bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of gemfibrozil on in vitro cultured normal human skin explants
Authors: Wolf Ronni , Lo Schiavo Ada , Russo Adolfo , De Angelis Francesca , Ruocco Vincenzo 
Published: March 2003

Abstract Background Several lipid‐lowering agents, when given topically, show a profound effect on skin morphology. Because of low bioavailability of these drugs for keratinocytes, the incidence is extremely low clinically. The most appropriate way to study the effect of hypolipidemic drugs on keratinocytes is by artificial exposure of the skin to high drug concentrations. Objective To study the effects of gemfibrozil on the morphology of in vitro cultured normal human skin explants. As gemfibrozil induces barrier disruption by inhibiting epidermal sterologenesis, essential for a competent permeability barrier, it is interesting to investigate the morphologic changes associated with this phenomenon. Studying the epidermal changes induced by lipid‐lowering agents is important, not only because it might lead to a better understanding of the effects of these drugs on keratinocytes, but as it might also unlock the door to a wider knowledge of the pathomechanism of disorders of cornification. Methods Normal human skin from patients undergoing mastectomy was cultured in the presence of 2, 5, and 10 mM of gemfibrozil for 4 days The morphologic changes were evaluated by three blinded observers. Their reports were matched and collated. Results The cultured skin in the presence of gemfibrozil showed cell crowding of keratinocytes in the lower part of the epidermis, indicating epidermal hyperplasia and increased proliferation. Intercellular edema with the formation of small cavities in the epidermis, intracellular edema, and vacuolar alteration of keratinocytes in the upper portion of the epidermis were also observed. The intensity of these changes tended to parallel the gemfibrozil concentration. Some dermo‐epidermal detachments did not correlate with the gemfibrozil concentration, but rather with tissue characteristics peculiar to each explant. Conclusions The morphologic changes caused by gemfibrozil to normal human skin were not characteristic of psoriasis, and included intracellular and intercellular edema in the upper portion of the epidermis and cell crowding, indicating epidermal hyperplasia in the lower portion of the epidermis. The present experimental study gives further support to the hypothesis that hypolipidemic drugs cause an initial break in the barrier function of the epidermis, followed by a physiologic epidermal response, aimed at barrier restoration. This rather nonspecific stimulus to epidermal proliferation may trigger psoriasis in predisposed patients.
Benign symmetric lipomatosis in a Chinese man with bullous pemphigoid
Authors: Ho Man Hon , Lo Kuen Kong , Mbbs . 
Published: March 2003

Hong Kong[TAB]A 70‐year‐old Chinese man with biopsy proven bullous pemphigoid was treated with oral prednisolone, 60 mg daily, azathioprine, 100 mg daily, and dapsone, 100 mg daily. Changes were observed in his body build within 2 weeks of steroid treatment.Clinical examination showed multiple, firm, lobulated, fat‐feeling masses distributed symmetrically on the occiput, neck, shoulder girdle, upper trunk, proximal upper extremities, and supraclavicular fossae ( Fig. 1a,b). The deposits on the neck gave a characteristic, peculiar, “horse‐collar” appearance (
Fig. 2). The legs and lower part of the trunk were spared. The overlying epidermis was normal. The overall appearance was pseudo‐athletic instead of Cushingoid. Multiple, mobile, shotty lesions were palpable along the neck, suspicious of cervical lymph nodes.Anterior (a) and posterior (b) views of the patient showing symmetric deposition of adipose tissue in the upper trunk, supraclavicular fossae, and proximal upper limbs and typical sparing of the distal extremitiesimageA close‐up view of the fat deposits on the occiput showing the characteristic “Madelung’s neck”imageThe patient had been drinking alcoholic beverages for 28 years, with an average daily intake of 4 fluid ounces. There was no history of liver disease or other systemic diseases. No family member had a similar problem.Excisional biopsy of the neck mass was performed to exclude cervical lymph node metastasis and tuberculosis lymphadenitis. The histology revealed mature adipose tissue only. Complete blood counts were normal. Liver function test showed isolated elevation of γ‐glutamyl transferase of 220 U/L (normal, 9–62 U/L) and low serum albumin of 35 g/L (normal, 44–56 g/L). Hepatitis B surface antigen was negative. These changes were secondary to chronic alcoholism. Fasting urate, blood sugar, and triglyceride were within normal limits. Fasting cholesterol was 6.3 mmol/L (normal, 4.1–6.2 mmol/L) which was slightly elevated.Ultrasonic examination of the abdomen showed a normal sized liver and spleen. Liver parenchymal echogenicity was slightly increased, compatible with fatty change. Chest roentgenogram was normal. A computed axial tomography (CAT) scan of the thorax and abdomen did not reveal any mass lesion or lymph node.The whole clinical picture and investigations supported the diagnosis of benign symmetric lipomatosis (BSL). At the time of reporting, bullous pemphigoid was well controlled with prednisolone, 15 mg daily, and BSL remained static.Discussion
Erythroderma with pemphigus immunofluorescence. An erythrodermic variant of pemphigus?
Authors: Cozzani Emanuele , Balestrero Sonia , Parodi Aurora , Rebora Alfredo 
Published: March 2003

A 79‐year‐old woman had suffered from a severe pruritic eruption for 2 years which worsened whenever she was given nonsteroidal anti‐inflammatory drugs (NSAIDs). Treatment with itraconazole, 100 mg/day for 16 days, was of no benefit, while partial remission was obtained with methylprednisolone 4 mg/day.On examination, she was in good general condition and exhibited several pruritic polycyclic urticarial lesions ( Fig. 1). In a week, from their initial localization at the trunk and limbs, her lesions spread centrifugally to eventually involve the whole body. Oral lesions were not present.Erythematous polycyclic lesions of the legimageRoutine laboratory tests, including those directed to the detection of a possible neoplasm, were normal. Eosinophils were 800/mL. Three biopsies were taken 1 week apart. All revealed only a mild epidermal hyperplasia and a lymphocytic infiltrate in the superficial dermis, with some neutrophils and eosinophils. No acantholysis or spongiosis was observed.Direct immunofluorescence (DIF) performed on lesional skin disclosed deposits of both immunoglobulin G (IgG) and C3 in the intercellular spaces (ICS) of the entire epidermis ( Fig. 2), and deposits of both IgM and C3 in the vessel walls. Three serum specimens were taken simultaneously with biopsies to detect anti‐ICS antibodies. Anti‐ICS antibodies were not found in the serum by indirect immunofluorescence (IIF) with monkey esophagus as substrate and by immunoblotting (IB) on epidermal extract.Deposits of IgG in the intercellular spaces of the epidermisimageBecause of the DIF features, the patient was diagnosed as having pemphigus and given 2 mg/kg/day prednisone. The lesions cleared after 1 month. During disease remission, however, IIF became positive disclosing IgG anti‐ICS antibodies at a serum dilution of 1/40 and, 6 months later, when the patient was taking 5 mg/day prednisone, the IgG titer rose to 1/80. After a further 2 months, when the patient was in clinical remission, IIF was again negative.
Ecthyma gangrenosum
Authors: Güçlüer Hülya , Ergun Tülin , Demirçay Zeynep 
Published: March 2003

Case 1. An 18‐year‐old white man with AML‐M3 received allogeneic bone marrow transplantation (BMT) in August 1997. On the seventh day of BMT, he developed chills, fever (39.1 °C), anorexia, and perirectal pain. On physical examination, a hemorrhagic bulla and “punched out” ulceration were observed on the perirectal region. Subsequently, the ulcer was surrounded by a red, swollen, tender, cellulitic plaque (Fig. 1).The ulceration on the perianal region of the first patientimageLaboratory analyses showed leukopenia (200/mm3 ) with anemia (hemoglobin (Hb), 10.5 g/dL) and thrombocytopenia (17,000/mm3 ). Tzanck test of the lesion was negative. The direct examination of the ulcer material revealed leukocytes and Gram‐negative bacilli, but no pathogen grew on culture. Blood and catheter cultures revealed Pseudomonas aeruginosa. Intravenous imipenem, 2 g/day, and amikacin, 1 g/day, were started. The lesion resolved within 3 weeks following antibiotic treatment and surgical debridement.
Nevus sebaceous syndrome
Authors: Jang In Gang , Choi Jung Min , Park Kee Woan , Kim Si‐Yong 
Published: March 2003

A 10‐day‐old boy presented with an 11‐cm × 7‐cm asymptomatic well‐demarcated alopecic verrucous yellowish plaque on the right temporoparietal area, a 5‐cm × 3‐cm verrucous yellowish plaque on the forehead, and a linear plaque extending from the forehead to the nose ridge present since birth. He also had a 2‐cm pedunculated mass from the right bulbar and tarsal conjunctiva ( Fig. 1). The gestational age was 39 weeks and 5 days and he weighed 4.04 kg at birth. No abnormalities were observed upon physical examination except for the cutaneous and optical findings. An examination of the fundus revealed macular agenesis and peripapillary atrophy (
Fig. 2). No family history was revealed. The results of laboratory tests, including complete blood count, blood chemistry, immunochemical study, screening test for inborn metabolic disorders (methionine, leucine, phenylalanine, galactose, thyroid hormone, thyroid stimulating hormone), and antibody tests to TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes virus), were normal. The results from the chromosomal study, brainstem auditory evoked potential, and visual evoked potential were normal. Chest and skull X‐ray did not show any abnormal signs. Orbit and brain magnetic resonance images showed findings suggesting a lipodermoid cyst from the right eyeball and subdural hygroma or arachnoid cysts in both of the frontal and both of the temporal areas (
Fig. 3). The histopathologic examination of a lesional biopsy specimen revealed hyperkeratosis, papillomatosis in the epidermis, large numbers of sebaceous glands of various sizes, and immature hair structures in the dermis.Asymptomatic verrucous yellowish alopecic plaque on the right frontal temporoparietal area and linear verrucous yellowish plaque on the nose. Solitary 2‐cm pedunculated mass from right tarsal and bulbar conjunctivaimageFundus photograph reveals macular agenesis and peripapillary atrophyimageWidening of the cerebrospinal fluid (CSF) space is noted at the bilateral anterior temporal fossa and bilateral frontal area, suggesting subdural hygroma or arachnoid cystimage
Pyloric atresia with junctional epidermolysis bullosa(PA‐JEB) syndrome: absence of detectable β4 integrin and reduced expression of epidermal linear IgA dermatosis antigen
Authors: Kim Jeong Nyun , Namgung Ran , Kim Soo‐Chan , Lee Min Geol , Lee Jin Sung , Lee Chul 
Published: March 2003

A newborn girl with pyloric atresia with junctional epidermolysis bullosa (PA‐JEB) developed vomiting and blisters after birth. Radiography revealed pyloric atresia, and a resection of atretic segment and gastroduodenostomy were carried out at 4 days after birth. Physical examination revealed multiple bullae on the trunk and extremities ( Fig. 1). Light microscopy of a skin biopsy specimen showed subepidermal bullae with few inflammatory cells. Electron microscopy showed separation in the lamina lucida and rudimentary hemidesmosomes (
Fig. 2). A direct immunofluorescence (IF) mapping study was negative for immunoglobulin G (IgG), IgA, IgM, C3, and fibrin. To determine the cleavage level, an IF mapping study was performed on 6 μm cryostat sections of a frozen skin biopsy specimen, using bullous pemphigoid (BP) antibody, monoclonal antibody against type IV collagen (Dako, Copenhagen, Denmark), monoclonal antibody (LH 7.2) against type VII collagen (Serotec, Oxford, UK), and epidermolysis bullosa acquisita (EBA) serum. The staining for BP was identified on the epidermal side. The staining for monoclonal antibody against type IV collagen, type VII collagen, and EBA was identified on the dermal side. This pattern was compatible with the diagnosis of JEB. We also performed an IF mapping study using GB3 monoclonal antibody (Sera Laboratory, Cambridge, UK), which recognizes laminin 5 monoclonal antibody against β4 integrin (Chemicon, Los Angeles, CA), and linear IgA dermatosis (LAD) antibody, which binds to the epidermal side of salt‐split skin substrate (
Fig. 3). The patient’s skin has normal laminin 5 expression, but an absence of detectable β4 integrin and reduced epidermal LAD antigen expression. Despite nutritional support with parenteral nutrition and special formula feeding, chronic diarrhea and bloody mucoid stools persisted and malnutrition was not improved.Photograph of the patient with pyloric atresia with junctional epidermolysis bullosa (PA‐JEB). Multiple bullae are seen on the trunk, shoulder, and areas exposed to pressure and minor trauma. The operation scar for pyloric atresia is seen on the abdomenimageElectron microscopic findings: reduced number of hemidesmosomes were found at basal cellsimageImmunofluorescence analysis of the patient (right column) compared with normal skin (left column), A, B, GB3 Ab; C, D, β4 integrin; E, F, LAD serum. The skin of the patient has normal laminin 5 expression, but an absence of detectable β4 subunit at reduced LAD antigen expressionimage
Squamometry in seborrheic dermatitis
Authors: Piérard‐Franchimont Claudine , Willemaers Valentine , Fraiture Anne‐Laure , Piérard Gérald E. 
Published: March 2003

Abstract Background Seborrheic dermatitis is a corticosteroid‐responsive condition. Topical corticosteroids exhibit distinct activities according to the type and cellular site of action of the hormone and its vehicle. The latter influences not only drug penetration, but also the structure and function of the horny layer. Objective The present study compared the early response of seborrheic dermatitis to two topical corticosteroids using objective quantifications of the stratum corneum alterations. Method Squamometry was used to supplement the clinical assessment of the therapeutic activity of 0.1% hydrocortisone butyrate in an oil‐in‐water emulsion (Locoid Crelo®) and 0.05% betamethasone 17–21 dipropionate lotion (Diprosone® lotion). Results The hydrocortisone butyrate formulation had a faster onset of efficacy as documented by a greater improvement of lesions after a 1‐week twice‐daily treatment. Clearance or marked improvement was observed in the two treatment groups at completion of the 2‐week trial. Conclusions As the ranking of the clinical efficacy was not predicted by the intrinsic anti‐inflammatory potency of the steroids, it is suggested that the vehicle contributed itself to the global in vivo efficacy. The anti‐inflammatory action of hydrocortisone butyrate appears to be synergistically implemented by the emollient effect of the specially designed oil‐in‐water emulsion.
Prurigo pigmentosa
Authors: Gürses Leyla , Gürbüz Oya , Demirçay Zeynep , Kotilogˇlu Esin 
Published: March 2003

Case 1 A 28‐year‐old woman with skin type 2 was first seen in May 1997 with a 10‐year history of a recurrent pruritic eruption in the intermammary area. Her medical history was not significant regarding a systemic disease or a triggering factor that could have been related to her eruption. Results of laboratory investigations, including peripheral blood cell counts, liver and renal function tests, blood glucose levels, and urinalysis, were within normal limits. Physical examination revealed erythematous papules and reticulated hyperpigmentation in the intermammary area. Histopathologic examination from an erythematous papule showed parakeratosis, mild acanthosis, spongiosis, dyskeratotic keratinocytes, and focal vacuolar degeneration of basal keratinocytes within the epidermis; and perivascular lymphocytic infiltrate and pigment incontinence within the upper dermis
(
Fig. 1). Following an initial treatment with topical corticosteroid for 2 weeks with a partial response, doxycycline was started in 200 mg daily doses for 3 weeks. The eruption resolved leaving marked residual hyperpigmentation within 3 weeks. No recurrence has been observed over the past 6 months.Biopsy of an erythematous papule revealed parakeratosis, mild acanthosis, spongiosis, necrotic keratinocytes (double arrows), and focal vacuolar alteration of the basal layer (single arrows) (hematoxylin and eosin stain; original magnification, × 100)image Case 2 A 23‐year‐old woman with skin type 3 presented in June 1997 with a 2‐month history of a recurrent pruritic eruption on her chest. She denied any provoking factor that could have been responsible for her eruption. Her examination revealed erythematous papules and reticulated hyperpigmentation localized to the inframammary area
(
Fig. 2).Skin biopsy showed focal parakeratosis, minimal acanthosis, spongiosis, and a lymphocytic infiltrate around the blood vessels of the upper dermis. The lesions resolved spontaneously leaving residual reticulated hyperpigmentation within 2 weeks. The following course of her lesions is not known as she was lost to follow‐up.Reticulated hyperpigmentation in the inframammary areaimage
Improvement in psoriasis after intradermal administration of heat‐killed Mycobacterium vaccae
Authors: Balagon Maria V. , Walsh Douglas S. , Tan Paul L. , Cellona Roland V. , Abalos Rodolfo M. , Tan Esterlina V. , Fajardo Tranquilino T. , Watson James D. , Walsh Gerald P. 
Published: March 2003

Abstract Background New treatments for psoriasis are being developed, but many are associated with limited efficacy, side‐effects, or rapid recurrence after discontinuation. Thus, the aim of new agents is to induce longer term remissions with fewer side‐effects. Preliminary studies have shown that Mycobacterium vaccae, a nonpathogenic organism prepared as a heat‐killed suspension, may induce periods of remission in some psoriasis patients when administered intradermally. Methods To further assess the efficacy and tolerability of M. vaccae in patients with moderate to severe psoriasis (psoriasis area and severity index (PASI) of 12–35), we conducted an open label study whereby 24 patients received two intradermal inoculations of M. vaccae in lesion‐free deltoid skin, separated by a period of 3 weeks. Results Twelve weeks after starting treatment, 14 of 24 patients (58%) showed marked improvement in the PASI score (greater than 50% reduction), two had moderate improvement (25–50% reduction), six were unchanged (< 25% reduction), and two had worsened (> 5% increase). By 24 weeks, 11 of 22 patients continued to show greater than 50% improvement. Five patients had complete clearance of skin lesions that lasted for at least 6 months. Conclusions Intradermal administration of heat‐killed M. vaccae suspension was well tolerated and induced clinically significant improvement in a majority of psoriasis patients in this cohort. Placebo‐controlled testing to further define the efficacy of this treatment is warranted.
Non malignant superior vena cava syndrome
Authors: Musumeci Maria Letizia , De Pasquale Rocco , Tedeschi Aurora , Neri Sergio , Micali Giuseppe 
Published: March 2003

A 62‐year‐old woman was admitted to our clinic for the evaluation of 2.5‐year history of progressive exertional facial flushing, and swelling of the head, face, and neck. Three years earlier, she had undergone implantation of a definitive pacemaker with an endocardial ventricular lead for a severe bradycardia. Physical examination revealed facial swelling and erythema including the periorbital areas, distended neck and edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules were present on the ventral upper thoracic wall interspersed with patches of intense flush and large areas of normally colored skin (Fig. 1). There had been no weight loss within the previous months. History of angioedema, allergic reactions, autoimmune diseases, or medication was negative. Enlarged lymph nodes were not detected. Complete blood cell count, fibrinogen, Quick's test for prothrombin, antithrombin III, C‐reactive protein, lipidic profile, renal functions, urinanalysis, and thyroid function test were within normal ranges. Standard X‐ray and sectional radiography of the chest revealed no lung diseases or alterations of the mediastinum. Doppler examination of the supraaortic trunks and chest CT scan showed normal findings. A diagnosis of superior vena cava syndrome (SCVS) was suspected and a cavography was performed, by injecting contrast medium simultaneously through the basilic veins, that revealed marked narrowing of the confluence of the two brachiocephalic veins at the junction of the internal jugular and right subclavian veins with a total obliteration of the right brachiocephalic vein (Fig. 2). The diagnosis of pacemaker‐induced SVCS was confirmed and the woman was referred for angiosurgery.Presence of edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules on the ventral thorax wall interspersed with patches of intense erythema and large areas of normally colored skin were presentimageCavography showing obliteration of the right brachiocephalic vein at its confluence with the left brachiocephalic veinimage
Primary cutaneous nocardiosis associated with intra‐articular corticosteroid injection
Authors: Aydıngöz İkbal E. , Candan İnci , Dervent Barış , Hitit Gülden 
Published: March 2003

A 65‐year‐old woman presented to our clinic with a 2‐month history of papulopustular lesions on her right hand that had progressively increased in size and number. She had a 15‐year history of psoriasis vulgaris and had developed digital arthralgias within the preceding few months. A diagnosis of psoriatic arthropathy was made and she was treated by multiple intra‐articular steroid injections on the back of the right hand. One month after the last injection, the lesions had developed over the treatment area. The patient had no apparent history of trauma, but had grown flowers for years.Dermatologic examination revealed three fluctuating, erythematous, superficial, scaling nodules, measuring 0.5‐1.5 cm, on the second and fourth metacarpal bones and on the proximal phalanx of the fourth finger. Many scattered papulopustular lesions were also present on the back of the right hand (Fig. 1).Nodules and papulopustular lesions found on the back of the right hand on admissionimageRoutine laboratory investigations, including urine analysis, complete blood count, sedimentation rate, glucose, liver function tests, renal function tests, total protein, and albumin were within normal limits. Chest X‐ray and right hand roentgenogram were normal. Microbiological examination of the aspiration fluid obtained from the nodules revealed Gram‐positive, acid‐resistant, filamentous bacteria with fine branching. The isolates were grown within a few days in blood agar and within a week in Lowenstein‐Jensen medium. The microorganism was identified as Nocardia brasiliensis.The patient was given trimethoprim/sulfamethoxazole (160/800 mg) twice daily for 6 weeks. It later became evident that the patient had stopped the treatment within 3 weeks, when a dramatic improvement was observed (Fig. 2). No recurrences were noted at 15 months.Clinical appearance of the hand after treatmentimage