bluuebunny/crossref_metadata_2025 huggingface dataset:
ISOTOPIC RESPONSE
Authors: WOLF RONNI , BRENNER SARAH , RUOCCO VINCENZO , FILIOLI FABRIZIO GRIMALDI
Published: May 2007

Background. The occurrence of a new skin disorder exactly at the site of another one, already healed and unrelated, was first described in 1955. In 1985, Wolf et al. recognized that we are dealing with a dermatologic phenomenon and established a precise definition for this phenomenon. Fifty‐eight cases corresponding to the definition of this phenomenon have been reported until now.

Methods. The new phenomenon, for which the term “isotopic response” has been suggested, has been defined. Cases corresponding to the definition have been analyzed with special emphasis on the diseases involved, the time intervals, and the locations of the diseases. Eight new cases are described.

Results. A total of 58 cases of isotopic response have been described. The first disease in most of the patients was herpes zoster; in three cases it was herpes simplex, in two varicella, and in one, thrombophlebitis. The second disease, which appeared exactly at the site of the first, already healed disease, was in most reported cases a carcinoma (26 cases, in particular 15 cases of breast carcinoma, 5 basal cell carcinomas (BCC), 4 squamous cell carcinomas (sec), 2 basosquamous carcinomas), or granuloma annulare (16 cases). Additional diseases were Kaposi's sarcoma (2 cases), pseudolymphoma (2 cases), sarcoid (2 cases), tinea (2 cases), tuberculoid and vasculitis granuloma (1 case), angiosarcoma, metastasis, Bowen's disease, lymphoma, leukemia cutis, and acne (1 case each). The diseases did not show any predilection for a particular location. The interval between the first and second disease was extremely variable (ranging from days to years) and showed no particular features.

In the eight additional cases described in the present report, the first disease was herpes simplex (6 cases) or herpes zoster (2 cases). The second disease was viral warts (3 cases) or squamous cell carcinoma (2 cases). Additional diseases were furunculosis, contact dermatitis, and molluscum contagiosum (1 case each).

Conclusions. The new term, “isotopic response,” describes the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease.

It is suggested that the term “isotopic response” be included in the lexicon (glossary) of dermatology.

Introducing the new term and classifying all the cases under a single key word, will make it possible to locate and collect them easily and to search for the mechanism underlying this phenomenon.
COMPARATIVE STUDY OF WOUND HEALING IN PORCINE SKIN WITH CO2 LASER AND OTHER SURGICAL MODALITIES: PRELIMINARY FINDINGS
Authors: MOLGAT YVONNE M. , POLLACK SHELDON V. , HURWITZ JEFFREY J. , BUNAS STANLEY J. , MANNING THOMAS , McCORMACK KEVIN M. , PINNELL SHELDON R.
Published: May 2007

Background. The CO2 laser is a common surgical modality in dermatology. To clarify conflicting reports on the histological healing properties of CO2 laser on incisional or ablative wounds, we have applied it in a miniature hairless porcine skin model at power settings similar to those used in clinical practice.

Methods. Histological parameters of wound healing in skin incisions using the CO2 laser were compared with those using scalpel, hot scalpel, and electrosection, and in dermal ablation using CO2 laser, fraize, wire brush, and electrofulguration alone or with curettage.

Results. In incisional wounds, tissue damage was most extensive in CO2 laser wounds, with delayed dermal healing and reepithelialization. In ablative wounds, CO2 laser caused a similar degree of tissue damage as did the electrosurgical modalities, and more damage than did fraize or wire brush. Reepithelialization was complete in CO2 laser, fraize, and wire brush wounds before electrosurgical wounds. Final histology of both incisional and ablative wounds at 6 weeks was similar with all surgical modalities.

Conclusion. The CO2 laser and electrosurgery both produce greater focal tissue damage in incisional and ablative applications than the other modalities. Delayed epithelialization of the wound occurs with both modalities in incisional wounds but only with electrosurgery in ablative wounds. At 6 weeks, the appearance of the scar in all incisional and ablative modalities is similar grossly and histologically. Confirmation of these findings requires standardization of power density of the CO2 laser in incision and ablation.
IDIOPATHIC HYPERSENSITIVITY VASCULITIS: CLINICOPATHOLOGIC CORRELATION OF 61 CASES
Authors: RATNAM KAVIPURAPU VENICATA , BOON YIM HENG , PANG BRYAN K.
Published: May 2007

Background. Little is known of the course and prognosis of hypersensitivity vasculitis (hv).

Methods. Sixty‐one cases of idiopathic hv were biopsied and followed‐up for 5 years.

Results. There were two predominant patterns of presentation: palpable purpura (pp) and vasculitic ulcers (vu). The former was self‐limiting, whereas the prognosis of the latter was poor. Findings on histopathology correlate well in pp patients having acute episodes, whereas in patients with vu there is correlation with duration and recurrence.

Conclusion. A biopsy of a fresh lesion is recommended to help in determining the outcome.
DEXAMETHASONE‐CYCLOPHOSPHAMIDE PULSE THERAPY FOR PEMPHIGUS
Authors: PASRICHA JAGJIT S. , KHAITAN BINOD K. , RAMAN R. SHANTHA , CHANDRA MITHILESH
Published: May 2007

Background. During the last 12 years, we have used a different approach, arbitrarily designed by us, for treating pemphigus patients that has given us very different and encouraging results.

Method. The treatment schedule consists of giving 100 mg dexamethasone on 3 consecutive days and 500 mg cyclo‐phosphamide on one day and repeating these pulses (DCPS) every 4 weeks. In between the DCPS, the patient receives only 50 mg cyclophosphamide orally daily and generally no corticosteroids. An essential component of the regimen is to administer a specified amount of the treatment for 1.5 years after achieving clinical remission.

Results. Of the 300 patients enrolled for this treatment, 61 patients could not complete the treatment, whereas 12 patients have died, some of them due to unrelated causes. Of the remaining 227 patients, 190 patients (84%) have already completed the treatment and are free of the disease even after complete withdrawal of all treatment, the duration of posttreatment follow‐up being more than 5 years in 48 patients, 2 to 5 years in 75 patients, and less than 2 years in 67 patients. The maximum duration of posttreatment follow‐up is 9 years. The remaining patients are also showing the same trend. Twenty‐four patients are in remission but have not yet completed the treatment schedule, whereas 13 patients are still having evidence of clinically active disease, although it has already become much milder. The blood levels of intercellular antibody also decrease as the treatment progresses. The side effects commonly observed during treatment with corticosteroids are generally absent or insignificant. The relapses of the disease, seen so far in 59 patients, have been observed mostly in those patients who defaulted during the treatment, but a further course of the DCP regimen led again to complete recovery.
TOPICAL NICOTINAMIDE COMPARED WITH CLINDAMYCIN GEL IN THE TREATMENT OF INELAMMATORY ACNE VULGARIS
Authors: SHALITA ALAN R. , SMITH J. GRAHAM , PARISH LAWRENCE CHARLES , SOFMAN MICHAEL S. , CHALKER DAN K.
Published: May 2007

Background. Systemic and topical antimicrobials are effective in the treatment of inflammatory acne vulgaris; however, widespread use of these agents is becoming increasingly associated with the emergence of resistant pathogens raising concerns about microorganism resistance and highlighting the need for alternative nonantimicrobial agents for the treatment of acne. Nicotinamide gel provides potent antiinflammatory activity without the risk of inducing bacterial resistance.

Methods. In our double‐blind investigation, the safety and efficacy of topically applied 4% nicotinamide gel was compared to 1% clindamycin gel for the treatment of moderate inflammatory acne vulgaris. Seventy‐six patients were randomly assigned to apply either 4% nicotinamide gel (n = 38) or 1% clindamycin gel (n = 38) twice daily for 8 weeks. Efficacy was evaluated at 4 and 8 weeks using a Physician's Global Evaluation, Acne Lesion Counts, and an Acne Severity Rating.

Results. After 8 weeks, both treatments produced comparable (P = 0.19) beneficial results in the Physician's Global Evaluation of Inflammatory Acne; 82% of the patients treated with nicotinamide gel and 68% treated with clindamycin gel were improved. Both treatments produced statistically similar reductions in acne lesions (papules/pustules; −60%, nicotinamide vs. −43%, clindamycin, P = 0.168), and acne severity (−52% nicotinamide group vs. −38% clindamycin group, P = 0.161).

Conclusions. These data demonstrate that 4% nicotinamide gel is of comparable efficacy to 1% clindamycin gel in the treatment of acne vulgaris. Because topical clindamycin, like other antimicrobials, is associated with emergence of resistant microorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.
AGE AND GENDER DIFFERENCES IN THE IMPACT OF PSORIASIS ON QUALITY OF LIFE
Authors: GUPTA MADHUUKA A. , GUPTA ADITYA K.
Published: May 2007

Background. The impact of psoriasis upon the quality of life contributes significantly to the overall morbidity associated with the disease. An older age at onset of psoriasis and being a man have been associated previously with lower psychosocial morbidity. In order to further evaluate these potentially important mitigating factors, we examined the relation of age and gender on some aspects of psoriasis‐related psychosocial morbidity.

Methods. Two hundred and fifteen consenting psoriasis patients, representing a wide range of disease severity, were studied. They included 110 men and 105 women, age range 19–87 years (age: mean ± SD: 48·0 ± 15·9 years); all endorsed a list of 30 items (by checking a “Yes” or “No”) pertaining to life events related to psoriasis that they had experienced in the previous one month. The patients self‐rated the severity of their psoriasis. The patients were categorized into four age groups of 18–29 years (N = 28), 30–45 years (N = 77), 46–65 years (N = 76), and > 65 years (N = 34), respectively, for the statistical analyses.

Results. No age or gender differences in the severity of psoriasis were observed. Patients of both sexes in the 18 to 29 and 30 to 45 year age groups reported more frequent (P 0·05) problems related to both appearance/socialization and occupation/finances, in contrast to patients in the 46–65 and over‐65‐year age groups. No gender differences (P 0·05) were observed in the frequency of items related to appearance and socialization; however, men reported greater work‐related stresses.

Conclusion. Psoriasis has a greater impact upon the quality of life of patients in the 18 to 45 year age range and affects the socialization of both sexes equally. Men face greater work‐related stresses as a result of their psoriasis.
MULTIPLE GIANT DISSEMINATED PYOGENIC GRANULOMA IN THREE PATIENTS BURNED BY BOILING MILK
Authors: MOMENI ALI‐Z , ENSHAIEH SHAHLA , SODIFI MANOUCHEHR , AMINJAWAHERI MALI
Published: May 2007

Background. Pyogenic granuloma is a common benign skin tumor. The multiple disseminated form of the disease is relatively rare.

Methods. We examined three patients who developed giant pyogenic granuloma after burns from boiling milk. The patients were a 1.5‐year‐old boy, a 5‐year‐old girl, and a 35‐year‐old woman, All three patients had second‐degree burns over their face and trunk.

Results. In these patients, pyogenic granuloma had developed over the previously burned areas 2–3 weeks after exposure. The general condition of the patients remained good and all lesions involuted spontaneously. In a 6‐month follow‐up period no relapse of the lesions was seen.

Conclusions. The cause for development of multiple giant pyogenic granulomas after burns from milk remains unknown, but milk proteins or other components of milk, microorganisms, or the burn itself may be causative factors.
FINASTERIDE INHIBITS 5α‐REDUCTASE ACTIVITY IN HUMAN DERMAL FIBROBLASTS: PREDICTION OF ITS THERAPEUTIC APPLICATION IN ANDROGEN‐RELATED SKIN DISEASES
Authors: NGUYEN QUAN H. , CHEN TAO , WANG XUESHENG , CHEN YING , CHIEN PAUL
Published: May 2007

Background. The potential role of finasteride in treating androgen related skin disorders was investigated.

Methods. Pooled human dermal fibroblasts were used to assess the effect of finasteride on the 5α‐reductase activity in skin tissue. Vmax and Km were estimated in the presence of 0, 10, and 200 nM finasteride.

Results. Vmax values remain constant near 1.20 pmol/mg protein/h in the presence of increasing concentrations of finasteride; however, apparent Km increases from 0.27 nM at 0 nM finasteride to 0.31 nM and 0.44 nM at 10 nM and 200 nM finasteride, respectively. This suggests that ministered competes with testosterone and has a high affinity for same binding site of the 5α‐reductase enzyme. Apparent Ki was estimated at 282 nM, indicating that a high concentration of finasteride is required to significantly suppress the enzyme activity.

Conclusions. This study confirms that finasteride inhibits the conversion of testosterone to dihydrotestosterone in human reticular dermal fibroblasts. Finasteride may have therapeutic potential in treating skin disorders influenced by the action of dihydrotestosterone.
EFFECT OF SYSTEMIC ADMINISTRATION OF ISOTRETINOIN ON BLOOD LIPIDS AND FATTY ACIDS IN ACNE PATIENTS
Authors: OSTLERE LUCY S. , HARRIS DAVID , MORSE‐FISHER NANCY , WRIGHT STEPHEN
Published: May 2007

Background. In many studies, an increase in total cholesterol and triglycerides with isotretinoin therapy have been shown and investigators have commented on potential cardiovascular risk. A low intake of linoleic acid, the main essential fatty acid in man, may act as an independent risk factor for coronary heart disease. In vitro etretin alters both the incorporation of extracellular fatty acids into cell membranes and the fatty acid composition of the cell membrane itself. It is, therefore, important to establish whether isotretinoin has any effect on the metabolism of polyunsaturated fatty acids.

Methods. The effect of treatment with isotretinoin for 4 months on the metabolism of polyunsaturated fatty acids in patients with acne was assessed. Quantitative total cholesterol and triglycerides as well as plasma phospholipid, triglycerides, and cholesteryl ester fatty acids were measured in 12 patients and red cell phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol fatty acids were measured in 13 patients before and after isotretinoin therapy.

Results. There was a significant increase in the concentrations of cholesterol (P < 0.02) and triglycerides (P < 0.04) during treatment. There was no significant difference in plasma phospholipids, triglycerides, and cholesterol esters, or in the red cell phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol during isotretinoin therapy.

Conclusions. This study failed to demonstrate any effect of isotretinoin on the metabolism of polyunsaturated fatty acids. There was a significant increase in total cholesterol and triglyceride levels following isotretinoin therapy supporting the findings of many previous studies.
ALLERGIC CONTACT DERMATITIS: CLINICAL FEATURES AND PROFILE OF SENSITIZING ALLERGENS IN RIYADH, SAUDI ARABIA
Authors: AL‐SHEIKH OMAR AHDULAZIZ , EL‐RAB MOHAMED OSMAN GAD
Published: May 2007

Background. No reports are available on allergic contact dermatitis in Saudi Arabia, although it seems to be a common skin problem. We attempted to explore certain clinical aspects in addition to the profile of sensitizing allergens in our area. As no standard panel for patch testing is available in our geographic region, we examined the suitability of the European Standard Series.

Methods. Patch testing was performed on 271 consecutive patients with various forms of dermatitis, referred for evaluation of possible allergic contact dermatitis. The study included 147 women and 124 men. The patients were between 12 and 75 years of age.

Results. Out of 271 subjects, 152 (56.1%) showed one or more positive reactions. Of these, 80 (52.6%) were women and 72 (47.4%) were men. Almost one quarter of the patients (25.7%) presented with hand dermatitis.

Positive reactions to 21 out of the 22 allergens were found. Sensitization was most common to nickel sulfate (39.5%), potassium dichromate (32.9%), and cobalt chloride (30.9%). Reactions to the other allergens ranged between 14.5% and 1.3%. Less than one percent of the patients (0.66%) reacted to benzocaine and showed no reaction to primin.

Conclusions. Allergic contact dermatitis is a common skin problem in Saudi Arabia. Further studies that address the prevalence and incidence of the disease are indicated. The European Standard Series is suitable for patch testing patients in our community; however, we suggest exclusion of benzocaine and primin. The addition of three allergens of local relevance, black seed oil, local perfume mix, and henna, are presented and discussed. The formulation of a regional standard series for patch testing dermatitis patients in our geographic area requires further collaborative studies.
SUNLIGHT AND AIR TEMPERATURE AFFECT AUTOANTIBODY ACTIVITY AND SKIN INVOLVEMENT OF BULLOUS PEMPHIGOID
Authors: KYRIAKIS KYRIAKOS P. , PANTELEOS DEMETRIUS N. , TOSCA ANDRONIKI D.
Published: May 2007

Background and Design. Sunlight and air temperature are environmental parameters with considerable influence upon autoimmunity. Their impact on idiopathic bullous pemphigoid (BP) was studied 1) in a prospective series of 27 patients with regard to clinical activity and 2) in a retrospective series of 232 cases during a 7‐year period with regard to immunoserology.

Results. Skin involvement and the onset of disease showed an immediate and cumulative pattern of response to sunlight and air temperature. Immunoserologic analysis showed a strong correlation of autoantibody expressivity with these two environmental measurements.

Conclusions. This study verifies previous sporadic clinical and experimental data concerning the influence of environmental factors on BP. Accordingly, preventive measures against exposure to sunlight and high temperature are recommended.
FAILURE OF INTERFERON‐ALPHA 2B IN THE TREATMENT OF MATURE KELOIDS
Authors: AL‐KHAWAJAH MARWAN M.
Published: May 2007

Background. An unchecked proliferation of fibrous tissue after an injury to the skin is the basic mechanism for keloid formation. Recent studies have shown the inhibitory effect of interferons on dermal fibroblast growth and/or collagen production. Various therapeutic modalities have been used for the treatment of keloids, although only with limited success. There are only a few reports on the use of interferons in the treatment of keloids. To our knowledge no controlled clinical trials have examined the efficacy of intralesional interferon‐alpha 2b on mature keloid lesions. In this study, recombinant human interferon‐alpha 2b was examined for its ability to modify keloids clinically.

Methods. Twenty‐two patients with at least two mature keloids were studied twice weekly for 3 weeks. Patients were treated by injection of recombinant human interferon‐alpha 2b, 0.5 million per cm2 of keloid, into one lesional site and diluent alone into another lesional site. Lesions were measured before and on days 8, 15, 22, and 29 after starting treatment.

Results. Only 13 of 22 patients could be evaluated at the end of the study; seven patients withdrew from the study because of severe local pain during injection. Three of the 13 patients showed insignificant reduction in the height of keloids after interferon treatment. No serious laboratory abnormalities were detected.

Conclusions. Recombinant interferon‐alpha 2b is not efficacious in the treatment of mature keloids.
TOXIC EPIDERMAL NECROLYSIS
Authors: PASRICHA JAGJIT S. , KHAITAN BINOD K. , SHANTHARAMAN RAMAN , MITAL ASIT , GIRDHAR MUKESH
Published: May 2007

Background. Most studies on drug‐induced toxic epidermal necrolysis (TEN) report a high mortality rate. This has been attributed partly to the use of corticosteroids for its treatment. However, we consider corticosteroids to be the sheet anchor for saving the patients having TEN.

Materials and Methods. Our approach to the treatment of this disease consists of administering a relatively high dose of corticosteroids to control the reaction at the earliest possible time and then withdrawing corticosteroids at the fastest possible rate.

Results. As illustrated by the five case reports, the reaction is controlled within 24 to 48 hours and the corticosteroids are withdrawn within the next 7 to 10 days. During this period, the skin also shows almost complete healing. With the confidence gained with this approach, we undertake the provocation test as a rule in every patient to find the actual drug responsible for the reaction.

Conclusions. Corticosteroids used in an appropriate dosage schedule constitute an important component of the treatment for TEN to ensure early recovery.
MICROBIOLOGY OF INFECTED ATOPIC DERMATITIS
Authors: BROOK ITZHAK , FRAZIER EDITH H. , YEAGER JOSEF K.
Published: May 2007

Background. Bacterial infections occur frequently in lesions of atopic dermatitis (AD). The objectives of the study were to establish the aerobic and anaerobic microbiology of secondarily infected AD.

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

Results. Bacterial growth was noted in 41 specimens. Aerobic or facultative anaerobic bacteria only were present in 15 patients (36%), anaerobic bacteria only in eight (20%), and mixed anaerobic‐aerobic flora was present in 18 (44%). Seventy‐ two isolates were recovered (1.8 per specimen), 34 aerobic or facultative bacteria, 35 strict anaerobes, and three Candida sp. The predominant aerobic and facultative bacteria were Staphylococcus aureus (12 isolates). Group A beta hemolytic streptococcus in five isolates, and Escherichia coli in four. The predominant anaerobes were peptostreptococcus spp. (13 isolates), pigmented Prevotella and Porphyromonas spp. in eight, and Fusobacterium spp. in four isolates. Single bacterial isolates were recovered in 14 patients (34%), seven of which were S. aureus. Twenty‐one of the organisms isolated from 16 patients (39%) produced the enzyme beta‐lactamase. 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 legs and buttocks. Group A beta‐hemolytic streptococci, pigmented Prevotella, and Porphyromonas and Fusobacterium spp. were most frequently recovered in lesions of the finger, scalp, face, and neck.

Conclusions. The polymicrobial etiology of secondarily infected AD lesions and the association of bacterial flora with the anatomic site of the lesions are demonstrated.
CHRONIC ULCERATIVE STOMATITIS WITH STRATIFIED EPITHELIUM‐SPECIEIC ANTINUCLEAR ANTIBODIES
Authors: LEWIS JOHN E. , BEUTNER ERNST H. , ROSTAMI REZVAN , CHORZELSKI TADEUSZ P.
Published: May 2007

Abstact

Background. In 1990 a new disease‐associated antinuclear antibody was first recognized as a specific immunologic marker for a chronic form of ulcerative stomatitis (cus).

Methods. Another case is reported herein and the subject of chronic ulcerative stomatitis with stratified epithelium‐specific antinuclear antibodies (SES‐ANA) is reviewed. Intraoral biopsies from this patient were submitted for microscopic examination and direct immunofluorescence. Indirect immunofluorescence studies were also performed. Serial SES‐ANA titers were obtained with the patient on maintenance treatment with hydroxychloroquine. A skin biopsy of a recent lichenoid eruption was obtained and skin explants grown in the serum of this patient were studied in tissue culture with reference to SES‐ANA binding and complement fixation.

Results. Biopsy and serum studies confirmed a diagnosis of cus with SES‐ANA in the patient reported. Skin biopsy showed lichen planus. The patient was treated with hydroxychloroquine with a favorable response. Serial SES‐ANA titers did not parallel the disease activity. Among the substantive observations made from skin explants cultured in the serum of this patient was widespread fixation of C3 to the nuclei of basal cells.

Conclusions. The case described herein extends the findings in cus to include lichenoid skin lesions. Records show that at least four of 11 cases of cus had skin lesions, whereas all had oral lesions. Stratified epithelium‐specific antinuclear antibodies serve as the key marker of cus. Skin explants grown in the serum of this cus patient bind SES‐ANA in tissue culture. Sections of explants fix complement. Titers of SES‐ANA have been reported to parallel disease activity in one case, but not in the present case. Thus, there appears to be case‐to‐case variation. The treatment of choice for cus is hydroxychloroquine.
TREATMENT OF ACTINIC PRURIGO IN CHIMILA INDIANS
Authors: DURÁN MARIA M. , ORDOÑEZ CLARA P. , PRIETO JUAN C. , BERNAL JAIME
Published: May 2007

Background. Actinic prurigo has a high prevalence in women of child‐bearing age. Its treatment has been, among others, with thalidomide. To avoid the deleterious effects of this drug on the embryo, therapeutic alternatives have been sought. Among these, tetracycline and vitamin E have been investigated as to their influence on the symptoms of actinic prurigo. Both these drugs affect superoxide radicals that are thought to be involved in the pathogenesis of actinic prurigo.

Materials and Methods. Patients (Chimila Indians with a high prevalence of actinic prurigo) received either (a) tetracycline, 500 mg three times daily, for 6 months, or (b) vitamin E, 100 IU daily, for 6 months. The patients were seen once monthly. There were eight patients in each group.

Results. Both drugs used were effective. Pruritus was remarkably improved by either treatment. None of the side effects were severe enough to lead to interruption of treatment, but the observation period posttreatment was relatively short, 4 months for tetracycline and 2 months for vitamin E. The improvement occurred in spite of the continuation of extensive exposure to the sun.

Conclusions. Tetracycline and vitamin E are efficacious in relieving the pruritus of actinic prurigo. Preliminary trials of a combination treatment with these two drugs is a new avenue which has shown in preliminary trials to yield synergistic effects which might allow the dosage of tetracycline to be reduced.
DETECTION OF T LYMPHOCYTES AND T LYMPHOCYTE SUBSETS IN LICHEN PLANUS: IN SITU AND IN PERIPHERAL BLOOD
Authors: AL‐FOUZAN ABDULWAHAB S. , HABIB MOHAMED A. , SALLAM TARIF H. , EL‐SAMAHY MAY H. , ROSTOM AMR I.
Published: May 2007

Background. Abnormal immune mechanisms are thought to be important in the pathogenesis of lichen planus (LP). This is a study to clarify the changes that occur in T lymphocytes and T lymphocyte subsets, both in situ and in peripheral blood.

Methods. A group of 100 patients with LP were included in this study. T lymphocytes and T lymphocyte subsets were detected in lesional skin by immunoperoxidase cell surface staining using monoclonal antibodies. Peripheral T lymphocytes and T lymphocyte subsets were also detected by indirect immunofluorescence using monoclonal antibodies. A group of 10 normal healthy subjects were used as controls.

Results. The study of the lesional T lymphocytes and T lymphocyte subsets demonstrated that helper T cells was the predominant subset in LP lesions in most of the patients. This predominance was evident irrespective of the duration of the disease and was more evident in late than in early lesions. The percentage of both total T lymphocytes and helper T cells in peripheral blood was decreased significantly in patients compared with controls. A significant decrease in helper T cells and the helper/cytotoxic T cell ratio was detected in patients with a longer duration of the disease.

Conclusion. Activation of helper T lymphocytes that were found to be the predominant subsets in LP lesions may be responsible for epidermotropic cellular infiltrates leading to damage and destruction of epidermal cells.
UTILITY OF BONE MARROW AND LIVER BIOPSIES FOR STAGING CUTANEOUS T‐CELL LYMPHOMA
Authors: MARTÍ ROSA M. , ESTRACH TERESA , REVERTER JUAN C. , CAMPO ELÍAS , BRUGUÉS ROSA , BRUGUERA MIGUEL , MASCARÓ JOSÉ M.
Published: May 2007

Background. The wide use of staging procedures, looking for visceral involvement in patients with cutaneous T‐cell lymphoma (CTCL), is controversial, especially in the early stages. In this study, we analyzed the results of bone marrow biopsy and laparoscopy with liver biopsy in a series of 43 patients with CTCL.

Methods. Clinicopathologic stages were established by a modification of the TNM system proposed in 1979. Results of staging procedures were correlated with blood cell counts and laboratory tests. The usefulness of the staging procedures was analyzed particularly in patients without clinical or biologic evidence of extracutaneous disease.

Results. The patient's median age was 66 years; 35 patients were men and eight women. The clinicopathologic stages were as follows: T1: 3 cases; T2: 15; T3: 14; T4: 11; NO: 15; N1: 28; MO: 38; Ml: 5; BO: 37; and B1: 6 cases. Internal lymph node disease, diagnosed by lymphangiography and/or abdominal scanning, was demonstrated in 37% of patients. Bone marrow infiltration was seen in 12% of patients and was the only form of visceral involvement. All liver biopsies were negative. Serum lactate dehydrogenase (LDH) levels were raised in patients with lymph node disease; it was the only laboratory test that correlated with extracutaneous involvement. Staging procedures changed three of the nine patients with a clinical T1‐T2N0M0B0 stage (33%) to a more advanced stage. The abdominal lymph node evaluation allowed a reclassification from NO to N1 in two of nine cases (22%); one of the remaining cases was reclassified from MO to M1 on the basis of bone marrow biopsy results.

Conclusions. Our results indicate that bone marrow biopsy is a useful investigational procedure for determining extracutaneous disease in CTCL. Peritoneoscopy with liver biopsy rarely is informative; however, as our study does not include a very large number of patients, these preliminary conclusions must be confirmed in the future by including more cases.
EXPRESSION OF KERATOHYALIN‐TRICHOHYALIN HYBRID GRANULES IN MOLLUSCUM CONTAGIOSUM
Authors: MANABE MOTOMU , YAGUCHI HITOSHI , BUTT KHALID IQBAL , O'GUIN W. MICHAEL , SUN TUNG‐TIEN , OGAWA HIDEOKI
Published: May 2007

Background. Recently, in the filiform papillae epithelium of mouse dorsal tongue, we showed the presence of hybrid granules in which filaggrin and trichohyalin were both present, but physically segregated. Further, trichohyalin was also detected in scattered granular cells of a number of hyperplastic skin diseases.

Methods. The epidermis infected with molluscum contagiosum virus (MCV) was studied by conventional electron microscopy in conjunction with light and electron‐microscopic immunohistochemistry, using both antifilaggrin and antitrichohyalin antibodies as probes.

Results. We found that the granular cells of MCV‐infected epidermis contained both filaggrin and trichohyalin. Subsequent electron‐microscopic examination showed that the granular cells contained morphologically heterogeneous granules that appeared to be composed of discrete areas of distinct electron densities. Double‐labeling, using antibodies to filaggrin and trichohyalin, clearly indicated that filaggrin and trichohyalin were both present in the hybrid granules and that the electron‐dense regions contained trichohyalin while the more electron‐lucent regions contained filaggrin.

Conclusions. The expression of trichohyalin was a common feature observed in the epidermis from a heterogenous group of hyperplastic conditions, including MCV Infection. This finding has led us to speculate that trichohyalin may be specifically or preferentially involved in interacting with the hyperproliferation‐related keratin pair (K6/K16), whereas the function of filaggrin is more closely linked to the skin‐type keratin pair (K1/K10) that are normal keratins found in the differentiated epidermis.
DOUBLE‐BLIND STUDY OF PREDNICARBATE VERSUS FLUOCORTIN BUTYL ESTER IN ATOPIC DERMATITIS
Authors: ALIAGA ADOLFO , RODRÍGUEZ M. , ARMIJO M. , BRAVO J. , LÓPEZ AVILA A. , MASCARO J.M. , FERRANDO J. , RIO R. DEL , LOZANO R. , BALAGUER A.
Published: May 2007

Patients and Methods

This parallel‐group, double‐blind trial compared the efficacy and tolerability of topical prednicarbate, 0.25% ointment, with that of fluocortin butyl ester, 0.75% ointment.

The trial included 79 outpatients at three participating centers. All patients had a diagnosis of atopic dermatitis on the basis of Hanifin and Rajka's criteria.1 Other inclusion criteria were: age ≥ 18 years and stability or worsening of the condition for at least 1 week in the current episode. Patients were required to have been treatment‐free for minimum periods of: 7 days if previously treated with other topical corticosteroids; 1 month if previously treated with systemic corticosteroids; 3 days if previously treated with shortacting antihistamines; 2 months if previously treated with astemizole.

Exclusion criteria were: severe incapacitating dermatitis; infectious processes or association with other skin changes; need for the concomitant administration of antihistamines or antimicrobials; serious concurrent illness. Women not using adequate contraception were also excluded.

A thin layer of topical prednicarbate (N = 42) or fluocortin butyl ester (N = 37) was applied to the affected area of skin twice daily, without occlusion. The duration of treatment was set at 21 days, but it could be interrupted earlier, at the discretion of the investigator, on the grounds of total disappearance of the condition, inefficacy, or the appearance of any adverse reaction. A daily application of an emollient oil and/or a cleaning or emollient aqueous cream could be used at the investigator's discretion.

At the start of treatment and at 4, 7, 14, and 21 days, each of the following features was rated on a scale of 0 to 3 (0; absent, 1: mild, 2: moderate, 3: severe): pruritus; excoriations; erythema; scaling; lichenification; vesiculation; hyper‐keratosis. On the basis of these scores, the overall efficacy of treatment was rated as: improvement > improvement of > 50 to 75%; improvement of > 25 to 50%; improvement < 25%; no improvement; worsening.

If the treatment ended before 21 days, owing to either cure or inefficacy, the score for the last evaluation was used for all subsequent followup points. At the end of treatment the investigator and the patient rated treatment as excellent, good, fair, or poor. Cosmetic acceptance by the patient was evaluated in the same terms.
LINEAR SCLERODERMA IN CHILDREN
Authors: EUBANKS LEIGH ELLEN , McBURNEY ELIZABETH I. , GALEN WESLEY , REED RICHARD
Published: May 2007

Background. Linear scleroderma is a cutaneous disease of unknown etiology. It most often affects children, who develop band‐like lesions in an asymmetric distribution. The literature is reviewed as to the diagnosis, pathogenesis, and treatment of linear scleroderma.

Case Report. Six new cases of linear scleroderma in children are reported. Their ages ranged from 6 to 17 years, and five were girls. A 17–year‐old girl had en coup de sabre. Multiple treatment modalities were used. All laboratory testing was negative.

Conclusions. Linear scleroderma is a clinical diagnosis. The pathogenesis remains unknown. A consistently effective therapy has not been found, although diphenylhydantoin and ticlopidine hydrochloride should be evaluated in clinical trials.
ACCESSORY MAMMARY TISSUE ASSOCIATED WITH CONGENITAL AND HEREDITARY NEPHROURINARY MALFORMATIONS
Authors: URBANI CARLO ENRICO , BETTI ROBERTO
Published: May 2007

Background and Objectives. The association between polythelia (supernumerary nipple) and kidney and urinary tract malformations (KUTM) is controversial. Some authors reported this association in newborns and infants. Case‐control studies dealing with adult subjects are not found in the literature. The purpose of this study is to determine the frequency of the association between accessory mammary tissue (AMT) and congenital and hereditary nephrourinary defects in an adult population compared to a control group.

Methods. The study was performed in 146 white patients (123 men, 23 women) with AMT out of 2645 subjects consecutively referred to us for physical examination. The following investigations were undertaken: ultrasonographic examination of the abdomen and the kidneys, ECG, echocardiogram, roentgenogram of the vertebral column, urinalysis, and other laboratory tests. A sex‐ and age‐matched control group without any evidence of AMT or lateral displacement of the nipples underwent the same examinations.

Results. Kidney and urinary tract malformations were detected in 11 patients with AMT (nine men, two women) and in one control. These data indicate a significantly higher frequency of KUTM in the AMT‐affected patients compared to controls (7.53% vs. 0.68%, P < 0.001). A broad spectrum of KUTM was discovered in association with AMT: adult dominant polycystic kidney disease, unilateral renal agenesis, cystic renal dysplasia, familial renal cysts, and congenital stenosis of the pyeloureteral joint.

Conclusion. Accessory mammary tissue offers an important clue for congenital and hereditary anomalies of the kidneys and urinary collecting systems. Patients with AMT should, therefore, be extensively examined for the presence of occult nephrouropathies.
ETIOLOGIES OF THE SICCA SYNDROME: PRIMARY SYSTEMIC AMLOIDOSIS AND OTHERS
Authors: RICHEY TROY K. , BENNION SCOTT D.
Published: May 2007

Background. The sicca syndrome has been defined as the occurrence of xerostomia and xerophthalmia. Sjögren's syndrome is the most common cause of the sicca syndrome; however, these two syndromes are not synonymous and there are many potential etiologies of the sicca syndrome. A less known cause of sicca syndrome is amyloidosis that to date has only been reported in the nondermatology literature.

Observations. A 79‐year‐old man with known amyloidosis presented with persistent xerostomia. He had the classic cutaneous findings of periorbital and “pinch” purpura. A labial biopsy showed diffuse deposition of amorphous eosinophilic material surrounding salivary acini. Apple‐green birefringence was noted with Congo red staining and the diagnosis was made of amyloidosis in the minor salivary glands causing xerostomia.

Conclusions. The sicca syndrome can be caused by systemic amyloidosis. Because this fact is not in the dermatologic literature, many dermatologists are not aware of this uncommon presentation. The knowledge of the many causes of the sicca syndrome and an understanding of the differences between this and Sjögren's syndromes are important for any dermatologist.
Febrile Ulceronecrotic Mucha‐Habermann's Disease
Authors: Güngör Emel , Alii Nuran , Artuz Ferda , Lenk Nurdan
Published: May 2007

The Correspondence Section serves as a forum for opinion exchange about subjects of general interest such as dermatologic training, relations between dermatologists and pharmaceutical houses, governmental control of dermatology and medical practice in general, peculiarities of dermatology related to geographic, climatic, or racial factors, the flow of information and publications, as well as other concerns the readershi p might have. Originality is highly desirable and repetitious contributions or minutiae are discouraged. We wish also to foster submission of hypotheses marked accordingly. These should be based on reality and should stimulate thought. Contributions should conform to the format for correspondence as outlined in, “Notice to Contributors.” Manuscripts will undergo standard editorial procedures. Submit all correspondence to Mauricio Goihman‐Yahr, M.D., Ph.D., Section Editor, Jet International M‐154, P.O. Box 020010, Miami, FL 33102.
The impact of an alien plant on a native plant–pollinator network: an experimental approach
Authors: Lopezaraiza–Mikel Martha E. , Hayes Richard B. , Whalley Martin R. , Memmott Jane
Published: May 2007

Studies of pairwise interactions have shown that an alien plant can affect the pollination of a native plant, this effect being mediated by shared pollinators. Here we use a manipulative field experiment, to investigate the impact of the alien plant Impatiens glandulifera on an entire community of coflowering native plants. Visitation and pollen transport networks were constructed to compare replicated I. glandulifera invaded and I. glandulifera removal plots. Invaded plots had significantly higher visitor species richness, visitor abundance and flower visitation. However, the pollen transport networks were dominated by alien pollen grains in the invaded plots and consequently higher visitation may not translate in facilitation for pollination. The more generalized insects were more likely to visit the alien plant, and Hymenoptera and Hemiptera were more likely to visit the alien than Coleoptera. Our data indicate that generalized native pollinators can provide a pathway of integration for alien plants into native visitation systems.
Commodity Prices and Unit Root Tests
Authors: Wang Dabin , Tomek William G.
Published: May 2007

Price theory suggests that commodity prices should be stationary series. Yet, tests for unit roots rather frequently imply that these prices are not stationary. This seeming inconsistency is investigated by applying alternative specifications of unit root tests to prices of corn, soybeans, barrows and gilts, and milk. The preponderance of evidence suggests that nominal prices do not have unit roots, but the results are sensitive to the specification of the test equation. Accounting for a structural change that shifts the mean appears to be an important issue in unit root tests.
American notebook
Authors: MARTIN JEAN
Published: May 2007

This is the first of a series which will deal with some of the odds and ends of the American art scene not usually picked up in the international art journals and which The Art Book hopes will be of special interest to British readers.
Vocationalism Must Come First
Authors: Galletley Ian
Published: May 2007

Is the kind of curriculum which Alan Dyson advocates, with its emphasis on the Educated Man, likely to meet the needs of today's leavers who have special educational needs? Ian Galletley, senior adviser for special educational needs, Newcastle upon Tyne LEA, goes for the vocational approach.
Could Schools Do More for Leavers?
Authors: Hirst Michael
Published: May 2007

How do young people with disabilities view the preparation for adult life that they receive at school? Michael Hirst, Social Policy Research Unit, University of York, discovered that most of the young people he surveyed were dissatisfied.
Training with a School Focus
Authors: Norwich Brahm , Cowne Elizabeth
Published: May 2007

A new one‐term course which has its focus on the school, local education authorities and practical projects chosen by course members is described by Dr Brahm Norwich, lecturer in special needs, London University Institute of Education, and Elizabeth Cowne, tutor to the course for teachers of children with special educational needs in the ordinary school.
How Should We Respond to Change?
Authors: Widlake Paul
Published: May 2007

In the following two articles Paul Widlake and Carole Edwards argue that the most effective method of reaching these pupils (in terms both of educational ideals and cost!) is through a support system delivered by the direct involvement of special needs teachers in mainstream classrooms. First, Paul Widlake, honorary lecturer, Manchester University, makes a case for change in the organisation and curriculum of secondary schools.
On Launching a Support Service
Authors: Edwards Carole
Published: May 2007

Carole Edwards, until recently coordinator for special needs in a comprehensive school in an outer London borough, describes the school's experience in establishing a support service and draws out the practical implications for others who might wish to follow suit.
Towards Independence in Spelling
Authors: Comber Barbara
Published: May 2007

Barbara Comber, who is a senior area advisory teacher for special educational needs in Staffordshire, suggests ways of helping children to become independent learners of spelling so that, for pupils with special educational needs, spelling becomes a tool for writing rather than an obstacle.
Programs to Encourage Learning
Authors: Richards Colin
Published: May 2007

Colin Richards, manager of the Northern Special Education Microelectronics Resource Centre (SEMERC) based at Newcastle upon Tyne Polytechnic, writes about some of the issues in choosing software for children with mild learning difficulties.
Biology at Lord Mayor Treloar College
Authors: Lones Jane
Published: May 2007

Biology should be part of the curriculum for all pupils who are physically handicapped, writes Dr Jane Lones, senior mistress, Lord Mayor Treloar College, Alton, Hampshire, formerly head of science at the school.
The Whole‐School Approach to Integration
Authors: Thomas Gary , Jackson Barry
Published: May 2007

Gary Thomas, senior lecturer, Oxford Polytechnic, and Barry Jackson, head of Educational Resource and Support Department, Bicester School, discuss some of the problems of introducing and carrying out a whole‐school approach to integration, and the advantages it can bring for pupils with special educational needs.
Special Needs and FE in Wales
Authors: Bramley Kim , Harris John
Published: May 2007

Further education helps young people to prepare for adult life and according to Newell (1982) local authorities have a ‘clear and absolute duty’ to provide full time education up to the age of 19 for all young people with special needs who want it. However, this study of further education provision in Wales carried out by Kim Bramley and Dr. John Harris, Department of Education, University College, Cardiff, found that not all further education colleges accept handicapped students. Among those that do there is considerable variation in the provision of special facilities and only six colleges run special courses for handicapped students.
Games for Learning to Count
Authors: McConkey Roy , McEvoy John
Published: May 2007

Children with severe learning difficulties do not find it easy to learn to count. Table top games with special dice can help to improve their basic number skills, report Dr Roy McConkey, senior research officer, and John McEvoy, former senior research officer, St Michael's House, Dublin, now senior psychologist, Cheeverstown House, Dublin.
Research Supplement: Written Syntax in Deaf Children and the Paget Gorman Sign System
Authors: Brooke M.V.
Published: May 2007

The ability to handle English syntax in written output by hearing impaired children is examined by Michael Brooke, now special education advisory teacher for the London borough of Richmond‐upon‐Thames.
Language through Reading
Authors: Gillies Muriel
Published: May 2007

Reading materials developed for five to nine year old children with severe specific speech and language disorders at John Horniman School, Worthing, Sussex are described by Muriel Gillies, headteacher. The materials are being used in some ordinary as well as in special schools, and for children with a wider range of learning difficulties than those at the Worthing school, which is run by the Invalid Children's Aid Association.
Helping the Deaf‐Blind Child in Class
Authors: Murdoch Heather
Published: May 2007

Heather Murdoch, who teaches deaf‐blind children at the Royal School for the Deaf, Margate, offers advice to other teachers who may have a child with these difficulties in their class.