictors for onychomycosis included the duration of diabetes (P < 0.01), absent or feeble peripheral pulses (P < 0.15), peripheral neuropathy (P < 0.05), and retinopathy (P < 0.001).

Conclusions Diabetics were found to be 2.5 times more likely to have onychomycosis than the controls. Predisposing factors included increasing age, male gender, duration of diabetes, impaired peripheral circulation, peripheral neuropathy and retinopathy.
Cryptococcal infection in sarcoidosis
Authors: Mehrany Khosrow , Kist Joseph M. , Gibson Lawrence E.
Published: March 2003

A 48‐year‐old man with a history of sarcoidosis was transferred to the Mayo Clinic for evaluation and management of progressive neurologic decline. Two years before admission, he was admitted to a local hospital with mental status changes accompanied by ataxia and severe headache. A diagnosis of pulmonary and central nervous system sarcoidosis was made based on computed tomography of the head, lumbar puncture, and chest radiography. A mediastinoscopy with lymph node biopsy exhibited noncaseating granulomas and negative stains for microorganisms. Prednisone therapy was initiated at 80 mg/day. Clinical improvement was apparent for 13 months during steroid therapy until the slow taper reached a dosage of 20 mg/day. At that time, the patient was readmitted to the local hospital with severe confusion and skin lesions. When intravenous methylprednisolone therapy for presumed central nervous system sarcoidosis did not improve the patient's mental status, he was transferred to the Mayo Clinic.

Physical examination of the thighs revealed large, well‐marginated, indurated, irregularly bordered, violaceous plaques and rare, umbilicated, satellite papules with central hemorrhagic crusts (Fig. 1A). Superficially ulcerated plaques with a similar appearance to the thigh lesions were coalescing around the lower legs (Fig. 1B). A skin biopsy specimen of the thigh demonstrated abundant numbers of encapsulated organisms and minimal inflammatory response (Fig. 2). Skin, blood, and cerebrospinal fluid cultures confirmed the presence of Cryptococcus neoformans. Amphotericin and flucytosine combination therapy was initiated, and steroid dosages were gradually tapered. A test for human immunodeficiency virus was negative. The patient was dismissed from hospital after a complicated 2‐month course resulting in improved mental status but progression of the lower extremity ulcerations as a result of polymicrobial infection.

(A) Violaceous plaque with satellite papules on thigh. (B) Ulcerating plaques coalescing around leg

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(A) Sparse inflammatory infiltrate and abundant encapsulated organisms (hematoxylin and eosin; × 20). (B) Cryptococcal organisms (Gomori's methenamine silver; × 40)

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Evidence supporting zinc as an important antioxidant for skin
Authors: Rostan Elizabeth F. , DeBuys Holly V. , Madey Doren L. , Pinnell Sheldon R.
Published: March 2003

Antioxidants play a critical role in keeping skin healthy. The antioxidant benefits of vitamin C and E are well known, but the importance of the trace mineral, zinc, has been overlooked. This article reviews the evidence supporting zinc's antioxidant role in protecting against free radical‐induced oxidative damage. Zinc protects against UV radiation, enhances wound healing, contributes to immune and neuropsychiatric functions, and decreases the relative risk of cancer and cardiovascular disease. All body tissues contain zinc; in skin, it is five to six times more concentrated in the epidermis than the dermis. Zinc is required for the normal growth, development and function of mammals. It is an essential element of more than 200 metalloenzymes, including the antioxidant enzyme, superoxide dismutase, and affects their conformity, stability, and activity. Zinc also is important for the proper functioning of the immune system, and for glandular, reproductive and cell health.

 Abundant evidence demonstrates the antioxidant role of zinc. Topical zinc, in the form of divalent zinc ions, has been reported to provide antioxidant photoprotection for skin. Two antioxidant mechanisms have been proposed for zinc: zinc ions may replace redox active molecules, such as iron and copper, at critical sites in cell membranes and proteins; alternatively, zinc ions may induce the synthesis of metallothionein, sulfhydryl‐rich proteins that protect against free radicals. No matter how they work, topical zinc ions may provide an important and helpful antioxidant defense for skin.