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Blepharitis--a diagnostic and therapeutic challenge. A report on 407 consecutive cases.

Over the last few years the number of patients with chronic bilateral blepharitis has increased dramatically. From January 1985 until the end of 1989, a total of 407 patients with this diagnosis underwent ophthalmological and dermatological investigations at our out-patient clinic. Keratoconjunctivitis sicca (KCS) in conjunction with blepharitis occurred in 14.5% of the patient population who also suffered from acne rosacea. A comparison of the spectrum of microorganisms that have previously been isolated from affected sites with data obtained in the present study revealed that the range of microorganisms associated with this chronic localized inflammation has apparently shifted in recent years. The prevalence of Staphylococcus aureus, which was considerable in the pre-antibiotic era, has markedly decreased, although a distinct entity of staphylococcal blepharitis seems to remain, either alone or in combination with seborrheic blepharitis (62.8% of our patients). The clinical picture, microbiological findings and therapy for this condition are presented.

Adolescent↗

Transformation of seborrheic keratosis into Bowen's disease.

This case proves the possibility of a malignant transformation of seborrheic keratosis. This evidence is furnished by a biopsy specimen that shows not only a topical relationship between seborrheic keratosis and Bowen's disease, but also the progressive transition. An evident biopsy has to be made prior to clinical suspicion of malignant degeneration, that means prior to the destruction of the transitional zone by the tumor.

Aged↗

Kinetics of cell proliferation in benigh and premalignant tumors of the human epidermis.

A double labeling method with two levels of tritiated thymidine was used to study 6 patients with seborrheic keratosis, 1 with a fibroepithelial tumor of Pinkus, and 1 with basal cell nevus syndrome manifesting three pits on the palm of the hand. The two latter types of lesions, known to be able to evolve into basal cell carcinoma, had an increased S-phase duration (18 hr for the germ cells of the palmar pits) as compared with normal epidermis (10 hr). This situation was similar to that observed in basal cell carcinoma, However, the S phase was not lengthened in seborrheic keratosis (9.2 plus or minus 1.6), a benign tumor in which malignant transformation is extremely rare. S phase was also of normal duration in the benign eosinophilic septa of the tumor of Pinkus.

Basal Cell Carcinoma↗

[Anti-seborrhea effect of cimetidine].

Cimetidine, a histamine H2 antagonist, seems to have anti-androgenic activity. 22 young women were studied during follicular phase prior to and after a 3 month period of treatment with cimetidine (1,200 mg daily). Three month treatment with cimetidine resulted in a significant decrease of seborrheic index (p less than 10(-4)) and casual level (p less than 10(-4)). Testosterone level, TeBG binding capacity and free testosterone were unaffected by the treatment. Cimetidine decrease sebum secretion without change in androgen parameters.

Acne Vulgaris↗

[Experimental evaluation of anti-seborrheic substances].

The effects of different drugs on the sebaceous gland is described by the use of an animal model. A castrated rat Wistar was made hyperseborrheic with implant of testosterone. On this model, graduated by a different anti androgen (acetate of cyproterone), anti-seborrheic effect is measured, bound or not the antiandrogenic effect of retinoids, cimetidine, spironolactone and, minoxidil. Retinoids reduced the surface of sebaceous glands but did not express an anti-androgenic effect. Cimetidine and spironolactone presented the same action. Minoxidil had no effect on this model.

Animals↗

Cutaneous complications in heart transplant recipients in Norway 1983-1993.

All Norweigian heart transplant recipients with more than one year's survival (n = 140) were investigated for dermatological disorders. Observation time after transplantation was 1-10 years (mean 5.0 years). Patients alive at the end of 1993 (n = 122) were examined clinically, and medical records for all patients were reviewed. The histopathological diagnoses of excised skin specimens were reevaluated. Malignant skin tumours (i.e. basal cell carcinoma, squamous cell carcinoma and malignant melanoma) and/or premalignant skin tumours (i.e. morbus Bowen (carcinoma in situ), solar keratosis and keratoacanthoma) were found in 34 patients (24.3%), of which 18 patients (12.9%) had malignant skin tumours. Seventeen lesions diagnosed as keratoacanthoma and two lesions diagnosed as morbus Bowen had primarily been diagnosed as squamous cell carcinoma. Five patients (3.6%) had multiple keratoacanthomas. Other frequent dermatological diagnoses included hypertrichosis (86.9%), steroid-induced skin features (59.8%), common warts (42.6%) and seborrheic skin disorders (20.5%). This study demonstrates the importance of dermatological surveillance in the follow-up of heart transplant recipients.

Adolescent↗

Malignancy in seborrheic keratoses.

Among 5 500 seborrheic keratoses 3 were found with marked squamous cell atypia. Clinically they were seborrheic keratoses. Even though they were incompletely removed, no recurrences were observed. In contrast to some reports in the literature we regard these lesions as biologically benign, and suggest that they be treated accordingly.

Aged↗

Immunohistochemical study on keratin expression in certain cutaneous epithelial neoplasms. Basal cell carcinoma, pilomatricoma, and seborrheic keratosis.

We investigated immunohistochemically 20 basal cell carcinomas (BCC), five pilomatricomas, and nine seborrheic keratoses using anti-BCC keratin monoclonal antibody (BKN-1) and anti-hair keratin monoclonal antibodies (HKN-2, HKN-4- -7). The neoplastic cells in all the cases of BCC were always uniformly stained by BKN-1, HKN-2, and HKN-4, indicating that the BCC cells display a constant antigenicity of keratin, which may be different from that of the normal epidermis. Although no fluorescence by HKN-6 or HKN-7 was seen in any cases of BCC, HKN-5 partially but strongly stained the neoplastic nests in most cases of BCC; BCC may have differentiation toward the lower part of hair follicular epithelium. In pilomatricoma, all the anti-keratin monoclonal antibodies showed a similar staining pattern; the differentiating neoplastic cells undergoing transition from basaloid to eosinophilic were positively stained by each antibody in all the cases. This finding of pilomatricoma corresponds to that of the differentiating cells in the inner hair layers, especially in the hair cortex. In seborrheic keratoses, no fluorescence was recognized with HKN-5- -7, which stain the lower follicular cells in the normal human skin. The staining patterns of seborrheic keratosis by BKN-1, HKN-2, and HKN-4 were similar to those of the normal interfollicular epidermis. These anti-keratin monoclonal antibodies seem to be useful for the investigation of the direction of differentiation of skin adnexal neoplasms.

Antibodies, Monoclonal↗

A new association of ethinylestradiol (0.035 mg) cyproterone acetate (2 mg) in the therapy of polycystic ovary syndrome.

The authors treated 28 patients with polycystic ovary syndrome (PCOS) with the new preparation SH B 209 AE consisting of 0.035 mg of ethinylestradiol and 2 mg of cyproterone acetate (EE + CPA) throughout 12 months. From the analysis of the endocrine and clinical modifications induced by the drug along with the negligible incidence of side effects the conclusion can be drawn that this new estro-progestational association is indicated in the therapy of PCOS.

Acne Vulgaris↗

Dog factor differences in Can f 1 allergen production.

BACKGROUND: The clinical importance of dog allergy is well known, but it is unknown if all types of dogs represent the same risk for allergic patients. The purpose of this work was to evaluate among 288 healthy dogs if the levels of Can f 1 on fur vary between breeds (German Shepherd, Pyrenean Shepherd, Poodle, Cocker spaniel, Spaniel, Griffon, Labrador retriever and Yorkshire terrier), gender, hormonal status, hair length, and according to the presence of seborrhea. METHODS: Each dog was shaved in a limited area and Can f 1 concentrations were measured in mug/g fur by ELISA. The results (geometric mean values and 95% confidence intervals) were analyzed using analysis of variance and with nonparametric tests. RESULTS: A wide variability in Can f 1 levels was found between dog breeds, from Labradors [1.99 (0.03-129.91)] to Yorkshires [16.72 (3.67-76.16)] and Poodles [17.04 (2.79-103.94)] but only the Labrador levels were significantly different from each other breed. Males produced more Can f 1 than females, 11.75 (1.27-108.40) vs 8.89 (0.91-86.39). No difference was found according to hair length or hormonal status. The seborrheic status highly (P = 0.0019) influenced the presence of Can f 1 on hair: 16.66 (1.59-173.96) vs 9.40 (1.03-85.70). CONCLUSION: Breeds (Labrador retriever), sex and seborrhea seem to influence the levels of Can f 1 on fur.

Allergens↗

Ovulation inhibitors containing cyproterone acetate or desogestrel in the treatment of hyperandrogenic symptoms.

An open, randomized, multicenter study was carried out to compare two oral contraceptives as regards their therapeutic efficacy in androgenization symptoms such as acne, seborrhea and hirsutism in women. The preparations used were the combination of 2 mg cyproterone acetate (CPA) with 0.035 mg ethinyl estradiol (EE) (Diane 35, Schering AG, Berlin-West) and 0.150 mg desogestrel (DG) with 0.03 mg ethinyl estradiol (Marvelon, Organon, Oss, The Netherlands). The duration of therapy was 9 months. The combination of CPA-EE was used by 83 patients for 658 cycles and the combination of DG-EE by 79 women for 618 cycles. No pregnancy occurred under either therapy. Both preparations are well tolerated. However, some side-effects, such as reduced libido, nervousness and breast tenderness, were observed more frequently (p less than 0.05) in the DG-EE group than among the users of the CPA-EE combination. The therapeutic outcome was better in the CPA-EE group, especially in cases of facial acne (p less than 0.05). Seborrheic symptoms also responded better to the CPA-EE therapy. The results show that the CPA-EE combination is superior to the DG-EE combination in the treatment of acne and seborrhoea.

Acne Vulgaris↗

The clinical spectrum of pigmented lesions.

This article presents the clinical features of a spectrum of pigmented lesions. It begins with benign lesions that may be confused with melanocytic nevi, such as lentigines, seborrheic keratoses, and dermatofibromas. The next section focuses on the various types of melanocytic nevi, including congenital, blue, and Spitz nevi. A description of atypical nevi is provided, followed by an outline of the clinical characteristics of each subtype of cutaneous melanoma. The clinical characteristics of various pigmented lesions are illustrated.

Dermatitis, Seborrheic↗