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PubMed1990

Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole.

The yeast Pityrosporum orbiculare is thought to cause the folliculitis associated with seborrheic eczema. However, a combination of mechanical and microbiological factors may be involved, with follicular occlusion leading to yeast overgrowth and folliculitis. Scanning electron microscopy was used to investigate this hypothesis. Skin biopsy specimens obtained from patients with Pityrosporum folliculitis were examined by scanning electron microscopy before and after oral ketoconazole therapy. Patients with active disease showed occlusion of noninflamed follicles, which resolved after ketoconazole treatment. Follicular occlusion was not present in biopsy specimens obtained from unaffected controls nor was it related to the presence of P orbiculare. These findings suggest that follicular occlusion may be a primary event in the development of this folliculitis, with yeast overgrowth a secondary occurrence. The beneficial effect of ketoconazole in this disease may be due to direct effects on the follicle.

Administration, Oral↗
PubMed2004

Differentiation of hidroacanthoma simplex from clonal seborrheic keratosis--an immunohistochemical study.

Hidroacanthoma simplex (HS) is an uncommon poroid neoplasm confined within the epidermis. The clinical features of HS are not distinctive and histopathologically HS may be confused with clonal seborrheic keratosis (CSK) if cystic or ductal structure is not present. The purpose of our study was to differentiate HS from CSK by the immunohistochemical expressions of various cytokeratins, CEA, CD1a, and S-100 protein, as well as by the degrees of deposition of melanins and glycogen. Four cases of HS and seven cases of CSK were included in the research. In contrast with CSK, HS showed a very low density of Langerhans cells (19.9 +/- 7.7 versus 3.1 +/- 1.0 CD1a (+) cells/mm, P = 0.027) and sparse melanin deposition in the nests. However, HS could not be set apart from CSK by the expressions of cytokeratins. The nests of both HS and CSK showed very similar patterns of cytokeratin expression and seemed to be mainly composed of basaloid cells with focal differentiation toward epidermal suprabasal cells.

Acrospiroma↗
PubMed1991

Trichilemmal tumor arising in a seborrheic keratosis: analysis of cell kinetics by BrdU staining.

We report a case of a 74-year-old male with a trichilemmal tumor arising in a seborrheic keratosis on the buttock and the results of a cell kinetic study of this tumor using a BrdU staining method. The incidence of trichilemmal tumor arising in a seborrheic keratosis seems to be extremely rare. The labeling index of this tumor was 12.0%; this was a level intermediate between normal epidermis and a variety of hyperproliferative skin diseases such as squamous cell carcinoma, Bowen's disease, and psoriasis vulgaris. DNA replicating cells were present in the germinative layers in normal epidermis and the benign hyperproliferative skin diseases, psoriasis vulgaris. In contrast, DNA replicating cells were found throughout the entire epidermis in premalignant and malignant tumors such as in Bowen's disease and squamous cell carcinoma. In this case, DNA replicating cells were localized mainly in the basal and parabasal cell layers, but also seen in the upper squamous layers. These findings suggest that this trichilemmal tumor had a malignant tendency, though it was slow-growing and relatively benign in nature.

Aged↗
PubMed1991

Diagnostic accuracy and appropriateness of care for seborrheic keratoses. A pilot study of an approach to quality assurance for cutaneous surgery.

In 1985 there were more than 40 million visits for ambulatory surgical procedures in the United States. Although benign cutaneous lesions are among the most frequent conditions to receive surgical treatment in ambulatory settings, their treatment is seldom subject to peer review. In this pilot study we assessed diagnostic accuracy and appropriateness of care using information available from the surgical pathology laboratory. We assessed these two measures of physician performance for 527 seborrheic keratoses removed by 133 clinicians affiliated with four different institutions. Overall, a correct preoperative diagnosis was provided in only 49% of cases. Dermatologists had the highest diagnostic accuracy (61% vs 35% for all other physicians). An appropriate procedure for the actual pathological diagnosis was performed in only 50% of cases. Lesions with a correct preoperative diagnosis were more than eight times more likely to receive appropriate care. Our data suggest that many clinicians fail to note a correct diagnosis of common cutaneous lesions before surgical removal, and many patients are treated with procedures that are more invasive than necessary for the final pathological diagnosis. Because the approach used in this pilot study relies on data already available, it has promise as a low-cost method of monitoring the quality of care of ambulatory surgery.

Adult↗
PubMed1980

A comparative study of seborrheic keratoses and basal cell epitheliomas by complement immunofluorescence and electron microscopy.

Eight cases of seborrheic keratosis (SK) and 7 cases of basal cell epithelioma (BCE) were studied comparatively by complement immunofluorescence using pemphigoid serum which was reactive not only to the basement membrane zone (BMZ) but also to the cell membrane or the intercellular space (CMICS) of basal cells in normal human epidermis. Positive immunofluorescence both at the BMZ and the CMICS of proliferating basaloid cells was observed in all cases of SK, whereas in BCE, immunofluorescence weaker than that in SK was observed only a the BMZ of tumor cell nests. These tumors were also examined by light and electron microscopy, and differences already described in the literature between SK and BCE were confirmed. These findings suggest that antigenic properties of the BMZ of the skin are affected by proliferating epithelial cells and that epithelial cells are involved in the formation of the BMZ.

Basement Membrane↗
PubMed2000

Apoptosis in the areas of squamous differentiation of irritated seborrheic keratosis.

Seborrheic keratosis (SK) consists of a localized proliferation of basaloid keratinocytes, often accompanied by hyperkeratosis and hyperpigmentation. In irritated SK, these features are associated with areas of squamous differentiation with larger keratinocytes and squamous cell eddies. This work is concerned with the evaluation of apoptosis, as demonstrated by the TUNEL method, in the different varieties of SK. Apoptosis was highly expressed in the areas of squamous differentiation of irritated SK, but only mildly increased in the other varieties of SK. These data support the hypothesis that apoptosis has a role in the squamous differentiation of irritated SK. In consideration also of previous data showing that irritated SK is associated with downregulation of EGF-R expression and 125I-EGF binding, we postulate that the morphologic features of irritated SK could correspond to an involution phase of the disease, characterized by altered cell balance with inadequate cell renewal and increased cell loss.

Adult↗
PubMed1993

[Comparative study of the development and prognosis of pemphigus vulgaris and seborrheic pemphigus].

Traditionally, the prognosis of pemphigus erythematosus is thought to be more favourable than that of pemphigus vulgaris. A retrospective study of the records of 10 patients with pemphigus erythematosus and 13 patients with pemphigus vulgaris was set up to compare the courses of the two diseases. This comparison, carried out in populations with similar age, sex ratio, pretreatment duration of the disease and treatment received, showed that relapses were more frequent in the course of pemphigus erythematosus, whereas remissions, mean duration of the disease and iatrogenic complications were the same in both groups. This study, therefore, throws some doubts on the dogma of relative mildness of pemphigus erythematosus, which goes back to a period long before systemic corticosteroid therapy was known. Mortality studies performed since the event of this treatment have shown that the prognosis had improved and tended to be the same in both diseases. The other data concerning the course of treated pemphigus erythematosus are little known and were never compared with those concerning pemphigus vulgaris. Our study shows that treatments similar to those of pemphigus vulgaris are necessary to obtain remissions in pemphigus erythematosus and that these diseases share the same evolutive profile. However, the question of the best therapeutic strategy to be used has not yet been answered.

Adult↗
PubMed1980

Qualitative and quantitative investigations on the resident bacterial skin flora in healthy persons and in the non-affected skin of patients with seborrheic Eczema.

The composition of the aerobic and anaerobic bacterial skin flora was investigated quantitatively and qualitatively in 25 patients with seborrheic eczema (SE) and in 35 healthy persons. In SE patients, the geometric mean count for propionibacteria in the pilosebaceous ducts of the forehead was reduced to a statistically significant extent in comparison with the control group. There was the same tendency with regard to the geometric mean count of the superficial anaerobic bacterial flora of the back, whereas the geometric mean counts of the coagulase-negative staphylococci were the same in the two groups. These results may explain earlier findings of a reduction of free fatty acids in the surface lipids in SE patients. According to the results of differentiation in 295 propionibacteria and 157 micrococcaceae, 7 biotypes and 10 phage types of propionibacteria which were so far unknown could be demonstrated. Significant differences between the groups with regard to the frequency of different biotypes, serotypes, and phage types could be demonstrated neither in propionibacteria nor in coagulase-negative staphylococci. The results of typing, however, showed that patients with SE displayed much more frequently several different propionibacterial species and types as well as different micrococcal species and types than persons with healthy skin.

Adult↗
PubMed1989

Effects of azelaic acid on sebaceous gland, sebum excretion rate and keratinization pattern in human skin. An in vivo and in vitro study.

The effects of azelaic acid (AZA) on the epidermis of 47 individuals (12 with normal skin, 15 with seborrheic skin and 20 suffering from acne) and on in vitro cultured keratinocytes are reported. Topical application of a 20% AZA cream significantly improved the lesions of acne patients, but failed to induce clinically detectable changes in normal or seborrheic epidermis. Complementary investigations clearly showed that AZA treatment failed to induce specific changes in sebum composition, excretion rate, or in the size of sebaceous glands, but modified epidermal keratinization. Keratohyalin granules and tonofilament bundles were reduced in size and number, mitochondria were swollen and the rough endoplasmic reticulum of malpighian keratinocytes enlarged. The infundibular epidermis of acne individuals showed marked reduction of the horny layer thickness, widening of the horny cell cytoplasm, transitional corneal cells, normalization of filaggrin distribution, and the comedo contained few bacteria and spores. In vitro, AZA exerted marked time- and dose-dependent antiproliferative cytostatic effects on cultured keratinocytes, with a 50% inhibitory dose of 20 mM, decreased some keratinocyte proteins (highly soluble fractions S2, keratohyalin macroaggregate R2, and non-cross-linked fibrous protein S4) and a 95 kD and a 35 kD protein of the cytosolic fraction. Mitochondria were frequently damaged and the rough endoplasmic reticulum enlarged. Our results indicate that AZA is an antikeratinizing agent, displaying antiproliferative cytostatic effects on keratinocytes and modulating the early and terminal phases of epidermal differentiation.

Acne Vulgaris↗
PubMed1996

Interobserver concordance in discriminating clinical atypia of melanocytic nevi, and correlations with histologic atypia.

BACKGROUND: The clinical features attributed to atypical (formerly ¿dysplastic") nevi and to the atypical multiple mole melanoma syndrome have been used in clinical practice, as well as experimentally, to assign melanoma risk. Little information is available, however, on the interobserver reliability in assessing those features. OBJECTIVE: Our purposes were to quantify interobserver and intraobserver concordances in recognizing certain atypical characteristics of nevi and to correlate the clinical assessments with the histologic characteristics. METHODS: Three observers evaluated clinical photographs of 100 pigmented lesions (predominantly melanocytic nevi, with some lentigines and seborrheic keratoses) from 95 subjects, of whom 85 were family members of four multiple melanoma kindreds and 10 were spouses. Each lesion was rated for border irregularity, color variegation, surface contour irregularity, pigment diffusion, and macularity versus papularity. Predictions were made as to the histologic diagnoses and presence of melanocytic atypia for those lesions judged to be nevi. RESULTS: The pair-wise concordances before agreement on specific criteria were quantified by kappa statistics, which indicated slight to fair agreement in judging the atypical clinical characteristics; concordances increased to moderate levels after consensus development of criteria for color variegation and assessment of macularity, but agreement on the other features remained limited. Whereas macularity and color variegation did correlate somewhat with higher grades of histologic atypia, correlations were generally low between the clinical and histologic diagnoses. CONCLUSION: There is limited interobserver reliability in the clinical assessment of nevus atypia, although correlations do exist between some atypical characteristics and grades of histologic atypia. Because of the low concordances, the clinical discrimination of the melanoma-associated atypical nevus phenotype should rely more on quantitative aspects of the trait, such as total numbers or maximal sizes of nevi, rather than on the subjective determinations of atypia.

Dermatitis, Seborrheic↗
PubMed2000

The prevalence of seborrheic keratoses in people aged 15 to 30 years: is the term senile keratosis redundant?

BACKGROUND: Seborrheic keratoses (SKs) are common skin lesions that have been shown to occur with increasing age, although the age of onset is not well recorded. OBJECTIVE: To determine the prevalence, nature, and distribution of SKs in young people. METHODS: One hundred seventy people aged 15 to 30 years were given a total body examination during which the presence, number, site, and size of SKs were recorded. Biopsy specimens were taken from the first 22 people who had lesions clinically diagnosed as SKs. Data on age, skin type, eye color, and hair color were recorded for all respondents. RESULTS: Forty (23.5%) of 170 respondents had at least one SK, with no significant difference between the sexes. There was an increase in prevalence with age from 15.7% in 15- to 19-year-olds to 32.3% in those aged 25 to 30 years. The size of the SKs also increased with age. A total of 77.5% of SKs were found on the trunk and 22.5% on the limbs, head, and neck. There was no correlation between SKs and any particular hair and eye color or skin type. CONCLUSIONS: These findings confirm that SKs are common lesions in young Australians, appearing in a substantial proportion of people younger than 30 years. The term senile keratosis is no longer appropriate for these lesions.

Adolescent↗
PubMed2003

Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis.

PURPOSE: To assess the effect of minocycline on the ocular flora in patients with acne rosacea or blepharitis. METHODS: A total of ten patients were enrolled in this prospective study, with six patients diagnosed with acne rosacea with concomitant meibomianitis, two patients with acne rosacea without concomitant ocular involvement, and two patients with seborrheic blepharitis. The eyelids and conjunctiva of both eyes were cultured before the initiation of systemic minocycline therapy, after 3 months of active therapy, and 3 months after the discontinuation of therapy. Isolated bacteria were identified and quantified, and antibiotic susceptibility was determined. RESULTS: The colony-forming units (CFU) isolated from the eyelids significantly decreased after a 3-month treatment with minocycline (P = 0.0013). The CFU significantly increased to approach that of the baseline with the discontinuation of minocycline (P = 0.0275). The most common isolated bacteria, including coagulase-negative Staphylococcus (CNS), Staphylococcus aureus (S. aureus), and Propionibacterium acne (P. acne), except for corynebacterium, had a significant decrease in bacterial count with minocycline therapy compared with baseline (P < 0.05). There was a trend in the decrease of bacterial CFU isolated from the conjunctiva with minocycline therapy, although this was not statistically significant (P = 0.1955). Four of the ten patients carried tetracycline-resistant CNS strains, but none of the S. aureus or P. acne isolated at baseline was resistant to tetracycline. All six patients with acne rosacea and concomitant meibomianitis had marked clinical improvement. CONCLUSION: Minocycline effectively decreased eyelid bacterial flora in patients with acne rosacea or blepharitis. One of the mechanisms of newer generation tetracycline analogues may be a decrease or elimination of bacterial flora from the eyelids.

Anti-Bacterial Agents↗
PubMed1978

Woolly hair nevus. Two case reports and a discussion of unruly hair forms.

Woolly hair is very curly hair that is characteristically unruly and will not form naturally into locks. Woolly hair nevus first appears when the scalp hair begins to grow. It is seen as a patch of unruly, very curly hair, arising in a field of otherwise unremarkable scalp hair. Woolly hair can also be seen as a hereditary trait involving the entire scalp and in acquired forms. It may be distinguished from two other types of unruly hair, pili torti and spun glass hair.

Adult↗