bluuebunny/crossref_metadata_2025 huggingface dataset:
Contact dermatitis to Asparagus officinalis
Authors: Rademaker Marius , Yung Anthony
Published: March 2003

A 53‐year‐old farm worker presented with a 3‐year history of an occupational allergic contact dermatitis to asparagus. The dermatitis cleared quickly with courses of systemic corticosteroids but relapsed within days of further exposure to asparagus. The genera Asparagus is made up of some 300 species. It belongs to the family Liliaceae which includes tulips, onions and garlic. Asparagus contains asparagin, coniferin and the glucoside vanillin. The allergen may be a plant growth inhibitor, 1,2,3‐Trithiane‐5‐carboxylic acid, which is present in young shoots.
Treatment of warts at the turn of the millennium
Authors: Dyall‐Smith Delwyn J
Published: March 2003

Gunpowder may no longer be a recommended treatment for warts, but most of the therapies used in 1950 are still used to some extent now. The problems, now as then, are the multiplicity of treatment options and the lack of a cure. Several treatments popular in the past decade are discussed.
Acne vulgaris: Yesterday, today and tomorrow
Authors: Chan Jonathan J , Rohr James B
Published: March 2003

Acne vulgaris is one of the commonest diseases known to humanity, affecting up to 98% of all adolescents. This review examines important aspects of its epidemiology, aetiology and management in Australia in the year 2000, in comparison with a symposium in the inaugural volume of the Australian Journal of Dermatology in 1951.
Presentation of cutaneous mastocytosis in 173 children
Authors: Hannaford Rodney , Rogers Maureen
Published: March 2003

This is a retrospective review of the case files and clinical photographs of 173 children diagnosed with cutaneous mastocytosis by a dermatologist in an exclusively paediatric practice. Of the 98 males and 75 females, 51% had mastocytomas, 47% had urticaria pigmentosa and three patients had diffuse cutaneous mastocytosis. Of these cases, 87% first appeared prior to or at 6 months of age. Flushing occurred in 26% of urticaria pigmentosa cases, 29% of mastocytomas and 100% of diffuse cutaneous mastocytosis. Blistering was noted in 23% of urticaria pigmentosa, 31% of mastocytomas and 100% of diffuse cases. Neither symptom was noted in 59% of urticaria pigmentosa and 49% of mastocytomas. There were three cases with a positive family history. The finding of a palmar mastocytoma has only once been previously reported. Illustrated descriptions of our cases are provided.
Cheilitis caused by contact urticaria to mint flavoured toothpaste
Authors: Holmes Gary , Freeman Susanne
Published: March 2003

A 26‐year‐old woman presented with a 12‐month history of persistent dermatitis of the lips. She had failed to respond to cosmetic avoidance and therapeutic measures. Patch testing was negative, including her toothpaste and toothpaste flavours. She defied diagnosis until an acute flare followed immediately after dental treatment with a mint flavoured tooth cleaning powder. This led us to prick test her to mint leaves and this was positive. Her cheilitis settled after changing from her mint‐flavoured toothpaste. A diagnosis of contact urticaria should be considered in cases of cheilitis of unknown cause.
Cutaneous alternariosis in a cardiac transplant recipient
Authors: Gilmour Tanya K , Rytina Ed , O’Connell P Brian , Sterling Jane C.
Published: March 2003

A 55‐year‐old male cardiac transplant recipient presented with cutaneous nodules on the limbs caused by Alternaria alternata. Oral fluconazole 200 mg daily for 3 weeks was ineffective. Itraconazole 100 mg oral daily was ceased when hyperglycaemia developed. Individual lesions were successfully treated with either curettage and cautery or double freeze‐thaw cryotherapy. Alternaria spp. are ubiquitous fungal saprophytes which may cause cutaneous infections particularly in immunocompromised patients.
Multiple corticosteroid allergies
Authors: Chow Elizabeth Ty
Published: March 2003

A case of vulval dermatitis and perioral dermatitis due to contact allergy to multiple class D corticosteroids, mometasone furoate and methylprednisolone aceponate is presented. Patch testing with commercially available corticosteroid creams is a simple and useful diagnostic test. Beware of delayed positive reaction, seen on day 8 of the repeat open application test on this patient.
RESEARCH REPORT Bexarotene capsules and gel for previously treated patients with cutaneous T‐cell lymphoma: Results of the Australian patients treated on phase II trials
Authors: Prince H Miles , McCormack Christopher , Ryan Gail , Baker Christopher , Rotstein Harvey , Davison Jill , Yocum Richard
Published: March 2003

Bexarotene (Targretin®, LGD1069) is a novel synthetic retinoid analogue that binds selectively to retinoid X receptors. We describe eight previously treated patients who entered phase II international multicentre studies examining the role of bexarotene in cutaneous T‐cell lymphoma. Patients received either the oral formulation (n = 7) or the topical gel (n = 1). Of the seven patients who received 300 mg/m2per day capsules, five (71%) achieved a partial response, with mean time to onset of response of 27 days (range, 20–29) with responses persisting for a mean of 92 days (range, 57–115). The single patient receiving the topical preparation (stage IB) remains in partial response at 31 months. The major toxicity with oral administration was hypertriglyceridaemia requiring therapy. Bexarotene capsules and gel are active and generally well‐tolerated agents in patients with cutaneous T‐cell lymphoma and studies examining its role in previously untreated patients or as part of combination therapy are warranted.
CASE REPORT Treatment of refractory hand warts by isolated limb infusion with melphalan and actinomycin D
Authors: Damian Diona L , Barnetson Ross St C , Rose Barbara R , Bonenkamp Johannes J , Thompson John F
Published: March 2003

We present an immunocompetent man with extensive warts on the hands, refractory to a number of conventional treatment modalities and causing substantial morbidity and impairment of normal function. Isolated limb infusion (regional intra‐arterial chemotherapy) with melphalan and actinomycin D was performed, with substantial clearing of the warts within 2 months. Treatment‐induced morbidity was limited to mild local erythema and oedema which resolved within 3 weeks. After 9 months’ follow up, the patient had only a few residual warts and was able to resume normal activities.
CASE REPORT Therapeutic undermining of scars (Subcision®)
Authors: Goodman Greg J
Published: March 2003

Two patients are described with depressed atrophic scars. The first patient had undergone skeletal traction around the knee and the second patient developed an apparent anetoderma of the left side of the nose. Dermal undermining was performed as the only treatment with successful resolution of their contour abnormalities. Only a single treatment session was required in each case. A brief review of this technique is presented.
CASE REPORT Bullous pemphigoid induced by cephalexin
Authors: Czechowicz Romuald T , Reid Catherine M , Warren Lachlan J , Weightman Warren , Whitehead Fergus J
Published: March 2003

Two young men developed severe bullous eruptions with a distinctive clinical picture of severe flexural involvement and extensive mucosal ulceration. Biopsies showed subepidermal bullae and associated inflammation consisted of predominantly neutrophils. Both had IgG and C3 staining of the dermal‐epidermal junction on direct immunofluorescence. Bullous pemphigoid was diagnosed on the basis of clinical, histopathological and immunofluorescence findings. Both cases occurred after recent ingestion of cephalexin. We believe they represent the first reported cases of bullous pemphigoid induced by cephalexin.
SIGNS, SYNDROMES AND DIAGNOSES Cutaneous spectrum of coeliac disease
Authors: Poon E , Nixon R
Published: March 2003

Coeliac disease is characterized by gluten intolerance and immunologically mediated damage to small intestinal mucosa. Patients classically present with gastrointestinal symptoms including chronic diarrhoea, steatorrhoea, weight loss, anorexia and abdominal distension. In a substantial proportion of cases however, gastrointestinal symptoms are minor or absent, and cutaneous manifestations may provide an early clue to diagnosis. Early recognition of coeliac disease, with appropriate implementation of a gluten‐free diet, may reduce the incidence of benign and malignant complications associated with this condition.
DERMATOPATHOLOGY PRESENTATION Spindle cell variant of epithelioid sarcoma: An easily misdiagnosed tumour
Authors: Tan Suat Hoon , Ong Beng Hock
Published: March 2003

Epithelioid sarcoma is a histologically distinct soft tissue sarcoma of high grade malignancy. We report a case of epithelioid sarcoma in a young man who presented with multiple nodules over the left forearm, with bony invasion and pulmonary metastases. The histological features of the dermal tumour were those of a malignant spindle cell tumour with positive cytokeratin and vimentin staining and differed from the classical epithelioid sarcoma in its absence of typical necrobiotic nodular epithelioid pattern. It was the clinical presentation and the histology of the subcutaneous nodules that led to the final diagnosis of epithelioid sarcoma. This case illustrates a predominance of spindle cell pattern in the dermal tumour of epithelioid sarcoma, which has previously been reported as fibroma‐like variant of epithelioid sarcoma.
SURGERY CORNER Lateral longitudinal nail biopsy
Authors: De Berker David Ar
Published: March 2003

Lateral longitudinal nail biopsy is the gold standard of incisional nail biopsies. It can be obtained under local anaesthetic and requires normal biopsy instruments. Preoperative planning with the patient is important in order that they have realistic expectations of the therapeutic outcome and understand how to care for the wound in the postoperative period.
RESEARCH REPORT Long‐term patient satisfaction with cosmetic outcome of minor cutaneous surgery
Authors: Kearney Christopher R , Holme S Alexander , Burden A David , McHenry Pamela
Published: March 2003

We evaluated our patients’ own assessment of the cosmetic outcome of minor dermatological surgery procedures. A postal questionnaire was sent to patients who had undergone surgery between 12 and 18 months previously. Patient satisfaction was correlated with variables, including age, sex, lesion size and site, indication for excision, histological diagnosis and operator. Two hundred and seven excisional procedures were identified in 193 patients. Seventy‐nine per cent of the questionnaires (163/207) were returned. Seventy per cent of patients reported that the scar was invisible or better than expected and 9% rated it to be worse than expected. Ninety per cent of patients said they would undergo the procedure again. Patient dissatisfaction was associated significantly and independently with excisions from the back, younger age and benign histology.
Subcutaneous panniculitic T‐cell lymphoma and cytophagic histiocytic panniculitis
Authors: Yung Anthony , Snow John , Jarrett Paul
Published: March 2003

A 43‐year‐old Maori man presented with a 1 month history of malaise, weight loss, anorexia, arthralgia, recurrent fever and tender erythematous subcutaneous skin lesions. Histological examination of an incisional biopsy of a lesion revealed a lobular panniculitis with an inflammatory infiltrate of atypical lymphocytes and evidence of cytophagocytosis consistent with a diagnosis of subcutaneous T‐cell lymphoma. The systemic symptoms and skin lesions resolved spontaneously within 3 weeks, only to recur 2 months later, requiring treatment with oral prednisolone. T‐cell gene rearrangement studies demonstrated a monoclonal T‐cell receptor (γ‐chain) gene rearrangement, further supporting the diagnosis of subcutaneous panniculitic T‐cell lymphoma. Treatment with chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone) led to remission of symptoms. Four months after completing chemotherapy, the patient remained asymptomatic with a few indurated subcutaneous plaques on the chest. Biopsy of these areas revealed lobular panniculitis, lymphocytic infiltrate without cytological atypia, abundant lipophages and fibrosis and sclerosis consistent with a healing response. He remains well 24 months following chemotherapy.
A case of severe actinic prurigo successfully treated with thalidomide
Authors: Ng Jonathan CH , Foley Peter A , Crouch Rohan B , Baker Christopher S
Published: March 2003

Actinic prurigo is an uncommon and usually persistent idiopathic photodermatosis with typical human leukocyte antigen (HLA) associations (HLA‐DR4, particularly subtypes DRB1*0407 and DRB1*0401). Although its mechanism of action is not clearly understood, thalidomide has been shown to be particularly efficacious in treating actinic prurigo, among other conditions. A 31‐year‐old Australian woman who had suffered actinic prurigo for most of her life was treated with two courses of thalidomide (50–100 mg nocte) over consecutive summers. Remission was observed after cessation of the second course of thalidomide and had continued 4 years later. Abnormalities in the cutaneous response to ultraviolet radiation at the time of diagnosis, detected by monochromator phototesting, reverted to normal following treatment.
Objective assessment of port‐wine stains following treatment with the 585 nm pulsed dye laser
Authors: Yong‐Gee Simon A , Kurwa Habib A , Barlow Richard J
Published: March 2003

Previous studies assessing the treatment of port‐wine stains (PWS) with the 585 nm pulsed dye laser have relied on either subjective clinical assessment or in vivo measurement of skin colour alone. The aim of the present retrospective study was to develop an objective method of assessing available pre‐ and post‐treatment photograph pairs. Port‐wine stains depicted in photographs of 23 patients following six or more treatment sessions were assessed for changes in colour (ΔH*) and PWS size by computer image analysis and were compared with a subjective assessment of PWS reduction by a ‘blinded’ physician examining the same images. The post‐treatment mean reduction in the PWS assessed by the physician was 39.7%. A global assessment score incorporating values of ΔH* and PWS size by computer analysis showed a mean reduction of 12%, with a more significant correlation with the physician assessment (Spearman’s rank correlation coefficient 0.627; P = 0.001) than changes in size or colour alone.
Tinea due to Trichophyton violaceum and Trichophyton soudanense in Hamilton, New Zealand
Authors: Lamb Steven R , Rademaker Marius
Published: March 2003

Between 1994 and 2000, 63 isolates of Trichophyton violaceum and five isolates of Trichophyton soudanense were recorded in both private and public laboratories in Hamilton, New Zealand. A retrospective analysis of medical records of these patients was performed. From these 68 isolates, 58 were recovered from scalp specimens and 10 were recovered from other body sites. There were 51 patients with tinea capitis and nine patients in the tinea corporis group. Six patients had more than one isolate reported at different laboratories. As expected, the vast majority of scalp infections (46/51 patients) were children, with an overall median age of 6 years (range 8 months to 66 years). All patients in the tinea capitis group, except one, were refugee immigrants from East Africa. Of nine patients in the tinea corporis group, six were refugees from the same area. For tinea capitis, 31 patients received systemic antifungal therapy for at least 4 weeks, with either terbinafine (21 patients), griseofulvin (four patients) or itraconazole (six patients). Five patients received topical antifungal creams or shampoo as monotherapy only. The remainder (15 patients) received either no therapy or no record was available. The emergence of these two pathogens as causes of tinea capitis in Hamilton closely correlates with the increasing number of refugees from endemic areas. There is a high rate of person‐to‐person transmission with these anthropophilic organisms in children as well as adults in the family. Transmission of infection to the local population has been observed, but there is no evidence to date to suggest that these organisms have become endemic in the local population.
Lupus vulgaris in a child following BCG immunization
Authors: Kokcam Ibrahim , Kose Ahmet , Yekeler Hayrettin , Doymaz M Ziya
Published: March 2003

A three year old girl presented with lupus vulgaris of the upper arm, which appeared 1 month after BCG immunization. The diagnosis was confirmed by polymerase chain reaction after histology and culture were negative for mycobacteria. Complete healing followed 6 months of oral isoniazid.
Long‐term thalidomide for actinic prurigo
Authors: Yong‐Gee Simon A , Muir James B
Published: March 2003

A 35‐year‐old man presented at the age of 8 years with recurrent pruritic papulovesicular lesions on his face and body appearing within minutes of light exposure. A recent positive finding of human leukocyte antigen (HLA) DR4 with the rare DRB1*0407 subtype confirmed a diagnosis of actinic prurigo. Thalidomide (100 mg/day) was commenced at the age of 11 years after an unsuccessful trial of other treatments and his lesions resolved within 2 months. Attempts to withdraw thalidomide have resulted in recurrence of photosensitivity and the patient has remained on a virtually continuous maintenance dose of thalidomide (50 mg/ day) for 23 years. His cumulative dose is estimated to be over 400 g. To date, he has not experienced any adverse effects and investigations have shown no evidence of neuropathy. This case illustrates the safe long‐term use of thalidomide.
Sarcoidosis with prominent giant cells
Authors: Drummond Catherine , Savdie Elliott , Kossard Steven
Published: March 2003

A 31‐year‐old man presented with a widespread papular eruption and systemic symptoms including renal colic and decreased exercise tolerance. The combination of clinical features and laboratory investigations that revealed an elevated angiotensin converting enzyme level and hypercalcaemia enabled a diagnosis of sarcoidosis to be made. Multiple skin biopsies showed prominent Touton‐like giant cells which delayed the diagnosis. Giant cells are frequently seen in sarcoidal granulomas but in some cases their prominence and Touton‐like appearance may suggest alternative diagnoses such as xanthogranulomas.
CONTINUING MEDICAL EDUCATION REVIEW Occupational skin disease in hairdressers
Authors: Lee Adriene , Nixon Rosemary
Published: March 2003

Hairdressers belong to an occupational group that is commonly affected by occupational skin disease, specifically contact dermatitis, which may be allergic or irritant and, less commonly, contact urticaria. Occupational contact dermatitis predominantly affects apprentices, and atopy is a recognized risk factor associated with a poor prognosis. Repetitive wet work leading to irritant contact dermatitis, followed by exposure to allergens and the development of allergic contact dermatitis, are the main factors contributing to occupational contact dermatitis. Once developed, it is often difficult to manage and is a cause of significant morbidity. Early education, training and prevention is the best approach to the management of this disorder that is endemic among hairdressers.
Necrobiotic xanthogranuloma occurring within linear morphoea
Authors: Chandra Suresh , Finklestein Eve , Gill David
Published: March 2003

A 32‐year‐old woman with linear morphoea of her left arm was noted to have a yellowish atrophic plaque within the linear morphoea. Review of photographs taken on her first visit 3 years previously revealed that the lesion had been present and had increased in size over the 3 years. Necrobiotic xanthogranuloma (NXG) was diagnosed on biopsy. Paraproteinaemia was not detected. The NXG was surgically excised and it has not recurred in 12 months of follow up.
Venison contact dermatitis
Authors: Reiche Louise
Published: March 2003

A 37‐year‐old meat inspector presented with a 5‐month history of forearm eczema. His symptoms improved at weekends and over holidays but flared within a day of work. Scratch patch tests were strongly positive to fresh venison diaphragm and venison liver and weakly positive to venison hide and blood, and lamb blood. They were negative to other venison and lamb components. Type IV allergy tests with Standard European and fragrance batteries were negative. The eczema cleared with a change in work role, clobetasol‐17‐propionate cream, flucloxacillin and aqueous cream. He was then able to return to meat inspecting. Provided he was diligent about applying ‘Dermashield’ barrier foam and minimizing contact with irritants, his eczema has remained well controlled over the last 4 years. Attention to irritant contact dermatitis is important in the management of protein contact urticaria.
Diseases of the generative nail apparatus. Part I: Nail matrix
Authors: Nicolopoulos Jenny , Goodman Greg J , Howard Anne
Published: March 2003

Disorders of the generative structures of the nail produce a characteristic set of outcomes. The matrix is the seat of nail development and diseases or insults of this germinative epithelium will tell a story in the signs that unfold in the ensuing nail growth. This story will be influenced by the intensity, duration and extent of this pathology.

A method of categorizing changes associated with the generative matrix of the nail will be presented.
Ultrastructural immunocytochemistry of autoimmune bullous diseases
Authors: Karpouzis Anthony , Vamvassakis Emmanuel , Stavrianeas Nicholas , Koumantaki‐Mathioudaki Elma , Karpouzi Myrsini , Vareltzides Anthony
Published: March 2003

Advanced immunopathological assays have been developed to elucidate the pathophysiology and provide more precise nosological definitions of the immunobullous diseases. Forty‐seven patients suffering from autoimmune bullous diseases (intra‐ or subepidermal) were studied by immunoelectron microscopy (direct and indirect). Peroxidase staining was revealed by diaminobenzidine (determination of immune deposit location) in the majority of the cases of subepidermal bullous diseases, but in less than half of the cases of intraepidermal bullous diseases. Immunoelectron microscopy features contributed in verifying the diagnosis of rare entities such as cicatricial pemphigoid, paraneoplastic autoimmune bullous disease, linear IgA disease and epidermolysis bullosa acquisita.
Loose anagen syndrome: A prospective study of three families
Authors: Chong Alvin H , Sinclair Rodney
Published: March 2003

Loose anagen syndrome (LAS) is an autosomal dominant, age‐related disorder characterized by the ability to easily and painlessly extract unsheathed anagen hairs from the scalp with a gentle hair pull. The phenotype is heterogeneous with three distinct clinical presentations. To further characterize the phenotype of loose anagen syndrome and its fluctuations over time, a prospective study of eight cases from three families was conducted over a period of 18 months. Patients were examined using standardized hair‐pull and hair‐pluck protocols.

Each of the three different phenotypes of LAS were found to be present in one family. This implies that these phenotypes are variants of a single genotype, modified by environmental or age‐related factors.

The hair‐pluck trichogram from LAS cases consistently showed a high proportion of loose anagen (LA) hairs. In contrast the hair‐pull test was found to vary over time with regards to the number of LA hairs that could be extracted. Periods where no hairs could be obtained on hair pull were found. These findings have important implications in the diagnosis of LAS. A single negative hair‐pull test does not exclude the diagnosis. If LAS is suspected on clinical grounds, then either a hair‐pluck trichogram or serial re‐examination by hair pull would be required to exclude the diagnosis.
Clinical improvement and significant reduction of total serum IgE in patients suffering from severe atopic dermatitis treated with oral azathioprine
Authors: Kuanprasert Natita , Herbert Oliver , Barnetson Ross StC
Published: March 2003

Atopic dermatitis (AD) is a common inflammatory skin disease: the incidence is increasing in many countries and treatment can be difficult. The aim of this retrospective case series was to examine the effect of oral azathioprine on the clinical severity and serum IgE levels in 38 patients with severe atopic dermatitis. The AD was well‐controlled in nearly 80% (30/38). The maintenance dose required was in the range 25–200 mg per day. Four patients withdrew because of adverse affects, including one case of pancytopenia and a further four ceased azathioprine after 4 months because of a lack of clinical improvement. Total serum IgE levels were measured before commencing azathioprine and after two years of treatment in 26 patients. IgE levels decreased in almost all patients and this was statistically significant (P = 0.012).
Photosensitive dermatitis due to sunscreen allergy in a child
Authors: Cook Natasha , Freeman Susanne
Published: March 2003

We report a case of photoallergic contact dermatitis to two sunscreen agents, methoxycinnamate and oxybenzone, occurring in a 6‐year‐old Asian boy.
Allopurinol‐induced pustular eruption: An unusually mild case
Authors: Lun Karyn , Harley Wendy
Published: March 2003

Pustular drug eruptions are uncommon and usually present with an acute illness. A 75‐year‐old‐woman presented with a widespread pruritic pustular erythematous skin rash. She was otherwise well and had been commenced on allopurinol for gout 3 weeks before developing the rash. A skin biopsy was consistent with a pustular drug eruption, with features of acute generalized exanthematous pustulosis (AGEP). Allopurinol was the probable causative agent and withdrawal resulted in resolution of her eruption within 6 weeks. A diagnosis of AGEP was considered, however, this patient did not fulfil the diagnostic criteria.
Teledermatology: Influence of zoning and education on a clinician's ability to observe peripheral lesions
Authors: Chen Keng , Lim Adrian , Shumack Stephen
Published: March 2003

Teledermatology can benefit rural and remote communities, where specialist dermatological services may not be readily available. Regarding store‐and‐ forward teledermatology, we hypothesized that the site of a lesion in an image (zoning) may influence a clinician's ability to observe target lesions, and that education on image viewing may improve use of this technology. We examined this by conducting both pre‐ and post‐education studies. The education on image viewing consisted of a presentation on the outcome of the first study‐survey on image viewing. The first study demonstrated that zoning influences a clinician's visual attention and that significant, concurrent lesions in the periphery may be missed. The second study demonstrated that brief education could produce a measurable change in observing peripheral lesions. These findings have medico‐legal implications and suggest that further education in the use of such technology is necessary in order to optimize patient care and prevent potential errors.
Thalidomide experience of a major Australian teaching hospital
Authors: Crouch Rohan B , Foley Peter A , Ng Jonathan CH , Baker Christopher S
Published: March 2003

St Vincent's Hospital Melbourne cautiously prescribes thalidomide as a treatment for recalcitrant dermatoses. The guidelines used for prescribing and monitoring thalidomide for dermatological conditions at this institution are presented. Fourteen patients were treated with thalidomide (11 women, three men) over a 5‐year period. The diagnoses of patients treated were actinic prurigo, prurigo nodularis, lupus erythematosus and Behçet's syndrome. A clinical improvement was noted in 10 patients (71.4%) prescribed thalidomide. Cessation of thalidomide treatment occurred in seven patients (50%) because of adverse effects. Of the patients with adverse effects, four developed abnormal nerve conduction studies and three developed intolerable adverse events (such as dizziness and vomiting). Adverse effects from thalidomide treatment are common but, through vigilant treatment planning, patient education and regular monitoring, the risk of permanent peripheral neuropathy and teratogenicity from thalidomide toxicity can be minimized.
Contact dermatitis to phenol‐formaldehyde resin in two plywood factory workers
Authors: Rademaker Marius
Published: March 2003

Two cases of occupational allergic contact dermatitis in plywood mill workers are presented. Although both patients thought they were allergic to sawdust, they were in fact allergic to a phenol‐formaldehyde resin used to bond the plywood sheets together. Both patients only developed their dermatitis when they came into contact with uncured glue.
Molecular and cellular biology of basal cell carcinoma
Authors: Dicker Tony , Siller Gregory , Saunders Nicholas
Published: March 2003

The finding of mutations in the PTCH gene in both Gorlin's syndrome and sporadic basal cell carcinomas has significantly advanced our understanding of the molecular defects that lead to the formation of these tumours. Knowledge of the specific molecular and functional changes that have taken place in these tumours will help us devise more defined therapies, as well as give us a better understanding of normal molecular pathways involved in skin development and function. The following is a summary of our current understanding of the molecular and cellular biology of basal cell carcinoma.
Acitretin for chemoprevention of non‐melanoma skin cancers in renal transplant recipients
Authors: George Renu , Weightman Warren , Russ Graeme R , Bannister Kym M , Mathew Timothy H
Published: March 2003

A prospective, open randomized crossover trial was conducted to evaluate the efficacy of acitretin for chemoprevention of squamous cell carcinomas and basal cell carcinomas in renal allograft recipients. Analysis was performed according to the intention‐to treat principle. Twenty‐three patients with previous history of non‐melanoma skin cancer enrolled into the study and were randomly allocated into two groups. They crossed over at the end of 1 year. Eleven (47.8%) patients completed the 2‐year trial. Twelve (52.2%) patients withdrew from the trial. Nine of these withdrew because of side‐effects of acitretin. The majority of the patients who continued with the acitretin could tolerate 25 mg of acitretin daily or on alternate days. The number of squamous cell carcinomas (SCC) observed in patients while on acitretin was significantly lower than that in the drug‐free period (P = 0.002). A similar trend was observed in patients with basal cell carcinomas, but this was not significant and the numbers were small. Side‐effects were a major limiting factor. A severe rebound increase in SCC occurred in one patient after the acitretin was ceased.
Photosensitivity: The 9‐year experience at a Sydney contact dermatitis clinic
Authors: Lee Penny A , Freeman Susanne
Published: March 2003

In this retrospective study, 81 patients with photosensitivity were referred to the Contact and Occupational Dermatitis Clinic at The Skin and Cancer Foundation Australia, in Sydney, between 1991 and 1999. Photoallergic contact dermatitis (PACD) was diagnosed in 39.5% of patients, with 87.5% of these reactions being to sunscreen chemicals. Polymorphic light eruption (PMLE) accounted for 19.7% of cases, drug photosensitivity 14.8%, and photoaggravated atopic dermatitis and chronic actinic dermatitis (CAD) each constituted 7.4%. Compared with overseas studies, there was a high incidence of PACD, possibly reflecting the referral bias and widespread use of sunscreens. The incidence of PMLE and CAD was less than studies from cooler climates overseas. No cause could be determined for three photosensitive patients.
Docetaxel‐induced nail dystrophy
Authors: Nicolopoulos Jenny , Howard Anne
Published: March 2003

A 73‐year‐old man with metastatic prostate cancer treated with weekly docetaxel chemotherapy for 5 months developed an acute nail dystrophy restricted to the fingernails. This was characterized by onycholysis, subungual haemorrhage and acute paronychia, progressing to a subungual abscess of the right index finger. Nail bed hyperaemia and haemosiderin‐like nail bed discoloration were present. Nail plate avulsion was performed to decompress the acutely painful subungual abscess. The right thumb, middle finger and left index finger demonstrated early, proximal white subungual collections of pus obscuring the lunula (onychophosis). Central nail plate fenestrations with a surgical drill led to exudation of purulent material. Cultures of the subungual abscess material yielded mixed organisms, possibly related to administration of flucloxacillin for 1 week prior to presentation. The patient completed a further two courses of docetaxel without sequelae, and the nail dystrophy appears to be resolving. Docetaxel‐induced nail changes are a common adverse effect, occurring in 30–40% of patients. Mild changes do not usually warrant the discontinuation of treatment.
Disseminated lobular capillary haemangioma
Authors: Behne Karen , Robertson Ivan , Weedon David
Published: March 2003

A 58‐year‐old woman presented with a 5‐week history of multiple widespread vascular lesions. Histological examination confirmed the clinical diagnosis of disseminated lobular capillary haemangioma. No underlying cause for this eruption could be found. The lesions resolved over the following 2 months without intervention. Reports of disseminated lobular capillary haemangioma are scarce in the literature. In general, this condition does not appear to be related to an underlying disorder and in particular is not a marker for underlying malignancy. No unifying concept as to the aetiology of disseminated lobular capillary haemangioma has been identified. The condition appears to follow a benign course, with spontaneous resolution over 6–12 months.
Isolated lichen planus of the lip
Authors: Cecchi Roberto , Giomi Andrea
Published: March 2003

Lichen planus (LP) is an inflammatory disease that may involve multiple skin sites as well as mucous membranes, hair follicles and nails. It rarely occurs on the lips and usually then in association with oral lesions. We report a 43‐year‐old man with a 7‐month history of inflammation and erosive lesions of the lower lip. Histopathological and immunofluorescence studies showed features of LP. Local treatment with betamethasone dipropionate 0.5% ointment led to complete resolution within 1 month. Four months later, the patient developed typical cutaneous LP.

Isolated LP of the lip is unusual, although this condition may be underestimated and therefore under‐reported in the literature.
Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia
Authors: Sinclair Rodney D , Mallari Rica S , Tate Bruce
Published: March 2003

We report a 24‐year‐old woman with androgenetic alopecia who became sensitized to topical minoxidil following use of an extemporaneous preparation of minoxidil 4% with retinoic acid in a propylene glycol base. She subsequently also became sensitized to saw palmetto (Serenoa repens), a topical herbal extract commonly promoted for the treatment of hair loss.
Atypical lentiginous junctional naevi of the elderly and melanoma
Authors: Kossard Steven
Published: March 2003

The diagnosis of atypical lentiginous melanocytic naevi in chronic sun‐damaged skin is a clinical and pathological challenge. Mottled skin in the elderly is a result of extensive freckling, guttate hypomelanosis, solar lentigines, seborrhoeic keratoses and small dark lentigines. In addition, atypical lentiginous junctional naevi may be seen as isolated lesions and may merge with lesions that are indistinguishable from lentigo maligna. The predominant site distribution of such lesions on the trunk and limbs and the presence of a nested naevoid pattern on biopsy differs from classical lentigo maligna, which develops mainly on the head and neck. Based on case studies combining dermatoscopy with clinical and pathological features, we have found that atypical lentiginous junctional naevi of the elderly may evolve to lentigo maligna and in some cases to small cell (naevoid) melanomas. Such lesions have been previously classified as dysplastic naevi, atypical melanocytic hyperplasia, atypical melanocytic proliferation, atypical lentiginous melanocytic proliferation or premalignant melanosis (McGovern). The current definition of lentigo maligna appears too narrow and the pathway to lentigo maligna in the elderly skin may include a naevoid subset.
Scrubbing for cutaneous procedures can be hazardous
Authors: Huynh Nghi T , Commens Christopher A
Published: March 2003

Office‐based minor cutaneous surgery is a service provided by many medical practitioners. In New South Wales, Australia, it is a legal requirement for practitioners to surgically scrub before donning sterile gloves for all forms of invasive surgery, including minor cutaneous procedures. Frequent scrubbing causes altered skin barrier function, irritant dermatitis and a potential risk of latex sensitization. These adverse effects are associated with significant morbidity and cost. Better tolerated alternatives, including alcohol‐based hand rubs, should be considered in preference to traditional surgical scrubs in order to reduce these occupational risks for minor proceduralists. Well‐ controlled, prospective studies should explore what extent of hand washing is necessary for donning sterile gloves for minor cutaneous surgery.
Scurvy: A cutaneous clinical diagnosis
Authors: Nguyen Roland TD , Cowley David M , Muir James B
Published: March 2003

Two cases of scurvy diagnosed following presentation with a purpuric rash are presented. A 44‐year‐old man developed scurvy as a result of poor dietary intake of vitamin C. This occurred because of a number of factors. including poor dentition, diarrhoea, depression and benzodiazepine/narcotic dependence. A 69‐year‐old man with acute myeloid leukaemic transformation of myelodysplastic syndrome developed mucositis, nausea, vomiting and diarrhoea as complications of chemotherapy. This led to poor dietary intake and consequently scurvy. Both cases demonstrated specific and diagnostic cutaneous manifestations of scurvy, particularly perifollicular purpura, ecchymoses and coiled corkscrew hairs. The diagnosis was supported by specific diet history. Ascorbic acid tolerance test was used as a simple laboratory method to confirm the clinical diagnosis.
Warfarin‐induced skin necrosis associated with acquired protein C deficiency
Authors: Parsi Kurosh , Younger Ian , Gallo John
Published: March 2003

A 36‐year‐old woman developed skin necrosis of the inner thighs following the re‐introduction of warfarin after a laparoscopic cholecystectomy. She had a history of liver disease and cardiomyopathy and was on warfarin for 10 years. Warfarin‐induced skin necrosis secondary to protein C deficiency was diagnosed. Although warfarin was ceased immediately, the prothrombin time measurements remained prolonged and warfarin levels remained therapeutic. Our patient, who had attached great significance to warfarin therapy, had continued the ingestion of warfarin despite our advice. She required three surgical debridements. Protein C levels, as measured 1 year later, were within normal limits, confirming the transient nature of the acquired deficiency during the acute event. This is the second reported case of warfarin necrosis associated with acquired protein C deficiency.
Twenty‐nail dystrophy in a girl with incontinentia pigmenti
Authors: Scardamaglia Laura , Howard Anne , Sinclair Rodney
Published: March 2003

A 9‐year‐old girl with incontinentia pigmenti (IP) diagnosed soon after birth subsequently developed 20‐nail dystrophy at the age of 3 years. This persists unchanged 6 years later, and she has no other evidence of any other cutaneous disease, nor a family history of IP or nail dystrophy. Twenty‐nail dystrophy has been associated with a number of diseases including eczema, lichen planus, alopecia areata and psoriasis and a number of other congenital associations, but the association with IP appears to be unique.
Molecular and genetic considerations for long‐term nutrition interventions
Authors: Stover Patrick J , Garza Cutberto
Published: March 2003

The potential for new functional foods and substantial modification of traditional foods presents unprecedented opportunities and new challenges to the public health community. The technical advances that enable these possibilities presumably present an efficient, cost‐effective, and sustainable means of improving human health and preventing nutrition‐related diseases. Directed manipulation of the food supply, however, presents risks that also must be considered and monitored carefully to avoid known adverse consequences associated with elevated nutrient intakes. Additionally, more research is necessary to understand the subtle effects and long‐term consequences that result from elevated individual nutrient intakes on human health and disease risk through changes in gene expression and genome stability. Growing awareness that genetic variation influences both nutrient requirements and upper levels of safe intake require that the risks and benefits associated with manipulation of the food supply be considered at the individual and population levels. In the present report current approaches and limitations to the precise manipulation of the food supply are considered in light of recent efforts to prevent neural tube defects by increasing the population's dietary folic acid intake.
Bioavailability and vitamin A value of carotenes from red palm oil assessed by an extrinsic isotope reference method
Authors: You Cha‐Sook , Parker Robert S , Swanson Joy E
Published: March 2003

Red palm oil (RPO) contains high concentrations of β‐ and α‐carotene, and is presumed to possess a higher vitamin A value than other foods. The objective was to determine the metabolic vitamin A and carotene values of refined red palm oil in healthy adult subjects, using a stable isotope reference method. Twelve healthy subjects were administered a small standardised meal containing 10 g RPO (2.4 mg β‐carotene and 1.8 mg α‐carotene) in a blended juice‐based drink also containing 2 mg tetradeuterated retinyl acetate (d4‐RA) as a metabolic reference. At baseline and at several times after the test meal, the concentrations of carotenes and of d4‐ and d0‐(unlabelled) retinyl esters, in the plasma chylomicron‐rich (d < 1.006) fraction were determined by high high‐performance liquid chromatography and gas chromatography mass spectrometry, respectively. The masses of palm oil‐derived vitamin A and carotenes absorbed (‘yield’) were calculated assuming 80% absorption of the d4‐RA reference dose. The mean yield of retinol from the RPO was 0.41 mg, ranging from 0.17 mg to 0.86 mg. The mean yields of β‐ and α‐carotene were 0.29 mg and 0.25 mg, respectively, suggesting that β‐carotene was more extensively metabolised than α‐carotene. Subjects assimilated an average of 23% of the dose of carotenes, as the sum of retinol and unmetabolised carotenes. The vitamin A values of red palm oil obtained under these conditions, a mean of 0.17 mg retinol absorbed per mg β‐carotene consumed (β‐carotene : retinol equivalency of 5.7:1) is higher than that of all other vegetable sources we have evaluated to date.
Polyphenol‐enriched extract of oil palm fronds (Elaeis guineensis) promotes vascular relaxation via endothelium‐dependent mechanisms
Authors: Abeywardena Mahinda , Runnie Irine , Nizar Mohd ,   Suhaila Momamed, Head Richard
Published: March 2003

Plant‐based polyphenolic compounds have been reported to possess cardiovascular health benefits. Several dietary sources, including herbs and spices, fruits and vegetables, and tea and wine, contain an array of biologically active compounds that have been shown to be effective in retarding oxidation of low‐density lipoproteins (LDL) and promoting vascular relaxation. In the present study four different plant sources, both edible and non‐edible, were evaluated for potential activity. Organic extracts enriched in polyphenols were prepared from palm fronds (Elaesis guineensis); lemongrass (Cymbopogon citrates); papaya shoots (Carica papaya) and green chilli (Capsicum frutescenes) and tested for their ability to prevent in vitro oxidation of LDL, and for potential vascular relaxation actions. Rings of rat thoracic aorta and isolated perfused mesenteric vascular beds were mounted in organ baths, contracted using a half‐maximal dose of noradrenaline and exposed to cumulative additions of test extracts. Palm frond extract resulted in considerable relaxation (>75%) in both preparations and was found to be endothelium‐dependent as removal of endothelium or inhibition of endogenous nitric oxide (NO) led to a total loss in relaxant activity. Lemongrass extract caused a greater relaxation action in the mesenteric preparation compared to aortic rings, and appears to be mediated via NO‐independent and non‐prostanoid mechanisms. Of the extracts tested, palm fronds also demonstrated the highest antioxidant capacity, as determined by the ferric reducing activity/potential assay, and resulted in a significant delay (P < 0.05) in the oxidation of LDL. Collectively, these preliminary findings lend further support to the potential cardiovascular actions of plant polyphenols and also identify oil palm fronds as containing constituents that promote vascular relaxation via endothelium‐dependent mechanisms.
Vitamin E in cardiovascular disease: has the die been cast?
Authors: Yusoff Khalid
Published: March 2003

Cardiovascular disease, in particular coronary artery disease (CAD), remains the most important cause of morbidity and mortality in developed countries and, in the near future, more so in the developing world. Atherosclerotic plaque formation is the underlying basis for CAD. Growth of the plaque leads to coronary stenosis, causing a progressive decrease in blood flow that results in angina pectoris. Acute myocardial infarction and unstable angina were recently recognised as related to plaque rupture, not progressive coronary stenosis. Acute thrombus formation causes an abrupt coronary occlusion. The characteristics of the fibrin cap, contents of the plaque, rheological factors and active inflammation within the plaque contribute to plaque rupture. Oxidative processes are important in plaque formation. Oxidized low density lipoproteins (LDL) but not unoxidized LDL is engulfed by resident intimal macrophages, transforming them into foam cells which develop into fatty streaks, the precursors of the atherosclerotic plaque. Inflammation is important both in plaque formation and rupture. Animal studies have shown that antioxidants reduce plaque formation and lead to plaque stabilisation. In humans, high intakes of antioxidants are associated with lower incidence of CAD, despite high serum cholesterol levels. This observation suggests a role for inflammation in CAD and that reducing inflammation using antioxidants may ameliorate these processes. Men and women with high intakes of vitamin E were found to have less CAD. Vitamin E supplementation was associated with a significant reduction in myocardial infarction and cardiovascular events in the incidence of recurrent myocardial infarction. In the hierarchy of evidence in evidence‐based medicine, data from large placebo‐controlled clinical trials is considered necessary. Results from various mega‐trials have not shown benefits (nor adverse effects) conferred by vitamin E supplementation, suggesting that vitamin E has no role in the treatment of CAD. These results do not seem to confirm, at the clinical level, the effect of antioxidants against active inflammation during plaque rupture. However, a closer examination of these studies showed a number of limitations, rendering them inconclusive in addressing the role of vitamin E in CAD prevention and treatment. Further studies that specifically address the issue of vitamin E in the pathogenesis of atherosclerosis and in the treatment of CAD need be performed. These studies should use the more potent antioxidant property of α‐tocotrienol vitamin E.