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PubMed2004

Rapid identification and differentiation of fungal DNA in dermatological specimens by LightCycler PCR.

The aim was to develop a LightCycler PCR method for the rapid detection and differentiation of fungal DNA in dermatological specimens such as skin scales and skin swabs. LightCycler PCR assays were established for seven primer sets specific for fungal DNA. For each primer set LightCycler melting points were defined by amplification of DNA from 21 fungi and sensitivity was determined by amplification of serial dilutions of fungal DNA. A protocol was established that allows detection and differentiation of mould and yeast DNA with one highly sensitive PCR reaction by assessment of LightCycler melting points. Two subsequent LightCycler PCR reactions and one RFLP reaction allowed the differentiation of dermatophytes and non-dermatophyte moulds and the subclassification of yeasts. Analysis of clinical samples from 38 patients with fungal skin diseases provided conclusive new diagnostic information in 9/38 cases (23.7 %) by this PCR protocol that was not equally provided by direct microscopy and mycological culture. Thus the LightCycler PCR protocol established here represents a rapid diagnostic tool that aids in the diagnosis of fungal skin disease in a substantial number of patients.

DNA, Fungal↗
PubMed2000

An imaging system with calibrated color image acquisition for use in dermatology.

We propose a novel imaging system useful in dermatology, more precisely, for the follow-up of patients with an increased risk of skin cancer. The system consists of a Pentium PC equipped with an RGB frame grabber, a three-chip charge coupled devices (CCD) camera controlled by the serial port and equipped with a zoom lens and a halogen annular light source. Calibration of the imaging system provides a way to transform the acquired images, which are defined in an unknown color space, to a standard, well-defined color space called sRGB. sRGB has a known relation to the CIE1 XYZ and CIE L*a*b* colorimetric spaces. These CIE color spaces are based on the human vision, and they allow the computation of a color difference metric called CIE deltaE*ab, which is proportional to the color difference, as seen by a human observer. Several types of polynomial RGB to sRGB transforms will be tried, including some optimized in perceptually uniform color spaces. The use of a standard and well-defined color space also allows meaningful exchange of images, e.g., in teledermatology. The calibration procedure is based on 24 patches with known color properties, and it takes about 5 minutes to perform. It results in a number of settings called a profile that remains valid for tens of hours of operation. Such a profile is checked before acquiring images using just one color patch, and is adjusted on the fly to compensate for short-term drift in the response of the imaging system. Precision or reproducibility of subsequent color measurements is very good with (deltaE*ab) = 0.3 and deltaE*ab < 1.2. Accuracy compared with spectrophotometric measurements is fair with (deltaE*ab) = 6.2 and deltaE*ab < 13.3.

Calibration↗
PubMed1991

Gene amplification by polymerase chain reaction in dermatology.

The polymerase chain reaction (PCR) is another new powerful technique in molecular biology that has begun to open new perspectives in modern science and also in dermatology. This brief report will therefore elucidate the general principles of the polymerase chain reaction, as well as its limitations and possible pitfalls. Furthermore an overview will be provided on the impact of PCR on molecular biologic approaches in oncology, immunology, and human genetics. The use of the method as a tool to detect microorganisms particularly viruses and bacteria, in cutaneous tissue and it potential other future applications are described as well. Because PCR is automated and is being more and more established in routine laboratories, physicians and scientists should be familiar with the basic principles and potential uses of this methodology.

Gene Amplification↗
PubMed1976

Genetics and dermatology: a review.

The development of genetic studies over the last hundred years, in particular as they have affected dermatology, has been reviewed. The clinical application of knowledge derived from other fields has been emphasized, areas of future research have been indicated, and suggestions for cooperation with other disciplines have been offered.

Animals↗
PubMed1990

Recombinant interferon-gamma (rIFN-gamma) in dermatology.

This paper gives a short review on the function, pharmacokinetics, and therapeutic application of recombinant interferon-gamma (rIFN-gamma) in dermatology. Simultaneously, our own experiences are presented for 57 patients (phase II study) suffering from genital warts (21 patients), psoriatic arthritis (10 patients), psoriasis vulgaris (three patients), malignant melanoma (six patients), bowenoid papulosis (four patients), Behcet's disease (four patients), basal cell carcinoma (six patients), as well as herpes simplex recidivans, epidermodysplasia verruciformis, and mycosis fungoides (one patient each). We conclude that there might be an indication for treatment with rIFN-gamma in genital warts, bowenoid papulosis, Behcet's disease, and microbial infections, such as leprosy and cutaneous leishmaniasis. Even though there are reports of a limited beneficial effect of rIFN-gamma on arthritis and skin lesions in psoriasis, we failed to observe any in 10 patients. The main side effects in our low-dose study (50-100 micrograms/d) were mild fever (78%), fatigue (78%), and myalgia (65%). Laboratory tests revealed an increase in the serum triglyceride level, in particular, in psoriatic patients.

Bacterial Infections↗
PubMed2004

Allergic and non-allergic periorbital dermatitis: patch test results of the Information Network of the Departments of Dermatology during a 5-year period.

Periorbital dermatitis is common and can be due to the external use of ophthalmic drugs. We evaluated patch test results of the Information Network of the Departments of Dermatology. During a 5-year period (1995-99), of a total 49,256 patch-tested patients, 1053 (2.1%) were eventually diagnosed as allergic periorbital contact dermatitis (APD) and 588 (1.2%) as non-allergic periorbital dermatitis (NAPD). Patient characteristics between APD, NAPD and other cases (OCs) differed with respect to sex (19.7% male in both periorbital groups versus 36.3% in OCs), atopic dermatitis (10.4% in APD versus 60.2% in NAPD versus 16.9% in OCs) and age, APD being substantially more often (68.2%) aged 40 and above than NAPD (52.6%). Several of the top allergens in OCs [such as fragrance mix, Myroxylon pereirae resin (balsam of Peru), lanolin alcohol and potassium dichromate] caused significantly fewer positive test reactions in both periorbital groups. In contrast, thimerosal, phenylmercuric acetate, sodium disulfite, gentamicin sulfate, phenylephrine hydrochloride and benzalkonium chloride tested positively significantly more often in APD but not in NAPD, verifying them as true ophthalmic allergens. Finally, in 42 cases (4%) of APD patients, additional allergens were identified by testing of the patients' own substances (mostly beta-blockers, oxybuprocaine and dexpanthenol), supporting the necessity of testing with ophthalmic drugs as is where individual substances are not readily available.

Adult↗
PubMed2004

Frequency of contact allergy in German children and adolescents patch tested between 1995 and 2002: results from the Information Network of Departments of Dermatology and the German Contact Dermatitis Research Group.

Allergic contact dermatitis (ACD) affects approximately 7% of the general population. To evaluate the frequency of ACD in children, we analysed patch test results collected by the Information Network of Departments of Dermatology between 1995 and 2002. Data of 285 children (6-12 year) and 2175 adolescent patients (13-18 year) were analysed to determine the frequency of sensitization to the 30 most common contact allergens, adjusting for age and sex. As control group, we defined adult patients (60-66 year, n = 7904). The top allergens in children were thimerosal, gentamicin sulphate, nickel-II-sulphate, ammoniated mercury, cobalt-II-chloride, fragrance mix, bufexamac, Compositae mix, propylene glycol and turpentine. The overall proportion of sensitized patients according to the patch test results was 52.6% in the children group compared to 49.7% in the adolescent group. These findings were similar in the adult group at 52.2%. The detailed analysis regarding sex, occupation, atopy, site of eczema and age showed distinct patterns in each group indicating age-specific exposures. Atopy-related diseases were more common in children compared to adults. On the basis of the data of this study, the relationship between atopy and the risk of development of ACD, at least in children, needs further investigation.

Adolescent↗
PubMed2004

Statins: novel additions to the dermatologic arsenal?

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), atorvastatin, cerivastatin, fluvastatin, pravastatin, lovastatin and simvastatin, reduce atherogenesis and cardiovascular morbidity. Besides, there is growing evidence that statins have immunomodulatory activities. Statins downregulate the expression of adhesion molecules, intercellular adhesion molecule-1 (ICAM-1), monocyte chemotactic protein-1 (MAC-1) and lymphocyte function-associated antigen-1 (LFA-1), on leucocytes and endothelial cells and, through binding to LFA-1, interfere with ICAM-1-LFA-1 interaction, which is crucial for activation of lymphocytes by antigen-presenting cells, ingress of leucocytes into the inflammation sites and immunologic cytotoxicity. Statins inhibit the inducible expression of major histocompatibility complex class II in several cell types including macrophages and downregulate the expression of T-helper-1 (Th1) chemokine receptors on T cells, leading further to inhibition of activation of lymphocytes and their infiltration into the inflammation sites. Statins block the induction of inducible nitric oxide synthase and the expression of several proinflammatory cytokines such as tumour necrosis factor-alpha and interferon-gamma in macrophages and possess antioxidant effects. These agents inhibit the proliferation of immunocytes and the activation of natural killer cells. Regarding the above facts and in view of their safety and inexpensiveness, statins may prove invaluable in the treatment of a multiplicity of dermatologic disorders, especially those characterized by ingress of activated leucocytes into the skin, such as alopecia areata, vitiligo, lichen planus, subacute cutaneous lupus erythematosus, erythema multiforme, psoriasis, bullous pemphigoid, systemic sclerosis, mycosis fungoides, toxic epidermal necrolysis and Behcet's disease.

Humans↗
PubMed2004

Use of IGIV in the treatment of immune-mediated dermatologic disorders.

Immunoglobulin (Ultravenous, IGIV) is now used in a variety of immune-mediated diseases. Its presumed mechanism of action involves both anti-inflammatory and immunomodulatory activities. A number of dermatologic conditions are believed to be immune mediated and in these disorders, IGIV has shown benefit in reducing symptoms and the need for cortecosteroids or cytotaxic drugs. In many of these diseases, the initial benefits seen in open-labeled trials must be confirmed in controlled clinical trials.

Autoimmune Diseases↗
PubMed1990

Clinical survey of syphilis at the Dermatological Clinic of Nippon Medical School Hospital from 1984 to 1988, with special reference to the recent clinical manifestations and evaluation of IgM antibodies to Treponema pallidum.

One hundred eighty-one patients with syphilis were seen from May 1, 1984, to April 30, 1988 at the Dermatological Clinic of Nippon Medical School Hospital. The incidence of syphilis has increased gradually year by year. The number of early infectious syphilis cases was almost twice as high as late latent syphilis ones. As a source of infection, female prostitutes were noteworthy. Among primary syphilis cases, multiple chancres were observed in 29.2%. The frequency of ulcus durum was much higher than initial sclerosis. A relationship with oral sex is suggested. Among secondary syphilis cases, pruritus was observed in 23.9%, prominently on volar lesions. Psoriasiform papular and macular syphilide were the commonest features. Secondary syphilis with persisting chancres were seen in 41.3% and is gradually increasing. JH reactions were observed in 26.3%. The frequency was highest in late primary and in early secondary stages. IgM-TPHA and IgG-TPHA were tested in 94 sera by gel-filtration and 77 by HPLC. IgM-TPHA tests were reactive in virtually all the sera from untreated syphilis cases. The titres in untreated syphilis were higher than in treated cases. IgM-TPHA/IgM-TPHA + IgG-TPHA was higher in early syphilis than in late syphilis. Fifty-eight untreated cases were tested at frequent intervals after treatment for up to 12 months. IgM antibodies disappeared in 53 patients within 12 months. Non-treponemal antibodies measured by the CF test disappeared within 15 patients and TPHA tests remained positive after 12 months in all patients. IgM-TPHA may support a diagnosis of active syphilis.

Adolescent↗
PubMed1994

Basal cell carcinoma: seven years' experience at the Institute of Dermatology in Bangkok.

Sixty-seven patients with basal cell carcinoma (BCC) were observed at the Institute of Dermatology, Bangkok, Thailand between 1982 and 1989. The male:female ratio was 1:2. The average age of the patients at first examination was 60.6 years. Lesions in sun-exposed areas were three times more frequent than lesions in covered areas. The principal location was the face, including the cheek, nose, periorbital area, ears, and forehead. The remainder were on the scalp, breast, abdomen, back, thigh, and knee. Ulceration was the most frequent symptom, followed by a mass. Histopathologically, pigmented BCC was the most frequent, followed by solid BCC, superficial BCC, adenoid BCC, morphoeic BCC, cystic BCC, basosquamous BCC, mixed carcinoma, keratotic BCC, and fibroepitheliomatous BCC. In patients younger than 50 years of age, solid or pigmented tumors were frequent. The morphoeic type was present only on the face and scalp. In females, solid BCC or adenoid BCC predominated. Only 4 of our 67 patients had histories of ingestion of herbal medicine with arsenic as one of the ingredients. Sixty-one patients were treated surgically. There was only one case of tumor recurrence after surgery. The remaining patients were treated by electric cautery, liquid nitrogen, or irradiation. No patients developed distant metastasis.

Adolescent↗
PubMed1995

The porphyrias: a brief overview based on 25 years of experience (1969-1994) by the Department of Dermatology of the Hospital Clinic and Faculty of Medicine of Barcelona, Spain.

The porphyrias are uncommon diseases caused by enzymatic deficiencies in the heme pathway. In the 25 year period 1969-1994, the Department of Dermatology of the Hospital Clinic of Barcelona has been able to study 793 cases of porphyria (724 cases of PCT, 27 of EPP, 26 of PV, 5 of CEP, 5 of HEP, 5 of AIP, 1 of HCP). Homozygous expression of an enzymatic deficiency in the heme pathway produces severe disease. Commonly, clinical manifestations appear in the homozygous state (the autosomal recessive porphyrias). However, homozygous forms of autosomal dominant porphyrias may occur exceptionally. Moreover, there are cutaneous porphyrias whose clinical manifestations do not permit dermatologists to classify them clearly into one of the well-defined syndromes. These uncommon and atypical forms are difficult to recognize without biochemical and enzyme studies. The porphyrias have a wide clinico-biochemical spectrum, including a large proportion of well defined diseases. Nevertheless, atypical forms occur and may be difficult to evaluate. It is important to note the genetic heterogeneicity of porphyrias, which accounts for the varying phenotypic expression.

Hospital Departments↗
PubMed2003

Dermatological side effects of brimonidine: a report of three cases.

Brimonidine is a potential first line therapy for primary open angle glaucoma (OAG) and ocular hypertension (OHT). It is known to cause various ocular and systemic side effects. Being a newer drug, the whole spectrum of its adverse effects is not known. The dermatological side effects caused by brimonidine have rarely been reported before. We present three OAG patients who presented to us with contact dermatitis of periorbital skin and lichen planus of nail following the use of topical brimonidine (0.2% twice a day) for more than six months. These side effects slowly disappeared on discontinuing the drug but reappeared on reintroducing topical formulation. Such side effects from the use of brimonidine have not been reported before.

Administration, Topical↗
PubMed1976

The place of intralesional steroid therapy in dermatology.

Intralesional steroid therapy has a definite, if small, place in dermatology and triamcinolone acetonide is the preparation in most common use. Such therapy may be used, particularly in nail disorders, keloids and hypertrophic scars, cystic acne, and to speed regrowth of hair in localized alopecia areata. Other conditions in which it has a place include cutaneous lupus erythematosus and sarcoidosis. There are some conditions where use is occasionally indicated and yet others where further trial is merited.

Acne Vulgaris↗
PubMed1978

Circulating Sézary cells in hospitalized dermatology patients.

Sézary cells in the circulation were counted daily in 14 hospitalized dermatology patients: six with contact dermatitis, five with atopic dermatitis, and three with exfoliative psoriasis. All had circulating Sézary cells, but absolute counts of Sézary cells of more than 1000/mm3 appeared to correlate with a severe refractory course in two patients. It is probable that low, intermittent levels of circulating Sézary cells accompany many inflammatory dermatoses, and it is reasonable that monitoring this cell population may aid in anticipating more consequential skin disease.

Dermatitis↗
PubMed1978

A new apparatus for the delivery of high intensity UVA and UVA+UVB irradiation, and some dermatological applications.

A new apparatus consisting of a 200 W super pressure mercury lamp and a flexible light guide with a liquid light-conducting core is presented. Its transmission for UVA irradiation is more than threefold as compared to conventional quartz fibre optic bundles. The light guide is capable of transmitting density levels exceeding I W/cm2. UVA and UVB are transmitted. By inserting a filter platelet (WG 345) into the light guide the UVB is cut off. The output of the unfiltered guide is 700 mW (3570 mW/cm2), of the filtered guide 400 mW (2040 mW/cm2), centered mainly at 366 nm. The light apparatus proved useful for several dermatological applications. It replaces in many respects conventional Kromayer lamps, especially because the flexible light guide, which is 160 cm long and weighs only 210 g, can be brought into direct contact with the skin. Results of determining the minimal erythema dose (MED), of phototesting (8-MOP photoallergy, persistent light reactor, erythropoietic protoporphyria) and of photochemotherapy are given.

Acrodermatitis↗
PubMed1979

A history questionnaire for dermatology out-patients.

A questionnaire has been devised to be completed by new patients at home before attending the dermatology clinic. We report our experience with this questionnaire and discuss the potential advantages of this system; these include increased detail and accuracy of history, standardization of information and easier availability of information at patients' follow-up. Previously used questionnaires and other similar methods of obtaining a self administered history are discussed.

Ambulatory Care↗