bluuebunny/crossref_metadata_2025 huggingface dataset:
Availability of Genetic Services: Implementation and Policy Issues
Authors: Blancquaert Ingeborg
Published: April 2003

Data on the availability of genetic services are relatively scarce and suffer from several limitations. However, specific patterns of service delivery are observed in different countries. An analysis of the emerging patterns of organisation of services may help understand which factors influence the availability of genetic tests and services. The ability of each healthcare system to respond to an increasing demand for genetic tests and services will depend not only on the type of healthcare system and on its financial resources, but also on the organisation and structure of its genetic services. In particular, the strengths and weaknesses of the laboratory infrastructure and the clinical and counselling services, the networking of clinical geneticists and the responsibilities assumed by tertiary and primary care may determine the appropriate use of new diagnostics. Consideration of organisational issues is necessary to plan for the future provision and funding of clinical and laboratory genetic services. An additional concern in developing health policies for genetic services is the implementation of adequate oversight mechanisms.
Banking Biological Collections: Data Warehousing, Data Mining, and Data Dilemmas in Genomics and Global Health Policy
Authors: Blatt Robin J.R.
Published: April 2003

While DNA databases may offer the opportunity to (1) assess population-based prevalence of specific genes and variants, (2) simplify the search for molecular markers, (3) improve targeted drug discovery and development for disease management, (4) refine strategies for disease prevention, and (5) provide the data necessary for evidence-based decision-making, serious scientific and social questions remain. Whether samples are identified, coded, or anonymous, biological banking raises profound ethical and legal issues pertaining to access, informed consent, privacy and confidentiality of genomic information, civil liberties, patenting, and proprietary rights. This paper provides an overview of key policy issues and questions pertaining to biological banking, with a focus on developments in specimen collection, transnational distribution, and public health and academic-industry research alliances. It highlights the challenges posed by the commercialization of genomics, and proposes the need for harmonization of biological banking policies.
Population-Based Estimates of the Prevalence of Family History of Cancer among Women
Authors: Hall Ingrid J. , Burke Wylie , Coughlin Steven , Lee Nancy C.
Published: April 2003

Objective: Family history of cancer is recognized as one of the most important risk factors in predicting personal cancer risk. Nevertheless, there are few published population-based estimates of family history prevalence by age categories. Methods: We used responses of female controls (n = 4,754) from the population-based Cancer and Steroid Hormone study (1980–1982) to estimate the frequency of family history of various cancers among female relatives. We determined the age- and race-specific prevalence of family history of breast, ovarian, endometrial, and other cancers in first-degree female relatives of women aged 20–54 years. To evaluate changes in reporting family history over time, we also analyzed responses of control women (n = 1,544) from the Women’s Interview Study on Health (WISH) (1990–1992) to estimate the prevalence of family history of breast cancer. Results: The prevalence of a first-degree family history of breast, ovarian, endometrial, and cervical cancers was 6.4% (95% CI 5.7–7.1%), 1.1% (0.8–1.4%), 3.5% (3.0–4.0%), and 2.1% (1.7–2.5%), respectively. Among first-degree female relatives, the prevalence of family history of colon, lung, and thyroid cancers was 2.4% (2.1–2.9%), 1.5% (1.2–1.8%), and 0.5% (0.3–0.7%), respectively. The prevalence of family history of breast and colon cancers increased significantly with respondent’s age. Similar results for family history of breast cancer were obtained from an analysis of responses from the WISH. Conclusions: In addition to providing a point of reference for research and health policy, these results may be of interest to providers who care for female patients because of the usefulness of information about family history of cancer for assessing lifetime risk of cancer.
Beyond the Cholinergic Hypothesis: The Effect of Metrifonate and Other Cholinesterase Inhibitors on Neuropsychiatric Symptoms in Alzheimer’s Disease
Authors: Kaufer Daniel
Published: April 2003

Preliminary studies suggest that non-cognitive behavioural and personality alterations in Alzheimer’s disease may benefit from agents which inhibit central acetylcholinesterase (AChE). A double-blind, placebo-controlled, 26-week study of the AChE inhibitor metrifonate using the NeuroPsychiatric Inventory (NPI) to assess the effects of treatment on neuropsychiatric symptoms observed statistically significant mean change differences favouring treatment in the total NPI score and in symptoms of depression, apathy and hallucinations, as well as a nearly significant difference in aberrant motor behaviours. These data are consistent with previous studies and are believed to represent the first large prospective, controlled study demonstrating a beneficial effect of AChE inhibitor therapy on neuropsychiatric symptoms in Alzheimer’s disease. The nature of non-cognitive symptom responses to AChE inhibitor therapy and their potential impact on caregivers is discussed.
Differential Diagnosis of Frontotemporal Dementia: Pick’s Disease
Authors: Rossor Martin N.
Published: April 2003

Recognition of frontotemporal degeneration has been an important clinical and neuropathological advance. However, the clinical pathological correlates within this group present a major challenge. An EU-funded consortium has examined a retrospective series of neuropathologically confirmed Pick’s disease cases to explore potential clinical diagnostic features. From these, draft clinical criteria have been developed.
Polymorphisms of the Apolipoprotein E Gene Regulatory Region and of the LDL Receptor Gene in Late-Onset Alzheimer’s Disease in Relation to the Plasma Lipidic Pattern
Authors: Scacchi R. , Gambina G. , Martini M.C. , Ruggeri M. , Ferrari G. , Silvestri M. , Schiavon R. , Corbo R.M.
Published: April 2003

Two new polymorphisms in the regulatory region of the apolipoprotein E gene, –491 A/T and –427 T/C, have been reported to be associated with the risk of Alzheimer’s disease (AD). Moreover, in vitro studies suggest that the two polymorphisms modulate the levels of apoE protein expression. We examined these two polymorphisms, as well as the MspI polymorphism in the LDL receptor gene, in a series of elderly patients with late-onset sporadic AD and in an age-matched control group but failed to find any kind of association between these genetic features and an increased risk of AD. In the same samples we investigated the relationships between various genotypes and plasma lipid levels. Since the well-known effect of the three-allelic APOE polymorphism on plasma lipid levels could mask the effect of other polymorphisms, the analyses were performed taking into account the APOE genotype. The two regulatory region polymorphisms had significant effects only on the apoE levels. The –427 TT homozygotes had lower, and the –491 AA homozygotes had higher levels of apoE than other genotypes. This result confirmed in vivo the already observed in vitro effects of –491 A/T and –427 T/C polymorphisms on APOE promoter transcription activity.
Mutations of the Notch3 Gene in Non-Caucasian Patients with Suspected CADASIL Syndrome
Authors: Kotorii Satoshi , Takahashi Keikichi , Kamimura Kohei , Nishio Takeshi , Arima Kunimasa , Yamada Haruki , Uyama Eiichiro , Uchino Makoto , Suenaga Akihito , Matsumoto Masayasu , Kuchel George , Rouleau Guy A. , Tabira Takeshi
Published: April 2003

The Notch3 gene has been recently identified as a causative gene for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). To investigate the genetic contribution of Notch mutations in familial cases with vascular leukoencephalopathy, we screened 13 patients from 11 unrelated families, which were selected on the basis of magnetic resonance imaging findings and positive family history. We identified three different missense mutations in 5 patients from 4 families. Two (Arg90Cys and Arg133Cys) are the same as previously reported in Caucasian patients, the other (Cys174Phe) is a novel mutation causing a loss of a cysteine in epidermal-growth-factor-like repeats of Notch3. These data indicate that the CADASIL Notch3 mutations were found in approximately 35% of familial cases with leukoencephalopathy, suggesting genetic heterogeneity of the disease.
Inhibitory Effects of Retinoids on Vascular Endothelial Growth Factor Production by Cultured Human Skin Keratinocytes
Authors: Lachgar S. , Charvéron M. , Gall Y. , Bonafé J.L.
Published: April 2003

Background: Vascular endothelial growth factor (VEGF), a potent angiogenic factor and vasodilator, is strongly expressed by epidermal keratinocytes in many angiogenesis-dependent skin disorders. Retinoids may modulate VEGF in skin and this may be related to an effect on rosacea. Aim: To investigate the effect of retinaldehyde on VEGF production by human keratinocytes. Methods: The effects of different concentrations of retinoids (all-trans-retinal and all-trans-retinoic acid) on VEGF production by cultured human skin keratinocytes in both cell extracts and supernatants were determined. Expression of VEGF was analyzed by enzyme-linked immunosorbent assay (ELISA) and RT-PCR. Results: The amount of cell-associated and secreted VEGF strongly decreased with retinoid concentration (e.g. 48, 69% inhibition at 0.1 µM all-trans-retinal and -retinoic acid, respectively, in the supernatants). In parallel, approximately 25% inhibition of VEGF mRNA expression was obtained in the presence of 0.01 µM all-trans-retinal. Conclusion: The decrease in VEGF expression by keratinocytes on contact with retinoids may prevent skin neoangiogenesis in certain skin diseases.
Clinical Use of Topical Retinaldehyde on Photoaged Skin
Authors: Creidi P. , Humbert Ph.
Published: April 2003

Background: Retinaldehyde, the natural precursor of retinoic acid, should exert similar effects on photoaged skin. Objective: To establish the efficacy and safety of topical retinaldehyde on photoaged skin. Methods: Open and controlled clinical studies using image analysis of silicone skin replicas. Results: Retinaldehyde proved efficient and safe. Conclusion: Retinaldehyde is efficient and well tolerated for the improvement of the signs of photoaging.
F.I.GU.R.E.: Facial Idiopathic GranUlomas with Regressive Evolution
Authors: Skowron François , Causeret Anne-Sophie , Pabion Claire , Viallard Anne-Marie , Balme Brigitte , Thomas Luc
Published: April 2003

We report the case of a 69-year-old woman who presented a papular eruption on the eyelids. Histological features revealed a tuberculoid granuloma with a central caseating necrosis. Laboratory and radiological investigations revealed no tuberculosis and no systemic granulomatosis. Absence of vascular symptoms, inefficiency of cyclines and histopathological findings excluded granulomatous-type rosacea. Lupus miliaris disseminatus faciei (LMDF) was our final diagnosis. On the basis of our findings and a literature review, we believe that LMDF is an entity distinct from either skin tuberculosis or granulomatous-type rosacea. However, its name is confusing, and we propose to change it to ‘facial idiopathic granulomas with regressive evolution (FIGURE)’.
Bacillary Angiomatosis in HIV-Infected Patients – An Epidemiological and Clinical Study
Authors: Plettenberg A. , Lorenzen T. , Burtsche B.T. , Rasokat H. , Kaliebe T. , Albrecht H. , Mertenskötter T. , Bogner J.R. , Stoehr A. , Schöfer H.
Published: April 2003

Background: No data were available on the epidemiological and clinical characteristics of bacillary angiomatosis (BA) in Germany. Objective: To determine epidemiological and clinical data on HIV-associated BA. Methods: A chart review of all BA cases between 1990 and 1998 was performed in 23 German AIDS treatment units. Results: A total of 21 cases of BA was diagnosed. During this period, the participating HIV centers treated about 17,000 HIV-infected patients. As a result, a BA prevalence of 1.2 cases/1,000 patients can be assumed. 19 BA were localized in the skin; in 5 cases bones and in 4 cases the liver were involved. Out of 20 patients who received antibiotic therapy, 13 had complete remission. The median time of duration up to complete remission was 32 days (9–82). During the follow-up of the 20 patients, 7 relapses were observed. Conclusion: BA is a rare HIV-associated disease with a prevalence of 1,2 cases/1,000 patients in the presented study.
Primary Cutaneous T-Cell-Rich B-Cell Lymphoma and Hodgkin’s Disease in a Patient with Gardner’s Syndrome
Authors: Kamarashev Jivko , Dummer Reinhard , Hess Schmidt Monika , Kempf Werner , Kurrer Michael O. , Burg Günter
Published: April 2003

A 50-year-old patient, suffering from familial polyposis (Gardner’s syndrome), initially presented with several nodules on his left arm. Histological examination revealed primary cutaneous T-cell-rich B-cell lymphoma (TCRBCL). Staging procedures failed to detect any systemic involvement. Three years after total excision of the tumours, the patient presented with a non-specific dermatitis, enlarged axillary lymph nodes and splenomegaly. Histological and immunohistochemical examination of lymph node and spleen biopsy specimens resulted in the diagnosis of Hodgkin’s disease (HD) of the nodular sclerosis type. Sequence analysis of single cells micromanipulated from skin and from lymph node lesions indicated that both lymphoma infiltrates were derived from the same precursor germinal centre B-cell clone. This is a case showing a clonal relationship between TCRBCL and HD, providing support to the B-cell origin of Hodgkin and Reed-Sternberg cells.
Microwave Corneosurfametry and the Short-Duration Dansyl Chloride Extraction Test for Rating Concentrated Irritant Surfactants
Authors: Goffin V. , Piérard G.E.
Published: April 2003

Background: There are ethical concerns to conduct in vivo tests in the animal and human to provide evidence that cosmetics and other topical products are safe. Objective: To compare two methods, namely the short-duration dansyl chloride extraction test and the microwave corneosurfametry bioassay, to test the irritation potential of concentrated surfactant systems. Methods: Five surfactants and water were tested using the in vivo test and the bioassay. Results: A significant linear correlation was found between data yielded by the two procedures. Conclusion: The short-duration dansyl chloride extraction test and the microwave corneosurfametry bioassay provide similar information. The latter has the advantage of being safe.
Bcl-2 Expression in Skin Pathergy Reaction of Behçet’s Disease
Authors: Sullu Yuksel , Senturk Nilgun , Yildiz Levent , Sullu Yurdanur Demirel , Turanli Ahmet Yasar
Published: April 2003

Background: Bcl-2 expression in leukocytes plays an important role in autoimmune and inflammatory disease. Objective: In the present study, we investigated the Bcl-2 expression in the skin pathergy reaction (SPR) of Behçet’s disease (BD). Methods: The skin pathergy test (SPT) was performed on 23 patients with BD and 7 healthy controls. After 48 h, SPT specimens were taken by punch biopsy. Control samples were also obtained from the normal skin of 7 patients with BD and 11 patients with BD-unrelated leukocytoclastic vasculitis. Biopsy specimens were evaluated by routine histopathological examination and immunohistochemical Bcl-2 staining. Results: The SPT was clinically positive in 9 of 23 patients and histopathologically positive in 13 but never in the healthy controls. The majority of leukocytes in 12 of 13 histopathologically positive specimens were stained with Bcl-2. Only 3 BD-unrelated leukocytoclastic vasculitis samples showed Bcl-2 positivity. No Bcl-2 staining was found in healthy controls and normal skin samples of patients with BD. Conclusion: Our data may suggest a role of Bcl-2-mediated inflammation in the pathogenesis of the SPR in BD.
Treatment of Classical Kaposi’s Sarcoma with Gemcitabine
Authors: Brambilla Lucia , Labianca Roberto , Ferrucci Silvia M. , Taglioni Michela , Boneschi Vinicio
Published: April 2003

Background: Several drugs are active in aggressive classical Kaposi’s sarcoma (CKS); chemotherapeutic agents with fewer side-effects, more rapid response and able to overcome resistance to previous treatment are advisable when treating patients in a second line. Gemcitabine, an analogue of deoxycytidine with cytotoxic activity in the treatment of solid tumours, has been found to have no serious side-effects. Objective: To evaluate the usefulness of treating patients affected by aggressive CKS with gemcytabine. Methods: Twelve patients with a recurrent aggressive form of CKS previously treated with chemotherapy were treated with gemcitabine. The drug was administered intravenously at the dose of 1.2 g/week for 2 weeks, followed by a 1-week interval, until maximal response was reached. Objective responses and toxicity were evaluated according to WHO criteria. Results: Eleven evaluable patients achieved an objective response: CR in 1/11 and PR in 10/11. Toxicity was limited. Conclusion: This study shows the usefulness of treating patients affected with aggressive CKS with gemcitabine, in order to obtain control of the disease and to reduce the related symptoms as well as to overcome a possible resistance to previous treatments.
Influence of Body Posture and Gravitational Forces on Shear Wave Propagation in the Skin
Authors: Nizet J.L. , Piérard-Franchimont C. , Piérard G.E.
Published: April 2003

The body posture and gravitational forces govern in part the intrinsic skin tensile strength because they influence the orientation of the dermal fibre networks. Our objective was to assess changes in shear wave propagation in the skin according to the body posture and orientation of the gravitational forces. The study was performed in 30 middle-aged women with a normal body mass index. The Reviscometer® was used to assess the mechanical wave propagation on the volar forearm in extension or flexion. Similar measurements were made on the supra-areolar region of the breast when the trunk was in the horizontal or vertical position. Four measurements were made in each of 4 directions at given angles with regard to the body axis. The device gave reproducible data. Shear wave propagation was influenced by the body posture. The intra-individual variability in shear wave velocity according to the directions of measurements increased when the tissues were in a relaxed position. Skin tensile anisotropy increased in a relaxed body posture. Shear wave propagation may be a convenient non-invasive tool to better identify the natural skin tension lines in the skin, thus refining the orientation of incision during cutaneous surgery.
Minimizing the Risks of Missing a Contact Allergy
Authors: Goossens A.
Published: April 2003

The diagnosis of a contact allergy can be missed in the various stages of the allergological investigation: the clinical examination of the patients, the anamnesis, the skin testing as well as the determination of the relevance of a positive test. This is illustrated by means of examples from the literature.
Identification of TIA-1+ and Granzyme B+ Cytotoxic T Cells in Lichen sclerosus et atrophicus
Authors: Gross T. , Wagner A. , Ugurel S. , Tilgen W. , Reinhold U.
Published: April 2003

Background: The onset and persistence of cutaneous lichen sclerosus et atrophicus (LSA) are linked to the presence of an inflammatory infiltrate of CD3+ T cells that includes CD4+ and CD8+ cells. The functional relevance of the presence of these cells is unknown. Objective: The study intended to quantify resting and activated cytotoxic T cells in LSA lesions. Methods: Twenty patients with active LSA were studied. Skin-infiltrating T cells were immunohistologically characterized with antibodies against CD3, CD8, T-cell-restricted intracellular antigen (TIA-1) and granzyme B (GrB). TIA-1 labels cytotoxic granules of resting and activated T cells, whereas GrB designates activated cytotoxic T lymphocytes (CTL). Results: In all cases, numerous T cells were consistently found expressing cytotoxic granules. The results indicated a high number of infiltrating CD8+ TIA+ T cells. Furthermore, a notable number of GrB+ activated CTL associated with hydropic degeneration of the basal cell layer were found within the dermal infiltrate and at the dermoepidermal interface. Conclusion: This study shows that a high proportion of skin-infiltrating T cells in LSA has a potential cytotoxic function. The results indicate that hydropic degeneration of basal keratinocytes may at least partially be mediated by CTL-dependent mechanisms. Our data also indicate that a cell-mediated immune response may play an important role in the pathogenesis of the disease.
Efficacy of Itraconazole, Terbinafine, Fluconazole, Griseofulvin and Ketoconazole in the Treatment of Scopulariopsis brevicaulis Causing Onychomycosis of the Toes
Authors: Gupta Aditya K. , Gregurek-Novak Teodora
Published: April 2003

Background:Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis. Objective: To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis.Patients and Methods: In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks. Results: There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25–53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment. Conclusions: Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.
Wegener’s Granulomatosis: Description of a Case Where Cutaneous Involvement Was Correlated with Elevation of the c-ANCA Titer
Authors: Mock M. , Cerottini J.P. , Derighetti M. , Buxtorf K. , Livio F. , Panizzon R.G.
Published: April 2003

Wegener’s granulomatosis is a systemic disease characterized by necrotizing granulomas and vasculitis involving the upper and lower respiratory tract as well as the kidneys. Cutaneous manifestations consist mainly of papules or papulonecrotic lesions. c-ANCA are known to be a valuable adjunct for the diagnosis and follow-up of Wegener’s granulomatosis with systemic involvement. We report the case of a 49-year-old man with Wegener’s granulomatosis who developed two relapses of the disease with cutaneous manifestation and who presented with concomitant elevation of the c-ANCA and more precisely the subset PR3-ANCA during the acute phase of the disease.
Skin Cancers in Organ Transplant Recipients: Two Cases of Virus-Induced Neoplasms
Authors: Hofbauer Günther F.L. , Dummer Reinhard , Hafner Jürg , Burg Günter , Binswanger Ulrich , Kempf Werner
Published: April 2003

Immunosuppression profoundly influences the prevalence of skin disorders in transplant recipients. Skin tumors occur with high incidence and constitute a major part of transplantation-related morbidity and mortality. We report on 2 immunosuppressed patients presenting with rapidly growing epithelial and mesenchymal neoplasms after renal transplantation. The diagnostic approach, differential diagnosis and treatment options are discussed emphasizing the characteristics of cutaneous lesions in immunosuppressed transplant recipients.
Ulcerative Sarcoidosis Successfully Treated with Apligraf
Authors: Streit M. , Böhlen L.M. , Braathen L.R.
Published: April 2003

The case of a 73-year-old female patient is reported with a 25-year-long history of widespread cutaneous sarcoidosis without any known extracutaneous manifestations. The skin manifestations started with erythematous and plaque-like lesions that had ulcerated on the legs for the last half-year. A relevant venous insufficiency or other etiology of the ulcers could not be found. Histology from lesions of the trunk and from the surroundings of the ulcers revealed the typical noncaseating granulomas. A systemic involvement could not be observed; leukopenia and a slightly elevated angiotensin-converting enzyme level in the serum were found. Topical steroids did not prove successful on the ulcers. Apligraf, a bilayered skin equivalent, was transplanted twice on the ulcers leading to complete closure within 3 months. A therapy with systemic steroids could thus be avoided.
Vulvodynia after CO2 Laser Treatment of the Female Genital Mucosa
Authors: Tschanz C. , Salomon D. , Skaria A. , Masouyé I. , Vecchietti G.L. , Harms M.
Published: April 2003

We have observed 3 cases of vulvodynia after CO2 laser (pulse or scan) treatment of condylomata acuminata (n = 1) or bowenoid papulosis (n = 2) of the female genital mucosa. Laser treatment was associated with a considerable delay in healing (3–4 months) and chronic pain. The histology of the treated areas showed a scar tissue and severe mucosal atrophy. The occurrence of painful scars following CO2 laser treatment could be related to an inadequate laser technique considering the morphology of the vagina.
Teloptosis, a Turning Point in Hair Shedding Biorhythms
Authors: Piérard-Franchimont C. , Piérard G.E.
Published: April 2003

The timing regulation of the hair growth phases is quite complex. We name teloptosis the termination of the telogen phase with hair shedding. The initiation of the next anagen I phase is independent from teloptosis. Both events are triggered by distinct factors. Indeed, teloptosis is the result of the loss of adhesion between cells of the club hair and those of its epithelial envelope. Teloptosis synchronization is perceived as telogen effluvium, related or not to shortening of the anagen phase. Subtle changes leading to early or delayed teloptosis affect hair density. It is possible to distinguish two types of telogen hairs on a trichogram. Those with an epithelial sheath indicate strong binding, suggesting early telogen, whereas the absence of an epithelial sheath indicates loose binding, conveying teloptosis.
Psychosocial Impact of Acne vulgaris
Authors: Mulder M.M.S. , Sigurdsson V. , van Zuuren E.J. , Klaassen E.J. , Faber J.A.J. , de Wit J.B.F. , van Vloten W.A.
Published: April 2003

Background: Although knowledge concerning the impact of acne vulgaris on quality of life has increased in recent years, relatively few studies have assessed the effect of a change in clinical severity on psychosocial state. Objective: Assessment of the effect of a change in clinical acne severity on psychosocial state. Methods: This was investigated by means of questionnaires and clinical assessements by acne patients and dermatologists. Fifty females with mild to moderate facial acne were seen before and after a 9-month treatment with oral contraceptives. Results: The results showed a great variability in psychosocial impairment between individuals. After 9 months, a significant reduction in clinical severity was seen overall which did not relate to the significant improvements in self-esteem, stability of self-esteem and acceptance of appearance. Conclusion: Perceived psychosocial impairment is individually based, is greater in women who subjectively overrate their acne and does not relate to clinical improvement.
Basal Cell Carcinoma on the Vermilion Border of the Lip: A Study of Six Cases
Authors: de Sousa Joao , Sánchez Yus Evaristo , Rueda María , Rojo Sonsoles
Published: April 2003

Background: The vermilion border of the lower lip is a frequent location of squamous cell carcinoma (SCC), but it is very rarely mentioned within the published series of basal cell carcinomas (BCCs). Objective: We present 6 cases of BCC involving either mainly or exclusively the vermilion border of a lip. Methods: We reviewed from our files all the cases of BCC diagnosed in a period of 11 years. Results: A number of 3,477 BCCs were histologically diagnosed in that period; 2,872 (82.6%) of them were located on the head, and 66 (2.3%) of the latter (1.9% of all BCCs) were on the lips. In 6 cases, the neoplasm involved either mainly or exclusively the vermilion border of either the lower (5 cases) or the upper (1 case) lip. Conclusion: Not every carcinoma of the vermilion border of the lip is a SCC.
Multilesional Primary Cutaneous Diffuse Large B-Cell Lymphoma Responsive to Antibiotic Treatment
Authors: Hofbauer Günther F.L. , Kessler Birgit , Kempf Werner , Nestle Frank O. , Burg Günter , Dummer Reinhard
Published: April 2003

Borrelia burgdorferi infection has been implicated in cutaneous B-cell lymphoma. We report a case of multilesional primary cutaneous large B-cell lymphoma without extracutaneous spread in a patient with elevated B. burgdorferi titers. After antibiotic therapy, clinical remission and a subsequent drop in B. burgdorferi antibody titers were obtained.
Influence of Occupational Exposure to Latex on the Prevalence of Sensitization and Allergy to Latex in a Swiss Hospital
Authors: Galobardes B. , Quiliquini A.-M. , Roux N. , Taramarcaz P. , Schira J.-C. , Bernstein M. , Morabia A. , Hauser C.
Published: April 2003

Background: Replacement of powdered latex gloves has been recommended in order to prevent the development of latex allergy in health care workers. The conclusion that occupational exposure to latex gloves represents a risk factor for latex allergy is mainly based on studies without exposure controls. Atopy is also thought to be a risk factor for the development of latex allergy. Objective: To determine the prevalence of atopy, sensitization to latex, and symptoms following latex exposure in professionally exposed and nonexposed hospital personnel by means of a cross-sectional study. Methods: Six hundred randomly sampled individuals working in medicine and surgery departments and in surgery theaters and 300 sex- and age-matched individuals classified as administrative personnel were selected from the employee data base of the Geneva University Hospital. A questionnaire about exposure to latex and symptoms following this exposure was sent to all individuals. Skin prick test reactions and serum IgE to latex as well as standard environmental allergens were determined in both groups. Results: Respiratory and skin (local) symptoms but not objective tests of latex sensitization (positive skin prick test and specific IgE to latex) were significantly associated with occupational exposure to latex (p < 0.001). Only among atopics subjects was 15 years or more of occupational exposure associated with a significantly higher prevalence of local symptoms than among those who were exposed from 1 to 9 years (odds ratio: 3.2; 95% confidence interval: 1.6–6.5). Atopy was significantly associated with sensitization to latex (odds ratio: 10.3; 95% confidence interval: 4.0–26.6) but not with local symptoms. Tests of latex sensitization were both frequently positive, less frequently negative, resulting in low kappa values. Conclusion: These results support the current preventive health care recommendation to replace powdered latex gloves. In atopics, increasing years of occupational exposure increase the risk of developing latex allergy. In contrast to questionnaires about local symptoms, skin prick tests and specific serum IgE to latex are of limited value in epidemiologic studies of latex allergy.
Cutaneous Eruptions in Coma Patients with Nontraumatic Rhabdomyolysis
Authors: Miyamoto Toru , Ikehara Akiko , Kobayashi Terukazu , Kitada Shingo , Hagari Yoshitaka , Mihara Motoyuki
Published: April 2003

Background: Rhabdomyolysis has been described most commonly after muscle injury but may also result from coma due to alcohol intake or drug abuse. Its clinical findings usually occur as muscular pain and swelling, but these symptoms are also seen in as many as 60% of patients with nontraumatic rhabdomyolysis. The diagnosis of slight nontraumatic rhabdomyolysis is often difficult to establish clinically. Few previous studies have reported cutaneous symptoms in nontraumatic rhabdomyolysis. Objective: We attempted to elucidate a relationship between nontraumatic rhabdomyolysis and cutaneous eruption. Methods: We studied 7 patients who were diagnosed as having massive to slight nontraumatic rhabdomyolysis with a cutaneous eruption in pressure areas at the first visit to our hospital between March 28, 1988, and June 27, 1998. Results: They revealed wine-red-colored urine and elevated serum myogenic enzyme. Two patients complained of muscle pain. In all patients, cutaneous eruptions including well-demarcated erythema, bullae and deep ulcers were observed in areas of pressure. The pathological findings of 5 cutaneous eruptions revealed necrosis of sweat ducts and glands in the dermis. Conclusions: The pathogenesis of nontraumatic rhabdomyolysis and the cutaneous eruptions in coma patients has not been elucidated, but these conditions are due to similar factors; pressure and hypoxia are considered to be important causative factors for both. Cutaneous eruptions in the coma patient may be an important clinical symptom of nontraumatic rhabdomyolysis.
Lip Sun Protection Factor of a Lipstick Sunscreen
Authors: Gabard Bernard , Ademola John
Published: April 2003

Background and Objective: There is a well-documented need for effective human UVA and UVB photoprotection. Since there are important anatomical variations, the sun protection factor (SPF) of a lipstick sunscreen was measured on the anatomical site intended for use. Methods: The SPF tests were performed according to Federal US and European COLIPA guidelines. Prior to performing a test on the lip, the minimal erythemal dose (MED) of the unprotected back skin was determined. Subsequently, the sunscreen SPF was measured on the anatomical target site (lip). The evaluator was blinded with respect to scoring the SPF of each sunscreen treatment. Individual test sites were assigned to one of the following treatment conditions: (1) no treatment (MED of unprotected skin); (2) test formulation; (3) reference standard. Results: The MED on unprotected back skin was found to be 25% lower than on unprotected lip skin. The SPF of the lipstick sunscreen was measured 2 units lower than the SPF determined in the classical way on the back skin. Conclusion: It was hypothesized that the higher MED of the lower lip compared with back skin was due to the adaptation of this tissue to the continuous exposure to UV radiation.
Anxiety and Depression as Risk Factors for Oral Lichen planus
Authors: García-Pola Vallejo M.J. , Huerta G. , Cerero R. , Seoane J.M.
Published: April 2003

Background: Stress and anxiety have frequently been mentioned as possible factors related to the development of oral lichen planus (OLP), although this association remains controversial. Objective: To determine whether anxiety and depression constitute risk factors in the development of OLP. Material and Methods: Eighty patients diagnosed as having OLP were studied: anxiety was evaluated by the Hamilton Anxiety Scale and depression with the Montgomery-Asberg Depression Rating Scale. The results were contrasted with those obtained in a control series of the same number of subjects (n = 80) matched for age and sex. Results: Significantly greater anxiety and depression were observed among patients with OLP than in the control group. Odds ratios of 2.8 and 4.4 were obtained for anxiety and depression, respectively. Conclusion: Our findings suggest that anxiety and depression constitute risk factors that could influence the development of OLP.
Pattern of Skin Diseases in a Geriatric Patient Group in Taiwan: A 7-Year Survey from the Outpatient Clinic of a University Medical Center
Authors: Liao Y.H. , Chen K.H. , Tseng M.P. , Sun C.C.
Published: April 2003

Background: Geriatric health care has become a worldwide concern, but relatively few statistical studies are available about geriatric skin diseases. Moreover, no information exists regarding skin disorders among the elderly population in Taiwan that has become a geriatric country. Objective: To determine the characteristic pattern and the prevalence of various skin disorders for the elderly who visited the National Taiwan University in the last 7 years. Methods: Using a database from the Dermatology Outpatient Clinic of the National Taiwan University Hospital, 1993–1999 file, we conducted a retrospective cross-sectional study by evaluating the age, proportion, and gender of each specific cutaneous disease category, χ2 tests were used for analyzing statistical significance. The analysis supplied odds ratios and 95% confidence intervals. Results: A total of 16,924 patients aged 65 years and older, which constituted 11% of the total patients seen at the Clinic of Dermatology from 1993 through 1999, were studied. The male to female ratio was 1.3 to 1. The most common cutaneous disorder in the elderly was dermatitis (58.7%), followed by fungal infections (38.0%), pruritus (14.2%), benign tumors (12.8%), and viral infections (12.3%). Cutaneous malignant tumors were found in 2.1%. Basal cell carcinoma occurred in 29.8%, actinic keratosis in 22.4%, Bowen’s disease in 13.3% and squamous cell carcinoma 13.3%. Interestingly, our cases of extramammary Paget’s disease showed a male predominance. Most melanomas were acral lentiginous melanoma located on the soles. The prevalence of common diseases in elderly patients compared with those outpatients of less than 65 years showed a 3-fold increased risk for pruritus. Moreover, the pattern of geriatric skin diseases in Taiwan was significantly different from Western countries. Conclusion: The prevalence of skin diseases in elderly patients emphasizes the importance of health education in geriatric people in Taiwan concerning appropriate use of emollients, proper foot care, sun protection and early detection of skin cancers.
Anti-Irritative Effect of Methylrosaniline Chloride (Gentian Violet)
Authors: Gloor Max , Wolnicki Damian
Published: April 2003

Background: There are no published studies of the effect of methylrosaniline chloride (MRC) on inflammation when used at the concentration recommended in the New German Formulary. A tissue-damaging effect has been described in animal studies and at higher concentrations in humans. Objective: To determine whether 0.5% MRC increases or reduces skin damage in irritative dermatitis. Methods: The study was carried out on the sodium lauryl sulfate (SLS) skin irritation model in 18 healthy volunteers. The impact of intermittent treatment with 0.5% MRC or drug-free vehicle on three SLS exposure effects was determined: reduction of stratum corneum water content (corneometry), increase in subpapillary blood flow (laser Doppler method) and barrier damage (transepidermal water loss). Results: MRC produced significant reductions in all three SLS exposure effects. Conclusions: Treatment of irritative dermatitis with 0.5% MRC is expected to produce a high clinical efficacy not only because of the compound’s established antimicrobial activity, but also because of its anti-irritative effect.
Sun Exposure Is an Aggravating Factor Responsible for the Recalcitrant Facial Erythema in Adult Patients with Atopic Dermatitis
Authors: Deguchi Hideki , Danno Kiichiro , Sugiura Hisashi , Uehara Masami
Published: April 2003

Background: In Japan, a considerable number of adult patients with atopic dermatitis suffer from recalcitrant facial erythema that resists common treatment with topical corticosteroids and antihistamines. Objective: Our purpose was to investigate the potential role of sun exposure in the aggravation of these facial lesions. Methods: The history of photoaggravation was taken from 74 adult patients with atopic dermatitis who suffered from recalcitrant facial erythema. Repeated UVB and UVA phototests were performed in 36 patients. Surface markers of infiltrating cells in UVB-provoked lesions were characterized immunohistochemically. Results: Forty-one of 74 patients experienced an exacerbation of the facial lesions after sun exposure. UVB testing revealed an abnormal, papular response in 14 of 36 patients. All of the 14 patients complained of clinical aggravation after sun exposure. No abnormal reactions were observed at UVA testing. In UVB-provoked lesions, CD4+ cells were predominant to CD8+ cells. Conclusion: Exposure to UVB radiation may be responsible for the recalcitrant facial erythema in at least some of the patients with atopic dermatitis.
Prevention and Treatment of Keloids with Intralesional Verapamil
Authors: D’Andrea Francesco , Brongo Sergio , Ferraro Giuseppe , Baroni Adone
Published: April 2003

Background: The current treatment of keloids is based on surgery, medical therapy and physical treatment. The optimal treatment remains undefined. Objective: This clinical study determines the effectiveness of verapamil hydrochloride on the prevention and treatment of keloids. Methods: Two groups of patients with keloids were divided according to lesion site and age. The first group was treated by perilesional surgical excision of keloids and topical silicone, combined with adjuvant treatment of intralesional 2.5 mg/ml verapamil hydrochloride injections administered at timed intervals. The second group served as control, receiving the same treatment except the verapamil hydrochloride. Results: A periodical examination to check specific clinical parameters and an 18-month follow-up determined that keloids were cured in 54% of the cases in the first group, compared to 18% in the second group. Moreover, in the remaining 36% of patients in the first group in whom keloids recurred, there was an improvement in size and above all in consistence. Conclusion: These findings suggest that verapamil hydrochloride is an effective tool for the prevention and therapy of keloids.
Combined Vaccination by Measles and Hepatitis B Vaccines: A New Cause of Gianotti-Crosti Syndrome
Authors: Andıran Nesibe , Şentürk Gonca Boztepe , Bükülmez Gül
Published: April 2003

An 11-month-old boy presented with Gianotti-Crosti syndrome. He had received measles and a third dose of hepatitis B vaccines 2 weeks before the onset of the eruption. There were no clinical symptoms of any viral infection at the presentation. Serological tests for common viral infections were negative. The combination of measles and hepatitis B vaccines was likely the relevant factor in the etiology.
In situ Localization of CD83-Positive Dendritic Cells in Psoriatic Lesions
Authors: Koga Tetsuya , Duan Hong , Urabe Kazunori , Furue Masutaka
Published: April 2003

Background: Dendritic cells (DC) are considered to be the most potent antigen-presenting cells, and CD83 is expressed at a high level on immune-competent, activated and mature DC. Although changes in the number or localization of mature and activated CD83+ DC could be expected in psoriasis, there is little information on such changes. Aim: Morphological identification of CD83+ DC in psoriatic skin lesions. Materials and Methods: Immunohistochemical staining was performed in 5 specimens of psoriasis vulgaris and 6 specimens of pustular psoriasis. Formalin-fixed, paraffin-embedded sections were used for examination in this study. The skin sections were pretreated with 0.1% trypsin for 60 min at 37°C prior to immunostaining for CD83. Results: A small but significant subpopulation of CD83+ DC was found in the upper dermis. In addition, CD83+ DC were occasionally scattered in the epidermis. The most common distribution pattern of CD83+ DC was as clusters with mononuclear lymphoid cells in the upper dermis. CD83+ DC were in close contact with lymphocytes. High-intensity staining of CD83 antigens was detected not only on the surface, but also in the cytoplasm of DC. Conclusion: These results indicate that activated and mature CD83+ DC may play a role in the immune response in psoriasis and provide in vivo support for the concept that CD83+ DC provide signals for direct intralesional T cell activation.
Ichthyosiform Mycosis fungoides
Authors: Marzano Angelo V. , Borghi Alessandro , Facchetti Maura , Alessi Elvio
Published: April 2003

Background: Mycosis fungoides (MF) is a skin malignancy of T helper lymphocytes with a wide clinical spectrum. Among the atypical variants of MF, there is an ichthyosis-like presentation. However, to date, only 1 case of ichthyosiform MF has been reported. Objective: Our goal was to summarize the clinical characteristics and course, and the pathological, immunohistochemical and molecular genetic findings on 4 patients with ichthyosiform MF. Methods: A retrospective study was conducted. Results: The 4 patients represented 1.8% of the 221 patients with MF seen by us since 1975. None progressed to systemic disease in up to 12 years (median, 10 years) after the onset of the cutaneous manifestations. Interestingly, skin lesions typical of so-called follicular MF (FMF) were associated in 3 of 4 cases, whereas cutaneous manifestations of classic MF were absent in all 4 patients. Conclusion: Ichthyosiform MF represents a rare variant within the clinicopathologic spectrum of MF usually featuring a benign course and a tendency to be associated with lesions of FMF but not with lesions of classic MF.