Showing papers in "International Journal of Dermatology in 2003"

Sweet's syndrome revisited: a review of disease concepts

Abstract: Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by a constellation of symptoms and findings: fever, neutrophilia, erythematous and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils, and prompt improvement of both symptoms and lesions after the initiation of treatment with systemic corticosteroids. Hundreds of patients with this dermatosis have been reported. The manifestations of Sweet's syndrome in these individuals have not only confirmed those originally described by Dr Robert Douglas Sweet in 1964, but have also introduced new features that have expanded the clinical and pathologic concepts of this condition. The history, clinical characteristics, laboratory findings, associated diseases, pathology, and treatment options of Sweet's syndrome are reviewed. The evolving and new concepts of this dermatosis that are discussed include: (i) Sweet's syndrome occurring in the clinical setting of a disease-related malignancy, or medication, or both; (ii) detection of additional sites of extracutaneous Sweet's syndrome manifestations; (iii) discovery of additional Sweet's syndrome-associated diseases; (iv) variability of the composition and/or location of the cutaneous inflammatory infiltrate in Sweet's syndrome lesions; and (v) additional efficacious treatments for Sweet's syndrome.

Prevalence of Behçet's disease in Istanbul, Turkey.

Abstract: Background The prevalence of Behcet's disease (BD) is much higher in countries along the ancient Silk Route, extending from Japan to Mediterranean countries including Turkey, than in northern Europe and the USA. Three previous epidemiologic surveys have been carried out in different regions of Turkey. Patients and methods This study investigated the cross-sectional prevalence of BD in individuals aged > 12 years in Istanbul, Turkey, in two stages. The first stage aimed to identify individuals with recurrent oral ulcers (ROUs) by visiting them in their homes, and the second stage aimed to further examine those with ROUs for the presence of other BD-related manifestations under hospital conditions. The sample size was determined to be 24,000 with an expected BD prevalence rate of 1/1000 and a sampling error of 4/10,000, with a 95% confidence interval (CI) of 6–14/10,000. The number of individuals to be screened in each district was determined in proportion to the population of all districts in Istanbul. Results The standard questionnaire was applied to a total of 23,986 individuals at their homes. A history of ROU was recorded in 2289 individuals (9.5%), and a previous diagnosis of BD was recorded in 47. The diagnosis of ROU was confirmed in 700, and the diagnosis of BD was established in 101 according to the International Study Group criteria. The prevalence rate of BD was estimated as 42/10,000 (95% CI, 34–51/10,000) in Istanbul, Turkey. Conclusions This survey conducted in Istanbul, the largest cosmopolitan city in Turkey with immigrants from all over the country, has a larger sample size than other previous studies, and therefore the reported prevalence rate of BD has a more acceptable confidence interval. This study aids in the estimation of the prevalence of BD in Turkey, and supports previous findings that Turkey has the highest prevalence rate of the disease in the world.

Evaluation of clinical findings according to sex in 2313 Turkish patients with Behçet's disease.

Abstract: Background Behcet's disease is a multisystem disease featuring mucocutaneous, ocular, articular, vascular, intestinal, urogenital, and neurologic involvement and occurs with a high prevalence in the Mediterranean including Turkey. Higher incidence of severe clinical course and systemic involvement is observed in male patients. Objective To determine the influence of sex on the clinical course of Behcet’ s disease. Methods We retrospectively evaluated the clinical findings of 2313 Behcet patients followed up at the multidisciplinary Behcet's Disease Center at Ankara University. Results The male/female patient ratio was 1.03. Oral aphthae was seen in all patients. In male Behcet patients, the prevalence of mucocutaneous lesions and systemic manifestations was as follows: 85.6% genital aphthae, 45.5% erythema nodosum, 59.5% papulopustular lesions, 17.5% thrombophlebitis, 38.1% ocular involvement, 11.3% articular involvement, 11.7% vascular involvement, 3.3% neurologic involvement, 1.4% gastrointestinal involvement, and 1.8% pulmonary involvement. In female Behcet patients, the prevalence of manifestations were as follows: 91% genital aphthae, 49.8% erythema nodosum, 48.3% papulopustular lesions, 3.5% thrombophlebitis, 19.8% ocular involvement, 11.8% articular involvement, 2.1% vascular involvement, 1.3% neurologic involvement, 1.4% gastrointestinal involvement, and 0.03% pulmonary involvement. Conclusions Only genital aphthae and erythema nodosum were more frequent in females. On the other hand papulopustular eruptions, thrombophlebitis, ocular, neurologic, pulmonary and vascular involvement were more frequent in males. While female patients had the best prognosis, male patients had a worse overall prognosis than females.

Alopecia areata: psychiatric comorbidity and adjustment to illness

Abstract: Background Decades ago, alopecia areata (AA) was regarded as a well-known example of psychosomatic disease. The poor development of measurement methods and criteria for the classification of psychiatric disorders at that time was probably partly to blame for the lack of methodologic validity of some studies. Methods We studied a random sample of 32 patients with AA (patchy form). Sociodemographic, dermatologic, and psychiatric variables were collected. Psychiatric examination was carried out by standardized interviews: Schedules for Clinical Assessment in Neuropsychiatry (SCAN), International Personality Disorders Examination (IPDE), and Psychological Adjustment to Illness Scale (PAIS), using the Research Diagnostic Criteria of the International Classification of Diseases, 10th edition, to assess the diagnosis. A descriptive and association study was performed, correlating the patient's adjustment and adaptation to the illness to various factors (linear regression techniques and analysis of variance). Results Sixty-six per cent of patients presented with psychiatric comorbidity, mainly adjustment disorders (F.43.2), generalized anxiety disorders (F.41.1), and depressive episodes (F.32). Overall adaptation to the illness, however, was satisfactory, showing few repercussions in family or social life, work, or sexual adjustment. Poor adjustment was associated with a dependent personality (Pearson's r = 0.66), antisocial personality (r = 0.39), generalized anxiety (P = 0.003), and depression (P = 0.02). Conclusions There is a high psychiatric comorbidity in AA (anxiety and mood disorders), requiring systematic psychiatric evaluations of these patients. A satisfactory overall adaptation to mild/moderate forms of the disease is the norm, but adaptation and comorbidity in severe forms (totalis, universalis) are unknown. A dermatology/liaison psychiatry setting could improve the management of AA.

A clinical, prospective, randomized, double-blind trial comparing skin whitening complex with hydroquinone vs. placebo in the treatment of melasma.

Abstract: Objectives To compare, in a double-blind, randomized, prospective study, the clinical improvement of hyperpigmentation in 30 patients with melasma using hydroquinone or skin whitening complex topically on one side of the face vs. a placebo cream on the other. The study was performed during the period November 2000 to March 2001 at the Federal University of Sao Paulo, Escola Paulista de Medicina. Methods Thirty patients received three tubes of cream and were divided into two groups: group 1, one tube containing hydroquinone 4% cream and one tube containing placebo to be applied to opposite sides of the face at night, and standardized sunscreen [sun protection factor (SPF) 25] for daily use; group 2, one tube containing skin whitening complex 5% cream and one tube containing placebo to be applied to opposite sides of the face at night, and standardized sunscreen (SPF 25). All of the tubes had the same appearance and the creams had the same characteristics. The only person who knew what was being used by each patient on each side of the face was the pharmacist. A professional photographer took photographs before and after treatment, which lasted for 3 months. Clinical evaluation was performed by two independent observers and by the patients themselves. Statistical evaluation was by the chi-squared and kappa methods. Results Twenty-five patients completed the study, with an overall improvement of 72% in comparison with placebo. Group 1 (hydroquinone and placebo) presented an improvement of 76.9% with 25% side-effects, and group 2 (skin whitening complex and placebo) presented an improvement of 66.7% with 0% side-effects. Conclusions Both depigmentation agents were useful in the treatment of melasma. The hydroquinone group presented more collateral effects than the skin whitening complex group. Considering that the patients showed Fitzpatrick skin types IV to VI and the study was conducted in the summer, skin whitening complex seems to be an excellent choice for the treatment of melasma.

Wells’ syndrome: a clinical and histopathologic review of seven cases

Abstract: Wells' syndrome, or eosinophilic cellulitis, is characterized clinically by an acute dermatitis resembling cellulitis, which evolves into violaceous plaques that resolve spontaneously without scarring. The histopathologic features are dynamic, starting with dermal edema and infiltration of eosinophils, the development of "flame figures," and finishing with the appearance of phagocytic histiocytes. We present the clinical and histopathologic features of seven cases of eosinophilic cellulitis.

Lichen planopilaris: report of 30 cases and review of the literature.

Abstract: Background Lichen planopilaris (LPP) affects primarily the scalp, resulting in scaling, atrophy, and alopecia with scarring. The purpose of our study was to obtain original data on LPP and to evaluate the efficacy of topical therapy in comparison with systemic therapies. Methods We examined 30 patients affected by LPP between 1996 and 2001, performing clinical, laboratory, histopathologic and direct immunofluorescence examinations. Twenty-one of the patients (70%) were women and nine (30%) were men. The average age at presentation was 51.5 years. The average duration of the disease was 13 months at the time of the diagnosis. All patients received topical steroids for a total of 12 weeks. Results Resolution of the inflammatory process and blocking of the cicatricial progression were observed in 66% of cases, a mild reduction of fibrosis and cicatrization in 20% of patients, and no response in 13%. Conclusions We concluded that topical therapy may be a valid alternative to systemic therapies, especially in patients with lesions in the early phase.

Polymerase chain reaction based detection of Mycobacterium tuberculosis in tissues showing granulomatous inflammation without demonstrable acid-fast bacilli.

Abstract: Background Cutaneous tuberculosis is especially difficult to distinguish from other granulomatous dermatoses. We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and atypical mycobacterial infection in formalin-fixed, paraffin-embedded tissues with unspecified granulomatous inflammation and negative results for acid-fast bacilli (AFB), and analyzed the pattern of cutaneous tuberculosis in this group of patients. Methods A total of 38 specimens which had been collected from 36 patients and fulfillled the criteria for tissues described above were used in this study. Two different primer pairs targeting the gene encoding for 16S ribosomal RNA (common to all mycobacteria) and the insertion sequence IS6110 (specific for M. tuberculosis complex) were used in the PCR assays. The clinical characteristics, histopathologic findings, and culture results of the patients were also analyzed. Results Four specimens were excluded from the analysis due to the lack of internal control testing. Of the remaining 34 specimens, 22 were PCR positive for the 16S rRNA gene. Among them, 18 specimens were PCR positive for both the 16S rRNA gene and IS6110. Cutaneous tuberculosis could be diagnosed in these 18 cases (56.2%). Out of the 18 cases, there were 8 women and 10 men. The age range was 15–77 years (mean: 44.2 years). After reviewing their clinical presentation, 11 cases were considered as tuberculosis verrucosa cutis, 6 cases as lupus vulgaris, and 1 case as erythema induratum. The remaining 4 cases (12.5%) positive only for 16S rRNA gene were considered as possible atypical mycobacteria infection. Conclusions These results show that in paucibacillary form of cutaneous tuberculosis with unclassical clinical and histological presentation, this PCR system provides rapid and sensitive detection of M. tuberculosis DNA in formalin-fixed, paraffin-embedded specimens. Cutaneous tuberculosis represents a significant proportion in specimens showing granulomatous inflammation. In areas like Taiwan, where prevalence of pulmonary tuberculosis is still high, tuberculosis verrucosa cutis and lupus vulgaris are common forms of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection.

Prevalence of skin diseases in rural areas of Assiut Governorate, Upper Egypt

Abstract: Background Few epidemiological surveys have been carried out to determine the prevalence of skin diseases in the population of Egypt, particularly “Upper Egypt”. So it is a pressing necessity to conduct such a study in rural Assiut. Objectives To determine the prevalence of various skin diseases in rural Assiut. Subjects and methods A cross-sectional community-based survey was followed. The survey included 8008 rural inhabitants of all ages and both sexes from a representative of three villages of Assiut Governorate, Upper Egypt. The data were collected through personal interview and examination at homes from December 1994 to December 1996. Results They showed that 6961 (86.93%) of the studied population had one or more skin diseases. The group with parasitic skin infestations had the highest prevalence rate (27.40%) of the total sample, of which pediculosis capitis (19.37%) was the commonest. Eczema/dermatitis group had a rate of 19.82%, with pityriasis alba forming the majority (13.49%). Pigmentary disorders were 17.68%, followed by fungal skin infections (16.17%), then naevoid disorders (16.10%), hair and scalp disorders (12.07%), bacterial skin infections (10.10%), sweat gland disorders (6.16%), acne vulgaris (5.37%). Leprosy constituted 1.6/10,000. Other various skin disorders were recorded. Conclusions Infective-parasitic diseases were a major problem particularly among the younger age-group and those of low socio-economic status.

The role of gabapentin in treating diseases with cutaneous manifestations and pain.

Abstract: Background Gabapentin was first approved by the FDA in 1993 as an add-on treatment for partial epileptic seizures. In May of 2002, it was approved as treatment for post-herpetic neuralgia by the Food and Drug Administration. It appears to be a promising agent in the treatment of pain, alterations of sensation and pruritus associated with dermatological disease, but no review of these uses exists. Methods Medline and Google searches were performed for the words "Gabapentin" and "Neurontin." The articles found were reviewed. Article identified that contained references to the treatment of skin disease and neuropathic pain were examined and their contents surveyed. Results Approximately 1200 articles were located in Medline that referred to Garbapentin or Neurontin. Over 150 articles reviewed its use for neuropathic pain, neuritis or neuralgia of various sorts. Approximately 20 articles reviewed its use for a variety of dermatological conditions or diseases with dermatological manifestations that included: pain control associated with wound dressing changes, erythromelagia, piloleiomyoma related pain, brachioradial pruritus, Glossodynia, vulvodynia, and reflex sympathetic dystrophy. Over 100 articles that related to Gabapentin side effects were reviewed. Conclusions Gabapentin is a very promising medication in the treatment of post-herpetic neuralgia and pain. Because dermatological patients suffer pain from painful tumors, after surgery, in conjunction with neuropathic ulcers, during dressing changes involving serious medical conditions, its applications seem manifold. Future studies must assess its role in the treatment of pruritus and other dermatological conditions involving pain or alteration of sensation.

Microbiology's principle of biofilms as a major factor in the pathogenesis of acne vulgaris

Abstract: Propionibacterium acnes reside within the pilosebaceous unit in a biofilm. As such, they live in a community of bacteria that encase themselves within an extracellular polysaccharide lining, which the organisms secrete after adherence to the surface. This gylcocalyx polymer acts as a protective exoskeleton and serves as a physical barrier, limiting effective antimicrobial concentrations within the biofilm microenvironment. The gylcocalyx polymer secreted by P. acnes as a biofilm may explain the immunogenicity of the organism as well as the clinical course of the disease. The P. acnes' biofilm model explains many aspects of acne pathogenesis and therapy, including why prolonged antibiotic treatment is needed, why antibiotic resistance is not a reliable assessment of treatment outcome, why accutane offers long-lasting effectiveness, and why benzoyl peroxide radicals are beneficial. This microbiologic principle of biofilms as applied to acne leads to numerous new pathways of assessment and exploration.

Paederus dermatitis in northern Iran: a report of 156 cases.

Abstract: Background Paederus dermatitis develops when beetles of the genus Paederus (often called rove beetles) are crushed on the skin, releasing the vesicant pederin. These beetles are found in many tropical and subtropical habitats. Methods We describe 156 patients who presented to a dermatology clinic in the Guilan province of northern Iran during a 6-month period (May–October 2001). Results The peak time of presentation was in September, and the face and neck were the most common sites of involvement. Clinically, the most common presentation comprised geographic erythematous plaques with micropustules. In three-quarters of patients, more than one lesion was present. Kissing lesions were seen in 5% of cases, and 15% of patients developed diffuse desquamation. The majority of patients resided within 1 km of rice fields and used fluorescent lighting at home. In half of the cases, another family member was also affected. Conclusions Paederus dermatitis is a common skin condition in northern Iran. We believe that increased public awareness of this condition can decrease mucocutaneous exposure to pederin.

Lasers for facial rejuvenation: a review.

Abstract: Background Different types of laser are used for resurfacing and collagen remodeling in cutaneous laser surgery. Methods A systematic review was performed of the different types of laser currently employed for skin rejuvenation. These systems are either ablative [high-energy pulsed or scanned carbon dioxide (CO2) laser emitting at a wavelength of 10,600 nm, single- or variable-pulse or dual ablative/coagulative mode erbium:yttrium aluminum garnet (Er:YAG) laser emitting at a wavelength of 2940 nm, or systems combining both 10,600 nm and 2940 nm wavelengths] or nonablative [Q-switched neodymium:yttrium aluminum garnet (Nd:YAG) laser emitting at a wavelength of 1064 nm, Nd:YAG laser emitting at a wavelength of 1320 nm, or diode laser emitting at a wavelength of 1450 nm]. Different protocols, patient selection, treatment techniques, and complications are discussed for each system. Results New-generation CO2 resurfacing lasers have been successful in the treatment of photodamaged skin and scarring, with a postoperative morbidity dependent on the depth of thermal damage. Because of its minimal penetration, the pulsed Er:YAG laser, usually used in the treatment of more superficial rhytides, produces less postoperative morbidity. Novel ablative systems have been developed and a further understanding of laser–tissue interaction has led to the design of nonablative systems for the treatment of rhytides, scarring, and photodamaged skin, the efficacy and profile of which remain to be evaluated in the long term. Conclusions There are several effective techniques for scar revision and the treatment of aged skin, but all have their drawbacks due to a lack of precise depth control and unwanted damage to the lower layers of the dermis. The Er:YAG laser is the treatment of choice for fine lines and superficial scars, whereas the CO2 laser is better for deeper rhytides and scars. In the future, a combination of lasers may be used for facial rejuvenation.

Melanocyte–keratinocyte cell transplantation for stable vitiligo

Abstract: Background Vitiligo is a common disorder with a worldwide prevalence of 1–2%. In India the psychological and social impact of the disease is significant and is detrimental to patients. Objective To evaluate the usefulness of epidermal cell transplantation in the treatment of vitiligo. Methods A simpler and modified method based on that of Olsson and Juhlin has been used. It utilizes a shave biopsy skin sample of up to one-tenth the size of the recipient area. The skin sample is incubated, the cells mechanically separated using trypsin EDTA solution, and then centrifuged to prepare a suspension. The cell suspension is then applied to the derm-abraded depigmented skin area and collagen dressing is applied to keep it in place. Results One hundred and twenty-two patients with generalized vitiligo, 43 with segmental and 19 with focal vitiligo were treated and observed for a period of 1 year. In the generalized vitiligo group 65 (53%) showed excellent pigmentation, 10 (8%) showed good pigmentation, 11 (9%) showed fair pigmentation and 28 (23%) patients showed poor pigmentation. Eight (7%) patients did not follow up. Thirty-six (84%), five (12%) and two (4%) patients showed excellent, good and poor pigmentation, respectively, in the segmental vitiligo group. Thirteen (69%) and five (26%) patients showed excellent and poor results, respectively, in the focal vitiligo group. One (5%) patient did not appear for follow up. Recurrence was observed in 15 patients. Conclusion This surgical treatment gives its best results in segmental and focal vitiligo, even with large affected areas, and in at least 50% of patients with generalized vitiligo, thus improving their appearance.

Safety and efficacy of 4% hydroquinone combined with 10% glycolic acid, antioxidants, and sunscreen in the treatment of melasma

Abstract: Background Melasma, also known as mask of pregnancy, is a common, acquired hypermelanosis seen in women with Fitzpatrick skin types II–V, and is often recalcitrant to treatment with depigmentation agents. Glycolic acid has been added to hydroquinone formulations in the past to enhance their depigmentation effects, but may cause irritation, leading to postinflammatory hyperpigmentation. Aim To assess the safety and efficacy of a cream containing 4% hydroquinone, 10% buffered glycolic acid, vitamins C and E, and sunscreen (Glyquin, ICN Pharmaceuticals, Costa Mesa, USA) vs. a cream containing sunscreen alone in the depigmentation of epidermal melasma of the face. Methods Thirty-nine Hispanic women, Fitzpatrick skin types III–V, with bilateral epidermal melasma were enrolled in a randomized controlled trial lasting 12 weeks. Patients underwent twice-daily full-face application with the study cream or with the cream containing sunscreen only. Changes in pigmentation were measured using a mexameter, the melasma area and severity index (MASI), and a global evaluation by the patient and blind investigator. Safety evaluations were performed at each follow-up visit. Results Thirty-five patients completed the trial. Irritation was more common with the study cream, but resolved with temporary cessation of cream application and the addition of moisturizers. Mexameter results demonstrated a significant decrease in the degree of pigmentation using the study cream compared with the cream containing sunscreen alone (P < 0.0001). Fifteen of 20 patients (75%) using the study cream improved, whereas only two of 15 patients (13%) improved using sunscreen alone. Conclusions A cream containing 4% hydroquinone, 10% buffered glycolic acid, vitamins C and E, and sunscreen is safe and effective in the treatment of melasma.

Vascular endothelial growth factor levels are increased and associated with disease activity in patients with Behçet's syndrome.

Abstract: BACKGROUND/AIMS Vascular endothelial growth factor (VEGF) is a cytokine participating in inflammation with potent endothelial cell effects. It is produced by macrophages, neutrophils and vascular endothelial cells and can alter vessel permeability. Behcet's syndrome is a systemic inflammatory disorder with unknown etiology. Vascular endothelial dysfunction is one of the prominent features of the disease. We previously demonstrated the possible involvement of proinflammatory cytokines [tumor necrosis factor (TNF)-alpha, soluble interleukin-2 receptor (sIL-2R), interleukin (IL)-6 and IL-8], nitric oxide (NO) and adrenomedullin in the etiopathogenesis of Behcet's syndrome. Since VEGF expression is induced by these cytokines and VEGF itself is a potent stimulator of NO production with endothelial cell effects, this study aimed to investigate whether VEGF was affected during the course of Behcet's syndrome. We also assessed the possible involvement of VEGF in ocular Behcet's syndrome or in disease activity. METHODS This multicenter case-control study included a total of 39 patients with active (n = 22) or inactive (n = 17) Behcet's syndrome (mean age, 38.1 +/- 10.4 years; 21 men and 18 women) satisfying International Study Group criteria, and 15 healthy hospital-based control volunteers (mean age, 39.2 +/- 9.3 years; eight men and seven women) matched for age and gender from a similar ethnic background. Patients were examined by a dermatologist and an ophthalmologist with an interest in Behcet's syndrome. Plasma VEGF concentrations were measured using a newly established enzyme-linked immunosorbent assay. Clinical findings and acute-phase reactant parameters such as erythrocyte sedimentation rate, alpha1-antitrypsin, alpha2-macroglobulin, and neutrophil count were used to classify the disease in Behcet's patients as active or inactive. The Wilcoxon test or the Mann-Whitney U-test was used for statistical analysis as indicated and the results were expressed as mean +/- SD, with range. RESULTS The mean plasma VEGF level in patients with Behcet's syndrome (291.9 +/- 97.1 pg/mL; range 121-532 pg/mL) was higher than that in control subjects (103.0 +/- 43.6 pg/mL; range 25-187 pg/mL) and the difference was significant (P < 0.001). Patients with active disease had significantly (P < 0.001) higher VEGF levels than patients with inactive disease (347.6 +/- 87.1 vs. 219.9 +/- 51.6 pg/mL). In addition, ocular Behcet's patients (n = 23) had higher VEGF levels (315.7 +/- 92.1 pg/mL) than nonocular patients (n = 16, 257.8 +/- 96.6 pg/mL) and the difference was of borderline significance (P = 0.041). The levels of all acute-phase reactant parameters were significantly higher in the active stage than in the inactive stage (for each, P < 0.01) or in control subjects (for each, P < 0.001). CONCLUSIONS VEGF may participate in the course of Behcet's syndrome, especially in the active stage, and elevated levels of VEGF may be an additional risk factor for the development of ocular disease, contributing to poor visual outcome.

Clinical course of psoriasis during pregnancy.

Abstract: Background Since the landmark study on rheumatoid arthritis, many reports have suggested that physiological changes during pregnancy often induce remission of systemic and cutaneous inflammatory diseases. In this study we investigated the clinical course of psoriasis during pregnancy. Objective In this retrospective study information was collected from Psoriasis Life History Questionnaires. The data obtained from 736 questionnaires were entered into a computerized database. Information relevant to the clinical course of psoriasis during pregnancy was evaluated in respect to improvement/worsening, number of pregnancies, severity of the disease, and certain other clinical parameters. Results In a majority of the patients psoriasis improved during pregnancy. Data available from 91 pregnancies revealed: psoriasis improved in 51 (56%), worsened in 24 (26.4%), and remained unchanged in 16 (17.6%). Also, appearance of psoriasis new lesions was found to be frequent during the early postpartum period. Patients who improved in the first pregnancy were found to have a similar response in the following pregnancies. Conclusion Research on immuno-endocrine interactions during pregnancy is a relatively new field. Proinflammatory Th-1 cytokines are up-regulated in psoriasis and play a key role in the inflammatory cascades of psoriasis. It is likely that during pregnancy the Th-2 cytokine-mediated down-regulation of the immune response by virtue of its anti-inflammatory and antagonizing effects on the Th-1 cytokines improves psoriasis.

308-nm excimer laser for the treatment of localized vitiligo.

Abstract: Background and Objective Vitiligo is commonly treated with PUVA, and more recently, narrow-band UVB (NBUVB) phototherapy. Given the proximity of the wavelengths of NBUVB (311 nm) and the excimer laser (308 nm), we undertook a clinical trial to test the efficacy of this device. Methods Twice-weekly 308-nm UV-B radiation was given to selected vitiligo lesions for a maximum of 60 treatments. These lesions had been unsuccessfully treated previously with at least one other method of treatment. Initial doses were 100 mJ/cm2 with increments of 10–25%. Improvement was assessed on a visual scale via serial photographs. Results Subjects tolerated the treatment well. Improvement varied with body site. After 60 treatments, lesions on the hands and feet showed grade 2 improvement in 2/10 subjects and grade 1 in 8/10. For the axillae, there was grade 4 improvement in 1/3 subjects and grade 2 improvement in 2/3 by treatment 60. The face demonstrated the most rapid repigmentation with grade 4 repigmentation seen in 3/5 subjects by 40 treatments and grade 3 in 2/5 by 30 treatments. There were no adverse effects. Conclusions The user-friendly 308-nm excimer laser allows targeted treatments of localized vitiligo.

The prevalence of pediculosis capitis in schoolchildren in Mersin, Turkey

Abstract: Background Pediculosis capitis is an endemic parasitosis affecting many countries of the world. The aim of this study was to investigate the incidence of head lice infestation in Mersin, Turkey. Methods A total of 5318 elementary schoolchildren, aged 8–16 years, were examined for the presence of Pediculus capitis. If any evidence of head lice was detected, such as live or dead eggs, or nits, the child was considered to be infected. The following details were recorded for each child: age, sex, family size, monthly income, number of siblings, parents’ education, presence or absence of social security of the family, pet (cat or dog) ownership, and frequency of hair washing (per week). The chi-squared test and logistic regression analysis were performed to analyze the results. Results Pediculosis capitis was detected in 360 (6.8%) children. The prevalence of infestation was significantly higher in girls (13.3%) than in boys (1.1%) (χ2 = 313.2, d.f. = 1, P = 0.000). Children aged 8–9 years exhibited a significantly lower prevalence rate than those aged 10–11 years and those aged 12 years and above. The following variables were found to be statistically significantly related to pediculosis capitis: sex, age, father's education level, and pet ownership (cat or dog). Conclusions Our results show that the prevalence of pediculosis capitis is not very high in Mersin, Turkey, and is observed in all schools regardless of the socio-economic and personal hygiene status of the children.

Sporotrichosis with widespread cutaneous lesions: report of 24 cases related to transmission by domestic cats in Rio de Janeiro, Brazil.

Abstract: Background Sporotrichosis most commonly presents as a localized lymphocutaneous infection following traumatic inoculation of soil, vegetables or organic substrates contaminated with the dimorphic fungus Sporothrix schenckii. Cases of widespread cutaneous lesions are rare. There have been isolated reports of household outbreaks of sporotrichosis involving cats and humans. Methods We report 24 cases of culture-proven sporotrichosis presenting with widespread cutaneous lesions. Results These 24 cases are part of an epidemic currently occurring in Rio de Janeiro. All patients reported contact with cats with sporotrichosis and 17 reported a history of a scratch or bite. Clinical manifestations included fixed lesions at multiple anatomical sites, and fixed lesions associated with the lymphocutaneous, bilateral lymphocutaneous and mucosal forms of the disease. Two patients were alcoholics and one patient was diabetic, while the remaining patients did not present any immunosuppressing condition. All patients responded to treatment with itraconazole. Conclusions The domestic cat has played an important role in the transmission of sporotrichosis in Rio de Janeiro and seems to have contributed to this unusual clinical manifestation.

Detection of new endemic areas of cutaneous leishmaniasis in Pakistan: a 6-year study.

Abstract: Background Cutaneous leishmaniasis (CL) is endemic in Pakistan and is widely spreading. Recently, an outbreak of the disease was observed in the region. We report some new endemic areas of CL in the country. Methods A total of 1210 cases of CL who visited our department from 1996 to 2001 are reported. Among them, 760 were residents of the Jacobabad, Larkana, and Dadu districts of Sindh province and had never previously traveled to endemic areas. These districts have never been reported/recognized as endemic for CL. Others were residents of endemic areas of Balochistan province. Diagnosis was made on clinical presentation; a giemsa-stained smear test and histopathological results. All the cases were treated with the meglumine antimoniate 600 mg/day (adults) and 15 mg/kg/day (children) intramuscularly for 20 consecutive days. Results All the patients were aged between 2.5 months and 65 years. Three hundred and ninety-two patients were females and 368 were males. Duration of the disease ranged from 2 to 18 months. Most of the patients had a single lesion on the face and/or extremities. Clinically, the disease was classified as: dry papular type, 407 cases; dry ulcerative type, 335 cases; and wet ulcerative type, 18 cases. No cases of muco-cutaneous or visceral leishmaniasis were found during this period. Smear testing was positive in 845 cases, while 365 cases were histopathologically positive. An ultrastructural study was performed using specimens of a few of the cases. Leishmania parasites were detected in the dermal tissues as well as in the macrophages. Conclusions We propose that the Jacobabad, Larkana and Dadu districts could be considered endemic for CL. Wet- and dry-type lesions indicate the presence of both Leishmania tropica and L. major in this tropical region.

Efficacy of betamethasone valerate foam formulation in comparison with betamethasone dipropionate lotion in the treatment of mild-to-moderate alopecia areata: a multicenter, prospective, randomized, controlled, investigator-blinded trial.

Abstract: Background Betamethasone valerate foam (BVF) is a new topical corticosteroid formulation. In scalp psoriasis patients BVF has induced a significantly greater clinical improvement in comparison with corticosteroid lotions. No data are available to date regarding the efficacy and safety of BVF in mild-to-moderate alopecia areata (AA). Study aim To evaluate the efficacy, tolerability and safety of BVF treatment in patients with mild-to-moderate AA. Subjects and Methods Sixty-one patients (26 men and 35 women; mean age 41 ± 13 years) with mild-to-moderate AA (hair loss < 26%) were enrolled in a parallel-group, investigator-blinded trial. Subjects were assigned randomly to BVF (31 patients) or to betamethasone dipropionate lotion (BDL) (30 subjects). Both treatments were applied to the affected areas twice a day for 12 consecutive weeks. Outcomes The primary study outcome was to compare the hair regrowth rate. Efficacy was evaluated at weeks 8 and 12 and at follow up (week 20), using a hair regrowth score (RGS) with a scale ranging from 0 (regrowth 75%). Results Fifty-seven subjects (93%) completed the trial. At week 20, the RGS was 3.1 ± 1.5 and 1.8 ± 1.6 in the BVF and BDL groups, respectively (P 3 was observed in 61% of patients in the BVF group (19/31) in comparison with 27% (8/30) in the BDL group (P < 0.03). No serious adverse events were observed in both groups during the study. Conclusion Betamethasone valerate foam has shown to be an effective and well-tolerated treatment of mild-to-moderate AA. Further trials are warranted to evaluate the role of this new formulation in comparison or in combination with intralesional corticosterioids in AA treatment.

Treatment of chromomycosis by cryosurgery with liquid nitrogen: 15 years' experience.

Abstract: Background Chromomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by various dematiaceous fungi, the most common of which is Fonsecaea pedrosoi. The disease is difficult to treat. Methods Twenty-two chromomycosis patients treated by cryosurgery with liquid nitrogen as the sole or associated therapy were studied. Diagnosis was confirmed by direct examination of KOH cleared specimens, culture, and histology, according to a method previously described by Pimentel et al. (Pimentel ERA, Castro LGM, Cuce LC, Sampaio SAP. Treatment of chromomycosis by cryosurgery with liquid nitrogen. J Dermatol Surg Oncol 1989; 15: 72–77). Small lesions were frozen in a single session, whilst larger lesions were frozen in small parts. All patients received double freeze–thaw cycles. An author-created severity index, based on the extent of the diseased area, number of lesions, presence of complications (lymphedema, ulceration, and secondary infection) and unresponsiveness to previous treatments, was used to determine disease severity. ResultsFonsecaea pedrosoi was isolated from all but one patient. Caucasian (50.0%) males (4.5 : 1.0) were most commonly affected. The average number of cryosurgery sessions per patient was 6.7, varying from one to 22 sessions. The duration of treatment lasted for up to 126 months. Nine patients (40.9%) were considered to be cured (clinically disease-free period of at least 3 years), eight (36.4%) were under observation (clinically disease-free but less than 3 years of follow-up), two (9.1%) were under treatment (still with active lesions), and three (13.6%) were classified as unsuccessful. The average cure period was 7.5 years, varying from 3 to 16 years. Five (55.6%) of the nine cured patients had been cured for periods exceeding 9 years. Six (66.7%) of the nine cured patients were classified as having mild, two (22.2%) severe, and one (11.1%) moderate disease. Conclusions Cryosurgery with liquid nitrogen is an option in the treatment of chromomycosis.

Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin.

Abstract: Background Demodex mites are almost ubiquitous on older adult skin but are infrequent in young children. In immunocompromised patients, demodicosis may be more frequent and severe, and systemic therapy may be needed to achieve clinical resolution. Case report A six-year-old boy having maintenance chemotherapy for acute lymphoblastic leukemia presented with widespread erythema and scaling of the face. Skin scrapings were negative and the eruption worsened despite the completion of chemotherapy and the use of topical corticosteroids. Pustules developed on the face and around the eyelids, associated with bilateral blepharitis and lower lid chalazia. Skin biopsy then revealed heavy infestation with Demodex folliculorum. The child was treated with a combination of topical permethrin and oral ivermectin, with a total of four doses of ivermectin given over 6 weeks. The facial eruption had completely resolved 3 months after initiation of this combined treatment. Comment Demodex infestation can cause dramatic facial and eyelid inflammation in immunocompromised patients. Oral ivermectin, in combination with topical permethrin, can be a safe and effective treatment for severe demodicosis.

Comparison of chronic autoimmune urticaria with chronic idiopathic urticaria.

Abstract: Background Chronic urticaria has been described in patients with Helicobacter pylori infection. Despite numerous studies, the correlation between H. pylori infection and chronic urticaria is doubtful. Our study was performed to determine the prevalence of H. pylori infection in autoimmune urticaria and in patients suffering from autoimmune urticaria and autoimmune thyroiditis Methods The authors widely investigated 48 patients. The examinations were extended principally to autologous serum skin test, antithyroid antibodies, and the presence of H. pylori infection as well as detection of antibodies against H. pylori. Results Out of the 48 patients, 26 were regarded as having autoimmune origin. The prevalence of antithyroid antibodies was different in the two groups of patients with urticaria. There were 11 patients (42.3%) in the autoimmune group compared with three patients (13.6%) in the nonautoimmune group with antithyroid peroxidase antibody (P = 0.03). The difference in the prevalence of H. pylori infection was significant between autoimmune urticaria with and without thyroid autoimmunity (90.9% vs. 46.7%; P = 0.02). Autoimmune thyroiditis was connected with CagA +H. pylori strains, as the H. pylori- specific IgG antibodies revealed significant differences in a prevalence of 120 kDa (P < 0.05). Conclusions The authors observed a relationship between autoimmune urticaria and autoimmune thyroiditis. The results strengthen the possibility of cross-reactivity being triggered between CagA plus H. pylori strains and some other organ-specific autoimmune diseases such as autoimmune urticaria and autoimmune thyroiditis. This indicates a possible role of H. pylori in triggering autoimmune urticaria in at least a select group of patients.

Incidence of cutaneous tuberculosis in patients with organ tuberculosis.

Abstract: Background Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well. Aim To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB. Material and methods A total of 370 patients (145 females and 225 males), aged 2–76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas. Results Three hundred and forty-seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty-three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette-Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not. Conclusions Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.

Rare variants of Cutaneous Leishmaniasis: whitlow, paronychia, and sporotrichoid

Abstract: Cutaneous Leishmaniasis is endemic in certain areas of Pakistan, with the wet form of the disease being the most prevalent. It has a number of morphological variants, which are dependent on the immune status of the host, the subspecies of the Leishmania, and also, to some extent, on the site of involvement. We describe here a case of Leishmaniasis showing two very rare variants, whitlow and paronychial lesions, occurring concurrently with sporotrichoid spread. The patient responded to intramuscular sodium stibogluconate with resolution of the skin lesions.

Perioral dermatitis: an update.

Abstract: Perioral dermatitis is a distinct condition, first described as “light sensitive seborrhoeide” in 1957, 1 and recognized as a distinct entity in 1964. 2 It presents as a persistent erythematous eruption composed of tiny papules and papulopustules distributed primarily around the mouth, with a narrow zone of sparing around the vermilion border of the lips (Fig. 1). Without treatment, it tends to run a fluctuating course.

Transient effect of topical treatment of cutaneous leishmaniasis with imiquimod.

Abstract: Background Treatment of cutaneous leishmaniasis can be painful and protracted and cosmetic results are often unsatisfying. The immune modulator imiquimod has been reported to be suitable for the treatment of a variety of infectious skin diseases and neoplasias. Objective We investigated the efficacy of topical application of imiquimod in the treatment of old world leishmaniasis in a placebo-controlled prospective study. Methods Twelve patients were treated with imiquimod cream using a standard protocol, i.e. topical application three times a week, and a further three served as control group. Results Lesions of cutaneous leishmaniasis regressed within the first 2–4 weeks in 10 of the 12 patients, whereas in two patients no change was observed. However, after 8 weeks all lesions showed progression. Conclusion Our results thus demonstrate that topical application of imiquimod alone is ineffective in treating old world cutaneous leishmaniasis. Further studies are required to demonstrate a possible benefit of imiquimod in combination with other, preferably orally administered medicines.

Comparative evaluation of different hair removal lasers in skin types IV, V, and VI

Abstract: Background Lasers permit treatment of unwanted excess hair with less discomfort than other methods of epilation Many lasers with different parameters are now available from which the dermatologist can choose Improved clinical results are made possible by the high specificity and selectivity of the laser systems to pigmented hair because of the use of an appropriate wavelength with the proper pulse and duration Objectives We aimed to compare the results of treatment of skin types IV, V, and VI using three different laser systems Methods One hundred female patients were compared using different laser systems: 35 patients underwent epilation using a Nd-Yag laser, 33 patients using an Alexandrite laser, and 32 patients using a Diode laser Results Follow up 12 months after the multiple treatments (three to six sessions) showed an insignificant difference between these three groups (35–40%) Conclusion Our findings indicate that all three laser systems tested can be used for dark skin; however, one should select a system that minimizes side-effects, primarily hypo- and hyper-pigmentation, especially when used for skin types IV, V, and VI