bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perianal candidosis—a comparative study with mupirocin and nystatin
Authors: de Wet Peter M. , Rode Heinz , van Dyk Anna , Millar Alastair J. W. 
Published: March 2003

AbstractObjective To assess the efficacy and clinical outcome of 2% mupirocin in a polyethylene glycol base and nystatin cream as treatment regimens in diaper candidosis.Design A prospective randomized comparative study.Methods
In vitro. The susceptibility of 20 clinical isolates of Candida albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar‐well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed.Results
In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 μg/mL in one case, 256 μg/mL in six cases, 200 μg/mL in 10 cases and 400 μg/mL in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication of all Candida organisms was achieved within 2–6 days (mean, 2.6 days) in 10 patients receiving topical mupirocin therapy with rapid healing of the excoriated wounds (mean, 4.7 days). Both Gram‐positive and Gram‐negative bacteria were eradicated from the infected area within the trial period. Ten patients received topical nystatin cream and, in each case, Candida was successfully cleared within 5 days (mean, 2.8 days). Only three wounds were clinically healed within the trial period, however. The remaining seven wounds showed evidence of improved, but ongoing excoriated dermatitis and a heavy growth of polymicrobial organisms.Conclusions Both agents eradicated Candida, the major difference being the marked response of the diaper dermatitis to mupirocin. Mupirocin should be applied topically 3–4 times daily or with each diaper change and is an excellent antifungal agent.
Sensory analysis of four medical spa spring waters containing various mineral concentrations
Authors: Bacle Irène , Meges Sandrine , Lauze Christophe , Macleod Patrick , Dupuy Patrick 
Published: March 2003

Abstract Background Medical spa spring waters (MSSWs) have been extensively used as adjunctive treatments for various skin conditions to provide skin comfort. We carried out a double‐blind study to compare the sensory profile of four MSSWs with increasing mineral content. Methods A panel of 36 women, trained to perform comparative sensory analysis, applied in pairs four MSSWs with mineral contents of 0.2, 0.45, 5, and 11 g/L on the right and left cheeks. At baseline, 5 min, and 10 min after the applications, the subjects evaluated each water for the following factors using a computerized analog scale: freshness, mild stinging, softness, suppleness, and comfort of the skin. Results After 5 min, all four waters induced a sensation of freshness, irrespective of their mineral concentration. A mild stinging was also perceived with all four waters, with a magnitude that was dependent on the mineral density. After 10 min, softness, suppleness, and skin comfort were the prominent features induced by the waters, but the lower the mineral content, the greater these perceptions. Statistically significant differences were demonstrated between the 0.2 g/L group and the 5 and 11 g/L groups for stinging (P = 0.0001), softness and suppleness (P < 0.05), and skin comfort (P = 0.006) after 10 min. Conclusions Our results indicate that the sensory effects provided by MSSWs when topically applied depend on their mineral concentration.
Notalgia paresthetica: a study on pathogenesis
Authors: Şavk Ekin , Şavk Ş. Öner , Bolukbasi Okan , Ccedilulhaci Nil , Dikicioğlu Emel , Karaman Göksun , Şendur Neslihan 
Published: March 2003

Abstract Background  Notalgia paresthetica is a sensory neuropathy involving the dorsal spinal nerves. The characteristic symptom is pruritus on the back, occasionally accompanied by pain, paresthesia, and/or hyperesthesia, which results in a well‐circumscribed hyperpigmented patch in the symptomatic area. The etiology of this condition has not yet been completely defined.Objective  Possible mechanisms that could explain the pathogenesis of notalgia paresthetica were investigated through clinical examination and various diagnostic tests.Methods  Ten cases of notalgia paresthetica underwent dermatologic, neurologic, and orthopedic examination. This was followed by skin biopsy, electrodiagnostic investigation, and radiography of the spine.Results  All patients had a typical symptomatology and dermatologic picture. Neurologic examination and standard electrodiagnostic investigation results were normal in all cases. Histopathology was compatible with postinflammatory hyperpigmentation; there were no amyloid deposits. In seven cases, degenerative changes in the vertebrae were observed and, in all of these cases, these changes were most prominent in the vertebrae which corresponded to the dermatome of the cutaneous lesion.Conclusions  The striking correlation of notalgia paresthetica localization with degenerative changes in the spine suggests that spinal nerve impingement may contribute to the pathogenesis of this entity.
Tuberculosis verrucosa cutis associated with tuberculous lymphadenitis
Authors: Pereira Mariana Burnier , Gomes Maria Katia , Pereira Francisco 
Published: March 2003

A 34‐year‐old man presented with a large cutaneous lesion on his left thigh that had started as a small papule when he was 13 years of age. The lesion had enlarged slowly over the last 21 years. The patient had received bacillus Calmette–Guérin (BCG) vaccination in childhood. The family history was significant for tuberculosis.Clinical examination revealed a large, purplish‐red, indurated plaque measuring 30 × 29 cm on the left thigh, extending to the buttock area. The edges of the lesion had a serpiginous contour with an involuted center (Fig. 1). A left inguinal lymph node was palpated.Lesion on the left thigh, extending to the buttock areaimageChest X‐ray and blood cell count were normal. No other focus of disease was identified. Laboratory testing for human immunodeficiency virus (HIV) infection was negative. Purified protein derivative (PPD) intradermal injection disclosed a 19‐mm skin induration.Both the cutaneous lesion and the inguinal lymph node were biopsied. Histopathologic sections of the skin fragment showed epidermal hyperkeratosis, neovascular proliferation, and a dense dermal lymphocytic infiltrate. The histopathology of the lymph node demonstrated few granulomas with focal areas of central necrosis.Staining for fungus was negative. Ziehl–Neelsen staining was negative on both the skin and lymph node specimens. Culture for fungus and Leishmania sp. was negative. Tissue culture on Lowenstein–Jensen medium from skin and lymph node was positive for Mycobacterium colonies after 5 and 7 weeks, respectively.Multidrug therapy was instituted with rifampin 600 mg/day, isoniazid 400 mg/day, and pyrazinamide 2 g/day for 2 months, and then rifampin 600 mg/day and isoniazid 400 mg/day alone for the next 4 months. An excellent response was obtained at the end of treatment (Fig. 2).Lesion after treatmentimage
Correlation between diffuse pigmentation and keratinocyte‐derived endothelin‐1 in systemic sclerosis
Authors: Tabata Hideyuki , Hara Noriaki , Otsuka Shun , Yamakage Akio , Yamazaki Soji , Koibuchi Noriyuki 
Published: March 2003

Abstract Background  The precise mechanism of diffuse pigmentation in systemic sclerosis (SSc) is still unknown. We suspected the participation of endothelin‐1 (ET‐1), which is produced by keratinocytes, in the hyperpigmentation in SSc. The aims of this study are to demonstrate the hyperproductivity of ET‐1 from epidermal cells in SSc by in situ hybridization histochemistry, and to show a correlation between the hyperproductivity of ET‐1 in keratinocytes and skin hyperpigmentation.Methods  In situ hybridization histochemistry was performed on nine SSc specimens (five cases of diffuse scleroderma (dSSc), four cases of acrosclerosis (lSSc)), and compared with four normal control specimens. We counted the grains on 10 × 10 μm2 of epidermis and microvessels in each histology and examined the degree of skin pigmentation using the skin reflectance factor (Y).Results  In the specimens of the SSc patients, the number of grains on the epidermis was remarkably higher than those of the control specimens (P < 0.01). We found a close correlation between the number of grains and the skin reflectance factor in dSSc patients (P = 0.02). Correlations were not identified between serum ET‐1 and skin pigmentation and between serum ET‐1 and the frequency of grains on the epidermis. As for grains on microvessels, lSSc patients showed a greater frequency than dSSc patients.Conclusions  The findings of this study suggest that an increase in the ET‐1 productivity of keratinocytes is experienced in SSc patients, especially in dSSc patients. The results suggest a strong correlation between the ET‐1 productivity of keratinocytes and skin pigmentation in severe cases of SSc. We conclude from these results that keratinocyte‐derived ET‐1 plays an important role in the pathogenesis of the hyperpigmentation of the skin in SSc patients.
Retiform hemangioendothelioma
Authors: Darouti M. El ,   md, Marzouk Salonas A. ,   md, Sobhi Rehab M. ,   md, Bassiouni Dalia A. ,   md
Published: March 2003

A 32‐year‐old white woman presented with a 2‐year history of a gradually enlarging, asymptomatic, cutaneous and subcutaneous, 3 Ï 5‐cm plaque with a nodular surface on the left upper thigh ( Fig. 1). There were no other complaints or physical signs. The clinical differential diagnosis included: cutaneous lymphoma, metastatic adenocarcinoma, and dermatofibrosarcoma protuberans.Retiform hemangioendothelioma: clinical presentation is in the form of an exophytic plaque with an irregular surfaceimageA 6‐mm punch biopsy was taken and showed numerous dilated vascular spaces in the upper dermis lined by monomorphic endothelial cells. Some of these vessels showed endovascular papillae with hyaline collagenous cores ( Fig. 2). In addition, there were solid nests of endothelial cells observed in the vicinity of the affected vessels. Lymphocytic infiltrate was conspicuous both within the endovascular papillae and the dermis. Most of the lymphocytes within the blood vessels occurred in close association with the endothelial cells.Area of the tumor showing an intravascular papilla with a collagenous core and lined by endothelial cells. Lymphocytes are seen in close association with some of the endothelial cells (hematoxylin and eosin, × 400)imageStaining with factor VIII related antigen was positive in the endothelial lining of the blood vessels, but not in the solid nests ( Fig. 3). At this stage, a diagnosis of Dabska's tumor was entertained; however, excision biopsy of the whole lesion showed the presence of very characteristic arborizing blood vessels (
Fig. 4), arranged in a retiform pattern, within the lower dermis. These blood vessels were lined by bland endothelial cells and contained, in some of them, endovascular papillary projections with collagenous cores. The papillary projections were lined by cuboidal endothelial cells occurring in close association with intravascular lymphocytes.Staining with factor VIII related antigen. Endothelial cells lining the blood vessels are reactive, while the extravascular solid areas are not (factor VIII related antigen, × 400)imageRetiform hemangioendothelioma: one area of the tumor showing long arborizing blood vessels arranged in a retiform pattern reminiscent of normal rete testis. Perivascular lymphocytic infiltrate is present in the deep dermis (hematoxylin and eosin, × 40)imageThe final diagnosis was retiform hemangioendothelioma. There was no recurrence or lymph node metastases during a follow‐up period of 1.5 years.
Linear IgA disease associated with membranous glomerulonephropathy
Authors: Egan Christine L. ,   md, Liu Vincent ,   md, Harris Ronald M. ,   md, White Soren M. ,   md, Lessin Stuart R. ,   md, Weinberg Jeffrey M. ,   md
Published: March 2003

A 33‐year‐old Caucasian man developed an acute nephrotic syndrome with a proteinuria of 15 g/day. His past medical history was significant for a cholecystectomy secondary to complications of hypercholesterolemia, and his medications included niacinamide, simvastatin, and multivitamins. A renal biopsy revealed a membranous glomerulonephropathy, with thickening of the capillary loops by light microscopy and 4+ granular immunoglobulin G (IgG) staining of the capillary loops by immunofluorescence. Multiple discrete subepithelial deposits were also noted by electron microscopy. He was treated with cyclophosphamide, chlorambucil, and high dose steroids. Laboratory data at that time were notable for an elevated erythrocyte sedimentation rate (ESR), decreased albumin, a negative antinuclear antibody, and normal complement levels. His symptoms improved, and the proteinuria stabilized to 7 g/day. His systemic therapy was discontinued without a flare in his renal disease.Approximately 9 months later, he developed a pruritic, blistering eruption which began on his face and neck. An initial skin biopsy showed a subepidermal blister with many eosinophils and eosinophilic spongiosis. A direct immunofluorescence (DIF) study revealed linear deposits of IgG and IgA, and focally linear C3 at the basement membrane zone. This pattern was interpreted to be most consistent with bullous pemphigoid. He was referred to the Philadelphia VA Medical Center for further evaluation and treatmentCutaneous examination revealed multiple urticarial plaques with tense bullae studding the peripheral margin, in a rosette pattern, distributed on his face, trunk, groin, extremities, and feet, with one healing erosion on the hard palate. Laboratory data revealed abnormal, but stable, renal disease, with an elevated blood urea nitrogen (21.1) and creatinine (1.5). Serum IgA was elevated (400), and serum albumin (3.3) and a total protein (5.5) were decreased.A second skin biopsy from a blister edge demonstrated a subepidermal bulla with numerous eosinophils and collections of neutrophils at the dermal papillae tips ( Fig. 1). DIF revealed 3+ linear IgA deposition at the basement membrane zone (
Fig. 2), and an indirect immunofluorescence study on monkey esophagus showed linear IgA deposition in the basement membrane zone. A diagnosis of linear IgA disease was made. Dapsone 50 mg p.o. daily was started, with a dramatic improvement on his blistering within 2 weeks. His renal disease remained stable.Biopsy specimen demonstrating subepidermal bulla with numerous eosinophils and collections of neutrophils at the dermal papillae tips, consistent with LABD (hematoxylin and eosin; original magnification, ×100)imageIF revealing linear IgAdeposition at the basement membrane zoneimage
Infiltrating basal cell carcinoma in the setting of a venous ulcer
Authors: Lutz Michael E. , Davis Mark D. P. , Otley Clark C. 
Published: March 2003

A 77‐year‐old man was referred with a 5‐year history of an intermittently painful, nonhealing right medial ankle ulcer. The ulcer had not responded to multiple treatment modalities, including Unna boots, compression therapy, sclerotherapy, and split‐thickness skin grafting.The past medical history was significant for a deep venous thrombosis in the right leg 30 years earlier (treated with warfarin for 3 months) and a history of greater saphenous vein harvesting for coronary bypass grafting 28 years previously. After the vein stripping, the patient had suffered from increasing right leg edema and stasis changes in the right leg. His history was also remarkable for coronary artery disease, dyslipidemia, and lymphoma treated with chemotherapy 8 years before presentation, with no evidence of recurrence. He had stopped smoking approximately 20 years earlier. Medications included atenolol, simvastatin, nicardipine, nitroglycerin, and aspirin.Skin examination revealed a 3.0 × 3.5‐cm ulcer adjacent to the medial malleolus. The edges of the ulcer appeared raised and rolled ( Fig. 1). Centrally, there was granulation tissue, which appeared healthy. There were surrounding dermatitic changes. Dorsalis pedis and the posterior tibial pulses were normal.of the ulcerimageNoninvasive vascular studies revealed severe venous incompetence of the right popliteal and superficial veins. Arterial studies and transcutaneous oximetry were normal. Computed tomographic scan of the pelvis did not reveal any adenopathy, and radiographic imaging did not reveal any bony changes suggestive of osteomyelitis.Biopsy of the ulcer edge and base showed infiltrating basal cell carcinoma ( Fig. 2). Mohs' micrographic surgery required three layers; the final extent of the ulcer was 7.8 × 6.9 cm. A split‐thickness skin graft was placed.section from biopsy specimen of edge/base of ulcer (hematoxylin and eosin; × 67)image
Retrospective study of Mycobacterium marinum skin infections
Authors: Ang Por , Rattana‐Apiromyakij Niramol , Goh Chee‐Leok 
Published: March 2003

Abstract Background Although infection by Mycobacterium marinum is well reported in the literature, there have been few epidemiologic studies. The purpose of this study was to review the epidemiology of patients with cutaneous M. marinum infection over a 3‐year period at the National Skin Centre in Singapore. Methods Patients with a diagnosis of cutaneous M. marinum infection, confirmed histologically, were collated from computerized data from 1995 to 1997. Thirty‐eight patients were diagnosed as having cutaneous M. marinum infection based on history, and clinical and histologic features. Results Out of the 38 cases of M. marinum infection, there were 30 men and eight women. The age range was 14–85 years (mean: 44.7 years). The duration of disease ranged from 1 to 132 months (mean: 19 months). Thirteen patients (34.2%) had fish rearing as a hobby and four patients (10.5%) had occupational exposure to fish. Twelve patients (31.5%) gave a history of trauma to the disease site. All patients had biopsies of the lesions. All showed infective granulomas/granulomatous inflammation on histology. Acid‐fast bacilli were identified in five out of 38 patients (13.2%) and mycobacteria were isolated in one out of 35 patients (2.9%). Nineteen patients received treatment with cotrimoxazole–trimethoprim alone, three with minocycline alone, five with minocycline and cotrimoxazole–trimethoprim, seven with various combinations of drugs, one with excision, and three defaulted treatment. The duration of treatment ranged from 4 to 38 weeks (mean: 14.9 weeks). Twenty‐six patients (68.4%) showed clinical improvement, two (5.3%) had no response, and 10 (26.3%) were lost to follow‐up. None of the patients worsened with treatment. The follow‐up period ranged from 1 to 20 months (mean: 6.8 months). Conclusions The diagnosis of cutaneous M. marinum infection is mainly clinical, with supporting evidence from histologic features and the response to therapy. Risk factors include a history of trauma and water/fish‐related hobbies or occupations. There is a poor yield of positive isolates in our experience; however, empirical treatment usually produces a good clinical response. In future, the polymerase chain reaction (PCR) technique may become more widely available as a rapid, sensitive, and specific means of diagnosis.
Papular perniosis mimicking erythema multiforme: the first case report in Thailand
Authors: Wessagowit Phongsakorn , Asawanonda Pravit , Noppakun Nopadon 
Published: March 2003

A healthy 23‐year‐old man of Thai descent presented with skin lesions on the acral part of the feet, which developed after exposure to an Australian winter with an average temperature of 5 °C. Immediately after the exposure, the patient developed mild anesthesia around the toes which was accentuated after a bath. During the exposure, warm winter clothes, including boots and socks, were worn. Several hours later, a few itchy bumps were noted bilaterally on the fifth toes. The patient then cleansed and immersed his feet in an over‐the‐counter antiseptic preparation. By the next day, the lesions had enlarged and formed blisters filled with clear fluid. The lesions gradually progressed to cover the dorsal part of the feet within the next few days. He applied an over‐the‐counter antibacterial/antifungal cream to the lesions for 3 days without any improvement. Five days later the lesions became purplish red. Itching was the only symptom experienced. The patient was a nonsmoker who was in good health and denied a history of skin diseases, herpes simplex viral infection, or any intake of oral medication.Physical examination, performed in Thailand, revealed symmetrically distributed, discrete, purplish papules, some with dusky red centers, on the dorsal surfaces of all toes without blisters or erosion ( Fig. 1). No lesions were detected on the plantar surfaces of the feet, the legs, hands, or elsewhere on the body. Complete blood cell count, erythrocyte sedimentation rate (ESR), venereal disease research laboratory (VDRL) test, cryoglobulin, hepatitis B surface antigen (HBsAg), and anti‐hepatitis core immunoglobulin M (anti‐HBC IgM) were within normal limits or negative.Erythema multiforme‐like lesions on the acral part of the feetimageThe clinical diagnosis at the initial visit was cold injury; however, the differential diagnosis included contact erythema multiforme and vasculitis.Skin biopsy performed on one of the purplish papules revealed proliferation of thick‐walled blood vessels and edema of the dermal papillae. The lumens of these vessels were narrow. There was a superficial and deep perivascular lymphocytic infiltrate in the upper dermis. The epidermis revealed only mild spongiosis and focal lymphocytic exocytosis without necrotic keratinocytes ( Fig. 2). The findings were consistent with perniosis.The patient was treated with topical triamcinolone acetonide 0.1% cream with significant improvement observed within a few days ( Fig. 3).
Melanonychia and mucocutaneous hyperpigmentation due to hydroxyurea use in an HIV‐infected patient
Authors: Laughon S. K. , Shinn L. L. , Nunley Julia R. 
Published: March 2003

A 51‐year‐old black woman with human immunodeficiency virus (HIV) infection presented to the Dermatology Clinic in June of 1998. She complained of dark bands in her nails, as well as darkening of her tongue, hands, and feet. She first noticed these changes in April 1998. One month earlier she had been started on hydroxyurea, nevirapine, and didanosine. Zidovudine had been discontinued 1 year prior to presentation. No nail changes were noted at that time. Other medications included acyclovir, propanolol, trimethoprim/sulfamethoxazole, and ibuprofen.The physical examination was remarkable for irregular, hyperpigmented patches, some confluent, on the tongue and oral mucosa (Fig. 1). Perioral hyperpigmentation was also present. Irregular, hyperpigmented macules were present on the palms and soles, and there was diffuse hyperpigmentation of the dorsal hands and feet. Blue–gray, well‐demarcated, horizontal bands were present on all 20 nails beginning at the proximal nail fold and progressing distally (Fig. 2). A diagnosis of hydroxyurea‐induced hyperpigmentation was made and hydroxyurea was discontinued. Six months later, the mucocutaneous areas of hyperpigmentation were lighter, but still present. The hyperpigmented bands on the fingernails had fully grown out and those on the toenails were more distally located.Hyperpigmentation was evident on the oral mucosa, as seen here on the tongueimageHorizontal bands present on all 20 nailsimage