bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atypical molluscum contagiosum infection in an HIV‐infected patient
Authors: Mastrolorenzo MD Antonio , Urbano MD Francesco G. , Salimbeni MD Luca , Paoli MD Simone , Comin Camilla E. , Zuccati MD Giuliano 
Published: March 2003

A 43‐year‐old man, who was an intravenous drug abuser from 1978 to 1988, was referred to our STD & AIDS Center in October 1995 with flesh‐colored nodules of the foreskin. He was confirmed to be seronegative in February 1989, and the first positive human immunodeficiency virus (HIV) serology was documented in October 1989. At that time, the CD4+ count was 114/mm3 and anti‐retroviral therapy was therefore initiated and prolonged until October 1995. Within the last 4 months, the patient progressively lost weight (13 kg) and suffered from recurrent oral candidiasis, cytomegalovirus (CMV) retinitis, and severe oral herpes simplex virus (HSV) infection. Shortly afterwards the dermatologic lesions appeared. At this time, the CD4+ count had decreased to 8/mm3. Examination revealed nodules distributed over the external and internal linings of the foreskin, some isolated and some grouped, but individually well defined. These lesions, of the same color as the surrounding skin or slightly erythematous, were of varying sizes ranging from 0.5 to 1 cm in diameter, sessile, globous, coated with a keratotic epidermal layer, not shiny, hard‐elastic, non‐tender at compression, and without evident central umbilication, mimicking condylomata acuminata (Fig. 1). Upon squeezing, no discharge could be seen. The source of this infection was not identified as the patient denied sexual contact for the previous year.A three‐lesions biopsy showed the characteristic histologic features of molluscum contagiosum (MC). The dermis appeared indented by multiple, closely packed, lobules of proliferating epithelium (Figs 2 and 3). The infected keratinocytes contained intracytoplasmatic inclusions, the so‐called molluscum bodies displacing the nucleus and enlarging the infected cells.
Erythema nodosum and associated diseases. A study of 129 cases
Authors: Cribier Bernard , Caille Anne , Heid Ernest , Grosshans Edouard 
Published: March 2003

AbstractBackground Erythema nodosum (EN) is associated with many infectious diseases. The purpose of this study was to evaluate the relative prevalence of associated diseases in a large series of EN, and to review the previously described causes of EN.Materials and methods A total of 157 inpatients with a diagnosis of EN made in Strasbourg, France between 1960 and 1995 were studied retrospectively, but only 129 patients with confirmed EN were evaluated. A biopsy was taken in 30 patients with atypical clinical symptoms. Chest radiography, blood cell count, throat swab, and anti‐streptolysin dosage were performed systematically. Viral investigations and serodiagnoses for various bacterial infections were carried out in approximately half of the patients. All investigations were analyzed retrospectively and compared with the world literature.Results The female : male ratio was 5 : 1 and the mean age was 31 years. We found 28% confirmed streptococcal infections, 11% sarcoidosis, 1.5% enteropathies, 1.5% Chlamydia infections, 0.8% Mycoplasma infections, 0.8% Yersinia infections, 0.8% hepatitis B, and 0.8% tuberculosis (one case). The causative factor could not be determined in 55% of patients.Conclusions Our data confirm the predominance of streptococcal infections and sarcoidosis among patients with EN. Tuberculosis has virtually disappeared, since the last case was observed in 1962. Various viral or bacterial diseases are rarely associated with EN, but all patients were not thoroughly investigated. A large and prospective study should be performed in order to determine the true prevalence of associated diseases in EN. In the absence of specific symptoms, exhaustive investigations are not cost‐effective.
Frequency of pre‐existing actinic keratosis in cutaneous squamous cell carcinoma
Authors: Mittelbronn Michele A. , Mullins Diane L. , Ramos‐Caro Francisco A. , Flowers Franklin P. 
Published: March 2003

AbstractBackground Controversy over the rate of malignant transformation of actinic keratosis (AK) into cutaneous squamous cell carcinoma (SCC) has generated considerable debate regarding the importance of treating all such precancers to preclude their transofrmation. Current changes in US healthcare policy will deny many individuals access to certain simple and effective treatment modalities for precancerous lesions.Objective Our purpose was to determine whether there is a significant association between the presence of cutaneous SCC and pre‐existing AK.Methods One hundred and sixty five consecutive cases of cutaneous SCC, retrieved from the files of a university‐affiliated dermatopathology laboratory serving north‐central Florida, were selected for review by a single dermatopathologist (D.M.). Hematoxylin and eosin stained skin tissue slides were examined under light microscopy for the presence of AK in close proximity to, or giving rise to, cutaneous SCC.Results Of the 165 cutaneous SCC cases reviewed, 82.4% (136 out of 165) were found to have concomitant AK giving rise to and/or in close proximity to SCC. Of the 136 AK‐positive SCC cases, 26.7% (44) were identified as superficial SCC arising within an AK (AKSSCC) and 55.7% (92) had AK in close proximity to SCC (AK + SCC). Close proximity is defined to include AK changes located directly adjacent to (on the shoulder of) SCC, to a maximum distance of 8 mm away.Conclusions The 82.4% prevalence of concomitant AK and cutaneous SCC in our biopsy population suggests a strong correlation between these two lesions. The fact that 26.7% of these lesions had SCC arising from AK highlights the importance of early recognition and effective treatment for AK.
The histopathology of pathergy: a chronologic study of skin hyperreactivity in Behçet's disease
Authors: Ergun Tülin , Gürbüz Oya , Harvell Jeff , Jorizzo Joseph , White Wain 
Published: March 2003

AbstractBackground many patients with Behçet's disease (BD) demonstrate hyperreactivity (pathergy), and the induced skin lesions may serve as a model for the disease.Objective This study examined the sequence of histopathologic changes after needle prick trauma.Methods Eight patients fulfilling the International Study Group Criteria for Behçet's Disease, two patients with recurrent aphthous stomatitis, and two healthy controls each underwent intradermal injections with subsequent biopsies at 0, 4, 24, and 48 h. Hematoxylin and eosin sections were evaluated in a blinded fashion according to 11 histopathologic criteria.Results At time zero, normal skin was seen. By 4 h, neutrophils were present usually admixed with lymphocytes (8 out of 10). The inflammatory cell density peaked by 24 h in 8 out of 10 patients and at 48 h in 2 out of 10 patients. Sparse leukocytoclasis was identifiable from 4 to 48 h, but was not associated with fibrin. True vasculitis (as evidenced by fibrin within vessel walls and/or intraluminal thrombi) was not seen. Intraepidermal pustules (IEPs) and polymorphonuclear (PMN) aggregates within the needle tract were seen as early as 4 h. The control patients and three out of eight of the BD patients failed to develop clinical lesions. Among this group histopathologic IEPs were lacking in all but two BD patients.Conclusions These data suggest that early pathergy is mediated by PMNs and lymphocytes without vasculitis. Hyperchemotaxis may explain the rapid accumulation of PMNs along the injection site.
Lupus miliaris disseminatus faciei evoked during pregnancy in a patient with cutaneous lupus erythematosus
Authors: Walchner Monika , Plewig Gerd , Messer Gerald 
Published: March 2003

A 30‐year‐old woman with a history of cutaneous lupus erythematosus (LE) developed lupus miliaris disseminatus faciei (LMDF) during her 32nd gestational week ( Fig. 1). After the birth of a healthy daughter, the skin lesions improved without treatment. A worsening of LMDF 6 months later was treated with 20 mg isotretinoin (0.3 mg/kg body weight) in combination with an oral contraceptive. The skin lesions improved significantly after 1 month of systemic treatment; however, 4 months later, new lesions occurred on both cheeks, and were diagnosed as cutaneous LE (
Fig. 2). Systemic isotretinoin therapy was discontinued and local application of a prednicarbate‐containing ointment was initiated, leading to an improvement of the skin manifestations.Lupus miliaris disseminatus faciei (LMDF)imageCutaneous lupus erythematosus; flare‐up after healing of LMDFimageHistopathologic examination of an erythematous papule of the cheek revealed necrotic areas in the dermis surrounded by giant and epithelioid cells, as well as an inflammatory infiltrate around the hair follicles with lymphocytes, granulocytes, and histiocytes ( Fig. 3). A skin biopsy taken from an erythematous plaque of the face revealed a thin epidermis with vacuolization of the dermo–epidermal junction, as well as necrotic keratinocytes, lymphocytic infiltrates, and the deposition of mucin, consistent with the diagnosis of LE (
Fig. 4). Antinuclear antibodies (ANA) were positive (titer, 1 : 320), all routine laboratory parameters were within normal limits, and no anti‐cardiolipin, ‐Ro/SSA, or ‐La/SSB antibodies were detectable.Caseation necrosis in the dermis surrounded by giant and epithelioid cells, and inflammatory infiltrates around the hair follicles with lymphocytes, granulocytes, and histiocytes, consistent with the diagnosis of LMDFimageLymphocytic infiltrates, vacuolar degeneration, and deposition of mucin, consistent with the diagnosis of lupus erythematosusimageThe clinical course of this patient suggests that possible common pathogenetic pathways of LMDF and LE may involve a localized autoimmune‐like process initially restricted to the site of the sebaceous glands, and in both diseases antigen expression may be provoked by UV radiation, hormonal, or viral factors.
Terbinafine 1% cream vs. bifonazole 1% cream in the treatment of tinea cruris
Authors: Budimulja Unandar 
Published: March 2003

A total of 185 patients with a clinical diagnosis of tinea cruris and a positive mycologic examination were recruited into this double‐blind randomized multicenter study comparing 1% terbinafine cream once daily for 1 week and 2 weeks placebo with 1% bifonazole cream applied once daily for 3 weeks.At the first visit and 1, 2, 3, and 8 weeks after the start of the study, signs and symptoms were assessed clinically and scores were taken for mycologic assessments (microscopy and culture). Assessments of clinical signs and symptoms were scored as follows. Pruritus: 0 = absent; 1 = mild, occasionally disturbing daily activities; 2 = severe, frequently disturbing daily activities and sleep. Erythema: 0 = absent; 1 = redness;2 = bright redness, easily visualized. Scales: 0 = absent; 1 = scarcely visible and only in some areas; 2 = thick, covering a large area. Papule: 0 = absent; 1 = scarcely distributed; 2 = densely distributed and/or in the presence of plaques. At weeks 1, 2, 3, and 8, the effectiveness of therapy was clinically evaluated globally and given a rating of cured = 0, mild = <4, or severe = 4–8. The primary efficacy parameter was the mycologic cure rate at the follow‐up weeks during treatment and 5 weeks after the end oftreatment. The tolerability of the study medication was assessed at weeks 1, 2, and 3 of follow‐up. Adverse events were also recorded at the same time. Routine hematologic and biochemical tests were performed at the start of the study and at the end of treatment.
Class II major histocompatibility complex typing across the ethnic barrier in pemphigoid gestationis. A study in Mexicans
Authors: García‐González Edith , Castro‐Llamas Javier , Sci Bch , Karchmer Samuel , Zúñiga Joaquín , De Oca Darío Montes , Ambaz Miguel , Bolaños Rubén , Granados Julio 
Published: March 2003

Abstract Background Pemphigoid gestationis (PG), also called herpes gestationis, is a rare autoimmune disease of pregnancy or puerperium (estimated 1 out of 50,000 pregnancies among Caucasians). A previous series has demonstrated an association of PG with human leukocyte antigen (HLA)‐DR3 or HLA‐DR4 haplotypes. While these haplotypes are most commonly found in individuals of European ancestry, they have also been found in African–American patients affected with PG. PG has rarely been reported in other ethnic groups, and the HLA association in non‐Europeans has not been examined. Methods We have characterized eight patients of Mexican ancestry who have PG by clinical, histologic, and immunofluorescence criteria. Class I and class II major histocompatibility complex (MHC) antigens were studied by standard microlymphocytotoxicity assays. Class II MHC antigens were further studied by polymerase chain reaction (PCR) amplification of HLA‐DRB1, DQA, and DQB genes and allele‐specific oligonucleotide hybridization. For comparison purposes, we used results obtained from a group of 100 ethnically matched healthy individuals. Results We found that all eight patients had the HLA‐DR3/DR4 phenotype; all HLA‐DR3 haplotypes were HLA‐DRB1*0301, DQA1*0501, and DQB1*0201, whereas half of the HLA‐DR4 haplotypes were from the DRB1*0401 subtype and the other half were DRB1*0407. Conclusions These results suggest that, in Mexicans, the genetic susceptibility for the development of PG is strongly influenced by the genetic admixture of Caucasian origin, and the role of class II MHC antigens in the pathophysiology of this disease is confirmed.
Sensitivity of indirect immunofluorescence and immunoblotting for the detection of intercellular antibodies in endemic pemphigus foliaceus (fogo selvagem)
Authors: Rowilson‐Cunha Paulo , Bystryn Jean‐Claude 
Published: March 2003

Abstract Background Two assays are available to detect anti‐skin antibodies in patients with fogo selvagem (FS): indirect immunofluorescence (IIF) and immunoblotting (IB). This study was conducted to compare the sensitivity of these assays in detecting FS antibodies. Design Eighty‐nine serum samples of 48 patients with FS and control serum from 15 normal individuals were tested concurrently for the presence of FS antibodies by IIF and IB. IIF studies were conducted using four different substrates: human skin, monkey and guinea pig esophagus, and bovine tongue. Results FS antibodies were detected much more commonly by IIF than by IB, i.e. in 71% vs. 28% of serum samples respectively. By IIF, the antibodies reacted most strongly against human skin. Conclusions IIF is a more sensitive assay than IB for detecting antibodies associated with FS. The sensitivity of the test is maximized by using human skin as a substrate.
Epidemiology and control of scabies in an Egyptian village
Authors: Hegazy Aly A. , Darwish Nora M. , Abdel‐Hamid Ibrahim A. , Hammad Sabry M. 
Published: March 2003

Abstract Background Some studies have addressed the epidemiology of scabies among rural populations in developing countries; however, the epidemiology of scabies among the rural population in Egypt is unknown. We sought to determine the magnitude of scabies infestation in an Egyptian village and to evaluate the control measures after 1 year. Methods This study was carried out on 3147 residents of Mit‐Moaned village in Dakahlia governorate, Egypt. It was a cross‐sectional follow‐up study where the same individuals examined in round I were re‐examined in round III. The two rounds were separated by a period of 1 year, during which infested patients were followed up and new cases were discovered (round II). Patients and their household contacts received treatment with topical permethrin. Patients showing resistance to permethrin received a single oral dose of ivermectin. Results In round III, the overall prevalence rate of scabies was reduced from 5.4% in round I to 1.1%. The incidence of new cases among susceptible persons during round II was 1.1%. Scabies was significantly (P < 0.05) more prevalent among families of large size, high crowding index at night, low socioeconomic standards, and those receiving their water supply from a hand pump. Children younger than 10 years showed the highest prevalence. Conclusions Our data provide the first complete picture of the epidemiology of scabies in rural Egypt. The epidemiologic characteristics of the disease should be considered in the design of disease control programs for other villages with scabies epidemics. Our findings revealed that good control was achieved with the following: increased awareness and better case finding, education of the staff at the rural health unit, improved hygiene measures, and massive treatment campaigns using effective drugs such as topical permethrin and oral ivermectin.
Treatment outcome of acne vulgaris with oral isotretinoin in 89 patients
Authors: Ng Patricia Pei‐Lin , Goh Chee‐Leok 
Published: March 2003

This is a retrospective study of 114 patients who received oral isotretinoin for acne vulgaris for a minimum of 6 weeks between January 1994 and March 1995. Relapse was defined as deterioration in acne sufficient to merit systemic therapy, either with antibiotics or with another course of isotretinoin. Patients were considered nonrelapsers after a minimum period of 1 year post‐treatment with isotretinoin.Case notes were traced and the following data were retrieved: age, sex, duration of acne, site of acne, previous treatment with either antibiotics or isotretinoin, indications for treatment, total cumulative dose of oral isotretinoin, average daily dose of isotretinoin,response, relapse, time taken to relapse, and subsequent treatment. Those with either complete or partial (>80%) clearance were considered as responders because of the difficulty in categorizing them accurately due to the retrospective nature of the study. A telephone interview was conducted as far as possible with all patients who had an inadequate follow‐up period to ascertain if they had relapsed, i.e. if they had been prescribed systemic therapy for further flares of acne. Analyses of laboratory abnormalities were performed only in patients who had serial alanine aminotransferase (ALT), total cholesterol, and triglyceride readings.Data were analyzed using the chi‐squared test, Student’s t‐test, Mann–Whitney U‐test, and Fisher’s exact test.Of the 114 cases studied, 21 were excluded because of the following reasons: no weight was documented, 12; antibiotics were started immediately after completion of treatment making it impossible to document relapse, 2; patients were not seen at all after completing treatment and were uncontactable, 7. A further four cases with a break of 4 weeks or more during treatment were excluded as the accuracy of the calculated total cumulative dose of isotretinoin may be affected, given the half‐life of 10–20 h.
Terbinafine vs. placebo for onychomycosis in black patients
Authors: Billstein Stephan , Mph . , Kianifard Farid , Justice Angela 
Published: March 2003

Eight US centers enrolled in a multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group trial comparing the efficacy of 12, 16, and 24 weeks of oral therapy with terbinafine, 250 mg/day, and placebo in patients aged 18 to 75 years with both a positive KOH wet mount and mycologic culture of one or more dermatophytes from the large toenail, designated as the target toenail, or another infected toenail if no large toenail was infected. Primary exclusion criteria included: systemic antifungal therapy during the previous 3 months; topical antifungal therapy for the infected toenail(s) during the previous month; white superficial toenail onychomycosis; immunosuppression or immunodeficiency, including known human immunodeficiency virus (HIV) infection; hepatic enzymes >1.5 times the upper limit of normal at screening; and any marked laboratory abnormalities.Patients were randomized into four treatment groups: (i) 12 weeks of terbinafine (250 mg/day) followed by 12 weeks of placebo; (ii) 16 weeks of terbinafine followed by 8 weeks of placebo; (iii) 24 weeks of terbinafine; and (iv) 24 weeks of placebo. Both patient and physician were blinded to the treatment for the 24‐week treatment period. Blinding was maintained through the end of the study. Assessments were done at week −6 (screening visit) and at weeks 4, 8, 12, 16, 20, and 24 during the treatment period. Follow‐up assessments were scheduled for weeks 30, 36, 42, 48, 60, and 72. The mycologic efficacy variables included the percentage of patients with negative mycologic cultures, with negative KOH wet mounts, and with mycologic cure (both negative culture and negative KOH). The evaluations at week 48 and week 72 are reported here. The primary clinical variable was clinical cure, defined as 0% involvement of the target toenail.The efficacy analysis included all patient who were randomized to therapy, fulfilled the mycologic criteria at screening, took at least one dose of study drug, and had at least one post‐baseline assessment. For each variable, the percentage in each treatment group showing efficacy was compared with the percentage in the corresponding placebo group.
Calcipotriol ointment vs. betamethasone 17‐valerate ointment in the treatment of lichen amyloidosis
Authors: Khoo Boo‐Peng , Tay Yong‐Kwang , Goh Chee‐Leok , Centre From the National Skin , Singapore . 
Published: March 2003

Sixteen Asian patients (6 men and 10 women), in the age range 41–74 years, presenting clinically with symmetrically distributed lichen amyloidosis (LA) on the extremities, were enrolled in this double‐blind, right–left comparison pilot study to evaluate the efficacy of calcipotriol ointment (50 μg/g) vs. betamethasone 17‐valerate ointment (0.1%).This trial was conducted in a tertiary skin referral center in Singapore and consecutive patients with LA were recruited over a 3‐month period. Excluded were patients who were pregnant or lactating, patients with known contact allergy to either calcipotriol or topical steroid, patients with hypercalcemia, and those with significant hepatic or renal disease.After a washout period of 2 weeks, the ointments were applied separately to either the right or left extremities twice daily for a period of 12 weeks. Assessments were made at weeks 0, 4, 8, and 12 by both the physician and the patient. Treatment responses were assessed as follows: roughness (visual analog scale of 1–10, 1 being the least rough and 10 being the most rough), hyperpigmentation (visual analog scale of 1–10, 1 being the least hyperpigmented and 10 being the most hyperpigmented), and any adverse events. An additional parameter assessed by the patient was pruritus (visual analog scale of 1–10, 1 being the least pruritic and 10 being the most pruritic). Clinical photographs were taken during each review.For analyses of the responses, the mean roughness score is defined as the average sum of the roughness score of all patients for each treated side. Likewise the mean hyperpigmentation score and the mean pruritus score are defined as the average sum of hyperpigmentation and the average sum of pruritus, respectively. Any score differences observed between week 0 and week 12 within the two treatment groups were analyzed by Wilcoxon signed ranked test for statistical significance; differences in scores between the two treatment groups were analyzed by Mann–Whitney U‐test.