bluuebunny/crossref_metadata_2025_split huggingface dataset:
Solitary hyperpigmented island in a sea of elastosis (anelastosis)
Authors: Ramos‐Caro Francisco A. , Sevigny Gina , Mullins Diane 
Published: March 2003

A 77‐year‐old Caucasian woman presented to our clinic for skin screening with a history of multiple, cutaneous, actinic keratoses and basal cell carcinomas treated in the past. She has had prolonged and intense exposure to the sun throughout her life. On physical examination, a tanned, leathery skin was present on her face, neck, V‐area of the chest, and upper extremities. Multiple scars of previously treated areas were present. As an incidental finding, a solitary, 2 cm × 2 cm, square‐shaped, hyperpigmented, well‐demarcated, depressed, soft plaque with a “skin‐graft” appearance was noted on her right anterior neck ( Fig. 1). This area was surrounded by leathery skin, but unaffected by it. On further questioning, she denied any surgery of the area, including skin‐grafting (there was no donor scar anywhere on her body). She could not recall precisely how long it had been there, or if it had grown in size, as it was asymptomatic. She did state that it had been there for many years, and possibly since childhood. She was asked to bring any old photographs that might picture this area, but could not find any. With her permission, a skin biopsy was performed of the edge of the lesion to include the hyperpigmented area and the surrounding skin.Well‐circumscribed patch surrounded by severely sun‐damaged skin on the neckimageHistologically, the shave biopsy taken from the edge of the lesion on the right neck revealed marked elastosis in the papillary dermis of the surrounding skin ( Fig. 2). The lesional skin did not demonstrate any elastosis in the papillary dermis, and had a thin epidermis with relatively increased pigmentation of the basal layer. No melanophages were seen. The elastic stain enhances the demarcation between the surrounding elastosis and the anelastotic lesion. There was no elastic tissue, normal or damaged, in the papillary dermis of the affected skin (
Fig. 3).Demarcation between the lesion (left) and the elastotic skin (right). No solar elastosis is present in the papillary dermis of the lesion (right or left) (hematoxylin and eosin, ×4)imageElastic stain. No solar elastosis in the lesional papillary dermis (left) (×10)image
Intermittent use of topical dimethyl sulfoxide in macular and papular amyloidosis
Authors: Özkaya‐Bayazit Esen , e Kavak Ayş , Güngör Havva , Özarmagan Güzin 
Published: March 2003

AbstractBackground Severe and therapy‐resistant pruritus is the most prominent feature of macular (MA) and lichen (LA) amyloidosis that leads to further amyloid deposition by recurrent frictional trauma to the epidermis. Of the various therapeutic modalities with variable success, the most encouraging and beneficial effect has been observed with topical dimethyl sulfoxide (DMSO) therapy. In a previous study, we achieved marked clinical improvement in nine of 10 patients in a daily treatment regimen over 6–20 weeks, but relapses occurred in the post‐treatment follow‐up period. The aims of this study are to investigate whether the patients would benefit from intermittent therapy and to determine the optimal application interval of DMSO to maintain the relief of symptoms.Methods Thirteen patients with histopathologically verified cutaneous amyloidosis (five MA, two LA and six biphasic) were enrolled in the study. They were treated once daily with a 50 or 100% DMSO solution until pruritus disappeared. Then, DMSO was applied at increasing intervals until the widest effective application interval for maintenance of relief was reached. Patients were regularly followed‐up by a scoring system for pruritus, papules, and pigmentation, control biopsies, photographs, blood biochemistry, and side‐effects.Results The mean time required for the disappearance of pruritus was 4.1 weeks. Remarkable flattening of the papules was achieved after an average therapy period of 9 weeks. After a total therapy period of 6.5 months, a nearly 50% remission in pigmentation and >70% flattening of papules were achieved. The widest effective DMSO application interval was 8.6 days. The side‐effects of therapy were contact urticaria, desquamation, burning sensation, and garlic‐like breath odor, which were more prominent with the higher concentration of DMSO. In interval therapy, side‐effects were tolerated more easily than in daily therapy. No reduction of amyloid deposits was revealed in control biopsies.Conclusions Locally applied DMSO can break the vicious “pruritus–amyloid deposition–pruritus” cycle in patients with MA and LA. In addition to its daily use, interval therapy seems to maintain this effect and enables patients to tolerate side‐effects more easily.
Myotonic dystrophy (Steinert disease): a morphologic and biochemical hair study
Authors: Amorosi Beatrice , Giustini Sandra , Rossi Alfredo , Giacanelli Manlio , Calvieri Stefano 
Published: March 2003

Abstract Background Myotonic dystrophy is a systemic genetic disorder, with dominant transmittance. It is characterized by generalized progressive muscular abnormality. Although frontoparietal alopecia is one of the most common symptoms in myotonic dystrophy, it has not received much attention. Methods We examined 25 subjects from two families: 10 patients were affected by Steinert disease and 15 were not. The various morphologic and biochemical hair alterations are reported. Results All investigated subjects (affected or not) presented the same type of morphologic and biochemical hair alterations. Conclusions These findings could be used to construct a hypothesis to explain the cause of the disease.
Spiders and Borrelia burgdorferi: no evidence of reservoir occurrence in central Arkansas
Authors: Suffridge P. J. , Smoller Bruce R. , Carrington P. R. 
Published: March 2003

Abstract Background Although Ixodes ticks are considered the chief vector for Borrelia burgdorferi in the USA, B. burgdorferi has also been identified in mosquitoes, horse flies, and deer flies. We examined the possibility of these organisms being harbored in two species of spider in central Arkansas. Methods Ten wolf spiders (Lycosa gulosa) and two brown recluse spiders (Loxosceles reclusa) were collected in central Arkansas during early summer and fixed in formalin. Paraffin‐embedded sections of the spiders were examined for spirochetes using the modified Steiner spirochete staining method and examined for B. burgdorferi using immunohistochemistry. Results All 12 spiders from both species were found to be negative for all spirochetes including B. burgdorferi. Conclusions Spiders in our sample appeared not to harbor B. burgdorferi. Further studies utilizing larger sample sizes, more sensitive testing measures, or spiders from an area more endemic with B. burgdorferi may further prove or disprove that spiders are capable of harboring this organism.
Mucocutaneous manifestations of HIV infection: a retrospective analysis of 145 cases in a Chinese population in Malaysia
Authors: Jing Wang , Ismail Rokiah 
Published: March 2003

Abstract Background Mucocutaneous lesions directly related to human immunodeficiency virus (HIV) infection usually present as initial manifestations of immune deficiency. The most common mucocutaneous lesions are Kaposi’s sarcoma, histoplasmosis, oro‐esophageal candidiasis, oral hairy leukoplakia, and, in Asia, Penicillium marneffei infection. Non‐HIV‐related skin lesions, such as psoriasis, seborrheic dermatitis, and nodular prurigo, may be the initial presentation among HIV infected patients attending outpatient clinics. Methods A retrospective analysis was performed on 145 HIV‐positive Malaysians of Chinese descent from two centers at the University Hospital Kuala Lumpur (UHKL) and the General Hospital Kuala Lumpur (GHKL) from March 1997 to February 1998. Demographic data and clinical data were analyzed. Results The analysis showed that 104 out of 145 patients had mucocutaneous disorders (71.7%). In the study, there were 100 men (96.2%) and four women (3.8%). The majority of patients were in the age group 20–50 years. The patients who presented with mucocutaneous disease also had low CD4+ T‐lymphocyte counts and most had acquired immunodeficiency syndrome (AIDS) defining illness. The number of cases with generalized hyperpigmentation was very high in the group (35.9%), followed by nodular prurigo (29.7%) and xerosis (27.6%). Seborrheic dermatitis was seen in 20.7% of cases, with psoriasis in 8.3%. The most common infections were oral candidiasis (35.9%), tinea corporis and onychomycosis (9.7%), and herpes infection (5.5%); however, mucocutaneous manifestations of Kaposi’s sarcoma were rare. Conclusions The results suggest that mucocutaneous findings are useful clinical predictors of HIV infection or signs of the presence of advanced HIV infection.
Psoriatic scarring alopecia: observations in four patients
Authors: Bardazzi Federico , Fanti Pier Alessandro , Orlandi Catuscia , Chieregato Carlo , Misciali Cosimo 
Published: March 2003

Abstract Background and design  Although acute or chronic hair loss in psoriasis of the scalp can be a symptom of the disease, until now there has been no agreement as to whether or not it is only restricted to erythrodermic, generalized pustular and scalp plaque psoriasis. The purpose of this study was to evaluate patients with chronic scalp psoriasis and alopecia and to determine if the alopecia was of the scarring type. Results  We report four cases of psoriatic scarring alopecia and describe the clinical and histologic features of these patients. The diagnosis was made by scalp biopsies (vertical and transverse sections) and other causes of scarring alopecia were excluded. Conclusions  Psoriasis can cause scarring alopecia.
Carcinoma erysipeloides as a presenting feature of breast carcinoma
Authors: Nambi Rabindranath , Dd . , Tharakaram Sriramulu 
Published: March 2003

Drug nametamoxifen: NolvadexAn 80‐year‐old caucasian woman was seen in November 1997 for an asymptomatic raised lesion on the left side of the neck extending to the infraclavicular area of 7 months’ duration. She had been treated with topical steroids by her general practitioner with no relief. On examination, there was a large, irregular, ill‐defined, indurated, erythematous plaque, 7 × 4 cm, over the left side of the neck extending to the infraclavicular area ( Fig. 1). The diagnoses entertained included tinea incognito, cutaneous mucinoses, and carcinoma erysipeloides.Infiltrated plaque of carcinoma erysipeloides on the left side of the neckimageGeneral examination and breast examination were normal with no mass palpable, and there was no regional lymphadenopathy. Routine blood investigations were normal. A biopsy taken from the plaque revealed marked dilation of dermal lymphatics containing a tightly packed infiltrate of pleomorphic malignant cells with abnormal mitotic figures, confirming the diagnosis of carcinoma erysipeloides ( Fig. 2). The tumor cells were estrogen receptor positive, supporting the origin of cells from the breast. A mammogram showed the presence of a small spiculated mass in the lower outer quadrant of the left breast. This was considered to be the source of the cutaneous metastasis and the patient was started on tamoxifen.Dilated lymphatics packed with malignant infiltrate: carcinoma erysipeloidesimage
Pretibial epidermolysis bullosa
Authors: Soriano Luisa , Fariña Carmen , Manzarbeitia Felix , Requena Luis 
Published: March 2003

A 37‐year‐old white man with a history of essential arterial hypertension and idiopathic thrombocytopenic purpura (for the latter disorder, oral corticosteroids had been administered successfully), was first examined in our department in June 1997. He had a persistent, pruriginous eruption on the pretibial regions which had been present since the age of 16 years. He complained of bullous lesions after minor trauma to the skin. Examination revealed bilateral, brown, erythematous, shiny, indurated plaques on the anterior regions of his lower legs. Several clear blisters, scars, and excoriations were also present on the left leg ( Fig. 1). His toenails were thickened and dystrophic, but his teeth and hair were normal.Vesicles, erosions, and crusts on the left legimageHistopathologic examination of a vesicle on the left leg revealed a subepidermal blister with sparse perivascular lymphocytic infiltrate in the upper dermis. The contents of the blister were fibrinous ( Fig. 2A). Immunohistochemical study was automatically performed (TechMate 500) with monoclonal antibody to type IV collagen (clone CIU 22, Dako), a component of lamina densa, after enzymatic and heat antigen retrieval. Type IV collagen was present on the roof of the blister, indicating that the blister formation was beneath the lamina densa (
Fig. 2B). Ultrastructural examination showed an intact dermoepidermal junction with normal hemidesmosomes and basal keratinocytes; however, the anchoring fibrils were markedly decreased in number (
Fig. 3) and were rudimentary.(A) A subepidermal blister covered by intact epidermis and sparse inflammatory infiltrate in the papillary dermis (hematoxylin and eosin, ×100). (B) Immunohistochemical investigation for collagen IV demonstrated that the blister developed beneath the lamina densa (collagen IV, ×200)imageUltrastructural examination showed a decreased number of anchoring fibrils in the dermal papillae (×12,000)imageThe father of the patient and the paternal grandfather had a similar blistering eruption on the pretibial areas. His son, a 2‐year‐old boy, also presented bullous lesions on the anterior surface of the legs, with scars and milia. His daughter, a 6‐year‐old girl, was not affected. The pattern of inheritance was autosomal dominant.
Microbiology of infected pustular psoriasis lesions
Authors: Brook Itzhak , Frazier Edith H. , Yeager Joseph K. 
Published: March 2003

AbstractBackground Bacterial infections can occur in lesions of pustular psoriasis (PP). The objective of this study was to establish the aerobic and anaerobic microbiology of secondarily infected PP.Methods A retrospective 10‐year review was carried out of clinical and microbiology laboratory records from patients with secondarily infected PP lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria.Results Bacterial growth was noted in 23 specimens. Aerobic or facultative anaerobic bacteria only were present in 12 patients (52%), anaerobic bacteria only in four (17%), and mixed anaerobic–aerobic flora was present in seven (30%). Thirty‐six isolates were recovered (1.6 per specimen), 23 aerobic or facultative bacteria and 13 strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus(15 isolates), Group D Enterococcus (two isolates), and Escherichia coli (two isolates). The predominant anaerobes were Peptostreptococcus spp. (six isolates) and Bacteroides fragilis group, Propionibacterium acnes, and pigmented Prevotella spp. in two each. Single bacterial isolates were recovered in 14 patients (61%), 11 of which were S. aureus. Nineteen of the organisms isolated from 18 patients (78%) produced the enzyme beta‐lactamase. S. aureus was isolated from all body sites. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. EntericGram‐negative rods and Bacteroides fragilis group predominated in lesions on the legs and buttocks. Group A beta‐hemolytic streptococci, pigmented Prevotella, and Fusobacterium spp. were most frequently recovered in lesions of the hand.Conclusions The polymicrobial etiology of secondarily infected PP lesions and the association of bacterial flora with the anatomic site of the lesions were demonstrated.
Immunoperoxidase technique for detecting spirochetes in tissue sections: comparison with other methods
Authors: Phelps Robert George , Knispel Jeffrey , Tu Erik Schuman , Cernainu Georgetta , Saruk Michael 
Published: March 2003

Abstract Background  With the increasing incidence of human immunodeficiency virus (HIV) infection and immunosuppressive therapy, the incidence of syphilis has been increasing. Given the fact that the above conditions may mask or obscure the usual clinical signs and symptoms of syphilis, a means of enhanced detection is essential.Aims methods  The purpose of this study was to determine whether an immunoperoxidase method using an antibody against treponemes would increase the sensitivity and specificity of diagnosis in biopsies of patients with secondary syphilis. This was compared to serology and silver stain in cases of known syphilis.Results  Immunoperoxidase for treponemes was at least as sensitive (9/10) as pathology (9/10), and more sensitive than conventional silver stain (6/10) or serology (7/10).Conclusions  In those equivocal cases of secondary syphilis, where confirmation is essential, immunoperoxidase for treponemes may be a useful adjunct.
Hypereosinophilic syndrome: correlation between clinical severity and cutaneous microthrombi
Authors: Kim Hee Sung , Chun Yoon‐Sun , Chang Sung Nam , Park Wook‐Hwa 
Published: March 2003

A 32‐year‐old man, with a 12‐year history of recurrent edema of the upper and lower extremities, was admitted in February 1998 due to edema of the right forearm and tiredness of 1‐month duration. Examination revealed an ill‐defined, itchy, slightly erythematous, indurated patch with excoriation on the right forearm (Fig. 1). There was no history of drug intake, atopy, or asthma. He recalled, however, having experienced cold‐induced Raynaud's phenomenon and intermittent arthralgia. In laboratory tests, there was a white cell count of 11.77 × 103/μL with 48% eosinophils (4830/μL). Liver function tests showed elevated serum glutamic pyruvic transaminase (SGPT) and alkaline phosphatase. Rheumatoid factor was positive. Total immunoglobulin E (IgE) concentration was elevated to 4703 U/mL (normal, < 378 U/mL), while other serum immunoglobulins, including IgG, IgA, and IgM, were normal. Bone marrow aspirate and biopsy showed normocellular marrow with an excess of mature eosinophils, but no evidence of blast cells. There was no evidence of parasitic infestation, and allergy skin test was negative. An extensive systemic evaluation showed no other organ involvement. A skin biopsy specimen revealed many eosinophils infiltrating the perivascular, periappendageal, and subcutaneous fat area and also within the vessel walls. Multiple microvascular thrombi with eosinophils were observed in the mid and lower dermis and subcutaneous fat (Fig. 2). The eosinophils showed positive staining with eosinophil cationic protein (ECP) using the monoclonal antibody EG2. On the basis of the above findings, we diagnosed hypereosinophilic syndrome (HES). Treatment with 60 mg prednisolone daily was started and, within 7 days, his edema and itching sensation started to resolve. Follow‐up laboratory and biopsy findings after 1 month returned to normal. The prednisolone dosage was slowly tapered over a 9‐month period and he is currently on a maintenance dose of prednisolone 10 mg alternate day therapy.An ill‐defined, slightly erythematous, indurated patch with excoriation on the right forearmimageA vessel showing thrombus formation with many eosinophils (× 100)image
Identification of clustered cells in human hair follicle responsible for MMP‐9 gelatinolytic activity: consequences for the regulation of hair growth
Authors: Jarrousse Françoise , Boisnic Sylvie , Branchet Marie‐Christine , Beranger Jean‐Yves , Godeau Gaston , Breton Lionel , Bernard Bruno A. , Mahé Yann F. 
Published: March 2003

AbstractBackground  The control of human hair follicle growth and differentiation is dependent upon several well‐identified factors, including androgens, cytokines, and growth factors. In humans, alopecia androgenetica is a common aging process thought to be regulated through complex genetic imbalances, which also involve several of these crucial identified factors (and probably others not yet characterized), alone or in combination. Among these factors, epidermal growth factor (EGF), as well as pro‐inflammatory cytokines, play a pivotal role, as evidenced by their direct inhibitory effects on hair growth both in vitro and in vivo. Following such treatments, the in vitro growth of hair follicles was rapidly arrested and deleterious modifications of hair morphology were also observed.Aim  Because these cytokines act, at least partly, through the induction of matrix metalloproteinases (MMP), and because tissue remodeling occurs during the hair cycle, we attempted to identify and localize MMP in the human pilosebaceous unit.Method  We used zymography to observe human hair follicles in culture in vitro.Results  We observed that human hair follicles in culture in vitro mainly and almost exclusively produce MMP‐2 and MMP‐9 gelatinolytic activities. Furthermore, after stimulation with EGF, tumor necrosis factor‐α (TNF‐α), or interleukin‐1α (IL‐1α), MMP‐9 production was strongly increased. Using immunohistochemistry, we then precisely localized MMP‐9 in the lower part of the inner root sheath (Henle's layer) of control human anagen hair follicles.Conclusions  Cytokine‐ and EGF‐induced upregulation of MMP‐9 in the lower epithelial compartment of the human hair bulb is a major mechanism through which hair follicle involution, observed in alopecia, may occur.
Molluscum contagiosum in herpes zoster scars
Authors: Nico Marcello Menta S. , Bergonse Fabiane Noronha , Godoy Andréa M. 
Published: March 2003

A 29‐year‐old white woman was seen for the evaluation of an eruption on her neck and shoulder. She was being treated for human immunodeficiency virus (HIV) infection (blood CD4+ lymphocyte count, 187 cells/μL) with saquinavir, ritonavir, and nevirapine antiretroviral therapy. Two months previously, she had suffered from herpes zoster. The new lesions were located exclusively on the site of the herpes zoster scars. Clinical examination revealed slightly hypertrophic and hypochromic cicatricial lesions on the left cervical (c3, c4, c5) dermatome; in this area, there were many skin‐colored, umbilicated, isolated, 1–2 mm papules (Fig. 1). Histopathology of a papule showed changes typical of molluscum contagiosum (Fig. 2). The patient was treated with local application of 70% trichloroacetic acid with excellent results (Fig. 3). The lesions did not recur after 6 months of follow‐up.Skin‐colored, umbilicated, isolated, 1–2 mm papules on the left cervico‐thoracic dermatomeimageHistopathology of a papule showing changes typical of molluscum contagiosumimagePatient after treatment with local application of 70% trichloroacetic acidimage