bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of risk‐based caries prevention inpreschool‐aged children
Authors: Pienihäkkinen Kaisu , Jokela Jorma
Published: March 2003

Objective: The aim of this study was to evaluate outcomes in young children of risk‐based management of dental caries in comparison with routine prevention. Methods: The study was carried out in two municipal health centers in Central Finland. The risk‐based prevention group consisted of 299 children from Vanha Korpilahti, and the routine prevention group of 226 children from Saarijärvi. The children were 2 yr old at baseline, and they were followed up for 3 yr. All children received regular annual oral health care. In the risk‐based prevention group, the presence of mutans streptococci (MS) in plaque (Dentocult‐SM® strip mutans ‐test, Orion Diagnostica, Espoo, Finland) and incipient caries lesions were the screening criteria. Additional prevention was targeted at MS‐positive subjects twice a year, consisting of health education and application of fluoride varnish. For those who had incipient lesions, ‘the high‐risk category’, additional prevention was given four times a year and this included also chlorhexidine varnish treatments. Results: The screening and the preventive measures were successfully carried out by specially trained dental assistants. The proportion of children with cavitated caries or fillings was significantly lower in the risk‐based than in the routine prevention group. The treatment effect was strongest within the high‐risk category: two subjects had to be treated with intensive care for 3 yr to avoid restorative treatment of dental caries by the age of 5 yr in one subject (number needed to treat (NNT) = 2.0; 95% CI 1.4–3.8). The accuracy of screening was evaluated in the routine prevention group and found acceptable. Conclusions: The results indicate that in young children, risk‐based management of caries seems practical, and prevention of caries can be targeted efficiently to individuals at risk.
Two‐year incidence of oral disadvantage, a measure of oral health‐related quality of life
Authors: Chavers L. Scott , Gilbert Gregg H. , Shelton Brent J.
Published: March 2003

Abstract – Dental research has progressed from describing the burden of oral disease using traditional epidemiologic measures of incidence and prevalence, to measuring how oral disease, oral signs, and oral symptoms affect the daily activities and the overall quality of life of the individual. However, longitudinal evaluation of these associations remains rare.

Objectives: To (i) describe the 2‐year incidence and patterns of oral disadvantage; (ii) identify dimensions of oral health measures that are significant antecedents of oral disadvantage; and (iii) determine which oral health dimensions are the most strongly predictive of oral disadvantage.

Methods:  The Florida Dental Care Study was a longitudinal study of oral health in diverse groups of persons who at baseline had at least one tooth and were 45 years or older. Incidence rates, odds ratios, and 95% confidence intervals were used to describe oral disadvantage and its relation to other measures of oral health.

Results:  Nearly one‐half of the participants experienced oral disadvantage at least once during 24 months of follow‐up. The strongest antecedents associated with oral disadvantage were toothache pain and chewing difficulty.

Conclusions:  The incidence of oral disadvantage is substantial and consistent with the notion that oral health has a substantial impact on quality of life. Measures of oral pain and oral functional limitation were more strongly predictive of oral disadvantage than disease and tissue damage antecedents.
Increase in sensitization to oil of turpentine: recent data from a Multicenter Study on 45,005 patients from the German‐Austrian Information Network of Departments of Dermatology (IVDK)
Authors: Treudler R. , Richter G. , Geier J. , Schnuch A. , Orfanos C. E. , Tebbe B.
Published: March 2003

Contact allergy to oil of turpentine was reported to have become rare. However, the evaluation of standardized data of 45,005 patients tested 1992–1997 in 30 Dermatological Centers associated with the German‐Austrian Information Network of Departments of Dermatology (IVDK) showed an increase in positive patch test reactions to turpentine from 0.5% during the years 1992–1995, up to 1.7% in 1996 and 3.1% in 1997. In particular, 17,347 patients tested in 1996–1997 were evaluated in detail by comparing 431 individuals with positive patch test reactions with the rest of the group found negative to turpentine. Using the so‐called MOAHLFA index, the following characteristics were shown. Turpentine allergy (a) was found to be significantly less frequent in men and in patients with occupational dermatitis, (b) showed no difference in its association with atopic dermatitis, (c) patients with turpentine allergy had significantly less symptoms of the hands, more symptoms of the legs or in the face and (d) were significantly more often aged over 60 years. Also, patients sensitized to turpentine had increased rates of additional sensitizations. The definite reason for the increase in turpentine sensitization in the population tested here is not clear. Therefore, a detailed exposure analysis is necessary; the new increase in turpentine allergies may be due to popular topical remedies or household chemicals.
Chronic irritant contact dermatitis: recovery time in man
Authors: Choi Jung Min , Lee Jun Young , Cho Baik Kee
Published: March 2003

Chronic irritant contact dermatitis (ICD) is a common skin disease, especially in the workplace, but determining the recovery time of chronic ICD is not easy. To measure the recovery time of chronic ICD, we examined the skin reactivity to a model surfactant, sodium lauryl sulfate (SLS), on previous chronic ICD and normal sites by visual grade and non‐invasive instruments. Chronic ICD was induced on the forearms of 10 volunteers (aged 23 to 43 years) by occluded application of 1% SLS for 30 min on 5 consecutive days each week for 3 weeks. Previous ICD and normal sites were provoked by the occluded application of 7.5% SLS for 30 min daily on 4 consecutive days, 2, 5 and 10 weeks after induction. Skin reactivity was assessed daily by awarding visual erythema scores, visual scale scores and measuring transepidermal water loss, skin color reflectance, and electrical capacitance. Skin reactivity of previous chronic ICD sites to SLS showed hyperreactivity compared to normal sites even after the 10th week post‐induction.
Sensitizing capacity of 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐(hydroxymethyl)‐dibenzyl ethers in the guinea pig
Authors: Zimerson Erik , Bruze Magnus
Published: March 2003

In patients hypersensitive to p‐tert‐butylphenol‐formaldehyde resin (PTBP‐F‐R), it is for diagnostic, therapeutic and preventive reasons necessary to know the identity of the primary sensitizing substances, their sensitizing capacities as well as their cross‐reaction patterns. We have recently shown that the 2 dimers in PTBP‐F‐R, 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3‐hydroxymethyl‐dibenzyl ether (X) and 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐3,3′‐dihydroxymethyl‐dibenzyl ether (IX) are contact sensitizers in man. The aim of this study was to investigate the sensitizing capacities of these dimers in PTBP‐F‐R and potential cross‐reacting substances in the guinea pig with the guinea pig maximization test. IX, X, 2,6‐dimethylol‐p‐tert‐butylphenol (2,6‐MPTBP), 2‐methylol‐p‐tert‐butylphenol (2‐MPTBP), p‐tert‐butylcatechol (PTBC), 5,5′‐di‐tert‐butyl‐2,2′‐dihydroxy‐dibenzyl ether (XI) were used as possible cross reacting substances. IX and X were shown to be sensitizers. When compared to the sensitizers in phenol‐formaldehyde resin, IX is a strong sensitizer (p=0.00052) and X a moderate sensitizer (p=0.0053). Animals sensitized to IX showed cross‐reactions to X (p=0.010), 2,6‐MPTBP (p=0.0011) and PTBC (p=0.0498). Animals sensitized to X showed no cross‐reactions to the substances that were tested. The results indicate that IX is a main allergen in PTBP‐F‐R, with possibly also X.
Patch testing and aeroallergen intradermal testing in facial dermatitis
Authors: Li Lin‐Feng , Wang Jing
Published: March 2003

The rôle of contact allergens and aeroallergens in facial dermatitis (FD) was studied. 114 cases of FD were divided into 3 groups. Group 1 comprised 47 cases of facial cosmetic dermatitis (FCD), in which all patients had a history of dermatitis related to cosmetics clinically; group 2 comprised 15 cases of seasonal facial dermatitis (SFD); Group 3 comprised 52 cases of other FD (OFD) that could not be categorized as FCD or SFD. Reactions to contact allergens and aeroallergens were detected using patch testing and intradermal testing, respectively, with non‐facial eczematous skin disease patients serving as controls. The positivity rate for each allergen between different groups was compared by the χ2‐test. The results show that the positivity rate for fragrance mix in FCD is much higher than in non‐FCD (27.7% versus 6.7% in SFD, 7.6% in OFD and 6% in eczema patients, p<0.05). No significant difference was detected for other common allergens, such as PPD, rubber mix, nickel sulfate, and colophonium (p>0.05 for all). These results suggest that fragrance mix contains the main contact allergens in FCD. Patch testing with patients' own products also yields high numbers of relevant results in FCD and OFD. No relevant patch test results were found in SFD, indicating that contact allergy may not be relevant to SFD. No significant difference was observed between intradermal skin reactions to aeroallergens, including pollens and moulds, in SFD, OFD, FCD and controls. These results suggest that Type I reactions to aeroallergens may not be relevant in FD. The rôle of aeroallergens in FD needs to be studied further.
Allergic contact dermatitis from glutaraldehyde in health‐care workers
Authors: Shaffer Matthew P. , Belsito Donald V.
Published: March 2003

Glutaraldehyde is considered the disinfectant of choice for sterilizing medical and dental equipment. Unfortunately, glutaraldehyde has many toxic side‐effects, including the ability to induce allergic contact dermatitis. In a 5‐year study at the University of Kansas, 468 patients were patch tested to glutaraldehyde. A comparison of results was made between those employed in a health‐care related field and those who were not. Health‐care workers (HCWs) were more than 8× more likely to be allergic to glutaraldehyde than their non‐health‐care working peers (NHCWs). Statistically significant differences between HCWs and NHCWs were seen in their reactivity to glutaraldehyde, thimerosal, benzalkonium chloride and methyl methacrylate. A higher than expected co‐reactivity between glutaraldehyde and formaldehyde was also noted among HCWs and NHCWs, which cannot fully be explained by concomitant exposure. Allergic contact dermatitis from glutaraldehyde often causes persistent dermatitis, which frequently forces patients to leave their jobs. Although the National Institute of Occupational Safety and Health has published guidelines for safe handling of glutaraldehyde, allergy appears to continue to rise, especially among those employed in health‐care professions. Until a less sensitizing disinfectant is developed, it is in the best interest of those in health‐care professions, and other professions exposed to glutaraldehyde, to heighten occupational safety standards and to improve methods of barrier protection.
Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore
Authors: Lim Shueh Wei , Goh Chee Leok
Published: March 2003

In a retrospective epidemiologic study of 202 patients with eczematous cheilitis attending a patch test clinic, females (182 (90%)) predominated over males (20 (10%)). The mean age of our patients was 30.9 years. There was no significant difference between the mean age of females (31 years) presenting with cheilitis compared to males (29 years). Endogenous cheilitis (53%) was the commonest diagnosis, followed by allergic contact dermatitis (34%) and irritant contact dermatitis (5.4%). A personal history of atopy was recorded in 33%. There was no significant difference in the prevalence of atopy between the sexes or among the diagnoses. The mean duration of cheilitis was 16.4 months. The duration was significantly longer in males (29 months) than in females (15 months) (p=0.004). The mean number of positive patch test reaction in patients with allergic contact cheilitis (2.8) was significantly higher than in those with irritant contact cheilitis (0.2) (p=0.012) or endogenous cheilitis (0.5) (p=0.00). The commonest cause of allergic contact cheilitis were lip cosmetics, including lipsticks and lipbalms, followed by toothpastes. The commonest cause of irritant contact cheilitis was lip‐licking, lipsticks and medication. In 81/202 (40%) patients, 1 or more causes of contact cheilitis could be ascertained. In females, lip cosmetics were the commonest cause, accounting for 54% (44/81) of cases. Toothpastes accounted for 21% (17/81), followed by topical medication 7% (6/81). For males, toothpastes were the commonest cause of allergic contact cheilitis. Ricinoleic acid and the patient's own lip preparations were the commonest relevant contact allergens.
Analytical control of preservative labelling on skin creams
Authors: Rastogi Suresh Chandra
Published: March 2003

Contents of 23 preservatives (22 permitted and 1 non‐permitted) were analysed in 67 skin creams to verify whether these products complied with the Cosmetic Directive with respect to ingredient labelling, as well as with respect to maximum allowed concentrations of the respective preservatives. The preservatives selected for the analysis were: parabens, 2‐phenoxyethanol, benzoic acid, 4‐hydroxybenzoic acid, sorbic acid, salicylic acid, formaldehyde and formaldehyde releasers, 3:1 mixture of 5‐chloro‐2‐methyl‐4‐isothiazolin‐2‐one and 2‐methyl‐4‐isothiazolin‐2‐one (Kathon CG), 2‐bromo‐2‐nitropropane‐1,3‐diol (Bronopol), 5‐bromo‐2‐nitro‐1,3‐dioxane (Bronidox) and methyldibromo glutaronitrile. 1 or more parabens were present in 87% (n=58) of the investigated products, 2‐phenoxy ethanol in 49% (n=33) of the products, and formaldehyde/formaldehyde releasers were present in 51% (n=34) of the products. Kathon CG was found in 3 products, acid preservatives (except salicylic acid) in 8 products, Bronopol in 5 products, and methyldibromo glutaronitrile was present in 4 products. The contents of all of the target preservatives in the skin creams were within the maximum allowed concentrations of the respective substances. Incorrect ingredient labelling with respect to paraben content was found in 10% (n=7) of the investigated products, 33% (n=22) of the products were not declared for the content of formaldehyde/formaldehyde releaser, and 7% (n=5) products were incorrectly labelled for the content of 2‐phenoxyethanol. In 1 of the products containing Kathon CG, the ratio of 5‐chloro‐2‐methyl‐4‐isothiazolin‐2‐one to 2‐methyl‐4‐isothiazolin‐2‐one (1.4:1) was not correct. 4 of the 8 products containing acid preservatives were not labelled for the content of these substances. All in all, in 45% (n=30) of the investigated skin creams ingredient labelling was incorrect with respect to preservative contents. The proportion of incorrect labelling is reduced to 23% (n=15), when the formaldehyde content in skin creams below 30 ppm is not accounted.
Occupational contact allergy to (meth)acrylates
Authors: Geukens S. , Goossens A.
Published: March 2003

Among 13,833 patients suspected of contact dermatitis examined during the years 1978–1999, occupational contact allergy to (meth)acrylates was diagnosed in 31 patients. The 3 most common sensitizers were ethyleneglycol dimethacrylate (17 positive patch tests), 2‐hydroxyethyl methacrylate (14) and triethyleneglycol dimethacrylate (6). The aim of this report was to assess the different occupations and industries responsible for occupational sensitization to (meth)acrylates. 14 of the 31 patients work in the dental sector, either as a dentist or as a student of dental technology, where (meth)acrylate‐containing dental prostheses and dental composites are mainly responsible for allergy to (meth)acrylates. An increasing trend in dermatological problems related to the expansion of the use of (meth)acrylates is clearly reflected in the patient population of our dermatology department.
Standardization of the TRUE Test imidazolidinyl urea and diazolidinyl urea patches
Authors: Agner T. , Andersen K. E. , Björkner B. , Bruze M. , Frosch P. J. , Gruvberger B. , Hoeck U. , Kreilgaard B. , Menné T. , Sommer J.
Published: March 2003

The preservatives imidazolidinyl urea (IMID, Germall 115) and diazolidinyl urea (DU, Germall II) are commonly used in cosmetic products and are well‐known sensitizers. The aim of the present study was to establish the optimal patch test concentration in hydrophilic dried‐in vehicle (TRUE Test) for IMID and DU. 181 patients were included in the study. Of these, 150 were patients referred for patch testing, 12 were patients with known allergy to IMID and 19 were patients with known allergy to DU. 76 consecutive patients and the 12 IMID‐allergic patients were patch tested with a dilution series IMID (0 to 600 μg/cm2), formaldehyde (180 μg/cm2) and DU (200 μg/cm2). 74 consecutive patients and the 19 DU‐allergic patients were patch tested with a dilution series of DU (0 to 600 μg/cm2), formaldehyde (180 μg/cm) and IMID (200 μg/cm2). A positive dose‐response relationship was found. The number of doubtful reactions decreased with increasing test concentrations. No late reactions were observed. A patch test concentration in hydrophilic dried‐in vehicle (TRUE Test) of 600 μg/cm2 was found to be adequate and safe for both IMID and DU.
Understanding fragrance allergy using an exposure‐based risk assessment approach
Authors: Gerberick G. Frank , Robinson Michael K , Felter Susan P , White Ian R , Basketter David A
Published: March 2003

Conducting a sound skin sensitization risk assessment prior to the introduction of new ingredients and products into the market place is essential. The process by which low‐molecular‐weight chemicals induce and elicit skin sensitization is dependent on many factors, including the ability of the chemical to penetrate the skin, react with protein, and trigger a cell‐mediated immune response. Based on our chemical, cellular and molecular understanding of allergic contact dermatitis, it is possible to carry out a quantitative risk assessment. Specifically, by estimating the exposure to the allergen and its allergenic potency, it is feasible to assess quantitatively the sensitization risk of an ingredient in a particular product type. This paper focuses on applying exposure‐based risk assessment tools to understanding fragrance allergy for 2 hypothetical products containing the fragrance allergen cinnamic aldehyde. The risk assessment process predicts that an eau de toilette leave‐on product containing 1000 ppm or more cinnamic aldehyde would pose an unacceptable risk of induction of skin sensitization, while a shampoo, containing the same level of cinnamic aldehyde, would pose an acceptable risk of induction of skin sensitization, based on limited exposure to the ingredient from a rinse‐off product application.
Patch test results in 542 patients with suspected contact dermatitis in Turkey
Authors: Akasya‐Hillenbrand Esra , Özkaya‐Bayazit Esen
Published: March 2003

In this retrospective study, patch test results of 542 patients (303 female and 239 male), referred to our clinic between June 1996 and July 1999, were evaluated. All patients were patch tested with 32 allergens of an extended European standard series, 140 patients were tested with supplemental series, and 246 patients with their own substances. 280 (51.7%) patients had 1 or more positive results but allergic contact dermatitis, according to clinical relevance, was diagnosed in only 190 (67.9%) of these. Nickel sulfate was the most frequent sensitizer (19.1%), followed by potassium dichromate (11.8%), palladium chloride (9.4%), cobalt chloride (8.5%), and thiuram mix (7.7%). Frequencies of contact allergy to fragrance mix (5.5%), balsam of Peru (Myroxylon Pereirae resin) (2%), quaternium‐15 (0.6%), and Kathon CG (methylchloroisothiazolinone+methylisothiazolinone) (0.2%) were relatively low, while no positive reactions were obtained to paraben mix in any case. Current clinical relevance to the present dermatitis was most frequently seen with carba mix (96.2%), thiuram mix (95.2%) and potassium dichromate (78.1%), whereas this rate was low for nickel (37.5%). In 85.8% of patients with allergic contact dermatitis, the responsible allergen was detected by testing with the extended standard series alone (18.4% identified by testing with the additional 10 allergens), in 11.6% by testing with the patients' own substances, and in 2.6% by testing with the supplemental series. Occupational contact dermatitis was diagnosed in 77 of the patients with positive reactions (27.5%), most of these being construction workers and house painters who showed relevant sensitizations to potassium dichromate, cobalt chloride, thiuram mix and carba mix. There was no statistically significant difference in the total contact sensitization rate between atopics and non‐atopics, but contact sensitivity to nickel sulfate and palladium chloride was significantly higher among atopics. MOAHL index in % was: 44.1/14.2/24.9/ 54.4/2.4. In conclusion, we believe that similar large series of patients would be helpful to delineate the exact profile of contact dermatitis in Turkey.
Contaminating resin acids have not caused the high rate of sensitivity to oak moss
Authors: Buckley D. A. , Rycroft R. J. G. , White I. R. , McFadden J. P.
Published: March 2003

Commercially available oak moss absolute patch test material has recently been shown to contain resin acids of the type found in colophony (colophonium). We wished to assess whether the high frequency of positive patch tests to oak moss absolute at this institute was likely to reflect significant contamination by resin acids. The rate of positive reactions to colophony among our oak moss‐allergic patients patch tested during 1984–2000 was retrospectively investigated. 25,395 patients were tested to the European standard series during this period and 1,963 (7.7%) were allergic to the fragrance mix. 342 of these patients were allergic to oak moss absolute, of whom 73 (21.3%) were allergic to colophony. In comparison, 115 (13.4%) of 861 fragrance mix‐positive but oak moss‐negative patients were allergic to colophony (p = 0.0002, Fisher's exact test). This strongly statistically significant association between oak moss absolute and colophony shows only a small increase in rates of allergy to colophony in oak moss‐positive patients. Thus we conclude that contaminating resin acids have not alone caused the high rate of sensitivity to oak moss.
Tetrazepam drug sensitivity − usefulness of the patch test
Authors: Pirker C. , Mišic A. , Brinkmeier T. , Frosch P. J.
Published: March 2003

The muscle relaxant tetrazepam may cause severe cutaneous adverse effects. We report 4 cases of varying intensity: Stevens–Johnson syndrome, erythema–multiforme‐like exanthema, maculopapular and maculo‐urticarial exanthema. Patch testing with tetrazepam (10% in petrolatum) was strongly positive in the 2 patients with severe skin eruptions and weakly positive in the other 2. Oral rechallenge with tetrazepam was positive in 3 patients (1 not done). Diazepam, with a similar chemical structure to tetrazepam, was negative on patch testing and on oral challenge testing in 2 patients. Although the optimal patch test concentration of tetrazepam has still to be determined, it is a useful diagnostic tool to confirm sensitization, particularly in patients with severe bullous eruptions.
Latex allergy among construction workers
Authors: Conde‐Salazar L. , Gatica M. E. , Barco L. , Iglesias C. , Cuevas M. , Valks R.
Published: March 2003

To assess the incidence of latex allergy in construction workers, we studied all the 230 construction workers who attended our clinic between 1996 and 2000. In the 54 (23.5%) patients who reported any kind of intolerance to rubber gloves or boots, we performed both patch testing with the TRUE TestTM standard series and a rubber series and prick testing for latex. Latex‐specific IgE levels were measured when prick testing was positive. 16 patients (7.0%) had a positive prick test to latex, of whom 14 had allergic contact urticaria from latex (ACUL). All of these 14 patients (6.1%) showed 1 or more positive reactions to the True Test series, which included 1 or more rubber chemicals in 9 of them. The level of specific Ig E to latex was greater than 0.35 kU/L in 15 of the 16 patients. In conclusion, our data suggest that the incidence of latex allergic contact urticaria among construction workers may be as high as that among health care workers. Most of these construction workers with Type I latex hypersensitivity had a concurrent Type IV hypersensitivity to chromate or rubber chemicals, presenting as occupational allergic contact dermatitis, which could have facilitated sensitization to latex.
Further important sensitizers in patients sensitive to fragrances
Authors: Frosch P. J. , Johansen J. D. , Menné T. , Pirker C. , Rastogi S. C. , Andersen K. E. , Bruze M. , Goossens A. , Lepoittevin J. P. , White I. R.
Published: March 2003

In order to find sensitizers additional to the current fragrance mix (FM) a series of fragrance materials (series II) was evaluated in 6 dermatological centres in Europe. 11 of the test materials were essential oils, the remaining 7 being either mixtures of isomers or simple chemicals of frequent usage in the perfume industry. 1606 patients were consecutively tested with series II and 8% FM. Each patient was classified regarding a history of adverse reactions to scented products: certain, probable, questionable, none. Reactions to FM occurred most frequently in 11.4% of the subjects. The 6 materials with the highest reactivity after the FM were ylang‐ylang oil (YY) I (2.6%), YY II (2.5%), lemongrass oil (1.6%), narcissus absolute (1.3%), jasmine absolute (1.2%) and sandalwood oil (0.9%). 48 (3.0%) of the patients reacted only to materials of series II and not to FM. 6.0% of 1606 patients gave a history of adverse reactions to fragrances which was classified as certain. This group reacted to FM only in 22.9%, to series II and FM in 15.6% and to series II only in 5.2%. 63.5% of the patients reacting to both FM and 1 of the materials of series II had some type of positive fragrance history, which was higher in comparison to those with isolated reactions to FM (46.2% of 121) or to series II, respectively, (45.8% of 48). However, this difference was not statistically significant. In conclusion, the materials of series II identified a further subset of patients with a fragrance problem, which would have been missed by the current FM as the single screening tool for patch testing.
Cutaneous metastases as initial manifestation of dedifferentiated chondrosarcoma of bone. An autopsy case with review of the literature
Authors: Arce Félix P. , Pinto Jesús , Portero Isabel , Echevarría Santiago , Val‐Bernal J. Fernando
Published: March 2003

Metastases of chondrosarcoma to the skin are uncommon. We report a case of dedifferentiated chondrosarcoma that manifested as cutaneous metastases and had an outcome of three weeks. A 69‐year‐old male presented with two cutaneous nodules, one in the chest and other in the inguinal area. The punch biopsy of the latter showed a poorly differentiated mesenchymal metastatic tumor. Shortly before death, an X‐ray revealed a proximal epiphyseal lesion in the right humerus, radiographically interpreted as chondrosarcoma. The autopsy showed this lesion to be a dedifferentiated chondrosarcoma whose nonchondroid mesenchymal part was akin, histologically and immunohistochemically, to the cutaneous metastases. While ten previous reports of chondrosarcoma metastatic to the skin are known, we believe that this is the first case to report the cutaneous metastases of the dedifferentiated variety. Furthermore, skin metastasis preceding the diagnosis of chondrosarcoma has not been previously reported. The fact that one part of this kind of tumor can be highly undifferentiated or, else, differentiated along lines not usually reminiscent of bone tumors, can make the diagnosis of such cases extremely difficult. Most chondrosarcomas metastatic to the skin arise in bones of the extremities, including the hand. The most common type of tumor is conventional chondrosarcoma. These metastases can be either single or multiple with a slight predilection for the head and neck region. Most patients die in a mean time of 6 months after the appearance of cutaneous metastases.
Expression of growth hormone receptor in benign and malignant cutaneous proliferative entities Note
Authors: Ginarte Manuel , García‐Caballero Tomás , Fernández‐Redondo Virginia , Beiras Andrés , Toribio Jaime
Published: March 2003

The skin has the necessary elements to respond to growth hormone (GH) and suffers clinical changes in the pathological circumstances of excess and deficiency of GH. The GH has been involved in the development of different types of human neoplasms. Based on these data, we have studied the GH receptor (GHR) expression in acrochordons, seborrheic keratosis, melanocytic nevi, histiocytomas, squamous cell carcinomas, basal cell carcinomas, and malignant melanomas by means of the immunohistochemistry with the monoclonal antibody MAb 263. All the entities showed immunoreactivity for GHR. In the histiocytomas, the expression of GHR in the keratinocytes of the hyperplastic epidermis coating the lesion showed a strong nuclear pattern, but the non‐hyperplastic epidermis of the edges of the histiocytomas expressed GHR with a cytoplasmic pattern. In the basal cell carcinoma and squamous cell carcinoma, the immunoreactivity was weaker than in normal skin. In the squamous cell carcinoma, the intensity of immunostaining correlated directly with the grade of cellular differentation. In conclusion, the GH may be involved in the development of different kinds of cutaneous neoplasms, and the intracellular localization of GHR may imply a functional significance, at least in the histiocytomas.
New insights into the applicability of T‐cell receptor γ gene rearrangement analysis in cutaneous T‐cell lymphoma
Authors: Li Ning , Bhawan Jag
Published: March 2003

Background: Detection of clonal T‐cell receptor (TCR) γ gene rearrangement by polymerase chain reaction (PCR) based method is a marker for cutaneous T‐cell lymphoma (CTCL) although it can be seen in some benign dermatoses. To determine the accuracy of histologic criteria alone as well as the adjuvant diagnostic role of TCR gene rearrangement for the diagnosis of CTCL, we studied 100 patients with cutaneous T‐cell infiltrates by both histology and TCR gene rearrangement.

Methods: The histologic features of the 100 patients were first reviewed by two independent dermatopathologists and their confidence in the diagnosis of CTCL was assigned one of four levels. Then the specimens were analyzed for TCR gene rearrangement either on paraffin‐embedded or fresh‐frozen tissue by PCR/denaturing gradient gel electrophoresis (DGGE).

Results: The clonality was detected in 100% (15/15) diagnostic of, 84.6% (11/13) consistent with, 57.6% (19/33) suggestive of CTCL. In 9 cases TCR gene rearrangement was compared between formalin‐fixed and fresh specimens of the same individual, but with different degrees of histologic confidence (no lower than suggestive). In all cases fresh specimens were positive. In 5 of the cases (2‐diagnostic, 2‐consistent, 1‐suggestive) formalin‐fixed specimens were positive as well, and in 4 cases (1‐consistent, 3‐suggestive) formalin‐fixed specimens were negative. When TCR gene rearrangement was studied in eight cases on sequential biopsies from the same patient, the clonality was detected in only one or two biopsies in four cases in which the histologic confidence was low (suggestive or nondiagnostic). The TCR gene rearrangement study showed identical banding patterns in lesions from different clinical stages in most patients. However, we observed that in one case, oligoclonal‐banding pattern was seen in initial biopsy with histopathologic consistent with CTCL, while monoclonal banding pattern in more advanced lesion.

Conclusions: Our data have demonstrated that TCR gene rearrangement studies by PCR/DGGE are consistently positive regardless of tissue fixation (formalin‐fixed, paraffin‐embedded vs. fresh‐frozen tissue) and biopsy site when the histologic degree of confidence is very high (diagnostic). So, it may be of less importance as an adjuvant to histopathologic diagnosis for the cases with diagnostic CTCL histology. However, TCR gene rearrangement studies are particularly important in earlier cases with less conclusive histology, which provides strong confirmatory evidence of an evolving CTCL. In these cases, multiple biopsies may be required to establish the diagnosis and analysis of fresh tissue is suggested to increases the sensitivity. Moreover, our observation also suggested that some CTCL might not be monoclonal de novo, but oligoclonal instead.
Lymphomatoid papulosis and human herpesviruses – A PCR‐based evaluation for the presence of human herpesvirus 6, 7 and 8 and related herpesviruses
Authors: Kempf Werner , Kadin Marshall E. , Kutzner Heinz , Lord Carol L. , Burg Guenter , Letvin Norman L. , Koralnik Igor J.
Published: March 2003

Background:

Lymphomatoid papulosis (LyP) is a chronic, recurrent lymphoproliferative disorder of the skin that belongs to the group of primary cutaneous CD30‐positive T‐cell lymphomas. Ultrastructural and clinical features of LyP suggest that it has a viral etiology. Human herpesviruses have been proposed as causative cofactors for LyP because of their oncogenic potential and their association with other lymphomas.

Methods: LyP skin lesions and a LyP‐derived cell line were examined for the presence of the recently discovered oncogenic human herpesvirus 8 (HHV‐8) and the two T‐lymphotropic human herpesviruses 6 and 7 (HHV‐6 and HHV‐7) by nested polymerase chain reaction (PCR) using virus‐specific oligonucleotide primers. Furthermore, a recently described method involving degenerate PCR primers was applied to detect highly conserved DNA sequences shared by a variety of herpesviruses, especially oncogenic gamma‐herpesviruses, in an attempt to identify a yet undiscovered herpesvirus associated with LyP.

Results: HHV‐6 and 8 could not be found in 26 archival and 11 snap‐frozen LyP lesions and a LyP tumor cell line. HHV‐7 DNA sequences were detected in 14% (5 of 37) of LyP samples. HHV‐6 was found in 23% (3 of 13) and HHV‐7 in 8% (1 of 13) of normal skin samples from healthy individuals, respectively. Using degenerate PCR primers to amplify the highly conserved polymerase region of herpesviruses, no DNA sequences related to human herpesviruses could be detected.

Conclusions: LyP is not associated with HHV‐6, HHV‐7 and HHV‐8. In addition, the studies using degenerate PCR primers do not indicate the presence of a previously undescribed human herpesvirus in LyP.
CD45RA+ immunophenotype in mycosis fungoides: clinical, histological and immunophenotypical features in 22 patients
Authors: Fierro M. T. , Novelli M. , Savoia P. , Cambieri I. , Quaglino P. , Osella‐Abate S. , Bernengo M. G.
Published: March 2003

Background: Mycosis fungoides (MF) is a cutaneous T‐cell lymphoma (CTCL) usually characterized by a T‐helper memory phenotype (CD3+, CD4+, CD8−, CD45R0+). Aberrant phenotypes are more commonly seen in the tumor stages. CD45RA expression has so far been documented in only a few cases of CD8+ or TCRγδ+ CTCL and in some pagetoid reticulosis cases.

Methods: Two hundred and fifteen MF patients were immunophenotyped in our laboratory between January 1992 and June 2000 and 22 cases of CD45RA+ MF (8.7%) were identified by immunohistochemical analysis.

Results: The majority of these CD45RA+ patients (20/22) showed a patch‐plaque stage disease and an indolent clinical course, as expected in early‐stage MF. The remaining 2 patients presented with stage IIB and IVA MF, and were characterized by an aggressive clinical course, with systemic spread. The immunohistochemical analysis revealed that CD45RA+ neoplastic cells belonged to the memory compartment, displaying a CD62L−, CD11a+, CD29+ phenotype. Most patients showed aberrant phenotypes, with a loss of T‐cell lineage markers and expression of cytotoxic molecules or gamma‐delta chain of the T‐cell receptor.

Conclusions: Our data show that CD45RA+ MF is a rare variant of CTCL and shares with the classic MF cases both the clinical features and disease course, even if it is characterized by a higher incidence of immunopathological abnormalities.
CD34 expression in desmoplastic melanoma
Authors: Hoang Mai P. , Selim M. Angelica , Bentley Rex C. , Burchette James L. , Shea Christopher R.
Published: March 2003

Background: Primary and metastatic malignant melanoma can simulate various soft tissue tumors, including dermatofibrosarcoma protuberans (DFSP). Expression of CD34, a marker characteristic of DFSP, as well as other spindle cell tumors, has not been previously documented in malignant melanoma.

Methods: We present here an unusual case of metastatic malignant melanoma with a strong histologic resemblance to DFSP and also CD34 expression.

Results: The patient, a 72‐year‐old man with a history of an invasive malignant melanoma of the skin of the right lower abdomen, presented with a right axillary mass. Histologic sections revealed intersecting fascicles of spindle cells with nuclear pleomorphism and numerous mitotic figures, diffusely infiltrating the adipose tissue in a pattern closely simulating that seen in DFSP. In other foci, epithelioid neoplastic cells with abundant cytoplasm, prominent nucleoli, nuclear pseudoinclusions, and focal cytoplasmic melanin pigment were seen. The neoplastic spindle cells were strongly labeled by two anti‐CD34 monoclonal antibodies. Some of the spindle cells and the majority of the epithelioid neoplastic cells expressed S‐100 protein and focally tyrosinase. The tumor cells were negative for HMB‐45 and MART‐1. Melanosomes were not identified by electron microscopy.

Conclusion: This case demonstrates the potential of melanoma to simulate DFSP closely, on both morphologic and immunohistochemical grounds, and confirms the utility of employing a broad panel of immunohistochemical reagents in problematic cases.
Periappendageal lichen nitidus: report of a case
Authors: Sanders Scott , Collier De Anne H. , Scott Rachelle , Wu Hong , McNutt N. Scott
Published: March 2003

Background:  The histology of lichen nitidus has been described previously but a follicular variant has not been emphasized.

Method:  We report a case of lichen nitidus with periappendageal inflammation resulting in histologic similarities to lichen striatus.

Results:  This case extends the spectrum of histologic findings in lichen nitidus and shows overlap in the distribution of the inflammatory infiltrate in lichen nitidus and lichen striatus.
Absence of HHV‐8 DNA in hobnail hemangiomas
Authors: Gutzmer Ralf , Kaspari Markus , Herbst Rudolf A. , Kapp Alexander , Kiehl Peter
Published: March 2003

Background:  Hobnail hemangioma (HH) is a rare subtype of hemangioma that shares the morphological feature of hobnail endothelia with retiform hemangioendothelioma (RHE) and has to be considered in the differential diagnosis of Kaposi sarcoma. Since DNA of the human herpesvirus type 8 (HHV‐8) has been detected in more than 90% of Karposi sarcomas and could recently be demonstrated in RHE, we sought to detect HHV‐8 DNA in HH.

Methods and results:  DNA from 12 HH was extracted and subjected to polymerase chain reaction analysis for HHV‐8 DNA using two independent protocols with a single set of primers and a nested PCR approach, respectively. PCR amplification was performed using the LightCycler as well as using a thermocycler. HHV‐8 DNA could not be detected in HH, although each sample contained DNA adaequately preserved for PCR reactions, as determined by amplification of the beta actin gene.

Conclusions:  HHV‐8 appears to play no rule in the pathogenesis of HH. Absence of HHV‐8 DNA in HH might be important in the differential diagnosis to other vascular tumours, in particular Kaposi sarcoma.
Fascin expression in CD30‐positive cutaneous lymphoproliferative disorders
Authors: Kempf Werner , Levi Edi , Kamarashev Jivko , Kutzner Heinz , Pfeifer Walther , Petrogiannis‐Haliotis Tina , Burg Günter , Kadin Marshall E.
Published: March 2003

Background: CD30‐positive cutaneous lymphoproliferative disorders (LPD) represent a spectrum of diseases ranging from low‐grade (lymphomatoid papulosis; LyP) to high‐grade (pleomorphic and anaplastic large‐cell lymphoma; PTL, ALCL) with overlapping morphologic and immunophenotypic features. The common phenotypic hallmark is the expression of CD30‐antigen by the tumor cells which morphologically resemble Reed–Sternberg cells. Although LyP is a non‐fatal recurring disorder, it is associated with systemic lymphomas including Hodgkin's lymphoma (HL), mycosis fungoides (MF) and ALCL in 5–20% of the cases. Currently there is no marker to predict the development of systemic lymphomas in patients with LyP. Fascin, an actin bundling protein, has recently been shown to be a unique marker found in almost 100% of classical HL.

Methods: Because of the association of LyP with HL, fascin expression was analyzed by immunohistochemistry in LyP (n = 45), cutaneous CD30+ ALCL (n = 17) and pleomorphic T‐cell lymphoma (n = 9) (PTL) and LyP associated with systemic lymphomas (7 HL, 2 ALCL, 1 MF), with the intent to determine if fascin expression can predict disease progression.

Results: Fascin was expressed by tumor cells in 11/45 (24%) cases of LyP, 11/17 (64%) cases of ALCL, 7/9 (77%) cases of PTL and 6/10 (60%) cases of LyP associated with systemic lymphomas. Fascin expression in LyP was significantly less frequent than in ALCL (p < 0.001) and also than in LyP associated with lymphomas (p < 0.05). There was no significant difference of fascin expression within the histological subtypes of LyP. We found no evidence of ALK expression nor of Epstein–Barr virus expression in any case either by in situ hybridization or immunohistochemistry in the LyP cases associated with HL.

Conclusions: This is the first study to demonstrate that fascin is expressed in cutaneous CD30+ LPD and that it is a candidate marker of disease progression in LyP.
Atypical cells in human cutaneous re‐excision scars for melanoma express p75NGFR, C56/N‐CAM and GAP‐43: evidence of early Schwann cell differentiation
Authors: Trejo Octavio , Reed Jon A. , Prieto Victor G.
Published: March 2003

Background:  A common problem in the routine examination of melanoma re‐excision scars occurs when a few or rare mildly atypical cells are present within the scar, raising the question of residual disease. Little is known about the derivation of these cells. Because the normal cutaneous wound‐healing process is reparative, we hypothesized that these atypical cells may be reactive proliferating Schwann cell precursors.

Methods:  The expression of the Schwann cell differentiation markers p75NGFR, CD56/N‐CAM and GAP‐43 was examined by immunohistochemistry in scars of wide local re‐excisions for melanoma and non‐melanoma tumors. Expression of S100, gp100 (with HMB45) and MART1 was also analyzed by immunohistochemistry.

Results:  All melanoma and non‐melanoma re‐excision specimens contained mildly atypical, spindled or epithelioid cells within the scar. They varied in number from case to case and expressed S100, p75NGFR, CD56/N‐CAM or GAP‐43 but not gp100 (with HMB45) or MART1. Rare epithelioid non‐melanoma cells within the superficial dermis expressed MART‐1.

Conclusions: Atypical cells are present in re‐excision scars from melanoma and non‐melanoma cases. They demonstrate early Schwann cell differentiation and appear to proliferate during the scarring process. The use of anti‐MART‐1 alone in the examination of melanoma re‐excisions specimens may be inadequate as it may label rare, superficially located, non‐melanoma cells within the scar.
Cutaneous lesions showing giant yeast forms of Blastomyces dermatitidis
Authors: Walker Karen , Skelton Henry , Smith Kathleen
Published: March 2003

Background: The yeast forms of Blastomyces dermatitidis usually range from 8 to 15–20 µm in diameter. Larger yeast forms have previously been reported only twice in immunosuppressed patients. In both patients these large forms were seen within the lung.

Case report: We present a 14‐year‐old cardiac transplant patient, who presented 36 days following his transplantation with acute respiratory distress followed a few days later by erythematous cutaneous papules.

Results: Biopsy of a skin lesion showed yeast forms, some greater than 40 µm in diameter, within and surrounding dermal vessels. Cultures later grew Blastomyces dermatitidis.

Conclusion: To our knowledge this is the first reported case of giant forms of Blastomyces dermatitidis within the skin. With increased iatrogenic immunosuppression, we may expect to see more diverse morphologic forms with deep fungal infections.
Syringocystadenoma papilliferum contiguous to a verrucous cyst
Authors: Li Ailing , Sanusi I. Daniel , Pena Jose R. , Nopajaroonsri Charn , Kent Micheal , Smoller Bruce R.
Published: March 2003

Background:  Syringocystadenoma papilliferum (SCAP) and verrucous cyst are two uncommon benign tumors. The simultaneous occurrence of the two lesions has not been reported before.

Methods:  We report four cases of the simultaneous occurrence of the two rare lesions as so‐called collision lesions with a review of the literature.

Conclusion:  The relationship of SCAP with viral infection needs further investigation.
A continuing education programme for general practitioners
Authors: Wiskott H. W. Anselm , Borgis Serge , Simoness Michelle
Published: March 2003

In 1992, following newly issued university regulations, the board of the School of Dental Medicine of the University of Geneva decided to establish a structured continuing education course programme for practising dentists in an effort to better meet the school’s continuing education mandate. The programme started in January 1994 and was structured so that regular courses would be offered in each discipline of dentistry. The course contents were aimed at satisfying the demands of practising dentists, but it was also established that basic science issues and theoretical concepts should be included. Possible course formats were ‘conference’, ‘hands‐on’, ‘clinical’ and ‘seminar’. The courses were meant as a form of knowledge transfer from the school to the practising community, but also as a means to generate revenue for research and teaching programmes. Operative aspects were supervised by a small staff which was assisted by computer software designed to handle all procedural steps of course administration, participant registration, accounting, communication. The dentists’ responses were rewarding in that attendance was very satisfactory. Closer scrutiny of our data, however, indicates that our impact is still low since at best only 20% of the course‐hours required by the Swiss dental association are actually taken. Both course and programme evaluations were satisfactory and are discussed using the Harden and Laidlaw CRISIS criteria.