bluuebunny/crossref_metadata_2025_split huggingface dataset:
Localized hyperhidrosis treated with aluminum chloride in a salicylic acid gel base
Authors: Benohanian Antranik , Dansereau Alain , Bolduc Chantal , Bloom Ernest 
Published: March 2003

A total of 238 patients with a clinical diagnosis of localized hyperhidrosis (HH) were treated on 332 anatomic sites (axillae, feet, hands, and groin). The purpose of the study was to evaluate the effectiveness of aluminum chloride hexahydrate (AC), in a salicylic acid gel base (SAGB) containing 4% salicylic acid (SA), for the treatment of localized HH. The SAGB was similar to a keratolytic gel, 1Keralyt® (Westwood Squibb). Because SAGB and anhydrous alcohol (AA), the standard vehicle for AC, have different consistencies, double blinding was not possible. Bromhidrosis (BH) was documented when present, whether of apocrine (axillae and groin) or eccrine (feet) origin. For the sake of uniformity, AC in SAGB was compounded by the same pharmacist. The concentration of AC varied from 10 to 40%, depending on the site to be treated. The improvement of HH was subjectively assessed through a questionnaire as follows: nil = no improvement; poor = <25%; fair = 25–50%; good = 50–75%; and excellent = >75%.Armpits: 20% AC was used to control axillary HH. When 20% AC failed to control HH, its concentration was gradually increased to 25% and, rarely, to 30%. When irritation occurred, the concentration of AC was decreased to 15 or 10%, and 1% hydrocortisone (HC) was added to the preparation. Patients were instructed to apply the medication initially 2–3 nights per week, gradually decreasing the frequency as required. When possible, only the active focal area of HH was treated.
2As with AC in AA, the medication was applied at bedtime. Patients were instructed to avoid rubbing and the application of the medication on recently shaved skin.Hands and feet: for these areas, the concentration of AC was 30% initially, but could be increased up to 40% if necessary.
3Application was daily at bedtime, and later at gradually longer intervals. Occlusion was never used.
Cutaneous infections by papillomavirus, herpes zoster and Candida albicans as the only manifestation of idiopathic CD4+ T lymphocytopenia
Authors: Lopez Pilar Manchado , De Morales Jose M. G. Ruiz , González Inmaculada Ruiz , Prieto Manuel A. Rodriguez 
Published: March 2003

AbstractBackground Selective depletion of CD4+ T lymphocytes is common in both primary and secondary immunodeficiencies. Idiopathic CD4+ T lymphocytopenia (ICL) cases are defined as a persistent CD4+ T lymphocyte count of less than 300×106 cells/L and/or less than 20% of the total T‐cell count.Method A 40‐year‐old woman, with a history of psoriasis and paracetamol allergy, presented with persistent warts of the hands and condylomas of the ano‐genitalia. Histological and virological analysis was carried out on genital and cutaneous lesions and peripheral blood.Results Serology for HIV‐1, HIV‐2, Epstein–Barr virus and parvovirus B19 were negative. There was lymphopenia of 10% CD4+ cells, with normal numbers of total leukocytes; there were no other abnormal immunological findings. DNA analysis of cutaneous lesions revealed HPV‐49 and HPV‐3 in the hands and HPV‐6 in the genital region.Conclusions The cause of the ICL in this patient is unknown. HPV is not known to be an immunosuppressive agent; it remains to be determined whether the HPV‐associated lesions are the cause or the result of immunosuppression.
Lesional T‐cell subset in leprosy and leprosy reaction
Authors: Mahaisavariya Punkae , Kulthanan Kanokvalai , Khemngern Supakan , Pinkaew Sumruay 
Published: March 2003

Abstract Background The T‐cell‐mediated immune response plays an important role in leprosy. The in situ proportion and pattern of distribution of T‐cell subsets in leprosy skin lesions have been studied, but no conclusion could be drawn. Methods We used monoclonal antibodies for T‐helper and T‐suppressor surface antigen to define the nature of dermal infiltration in 17 cases of nonreactional leprosy and 20 cases of reactional leprosy. Results We found T helper admixed with T suppressor in an aggregated pattern in the granulomas of most cases of nonreactional leprosy and in type I reactional leprosy, but a diffuse infiltrate throughout the dermis of type II reactional leprosy. The T‐helper/suppressor ratio was 1.68 in tuberculoid and 1.5 in lepromatous cases. The T‐helper/suppressor ratios of borderline tuberculoid (3.11) and type I reactional leprosy (2.54) were not statistically different. The T‐helper/suppressor ratio of type II reactional leprosy (5.83) was statistically higher than nonreactional lepromatous cases. Conclusions The alteration of the T‐helper/suppressor ratio in our study is mainly due to the reduction of T‐suppressor cells in the dermal infiltrates, especially in type II reactional leprosy. Further studies of T‐suppressor functions may be important in the pathogenesis of leprosy.
Bacteriologic and immunologic aspects of Gram‐negative folliculitis: a study of 46 patients
Authors: Neubert Uwe , Jansen Thomas , Plewig Gerd 
Published: March 2003

Abstract Background Gram‐negative folliculitis is an infection with Gram‐negative rods that most often occurs as a complication of prolonged broad‐spectrum antibiotic therapy in patients suffering from acne and rosacea. Methods The bacteriologic and immunologic findings are reported in 46 patients, 39 men and 7 women, aged 16–79 (median, 28) years, with Gram‐negative folliculitis. Hypersensitivity reactions to various microbial recall antigens as well as granulocyte functions were evaluated. Quantitative measurements of serum levels of immunoglobulin M, G, A, and E, total complement activity, complement factors C3 and C4, and alpha‐1‐antitrypsin were performed. Results The Gram‐negative organisms most frequently cultivated from nares, facial skin, and pustules were Klebsiella spp., Escherichia coli, Enterobacter spp., and Proteus spp. In all patients, deviations of one or more immune parameters were detected, including lowered serum concentrations of immunoglobulin M and alpha‐1‐antitrypsin, and elevated levels of immunoglobulin E. The humoral and cellular parameters were not influenced by isotretinoin therapy of Gram‐negative folliculitis. Conclusions These findings suggest that Gram‐negative folliculitis is not only a complication of long‐lasting antibiotic treatment of acne and rosacea, but might be an entity of its own. Immunologic factors may play a critical role in the pathogenesis of Gram‐negative folliculitis.
Azithromycin for the treatment of acne
Authors: Fernandez‐Obregon Adolfo C. 
Published: March 2003

Abstract Background Acne affects a large number of young adults, including women, who often present with facial as well as truncal involvement. Systemic antimicrobial agents currently used for the reduction of inflammatory papules and cysts require frequent administration and are sometimes associated with uncomfortable side‐effects contributing to a decrease in compliance. Methods Ninety‐nine episodes of inflammatory acne in 79 patients treated with oral antimicrobial agents were studied retrospectively over a period of 46 weeks. Patients were treated with tetracycline, erythromycin, minocycline, and doxycycline, the most commonly prescribed oral antimicrobials used to treat acne. Individuals that were unable to tolerate this therapy or had failed conventional therapy were treated with the azalide antibiotic azithromycin, given in a single oral 250‐mg dose three times a week. The other agents were administered daily in divided doses as is current practice. Patients were also on topical care. Results The efficacy and reported side‐effects were examined for all agents. Significant improvement was noted in 4 weeks. All agents were effective in reducing inflammatory lesions and improving acne. Azithromycin produced a slightly higher percentage of patients with a greater than 80% reduction in their inflammatory acne lesions (85.7%) vs. an average of 77.1% for all other agents. All differences observed were not statistically significant. Conclusions The results show that azithromycin is a safe and effective alternative in the treatment of inflammatory acne with few side‐effects and good compliance, and suggest the need for further investigation with a clinical trial that will compare the long‐term efficacy and tolerability.
Tinea pedis in Korean children
Authors: Jang Kyoung‐Ae , Chi Doo‐Hyun , Choi Jee‐Ho , Sung Kyung‐Jeh , Moon Kee‐Chan , Koh Jai‐Kyoung 
Published: March 2003

Abstract Background Tinea pedis is an infrequent disease in children before the age of puberty. There are few epidemiologic and clinical data regarding cases of tinea pedis observed in children. Materials and methods We prospectively collected all cases of tinea pedis in children diagnosed during the years 1995–1997. Only those showing a positive result with potassium hydroxide preparation were included in the study. We performed fungal cultures in Sabouraud’s agar in all cases to document the etiologic fungi. The clinical characteristics were investigated. Results A total of 21 children, aged 3 months to 14 years, were included. Fifteen patients were boys and six were girls. The mean age was 7.1 years. All the children were otherwise healthy. Prior to the establishment of the diagnosis of tinea pedis, 17 patients (80.9%) were treated for eczema without improvement. The intertriginous type was most common (53.3%). The first or second toe‐webs were the sites of predilection (32.3%). Eighteen children (86%) had a family history of tinea pedis and more than half of cases (52.4%) showed occurrence in the summer. The results of fungal cultures were positive in 13 patients (57%). Trichophyton rubrum was the most commonly isolated pathogen (69.2%). The other associated dermatoses were onychomycosis (33.3%), atopic dermatitis (14%), plantar warts (10%), and chronic urticaria (5%). Tinea pedis and onychomycosis cleared after treatment with topical antifungals with or without systemic antifungals in all cases. Conclusions Tinea pedis in children can occur more frequently than suspected. Our study shows the strong association with a family history and the seasonal relationship with occurrence in summer in more than half of cases. We suggest that tinea pedis should be considered in the differential diagnosis of foot dermatitis in children.
Chronic lymphocytic leukemia presenting as cutaneous and bone involvement
Authors: Stefanidou Maria P. , Kanavaros Panayotis E. , Tosca Androniki D. 
Published: March 2003

An 84‐year‐old man had a 3‐year history of a progressive, painless, papulonodular eruption, that was particularly prominent on the face and extremities. Physical examination revealed firm, bluish‐red nodules and plaques, located on the tip of the nose, the cheeks, ears, and distal digits. Skin lesions produced a leonine facies (Fig. 1), deformities of the fingers and toes, finger clubbing, and onyxis. An identical lesion was seen on a postoperational scar on the left cheek. The mucous membranes were spared. The patient had anterior and posterior cervical and bilateral axillary lymphadenopathy and splenomegaly.Leonine faciesimageOn admission, the peripheral blood count revealed 260,000/mm3 leukocytes (lymphocytes 97%, neutrophils 2%, and monocytes 1%), a hemoglobin level of 9.5 g/dL, and platelet count of 100,000/mm3. Hypogammaglobulinemia with reduction of immunoglobulin G (IgG) and IgM was found.Radiography of the fingers showed multiple osteolytic lesions of the phalanges and phalangette destruction of the left median finger (Fig. 2a,b). Computed tomography of the chest and abdomen revealed bilateral axillary, mediastinal, and para‐aortic lymphadenopathy and spleen enlargement.X‐Ray of the hands: (a)  multiple osteolytic lesions of the phalanges and (b)  partial destruction of the left median phalangetteimageSkin biopsy specimens from the ear and finger lesions showed a massive nonepidermal leukemic infiltration in the papillary and reticular dermis, with a grenz zone consisting of small lymphocytes (Fig. 3).Skin biopsy (hematoxylin and eosin, × 250). Massive leukemic infiltration consisting of small lymphocytes. Subepidermally, a grenz zone of connective tissue is notedimageBiopsy of the enlarged cervical lymph node showed a diffuse infiltration with lymphocytes. Tissue biopsy from a finger lytic lesion revealed infiltration of bone trabecular and fibrous tissue with a dense population of small‐ and medium‐sized lymphocytes. Immunohistochemical study of cutaneous and bone lesions showed that the infiltrate in both biopsies consisted mainly of B lymphocytes (CD20+, CD45R+, CD45Ro–, OPD4–).Peripheral blood smear had a B‐cell phenotype (CD19 98%, CD20 97%, CD23 99%, CD25 40%, CD5 90%, HLA‐DR 100%). Bone marrow smear and immunophenotyping surface marker analysis found a diffuse pattern of B‐lymphocytic infiltration.A diagnosis of B‐cell chronic lymphocytic leukemia stage C (Binet staging system), with specific cutaneous and bone lesions, was established.The patient received chemotherapy with chlorambucil and methylprednisolone, which resulted in improvement of the hematologic profile. Two years later, the cutaneous lesions showed partial remission.
Rosacea fulminans (pyoderma faciale): successful treatment of a 3‐year‐old girl with oral isotretinoin
Authors: Firooz Alireza , Firoozabadi Mehdi Rashighi , Dowlati Yahya 
Published: March 2003

A 3‐year‐old girl presented with several erythematous papules, pustules, cysts, and purulent discharging sinuses on the face. The lesions suddenly appeared on the cheeks 3 months previously and then rapidly extended to other areas of the face. She had been treated with a variety of topical and systemic antimicrobials (including erythromycin, cephalexin, dicloxacillin, and suIfamethoxazole‐trimethoprim) and topical corticosteroids with no effect. Examination revealed deep red erythema of facial skin with several papules, pustules, cysts, and draining sinuses on the cheeks, chin, perioral, and paranasal areas (Fig. 1). No comedones or signs of hidradenitis suppurativa were observed. The child was otherwise in good health. She did not have a family history of severe acne vulgaris.Patient before treatmentimageRoutine laboratory tests, including complete blood count, blood chemistry, and urinalysis, were within normal limits. Bacterial cultures showed negative results. Her parents refused to give consent to perform a biopsy.She was initially treated with oral erythromycin, 250 mg four times daily, oral prednisolone, 7.5 mg (0.5 mg/kg body weight) daily, tapered to zero in 2 weeks, 0.025% fluocinolone acetonide cream, and warm compresses for 2 weeks with moderate improvement. Then oral isotretinoin, 10 mg (0.75 mg/kg body weight) daily, was instituted. The lesions showed marked improvement after 4 weeks and disappeared completely after 8 weeks, leaving only a few pitted scars (Fig. 2). The treatment with isotretinoin was continued for a total of 24 weeks. She tolerated isotretinoin very well. She was followed for 1 year after completion of treatment with no relapse.Patient after 8 weeks of treatment with oral isotretinoinimage
Lichenoid photodermatitis associated with nimesulide
Authors: Tursen Umit , Kaya Tamer Irfan , Kokturk Aysin , Dusmez Duygu 
Published: March 2003

An 81‐year‐old‐female patient presented with a 2 week history of erythematous to violaceous lichenoid papules and plaques exhibiting a reticulated pattern on the ‘‘V’' area of the chest and dorsal hands. Fine, whitish reticulated networks were present over the surface of many well developed papules. The lesions were sharply demarcated and moderately pruritic (Fig. 1). Violaceous lichenoid papules with reticular pattern located on the ‘‘V’' area of the chestimageThe result of routine complete blood cell count, urinalysis, erythrocyte sedimentation rate, liver and kidney function tests were within normal limits. Antinuclear and anti‐DNA antibodies were negative, and total C3 and C4 complement levels were normal. Hepatitis B surface antigen, anti‐Hepatitis B surface antigen, anti‐Hepatitis B core IgM antibody were negative, while anti‐Hepatitis C virus antibody was positive. A skin biopsy specimen obtained from the neck of our patient revealed an interface lichenoid dermatitis accompanied by individual necrotic epidermal keratinocytes, parakeratosis and eosinophils in the infiltrate (Fig. 2). Interface lichenoid dermatitis accompanied by individual necrotic epidermal keratinocytes and parakeratosis (Hematoxylin and eosin; original magnification, × 200)imageNimesulide therapy was stopped and the patient was treated with topical corticosteroids and systemic antihistamines. The eruption resolved within 5 days. The rash returned following nimesulide rechallenge.
Prurigo pigmentosa
Authors: Gür‐Toy Günes , Güngör Emel , Artüz Ferda , Aksoy Fehmi , Alli Nuran 
Published: March 2003

AbstractBackground Prurigo pigmentosa is a rare inflammatory dermatosis of unknown etiology characterized by recurrent, pruritic erythematous papules and gross reticulate hyperpigmentation. It is seen most commonly among young adult Japanese females. Only 20 cases have been described outside Japan.Methods We report two female, Turkish patients aged 20 and 26 years who had a pruritic rash with the characteristic clinical appearance and supportive histopathology of prurigo pigmentosa.Results They were successfully treated with minocycline and doxycycline.Conclusions Prurigo pigmentosa is a relatively new clinical entity, and we believe that a more widespread knowledge of this disease will lessen its misdiagnosis. We find it noteworthy to point out that there may be a predisposition to prurigo pigmentosa amongst the Turkish and Sicilian populations.
Leukomelanodermic leprosy
Authors: Tomimori‐Yamashita Jane , Maeda Solange M. , Sunderkötter Cord , Kaminsky Silvia K. , Michalany Nilceo S. , Rotta Osmar , Castro Raimundo M. 
Published: March 2003

A 39‐year‐old woman presented with a 6‐year history of asymptomatic macules on her back. The patient had no other complaints, and she did not report any case of infectious disease in her family. Examination revealed hyperpigmented macules, presenting irregular edges but with a sharp demarcation, on the midline of the back from the cervical to the lumbar region. Within these hyperpigmented areas, islands of normal appearing skin were observed. There were also some hypopigmented macules on the lateral and posterior aspects of the trunk (Fig. 1). The patient presented thickening of the left ulnar nerve and sensory loss to temperature on the lateral aspect of the left arm.Hyperpigmented macules, presenting irregular but sharply demarcated edges, on the midline of the back. Islands of normal appearing skin are observed in these hyperpigmented areas. Hypopigmented macules on the lateral and posterior aspects of the trunkimageBiopsy specimens were obtained from the hyper‐ and hypopigmented areas. In the hyperpigmented macule, the biopsy revealed focal areas of hypomelanosis in the epidermis and the presence of melanophages in the superficial dermis, but no acid‐fast bacilli were found (Fig. 2a). The Masson–Fontana stain showed an evident pigmentary incontinence (Fig. 2b). The biopsy obtained from the hypopigmented lesion also revealed focal areas of hypomelanosis, but in the superficial dermis an infiltrate of foamy macrophages was observed, as typically found in lepromatous leprosy (Fig. 3a); acid‐fast bacilli were found by Fite–Faraco stain. The focal hypomelanosis was confirmed by Masson–Fontana stain (Fig. 3b). Mitsuda's reaction in this patient was negative and slit‐skin smears (cutaneous lesion, earlobes, elbows, and knees) were negative for acid‐fast bacilli.Biopsy of hyperpigmented macule. (a) Focal areas of hypomelanosis and presence of melanophages in the superficial dermis (hematoxylin and eosin stain, ×100). (b) Evident pigmentary incontinence in the superficial dermis (Masson–Fontana stain, ×100)imageBiopsy of hypopigmented macule. (a) Focal areas of hypomelanosis in the epidermis and dermal infiltrate of foamy macrophages (hematoxylin and eosin stain, ×100). (b) Focal areas of hypomelanosis (Masson–Fontana stain, ×100)imageThe patient was treated with multidrug therapy for multibacillary leprosy: rifampin, 600 mg once monthly (supervised), clofazimine, 300 mg once monthly (supervised), dapsone, 100 mg daily, and clofazimine, 50 mg daily, all given for 2 years. After 7 months of treatment, the hypopigmented lesions diminished and the hyperpigmented lesions improved after 2 years of treatment and the sensory loss to temperature was restored.
An open‐label study of the safety and efficacy of limited application of fluticasone propionate ointment, 0.005%, in patients with atopic dermatitis of the face and intertriginous areas
Authors: Tan Mei‐Heng , Meador Stacie L. , Singer Giselle , Lebwohl Mark G. 
Published: March 2003

AbstractBackground The treatment options for facial and intertriginous skin are limited because these sites are more susceptible to corticosteroid‐induced atrophy. The long‐term management of these corticosteroid‐sensitive sites requires the use of dosing regimens that are effective, but also safe.Methods The affected areas in 21 patients with atopic dermatitis were treated twice daily for 2 weeks, and then once daily for two consecutive days each week for eight more weeks.Results After 2 weeks, treatment success occurred in 95% of facial and intertriginous lesions and also in 95% of nonfacial, nonintertriginous lesions. During long‐term therapy, treatment success was maintained in > 76% of facial and intertriginous lesions, and > 76% of other lesions. Recurrence rates were low, and skin atrophy and telangiectasia did not occur.Conclusions Patients with atopic dermatitis of facial and intertriginous areas were successfully treated with a limited application of fluticasone propionate ointment, 0.005%. The treatment resulted in rapid healing and provided efficacy with a low rate of recurrence and no evidence of skin atrophy or telangiectasia over 8 weeks.
Kaposi's sarcoma in renal transplant patients: experience at the Cruces Hospital in Bilbao
Authors: Mitxelena Josune , Gomez‐Ullate Pablo , Aguirre Antonio , Rubio Gurutze , Lampreabe Ildefonso , Díaz‐Pérez José Luis 
Published: March 2003

AbstractBackground Kaposi's sarcoma (KS) in renal transplant recipients (RTRs) probably arises from a complex interplay of multiple factors.Objective In order to analyze the prevalence of KS in patients transplanted at the Cruces Hospital in Bilbao, together with their clinical features, treatment, and etiologic factors, we performed a study using the registry of RTRs in our center.Methods The records of 1230 kidney transplant patients at the Cruces Hospital between 1979 and 1998 were reviewed. Immunosuppressive therapy was reduced once a diagnosis of KS was made. A nested polymerase chain reaction was used to detect human herpesvirus 8 (HHV‐8) DNA in the biopsy tissue. The DNA was extracted from fresh tissue (n = 2) or from formalin‐fixed, paraffin‐embedded specimens (n = 5).Results Six cases of KS were diagnosed. All patients with cutaneous KS improved with a reduction in immunosuppressive drugs. HHV‐8 was detected in 100% (2/2) of the frozen biopsies and 20% (1/5) of the formalin‐fixed samples investigated.Conclusions Our experience indicates that a continuous state of immunodeficiency is important for the development of KS in RTRs. The association, previously described between HHV‐8 and transplant‐associated KS, also exists in the studied population.