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About This Journal [About This Journal]

This Month in Archives of Dermatology [This Month in Archives of Dermatology]

The Increase of Certain Contagions Following the Great Fire in San Francisco [Archives a Century Ago]

Fractional Photothermolysis: A New Therapeutic Modality for Xanthelasma [The Cutting Edge]

Large Sample of Nephrogenic Systemic Fibrosis Cases From a Single Institution [Study]

Objectives To estimate and stratify the risk of development of nephrogenic systemic fibrosis (NSF) in well-defined at-risk subpopulations from a large single institution, and to perform a single-institution case series study of patients with biopsy-proven NSF. Design Retrospective cohort of patients exposed to gadolinium-based contrast agents (GBCAs) at a single institution during an 8-year period (January 1, 1999, to December 31, 2006), and a case series study of patients with biopsy-proven NSF. Setting A primary, secondary, and tertiary health care center that treated more than 2.2 million outpatients and had 135 000 hospital admissions in 2007. Patients A total of 94 917 patients exposed to GBCAs; patients at risk for NSF (3779 patients on hemodialysis, 1694 patients with renal transplants, and 717 patients with liver transplants, a well-defined subgroup that includes patients at risk for reduced renal function); and 61 patients with a clinical diagnosis of NSF. Main Outcome Measure Risk estimate for NSF. Results The risk of development of NSF is 1.0% for patients who undergo hemodialysis (8 of 827), 0.8% for patients with renal transplantation (4 of 527), and 0% for patients with liver transplantation at our institution (0 of 327). Conclusions Despite the limitations, this study, which reviewed a large number of patients who underwent intravascular GBCA injections, demonstrates a 77-fold higher risk of NSF among patients who undergo hemodialysis and a 69-fold higher risk in patients with renal transplantation. This increased risk is thought to be associated with poor clearance of most GBCAs.

Highly Sensitive Multivariable Assay Detection of Melanocytic Differentiation Antigens and Angiogenesis Biomarkers in Sentinel Lymph Nodes With Melanoma Micrometastases [Study]

Objectives To evaluate the prognostic value of melanocytic differentiation antigens and angiogenesis biomarkers in sentinel lymph nodes (SLNs) with melanoma micrometastases. Design Prognostic study of an inception cohort. Setting Academic research. Patients Between July 1, 1999, and July 31, 2002, all patients who had primary cutaneous or mucosal melanomas that have a Breslow depth of 1.5 mm or greater, ulceration, or Clark level IV or V, or had SLN biopsies. Main Outcome Measures By the use of quantitative reverse transcription–polymerase chain reaction, the expression of the following was analyzed in SLNs: 2 melanocytic differentiation antigens (tyrosinase [P17646] and melanoma antigen recognized by T cells [MART-1; Q16655]) and genes involved in angiogenesis (VEGF [NM_001025366] and VEGFR2 [AF035121]), lymphangiogenesis (VEGFC [NM_005429], VEGFR3 [X68203], LYVE1 [NM_016164], and PROX1 [002763]), and invasion (uPA [NM_002658], PAI1 [NM_00602], and EMMPRIN [L10240]). Outcome measures were the association of these melanocytic differentiation antigens and angiogenesis biomarkers with clinicopathologic characteristics of patients, and an evaluation of the prognostic value for relapse-free survival and overall survival. Results Ninety-one patients were included, with a median follow-up period of 41 months. Micrometastases were present in 15% (14 of 91) of patients. Tyrosinase (P < .001), MART-1 (P < .001), vascular endothelial growth factor 121 (VEGF121) (P = .007), and PAI1 (P = .02) expression was significantly associated with micrometastasis. In univariate analysis, histologic findings and tyrosinase and MART-1 expression were significantly associated with relapse-free survival. Tyrosinase and MART-1 expression was associated with overall survival. A multiple Cox proportional hazards regression model identified negative histologic findings and tyrosinase expression that exceeded 27 copies/copy of TATA box-binding protein (third quartile) as significantly associated with an increased risk of relapse or death. Conclusions Quantitative assessment of melanocytic differentiation antigens in SLNs, which has prognostic value, is more specific than qualitative assessment. Prognosis may be more effectively predicted by the combination of quantitative assessment of melanocytic differentiation antigens in SLNs with histologic assessment. A significant association was found between the presence of micrometastases and the expression of angiogenesis biomarkers.

The Incredible Being of Lightness [Notable Notes]

Molecular Analysis of Aggressive Microdermabrasion in Photoaged Skin [Study]

Objective To investigate dermal remodeling effects of crystal-free microdermabrasion on photodamaged skin. Design Biochemical analyses of human skin biopsy specimens following microdermabrasion treatment in vivo. Setting Academic referral center. Participants Volunteer sample of 40 adults, aged 50 to 83 years, with clinically photodamaged forearms. Intervention Focal microdermabrasion treatment with diamond-studded handpieces of varying abrasiveness on photodamaged forearms and serial biopsies at baseline and various times after treatment. Main Outcome Measures Quantitative polymerase chain reaction, immunohistochemistry, and enzyme-linked immunosorbent assay were used to quantify changes in inflammatory, proliferative, and remodeling effectors of normal wound healing. Type I and type III procollagen served as the main outcome marker of dermal remodeling. Results Coarse-grit microdermabrasion induces a wound healing response characterized by rapid increase in induction of cytokeratin 16 and activation of the AP-1 transcription factor in the epidermis. Early inflammation was demonstrated by induction of inflammatory cytokines, antimicrobial peptides, and neutrophil infiltration in the dermis. AP-1 activation was followed by matrix metalloproteinase–mediated degradation of extracellular matrix. Consistent with this wound-healing response, we observed significant remodeling of the dermal component of the skin, highlighted by induction of type I and type III procollagen and by induction of collagen production enhancers heat shock protein 47 and prolyl 4-hydroxylase. Dermal remodeling was not achieved when microdermabrasion was performed using a medium-grit handpiece. Conclusions Microdermabrasion using a coarse diamond-studded handpiece induces a dermal remodeling cascade similar to that seen in incisional wound healing. Optimization of these molecular effects is likely the result of more aggressive treatment with a more abrasive handpiece. Trial Registration clinicaltrials.gov Identifier: NCT00111254

Practical Guidelines for Evaluation of Loose Anagen Hair Syndrome [Study]

Objectives To better categorize the epidemiologic profile, clinical features, and disease associations of loose anagen hair syndrome (LAHS) compared with other forms of childhood alopecia. Design Retrospective survey. Setting Academic pediatric dermatology practice. Patients Three hundred seventy-four patients with alopecia referred from July 1, 1997, to June 31, 2007. Main Outcome Measures Epidemiologic data for all forms of alopecia were ascertained, such as sex, age at onset, age at the time of evaluation, and clinical diagnosis. Patients with LAHS were further studied by the recording of family history, disease associations, hair-pull test or biopsy results, hair color, laboratory test result abnormalities, initial treatment, and involvement of eyelashes, eyebrows, and nails. Results Approximately 10% of all children with alopecia had LAHS. The mean age (95% confidence interval) at onset differed between patients with LAHS (2.8 [1.2-4.3] years) vs patients without LAHS (7.1 [6.6-7.7] years) (P < .001), with 3 years being the most common age at onset for patients with LAHS. All but 1 of 37 patients with LAHS were female. The most common symptom reported was thin, sparse hair. Family histories were significant for LAHS (n = 1) and for alopecia areata (n = 3). In 32 of 33 patients, trichograms showed typical loose anagen hairs. Two children had underlying genetic syndromes. No associated laboratory test result abnormalities were noted among patients who underwent testing. Conclusions Loose anagen hair syndrome is a common nonscarring alopecia in young girls with a history of sparse or fine hair. Before ordering extensive blood testing in young girls with diffusely thin hair, it is important to perform a hair-pull test, as a trichogram can be instrumental in the confirmation of a diagnosis of LAHS.

Rates of Skin Cancer Screening and Prevention Counseling by US Medical Residents [Study]

Objective To determine factors related to residents’ self-reported skill level for the skin cancer examination (SCE). Design Survey of residents in November 2003. Setting Four US residency programs. Participants Medical residents in family medicine, pediatrics, obstetrics and gynecology, and internal medicine and specialists. Main Outcome Measure Proportion of residents reporting their current skill level for the performance of the SCE. Results Of 454 surveys distributed, 342 residents completed the survey (75.3% response rate). Clinical training for the SCE during residency was infrequent. During residency, 75.8% were never trained in the SCE, 55.3% never observed an SCE, and 57.4% never practiced the examination. Only 15.9% of residents reported being skilled in the SCE. However, the conduct of 4 SCEs (or slightly more than 1 per each year of residency) was associated with manifold increases in self-reported skill levels. Conclusions Information now collected from 7 medical schools and 4 residency programs underscores the need for more supervised opportunities to enable physicians in training to perform an SCE during routine patient examinations.

Reflectance Confocal Microscopy and Features of Melanocytic Lesions: An Internet-Based Study of the Reproducibility of Terminology [Study]

Objective To test the interobserver and intraobserver reproducibility of the standard terminology for description and diagnosis of melanocytic lesions in in vivo confocal microscopy. Design A dedicated Web platform was developed to train the participants and to allow independent distant evaluations of confocal images via the Internet. Setting Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy. Participants The study population was composed of 15 melanomas, 30 nevi, and 5 Spitz/Reed nevi. Six expert centers were invited to participate at the study. Intervention Evaluation of 36 features in 345 confocal microscopic images from melanocytic lesions. Main Outcome Measure Interobserved and intraobserved agreement, by calculating the Cohen statistics measure for each descriptor. Results High overall levels of reproducibility were shown for most of the evaluated features. In both the training and test sets there was a parallel trend of decreasing values as deeper anatomic skin levels were evaluated. All of the features, except 1, used for melanoma diagnosis, including roundish pagetoid cells, nonedged papillae, atypical cells in basal layer, cerebriform clusters, and nucleated cells infiltrating dermal papillae, showed high overall levels of reproducibility. However, less-than-ideal reproducibility was obtained for some descriptors, such as grainy appearance of the epidermis, junctional thickening, mild atypia in basal layer, plump bright cells, small bright cells, and reticulated fibers in the dermis. Conclusion The standard consensus confocal terminology useful for the evaluation of melanocytic lesions was reproducibly recognized by independent observers.

Efficacy and Safety of Microfoam Sclerotherapy in a Patient With Klippel-Trenaunay Syndrome and a Patent Foramen Ovale [Observation]

Background Sclerotherapy with polidocanol microfoam injection under duplex guidance is a new treatment for venous malformations associated with Klippel-Trenaunay syndrome. Multidetector-row computed tomography (MDCT) venography is extremely helpful in the assessment of disease extension and the planning of therapy. Observation In this particular case, MDCT venography demonstrated the origin, course, and relationship to adjacent anatomical structures of aberrant vessels that configure the superficial venous system with an anatomically normal and patent deep venous system. At the end of the treatment, which consisted of 8 sessions of microfoam sclerotherapy within 12 months, a considerable reduction in the number and size of the percutaneously treated aberrant veins was observed. The obvious clinical improvement was objectively demonstrated with MDCT venography, which showed clear reduction in the number and size of treated veins. Further clinical investigation performed because of isolated migraine episodes related to the sclerotherapy session revealed that the patient had a patent foramen ovale. A transcranial Doppler examination during the procedure showed middle cerebral artery bubbles, which indicated right-to-left shunt. No cerebral damage was observed in a subsequent diffusion-weighted magnetic resonance examination. Conclusions Microfoam sclerotherapy is an effective treatment option in patients with Klippel-Trenaunay syndrome. MDCT venography allows diagnosis of the disease, planning of therapy, and assessment of response to treatment. Although foam-induced microembolism is a common phenomenon during sclerotherapy, in this report we demonstrate that polidocanol microfoam prepared with a low-nitrogen gas mixture is safe in a patient with a patent foramen ovale.

Adenosquamous Carcinoma of the Skin: A Case Series [Observation]

Background Adenosquamous carcinoma is an uncommon cutaneous malignant neoplasm with mixed glandular and squamous differentiation and a propensity for aggressive clinical behavior. Observations Of 27 patients diagnosed as having adenosquamous carcinoma, 19 were men and 5 were immunosuppressed. The mean age was 74 years. The majority of tumors were located on the face and scalp (19 of 27 [70%]) or upper extremity (4 of 27 [15%]). Squamous and glandular differentiation was characteristic. Thickness of the primary lesion ranged from 1.2 to 9.2 mm, with all tumors extensively invading the reticular dermis. Perineural invasion was seen in 4 of 27 primary cases (15%). Although 3 of 6 patients treated with Mohs micrographic surgery had subsequent locoregional recurrences, there was no evidence of distant metastasis after a mean of 2.3 years of patient follow-up. Conclusions Adenosquamous carcinoma is best considered as a locally aggressive high-risk subtype of cutaneous squamous cell carcinoma. Tumor thickness and perineural invasion are high-risk histopathological attributes, and immunosuppression is an important clinical risk factor. Although Mohs micrographic surgery may be the best initial treatment, locoregional recurrence is common.

Subcorneal Pustular Dermatosis-Type IgA Pemphigus With Autoantibodies to Desmocollins 1, 2, and 3 [Observation]

Background IgA pemphigus is a rare neutrophilic acantholytic autoimmune disease that is characterized by IgA deposits on keratinocyte cell surfaces. Clinically and histologically, IgA pemphigus is divided into 2 major subtypes: subcorneal pustular dermatosis and intraepidermal neutrophilic IgA dermatosis. We report the first case of subcorneal pustular dermatosis–type IgA pemphigus that showed reactivity to all 3 isoforms of the desmocollin family by indirect immunofluorescence microscopy of COS7 cells transfected with desmocollin 1, 2, or 3. Observations We describe a 94-year-old woman with IgA pemphigus with a unique immunopathologic pattern. Direct immunofluorescence microscopy revealed IgA deposits throughout the entire epidermis, with stronger staining in the upper epidermis. The autoantibodies from this patient did not show IgA or IgG reactivity with desmogleins via immunoblotting or enzyme-linked immunosorbent assay. By indirect immunofluorescence by the use of COS7 cells transfected with desmocollin 1, 2, or 3, IgA autoantibodies in a serum sample from our patient clearly reacted with all of them. Conclusions The pathophysiology and autoantigen profile of bullous autoimmune diseases, especially pemphigus and its subforms, are more complex than previously believed. Because pemphigus seems to be a heterogeneous disorder, further studies are needed to evaluate the complexity of the disease.

Detection of Clonal T Cells in the Circulation of Patients With Nephrogenic Systemic Fibrosis [Observation]

Background Nephrogenic systemic fibrosis is a sclerodermalike disease in patients with acute or chronic renal insuffiency related to administration of gadolinium-containing contrast agents. Previous studies have demonstrated clonal T-cell populations in the blood of patients with systemic sclerosis, suggesting that these cells may be involved in the pathogenesis of the disease. Facing the clinical similarities of both diseases, we hypothesized that clonal expansion of T cells could be present in nephrogenic systemic fibrosis as well. Observations Findings from polymerase chain reaction and high-resolution capillary electrophoresis for T-cell receptor gene rearrangement analysis showed that all 6 prospectively evaluated patients (100%) with nephrogenic systemic fibrosis had detectable clonal T cells in their peripheral blood. In contrast, only 4 of the 15 control patients (27%) with chronic renal failure and none of the 12 healthy individuals analyzed in this study had evidence for T-cell clonality using the same type of examination. Clonal T-cell–positive patients with systemic sclerosis have previously been reported to better respond to extracorporeal photopheresis. However, this was not the case in 2 of our patients with nephrogenic systemic fibrosis. Conclusion As in systemic sclerosis, clonally expanded T-cell populations could play a critical role in the pathogenesis of nephrogenic systemic fibrosis, probably as an in vivo–activated inflammatory response to gadolinium exposure.

UV-A1 Therapy for Nephrogenic Systemic Fibrosis [Observation]

Background Nephrogenic systemic fibrosis (NSF) is a rare sclerosing skin condition associated with end-stage renal disease and gadolinium exposure. Therapy for NSF is challenging, with few options other than preventing exposure to gadolinium and improving renal function through transplant. However, in some cases neither of these options is tenable. We report the successful use of UV-A1 phototherapy in 4 patients with NSF. Observations Four patients with NSF were treated with UV-A1 phototherapy at a tertiary medical center from 2005 through 2007. To our knowledge, it is unique to this series that all patients were receiving hemodialysis before, during, and after therapy with UV-A1. All experienced improvement in the degree of induration, and 2 experienced improvement in mobility of the hands and legs. Total treatments ranged from 22 treatments (with a cumulative dose of 1855 J/cm2) to 50 treatments (total UV-A1 exposure, 3850 J/cm2). No adverse events were observed. Conclusions Although no patient had complete resolution of indurated plaques, the improvement was substantial. For 2 patients, it resulted in a resumption of hand and leg mobility. As a result, UV-A1 therapy may represent a treatment for NSF when kidney transplantation is not an option or is delayed. Limitations of this study include the lack of a controlled trial, lack of quantification of gadolinium levels within tissue, and the lack of a defined grading scale for NSF severity.

A Glimpse of Future Management of Melanoma [Editorial]

Estimates of Risk, Empirical Treatment Observations, and Unexpected Laboratory Findings Reveal the Complexity of Nephrogenic Systemic Fibrosis [Editorial]

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman--Quiz Case [Off-Center Fold]

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman--Diagnosis [Off-Center Fold]

Asymptomatic Red Plaque on the Leg of a 7-Year-Old Girl--Quiz Case [Off-Center Fold]

Asymptomatic Red Plaque on the Leg of a 7-Year-Old Girl--Diagnosis [Off-Center Fold]

Multiple Blue Macules and Papules on the Scalp--Quiz Case [Off-Center Fold]

Multiple Blue Macules and Papules on the Scalp--Diagnosis [Off-Center Fold]

Slowly Enlarging Nodule on a Finger--Quiz Case [Off-Center Fold]

Slowly Enlarging Nodule on a Finger--Diagnosis [Off-Center Fold]

Defining Wound Microbial Flora: Molecular Microbiology Opening New Horizons [Research Letters]

Physician Workforce for Acne Care in the United States, 2003 Through 2005 [Research Letters]

Squamous Cell Carcinoma in Solid Organ Transplant Recipients: Influences on Perception of Risk and Optimal Time to Provide Education [Research Letters]

A New Dermoscopic Finding in Healthy Children: Dirt! [Correspondence]

A New Dermoscopic Finding in Healthy Children: Dirt!--Reply [Correspondence]

Large Amelanotic Melanoma and Vitiligo [Correspondence]

Axillary Web Syndrome or Cording, a Variant of Mondor Disease, Following Axillary Surgery [Correspondence]

Classic Kaposi Sarcoma Treated With Intralesional 5-Aminolevulinic Acid Injection Photodynamic Therapy [Correspondence]

Acute Edema/Cutaneous Distention Syndrome Associated With Refeeding in a Patient With Anorexia Nervosa [Correspondence]

Dermoscopic Features of Birt-Hogg-Dube Syndrome [skINsight]

Progressive refractory ulcer of the nipple: a quiz.

Related Articles Progressive refractory ulcer of the nipple: a quiz. Acta Derm Venereol. 2009;89(4):445-6 Authors: Nomura Y, Akiyama M, Nishie W, Shimizu H PMID: 19688175 [PubMed - indexed for MEDLINE]

Pigmented lesion on the cheek: a quiz.

Related Articles Pigmented lesion on the cheek: a quiz. Acta Derm Venereol. 2009;89(4):445-6 Authors: Zaraa I, Dammak A, Tounsi H, Amouri M, Mouaffek M, Mokni M, Boubaker S, Osman AB PMID: 19688174 [PubMed - indexed for MEDLINE]

A case of cutaneous polyarteritis nodosa in autoimmune hepatitis.

Related Articles A case of cutaneous polyarteritis nodosa in autoimmune hepatitis. Acta Derm Venereol. 2009;89(4):442-3 Authors: Lee WJ, Kim CH, Chang SE, Lee MW, Choi JH, Moon KC, Koh JK PMID: 19688173 [PubMed - indexed for MEDLINE]

Benign symmetric lipomatosis associated with atopic dermatitis and chronic alcohol abuse in a Japanese man.

Related Articles Benign symmetric lipomatosis associated with atopic dermatitis and chronic alcohol abuse in a Japanese man. Acta Derm Venereol. 2009;89(4):440-1 Authors: Kawakami T, Takeuchi S, Soma Y PMID: 19688172 [PubMed - indexed for MEDLINE]

Spontaneous regression and recurrence in a case of nodular fasciitis.

Related Articles Spontaneous regression and recurrence in a case of nodular fasciitis. Acta Derm Venereol. 2009;89(4):438-9 Authors: Hüter EN, Lee CC, Sherry RM, Udey MC PMID: 19688171 [PubMed - indexed for MEDLINE]

Malignant acanthosis nigricans with enhanced expression of fibroblast growth factor receptor 3.

Related Articles Malignant acanthosis nigricans with enhanced expression of fibroblast growth factor receptor 3. Acta Derm Venereol. 2009;89(4):435-7 Authors: Hida Y, Kubo Y, Nishio Y, Murakami S, Fukumoto D, Sayama K, Hashimoto K, Arase S PMID: 19688170 [PubMed - indexed for MEDLINE]

Cutaneous necrosis secondary to terlipressin therapy.

Related Articles Cutaneous necrosis secondary to terlipressin therapy. Acta Derm Venereol. 2009;89(4):434-5 Authors: Posada C, Feal C, García-Cruz A, Alvarez V, Alvarez M, Cruces MJ PMID: 19688169 [PubMed - indexed for MEDLINE]

Pseudolymphomatoid cutaneous leishmaniasis in a patient treated with adalimumab for rheumatoid arthritis.

Related Articles Pseudolymphomatoid cutaneous leishmaniasis in a patient treated with adalimumab for rheumatoid arthritis. Acta Derm Venereol. 2009;89(4):432-3 Authors: Baltà-Cruz S, Alsina-Glbert M, Mozos-Rocafort A, Cervera C, Colomo-Saperas L, Del Río A, Estrach-Panella T PMID: 19688168 [PubMed - indexed for MEDLINE]

Atypical presentation and dermoscopic evaluation of cutaneous Rosai-Dorfman Disease.

Related Articles Atypical presentation and dermoscopic evaluation of cutaneous Rosai-Dorfman Disease. Acta Derm Venereol. 2009;89(4):430-1 Authors: Rodríguez-Blanco I, Suárez-Peñaranda JM, Toribio J PMID: 19688167 [PubMed - indexed for MEDLINE]

Thoracic subcutaneous infiltration: an unusual presentation of subcutaneous panniculitis-like T-cell lymphoma.

Related Articles Thoracic subcutaneous infiltration: an unusual presentation of subcutaneous panniculitis-like T-cell lymphoma. Acta Derm Venereol. 2009;89(4):427-9 Authors: Ballanger F, Barbarot S, Le Gouill S, Gaillard F, Cassagnau E, Lodé L, Dréno B, Stalder JF PMID: 19688166 [PubMed - indexed for MEDLINE]

Intravascular large B-cell lymphoma: successful therapy with bendamustine and rituximab.

Related Articles Intravascular large B-cell lymphoma: successful therapy with bendamustine and rituximab. Acta Derm Venereol. 2009;89(4):425-7 Authors: Mleczko A, Franke I, Scheinpflug K, Gollnick H, Leverkus M PMID: 19688165 [PubMed - indexed for MEDLINE]

Folliculotropic mycosis fungoides with severe hepatic failure due to hepatic involvement.

Related Articles Folliculotropic mycosis fungoides with severe hepatic failure due to hepatic involvement. Acta Derm Venereol. 2009;89(4):423-4 Authors: Shibata S, Sugaya M, Minatani Y, Fujita H, Tsunemi Y, Miyagaki T, Saeki H, Kikuchi K, Asai T, Kurokawa M, Tamaki K PMID: 19688164 [PubMed - indexed for MEDLINE]

Mycosis fungoides with recurrent Hodgkin's lymphoma and diffuse large B-cell lymphoma.

Related Articles Mycosis fungoides with recurrent Hodgkin's lymphoma and diffuse large B-cell lymphoma. Acta Derm Venereol. 2009;89(4):421-2 Authors: Miyagaki T, Sugaya M, Minatani Y, Fujita H, Hangaishi A, Kurokawa M, Takazawa Y, Tamaki K PMID: 19688163 [PubMed - indexed for MEDLINE]

Bullous pemphigoid with localized umbilical involvement.

Related Articles Bullous pemphigoid with localized umbilical involvement. Acta Derm Venereol. 2009;89(4):419-20 Authors: Schmidt E, Benoit S, Bröcker EB PMID: 19688162 [PubMed - indexed for MEDLINE]

Successful hair re-growth with multimodal treatment of early cicatricial alopecia in discoid lupus erythematosus.

Related Articles Successful hair re-growth with multimodal treatment of early cicatricial alopecia in discoid lupus erythematosus. Acta Derm Venereol. 2009;89(4):417-8 Authors: Hamilton T, Otberg N, Wu WY, Martinka M, Shapiro J PMID: 19688161 [PubMed - indexed for MEDLINE]

Acquired dermal melanocytosis naevus of Ota-like macules on the face and extremities lesions in a young Japanese woman.

Related Articles Acquired dermal melanocytosis naevus of Ota-like macules on the face and extremities lesions in a young Japanese woman. Acta Derm Venereol. 2009;89(4):415-6 Authors: Kawakami T, Saito C, Soma Y PMID: 19688160 [PubMed - indexed for MEDLINE]

Cutis verticis gyrata in a patient with hyper-IgE syndrome.

Related Articles Cutis verticis gyrata in a patient with hyper-IgE syndrome. Acta Derm Venereol. 2009;89(4):413-4 Authors: Kim HS, Teo RY, Tan AW PMID: 19688159 [PubMed - indexed for MEDLINE]

Urticaria associated with hyper-IgE in a patient with psoriasis undergoing treatment with efalizumab.

Related Articles Urticaria associated with hyper-IgE in a patient with psoriasis undergoing treatment with efalizumab. Acta Derm Venereol. 2009;89(4):412-3 Authors: Saraceno R, Scotto G, Chiricozzi A, Chimenti S PMID: 19688158 [PubMed - indexed for MEDLINE]

Localized abdominal wall bile staining due to retroperitoneal bile leak.

Related Articles Localized abdominal wall bile staining due to retroperitoneal bile leak. Acta Derm Venereol. 2009;89(4):410-1 Authors: Allegue F, Pérez-Pérez L, Maza MT, Hermo JA, Zulaica A PMID: 19688157 [PubMed - indexed for MEDLINE]

Fatal case of Darier's disease with recurrent severe infections.

Related Articles Fatal case of Darier's disease with recurrent severe infections. Acta Derm Venereol. 2009;89(4):408-9 Authors: Okada E, Nagai Y, Motegi S, Tamura A, Ishikawa O PMID: 19688156 [PubMed - indexed for MEDLINE]

Simultaneous onset of segmental vitiligo and a halo surrounding a congenital melanocytic naevus.

Related Articles Simultaneous onset of segmental vitiligo and a halo surrounding a congenital melanocytic naevus. Acta Derm Venereol. 2009;89(4):402-6 Authors: Hofmann UB, Bröcker EB, Hamm H Unlike in common melanocytic naevi, an acquired leukoderma (halo) surrounding a congenital melanocytic naevus is a rare phenomenon. A 6-year-old boy developed a depigmentation around a congenital melanocytic naevus on the right thigh. Simultaneously, segmental vitiligo appeared on the thigh, lower abdomen and buttock of the same side with sharp midline demarcation. Examination for associated autoimmune diseases proved negative. The simultaneous occurrence of a halo phenomenon around a congenital melanocytic naevus and segmental vitiligo, as well as identical histological and immunohistological findings in both pigmented lesions, suggest shared immunological mechanisms. PMID: 19688155 [PubMed - indexed for MEDLINE]

Digital gangrene in systemic lupus erythematosus.

Related Articles Digital gangrene in systemic lupus erythematosus. Acta Derm Venereol. 2009;89(4):398-401 Authors: Nagai Y, Shimizu A, Suto M, Tanaka S, Yasuda M, Tago O, Hasegawa M, Ishikawa O Digital ulcers and gangrene are common skin manifestations of connective tissue diseases, especially systemic sclerosis, although they are relatively rare in systemic lupus erythematosus. We describe here three patients with digital gangrene and systemic lupus erythematosus. None of the patients showed high disease activity of systemic lupus erythematosus at the time the digital gangrene developed. Two patients were positive for anti-RNP antibodies; however, no symptoms of other collagen diseases were present. One patient had anti-phosphatidylserine/prothrombin complex antibodies, and the other had anti-cardiolipin beta2 glycoprotein I antibodies and lupus anticoagulant at low titre. All patients showed narrowing or occlusion of radial and/or ulnar arteries in addition to digital arteries. Although a complication of anti-phospholipid syndrome is considered to be a possible cause, there may be unidentified causes other than thrombosis, atherosclerosis, overlap syndrome and vasculitis. PMID: 19688154 [PubMed - indexed for MEDLINE]

Antiviral therapy in children with hydroa vacciniforme.

Related Articles Antiviral therapy in children with hydroa vacciniforme. Acta Derm Venereol. 2009;89(4):393-7 Authors: Lysell J, Wiegleb Edström D, Linde A, Carlsson G, Malmros-Svennilson J, Westermark A, Andersson J, Wahlgren CF Hydroa vacciniforme is a rare, usually quite severe, photo-dermatosis. Association with Epstein-Barr virus infection and a possibly increased risk of lymphoproliferative malignancy have been demonstrated. We describe here four patients with Epstein-Barr virus-associated hydroa vacciniforme treated with acyclovir/valacyclovir therapy with a good clinical response. The children were reported to have less fatigue, fewer eruptions, less scarring, and increased ability to spend time outdoors without provoking new eruptions. This was also in agreement with clinical observations. However, one patient progressed into an anaplastic lymphoma kinase-1-negative anaplastic large-cell lymphoma in the upper jaw. This was preceded by an increase in EBV viral load. Acyclovir/valacyclovir therapy is a safe treatment. Further studies are required to confirm these results. PMID: 19688153 [PubMed - indexed for MEDLINE]

Chronic urticaria is usually associated with fibromyalgia syndrome.

Related Articles Chronic urticaria is usually associated with fibromyalgia syndrome. Acta Derm Venereol. 2009;89(4):389-92 Authors: Torresani C, Bellafiore S, De Panfilis G Although the pathophysiology of chronic urticaria is not fully understood, it is possible that dysfunctioning of peripheral cutaneous nerve fibres may be involved. It has also been suggested that fibromyalgia syndrome, a multi-symptomatic chronic pain condition, may be associated with alterations and dysfunctioning of peripheral cutaneous nerve fibres. The aim of this study was to determine whether patients with chronic urticaria are also affected by fibromyalgia syndrome. A total of 126 patients with chronic urticaria were investigated for fibromyalgia syndrome. An unexpectedly high proportion (over 70%) had fibromyalgia syndrome. The corresponding proportion for 50 control dermatological patients was 16%, which is higher than previously published data for the Italian general population (2.2%). It is possible that dysfunctional cutaneous nerve fibres of patients with fibromyalgia syndrome may release neuropeptides, which, in turn, may induce dermal microvessel dilatation and plasma extravasation. Furthermore, some neuropeptides may favour mast cell degranulation, which stimulates nerve endings, thus providing positive feedback. Chronic urticaria may thus be viewed in many patients, as a consequence of fibromyalgia syndrome; in fact, skin neuropathy (fibromyalgia syndrome) may trigger neurogenic skin inflammation (chronic urticaria). PMID: 19688152 [PubMed - indexed for MEDLINE]

Characteristics of nickel-allergic dermatitis patients seen in private dermatology clinics in Denmark: a questionnaire study.

Related Articles Characteristics of nickel-allergic dermatitis patients seen in private dermatology clinics in Denmark: a questionnaire study. Acta Derm Venereol. 2009;89(4):384-8 Authors: Thyssen JP, Hald M, Avnstorp C, Veien NK, Lauerberg G, Nielsen NH, Kaaber K, Kristensen B, Kristensen O, Thormann J, Vissing S, Menné T, Duus Johansen J The use of nickel in certain consumer goods has been regulated in Denmark since 1990. The aim of this study was to reveal the clinical characteristics of nickel-allergic patients seen in seven private dermatology clinics and to identify current sources of nickel that may elicit nickel dermatitis. During 2006 to 2007, 634 patients with dermatitis aged 17-91 years were patch-tested and completed a questionnaire including a question about the occurrence of dermatitis following skin contact with ear-rings or ear-pins, watches, buttons or metal clasps (i.e. metal dermatitis). chi2 tests were applied to test for statistical significant differences. Analysis revealed a lower prevalence of nickel allergy among women in the youngest age group (17-22 years) in comparison with older age groups (23-34 years and 35-46 years) (p < 0.03). Most patients experienced metal dermatitis on the first occurrence be-tween 1975 and 1985. No new cases of metal dermatitis were identified after 1985. We conclude that nickel allergy has decreased among young females with dermatitis due to the nickel regulation. PMID: 19688151 [PubMed - indexed for MEDLINE]

Clinical aspects of itch in adult atopic dermatitis patients.

Related Articles Clinical aspects of itch in adult atopic dermatitis patients. Acta Derm Venereol. 2009;89(4):379-83 Authors: Chrostowska-Plak D, Salomon J, Reich A, Szepietowski JC Although pruritus is an essential symptom of atopic dermatitis, its complex pathomechanism is not fully understood. The aim of this study was to characterize the clinical pattern of itch in adult subjects with atopic dermatitis. A total of 89 patients (59 females, 30 males) with atopic dermatitis, age range 18-60 years, were included in the study. Each patient completed a questionnaire about clinical features of itch. At the time of examination pruritus was present in 83.1% of patients. The majority of patients experienced itch in the evening (52.8%) and at night (38.2%). In 81% of patients itch caused difficulty in falling asleep. Twenty-five patients (28.1%) experienced itch every day. The main factors exacerbating pruritus were dryness, sweat, physical effort, food and hot baths. The most frequently used management regimes were topical emollients and oral antihistamines, but the long-term effects of these were very limited. There was a positive correlation between intensity of itch and age (r = 0.3, p = 0.004), and between disease duration and intensity of maximal itch (r = 0.22, p = 0.04). Patients with more severe disease reported more intense pruritus. PMID: 19688150 [PubMed - indexed for MEDLINE]

Single low-dose red light is as efficacious as methyl-aminolevulinate--photodynamic therapy for treatment of acne: clinical assessment and fluorescence monitoring.

Related Articles Single low-dose red light is as efficacious as methyl-aminolevulinate--photodynamic therapy for treatment of acne: clinical assessment and fluorescence monitoring. Acta Derm Venereol. 2009;89(4):372-8 Authors: Hörfelt C, Stenquist B, Halldin CB, Ericson MB, Wennberg AM This controlled study investigated single low-dose red light photodynamic therapy and methyl-aminolevulinate (MAL) for treatment of moderate to severe facial acne in 19 patients. The right cheek was treated with MAL (160 mg/g) for 3 h prior to illumination. The left cheek received red light only. Both cheeks were illuminated with narrow-band red light (635 nm) at a light dose of 15 J/cm2. The global severity of acne was assessed at baseline and at follow-up, 10 and 20 weeks after treatment. Fluorescence images, clinical photographs and skin surface biopsies were obtained. Both MAL-photodynamic therapy and control areas showed a significant decrease in acne score at follow-up; no significant difference was found compared with control. MAL-photodynamic therapy was associated with adverse effects such as erythema and stinging. Fluorescence images revealed poor selectivity of MAL-induced fluorescence to the acne lesions, suggesting a general photoablating mechanism rather than selective destruction of sebaceous glands. No significant reduction in Propionibacterium acnes or sebum excretion was found. PMID: 19688149 [PubMed - indexed for MEDLINE]

Factors influencing the clinical evaluation of facial acne.

Related Articles Factors influencing the clinical evaluation of facial acne. Acta Derm Venereol. 2009;89(4):369-71 Authors: Faure M, Pawin H, Poli F, Revuz J, Beylot C, Chivot M, Auffret N, Moyse D, Dréno B Existing scoring systems for facial acne focus on the lesions themselves, but clinical decisions are based on a general assessment of severity, including the time since onset, the site(s) of involvement, the patient's history, and the response to prior treatments. The aim of this study was to investigate the influence of some of these factors on the global assessment of acne severity. Involvement of the trunk, prior systemic treatment and a positive family history of acne increased the severity score. Inclusion of these factors could help to compose more homogeneous groups for clinical trials. PMID: 19688148 [PubMed - indexed for MEDLINE]

Relevance of psychosomatic factors in psoriasis: a case-control study.

Related Articles Relevance of psychosomatic factors in psoriasis: a case-control study. Acta Derm Venereol. 2009;89(4):364-8 Authors: Janković S, Raznatović M, Marinković J, Maksimović N, Janković J, Djikanović B The aim of this study was to assess the role of stressful life events, lack of social support and attachment insecurity in triggering exacerbations of psoriasis. Outpatients experiencing exacerbation of psoriasis in the last 6 months (n = 110) were compared with outpatients affected by skin conditions in which psychosomatic factors are believed to play a minor role (n = 200). Stressful life events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Perceived social support and attachment relationship were assessed with the Multidimensional Scale of Perceived Social Support and Experiences in Close Relationships Scale, respectively. In comparison with controls the patients with psoriasis reported more stressful life events in the last year. The statistically significant difference was found only for the sum of the first 25 events (odds ratio (OR) 1.98; 95% confidence interval (CI) 1.37-2.87; p < 0.001). Also, patients with psoriasis were more likely to score higher on both anxiety (OR = 1.44; CI = 1.09-1.92; p = 0.011) and avoidance attachment scale (OR = 1.49; CI = 1.04-2.14; p = 0.030), and perceived less support from their social network than did the comparison subjects. The results of this study confirm the relevance of psychosocial factors in psoriasis. PMID: 19688147 [PubMed - indexed for MEDLINE]

Skin pigmentation kinetics after exposure to ultraviolet A.

Related Articles Skin pigmentation kinetics after exposure to ultraviolet A. Acta Derm Venereol. 2009;89(4):357-63 Authors: Ravnbak MH, Philipsen PA, Wiegell SR, Wulf HC Multiple exposures to ultraviolet radiation (UVR) are the norm in nature and phototherapy. However, studies of the kinetics of pigmentation following UVA exposure have included only fair-skinned persons. The aim of this study was to investigate steady-state pigmentation and fading in 12 Scandinavians and 12 Indians/Pakistanis after 6 and 12 exposures on the back using broadband UVA and UVA1 with equal sub-minimal melanogenic doses (individually predetermined). Pigmentation was measured by skin reflectance at 555 and 660 nm. The UV dose to minimal pigmentation was higher in dark-skinned persons after a single broadband UVA exposure, but independent of pigmentation/skin type after single and multiple UVA1 exposures. To elicit minimal melanogenic doses after 6 and 12 exposures, every dose is lowered by a factor of 2 and 3, respectively, but the cumulative dose increases three- and four-fold, respectively. The absolute increase in pigmentation was independent of pre-exposure pigmentation; therefore the percentage increase in pigmentation was higher in fair-skinned subjects. The absolute increase in pigmentation was higher and it took 2-3 days longer to reach steady-state after 12 UV exposures compared with 6 UV exposures. Days to steady-state pigmentation and fading were independent of pre-exposure pigmentation, and fading took 5-6 months. Comparing data from a narrowband UVB source and a Solar Simulator, it was shown that pigmentation built up faster and increased more after 12 UVA exposures (16 days) than with the Solar Simulator (21 days). PMID: 19688146 [PubMed - indexed for MEDLINE]

Downregulation of SMAD2, 4 and 6 mRNA and TGFbeta receptor I mRNA in lesional and non-lesional psoriatic skin.

Related Articles Downregulation of SMAD2, 4 and 6 mRNA and TGFbeta receptor I mRNA in lesional and non-lesional psoriatic skin. Acta Derm Venereol. 2009;89(4):351-6 Authors: Yu H, Mrowietz U, Seifert O Transforming growth factor beta (TGFbeta) has been suggested to be an effective inhibitor of the increased keratinocyte proliferation in psoriasis. Three TGFbeta isoforms are described (TGFbeta1, 2 and 3), signalling via a heteromeric receptor complex of TGFbetaRI and TGFbetaRII. Receptor binding activates SMAD2, 3 and 4, which translocate into the nucleus and regulate TGFbeta-responsive genes. SMAD6 and 7 proteins represent a negative feedback loop inhibiting the TGFbeta-SMAD signalling path-way. As TGFbeta1 overexpression inhibits keratinocyte proliferation, the aim of this study was to investigate with real-time RT-PCR the expression of TGFbeta1, 2 and 3, TGFbetaRI and TGFbetaRII and SMAD2, 3, 4, 6 and 7 in lesional and non-lesional psoriatic skin from 13 patients with chronic plaque-type psoriasis as compared to skin from 10 healthy subjects . The study data demonstrate significantly downregulated TGFbetaRI and SMAD2, 4 and 6 mRNA expression in lesional and non-lesional psoriatic skin. SMAD7 mRNA expression was significantly decreased in lesional psoriatic skin compared with both non-lesional psoriatic skin and healthy skin. A significant TGFbeta3 and TGFbetaRII mRNA upregulation exclusively in non-lesional psoriatic skin but no significant difference in the expression of TGFbeta1 and 2 was found. The results of this study suggest that the expression of TGFbeta isoforms, receptors and SMADs may be involved in the increased proliferation of keratinocytes in psoriatic skin. PMID: 19688145 [PubMed - indexed for MEDLINE]

Epidemiology of itch: adding to the burden of skin morbidity.

Related Articles Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol. 2009;89(4):339-50 Authors: Weisshaar E, Dalgard F Itch is the most frequent symptom in dermatology and has been researched more extensively in recent years. Nevertheless, there are few true epidemiological studies on itch. The aim of this paper is to review the current state of research on the epidemiology of chronic itch in Western and non-Western populations. The electronic databases PubMed, Medline and the Cochrane Library were searched. Conference proceedings and national and international studies were included. It is difficult to compare existing studies due to differing methodology and lack of standardized measures. The symptom of itch is a challenge, not only to clinicians, but also within the structure of regional health systems, and with regards to accessibility to specialized medical doctors in non-Western countries. Published studies show that the symptom of itch is highly prevalent; it should therefore receive adequate attention from physicians and other healthcare providers, including healthcare planners. PMID: 19688144 [PubMed - indexed for MEDLINE]

Acknowledgment

Ichthyosis: Clinical Manifestations and Practical Treatment Options

Cutaneous Lupus Erythematosus: Issues in Diagnosis and Treatment

Efficacy of Dapsone in the Treatment of Pemphigus and Pemphigoid: Analysis of Current Data

Topical Clobetasol Propionate in the Treatment of Psoriasis: A Review of Newer Formulations

Impact of Psoriasis on Patients Work and Productivity: A Retrospective, Matched Case-Control Analysis

Patient Characteristics in Behcet Disease: A Retrospective Analysis of 213 Turkish Patients during 20014

Giant Melanoma and Depression

Alitretinoin in Severe Chronic Hand Eczema

Prunella vulgaris extract and rosmarinic acid prevent UVB-induced DNA damage and oxidative stress in HaCaT keratinocytes

Abstract Solar radiation is a very important exogenous factor in skin pathogenesis and can lead to the development of a number of skin disorders. UVB irradiation is known to induce oxidative stress, inflammation and especially DNA lesions in exposed cells. It is important, therefore, to identify agents that can offer protection against UVB-caused skin damage. Natural compounds have been studied for their possible ability to control/modulate various lifestyle-related diseases. The application of plant compounds/extracts with screening, antioxidant and anti-inflammatory activities may also successfully protect the skin against UV-caused injury. We assessed the potency of Prunella vulgaris extract (PVE) and its main phenolic acid component, rosmarinic acid (RA), to suppress UVB-induced (295–315 nm) alterations to human keratinocytes HaCaT using a solar simulator. Pre- and post-treatment of HaCaT cells with PVE (5–50 mg/l) and RA (0.18–1.8 mg/l) reduced breakage together with the apoptotic process. PVE and RA also significantly eliminated ROS production and diminished IL-6 release. Taken together, both PVE and RA prevent UVB-caused injury to keratinocytes. However their efficacy needs to be demonstrated in vivo. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0999-6Authors Jitka Vostálová, Palacký University Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry Hněvotínská 3 77515 Olomouc Czech RepublicAdéla Zdařilová, Palacký University Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry Hněvotínská 3 77515 Olomouc Czech RepublicAlena Svobodová, Palacký University Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry Hněvotínská 3 77515 Olomouc Czech Republic Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Capparis spinosa protects against oxidative stress in systemic sclerosis dermal fibroblasts

Abstract High reactive oxygen species (ROS), Ha-Ras, and active ERK1/2 in fibroblasts play an essential role in the pathogenesis of systemic sclerosis (SSc). The present study was carried out to evaluate the effects of the ethanol extract from fruits of Capparis Spinosa L. (ECS) on oxidative stress and ROS-ERK1/2-Ha-Ras signal loop in SSc dermal fibroblasts in vitro. Cultured dermal fibroblasts from three SSc patients and three normal controls were treated with ECS by different concentration (10, 50, 100 μg/ml). ECS significantly reduced the production of O2 –, H2O2, and ROS in SSc fibroblasts in a dose-dependent manner. ECS effectively minimized the loss of cell viability and apoptosis induced by H2O2 in normal and SSc fibroblasts. Furthermore, the protective effect of ECS on SSc fibroblasts was more significant than on normal ones. ECS decreased the expression of P-ERK1/2 and Ha-Ras in a dose-dependent manner. In conclusion, ECS exhibits a notable activity in protecting against oxidative stress and interrupting of ROS-ERK1/2-Ha-Ras signal loop in SSc, suggesting its potential protective effects against skin sclerosis. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0998-7Authors Yue-lan Cao, Zhejiang University Department of Dermatology, Second Affiliated Hospital, School of Medicine 88 Jiefang Road 310009 Hangzhou ChinaXin Li, Hangzhou Center for Disease Control and Prevention Department of STD and AIDS Prevention 310006 Hangzhou ChinaMin Zheng, Zhejiang University Department of Dermatology, Second Affiliated Hospital, School of Medicine 88 Jiefang Road 310009 Hangzhou China Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Autoantibody against one of the antioxidant repair enzymes, methionine sulfoxide reductase A, in systemic sclerosis: association with pulmonary fibrosis and vascular damage

Abstract Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis and vascular changes in the skin and internal organs with autoimmune background. It has been suggested that oxidative stress plays an important role in the development of SSc. To determine the prevalence and clinical correlation of autoantibody to methionine sulfoxide reductase A (MSRA), one of the antioxidant repair enzymes, in SSc, serum anti-MSRA autoantibody levels were examined in patients with SSc by enzyme-linked immunosorbent assay using recombinant MSRA. The presence of anti-MSRA antibody was evaluated by immunoblotting. To determine the functional relevance of anti-MSRA antibody in vivo, we assessed whether anti-MSRA antibody was able to inhibit MSRA enzymatic activity. Serum anti-MSRA antibody levels in SSc patients were significantly higher compared to controls and this autoantibody was detected in 33% of SSc patients. Serum anti-MSRA levels were significantly elevated in SSc patients with pulmonary fibrosis, cardiac involvement, or decreased total antioxidant power compared with those without them. Anti-MSRA antibodies also correlated positively with renal vascular damage determined as pulsatility index by color-flow Doppler ultrasonography of the renal interlobar arteries and negatively with pulmonary function tests. Furthermore, anti-MSRA antibody levels correlated positively with serum levels of 8-isoprostane and heat shock protein 70 that are markers of oxidative and cellular stresses. Remarkably, MSRA activity was inhibited by IgG isolated from SSc sera containing IgG anti-MSRA antibody. These results suggest that elevated anti-MSRA autoantibody is associated with the disease severity of SSc and may enhance the oxidative stress by inhibiting MSRA enzymatic activity. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0996-9Authors Fumihide Ogawa, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanKazuhiro Shimizu, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanToshihide Hara, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanEiji Muroi, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanKazuhiro Komura, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanMotoi Takenaka, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 JapanMinoru Hasegawa, Kanazawa University Graduate School of Medical Science Department of Dermatology Kanazawa JapanManabu Fujimoto, Kanazawa University Graduate School of Medical Science Department of Dermatology Kanazawa JapanKazuhiko Takehara, Kanazawa University Graduate School of Medical Science Department of Dermatology Kanazawa JapanShinichi Sato, Nagasaki University Graduate School of Biomedical Sciences Department of Dermatology 1-7-1 Sakamoto Nagasaki 852-8501 Japan Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Upregulation of chemokine (C–C motif) ligand 20 in adult epidermal keratinocytes in direct current electric fields

Abstract Electric fields (EFs) of around 100 mV/mm are present in normal healing wounds and induce the directional migration of epithelial cells. Reepithelialization during wound healing thus may be controlled in part by this electrical signal. In this study, the early transcriptional response of human epidermal keratinocytes to EFs is examined using microarrays. Increased expression of various chemokines, interleukins, and other inflammatory response genes indicates that EFs stimulate keratinocyte activation and immune stimulatory activity. Gene expression activity further suggests that interleukin 1 is either released or activated in EFs. Expression of the chemokine CCL20 steadily increases at 100 mV/mm over time until around 8 h after exposure. This chemokine is also expressed at field strengths of 300 mV/mm—above the level of endogenous wound fields. The early effects of EFs on epithelial gene expression activity identified in these studies suggest the importance of naturally occurring EFs both in repair mechanisms and for the possibility of controlling these responses therapeutically. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0995-xAuthors Jessica Amber Jennings, University of Alabama at Birmingham Department of Biomedical Engineering 1075 13th St. South Birmingham AL 35294 USADongquan Chen, Universtiy of Alabma at Birmingham Biostatistics and Bioinformatics Unit, Comprehensive Cancer Center 1530 3rd Avenue South Birmingham AL 35294 USADale S. Feldman, University of Alabama at Birmingham Department of Biomedical Engineering 1075 13th St. South Birmingham AL 35294 USA Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Effects of a three-session skin rejuvenation treatment using stabilized hyaluronic acid-based gel of non-animal origin on skin elasticity: a pilot study

Abstract The purpose of this study was to evaluate in vivo the effects of micropuncture injections of stabilized hyaluronic acid-based gel of non-animal origin (NASHA™, Restylane Vital™) on skin elasticity, a major aspect of skin ageing. Patients (n = 19) underwent a series of three treatment sessions, spaced 4 weeks apart, with NASHA injected into the lower facial cheeks. Using the suction principle, 12 parameters describing the viscoelastic properties of the skin were assessed, before each treatment session and at follow-up visits 4 and 16 weeks after the last treatment. Treatment with NASHA significantly increased skin firmness and improved its viscoelastic recovery capacities. The most significant differences from baseline were noted at the end of the study. The changes observed in this study may underlie some of the cosmetic improvements noted after treatment with NASHA. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0988-9Authors Tilmann Reuther, University of Hamburg Division of Cosmetic Sciences, Department of Chemistry Martin-Luther-King-Platz 6 20146 Hamburg GermanyJulia Bayrhammer, University of Hamburg Division of Cosmetic Sciences, Department of Chemistry Martin-Luther-King-Platz 6 20146 Hamburg GermanyMartina Kerscher, University of Hamburg Division of Cosmetic Sciences, Department of Chemistry Martin-Luther-King-Platz 6 20146 Hamburg Germany Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Patented natural avocado sugars modulate the HBD-2 expression in human keratinocytes through the involvement of protein kinase C and protein tyrosine kinases

Abstract Skin keratinocytes constitute a protective mechanical barrier against invading microorganisms. Stimulated keratinocytes produce endogenous peptides such as the β-defensins that have direct antimicrobial activity against a broad spectrum of pathogens, including most bacteria, certain fungi and enveloped viruses. In particular, human β-defensin 2 (HBD-2) is virtually absent in normal skin and its expression in human keratinocytes requires stimulation by cytokines or bacteria. AV119, a patented avocado sugar, triggers the up-regulation of HBD-2, but the signalling mechanisms involved in this up-regulation in stimulated keratinocytes are not fully understood. In the present study, we examined the intracellular signalling pathways and nuclear responses in skin keratinocytes that contribute to HBD-2 gene expression upon stimulation with AV119. Our data provide information on signalling pathways in which the activation of protein tyrosine kinases (PTKs) and protein kinase C (PKC) takes place and leads to AP-1 and HBD-2 gene activation. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0991-1Authors Iole Paoletti, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyElisabetta Buommino, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyLaura Tudisco, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyCaroline Baudouin, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyPhilippe Msika, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyMaria Antonietta Tufano, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyAdone Baroni, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples ItalyGiovanna Donnarumma, Second University of Naples Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology Via Costantinopoli, 16 80100 Naples Italy Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

The UV response of the skin: a review of the MAPK, NFκB and TNFα signal transduction pathways

Abstract The sun emits different types of ultraviolet (UV) light. Our skin is a natural target of UV radiation which is involved in vitamin D3 production in our body. UV radiation at high doses is an environmental carcinogen which can elicit skin damage as well as inducing skin cancer. It can mediate inflammatory and immunological reactions through activation of receptors, DNA/RNA damage and production of reactive oxygen species. It is also involved in the release of pro-inflammatory cytokines, of which TNFα has been implicated in tumorigenic activities. In order to mediate its effects, UV radiation is known to activate multiple signalling cascades such as the p38 MAPK, Jun N-terminal kinase, extracellular signal-regulated kinase 1/2 and NFκB pathways in skin cells. The role each of these pathways plays in mediating the release of cytokines such as TNFα remains to be fully characterized. Once the function of these pathways is known, this information may provide for the formulation of therapy which will prevent the release of immunosuppressive cytokines resulting in a reduction in skin cancer formation. Content Type Journal ArticleCategory Mini ReviewDOI 10.1007/s00403-009-0994-yAuthors Visalini Muthusamy, RMIT University School of Medical Sciences PO Box 71 Bundoora VIC 3083 AustraliaTerrence J. Piva, RMIT University School of Medical Sciences PO Box 71 Bundoora VIC 3083 Australia Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Effect of lipopolysaccharide, skin sensitizers and irritants on thioredoxin-1 expression in dendritic cells: relevance of different signalling pathways

Abstract Thioredoxin-1 is a ubiquitous protein involved in phenotypical and functional changes in dendritic cells (DC). We investigated the effect of lipopolysaccharide (LPS), skin sensitizers, and irritants on thioredoxin-1 by Western blot and immunofluorescence and on mRNA by real-time PCR. As DC models, we used a skin DC line and DC derived from human blood monocytes. We observed that all tested chemicals increased thioredoxin-1 expression, which is only transient for irritants, being the strongest effect observed for LPS (63 ± 15%). To address the involvement of thioredoxin-1 in DC maturation, we analysed the effect of an activator of thioredoxin-1 expression, hydrogen peroxide, on CD86 expression, a marker of DC maturation. We found that hydrogen peroxide increases thioredoxin-1 and CD86 expression reinforcing thioredoxin-1 involvement in DC maturation. Because mitogen-activated protein kinases and PI3K are activated upon DC maturation, we also analysed their involvement in thioredoxin-1 modulation. We verified that LPS-induced upregulation of thioredoxin-1 expression was dependent on PI3K pathway. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0993-zAuthors Vera Francisco, University of Coimbra Center for Neuroscience and Cell Biology 3004-517 Coimbra PortugalBruno Miguel Neves, University of Coimbra Center for Neuroscience and Cell Biology 3004-517 Coimbra PortugalMaria Teresa Cruz, University of Coimbra Center for Neuroscience and Cell Biology 3004-517 Coimbra PortugalMargarida Gonçalo, Coimbra’s University Hospitals Department of Dermatology, Faculty of Medicine Praceta Dr. Mota Pinto 3004-561 Coimbra PortugalAmérico Figueiredo, Coimbra’s University Hospitals Department of Dermatology, Faculty of Medicine Praceta Dr. Mota Pinto 3004-561 Coimbra PortugalCarlos B. Duarte, University of Coimbra Center for Neuroscience and Cell Biology 3004-517 Coimbra PortugalMaria Celeste Lopes, University of Coimbra Center for Neuroscience and Cell Biology 3004-517 Coimbra Portugal Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Lymphocyte subsets in peripheral blood of patients with psoriasis before and after treatment with leishmania antigens

Abstract Peripheral blood mononuclear cells (PBMC) collected from subjects prior to treatment and post-treatment with a vaccine composed of leishmania antigens were analyzed by flow cytometry. Upon analysis, it was noticed that lymphocyte subsets (LS) varied with psoriasis area and severity index (PASI) range (1–10, 11–20 and 21–72). Pre-treatment absolute values of gated LS were as follows. CD4+CD8−, CD3+CD8−, CD8+CD3+, CD8+CD4− and CD8+HLA− decreased in PBMC as PASI increased, suggesting migration from the blood to the skin. Contrary to the previous finding, the following LS, CD8+HLA+ and HLA+CD8−, and membrane surface immunoglobulin IgA+, IgD+ and IgM+ increased in PBMC as PASI increased, suggesting activation and proliferation by unknown antigens. After treatment with seven doses of AS100, the following LS, CD3+CD8−, CD8+CD3−, HLA+CD8−, CD8+HLA+ and CD4+CD8−, increased, while CD8+CD3+, CD8+HLA−, CD19 and CD8+CD4+ decreased in PBMC. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0992-0Authors Jose Antonio O’Daly, Astralis LTD. 75 Passaic Ave. Fairfield NJ 07004 USABeatriz Rodriguez, Instituto Venezolano de Investigaciones Científicas Altos de Pipe Km. 10 Carretera Panamericana Caracas 1010A VenezuelaTania Ovalles, Instituto Venezolano de Investigaciones Científicas Altos de Pipe Km. 10 Carretera Panamericana Caracas 1010A VenezuelaCivel Pelaez, Center for Psoriasis Research and Treatment Ave. Las Ciencias, Calle Codazzi, Los Chaguaramos Caracas Venezuela Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Genetic evidence for involvement of the IL23 pathway in Thai psoriatics

Abstract A recent genome-wide association analysis of psoriasis identified IL12B and IL23R as significantly associated with psoriasis. Here we report association test results of a Thai cohort consisting of 206 psoriasis cases and 114 controls. The IL23R SNPs rs7530511 and rs11209026, and IL12B SNPs rs3212227 and rs6887695 were genotyped using Taqman assays. Data were analyzed using a logistic regression model for linear trend of association. One of the IL23R markers, rs7530511, was marginally significant (P = 0.017). The other IL23R marker, rs11209026, was not polymorphic. One of the IL12B markers, rs3212227, showed significant association with psoriasis (OR = 1.64, P = 0.0058) while the other, rs6887695, did not (OR = 1.29, P = 0.12). Haplotype analysis of the two IL12B SNPs yielded highly significant association (P = 0.00081, OR = 1.73). These results showed that IL12B is an important genetic factor in psoriasis pathogenesis in the Thai population, with an association strong enough to yield significant confirmatory evidence using a modest sample size. Together with previously reported evidence for IL12B association in Caucasian, Japanese, and Chinese psoriatics, our results support the hypothesis that genes encoding components of the IL23-mediated inflammatory pathway are important determinants of psoriasis pathogenesis across multiple racial groups. Content Type Journal ArticleCategory Short CommunicationDOI 10.1007/s00403-009-0986-yAuthors Rajan P. Nair, University of Michigan Department of Dermatology 3430 CCGC, Box 5932 1500 East Medical Center Dr. Ann Arbor MI 48109-5932 USAPhilip E. Stuart, University of Michigan Department of Dermatology 3430 CCGC, Box 5932 1500 East Medical Center Dr. Ann Arbor MI 48109-5932 USAPreya Kullavanijaya, Institute of Dermatology Bangkok ThailandPrisana Kullavanijaya, Institute of Dermatology Bangkok ThailandTrilokraj Tejasvi, University of Michigan Department of Dermatology 3430 CCGC, Box 5932 1500 East Medical Center Dr. Ann Arbor MI 48109-5932 USAJohn J. Voorhees, University of Michigan Department of Dermatology 1910 TC, Box 5314 1500 East Medical Center Dr. Ann Arbor MI 48109-5314 USAJames T. Elder, University of Michigan Department of Dermatology 3312 CCGC, Box 5932 1500 East Medical Center Dr. Ann Arbor MI 48109-5932 USA Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Rhodiola rosea ability to enrich cellular antioxidant defences of cultured human keratinocytes

Abstract Keratinocytes are cells strongly exposed to oxidative stress, but normally good equipped for antioxidant responses. However, it has long been suggested that exogenous antioxidants could play a useful role in minimizing the adverse skin responses associated with such oxidant species. In this work it was paid attention to the extract of Rhodiola rosea L. roots by using the phytocomplex as a whole because of the important activity of its composition and mutual distribution of its components. We have measured the protection afforded by the extract to reduced glutathione levels, glyceraldehyde-3-phosphate dehydrogenase activity, and thiobarbituric acid reactive substances levels in cultured human keratinocytes (NCTC 2544) exposed to different oxidative insults: Fe(II)/ascorbate, Fe(II)/H2O2, and tert-butyl-hydroperoxide. We also have investigated the influence of the R. rosea extract on the production of intracellular reactive oxygen species and on the activity of antioxidant enzymes (catalase, superoxide dismutase, glutathione peroxidase, and glutathione reductase). Furthermore, we have demonstrated that R. rosea extract was able to increase in a time- and dose-dependent manner the activity of the trans plasma membrane oxido reductase activity as an indirect evaluation of the intracellular redox status and this effect was already evident with small concentration of the extract and in a long time. As a result, NCTC 2544 are able to better counteract to several oxidative insults if incubated with R. rosea extract demonstrating a very good antioxidant activity of this phytocomplex. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0985-zAuthors Cinzia Calcabrini, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyRoberta De Bellis, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyUmberto Mancini, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyLuigi Cucchiarini, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyLucia Potenza, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyRoberta De Sanctis, Università degli Studi di Urbino “Carlo Bo” Istituto di Chimica Biologica “Giorgio Fornaini” Via A. Saffi, 2 61029 Urbino PU ItalyVania Patrone, Università degli Studi di Urbino “Carlo Bo” Istituto di Igiene Urbino PU ItalyCarla Scesa, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome ItalyMarina Dachà, Università Campus Bio-Medico Rome Italy Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Expression and function of glycogen synthase kinase-3 in human hair follicles

Abstract β-Catenin is involved in the hair follicle morphogenesis and stem cell differentiation, and inhibition of glycogen synthase kinase-3 (GSK-3) increases β-catenin concentration in the cytoplasm. To examine the effects of GSK-3 inhibition on the hair follicle epithelium, we first examined the expression of GSK-3 in plucked human hair follicles by RT-PCR and found GSK-3 expression in hair follicles. Western blotting with a GSK-3β-specific antibody, Y174, also demonstrated GSK-3β expression in the follicles. Moreover, GSK-3β immunostaining with Y174 showed that GSK-3β colocalized with hair follicle bulge markers. Contrary to GSK-3β, GSK-3α was widely expressed throughout the follicles when immunostained with a specific antibody, EP793Y. We then investigated the influence of GSK-3 inhibition. A GSK-3 inhibitor, BIO, promoted the growth of human outer root sheath cells, which could be cultured for up to four passages. The BIO-treated cells exhibited smaller and more undifferentiated morphology than control cells. Moreover, in organ culture of plucked human hair, outer root sheath cells in the middle of a hair follicle proliferated when cultured with BIO. These results indicate that GSK-3β is expressed in hair bulge stem cells and BIO promotes the growth of ORS cells, possibly by regulating the GSK-3 signaling pathway. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0987-xAuthors Koichi Yamauchi, Hair Clinic Reve-21 Corporation 2-1-61 Shiromi, Chuo-ku Osaka 540-6122 JapanAkira Kurosaka, Kyoto Sangyo University Department of Biotechnology, Faculty of Engineering Kamigamo-motoyama, Kita-ku Kyoto 603-8555 Japan Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Comparison between human fetal and adult skin

Abstract Healing of early-gestation fetal wounds results in scarless healing. Since the capacity for regeneration is probably inherent to the fetal skin itself, knowledge of the fetal skin composition may contribute to the understanding of fetal wound healing. The aim of this study was to analyze the expression profiles of different epidermal and dermal components in the human fetal and adult skin. In the human fetal skin (ranging from 13 to 22 weeks’ gestation) and adult skin biopsies, the expression patterns of several epidermal proteins (K10, K14, K16, K17, SKALP, involucrin), basement membrane proteins, Ki-67, blood vessels and extracellular matrix proteins (fibronectin, chondroitin sulfate, elastin) were determined using immunohistochemistry. The expression profiles of K17, involucrin, dermal Ki-67, fibronectin and chondroitin sulfate were higher in the fetal skin than in adult skin. In the fetal skin, elastin was not present in the dermis, but it was found in the adult skin. The expression patterns of basement membrane proteins, blood vessels, K10, K14, K16 and epidermal Ki-67 were similar in human fetal skin and adult skin. In this systematic overview, most of the differences between fetal and adult skin were found at the level of dermal extracellular matrix molecules expression. This study suggests that, especially, dermal components are important in fetal scarless healing. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0989-8Authors Neeltje A. Coolen, Association of Dutch Burn Centres P.O. Box 1015 1940 EA Beverwijk The NetherlandsKelly C. W. M. Schouten, Association of Dutch Burn Centres P.O. Box 1015 1940 EA Beverwijk The NetherlandsEsther Middelkoop, Association of Dutch Burn Centres P.O. Box 1015 1940 EA Beverwijk The NetherlandsMagda M. W. Ulrich, Association of Dutch Burn Centres P.O. Box 1015 1940 EA Beverwijk The Netherlands Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Behçet’s disease: an algorithmic approach to its treatment

Abstract Behçet’s disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology with the clinical features of mucocutaneous lesions, ocular, vascular, articular, gastrointestinal, urogenital, pulmonary, and neurologic involvement. Mucocutaneous lesions figure prominently in the presentation and diagnosis, and may be considered the hallmarks of BD. Therefore, their recognition may permit earlier diagnosis and treatment. Although, the treatment has become much more effective in recent years, BD is still associated with severe morbidity and considerable mortality. The main aim of the treatment should be the prevention of irreversible organ damage. Therefore, close monitoring, early and appropriate treatment is mandatory to reduce morbidity and mortality. We reviewed the current state of knowledge regarding the therapeutic approaches for BD and designed a stepwise, symptom-based, algorithmic approach, mainly based on controlled studies and our clinical experience in this field to provide a rational framework for selecting the appropriate therapy along the various treatment choices. Content Type Journal ArticleCategory Mini ReviewDOI 10.1007/s00403-009-0990-2Authors Erkan Alpsoy, Akdeniz University School of Medicine Department of Dermatology and Venerology Antalya 07070 TurkeyAyse Akman, Akdeniz University School of Medicine Department of Dermatology and Venerology Antalya 07070 Turkey Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696 Journal Volume Volume 301 Journal Issue Volume 301, Number 10 / October, 2009

PCR analysis for Wolbachia in human and canine Demodex mites

Abstract In many skin diseases such as Demodex folliculitis, rosacea- or steroid-induced rosacea Demodex mites are present in abundance and are at least partially held responsible for causing these disorders. Although it is known that these diseases respond well to tetracyclines, it is unclear if this is due to the antiinflammatory effects of the antibiotics or to an antibacterial effect on so far unknown bacteria within the Demodex mites. As in filariasis, where the response to doxycycline can be explained by the presence of Wolbachia within the filarial nematodes, this study was performed to see whether Wolbachia also use Demodex mites as their hosts. Human and canine Demodex mite samples were taken by skin scrapings and tested by PCR for the presence of Wolbachia DNA. Wolbachia pipientis DNA was used as positive control. In none of the DNA extracts, Wolbachia were detected showing no evidence for the presence of these bacteria in Demodex mites. The response of Demodex aggravated or Demodex caused diseases to tetracyclines seems not to be due to the presence of Wolbachia in Demodex mites in contrast to the results seen in filariasis. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0984-0Authors Sibylle N. Borgo, Ludwig-Maximilian-University Department of Dermatology and Allergology Frauenlobstrasse 9-11 80337 Munich GermanyElke C. Sattler, Ludwig-Maximilian-University Department of Dermatology and Allergology Frauenlobstrasse 9-11 80337 Munich GermanyMichael Hogardt, Ludwig-Maximilian-University Max von Pettenkofer-Institute for Hygiene and Medical Microbiology Munich GermanyKristin Adler, Ludwig-Maximilian-University Max von Pettenkofer-Institute for Hygiene and Medical Microbiology Munich GermanyGerd Plewig, Ludwig-Maximilian-University Department of Dermatology and Allergology Frauenlobstrasse 9-11 80337 Munich Germany Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696 Journal Volume Volume 301 Journal Issue Volume 301, Number 10 / October, 2009

Topical tamoxifen therapy in hypertrophic scars or keloids in burns

Abstract As acute burn patients have experienced increasing survival rates, the number of patients who need specific care due to aberrant scarring is also increasing. The burned skin often responds with fibrotic tissue proliferation, which can lead to a hypertrophic scar or a keloid. Non-physiologic scars are mostly not acceptable for the burn patient. Intradermal and topical therapy in burns comprise the treatment of the skin injury and its possible texture, elasticity and color alterations with the aid of active substances that result in fibroblastic modulation. An alteration of cytokine levels may mediate these effects, and evidences suggest that keloid scar formation may be mediated, in part, by deranged growth factor activity, including that of transforming growth factor (TGF)-β1. The addition of tamoxifen, a non-steroidal anti-estrogen, usually used in breast cancer, to standard treatment may lead to improved wound healing in keloids by decreasing the expression of TGF-β1, with the consequent inhibitions of both fibroblast proliferation and collagen production. Topical tamoxifen citrate chemical treatment has been shown to improve scarring. However, prospective studies must be undertaken to validate the inclusion of tamoxifen into standard clinical practice. Content Type Journal ArticleCategory News and ViewsDOI 10.1007/s00403-009-0983-1Authors Alfredo Gragnani, Federal University of Sao Paulo Division of Plastic Surgery, Department of Surgery Napoleão de Barros St 715, 4th Floor Sao Paulo 04024-002 SP BrazilMario Warde, Federal University of Sao Paulo Division of Plastic Surgery, Department of Surgery Napoleão de Barros St 715, 4th Floor Sao Paulo 04024-002 SP BrazilFabianne Furtado, Federal University of Sao Paulo Division of Plastic Surgery, Department of Surgery Napoleão de Barros St 715, 4th Floor Sao Paulo 04024-002 SP BrazilLydia Masako Ferreira, Federal University of Sao Paulo Division of Plastic Surgery, Department of Surgery Napoleão de Barros St 715, 4th Floor Sao Paulo 04024-002 SP Brazil Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Validity, reliability, and sensitivity-to-change properties of the psoriatic arthritis screening and evaluation questionnaire

Abstract Psoriatic arthritis (PsA) is an inflammatory arthritis associated with irreversible joint damage in a subset of individuals. There is a need to screen early for this condition to prevent damage. To meet this need, we have developed the psoriatic arthritis screening and evaluation (PASE) questionnaire. The 15-item PASE questionnaire was administered to 190 individuals with either psoriasis or PsA. The PASE questionnaire was readministered to a subset of individuals with PsA in order to assess test–retest reliability and sensitivity-to-change. Receiver operator curves were constructed to optimize sensitivity and specificity for the diagnosis of PsA. Of the 190 participating in the study, 19.5% (37/191) participants were diagnosed with PsA. PASE total scores ranged from 15 to 74 (possible range, 15–75). The PsA group had a median Total score of 51 (25th and 75th percentile 44 and 57), and non-PsA group had a median total score of 34 (25th and 75th percentile 21 and 49) (p < 0.001). A PASE total score of 44 was able to distinguish PsA from non-PsA participants with 76% sensitivity and 76% specificity. Furthermore, 13 of the 15 items demonstrated significant test–retest reliability as assessed by Pearson correlation coefficient (r ≥ 0.5). PASE was sensitive-to-change with therapy; PASE scores were significantly lower for PsA individuals after systemic therapy (p < 0.034). The PASE questionnaire is a valid and reliable tool to screen for active PsA among individuals with psoriasis. PASE scores may be used as a marker of therapeutic response. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0981-3Authors Patrick Lee Dominguez, Harvard Medical School Department of Dermatology, Center for Skin and Related Musculoskeletal Diseases, Brigham and Women’s Hospital (BWH) 45 Francis St, 221L Boston MA 02115 USAM. Elaine Husni, Cleveland Clinic Foundation Department of Rheumatologic and Immunologic Diseases Cleveland OH USAElizabeth W. Holt, Tulane School of Public Health and Tropical Medicine Department of Epidemiology New Orleans LA USAStephanie Tyler, Harvard Medical School Department of Dermatology, Center for Skin and Related Musculoskeletal Diseases, Brigham and Women’s Hospital (BWH) 45 Francis St, 221L Boston MA 02115 USAAbrar A. Qureshi, Harvard Medical School Department of Dermatology, Center for Skin and Related Musculoskeletal Diseases, Brigham and Women’s Hospital (BWH) 45 Francis St, 221L Boston MA 02115 USA Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696 Journal Volume Volume 301 Journal Issue Volume 301, Number 8 / September, 2009

Decrease in Mycobacterium tuberculosis specific immune responses in patients with untreated psoriasis living in a tuberculosis endemic area

Abstract Tuberculosis has emerged as a major concern in patients with immuno-mediated diseases, including psoriasis, undergoing treatment with biologicals. However, it is not known whether the chronically activated immune system of psoriasis patients interferes with their Mycobacterium tuberculosis (Mtb)-specific immunity, especially in tuberculosis-endemic areas like Brazil. We evaluated T-cell responses to a Mtb lysate and to the recombinant Mtb proteins ESAT-6 and Ag85B of tuberculin skin test (TST) positive and TST negative patients with severe or mild/moderate, untreated psoriasis in three different assays: lymphocyte proliferation, enzyme immunoassay for interferon (IFN)-γ and interleukin (IL)-10 production by peripheral blood mononuclear cells and overnight enzyme immunospot (ELISpot) for enumerating IFN-γ-secreting cells. In our cohort, a low proportion (29%) of the severe psoriasis patients tested were TST-positive. IFN-γ and IL-10 secretion and T-cell proliferation to Mtb antigens were reduced in TST-negative but not in TST-positive patients with severe psoriasis when compared to healthy controls with the same TST status. Similarly, severe psoriasis patients had decreased cytokine secretion and proliferative response to phytohemagglutinin. However, most psoriasis patients and healthy controls showed detectable numbers of IFN-γ-secreting effector-memory T-cells in response to Mtb antigens by ELISpot. TST-negative, mild/moderate psoriasis patients had responses that were mostly intermediary between TST-negative controls and severe psoriasis patients. Thus, patients with severe psoriasis possess decreased anti-Mtb central memory T-cell responses, which may lead to false-negative results in the diagnosis of TB infection, but retain T-cell memory-effector activity against Mtb antigens. We hypothesize that the latter may confer some protection against tuberculosis reactivation. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0982-2Authors Léia C. R. Silva, Medical School of the University of São Paulo Laboratory of Dermatology and Immunodeficiencies Av. Dr. Enéas de Carvalho Aguiar 500 3º. Floor Sao Paulo BrazilGuilherme G. Silveira, Medical School of the University of São Paulo Laboratory of Dermatology and Immunodeficiencies Av. Dr. Enéas de Carvalho Aguiar 500 3º. Floor Sao Paulo BrazilMarcelo Arnone, Medical School of the University of São Paulo Division of Clinical Dermatology, Hospital das Clínicas Av. Dr. Enéas de Carvalho Aguiar 255 Sao Paulo BrazilRicardo Romiti, Medical School of the University of São Paulo Division of Clinical Dermatology, Hospital das Clínicas Av. Dr. Enéas de Carvalho Aguiar 255 Sao Paulo BrazilAnnemiek Geluk, Leiden University Medical Center Department of Infectious Diseases Leiden The NetherlandsKees C. L. M. Franken, Leiden University Medical Center Department of Infectious Diseases Leiden The NetherlandsAlberto José da Silva Duarte, Medical School of the University of São Paulo Laboratory of Dermatology and Immunodeficiencies Av. Dr. Enéas de Carvalho Aguiar 500 3º. Floor Sao Paulo BrazilMaria Denise Fonseca Takahashi, Medical School of the University of São Paulo Division of Clinical Dermatology, Hospital das Clínicas Av. Dr. Enéas de Carvalho Aguiar 255 Sao Paulo BrazilGil Benard, Medical School of the University of São Paulo Laboratory of Dermatology and Immunodeficiencies Av. Dr. Enéas de Carvalho Aguiar 500 3º. Floor Sao Paulo Brazil Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Do guidelines change the way we treat? Studying prescription behaviour among private practitioners before and after the publication of the German Psoriasis Guidelines

Abstract Evidence-based psoriasis treatment guidelines may help physicians overcome uncertainties in initiating and monitoring systemic treatment and have thus been suggested as a tool for improving the care provided to psoriasis patients. A prospective cohort study of dermatologists’ prescription behaviour was performed with two consecutive documentation periods (before and after the publication of the guidelines). 49 dermatologists were asked to provide continuous documentation of their treatment choices for patients with psoriasis by filling in a standardised documentation form. In addition, a questionnaire consisting of eight items was used to assess familiarity with, attitudes towards, and the impact of the psoriasis guidelines on the participating dermatologists. 49 dermatologists documented their treatment choices during 4,491 patient visits before and 4,120 visits after the publication of the German national psoriasis treatment guidelines. The average proportion of prescribed systemic treatments for patients with moderate to severe psoriasis increased from 31 to 35% after the guidelines were published. 80% of the participants stated that the guidelines had led to changes in their treatment decisions, whereas only 20% stated that the guidelines had had no impact in this regard. All but one participant considered the guidelines “useful” or “very useful”. The results of the study show that guidelines can be an important tool for improving the quality of care provided to patients with psoriasis. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0978-yAuthors Alexander Nast, Charité Universitätsmedizin-Berlin Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Campus Charité Mitte, Charitéplatz 1 10117 Berlin GermanyR. Erdmann, Charité Universitätsmedizin-Berlin Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Campus Charité Mitte, Charitéplatz 1 10117 Berlin GermanyV. Hofelich, Charité Universitätsmedizin-Berlin Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Campus Charité Mitte, Charitéplatz 1 10117 Berlin GermanyN. Reytan, Charité Universitätsmedizin-Berlin Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Campus Charité Mitte, Charitéplatz 1 10117 Berlin GermanyH. Orawa, Charité Universitätsmedizin Koordinierungszentrum für klinische Studien, Abteilung für Biometrie und Datenmanagement Berlin GermanyW. Sterry, Charité Universitätsmedizin Klinik für Dermatologie Berlin GermanyB. Rzany, Charité Universitätsmedizin-Berlin Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Campus Charité Mitte, Charitéplatz 1 10117 Berlin Germany Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696 Journal Volume Volume 301 Journal Issue Volume 301, Number 8 / September, 2009

Gingko biloba extract reduces VEGF and CXCL-8/IL-8 levels in keratinocytes with cumulative effect with epigallocatechin-3-gallate

Abstract In skin inflammation, vascular endothelial growth factor (VEGF) and CXCL-8/IL-8 play an important role and are produced by activated keratinocytes. Extracts from Ginkgo biloba leaves (GBE), widely used in phytotherapy, have been reported to exert antioxidant and anti-inflammatory properties in the skin. We therefore evaluated the effects of GBE on the release of VEGF and CXCL8/IL-8 by normal human keratinocytes (NHKs) activated by tumor necrosis factor α (TNFα). Moreover, as we previously showed that epigallocatechin-3-gallate (EGCG) reduces VEGF and CXCL8/IL-8 secretion in TNFα-activated NHKs, we also tested its effect in association with GBE. Our results showed that GBE exerted a potent inhibition on VEGF and CXCL8/IL-8 levels in activated cells. In association with EGCG, GBE down-regulated VEGF and CXCL8/IL-8 levels in a cumulative manner in TNFα-stimulated NHKs. These results suggest that GBE, alone or in association with EGCG may contribute to moderate inflammatory processes in skin diseases associated with angiogenesis. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00403-009-0979-xAuthors Sandra Trompezinski, Université de Lyon, EA4169, Hôpital E. Herriot 69437 Lyon FranceMarlène Bonneville, Laboratoire Dermatologique Bioderma 75 Cours Albert Thomas 69003 Lyon FranceIngrid Pernet, DIPTA, 505, rue Pierre Berthier 13855 Aix-en-Provence FranceAlain Denis, Laboratoire Dermatologique Bioderma 75 Cours Albert Thomas 69003 Lyon FranceDaniel Schmitt, Université de Lyon, EA4169, Hôpital E. Herriot 69437 Lyon FranceJacqueline Viac, Université de Lyon, EA4169, Hôpital E. Herriot 69437 Lyon France Journal Archives of Dermatological ResearchOnline ISSN 1432-069XPrint ISSN 0340-3696

Professional use of the internet among Saudi Arabian dermatologists: a cross-sectional survey

Background: The internet is an increasingly important tool for physicians, but the extent to which it is used by dermatologists is unknown. We aimed to investigate the utilization of the internet by dermatologists in Saudi Arabia for medical purposes during their daily practice and to clarify the reasons for its use and non-use. Methods: A self-administered questionnaire was distributed to all 160 dermatologists attending the National Dermatology conference in 2007. Results: A total of 107 questionnaires were completed. Sixty-two percent of respondents had access to the internet in the workplace. The use of the internet to update medical knowledge was reported by 91%.Only 27% had internet access in consultation rooms. The majority of information retrieval occurred outside patient consultation hours (91%).Only 13% reported using the internet during patient consultation. Possible reasons included: lack of access (54%), time pressure (37%), possible interference with the physician-patient relationship (30%), and that use of the internet was too time-consuming (10%). The mean searching time used to solve a clinical problem was 34 ± 3 minutes. Fifty-eight percent used Pubmed; however, 77% of the dermatologists had no training at all in how to use this tool. Conclusion: Professional medical use of the internet is widespread among dermatologists in Saudi Arabia. Providing access to the internet in the workplace and training of dermatologists to perform effective electronic searches are badly needed to improve the professional medical use of internet, which is expected to lead to better delivery of patient care.

Volumizing effects of a smooth, highly cohesive, viscous 20-mg/mL hyaluronic acid volumizing filler: prospective European study

Background: Facial volume loss contributes significantly to facial aging. The 20-mg/mL hyaluronic acid (HA) formulation used in this study is a smooth, highly cohesive, viscous, fully reversible, volumizing filler indicated to restore facial volume. This first prospective study evaluated use in current aesthetic clinical practice. Methods: A pan-European evaluation conducted under guidelines of the World Association of Opinion and Marketing Research, the trial comprised a baseline visit (visit 1) and a follow-up (visit 2) at 14 ± 7 days posttreatment. Physicians photographed patients at each visit. Each patient was treated with the 20-mg/mL HA volumizing filler as supplied in standard packaging. Procedural details, aesthetic outcomes, safety, and physician and patient ratings of their experience were recorded. Results: Fifteen physicians and 70 patients (91% female; mean age: 50 years) participated. Mean volume loss at baseline was 3.7 (moderate) on the Facial Volume Loss Scale. Local anesthesia was used in 64.3% of cases. Most injections (85%) were administered with needles rather than cannulas. Of the 208 injections, 59% were in the malar region, primarily above the periosteum. Subcutaneous injections were most common for other sites. The mean total injection volume per patient was 4.6 mL. The mean volume loss score declined significantly (P < .001) to 2.1 at visit 2. On the Global Aesthetic Improvement Scale, 88% and 76% of the treatments were rated very much improved or much improved by physicians and patients, respectively. Of the physicians, 95.6% rated this HA filler as very or fairly easy to use. Similarly, 92% of patients were very likely or quite likely to return for treatment; nearly all (98%) would recommend this treatment to friends. Transient (mean duration: 5.5 days) injection-site adverse events (AEs) occurred in 24 patients. Bruising was the most common AE. Conclusion: The 20-mg/mL smooth, highly cohesive, viscous, volumizing HA filler was effective, well tolerated, and easy to use in current clinical practice. Participants were very likely to recommend this product to colleagues and friends, and patients would be very or quite likely to request this product for future treatments.

Familial keloids in five pedigrees: evidence for autosomal dominant inheritance and phenotypic heterogeneity

Background: Familial keloids have been reported, having either autosomal dominant or autosomal recessive inheritance. We wished to determine the inheritance pattern and phenotype of keloids among multigenerational families, as a prelude to a positional mapping strategy to identify candidate genes. Methods: We studied three African American families, one Afro-Caribbean family and one Asian-American family. Phenotyping including assessing all patients for the presence, distribution, and appearance of keloids, together with the timing of keloid onset and provocative factors. The clinical trial was registered at clinicaltrials.gov (NCT 00005802). Results: Age of keloid onset varied considerably within families, but commonly occurred by the second decade. The fraction of affected individuals was 38%, 45%, 62%, 67% and 73% among the five families respectively. Keloid severity and morphology differed within and between families. A novel finding is that certain families manifest keloids in distinct locations, with one family showing an excess of extremity keloids and two families showing an excess of axilla-groin keloids. Conclusion: Familial keloids appear to most commonly manifest autosomal dominant or semidominant inheritance, and there may be familial patterns of keloid distribution.

Role of the EGF +61A>G polymorphism in melanoma pathogenesis: an experience on a large series of Italian cases and controls.

Background: A single nucleotide polymorphism (61A>G) in the epidermal growth factor (EGF) gene has been implicated in both melanoma pathogenesis and increased melanoma risk. To further evaluate this association, we conducted a case-control study in a clinic-based Italian population. Methods: Individuals with less than 10 (N = 127) or more than 100 (N = 128) benign nevi, and patients with cutaneous melanoma (N = 418) were investigated for the EGF +61A>G polymorphism, using an automated sequencing approach. Results: Overall, no difference in EGF genotype frequencies was observed among subjects with different number of nevi as well as when non-melanoma healthy controls were compared with the melanoma patients. However, a heterogeneous distribution of the frequencies of the G/G genotype was detected among cases and controls originating from North Italy (21.1 and 18.3%, respectively) vs. those from South Italy (12.6 and 17.1%, respectively). Conclusion: Our findings further suggest that EGF +61A>G polymorphism may have a limited impact on predisposition and/or pathogenesis of melanoma and its prevalence may vary in different populations.

A population-based survey on tanning bed use in Germany

Background: The suntanning industry has grown up over the last decade in Europe, mainly because tanned skin is considered socially desirable and attractive. Because of the potential negative impact of artificial tanning on public health, this study was to investigate tanning bed use behaviour, UV related risk perception and beliefs about tanning in the German population. Methods: In 2007, a representative telephone survey was carried out among 1501 German residents aged 14 years and older. Results: More than one fourth (28%) of the German population have used tanning beds at least once before in their lifetime. High-frequency tanning behaviour, i.e. using tanning beds more than 10 times per year, were recorded for 11%. Men and women aged 18 to 44 years and young women under the age of 18 used tanning beds more frequently (>10 times per year). Tanning bed use was positively related to appearance and lifestyle related beliefs as well as to the perception that tanned skin is healthy. Conclusion: This analysis indicates that tanning bed use is common in Germany. The positive relationships of appearance and health related beliefs with tanning bed use are of great concern. The results indicate underlying misconceptions about the positive effect of artificial UV radiation compared to natural UV radiation particular for high-frequency tanners. The data shows the importance as well as the limitations for risk communication in its current effort to inform effectively about the dangers of artificial UV radiation.

HLA-Cw*0602 associates with a twofold higher prevalence of positive streptococcal throat swab at the onset of psoriasis: a case control study

Background: The influence of streptococcal infections in the pathogenesis of psoriasis is not yet understood. In vitro data suggest that streptococcal factors influence T-cell function in psoriasis in a HLA-dependent manner, but studies designed to measure the HLA-C/Streptococci interaction are lacking. In the present study, we hypothesized that there is a statistical interaction between the result of streptococcal throat cultures and the presence of the HLA-Cw*0602 allele in psoriasis patients. Methods: We performed a case control study using the "Stockholm Psoriasis Cohort" consisting of patients consecutively recruited within 12 months of disease onset (Plaque psoriasis = 439, Guttate psoriasis = 143), matched to healthy controls (n = 454) randomly chosen from the Swedish Population Registry. All individuals underwent physical examination including throat swabs and DNA isolation for HLA-Cw*0602 genotyping.The prevalence of positive streptococcal throat swabs and HLA-Cw*0602 was compared between patients and controls and expressed as odds ratios with 95% confidence intervals. Associations were evaluated separately for guttate and plaque psoriasis by Fisher's exact test. Results: Regardless of disease phenotype, the prevalence of positive streptococcal throat swabs in HLA-Cw*0602 positive patients was twice the prevalence among HLA-Cw*0602 negative patients (OR = 5.8 C.I. = 3.57–9.67, p < 0.001), while no difference was observed among Cw*0602 positive versus negative controls.The corresponding odds ratios for the guttate and plaque psoriasis phenotypes were 3.5 (CI = 1.5–8.7, p = 0.01) and 2.3 (CI = 1.0–5.1, p = 0.02) respectively. Conclusion: These findings suggest that among HLA-Cw*0602 positive psoriasis patients, streptococci may contribute to the onset or exacerbation of the inflammatory process independent of the disease phenotype. However, studies on the functional interaction between HLA-C and streptococcal factors are needed.

Prevalence and characteristics of aquagenic pruritus in a young African population

Background: Aquagenic pruritus (AP) occurs during or after contact of the skin with water such as occurs in bathing. Methods: This study aims to describe the prevalence of aquagenic pruritus in a young adult population and describe the circumstances of bathing.A Population-based cross sectional study involving administration of Questionnaires to young adult Nigerians on the occurrence of pruritus associated with bathing. Results: The prevalence of bathing pruritus among respondents in this study was 23.8%. The commonest type of water respondents itch to was rain water (23%) followed by cold water (19%). 8.33% of respondents feels like avoiding bathing because of these. Conclusion: Bathing pruritus is a common finding among young adult Nigerians in the general population.

Evaluation of the in vitro skin permeation of antiviral drugs from penciclovir 1% cream and acyclovir 5% cream used to treat herpes simplex virus infection

Background: Herpes simplex virus infection (HSV) is a common and ubiquitous infection of the skin which causes mucocutaneous lesions called cold sores (herpes labialis) or fever blisters. It is estimated that approximately 80% of the population worldwide are carriers of the Herpes simplex virus, approximately 40% suffer from recurrent recurrent infections. This study evaluates the in vitro skin permeation and penetration of penciclovir and acyclovir from commercialized creams for the treatment of herpes labialis (cold sores), using non viable excised human abdominal skin samples, which were exposed to 5 mg/cm2 of acyclovir 5% cream or penciclovir 1% cream. Methods: After 24 h of cream application, excess cream was washed off and layers of stratum corneum were removed by successive tape stripping. Amounts of active ingredients having penetrated through the skin were measured, as well as the amounts in the washed-off cream, in skin strips and creams remaining in the skin. Molecular modelling was used to evaluate physico-chemical differences between the drugs. Western blot analysis enabled to determine whether the marker of basal cells keratin 5 could be detected in the various tape strips. Results: Application of penciclovir 1% cream yielded higher concentration of drug in the deeper layers of the epidermis as well as a higher drug flux through the skin. Molecular modelling showed two higher hydrophobic moieties for acyclovir. Presence of the basal cell marker keratin 5 was underscored in the deeper tape strips from the skin, giving evidence that both drugs can reach their target cells. Conclusion: Penciclovir 1% cream has the tendency to facilitate the diffusion of the drug through the stratum corneum into the deeper epidermis layers, in which it could reach the target basal cells at effective therapeutical concentration. The small difference in the surface properties between both molecules might also contribute to favour the passage of penciclovir through the epidermis into the deeper basal cells.

Nonlinear modeling of venous leg ulcer healing rates

Background: The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. Methods: We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. Results: A majority (72%) of VLUs exhibited surface area reduction via an exponential decay model, particularly during the early stages of healing. These results were consistent with the mechanics of wound contraction and epithelial cell proliferation, supported by the higher frequency at which exponential surface area reduction associated with full wound closure (35% of wounds that fit the exponential model healed vs. 21% of wounds that did not fit the exponential model completely healed during the study period, p = 0.018). Goodness-of-fit statistics suggested that much of the individual variation in healing could be described as nonlinear variation from the exponential model. Conclusion: We believe that parameter estimates from a mathematical model may provide a more accurate quantification of wound healing rates, and that similar models may someday reach routine use in comparing the efficacy of various treatments in routine practice and in product registration trials.

Mutation analysis of the Gadd45 gene at exon 4 in atypical fibroxanthoma

Background: Atypical fibroxanthoma (AFX) histologically mimics high-grade sarcoma in the skin, although it follows a benign clinical course. AFX occurs in the sun-exposed skin and for this reason, an association with ultraviolet light has long been suspected. Bax and Gadd45 are p53 effector proteins. Bax is a programmed cell death protein and belongs to the Bcl-2 family. Gadd45 is a multifunctional DNA damage-inducible gene associated with the process of DNA damage. Methods: Immunohistochemical expression of Bax was analyzed in 7 cases of AFX, and in 7 cases of benign fibrous histiocytoma (BFH) used as a comparison. The expression pattern of Bax was compared to previously reported p53 and Gadd45 expressions in a correspondent series. Mutation of the Gadd45 gene at exon 4 was also analyzed in AFX. Results: AFX and BFH showed immunoreactivities respectively for Bax (3/7, 0/7), Gadd45 (4/7, 1/7) and p53 (2/7, 0/7). There was no exact correlation between p53 expression and Bax or Gadd45 expression. However, the pattern of expression between Bax and Gadd45 was also the same, with the exception of one case. No mutation of the Gadd45 gene at exon 4 was observed in a series of 6 AFX cases where DNA was available (0/6). Conclusion: These results suggest a possible association between Bax and Gadd45 in AFX, and may refute any possibility of dysfunction of Gadd45 in terms of gene mutation, at least at exon 4 of the Gadd45 gene.