bluuebunny/crossref_metadata_2025 huggingface dataset:
Imazaquin mobility in tropical soils in relation to soil moisture and rainfall timing
Authors: Regitano J B , Prata F , Rocha W S D , Tornisielo V L , Lavorenti A
Published: March 2003

SummaryThis research studied the influence of soil type, soil moisture and incubation time before rain on the mobility of imazaquin in two highly weathered tropical soils, named clay and sandy clay. The soils were packed in glass columns and treated at three different moisture contents. Then, the applied imazaquin (150 g a.i. ha−1) was incubated for 0, 1 and 30 d before rainfall simulation began. Leaching was significantly higher in the sandy clay soil, when imazaquin was applied to moist samples and rainfall occurred soon after application (in this case, 73.4% of applied imazaquin was leached). Leaching was always low in the clay soil (in all cases, <1.8% of applied imazaquin was leached). In addition, imazaquin leaching potential was overestimated by the lowKdvalue (1.24 L kg−1) measured for the clay soil using batch equilibration data. For this soil, the vacuum displacement method also failed to predict leaching (in this case, 28.9% of applied imazaquin was leached). Consequently, batch equilibration and vacuum displacement methods cannot be used to predict leaching of anionic organic molecules, such as imazaquin, in fine‐textured tropical soils. Moreover, soil type and weather patterns or irrigation timing must be considered before imazaquin application to avoid environmental or carry‐over problems and to achieve maximum effectiveness of the herbicide.
Protein C and Protein S activities in Behçet's disease as risk factors of thrombosis
Authors: Lenk, MD Nurdan , Özet, MD Gülsüm , Alli, MD Nuran , Çoban, MD Özgül , Erbaşi, MD Servet
Published: March 2003

Background

In Behçet's disease (BD), there is a marked increase in vascular complications. Approximately 30% of patients with BD suffer from thrombosis of the arteries and veins, varices, aneurysms, and thrombophlebitis of superficial or deep veins. Protein C and Protein S are major inhibitors of coagulation, and it is well known that the deficiency of Protein C and Protein S causes thrombotic disorders.

Methods

Protein C and Protein S activities were measured in 23 patients with BD and in a control group consisting of 23 age‐ and sex‐matched healthy volunteers. Patients who had received anticoagulant or oral contraceptive drugs, or who had liver disease or active thrombosis, were not included in the study.

Results

Of the 23 patients with BD (age, 13–55 years), the mean Protein S activities (94.2 ± 11.3%) were slightly lower than the means of the control group (109.1 ± 8.4%), but not statistically significant differences could be demonstrated (p > 0.05). Compared with the means of the control group (103.5 ± 6.9%), the Protein C activities were not lower in BD (106.3 ± 8.4%). No statistical difference was determined.

Conclusions

Protein C and Protein S deficiencies are not a probable cause of thrombotic manifestations in BD. We do not recommend the measurement of these activities routinely in BD unless thrombosis is the major and primary manifestation of BD.
Wound healing in Behçet's syndrome
Authors: Mat, MD M. , Nazarbaghi, MD Marina , Tüzün, MD Yalçın , Hamuryudan, MD Vedat , Hizli, MD Nail , Yurdakul, MD Sebahattin , Özyazgan, MD Yilmaz , Yazıcı, MD Hasan
Published: March 2003

Background Because there is an increased inflammatory response to trauma, particularly of the skin, in patients with Behçet's syndrome (BS), an alteration in wound healing in BS is expected. The aim of this study was to investigate the healing features of punch biopsy wounds in BS and acne vulgaris (AV) patients used as controls.

Method Full‐thickness skin punch biopsies (4 mm) were taken from the hairless sites of the non‐dominant forearms in 20 BS and 20 AV patients. Each patient was examined on days 1, 2, 3, 4, 5, 8, and 10, and the biopsy wound area and induration were marked on sterile glass slides. Other inflammatory changes, such as suppuration and pain, were also recorded. No antiseptic solutions or ointment, except saline, were used.

Results The wound area healed similarly in both groups (p > 0.05). Thirteen (65%) BS patients had erythematous haloes around the wound on the first day. The number of patients presenting inflammatory changes reached 18 (90%) on the second day in the BS group. The area of erythema around the wound in BS patients was significantly greater than that in AV patients (5; 25%). It gradually decreased day by day. Purulent changes were observed in four BS patients on day 1, and induration around the biopsy wound in six patients on day 2. Only one patient with AV had suppuration, which appeared on the second day, while no AV patient displayed induration.

Conclusion Biopsy‐induced trauma may cause increased inflammation in BS, but wound healing is not altered.
Cryosurgery in oral lesions
Authors: Ishida MD Cleide Eiko , Ramos‐e‐Silva MD, PhD Marcia
Published: March 2003

Background Cryosurgery is a therapeutical method successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity.

Methods Liquid nitrogen spray or cryoprobe have been used alone or associated with other surgical methods in various types of oral lesions, such as pyogenic granuloma, angioma, actinic cheilitis, keratoacantoma, fibroma, HPV lesions in HIV and non‐HIV patients, hypertrophic lichen planus, leukoplakia and erythroplakia, verrucous carcinoma, mucous cysts, and papillary hyperplasia of the palate, among others.

Results Our experience and the literature have shown that cryosurgery is a very useful technique for treatment of oral lesions. The oral mucosa, because of its characteristics of humidity and smoothness, is an ideal site for this technique. It shows a very good esthetic result and it may be either the first choice or an alternative option to conventional surgery.

Conclusions Cryosurgery is a very safe, easy to perform, and relatively inexpensive technique for treating various oral lesions in an out‐patient clinic.
Short‐ and long‐term histologic effects of topical tretinoin on photodamaged skin
Authors: Bhawan MD Jag
Published: March 2003

Background A series of clinical trials lasting up to 4 years had demonstrated that topical tretinoin improves facial appearance by reducing the visible signs of photodamage.

Objective This paper reviews the studies designed to explore the relationship between clinical improvement and histologic changes.

Methods Histologic changes in biopsies taken at various time points from clinical trial participants were examined by pathologists blinded to treatment regimens.

Results Histologic evaluations of photodamaged skin during the course of treatment with tretinoin have revealed an array of time‐dependent morphologic changes which can be classified as early, intermediate, and late. Initial changes in fine wrinkling and texture appear to correlate with epidermal mucin and compaction of the stratum corneum, but the latter is transient and ultimately returns to pre‐treatment levels. Alterations in dermal matrix components have been noted with prolonged treatment. Partial restoration of the dermal collagen by new synthesis may contribute to the sustained improvement in fine wrinkling noted even when the treatment frequency is reduced from daily to three times weekly. As treatment is continued beyond 24 months, the collagen organization continues to improve and elastosis continues to decrease. Increases in epidermal and dermal mucin and decreases in epidermal melanin are consistent throughout the treatment period. The reduction in the hyperpigmentation of photodamage is comparable with the histologic and clinical improvements seen when tretinoin is used to treat conditions such as melasma. No adverse effects on the histopathology of the skin are noted with long‐term exposure to tretinoin. Neither keratinocyte nor melanocyte atypia is detected.

Conclusions Although there does not seem to be a direct correlation between histologic changes and clinical improvement, the major structural changes appear to be directed at restoring the skin to the pre‐sun‐damaged state.
Amyopathic dermatomyositis in Hong Kong – association with nasopharyngeal carcinoma
Authors: Fung Wai Kit Joseph , Chan Hin Lee Henry , Lam Wai Man Wynnie
Published: March 2003

Background Amyopathic dermatomyositis (ADM) is a rare variant of dermatomyositis (DM) in which there is no apparent muscle involvement at initial presentation, but clinical and laboratory evidence of myopathy may appear later. Like DM, it has a known association with malignancy.

Objective To record the occurrence of ADM in Hong Kong during the period from January 1988 to June 1996, and to establish the types of carcinoma with which it is associated.

Methods The records of all patients diagnosed with ADM in three major dermatology clinics in Hong Kong were retrospectively studied to confirm the diagnosis and to look for any associated malignancy at any stage of the disease.

Results Between 1988 and 1996, six patients in Hong Kong (five men and one woman; mean age, 50 years) fulfilled the criteria of ADM. During a follow‐up period ranging from 20 to 90 months (average, 35.6 months), none developed any evidence of myositis. Associated malignancy was found in the five male patients. There were three cases of nasopharyngeal carcinoma (NPC), one case of non‐small cell carcinoma of the lung, and one case of metastatic carcinoma of the cervical lymph node of unknown primary. No carcinoma had developed in the female patient during a follow‐up period of 90 months.

Conclusions There is a strong association between ADM and NPC in Hong Kong.
Epidermolysis bullosa acquisita in a 6‐year‐old Japanese boy
Authors: Hayashi Kazuhiro , Ueda Masato , Sakai Makiko , Fujikawa Yoshiaki , Tsuru Kenta , Amagai Masayuki , Ichihashi Masamitsu
Published: March 2003

A 6‐year‐old Japanese boy started to develop blisters around the mouth and eyes in May 1996. With provisional diagnoses of herpes simplex or Kaposi's varicelliform eruption, he was treated with acyclovir and immune globulin. Blister formation increased, however, and he was referred to the Dermatology Clinic of Kobe University School of Medicine in August 1996.

On physical examination, tense bullae and vesicles were observed on the trunk and limbs and also on the palms and soles (Fig. 1). Neither mucosal involvement nor cutaneous fragility was observed, and no nail deformity was seen. The blistering on both erythematous bases and normal skin showed a “string‐of‐pearls” arrangement. Abnormal laboratory results were as follows: white blood cell count, 12.4×103/mm3 (N = 4–8.5) (eosinophils, 25%); platelets, 514×103/mm3 (N = 130–300); total protein, 4.9 g/dL (N = 6.5–7.8); albumin, 2.4 g/dL (N = 4.1–5.0); glutamate pyruvate transaminase (GPT), 56 IU/L (N = 7–34); lactate dehydrogenase (LDH), 573 IU/L (N = 227–416); alkaline phosphatase (ALP), 384 IU/L (N = 100–303); C‐reactive protein (CRP), 3.08 mg/dL (N = 0–0.3). The antinuclear antibody test gave negative results.

Disseminated tense blisters with an annular pattern developing on erythematous plaques on the trunk

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Histologic examination of a skin biopsy specimen revealed a subepidermal blister containing neutrophils and eosinophils, and an infiltrate of lymphocytes with eosinophils and neutrophils in the superficial dermis. Direct immunofluorescence of perilesional skin showed a linear band of immunoglobulin G (IgG) and C3 at the dermo–epidermal junction. Indirect immunofluorescence on 1 mol/L sodium chloride‐split normal skin showed IgG deposits on the dermal side of the blister. Western immunoblot analysis of the reactivity of the patient's serum on epidermal and dermal extracts revealed that autoantibodies were bound to the 290‐kDa antigen in the dermal extract (Fig. 2). No reactivity was observed in the epidermal extract.

Western immunoblot analysis on a dermal extract. Lanes 1 and 2, adult EBA serum sample; lane 3, patient's serum; lane 4, normal control serum

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The boy was treated with prednisolone (1.3 mg/kg body weight per day) which inhibited new blistering. Since a reduction of the dose of prednisolone to 1.1 mg/kg body weight per day induced new blistering,dapsone (1.6 mg/kg body weight per day) and prednisolone (1.1 mg/kg body weight per day) were given in combination, leading to improvement. A further decrease in the dose of prednisolone to 0.9 mg/kg body weight per day resulted in new bulla formation, and the prednisolone was replaced by betamethasone. The disease activity then markedly subsided and the bullae healed with the formation of milia.
Solitary hyperpigmented island in a sea of elastosis (anelastosis)
Authors: Ramos‐Caro Francisco A. , Sevigny Gina , Mullins Diane
Published: March 2003

A 77‐year‐old Caucasian woman presented to our clinic for skin screening with a history of multiple, cutaneous, actinic keratoses and basal cell carcinomas treated in the past. She has had prolonged and intense exposure to the sun throughout her life. On physical examination, a tanned, leathery skin was present on her face, neck, V‐area of the chest, and upper extremities. Multiple scars of previously treated areas were present. As an incidental finding, a solitary, 2 cm × 2 cm, square‐shaped, hyperpigmented, well‐demarcated, depressed, soft plaque with a “skin‐graft” appearance was noted on her right anterior neck ( Fig. 1). This area was surrounded by leathery skin, but unaffected by it. On further questioning, she denied any surgery of the area, including skin‐grafting (there was no donor scar anywhere on her body). She could not recall precisely how long it had been there, or if it had grown in size, as it was asymptomatic. She did state that it had been there for many years, and possibly since childhood. She was asked to bring any old photographs that might picture this area, but could not find any. With her permission, a skin biopsy was performed of the edge of the lesion to include the hyperpigmented area and the surrounding skin.

Well‐circumscribed patch surrounded by severely sun‐damaged skin on the neck

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Histologically, the shave biopsy taken from the edge of the lesion on the right neck revealed marked elastosis in the papillary dermis of the surrounding skin ( Fig. 2). The lesional skin did not demonstrate any elastosis in the papillary dermis, and had a thin epidermis with relatively increased pigmentation of the basal layer. No melanophages were seen. The elastic stain enhances the demarcation between the surrounding elastosis and the anelastotic lesion. There was no elastic tissue, normal or damaged, in the papillary dermis of the affected skin (
Fig. 3).

Demarcation between the lesion (left) and the elastotic skin (right). No solar elastosis is present in the papillary dermis of the lesion (right or left) (hematoxylin and eosin, ×4)

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Elastic stain. No solar elastosis in the lesional papillary dermis (left) (×10)

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Intermittent use of topical dimethyl sulfoxide in macular and papular amyloidosis
Authors: Özkaya‐Bayazit Esen , e Kavak Ayş , Güngör Havva , Özarmagan Güzin
Published: March 2003

Background Severe and therapy‐resistant pruritus is the most prominent feature of macular (MA) and lichen (LA) amyloidosis that leads to further amyloid deposition by recurrent frictional trauma to the epidermis. Of the various therapeutic modalities with variable success, the most encouraging and beneficial effect has been observed with topical dimethyl sulfoxide (DMSO) therapy. In a previous study, we achieved marked clinical improvement in nine of 10 patients in a daily treatment regimen over 6–20 weeks, but relapses occurred in the post‐treatment follow‐up period. The aims of this study are to investigate whether the patients would benefit from intermittent therapy and to determine the optimal application interval of DMSO to maintain the relief of symptoms.

Methods Thirteen patients with histopathologically verified cutaneous amyloidosis (five MA, two LA and six biphasic) were enrolled in the study. They were treated once daily with a 50 or 100% DMSO solution until pruritus disappeared. Then, DMSO was applied at increasing intervals until the widest effective application interval for maintenance of relief was reached. Patients were regularly followed‐up by a scoring system for pruritus, papules, and pigmentation, control biopsies, photographs, blood biochemistry, and side‐effects.

Results The mean time required for the disappearance of pruritus was 4.1 weeks. Remarkable flattening of the papules was achieved after an average therapy period of 9 weeks. After a total therapy period of 6.5 months, a nearly 50% remission in pigmentation and >70% flattening of papules were achieved. The widest effective DMSO application interval was 8.6 days. The side‐effects of therapy were contact urticaria, desquamation, burning sensation, and garlic‐like breath odor, which were more prominent with the higher concentration of DMSO. In interval therapy, side‐effects were tolerated more easily than in daily therapy. No reduction of amyloid deposits was revealed in control biopsies.

Conclusions Locally applied DMSO can break the vicious “pruritus–amyloid deposition–pruritus” cycle in patients with MA and LA. In addition to its daily use, interval therapy seems to maintain this effect and enables patients to tolerate side‐effects more easily.
Myotonic dystrophy (Steinert disease): a morphologic and biochemical hair study
Authors: Amorosi Beatrice , Giustini Sandra , Rossi Alfredo , Giacanelli Manlio , Calvieri Stefano
Published: March 2003

Background Myotonic dystrophy is a systemic genetic disorder, with dominant transmittance. It is characterized by generalized progressive muscular abnormality. Although frontoparietal alopecia is one of the most common symptoms in myotonic dystrophy, it has not received much attention.

Methods We examined 25 subjects from two families: 10 patients were affected by Steinert disease and 15 were not. The various morphologic and biochemical hair alterations are reported.

Results All investigated subjects (affected or not) presented the same type of morphologic and biochemical hair alterations.

Conclusions These findings could be used to construct a hypothesis to explain the cause of the disease.
Spiders and Borrelia burgdorferi: no evidence of reservoir occurrence in central Arkansas
Authors: Suffridge P. J. , Smoller Bruce R. , Carrington P. R.
Published: March 2003

Background Although Ixodes ticks are considered the chief vector for Borrelia burgdorferi in the USA, B. burgdorferi has also been identified in mosquitoes, horse flies, and deer flies. We examined the possibility of these organisms being harbored in two species of spider in central Arkansas.

Methods Ten wolf spiders (Lycosa gulosa) and two brown recluse spiders (Loxosceles reclusa) were collected in central Arkansas during early summer and fixed in formalin. Paraffin‐embedded sections of the spiders were examined for spirochetes using the modified Steiner spirochete staining method and examined for B. burgdorferi using immunohistochemistry.

Results All 12 spiders from both species were found to be negative for all spirochetes including B. burgdorferi.

Conclusions Spiders in our sample appeared not to harbor B. burgdorferi. Further studies utilizing larger sample sizes, more sensitive testing measures, or spiders from an area more endemic with B. burgdorferi may further prove or disprove that spiders are capable of harboring this organism.
Mucocutaneous manifestations of HIV infection: a retrospective analysis of 145 cases in a Chinese population in Malaysia
Authors: Jing Wang , Ismail Rokiah
Published: March 2003

Background Mucocutaneous lesions directly related to human immunodeficiency virus (HIV) infection usually present as initial manifestations of immune deficiency. The most common mucocutaneous lesions are Kaposi’s sarcoma, histoplasmosis, oro‐esophageal candidiasis, oral hairy leukoplakia, and, in Asia, Penicillium marneffei infection. Non‐HIV‐related skin lesions, such as psoriasis, seborrheic dermatitis, and nodular prurigo, may be the initial presentation among HIV infected patients attending outpatient clinics.

Methods A retrospective analysis was performed on 145 HIV‐positive Malaysians of Chinese descent from two centers at the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic data and clinical data were analyzed.

Results The analysis showed that 104 out of 145 patients had mucocutaneous disorders (71.7%). In the study, there were 100 men (96.2%) and four women (3.8%). The majority of patients were in the age group 20–50 years. The patients who presented with mucocutaneous disease also had low CD4+ T‐lymphocyte counts and most had acquired immunodeficiency syndrome (AIDS) defining illness. The number of cases with generalized hyperpigmentation was very high in the group (35.9%), followed by nodular prurigo (29.7%) and xerosis (27.6%). Seborrheic dermatitis was seen in 20.7% of cases, with psoriasis in 8.3%. The most common infections were oral candidiasis (35.9%), tinea corporis and onychomycosis (9.7%), and herpes infection (5.5%); however, mucocutaneous manifestations of Kaposi’s sarcoma were rare.

Conclusions The results suggest that mucocutaneous findings are useful clinical predictors of HIV infection or signs of the presence of advanced HIV infection.
Psoriatic scarring alopecia: observations in four patients
Authors: Bardazzi Federico , Fanti Pier Alessandro , Orlandi Catuscia , Chieregato Carlo , Misciali Cosimo
Published: March 2003

Background and design  Although acute or chronic hair loss in psoriasis of the scalp can be a symptom of the disease, until now there has been no agreement as to whether or not it is only restricted to erythrodermic, generalized pustular and scalp plaque psoriasis. The purpose of this study was to evaluate patients with chronic scalp psoriasis and alopecia and to determine if the alopecia was of the scarring type.

Results  We report four cases of psoriatic scarring alopecia and describe the clinical and histologic features of these patients. The diagnosis was made by scalp biopsies (vertical and transverse sections) and other causes of scarring alopecia were excluded.

Conclusions  Psoriasis can cause scarring alopecia.
Carcinoma erysipeloides as a presenting feature of breast carcinoma
Authors: Nambi Rabindranath , Dd . , Tharakaram Sriramulu
Published: March 2003

Drug name

tamoxifen: Nolvadex

An 80‐year‐old caucasian woman was seen in November 1997 for an asymptomatic raised lesion on the left side of the neck extending to the infraclavicular area of 7 months’ duration. She had been treated with topical steroids by her general practitioner with no relief. On examination, there was a large, irregular, ill‐defined, indurated, erythematous plaque, 7 × 4 cm, over the left side of the neck extending to the infraclavicular area ( Fig. 1). The diagnoses entertained included tinea incognito, cutaneous mucinoses, and carcinoma erysipeloides.

Infiltrated plaque of carcinoma erysipeloides on the left side of the neck

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General examination and breast examination were normal with no mass palpable, and there was no regional lymphadenopathy. Routine blood investigations were normal. A biopsy taken from the plaque revealed marked dilation of dermal lymphatics containing a tightly packed infiltrate of pleomorphic malignant cells with abnormal mitotic figures, confirming the diagnosis of carcinoma erysipeloides ( Fig. 2). The tumor cells were estrogen receptor positive, supporting the origin of cells from the breast. A mammogram showed the presence of a small spiculated mass in the lower outer quadrant of the left breast. This was considered to be the source of the cutaneous metastasis and the patient was started on tamoxifen.

Dilated lymphatics packed with malignant infiltrate: carcinoma erysipeloides

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Pretibial epidermolysis bullosa
Authors: Soriano Luisa , Fariña Carmen , Manzarbeitia Felix , Requena Luis
Published: March 2003

A 37‐year‐old white man with a history of essential arterial hypertension and idiopathic thrombocytopenic purpura (for the latter disorder, oral corticosteroids had been administered successfully), was first examined in our department in June 1997. He had a persistent, pruriginous eruption on the pretibial regions which had been present since the age of 16 years. He complained of bullous lesions after minor trauma to the skin. Examination revealed bilateral, brown, erythematous, shiny, indurated plaques on the anterior regions of his lower legs. Several clear blisters, scars, and excoriations were also present on the left leg ( Fig. 1). His toenails were thickened and dystrophic, but his teeth and hair were normal.

Vesicles, erosions, and crusts on the left leg

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Histopathologic examination of a vesicle on the left leg revealed a subepidermal blister with sparse perivascular lymphocytic infiltrate in the upper dermis. The contents of the blister were fibrinous ( Fig. 2A). Immunohistochemical study was automatically performed (TechMate 500) with monoclonal antibody to type IV collagen (clone CIU 22, Dako), a component of lamina densa, after enzymatic and heat antigen retrieval. Type IV collagen was present on the roof of the blister, indicating that the blister formation was beneath the lamina densa (
Fig. 2B). Ultrastructural examination showed an intact dermoepidermal junction with normal hemidesmosomes and basal keratinocytes; however, the anchoring fibrils were markedly decreased in number (
Fig. 3) and were rudimentary.

(A) A subepidermal blister covered by intact epidermis and sparse inflammatory infiltrate in the papillary dermis (hematoxylin and eosin, ×100). (B) Immunohistochemical investigation for collagen IV demonstrated that the blister developed beneath the lamina densa (collagen IV, ×200)

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Ultrastructural examination showed a decreased number of anchoring fibrils in the dermal papillae (×12,000)

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The father of the patient and the paternal grandfather had a similar blistering eruption on the pretibial areas. His son, a 2‐year‐old boy, also presented bullous lesions on the anterior surface of the legs, with scars and milia. His daughter, a 6‐year‐old girl, was not affected. The pattern of inheritance was autosomal dominant.
Microbiology of infected pustular psoriasis lesions
Authors: Brook Itzhak , Frazier Edith H. , Yeager Joseph K.
Published: March 2003

Background Bacterial infections can occur in lesions of pustular psoriasis (PP). The objective of this study was to establish the aerobic and anaerobic microbiology of secondarily infected PP.

Methods A retrospective 10‐year review was carried out of clinical and microbiology laboratory records from patients with secondarily infected PP lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria.

Results Bacterial growth was noted in 23 specimens. Aerobic or facultative anaerobic bacteria only were present in 12 patients (52%), anaerobic bacteria only in four (17%), and mixed anaerobic–aerobic flora was present in seven (30%). Thirty‐six isolates were recovered (1.6 per specimen), 23 aerobic or facultative bacteria and 13 strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus

(15 isolates), Group D Enterococcus (two isolates), and Escherichia coli (two isolates). The predominant anaerobes were Peptostreptococcus spp. (six isolates) and Bacteroides fragilis group, Propionibacterium acnes, and pigmented Prevotella spp. in two each. Single bacterial isolates were recovered in 14 patients (61%), 11 of which were S. aureus. Nineteen of the organisms isolated from 18 patients (78%) produced the enzyme beta‐lactamase. S. aureus was isolated from all body sites. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. Enteric

Gram‐negative rods and Bacteroides fragilis group predominated in lesions on the legs and buttocks. Group A beta‐hemolytic streptococci, pigmented Prevotella, and Fusobacterium spp. were most frequently recovered in lesions of the hand.

Conclusions The polymicrobial etiology of secondarily infected PP lesions and the association of bacterial flora with the anatomic site of the lesions were demonstrated.
Immunoperoxidase technique for detecting spirochetes in tissue sections: comparison with other methods
Authors: Phelps Robert George , Knispel Jeffrey , Tu Erik Schuman , Cernainu Georgetta , Saruk Michael
Published: March 2003

Abstract

Background  With the increasing incidence of human immunodeficiency virus (HIV) infection and immunosuppressive therapy, the incidence of syphilis has been increasing. Given the fact that the above conditions may mask or obscure the usual clinical signs and symptoms of syphilis, a means of enhanced detection is essential.

Aims methods  The purpose of this study was to determine whether an immunoperoxidase method using an antibody against treponemes would increase the sensitivity and specificity of diagnosis in biopsies of patients with secondary syphilis. This was compared to serology and silver stain in cases of known syphilis.

Results  Immunoperoxidase for treponemes was at least as sensitive (9/10) as pathology (9/10), and more sensitive than conventional silver stain (6/10) or serology (7/10).

Conclusions  In those equivocal cases of secondary syphilis, where confirmation is essential, immunoperoxidase for treponemes may be a useful adjunct.
Hypereosinophilic syndrome: correlation between clinical severity and cutaneous microthrombi
Authors: Kim Hee Sung , Chun Yoon‐Sun , Chang Sung Nam , Park Wook‐Hwa
Published: March 2003

A 32‐year‐old man, with a 12‐year history of recurrent edema of the upper and lower extremities, was admitted in February 1998 due to edema of the right forearm and tiredness of 1‐month duration. Examination revealed an ill‐defined, itchy, slightly erythematous, indurated patch with excoriation on the right forearm (Fig. 1). There was no history of drug intake, atopy, or asthma. He recalled, however, having experienced cold‐induced Raynaud's phenomenon and intermittent arthralgia. In laboratory tests, there was a white cell count of 11.77 × 103/μL with 48% eosinophils (4830/μL). Liver function tests showed elevated serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase. Rheumatoid factor was positive. Total immunoglobulin E (IgE) concentration was elevated to 4703 U/mL (normal, < 378 U/mL), while other serum immunoglobulins, including IgG, IgA, and IgM, were normal. Bone marrow aspirate and biopsy showed normocellular marrow with an excess of mature eosinophils, but no evidence of blast cells. There was no evidence of parasitic infestation, and allergy skin test was negative. An extensive systemic evaluation showed no other organ involvement. A skin biopsy specimen revealed many eosinophils infiltrating the perivascular, periappendageal, and subcutaneous fat area and also within the vessel walls. Multiple microvascular thrombi with eosinophils were observed in the mid and lower dermis and subcutaneous fat (Fig. 2). The eosinophils showed positive staining with eosinophil cationic protein (ECP) using the monoclonal antibody EG2. On the basis of the above findings, we diagnosed hypereosinophilic syndrome (HES). Treatment with 60 mg prednisolone daily was started and, within 7 days, his edema and itching sensation started to resolve. Follow‐up laboratory and biopsy findings after 1 month returned to normal. The prednisolone dosage was slowly tapered over a 9‐month period and he is currently on a maintenance dose of prednisolone 10 mg alternate day therapy.

An ill‐defined, slightly erythematous, indurated patch with excoriation on the right forearm

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A vessel showing thrombus formation with many eosinophils (× 100)

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Identification of clustered cells in human hair follicle responsible for MMP‐9 gelatinolytic activity: consequences for the regulation of hair growth
Authors: Jarrousse Françoise , Boisnic Sylvie , Branchet Marie‐Christine , Beranger Jean‐Yves , Godeau Gaston , Breton Lionel , Bernard Bruno A. , Mahé Yann F.
Published: March 2003

Abstract

Background  The control of human hair follicle growth and differentiation is dependent upon several well‐identified factors, including androgens, cytokines, and growth factors. In humans, alopecia androgenetica is a common aging process thought to be regulated through complex genetic imbalances, which also involve several of these crucial identified factors (and probably others not yet characterized), alone or in combination. Among these factors, epidermal growth factor (EGF), as well as pro‐inflammatory cytokines, play a pivotal role, as evidenced by their direct inhibitory effects on hair growth both in vitro and in vivo. Following such treatments, the in vitro growth of hair follicles was rapidly arrested and deleterious modifications of hair morphology were also observed.

Aim  Because these cytokines act, at least partly, through the induction of matrix metalloproteinases (MMP), and because tissue remodeling occurs during the hair cycle, we attempted to identify and localize MMP in the human pilosebaceous unit.

Method  We used zymography to observe human hair follicles in culture in vitro.

Results  We observed that human hair follicles in culture in vitro mainly and almost exclusively produce MMP‐2 and MMP‐9 gelatinolytic activities. Furthermore, after stimulation with EGF, tumor necrosis factor‐α (TNF‐α), or interleukin‐1α (IL‐1α), MMP‐9 production was strongly increased. Using immunohistochemistry, we then precisely localized MMP‐9 in the lower part of the inner root sheath (Henle's layer) of control human anagen hair follicles.

Conclusions  Cytokine‐ and EGF‐induced upregulation of MMP‐9 in the lower epithelial compartment of the human hair bulb is a major mechanism through which hair follicle involution, observed in alopecia, may occur.
Molluscum contagiosum in herpes zoster scars
Authors: Nico Marcello Menta S. , Bergonse Fabiane Noronha , Godoy Andréa M.
Published: March 2003

A 29‐year‐old white woman was seen for the evaluation of an eruption on her neck and shoulder. She was being treated for human immunodeficiency virus (HIV) infection (blood CD4+ lymphocyte count, 187 cells/μL) with saquinavir, ritonavir, and nevirapine antiretroviral therapy. Two months previously, she had suffered from herpes zoster. The new lesions were located exclusively on the site of the herpes zoster scars. Clinical examination revealed slightly hypertrophic and hypochromic cicatricial lesions on the left cervical (c3, c4, c5) dermatome; in this area, there were many skin‐colored, umbilicated, isolated, 1–2 mm papules (Fig. 1). Histopathology of a papule showed changes typical of molluscum contagiosum (Fig. 2). The patient was treated with local application of 70% trichloroacetic acid with excellent results (Fig. 3). The lesions did not recur after 6 months of follow‐up.

Skin‐colored, umbilicated, isolated, 1–2 mm papules on the left cervico‐thoracic dermatome

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Histopathology of a papule showing changes typical of molluscum contagiosum

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Patient after treatment with local application of 70% trichloroacetic acid

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Hypomelanosis of Ito with ileal atresia
Authors: Kaya Tamer Irfan , Kokturk Aysin , Nayci Ali , Aksoyek Selim , Dusmez Duygu
Published: March 2003

A 1‐year‐old girl was referred to our dermatology clinic by the Pediatric Surgery clinic for hypopigmented macular lesions over her trunk and proximal parts of the extremities. Physical examination revealed bilateral streak and whorl shaped hypopigmented macular lesions which had developed gradually since birth and were distributed along Blaschko's lines (Fig. 1). Some of the lesions, particularly the ones located in the gluteal region, gave a ‘‘splashed water’' appearance (Fig. 2). The majority of these macular lesions measured between 1–3 cm in diameter. They were asymptomatic. There was neither a history of preceding lesions nor a history of trauma at the sites of the lesions. The patient was otherwise healthy.

Streak and whorl shaped hypopigmented macular lesions along Blaschko’s lines

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The lesions located in the gluteal region gave a "splashed water’’ appearance

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The history of the patient revealed congenital ileal atresia. The patient was presented to the Pediatric Surgery clinic with abdominal distension, bilious vomiting, and lack of meconium passage at the second day after birth. Surgery was performed upon diagnosis of ileus and an ileal atresia (type II) was detected at the operation. The congenital defects of the small bowels were removed and the intestines were repaired with end to end anastomosis. The diagnosis of the congenital ileal atresia was confirmed by a histopathologic examination of the removed tissue specimens. The child was the product of a normal pregnancy, routine ultrasound was normal and there was no history of exposures to medications, infections or X‐rays during the pregnancy. She was the fourth child of nonconsanguineous parents. There was no family history of a congenital anomaly or similar cutaneous lesions.

A biopsy specimen was obtained from a trunk lesion. Although areas of focal pigmentation were observed, histopathological examination of the biopsy specimen showed a decrease in the pigmentation of the basal cell layer. Pigment incontinence was not observed in the dermis. A full blood count, routine urinalysis, liver and renal function tests, serum electrolyte levels and erythrocyte sedimentation rate were within normal limits.

Upon consideration of these findings we diagnosed the patient as suffering from hypomelanosis of Ito (HI) with ileal atresia.
A simple surgical technique for the treatment of steatocystoma multiplex
Authors: Kaya Tamer Irfan , Ikizoglu Guliz , Kokturk Aysin , Tursen Umit
Published: March 2003

Abstract

Background  Since steatocystoma multiplex is an uncommon disorder, its treatment has not been discussed in detail in the textbooks and surgical excision is the most commonly mentioned method. In this article, we describe a very simple surgical technique, which was developed by modifying previous reports.

Methods  A 29‐year‐old woman, diagnosed clinically and histologically as steatocystoma multiplex, was treated with this modified technique. We punctured the cysts under local anesthesia with a sharp‐tipped cautery point and evacuated the contents by squeezing the cyst with a fine forceps. Then, the cyst wall was grasped by the forceps and the sacs were extracted through small holes. More than 50 cysts were treated.

Results  The treatment was well tolerated by the patient. No complications developed during or after the procedure. After 14 months follow up no recurrences were observed and the results were cosmetically excellent.

Conclusions  This modified technique is very simple and time saving. Its cosmetic and long‐term results are successful. We believe that it must be considered as the treatment of choice for steatocystoma multiplex.
Multiple pilomatricoma with perforation
Authors: Fetil Emel , Özkan Şebnem , İlknur Turna , Erdem Yasemin , Lebe Banu , Güneş Ali Tahsin
Published: March 2003

A 22‐year‐old woman presented to our clinic with a complaint of masses on various parts of her body. A mass on her right forearm had appeared 5 years ago and had enlarged during the past 6 months. Two lesions on the back of her neck had a 3‐year history, one lesion on her eyebrow had a 2‐year history, and one lesion on her left forearm had a 1‐year history. The lesion on her left forearm was discharging purulent material.

Dermatologic examination revealed a 15 × 16 mm tumor on the right forearm, 11 × 6 mm and 10 × 5 mm tumors on the back of the neck, and a 20 × 20 mm tumor on the eyebrow; they were flesh‐colored, well‐defined, firm tumors. On her left forearm, there was a 12 × 10 mm, well‐defined, firm, blue–red tumor discharging chalky white granules; purulent material was detected (Fig. 1).

Firm, blue–red tumor discharging chalky white granules

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There was no regional lymphadenopathy. Systemic examination was normal. Laboratory examination of hematologic, biochemical, and urinalysis tests was normal. There was no family history of similar lesions.

Total excision of all the tumors was performed. Histopathologic examination of the material revealed clusters of eosinophilic shadow cells surrounded by a fibrous capsule. There were also foreign body giant cells. Areas of calcification, cholesterol clefts, and ossification were detected. An intraepidermal perforating area was detected from the biopsy material of the left forearm (Fig. 2). There were no recurrences after 1 year of follow‐up.

Intraepidermal perforating area and clusters of shadow cells (hematoxylin and eosin, × 200)

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Rejuvenating facial massage – a bane or boon?
Authors: Khanna Neena , Datta Gupta Siddhartha
Published: March 2003

Background Facial massage is an extremely popular form of beauty treatment and is thought to rejuvenate the skin. We decided to study the benefits and untoward effects of this form of facial beauty treatment.

Methods One hundred and forty‐two women (aged 17–63 years), who had received facial beauty treatment in three well‐established beauty parlours in New Delhi, were entered into the study and observed for a period of 12 weeks after the facial beauty treatment. Twenty‐seven of the subjects had a repeat facial beauty treatment 4–6 weeks after entry into the study, giving a total of 169 massage episodes observed. Immediate and delayed effects of the beauty treatment were examined.

Results Facial beauty treatment generally consists of three steps: vigorous massaging of the face with creams, steaming (using a hot towel or a steaming gadget), and application of a face mask containing adsorbents and astringents. In our study, the creams used for massage included “off the shelf” creams manufactured by standard cosmetic companies in 95 (56.3%) subjects, herbal creams in 61 (36.1%), and creams containing exotic ingredients, such as gold salts, in 13 (7.7%). Sixty‐one (36.1%) patients developed erythema and puffiness within 15 min to 2 h after the beauty treatment. This lasted for 2–6 h. Forty‐one (24.3%) women underwent the procedure of comedone extraction after steaming. In 12 (7.1%) of these women, persistent erythema was noticed at the site of comedone extraction. Eight (4.7%) women developed mild dermatitis on the face, 2–7 days after the facial beauty treatment. Patch testing with constituents used in the facial beauty treatment was positive in four patients (herbal cream, 1; witch hazel, 1; orange face pack, 1; and gold cream, 1). In 47 (33.1%) subjects, an acneiform eruption was observed 3–10 weeks after the facial beauty treatment (mean, 6.1 ± 3 weeks). Thirteen (27.7%) of these subjects had taken the facial beauty treatment for the first time, whereas 34 (72.3%) developed an acneiform eruption after every facial massage. The predominant lesions were deep‐seated nodules, although a few comedones, especially closed ones, were present in some patients. Lesions were always present on the cheeks, an area of focus during the facial massage, and healed with hyperpigmentation. The benefits of facial beauty treatment, as mentioned by the subjects, included a feeling of freshness and rejuvenation in 84 (59.1%), keeping the skin supple in 76 (53.5%), feeling of warmth and tightening of the skin in 71 (50%), and delaying the onset of wrinkles in 21 (14.8%).

Conclusions Although there are several subjective benefits with facial beauty treatment, there may be immediate side‐effects, such as erythema and edema, as well as delayed problems, such as dermatitis and acneiform eruption, in about one‐third of patients.
False positive VDRL (BFP‐STS) and systemic lupus erythematosus; new data in clinico‐laboratory associations
Authors: Al Attia Haider M.
Published: March 2003

Aim To investigate the relationships between clinical features and serological parameters in systemic lupus erythematosus (SLE) patients with false positive venereal disease research laboratory (VDRL) test (BFP‐STS) and those without.

Methods The records of 74 patients with SLE were reviewed. These were divided on the basis of the presence of a biologically fase positive serological test (BFP‐STS) (n = 18) or its absence (n = 56). The clinical features and serological parameters were subsequently evaluated in each group.

Results A biologically fase positive serological test was found in 18 patients (24.5%). Clinically, they had a significantly higher frequency of malar rash (P < 0.02), hemolytic anaemia (P < 0.02) and SLE‐related antiphospholipid (APL) syndrome (P < 0.02). Neuropsychiatric lupus was more frequent in the group without BFP‐STS. Moreover, subacute cutaneous LE (SCLE), Raynaud's phenomenon, livedo reticularis (LR) and cardiopulmonary complications were present only in the latter group. There was no significant association between BFP‐STS and other autoantibodies including Extractable nuclear antigen (ENAs), however, there was a significant association with C3 hypocomplementemia (P < 0.05). Half of the patients with BFP‐STS were positive for anticardiolipin antibodies (aCL Abs) vs. 28% in the negative group (P = NS).

Conclusions The study suggests that the clinical and serological relevance of BFP‐STS in lupus patients may vary from those described in relation to other antiphospholipid determinants. Our patients appeared to have sparing of certain major organ systems, yet there was a greater tendency to developing Antiphospholipid (APL) syndrome and hemolytic anaemia.
Review of fexofenadine in the treatment of chronic idiopathic urticaria
Authors: Kawashima Makoto , Harada Shotaro , Tango Toshiro
Published: March 2003

Chronic idiopathic urticaria (CIU), characterized by the appearance of itchy wheals of unknown etiology, can be extremely debilitating and can significantly reduce a patient's quality of life (QOL). Fexofenadine, a non‐sedating, H1‐receptor selective, long‐acting antihistamine, is licensed worldwide for the treatment of CIU. A number of dose‐ranging studies have evaluated the efficacy and safety of fexofenadine for the the treatment of CIU. In two similar North American studies, patients received either fexofenadine HCI (20, 60, 120, or 240 mg bid) or placebo. All four doses of fexofendine were statistically superior to placebo at reducing pruritus and reducing the number of wheals (P  0.0238). A dose‐finding study undertaken in Japanese patients confirmed that fexofenadine HCI (60 mg and 120 mg bid) is an effective treatment for CIU. A similar dose response was shown in all three studies when the results were compared. Furthermore, health outcome analyses of the North American studies indicated that fexofenadine HCI 60 mg bid significantly improved patient's QOL. In these studies, fexofenadine had a consistently comparable safety profile to placebo, with no dose‐related trends in the incidence of adverse events. In conclusion, fexofenadine is an effective and well‐tolerated treatment for CIU, with a wide therapeutic window. Importantly, the lack of ethnic differences between the studies from North America and Asia indicate that the efficacy and safety of fexofenadine demonstrated in these studies are cross‐culturally applicable.
Papillon‐Lefévre syndrome: the response to Acitretin
Authors: Al‐Khenaizan Sultan
Published: March 2003

Papillon‐Lefévre syndrome is a rare autosomal recessive disease comprising palmoplantar keratoderma and periodontitis. Palmoplantar keratoderma can be severe, necessitating systemic treatment. Different systemic retinoids were found to be highly efficacious. We describe the successful use of acitretin in one patient who had severe palmoplantar keratoderma, with maintenance of the improvement using topical treatment.