bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of once‐daily application of mometasone furoate 0.1% cream compared with twice‐daily hydrocortisone valerate 0.2% cream in pediatric atopic dermatitis patients who failed to respond to hydrocortisone
Authors: Lebwohl Mark , group the mometasone furoate study 
Published: March 2003

Two hundred and nineteen patients completed this multicenter, randomized, evaluator‐blind, parallel‐group study evaluating the efficacy and safety of once‐daily application of mometasone furoate 0.1% cream compared with twice‐daily hydrocortisone valerate 0.2% cream in children with moderate to severe atopic dermatitis.Enrolled patients were between 2 and 12 years of age and had failed to respond to at least 7 consecutive days of treatment with a topical hydrocortisone preparation, with the last application of hydrocortisone occurring within a week before enrolling in the current study.Patients were randomized to treatment from 10 centers in the USA with either mometasone furoate 0.1% cream (n = 109) or hydrocortisone valerate 0.2% cream (n = 110) for up to 3 weeks. At enrollment, a target area of dermatitis (not the face or forehead) of at least 20 cm2 was selected by the investigator for specific evaluation of the effects of treatment on disease signs and symptoms. Additionally, patients had to present with at least 15% total body surface involvement, excluding the face and forehead, with the current exacerbation of atopic dermatitis. The severity of erythema, induration/lichenification, scaling/crusting, exudation, excoriation, and pruritus was graded on the following scale: 0 = none; 1 = mild; 2 = moderate; 3 = severe. A total sign/symptom severity score (sum of six individual sign/symptom severity scores) of ≥ 8 was required in the target area (maximum = 18), with a severity score of ≥ 2 required for erythema and for one other sign. Patients were examined on return visits on days 4, 8, 15, and 22 of treatment and the severity of the signs and symptoms present in the target area was rated by the investigator at each visit. Areas outside the target area were also treated with the study medications and evaluated by the investigator in the global response to treatment. The criteria for global clinical response compared to baseline were as follows: cleared (100% improvement); excellent (75–99% improvement); good (50–74% improvement); fair (25–49% improvement); poor (< 25% improvement); exacerbation (a flare‐up at a treatment site). No other therapies for atopic dermatitis were permitted.
Betamethasone valerate foam 0.12%: a novel vehicle with enhanced delivery and efficacy
Authors: Franz Thomas J. , Parsell Dawn A. , Halualani Roger M. , Hannigan John F. , Kalbach Jacqueline P. , Ma . , Harkonen W. Scott 
Published: March 2003

AbstractBackground: A new topical formulation of betamethasone valerate (BMV) with enhanced dermal penetration has been developed.Objective: These studies were designed to evaluate: (1) the relative bioavailability of BMV foam, and (2) the safety and efficacy of BMV foam in the treatment of scalp psoriasis as compared to a lotion formulation of BMV and placebo.Methods: Safety and efficacy were evaluated in a randomized, multicenter, double‐blind, active‐and placebo‐controlled trial in adult patients with moderate to severe scalp psoriasis. A separate study in 18 patients was conducted to evaluate the potential for suppression of the hypothalamic–pituitary–adrenal (HPA) axis. Relative bioavailability was measured using the human cadaver skin model.Results: 72% of patients using BMV foam were clear or almost clear of disease at the end of 28‐days of treatment as judged by the investigator’s global assessment of response. Only 47% of BMV lotion patients and 21% of placebo showed a similar level of response. There was no evidence of increased toxicity or HPA‐axis suppression for BMV foam, but assessment of relative bioavailability showed BMV penetration into the skin to be more than two‐fold greater than from BMV lotion.Conclusions: A novel foam formulation with enhanced BMV bioavailability has been shown to be of increased efficacy in the treatment of scalp psoriasis without an associated increase in toxicity.
Majocchi’s granuloma trichophyticum in an immunocompromised patient
Authors: Gupta Somesh ,   DNB, Kumar Bhushan ,   MNAMS, Radotra Bishan Dass , Rai Ranju , Of Dermatology Departments ,   Venereology and Leprology and Pathology, Of Medical Education Post Graduate Institute ,   Research,   Chandigarh,   India
Published: March 2003

A 40‐year‐old man with alcoholic liver disease was referred to the dermatology clinic for asymptomatic papulonodular lesions over the face of 15 days’ duration. Cutaneous examination revealed multiple, dusky red to yellow, follicular as well as perifollicular papulonodular lesions, varying in size from 0.5 to 2 cm ( Fig. 1). They were distributed over the forehead, cheeks, eyelids, nose, chin, beard area, retroauricular area, and neck. Careful examination revealed well‐defined scaly margins on the back of the pinna (
Fig. 2). KOH examination of a scraping from the neck revealed nonpigmented septate hyphae. Histopathologic examination of the excised nodule revealed epitheloid cell granulomas with neutrophilic microabscesses surrounding the hair follicles. Periodic acid–Schiff stain was noncontributory. Culture of an excised nodule on Sabouraud’s agar showed growth of Trichophyton rubrum. Considering his liver disease, the patient was initially treated with topical terbinafine. Because of a lack of a satisfactory response this was changed to oral terbinafine 250 mg/day. There was marked regression of the lesions by the sixth day. Unfortunately, the patient succumbed to complications relating to his liver disease.Follicular and perifollicular lesions of Majocchi’s granulomaimageA well‐defined scaly margin of tinea on the back of the pinaimage
A child with spider bite and glomerulonephritis: a diagnostic challenge
Authors: Lung Jennifer M. , Mallory Susan B. 
Published: March 2003

A previously healthy 7‐year‐old white boy presented to St. Louis Children's Hospital with a 1‐day history of headache, malaise, temperature of 38.7 °C, and a progressively erythematous, tender calf with central dusky purpura. On the morning of admission, his mother noticed a 2‐mm crust on the patient's right calf with a 3‐cm × 3‐cm area of surrounding erythema. No history of recent trauma or bite was obtained. He had suffered two episodes of nonbloody, nonbilious emesis during the last day. In addition, over the previous 12 h, he presented brown urine without dysuria. His mother and brother had suffered from gastroenteritis over the previous week without bloody diarrhea.On initial physical examination, there was a 6‐cm × 11‐cm macular tender purpuric plaque with a central punctum on the right inner calf, which was warm and tender to the touch, with erythematous streaking towards the popliteal fossa ( Fig. 1). The inguinal area was also erythematous with tender lymphadenopathy and induration, but without fluctuance. Laboratory studies included an elevated white blood cell count of 20,800/μL with 6% bands, 86% segs, and 7% lymphocytes, hemoglobin of 12.5 g/dL, hematocrit of 35.1%, and platelets of 282,000/μL. The prothrombin time/activated partial tissue thromboplastin was 10.4/28.0 s (normal PT, 9.3–12.3 s; normal PTT, 21.3–33.7 s) and fibrinogen was 558 mg/dL (normal, 192–379 mg/dL). Urinalysis showed 1+ protein, 8–10 white blood cells, too numerous to count red blood cells, and no hemoglobinuria. His electrolytes, blood urea nitrogen (BUN), and creatine were normal. The urine culture was negative. Blood culture after 24 h showed one out of two bottles of coagulase negative Staphylococcus epidermidis.(A) 7‐year‐old boy with painful purpura of the calfimageThe patient's physical examination was highly suggestive of a brown recluse spider bite with surrounding purpura. Over the next 2 days, the surrounding rim of erythema expanded. The skin within the plaque cleared and peeled at the periphery. The coagulase negative staphylococci in the blood culture were considered to be a contaminant. Cefotaxime and oxacillin were given intravenously. His leg was elevated and cooled with ice packs. The patient's fever resolved within 24 h. The lesion became less erythematous and nontender with decreased warmth and lymphadenopathy. The child was discharged on Duricef for 10 days.Because the patient experienced hematuria rather than hemoglobinuria, nephritis was suggested. In this case, poststreptococcal glomerulonephritis was the most likely cause. His anti‐streptolysin‐O titer was elevated at 400 U (normal, <200 U) and C3 was 21.4 mg/dL (normal, 83–177 mg/dL). His urine lightened to yellow–brown in color. His blood pressure was normal. Renal ultrasound showed severe left hydronephrosis with cortical atrophy, probably secondary to chronic/congenital ureteropelvic junction obstruction. His right kidney was normal.
Minor cutaneous features of atopic dermatitis in South Korea
Authors: Lee Hyun‐Jeong , Cho Sang‐Hyun , Ha Seog‐Jun , Ahn Won‐Keun , Park Young‐Min , Byun Dae‐Gyoo , Kim Jin‐Wou 
Published: March 2003

Abstract Background Minor cutaneous features are important in atopic dermatitis (AD) because they are related to the ethnic or genetic background and to the etiopathogenesis of the disease other than atopic allergy. In addition, they can be used as auxiliary diagnostic criteria in patients with uncertain major features. It is our experience that our AD patients have characteristic features that have not been described previously in the literature. Methods AD patients (n = 130) and control subjects (n = 198) were examined for the 32 conventional and seven additional minor features (sandpaper‐like skin lesions on elbow/knee/lateral malleolus, hangnail, ventral wrist dermatitis, itchy hyperkeratotic papules on the dorsum of the hands, oily skin, fissured heel, and palmar erythema). The frequency of each feature was compared between AD patients and controls. The diagnostic significance of these minor features was analyzed separately in the childhood and adolescent–adult AD groups, and the age‐related changes were documented. Results The seven additional features were significant for the diagnosis of AD in South Korean patients. Many of the other conventional minor features were also significant. Nine features were of diagnostic importance only in the adolescent–adult AD group, and three features were characteristic only in the childhood AD group. Conclusions Our data suggest that ethnic backgrounds influence the phenotype of AD and that an additional seven features need to be examined to confirm the ethnic effect. As the general clinical presentation of AD is dependent upon age, the frequency of minor features varied in the different age groups.
A study of cutaneous myiasis in Sri Lanka
Authors: Kumarasinghe S. Prasad W. , Karunaweera N. D. , Ihalamulla R. L. 
Published: March 2003

Abstract Background  and objectives Cutaneous myiasis (CM) due to Diptera fly larvae shows different patterns in different regions. Many modalities of treatment have been described. The objectives of our study were to identify the species causing CM in Sri Lanka, the common sites of infestation, and the contributory factors, and to assess some treatment modalities, in particular mineral turpentine and certain herbal preparations.Methods  All patients with CM admitted or referred to the Dermatology Unit at the General Hospital, Kalutara, over 18 months starting from July 1997, and all patients with CM from the orthopedic and surgical wards of the National Hospital of Sri Lanka in Colombo over 6 months from July 1997, were studied. Details of the history and examination were recorded on specially designed forms. Maggots extracted were identified at the Department of Parasitology, Faculty of Medicine, University of Colombo. The modalities of treatment employed in the patients were recorded. In the Department of Parasitology, a colony of Chrysomya megacephala was maintained. Homogenized leaf extracts of Azadirachta indica (neem) and Pongamia pinnata (Indian beech) and mineral turpentine (active ingredient–‐low aromatic white spirits) were tested for efficacy in killing C. megacephala larvae in vitro. Leaf extracts were not used directly on patients.Results  There were 16 patients (10 males and five females; the sex of one patient was not recorded). The mean age was 58.5 years (range, 11–94 years). Identification of larvae revealed C. bezziana in 14 (87.5%) and C. megacephala in two (12.5%) patients. The foot was affected in 15 (93.7%) and the scalp in one patient. The immediate predisposing factor for CM in dermatology patients was infected dermatitis. The other relevant associated factors were: diabetes mellitus, psychiatric illness, leprosy, and mental subnormality. Turpentine was a useful adjunct in the removal of maggots manually. There were no side‐effects to turpentine. In the in vitro testing, turpentine was 100% effective in killing maggots. Some patients required surgical removal under anesthesia. Indian beech and neem leaf extracts were not effective against Chrysomya larvae in vitro.Conclusions  All cases of CM were due to larvae of Chrysomya species. The commonest was C. bezziana. C. megacephala larvae causing CM have been reported for the first time in Sri Lanka. The foot was the site of predilection. Dermatitis, psychiatric illness, leprosy, diabetes, and mental subnormality were some contributory factors. Topically instilled mineral turpentine, followed by manual removal of maggots, was effective in most cases. The plant extracts tested in vitro were ineffective. As C. bezziana is an obligatory parasite capable of penetrating deeply, the importance of preventive measures is emphasized.
Cutaneous cryptococcosis associated with lepromatous leprosy
Authors: Azulay Rubem David , Mendonça Ignez Regina Muri , Santos Cristiane Marcia , Monteiro Paulo Cesar Fialhomonteiro , Lazéra Marcia Santos , Kac Bernardo Kawa , Schechtman Regina Casz 
Published: March 2003

A 65‐year‐old Brazilian man presented with an erythematous nodular lesion on the left forearm (Fig. 1). The patient had been treated with multidrug therapy for 8 months for lepromatous leprosy. During therapy, he developed recurrent episodes of reactions which were treated with high doses of prednisone and thalidomide. The histopathology of the cutaneous nodular lesion showed a granulomatous inflammatory infiltrate; some histiocytes contained vacuolations and others demonstrated oval‐like or coma‐like structures (Fig. 2). The specimen was cultivated in Sabouraud agar at room temperature. The colonies were transferred to Petri dishes containing Niger Seed Agar (NSA) (Fig. 3). The confirmed diagnosis was Cryptococcus neoformans var. neoformans based on microscopy and physiology, including the canavanine–glycine–bromothymol blue (CGB) medium (Lazéra MS, Pires FDA, Camillo‐Coura L et al. Natural habitat of Cryptococcus neoformans var. neoformans in decaying wood forming hollows in living trees. J Med Vet Mycol 1996; 34: 127–131). The liquor culture was negative. Hemoculture and urine culture were also negative. Latex agglutination test was blood positive and liquor negative.Erythematous nodular lesion on the left forearm measuring 9 cm in diameterimageGranulomatous infiltrate presenting oval‐like or coma‐like structures inside the histiocytes (mucicarmine stain, × 100)imagePetri dishes with Niger Seed Agar containing numerous colonies of Cryptococcus neoformans var. neoformans imageThe patient's hemogram revealed normocytic anemia and normal total and differential white blood count. The CD4 count was 189/m3 and the CD8 count was 141/m3. Serology for anti‐human immunodeficiency virus‐I (anti‐HIV‐I) antibodies was negative. The X‐ray of the lungs showed an areolar image in the superior lobe of the right lung.Therapy with prednisone was suspended and fluconazole (300 mg/day) was prescribed. The nodular cutaneous lesion regressed completely after 90 days. The patient was submitted to a second skin biopsy for treatment control. The culture of the specimen taken was still positive and the histopathology showed the same picture as before treatment. After 5 months of continued therapy with fluconazole, another biopsy was performed but no fungus was recovered from the specimen.
Allergic contact dermatitis to temporary tattoos with positive para‐phenylenediamine reactions: report of four cases
Authors: Chung Wen‐Hung , Wang Chun‐Min , Hong Hong‐Shang 
Published: March 2003

AbstractBackground  In recent years, temporary tattoos instead of permanent tattoos have become popular worldwide. Although contact allergy to temporary henna tattoos appears to be rare in the past, it is progressively more commonly reported.Patients  Four Taiwanese patients of allergic contact dermatitis following application of temporary tattoos were patch tested and they were followed up for 1 year after treatment.Results  All four of the tested patients were positive to paraphenylenediamine. At 1‐year follow‐up, all four patients still showed various degrees of remnant hyperpigmentation on their previous tattooed areas.Conclusion  Temporary tattoos may pose similar risks of allergic reactions associated with permanent tattoos. A high risk of prolonged post‐inflammatory hyperpigmentation after allergic contact dermatitis from temporary tattoos should also be alerted, especially in Asian skin type.
Eosinophilic folliculitis occurring in a patient affected by Hodgkin lymphoma
Authors: Vassallo Camilla , Ciocca Olga , Arcaini Luca , Brazzelli Valeria , Ardigò Marco , Lazzarino Mario , Borroni Giovanni 
Published: March 2003

A 25‐year‐old female had a 4‐month history of bilateral cervical lymphoadenopathies, weight loss, mild fever, and severe pruritus. A few months earlier, allergological analysis had been performed which revealed raised IgE (4.6 kU/L) against fungi antigens. A right cervical node biopsy led to histological diagnosis of nodular sclerosis‐type Hodgkin lymphoma. Clinical symptoms, bilateral cervical lymphoadenopathies, and a large mediastinal involvement (revealed by chest X‐ray and thoracic TC) were characteristic of stage IIB (bulky disease). The patient was treated with adriblastine, bleomycin, vinblastine, dacarbazine polychemotherapy (ABVD). Immediately after the administration of this cycle, she developed slightly erythematous, follicular, itchy papules and pustules, localized on her scalp (Fig. 1), trunk (Fig. 2), and thighs. A biopsy from the scalp was obtained under local anesthesia, after patient's consent. Histopathologic findings were characterized by a superficial and deep, dense perifollicular and interstitial infiltrate composed mainly of eosinophils, accompanied by few neutrophils and lymphocytes. Eosinophilic folliculitis involved the whole follicle (inferior segment, isthmus and infundibulum), and also the sebaceous gland (Fig. 3). PAS revealed the presence of some spores of Pityrosporum on the epidermis and also in the follicle. Gram stains proved negative. Eosinophilic folliculitis in an immunocompromised patient was diagnosed. Laboratory findings ascertained that the eosinophil count was in the normal range (eosinophils: 1%; white blood cell count: 10 700/mm3). The lesions healed spontaneously in about 10 days. After a second cycle of polychemotherapy (without dacarbazine, because the patient suffered repeated vascular injection injuries due to this chemotherapeutic agent), new crops of lesions in the same areas developed and in a few days faded away spontaneously. The blood clotting analysis performed just before this new cycle of ABV therapy revealed an eosinophil count of 10%, with a white blood cell count of 4500 mm3. Radiotherapy and four additional cycles of ABV polychemotherapy were made; in the meanwhile, the patient did not develop cutaneous lesions. Actually she is free from Hodgkin lymphoma and from eosinophilic folliculitis.Pustules with extrusion of whitish material, on the patient's scalpimagePapules and pustules, some of them excoriated, localized on the chestimageThe eosinophilic infiltrate is present also inside the sebaceous gland, a typical finding of eosinophilic folliculitis in immunocompromised patients (H&E, original magnification × 40)image
Microcirculatory changes in travelers to a tropical country
Authors: Zeegelaar Jim E. , De Feijter Annemieke , De Vries Henry J. C. , Fat Rudy F. M. Lai A , Neumann Martino A. M. , Faber William R. 
Published: March 2003

AbstractBackground Travelers to tropical areas seem to be affected by nonhealing leg ulcers more frequently. One of the factors that can affect wound healing in a negative manner is leg edema. This study was performed to determine whether there is increased leg edema in travelers to tropical areas.Method In this study, we measured the capillary filtration rate (CFR) of the lower leg by strain gauge plethysmography, as a measure of leg edema, on location in Surinam. Three groups were included: A, travelers in the first few weeks after arrival; B, travelers who had stayed in the tropics for a minimum of 2 months; C, native inhabitants.Results The mean CFR (mL/100 mL tissue/min) was significantly higher in group A than in groups B and C; the difference between groups B and C was not significant (group A 0.05 mL/100 mL tissue/min (standard deviation (SD), 0.03) vs. group B 0.02 mL/100 mL tissue/min (SD, 0.02), P = 0.01, and vs. group C 0.02 mL/100 mL tissue/min (SD, 0.02), P = 0.01).Conclusions Travelers to tropical areas are affected by increased CFR in the first few weeks after arrival. A prolonged stay leads to the normalization of the CFR. Compression therapy is recommended for travelers to the tropics.
Lymphocyte subtypes and adhesion molecules in actinic prurigo: observations with cyclosporin A
Authors: Umaña Angela , Gómez Alberto , Durán María Mélida , Porras Luisa 
Published: March 2003

AbstractBackground Actinic prurigo is a photodermatitis in which UV light is implicated by an unknown mechanism.Methods Skin biopsies of 19 patients with actinic prurigo and 11 controls were analyzed by immunohistochemistry.Results In actinic prurigo patients, there was a significant increase in the number of CD3, CD4, CD8, CD45RA, CD45RO, and CD45RB lymphocytes and Langerhans cells, as well as in the level of human leukocyte antigen‐DR (HLA‐DR) expression and cell adhesion molecules lymphocyte functional antigen‐1 (LFA‐1), intercellular adhesion molecule‐1 (ICAM‐1), and endothelial leukocyte adhesion molecule‐1 (ELAM‐1). Actinic prurigo patients were treated with cyclosporin A (CsA), and a final skin biopsy was taken after 6 months of treatment. All the cell populations and markers studied, except for the CD4 lymphocytes, Langerhans cells, and HLA‐DR expression, returned to normal levels.Conclusions CsA was found to be effective in relieving the clinical symptoms of actinic prurigo.