bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of high‐dose methylprednisolone pulse therapy in patients with progressive and stable vitiligo
Authors: Seiter Simone , Ugurel Selma , Tilgen Wolfgang , Reinhold Uwe 
Published: March 2003

Abstract Background  Although there are several treatment options available for patients with generalized vitiligo, their efficacy is still a matter of debate. Although shown to be effective, corticosteroids applied either systemically or topically carry the risk of significant side‐effects in long‐term therapy. We evaluated the effectiveness of intravenous methylprednisolone (8 mg/kg body weight) administered on three consecutive days in patients with generalized vitiligo.Materials and methods  A total of 14 patients with progressive or static vitiligo were included in a prospective, open, clinical study.Results  Eighty‐five per cent of the patients presenting with progressive disease showed cessation of disease progression after the infusion therapy. Repigmentation was observed in 71% of patients with progressive vitiligo. None of the six patients presenting with static disease showed any repigmentation in response to this form of treatment. The therapy was well tolerated in all but one patient who developed intermittent arterial hypertension during therapy.Conclusions  High‐dose glucocorticoid pulse therapy may represent a therapeutic option in patients with generalized progressive vitiligo, and should be further evaluated in a prospective, randomized, clinical trial.
Demodex folliculorum in pregnancy
Authors: Aydingöz İkbal Esen , Dervent Barış , Güney Osman 
Published: March 2003

Abstract Background  Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS).Objective  We aimed to determine the influence of pregnancy on the carriage of DF.Methods  Mite density in 40 pregnant women was compared with that of age‐ and sex‐matched controls. Two standardized skin surface biopsies were taken from each subject.Results  In pregnant women, DF was found at 0.55/cm2, compared with a mean value of 1.2/cm2 in nonpregnant controls. The difference between the two groups was not statistically significant (Mann–Whitney test, P = 0.22).Conclusions  Our findings indicate that pregnancy may not have a direct effect on mite density.
Adapalene: an update on newer comparative studies between the various retinoids
Authors: Millikan Larry E. 
Published: March 2003

AbstractBackground  Extensive modification of the retinoic acid molecular skeleton has resulted in the development of adapalene, a more stable, less irritating compound with receptor selectivity. Adapalene selectively targets nuclear retinoic acid receptors found primarily in the epidermis. Pharmacologic and preclinical studies have demonstrated excellent follicular penetration, comedolytic activity, and anti‐inflammatory activity.Methods  Recent comparative trials were reviewed.Results  Adapalene is a useful new agent because of its tolerability and stability. It is a good therapeutic choice for combination with other topical anti‐acne medications, such as antimicrobials or benzoyl peroxide. Patient compliance with either combination or single‐agent adapalene regimens is likely to be enhanced because of the greater comfort and reduced skin irritation associated with the new compound. Other investigators have confirmed that adapalene gel produces consistent and significantly reduced irritation.Conclusions  Recent comparative trials on retinoids have provided new data to aid in the selection of the appropriate combination of topical agents for individual patients.
The safety of terbinafine in patients over the age of 60 years: a multicenter trial in onychomycosis of the feet
Authors: Smith Edgar B. , Stein Linda F. , Fivenson David P. , Atillasoy Ercem S. 
Published: March 2003

Thirty patients completed this open‐label, multicenter prospective study performed to evaluate the efficacy and safety of terbinafine treatment of onychomycosis of the feet in elderly patients. Inclusion criteria included an age of 60 years or older, a diagnosis of onychomycosis confirmed by positive potassium hydroxide (KOH) preparation at baseline, and toenails capable of regrowth. Patients were excluded from the study if they had received any systemic antifungal therapy within the previous 3 months or topical antifungal therapy within 1 week prior to the start of the study; had psoriasis; had toenail abnormalities interfering with normal toenail appearance; were immunosuppressed or immunodeficient; or had serum hepatic enzyme (serum glutamic‐oxaloacetic transaminase, SGOT; serum glutamic‐pyruvic transaminase, SGPT) values greater than 1.5 times the upper limit of normal at baseline.Following baseline evaluations, eligible patients received a 12‐week supply of oral terbinafine (250 mg/day) for self‐administration. Compliance was assessed by tablet counts at each visit and defined as the use of at least 80% of the medication prescribed at the first two visits. Follow‐up evaluations were conducted for the next 60 weeks, for a total study period of 72 weeks. These visits occurred at weeks 6, 12, 24, 36, 48, and 72. All follow‐up visits included: (i) the reporting of adverse effects; (ii) assessment of efficacy by KOH preparation, mycologic culture, and investigator evaluation; and (iii) physician and patient global assessments of various quality of life parameters (except for the visit at week 36).Safety and tolerance were assessed by physical examination at baseline and week 12, by laboratory evaluations (hematology, blood chemistry, and urinalysis) at baseline, week 6 and week 12, and by reporting and evaluation of adverse events throughout the entire study. Investigators assessed the extent of involvement of the target toenail and recorded global assessments of therapeutic efficacy at all visits. Mycologic evaluation was conducted by KOH preparation and a mycologic culture of the target toenail. Because of discrepancies in KOH results between the investigator sites and the central laboratory in early analyses, we chose to use the mycologic culture results to evaluate efficacy. Because all 30 subjects were treated with terbinafine, the entire group was considered for safety evaluation.
Lichenoid and granulomatous dermatitis
Authors: Magro Cynthia M. , Crowson A. Neil 
Published: March 2003

Abstract Background The prototypic lichenoid eruptions, lichen planus (LP), lichenoid drug eruptions, secondary syphilis, and collagen vascular disease, are defined histologically by a band‐like lymphocytic infiltrate in close apposition to the epidermis. We describe a novel form of lichenoid dermatitis with a granulomatous component. Design Skin biopsies from 40 patients demonstrating a band‐like lymphocytic infiltrate with concomitant granulomatous inflammation were encountered over 4 years. Clinicians were contacted to elucidate underlying triggers and medical illnesses. Results A lichenoid dermatitis, a linear eruption, vasculitis, annular erythema, and erythroderma were among the clinical presentations. A drug‐based etiology was implicated in 14 cases: the drugs included antibiotics, lipid‐lowering agents, anti‐inflammatory drugs, antihistamines, hydroxychloroquine sulfate, and angiotensin‐converting enzyme inhibitors. Over one‐third of patients with drug‐related eruptions had other medical illnesses associated with cutaneous granulomatous inflammation, namely rheumatoid arthritis (RA), Crohn’s disease, hepatitis C, diabetes mellitus, and thyroiditis. A microbial trigger was implicated in 12 patients in the context of infective id reactions to herpes zoster, Epstein–Barr virus (EBV), or streptococci, or active infections by Mycobacterium tuberculosis, M. leprae, fungi, and spirochetes. The remainder had hepatobiliary disease and RA without obvious exogenous triggers, cutaneous T‐cell lymphoma (CTCL), and idiopathic lichenoid eruptions (i.e. LP, lichen nitidus, and lichen striatus). One patient with LP had underlying multicentric reticulohistiocytosis. The histiocytic infiltrate assumed one or more of five light microscopic patterns: (i) superficially disposed loose histiocytic aggregates; (ii) cohesive granulomata within zones of band‐like lymphocytic infiltration with or without deeper dermal extension; (iii) a diffuse interstitial pattern; (iv) scattered singly disposed giant cells; and (v) granulomatous vasculitis. Additional features included lymphocytic eccrine hidradenitis in those patients with drug reactions, hepatobiliary disease, and antecedent viral illnesses, tissue eosinophilia and erythrocyte extravasation in drug hypersensitivity, granulomatous vasculitis in patients with microbial triggers, drug hypersensitivity or RA, and lymphoid atypia in lesions of CTCL or drug hypersensitivity. Conclusions The cutaneous lichenoid and granulomatous reaction may reflect hepatobiliary disease, endocrinopathy, RA, Crohn’s disease, infection, or a drug reaction. One‐fifth of cases represent idiopathic lichenoid disorders. Lymphoproliferative disease or pseudolymphomatous drug reactions must be considered in those cases showing lymphoid atypia.
New topical treatments change the pattern of treatment of psoriasis: dermatologists remain the primary providers of this care
Authors: Feldman Steven R. , Fleischer Alan B. , Cooper Jennifer Z. 
Published: March 2003

AbstractBackground Psoriasis is a common chronic skin disorder that can be debilitating both physically and psychologically. The treatment of psoriasis is complicated by the many manifestations of the disease, different patients’ subjective impression of the disease, and the availability of numerous topical agents, systemic agents, and phototherapy options for the disease.Purpose The purpose of this study was to characterize how topical psoriasis treatment is changing in the USA.Methods Data from the National Ambulatory Medical Care Survey (1990–1996) were used to characterize the use of medication at physician office visits for psoriasis vulgaris. Corticosteroid agents in the years 1990–1994 were classified by relative potency.Results There were 1.0 million yearly visits for psoriasis. Dermatologists were responsible for 95% of these office visits. Topical corticosteroids were the only medication listed at 50% of psoriasis visits, and were used in combination with another medication in an additional 26% of visits. High and superpotent corticosteroid agents accounted for 55% of all topical corticosteroid agents listed. Topical calcipotriene was the most commonly used noncorticosteroid treatment, and its use in combination with corticosteroids increased from 17% to 84% between 1994 and 1996.Conclusions 80% or more of people with psoriasis do not see a physician for the disease in any given year. A combination of different topical medications is commonly used to treat psoriasis. Patients should be aware of the availability of new therapeutic options and the special expertise of dermatologists in managing complex treatment regimens for psoriasis.Introduction
The relationship between Helicobacter pylori IgG antibody and autologous serum test in chronic urticaria
Authors: Hizal Müge , Tüzün Binnur , Wolf Ronni , Tüzün Yalçin 
Published: March 2003

Abstract Background In chronic urticaria, suspicious factors are Helicobacter pylori (HP) infection and autoimmunity, as well as other etiologic agents. Autologous serum injection is the first step to identify autoimmune urticaria. Our study was performed to determine the prevalence of HP infection in patients with chronic urticaria, and to evaluate the results of autologous serum testing in chronic urticaria patients who had HP antibodies. Methods HP immunoglobulin G (IgG) antibody was defined by an immunochromatographic method in 61 chronic urticaria patients and 15 healthy persons. Autologous serum testing was performed in 32 chronic urticaria patients. Results HP IgG antibody was found to be positive in 41% of chronic urticaria patients and 26% of healthy controls (χ2 = 7.82, P = 0.005). Autologous serum testing was positive in 40% of chronic urticaria patients who had HP IgG antibody. This ratio was 14.3% in chronic urticaria patients who did not have HP IgG antibody (χ2= 9.23, P = 0.002). Conclusions In this study, autologous serum testing was found to highly positive in chronic urticaria patients with HP IgG antibody, but the relationship between autoimmunity and HP infection requires further investigations.
A unique variant of Darier's disease
Authors: Peterson Christopher M. , Lesher Jack L. , Sangueza Omar P. 
Published: March 2003

A 45‐year‐old black woman presented with a chief complaint of an increasing number of ‘‘light spots’' on her face, upper trunk, and legs. She had a 4‐year history of a pruritic eruption on the dorsum of her hands. The eruption was particularly pruritic in the summer months. Other family members, including her sister and her daughters, reportedly had a similar dermatologic problem. The patient had been previously evaluated and biopsied by another dermatologist. The earlier biopsy was nondiagnostic, however, and she presented for further evaluation of this problem.On physical examination, the patient had hypopigmented macules along her jawline (Fig. 1), lateral neck, and upper chest. She had similar hypopigmented macules on her thighs. She had hyperkeratosis of the palmoplantar surface of her hands and feet. The dorsum of her hands had numerous coalescing, shiny, flat‐topped, hypopigmented papules (Fig. 2), and several of her fingernails had distal, V‐shaped notching.Hypopigmented macules on the cheek and along the jawlineimageCoalescing, hypopigmented papules on the dorsal aspect of the fingers and hand, with distal notching of the fingernailsimageA punch biopsy from a papule on the dorsum of her hand was obtained. The epidermis had corps ronds present with focal areas of acantholysis above the basal layer (Fig. 3). The dermis had sparse, superficial, perivascular infiltrates composed of lymphocytes and histiocytes. These changes were consistent with our clinical diagnosis of Darier's disease (keratosis follicularis).Corps ronds (large arrow) and focal acantholysis with suprabasal clefts (small arrow) are present in the epidermis (hematoxylin and eosin; original magnification, × 40)image
Generalized lichenoid drug eruption following Blaschko lines
Authors: Krasowska Dorota , Schwartz Robert A. , Lecewicz‐Torun Barbara 
Published: March 2003

A 16‐year‐old girl was referred for evaluation of a widespread rash of 1 month duration. Its onset was on the trunk, but it rapidly generalized to cover virtually the entire body. It was intensely pruritic. The girl had a history of recurrent frontal headaches and had been taking ibuprofen 1 month prior to and during the onset of the rash. She was in otherwise good health.She apeared to be a healthy adolescent with flat topped violaceous papules scattered on her entire body following an arch line unilateral pattern on the right cheek, band‐shaped on the neck and ‘‘S’' shaped lines on the frontal chest and abdomen (Fig. 1). They were ‘‘V’' shaped on the back, and had a linear pattern on all limbs. The nails, scalp, oral and genital mucosa were clear.Band‐shaped violaceous papules on the neck and armsimageRoutine laboratory findings were within normal limits. Serological tests for hepatitis B and C virus infection were negative. Histological features of lichen planus were evident on the skin biopsy specimen: orthokeratosis without parakeratosis, hypergranulosis, liquefactive degeneration of the basal layer, saw‐toothing of the rete ridges, pigmentary incontinence in the superficial dermis, band‐like interface infiltration of lymphocytes and histiocytes, and colloid bodies within the lower dermis and papillary dermis. There were no eosinophils evident in the dermis.This girl was given cimetidine 400 mg twice daily combined with topical fluticasone proproniate, but after 4 weeks showed no improvement. Methylprednisolone was given 16 mg daily for 2 weeks until remission began, then tapered for another 3 weeks. The pruritus ended after a few days of treatment, whereas the papules slowly resolved leaving behind fading hyperpigmentation, a cosmetic problem. Further treatment involved hydroxyzine and exfoliative ointments, but the hyperpigmentation did not resolve completely (Fig. 2).Hyperpigmented linear macules on the extremitiesimage
Hard palate perforation: an unusual finding in paracoccidioidomycosis
Authors: Castro Luiz G. M. , Müller Andreas P. , Mimura Maria Angela M. , Migliari Dante A. 
Published: March 2003

A 36‐year‐old black man presented to his dermatologist in May 1996 complaining of mucosal lesions in the mouth, as well as perforation of the hard palate. The lesions had started approximately 7 months before and had worsened gradually. Other complaints included odynophagia, dysphagia, mild dyspnea, and dry cough. The patient was in good general health, but reported a 3 kg weight loss over the previous semester. The hard and soft palate presented erythematous ulcers with a finely granulated base and irregular, but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate was seen in the center of the ulcerated region (Fig. 1). Direct examination of 10% KOH cleared specimens showed typical double‐walled, multiple budding yeast structures. Paracoccidioidomycosis (PCM) serologic reactions tested positive for double immunodiffusion (DI), complement fixation (CF) 1 : 256 and counterimmunoelectrophoresis (CIE) 1 : 128. Hematoxylin and eosin‐stained sections of oral lesions showed an ulcer covered by a fibrous leukocytic crust, with a lymphoplasmacytic infiltrate, as well as multinuclear giant cells containing round bodies with a double membrane. Gomori–Grocott staining showed budding and blastoconidia suggestive of PCM. Lung computed tomography (CT) exhibited findings consistent with pulmonary PCM. Diagnosis of the chronic multifocal form of PCM with oral and pulmonary manifestations was established. Drug therapy was initiated with ketoconazole (KCZ) 200 mg twice daily, which led to clinical cure in approximately 2 months. Serum antibody values rose 30 days after institution of therapy (CIE 1 : 256; CF 1 : 512), peaking at day 60 (CIE 1 : 1024; CF 1 : 1024). Three months later the daily dose was reduced to 200 mg and titers declined slowly. The diameter of the perforation remained unchanged (Fig. 2). The hard palate perforation was corrected with a palatoplasty 27 months after initiation of drug therapy (Fig. 3). KCZ was discontinued when serologic cure was achieved after 34 months of treatment (DI weakly positive; CIE 1 : 8; CF not measurable). The patient was discharged 46 months after the first visit.Ulcers with a finely granulated base on the hard palate with irregular but clearly defined margins. A perforation (diameter, 0.5 cm) of the hard palate is seen in the center of the ulcerated regionimageClinical aspect after 2 months of oral ketoconazole 200 mg twice daily. Resolution of ulceration was evident, but the diameter of the perforation remained unchangedimageFinal result of palatoplasty to cover hard palate perforationimage
‘‘Pot‐lid’’ technique for aesthetic removal of small lipoma on the face
Authors: Gupta Somesh , Pandhi Roma , Kumar Bhushan 
Published: March 2003

AbstractBackground  Patients presenting with an asymptomatic subcutaneous facial lipoma desire its removal in order to restore the contour of the face. The standard treatment for lipoma is excision, with the size of the incision being about one‐half of that of the tumor itself. The long linear scar resulting from simple excision may fail to improve the appearance of the patient. The removal of the lipoma through a small incision or a punch hole decreases the size of the resulting scar, but does not eliminate it completely.Objective  To improve the aesthetic outcome of the commonly used technique for lipoma removal, known as the narrow hole extrusion technique (NHET), by modification.Methods  Four patients (three men and one woman) with small lipomas on the face (three on the forehead and one on the cheek) were selected for the procedure. A 5‐mm punch was inserted deep into the center of the lesion to create a circular hole. The punched‐out piece of skin was kept in normal saline. The lipoma was extruded with the help of a hemostat and by squeezing pressure. This resulted in the formation of a subcutaneous cavity. After achieving hemostasis, two absorbable buried subcutaneous sutures were placed to create support for the graft. The punched‐out piece of skin was then positioned to cover the defect, like a ‘‘lid on a pot’' and dressed.Results  The color and texture match of the graft with the surrounding skin were excellent in three of the four patients by the end of 6 months. The graft, which was depressed in the fourth patient, improved through spot dermabrasion.Conclusion  The proposed modification of the NHET for lipoma removal improves the cosmetic outcome.
A randomized parallel trial of topical aspirin–moisturizer solution vs. oral aspirin for acute herpetic neuralgia
Authors: Balakrishnan Sadasivam , Bhushan Kumar , Bhargava Vinod Kumar , Pandhi Promila 
Published: March 2003

AbstractBackground  In this study, the efficacy of oral aspirin vs. topical aspirin in moisturizer (Vaseline Intensive Care Lotion) was studied in an open, randomized, parallel trial in patients with acute herpetic neuralgia.Methods  Thirty patients were evaluated in the trial, with 15 in each group. The patients were randomized to receive either oral aspirin, 375–750 mg three times a day, or 75 mg topical aspirin/mL of moisturizer (5–10 mL, depending on the extent of involvement), three times a day, for 21 days. Pain was assessed daily by means of a self‐rating visual analog scale and physician assessment. In addition, the skin and plasma levels of aspirin were measured in both groups.Results  The mean time to onset of pain relief was 44 min with topical aspirin and 110 min with oral aspirin. The mean duration of pain relief after a single application of topical aspirin was 5.4 h, whereas it was 3.5 h with oral aspirin. The mean visual analog scale scores for pain with oral aspirin decreased from 68.2 ± 6.1 on day zero to 43.1 ± 8.7 on day 21, which was not significant compared with the baseline score. With topical aspirin, the baseline pain score was 77.5 ± 3.7 and decreased to 6.8 ± 3 on day 21 (P < 0.001 compared to the baseline score and compared to oral aspirin). The mean plasma and skin levels of aspirin following oral administration were 16.21 ± 1.1 μg/mL and 1.97 ± 0.3 μg/mm2, respectively. After topical administration, the mean plasma level of aspirin was 2.29 ± 0.5 μg/mL (P < 0.01 vs. oral aspirin) and the skin level was 5.96 ± 0.4 μg/mm2 (P < 0.05 vs. oral aspirin). Treatment tolerance was excellent in both groups.Conclusions  This trial has demonstrated that topical aspirin in moisturizer is clearly superior to oral aspirin in relieving the pain of acute herpetic neuralgia, and that the analgesic activity of aspirin is largely due to its local effect.