bluuebunny/crossref_metadata_2025_split huggingface dataset:
Botulinum Toxin in the Treatment of Axillary Hyperhidrosis
Authors: Ibrahim Galadari , Jameelah Alkaabi 
Published: June 2007

Introduction. Axillary hyperhidrosis can be a source of social isolation and embarrassment. The available treatments are either ineffective or have intolerable side effects. The search for a simple, long‐lasting, and safe treatment has led to the use of botulinum‐A toxin injections in those with excessive axillary hyperhidrosis.
Materials and Methods. Fifteen patients participated in this study. All had a history of axillary hyperhidrosis of 1–6 years duration and were using different types of therapies without any benefit. Each patient was injected intradermally with 125 units of botulinum‐A toxin (Dysport, Spenywood Pharmaceutical) in 5–6 points over an elliptical area on each side. Patient follow‐up was performed using the iodine‐starch test.
Results. A total of 14 out of the 15 patients had complete anhidrosis 1 week after the injection. This result lasted for periods ranging from 1–6 months. No side effects were encountered.
Conclusion. Intradermal injection of botulinum‐A toxin seems to be a safe, rapid, and effective method of treatment in axillary hyperhidrosis.
Fibroepithelioma of Pinkus Presenting as a Sessile Thigh Nodule
Authors: Philip R. Cohen , Jaime A. Tschen 
Published: June 2007

A 68‐year‐old white man noticed the rapid enlargement of a newly appearing, painless lesion on his left leg during the previous month. There was no history of arsenic ingestion or local radiotherapy. A nontender, lobulated, sessile, red, 15×15×10 mm nodule protruded from the lateral side of his proximal right thigh (Figure 1). A tangential excision of the lesion was performed and the surgical site was allowed to heal by secondary intention. Microscopic examination showed anastomosing strands of basaloid cells extending from the overlying epidermis into the dermis (Figure 2). Some of the basaloid cells had atypical nuclei. Eccrine ducts were present within the strands of tumor cells. A fibromucinous stroma loosely surrounded the tumor. Focally, in the deeper portions of the tumor within the reticular dermis there was palisading of the peripheral row of cells and retraction of these tumor cells from the surrounding stroma (Figure 3). The tumor was completely removed in the sections examined. The pathologic changes were characteristic for the diagnosis of fibroepithelioma of Pinkus variant of basal cell carcinoma. Distant (A) and closer (B) views of a fibroepithelioma of Pinkus that presents on the patient's lateral right proximal thigh as a sessile nodule image Crusted polypoid nodule with a proliferation of anastomosing strands of basaloid epithelium embeded in abundant dense fibrous tissue (hematoxylin‐eosin stain, original magnification×4)image Another view shows some areas with stromal edema and focal retraction from the reticulated basaloid tumor (hematoxylin‐eosin stain, original magnification×4).image
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
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 maculeimage
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
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 scaleimage 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.
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
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.
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.