bluuebunny/crossref_metadata_2025 huggingface dataset:
Corticosteroid-Induced Pancreatitis in Patients with Autoimmune Bullous Disease: Case Report and Prospective Study
Authors: Yoshizawa Y. , Ogasa S. , Izaki S. , Kitamura K.
Published: April 2003

Corticosteroid pulse therapy using very high doses may produce corticosteroid-induced pancreatitis (CIP) that is unexpected during conventional oral corticosteroid therapy and may sometimes be fatal. Our goal was to evaluate the relation between pulse corticosteroid administration and pancreatitis. A case of CIP is reported, and a prospective study was performed. Corticosteroid pulse therapy followed by 30 mg prednisolone orally was utilized in 7 hospitalized patients with autoimmune bullous disease, and serum pancreatic enzymes were measured during therapy. The case report revealed reproducible pancreatitis in a dose-dependent manner after 2 corticosteroid regimens. In the prospective study, serum pancreatic enzyme levels increased significantly within several days after pulse therapy, then decreased with tapering of the dose of oral prednisolone. Laboratory pancreatic alterations appear to be induced within days after pulse corticosteroid administration in a dose-dependent manner: less than 25 mg of oral prednisolone may be below threshold to alter the pancreatic enzyme level.
Photosensitivity with Sulfasalazopyridine Hypersensitivity Syndrome
Authors: Bouyssou-Gauthier M.-L. , Bédane C. , Boulinguez S. , Bonnetblanc J.-M.
Published: April 2003

Five weeks after the start of treatment with an association of sulfasalazopyridine and piroxicam, a 30-year-old woman presented with an eczematous eruption in light-exposed areas, hepatomegaly and fever (38°C). Laboratory studies showed leukocytosis, eosinophilia and hepatic cytolysis. Treatment consisted of withdrawing the two drugs and topical steroids. The clinical signs regressed in 6 days. An increase in eosinophilia and hepatic cytolysis was observed until the tenth day, after which the trend reversed. Laboratory parameters were normal on the twentieth day. One month later, photopatch testing was performed. A patch test with sulfanilamide irradiated with UVA was positive. Clinical and laboratory findings were highly suggestive of drug hypersensitivity syndrome. The positive result from the UVA photopatch test with sulfanilamide suggests that sulfasalazopyridine was involved in the occurrence of hypersensitivity syndrome in our patient. We conclude that photodistributed eruptions can be observed in drug hypersensitivity syndrome with photosensitizing drugs.
Transfusion-Associated Graft-versus-Host Disease: An in situ Hybridization Analysis of the Infiltrating Donor-Derived Cells in the Cutaneous Lesion
Authors: Tanei R. , Ohta Y. , Ishihara S. , Katsuoka K. , Yokono H. , Motoori T.
Published: April 2003

Background: Acute graft-versus-host disease (GVHD) can occur after a blood transfusion. Objective: In order to elucidate the pathomechanisms responsible for transfusion-associated GVHD, infiltrating donor-derived cells in a cutaneous lesion were analyzed. Methods: A skin sample obtained from a 69-year-old woman who developed fatal GVHD after blood transfusions from male donors was studied by performing in situ hybridization (ISH) with a Y-chromosome-specific probe. Results: The cell infiltrates comprised mainly CD3+ T lymphocytes. Immunohistochemistry and ISH in combination demonstrated that 99% (182/184) of the Y-body-positive cells were CD3+. Y bodies were observed in 80% of the CD8+ cells in the epidermis and dermoepidermal junction and in 77 and 45% of the CD8+ and CD4+ cells, respectively, in the dermis. Conclusion: These findings suggest that both CD4+ and CD8+ cells of donor origin were involved in the development of cutaneous GVHD.
Mycosis fungoides in Patients under 20 Years of Age: Report of 7 Cases, Review of the Literature and Study of the Clinical Course
Authors: Quaglino P. , Zaccagna A. , Verrone A. , Dardano F. , Bernengo M.G.
Published: April 2003

Background: Mycosis fungoides (MF) is rare in young patients. Its clinical behavior is still uncertain, as some reports have suggested that it has a more aggressive course than does the adult-onset type. Aim: To ascertain if early-onset MF represents a heterogeneous group of cutaneous T cell lymphomas. Materials and Methods: Clinical, immunohistopathological and follow-up data of early-onset (<20 years of age) MF cases reported in the literature (n = 42) plus 7 described herein were compared with those of a cohort of adult-onset MF patients (n = 252) diagnosed at our institution since 1975. Results: The majority of the 49 early-onset MF patients had patch-plaque stage disease at diagnosis. Ten had hypopigmented lesions. The predominant phenotype was CD3+ CD4+CD7–CD8–. Seven patients had a stage progression, 6 with extracutaneous involvement. Five- and 10-year survival rates were 93 and 74%, respectively. Conclusions: No statistically significant differences were found in the disease course between early- and adult-onset MF.
Effects of Cyclosporin A on Immune Activation Markers in Patients with Active Psoriasis
Authors: Economidou J. , Barkis J. , Demetriou Z. , Avgerinou G. , Psarra K. , Degiannis D. , Vareltzidis A. , Katsambas A.
Published: April 2003

Background: Psoriasis is a T-cell mediated autoimmune disease. The objective of this work was to investigate the presence of cellular and soluble activation molecules in the blood of patients with psoriasis, not responding to local treatment and to study the effect of cyclosporin A (CsA) on these markers. Methods: Twenty-seven patients and 30 healthy controls were included in the study. The results were evaluated at baseline and at 15 days, 3, 6 and 12 months following initiation of treatment. Results: We found increased baseline values of lymphocytes and cells expressing the marker CD3+CD25+, CD54+ (ICAM-1) and CD58+ (LFA-3). Following CsA treatment, a significant decrease in the percentage of activated T cells expressing CD3+CD25+ and CD3+HLA-DR+ was noted at 6 and 12 months. Among the soluble factors studied, increased baseline serum levels of sIL-2R, sCD23 and neopterin were observed. CsA significantly reduced the levels of sIL-2R and IL-12. Conclusion: Although there is evidence for systemic immune activation in psoriasis, sIL-2R is the most consistently increased activation marker, related to the Th1 immune response, that may be used as a marker for monitoring disease activity and response to treatment with CsA in psoriatic patients.
Successful Treatment of Subcorneal Pustular Dermatosis (Sneddon-Wilkinson Disease) by Acitretin: Report of a Case
Authors: Marlière V. , Beylot-Barry M. , Beylot C. , Doutre M.-S.
Published: April 2003

We report a case of subcorneal pustular dermatosis (SPD) first treated with dapsone with poor response. Dapsone was changed to acitretin, which dramatically improved the lesions in a few days. Dapsone is the first-line treatment in SPD, but it may be ineffective in some cases and its toxicity is important. Therapeutic alternatives are limited and less effective (systemic corticosteroids, phototherapy). Our observation underlines the usefulness of retinoids, when dapsone is ineffective or poorly tolerated. Their effectiveness is comparable, but they are effective more rapidly and are better tolerated. A dose maintenance is necessary to avoid relapses. Their action in SPD remains unclear but may be due to the inhibition of neutrophil functions.
Nevoid Bag-Like Soft Fibromas
Authors: Worm M. , Skarabis W. , Audring H. , Sterry W. , Kolde G.
Published: April 2003

True nevi and nevoid disorders are defined as visible, circumscribed and long-lasting lesions of the skin, reflecting genetic mosaicism. We report on a 17-year-old young man presenting with large pedunculated soft fibromas restricted to a circumscribed area of the right abdomen. We suggest that these nevoid bag-like soft fibromas represent a new malformation in the heterogenous group of nevoid tumors.
Anaphylactic Shock Reaction to Dibutyl-Phthalate-Containing Capsules
Authors: Gall H. , Köhler A. , Peter R.U.
Published: April 2003

We report on a patient who was taking a Gelomyrtol forte capsule, a mucosecretolytic herbal product, to treat an infection of the upper respiratory tract. Itching, urticaria and respiratory distress occurred after 20 min which culminated in anaphylactic shock. Prick tests were carried out with the individual substances from Gelomyrtol forte capsules. Dibutyl phthalate produced a strong positive result. It is used as a plasticizer in films covering tablets, dragées and capsules. As a triggering agent of anaphylactic reactions to drugs, the auxiliary materials, e.g. dibutyl phthalate, should also be taken into consideration.
Effect of Gentian Violet, Corticosteroid and Tar Preparations in Staphylococcus-aureus-Colonized Atopic Eczema
Authors: Brockow Knut , Grabenhorst Petra , Abeck Dietrich , Traupe Bernd , Ring Johannes , Hoppe Udo , Wolf Florian
Published: April 2003

Background: In atopic eczema (AE), skin colonization with Staphylococcus aureus plays a possible role in the pathophysiology of the disease. Methods: Thirty-eight patients with AE were screened for their cutaneous colonization with S. aureus. The antibacterial and clinical efficacy of topical therapy with the antiseptic dye gentian violet, a potent glucocorticosteroid or a tar solution (liquor carbonis detergens) was evaluated in vivo in 21 patients with a density of >104 CFU/cm2 and in vitro. Skin sites were treated twice daily for 4 days with the active drug or a corresponding control. Quantification of S. aureus was done daily during therapy as well as 3 days thereafter. The severity of the lesions was rated by a regional SCORAD. Results: In gentian-violet-treated skin, bacterial density decreased significantly in lesional (p < 0.001) and unaffected skin (p < 0.001). Bacterial densities did not decrease during therapy with glucocorticosteroid or liquor carbonis detergens but dropped afterwards. All therapeutics reduced the severity score, reduction being greatest for the glucocorticosteroid and lowest for liquor carbonis detergens. In vitro, a high antibactericidal efficacy was demonstrated only for gentian violet. Conclusions: Antibacterial therapy with gentian violet not only reduces S. aureus dramatically, but also reduces the severity of the eczema. Reduction of S. aureus after therapy with glucocorticosteroids and LCD seems to be secondary to improvement of the skin condition.
The Use of Itraconazole to Treat Cutaneous Fungal Infections in Children
Authors: Gupta Aditya K. , Nolting Siegfried , de Prost Yves , Delescluse Jacques , Degreef Hugo , Theissen U. , Wallace Robert , Marynissen Greet , De Doncker Piet
Published: April 2003

Background: Cutaneous mycoses such as tinea capitis, onychomycosis and some cases of tinea corporis/cruris, and tinea pedis/manus require oral antifungal therapy. There is relatively limited data regarding the use of the newer oral antifungal agents, e.g. itraconazole, in the treatment of these mycoses in children. Objective: We wished to determine the efficacy and safety of itraconazole continuous therapy in the management of cutaneous fungal infections in children. Methods: Children with cutaneous mycoses were treated with itraconazole in an open-label manner in 4 studies. For tinea capitis, the treatment regimens using itraconazole continuous therapy were: study 1, 3 mg/kg/day for 4 or 8 weeks; study 2, 5 mg/kg/day for 6 weeks, and study 3, 5 mg/kg/ day for 4 weeks. In a different trial, study 4, itraconazole continuous therapy 5 mg/kg/day was used to treat toenail onychomycosis (duration: 12 weeks), tinea corporis/ cruris (duration: 1 week) and tinea pedis/manus (duration: 2 weeks). Results: The efficacy rates at follow-up 12 weeks from the start of therapy in children with tinea capitis treated using the itraconazole continuous regimen were: clinical cure (CC) and mycological cure (MC) in study 1 (n = 10, Trichophyton violaceum all patients), CC 50%, MC 86%; in study 2 (n = 35, Microsporum canis 22 patients, Trichophyton sp. 12 patients), CC 82.8%, MC 80%, and in study 3 (n = 16, M. canis 11 patients, Trichophyton sp. 5 patients), (CC 66.7%, MC 78.5%. Itraconazole was also effective in the treatment of dermatomycoses in 24 children (study 4). The CC and MC rates at the follow-up 8 weeks from the start of therapy in children with dermatomycoses and 12 months in children treated for onychomycosis were: onychomycosis (n = 1, T. rubrum), CC 100%, MC 100%; tinea corporis (n = 12, M. canis 10 patients), CC 100%, MC 90%; tinea cruris (n = 3, Trichophyton sp. 2 patients), CC 100%, MC 100%; tinea manus (n = 1, T. rubrum), CC 100%, MC 100%, and tinea pedis (n = 7, T. rubrum), CC 100%, MC 100%). Adverse effects consisted of a cutaneous eruption in 1 (1.2%) of the 85 children, with mild, transient, asymptomatic elevation of liver function tests (less than twice the upper limit of normal) in 2 (3.4%) of 58 children in whom monitoring was performed. Conclusions: Itraconazole is effective and safe in the treatment of tinea capitis and other cutaneous fungal infections in children.
Mutilating Facial Sarcoidosis
Authors: Dumitrescu S.M. , Schwartz R.A. , Baredes S. , Whitworth J.A. , McDonald R. , Zarbin M. , Langer P. , Ho A. , Lambert W.C.
Published: April 2003

We report a patient with massive facial sarcoidosis. While skin involvement is a common manifestation of sarcoidosis, it is unusual to see it in the dramatic form of cutaneous tumors with mutilation of the central face. There are few reports of tumoral cutaneous sarcoidosis like that of our patient.
Does Mountaineering Increase the Incidence of Cutaneous Melanoma?
Authors: Moehrle Matthias , Garbe Claus
Published: April 2003

Exposure to ultraviolet radiation is considered a major risk factor for the development of cutaneous melanoma. In white populations in Australia or the USA, the melanoma incidence increases with the vicinity of residence to the equator. In Europe decreasing incidence rates towards southern countries may be due to the darker pigmentation of the Mediterranean population. The comparison of age-standardized incidence rates (world standard population) in Europe shows that Swiss cancer registries and the Austrian Tyrol registry have much higher incidence rates for cutaneous melanoma than other Central European cancer registries. The excess of Swiss/Austrian incidence rates is even more pronounced when head localization is analysed separately. Due to the altitude-related increase in UV radiation two possible explanations for the Swiss/Austrian excess rates may be considered: firstly, as a result of the altitude of residence, higher UV exposure is generally present in these countries; secondly, mountaineering activities may additionally increase UV exposure.
Efficacy of Topical Application of Eosin Compared with Zinc Oxide Paste and Corticosteroid Cream for Diaper Dermatitis
Authors: Arad Ariela , Mimouni Daniel , Ben-Amitai Dan , Zeharia Avraham , Mimouni Marc
Published: April 2003

Background: Corticosteroids, zinc paste and eosin 2% are well-known topical agents for the treatment of moderate to severe diaper dermatitis. Among these treatments, the aqueous solution of eosin 2% is extensively used in several European countries, but not in the USA or Israel. Objective: To assess the therapeutic efficacy of eosin 2% solution compared to the other treatment modalities for diaper dermatitis. Methods: Fifty-four infants with diaper dermatitis, recruited from hospital wards and community clinics, were randomly assigned to three treatment groups: zinc oxide paste (containing allantoin 0.5%, cod liver oil 17% and zinc oxide 47epercnt;); clobetasone butyrate 0.05%, and aqueous solution of eosin 2%. The severity of the disorder was graded on a 6-point scale by observation and quantitative measurement of the lesions. The groups were compared for rates and time to heal. Due to the red color of eosin, a double-blind controlled study was impossible. Results: Following 5 days of treatment, the rate of complete healing in the group treated with eosin (61%) was significantly higher (p = 0.0479) than that in the zinc oxide paste and corticosteroid groups (22 and 33%, respectively). Furthermore, in cases of partial healing, the degree of improvement was higher in the eosin group than the other two (p = 0.0205). The fastest improvement was observed in the group treated with corticosteroid cream. Conclusion: Considering the potential hazards of topical corticosteroids and the greater overall efficacy of eosin 2% solution, we suggest that eosin is the preferred treatment for diaper dermatitis.
Two Cases of Cutaneous Apocrine Ductal Carcinoma of the Axilla
Authors: Katagiri Y. , Ansai S.
Published: April 2003

We report 2 cases of cutaneous apocrine ductal carcinoma (CADC) of the axilla in a 64- and a 54-year-old male. Histological examination revealed 2 solid, ductal and glandular tumors with decapitation secretion. Tumor cells showed cellular and nuclear atypism, and infiltrative growth of tumor cell nests was also observed. Although there were no characteristic features of extramammary Paget’s disease on the overlying skin, case 1 exhibited a typical Paget’s phenomenon. We concluded that the Paget’s phenomenon of case 1 was a result of upward extension of the tumor in the dermis. The neoplastic cells of both cases were immunohistochemically positive for gross cystic disease fluid protein, lysozyme, CD15 and carcinoembryonic antigen but negative for S-100 protein. Based on these findings, we concluded that these tumors were cutaneous apocrine ductal carcinomas. There was no evidence of tumor remnants in the axilla, and the patients have shown no signs of local recurrence or metastasis. We also reviewed the literature and summarize here the clinical features of CADC.
A Case of Acral Darier’s Disease
Authors: Romano C. , Massai L. , Alessandrini C. , Miracco C. , Fimiani M.
Published: April 2003

A sporadic case of acral Darier’s disease in a 20-year-old woman is reported. The disease was diagnosed on the basis of clinical, histological and ultrastructural data. Only few cases of exclusively acral clinical manifestations of Darier’s disease have been described in the literature.
Kaposi’s Sarcoma after Lung Transplantation in a Sephardic Jewish Woman
Authors: Kantor Rami , Mayan Haim , Shalmon Bruria , Reichert Nira , Farfel Zvi
Published: April 2003

One of the four types of Kaposi’s sarcoma (KS), KS after organ transplantation under immunosuppression, is a well-known entity and has been abundantly described in renal, heart and liver recipients. We report the second case of cutaneous KS after lung transplantation, under regular immunosuppression, in a Sephardic Jewish woman. This case, when added to the other 10 cases of posttransplantation KS reported from Israel, all being Sephardic Jews, indicates that in Israel, Sephardic Jews are at higher risk than Ashkenazi Jews to develop posttransplantation KS. This observation should be added to the well-known increased risk of Ashkenazi Jews to develop classic KS. Moreover, in Israel Ashkenazi Jews develop classic KS at higher rates than Sephardic Jews. This apparent discrepancy in the ethnic distribution between Sephardic and Ashkenazi Jews in classic versus posttransplantation KS may shed light on the pathogenesis of KS in general.
Pigmentation and Pits at Uncommon Sites in a Case with Reticulate Acropigmentation of Kitamura
Authors: Sharma R. , Chandra M.
Published: April 2003

Reticulate acropigmentation of Kitamura is now reported from all over the world. Additional features are being readily recognized. Our cases had pigmentation and pits on the dorsa of the distal phalanges of the fingers and toes – the classical features – as well as widely distributed pits on the palms, palmar aspect and sides of the fingers. The involvement in our cases was more pronounced than in the previously reported ones.
A Peculiar Sequence Motif in the Alpha-1-Domain of the HLA-C Molecule in Psoriasis
Authors: Brazzelli V. , Quaglini M. , Martinetti M. , Nolli G. , Salvaneschi L. , Cuccia M. , Borroni G.
Published: April 2003

Background: Most immunogenetic studies restrict the location of the susceptibility gene for psoriasis to the HLA-C locus. Objective: The present study evaluates the amino acid sequences of the HLA-C binding groove associated with the disease in a restricted population of Italian descent: Pavia, Northern Italy. Method: Forty patients, affected by psoriasis, underwent genomic analysis of exons 2 and 3 of the HLA-C gene by means of the PCR-SSP technique. Results: The HLA-C*0602 gene frequency was significantly higher in patients with respect to 122 sex-, age- and ethnically matched controls (25 vs. 8.6%, χ2 = 14.65, p = 0.000129). This frequency rose to 39.5% in patients with a family history positive for psoriasis. In particular, 4 amino acid substitutions were shown to be crucial for the predisposition to the disease, namely Ala 73 and Asn 77 (located in the C pocket of the antigen binding groove), Lys 80 in the F pocket and Asp 90 in the outer loop of the molecule. This peculiar motif, entirely located in the α1-domain of the HLA-C molecule, was characteristic of psoriatic patients being present in 77.5% of the cases against the 50.82% of controls (χ2 = 8.77; p = 0.0031). Homozygosity for the amino acids considered at these residues was found in 15% of patients and in 0% of controls (χ2 = 20.74, p = 0.0000053). Conclusion: The most important results emerging from this study indicate that Ala 73, Asn 77, Lys 80 and Asp 90 together form a motif restricted to few pathogenic peptides to be studied in the near future.
Detection of Herpes simplex Virus DNA in Non-Herpetic Areas of Patients with Eczema herpeticum
Authors: Amatsu A. , Yoshida M.
Published: April 2003

Background: Patients with atopic dermatitis may develop a widespread cutaneous herpes simplex virus (HSV) infection called eczema herpeticum. Objective: We examined the possible routes of indirect HSV dissemination in 10 patients with eczema herpeticum, although direct spread of HSV is the most likely route of infection. Methods: Specimens were collected from hands and ‘non-herpetic’ areas (i.e. without eczema herpeticum), with or without eczematous and/or erythematous lesions of atopic dermatitis, of 10 patients with eczema herpeticum. We tried to detect HSV DNA in the samples by polymerase chain reaction. Results: HSV DNA was frequently detected on both hands and on cutaneous surfaces clinically free of eczema herpeticum. These patients had scratched such lesions because of itching. Moreover, they had taken baths the day before the examination. Conclusion: These results suggest that there may be two routes of indirect transmission of this virus, namely via manual scratching of herpetic lesions or via a contaminated bath towel or item of underwear.
Strontium Nitrate Decreased Histamine-Induced Itch Magnitude and Duration in Man
Authors: Zhai H. , Hannon W. , Hahn G.S. , Harper R.A. , Pelosi A. , Maibach H.I.
Published: April 2003

Background: Previous studies have demonstrated that strontium salts have a potent and broad ability to suppress sensory irritation. Objective: To ascertain the possible antipruritic effects of topical strontium salts, we conducted a double-blind randomized study to evaluate the effect of 20% strontium nitrate on itch magnitude (intensity) and duration. Methods: In 8 human subjects, strontium nitrate was applied to the volar forearm and vehicle control to the contralateral volar forearm for 30 min; both substances were reapplied for an additional 5 min. Itch was then experimentally induced by intradermal injection of histamine. Itch magnitude was rated each minute for the first 20 min using a visual analogue scale (VAS). Itch duration in minutes was also recorded. Results: Strontium nitrate, in comparison to its vehicle control, significantly shortened itch duration from 28.1 ± 5.4 min (mean ± SEM) to 18.5 ± 4.2 min (p < 0.01) and reduced itch magnitude at time points 12–20 min and overall (p < 0.05). Conclusion: Strontium nitrate may act as a topical antipruritic agent in reducing histamine-mediated itch.
A Figurate Papulosquamous Variant of Inflammatory Vitiligo
Authors: Lee Dennis , Lazova Rossitza , Bolognia Jean L.
Published: April 2003

The classic description of inflammatory vitiligo is an erythematous rim at the periphery of a patch of hypopigmented or depigmented skin. The histological correlate is a superficial perivascular infiltrate of mononuclear cells. However, we observed a 61-year-old patient with inflammatory vitiligo who had thin solid pink scaly plaques as well as serpiginous lesions with fine scale. Histologically, a lichenoid infiltrate was seen as was a thickened stratum corneum with parakeratosis. In a review of the literature, scattered case reports of similar findings were identified, either in the Japanese and French literature or from over 25 years ago. The clinical and histological spectrum of inflammatory vitiligo should be expanded to include solid and annular papulosquamous plaques as well as lichenoid infiltrates with exocytosis.
A Case of Viral Warts with Particular Fibrillar Intracytoplasmic Inclusion Bodies
Authors: Egawa K. , Honda Y. , Ono T. , Kitasato H.
Published: April 2003

A new type of skin wart was observed in a Japanese patient. It was characterized by intracytoplasmic inclusions with a ‘fibrillar’ structure which were distinct from previously described wart-associated inclusions. The papillomavirus (HPV)-group-specific antigen could be detected, but DNA hybridization and PCR amplification using probes or PCR primers specific for the main skin HPV genotypes (including HPV-63 which is also associated with ‘filamentous’ inclusions) were negative. We consider that this cytopathic effect could correspond to an HPV genotype which has not yet been characterized.
Cytomegalovirus Infection in Normal and Immunocompromised Humans
Authors: Drago Francesco , Aragone Maria Grazia , Lugani Cesare , Rebora Alfredo
Published: April 2003

Although cytomegalovirus (CMV) disease is a severe complication among immunocompromised patients, its cutaneous features have not been reported frequently. CMV belongs to the Herpesviridae family sharing with the other members the ability to remain latent in their natural hosts after an initial infection and to produce overt disease in several settings. The natural history of human CMV infection is characterized by primary infection, latent infection and reinfection. This article reviews the extremely variable aspects of the clinical presentation of CMV infection in normal and immunocompromised humans, focusing on the dermatological manifestations, and indicates the laboratory tests for detecting CMV responsibility in skin disorders.
Multiple Familial Basal Cell Carcinomas Including a Case of Segmental Manifestation
Authors: Guarneri Biagio , Borgia Francesco , Cannavò Serafinella Patrizia , Vaccaro Mario , Happle Rudolf
Published: April 2003

Background: A tendency to develop multiple basal cell carcinomas at an early age is a characteristic feature of some rare hereditary disorders; moreover, multiple basal cell carcinomas are sometimes observed as a corollary of familial basaloid follicular hamartomas or familial multiple trichoepitheliomas. Observation: We report 3 cases of multiple basal cell carcinomas involving 3 successive generations of a family, with a segmental manifestation of lesions in one of these patients. No additional cutaneous or extracutaneous anomalies were found. Conclusions: We hypothesize that a gene mutation may have caused the tumors observed in this family as an autosomal dominant trait. The segmental arrangement of tumors may reflect loss of heterozygosity: at an early stage of embryogenesis, a postzygotic mutation would give rise to a population of cells either homozygous or hemizygous for the underlying gene. The segmental arrangement following the lines of Blaschko would visualize the dorsoventral proliferation of a cell clone characterized by loss of the corresponding normal allele.
Anal Verrucous Carcinoma and Penile Condylomata acuminata
Authors: Lu S. , Bodemer W. , Ostwald C. , Barten M. , Zimmermann R. , Seipp C. , Gross G.
Published: April 2003

A 50-year-old man presented with recurrent tumorous lesions on the penis and the anal region. The anal lesion was histologically diagnosed as verrucous carcinoma (VC) and the penile lesions were in line with condylomata acuminata. Samples taken from tumors of both sites were human papillomavirus (HPV) DNA positive. Two of them taken from the penis and the perianal region scored HPV DNA 6 positive by using polymerase chain reaction and the Southern blot method. Treatment of both VC and condylomata acuminata consisted in surgery and adjuvant immune therapy. Neither tumor recurrence nor metastases occurred up until 6 months after therapy.
Recurrent Neutrophilic Eccrine Hidradenitis in an HIV-1-Infected Patient
Authors: Bachmeyer C. , Reygagne P. , Aractingi S.
Published: April 2003

Most cases of neutrophilic eccrine hidradenitis (NEH) have been reported in patients receiving chemotherapy for acute myelogenous leukemia or other malignant diseases. We report the case of an HIV-1-infected patient who presented several and strikingly similar episodes of NEH without any medication as well as another one after the first course of chemotherapy for a B-cell non-Hodgkin’s lymphoma. This case strengthens the hypothesis that NEH may occur in different situations, as reported for other neutrophilic dermatoses.
Three Cases of Cutaneous Sarcoidosis: Search for Bacterial Agent by the 16S RNA Gene Analysis and Treatment with Antibiotics
Authors: Toutous-Trellu L. , Ninet B. , Rohner P. , Auckenthaler R. , Saurat J.-H. , Pechère M.
Published: April 2003

Background: The aetiology of sarcoidosis remains controversial. An infectious origin is often discussed, but only anti-inflammatory or immunosuppressive treatment is recommended. Objectives: To investigate the hypothesis of bacterial origin by treating cutaneous sarcoidosis with antibiotics. Methods: Patients with chronic cutaneous sarcoidosis, unresponsive to the usual treatment and not requiring systemic corticotherapy, were given combined antibiotherapy for 6 months. Search for bacterial DNA by amplification and sequencing of the 16S ribosomal RNA gene in skin biopsies of lesions before and after antibiotherapy was done. Results: Three patients received a combined treatment with clarithromycin 1 g/day and ciprofloxacin 1 g/day. No clinical changes occurred in 2 cases and transient worsening in 1. Amplification for bacterial DNA was positive in all skin biopsies. The sequencing of this DNA could not identify a unique bacterial species. Conclusion: No evident bacterial origin could be demonstrated; however, this approach should be extended to more patients.
Primary Cutaneous Cryptococcosis in aPatient with Systemic Immunosuppression after Liver Transplantation
Authors: Hunger R.E. , Paredes B.E. , Quattroppani C. , Krähenbühl S. , Braathen L.R.
Published: April 2003

We report a 36-year-old woman who slowly developed an ulceration on the left thigh 2 years after transplantation for Budd-Chiari syndrome. At this time point, the patient was treated with prednisone, tacrolimus and azathioprine for immunosuppression and with phenprocoumon and low-dose aspirin for anticoagulation in the presence of polycythemia vera. A biopsy of the skin lesion was obtained and revelaed encapsulated yeast that was identified by microbiological and serological methods as Cryptococcus neoformans serotype D. The patient had no signs of systemic infection and a therapy with fluconazole (200 mg/day) was started. The lesion healed within 8 weeks and fluconazole was stopped after 3 months. Due to interactions between fluconazole, tacrolimus and phenprocoumon, the latter drugs were decreased to prevent toxicity. So far, 1 month after stopping fluconazole, no recurrence of skin lesions has been observed.
Changes in Keratin 6 and Keratin 10 (Co-)Expression in Lesional and Symptomless Skin of Spreading Psoriasis
Authors: Mommers J.M. , van Rossum M.M. , van Erp P.E.J. , van de Kerkhof P.C.M.
Published: April 2003

Background: Keratin 6 (K6) and keratin 10 (K10) are markers for epidermal hyperproliferation and differentiation, respectively, and are both expressed in the suprabasal layers of the epidermis. They may be co-expressed in different stages of the spreading psoriatic lesion, but single expression can also occur. Objective: To investigate to what extent keratinocytes express K6 and K10, and to what extent they co-express K6 and K10 in different stages of the psoriatic lesion. We studied this in spreading psoriatic plaques. Methods: Three 3-mm punch biopsies were obtained from the inner involved margin of a spreading lesion, from the uninvolved skin immediately adjacent to the spreading plaque, and from the distant uninvolved skin of 8 patients with incipient psoriasis. From 9 healthy volunteers, 3-mm punch biopsies were obtained as controls. After preparation of single cell suspensions of these biopsies, a triple staining protocol was performed with markers for K6 (monoclonal antibody LHK6B), K10 (monoclonal antibody RKSE60) and DNA content (TO-PRO-3 iodide). Subsequently, cells were measured with a flow cytometer and the proportion of the markers was calculated using specific software. Results: We observed a population of K6/K10-co-expressing cells, but also populations expressing only K6. These subpopulations varied with the involvement of the lesion. There was a statistically significant difference between the inner margin and the outer margin with respect to the proportion of K6- and K10-expressing cells, whereas more K6-positive and K10-negative cells were detected in the inner margin of the lesions. The proportion of K6/K10-co-expressing cells in the inner margin was significantly different from the distant uninvolved skin. Conclusion: We confirmed that individual keratinocytes in psoriasis can express K6 or K10 depending on their localization in involved or uninvolved skin. There is a unique subpopulation of cells in the psoriatic plaques which co-express K6 and K10. More studies are required to fully understand the pathogenic relevance of co-expression and single expression of K6 and K10.
UVB Photosensitivity due to Ranitidine
Authors: Kondo S. , Kagaya M. , Yamada Y. , Matsusaka H. , Jimbow K.
Published: April 2003

We describe a 62-year-old male with photosensitivity due to ranitidine. An oral challenge test after taking ranitidine with UVB irradiation was positive. Ranitidine-induced UVB photosensitivity was persistent even after cessation of the medication.
Multifocal Fixed Drug Eruption to Paracetamol, Tropisetron and Ondansetron Induced by Interleukin 2
Authors: Bernand S. , Scheidegger E. Paul , Dummer R. , Burg G.
Published: April 2003

Fixed drug eruptions (FDEs) represent an uncommon subset of drug reactions where typically dusky red skin eruptions recur at the same site each time a drug is administered. Multifocal FDEs are defined by skin eruptions at more than one site. We describe a patient with metastatic melanoma who developed a multifocal FDE to paracetamol, tropisetron and ondansetron during chemoimmunotherapy with interleukin 2 (IL-2) and dacarbazine. This case is unique since to our knowledge there has been no previous report of such a drug reaction to tropisetron. Moreover, recurrences were induced by drugs which were chemically unrelated (i.e. tropisetron and paracetamol). We propose that this unusual skin reaction to multiple drugs was induced by IL-2 administered during immunochemotherapy for the metastatic melanoma.
A Case of Lipedematous Alopecia Occurring in a Male Patient
Authors: Ikejima Ayako , Yamashita Masayuki , Ikeda Shigaku , Ogawa Hideoki
Published: April 2003

A 30-year-old Japanese man presented with a thickening of the scalp and diffuse alopecia on the vertex. A skin biopsy specimen of the thickened scalp showed an increased thickness of subcutaneous adipose tissue and a marked decrease in the number of hair follicles. By an MRI examination, the irregularly thickened subcutaneous fatty tissue was visualized. These findings indicated that the patient had been suffering from lipedematous alopecia. This is a rare condition characterized by diffuse alopecia due to the thickening of the layer of adipose tissue covering the scalp. Only 4 female cases of lipedematous alopecia have been reported previously. MRI is thought to be useful for the differentiation of lipedematous alopecia from lipoma. The present case is considered to present the first male patient with lipedematous alopecia.
Cell-Kinetic Evidence for Increased Recruitment of Cycling Epidermal Cells in Psoriasis: The Ratio of Histone and Ki-67 Antigen Expression Is Constant
Authors: Castelijns Fransje A.C.M. , Gerritsen Marie-Jeanne P. , van Erp Piet E.J. , van de Kerkhof Peter C.M.
Published: April 2003

Background: One of the hallmarks of the psoriatic plaque is increased epidermal proliferation. Whether this is the result of an increased recruitment of cycling epidermal cells or a decrease in cell cycle time has been a matter of debate for years. Objective: Calculating cell-kinetic information from the number of S phase cells in psoriasis by in situ hybridisation using a histone probe and the number of cycling epidermal cells by immunohistochemistry using the MIB-1 antibody. Methods: Immunohistochemistry and non-isotopic in situ hybridisation were performed on serial sections of 33 untreated psoriatic samples and 14 tacalcitol-treated samples. Results: The labelling index (number of cells in S phase/number cycling cells per millimetre length of section) in psoriatic untreated as well as in treated plaques is 16%. The amount of S phase cells in our experiment is equal compared with the number of cells in S phase as determined by BrdU incorporation. Conclusion: Using this direct approach to study cell-kinetic behaviour of psoriatic skin, we reconfirm that the psoriatic abnormality is due to a defect in the G₀–G1 recruitment mechanism (by increased recruitment of G₀ cells), a decrease in apoptosis or an increase in the number of cell divisions in the transit-amplifying compartment, rather than a reduction in the cell cycle time.
Lichen scrofulosorum – A Series of Eight Cases
Authors: Beena K.R. , Ramesh V. , Mukherjee Ashok
Published: April 2003

Lichen scrofulosorum is a rare entity of children and young adults. The cutaneous lesions are typically symptomless papular eruptions, associated with a strong Mantoux reaction, tuberculosis of lymph nodes and/or other organs. Eight patients between the ages of 5 and 36 years were included in this series. Lesions were commonly seen on the trunk, though a case of involvement of the palms and soles was also observed. Pulmonary tuberculosis was seen in 5 adults; 1 patient each had pleural effusion, tuberculous adenitis and tuberculoma, respectively. Histopathological examination typically showed epithelioid cell granulomas around hair follicles. The histogenesis is unclear, a type IV hypersensitivity reaction provoked by chronic tubercular infection is probable. The patients responded well to antituberculous therapy.
An Innovative Topical Drug Formulation for Wound Healing and Infection Treatment: In vitro and in vivo Investigations of a Povidone-Iodine Liposome Hydrogel
Authors: Reimer Karen , Vogt P.M. , Broegmann Bianca , Hauser J. , Rossbach O. , Kramer A. , Rudolph P. , Bosse B. , Schreier H. , Fleischer W.
Published: April 2003

Background: In topical wound treatment, the combination of anti-infectious therapy and a healing-promoting moisturization has not been accomplished yet. Objective: Evaluation of a new topical drug consisting of a povidone-iodine (PVP-I) liposome hydrogel allowing for both antiseptic and moist treatment. Methods: Pharmaceutical formulation of a complex of PVP-I (3%) and phosphatidylcholine in a hydrogel. In vitro, interaction of the complex with relevant micro-organisms was analysed by electron microscopy. Antimicrobial activity was investigated using Staphylococcus aureus in a suspension test. Tissue toxicity was examined by an explantation test in a rodent model. A randomized clinical study on efficacy and tolerability in wound healing was carried out on 35 patients with mesh grafts in parallel groups (PVP-I liposome hydrogel vs. Bactigras) for proof of concept in humans. Results: A direct interaction of the PVP-I liposomes with micro-organisms by attachment to the cell surface was documented. A significantly better microbicidal activity and tissue tolerability of the PVP-I liposome hydrogel compared to conventional PVP-I formulations was shown. The results of the clinical study, especially measurements of neo-epithelization per time and transplant loss, demonstrate significant differences in favour of the PVP-I liposome hydrogel. Conclusion: The novel PVP-I liposome hydrogel combines microbicidal and wound healing activities resulting in enhanced epithelization.
Keratosis lichenoides chronica
Authors: Lombardo G.A. , Annessi G. , Baliva G. , Monopoli A. , Girolomoni G.
Published: April 2003

Keratosis lichenoides chronica (KLC) is a rare chronic dermatosis characterized by lichenoid hyperkeratotic papules arranged in a linear and reticular pattern, and seborrheic-dermatitis-like lesions on the face. Less frequently, palmoplantar keratoderma, nail dystrophies, mucosal as well as eye lesions are present. KLC affects adults and very few cases have been reported in childhood. Although infrequently, KLC has been associated with systemic diseases, including chronic infectious diseases, kidney disorders and lymphoma. Here we report the case of an adult KLC patient with skin, nail and mucosal involvement, and onset in the first year of life who developed a leg panniculitis and a mantle cell lymphoma. Following chemotherapy for the lymphoma, panniculitis resolved completely, and skin and mucosal KLC lesions ameliorated.
Prognostic Factors in Resected Primary Small Bowel Tumors
Authors: Brücher B.L.D.M. , Roder J.D. , Fink U. , Stein H.J. , Busch R. , Siewert J.R.
Published: April 2003

We report a retrospective analysis of 71 patients, operated for primary small bowel tumors (SBT): 47 malignant (66.2%) and 24 benign (33.8%) tumors. Of the malignant tumors, adenocarcinomas predominated (38.3%), followed by neuroendocrine tumors (31.9%), Non-Hodgkin lymphomas (NHL) (12.8%), leiomyosarcomas (10.6%) and other rare entities (6.4%). Morbidity of surgical treatment was 16.9%, 30-day mortality 7%. The estimated 5-year survival rate in malignant lesions was 31.8%. Univariate analysis identified the presence of distant metastasis and the resection status (R status) as prognostic factors (p = 0.034 and p = 0.001). There was no influence of T, N status or grading on survival. A complete macroscopic and microscopic tumor resection has to be the aim of any curative surgical approach in patients with SBT.
Impact of Sedation and Resident Teaching on Complications of Colonoscopy
Authors: Galandiuk Susan , Ahmad Pasha
Published: April 2003

There is controversy regarding the frequency of sedation-related complications of colonoscopies and whether these procedures are safely performed by physicians-in-training. We retrospectively reviewed the safety of 1,004 consecutive outpatient colonoscopies. No perforations occurred. No patients were hospitalized for sedation-related complications. Seventeen percent of patients had significant changes in vital signs that lasted less than 5 min. These changes were less common in patients receiving ≤3 mg midazolam intravenously without meperidine (p < 0.005). Complications were slightly more frequent in procedures performed by trainees (23%) than by gastroenterologists (12%) and by surgeons (18%) (p = 0.01). These data support the safety of colonoscopy under intravenous sedation, even when performed by trainees.
Cytokines in Surgical Trauma: Cholecystectomy as an Example
Authors: Reber P.U. , Andrén-Sandberg Å. , Schmied B. , Büchler M.W.
Published: April 2003

Interleukin-1 (IL-1), tumor necrosis factor and particularly IL-6 are potent mediators of the immune and acute phase response caused by surgery and trauma. Their production can be reduced by steroids, nonsteroidal anti-inflammatory agents, nitric oxide and anti-inflammatory cytokines such as IL-4, IL-10 and IL-13. Some of the benefits of minimal invasive surgery may be due to lower cytokine levels in these procedures compared to those of conventional surgery, although this is but one factor that should be taken into account. Therefore, all surgical procedures that cause a lower systemic cytokine response are to be favored if other effects and the side effects of the surgery are equal.
Listeria monocytogenes Causing Solitary Liver Abscess
Authors: Brönnimann Simon , Baer Hans U. , Malinverni Raffaele , Büchler Markus W.
Published: April 2003

The authors report on a case of a solitary liver abscess due to Listeria monocytogenes in a 53-year-old diabetic white male and review all published cases of solitary listerial abscesses of the liver. L. monocytogenes is a rare cause of solitary liver abcess which occurs in elderly patients with diabetes mellitus. The clinical signs are variable and often mimic malignancy, with epigastric pain, night sweats and weight loss. Prevalent features are poor control of glycemia, temperature up to 38.5°C and elevated alkaline phosphatase. Optimal treatment includes percutaneous drainage of the hepatic abscess and antibiotic therapy with an aminopenicillin or trimethoprim/sulfamethoxazole. Outcome of the reviewed patients was favourable with no mortality and no relapse of the disease.
Role of Intestinal Permeability in Monitoring Mucosal Barrier Function
Authors: Sun Zhengwu , Wang Xiangdong , Andersson Roland
Published: April 2003

The intestinal barrier function is considered to play an important role in protecting the penetration of luminal antigens, associated with the development of secondary infection and sepsis and the initiation of the multiple organ dysfunction syndrome. The intestinal mucosal barrier against luminal macromolecules and microorganisms consists of both non-immunological and immunological defence mechanisms. The main constituents of the intestinal barrier are the endothelial and epithelial barriers. The epithelial barrier selectively restricts micromolecular permeation and almost completely restricts macromolecular permeation, while the endothelial barrier has a very limited restriction to micromolecules and only partly to macromolecules. Maintenance of the barrier depends on the integrity of cellular plasma membranes and tight junctions, as well as the elaboration of endothelial and epithelial secretory products. Focal denudation of the barrier results in permeation of potentially threatening luminal compounds including antigens, proteases, H+, bacteria and endotoxin, and also other factors chemotactic for inflammatory cells. By initiating inflammation and thus acting on subepithelial tissues, such factors can further influence endothelial and epithelial transport and barrier function. The repair of endothelial and epithelial injury is also complex, and both restitution and enhanced endothelial and epithelial cell proliferation are likely to be important. At present, however, mechanisms for intestinal epithelial and endothelial permeation, their alterations in disease and potential ways to prevent or repair injury, are still not fully elucidated.
A Large Duplication Cyst of the Stomach in an Adult Presenting as Pancreatic Pseudocyst
Authors: Glaser Ch. , Kuzinkovas V. , Maurer Ch. , Glättli A. , Mouton W.G. , Baer H.U.
Published: April 2003

Intestinal duplication is a rare congenital disease. It appears throughout the gastrointestinal tract, especially in the ileum. Here we describe the rare case of a gastric duplication cyst in a 59-year-old patient. Diagnostic findings and surgical therapy are discussed. Gastric duplications in adults are extremely rare, and diagnosis is often missed. Symptoms are unspecified pain in the upper abdomen, vomiting and fever, with some patients having weight loss. Complications are rare. Chronic infections and ruptures are described. For diagnosis, CT scan with oral contrast is preferred. Endoscopy is negative in most cases. Therapy is surgery. Local excision of a small wall of gastric muscosa is sufficient in most cases, but sometimes a subtotal gastrectomy is necessary.