bluuebunny/crossref_metadata_2025 huggingface dataset:
CELL INFILTRATEN PROGRESSIVE PIGMENTED PURPURA (SCHAMBERG'S DISEASE): IMMUNOPHENOTYPE, ADHESION RECEPTORS, AND INTERCELLULAR RELATIONSHIPS
Authors: GHERSETICH ILARIA , LOTTI TORELLO , BACCI STEFANO , COMACCHI CLAUDIO , CAMPANILE GRAZIA , ROMAGNOLI PAOLO
Published: May 2007

Background. Progressive pigmented purpura (Schamberg's disease), a form of purpura pigmentosa chronica, is a lymphocytic capillaritis of unknown etiology and obscure pathogenesis. Our purpose was to assess the expression of cell membrane antigens (CD3, CD4, CD1a, CD36), of adhesion receptors (leukocyte function adhesion 1, LFA‐1, endothelial leukocyte adhesion molecule 1, ELAM‐1) intercellular adhesion molecule 1, ICAM‐1), and the intercellular relationships in the early phase of the disease.

Methods. Quantitative immunohistochemistry and electron‐microscopy were performed on specimens of five subjects, aged 45 to 63 years. These studies were repeated in two patients after treatment with topical corticosteroid (betamethasone valerate cream 0.1%) and psoralen‐ultraviolet A (puva).

Results. The infiltrate consisted mainly of CD4+ lymphocytes and CD1a+ dendritic cells. Electron‐microscopic investigation showed typical lymphocytes and two distinct types of dendritic cells. In the very early phase of the disease the adhesion receptors LFA‐i and ICAM‐1 were expressed intensely by all infiltrating cells; the adhesion receptors icam‐1 and ELAM‐i were expressed by endothelial cells. Close contact occured between lymphocytes and dendritic cells. After PUVA (120 J per cm2) and topical steroid therapy the infiltrate disappeared completely.

Conclusions. These data suggest that a cell‐mediated immune mechanism may be important in progressive pigmented purpura and that the early endothelial expression
KERATOACANTHOMA IN JAPANESE HAWAIIANS IN KAUAI, HAWAII
Authors: REIZNER GEORGE T. , CHUANG TSU‐YI , ELPERN DAVID J. , STONE JENNY L. , FARMER EVAN R.
Published: May 2007

Background. This is the first incidence report of keratoacanthoma (KA) in a Japanese ethnic population.

Methods. The study was designed as a 5‐year prospective incidence study using an island‐wide survey of Japanese residents in Kauai, Hawaii, during the years 1983 through 1987.

Results. Eleven Japanese residents of Kauai, three men and eight women, had ka. The crude incidence is 22.1 per 100,000 Japanese Kauaiian population. Two thirds of the lesions were on the extremities. No recurrence was noted, but a nonmelanoma skin cancer developed in some patients.

Conclusions. The incidence of ka in a Japanese ethnic population is not low. Ultraviolet light exposure must, in part, contribute to the development of ka. This is supported by fact that the incidence of ka in Japanese residents in Kauai is much higher than in Japan and that most of the KAS appear on exposed skin.
LOCAL INTERFERON THERAPY FOR MELANOMA PATIENTS
Authors: IKIĆ DRAGO , SPAVENTI ŠIME , PADOVAN IVO , KUSIĆ ZVONKO , ČAJKOVAC VLADIMIR , IVANKOVIĆ DAVOR , DAKOVIĆ NIKOLA , NOLA PETAR
Published: May 2007

Background. Melanoma, once considered a rare form of cancer, is increasing in incidence throughout the world. The prognosis of malignant melanoma is inversely related to the depth of tumor invasion.

Methods. Twenty‐seven patients were treated with r.IFN alpha 2c. Four patients were treated with human natural leukocyte interferon (HNLI). Interferon was applied locally. Historical control groups were used for comparison in the statistical analysis. The data were evaluated taking into account the single risk factor Clark levels III and IV. In the control group there were 10 patients with Clark levels III and IV; in the group of r.IFN apha 2c‐treated patients there were 20 patients. The data were analyzed by using the Kaplan‐Meier and Cox methods.

Results. The percentage of survivals was higher in the interferon‐treated groups with Clark levels III and IV, than in the control group, that is 60% compared to 25%, and 40% compared to 33%, respectively. The results of the statistical analysis after 60 months of follow‐up are significantly better in the interferon group (P = 0.0175).

Conclusions. The control group was not selected at random. Therefore, on the basis of our results, one can say that the treatment of the melanoma patients, Clark levels III and IV, with the r.IFN alpha 2c is promising and that further investigation is justified.
SQUAMOUS CELL CARCINOMA IN KAUAI, HAWAII
Authors: CHUANG TSU‐YI , EIZNER GEORGE T. , ELPERN DAVID J. , STONE JENNY L. , ARMER EVAN R.
Published: May 2007

Background. It is estimated that over 100,000 new cases of squamous cell carcinoma are diagnosed in the United States annually. This number is compounded by an increasing concern over the ozone layer depletion and the continued sunbathing behavior of many individuals. This could be particularly acute in Hawaii, which may have the highest rates of skin cancer in the country. We believe the updated information on skin cancer is essential to address the magnitude of the problem.

Methods. A prospective 5‐year population‐based incidence study was conducted on Kauai, Hawaii, between 1983 and 1987 to investigate the frequency of squamous cell carcinomas in resident Caucasians.

Results. A total of 58 residents, 37 men and 21 women, were identified with an initial episode of squamous cell carcinoma during the 5‐year period. The average annual incidence rate per 100,000 Kauai Caucasian residents, standardized to the 1980 U.S. white population, was 153 for men and 92 for women with a combined rate of 118. The average patient age was 66.4 years. The head and neck was the most common anatomic site, with the extremities second. Subsequent new squamous cell carcinoma occurred in 13.8% of patients. Only one patient (2%) developed a recurrence after treatment. Twenty‐five patients (43%) had basal cell carcinoma simultaneously or at other earlier times.

Conclusions. In Kauai the incidence rate of squamous cell carcinoma is the highest yet documented in the United States. No consistent trend in incidence rates was appreciated during this 5‐year period.
THE INCIDENCE OF BIRTHMARKS IN ISRAELI NEONATES
Authors: KAHANA MICHAEL , FELDMAN MICHAEL , ABUDI ZAMIR , YURMAN SHMUEL
Published: May 2007

Background. Several studies have documented cutaneous findings in neonates of various racial groups. Our purpose was to determine the frequency of birthmarks in Israeli neonates of Jewish and Arabic origin.

Methods. A cohort of 1672 newborn infants under 96 hours of age were examined for the presence of birthmarks. Of these 841 (50·3%) were Jewish and 831 (49·7%) were Arab. The Jewish group was further subdivided into various ethnic groups according to parental ancestry.

Results. Melanocytic brown lesions (Mongolian spots, congenital nevi, and cafe‐au‐lait spots), were more common in Arab infants. The vast majority of Jewish infants with Mongolian spots were of Asian or African ancestry. On the other hand, congenital melanocytic nevi were found only in Jewish infants of European ancestry. Vascular lesions (salmon patch and port‐wine stain) in Arab neonates exhibited a female preponderance.

Conclusions. Our data suggest that the prevalence of birthmarks in Israeli neonates is similar to the prevalence reported by others in white neonates.
PSEUDOPELADE: AN INHERITED ALOPECIA
Authors: SAHL WILLIAM J.
Published: May 2007

Background. Pseudopelade is a rare idiopathic progressive alopecia that has no initial inflammatory phase. Even so, pseudopelade has been classified as a scarring alopecia with postinflammatory alopecias. Atrophy rather than true scarring is the cardinal feature of pseudopelade.

Materials and Methods. A review of reported cases of pseudopelade, especially those with a family history, was undertaken. The discovery of a young man and his mother, who had pseudopelade, plus two other familial cases prompted this study.

Results. Examination of the clinical and pathologic material shows pseudopelade to be a disease separate from other alopecias. The striking familial association in these cases demonstrates a plausible etiology.

Conclusions. Pseudopelade is an autosomal dominant disorder of the scalp marked by atrophic loss of hair follicles.
PSORIASIS AND PREGNANCY: HORMONE AND IMMUNE SYSTEM INTERACTION
Authors: BOYD ALAN S. , MORRIS LAURA F. , PHILLIPS CHARLES M. , MENTER M. ALAN
Published: May 2007

Background. Various hormonal states are known to be associated with the waxing and waning of psoriasis. Patients with psoriasis commonly experience changes in their cutaneous disease during pregnancy or post partum.

Objective. We evaluated 100 women with psoriasis by questionnaire and interview. The women had been seen at the Baylor Psoriasis Center, Dallas, and had experienced a pregnancy while having psoriasis. The answers were sorted and tabulated. In addition, we reviewed the literature to ascertain possible causes of clinical changes in psoriasis during pregnancy.

Results. Ninety questionnaires were completed. Sixty‐nine women (76.7%) described a change In their psoriasis during pregnancy with 57 (63.3%) noting improvement. Seventy‐nine patients (87.7%) had a postpartum flare, most within 4 months of delivery.

Conclusions. The majority of women with psoriasis, who become pregnant, experience a change, usually an improvement, in their cutaneous disease. Pregnancy is associated with hormonal changes in estrogens and progesterone resulting in a state of altered immune surveillance.
CLINICAL‐EPIDEMIOLOGIC STUDY OF ALOPECIA AREATA
Authors: ROSELINO ANA MARIA F. , ALMEIDA ANA MARCIA , HIPPOLITO MIGUEL A. , CERQUEIRA BRASILINA C. S. , MAFFEI CLAUDIA M. L. , MFNEZES JOãO B. , VIEIRA RUBENS E. , ASSIS SERGIO L. W. , ALI SALIM AMED
Published: May 2007

Background. Alopecia areata is a common disease and may be associated with autoimmune disease, atopy, Down syndrome, emotional stress, and foci of sepsis.

Methods. Seven cases of alopecia areata were diagnosed among workers in the Water and Effluent Treatment Sector (WETS) of a paper factory, representing a 0.6% incidence, when the value for the population at large is 0.1%. Three of these workers are assigned to the WETS on a permanent basis and four provide maintenance services. One of the latter patients had alopecia areata that fully regressed. Because biologic treatment of water and effluents involves saprophytic bacteria and fungi as well as chemical substances such as acrylamide, a clinical examination and laboratory tests were performed on all workers assigned permanently to the WETS (N = 9) and on 25% of the workers, selected at random providing services to the sector (N = 14).

Results. There was no association between alopecia areata and atopy, dermatophytosis, or bacteria isolated. Toxicologic evaluation revealed an acrylamide‐like substance in 7 workers with alopecia areata, with a statistically significant correlation. Measures were taken at the workplace to decrease worker contact with the mists (probably containing acrylamide) in the pulp‐pressing room; no other cases of alopecia areata had been detected 1 year after the study.

Conclusions. A survey of the literature did not show reports of alopecia areata as an occupational dermatosis, but our conclusion is, that this dermatosis could be due to the professional activities of the workers at the paper factory studied.
HERPES SIMPLEX VIRUS TYPE 2 IN BRAZIL: SEROEPIDEMIOLOGIC SURVEY
Authors: DA ROSA‐SANTOS OMAR LUPI , DA SILVA ANGELA GONÇALVES , PEREIRA ANTORNIO CARLOS
Published: May 2007

Background. The incidence of genital herpes is increasing worldwide. Herpes simplex virus type 2 (HSV–2) is the most common cause of genital ulcerations among the sexually transmitted diseases (STDS). In order to investigate the sexual transmission of genital herpes infection in Brazil, the prevalence of specific antibodies to HSV‐2, in populations of high and low risk for STDS was evaluated.

Methods. The population at low risk for STDS was composed of 155 voluntary blood donors at the University Hospitals between February and August, 1994. The population at high risk for STDS was composed of 85 HIV‐seropositive persons, consisting of homosexual and promiscuous heterosexual men. A group of 20 highly active prostitutes was also studied between May and July, 1994. All blood samples were screened using an enzyme‐linked immunosorbent assay (ELISA) that detects type‐specific antibodies to HSV–2 glycoprotein G. Before donating blood, all persons in the study group were given a questionnaire concerning risk factors for acquisition of STDS and suitable to show the socioepidemiologic characteristics of the subjects.

Results. The prevalence of ELISA showing HSV–2 infections among HIV‐seroposite persons, was 73% (P < 0.01). In the whole group at high risk for STDS, the prevalence was 72% (P < 0.05). Infection with HSV‐2, as determined by seroprevalence, was significantly and independently associated with years of sexual activity, history of previous STDS, number of sexual partners in the previous month, number of pregnancies, and previous induced abortions, as well as the percentage of sexual acts involving receptive anal intercourse.
ERYTHEMA INDURATUM OE BAZIN
Authors: CHO KWANG‐HYUN , LEE DONG‐YOUN , KIM CHUL‐WOO
Published: May 2007

Background. There has been a long controversy about the tuberculous cause of erythema induratum, a chronic form of nodular vasculitis.

Method. We investigated clinical, histopathologic, and immunohistochemical features of patients with erythema induratum who showed positive tuberculin hypersensitivity reactions or had associated active tuberculosis.

Results. The ages of the 32 patients (M 7: W 25) ranged from 13 to 66 years (mean 36.6 years). All patients displayed recurrent crops of tender, painful, violaceous nodules or plaques. Most lesions presented on the legs, but they also occurred on thighs, feet, buttocks, and forearms. The skin lesions evolved for several weeks and healed with scarring and residual pigmentation. Twenty‐two patients were treated with isoniazid alone and the remaining 10 patients received combinations of antituberculous drugs. Relapses were encountered in four patients who received isoniazid alone or stopped the medication against medical advice. In most biopsies, histologic examination revealed lobular or septolobular panniculitis with varying combinations of granulomatous inflammation, primary vasculitis, and necrosis. Immunohistochemical labeling revealed a preponderance of T lymphocytes, monocyte‐macrophages, and Langerhans' cells, indicative of a type IV hypersensitivity reaction.

Conclusion. Erythema induratum of Bazin has distinct clinical, histopathologic, and immunohistochemical features. Erythema induratum of Bazin should be considered as a separate entity of nodular vasculitis caused by latent foci of tuberculous infection.
PROPOSAL FOR A PATHOGENESIS‐BASED CLASSIFICATION OF TUMORAL CALCINOSIS
Authors: SMACK DAVID PHILLIPS , NORTON SCOTT A. , FITZPATRICK JAMES E.
Published: May 2007

Background. Deposition of calcium in skin is currently categorized into a group of disorders referred to as calcinosis cutis. Divisions between types and subtypes within this confusing classification are predominantly based on morphologic differences in the calcification and serve to obscure pathogenesis. This is especially evident in a subtype of calcinosis cutis, known as tumoral calcinosis. Calcifications in cases of tumoral calcinosis share the following characteristics, but without evidence of a common pathogenesis: large size, juxtaarticular location, progressive enlargement over time, a tendency to recur after surgical removal, and an ability to encase adjacent normal structures. The goal of this study was to formulate a pathogenesis‐based classification for cases of tumoral calcinosis.

Methods. In a literature review 121 cases of tumoral calcinosis were identified. These cases, along with a case evaluated in our clinic, were reviewed retrospectively, and their features compared.

Results. Analysis suggests three pathogenetically distinct subtypes of tumoral calcinosis: (1) Primary normophosphatemic tumoral calcinosis: patients have normal serum phosphate, normal serum calcium, and no evidence of disorders previously associated with soft tissue calcification; (2) primary hyperphosphatemic tumoral calcinosis: patients have elevated serum phosphate, normal serum calcium, and no evidence of disorders previously associated with soft tissue calcification; and (3) secondary tumoral calcinosis: patients have a concurrent disease capable of causing soft tissue calcification. Justification for this classification is based on the presence or absence of disorders known to promote soft tissue calcification and statistically significant differences in family history, mean calcification number, mean serum phosphate level, and calcification recurrence after excision.

Conclusions. A classification for tumoral calcinosis is devised that outlines potential pathogenetic mechanisms and predicts response to therapy and prognosis. Analysis of other forms of calcinosis cutis may reveal definable pathogenetic differences that suggest a coherent classification for all cutaneous calcinoses.
ANDROGENS IN THE TOPICAL TREATMENT OF LICHEN SCLEROSUS
Authors: PASLIN DAVID
Published: May 2007

Background. Testosterone propionate has been shown repeatedly to be effective in the treatment of vulvar lichen sclerosus, yet studies of androgens in serum of women with untreated vulvar lichen sclerosus suggested an abnormal activity of 5‐alpha reductase in these patients. If impairment of 5‐alpha reductase in women with untreated vulvar lichen sclerosus is a proximate cause of this disease, then dihydrotestosterone should be more effective than testosterone propionate in the treatment of the condition.

Methods. To test this hypothesis, five women with vulvar lichen sclerosus received topically either dihydrotestosterone or testosterone propionate in a double‐blind crossover study.

Results. These androgens appear to be equally effective in inducing objective improvement of the vulvar lichen sclerosus by both gross and microscopic criteria.

Conclusions. Impairment of 5‐alpha reductase may not be germane to the pathogenesis of vulvar lichen sclerosus.
OIL OF BITTER ORANGE: NEW TOPICAL ANTIFUNGAL AGENT
Authors: RAMADAN WAFAÀ , MOURAD BASMA , IBRAHIM SUZAN , SONBOL FATMA
Published: May 2007

Background. Superficial dermatophyte infection is one of the most common dermatologic diseases. Some of these infections are extremely resistant to therapy.

Methods and Patients. Sixty patients participated in this study; they were classified into three groups (20 patients in each). All groups had comparable numbers of patients with tinea corporis, cruris, and pedis. Group 1 was treated with a 25% emulsion of oil of bitter orange (OBO) three times daily; group 2 was treated with 20% OBO in alcohol three times daily and group 3 was treated with pure OBO, once daily. Clinical and mycologic examinations were performed before therapy and every week until a complete cure had occurred.

Results. In group 1, 80% of patients were cured in 1 to 2 weeks and 20% in 2 to 3 weeks. In group 2, 50% were cured in 1 to 2 weeks, 30% in 2 to 3 weeks and 20% in 3 to 4 weeks. In group 3, 25% of patients did not continue the trial. Of the remaining patients, 33.3% were cured in one week, 60% in 1 to 2 weeks, and 6.7% in 2 to 3 weeks. Oil of bitter orange produced no side effects except mild irritation seen with the use of the pure form.

Conclusions. An in vitro study showed that OBO (natural product) exerts fungistatic and fungicidal activity against a variety of pathogenic dermatophyte species. It is a promising, cheap, and available topical antifungal therapeutic agent.
PERSISTENT VIABILITY OF THE MEDLAR BODY
Authors: ROSEN TED , OVERHOLT MEREDITH
Published: May 2007

Background. The Medlar body represents an adaptive tissue form of the fungi known to cause cutaneous chromomycosis. This study was designed to determine the in vitro viability of Medlar bodies that are found in profusion within lesional epidermis.

Methods. Epidermal scrapings of three indigenous cases from Texas of chromomycosis due to Fonsecaea pedrosoi were collected and periodically cultured to determine the duration of fungal viability.

Results. The causative organism could be recovered 11, 15, and 18 months, respectively, after epidermal scrapings were obtained from the three patients.

Conclusions. This simple but important experiment indicates that Medlar bodies are quite hardy. Thus, clinical lesions may appear after long incubation periods subsequent to traumatic implantation of etiologic fungi. The robust adaptability of the tissue form may also account for the difficulty in achieving a “cure” in cases of chromomycosis.
CUTANEOUS MYIASIS FOLLOWING TRAVEL TO BELIZE
Authors: SWETTER SUSAN M. , STEWART MARGARET I. , SMOLLER BRUCE R.
Published: May 2007

Two days after returning from Belize, a 70‐vear‐old man developed three nonhealing ulcers with serosanguinous drainage on the right posterior ankle. He recalled mildly pruritic “mosquito bites” on the ankles prior to leaving Belize, but no evidence of skin breakdown. Tbe patient denied fever, chills, or other systemic symptoms associated witb his skin lesions.

A one‐week course of cephalexin, 500 mg po q.i.d., given for “superficial cellulitis,” failed to improve the plaque on the right ankle. The patient was evaluated in the dermatology department 4 weeks after his return from Belize with no progression of the ankle lesions. The examination showed a 4 x7 cm indurated, nontender, erythematous plaque with three sinuses draining serosanguinous fluid (Fig. 1).

A skin biopsy was performed on an area containing a draining sinus tract and submitted for routine and special stains. Tissue and wound cultures were negative for bacteria (aerobic and anaerobic), fungi, mycobacteria, and Leishmania.

Histopathologic Findings: The deep retlcular dermis and subcutis showed an extensive, polymorphous, inflammatory reaction surrounding a parasitic structure that measured 1.8 mm in diameter (Fig. 2). The parasite had a thick eosinophilic cuticle with striated muscle visible around the out‐lines of the alimentary tube and other organs (Fig. 3). The morphologic appearance of the parasite was consistent with the larva of a fly, most likely of the Dermatobia species.

Clinical Course: Conservative treatment with polymyxin B sulfate‐bacitracin zinc ointment and ace wrap occlusion for 2 days resulted in the extraction of two mature larvae (Fig. 4). The patient reported the sensation of “movement” within the sinuses immediately prior to larval extraction. The third larval specimen was contained in the skin biopsy tissue. All three sites of larval penetration showed rapid healing following the extraction of the larvae.
FURUNCULAR CUTANEOUS MYIASIS CAUSED BY DERMATOBIA HOMINIS LARVAE EOLLOWING TRAVEL TO BRAZIL
Authors: TSUDA SHINGO , NAGAJI JUNKO , KUROSE KOICHIRO , MIYASATO MINORU , SASAI YOICHIRO , YONEDA YUTAKA
Published: May 2007

A 62‐year‐old Japanese man had visited Rondonia in central Brazii on May 28, 1994, at which time he suffered insect bites on the left axiila and ieft chest regions. Three bites persisted and became tender and painfui. These areas developed into tender nodules with moderate serous drainage from a central pore. Malaise and an intermediate‐grade fever accompanied the eruption. The tender nodules continued after he returned to Japan on July 7. The diagnosis of furunculosis was made by his family physician, but treatment with oral cefdinir (300 mg per day) and naproxen (600 mg per day) for 2 days and application of ointment containing 0.1% gentamicin sulfate failed to resolve the lesions. The patient complained of a crawling sensation under the skin. Since a maggot was removed from the axillary lesion with the aid of the patient's fingers, he was referred to the Dermatology Clinic of the Kurume University Hospital on August 1, for evaluation of parasitic diseases.

Physical examination revealed two firm furuncle‐like erythematous nodules, 2.0 cm in diameter, with a centrally placed 4 mm punctum on the left side of the chest (Fig. 1). There was serous drainage from each punctum and a motile larva was seen in each cavity. A lesion on the axilla had healed spontaneously. Laboratory tests were normal. Two florid lesions on the chest were surgically removed under local anesthesia with 0.5% lidocaine hydrochloride. Histologic examination revealed a mixed cell inflammatory infiltrate throughout the dermis with a tract containing a larva. Examination of the larva revealed a segmented ovoid organism, 1.5 × 0.5 cm in size (Fig. 2). The lesions healed completely within 2 weeks without further treatment. The larva removed by the patient was forwarded to the Department of Medical Zoology, Faculty of Medicine, Tokyo Medical and Dental University, and was identified as third instar larvae of Dermatobia hominis, the human botfly. The other two of the third instar larvae were transplanted under the skin of a rat and a mouse to obtain pupae or adults, but they failed to pupate and died.
FAMILIAL ACANTHOSIS NIGRICANS
Authors: DHAR SANDIPAN , DAWN GOUTAM , KANWAR AMRINDER J. , NADA RITAMBHARA
Published: May 2007

A 15‐year‐old girl (Case 1), presented with thickening and hyperpigmentation of the skin over the dorsa of both hands and feet, and the periorbital area. Hyperpigmentation at the above sites was noticed 6 months after birth; gradually the skin became thickened over the years. Her 39‐year‐old mother (Case 2) also had similar skin lesions since infancy. On enquiry, the girl's one brother (27 years old), maternal uncle (55 years old), and maternal grandfather (77 years old) were found to have similar skin lesions (Fig. 1).

No abnormality was detected on general physical and systemic examinations. Both the patient and her mother were of average build, nutrition, and weight. Dental, ophthalmologic, and endocrinologic examinations were essentially normal. Examination of the skin in both cases revealed hyperpigmented velvety plaques of skin over the dorsa of both hands and feet (Fig. 2, 3) helix of pinnae, and periorbital areas. The sides of the neck and the axillary, inframammary, and inguinal folds were minimally affected. Hairs, nails, and teeth were normal.

Histopathologic examination of the skin from both the dorsum of a hand and face in both patients showed almost identical features. The epidermis appeared to be thinned out over the tips of dermal papillae. There was hyperkeratosis with dermal papillae projecting upwards as fingerlike projections; however, there was mild to moderate acanthosis in the valleys between the papillae (Fig. 4). The rete ridges were poorly developed. There was no proliferation or increased activity of basal melanocytes. The dermis appeared normal.

The following investigations were carried out and were within normal limits: complete blood count, urinalysis, serum sodium, potassium, chloride, calcium, blood sugar, blood urea, creatinine, total bilirubin, transaminases, and alkaline phosphatase; chest roentgenogram and electrocardiogram (ECG). The patients were advised to use topical application of 0.05% retinoic acid and gradual reduction in hyperpigmentation and hyperkeratosis was observed over a period of 8 to 12 weeks. The nature of the condition was explained to the patients.
PULSED ADMINISTRATION OF CORTICOSTEROIDS IN THE TREATMENT OF ALOPECIA AREATA
Authors: SHARMA VINOD K.
Published: May 2007

Background. Widespread alopecia areata (AA) is difficult to treat and modalities such as topical and systemic steroids, topical sensitizers (e.g., squaric acid dibutylester and diphencyprone), psoralen‐ultraviolet A (PUVA) therapy, minoxidil, and immunomodulators have been tried.

Methods. Patients with widespread alopecia (> 40% scalp involvement), including alopecia totalis (AT) and universalis (AU), were treated with 300 mg oral prednisolone pulses at 4‐week intervals, for a minimum of 4 doses or until cosmetically acceptable hair growth was obtained. Response to therapy was monitored by serial photographs and patients were examined monthly for side effects of steroids. A 1000 mg oral prednisolone pulse was administered to five patients with alopecia totalis/universalis and to three failures of the 300 mg‐pulse treatment.

Results. Thirty‐two patients (24 men, 8 women) with a mean age of 29 years were recruited. They had alopecia for a mean period of 2.8 years. Twenty‐seven patients (21 alopecia areata, 5 alopecia universalis, 1 alopecia totalis) received 300 mg pulse therapy and eight patients received 1000 mg prednisolone pulses. Fourteen (58.3%) patients (13 AA, 1 AT) out of 24 evaluated treated with 300 mg pulse therapy showed complete or cosmetically acceptable hair growth. Response was evident on average after 2.4 months and was cosmetically acceptable at 4 months. Three (AA, AT, AU‐one each) out of seven patients assessed for the 1000‐mg pulse had cosmetically acceptable hair growth at 6–9 month.

Conclusions. An oral monthly pulse of prednisolone 300 mg is effective, safe, and can be administered on an outpatient basis. It is recommended as one of the modalities for the treatment of widespread alopecia areata.
ULTRASTRUCTURE AND HUMAN PAPILLOMAVIRUS DNA IN PAPILLOMATOSIS OF EXTERNAL AUDITORY CANAL
Authors: XIA MING‐YU , ZHU WEN‐YUAN , LU JUNG‐YU , LU QIN , CHEN LEI
Published: May 2007

Background. A viral etiology has been suspected in papillomatosis of the external auditory canal (peac), but virus particles have not been detected so far, although they are easily demonstrable in skin warts. The purpose of the study was to solve this discrepancy by the use of polymerase chain reaction (pcr).

Materials and Methods. Specimens from the external auditory canal of 14 patients with PEAC, but no human papilloma virus infection of the genital areas, were examined histologically by light and electron microscopy, as well as by PCR to detect viral dna.

Results. Histologically, papillomatosis was present in all specimens. Vacuolated cells were found in the upper part of the stratum malpighii in five cases. On electron microscopy, the numbers of perichromatin and interchromatin granules were increased, but no viral granules were observed. In all specimens, dna of hpv 6 was detected using PCR, but there was no evidence of DNA of other hpv.

Conclusions. Papilloma of the external auditory canal is produced by infection with hpv 6.
VALUE OF TOUCH PREPARATIONS (IMPRINTS) FOR DIAGNOSIS OF CUTANEOUS LEISHMANIASIS
Authors: BAHAMDAN KHALED A. , KHAN ABDUR RAUF , TALLAB TALAL M. , MOURAD MOHAMED MAZEN
Published: May 2007

Background. The clinical diagnosis of cutaneous leishmaniasis is confirmed by demonstrating the organism on a superficial smear or on a biopsy of the lesion. Misdiagnosis in a biopsy specimen may be due to scanty Leishmania organisms that may not be identified in histologic sections.

Methods. Punch biopsies of skin lesions, suspected clinically to be cutaneous leishmaniasis, from 29 patients were taken. Touch smears on slides were air‐dried, fixed with methyl alcohol, and stained with Giemsa stain. Results of routine histologic examination were then compared with those of touch preparation.

Results. Twenty‐one cases were positive for leishmaniasis. In 18 cases, the organisms were seen both in the biopsy and in the touch preparation. In three cases, the organisms were only identified on touch preparation.

Conclusions. A touch preparation improves the sensitivity of the diagnosis of cutaneous leishmaniasis without incurring additional cost to the laboratory.
CUTANEOUS LEISHMANIASIS: SCHEDULES FOR INTRALESIONAL TREATMENT WITH SODIUM STIBOGLUCONATE
Authors: TALLAB TALAL M. , BAHAMDAM KHALID A. , MIRDAD SOLEMAN , JOHARGI HANAN , MOURAD MOHAMED MAZE. , IBRAHIM KARAM , EL SHERBINI ABDUL HAMEED , KARKASHAN EMAN , KHARE ASHOK KUMAR , JAMAL AWATIF
Published: May 2007

Background. Various therapeutic modalities have been used for treating cutaneous leishmaniasis. Intralesional pentavalent antimonial injection is one of the effective therapeutic modalities. In this study, the efficacy of three different intralesional schedules with sodium stibogluconate have been investigated.

Methods. Ninety‐six patients with 129 lesions were entered into the study, all with confirmed diagnosis of cutaneous leishmaniasis. The lesions were treated with three different schedules, including daily, alternate day, and weekly interlesional injections of sodium stibogluconate. The clinical response was then compared to arrive at the most effective schedule.

Results. The clinical responses (complete and partial cure) were 67%, 97%, and 91% for the daily, alternate‐day, and weekly schedules, respectively. Lesions with either partial cure or failure of treatment were injected weekly with the same medication until complete cure had been achieved. The final overall success rate of complete cure was 99.2%.

Conclusions. Alternate day or weekly intralesional treatment of cutaneous leishmaniasis with sodium stibogluconate are more effective than daily treatments.
MEASUREMENT OF THE SKIN‐CLEANING EFFECTS OF SOAPS
Authors: WOLF RONNI , FRIEDMAN MARCEL
Published: May 2007

Background. In the past 30 years, many tests for assessing the irritancy of soaps have been introduced, but only very few tests for evaluating their cleaning properties. The urgent need for such a method is obvious.

Methods The method is based on the principles developed by Schrader, with substantial modifications. As in Schrader's method, we used a fat‐based ointment to emulate “dirt.” The washing process was performed by placing the examined hand in a rotating soap solution for 5 minutes. The capacity of various soaps to remove the “dirt” was assessed by comparing the sebumeter readings before and after the washing process. The difference between the two readings provided a quantitative estimate of the percentage of “dirt” (ointment) that was washed off during the process.

Results The cleansing capacity of two soaps was compared to that of water. Soap 1 showed a cleansing of 81.7 ± 2.4%, soap 2 a cleansing of 75.3 ± 2.9%, as compared to water of 29.7 ± 3.4%. The curve representing the distribution of the data was very smooth, bell‐shaped and symmetric about its mean. The difference between the cleaning activity of the two soaps tested was statistically significant (P < 0.0001).

Conclusions We have presented a new method for testing the cleansing capacity of soaps. We believe, that our method gives better results than that of Schrader; in particular, it enables us to discriminate more effectively among the various soaps. Our results indicate that the method is reliable and reproducible. It is also practical, easy to perform, does not require an expensive and complex washing machine, and can be carried out in every laboratory.
BEHÇET'S DISEASE: CLINICAL STUDY OF JORDANIAN PATIENTS
Authors: AL‐ABOOSI MUSTAFA M. , AL SALEM MAHMOUD , SAADEH ABDALLAH , AL‐JAMAL MOHAMMED , HIJAWI MUSTAFA , KHAMMASH MUHAMMAD , SHARMA RAGHAVENDRA V.
Published: May 2007

Background. Behçet's disease is a chronic, recurrent, inflammatory disorder characterized by the triad of oral and genital ulcers and ocular lesions. The etiology is unknown. This is the first report giving details of the clinical manifestations of Behçet's disease in Jordanian patients.

Methods. Twenty patients with Behçet's disease were studied to determine the clinical pattern in the North of Jordan. The patients were seen in Princess Basma Teaching Hospital in North Jordan. They presented to various clinics and underwent full clinical examination. Data for each patient on all features of Behçet's disease were recorded on a standard form. A comparison was made between Behçet's disease in Jordan and other countries in the region.

Results. Of the 20 patients, 14 were men and six women, giving a ratio of 2.3:1. Their ages ranged from 14 to 58 years. All had mouth ulcers, 65% genital ulcers, 65% ocular involvement, 55% joint involvement, 35% skin lesions, 20% vascular lesions, and 5% gastrointestinal involvement. The oral ulcers were the first manifestation of the disease process in 70% of our patients. Skin lesions, genital ulcers, and involvement of the central nervous system and the pulmonary system were less frequent in our study.

Conclusions. Although it is difficult to obtain figures as to the incidence and prevalence of Behçet's disease in Jordan, the clinical manifestations, with a few exceptions, are similar to those in other countries in the region.
PAPULAR‐PURPURIC GLOVES‐AND‐SOCKS SYNDROME
Authors: VARGAS‐DÍEZ ERICH , BUEZO GUADALUPE F. , ARAGÜES MAXIMILIANO , DAUDÉN ESTEBAN , DE ORY FERNANDO
Published: May 2007

Background and Objective. Papular‐purpuric gloves‐and‐socks syndrome (PPGSS) is a recently described dermatosis in which human parvovirus B19 (HPV B19) has been implicated as etiologic agent; however, it is suspected that PPGSS may be caused by various agents. This study was designed to survey the general characteristics of PPGSS and to determine the role of HPV B19 in its etiology.

Methods. We analyzed data from 21 patients and examined serum samples from three new cases for various viruses.

Results. The PPGSS displays a striking uniform clinical pattern. Histologic and immunofluorescence findings are nonspecific. Seroconversion of HPV B19 was reported in six cases and confirmed in two of our patients. In only one case was a possible causative role of Coxsackie virus B6 suggested consistently.

Conclusions. The PPGSS represents a distinctive dermatosis and a manifestation of HPV B19 infection. Unlike erythema infectiosum, anti‐HPV B19 antibodies seem to develop later after onset of the skin eruption and while viremia is still present.
CHLORACNE IN THE 1990s
Authors: VAZQUEZ EDUARDO ROSAS , MACIAS PABLO CAMPOS , TIRADO JOSE GUADALUPE OCHOA , SOLANA CARLOS GARCIA , CASANOVA ANTONIO , MONCADA JOSE FRANCISCO PALOMINO
Published: May 2007

Background. Chloracne is a disease associated with toxicity of halogenated compounds used in some industrial processes. A patient affected by chloracne led us to study a total of nine cases from a single factory.

Methods. We studied the clinical features of nine patients exposed chronically to chlorobenzenes. On all of them blood samples were drawn and biopsies of affected skin and liver were taken. Their work environment was visited and studied.

Results. All nine patients were men and had polymorphic skin lesions, characterized mainly by comedones and cysts. They had chronic conjunctivitis and seven had cysts in the Meibomian glands. All of them had polyneuropathy and liver damage and seven had hypertriglyceridemia. Compounds known to cause chloracne were found in exceedingly high concentrations in the water used in the workplace.

Conclusions. Every patient exposed to halogenated compounds with the cutaneous manifestations of chloracne should be carefully investigated for systemic complications (such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities).
OCCUPATIONAL ALLERGIC CONTACT DERMATITIS CAUSED BY 2,4,6‐TRIS‐(DIMETHYLAMINOMETHYL)PHENOL, AND REVIEW OF SENSITIZING EPOXY RESIN HARDENERS
Authors: KANEKRVA LASSE , ESTLANDER TUULA , JOLANKI RIITTA
Published: May 2007

Background. Epoxy resin compounds (ERG) include a large number of sensitizing chemicals such as epoxy resins (ER), hardeners (curing agents), and reactive diluents. Allergic contact dermatitis (ACD) caused by ERCS is often occupational.

Materials and Methods. We report a patient, sensitized to a hardener of a two‐component epoxy paint. Three conventional patch test sessions were performed to diagnose the causative chemical. We also review the literature on sensitizing epoxy‐resin hardeners.

Results. A 47‐year‐old nonatopic woman developed dermatitis from a two‐component epoxy paint. Patch testing with epoxy resin was negative, but 2,4,6–tris(dimethylaminomethyl)phenol (tris‐DMP), used in the paint hardener, induced an allergic patch test reaction. We also review briefly other epoxy hardeners that have caused allergic dermatitis, including: (1) aliphatic polyamines, e.g., ethylenediamine, diethylenetriamine, triethylenetetramine, 3‐dimethylaminopropylamine, and trimethylhexamethylenediamine; (2) cycloaliphatic polyamines, e.g., isophoronediamine and 3,3′‐dimethyl‐4,4‐diaminodicyclohexylmethane; (3) aromatic amines, such as 4,4′‐diaminodiphenylmethane, m‐phenylene diamine, and 1,3‐xylylene diamine; (4) dicyanodiamide; (5) triglycidyl isocyanurate, an epoxy compound that may be used as an epoxy‐resin hardener; and (6) additives in epoxy accelerators, such as hexavalent chromate.

Conclusions. No one chemical can be used to screen for sensitization to the many different epoxy hardeners. Extensive patch testing may be required to reveal the hardener that has caused the allergy. The hardener, 2,4,6‐tris‐dimethylaminomethyDphenol (tris‐DMP), is a new sensitizer. To verify ACD caused by tris‐DMP, patch‐testing at 1% in petrolatum is suggested.
DERMATOFIBROSARCOMA PROTUBERANS
Authors: GARCIA CARLOS , CLARK ROBERT E. , BUCHANAN MARK
Published: May 2007

Background. Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive soft tissue sarcoma in which recurrences are common. It usually affects middle‐aged individuals with the most common location being the trunk. Sex distribution varies among published series. Mohs surgery is the treatment of choice. Immunostaining for CD34 facilitates the diagnosis of DFSP and aids in indicating the surgical margins of the tumor; however, the sensitivity of this marker is variable.

Materials and Methods. This is a retrospective review of 16 cases of DFSP treated with Mohs surgery at Duke University Medical Center between 1981 and 1994. Clinical and histologic features are analyzed. Immunohistochemical stains for CD34 were performed in one case.

Results. Twelve of the 16 patients were women with four younger than 20 years. The most common location was the trunk. No recurrences following Mohs surgery have been documented. The average number of stages during Mohs surgery was 3.3. Surgical wounds were repaired by complex layered closure in 11 cases. Stains for CD34 were negative on the initial biopsy, but were positive on frozen sections.

Conclusions. Both sexes and all age groups are affected by DFSP. Mohs surgery is the treatment of choice and offers a significant improvement in cure rates with the cosmetic advantage of smaller postoperative wounds. Immunostains for CD34 appear to be an important adjunct to facilitate tumor removal, but the variable expression of CD34 antigen by DFSP tumors can lead to variable staining patterns.
Recent advances in the biogeography and genecology of symbioticFrankiaand its host plants
Authors: Benson David R. , Dawson Jeffrey O.
Published: May 2007

Molecular phylogenetic approaches have begun to outline the origin, distribution and diversity of actinorhizal partners. Geographic isolation ofFrankiaand its host plants resulting from shifting continents and dispersal patterns have apparently led to the development ofFrankiagenotypes with differing affinities for host genera, even within the same plant family. Actinorhizal plant genera of widespread global distribution tend to nodulate readily even outside their native ranges. These taxa may maintain infectiveFrankiapopulations of considerable diversity on a broad scale. Arid environments seem to have distinctive actinorhizal partnerships, with smaller and more specific sets ofFrankiasymbionts. This has led to the hypothesis that some host families have taxa that are evolving towards narrow strain specificity, perhaps because of drier habitats where fewerFrankiastrains would be able to survive. Harsh conditions such as water‐saturated soils near lakes, swamps or bogs that are typically acidic and low in oxygen may similarly lessen the diversity ofFrankiastrains present in the soil, perhaps limiting the pool of frankiae available for infection locally and, at a larger scale, for natural selection of symbiotic partnerships with host plants. Recent molecular ecological studies have also provided examples ofFrankiastrain sorting by soil environment within higher order cluster groupings ofFrankiahost specificity. Future frontiers for ecological research onFrankiaand actinorhizal plants include the soil ecosystem and the genome ofFrankiaand its hosts.
Testing Household‐Specific Explanations for the Inverse Productivity Relationship
Authors: Assunção Juliano J. , Braido Luis H. B.
Published: May 2007

The inverse relationship between land productivity and farm size is an old and puzzling empirical regularity. Most explanations for this relationship rely on market imperfections that jointly determine the farm size and the household's shadow price of some productive inputs. We use plot‐level data from the ICRISAT/VLS to assess whether these household‐specific theories can explain the puzzle. The data exhibit plots of different sizes being simultaneously cropped by the same household. The inverse relationship is shown to hold true with the same magnitude across the plots of each household, thus cross‐household heterogeneity does not suffice to explain the puzzle.
EXCHANGE RATE STABILISATION, LEARNING AND THE TAYLOR PRINCIPLE
Authors: SPAHN HEINZ‐PETER
Published: May 2007

The paper explores whether central banks can keep their interest rates independent from given foreign rates, and to what extent interest policies designed to stabilise nominal exchange rate changes can be applied instead of, or in addition to, the traditional interest rate response to inflation gaps. This modification of a Taylor Rule is analysed in a simple macro model with some New Keynesian features. Information is imperfect; agents cannot build rational expectations but try to learn ‘true’ market relations. Results show that the Taylor Principle can be generalised in an open economy with flexible exchange rates.
SUBSTITUTION AND COMPLEMENTARITY IN THE CREATION AND COMMUNICATION OF AUSTRALIAN UNIVERSITY RESEARCH*
Authors: BURGIO‐FICCA CLAUDIA , DOUCOULIAGOS HRISTOS
Published: May 2007

The generation of research is one of the major functions of the university sector. In most disciplines, journal articles continue to be the main outlet for the communication of research findings. However, in Australia, government induced distortions have rewarded refereed conference papers an equal status to refereed journal papers. The aim of this paper is to explore the association between research published in journals and research published in conference proceedings. We use a panel dataset of the research output of 36 Australian universities, for the period 1995–2004. Cobb‐Douglas research production functions are estimated, as well as a system of research production functions that allows for simultaneity. The results indicate that journals and conferences are contemporaneous substitutes – an expansion in conference publications displaces journal publications. There is also a ‘DEST effect’. On average, conference papers are not converted into subsequent journal papers. The DEST effect is found also through analysis of the publication histories of 152 business and law academics. Postgraduate enrolments are shown to contribute only to conferences and have no effect on journal publications. Research income has a positive effect on both conferences and journal publications.
Early‐Morning Behaviour in School
Authors: Johnson Barry
Published: May 2007

Several children whom I know arrive at school in an emotionally distressed state and tend to disrupt classroom activities. Presumably something has gone wrong at home. What can be done to ease this problem?
Social Integration of School Age ESN(S) Children in a Regular School
Authors: Rose C. D.
Published: May 2007

Eleven children classified as severely mentally handicapped were observed after a paper and pencil sociometric test given to non‐handicapped children in the school to determine their true level of socialisation with their non‐handicapped peers. the social play interactions were categorised on an adapted version of the Parten Social Participation Scale. It was shown that, by utilising non‐handicapped children in a peer tutor programme, there was a significant increase in associative and cooperative play whilst there was a significant decrease in the level of negative attention‐seeking and inappropriate behaviours.