bluuebunny/crossref_metadata_2025 huggingface dataset:
PROGRESSIVE SYSTEMIC SCLEROSIS ASSOCIATED WITH CUTANEOUS AMYLOIDOSIS
Authors: CHANOKI MIYAKO , SUZUKI SHINSUKE , HAYASHI YOICHIRO , ISHII MASAMITSU , HAMADA TOSHIO
Published: May 2007

A 43‐year‐old woman presented with a 3‐year history of Raynaud's phenomenon and a six‐month history of numbness in both arms. Sclerosis was noted on the entire body surface. The skin of the face was smooth and the lips were constricted (Fig. 1). The fingers and hands were atrophic and sclerotic, and full extension of the fingers and metacarpal joints was impossible (Fig. 2). There was pigmentation on the dorsal aspect of the hands. From the nape to the upper back, pruritic wavy, rippled or reticular pigmented macules in addition to sclerosis were noted (Fig. 3). Other parts of her skin did not show such a wavy pigmentation. Physical examination revealed no specific findings in the lung, heart, and abdomen. Neurologic examination was unremarkable. Motor function including muscle tonus was normal.

Laboratory studies disclosed that the complete blood count and tests of hepatic and renal function were within normal limits. Antinuclear antibody was I:80 and showed a speckled pattern, antitopoisomerase 1 antibody, anticen‐tromere antibody, anti‐Sm antibody and anti‐RNP antibody were all negative, and the CH50 was 31.5 units/ml; C3 was 59.4 mg/dL; and C4, 17 mg/dL. Radiologically the chest and esophagus were normal.

Pulmonary function and electro‐cardiogram were also normal. Histologic examination of a skin biopsy obtained from the upper back revealed that the collagen bundles throughout the dermis were thickened, homogenous, and closely packed. In the upper dermis, a small number of inflammatory cells around blood vessels was observed. Eosinophilic homogeneous masses were seen in the papillary dermis and upper dermis (Fig. 4). These homogeneous masses were positive to Dylan' (Fig. 5), Congo red, and thioflavin T staining. Therefore, the diagnosis of cutaneous macular amyloidosis was made.
PHOTODAMAGE AND SKIN CANCER AMONG PARAQUAT WORKERS
Authors: JEE SHIOU‐HWA , KUO HSIEN‐WEN , SU W.P. DANIEL , CHANG CHUN‐HSIANG , SUN CHEE‐CHING , WANG JUNG‐DER
Published: May 2007

Background. Some workers in paraquat manufacturing, exposed to bipyridines, have developed pigmentation and keratosis on sun‐exposed skin. This condition has been described as skin‐malignancy or premalignancy. This study was designed to clarify the pathologic features of these lesions and to explore the etiologic role played by bipyridine.

Methods. Twenty‐three biopsy specimens, obtained from the affected skin of 10 workers, were scrutinized by a dermatopathologist. A total of 242 exposed workers from 28 paraquat factories were examined and interviewed during the period from 1983 to 1991. The severity of the characteristic skin lesions was graded from the lowest to the highest response to analyze the data by Mantel extension for a trend that focused on the heavy exposure to bipyridines as risk factor.

Results. All pathology specimens showed various degrees of solar damage: early actinic change, solar lentigo, actinic keratosis (AK), AK coexisting with squamous cell carcinoma (sec), and sec. Six specimens from four workers were sec or sec in situ. Three of six sec showed the coexistence of AK. Of the workers, 133 had skin lesions ranging in severity from grade 1 to grade 3 on sun‐exposed areas. The severity of skin changes is strongly associated with heavy exposure to bipyridines (P < 0.0001).

Conclusion. This pathologic study proves that all the lesions showed either photodamage or skin cancer. The strong trend in the correlation between severity of photo‐damage and exposure to bipyridine leads to the speculation about the synergistic role of bipyridine exposure and the solar effect in causing these malignant and premalignant skin lesions.
PROTECTION AGAINST CYTOSINE ARABINOSIDE‐INDUCED ALOPECIA BY MINOXIDIL IN A RAT ANIMAL MODEL
Authors: HUSSEIN ATIF M.
Published: May 2007

Background. Alopecia is one of the most physically and psychologically distressing side effect of cancer chemotherapeutic agents. In the past 2 years, we reported that: (a) treatment of 8‐day‐old rats with 1‐B‐D‐arabinofuranosylcy‐tosine (Ara‐C), doxorubicin, and cyclophosphamide (cyc) consistently produced alopecia; (b) Imuvert, a biological response modifier, produced complete protection against alopecia induced by Ara‐C and doxorubicin, but not that produced by cyc, most probably through the release of in‐terleukin‐1; and (c) n‐acetylcysteine protected against cyc‐induced alopecia in the newborn rat.

Methods. As an extension to these observations, we chose to test the efficacy of minoxidil, a drug known to be a hypertrichotic agent, in preventing chemotherapy‐induced alopecia in the newborn rat animal model.

Results. Minoxidil, when injected locally, offered good local prevention against Ara‐C but not CYC‐induced alopecia. Minoxidil 2% dissolved in a vehicle of ethanol, propylene glycol, and water was not effective when applied topically.

Conclusions. The mechanism of action of minoxidil in its prevention against Ara‐C‐induced alopecia is currently unknown. This observation may shed some light on the in vivo mechanism of action of minoxidil and may prove to be important in our efforts to search for agents to prevent alopecia among patients receiving chemotherapy.
POLAR AND SUBPOLAR DIFFUSE CUTANEOUS LEISHMANIASIS IN BRAZIL: CLINICAL AND IMMUNOPATHOLOGIC ASPECTS
Authors: BARRAL ALDINA , COSTA JACKSON M.L. , BITTENCOURT ACHILLA L. , BARRAL‐NETTO M. , CARVALHO EDGAR M.
Published: May 2007

Background. Diffuse cutaneous leishmaniasis (DCL) is a rare manifestation of human leishmaniasis, characterized by multiple, slowly progressive nodules or plaques without ulceration, involving almost the entire body. It has been suggested, that DCL results from a lack of cell‐mediated immunity to leishmanial antigen, leading to uncontrolled parasite growth.

Methods. We have performed detailed clinical, histopathologic, and immunologic investigations in six patients with DCL. Biopsies were taken from the nodules, processed, and examined for determination of the macrophagic pattern present, based on the intensity of vacuolation and the frequency of vacuolated cells, the parasite index, and the presence of eosinophils. Immunologically, patients were evaluated by their response to intradermal skin test to PPD or leishmania antigen, determination of antileishmania antibodies by immunofluorescent assay, and lymphocyte proliferation assay.

Results. There seemed to be a negative relation between nodules and skin ulcerations, whereas the highest number of parasites were observed in patients with the greatest number of vacuolated macrophages. The delayed hypersensitivity skin test to leishmanial antigen was negative, and antileishmania IgG antibodies were positive in all patients.

Conclusions. Although all cases fulfill the criteria for being classified as DCL, they present a wide spectrum. Three cases were clearly at the unresponsive pole, and three other cases belonged to the subpolar form of DCL, exhibiting varying weak signs of antiparasite responsiveness.
DIAGNOSTIC EVALUATION OF THE LUPUS BAND TEST IN DISCOID AND SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: GEORGE RENU , KURIAN SUSY , JACOB MARY , THOMAS KURIAN
Published: May 2007

Background. The usefulness of the lupus band test (lbt) in the diagnosis of cutaneous lupus erythematosus remains controversial. The study was done to determine the sensitivity, specificity, and predictive value of the lbt in discoid lupus erythematosus (dle) and systemic lupus erythematosus (sle).

Methods. During the study period, 32 patients with SLE and 28 patients with DLE were included. The final classification of cases was based on the American Rheumatism Association Criteria (ara) for sle, histopathology, and consensus of the clinical staff. Thirty controls, 15 each for DLE and sle, were chosen from a group of patients, who had lesions clinically simulating dle and sle, but could be excluded by histopathology, laboratory tests, and follow‐up. Histopathologic examinations and direct immunofluorescence (DIF) tests were done on lesional skin.

Results. In dle, the sensitivity of the LE band test was 58% and the specificity 87%. The positive predictive value was 95% and negative predictive value was 32%. In sle the sensitivity was 93% and specificity 87%. The positive predictive value was 64% and negative predictive value 98%.

Conclusions. The high negative predictive value of lbt in sle suggests that it is valuable in excluding diseases clinically similar to sle.
AGE AND SITE PREVALENCE OE HISTOLOGIC SUBTYPES OE BASAL CELL CARCINOMAS
Authors: BETTI ROBERTO , INSELVINI ELENA , CARDUCCI MAURO , CROSTI CARLO
Published: May 2007

Background. Basal cell carcinomas (bcc) are the most frequently diagnosed skin cancers. The relationships between some clinical parameters, such as sex, age, and location of the tumor, and the histologic patterns play an important role as factors predictive of recurrence and treatment implications.

Methods. A total of 693 patients with bcc, divided according to sex, age, and location of the tumor were studied. The histologic patterns considered were nodular, superficial, and morpheiform bcc and fibroepithelioma. The correlation between clinical and histologic parameters was analyzed.

Results. All histologic patterns considered were most commonly represented in the 7th and 8th decades. There were no sex differences. A prevalence of a superficial pattern for sun‐unexposed areas and of a nodular pattern for sun‐exposed areas was observed. The morpheiform pattern showed no correlation with any body site. The fibroepithelioma showed an absolute prevalence for the lumbosacral region.

Conclusions. Age does not seem to be a discriminant or permissive factor for a particular histologic pattern of bcc. The prevalence of some subtypes for a particular body area may be explained on the basis of local predisposing conditions affecting the histologic development of the tumor.
ENVIRONMENTAL FACTORS INFLUENCING THE BIOLOGIC BEHAVIOR OF PATTERNS OF PEMPHIGUS VULGARIS: EPIDEMIOLOGIC APPROACH
Authors: KYRIAKIS KYRIAKOS P. , VARELTZIDIS ANTHONY G. , TOSCA ANDRONIKI D.
Published: May 2007

Background. Pemphigus vulgaris is an autoimmune disorder, in which environmental factors seem to play a role, both in the pathogenesis and the activity of the disease. The purpose of the study was to correlate the biologic activity of pemphigus vulgaris with sun exposure and air temperature.

Methods. An epidemiologic study was carried out, analyzing results of serology, skin involvement, and proportional morbidity rates, related to sun exposure and air temperature. The study was based on retrospective and prospective series of patients. All data were evaluated in a yearly seasonal distribution.

Results. Strong correlations were shown between climatologic data and pemphigus activity in the populations studied.

Conclusions. Environmental factors have a significant impact on the disease expression. This stresses the necessity of preventive measures against exposure to sun and high temperature.
CO‐MORBIDITY BETWEEN DERMATOLOGIC DISEASES AND PSYCHIATRIC DISORDERS IN PAPUA NEW GUINEA
Authors: JOHNSON FELIX Y. ATTAH , MOSTAGHIMI H.
Published: May 2007

Background. Neurodermatitis (now subdivided into lichen simplex chronicus and atopic dermatitis) was included among the psychosomatic disorders. Psychologic causes have been suggested for many skin conditions, such as urticaria, lichen simplex chronicus, atopic dermatitis, psoriasis, alopecia areata, and pruritus. The evidence for psychologic causation is neither strong nor convincing; however, psychiatric disorders are common among people with established skin diseases. Recent investigators have published data reporting co‐morbidity between certain psychiatric disorders and skin diseases. The objective of the research was a prospective clinical study of 132 consecutive patients, who attended the dermatologic outpatient clinic of the Port Moresby General Hospital during 1992.

Methods. The instrument for the study is the Harding Self‐Rating Questionnaire (sro) that has been demonstrated to work well as a gross screening instrument in the Urban Primary Health Care Clinic setting. The questionnaire was administered to 132 outpatients by one of the investigators (hm). Those patients who scored above the cut‐off point of seven were referred to the second investigator (fyaj) for examination of their mental state.

Results. The results of the study showed all 132 patients were adults, aged between 16 and 75 years. There were 67/132 (50.75%) men and 65/132 (49.24%) women patients. The psychiatric diagnoses for the women patients were: normal variation 17/65, anxiety neurosis 11/65, and neurotic depression 37/65. For the men patients, the psychiatric diagnoses were: normal variation 21/67, anxiety neurosis 15/67, and neurotic depression 30/67. One man with psoriasis also presented with clinical features of schizophrenic psychosis.

Conclusions. The results of the study support the hypothesis, that there is a co‐morbidity between some psychiatric disorders and some skin diseases.
MUCOCUTANEOUS MANIFESTATIONS OF LYMPHOMAS AND LEUKEMIAS IN BLACK KENYAN CHILDREN
Authors: RIYAT MALKIT S.
Published: May 2007

Background. Childhood leukemia and lymphoma are common problems in Tropical Africa, including Kenya. Studies done in Western populations indicate that 25–50% of patients with leukemia and lymphoma have specific or nonspecific cutaneous signs. In dark‐skinned patients, reports of such mucocutaneous manifestations are scarce. The lesions in these patients may easily be missed, if not specifically looked for.

Method. Eighty‐six indigenous Kenyan children with a confirmed diagnosis of leukemia or lymphoma were specifically examined for any mucocutaneous manifestations at presentation, during their treatment, and during subsequent follow‐up. Whenever possible, an attempt was made to determine the causes of these lesions. All patients were given standard therapy for the primary hematologic disorder.

Results. Two‐thirds of the patients had mucocutaneous symptomatology at presentation: 17.4% had skin infiltration by the malignant cells. During therapy an even larger number developed nonspecific skin manifestations. Most of these were the result of myelosuppression, immunosuppression, or direct cytotoxic effects on tissues.

Conclusions. Mucocutaneous manifestations in black children with leukemia and lymphoma are very common.
GENERALIZED NON‐LANGERHANS CELL HISTIOCYTOSIS: FOUR CASES ILLUSTRATE A SPECTRUM OF DISEASE
Authors: MULLANS ELIZABETH A. , HEEM THOMAS N. , TAYLOR JAMES S. , HELM KLAUS F. , OLIN JEFFREY W. , BERGFELD WILMA F.
Published: May 2007

Background. The proliferation of non‐Langerhans cell histiocytes is a poorly understood process of unknown cause. Variation in the clinical features and/or histopathology of histiocytic proliferation has led to subclassification of the general category of non‐Langerhans cell histiocytes. Although the current classification may provide some useful generalizations in regard to the anticipated clinical course, wide variability in presentation and outcome make this classification less than optimal when dealing with individual patients. The objectives of the study were to present four cases of generalized non‐Langerhans cell histiocytosis.

Materials and Methods. Medical records and slides of four patients diagnosed with non‐Langerhans cell histiocytosis at the Cleveland Clinic are reviewed.

Results. The patients exhibit features of more than one subtype of non‐Langerhans cell histiocytosis.

Conclusion. The overlap among the clinical and histologic features of the generalized cutaneous non‐Langerhans cell histiocytic disorders suggests that they represent one disease entity with a wide spectrum of presentations rather than many distinct disorders.
CONJUNCTIVAL MELANOMAS
Authors: ENG ANA M. , ROSNER MORDECHAI
Published: May 2007

Background. The nomenclature and the clinical and pathologic features of cutaneous and conjunctival melanomas are different. A comparison is made to familiarize dermatologists and ophthalmologists with these differences.

Methods. Five cases of conjunctival malignant melanoma from December 1983 to December 1990 were reviewed.

Results. The nomenclature of primary acquired melanosis is not used for cutaneous melanomas, and terms such as dysplasia and Clark's nevus are not used for conjunctival melanomas. Technical difficulties exist in orienting thin conjunctival tissues because of a tendency to curl during fixation, resulting in tangential sectioning and making a false diagnosis of a prognostically ominous pagetoid spread for an otherwise banal basilar hyperplastic pattern. Excision, cryotherapy, and rarely exenteration are the therapeutic measures in managing conjunctival melanomas; these have far more serious consequences for the patient compared with the excision of a skin melanoma.

Conclusion. Differences exist in several aspects between melanomas located in the skin and the eye.
INTERFERON REDUCES RECURRENCES OF BASAL CELL AND SQUAMOUS CELL CANCERS
Authors: IKIĆ DRAGO , PADOVAN IVO , PIPIĆ NEDIM , ČAJKOVAC VLADIMIR , KUSIĆ ZVONKO , DAKOVIĆ NIKOLA , GREGUREK‐NOVAK TEODORA , SOLDO‐BELIĆ ANTICA , SPAVENTI ŠIME , BELICZA MLADEN , FERENČIĆ ŽELJKO
Published: May 2007

Background.Interferon is considered to be an important curative agent for dermatologic diseases. We report the follow‐up experience of patients with basal cell or squamous cell carcinomas treated with human natural leukocyte interferon (hnli).

Results. Among 52 patients with basal cell carcinoma (bcc) treated with hnli more than 10 years ago, and among 58 treated more than 5 years ago, only 2 recurrences were observed. There were no recurrences in 75 patients who had a complete response to hnli treatment, nor were there any in 20 patients with either a partial or complete response to r.IFM alpha 2c treatment.

Of 52 patients with squamous cell carcinoma (scc), 31 had been treated more than 10 years earlier, two recurrences of the disease at the site of the original lesion were observed.

Conclusion. Interferon treatment makes it possible to achieve a persistent cure in patients with BCC and sec in a high proportion of cases. The potential advantage of nonsurgical treatment are an enhancement of cosmetic results through the prevention of destruction of important anatomic structures.
MIXED TUMORS WITH FOLLICULAR DIFFERENTIATION: COMPLEX NEOPLASMS OF THE PRIMARY EPITHELIAL GERM
Authors: RODRÍGUEZ‐DÍAZ ELOY , ARMIJO MIGUEL
Published: May 2007

Background. Some mixed tumors of the apocrine variety also show characteristics of follicular and/or sebaceous differentiation. This can be explained because of the common embryologic origin of the three structures in the primary epithelial germ of the superficial ectoderm.

Methods. Twenty specimens of apocrine mixed tumors were studied by conventional microscopy. The specimens were evaluated searching for some features of folliculo‐sebaceous differentiation.

Results. Certain features of folliculo‐sebaceous differentiation were found in 45% of the samples examined. Additionally, different tumoral architectures were observed, resembling several well‐characterized adnexal organoid neoplasms. In some tumors, there were also follicular structures of mesenchymal origin, similar to the dermal hair papilla and the arrector pili muscle.

Conclusion. Apocrine mixed tumors of the skin illustrate the ability of pluripotential primordial cells to differentiate in different directions within an individual tumor. Moreover, mixed tumors appear as a compendium of different folliculo‐sebaceous neoplasms. We suggest that these proliferations should be interpreted as “complex neoplasms of the primary epithelial germ.”
UV‐PROTECTIVE SUNGLASSES FOR UVA IRRADIATION PROTECTION
Authors: LEOW YUNG HIAN , THAM SIEW NEE
Published: May 2007

Background. Eye protection with uva‐blocking solar shields is recommended on the day of puva treatment and the following day for our patients; however, many patients found this eyewear cosmetically unacceptable.

Method. We investigated 34 pairs of sunglasses to determine their suitability for providing adequate protection. The method used was modified from the technique used by Moseley et al. in 1988.

Results. We found that 21 (61.8%) of the 34 pairs of sunglasses and only 9 (53%) of the 17 pairs of sunglasses used by our patients were “satisfactory.” Expensive brands and polarizing sunglasses do not guarantee optimal uva protection.

Conclusion. We recommend that all patients should use wrap‐around solar shields for optimal eye‐protection, while undergoing puva treatment. The availability of more cosmetically acceptable glasses will encourage better patients' compliance to protect their eyes with optical aids.
MORPHOLOGIC OBSERVATIONS ON THE DERMAL NERVES IN VITILIGO: AN ULTRASTRUCTURAL STUDY
Authors: AL'ABADIE MOHAMMED S.K. , WARREN M. ALASTAIR , BLEEHEN STANLEY S. , GAWKRODGER DAVID J.
Published: May 2007

Background. Vitiligo is a common idiopathic skin disorder. The etiology is unknown, although various hypotheses have been advanced. These include the neuronal hypothesis, where neuronal factors are thought to play a role in the pathogenesis of this disease.

Methods. Skin biopsies were taken from marginal and central parts of four vitiligo patients. Biopsies were also taken from nonvitiliginous skin of each patient and from four normal control subjects. Sections were examined under the electron‐microscope. Nerve fibers in the superficial dermis were examined.

Results. Subtle ultrastructural changes, including regeneration and degeneration, were consistently found in dermal nerves of vitiligo lesions. The most consistent feature, seen in all four vitiligo patients studied (in both lesional and marginal areas), was an increased thickness of the basement membrane of Schwann cells. This change was found in approximately three‐quarters of all dermal nerves in vitiligo biopsies, but in only about one‐quarter of dermal nerves in normal control skin. About half the abnormal dermal nerves in vitiligo skin showed minor axonal damage, although indicators of regeneration (increased mitochondria and rough endoplasmic reticulum) predominated. The dermal nerves in vitiligo showed no difference in fiber diameter or fiber density in comparison with controls.

Conclusions. In vitiligo both axonal degeneration and nerve regeneration may occur, with the latter possibly being a reactive change to earlier axonal damage. These findings support the hypothesis that there is a neuronal component to this disease.
CIRCULATING IMMUNE COMPLEXES IN VARIOUS FORMS OF BEHÇET'S DISEASE
Authors: ABDALLAH MOHAMMED A. , RAGAB NADER , KHALIL RASHA , KAMEL NADIA
Published: May 2007

Background. The etiology of Behget's disease (BD) is uncertain but there is strong evidence that the immune system is implicated in its pathogenesis.

Methods. We assessed circulating immune complexes (CIC) in peripheral blood of 34 patients with BD, forming eight clinical groups, using a laser nephelometer to obtain more insight in the pathogenesis of different clinical forms of bd. Twenty healthy controls and eight patients with recurrent oral ulcerations were also included in the study.

Results. Levels of CIC were significantly higher in patients (1.83 ± 0.93 μg/mL) than in controls (0.84 ± 0.51 μg/mL; P < 0.001). High titers were found in the groups of patients with erythema nodosum (3.14 ± 0.44 μg/mL), neurologic manifestations (2.9 ± 0.58 μg/mL), and ocular manifestations (2.34 ± 0.93 μg/mL). Compared to patients with recurrent oral ulcerations (1.91 ± 0.77 μg/mL), the mean value of CIC in patients with BD did not differ significantly, but the groups of patients having erythema nodosum, positive pathergy, and neurologic manifestations had significantly higher levels (P < 0.05) and the group of patients at the mild end of the spectrum (group 8) had a significantly lower level (1.09 ± 0.41 μg/mL) (P < 0.05). Only the groups having erythema nodosum, positive pathergy, and neurologic manifestations had significantly higher levels of CIC when compared to other groups lacking these clinical features, whereas group 8 had a significantly lower level (P < 0.05) when compared to all other groups.

Conclusion. Our results show that CIC may be involved in the pathogenesis of BD, especially in those clinical forms of the disease with erythema nodosum, neurologic manifestations, and ocular manifestations. Patients at the mild end of the BD spectrum do not show significant changes in CIC levels compared to healthy control subjects. We can, therefore, suggest that in BD CIC may be implicated more in the pathogenesis of some features than of others.
HYPOPIGMENTED MACULES IN ACANTHOLYTIC DISORDERS
Authors: ROWLEY MATTHEW J. , NESBITT LEE T. , CARRINGTON PATRICK R. , ESPINOZA CARMEN G.
Published: May 2007

Background. Widespread hypopigmented macules are rarely seen in heavily pigmented patients with Darier's disease. Previous hypotheses concerning the cause of decreased pigmentation suggest it is a postinflammatory phenomenon or that the hypomelanosis is evidence of sub‐clinical acantholysis.

Patients. This report presents 2 patients: a new case of disseminated guttate leukoderma in a black patient with Darier's disease and the first such case in a patient with transient acantholytic dermatosis (Grover's disease). Direct immunofluorescence and electron‐microscopic studies were carried out on lesional biopsies.

Observations. Numerous small hypopigmented macules were observed in two black patients followed for acantholytic disorders. Three biopsies of the hypopigmented macules revealed acantholysis, while one showed only decreased melanin. Direct immunofluorescence studies were negative. Electron‐microscopic studies of the leukodermic macules showed sparse melanocytes and melanosomes that were mostly pigmented stage IV melanosomes.

Conclusions. Disseminated guttate leukoderma can occur in transient acantholytic dermatosis, as well as in Darier's disease. It is readily apparent on darkly pigmented skin because of contrast. The etiology of this phenomenon is still unknown.
BASAL CELL CARCINOMA AND LIFESTYLE CHARACTERISTICS
Authors: SAHL WILLIAM J. , GLORE STEPHEN , GARRISON PEGGY , OAKLEAF KATY , JOHNSON STACY D.
Published: May 2007

Background. A number of lifestyle factors are important in the etiology of basal cell carcinoma. Previous studies have investigated smoking, alcohol, diet, and sun exposure as possible contributing factors. No previous studies have investigated case‐controlled lifestyle influences in basal cell carcinomas referred for Mohs micrographic surgery.

Methods. Cases were obtained from Mohs‐referred basal cell carcinoma patients. Matched controls were selected from a busy dermatology clinic. The only criteria for selection of controls was never having had cancer previously. Cases and controls were surveyed regarding lifestyle characteristics.

Results. Forty‐six age, sex, and skintype‐matched controls were compared. Sun exposure, alcohol, and smoking were not significant factors. Dietary fat, fiber, and the vitamins A, C, and beta carotene, as well as selenium showed important, but not significant differences. Caffeine consumption was higher in the cancer group.

Conclusions. Our findings agree with previously published studies in regard to antioxidant consumption as a protective factor for basal cell carcinoma. Caffeine consumption was higher in the cancer patients.
MALIGNANT SYPHILIS (LUES MALIGNA) AND CONCURRENT INFECTION WITH HIV
Authors: DON PHILIP C. , RUBINSTEIN RACHEL , CHRISTIE SHARON
Published: May 2007

Background. During the past 2 1/2 years we observed six patients who had a reactive serology for syphilis, of which four developed widespread noduloulcerative and two vesiculonecrotic lesions. The purpose was to report the occurrence of lues maligna, a rare form of secondary syphilis, in five patients infected with the human immunodeficiency virus (HIV) and in one patient with risk factors for infection.

Methods. Tzanck preparations, viral cultures, and skin biopsies were performed to evaluate the etiology of the lesions.

Results. Syphilis serology titers ranged from 1:32 to 1:128 and in one instance was as low as 1:8. Such titers can also be found in patients with the latent form of syphilis. Therefore, confirmation of the clinical diagnosis of lues maligna was dependent on skin biopsies that were compatible with secondary syphilis and negative viral studies that excluded varicella, disseminated varicella‐zoster or herpes simplex. Lues maligna takes an aggressive course in HIV‐infected patients since four of the patients required hospitalization and the two patients who refused to complete treatment, subsequently developed more severe skin and constitutional symptoms.

Conclusions. HIV‐infected patients are at risk for developing lues maligna. Despite its malignant presentation, lues maligna lesions respond rapidly to treatment with penicillin. Secondary syphilis should be added to the list of diseases known to be more aggressive in HIV‐infected patients.
INCREASED ANTICARDIOLIPIN ANTIBODIES ASSOCIATED WITH THE DEVELOPMENT OF ANETODERMA IN HIV‐1 DISEASE
Authors: LINDSTROM JILL , SMITH KATHLEEN J. , SKELTON HENRY G. , REDFIELD ROBERT , ALVING BARBARA M. , WAGNER KENNETH F. , LUPTON GEORGE P. ,   MILITARY MEDICAL CONSORTIUM FOR THE ADVANCEMENT OF RETROVIRAL RESEARCH (MMGARR)
Published: May 2007

Background and Objective. Anetoderma has been reported in patients with HIV‐1 disease. In patients with autoimmune disease, anetoderma has been associated with increased levels of antiphospholipid antibodies (APL) that include anticardiolipin antibodies (ACA) and lupus anticoagulant (LA). This has led to speculation that the autoimmune phenomena seen in HIV‐1 disease and the immune dysregulation induced by HIV‐1 disease may play a role in the development of these lesions. We have seen both primary and secondary lesions of anetoderma in patients followed for HIV‐1 disease. In this study, we wanted to determine whether there was an association in the development of anetoderma and elevated anticardiolipin antibodies (ACA) in HIV‐1 patients.

Methods. Quantitative ACA levels were measured in eight HIV‐1‐infected patients with anetoderma and four HIV‐1‐infected patients without anetoderma.

Results. Anticardiolipin antibodies were moderately elevated in seven of eight patients with lesions and were borderline in the four HIV‐1‐positive patients without lesions of anetoderma.

Conclusions. There appears to be a correlation between increased ACA and the development of cutaneous lesions of anetoderma in HIV‐I disease. Patterns of immune dysregulation, including APL, may predispose to the development of lesions of anetoderma in HIV‐1‐positive patients. Although some of the lesions appear to represent primary anetoderma, the majority of our patients develop lesions in areas secondary to well characterized eruptions.
ETHNIC AND GEOGRAPHIC DIFFERENCES AND SIMILARITIES OE HIV/AIDS‐RELATED MUCOCUTANEOUS DISEASES
Authors: SØNDERGAARD JORGEN , WEISMANN KAARE , VITHAYASAI P. , SRISUWAN S. , MANELA‐AZULAY M. ,   MEMBERS OF THE DANIDA STUDY GROUPS
Published: May 2007

Background. A study on HIV/AIDS‐related mucocutaneous manifestations has been carried out in three different ethnic and geographic areas, namely Brazil, Denmark, and Thailand.

Methods. The Brazil cohort comprised 110 patients, the Danish cohort 150, and the Thai cohort 206 patients. The majority of the Brazil and Thai cohort patients belonged to groups III and IV according to the CDC clinical staging system, whereas the patients in Denmark called their doctors earlier and only 8% were classified in groups III and IV.

Results. In all three areas the number of mucocutaneous diseases correlated well with the progression of the HIV disease. Ethnic differences were not identified, whereas geographic differences related to skin infections were marked. In the Asian cohort a generalized fungal infection was detected with characteristic mucocutaneous symptoms caused by Penicillium marneffei.

Conclusions. Teaching efforts about mucocutaneous signs as markers of HIV infection may be of value, particularly in developing areas, to allow earlier diagnosis. In future guidelines for classification of HIV/AIDS‐related mucocutaneous diseases geographic considerations should be included.
PLASMINOGEN ACTIVATORS, VENOUS LEG ULCERS AND REEPITHELIALIZATION
Authors: LOTTI TORELLO , BENCI MAUUIZIO
Published: May 2007

Background and Objective. The pathogenesis of leg ulcers due to chronic venous hypertension (CVH) seems to be related to perivenular fibrin‐film formation due to decreased cutaneous fibrinolytic activity dependent on reduced release of tissue‐type plasminogen activator that leads to tissue anoxia and ulcer formation. The purpose of the work is a spectrophotometric evaluation of urokinase (UPA) at the edge, the floor and in the periulcerous skin of leg ulcers.

Methods. We examined a group of 10 patients with chronic leg ulcers caused by CVH. The biopsies from each patient were taken: (1) from the edge of the ulcer; (2) from the perilesional skin and (3) from the floor of the ulcer. Urokinase levels were evaluated in the same areas in 10 control subjects. The UPA activity was determined spectrophotometrically at 405 nm.

Results. The results of our study showed that UPA is detectable in the center of the ulcer, on the edge, in the perilesional skin, as well as in the controls. Data are statistically significant. The highest levels of UPA are found at the edge of the ulcer; they were lower in the center and in the periulcerous skin.

Conclusion. A chemoattracting effect of UPA on human keratinocytes has been documented and this study showed significantly higher levels of UPA at the edge and on the floor of the ulcers, suggesting a possible role of an UPA gradient that could promote mobilization of keratinocytes from the edge to the floor, thus inducing reepithelialization. Moreover, UPA could play some role in neoangiogenesis and fibroblast chemoattraction, thus contributing in various ways to wound healing.
13‐CIS‐RETINOIC ACID AND BONE DENSITY
Authors: KOCIJANČIČ MILENA
Published: May 2007

Background. 13‐Cis‐retinoic acid has an influence on bone in patients on long‐term treatment as well as on short‐term treatment. The presence of skeletal abnormalities after the treatment was established by roentgenologic and scintigraphic examinations. We wanted to know whether a 6‐month course of low‐dose 13‐cis‐retinoic acid has a clinically important influence on bone density in men with severe acne.

Methods. We examined 15 men with severe acne before and after treatment with 13‐cis‐retinoic acid by dual‐photon absorptiometry of the lumbar spine.

Results. The mean increase in bone density was 3.0% (95% confidence interval 1.3–4.5), which is normal for the period from puberty to late twenties. Bone density increased in 13 of our 15 patients.

Conclusions. As shown by this highly sensitive modern densitometric method, 13‐cis‐retinoic acid has no clinically important influence on bone density in male patients with severe acne.
SYSTEMIC LUPUS ERYTHEMATOSUS IN SOUTH AFRICAN BLACKS: PROSPECTIVE STUDY
Authors: JACYK WITOLD K. , STEENKAMP K. JOHANNA
Published: May 2007

Background. The aim of the study was to evaluate clinical and laboratory findings in black South African patients with systemic lupus erythematosus (SLE) and to compare these with findings in a group of white patients.

Materials and Methods. Forty black patients were studied. The group of exclusively white patients reported by Beutner et al. was used for comparison.

Results. A decreased frequency of malar rash, photosensitivity, and hematologic involvement was found in black patients. They had anti‐Sm and anti‐nRNP antibodies and low complement more often than white patients with SLE in Beutner et al. group.

Conclusions. More differences have been noted in laboratory than in clinical parameters and findings reported in African‐Americans with SLE have been confirmed in black Africans. Ethnic factors may play a role in the symptomatology of SLE.
CHRONIC DISCOID LUPUS ERYTHEMATOSUS IN THAILAND: DIRECT IMMUNOFLUORESCENCE STUDY
Authors: KULTHANAN KANOKVALAI , ROONGPHIBOOLSOPIT PAISAL , CHANJANAKIJSKUL SOMCHAI , KULLAVANIJAYA PREYA
Published: May 2007

Background. Studies of chronic discoid lupus erythematosus (DLE) lesions by direct immunofluorescence (DIF) were heterogeneous with respect to classes of immunoglobulins and sites where these were deposited. Most of the studies were done in the USA and European countries.

Materials and Methods. To obtain representative data from Asiatic countries, we analyzed the direct immunofluorescent abnormalities of 100 DLE lesions in Thai patients who were diagnosed on the basis of clinical and histologic criteria.

Results. Granular deposits at the dermoepidermal junction (DEJ) were detected in 90% of cases. The common immunoreactants at the DEJ were IgG (63%) and IgM (47%). The deposits were usually combinations of various classes of immunoglobulins, mostly IgG (53%) and IgM (41%). Deposits of IgG and IgM alone at the DEJ were observed in 12% and 8%, respectively. Deposits at colloid bodies, dermal blood vessel walls, and epidermal nuclei were sometimes also seen.

Conclusions. The DIF test of skin biopsy specimens is diagnostically significant in chronic DLE. Our study in Thai patients showed that the most common deposit was a combination of various classes of immunoglobulins, mostly IgG and often IgM as well as C3, and occurred at the DEJ of the involved area.
SUPPLEMENTAL TESTS IN THE EVALUATION Of OCCUPATIONAL HAND DERMATITIS IN SOLDIERS
Authors: WOLF RONNI , MOVSHOWITZ MOSHE , BRENNER SARAH
Published: May 2007

Background. Hand dermatitis in soldiers is a considerable problem. The purpose of the study was to evaluate appropriate screening tests to improve the diagnosis of hand dermatitis in soldiers.

Materials and Methods. A group of 111 soldiers with occupational dermatitis from contact with fuels and oils underwent “tailored patch tests” with allergens relevant to their field of work and their environment. The control group consisted of 24 soldiers with various jobs similar to those of civilian life, who had not been exposed to oils and fuels. Seventy‐three civilian patients, attending the clinic for patch testing, were also included. Twenty soldiers, who had a history of intensive contact with oil and fuels, but no contact dermatitis, and who were admitted because of various skin diseases (fungal infections, acne, etc.) also underwent the supplemental testing and served as an additional control group.

Results. Of the soldiers, 31 (29%) showed one or more positive skin tests of the oil series and 30 patients of this group one or more positive reactions to the standard patch tests trays. No patient of the control groups had a positive test to the oil series.

Conclusions. Our results show the value of the supplementary tests as a first‐step screening test for detection of oil allergy in soldiers and automobile‐mechanics or in workers handling other gasoline‐ or diesel‐powered engineering equipment. The test method appears to be practical, easy to perform, reliable and giving clear and accurate results, with a negligible rate of false positive reactions.
SENSITIZATION TO PARA‐TERTIARY‐BUTYLPHENOLFORMALDEHYDE RESIN
Authors: MASSONE LUIGI , ANONIDE ANTONIO , BORGHI SUSANNA , USIGLIO DAVID
Published: May 2007

Background. Phenolformaldehyde resins, especially the para‐tertiary‐butylphenolformaldehyde resin (PTBP‐FR), are widely used in industry and in numerous materials of everyday use, such as glues, adhesives, or inks. They can cause many occupational and nonoccupational cases of dermatitis.

Patients and Methods. Forty‐one patients with positive patch test results to PTBP‐FR were selected for this study. They were patch‐tested with a series of chemically related compounds and cross‐reactions were noted.

Results. Phenolformaldehyde resin (PF‐R) was frequently positive (65.8%), whereas other compounds gave a much smaller number of positive results. Cases of occupational exposure (24.4%), location of the dermatitis (hands were involved in 46.3% of cases), and possible sources of exposure (shoes were the responsible agent in 12.2% of cases) were evaluated.

Conclusions. Phenolformaldehyde resins are an important cause of contact dermatitis and must be studied chemically and clinically to improve the prognosis of sensitized patients.
ISOTRETINOIN FOR ACNE VULGARIS
Authors: AL‐KHAWAJAH MARWAN M.
Published: May 2007

Background. The clinical efficacy of oral isotretinoin in the treatment of severe acne is now well established and so are the clinical and laboratory adverse effects of the drug. Isotretinoin was first introduced in Saudi Arabia late in 1987. In this 7‐year retrospective study, efficacy and side effects of isotretinoin are reviewed in Saudi patients with acne vulgaris seen in a university skin clinic in Riyadh, Saudi Arabia.

Materials and Methods. A total of 262 patients had been treated with isotretinoin. Their case records were studied with reference to demographic data, clinical findings, dosage of isotretinoin, response to the drug, and the prevalence and severity of clinical and laboratory adverse effects.

Results. Only 156 case records (69.9% women) could be evaluated. Most patients received 0.60 to 0.75 mg of isotretinoin per kg per day for a period ranging from 16 to 35 weeks (mean ± SD: 21.2 ± 3.3 weeks); a total cumulative dose of 75 to 146 mg per kg (mean ± SD: 104 ± 10.6 mg per kg). Approximately 56% of the patients had therapy‐resistant moderate acne and only 14% had nodulocystic acne. Of the patients, 90.4% had an excellent response and 3.8% were poor responders. Adverse effects occurred in 99% of the patients, but in no case did they lead to discontinuation of the drug. Except for minor differences in prevalence, the clinical side effects were similar to those reported in the literature. Elevation of plasma triglyceride levels was the most significant laboratory adverse effect.

Conclusions. This is the first report on the experience with isotretinoin in the treatment of acne in the Middle East. Moderate doses of isotretinoin are well tolerated and produce excellent results in Saudi patients with acne.
ADVANCED EPIDEMIC KAPOSI'S SARCOMA: TREATMENT WITH BLEOMYCIN OR COMBINATION OF DOXORUBICIN, BLEOMYCIN, AND VINCRISTINE
Authors: HERNÁNDEZ DIMAS E. , PÉREZ JOSÉ R.
Published: May 2007

Background. Systemic chemotherapy is a treatment modality in the management of epidemic Kaposi's sarcoma (EKS). We conducted a prospective trial to compare bleomycin as a single agent with a regimen of low‐dose doxorubicin, bleomycin, and vincristine (ABV) in patients with advanced EKS.

Methods. Twenty‐four homosexual or bisexual patients, between 21 and 40 years old, with positive enzyme‐linked Immunosorbent assay (ELISA) test for HIV and extensive EKS were included in the study. Half of the patients received bleomycin alone and the other half ABV.

Results. A total of seven patients achieved stable disease (SD) and five progressed during bleomycin treatment. A total of four patients achieved partial remission and eight SD during ABV treatment. There was no survival benefit between either arm of treatment.

Conclusions. Bleomycin alone is not a good starting agent for EKS, whereas ABV seems to be a good choice, because it can produce an acceptable palliation of advanced EKS without major toxicity.
SKIN SURFACE LIPIDS IN HIV‐POSITIVE PATIENTS WITH AND WITHOUT SEBORRHEIC DERMATITIS
Authors: OSTLERE LUCY S. , TAYLOR CHRISTOPHER R. , HARRIS DAVID W.S. , RUSTIN MALCOLM H. A. , WRIGHT STEPHEN , JOHNSON MARGARET
Published: May 2007

Background. Seborrheic dernnatitis (SD) is a frequent complication of infection with the human immunodeficiency virus (HIV). Most studies examining the cause of SD have concentrated on the roles of Pityrosporum ovale and sebaceous lipids. Previous studies of skin surface lipid from patients with SD have produced conflicting results, with some authors reporting an abnormal lipid composition and others finding little or no abnormality.

Methods. The composition of skin surface lipid was studied in 15 HIV‐positive and 10 HIV‐negative men with SD, in 14 HIV‐positive men without SD, and in 16 unaffected controls. Total lipids were extracted from unaffected forehead skin into petroleum ether and separated into lipid classes by thin layer chromatography. The lipid classes were quantitated by densitometry after charring with sulfuric acid.

Results. Patients, HIV‐positive with SD, had significantly lower proportions of free fatty acid (FFA) and higher levels of triglyceride than normal controls. Patients, HIV‐positive without SD, had a significantly increased proportion of FFA compared to HIV‐positive patients with SD. Patients with SD, both HIV‐positive and HIV‐negative, had a similar pattern of skin surface lipid. Levels of FFA were lower and those of triglyceride higher than in the patients unaffected by SD, whether HIV‐positive or not. There was no significant difference found between groups in free cholesterol, wax esters, and squalene.

Conclusions. Abnormalities of skin surface lipid composition may play a part in the development of SD in both HIV‐positive and HIV‐negative men.
SKIN DISEASES AMONG ADOLESCENT BOYS IN ABHA, SAUDI ARABIA
Authors: BAHAMDAN KHALED , MAHFOUZ AHMED A.R. , TALLAB TALAL , BADAWI IBRAHIM A. , AL‐AMARI OMAR M.
Published: May 2007

Background. Adolescence is characterized by a sensitivity to issues of attractiveness. With dermatologic conditions, this may adversely affect early detection and compliance.

Methods. A cross‐sectional study was carried out on a multistage stratified random sample of 647 adolescent schoolboys in Abha, Saudi Arabia, to determine the prevalence of skin diseases. The age of the boys ranged from 11 to 19 years with an average of 15.3 ± 1.9 years.

Results. It was found that 19.8% of the children were affected by one form or another of transmissible skin diseases (TSD). The most common types were: pediculosis capitis (9.6%), verruca vulgaris (3.9%), and tinea pedis (1.9%). The prevalence of TSD increased significantly as the age decreased and as the crowding index increased. As for nontransmissible skin diseases, acne vulgaris was the most prevalent disease (56.3%). The prevalence and severity of acne increased significantly as the age increased.

Conclusions. The findings indicate the need to develop regional intervention programs at the school level. Appropriate continuing medical education programs for school health workers in the region are mandatory to achieve this goal.
CUTANEOUS MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS: STUDY FROM LAHORE, PAKISTAN
Authors: KAPADIA NASEEMA , HAROON TAHIR SAEED
Published: May 2007

Background. Systemic lupus erythematosus (SLE) is an autoimmune disorder in which cutaneous lesions occur in 85% of patients. This study from Lahore, Pakistan, was conducted to determine the pattern and incidence of such lesions in SLE.

Methods. Forty patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) (1982) were examined between October 1992 and September 1993 for the presence of cutaneous manifestations.

Results. Skin changes noted were: noncicatricial diffuse alopecia (82.5%), malar rash (60%), mucosal lesions (60%), discoid eruption (57.5%), photosensitivity (60%), nail involvement (55%), vascular lesions (50%), pruritus (45%), and pigmentary changes (37.5%). Peripheral gangrene, chronic ulcers, Raynaud's phenomenon, urticaria, chilblains, thrombophlebitis, palmar erythema, and erythema multiforme were rare. Antinuclear antibody reaction was positive in 80% and anti‐dsDNA antibodies in 70%.

Conclusion. A different clinical pattern was noted in our patients than reported previously.