bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microcystic adnexal carcinoma induced by multiple radiation therapy
Authors: Schwarze Hardy P. ,   md, Loche François ,   md, Lamant Laurence ,   md, Kuchta Johannes ,   md, Bazex Jacques ,   md
Published: March 2003

We present an 84‐year‐old Caucasian man (Fitzpatrick classification: skin type II) with microcystic adnexal carcinoma (MAC) on his left cheek and a 15‐year history of recurrent squamous cell carcinoma (SCC) of the head, treated with numerous surgical interventions and multiple palliative 60‐Gy radiation therapy.In 1996, the patient developed a nontender, indurated, irregularly marked, erythematous lesion on his left cheek (1.5 × 1 cm). Furthermore, the patient suffered from radiodermatitis due to previous radiotherapy ( Fig. 1). Punch biopsy and a subsequent wedge excision showed features of both SCC and eccrine carcinoma. Histopathologic and immunohistochemical tests of the tumor revealed a diagnosis of MAC. The patient underwent Mohs' micrographically controlled surgery to obtain tumor‐free peripheral soft tissue margins. There was no evidence of any lymphatic invasion or distant metastasis in the physical and laboratory examination. So far, the patient has not developed any recurrences.Clinical picture of MAC showing features of radiodermatitisimageFollowing excision, the biopsy specimen (4 × 2.6 × 1 cm) was fixed in Dubosq‐Brazil and routinely processed for staining with hematoxylin and eosin. The neoplasm extended into the subcutaneous tissue with rare connection to the overlying epidermis ( Fig. 2). Follicular cysts with amorphous eosinophilic keratin and comma‐like tails of aggregates of epithelial cells were a prominent feature (
Fig. 3). Perineural invasion was evident, but there were only a very few mitotic figures. Immunohistochemistry on paraffin‐embedded tissue blocks was performed, showing strong labeling on dilated ducts for carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) in the lumina of tumor cells, and positive staining for anticytokeratin KL1 (55–57 kDa) and S‐100 protein. The latter was negative in ductal structures, but stained dendritic cells.Panoramic view of the tumor demonstrating poorly circumscribed and deeply infiltrative growth patterns. Rare connection of the tumor with epidermal structures is evident (hematoxylin and eosin, × 40)imageComma‐like tails of aggregates of epithelial cells and follicular cysts with amorphous eosinophilic keratin (hematoxylin and eosin, × 150)image
Cutaneous and neurologic manifestations of biotinidase deficiency
Authors: Navarro Paloma Cornejo ,   md, Guerra Aurora ,   md, Alvarez J. Gregorio ,   md, Ortiz F. Javier ,   md
Published: March 2003

A male newborn with no obstetric or familial antecedents, except that his parents were cousins, developed hypotonia, lethargy, and feeding problems from birth. Analysis revealed a marked metabolic acidosis and hyperammonemia. Three weeks later, he was admitted to hospital in order to receive parenteral nutrition and to undertake a study for metabolic diseases.The boy did not improve in spite of the use of parenteral nutrition and began to present with inspiratory stridor and tachypnea. One week later, he presented with an erythematous scaling eruption, which was especially intense in the lumbosacral region (Fig. 1a,b).The scalp was only slightly affected.Erythematous scaling eruption, more intense in the lumbosacral regionimageLaboratory findings were compatible with biotinidase deficiency diagnosed by demonstrating absent enzyme activity. His parents were also studied and they were found to have partial biotinidase deficiency (30% of enzyme activity).After 37 days of life, the baby was given a treatment consisting of 20 mg of biotin per day intravenously. Biochemical and neurologic alterations improved quickly.Meckel's diverticulum and a duodenal membrane were detected at the second month of life after a gastroduodenal survey, and both were operated on. The skin lesions did not improve, however, and intravenous biotin had to be increased to 40 mg/day. The eruption disappeared after 10 days.On his first birthday, he remained asymptomatic with 40 mg of oral biotin.
Successful treatment of tinea capitis with 2% ketoconazole shampoo
Authors: Greer Donald L. 
Published: March 2003

Abstract Background Oral antifungal drugs are required for effective treatment of tinea capitis. Topical antifungal shampoo's, namely ketoconazole 2% shampoo or products with selenium sulfide or salicylic acid are recommended as adjunctive therapy. Topical antifungal monotherapy has not been successful in the treated of tinea capitis. The purpose of this open study was to evaluate ketoconazole 2% shampoo as a monotherapy for the treatment of tinea capitis. Method A total of 16 black children, aged 3–6, all with proven tinea capitis caused by Trichophyton tonsurans, were treated daily for 8 weeks with 2% ketoconazole shampoo for a total of 56 treatments. Clinical and mycologic examinations were performed every 2 weeks and again at 4 weeks following treatment. The number of colonies were counted on each plate after each visit. Patients with positive cultures after 8 weeks were placed on oral griseofulvin; those with negative cultures were followed monthly by culture for an additional 12 months. Results Marked clinical improvement occurred in all patients within 2 weeks and absence of pruritus was noted by the patients as early as 2–6 days. After 8 weeks of shampoo, 14 of the 15 (93%) children were clinically healed. Mycologically, the cultures dropped from a confluent growth of T. tonsurans to less than 100 colonies within 2 weeks; fewer than 50 at week 4 and 20 colonies or fewer after week 6. At 8 weeks of treatment the number of colonies remained at 20 or fewer. Six of the 15 children (40%) had negative cultures after 2, 4, and 6 weeks. One child relapsed at the first 4‐week follow‐up visit. Five of 15 (33%) of the children remained culturally negative for 12 months post‐treatment. Conclusions Ketoconazole 2% shampoo alone reduces the number of viable arthroconidia in children with tinea capitis thus reducing the transmissibility and contagious nature of the disease. Unexpectedly, complete cure was obtained in 5/15 (33%) of the children. The children remained clinically and mycologically clear as long as one year after treatment.
American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics
Authors: De Oliveira‐Neto Manoel P. ,   phd, Mattos Marise S. , Perez Mauricio A. , Da‐Cruz Alda M. ,   phd, Fernandes Octavio ,   phd, Moreira João , Gonçalves‐Costa Sylvio C. ,   phd, Brahin Lúcia R. ,   msci, Menezes Claudio R. ,   Msci, Pirmez Claude ,   phd
Published: March 2003

Abstract Background Rio de Janeiro State in Brazil is an endemic area of American tegumentary leishmaniasis (ATL) induced by Leishmania (Viannia) braziliensis. Objective Our purpose was to describe the main clinical and epidemiologic characteristics of the disease in Rio de Janeiro State. Methods Patients from endemic areas of Rio de Janeiro State attending the Evandro Chagas Hospital were included in the study. A general physical, dermatologic, and otorhinolaryngologic examination was performed in all patients, as well as a Leishmanin skin test. Skin biopsy specimens were obtained and utilized for touch preparations (stained with Leishman dye), culture in special media (Nicolle, Nevy and McNeal; NNN), and histopathologic examination after hematoxylin and eosin stain. Positive cultures were identified with regard to species by the isoenzyme technique. Therapy with pentavalent antimonial compounds was employed in all cases. Eco‐epidemiologic characteristics were studied through regular field visits to endemic foci. Results Cutaneous disease was present in 87.2% of patients, and mucosal disease in only 12.7%. A single ulcerative cutaneous lesion was the most common clinical presentation. Demonstration of the parasite was always difficult and culture in special media gave the best results for diagnosis. The species involved in transmission was Leishmania (Viannia) braziliensis. Vectors included phlebotomine sand flies (Diptera: Psychodidae) of the genus Lutzomyia, and the most common species was Lutzomyia intermedia, captured mainly on the external walls of houses. Conclusions ATL in Rio de Janeiro is mostly a cutaneous disease. In general, the cases showed great sensitivity to antimony. A pattern of peridomestic transmission seems to be the rule.
Madurella infection in an immunocompromised host
Authors: Satta Rosanna , Sanna Silvana ,   BD, Cottoni Francesca 
Published: March 2003

A 77‐year‐old farmer, born and living in Sardinia, affected by acute myelogenous leukemia and undergoing chemotherapy treatment with cytosine arabinoside, presented at the Institute of Dermatology of Sassari in March 1998 with multiple subcutaneous lesions on the legs (Fig. 1) which had appeared 3 months previously. Scattered crusts were observed, and some nodules were necrotizing and ulcerated with a discharge of serosanguineous fluid. There was no history of trauma. A deep biopsy was performed and histologic examination showed suppurative inflammation in the middle and deep dermis with a mass of hyphae and numerous spores at periodic acid‐Schiff (PAS) reaction (Fig. 2). Culture of a small skin sample at 37 °C on Saboraud's dextrose agar resulted, 7 days later, in the development of flat, brownish, fluffy colonies. The reverse of the colony was black. Microscopically, the culture showed broad, segmented hyphae without conidia and with chlamydospores typical of Madurella. X‐Ray findings of the lower extremities showed no bony involvement.Red subcutaneous nodule on the legimageSuppurative inflammation in the dermis with a mass of hyphae and sporesimageOral itraconazole at a dosage of 100 mg twice daily was started and clinical evaluation demonstrated lesion resolution after 12 weeks with no adverse reaction.The patient had no evidence of relapse at follow‐up 10 months later.
Elevated plasma homocysteine levels in patients on isotretinoin therapy for cystic acne
Authors: Schulpis Kleopatra H. , Karikas George A. , Georgala Sophia , Michas Timos , Tsakiris Stylianos 
Published: March 2003

Abstract Background The use of Isotretinoin (Iso) for cystic acne (CA) therapy includes marked side‐effects such as dyslipidemia, increased liver enzymes, and reduction of biotinidase activity. Moreover, Homocysteine (Hcy), an amino acid, is metabolized in the liver requiring folate, vitamin B6, vitamin B12, and the activity of enzymes, i.e. cystathionine‐β‐synthase. Increased blood levels of Hcy are associated with premature occlusive vascular disease.Objective The aim of this study was the evaluation of Hcy levels and the responsible vitamins for its metabolism in patients with CA on Iso treatment.Methods  and Results  Twenty‐eight patients with CA were submitted to laboratory examinations before (Value 1) and after (Value 2) 45 days on Iso (0.5 mg/kg/24 h) therapy. Blood levels of Hcy and vitamin B6 were evaluated by HPLC methods, and folate and vitamin B12 using a commercial Kit. Hcy levels (Value 1 = 7.86 ± 1.6 μmol/L; Value 2 = 13.65 ± 3.3 μmol/L; P < 0.001) were statistically significantly increased in patients on treatment. Vitamins were unaltered, and lipids and liver enzymes increased. Significant correlation between Hcy levels, vitamins, and liver enzymes was found. Methionine loading tests performed in nine patient‐volunteers showed an abnormal response post‐treatment.Conclusions  It is suggested that the elevated Hcy levels in patients after 45 days on Iso therapy could be due either to the ‘inhibition’ of cystathionine‐β‐synthase by the drug and/or their liver dysfunction. Daily vitamin supplementation along with frequent evaluations of Hcy blood levels are recommended for the prevention of a premature occlusive vascular disease.
Lichen planopilaris
Authors: Sehgal Virendra N. , Bajaj Pramila 
Published: March 2003

P, a 20‐year‐old laborer displayed initial symptoms of the disease in question when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritis, and the appearance of slate‐blue eruptions on the scalp and elsewhere on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examination revealed the presence of grayish‐blue acuminate follicular papules, disposed singly and in groups (plaques). The pilo‐sebaceous orifices were conspicuously obliterated and filled by keratin plugs. Perifollicular erythema was a predominant feature on the scalp. The lesions were present over the scalp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male‐type baldness was a salient feature. In addition, it was studded with conspicuous acuminate papules in its center (Fig. 1a). The known nonhairy (glabrous) skin had classic lichen planus lesions (Fig. 1b).(a) Lichen planopilaris scarring alopecia, depicting slate‐blue acuminate papules. (b) Lichen planus plaqueimageimageHemotoxylin‐eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of the scalp were simultaneously studied. The former revealed changes in the epidermis comprising of hyperkeratosis, increase in thickness of stratum granulosum, hydropic degeneration of the basal cell layer and band‐like lympho‐histiocytic infiltrate pressing against and invading the epidermis, while the latter revealed uniform atrophy of the epidermis and vacuolization of basal cells. The hair follicles were dilated and were filled with keratin plugs. In addition to fibrosis of the dermis, pigment laden microphages and lympho‐histiocytic infiltrate was prominent. The follicles and the sebaceous glands were absent. However, arrectores pilorum and sweat glands were preserved (Fig. 2a,b).(a) Lichen planopilaris. Uniform atrophy of the epidermis, basal cell vacuolization, and dilated hair follicle filled with keratin plug. (b) Fibrosis of the dermis sebaceous and sweat glands preservedimageimage
Graves' disease presenting as elephantiasic pretibial myxedema and nodules of the hands
Authors: Cho Soyun , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung 
Published: March 2003

A 67‐year‐old man presented with a 2‐year history of asymptomatic, firm, multiple nodules and plaques and cerebriform hypertrophy of both lower legs and feet, and well‐defined, skin‐colored, firm nodules and tumors on both hands. He had been diagnosed as having Graves' disease 3 years previously, and had been treated with 10 mg of methimazole and 100 μg of thyroxin (T4) daily for 2 years. Physical examination revealed nonpitting edema, flesh‐colored to erythematous, firm, confluent, polypoid nodules and fissured plaques extending from the shins to the dorsa of both feet (Fig. 1), and round to oval, firm, skin‐colored, walnut‐to‐egg‐sized tumors on all 10 fingers and the ulnar side of the dorsum of the right hand (Fig. 2). The thyroid gland was diffusely enlarged; however, there was no exophthalmos, and extraocular movements were normal. There was no weight loss, loss of appetite, tremor, heat intolerance, diarrhea, or fatigue. On laboratory evaluation, thyroid‐stimulating hormone (TSH) had a markedly low titer of < 0.05 μU/mL (normal: 0.4–5.0), and the TSH receptor antibody was extremely high at 73.8% (normal: < 15%). Serum free triiodothyronine (T3), T4, antimicrosome, and antithyroglobulin antibodies were normal or negative. Skin biopsy samples from the shin and hand disclosed extensive mucin deposition throughout the dermis.Confluent, firm nodules and plaques on both shins and the dorsa of both feetimageFirm, nonpitting, well‐circumscribed, flesh‐colored masses with orange‐peel appearance of overlying skin and growth of coarse hair on the dorsum of the right handimage
Descriptive epidemiology of skin cancer on Aruba: 1980–1995
Authors: Kennedy Cornelis , Bajdik Chris D. 
Published: March 2003

Abstract Background  An epidemiology unit was established in Aruba in 1994. The primary focus was the development of an infrastructure for both surveillance and health information data systems. This effort resulted in the first analysis of available skin cancer data.Methods  A retrospective study of cancer and particularly skin cancer cases at the local histopathology laboratory for the period 1980–1995 was performed. All available records with a cancer diagnosis were evaluated.Results  During the study period, an increase in age‐adjusted rates for both men and women was observed for basal cell carcinomas and squamous cell carcinomas. No temporal trend was discerned for malignant melanoma or other skin cancers because the numbers of cases were small. Lesions were most often seen on the nose, face, and arm. Dermatologists provided the majority of skin cancer diagnoses and demonstrated the greatest diagnostic accuracy.Conclusions  The presence of a central histopathology laboratory may provide small island states, like Aruba, with important public health data. This first description of Aruba's skin cancer epidemiology provides information that may be utilized for future public health action.
Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction‐restriction analysis length polymorphism of the hsp65 gene
Authors: Ena Pasquale , Sechi Leonardo Antonio , Saccabusi Stanislao , Molicotti Paola , Lorrai Maria Paola , Siddi Massimiliano , Zanetti Stefania 
Published: March 2003

AbstractBackground  Nontubercular mycobacteria (NTM) may cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. This study involved eight patients (four men and four women) with primary cutaneous infections caused by NTM; the skin lesions included dermo‐hypodermal abscesses, suppurative granulomas, and papulonodules localized on the legs, arms, hands, and face. The general condition of the patients was relatively good and they were not immunosuppressed.Methods  All samples were processed with standard methods and the isolates were identified by pattern restriction analysis after polymerase chain reaction (PCR‐PCA) amplification of the heat shock protein of 65 kDa.Results  In this way, we were able to identify three Mycobacterium chelonae strains, two Mycobacterium marinum, two Mycobacterium fortuitum, and one Mycobacterium avium. The lesions disappeared in 3 or 4 weeks after treatment with two or more antimicrobials.Conclusions  For a correct diagnosis of cutaneous infection by NTM, demonstrating the presence of mycobacteria is essential; routinely available techniques lack sensitivity and are extremely tedious; often mycobacteria are not seen after acid‐fast stain. We used PCR‐PCA to identify mycobacteria grown in liquid media; the time of identification of mycobacteria was shortened relative to conventional methods.
A pilot study to determine the effect of tazarotene gel 0.1% on steroid‐induced epidermal atrophy
Authors: Kaidbey Kays , Kopper Scott C. , Sefton John , Gibson John R. 
Published: March 2003

Abstract Background  Repeated applications of a corticosteroid can induce epidermal atrophy. This study was performed to investigate whether the adjunctive use of tazarotene gel 0.1% might help to minimize the development of steroid‐induced epidermal atrophy.Methods  Each of 24 healthy volunteers received the following six treatments (applied 6 days per week for 4 weeks), which were randomized to each of six sites on their forearms: no treatment, tazarotene vehicle, tazarotene vehicle + tazarotene gel 0.1%, diflorasone diacetate 0.05% ointment, diflorasone diacetate 0.05% ointment + tazarotene vehicle, or diflorasone diacetate 0.05% ointment + tazarotene gel 0.1%.Results  The mean epidermal thickness was increased by 20% (NS) and 62% (P ≤ 0.0005) after applications of tazarotene vehicle and tazarotene gel 0.1%, respectively. Application of diflorasone diacetate reduced the mean epidermal thickness by 43% (P ≤ 0.0005). Concomitant application of tazarotene gel 0.1% with diflorasone diacetate did not entirely prevent atrophy, but was shown to ameliorate 37% of the epidermal atrophy induced by diflorasone diacetate alone (P ≤ 0.003 compared with steroid monotherapy).Conclusions  Tazarotene gel 0.1% significantly reduces epidermal atrophy induced by diflorasone diacetate 0.05% ointment.
The incidence of pemphigus in the southern region of Saudi Arabia
Authors: Tallab Talal , Joharji Hanan , Bahamdan Khalid , Karkashan Eman , Mourad Mohammed , Ibrahim Karam 
Published: March 2003

AbstractBackground  This is the first epidemiologic study of pemphigus in the southern region of Saudi Arabia.Methods  Data were collected from patient records in the outpatient and inpatient departments of Asir Central Hospital during the period 1990–99. The diagnosis of pemphigus was based on the clinical, histopathologic, and direct immunofluorescence patterns which were consistent with pemphigus.Results  The results showed that the mean incidence of the disease in the general population was 0.16/100 000; the mean incidence of the disease in the population above 20 years of age was 0.27/100 000. The prevalence of the disease at the end of the study period was1.56/100 000 for the total population, and 2.7/100 000 for the population above 20 years of age. The male to female ratio was 2.2 : 1. The age of onset of the disease ranged from 23 to 67 years, except for one case at an age of 9 years, giving an average of 43.1 ± 13.4 years and a median of 40 years. Pemphigus vulgaris was the most commonly encountered type, followed by pemphigus erythematosus (94.7% and 5.3%, respectively). Mucosal involvement occurred in 84.2% of cases. No association with neoplasia was found in the current study.Conclusions  Pemphigus in the southern region of Saudi Arabia is as common as in other parts of the world, but with higher mucosal involvement.
Mast cell density and IL‐8 expression in nonlesional and lesional psoriatic skin
Authors: Jiang Wen Yue , Chattedee Arka D. , Raychaudhuri Siba P. , Raychaudhuri Smriti K. , Farber Eugene M. 
Published: March 2003

AbstractBackground  An important cellular aberration at sites of psoriatic inflammation is an increase in the number of dermal mast cells. Being multifactorial immune effector cells, it is believed that mast cells play an essential role in perpetuating the inflammatory process of psoriasis. However, factors responsible for the infiltration and accumulation of mast cells in psoriatic lesions are largely unknown. Recent studies have demonstrated that Interleukin‐8 (IL‐8) exerts strong chemotactic effects on mast cells in vitro. Overexpression of IL‐8 has also been reported in psoriatic lesions. In this study, we have found a correlation between the expression of IL‐8 and dermal mast cell density in lesional psoriatic skin as compared to nonlesional psoriatic skin.Methods  Four‐mm punch biopsies were taken from 14 psoriatic patients and eight healthy volunteers. Using immunohistochemical techniques, 8 μm sections of lesional psoriatic, nonlesional psoriatic, and normal control samples were evaluated for dermal mast cell density and the density of IL‐8 expressing keratinocytes.Results  It was found that dermal mast cell density in lesional psoriatic, nonlesional psoriatic, and normal skin was 105.4 ± 71.2, 42.3 ± 30.1, and 47.5 ± 32.5 mast cells/mm2, respectively. IL‐8+ keratinocyte density in lesional psoriatic, non lesional psoriatic, and normal skin was 171.5 ± 67.1, 25.4 ± 14.9 and 20.6 ± 8.7 IL‐8+ Keratinocytes/mm2, respectively.Conclusions  The results of this study suggest that increased levels of IL‐8 in the keratinocytes of psoriatic plaques play a contributing role in the migration of mast cells to lesion sites.