bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Necrosis at the Injection Site Induced by Low-Molecular-Weight Heparin: Case Report and Review
Authors: Santamaría A. , Romaní J. , Souto J.C. , López A. , Mateo J. , Fontcuberta J.
Published: April 2003

Heparin-induced skin necrosis at the injection site is a rare adverse effect, more commonly associated with standard heparins than with low-molecular-weight heparins (LMWH) and its mechanism remains unclear. We report a case of LMWH-induced skin necrosis in a female during prophylactic treatment with LMWH after a surgical procedure. Determination of heparin-platelet-factor-4(PF4)-induced antibodies was positive. This case describes the occurrence of LMWH-induced skin necrosis and antibodies to heparin-PF4 complex, suggesting that this effect is more frequent than previously suspected.
Linear Lichen planus in the Region of the Mandibular Nerve Caused by an Allergy to Palladium in Dental Metals
Authors: Mizoguchi S. , Setoyama M. , Kanzaki T.
Published: April 2003

We observed a case of linear lichen planus extending from the right cheek to the jaw, which was accompanied by itching and an unusual sensation in the mouth. The eruption was located along the mandible and aligned with the mandibular nerve. The right molars of the patient contained metal compounds and these were considered to be the cause of his disease. Patch testing with various dental metals showed positive reactions to palladium and platinum. A biopsy specimen showed a lichenoid reaction in the lesional tissue, and dermal contact dermatitis was noted at the palladium patch test site. His dentist reported that palladium-silver-gold or nickel-chrome alloys without platinum had been used in the crown and bridge of his molars. After removal of the dental alloys, the skin eruption resolved with some residual hyperpigmentation. In addition, the peculiar mouth sensation disappeared dramatically within 2 months.
Life Span of Skin Fibroblasts in Patients with Systemic Sclerosis
Authors: Ohtsuka T.
Published: April 2003

Background: It remains unknown whether the life span of systemic sclerosis (SSc) skin fibroblasts (FB) and that of normals are the same or not, though SSc skin FB have been shown to present abnormalities such as elevated collagen synthesis. Objective: To find out whether the life span of SSc skin FB and that of normals are the same or not. Methods: Cell generation and colony-forming efficiency were calculated in 10 normal and 7 SSc FB, and total life spans were studied. Results: Colony-forming efficiency decreased from 30 to 5% until the cells reached senescence. The cell generations of normal and SSc FB showed no significant difference. Conclusion: SSc FB is senescent and may indicate that the senescence of SSc FB is independent of its abnormal features.
Larva currens: The Usefulness of the Agar Plate Method
Authors: Iwamoto T. , Kitoh M. , Kayashima K. , Ono T.
Published: April 2003

Creeping eruption caused by Strongyloides stercoralis is called larva currens, while those caused by other parasites are called larva migrans. To detect the parasite, the direct smear method was used. However, this method is not very sensitive in detecting S. stercoralis. A 62-year-old male with polyarteritis nodosa cutanea had an erythematous creeping eruption in various regions, such as his lumbar region, abdomen and thigh. The diagnosis of larva currens was made by the clinical appearance and the detection of S. stercoralis in his feces using the direct smear method and the agar plate method. This is the first reported case of larva currens in Japan. The agar plate method was useful and more sensitive than the usual direct smear method for detecting the S. stercoralis in feces and for elucidating the effects of treatment with antiparasitic drugs.
Overlap of Reticulate Acropigmentation of Kitamura, Acropigmentation of Dohi and Dowling-Degos Disease in Four Generations
Authors: Thami G.P. , Jaswal R. , Kanwar A.J. , Radotra B.D. , Singh I.P.
Published: April 2003

A large kindred is being reported in which reticulate acropigmentation of Kitamura (RAPK) and acropigmentation of Dohi (APD) were associated with features of Dowling-Degos disease (DDD). The pedigree was traced through four generations and 50% of the members were found to be affected. RAPK, APD and DDD are inherited as an autosomal dominant trait with variable penetrance. The differentiation and overlap/association of RAPK, APD and DDD is discussed.
Alteration of Cytokine Genes and bcl-2 Expression following Immunotherapy with Intralesional IFN-γ in a Patient with Tumor-Stage Mycosis fungoides
Authors: Yamamoto T. , Takahashi Y. , Katayama I. , Nishioka K.
Published: April 2003

Background: Interferon-γ (IFN-γ) is used in the treatment of tumor stage mycosis fungoides (MF), whereas its mechanism is still unknown. We have previously shown that treatment with intralesional IFN-γ induced tumor regression. Objective: To explore the possibility that IFN-γ may alter the cytokine expression by tumor cells, we studied cytokine gene expression in a tumor nodule of MF. Methods: By using the reverse transcriptase-polymerase chain reaction, Th1- and Th2-type cytokine mRNA expression was examined before and after intralesional IFN-γ therapy. Additionally, we examined bcl-2 protein expression on tumor cells. Results: We found weak mRNA expression of interleukin-4 (IL-4) and IL-5, and strong expression of IL-6, IL-10 and IFN-γ before therapy. After successful treatment of intralesional IFN-γ, mRNA expression of IL-5, IL-6 and IL-10 were significantly reduced and IL-2 mRNA was mildly induced. Culture for 24 h of tumor cells with IFN-γ showed upregulation of IL-2 mRNA and downregulation of IL-6 mRNA expression. bcl-2 expression was significantly decreased after successful intralesional IFN-γ therapy, photochemotherapy (PUVA) and radiation therapy. Conclusion: These data suggest that IFN-γ induces tumor regression by affecting cytokine gene expression in MF tumor lesions. The reduced bcl-2 expression did not seem to be induced by a direct immunological affect of IFN-γ, but to represent a nonspecific result of tumor regression after successful treatment.
Comparison of Conventional Photographs and Telephonically Transmitted Compressed Digitized Images of Melanomas and Dysplastic Nevi
Authors: Provost N. , Kopf A.W. , Rabinovitz H.S. , Stolz W. , DeDavid M. , Wasti Q. , Bart R.S.
Published: April 2003

Background: One of the most difficult problems in the in vivo diagnosis of cutaneous tumors is the differentiation clinically between early malignant melanoma (MM) and atypical (dysplastic) melanocytic nevi (AMNs) because these lesions share clinical features. High-quality digital imaging systems and store-and-forward technology have the potential for use in a teledermatology system with which experts would be able to immediately transmit their diagnostic opinions concerning these challenging lesions. Objective: The main purpose of this study was to determine if the clinical and dermoscopic diagnoses and the dermoscopic features of AMN and early MM are unaltered after telephonic transmission of their digitized images. Methods: Conventional and dermoscopic photographic transparencies of 22 AMNs and 9 early MMs, viewed on rearview projectors and then scanned, compressed, transmitted (Internet) and viewed on color monitors, were evaluated. Results: The concordance in the diagnosis of AMN and of early MM by all four observers, both clinically and dermoscopically, when comparing rearview-projected conventional transparency slides to transmitted, compressed, digitized images, was high. For most specific dermoscopic features, the concordance was good, although less so for the presence or absence of some dermoscopic features, namely ‘dots’, ‘blue/gray’ color and ‘red’ color. Conclusion: The results reported support the conclusion that Internet transmission of digitized images of MMs and AMNs retains sufficient informativeness for diagnostic purposes. This study is a step in the creation of an international teledermoscopy network for pigmented cutaneous lesions.
Extracorporeal Photopheresis of Cutaneous T-Cell Lymphoma Is Associated with Reduction of Peripheral CD4+ T Lymphocytes
Authors: Zouboulis Ch.C. , Schmuth M. , Doepfmer S. , Dippel E. , Orfanos C.E.
Published: April 2003

Background: Extracorporeal photopheresis (ECP) has been successfully introduced for the treatment of cutaneous T-cell lymphoma; however, the mechanism(s) of its action is (are) unknown. Objective: To investigate the effects of ECP on the immune system of patients with cutaneous T-cell lymphoma. Methods: Clinical response and changes of lymphocyte subpopulations in 20 patients with cutaneous T-cell lymphoma under ECP monotherapy or combined regimens were evaluated and compared after 3, 6 and 12 ECP cycles. Results: Thirteen of 20 patients showed a ≥50% reduction of skin lesions after 6–12 ECP cycles. An overall T-lymphocyte reduction was assessed with a balanced CD4+ T-helper and CD8+ T-suppressor cell decrease in responders. In contrast, there was a trend of CD4+ T-helper cell increase in nonresponders which could result from the failure of treatment to control the natural course of the disease. The CD4+/CD8+ ratios were 1.6 at baseline and 1.4 after 12 cycles in responders, while they increased from 1.7 to 4.1 in nonresponders, respectively (p = 0.047). In addition, there was an overall decrease in the CD57+/CD8+ T-cell subpopulation mostly due to a reduction in the responder group. Conclusion: The marked differences detected in certain T-cell subpopulations suggest an effect of ECP on peripheral T lymphocytes and, especially, on CD4+ cells.
IL-13 Production by Peripheral Blood Mononuclear Cells from Patients with Atopic Dermatitis
Authors: Takamatsu Y. , Hasegawa M. , Sato S. , Takehara K.
Published: April 2003

Background: Interleukin 13 (IL-13) shares several functional properties with IL-4 and has been shown to be capable of inducing IgE synthesis. Objective: To determine whether the production of IL-13 by peripheral blood mononuclear cells (PBMC) from patients with atopic dermatitis (AD) is connected with the development of AD. Methods: We examined PBMC from 52 patients with AD and 23 healthy volunteers as controls. PBMC were cultured with or without antigen extracted either from Dermatophagoides farinae or house dust for 48 h, and then the supernatants were measured for IL-13 by competitive enzyme immuno-assay. We also examined the effect of the immunosuppressant FK506 on the production of IL-13 by antigen-stimulated PBMC from AD patients. Results: The levels of IL-13 produced by non-stimulated PBMC in AD were significantly higher than those in controls. The IL-13 levels in AD were increased after antigen stimulation and were higher than those in controls. Moreover, the enhanced production of IL-13 in AD was suppressed by FK506. Conclusion: We suggest that IL-13 may play some role in the development of AD.
Pemphigus vulgaris Associated with Silicosis
Authors: Yamagami Y. , Kohda M. , Mimura S. , Ueki H.
Published: April 2003

Pemphigus vulgaris has never before been associated with silicosis, although there are many reports of silicosis accompanied by several autoimmune diseases such as progressive systemic sclerosis, systemic lupus erythematosus, dermatomyositis or rheumatoid arthritis. We observed a patient with pemphigus vulgaris accompanied with silicosis. The patient was a 75-year-old man with a 2-month history of repeated oral erosions and blisters on the back, thighs and axillas. Histological examination showed suprabasal cleavage with acantholysis. Immunoblotting analysis demonstrated binding of the patient’s serum to the 130-kD pemphigus vulgaris antigen (desmoglein 3) and the 160-kD pemphigus foliaceus antigen (desmoglein 1). The patient has radiographically been diagnosed as having silicosis. An elevated serum IgG, antinuclear antibody, anti-ssDNA, antimicrosomal antibodies and a biologically false-positive reaction to the Wassermann test were also detected. Although the clinical symptoms improved after treatment with systemic steroids, the patient died due to pneumonia. This is the first reported case in which the characteristics of both pemphigus vulgaris and silicosis could be detected.
Classic Kaposi’s Sarcoma: Low-Dose Interferon Alfa Treatment
Authors: Tur E. , Brenner S.
Published: April 2003

Background: Classic Kaposi’s sarcoma, a rare form of cancer, has no definitive cure. A beneficial effect of low-dose interferon (IFN) alfa was indicated by some case reports. In the present report, we summarize the results of our experience with subcutaneous low-dose IFN alfa treatment of 11 patients with extensive classic Kaposi’s sarcoma and review the literature. Design: Eleven patients, 56–96 years old, were treated: 10 men, 1 woman, 3 of whom had an associated malignancy. Subcutaneous injections of IFN alfa were given, starting with 3 million units 5 times a week, and modified according to side effects and response after 2 weeks (2–6 million units, 3–6 times a week). This treatment was continued for 6 months, except for 1 patient who died after 4 months and another who stopped treatment at 4 months due to surgery but was treated again after recurrence. Treatment was continued after 6 months when a partial response was noted, but further improvement was desired (1 patient). Results: In 9 out of the 11 patients, initial response was noted after 3–13 weeks of treatment. This was manifested by a reduction of lesion size and fading of color, leading to a partial resolution. Maximum response was achieved after 4–6 months. Remission lasted 4–72 months. Recurrences were retreated, with additional remissions after only 5–8 weeks of treatment. Side effects included fever and fatigue, which were overcome by dose reduction. Conclusion: Whereas in AIDS-related Kaposi’s sarcoma patients become refractory to IFN, this was not observed in our patients with classic Kaposi’s sarcoma. Moreover, unlike AIDS-related Kaposi’s sarcoma, continuous treatment was not needed in classic Kaposi’s sarcoma, and recurrences were responsive to retreatment.
Juvenile Xanthogranuloma and Neurofibromatosis 1
Authors: Tan H.H. , Tay Y.K.
Published: April 2003

A case of juvenile xanthogranuloma associated with neurofibromatosis type 1 in a 9-month-old Chinese boy is presented. The literature concerning the association between these two conditions and juvenile chronic myelogenous leukaemia is highlighted. The patient presently has no evidence of any haematological malignancy, but requires close follow-up.
Pigmented Dermatofibrosarcoma protuberans (Bednář Tumor) Occurring in a Japanese Infant
Authors: Kaburagi Y. , Hatta N. , Kawara S. , Takehara K.
Published: April 2003

A case of pigmented dermatofibrosarcoma protuberans (Bednář tumor) occurring in a Japanese infant is reported. A 6-month-old girl developed a 16 × 10 mm erythematous tumor with a slight elevation on the lower back at 1 month of age. Histological examination revealed proliferation of spindle-shaped, fibroblast-like cells in the myxoid interstitium. Subsequently the tumor grew gradually to a red-purplish tumor measuring 45 × 36 mm. The second biopsy specimen presented hypercellular proliferation composed of spindle-shaped cells showing slight nuclear atypia and a characteristic storiform pattern, with scattered slender dendritic cells containing a large amount of brown pigment. Immunohistochemical studies of the second biopsy specimen showed that the spindle-shaped tumor cells were positive for vimentin and CD34 and negative for factor XIIIa. The number of CD34-reactive spindle-shaped tumor cells increased in the second biopsy specimen compared with the first biopsy.
Physiopathogenic Investigations in a Case of Familial Stiff-Skin Syndrome
Authors: Richard M.A. , Grob J.J. , Philip N. , Rey J. , Chamson A. , Mege J.L. , Andrac L. , Faure F. , Basseres N. , Bonerandi J.J.
Published: April 2003

Background: Stiff-skin syndrome (SSS) is a rare cutaneous syndrome characterized by stony-hard skin and limitation of joint mobility. Its cause is still unknown. Objective: Biological investigations were performed in a new case of SSS. Methods: Collagen production and DNA biosynthesis were studied from fibroblast culture. Proinflammatory cytokines (TNF-α, IL-6 and TGF-β2) were measured in the patient’s serum. Results were compared with pathological findings. Results: Collagen production and DNA biosynthesis were normal whereas the level of circulating cytokines was high. Histological examination of the skin showed mild fibrosis in the dermis whereas the fascia was not thickened. Conclusion: Our clinical and biological findings suggest that in this case, cutaneous changes may be related to an inflammatory process rather than to a primary fibroblast defect or a fascial abnormality as previously hypothesized.
Photo Koebner Phenomenon in Erythema-multiforme-Like Eruption Induced by Contact Dermatitis due to Bufexamac
Authors: Kurumaji Y.
Published: April 2003

A photo Koebner phenomenon following contact dermatitis due to bufexamac is described. A 52-year-old man presented with dermatitis on his buttocks and an erythema-multiforme (EM)-like eruption near the original lesion and on sun-exposed areas. He had been using bufexamac ointment (Anderm®) around and inside the anus for a few weeks before he noticed exacerbation. On patch testing, he exhibited severe contact sensitivity to bufexamac. Phototesting performed on his first visit showed that he had an abnormal reaction to UVB. An EM-like eruption similar to the original lesions developed around the irradiated sites. In this case, photosensitivity does not seem to be a drug-induced photoallergy due to systemic or topical use, but rather a photo Koebner phenomenon.
Congenital Ulcerated Subcutaneous Fat Necrosis of the Newborn
Authors: Hernández-Martín A. , de Unamuno P. , Fernández-López E.
Published: April 2003

A neonate, born from a mother with hypertension during the last trimester of gestation, presented with ulcerated lesions on the right lower limb that had been present since birth. The baby also had necrosis of the fifth toe of the right foot and generalized muscle hypoplasia of the entire limb. The histologic appearance of the cutaneous lesions was diagnostic of subcutaneous fat necrosis of the newborn. The congenital presence of subcutaneous fat necrosis is exceptional, and to date, ulcerated forms have not been reported in the literature.
Kaposi’s Sarcoma in a Patient with Erythroblastopenia and Thymoma: Reactivation after Topical Corticosteroids
Authors: Pérez E. , Barnadas M.A. , García-Patos V. , Pedro C. , Curell R. , Sander C.A. , Kind P. , de Moragas J.M. , Alomar A.
Published: April 2003

We report a 69-year-old female with erythroblastopenia and thymoma who developed lesions of Kaposi’s sarcoma (KS) after thymectomy, 2 months after the initiation of therapy with methylprednisolone. Control of mucocutaneous KS lesions was obtained with radiotherapy, interferon alfa-2b and withdrawal of systemic immunosuppressive therapy. Erosive oral lichen planus appeared later, and after therapy with topical corticosteroids a new lesion of KS developed that regressed after withdrawal of topical corticosteroids. The detection of HHV-8 only in lesional skin supports the hypothesis that this virus can trigger the development of KS lesions.
A Case of a Human-Papillomavirus-60-Induced Wart with Clinical Appearance of Both Pigmented and Ridged Warts
Authors: Egawa K. , Kasai S. , Hattori N. , Saeki Y. , Matsuda M. , Hino H.
Published: April 2003

Human papillomavirus (HPV) type 60 infection is histologically associated with characteristic homogeneous intracytoplasmic inclusion bodies. However, it remains unclear whether the virus is associated with cystic, pigmented or ridged plantar warts. We report a 51-year-old Japanese female with a HPV-60-induced plantar wart which showed the clinical appearance of both pigmented and ridged warts. Masson-Fontana staining revealed increased melanin granules in the epidermis of the wart. This observation suggests that HPV-60 may be associated not only with cystic warts but also with the specific morphology of ridged warts, and the biological disorder of hyperpigmentation may be controlled by additional unknown factors which differ from case to case.
Prevalence of Hepatitis C Virus Antibodies and Cryoglobulinemia in Patients with Leukocytoclastic Vasculitis
Authors: Güngör E. , Cirit A. , Alli N. , Karakayali G. , Gür G. , Artüz F.
Published: April 2003

Background: Several dermatologic manifestations of hepatitis C virus (HCV) infection have been described. The association of HCV infection, essential mixed cryoglobulinemia and leukocytoclastic vasculitis (LV) have been published mainly in case reports. Objective: The aim of the present study was to determine the prevalence of HCV infection and cryoglobulinemia in patients with LV. Methods: Twenty-five cases of LV were tested for anti-HCV antibodies by means of a third-generation enzyme-linked immunosorbent assay, and cryoglobulins were detected by the precipitation method. Thirty healthy volunteers served as control group. Results: Anti-HCV antibodies were detected in 2/25 patients with LV (8%) and none of the control group. Cryoglobulinemia was detected in 1 patient with LV and none in the control group. Conclusion: Although no significant difference between patients and the control group was detected, the prevalence of anti-HCV antibodies in LV patients is as high as 8%. Considering this, it seems reasonable to investigate the presence of HCV in unexplained cases of LV.
Effect of Topical Antioxidants on UV-Induced Erythema Formation when Administered after Exposure
Authors: Dreher F. , Denig N. , Gabard B. , Schwindt D.A. , Maibach H.I.
Published: April 2003

Background: Photoprotective effects of topically applied antioxidants when applied before ultraviolet radiation (UVR) exposure are well known. Their protective effect when applied after UVR exposure is, however, less established. Objective: In a randomized, double-blinded, placebo-controlled human study the short-term photoprotective effects of different antioxidants and of their combinations were evaluated when applied after UVR exposure. Methods: Melatonin (N-acetyl-5-methoxytryptamine), vitamin E (α-tocopherol) and vitamin C (ascorbic acid) were topically administered alone or in combination following UVR exposure as single applications (immediately or 30 min after irradiation, respectively) or as multiple applications (three times: 30 min, 1 h and 2 h after irradiation). The erythemal reaction was evaluated visually and noninvasively with bioengineering methods (skin color and skin blood flow). Results: No significant protective effect of melatonin or the vitamins when applied alone or in combination were obtained when antioxidants were applied after UVR exposure. No improved photoprotective effect was obtained when multiple applications were done. Conclusion: UVR-induced skin damage is a rapid event, and antioxidants possibly prevent such damage only when present in relevant concentration at the site of action beginning and during oxidative stress.
Comparison of Two Formulations of Cyclosporin A in the Treatment of Severe Atopic Dermatitis
Authors: Zurbriggen B. , Wüthrich B. , Cachelin A.B. , Wili P.B. , Kägi M.K.
Published: April 2003

Background: Cyclosporin A (CsA) has been shown to be highly effective in the therapy of atopic dermatitis (AD). However, little information exists on the treatment of AD patients with Sandimmun Neoral® (Neoral), a microemulsion of CsA with improved pharmacokinetic properties in comparison to Sandimmun®. Objective: We have compared the efficacy and tolerability of Sandimmun and Neoral. Methods: In a randomised, monocentric, double-blind, cross-over pilot study (n = 14), each formulation was administered for 8 weeks, followed by switching to the other treatment group for another 8 weeks. Results: After 2 weeks of therapy, the improvement under Neoral therapy was significantly higher than with Sandimmun (disease activity p = 0.047; extent of disease p = 0.016). In contrast, after 8 weeks of therapy, both formulations yielded similar improvement in the patients’ condition. Conclusion: While both formulations are effective and well tolerated in the treatment of severe AD, Neoral may have a faster onset of action and higher initial efficacy, which makes it an adequate replacement for Sandimmun.
Vogt-Koyanagi-Harada Disease: Extensive Vitiligo with Prodromal Generalized Erythroderma
Authors: Wong S.S. , Ng S.K. , Lee H.M.
Published: April 2003

The occurrence of vitiligo with prodromal erythema in Vogt-Koyanagi-Harada (VKH) disease is rarely observed. We describe a 68-year-old Chinese woman who developed extensive vitiligo 6 months after the onset of a generalized erythroderma and 12 months after the onset of acute bilateral uveitis. She also had a 4-year history of psoriatic plaques on the trunk which resolved completely without recurrence 15 months after the onset of erythroderma. The extensive cutaneous inflammation prior to the onset of vitiligo in our patient with VKH disease has not been reported before and strongly suggests an immunologic etiology for VKH disease.
Evidence of Retroviral Involvement in an Italian Patient with Ofuji’s Disease
Authors: Veraldi S. , Ferrante P. , Mancuso R. , Gianotti R. , Caputo R.
Published: April 2003

Ofuji’s disease, also known as ‘eosinophilic pustular folliculitis’, is a rare inflammatory skin disorder of unknown aetiology, which affects mostly adult Japanese males. Only few Caucasian patients have been described so far. We report the case of a 44-year-old Italian woman with Ofuji’s disease who had circulating antibodies against the recombinant envelope glycoprotein (Rgp46I) of HTLV-1. By means of a very sensitive nested PCR, the tax region of HTLV-1, but not other regions, was found in peripheral blood mononuclear cells. Our observations suggest that a retrovirus, closely related to HTLV but not yet identified, could be involved in the pathogenesis of the disease in this patient.
Cyclosporin in Atopic Dermatitis
Authors: Naeyaert J.M. , Lachapelle J.M. , Degreef H. , de la Brassinne M. , Heenen M. , Lambert J.
Published: April 2003

This paper reflects the consensus reached among Belgian professors of dermatology on the place of cyclosporin (CsA) in the treatment of atopic dermatitis (AD). Existing therapeutic modalities and ways to evaluate efficacy of treatment are reviewed briefly. Based on data from the literature and personal experience, guidelines for the use of CsA in AD are proposed. CsA can be prescribed in recalcitrant cases of AD on a short-term basis, both in adults and children. Long-term treatment, up to 1 year, should be considered only in exceptional cases that cannot be controlled by short-time therapy. Contraindications, drug interactions and necessary controls during treatment are also discussed.
Regulatory Function of Factor-XIIIa-Positive Dendrocytes in Incipient Toxic Epidermal Necrolysis and Graft-versus-Host Reaction
Authors: Hermanns-Lê T. , Paquet P. , Piérard-Franchimont C. , Arrese J.E. , Piérard G.E.
Published: April 2003

Background: Lymphocyte-poor graft-versus-host-reaction (GVHR) and toxic epidermal necrolysis (TEN) share some histological resemblance. In both diseases, factor-XIIIa-positive dendrocytes show some morphological changes, probably as a response to altered cytokine environment. Objective: To study the ultrastructural aspect of boosted dendrocytes in GVHR and TEN. Methods: Sixty GVHR and 25 TEN lesions were examined using immunohistochemistry. Among them, 6 dendrocyte-rich cases of each disease were studied by electron microscopy. Results: Dendrocyte activation with enlarged endoplasmic reticulum, and collagen fiber and mast cell granule phagocytosis were evidenced in both diseases. Depletion in dendrocytes was only encountered in a few GVHR cases exhibiting specifically a sclerotic aspect in the superficial dermis. Conclusion: Factor-XIIIa-positive dendrocytes probably play a role in the regulation of the connective tissue remodeling that may accompany epidermal destruction.
An Unusual Case of Squamous Cell Carcinoma of the Nose
Authors: Hubert A. , Gheeraert P. , Lateur N. , Sass U. , André J. , Jortay A. , Bisschop P. , Coessens B. , Song M.
Published: April 2003

A 49-year-old man presented with a tumoral lesion of the tip of the nose which had been manifest for 2 months. Within a few weeks, the tumour increased in size and became infiltrated. The biopsy showed a squamous cell carcinoma. Treatment consisted of a radical surgical excision.
The Dyshidrotic Eczema Area and Severity Index – A Score Developed for the Assessment of Dyshidrotic Eczema
Authors: Vocks E. , Plötz S.G. , Ring J.
Published: April 2003

Background: Dyshidrotic eczema of the palms and soles is a common condition, which can be rather resistant to treatment. Therapy studies and their comparability are of clinical importance. Objective: As standardized assessment methods for the severity of this particular form of eczema are lacking, we developed a severity index for dyshidrotic eczema. Methods: The Dyshidrotic Eczema Area and Severity Index (DASI) is based on the severity grade of single items – number of vesicles per square centimetre (V), erythema (E), desquamation (S) and itch (I) – and the extension of the affected area (A) and is calculated with defined score points (p) as: DASI = (pv + pE = pS + pI) × pA. Results: In two treatment studies on dyshidrotic hand eczema, the DASI was found to be a simple and useful tool to assess the severity of dyshidrotic eczema and the effect of therapy. Conclusion: The DASI needs to be further validated in larger cohorts.
Dermatophytic Granuloma Caused by Microsporum canis in a Heart-Lung Recipient
Authors: Voisard J.J. , Weill F.X. , Beylot-Barry M. , Vergier B. , Dromer C. , Beylot C.
Published: April 2003

We present a case of dermatophytic granuloma caused by Microsporum canis in a heart-lung recipient. This 66-year-old man was seen for erythematous pustules and papules on the forearm. The diagnosis was suspected after histological examination showing an inflammatory infiltrate in the upper dermis with giant cells containing intracytoplasmic fungal elements. Cultures of the skin biopsy confirmed the diagnosis identifying M. canis. Our case emphasizes the possibility of deep dermatophytic infections in immunocompromised patients. There are only 4 additional reports of M. canis infection responsible for invasion of the dermis in such patients. The follicle involvement probably explains these dermal lesions due to the progression of the dermatophyte from the hair follicle to the dermis. In our observation topical antifungal therapy alone was unsuccessful and fluconazole seems to be the treatment of choice for these M. canis invasive dermal cutaneous infections.
Optimising the Use of Tazarotene in Clinical Practice: Consensus Statement from the European Advisory Panel for Tazarotene (Zorac™)
Authors: Gollnick H.P.M. , Finzi A.F. , Marks R. , Barker J.N.W.N. , Jansen C. , Revuz J. , Saurat J.-H.
Published: April 2003

Background: This paper reports the proceedings of the European Advisory Panel Meeting for tazarotene (Zorac™), which took place in Cologne on May 7, 1998. Aim: The aim of this meeting was to discuss recommendations for the use of tazarotene based on the clinical data available and on the clinical experience of the Advisory Panel members, and to identify future research needs. Recommendations: Based on currently available data, tazarotene can be used for the treatment of chronic, stable, plaque-type psoriasis, on the trunk or limbs covering up to 20% of the body surface area. In clinical trials, patients generally experienced a clinical response within 4 weeks of starting tazarotene treatment, and improvement was maintained for up to 12 weeks after stopping therapy. Results from published and not yet published clinical trials show that the efficacy and tolerability of tazarotene can be enhanced by the addition of topical corticosteroids to the treatment regimen and that, when used in combination with broad-band UVB phototherapy, tazarotene reduces the amount of UV light required to treat plaques. Tazarotene gel is available in two concentrations, 0.05 and 0.1%. The Advisory Panel recommends that the choice of concentration should be based on factors such as the irritability of the patient’s skin and the thickness of plaques. Irritation can be managed by reducing the concentration or frequency of application, or by adding a topical corticosteroid to therapy. Tazarotene shows promise as a treatment for psoriasis in special localisations, such as the scalp, face and skin folds, although clinical studies are required.
Dermatofibroma with Granular Cells: A Report of Two Cases
Authors: Aloi F. , Albertazzi D. , Pippione M.
Published: April 2003

We describe two examples of an unusual variant of dermatofibroma (DF) in which areas of granular cells were a prominent feature. The diagnosis of DF was confirmed by immunohistochemistry and by ultrastructural studies. Granular cell changes can be observed in numerous benign and malignant cutaneous tumors of different cellular lineage. Cellular granularity is a nonspecific phenomenon characterized by intracytoplasmic accumulation of lysosomes and may cause diagnostic difficulties. Traumatic factors may be involved in the pathogenesis of cellular granularity.
Paraneoplastic Pemphigus: A Case of Long-Term Survival Associated with Systemic Lupus erythematosus and Polymyositis
Authors: Mascaró Jr. J.M. , Ferrando J. , Solé M.T. , Alsina M. , Nousari H.C. , Anhalt G.J. , Font J. , Mascaró J.M.
Published: April 2003

A 35-year-old man presented with a generalized bullous eruption and oral ulceration. He had been diagnosed as having systemic lupus erythematosus and pelvic Castleman disease (hyaline-vascular type) in the past. Histologic, direct and indirect immunofluorescence and immunoprecipitation studies confirmed a diagnosis of paraneoplastic pemphigus (PNP). Initially several medical treatments were tried unsuccessfully. The pelvic tumor was surgically removed and the mucocutaneous lesions slowly regressed. Four years after presentation, he developed polymyositis which was completely controlled with short courses of corticosteroids. There was no evidence of relapse of PNP or lupus erythematosus at that time. At the 6-year follow-up he showed no clinical evidence of PNP, lupus erythematosus or polymyositis without requiring immunosuppressive therapy. This case emphasizes the fact that patients with benign-neoplasm-associated PNP may undergo complete remission of the autoimmune disease upon complete excision of the tumor. This case also stresses the possible association of PNP with other autoimmune diseases such as lupus erythematosus and polymyositis.
Surgical Treatment of an Endovascular Metastatic Melanoma of The Superior Vena cava
Authors: Blanco Patrick , Ly Sandra , Beylot Barry Marie , Laurent François , Roques Xavier , Doutre Marie-Sylvie , Beylot Claire
Published: April 2003

A 42–year-old woman, who had undergone excision of a melanoma of her right forearm 3 years before (Breslow’s index 4.4 mm), was admitted to hospital for the evaluation of an superior vena cava syndrome. The thoracic CT scan and the phlebography showed obstruction of the superior vena cava by an endovascular tumor. Abdominal, pelvis and cranial CT scans did not reveal any other metastatic localization. Surgery with extracorporeal circulation was performed. The mass was resected and histopathologic examination confirmed the endovascular metastatic melanoma. There was no heart metastasis. The patient was then given a polychemotherapy. She was still alive after 18 months of follow-up after the initial metastasis. To our knowledge, no similar case has previously been reported and surgical treatment, as for isolated heart metastatic melanoma, may be considered for vascular metastasis, as in our case.
Unilesional Follicular Mycosis fungoides
Authors: Marzano Angelo V. , Berti Emilio , Lupica Loredana , Alessi Elvio
Published: April 2003

Follicular mycosis fungoides (FMF) is an unusual clinical and histological variant of MF, characterized by selective involvement of hair follicles by atypical lymphocytes. We describe a female patient who had follicular papules located only on the medial aspect of her right thigh. To the best of our knowledge, this patient represents the first reported case of unilesional FMF.
Vaginal Ulcers as Initial Presentation of Subacute Myelomonocytic Leukemia
Authors: Senti G. , Schleiffenbaumb B. , Dummera R.
Published: April 2003

Cutaneous disorders can allow the detection of severe systemic disease. We report the case of a woman with vaginal ulcerations. The lesions persisted despite oral antibiotics, antifungal therapy and local care. Biopsy showed an inflammatory ulcerating process with discrete vasculitis. Peripheral blood count showed thrombocytopenia and monocytosis, and bone marrow smears revealed as subacute myelomonocytic leukemia. A review of the literature indicates that genital ulcerations are not known in association with subacute myelomonocytic leukemia. In our case, the persistent vaginal ulcerations were the initial symptom of the subacute myelomonocytic leukemia.
Continuous Topical Administration of a Petrolatum Formulation by a Novel Disposable Diaper
Authors: Odio Mauricio R. , O’Connor Robert J. , Sarbaugh Frank , Baldwin Sue
Published: April 2003

Background: Diaper dermatitis is a common childhood affliction. Aiming to help reduce the prevalence of this problem, we have developed a novel diaper to deliver to the skin dermatological formulations intended to help protect the skin from overhydration and irritation. Objective: To determine the clinical benefits of a novel disposable diaper designed to deliver a petrolatum-based formulation continuously to the skin during use. Methods: Two independent, blinded, randomized clinical trials were conducted, involving an aggregate total of 391 children, 8–24 months of age. All comparisons were done versus a control diaper, identical to the test product except for the absence of the petrolatum formulation. The studies determined the effects of the novel diaper on skin erythema and diaper rash. Results: Use of the formulation-treated diaper was associated with significant reductions in severity of erythema and diaper rash compared to the control product. Conclusions: The results demonstrated the clinical benefits associated with continuous topical administration of a petrolatum-based formulation by this novel diaper. We anticipate that this advance in diaper design will contribute significantly to further reduce the prevalence and severity of irritant contact dermatitis in the diaper area.
Minocycline-Induced Lupus
Authors: Schlienger Raymond G. , Bircher Andreas J. , Meier Christoph R.
Published: April 2003

Background: Minocycline has increasingly been associated with different adverse auto-immune reactions including drug-induced lupus. Objective: To identify the scope of minocycline-induced lupus and to characterise its typical features. Methods: Comprehensive Medline and Embase search of the English and non-English literature for case reports of minocycline-induced lupus. Results: We included 57 cases of minocycline-induced lupus (mean age ± SD at onset: 21.6 ± 8.6 years, median time of exposure: 19 months, range 3 days to 6 years). All patients showed the clinical features of polyarthralgia/polyarthritis often accompanied by liver abnormalities. Twelve patients had evidence of dermatological manifestations (i.e rash, livedo reticularis, oral ulceration, subcutaneous nodules, alopecia). The ANA test was positive in all patients. Conclusion: Long-term exposure to minocycline may be associated with drug-induced lupus. Baseline and periodic liver function and ANA tests accompanied by appropriate clinical monitoring are suggested for patients receiving long-term minocycline therapy.
Airborne Occupational Allergic Contact Dermatitis from Triglycidyl-p-Aminophenol and Tetraglycidyl-4,4`-Methylene Dianiline in Preimpregnated Epoxy Products in the Aircraft Industry
Authors: Kanerva Lasse , Jolanki Riitta , Estlander Tuula , Henriks-Eckerman Maj-Len , Tuomi Marja-Leena , Tarvainen Kyllikki
Published: April 2003

Background: Very little is known about allergic contact dermatitis (ACD) from preimpregnated epoxy products (prepregs). Objective: To describe a patient with occupational ACD from prepregs, and report new quantitative data on the content of prepregs. Methods and Results: A laminator developed work-related vesicular hand dermatitis. He worked in an aircraft plant assembling aircraft parts, being exposed to preimpregnated carbon fiber and fiberglass sheets (prepregs), and epoxy adhesive tapes and foams. Triglycidyl-p-aminophenol (TGPAP; 1–0.25%, 2+; 0.05%, 1+) and tetraglycidyl-4,4`-methylene dianiline (TGMDA; 1%, 3+; 0.5–0.05%, 2+) provoked allergic patch test reactions, whereas o-diglycidyl phthalate was negative (1–0.05% pet) and standard epoxy provoked a weak (?+) reaction. Six prepreg products provoking allergic patch test reactions were analyzed for their TGPAP, TGMDA and diglycidyl ether of bisphenol A (DGEBA) content using gas and liquid chromatographic methods, showing up to 10% of TGPAP, 19% of TGMDA and 5% of DGEBA in the prepregs. An epoxy primer contained 61% of TGPAP. Conclusion: TGPAP and TGMDA caused occupational ACD. These chemicals need to be used when patch testing patients are exposed to prepregs, because patch testing with DGEBA may be negative.
A Case of Pencil Core Granuloma with an Unusual Temporal Profile
Authors: Hatano Yutaka , Asada Yuji , Komada Shinji , Fujiwara Sakuhei , Takayasu Susumu
Published: April 2003

The patient is a 47-year-old female with a bluish tumor resembling malignant melanoma at the macroscopic level on the medial aspect of her left big toe. The patient had crushed a pencil with this toe about 30 years previously and, since then, a bluish lesion had been present. About 15 years ago, the lesion had suddenly increased in size over the course of a few months. Subsequently, the size of the lesion had not changed noticeably. Ultrasonography, but not magnetic resonance imaging was a helpful preoperative examination to distinguish the lesion from malignant melanoma. The excised lesion contained a piece of material that resembled pencil lead and bluish mud. X-ray microanalysis of the lead-like material revealed that its composition was similar to that of pencil lead. Histologic examination showed features of foreign-body reaction, except for necrotic change and few histiocytes.
Instrumental Measurement of the Mantoux Test: Differential Effects of Tuberculin and Sodium Lauryl Sulphate on Impedance Response Patterns in Human Skin
Authors: Nyrén Miruna , Hagströmer Lena , Emtestam Lennart
Published: April 2003

Background and Objective: The tuberculin (PPD) test is a model reaction for the cell-mediated immune system of the skin. The aim of this study is to compare the non-invasive technique based on electrical impedance for investigation of the tuberculin test with an irritant contact reaction induced by sodium lauryl sulphate, which has already been carefully evaluated using this method. Methods: 0.1 ml of PPD (2 TU) was injected intracutaneously into the volar forearms of 20 adult healthy subjects, all known to be tuberculin sensitized. Assessments were performed 3 and 7 days after the injections, using visual scoring, a new electrical impedance technique and transepidermal water loss (TEWL). Results: In the 16 cases that completed the study, compared to relevant controls and reactions induced by sodium lauryl sulphate statistically significant changes in 3 of the 4 impedance indices were found: both the means of index MIX and index IMIX increased (p ≤ 0.01) and the mean of index PIX decreased (p ≤ 0.05). Furthermore, similar impedance response patterns occurred in another cell- mediated immune reaction that we have studied previously – namely, the allergic contact reaction induced by nickel sulphate. Unlike the irritant reactions, no significant increase in TEWL values in tuberculin reactions were found. This can be explained by the fact that the epidermis is little affected, since the inflammatory process in the tuberculin reaction is located more deeply in the dermis than with the irritant reaction. Conclusion: The current study strongly indicates that electrical impedance in the described version, besides contact dermatitis, also seems suitable for studies of the tuberculin reaction. This will add a new indication for the technique, and studies of further clinical applications are in progress.
Phytobezoar: A Rare Cause of Intestinal Obstruction
Authors: Rubin Moshe , Shimonov Mordechai , Grief Franklin , Rotestein Zeev , Lelcuk Shlomo
Published: April 2003

Phytobezoar is a well-known although uncommon cause of mechanical alimentary tract obstruction, mainly in patients who have undergone previous gastric operation. Between January 1988 and March 1995, we operated on 14 patients with gastrointestinal obstruction due to phytobezoar. Eleven patients (78.6%) had undergone previous gastric operation and in all of them the diagnosis was made at the time of surgery. All admissions were during winter: supposedly because of the seasonal increase in intake of citrus fruits and persimmons. During the 7-year study period, we observed an unexpected increase in the incidence of this disorder. During the first 4 years we treated 2 patients (14.3%), an average of 0.5 patients a year, whereas during the last 3 years we operated on 12 patients (87.7%), an average of 4 patients a year. The recent increase in small-bowel obstruction secondary to phytobezoars may at least in part be explained by a major immigration wave from the former USSR. These immigrants have become exposed to an abundance of cheap fruits such as citrus and persimmons that were not available in their home country. The large consumption and the failure of information regarding the risks of consuming these fruits in association with previous gastric surgery may have played a major role in the recent increase of the incidence. Since phytobezoars may play increasingly an important role in the future due to the ingestion of great quantities of different fruits containing great amounts of cellulose, these findings call for restriction of citrus fruit and persimmons in patients who have undergone gastric surgery.
Surgical Treatment of Pancreatic Metastases from Renal Cell Carcinomas
Authors: Butturini Giovanni , Bassi Claudio , Falconi Massimo , Salvia Roberto , Caldiron Erminia , Iannucci Antonio , Zamboni Giuseppe , Graziani Rossella , Procacci Carlo , Pederzoli Paolo
Published: April 2003

Pancreatic metastases from a renal cell carcinoma are rare and may occur long after manifestation of the primary disease. Resection of the metastases should be regarded as the best treatment. In our center, owing to the slow evolution of these secondaries, we perform resections capable of limiting the destruction of the pancreatic parenchyma as far as possible. The use of ‘atypical’ resections of the pancreas is characterized by a higher incidence of postoperative complications, particularly fistulas. Despite this, we believe that adjusted resection is to be advocated because of the possibility of additional remote secondaries, the shorter duration of surgery, the preservation of the glandular parenchyma and intact adjacent organs, such as duodenum, stomach, and spleen, and the fact that there have been no reports on local recurrences.