bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duration of improvement in psoriasis after treatment with tazarotene 0.1% gel plus clobetasol propionate 0.05% ointment: comparison of maintenance treatments
Authors: Lebwohl Mark ,   md, Lombardi Kathleen ,   bsc, Tan Mei‐Heng ,   md
Published: March 2003

Fifty patients were enrolled in a double‐blind, randomized, parallel‐group study designed to determine whether tazarotene may have a role in maintenance therapy for psoriasis.The patients had stable moderate‐to‐severe plaque psoriasis on up to 15% of their body surface area, on sites other than the face and scalp. Their mean age was 55 years and the majority had had psoriasis for more than 10 years. Washout periods were: 2 weeks for topical drugs, 4 weeks for UVB or PUVA treatment, and 8 weeks for systemic drugs that might alter the course of psoriasis.For the initial open‐label treatment phase, patients applied tazarotene 0.1% gel plus clobetasol propionate 0.05% ointment for 6 weeks. The frequency of application of both medications was initially once daily and then was tapered to ensure gradual weaning. Thus, during weeks 1 and 2, patients applied tazarotene each morning and clobetasol propionate each evening. During weeks 3 and 4, patients applied tazarotene each morning and clobetasol propionate each Tuesday, Thursday, and Saturday evening. Finally, during weeks 5 and 6, patients applied tazarotene each Monday, Wednesday, and Friday morning, and clobetasol propionate each Tuesday and Thursday evening.For the subsequent double‐blind maintenance phase, patients were randomized to receive one of three maintenance regimens for 20 weeks – tazarotene/clobetasol (tazarotene 0.1% gel on Monday, Wednesday, and Friday mornings, plus clobetasol propionate 0.05% ointment on Tuesday and Thursday evenings), tazarotene/vehicle (tazarotene 0.1% gel on Monday, Wednesday, and Friday mornings, plus white petrolatum on Tuesday and Thursday evenings), and vehicle (tazarotene gel vehicle on Monday, Wednesday, and Friday mornings plus white petrolatum on Tuesday and Thursday evenings).Patients were instructed to apply a thin film of medication to their psoriatic plaques. Emollient use was permitted, but other topical formulations and excessive exposure to ultraviolet light were not.Efficacy was evaluated – at baseline, every 2 weeks during the initial treatment phase, and every 4 weeks during the maintenance phase – in terms of overall disease severity, plaque elevation, scaling, erythema, pruritus, and global response to treatment. The first four of these were rated by the physician as 0 = none, 2 = mild, 4 = moderate, 6 = severe, and 8 = very severe. Pruritus was rated as 0 = none, 1 = trace, 2 = mild, 3 = moderate, 4 = marked, and 5 = severe. Global response was rated as 0 = cleared, 1 = almost cleared (∼90% improvement), 2 = marked (∼75%) improvement, 3 = moderate (∼50%) improvement, 4 = slight (∼25%) improvement, 5 = unchanged, and 6 = worse.Analysis of variance and the Student's t‐test were used to compare maintenance regimens (P ≤ 0.05). In the maintenance phase, the last recorded score for each patient was carried forward to all subsequent visits.
Bluish patches on the ears and axillae with dark urine: ochronosis and alkaptonuria
Authors: Turiansky George W. ,   LTC,   MC,   USA, Levin Sondra W. 
Published: March 2003

A 45‐year‐old white woman presented with a 3‐year history of bluish discoloration of her ears (Fig. 1). The patient had noted a bluish‐black staining of the armpit areas of her clothing for the prior 6 months. A review of systems and past medical history were significant for a history of constant right lower back pain and bilateral knee pain for approximately 1 year. A review of medications revealed daily use of conjugated estrogens and multivitamins and intermittent use of ibuprofen. A review of her family history revealed that a sister was affected with the same disorder, but the spouse and children were not. The patient's parents were not known to be consanguineous.Bluish patches are present on the ear overlying the cartilageimageMucocutaneous examination was significant for bluish‐black patches on the ears in areas overlying cartilage. Larger bluish patches were also noted in the axillary vaults. Cardiac, ophthalmologic, and dental examinations were normal. An echocardiogram was normal. Orthopedic evaluation revealed limited spinal range of motion. Examination of lumbosacral X‐rays revealed marked degenerative disc disease at the T12–S1 levels and anterior osteophytosis at the T11–L2 levels. A bilateral knee X‐ray series was normal.Complete blood count and serum chemistries were normal. A urine sample darkened upon standing for 1 day (Fig. 2, left side) as compared to a fresh urine specimen (Fig. 2, right side). A 0.5 cm3 urine sample turned black immediately upon addition of 5 cm3 of silver nitrate solution (3 g/100 cm3 ) and alkalinization with three drops of dilute ammonia. Punch biopsy of the left ear demonstrated both degenerative change and focal yellow–brown pigmentation of the cartilage (Fig. 3). A qualitative assay for urinary homogentisic acid (HGA) was positive (Fishberg test) (Fishberg EH. The instantaneous diagnosis of alkaptonuria on a single drop of urine. JAMA 1942; 119: 882). The presence of large amounts of urinary HGA was confirmed by gas chromatography and mass spectrometry.A urine sample darkened upon standing for 1 day (left side of figure) as compared to a fresh urine specimen (right side of figure)imageA punch biopsy from the left ear demonstrates degenerative change of the cartilage with focal yellow–brown pigmentation (× 66)image
Melasma treated with hydroquinone, tretinoin, and a fluorinated steroid
Authors: Guevara Ian L. , Pandya Amit G. 
Published: March 2003

A retrospective study was conducted in six Hispanic women, 35–55 years of age, with Fitzpatrick skin types IV to VI, presenting to an academic dermatology clinic for resistant melasma (Table 1). They had all been treated with topical hydroquinone (2–4%) without success prior to being seen in our clinic.

Patient demographics

Patient
Age
Country

of origin
Affected

area
Duration of

disease (years)
Severity
Type of

melasma

1
39
El Salvador
Cheeks, upper lip
10
Moderate
Epidermal

2
37
Mexico
Cheeks
12
Moderate
Epidermal

3
35
Mexico
Cheeks
7
Moderate
Combination

4
35
Mexico
Cheeks
9
Moderate
Epidermal

5
55
Mexico
Cheeks, jaw
20
Moderate
Combination

6
32
Mexico
Cheeks, forehead
6
Moderate
Epidermal

A Wood's lamp was used to determine whether the melasma was epidermal, dermal, or a combination of the two. The patients were treated with a mixture containing 0.05% tretinoin cream, 0.05% triamcinolone acetonide cream, 6% hydroquinone, and 0.1% ascorbic acid (as a preservative) applied at night, and a sun protection factor (SPF) 15 UVB‐blocking sunscreen was applied each morning. They were instructed to use the mixture on the affected areas nightly for a period of 8 weeks. All of the patients were evaluated at baseline and monthly during the treatment period. Improvement in pigmentation was assessed at each subsequent visit by clinical examination and photography with polarized filters as well as black and white UV reflectance photography (Canfield Scientific, Inc.). Improvement was determined subjectively on a three‐point scale as follows: I, mild improvement; II, moderate improvement; III, significant improvement.
Eruptive lesions in a patient with bone marrow transplantation
Authors: Marini Mario , Saponaro Alberto , Remorino Laura , Lynch Patricia , Magariños Gabriel 
Published: March 2003

A 41‐year‐old man with a diagnosis of chronic myeloid leukemia presented with several elevated, small, soft, yellow papules, disseminated over the face and upper trunk. The cutaneous lesions had developed 5 years after transplantation (Fig. 1).Sebaceous hyperplasia on the upper trunk presenting as yellowish, dome‐shaped, asymptomatic papules, 1–2 mm in diameter. The lesion is umbilicated, with individual lobules growing out from the center; lesions may occur individually or in groupsimageIn December 1991, he was examined in Israel, where an allogenic bone marrow transplantation was performed, after immunosuppressive treatment with high doses of chemotherapy and lymphoid and total body irradiation.In spite of being on cyclosporine as a preventive medication, at a dose of 3 mg/kg body weight per day, he had a graft‐vs.‐host reaction.Later, he presented with diverse clinical complications: hemorrhagic cystitis; disseminated herpes zoster, with encephalic commitment; pneumonia and sepsis; and chronic graft‐vs.‐host reaction whose manifestations were controlled with decreasing doses of cyclosporine and prednisone.A skin biopsy specimen was obtained, with the diagnosis of sebaceous hyperplasia (Fig. 2). The histopathologic findings consisted of several enlarged sebaceous glands containing several small ducts, with sebaceous lobules grouped around each of them. The sebaceous gland lobules appeared fully mature, with a single peripheral row of generative cells in which there were few or no lipid droplets. Some of the sebaceous lobules were closed up to the lower portion of the epidermis, from where they extended downwards into the dermis.The sebaceous gland lobules appear fully mature, with a single peripheral row of generative cells in which there are few or no lipid dropletsimage
Livedoid vasculitis responding to PUVA therapy
Authors: Lee Jeong Ho , Choi Hyun‐Joo , Kim Soo Min , Hann Seung‐Kyung , Park Yoon‐Kee 
Published: March 2003

AbstractBackground  Livedoid vasculitis is a chronic disorder manifested as recurrent, painful, reticulated, and ulcerative lesions of the legs, which result in ivory atrophic scars with peripheral telangiectasia and hyperpigmentation. Its etiology remains obscure and therapy is difficult. In this study, we evaluated the clinical efficacy of psoralen plus UVA (PUVA) therapy and its side‐effects in the treatment of livedoid vasculitis.Methods  Eight South Korean patients with livedoid vasculitis were treated with UVA and 8‐methoxypsoralen (8‐MOP). Systemic PUVA was started with 4 J/cm2 of UVA two or three times a week, and then the dose was increased by 0.5 or 1 J/cm2 increments at each subsequent treatment as tolerated. The effects of treatment were evaluated using photographs of before, during, and after the study.Results  All patients experienced rapid cessation of new lesion formation, significant symptom relief, and complete healing of primary lesions. The mean times for each of the above were 3.6, 5.9, and 10 weeks, and the mean cumulative doses of UVA for each of the above were 55.9, 96.8, and 197.9 J/cm2, respectively. The patients tolerated PUVA therapy well without unacceptable side‐effects.Conclusions  We propose that systemic PUVA using 8‐MOP should be investigated further as an alternative treatment for patients with livedoid vasculitis.
Ultra‐late erysipeloid angiotropic metastatic malignant melanoma
Authors: Johnson Charles S. , Ramos‐Caro Francisco A. , Hassanein Ashraf M. 
Published: March 2003

In 1998, a 70‐year‐old white man developed a slowly increasing swelling of the right lower extremity of 5 months' duration. During the 3 weeks prior to presentation, the patient noted intensifying erythema accompanied by increasing tenderness and warmth on palpation. A clinical diagnosis of cellulitis was made and the patient underwent a 2‐week course of oral cephalexin, 500 mg four times a day, without improvement. Dermatology was consulted.The pertinent past medical history included: (i) wide local excision of a Clark's level II malignant melanoma from the left lower back in 1980; (ii) metastatic malignant melanoma involving the bladder removed by cystectomy in 1995, together with left inguinal node resection followed by systemic chemotherapy and radiation therapy; (iii) recurrent metastatic malignant melanoma on the right inguinal node, resected, and followed by docetaxel therapy in 1997 with resolution.Physical examination disclosed an ill‐looking, elderly man with a moderately well‐demarcated, elevated, slightly tender, edematous, warm, erythematous, confluent plaque involving the proximal right lower extremity and the right lower flank, suggestive of erysipelas (Fig. 1). Histologic examination revealed infiltration of the superficial and deep dermal vessels (mainly small venules) by highly anaplastic cells (Fig. 2). The vascular lumina were occluded with the neoplastic cells and focal microthrombi formation. Immunohistochemical staining for S‐100 protein, HMB‐45, and vimentin confirmed the diagnosis of metastatic melanoma. CD31 immunostaining decorated the endothelial lining of the dermal vessels. Tissue cultures and special stains for bacteria and fungi were negative. A diagnosis of erysipeloid metastatic malignant melanoma involving the vessels was made. The patient and the family declined further aggressive treatments, and the patient died within a few weeks under hospice care.Moderately well‐demarcated, edematous, erythematous plaque on the right lower flank and proximal right lower extremity with tenderness and warmth on palpationimageMalignant melanoma cells infiltrating a dermal vessel. The vascular lumen demonstrates occlusion by anaplastic cellsimage
Lichen planopilaris [cicatricial (scarring) alopecia] in a child
Authors: Sehgal Virendra N. , Bajaj Promila , Srivastva Govind 
Published: March 2003

A mother of a 12‐year‐old boy, 2 years ago, noticed that he showed patchy loss of hair on the vertex of the scalp. It was asymptomatic and progressive. Subsequently, similar patches appeared elsewhere on the scalp. Some of these patches joined to form a large bald patch. This was accompanied by dusky blue eruptions over the left upper lip and eyebrows. Later, there was localized loss of hair. A family history of a similar ailment was absent.Examination of the scalp revealed plaques of alopecia with mild to moderate erythema. The skin was smooth, shiny, and atrophic (Fig. 1). Atrophy was apparent by the presence of wrinkles in places, and by holding the skin between the thumb and the index finger. The periphery of the lesions was well demarcated and was occupied by erythematous, scaly, follicular papules. Lesions were also located on the patches of alopecia. In addition, flat‐topped, dusky blue, papules/plaques were present over the upper lip.Lichen planopilaris: plaques of alopecia showing smooth, shiny, atrophic skin with erythemaimageA study of hematoxylin and eosin‐stained microsections prepared from the upper lip and vertex of the scalp was undertaken. The former revealed hyperkeratosis, hypergranulosis, sawtooth irregular acanthosis, and destruction of the basal cell layer which, in turn, was embraced by a lymphohistiocytic infiltrate disposed in a band‐like fashion. A few cells were seen invading the epidermis. Pigment‐laden histiocytes were found intermingled with the infiltrate. In the scalp skin, on the other hand, atrophy of the epidermis with punctuation of keratin plugs, together with fibrosis of the dermis, was prominent. The walls of the hair follicles were hyperkeratotic, while their lumina were conspicuous by their dilatation and contained keratotic plugs (Fig. 2a,b). Sebaceous and sweat glands were absent.Lichen planopilaris showing atrophy of the epidermis, fibrosis of the dermis, dilatation of the hair follicle lumina containing keratotic plug(s), and hyperkeratosis of the wall of the follicle (hematoxylin and eosin: a , × 40; b , × 100)imageResponse to treatment, comprising ultramicronized griseofulvin (Gris O.D.) 375 mg/day (Sehgal VN, Abraham GJS, Malik GB. Griseofulvin therapy in lichen planus –‐ a double blind controlled trial. Br J Dermatol 1972; 86: 383–385; Sehgal VN, Bikhchandani R, Koranne RV et al. Histopathological evaluation of griseofulvin therapy in lichen planus. A double blind controlled study. Dermatologica 1980; 161: 22–27) and prednisolone 20 mg/day for 6 months, was excellent (Fig. 3). Topical betamethasone dipropionate (Diprovate) lotion was used as a supplement.Perceptible decline in band‐like lymphohistiocytic inflammatory infiltrate (hematoxylin and eosin, a, × 40; b, × 100)image
Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis
Authors: Cohen Arnon D. , Cagnano Emanuela , Halevy Sima 
Published: March 2003

A 91‐year‐old patient presented with a nonfebrile, pruritic, widespread eruption that appeared 10 days after starting therapy with cefuroxime tablets, 1000 mg/day, due to stasis dermatitis with secondary infection. The patient was also treated with paracetamol tablets,500–1000 mg/day, 10 days before the onset of the eruption. Previous diseases included congestive heart disease, hyperglycemia, and ectropion. There was no personal or family history of psoriasis. Additional medications, taken for more than 2 years at the time of the eruption, included indomethacin, captopril, hydrochlorothiazide, isosorbide‐5‐mononitrate tablets, and a combination drug Laxative®.Examination revealed widespread erythema involving 95% of the total body surface area, with numerous 1–2 mm nonfollicular pustules (Fig. 1). There was no predilection to the body folds. Within 24 h of hospitalization, during intravenous therapy with cefuroxime, the patient's condition worsened and bullae containing clear fluid appeared. Nikolsky's sign was positive on erythematous skin, and eventually skin detachment involved 41% of the total body surface area (Fig. 2). There were no target or target‐like lesions and there was no involvement of the mucous membranes.Numerous, 1−2 mm, nonfollicular pustules, with confluence (viewed in the lower left part of the photograph), on erythematous skinimageWidespread skin detachmentimageAn early biopsy from a pustule revealed subcorneal and intraepidermal spongiform pustules, papillary edema, perivascular mononuclear infiltrate with a few eosinophils in the dermis, and leukocytoclastic vasculitis. A later biopsy showed similar findings with no evidence of full‐thickness epidermal necrosis or necrotic keratinocytes. Direct immune fluorescence (DIF) taken from erythematous skin was negative.Laboratory studies showed the following results: sedimentation rate, 80 mm/h; white blood cell count, 26,200/mm3 with 87% polymorphonuclears and 1.8% eosinophils; hemoglobin,13.0 g/dL; albumin, 2.8 g/dL (normal, 3.5–5.5 g/dL); other blood chemistry tests were normal. Immunologic studies for rheumatoid factor, antinuclear antibodies, antismooth muscle antibodies, antiparietal cell antibodies, antimitochondrial antibodies, C3, and C4 were normal or negative. Serology for venereal disease research laboratory (VDRL) test, Epstein–Barr virus, cytomegalovirus, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and antistreptolysin titer was negative. Chest X‐ray was normal. Blood cultures were negative. Swab cultures taken from the pustules revealed Staphylococcus aureus as well as coagulase‐negative Staphylococcus.All systemic drugs, including intravenous cefuroxime, were withdrawn with close monitoring for signs of heart failure or infection. Topical therapy consisted of application of wet dressings. Within 10 days, the eruption resolved with re‐epithelialization of the erosions and the appearance of widespread post‐pustular desquamation (Fig. 3)Post‐pustular desquamation on the trunkimage
Recurrent primary cutaneous adenoid cystic carcinoma of the scrotum
Authors: Koh Bo‐Kyung , Choi Jung‐Min , Yi Jong Yuk , Park Chul‐Jong , Lee Hong‐Won , Kang Sung‐Hak 
Published: March 2003

A 60‐year‐old man had asymptomatic erythematous nodule on the right inguinal area, which had progressively grown for 2 years. Excision was performed at the Department of Urology of our hospital. Two months later, there was local recurrence on the excision site, and it extended locally to make several tender erythematous nodules on the right inguinal area and firm plaque on the scrotum (Fig. 1). Histopathologic examination of the excision specimen revealed large cell masses with tubular or cribriform pattern and many small, solid epithelial islands unattached to the overlying epidermis. The tumor was confined to the dermis and subcutaneous tissue. Round spaces formed by malignant epithelial cells and containing amorphophilic basement membrane‐like material occured inside the tumor masses. The tumor cells were basaloid cells with scanty cytoplasm and deeply stained round‐to‐oval nucleus (Fig. 2). There was clear perineural involvement by the tumor cells. A substance in the pseudoglandular spaces, cystic spaces and the stroma was stained strongly with periodic acid‐Schiff (PAS) and alcian blue (pH 2.5). A PAS‐positive substance was digested by diastase pretreatment. These findings suggested the substance to be a neutral mucopolysaccharide. Immunoperoxidase staining for S‐100 protein and cytokeratin were strongly positive with the tumor cells but not with carcinoembryonic antigen. A histopathologic diagnosis of ACC was made. Salivary glands, bronchi, esophagus, and other organs were examined, but there was no evidence of neoplasm in other organs. A diagnosis of primary cutaneous adenoid cystic carcinoma was made but the patient refused all the treatment, including surgery.Several erythematous nodules on the right inguinal area and indurated plaque on the adjacent scrotumimageThe characteristic tubular and cribriform pattern of basaloid cells with round spaces containing mucinous material in the dermis (H&E, × 400)image
Pyoderma gangrenosum: a report of 21 cases
Authors: Mlika Rym Benmously , Riahi Imed , Fenniche Samy , Mokni Mourad , Raouf Dhaoui Mohamed , Dess Néjib , Dhahri Amel Ben Osman , Mokhtar Insaf 
Published: March 2003

AbstractBackground Pyoderma gangrenosum (PG) is an uncommon, destructive, cutaneous ulceration, belonging to the neutrophilic disease spectrum. It is associated with systemic disease in 50% of cases.Methods We report a retrospective study of 21 cases of PG. All cases studied fulfilled the following criteria: (i) clinical features of PG; (ii) histopathology consistent with a diagnosis of PG, and excluding other specific dermatoses.Results The average age of our patients was 41.8 years. The male to female ratio was 1.1. The typical ulcerative variant was found in 17 patients, bullous PG in two patients, and the granulomatous variant in two patients. Sixty‐two per cent of our patients had lesions on their lower legs. Two patients had neutrophilic pulmonary involvement concurrent with the ulcers. An association with other internal diseases was noted in 12 patients. Histopathologic study showed vasculitis in 13 patients. Of these, 11 were leukocytoclastic and the others predominantly lymphocytic.Conclusions PG is a rare disease, with the ulcerative variant being most frequent. The lower legs are the most commonly affected sites. The recurrence rate in our study was about 46% regardless of the treatment prescribed. Pulmonary involvement was fatal in two patients.