bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultraviolet Carcinogenesis in Nonmelanoma Skin Cancer Part II: Review and Update on Epidemiologic Correlations
Authors: Mona Almahroos , Amal K. Kurban
Published: June 2007

The relationship between ultraviolet radiation and nonmelanoma skin cancer (NMSC) is further elucidated by a review of case‐control studies relating type of exposure to the development of NMSC. Intermittent sun exposure is important in the pathogenesis of basal cell carcinoma, whereas cumulative exposure is important for both basal cell carcinoma and squamous cell carcinoma. The regional distribution of NMSC is also in areas of sun exposure. Furthermore, there are inherent risk factors for the development of NMSC that include hair and eye colors. Once an individual develops NMSC, he/she has increased risk of developing basal cell carcinoma, squamous cell carcinoma, or melanoma.
A Primer of Mohs Micrographic Surgery: Common Indications
Authors: Keyvan Nouri , Maria Patricia Rivas
Published: June 2007

Mohs micrographic surgery is a highly effective technique for the removal of some skin cancers. The technique is founded on the idea of excision with minimal margins (sparing normal tissue) and immediate histologic examination of horizontal frozen sections of the specimen while the patient waits. By doing this, a Mohs surgeon is able to examine the margins. If residual tumor is present, subsequent excisions are performed until it is completely removed. In cases of aggressive tumors, recurrent tumors, or in which the lesions are present in high‐risk anatomic locations (H‐zone of the face) or functionally important areas (e.g., digits, genitals), the preferred treatment is Mohs micrographic surgery.
Auricular Granulomatosis
Authors: Ljubomir Stransky , Maria Balabanova , Valentina Broshtilova
Published: June 2007

A 42‐year‐old man presented with an 18‐month history of right earlobe indolent rigid swelling. The patient was in good health, had taken no medication recently, and did not have allergies. The physical examination showed rigid, red‐bluish infiltrate of the right earlobe. No plicated tongue was present. The routine blood tests (blood cell counts, blood glucose, liver enzymes, electrolytes, serum angiotensin‐converting enzyme level, and chlamydial and gonococcal serological tests) were within normal ranges. Parasitological feces tests and a gastrointestinal occult bleeding analysis were negative. Lung x‐ray examination, fibrocolonoscopy, and abdominal ultrasonography did not show any pathologic findings. Mantoux test was normergic. Electromyogram of facial muscles and facial nerve were normal. Otorhinolaryngologic examination gave no data of focal infections. A vertical segmental biopsy of the right earlobe infiltrate showed histologic data of noncaseating Langerhans cell granulomas (Figure 1) with epithelioid cells and central lymphocytic infiltrate (Figure 2). Microscopic foci of necrosis were not found. No acid‐fast bacteria were demonstrated by Ziehl‐Neelsen staining method. Culture and animal inoculation to rule out Mycobacterium bovinum were not undertaken. A course of systemic, non‐steroidal, anti‐inflammatory drugs did not prove effective. This was followed by intralesional corticosteroid treatment that resolved the inflammation and stopped lesion progression.

Noncaseating Langerhans cell granulomas

image

Langerhans cells

image
Alpha‐Hydroxy Acids: Unapproved Uses or Indications
Authors: Marcia Ramos‐e‐Silva , Maria Cristina Ribeiro de Castro , Sueli Coelho da Silva Carneiro
Published: June 2007

Alpha‐hydroxy acids have been used for rejuvenation since ancient times, and now there are several on the market. Depending on the concentration, some have been shown to be effective as peeling agents and for rejuvenation. Glycolic acid and lactic acid are theα‐hydroxy acids most frequently used in cosmetics, although there are many others used in combination. Some of the most striking advances in dermatology have followed the off‐label use of drugs, which is widespread and unavoidable, but a well founded scientific approach to an individual patient's pathology must be emphasized as the number of products, regimens, and adjuncts increases exponentially in the cosmetic field. In this article the authors review some unapproved uses ofα‐hydroxy acids. More published data on the scientific value of these off‐label indications that proves whether they are effective or not is needed.
Chronic Cutaneous Herpes Simplex in a Patient With Hypogammaglobulinemia
Authors: Cristine Kloeckner Kraemer , Cristiane Benvenuto , Cristina Worm Weber , Márcia Salete Zampese , Tania Ferreira Cestari
Published: June 2007

An 11‐year‐old boy presented to the hospital with extremely painful ulcers and generalized pruritus of 6 months' duration. The patient had been having recurrent infections such as otitis, sinusitis, pneumonias, and enteritis since the age of 6 months and frequent pyoderma since he was 7 years old. He was undernourished, showing high deficiency in body weight and height. His two brothers, aged 3 and 9 years, were healthy. On examination, the ulcerated lesions were distributed on his scalp, ears, and right foot, presented irregular edges, and were covered by adherent crusts and pus (Figure 1). There were also tiny crusts in the interdigital areas of both hands, hyperkeratotic plaques on the palms and soles, and generalized fine desquamation. The histology of the biopsied material from an ulcer was consistent with the diagnosis of herpes simplex (Figure 2). Laboratory evaluation revealed anemia and hypogammaglobulinemia of the IgG, IgA, and IgM fractions. The lymphocytes culture response to phytohemaglutinine and Pokeweed mitogens was normal; however, the assessment of the cellular immunity revealed low levels of both subpopulations of T lymphocytes: CD4 (246/mm3) and CD8 (633/mm3). The immunophenotyping showed absence of B cells in the peripheral blood. Human immunodeficiency virus tests (ELISA and PCR‐DNA) were negative. Pseudomonas aeruginosa and Staphylococcus aureus grew on the culture of scalp lesions; Sarcoptes scabiei were abundant on the skin, confirming the diagnosis of crusted scabies. The treatment with systemic acyclovir and specific antibiotics such as ampicilin plus sulbactam, ceftazidime, and gentamicin led to the remission of the ulcerated lesions (Figure 3). Scabies was treated with oral ivermectin (3 mg/wk, for 3 successive weeks) in combination with topical permethrin. The patient was started on subcutaneous immunoglobulin, once a month, which he has been receiving regularly with improvement in the humoral immunity expressed by normalization of IgG levels. After the regression of skin lesions and associated infections, there was partial improvement in the cellular immunity (CD4 534/mm3) despite persisting at the lower limit for his age.

Pus‐covered irregular ulcers, located on the scalp and helix of the external ear

image

Skin biopsy showing ulcerated area comprising the superficial dermis and chronic inflammatory infiltrate with central chromatolysis and scattered multinucleated giant cells (hematoxylin‐eosin stain, original magnification×40)

image

Regressive lesions with atrophic and hypochromic irregular scars in the ear and scalp after 2 months of antiviral treatment

image
Widespread Kaposi's Sarcoma in an HIV‐Negative Man
Authors: Kendrick Christina G. , Brown Rachel A.
Published: June 2007

A 75‐year‐old African‐American man presented with a history of progressively worsening, asymptomatic papules and plaques on his trunk and all extremities. He reported that the lesions initially began on his extremities and over the next 20 years gradually spread to his trunk. His medical history was remarkable for hypertension and benign prostatic hypertrophy. He denied travel outside of the United States. A complete blood count and complete metabolic profile were normal with the exception of a mild normocytic anemia (hemoglobin of 11.2 g/dL) and an elevated creatinine of 1.6 mg/dL. Tests for human immunodeficiency virus and human T‐cell lymphotropic virus 1 and 2 antibodies were negative. A chest x‐ray revealed no abnormalities. Physical exam at the time of presentation revealed nontender, nonblanching papules and oval plaques most prominent on the lower extremities, but also on the trunk, upper extremities, and neck (Figure 1). The color of the lesions ranged from reddish‐brown to bluish‐brown, and the lesions were from 1 to 10 cm in size. The ankles and neck had areas of hypopigmented scarring (Figure 2). The plantar surfaces of the feet were hyperkeratotic with areas of hypopigmentation. There were no oral lesions. There was no lymphadenopathy and no hepatomegaly or splenomegaly. A punch biopsy was performed and stained with hematoxylin and eosin (Figure 3). It revealed a proliferation of thin‐walled, dilated vessels having a jagged outline. These changes were accompanied by a lymphoplasmacytic infiltrate. The patient was given the option of undergoing treatment with injections of doxorubicin. After a thorough discussion addressing the possible benefits and side effects of the treatment, the patient elected not to undergo treatment. Nine months after diagnosis, he continues without evidence of extracutaneous disease.

Erythematous plaques on the trunk and all extremities

image

Examples of hypopigmented scarring shown here on the lower extremities (A) and neck (B)

image

Thin‐walled, dilated vessels with irregular outlines accompanied by a mixed lymphoplasmacytic infiltrate (hematoxylin‐eosin stain, original magnification x40)

image
Kaposi's Sarcoma Mimicking a Facial Cyst as the Presenting Sign of Human Immunodeficiency Virus
Authors: Scheinfeld Noah
Published: June 2007

A young man presented with a 2‐month history of an enlarging nodule on his left cheek. He stated he was otherwise in good health and lacked significant past medical history. Examination revealed a 3.0 cm × 4.0 cm subcutaneous nodule on the patient's left cheek with an overlying 0.5 cm × 0.5 cm brown macule (Figure 1). No lesions where noted in the patient's mouth. The nodule felt minimally freely movable. A parotid tumor or cyst was suspected. Aspiration of the nodule was attempted, but only a small quantity of fluid was extracted, and the aspirate showed spindle cells. The lesion was biopsied. Histopathologic examination showed prominent endothelial cells and a proliferation of silt‐like vascular spaces with hemosiderin deposits (Figures 2,3) diagnostic of Kaposi's sarcoma. Laboratory testing revealed that his CD4 count was 5 cc2 and his viral load was 75,000 cc2. Examination of his lungs and gastrointestinal tract did not reveal any systemic evidence of Kaposi's sarcoma. He began taking combivir, nelfinavir, bactrim, and azithromycin. Four months later his CD4 count had increased to 10 cc2, his viral load had decreased to 700 cc2, and his nodule had virtually disappeared.

Nodule on the patient's left cheek with an overlying 0.5 cm×0.5 cm brown macule

image
Agiokeratomas of the Vulva: Possible Association With Radiotherapy
Authors: Smith Barry L , Chu Paul , Weinberg Jeffrey M
Published: June 2007

A 52‐year‐old nulliparous white woman was referred for evaluation of asymptomatic multiple dark‐brown vulvar lesions of unknown duration. The lesions were initially noted during routine gynecologic examination. The patient denied any vulvar bleeding, pruritus, pain, edema, or dyspareunia. Her medical history was significant for a staging laporatomy and radiotherapy performed 18 years prior for the treatment of stage 1a Hodgkin's disease. Her medical history included hypothyroidism, Raynaud's syndrome, and chronic hemorrhoids. Physical examination revealed five violaceous, slightly scaly papules ranging in size from 2 mm to 4 mm distributed bilaterally on the labia majoria. No other cutaneous or mucosal lesions were present. Prominent external hemorrhoids were observed. A representative lesion was biopsied. Histologic examination revealed dilated, erythrocyte‐filled vascular spaces immediately beneath a hyperplastic and hyperkeratotic epidermis (Figure). Both clinical and histologic findings were consistent with a diagnosis of vulvar angiokeratoma. The patient refused treatment of the lesions.

Low‐power (A) and high‐power (B) views of dilated, erythrocyte‐filled vascular spaces immediately beneath a hyperplastic and hyperkeratotic epidermis.

image
Hereditary Palmoplantar (Epidermolytic) Keratoderma: Illustration Through a Familial Report
Authors: Sehgal Virendra N. , Sardana Kabir , Sharma Sonal , Raut Dharmendra
Published: June 2007

Hereditary palmoplantar keratoderma, a well‐known clinical entity, is illustrated through a familial report of an unmarried young man who is the product of a consanguineous marriage (paternal and maternal grandmothers were sisters). The lesions were characterized by immense yellow waxy thickening of the skin surrounded by erythematous border (halo) and fissures/cracks associated with extensive scaling of the palms and soles. The lesions were bilateral and symmetrical. These features were supported by orthokeratotic hyperkeratosis hypergranulosis and acanthosis in hematoxylin‐eosin stained tissue sections prepared from the soles. Mycelia/spores could not be identified on Periodic acid‐Schiff (PAS) reaction. An autosomal dominant trait was revealed through family pedigree. An abridged update to recap the current status is highlighted.
Maintenance Therapy for Acne Vulgaris: The Fine Balance Between Efficacy, Cutaneous Tolerability, and Adherence
Authors: Wolf John E.
Published: June 2007

Maintenance therapy is defined as the regular use of appropriate therapeutic agents to ensure that acne remains in remission. Topical agents are the mainstay of maintenance therapy. A number of topical therapeutic options are available, including topical retinoids, benzoyl peroxide, and azelaic acid. The choice of topical agents should be based on a number of criteria: efficacy in addressing the subclinical microcomedo, which is the precursor lesion for both comedones and inflammatory lesions; tolerability, due to the need for application to a broader epidermal surface; and other properties that may enhance adherence. Patients may be more motivated to use agents that are easily integrated into their lifestyles and that have potential “skin‐repairing” properties.
Mosaic Hair Regrowth Pattern of Ophiasis and Androgenic Alopecia in a Patient With Alopecia Areata Totalis
Authors: Tan Cheng , Zhu Wen‐Wuan
Published: June 2007

A 21‐year‐old man presented with the complaint of vertex pattern alopecia for the last 14 years after a sudden hair loss due to alopecia areata totalis 15 years ago. He was in otherwise good health and denied using any medication. Teeth and nails were normal. His serum hormone levels and thyroid function profile were within normal limits. Other autoimmune diseases, including systemic lupus erythematosus, vitiligo, and diabetes mellitus were excluded clinically and experimentally. First‐degree family had no such background. Potassium hydroxide preparation of plucking hair was negative for fungal hyphae and spores. A final diagnosis of alopecia areata was made. Application of steroid cream at the site of alopecia was effective at first: regrowth hair gradually appeared at the nonandrogenic‐dependent region, but remained stagnant for the following 14 years. There were neither symptoms associated with the lesions nor psychosocial disturbances preceding the onset. On examination, a circumscribed U shaped display of hair loss over the center of the scalp, with persistence of hair only at the hair margin, was observed, mimicking grade VII on the Hamilton male‐pattern baldness classification system scale (Figure 1 and Figure 2). Another area affected was identical to the distribution pattern of ophiasis in alopecia areata, which locates at the hair margin of the right temple with an area ranging 4 cm in diameter (Figure 3). There was no clinical evidence of inflammation. Exclamation point hair was invisible. Differential diagnoses to be considered May include trichotillomania, circumscribed scleroderma, congenital vertical alopecia, aplasia cutis congenital, and familial focal alopecia. All of these conditions might be ruled out on the basis of the patient's history and clinical findings.

A circumscribed U‐shaped display of hair loss is over the center of the scalp, with persistence of hair only at the hair margin, mimicking grade VII male‐pattern baldness on the Hamilton scale

image

Illustration of the Hamilton male‐pattern baldness classification system scale

image

Another area affected has a distribution just like that seen in ophiasis in alopecia areata, with bald patches located at the hair margin of the right temple with an area ranging about 4 cm in diameter.

image
Erythrokeratodermia Variabilis
Authors: Galadari Ibrahim , Galadari Hassan
Published: June 2007

A 4‐year‐old girl presented to the dermatology clinic with complaints of erythematous skin lesions on her face, extremities, forearms, and joints. The patient was a product of a full‐term, normal pregnancy and delivery and was born to healthy parents. The parents are cousins. The condition started a few months after birth with small, hyperkeratotic patches on her cheeks. These lesions did not respond to the treatment that was given. The condition progressed and a few months later similar skin lesions started to appear on her forearms and knees. Different types of treatment, such as topical antibiotics, emollients, topical steroids, and systemic antihistamines, have been tried without any benefit. Some lesions showed variable exacerbations and remissions. There was no family history of a similar problem, although her older brother showed marginal hair loss without any skin lesions. On physical examination (Figures 1–3), hyperkeratotic erythrodermic plaques of variable thickness with sharply demarcated borders were seen on cheeks, extensor surfaces of forearms, and on the knees. The palms, soles, nails, and teeth were normal. The hair showed normal appearance, but there was no hair growth on the margins of the scalp. The laboratory investigations showed normal complete blood count and normal serum zinc and ferritin levels. Urine microscopy and examination was normal. Skin biopsy was taken and histopathology showed nonspecific features of hyperkeratosis with moderate papillomatosis and acanthosis (Figure 4). A diagnosis of erythrokeratodermia variabilis was made and the patient was started on emollients as treatment. There was not much improvement with the treatment.

Hyperkeratosis, acanthosis, and papillomatosis are noticed

image
Women Leaders in American Dermatology
Authors: Marylou C. Thelmo , E. Dorinda Shelley , Gloria F. Graham
Published: June 2007

Background. Women leaders in dermatology opened doors that allowed many men and women to follow in their footsteps. Their achievements have included presidencies of national and state medical organizations, teaching, and research. They changed the specialty through words and leadership.

Objective. This study highlights four women who significantly influenced American dermatology.

Methods. We selected four female leaders in American dermatology, one of whom is deceased. For the other physicians, a questionnaire was sent to two and a telephone interview was conducted with one. Other responses were garnered through an autobiography, a self‐recorded interview, and journal articles.

Results. Brief biographies with career highlights are presented for Minerva Smith Buerk, MD, founder of the Women's Dermatologic Society; Naomi Marilyn Kanof, MD, the first female editor of The Journal of Investigative Dermatology; Wilma Fowler Bergfeld, MD, the first female president of the American Academy of Dermatology; and Antoinette Foote Hood, MD, the first female executive director of the American Board of Dermatology.
Diseases on Hair Follicles Leading to Hair Loss Part II: Scarring Alopecias
Authors: Katharina Wiedemeyer , Wolf‐Berhard Schill , Christoph Löser
Published: June 2007

In Part I of the review (July/August 2004), the anatomy of hair follicles, the diagnostic approach to diseases leading to hair loss, and nonscarring alopecias were discussed. In this article (Part II of II), the focus is on scarring alopecias (dissecting folliculitis, folliculitis decal‐vans, lichen planopilaris, lupus erythematosus) in regard to pathogenesis, clinical findings, and current options of treatment. Most important for the survival of the hair follicle are the epithelial stem cells within the follicular bulge that communicate with the fibroblasts of the dermal papilla. These structures may be destroyed by systemic autoimmune disorders as well as by granulomatous diseases. To prohibit permanent damage of hair follicles, early diagnosis and the correct treatment are necessary.
Rare Clinical Form in Two Patients Affected by a New Variant of Endemic Pemphigus in Northern Colombia
Authors: Ana María Abrèu Velez , Isabel Cristina Avila , Jaime Segovia , Maria Mercedes Yepes , Wendy B. Bollag
Published: June 2007

Background. Recently, the authors described a new variant of endemic pemphigus foliaceus in rural areas surrounding El Bagre, Colombia, but without association with malignant tumors.

Methods. The authors' 10‐year fieldwork provided the opportunity to observe various manifestations of El Bagre endemic pemphigus foliaceus, including the presence of bilateral plaques in pretibial areas.

Results. Based on personal experience and literature reviews, the authors have correlated the auto‐antibody profile with the appearance of pretibial plaques.

Conclusion. Since pretibial plaques occur in patients with both fogo selvagem and El Bagre variants of endemic pemphigus foliaceus, as well as in other forms of pemphigoid, these diseases must be considered in the differential diagnosis of patients with clinical, immunologic, and/or epidemiologic risk factors.
Pimecrolimus‐Induced Tinea Incognito
Authors: Crawford CPT Kevin M. , Bostrom MAJ Paul , Russ LTC Brian , Boyd CPT Jason
Published: June 2007

A 6‐year‐old boy was brought to his primary care provider by his mother, who complained of a pruritic rash near his right eye. The eruption was described as a small, erythematous, slightly scaly plaque at the lateral margin of the right eyelid. The child was in good health and took no medications. The diagnosis of eczema was made; the patient was treated with pimecrolimus cream b.i.d. to the affected area. After 2–3 days of treatment, the itching and erythema completely resolved; however, a rough and scaly plaque persisted. After 1–2 weeks of treatment, the itching gradually returned, and the lesion began to increase in size. Multiple, similar lesions appeared several centimeters from the initially affected area. Pimecrolimus was discontinued; topical nystatin/triamcinolone ointment was prescribed. The eruption continued to spread, and the patient was referred to dermatology for further evaluation. The patient presented to the dermatology clinic with multiple annular, scaly papules and plaques with central clearing. Excoriations and mild inflammation were noted around all affected areas (Figure). A potassium hydroxide examination of the lesions revealed numerous hyphae. The nystatin/triamcinolone ointment was discontinued; oral griseofulvin was prescribed. The eruption improved dramatically after 3 weeks and eventually cleared completely after 5 weeks of treatment. Topical 2% ketoconazole cream was applied b.i.d. for the final 2 weeks of treatment.

Multiple annular, scaly plaques with an erythematous leading edge involving the right temple, cheek, and periorbital skin

image
Hair and Nail Relationship
Authors: Robert Baran , Rodney P.R. Dawber , Eckart Haneke
Published: June 2007

Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur‐rich matrix. It was first noted early in the 20th century that the nail unit was comparable in several respects to a hair follicle sectioned longitudinally and laid on on its side. The epithelial components of hair follicle and nail apparatus are differentiated epidermal structures that may be involved jointly in several ways as congenital and hereditary anomalies and acquired conditions such as alopecia areata, lichen planus, iatrogenic causes, and fungal infection. Multielemental characterization of human hair and nails shows that even after sample washing, many elements are enriched in the surface of the nails.
The Development of BL 7660 as an Anti‐Acne Agent
Authors: Bowring Nick
Published: June 2007

BRL 7660, a 16,16 di‐substituted androstene steroid, was initially developed by Beecham Pharmaceuticals as a potential anti‐fertility agent for males. It proved inactive in this area, but subsequent studies showed it to be a potent testosterone 5‐α‐reductase inhibitor. It showed little classical steroidal activity but reduced sebum secretion in the rat. In the hamster flank organ, it reduced the stimulant effect of testosterone but not 5‐α‐dihydrotestosterone after topical administration, but had little oral activity. Human studies showed that topical administration significantly reduced sebum secretion. Acne symptoms were reduced in many patients who showed enthusiasm for the treatment. Placebo effects were variable and reduced significance, which suggested that further formulation studies were required. Commercial pressures from other drugs in development prevented our researchers from pursuing this approach, and the project was terminated.
Immunohistochemical Profile of Multicentric Reticulohistiocytosis
Authors: Flávio Barbosa Luz , Antonio Pedro Gaspar , Marcia Ramos‐e‐Silva , Eliene Carvalho da Fonseca , Enoi Guedes Villar , Andrea Rodrigues Cordovil Pires , Neide Kalil‐Gaspar
Published: June 2007

Background. There is enough evidence to support the knowledge that multicentric reticulohistiocytosis (MR) is a histiocytic proliferative disorder; however, the type of histiocytes involved is not well established.

Objective and Methods. To study the nature of cells present in MR lesions by studying the immunohistochemical profile of three new cases and reviewing 23 cases reported in the literature.

Results. MR histiocytic cells are positive for vimentin, CD68, and CD45, negative for S‐100 protein, CD34, and XIIIa factor, and weak reactors for thrombomodulin. Small activated histiocytes are MAC387 positive. Lymphocytes, mainly CD4+ cells, are found in MR infiltrates.

Conclusions. The MR immunophenotypic pattern does not suggest a type I or type II dendrocyte or a Langerhans cell origin. On the other hand, it points to a different cell derived from the monocyte‐macrophage line. CD4+ cells may be responsible for activating the proliferation of histiocytic cells. Small histiocytic MAC387+ cells are likely to become the MR multinucleated giant cells.
Dermatophytosis: The Management of Fungal Infections
Authors: Aditya K. Gupta , Jennifer E. Ryder , Melody Chow , Elizabeth A. Cooper
Published: June 2007

Dermatophytosis is an infection of the hair, skin, or nails caused by a dermatophyte, which is most commonly of theTrichophytongenus and less commonly of theMicrosporumorEpidermophytongenera. Tinea capitis, tinea pedis, and onychomycosis are common dermatologic diseases that may result from such an infection. The treatment of fungal infections caused by a dermatophyte has been successful when treated with oral or topical antifungal agents. Terbinafine, itraconazole, and fluconazole are oral antimycotics that are effective in the treatment of superficial mycoses, although, depending on the severity of the infection, a topical antifungal may be sufficient.
Cutaneous Squamous Cell Carcinoma in Patients With Chronic Lymphocytic Leukemia
Authors: Kaplan Andrew L. , Cook Jonathan L.
Published: June 2007

Patients with chronic lymphocytic leukemia are at heightened risk for the development of cutaneous malignancies, especially squamous cell carcinoma. These tumors portend a worse prognosis than is typically seen in immunocompetent patients. Patients with chronic lymphocytic leukemia who develop squamous cell carcinoma are more likely to develop multiple tumors, recurrences after treatment, and regional or distant spread of their tumor. Evaluation of the literature substantiates the ominous nature of squamous cell carcinoma in patients with underlying lymphocytic malignancies.
Is There a Role for Tumor Necrosis Factor‐α Inhibitors and Especially Thalidomide in Dermatology?
Authors: Moschella Samuel L.
Published: June 2007

Because of the relative shortcomings and their side effects of the available anti‐inflammatory drugs such as systemic nonsteroids, corticosteroids, and immunosuppressive drugs, and since tumor necrosis factor‐α plays a major role in noninfectious inflammatory and autoimmune disorders, tumor necrosis factor‐α inhibitory drugs and the available tumor necrosis factor‐α inhibitory biologic modifying reagents are described. Among the drugs reviewed are pentoxifylline, thalidomide, etanercept, infliximab, and adalimumab. Their relative effectiveness and side effects are reported and recommendations are made.
Atopic Profiles, Familial Histories, and Coexisting Conditions Associated With Hand Eczema
Authors: William Abramovits , Lisa C Stevenson
Published: June 2007

Background. Many of the eczema cases seen by dermatologists involve the hands. The discomfort and embarrassment of hand dermatitis in any of its forms may compromise a patient's quality of life, causing frustrated attempts to identify the cause of the disease and engendering disappointment with treatment failures. Methods. The authors assessed the severity scores for each patient, personal and familial histories of atopy, coexisting conditions, triggers of irritation, types of treatments, and their success rates. The authors administered a comprehensive survey to 50 consecutive patients presenting with eczematous dermatitis on the ventral aspect of the hands. The authors used a novel hand eczema severity index and a questionnaire that assessed personal and familial histories of atopy as well as coexisting conditions, triggers, and sources of irritation; types of treatments employed; and success rates. Patients were also encouraged to complete a composite quality of life assessment. Results. Results reveal a high frequency of personal and familial atopy, a 58% prevalence of contact allergy, a 67.4% history of hay fever, 25.6% cases of asthma, and a 44% incidence of fungal infection, which was one of the most common coexisting conditions. Conclusions. Both topical immunomodulators and topical corticosteroid therapy treatments demonstrated an impressive efficacy. An overlap should be considered when clinical symptoms and histological results vacillate between psoriasis and eczema.
PsEma—A Hitherto Unnamed Dermatologic Entity With Clinical Features of Both Psoriasis and Eczema
Authors: William Abramovits , Clay Cockerell , Lisa C. Stevenson , Adrian M. Goldstein , Torsten Ehrig , Alan Menter
Published: June 2007

Introduction. Recent advances in molecular biology have helped establish differences between psoriasis and a group of inflammatory skin disorders commonly referred to as eczema. The authors have observed significant overlap between these two conditions such that a distinction between them may not always be made, even with histologic examination of skin biopsy specimens.

Objective. To determine how frequently psoriasis patients present features of both psoriasis and eczema.

Methods. The authors conducted a prospective analysis of 100 consecutive psoriasis patients in their clinic.

Results. The authors found that 20% could be diagnosed as “intermediate,” having lesions with characteristics of both psoriasis and eczema, or a personal history of both. The authors suggest naming this category of inflammatory dermatosis “PsEma”—an overlap condition in which the clinical, histologic, molecular, biologic, and therapeutic responses show characteristics of both psoriasis and eczema.
Dercum's Disease
Authors: Wortham Noel C. , Tomlinson Ian P.M.
Published: June 2007

Dercum's disease (adiposis dolorosa, lipomatosis dolorosa morbus Dercum), is a rare disorder resulting in painful fatty deposits around the upper legs, trunk, and upper arms. The portrait painted of Dercum's disease is very complicated, with many other disorders seen associated with the disease. There are no clear pathological mechanisms known, although it is suspected that there is either a metabolic or autoimmune component involved. Here, the authors review the literature to date, including some information from their own studies. In particular, the authors will look at the different strands of evidence pointing to the pathological mechanism of the disorder.
Pimecrolimus for Treatment of Acne Rosacea
Authors: Crawford Capt Kevin M. , Russ Lt Col Brian , Bostrom Maj Paul
Published: June 2007

Background. Rosacea is a common disease, which is often resistant to treatment. Topical calcineurin inhibitors have been efficacious in the treatment of other inflammatory disorders of the skin, and tacrolimus has been reported as an effective treatment option for erythrotelangiectatic rosacea.

Objective. Because of the benefits seen with tacrolimus in previous publications, we investigated the efficacy of a closely related compound, pimecrolimus, in patients with erythrotelangiectatic, papulopustular, and edematous rosacea. Methods. Twelve patients with erthryotelangiectatic or papulopustular rosacea who had failed conventional therapy were treated with topical pimecrolimus cream twice daily for 12–18 weeks. No patients had used any other treatment for rosacea within 30 days of the start of therapy. During the course of the study, no other topical or systemic treatment of rosacea was allowed. Results. Ten of 12 patients showed substantial improvement of erythema, while five of six patients with a papulopustular component noted at least an 80% decrease in the number of lesions.

Conclusions. It appears pimecrolimus May be efficacious in the treatment of erythrotelangiectatic and papulopustular rosacea and May be considered in patients with recalcitrant disease.
Activation Markers in Behçet's Disease
Authors: Basak Coskun , Yunus Saral , Ahmet Gödekmerdan , Ilker Erden , Naci Coskun
Published: June 2007

Introduction. One of the main problems in Behçet's' disease is the lack of an original laboratory marker that can reflect clinical activity. In this study, laboratory parameters that could be used as indicators of active disease are investigated.

Materials and Methods. The study included a total of 40 patients with Behçet's disease, 25 of whom were active and 15 inactive, who applied to Firat University, Firat Medical Center Dermatology, Rheumatology, Physiotherapy, and Ophthalmology outpatient clinics and a control group composed of 30 healthy volunteers. Serum neopterin, C‐reactive protein (CRP), and sedimentation rate (ESR) levels were determined in all patients and healthy controls.

Results. Serum neopterin, CRP, and ESR levels in active Behçet's disease patients were significantly higher than those in both the inactive group and healthy controls ( p<0.001).

Conclusions. It was contemplated that together with serum CRP and ESR, neopterin could be a useful laboratory parameter in patients in whom disease activation could not be determined.
A Histologic Study of Adverse Effects of Different Cosmetic Skin Fillers
Authors: Meire B. Parada , Nílceo S. Michalany , Karime M. Hassun , Ediléia Bagatin , Sérgio Talarico
Published: June 2007

Objective. This study was designed to describe the histologic aspects of the cutaneous and mucosal adverse reactions to fillers used for cosmetic purposes.

Methods and Materials. Eleven specimens of adverse reactions caused by Restylane, Artecoll, Metacril, New‐Fill, Aquamid, and liquid silicone were processed and stained by hematoxylin–eosin and Alcian blue and submitted to polarized light.

Results. Most of the reactions were foreign‐body granulomas.

Conclusions. The type of granuloma and the characteristics of the agent were determined, contributing to the histologic identification of the material used. In the cases involving Restylane and Aquamid, it was possible to identify the material using Alcian blue stain and by the presence of necrosis. This stain was strongly positive in Restylane and faintly positive in Aquamid, and intense necrosis was observed in Aquamid cases. In the other cases the filler material itself was recognized and identified.
Combination Therapy With Adapalene Gel 0.1% and Doxycycline for Severe Acne Vulgaris: A Multicenter, Investigator‐Blind, Randomized, Controlled Study
Authors: Diane M. Thiboutot , Alan R. Shalita , Paul S. Yamauchi , Catherine Dawson , Stéphanie Arsonnaud , Sewon Kang
Published: June 2007

Background. Combination therapy with a topical retinoid and an antibiotic is recognized as a rational and effective approach for the treatment of acne vulgaris. Adapalene, a naphthoic acid derivative with anti‐inflammatory and receptor‐selective retinoid properties, is safe and well tolerated. While the combination of adapalene with oral or topical antibiotics has been shown to deliver a superior and faster response than an antibiotic alone, the clinical benefits of a combination of adapalene and doxycycline, the most frequently prescribed oral antibiotic for acne in the United States, have yet to be evaluated.

Objective and Methods. In a 12‐week study, the efficacy and safety of the combination of adapalene gel 0.1% with doxycycline was compared with doxycycline alone for the treatment of severe acne. Subjects were randomized to receive doxycycline once daily in the morning and either adapalene or vehicle once daily in the evening.

Results. At Week 12, the combination adapalene‐ doxycycline was significantly superior to doxycycline alone for change from baseline in total (p<0.001), inflammatory (p=0.02), and noninflammatory (p<0.001) lesions. Significant differences in total lesions were observed as early as Week 4 (p=0.04). Both treatments were well tolerated, and no serious adverse events were reported.

Conclusions. The study demonstrates that the combination of adapalene and an oral antibiotic provides a superior and faster benefit than antibiotic therapy alone and should be considered at the initiation of treatment.
Intralesional Methotrexate for Keratoacanthoma of the Nose
Authors: Philip R. Cohen , Keith E. Schulze , Craig F. Teller , Bruce R. Nelson
Published: June 2007

A 56‐year‐old woman developed a nodule on her nose. A shave biopsy of the enlarging lesion was performed after 2 weeks and showed a keratoacanthoma. During the subsequent 4 weeks, the lesion continued to grow rapidly, and she was referred for excision of the lesion using the Mohs microscopically controlled technique. A tender 10×12 mm (120 mm2) erythematous nodule with a keratin‐filled central umbilication was present on her left nasal ala (Figure 1). Treatment options were discussed. The left nasal ala was locally anesthetized with 1% lidocaine with 1:100,000 epinephrine and the keratoacanthoma was circumferentially infiltrated with 10 mg of methotrexate (0.8 mL of 12.5 mg/mL methotrexate) using a 30‐gauge needle. The total amount of methotrexate injected was divided among several injection sites: the peripheral shoulder of the lesion (such that there was blanching of the entire rim) and under the center of the lesion at a depth clinically judged to be the deepest area of involvement. Within the next 7 days, the tumor began to decrease in size and ulcerate centrally. Examination 2 weeks after the initial injection showed a 71% reduction in the area of the tumor, which now measured 35 mm2 (7.0×5.0 mm). The tumor was injected in a similar manner as before with 5 mg of methotrexate. After another 2 weeks, the tumor had continued to shrink. It was flat without nodularity and measured 12 mm2 (4.0×3.0 mm); the tumor area was 66% less than 2 weeks earlier and 90% less than its original size. The residual tumor was again injected with 4.5 mg of methotrexate. There was complete clinical involution of the tumor when the patient returned for evaluation 6 weeks after her initial injection of methotrexate (Figure 2). A biopsy of the lesional area to confirm histologic resolution of the keratoacanthoma was not performed since there was no visible residual tumor. Periodic follow‐up examination has been performed and there has been no subsequent recurrence of the keratoacanthoma.

Keratoacanthoma of the nose presenting as a rapidly growing nodule with a keratin‐filled central umbilication on the left nasal ala

image

Resolution of the left nasal ala keratoacanthoma 2 weeks after the third biweekly intralesional treatment with methotrexate

image
TNF‐α Inhibitors and Congestive Heart Failure
Authors: Shahrad M. Behnam , Shahdad E Behnam , John Y. Koo
Published: June 2007

Tumor necrosis factor‐α inhibitors are among the new class of drugs that offer new options for psoriasis control. In addition to serving as a key mediator in psoriasis, elevated tumor necrosis factor‐α levels have also been observed in patients with congestive heart failure, and clinical trials have been performed to examine the effects of tumor necrosis factor‐α inhibitors, such as etanercept and infliximab, in such a population. Two large‐scale trials examining the effects of etanercept in more than 2000 patients with heart failure did not indicate any increased risk of mortality or morbidity, and no US Food and Drug Administration warning has been issued regarding the use of etanercept in such a patient population. On the other hand, a study with infliximab showed significantly increased deaths, hospitalizations, and morbidity. Thus, infliximab >5 mg/kg is now contraindicated in patients with moderate‐to‐severe congestive heart failure (New York Heart Association functional class III/IV). If infliximab must be used, it should not exceed 5 mg/kg, and patients must be followed closely.
Skin Dimpling as a Delayed Manifestation of Traumatic Amniocentesis
Authors: Jesleen Ahluwalia , Eve Lowenstein
Published: June 2007

A 2‐month‐old infant girl was seen for marks on her abdomen. Born after a 39‐week, 2‐day normal twin gestation to a 37‐year‐old healthy multiparous mother, the prepartum history for “Baby B” was significant only for amniocentesis at 17 weeks' gestation, where three needle insertions were required for obtaining amniotic fluid from “Baby B.” During amniocentesis, performed under ultrasound guidance by an experienced obstetrician, the amniocentesis needle was misplaced in the fetal abdomen in one of the failed attempts. No evident adverse sequelae were noted and the pregnancy proceeded without complication. As the baby gained weight, by 6 weeks of life two indentations appeared on the skin, becoming more pronounced as the baby became chubbier. Aside from this finding, the baby was otherwise healthy. Close examination revealed nontender skin‐colored focal puckering on the right anterior lower abdomen and the right flank. No induration, fluid exudation, or fistulous opening was evident. At 13 months of age, the lesions remained stable and asymptomatic.
Synthesis, Densification, and Phase Evolution Studies of Al2O3–Al2TiO5–TiO2 Nanocomposites and Measurement of Their Electrical Properties
Authors: Somani Vikas , Kalita Samar Jyoti
Published: June 2007

Alumina–aluminum titanate–titania (Al2O3–Al2TiO5–TiO2) nanocomposites were synthesized using alkoxide precursor solutions. Thermal analysis provided information on phase evolution from the as‐synthesized gel with an increase in temperature. Calcination at 700°C led to the formation of an Al2O3–TiO2 nanocomposite, while at a higher temperature (1300°C) an Al2O3–Al2TiO5–TiO2 nanocomposite was formed. The nanocomposites were uniaxially compacted and sintered in a pressureless environment in air to study the densification behavior, grain growth, and phase evolution. The effects of nanosize particles on the crystal structure and densification of the nanocomposite have been discussed. The sintered nanocomposite structures were also characterized for dielectric properties.
Influence of implant diameter on surrounding bone
Authors: Brink Jeff , Meraw Stephen J. , Sarment David P.
Published: June 2007

Objectives: Implant osseointegration is dependent upon various factors, such as bone quality and type of implant surface. It is also subject to adaptation in response to changes in bone metabolism or transmission of masticatory forces. Understanding of long‐term physiologic adjustment is critical to prevention of potential loss of osseointegration, especially because excessive occlusal forces lead to failure. To address this issue, wide‐diameter implants were introduced in part with the hope that greater total implant surface would offer mechanical resistance. Yet, there is little evidence that variation in diameter translates into a different bone response in the implant vicinity. Therefore, this study aimed at comparing the impact of implant diameter on surrounding bone.

Material and methods: Twenty standard (3.75 mm) and 20 wide (5 mm) implants were placed using an animal model. Histomorphometry was performed to establish initial bone density (IBD), bone to implant contact (BIC) and adjacent bone density (ABD).

Results: BIC was 71% and 73%, whereas ABD was 65% and 52%, for standard and wide implants, respectively. These differences were not statistically different (P>0.05). Correlation with IBD was then investigated. BIC was not correlated with IBD. ABD was not correlated to IBD for standard implants (r2=0.126), but it was correlated with wide implants (r2=0.82). In addition, a 1 : 1 ratio between IBD and ABD was found for wide implants. It can be concluded, within the limits of this study, that ABD may be influenced by implant diameter, perhaps due to differences in force dissipation.
Oral rehabilitation using Camlog® screw–cylinder implants with a particle‐blasted and acid‐etched microstructured surface. Results from a prospective study with special consideration of short implants
Authors: Strietzel Frank Peter , Reichart Peter A.
Published: June 2007

Objectives: The purpose of the present clinical study was to report on the clinical performance of screw–cylinder implants with special consideration of the survival rate of short implants.

Material and methods: In this prospective study with consecutive patient recruitment, Camlog® screw–cylinder implants with a particle‐blasted and acid‐etched microstructured surface and a triple‐cam tube‐in‐tube implant‐abutment connection have been used only. Two groups of implants were evaluated: implants of 9 and 11 mm in length were considered short, those of 13 and 16 mm were considered long. Besides clinical and radiographic parameters, data of complications, patients' subjective evaluation of treatment outcome, general medical history and smoking habits were recorded.

Results: Three hundred and thirty‐three Camlog® screw–cylinder implants were inserted in 133 patients. One hundred and twenty‐nine patients were available for follow‐up, representing 325 implants. The median observation period was 33 months (Q25% 26; Q75% 38). After a maximum observation period of 55 months, the Kaplan–Meier‐survival analysis revealed no significant difference between the mean survival probabilities of 98.3% (n=59, patient‐related) of short implants, and of 95.7% of long implants (n=70, patient‐related) (P=0.162). No significant difference was found between implant survival rates considering maxilla (98.7%) and mandible (98.2%). A stratified analysis of short implants revealed a significant influence of premature cover screw exposures (P=0.02) and smoking (P=0.008) on implant survival. These influences were not found significant for long implants.

Conclusions: The prognosis of short Camlog® implants is comparable with that of long implants. Therefore, their clinical use instead of performance of sophisticated vertical augmentation procedures before installation of long implants might be considered as alternative treatment option. In smokers, the use of short implants should be considered cautiously, however. The risk of premature cover screw exposure should be minimized.