The Scientific World Journal: Dermatology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Pruritus in Systemic Diseases: A Review of Etiological Factors and New Treatment Modalities Thu, 09 Jul 2015 09:42:42 +0000 Pruritus is the most frequently described symptom in dermatology and can significantly impair the patient’s quality of life. In 10–50% of adults with persistent pruritus, it can be an important dermatologic clue for the presence of a significant underlying systemic disease such as renal insufficiency, cholestasis, hematologic disorder, or malignancy (Etter and Myers, 2002; Zirwas and Seraly, 2001). This review describes the presence of pruritus in different systemic diseases. It is quite important to discover the cause of pruritus for providing relief for the patients experiencing substantial morbidity caused by this condition. Nagihan Tarikci, Emek Kocatürk, Şule Güngör, Ilteriş Oğuz Topal, Pelin Ülkümen Can, and Ralfi Singer Copyright © 2015 Nagihan Tarikci et al. All rights reserved. Insulin Resistance and Skin Diseases Tue, 21 Apr 2015 12:22:40 +0000 In medical practice, almost every clinician may encounter patients with skin disease. However, it is not always easy for physicians of all specialties to face the daily task of determining the nature and clinical implication of dermatologic manifestations. Are they confined to the skin, representing a pure dermatologic event? Or are they also markers of internal conditions relating to the patient’s overall health? In this review, we will discuss the principal cutaneous conditions which have been linked to metabolic alterations. Particularly, since insulin has an important role in homeostasis and physiology of the skin, we will focus on the relationships between insulin resistance (IR) and skin diseases, analyzing strongly IR-associated conditions such as acanthosis nigricans, acne, and psoriasis, without neglecting emerging and potential scenarios as the ones represented by hidradenitis suppurativa, androgenetic alopecia, and hirsutism. Maddalena Napolitano, Matteo Megna, and Giuseppe Monfrecola Copyright © 2015 Maddalena Napolitano et al. All rights reserved. Geographic Tongue and Fissured Tongue in 348 Patients with Psoriasis: Correlation with Disease Severity Mon, 19 Jan 2015 09:56:57 +0000 Geographic tongue (GT) and fissured tongue (FT) are the more frequent oral lesions in patients with psoriasis. The aims of this study were to compare the prevalence of GT/FT between psoriasis group (PG) and healthy controls (HC) and investigate the correlation between GT/FT and psoriasis severity using the PASI and age of psoriasis onset. Three hundred and forty-eight PG and 348 HC were selected. According to the age of psoriasis onset, the individuals were classified as having early psoriasis and late psoriasis. The severity of vulgaris psoriasis was determined according to PASI. A follow-up was conducted in patients with psoriasis vulgaris (PV) with GT to evaluate the progression of oral and cutaneous lesions. The FT and GT were more frequent in PG than in HC. The incidence of GT was higher in patients with early psoriasis and that of FT in late-psoriasis. There is association between psoriasis intensity and GT; and a higher monthly decrease of PASI score in patients without GT. The presence of GT and FT is higher in PG than in the HC. GT is associated with disease severity and may be a marker of the psoriasis severity. Bruna L. S. Picciani, Thays T. Souza, Vanessa de Carla B. Santos, Tábata A. Domingos, Sueli Carneiro, João Carlos Avelleira, David R. Azulay, Jane M. N. Pinto, and Eliane P. Dias Copyright © 2015 Bruna L. S. Picciani et al. All rights reserved. Serum Levels of TNF-α, IL-12/23 p40, and IL-17 in Psoriatic Patients with and without Nail Psoriasis: A Cross-Sectional Study Wed, 31 Dec 2014 14:07:48 +0000 Nail involvement has started playing a major role in the overall assessment and management of psoriatic disease. Biologics indicated for moderate to severe chronic plaque psoriasis are shown to be beneficial in nail disease. This study aimed to assess and compare the serum levels of TNF-α, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail involvement. 52 consecutively selected patients with chronic plaque psoriasis were included in this cross-sectional study. Patients were studied and analyzed after they had been divided into 2 groups regarding the presence (n = 24) or not (n = 28) of nail psoriasis. The mean serum levels of TNF-α were significantly higher in the group of psoriatic patients with nail lesions compared to those without (t-test; 5.40 ± 1.17 versus 3.80 ± 1.63, P = 0.026). However, the median serum levels of both IL-12/23 p40 (Mann-Whitney; 92.52 (34.35–126.87) versus 150.68 (35.18–185.86), P = 0.297) and IL-17 (Mann-Whitney; 28.49 (0.00–28.49) versus 8.59 (0.00–8.59), P = 0.714) did not significantly differ between the 2 groups. These results confirm the important role of TNF-α in the pathogenesis of nail psoriasis and may suggest that anti-TNF agents could be more beneficial in psoriatic nail disease than agents targeting IL-12/23 p40 or IL-17 and its receptors. Aikaterini Kyriakou, Aikaterini Patsatsi, Timoleon-Achilleas Vyzantiadis, and Dimitrios Sotiriadis Copyright © 2014 Aikaterini Kyriakou et al. All rights reserved. Dietary Hyaluronic Acid Migrates into the Skin of Rats Tue, 14 Oct 2014 07:52:02 +0000 Hyaluronic acid is a constituent of the skin and helps to maintain hydration. The oral intake of hyaluronic acid increases water in the horny layer as demonstrated by human trials, but in vivo kinetics has not been shown. This study confirmed the absorption, migration, and excretion of 14C-labeled hyaluronic acid (14C-hyaluronic acid). 14C-hyaluronic acid was orally or intravenously administered to male SD rats aged 7 to 8 weeks. Plasma radioactivity after oral administration showed the highest level 8 hours after administration, and orally administered 14C-hyaluronic acid was found in the blood. Approximately 90% of 14C-hyaluronic acid was absorbed from the digestive tract and used as an energy source or a structural constituent of tissues based on tests of the urine, feces, expired air, and cadaver up to 168 hours (one week) after administration. The autoradiographic results suggested that radioactivity was distributed systematically and then reduced over time. The radioactivity was higher in the skin than in the blood at 24 and 96 hours after administration. The results show the possibility that orally administered hyaluronic acid migrated into the skin. No excessive accumulation was observed and more than 90% of the hyaluronic acid was excreted in expired air or urine. Mariko Oe, Koichi Mitsugi, Wataru Odanaka, Hideto Yoshida, Ryosuke Matsuoka, Satoshi Seino, Tomoyuki Kanemitsu, and Yasunobu Masuda Copyright © 2014 Mariko Oe et al. All rights reserved. An Analysis of the Malassezia Species Distribution in the Skin of Patients with Pityriasis Versicolor in Chengdu, China Sun, 10 Aug 2014 13:12:18 +0000 Pityriasis versicolor (PV) is a common clinical problem associated with Malassezia species (Malassezia spp.). Controversies remain regarding the specific species involved in the development of PV. This study analyzed the difference in Malassezia spp. distribution in lesional and nonlesional skin in Chinese PV patients. A paired design was applied. Lesional and nonlesional scales from 24 cases were collected; real-time fluorescence quantitative PCR was used to detect 10 different Malassezia spp. In lesional skin, the highest detection rates were for M. globosa (95.8%), M. restricta (91.7%), and M. sympodialis (50.0%). In nonlesional skin, the highest detection rates were for M. globosa (87.5%), M. restricta (79.2%), and M. dermatis (33.3%). A significant difference in the detection rate was only found for M. sympodialis (50.8% versus 20.8%, . Compared with nonlesional skin, the amount of M. globosa, M. restricta, and M. sympodialis in lesional skin was significantly higher ,  , and times higher, resp.). The results of this study do not indicate that M. globosa and M. restricta are directly correlated with PV development; however, M. sympodialis is more likely related to PV development in Chinese individuals. Zhen Xie, Yuping Ran, Hao Zhang, Min Zhang, Huiying Wan, and Conghui Li Copyright © 2014 Zhen Xie et al. All rights reserved. Cyanoacrylate Skin Surface Stripping and the 3S-Biokit Advent in Tropical Dermatology: A Look from Liège Wed, 06 Aug 2014 06:16:44 +0000 In the dermatopathology field, some simple available laboratory tests require minimum equipment for establishing a diagnosis. Among them, the cyanoacrylate skin surface stripping (CSSS), formerly named skin surface biopsy or follicular biopsy, represents a convenient low cost procedure. It is a minimally invasive method collecting a continuous sheet of stratum corneum and horny follicular casts. In the vast majority of cases, it is painless and is unassociated with adverse events. CSSS can be performed in subjects of any age. The method has a number of applications in diagnostic dermatopathology and cosmetology, as well as in experimental dermatology settings. A series of derived analytic procedures include xerosis grading, comedometry, corneofungimetry, corneodynamics of stratum corneum renewal, corneomelametry, corneosurfametry, and corneoxenometry. Gérald E. Piérard, Claudine Piérard-Franchimont, Philippe Paquet, Trinh Hermanns-Lê, Jean Radermacher, and Philippe Delvenne Copyright © 2014 Gérald E. Piérard et al. All rights reserved. Site-Specific Analysis of Inflammatory Markers in Discoid Lupus Erythematosus Skin Tue, 11 Mar 2014 08:02:57 +0000 Prior studies identified T cells, B cells, and macrophages in the inflammatory infiltrate and up-regulation of their protein products in discoid lupus erythematosus (DLE) skin; however, they lacked rigorous analyses to define their specific locations in skin. Thus, we compared expressions of selected T cell, B cell, and macrophage markers in five areas of DLE, psoriasis, and normal skin. Immunostainings for CD3, CD4, CD8, CD20, CD68, CXCR3, CXCL10, and TIA-1 were performed in biopsies of 23 DLE lesional skin, 11 psoriasis lesional skin, and 5 normal skin. Three independent observers used a graded scale to rate each marker’s presence in the epidermis, dermatoepidermal junction (DEJ), perivascular area, periadnexal area, and deep dermis. DLE lesional skin contained an increased abundance of CD3+, CD8+, and CD68+ cells at the DEJ, and CD20+ and CD68+ cells in the periadnexal area versus psoriasis and normal skin. CXCR3, CXCL10, and TIA-1 were elevated in periadnexal sites of DLE lesional skin versus psoriasis lesional skin. The aggregation of T cells, B cells, macrophages, and their protein products (CXCR3, CXCL10, and TIA-1) in the DEJ and periadnexal area of DLE lesional skin may contribute to the pathology of DLE through a coordinated, sophisticated process. Ryan B. Thorpe, Anna Gray, Kirthi R. Kumar, Joseph S. Susa, and Benjamin F. Chong Copyright © 2014 Ryan B. Thorpe et al. All rights reserved. Extracts of Artocarpus communis Decrease -Melanocyte Stimulating Hormone-Induced Melanogenesis through Activation of ERK and JNK Signaling Pathways Wed, 05 Mar 2014 08:02:13 +0000 Artocarpus communis is an agricultural plant that is also used in folk medicine to prevent skin diseases, including acne and dermatitis. Extracts of A. communis have been used to effectively inhibit melanogenesis; however, the antimelanogenesis mechanism of these extracts has not yet been investigated. The present study utilized a cell-free tyrosinase assay as well as α-melanocyte stimulating hormone- (-MSH-) induced tyrosinase assay conducted in B16F10 cells, performed a cytotoxicity assay, and determined cellular melanin content to examine the effects of a methanolic extract of A. communis (ACM) and various organic partition fractions of A. communis on melanogenesis. In addition, we performed western blot analysis to elucidate the mechanism of their antimelanogenesis effect. Our results indicated that, except for the n-hexane extract, ACM and the various partition extracts at noncytotoxic concentrations effectively decreased melanin content and tyrosinase activity by downregulating microphthalmia-associated transcription factor (MITF) and phosphorylated cAMP response element-binding protein (p-CREB). Moreover, ACM and the partition fractions activated phosphorylation of extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) to inhibit the synthesis of MITF and finally to decrease melanin production. In conclusion, we suggest that noncytotoxic concentrations of ACM and the various partition fractions may be useful as references for developing skin-lighting agents for use in medicines or cosmetics. Yi-Tzu Fu, Chiang-Wen Lee, Horng-Huey Ko, and Feng-Lin Yen Copyright © 2014 Yi-Tzu Fu et al. All rights reserved. IgG, IgM, and IgA Antinuclear Antibodies in Discoid and Systemic Lupus Erythematosus Patients Wed, 05 Mar 2014 06:43:21 +0000 IgG antinuclear antibodies (ANAs) are elevated in patients with systemic lupus erythematosus (SLE) compared with patients with discoid lupus erythematosus (DLE). To provide an expanded immunologic view of circulating ANAs in lupus patients, we compared the expressions of IgG, IgM, and IgA ANAs in DLE and SLE patients. In this cross-sectional study, sera from age-, gender-, and ethnic-matched SLE , DLE , and normal patients were tested for IgG, IgM, and IgA ANAs using enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence (IIF) with monkey esophagus as substrate. ELISAs showed elevated levels of IgG ANA, IgM ANA, and IgG/IgM ANA ratios in SLE patients compared with DLE and normal patients. IgA ANA expression was higher in SLE and DLE patients versus normal patients. IIF studies showed higher percentages of patients positive for IgG, IgM, and IgA ANAs in the SLE group. Higher IgG/IgM ANA ratios in SLE than DLE show enhanced class-switching and a more sustained humoral response in SLE. They also suggest a potential connection of IgM ANAs with disease containment. Sheridan A. Jost, Lin-Chiang Tseng, Loderick A. Matthews, Rebecca Vasquez, Song Zhang, Kim B. Yancey, and Benjamin F. Chong Copyright © 2014 Sheridan A. Jost et al. All rights reserved. Carrier-Based Drug Delivery System for Treatment of Acne Sun, 09 Feb 2014 12:54:16 +0000 Approximately 95% of the population suffers at some point in their lifetime from acne vulgaris. Acne is a multifactorial disease of the pilosebaceous unit. This inflammatory skin disorder is most common in adolescents but also affects neonates, prepubescent children, and adults. Topical conventional systems are associated with various side effects. Novel drug delivery systems have been used to reduce the side effect of drugs commonly used in the topical treatment of acne. Topical treatment of acne with active pharmaceutical ingredients (API) makes direct contact with the target site before entering the systemic circulation which reduces the systemic side effect of the parenteral or oral administration of drug. The objective of the present review is to discuss the conventional delivery systems available for acne, their drawbacks, and limitations. The advantages, disadvantages, and outcome of using various carrier-based delivery systems like liposomes, niosomes, solid lipid nanoparticles, and so forth, are explained. This paper emphasizes approaches to overcome the drawbacks and limitations associated with the conventional system and the advances and application that are poised to further enhance the efficacy of topical acne formulations, offering the possibility of simplified dosing regimen that may improve treatment outcomes using novel delivery system. Amber Vyas, Avinesh Kumar Sonker, and Bina Gidwani Copyright © 2014 Amber Vyas et al. All rights reserved. Cutaneous and Mucosal Lichen Planus: A Comprehensive Review of Clinical Subtypes, Risk Factors, Diagnosis, and Prognosis Thu, 30 Jan 2014 10:03:48 +0000 Lichen planus (LP) is a chronic inflammatory disorder that most often affects middle-aged adults. LP can involve the skin or mucous membranes including the oral, vulvovaginal, esophageal, laryngeal, and conjunctival mucosa. It has different variants based on the morphology of the lesions and the site of involvement. The literature suggests that certain presentations of the disease such as esophageal or ophthalmological involvement are underdiagnosed. The burden of the disease is higher in some variants including hypertrophic LP and erosive oral LP, which may have a more chronic pattern. LP can significantly affect the quality of life of patients as well. Drugs or contact allergens can cause lichenoid reactions as the main differential diagnosis of LP. LP is a T-cell mediated immunologic disease but the responsible antigen remains unidentified. In this paper, we review the history, epidemiology, and clinical subtypes of LP. We also review the histopathologic aspects of the disease, differential diagnoses, immunopathogenesis, and the clinical and genetic correlations. Farzam Gorouhi, Parastoo Davari, and Nasim Fazel Copyright © 2014 Farzam Gorouhi et al. All rights reserved. New Onset of Dermatomyositis/Polymyositis during Anti-TNF-α Therapies: A Systematic Literature Review Wed, 29 Jan 2014 12:38:39 +0000 We performed a systematic search of databases from 1990 to 2013 to identify articles concerning the new onset of dermatomyositis/polymyositis (DM/PM) in patients treated with anti-TNF-α therapy. We retrieved 13 publications describing 20 patients where the new onset of DM/PM after anti-TNF-α therapy was recorded. 17 patients were affected by rheumatoid arthritis (RA), one by Crohn’s disease, one by ankylosing spondilytis, and one by seronegative arthritis. In 91% of the cases antinuclear autoantibodies were detected after the introduction of anti-TNF-α therapy. In 6 patients antisynthetase antibodies were detected and other clinical findings as interstitial lung disease (ILD) were recorded. Improvement of DM/PM after anti-TNF suspension (with the concomitant use of other immunosuppressors) was recorded in 94% of cases. The emergence of DM/PM and antisynthetase syndrome seem to be associated with the use of anti-TNF-α agents, especially in patients with chronic inflammatory diseases (mainly RA) with positive autoantibodies before therapy initiation. In particular, physicians should pay attention to patients affected by RA with positive antisynthetase antibodies and/or history of ILD. In those cases, the use of the TNF-α blocking agents may trigger the onset of PM/DM or antisynthetase syndrome or may aggravate/trigger the lung disease. Alexandra Maria Giovanna Brunasso, Werner Aberer, and Cesare Massone Copyright © 2014 Alexandra Maria Giovanna Brunasso et al. All rights reserved. Effects of Isotretinoin on the Platelet Counts and the Mean Platelet Volume in Patients with Acne Vulgaris Wed, 29 Jan 2014 12:37:03 +0000 Aim. The aim of this study was to evaluate the platelet counts and the mean platelet volume in patients who received isotretinoin for the treatment of acne vulgaris. Method. A total of 110 patients were included in this retrospective study. Complete blood count parameters were recorded prior to and three-months following the treatment. Results. Both platelet counts and the mean platelet volume were significantly decreased following the treatment. No significant differences were noted on the levels of hemoglobin, hematocrit, and white blood cell count. Conclusion. Platelet counts and mean platelet volume significantly decreased following isotretinoin treatment. Since the decrease of platelet counts and the mean platelet volume was seen concomitantly, it is concluded that the effect of isotretinoin was through the suppression of bone marrow. Arzu Ataseven and Aynur Ugur Bilgin Copyright © 2014 Arzu Ataseven and Aynur Ugur Bilgin. All rights reserved. Clinical Features of 705 Borrelia burgdorferi Seropositive Patients in an Endemic Area of Northern Italy Thu, 16 Jan 2014 11:59:59 +0000 Background. Lyme Borreliosis is a multisystemic infection caused by spirochetes of Borrelia burgdorferi sensu lato complex. The features of Lyme Borreliosis may differ in the various geographical areas, primarily between the manifestations found in America and those found in Europe and Asia. Objective. to describe the clinical features of Lyme Borreliosis in an endemic geographic area such as Friuli-Venezia Giulia in the Northeastern part of Italy. Methods. The medical records of patients resulted seropositive for Borrelia burgdorferi have been retrospectively recorded and analyzed. Results. Seven hundred and five patients met the inclusion criteria, 363 males and 342 females. Erythema migrans was the most common manifestation, detected in 437 patients. Other classical cutaneous manifestations included 58 cases of multiple erythema migrans, 7 lymphadenosis benigna cutis, and 18 acrodermatitis chronica atrophicans. The musculoskeletal system was involved in 511 patients. Four hundred and sixty patients presented a neurological involvement. Flu-like symptoms preceded or accompanied or were the only clinical feature in 119 patients. Comments. The manifestations of Lyme borreliosis recorded in this study are similar to the ones of other endemic areas in Europe, even if there are some peculiar features which are different from those reported in Northern Europe and in the USA. Giuseppe Stinco, Maurizio Ruscio, Serena Bergamo, Davide Trotter, and Pasquale Patrone Copyright © 2014 Giuseppe Stinco et al. All rights reserved. Xeroderma Pigmentosum: Man Deprived of His Right to Light Sun, 29 Dec 2013 08:56:05 +0000 Xeroderma pigmentosum (XP) is a hereditary autosomal recessive disorder characterized by photo hypersensitivity of sun exposed tissues and subsequent several-fold increased risk for malignant changes resulting from impaired ability to repair UV-induced DNA damage. Estimated incidences vary from 1 in 20,000 in Japan to 1 in 250,000 in the USA, and approximately 2.3 per million live births in Western Europe. Diagnosis is made clinically by the presence of unusual sunburns or lentiginosis or onset of cancers at an early age. It is confirmed by cellular tests for defective DNA repair. Although there is no cure for XP as of now, skin problems can be ameliorated with the use of sunscreens, sun avoidance methods, and recurrent tumor excisions. Oral isotretinoin and topical application of 5-fluorouracil to treat actinic keratoses are other therapeutic options. T4N5 and photolyase liposomal lotions are innovations in the therapy of XP. Genetic counselling implicating the effect of consanguineous marriages should be considered in the management of XP patients. Subhash Mareddy, Jithendra Reddy, Subhas Babu, and Preethi Balan Copyright © 2013 Subhash Mareddy et al. All rights reserved. Association of Psoriasis Severity with Serum Prolactin, Thyroid Hormones, and Cortisol before and after Treatment Mon, 28 Oct 2013 08:09:31 +0000 Background. Prolactin (PRL) level is proposed to be associated with the severity of psoriasis although the previous studies reported different results. Objective. To find the association between PRL levels and severity of psoriasis before and after treatment. In addition, we aimed to find a difference in prolactin, thyroid stimulating hormone (TSH), thyroid hormones (T3 and T4), and cortisol levels between patients with psoriasis and normal controls. Methods. First, the levels of hormones were measured in 30 patients with psoriasis and 30 matched controls. The severity was assessed by psoriasis area and severity index (PASI). Then, patients were treated, and PASI was assessed every week until achieving PASI-75 response. At this time, the hormones were measured again and compared to the baseline. Results. No statistical significant difference was observed in the mean PRL, T3, T4, TSH, and cortisol levels between cases and controls. Comparing to the baseline, a significant decrease in PRL levels and a significant increase in T3 and serum cortisol levels were observed after treatment (), while the changes in other hormones were not significant. Conclusion. After treatment, PRL significantly decreased, and T3 and cortisol levels significantly increased. No correlation between hormone levels and improvement of PASI score existed. Reza M. Robati, Parviz Toossi, Mohammad Rahmati-Roodsari, Sara Khalilazar, Ehsan Abolhasani, Nastaran Namazi, and Shima Younespour Copyright © 2013 Reza M. Robati et al. All rights reserved. Cyclosporine Regimens in Plaque Psoriasis: An Overview with Special Emphasis on Dose, Duration, and Old and New Treatment Approaches Thu, 25 Jul 2013 11:37:51 +0000 Cyclosporine A (CsA) is one of the most effective systemic drugs available for the treatment of psoriasis, as evidenced by the results of several randomized studies and by a prolonged experience in dermatological setting. In clinical practice, CsA is usually used for the induction of psoriasis remission at a daily dose included in the range of 2.5–5 mg/kg and with intermittent short-term regimens, lasting on average 3–6 months. The magnitude and rapidity of response are dose dependent, as well as the risk of development of adverse events. Therefore, the dose should be tailored to patient’s needs and general characteristics and adjusted during the treatment course according to both the efficacy and tolerability. Some studies support the feasibility of pulse administration of CsA for a few days per week for both the induction and the maintenance of response in psoriasis patients. This paper will review the data on CsA regimens for plaque-type psoriasis and will focus the attention on dose, treatment duration, novel schedules, and role in combination therapies, including the association with biologicals. M. D. Colombo, N. Cassano, G. Bellia, and G. A. Vena Copyright © 2013 M. D. Colombo et al. All rights reserved. Promising New Treatments for Psoriasis Mon, 01 Jul 2013 15:58:34 +0000 Psoriasis is a chronic, proliferative, and inflammatory skin disease affecting 2-3% of the population and is characterized by red plaques with white scales. Psoriasis is a disease that can affect many aspects of professional and social life. Currently, several treatments are available to help control psoriasis such as methotrexate, ciclosporin, and oral retinoids. However, the available treatments are only able to relieve the symptoms and lives of individuals. The discovery of new immunological factors and a better understanding of psoriasis have turned to the use of immunological pathways and could develop new biological drugs against specific immunological elements that cause psoriasis. Biological drugs are less toxic to the body and more effective than traditional therapies. Thus, they should improve the quality of life of patients with psoriasis. This review describes new psoriasis treatments, which are on the market or currently in clinical trials that are being used to treat moderate-to-severe plaque psoriasis. In addition, this paper describes the characteristics and mechanisms in detail. In general, biological drugs are well tolerated and appear to be an effective alternative to conventional therapies. However, their effectiveness and long-term side effects need to be further researched. Sarah Dubois Declercq and Roxane Pouliot Copyright © 2013 Sarah Dubois Declercq and Roxane Pouliot. All rights reserved. Skin Reactions to Pine Processionary Caterpillar Thaumetopoea pityocampa Schiff Mon, 27 May 2013 18:35:03 +0000 Pine caterpillar, Thaumetopoea pityocampa Schiff, is a phyto- and xylophagous lepidopteran, responsible for the delay in the growth or the death of various types of pines. Besides nature damage, pine caterpillar causes dermatological reactions in humans by contact with its irritating larvae hairs. Although the dermatitis occurs among outdoor professionals, it is primarily extraprofessional. Contamination generally occurs in pinewoods, rarely in cities. Means of contamination comprise direct contact with the nest or the processional caterpillar and indirect contact with air dispersed hairs. The dermatitis is generally observed in late spring and particularly from April to June, among campers and tourers. The eruption has its onset 1–12 hours after contact with the hairs and presents with intense and continuous itching. Morphologically, it is strophulus-like and consists of papulous, excoriated, and pinkish lesions on an oedematous base. Diagnosis is usually straightforward. The pathogenetic mechanism of the affection is mechanical, pharmacological, and allergic in nature. Besides skin, T. pityocampa Schiff can involve the eyes and rarely the airways. Despite the considerable damages to humans and nature, pine caterpillar infestation is an underestimated problem; medical literature lists few studies, and often relevant information is referred to local media and popular wisdom. Domenico Bonamonte, Caterina Foti, Michelangelo Vestita, and Gianni Angelini Copyright © 2013 Domenico Bonamonte et al. All rights reserved. Thyroid Autoimmunity and Behçet’s Disease: Is There a Significant Association? Thu, 07 Feb 2013 09:48:45 +0000 Background. Behcet’s disease (BD) could be regarded as an autoimmune disease in many aspects. Autoimmune thyroid disease (ATD) is frequently accompanied by other various autoimmune diseases. Nevertheless, there is not still enough data showing the association between BD and ATD. In addition, no controlled study is present in the PubMed, which evaluates thyroidal autoimmunity using antithyroid peroxidase antibody in a large series of patients with BD. Methods. We aimed to investigate the frequency of ATD in patients with BD. The study included 124 patients with BD and 99 age- and sex-matched healthy volunteers. Results. Autoimmune thyroiditis was noted in 21 cases (16.9%) with BD. In the control group, 22 cases (22.22%) were diagnosed as autoimmune thyroiditis. There was no difference between the groups in respect to thyroid autoantibodies (). There were no statistically significant differences between baseline TSH levels of the BD patients and of the controls (). Statistically, the mean serum free T4 levels of the patients with BD were higher than those of the controls (). Conclusions. No association could be found between BD and ATD. Therefore, it is not of significance to investigate thyroid autoimmunity in BD. Filiz Cebeci, Nahide Onsun, Ayşe Pekdemir, Ahmet R. Uras, and Kadir Kayataş Copyright © 2013 Filiz Cebeci et al. All rights reserved. Predictors of Acquired Perforating Dermatosis in Uremic Patients on Hemodialysis: A Case-Control Study Tue, 11 Dec 2012 14:25:00 +0000 Objectives. The purpose of this study was to identify the predictors of acquired perforating dermatosis (APD) in patients on maintenance hemodialysis (HD). Methods. A case-control study was performed at our outpatient HD center between January 1, 2000 and March 31, 2011. Patients on HD with APD were matched (1 : 2) for gender and age with controls on HD. Conditional logistic regression was used to identify factors associated with APD. Results. A total of 19 patients with APD and 38 age and gender matched patients were enrolled in the study. Univariate logistic regression showed that APD was significantly associated with diabetes mellitus (DM), reduced levels of intact parathyroid hormone (iPTH) and albumin (Alb), reduced dialysis adequacy () and urea reduction rate (URR), and elevated levels of high-sensitivity C-reactive protein (hsCRP). Multivariate logistic regression identified reduced iPTH (hazard ratio (HR): 0.983; ) and Alb (HR: 0.099; ) and elevated hsCRP (HR: 1.210, ) as risk factors for APD. Conclusions. iPTH, hsCRP, and Alb are predictors for APD in HD patients. Cheng-Hao Weng, Ching-Chih Hu, Shir-Hwa Ueng, Chun-Chen Yu, Chung-Yee Hui, Ja-Liang Lin, Chih-Wei Yang, Cheng-Chieh Hung, Ching-Wei Hsu, and Tzung-Hai Yen Copyright © 2012 Cheng-Hao Weng et al. All rights reserved. The Evaluation of Thyroid Diseases in Patients with Pemphigus Vulgaris Mon, 15 Oct 2012 10:15:51 +0000 Background. Thyroid disorders may affect all of the organ systems of the body and they are also highly associated with a wide variety of skin disorders. The aim of this study was to investigate the prevalence of thyroid function abnormalities and thyroid autoimmunity in patients with pemphigus vulgaris (PV) and to determine the association between thyroid disorders and clinical involvement and systemic corticosteroid treatment in patients with PV. Methods. The study consisted of eighty patients with PV and eighty healthy individuals. Thyroid functions (fT3, fT4, and TSH) and thyroid autoimmunity (anti-thyroid peroxidase (anti-TPO), and anti-thyroglobulin (anti-Tg) antibodies) were investigated in both groups. Primary thyroid disease (PTD) was diagnosed with one or more of the following diagnostic criteria: (i) positive antithyroid antibodies, (ii) primary thyroid function abnormalities. Results. Significant changes in the serum thyroid profile were found in 16% (13/80) of the PV group and 5% (4/80) of the control group. Positive titers of antithyroid antibodies (anti-TPO and anti-Tg) were observed in 7 patients (9%) with PV and one in the control group (1,2%). Hashimoto thyroiditis was diagnosed in 9% of PV patients and it was found to be more prevalent in the mucosal form of PV. PTD was found in 13 of (%16) PV patients which was significantly high compared to controls. PTD was not found to be associated with systemic corticosteroid use. Free T3 levels were significantly lower in PV group compared to the control group and free T4 levels were significantly higher in PV group compared to the controls. Conclusions. PV may exist together with autoimmune thyroid diseases especially Hashimoto thyroiditis and primer thyroid diseases. Laboratory work-up for thyroid function tests and thyroid autoantibodies should be performed to determine underlying thyroid diseases in patients with PV. Mukaddes Kavala, Esra Kural, Emek Kocaturk, Ilkin Zindanci, Zafer Turkoglu, and Burce Can Copyright © 2012 Mukaddes Kavala et al. All rights reserved. Treatment of Superficial Cutaneous Vascular Lesions: Experience with the Long-Pulsed 1064 nm Nd:YAG Laser Mon, 17 Sep 2012 12:30:27 +0000 Recent published studies evaluating the long-pulsed 1064 nm Nd:YAG laser for superficial cutaneous vascular lesions have limited subjects and optimal treatment parameters have not been established. To determine the efficacy and safety of the long-pulsed 1064 nm Nd:YAG laser on superficial cutaneus vascular lesions and analyse retrospectively our experience of a 3-year period are the aims of this study. Over the 3-year period, 255 patients were treated [189 female and 66 male; median age 35 (range 7–65) years; Fitzpatrick skin types II-V]. Twenty-six patients with spider angioma, 130 with facial telangiectasia, and 99 with leg telangiectasia were treated. A long-pulsed 1064 nm Nd:YAG laser was used. A test dose was performed at the initial consultation and thereafter patients were reviewed and treated at 4-week intervals for 5 months. Of those patients who completed treatment and followup, 26/26 (100%) of spider angiomas, 125/130 (97%) of facial telangiectasia, and 80/99 (80,8%) of leg telangiectasia markedly improved or cleared. We suggest that the long pulsed Nd:YAG laser is a safe and effective treatment for common superficial cutaneous vascular lesions. However, it is not the first choise to use to treat superficial vessels on the face where depth is not the concern. Kemal Ozyurt, Emine Colgecen, Halit Baykan, Perihan Ozturk, and Mehmet Ozkose Copyright © 2012 Kemal Ozyurt et al. All rights reserved. Evaluation of Melanogenesis in A-375 Cells in the Presence of DMSO and Analysis of Pyrolytic Profile of Isolated Melanin Wed, 02 May 2012 13:50:59 +0000 The increase of a skin malignant melanoma (melanoma malignum) incidence in the world has been observed in recent years. The tumour, especially in advanced stadium with metastases, is highly resistant to conventional treatment. One of the strategies is to modulate melanogenesis using chemical compounds. In this study, the processes of differentiation and melanogenesis induced by dimethylsulfoxide (DMSO) in human melanoma cells (A-375) were investigated. Natural melanin isolated from A-375 melanoma cell line treated with 0.3% DMSO was analyzed by pyrolysis-gas chromatography-mass spectrometry (Py-GC/MS) method. The products derived from pheomelanin have not been stated in the pyrolytic profile of analyzed melanin. Within all products derived from eumelanins, 1,2-benzenediol has been predominated. It has been shown that in the melanoma cells stimulated with 0.3% and 1% DMSO, the increase of transcriptional activity of the tyrosinase gene took place. It was accompanied by the rise of tyrosinase activity and an accumulation of melanin in the cells. The better knowledge about the structure of melanins can contribute to establish the uniform criteria of malignant melanoma morbidity risk. Ewa Chodurek, Arkadiusz Orchel, Joanna Orchel, Sławomir Kurkiewicz, Natalia Gawlik, Zofia Dzierżewicz, and Krystyna Stępień Copyright © 2012 Ewa Chodurek et al. All rights reserved. Prevalence of Metabolic Syndrome in Patients with Psoriasis Tue, 24 Apr 2012 15:29:31 +0000 Background. Psoriasis is a chronic inflammatory skin disorder in which proinflammatory cytokines including IL-6 and TNF-α increase both locally and systematically. It is thought that chronic inflammation results in metabolic diseases and proinflammatory cytokines give rise to the development of atherogenesis, peripheral insulin resistance, hypertension, and type 2 diabetes. Our aim was to investigate the prevalence of metabolic syndrome in patients with psoriasis vulgaris. Methods. Study consisted of 115 plaque-type psoriasis patients and 140 healthy individuals. Data including body weight, height, waist circumference, body-mass index, and arterial blood pressure were collected. Fasting blood glucose, triglyceride, and HDL levels were determined. International Diabetes Federation Criteria for Metabolic Syndrome and Insulin Resistance were used for evaluating patients with metabolic syndrome and diabetes. Results. Compared to the control group, metabolic syndrome, diabetes mellitus, and hypertension were found to be higher in psoriasis patients. Metabolic syndrome was increased by 3-folds in psoriasis patients and was more prevalent in women than in men. It was determined that the prevalence of metabolic syndrome was higher in psoriasis patients after the age of 40. Metabolic syndrome was not related to smoking, severity of psoriasis, and duration of disease. Conclusions. Our findings suggest that psoriasis preconditions occurrence of a group of diseases such as diabetes mellitus, hypertension, and metabolic syndrome. For this reason, patients with psoriasis should be treated early and they should be followed with respect to metabolic diseases. Ilkin Zindancı, Ozlem Albayrak, Mukaddes Kavala, Emek Kocaturk, Burce Can, Sibel Sudogan, and Melek Koç Copyright © 2012 Ilkin Zindancı et al. All rights reserved. A Randomized Comparative Trial on the Therapeutic Efficacy of Topical Aloe vera and Calendula officinalis on Diaper Dermatitis in Children Thu, 19 Apr 2012 14:02:59 +0000 Introduction. Diaper dermatitis (DD) is a common inflammatory disorder among children and infants. The objective of the present randomized and double-blind trial was to compare the therapeutic efficacies of Aloe vera cream and Calendula officinalis ointment on the frequency and severity of DD in children. Methods. Sixty-six infants with DD (aged < 3 years) were randomized to receive either Aloe cream (𝑛=32) or Calendula ointment (𝑛=34). Infants were treated with these drugs 3 times a day for 10 days. The severity of dermatitis was graded at baseline as well as at the end of trial using a 5-point scale. The adverse effects of study medications were assessed during the trial. Results. Although improvement in the severity of DD was observed in both treatment groups (𝑃<0.001), patients receiving Calendula ointment had significantly fewer rash sites compared to Aloe group (𝑃=0.001). No adverse effect was reported from either of the medications. Discussion. The evidence from this study suggests that topical Aloe and in particular Calendula could serve as safe and effective treatment for the treatment of diaper dermatitis in infants. Yunes Panahi, Mohamad Reza Sharif, Alireza Sharif, Fatemeh Beiraghdar, Zahra Zahiri, Golnoush Amirchoopani, Eisa Tahmasbpour Marzony, and Amirhossein Sahebkar Copyright © 2012 Yunes Panahi et al. All rights reserved. Highlights of Thirty-Year Experience of CO2 Laser Use at the Florence (Italy) Department of Dermatology Thu, 19 Apr 2012 11:03:16 +0000 The CO2 laser has been used extensively in dermatological surgery over the past 30 years and is now recognised as the gold standard for soft tissue vaporization. Considering that the continuous wave CO2 laser delivery system and the newer “superpulsed” and scanned CO2 systems have progressively changed our practice and patient satisfaction, a long range documentation can be useful. Our experience has demonstrated that the use of CO2 laser involves a reduced healing time, an infrequent need for anaesthesia, reduced thermal damage, less bleeding, less inflammation, the possibility of intra-operative histologic and/or cytologic examination, and easy access to anatomically difficult areas. Immediate side effects have been pain, erythema, edema, typically see with older methods, using higher power. The percentage of after-treatment keloids and hypertrophic scars observed was very low (~1%) especially upon the usage of lower parameters. The recurrence of viral lesions (condylomas and warts) have been not more frequent than those due to other techniques. Tumor recurrence is minor compared with radiotherapy or surgery. This method is a valid alternative to surgery and/or diathermocoagulation for microsurgery of soft tissues. Our results are at times not consistent with those published in the literature, stressing the concept that multicentric studies that harmonization methodology and the patient selection are vital. Piero Campolmi, Paolo Bonan, Giovanni Cannarozzo, Andrea Bassi, Nicola Bruscino, Meena Arunachalam, Michela Troiano, Torello Lotti, and Silvia Moretti Copyright © 2012 Piero Campolmi et al. All rights reserved. Psychoeducational Characteristics of Children with Hypohidrotic Ectodermal Dysplasia Mon, 12 Mar 2012 14:46:50 +0000 Objective. Hypohidrotic ectodermal dysplasia (HED) is an X-linked hereditary disorder characterized by hypohidrosis, hypotrichosis, and anomalous dentition. Estimates of up to 50% of affected children having intellectual disability are controversial. Method. In a cross-sectional study, 45 youth with HED (77% males, mean age 9.75 years) and 59 matched unaffected controls (70% males, mean age 9.79 years) were administered the Kaufman Brief Intelligence Test and the Kaufman Test of Educational Achievement, and their parents completed standardized neurodevelopmental and behavioral measures, educational, and health-related information regarding their child, as well as standardized and nonstandardized data regarding socioeconomic information for their family. Results. There were no statistically significant differences between the two groups in intelligence quotient composite and educational achievement scores, suggesting absence of learning disability in either group. No gender differences within or between groups were found on any performance measures. Among affected youth, parental education level correlated positively with (1) cognitive vocabulary scores and cognitive composite scores; (2) educational achievement for mathematics, reading, and composite scores. Conclusion. Youth affected with HED and unaffected matched peers have similar profiles on standardized measures of cognition, educational achievement, and adaptive functioning although children with HED may be at increased risk for ADHD. Rolanda A. Maxim, Samuel H. Zinner, Hisako Matsuo, Theresa M. Prosser, Mary Fete, Terry L. Leet, and Timothy J. Fete Copyright © 2012 Rolanda A. Maxim et al. All rights reserved. Variation of Biophysical Parameters of the Skin with Age, Gender, and Body Region Mon, 12 Mar 2012 13:20:10 +0000 Background. Understanding the physiological, chemical, and biophysical characteristics of the skin helps us to arrange a proper approach to the management of skin diseases. Objective. The aim of this study was to measure 6 biophysical characteristics of normal skin (sebum content, hydration, transepidermal water loss (TEWL), erythema index, melanin index, and elasticity) in a normal population and assess the effect of sex, age, and body location on them. Methods. Fifty healthy volunteers in 5 age groups (5 males and females in each) were enrolled in this study. A multifunctional skin physiology monitor (Courage & Khazaka electronic GmbH, Germany) was used to measure skin sebum content, hydration, TEWL, erythema index, melanin index, and elasticity in 8 different locations of the body. Results. There were significant differences between the hydration, melanin index, and elasticity of different age groups. Regarding the locations, forehead had the highest melanin index, where as palm had the lowest value. The mean values of erythema index and melanin index and TEWL were significantly higher in males and anatomic location was a significant independent factor for all of 6 measured parameters. Conclusion. Several biophysical properties of the skin vary among different gender, age groups, and body locations. Alireza Firooz, Bardia Sadr, Shahab Babakoohi, Maryam Sarraf-Yazdy, Ferial Fanian, Ali Kazerouni-Timsar, Mansour Nassiri-Kashani, Mohammad Mehdi Naghizadeh, and Yahya Dowlati Copyright © 2012 Alireza Firooz et al. All rights reserved. Subcutaneous Leiomyosarcoma of the Frenulum Mon, 01 Jan 1900 00:00:00 +0000 Leiomyosarcomas of the penis are rare, with only 29 reported cases to date. We record the case of a patient who presented with a 2-year history of a seemingly indolent penile skin lesion. On histopathology of the local resection, a diagnosis of subcutaneous leiomyosarcoma was made. Specifically, leiomyosarcoma of the penile frenulum has not been clearly reported previously. The patient underwent a further excision to ensure an adequate resection margin and has had no disease recurrence at subsequent follow-up. Our case was of a lesion that, although clinically benign, was malignant and this possibility should be borne in mind when assessing patients. D. Mendis, S. R. J. Bott, and J. H. Davies Copyright © 2005 D. Mendis et al. All rights reserved. Wound Myiasis in a Patient with Squamous Cell Carcinoma Mon, 01 Jan 1900 00:00:00 +0000 A 60-year-old, otherwise healthy, male farmer presented to our Dermatology Department with a large ulcer on his lower right leg. The lesion had started as a small papule 6 months before, which became eroded and transformed into a rather rapidly progressive ulcer. On careful inspection, numerous larvae were found moving within the wound. The larvae were analyzed and found to be Lucilia sericata (the green bottle blowfly). The lesion was diagnosed histopathologically as squamous cell carcinoma. The myiasis was treated by submerging the wound in a dilute permanganate potassium solution. Mohammad Namazi and Mohammad Kazem M. K. Fallahzadeh Copyright © 2009 Mohammad Namazi and Mohammad Kazem M. K. Fallahzadeh. All rights reserved. Dermoscopy of Tick Bite Mon, 01 Jan 1900 00:00:00 +0000 Efstathios Rallis Copyright © 2010 Efstathios Rallis. All rights reserved. Giant Cell Arteritis Presenting as Scalp Necrosis Mon, 01 Jan 1900 00:00:00 +0000 The differential of scalp ulceration in older patients should include several causes, such as herpes zoster, irritant contact dermatitis, ulcerated skin tumors, postirradiation ulcers, microbial infections, pyoderma gangrenosum, and giant cell arteritis. Scalp necrosis associated with giant cell arteritis was first described in the 1940s. The presence of this dermatological sign within giant cell arteritis represents a severity marker of this disease, with a higher mean age at diagnosis, an elevated risk of vision loss and tongue gangrene, as well as overall higher mortality rates, in comparison to patients not presenting this manifestation. Even though scalp necrosis due to giant cell arteritis is exceptional, a high level of suspicion must be held for this clinical finding, in order to initiate prompt and proper treatment and avoid blindness. Daniel E. Maidana, Silvia Muñoz, Xènia Acebes, Roger Llatjós, Anna Jucglà, and Alba Álvarez Copyright © 2011 Daniel E. Maidana et al. All rights reserved. Biomolecular Study of the Correlation Between Papillomatosis of the Vulvar Vestibule in Adolescents and Human Papillomavirus Mon, 01 Jan 1900 00:00:00 +0000 The main goal of this study was to investigate, through a biomolecular study, the correlation between papillomatosis of the vulvar vestibule and human papillomavirus (HPV) infection, as well as to establish the necessity of treatment. A total of 44 female adolescents between 12 and 18 years of age were selected through a prospective study with a confirmed diagnosis of papillomatosis of the vulvar vestibule. Vulvar biopsies were obtained for the histological and biomolecular detection of HPV DNA through polymerase chain reaction (PCR). Twenty (45%) adolescents were virgins (group A), the other 24 (55%) were sexually active. The virgin adolescents (group A) and 12 sexually active adolescents (group B) did not show cytological and/or colposcopic alteration, suggesting infection by HPV either on the cervix or vagina. These were compared with 12 other sexually active adolescents who showed cervicovaginal infection caused by HPV (group C). Fisher exact test was applied for statistical analysis of the results, considering alpha equal or less than 0.05. There was no statistically significant difference in relation to HPV DNA through PCR among virgin and sexually active adolescents in group B, however, both differed from those in group C (A + B × C: p = 0.048*). The histological study did not reveal evident signs of infection caused by HPV on vestibular papillae, besides perinuclear halos. HPV DNA was detected on vestibular papillae in 27%. Our results confirmed a scarce correlation between vestibular papillae and HPV. Thus, we consider papillomatosis of the vulvar vestibule, in most cases, to be equivalent to physiological papillomatosis and, therefore, should not be treated. Geni Beznos, Veronica Coates, Jose Focchi, and Hatim A. Omar Copyright © 2006 Geni Beznos et al. All rights reserved. Dramatic Verrucae Confined to the Lower Lip Mon, 01 Jan 1900 00:00:00 +0000 M. R. Namazi and J. L. Jorizzo Copyright © 2008 M. R. Namazi and J. L. Jorizzo. All rights reserved. Palpebral Involvement as a Presenting and Sole Manifestation of Discoid Lupus Erythematosus Mon, 01 Jan 1900 00:00:00 +0000 Reza Yaghoobi, Amir Feily, Bahar Behrooz, Elena Yaghoobi, and Shabnam Mokhtarzadeh Copyright © 2010 Reza Yaghoobi et al. All rights reserved. Evaluation of the Drug Treatment and Persistence of Onychomycosis Mon, 01 Jan 1900 00:00:00 +0000 Onychomycosis is a common nail disease responsible for approximately 50% of diseases of the nail. It occurs more in the elderly, though several cases have been reported among children. Several factors influence, such as climate, geography, and migration. The two dermatophytes most commonly implicated in onychomycosis are Trichophyton rubrum and T. mentagrophytes, accounting for more than 90% of onychomycoses. Nonetheless, several other toxigenic molds have been implicated. For convenience, onychomycosis is divided into four major clinical presentations: distal subungal, which is the most common form of the disease; proximal subungal, which is the most common form found in patients with human immunodeficiency virus infection; superficial; and total dystrophic onychomycosis. Epidemiology of onychomycosis in adults and children is evaluated and the most common clinical symptoms addressed. Although the risk factors are discussed, the multifactorial nature of onychomycosis makes this inexhaustible. The diagnosis and treatments are difficult and the choice of appropriate antifungal drugs complex and require the knowledge of the chemical structures of the metabolites of the molds that cause onychomycosis and their interaction with the antifungal drugs. This is true because most of the antifungal drugs are derived from mold/fungal metabolism. Treatment with griseofulvin and amphotericin is displaced by the use of newer drugs from azole compounds, pyrimidines, and allylamines derivatives. Amorolfine, itraconazole, and ciclopirox nail lacquer solution 8 have gained support globally, but the side effects, drug resistance, and persistence of the disease are still a serious concern to the patients, just as economics and quality of life. Hence, the search for safer and more efficacious drug treatments are continuing. Andrew W. Campbell, Ebere C. Anyanwu, and Mohammed Morad Copyright © 2004 Andrew W. Campbell et al. All rights reserved. Lipodermatosclerosis: A Commonly Misdiagnosed Complication of Chronic Venous Insufficiency Mon, 01 Jan 1900 00:00:00 +0000 Mohammad Kazem Fallahzadeh, Mohammad Khalesi, and Mohammad Reza Namazi Copyright © 2010 Mohammad Kazem Fallahzadeh et al. All rights reserved. An Open-Label Study of an Herbal Topical Medication (QoolSkin) for Patients with Chronic Plaque Psoriasis Mon, 01 Jan 1900 00:00:00 +0000 QoolSkin is novel herbal topical medication indicated for the treatment of patients with psoriasis and we endeavored to determine the efficacy of QoolSkin in patients with chronic plaque psoriasis. In an open-label, parallel-group study conducted at four sites in Israel, patients with chronic plaque psoriasis were treated by application of QoolSkin two to three times per day, for a period of 16 weeks. Clinical assessment was performed using the Psoriasis Area and Severity Index (PASI) and the Beer-Sheva Psoriasis Severity Score (BPSS). The study included 100 patients (48 men, 52 women; age 18–65 years). QoolSkin was well tolerated and there were no local or systemic side effects. There was a 19% reduction in PASI, from a mean of 9.8 ± 9.5 before treatment to 8.0 ± 9.6 after treatment (p = 0.09). There was a 20% reduction in BPSS, from a mean of 16.1 ± 9.8 before treatment to 12.8 ± 10.6 after treatment (p = 0.01). The reduction in PASI and BPSS was pronounced in women (32 and 31%, respectively) as compared to men (9 and 11%, respectively). The reduction in PASI and BPSS was parallel to the length of time the patients were treated by QoolSkin. In patients treated by one of the investigators, who applied QoolSkin three times per day and for a long period of time (mean 101.1 days), the reduction in PASI was 32.0% and the reduction in BPSS was 37.8%. In patients with chronic plaque psoriasis, QoolSkin treatment was well tolerated. Application of QoolSkin was associated with a decrease in disease severity, as assessed by the patients and physicians. Application of QoolSkin three times per day for long period is associated with a better response to treatment. Arnon D. Cohen, Raquel Shalev, Ron Yaniv, and Avner Shemer Copyright © 2007 Arnon D. Cohen et al. All rights reserved. Adenosine Receptors and Wound Healing Mon, 01 Jan 1900 00:00:00 +0000 Recent studies have demonstrated that application of topical adenosine A2A receptor agonists promotes more rapid wound closure and clinical studies are currently underway to determine the utility of topical A2A adenosine receptor agonists in the therapy of diabetic foot ulcers. The effects of adenosine A2A receptors on the cells and tissues of healing wounds have only recently been explored. We review here the known effects of adenosine A2A receptor occupancy on the cells involved in wound healing. Bruce N. Cronstein Copyright © 2004 Bruce N. Cronstein. All rights reserved. Essential Type II Mixed Cryoglobulinemia Causing Pyoderma Gangrenosum–Like Ulcers Mon, 01 Jan 1900 00:00:00 +0000 M. R. Namazi, K. R. Kerchner, and R. O. Pichardo Copyright © 2008 M. R. Namazi et al. All rights reserved. Superficial Granulomatous Pyoderma Gangrenosum of the Penis: A Case Report Mon, 01 Jan 1900 00:00:00 +0000 Classic type of pyoderma gangrenosum (PG) is an uncommon ulceronecrotic cutaneous disease of uncertain aetiology characterised by broad zones of confluent ulceration with violaceous undermined margins. Some 50% of cases are associated with systemic diseases. The superficial granulomatous variant of pyoderma gangrenosum (SGPG) of the external genitalia is extremely rare Patients with this condition develop single or multiple ulcerated skin lesions often with sinus tract formation. The majority of these lesions were found on the trunk and limbs. SGPG is less likely to be associated with underlying disease processes than classic PG. We present a 58 year-old with recalcitrant penile ulceration demonstrated to be SGPG on biopsy. Although rare and poorly recognised, the histological features are sufficiently typical to allow the correct diagnosis to be established. Shyamala S. Gopi, Alan T. Evans, Asif Raza, and Derek J. Byrne Copyright © 2006 Shyamala S. Gopi et al. All rights reserved. Granuloma Annulare Mon, 01 Jan 1900 00:00:00 +0000 Diptesh Gupta and Brian Hess Copyright © 2010 Diptesh Gupta and Brian Hess. All rights reserved. Lepromatous Leprosy: A Commonly Misdiagnosed Disease Mon, 01 Jan 1900 00:00:00 +0000 Reza Yaghoobi, Amir Feily, Nastaran Ranjbari, Jalal Lotfi, and Elena Yaghoobi Copyright © 2010 Reza Yaghoobi et al. All rights reserved. Pediatric Burns in the Bedouin Population in Southern Israel Mon, 01 Jan 1900 00:00:00 +0000 Burn trauma is an important public health concern, with increased risk for burns in children. A cross-sectional study was performed to describe the epidemiological characteristics and risk factors for burns in hospitalized Bedouin children in Soroka University Medical Center during the years 2001–2002. In a population of 558 hospitalized burn-injured patients, 282 Bedouin children were identified. Two hundred and sixty five patients (94.0%) had burns involving less than 20% of the body surface area. Cause of the burns was scald in 190 patients (67.4%), fire in 80 patients (28.4%), chemical in 8 patients (2.8%), and explosion in 2 patients (0.7%). Two female patients (0.7%) aged 11 and 17 years died of their burns that were caused by fire. The mean length of hospitalization was 9.8 days. Pediatric burn injury has become a significant public health problem in the Bedouin population of the Negev. To reduce the burden of burn injury, it is necessary to increase current efforts in prevention of burns. Arnon D. Cohen, R. Gurfinkel, R. Glezinger, Y. Kriger, N. Yancolevich, and L. Rosenberg Copyright © 2007 Arnon D. Cohen et al. All rights reserved. Characterization of Malignant Melanoma Using Vibrational Spectroscopy Mon, 01 Jan 1900 00:00:00 +0000 Malignant melanoma, a malignant neoplasm of epidermal melanocytes is the third most common skin cancer. In many cases, melanoma develops from nevus, which is considered as the nonmalignant stage. Fourier transform infrared microspectroscopy (FTIR-MSP), which is based on characteristic molecular vibrational spectra of cells, was used to investigate spectral differences between melanoma, nevus, and the corresponding normal epidermis. In the present work, FTIR-MSP was performed on formalin-fixed biopsies of melanoma and nevi along with the adjoining histologically normal epidermis to understand the biochemical variations from the epidermis and identify suitable parameters for differentiation of nevi from melanoma. The comparative analysis of various parameters calculated from the spectral data of the normal epidermis and the abnormal regions showed that the changes in the nucleic acids was a significant indicator of the abnormal nature of the tissues. The RNA/DNA ratio was decreased in case of both melanoma and nevus compared to the epidermis. The amide II/amide I ratio was greater for nevus and melanoma compared to the epidermis. In contrast to other organs, the analysis of carbohydrates was not found as a suitable indicator in case of malignant melanoma. Shifts in band wave number were found to be a major distinguishing feature between the melanoma and compound nevi. The present study helps in the identification of spectral features suitable for distinction of melanoma from nevus that appear similar even in FTIR spectral features and thus can pave the way for development of in vivo screening systems based on these diagnostic markers. Ziad Hammody, Ranjit Kumar Sahu, Shaul Mordechai, Emanuela Cagnano, and Shmuel Argov Copyright © 2005 Ziad Hammody et al. All rights reserved. Spontaneous Penile (Cavernosal) Abscess: Case Report with Discussion of Aetiology, Diagnosis, and Management with Review of Literature Mon, 01 Jan 1900 00:00:00 +0000 The rare presentation of spontaneous, corpus cavernosal abscess with evident pus discharge is reported. The 19-year-old English man was successfully treated with surgical drainage and antibiotics with long-term sequelae in form of mild, left-sided penile deviation, but normal erectile function. Though he did not require any further surgical intervention for correction of chordee at that time, there remains a possibility of it getting worse over time, which may ultimately need surgery for correction. The possible aetiology, diagnosis, and treatment of this rare condition are briefly discussed. Jayesh Sagar, Bethani Sagar, and D. K. Shah Copyright © 2005 Jayesh Sagar et al. All rights reserved. Diffuse Melanosis and Ascites due to Metastatic Malignant Melanoma Mon, 01 Jan 1900 00:00:00 +0000 We present a female patient who developed mucosal and skin hyperpigmentation due to metastatic malignant melanoma. Diffuse cutaneus melanosis is a rare entity that complicates a small percentage of metastatic melanomas, confering a fatal prognosis. We discuss briefly the current evidence on pathogenesis of melanosis arising from metastatic melanoma. Elena Sendagorta, Angel Pizarro, Marta Feito, Matias Mayor, Paloma Ramírez, Uxua Floristán, and Rosa Feltes Copyright © 2008 Elena Sendagorta et al. All rights reserved. Severe Irritant Contact Dermatitis Causing Skin Ulceration Secondary to a Testosterone Patch Mon, 01 Jan 1900 00:00:00 +0000 Testosterone replacement has undergone somewhat of a revolution in the past decade with the introduction of topical administration techniques, including patches and gels, as well as an increasing interest in the treatment of older men with low testosterone levels for what is now termed andropause. Increasingly, testosterone replacement therapy is being individually tailored. Side effects to skin patches have been reported with irritant contact dermatitis being the most common. However, ulceration has previously not been reported. Herein, we present a case that highlights testosterone transdermal therapies, their potential side effects and management strategies, and broadens our knowledge as we approach an era where these types of treatments are likely to be more common. Nathan Lawrentschuk and Neil Fleshner Copyright © 2009 Nathan Lawrentschuk and Neil Fleshner. All rights reserved. Adenosine Receptors and Wound Healing, Revised Mon, 01 Jan 1900 00:00:00 +0000 Recent studies have demonstrated that application of topical adenosine A2A receptor agonists promotes more rapid wound closure and clinical studies are currently underway to determine the utility of topical A2A adenosine receptor agonists in the therapy of diabetic foot ulcers. The effects of adenosine A2A receptors on the cells and tissues of healing wounds have only recently been explored. Here we summarize the evidence indicating that adenosine and selective adenosine agonists, acting at A2A receptors, promote the salutary functions of inflammatory cells, endothelial cells and fibroblasts in stimulating wound healing. Bruce M. Cronstein Copyright © 2006 Bruce M. Cronstein. All rights reserved.