bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lichen planus or lichenoid tattoo reaction?
Authors: Dang Minh , Hsu Sylvia , Bernstein Eric 
Published: March 2003

A 27‐year‐old white man with a tattoo of 3 months’ duration was referred for possible laser removal because a pruritic eruption had developed in the tattoo 1 month after placement. Physical examination revealed erythematous papules confined to the red areas of the tattoo ( Fig. 1). He also had flat‐topped papules on the glans penis, which the patient stated had developed a few weeks after tattoo placement.Tattoo before treatment, showing involvement of only the red areasimageBiopsy of a penile lesion revealed a histologic pattern characteristic of lichen planus. Biopsy of the tattoo eruption revealed a lichenoid lymphocytic infiltrate with hyperkeratosis, hypergranulosis, and jagged epidermal hyperplasia. Deposits of black granular material were also present in the upper part of the dermis ( Fig. 2).Histopathology of the tattoo eruption shows a lichenoid lymphocytic infiltrate with hyperkeratosis, hypergranulosis, and jagged epidermal hyperplasia, with deposits of black granular material in the upper dermisimageDuring a 2‐week follow‐up visit, the patient developed more lesions on his arms and legs. After 4 weeks of treatment with halobetasol propionate ointment 0.05% to the tattoo, legs, and arms, all lesions had resolved. The red areas of the tattoo became flat, nonpalpable, and asymptomatic ( Fig. 3).Tattoo after treatment with topical corticosteroidsimage
Childhood pemphigus
Authors: Wananukul Siriwan , Pongprasit Prapai 
Published: March 2003

Abstract Background Five children with pemphigus are reported: three with pemphigus vulgaris, one with pemphigus vegetans, and one with pemphigus foliaceus. Only one case of juvenile pemphigus vegetans has been published in the literature. Materials and Methods All three patients with pemphigus vulgaris were treated with oral corticosteroid; in two cases, azathioprine was added for steroid‐sparing effect. The patient with pemphigus vegetans had a clinical presentation resembling pemphigus vulgaris, but the lesions in the perianal area healed as hypertrophic granulation tissue. He was treated with oral corticosteroid, azathioprine, and intralesional corticosteroid. The patient with pemphigus foliaceus presented with exfoliative dermatitis, and was treated with oral corticosteroid; methotrexate was added later for steroid‐sparing purposes Results The patients were followed up for 1–4 years; the prognosis of childhood pemphigus is good. Conclusions Long‐term follow‐up is needed to detect flaring of the disease and the side‐effects of immunosuppressive drugs.
Pityriasis lichenoides and acquired toxoplasmosis
Authors: Rongioletti Franco , Delmonte Sergio , Rebora Alfredo 
Published: March 2003

A 32‐year‐old man was seen in January 1997 for a skin eruption which had appeared 2 months earlier. He was in good health and was not taking any drugs. He had not left town and denied any other symptom except a short, flu‐like episode 2 months earlier.On examination, he showed multiple, papular, scaly and necrotic lesions over the trunk, arms ( Fig. 1), and thighs. The face and the mucosae were spared. No lymphadenopathy was evident, and the liver and spleen were not palpable.Scaly and necrotic papules on the armimageRoutine laboratory tests were insignificant. Histopathology of a papular lesion of the arm showed a thick scaly crust overlying a necrotic epidermis and a lichenoid infiltrate of lymphocytes and neutrophils ( Fig. 2). Extravasation of red blood cells and endothelial swelling of the small superficial vessels were also present.Histopathology showing a lichenoid infiltrate of lymphocytes and neutrophils with a thick scaly crust and necrosis of the epidermis (hematoxylin and eosin, ×100)imageA diagnosis of subacute pityriasis lichenoides (PL) was made, and treatment with 500 mg/day azithromycin, 3 days a week for 1 month, was prescribed without any benefit. Enzyme‐linked immunosorbent assay (ELISA) for Toxoplasma gondii showed immunoglobulin G (IgG) 150 (n.v. <10) and IgM 1.35 (n.v. <0.65). Diagnosis of recent toxoplasmosis prompted an ocular examination which excluded any eye involvement.A specific treatment with spiramycin, 3,000.000 U twice a day for 2 months, was given. The patient underwent a complete resolution of skin lesions which healed leaving atrophic and hyperpigmentary signs ( Fig. 3). At the end of therapy, ELISA was still positive for both IgG and IgM. Spiramycin was changed to trimethoprim–sulfamethoxazole, 800–160 mg twice a day, which was continued for 2 months.Clearing of the PL after specific anti‐Toxoplasma therapyimageReactive serology persisted for both IgG and IgM for 8 months, but no new lesions developed.
Comparative study of staphylococci from the skin of atopic dermatitis patients and from healthy subjects
Authors: Higaki Shuichi , Morohashi Masaaki , Yamagishi Takayoshi , Hasegawa Yoshinori 
Published: March 2003

Abstract Background Bacterial infections occur frequently on the skin of atopic dermatitis (AD) patients. The objectives of this study were to evaluate the microbiology of the skin of AD patients for staphylococci, the frequency and density of each species, and their susceptibility to antimicrobial drugs. Methods To study the staphylococci present on the skin of 21 AD outpatients and of 12 healthy subjects (HS), cutaneous organisms were obtained using the contact‐plate method. Results
Staphylococcus aureus was isolated in 85.7% of AD patients (mild type, 77.8%; moderate type, 87.8%; and severe type, 100%) and in 25% of HS, while Staphylococcus epidermidis was isolated in 83.3% of HS and in 38.1% of AD patients. Among the coagulase‐negative staphylococci (CNS) identified, S. epidermidis was the common type and several other CNS were detected in both AD patients and HS. As the eruption grade of dermatitic skin became more severe, the average density of S. aureus increased (severe, 2.68 ± 0.86; moderate, 2.49 ± 0.48; mild, 2.28 ± 0.44). A reversed tendency was seen in S. epidermidis (severe, 1.80; moderate, 1.90; mild, 2.10). Among nine antimicrobial drugs tested against S. aureus, S. epidermidis, and some other types of CNS isolates, vancomycin (VCM) and minocycline (MINO) were the most active, gentamycin (GM) was the less active, and ampicillin (ABPC) was the least active. Conclusions The skin of AD patients was more frequently colonized with S. aureus than that of normal controls. As the severity of the AD lesions increased, the numbers of S. aureus isolated increased. The skin of HS was more colonized with S. epidermidis. Other species of CNS were isolated from several cases of AD patients and HS. In addition, S. aureus, S. epidermidis, and the other CNS showed poor susceptibility to some of the tested antimicrobial drugs.
Long‐term administration of cyclosporin A to HCV‐antibody‐positive patients with dermatologic diseases
Authors: Miura Hiroyuki , Itoh Yuka , Matsumoto Yoshiko , Tani Mamori , Tanabe Noboru , Isonokami Masaaki , Kurachi Kishirou , Kozuka Takahito 
Published: March 2003

Abstract Background Cyclosporine A (CYA) is an immunosuppressive agent which is being used in the treatment of an increasingly wide range of dermatologic diseases, but its use has been avoided in carriers of hepatitis C virus (HCV). Methods We administered small doses of CYA (maximum, 3 mg/kg/day) for a long time to treat dermatologic diseases in one HCV‐antibody‐positive patient with no HCV‐RNA in the blood, one patient with a small amount of HCV‐RNA in the blood, and two patients with large amounts of HCV‐RNA in the blood. Results Skin lesions improved in all patients, but recurred upon complete or partial withdrawal of CYA. In the absence of HCV‐RNA in the blood, or when only a small quantity of HCV‐RNA was present in the blood, HCV‐RNA load showed no apparent change. In one patient with a large blood HCV‐RNA load, CYA dosage reduction was followed by increases in alanine aminotransferase (ALT) levels and decreases in blood HCV‐RNA. Aggravation of hepatitis due to immunologic reactivation was suspected in this patient. Conclusions The reduction of CYA dosage is a key element in the use of this agent for cutaneous diseases.
Onychomycosis in Lahore, Pakistan
Authors: Bokhari Mohammad Azam , Mcps . , Hussain Ijaz , Fcps . , Jahangir Mohammad , Mcps . , Haroon Tahir Saeed , Fcps . , Aman Shahbaz , Mcps . , Khurshid Khawar , Mcps . , Fcps . 
Published: March 2003

AbstractBackground Onychomycosis, a common nail disorder, is caused by yeasts, dermatophytes, and nondermatophyte molds. These fungi give rise to diverse clinical presentations. The present study aimed to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in the population in Lahore, Pakistan.Patients In 100 clinically suspected cases, the diagnosis was confirmed by mycologic culture. Different clinical patterns were noted and correlated with causative pathogens.Results Seventy‐two women (mean age, 32.6 ± 14.8 years) and 28 men (mean age, 40.6 ± 15.8 years) were studied. Fingernails were involved in 50%, toenails in 23%, and both fingernails and toenails in 27% of patients. The various clinical types noted were distolateral subungual onychomycosis (47%), candidal onychomycosis (36%), total dystrophic onychomycosis (12%), superficial white onychomycosis (3%), and proximal subungual onychomycosis (2%). Candida was the most common pathogen (46%), followed by dermatophytes (43%) (Trichophyton rubrum (31%), T. violaceum (5%), T. mentagrophytes (4%), T. tonsurans (2%), and Epidermophyton floccosum (1%) and nondermatophyte molds (11%) (Fusarium (4%), Scopulariopsis brevicaulis (2%), Aspergillus (2%), Acremonium (1%), Scytalidium dimidiatum (1%), and Alternaria (1%).Conclusions Onychomycosis is more common in women of 20–40 years of age. Distolateral subungual onychomycosis and candidal onychomycosis are the most common clinical presentations, and Candida and T. rubrum are the major pathogens in Pakistan.
Cathepsin D expression in early cutaneous malignant melanoma
Authors: Bartenjev Igor , Rudolf Zvonimir , Štabuc Borut , Vrhovec Ivan , Perkovič Tanja , Kansky Aleksej 
Published: March 2003

AbstractBackground The aspartic proteinase cathepsin D is believed to be associated with proteolytic processes leading to the invasion and seeding of tumor cells. An association between cathepsin D tissue concentration and aggressiveness of tumors has been detected in different cancer types, as well as in metastatic melanoma.Methods The concentration of cathepsin D was measured immunoradiometrically (ELSA‐CATH‐D kit, CIS Bio International) in the cytosols of 51 primary cutaneous melanomas (with Breslow index < 4 mm) to estimate the tissue concentrations of cathepsin D in early cutaneous melanoma.Results A significantly elevated concentration of cathepsin D was measured in the tumor cytosols as compared to adjacent normal tissue (44.2 vs. 14.7 pmol/mg of total protein,P < 0.001).Conclusions Our results indicate that cathepsin D is expressed at high levels by melanoma cells. The extremely high expression of cathepsin D in two of our patients, with later progression of the disease over a 42‐month follow‐up period, suggests a possible correlation between the cathepsin D tissue concentration and the prognosis of primary cutaneous malignant melanoma.
Evidence for Borrelia burgdorferi in morphea and lichen sclerosus
Authors: Özkan S˛ebnem , Atabey Nes˛e , Fetil Emel , Erkızan Verda , Günes˛ Ali Tahsin 
Published: March 2003

Abstract Background
Borrelia burgdorferi (Bb) infection has been implicated in the development of morphea and lichen sclerosus; however, conflicting results have been reported with different investigational methods from different regions. We looked for evidence of Bb in patients with morphea and lichen sclerosus by polymerase chain reaction (PCR) analysis of of skin biopsy samples. Methods Formalin‐fixed, paraffin‐embedded skin biopsy samples from 10 patients with morphea and 12 patients with lichen sclerosus were investigated by PCR analysis for the presence of Bb. Results The presence of Bb DNA was demonstrated in three of 10 patients with morphea and six of 12 patients with lichen sclerosus by nested PCR. Conclusions The data obtained in this study suggest that Bb may play a role in the etiopathogenesis of both morphea and lichen sclerosus at least in the western parts of Turkey.
Topical liquiritin improves melasma
Authors: Amer Mohamed , Metwalli Mohamed 
Published: March 2003

Twenty women with a clinical diagnosis of melasma were treated with liquiritin cream on one side of the face and with a vehicle cream on the other side twice daily for 4 weeks. Patients were advised to avoid sun exposure and/or used topical sunscreen during the entire period of treatment.Inclusion criteria included an age range from 18 to 40 years and bilateral and symmetrical idiopathic epidermal melasma. Exclusion criteria included patients with dermal melasma (differentiated by Wood's light), melasma with pregnancy, and patients currently receiving hormone replacement therapy.Melasma pigmentary intensity was rated on a five‐point scale in relation to the patient's normal facial skin (1, no difference; 2, slightly more pigmented; 3, moderately more pigmented; 4, markedly more pigmented; and 5, intensely more pigmented). The size of the lesions was measured directly using a millimeter grid scale. Ratings and measurements were made prior to treatment and at each of the follow‐up visits (after 2, 4, 6, 8, and 10 weeks).Clinical evaluation was performed at week 4; the overall response was rated as excellent, good, fair, or poor. Color photographs were taken at the start and at week 4 of the study. Side‐effects were observed and treated.
TNFα and IL‐6 are mediators in the blistering process of pemphigus
Authors: López‐Robles Eréndira , Avalos‐Díaz Esperanza , Vega‐Memije Elisa , Hojyo‐Tomoka Teresa , Villalobos Ricardo , Fraire Saúl , Domíguez‐Soto Luciano , Herrera‐Esparza Rafael 
Published: March 2003

Background  Pemphigus is an autoimmune disease characterized by intraepidermal blisters induced by pemphigus IgG. In addition to autoantibodies, molecular mechanisms involved in acantholysis remain largely unknown. For this reason, we address a possible role of the inflammatory cytokines IL‐6 and TNFα in pemphigus lesions.Methods  Sixteen biopsies from patients with different types of pemphigus were studied by in situ hybridization using DNA fluorescent probes for IL‐6 and TNFα mRNA.Results  Fifty‐six percent of lesional biopsies exhibited cytokine gene expression, which was poorly expressed in noninvolved skin. Deposits of TNFα and IL‐6 were products of in situ transcription at the epidermal level.Conclusions  Inflammatory cytokine expression around the blister could play a mediator role in pemphigus lesions by increasing epithelial damage.
Safety and efficacy of glycolic acid facial peel in Indian women with melasma
Authors: Javaheri Saeid Mirzazadeh , Handa Sanjeev , Kaur Inderjeet , Kumar Bhushan 
Published: March 2003

AbstractBackground  Melasma is a common disorder of facial hyperpigmentation. Many modalities of treatment are available, but none is satisfactory.Materials and methods  Twenty‐five nonpregnant female patients with a minimum melasma area and severity index (MASI) of 15 were recruited in the study. After a detailed history and clinical examination under natural light and Wood's light, MASI was calculated and color photographs were taken of all patients. Patients were advised to carry out a prepeel program of daily application of topical sunscreens (sun protection factor‐15, SPF‐15) and 10% glycolic acid lotion at night for 2 weeks. Patients were then treated with 50% glycolic acid facial peel once per month for three consecutive months. At regular intervals and at the end of the follow‐up period (3 months) after the last peel, the degree of improvement in pigmentation was assessed by remeasuring MASI. Side‐effects, if any, were also recorded. The data obtained were statistically analyzed using Student's paired t‐test and Spearman rank correlation coefficient test.Results  Improvement in melasma (reduction in MASI) was observed in 91% of patients (P < 0.01). Patients with epidermal‐type melasma demonstrated a better response to treatment than those with mixed‐type melasma (P < 0.05).Conclusions  The prepeel program followed by 50% glycolic acid facial peel once per month for three consecutive months proved to be an effective treatment modality in Indian patients without any significant side‐effects.
Rediscovering hydroxyurea: its role in recalcitrant psoriasis
Authors: Kumar Bhushan , Saraswat Abir , Kaur Inderjeet 
Published: March 2003

AbstractBackground  There is an acute paucity of second‐line systemic agents for the treatment of extensive chronic plaque psoriasis (CPP). Recent studies using hydroxyurea in patients with HIV infection and sickle cell anemia have rekindled interest in this old drug and have provided more data regarding safety and dosage.Objective  We wanted to test the efficacy and tolerability of hydroxyurea in patients with extensive CPP who had to discontinue first‐line oral agents for any reason.Methods  The study was a prospective nonrandomized series. Thirty‐one patients, including 26 with prior history of systemic antipsoriatic therapy were given hydroxyurea 1–1.5 g per day for a median duration of 36 weeks. They were followed up for a mean period of 36.1 ± 13.8 weeks.Results  Almost 75% of the patients showed an adequate response (35% reduction in Psoriasis Area and Severity Index at or before 8 weeks) with over half showing more than 70% reduction in PASI score. All adverse effects were mild and reversible and none of the patients required cessation of therapy.Conclusion  Hydroxyurea is an effective, very safe but relatively slower acting alternative for patients with extensive CPP over the short‐to‐medium term.
Anxiety level and severity of skin condition predicts outcome of psychotherapy in atopic dermatitis patients
Authors: Linnet Jakob , Jemec Gregor B. E. 
Published: March 2003

AbstractBackground  Atopic dermatitis (AD) is a skin disease associated with an increased anxiety level. Psychotherapy studies of AD patients report improvement in anxiety level and skin condition after psychotherapy.Methods  This psychotherapy study investigated 32 adult AD patients with mild to severe AD. Sixteen participants received 6 months of brief dynamic psychotherapy, while 16 were controls. The participants were compared using Spielberger's State–Trait Anxiety Index (STAI) and Severity Scoring of Atopic Dermatitis Index (SCORAD) pre‐ and post‐therapy, and at follow‐up after 12 months.Results  Initially, no outcome differences were found between the two groups; however, a post hoc multiple regression analysis indicated that AD patients with a higher intake level of trait anxiety (TA) showed greater improvement after psychotherapy, in terms of anxiety level and skin condition, than did AD patients with a low intake level of TA. Atopic dermatitis patients with a higher anxiety level, in the no‐treatment group, were more likely to discontinue the program.Conclusions  The results suggest that AD patients with a higher anxiety level are more likely to improve their psychologic and dermatologic condition after psychotherapy, but are more vulnerable to nonadherence when no adequate psychologic treatment is offered. The results underscore the importance of proper psychologic assessment and treatment in addition to dermatologic treatment.
Mucin‐poor follicular mycosis fungoides
Authors: Özdemir Mustafa , Demirkesen Cuyan , Arzuhal Nurcan , Tüzün Yalçýn 
Published: March 2003

A 49‐year‐old woman was admitted with generalized pruritus which she had for the last 4 years. Three months ago she developed erythema on her face, alopecia totalis, an erythematous macular eruption with follicular hyperkeratoses on the trunk and limbs (Fig. 1). She had bilateral palpable axillary lymphadenopathy. Histologic examination of the biopsies taken from the erythematous areas on the trunk and scalp revealed a folliculocentric infiltration composed of atypical, small and medium‐sized mononuclear cells, intermingled with reactive lymphocytes, histiocytes, plasmocytes, rare eosinophils, and giant cells without involvement of the epidermis (Fig. 2). The infiltrate surrounded and invaded the hair follicle epithelium without destroying it. With alcian blue staining, only small amounts of mucin were detected within the epithelium of the hair follicles. By the immunohistochemistry performed, folliculocentric infiltration was mainly composed of CD3(+), CD4(+), CD8(–) lymphocytes. A full blood count, peripheral smear, erythrocyte sedimentation rate (ESR), the concentration of nitrogen in the form of urea in the blood (BUN), creatinin, transaminases, serum electrolytes, C‐reactive protein (CRP), IgE, serum lipids, serum lactate dehydrogenase, urinalysis, roentgenogram and CT scan of chest were normal. Beta 2 microglobulin was 3.15 mg/L (normal range 1.2–2.5 mg/L). In the biopsy of the axillary lymph node, there was a focal infiltration of atypical T‐cells in the interfollicular area. She was given psoralen‐UVA (PUVA) treatment for 6 months (85 sessions, in escalating doses with a total 71.8 j/cm2) which resulted in a partial healing of the pruritus, erythematous plaques, follicular hyperkeratoses, and patchy hair regrowth. She then received oral methyl prednisolone, 40 mg daily for 3 weeks and the dose was gradually decreased and eventually reduced to 16 mg daily in 2 months. This resulted in healing of the pruritus, improvement in the erythematous plaques and follicular hyperkeratoses and axillary lymphadenopathy. Beta 2 microglobulin levels decreased to normal range (2.27 mg/L). After taking the 16 mg daily dose of the prednisolone for 6 months, her complaint of itching recurred. Erythematous plaques and follicular hyperkeratoses were noted again. The dosage of the steroids was increased to 40 mg daily and PUVA treatment was restarted. She is currently receiving oral methyl prednisolone and PUVA.Follicular papules are seen on the upper extremitiesimage(A) FMF; a folliculocentric infiltration demonstrated in the dermis. (H & E × 200) (B)FMF; typical convoluted lymphocytes both surrounding and involving the follicular epithelium intermingled with histiocytes and eosinophils (H & E × 1000)image