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Archives of Dermatology

Subject:
Dermatology
Publisher:
American Medical Association
American Medical Association
ISSN:
0003-987X
Scimago Journal Rank:
173
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Mycobacterium marinum Skin Infection Successfully Treated With Levofloxacin

lijima, Shigeruko;Saito, Junko;Otsuka, Fujio

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440013001

Abstract REPORT OF A CASE A 30-year-old Japanese man first noticed a small, slightly pruritic nodule on the dorsum of his left hand in December 1993. Before the patient presented to us in May 1994 he was treated by his personal physician, who prescribed several antibiotics for 2 months without apparent response. The nodule slowly grew and became tender. Another small nodule then appeared on his left forearm. The patient had kept tropical fish for 5 years and he reported injuring his left hand when cleaning the fish tank.A physical examination revealed 2 dark, erythematous, and slightly elevated nodules that measured 37×17 mm on the dorsum of his left hand and 47×25 mm on his forearm (Figure 1). Both nodules were exudative and purulent. The superficial regional lymph nodes were not swollen.Results of the laboratory examination, which included a complete blood cell count with differentiation, blood chemistry profile, and References 1. Edelstein H. Mycobacterium marinum skin infections: report of 31 cases and review of the literature . Arch Intern Med. 1994;154:1359-1364.Crossref 2. Kullavanijaya P, Sirimachan S, Bhuddhavudhikrai P. Mycobacterium marinum cutaneous infections acquired from occupations and hobbies . Int J Dermatol. 1993;32:504-507.Crossref 3. Donta ST, Smith PW, Levitz RE, Quintiliani R. Therapy of Mycobacterium marinum infections: use of tetracyclines vs rifampin . Arch Intern Med. 1986;146: 902-904.Crossref 4. Sanders WJ, Wolinsky E. In vitro susceptibility of Mycobacterium marinum to eight antimicrobial agents . Antimicrob Agents Chemother. 1980;18:529-531.Crossref 5. Arai H, Nakajima H, Kaminaga Y. In vitro susceptibility of Mycobacterium marinum to dihydromycoplanecin A and ten other antimicrobial agents . J Dermatol. 1990;17:370-374. 6. Brown BA, Wallace RJ Jr, Onyi GO. Activities of clarithromycin against eight slowly growing species of nontuberculous mycobacteria, determined by using a broth microdilution MIC system . Antimicrob Agents Chemother. 1992;36:1987-1990.Crossref 7. Kuhn SM, Rosen W, Wong A, Jadavji T. Treatment of Mycobacterium marinum facial abscess using clarithromycin . Pediatr Infect Dis J. 1995;14:631-632.Crossref 8. Leysen DC, Haemers A, Pattyn SR. Mycobacteria and the new quinolones . Antimicrob Agents Chemother . 1989;33:1-5.Crossref 9. Garcia-Rodriguez JA, Gomez Garcia AC. In-vitro activities of quinolones against mycobacteria . J Antimicrob Chemother. 1993;32:797-808.Crossref 10. Tomioka H, Sato K, Saito H. Comparative in vitro and in vivo activity of fleroxacin and ofloxacin against various mycobacteria . Tubercle. 1991;72:176-180.Crossref 11. Saito H, Tomioka H, Sato K, Dekio S. In vitro and in vivo antimycobacterial activities of a new quinolone, DU-6859a . Antimicrob Agents Chemother. 1994;38: 2877-2882.Crossref 12. Ishida M, Takei A, Itoh M, Tsuyuki S, Yamaguchi K. A case of atypical Mycobacterium infection [in Japanese] . Jpn J Dermatol. 1993;103:860. Abstract. 13. Arai H, lemoto G, Nakajima H, Kaminaga Y. A case of Mycobacterium marinum skin infection [in Japanese] . Hifubyoh-shinryoh. 1995;17:379-382. 14. Une T, Fujimoto T, Sato K, Osada Y. In vitro activity of DR-3355, an optically active ofloxacin . Antimicrob Agents Chemother. 1988;32:1336-1340.Crossref 15. Fujimoto T, Mitsuhashi S. In vitro antibacterial activity of DR-3355, the S-(-)— isomer of ofloxacin . Chemotherapy . 1990;36:268-276.Crossref 16. Tanaka M, Otsuki M, Une T, Mshino T. In vitro and in vivo activity of DR-3355, an optically active isomer of ofloxacin . J Antimicrob Chemother. 1990;26:659-666.Crossref 17. Takahashi H, Mogi S, Kobayashi M, et al. Assay of skin level and clinical investigation of levofloxacin in the treatment of skin infections [in Japanese] . Chemotherapy . 1992;40( (S-3) ):286-305. 18. Nakashima M, Uematsu T, Kanamaru M, Okazaki O, Hakusui H. Phase 1 study of levofloxacin, S—(-)-ofloxacin . Jpn J Clin Pharmacol Ther. 1992;23:515-520.Crossref
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Reliability of the Histopathologic Diagnosis of Melanocytic Dysplasia

Weinstock, Martin A.;Barnhill, Raymond L.;Rhodes, Arthur R.;Brodsky, Gilbert L.

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440019002

Abstract Objective: To determine the reliability of the histopathologic diagnosis of melanocytic dysplasia among diverse dermatopathologists who had no joint training, agreed to abide by predetermined criteria, and who were provided reference photomicrographs illustrative of the criteria. Design, Setting, and Participants: A stratified random sample of 112 melanocytic tumors were chosen from the files of the pathology department of a large staff-model health maintenance organization. The original diagnoses included typical and dysplastic melanocytic nevi and melanoma. A single representative slide for each case was interpreted independently by each of the 5 panel dermatopathologists and 2 melanoma specialists. They had no prior knowledge of the original diagnosis or the diagnoses of the other panel members. Interventions: None. Main Outcome Measures: Interrater reliability was measured by intraclass and Pearson correlation coefficients. Each case was graded on a 5-point scale from no dysplasia to melanoma. Results: The intraclass correlation among the panel members was 0.67 (95% confidence interval, 0.59-0.73). The Pearson correlations of each of the 5 panel dermatopathologists with the mean of the 2 melanoma specialists ranged from 0.67 to 0.84, and the correlations of the mean of the panel with the 2 melanoma specialists were 0.79 and 0.82; the mean reading of the melanoma specialists correlated 0.89 with the mean panel reading. Apparent protocol violations occurred in 6.5% of the readings. Conclusions: Agreement was substantial to excellent for the histopathologic diagnosis of 112 melanocytic tumors by dermatopathologists. Using predetermined criteria, melanocytic dysplasia can be reproducibly graded among diverse general dermatopathologists.Arch Dermatol. 1997;133:953-958 References 1. Weinstock MA. Dysplastic nevi revisited . J Am Acad Dermatol. 1994;30:807-810.Crossref 2. Roth ME, Grant-Kels JM, Ackerman AB, et al. The histopathology of dysplastic nevi: continued controversy . Am J Dermatopathol. 1991;13:38-51.Crossref 3. Rhodes AR, Mihm MC Jr, Weinstock MA. Dysplastic melanocytic nevi: a reproducible histologic definition emphasizing cellular morphology . Mod Pathol. 1989; 2:306-319. 4. Clemente C, Cochran AJ, Elder DE, et al. Histopathologic diagnosis of dysplastic nevi: concordance among pathologists convened by the World Health Organization Melanoma Programme . Hum Pathol. 1991;22:313-319.Crossref 5. Piepkorn MW, Barnhill RL, Cannon-Albright LA, et al. A multi-observer, population-based analysis of histologic dysplasia in melanocytic nevi . J Am Acad Dermatol. 1994;30:707-714.Crossref 6. Zar JH. Biostatistical Analysis. 2nd ed. Englewood Cliffs, NJ: Prentice-Hall International Inc; 1984. 7. Agresti A. Analysis of Ordinal Categorical Data . New York, NY: John Wiley & Sons Inc; 1984. 8. Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures . BMJ . 1992;304:1491-1494.Crossref 9. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit . Psychol Bull. 1968;70:213-220.Crossref 10. Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability . Educ Psychol Meas. 1973;33:613-619.Crossref 11. Maclure M, Willett WC. Misinterpretation and misuse of the kappa statistic . Am J Epidemiol. 1987;126:161-169.Crossref 12. Byrt T, Bishop J, Carlin JB. Bias, prevalence, and kappa . J Clin Epidemiol. 1993; 46:423-429.Crossref 13. Graham P, Jackson R. The analysis of ordinal agreement data: beyond weighted kappa . J Clin Epidemiol. 1993;46:1055-1062.Crossref 14. Sagebiel RW, Banda PW, Schneider JS, Crutcher WA. Age distribution and histologic patterns of dysplastic nevi . J Am Acad Dermatol. 1985;13:975-982.Crossref 15. Heenan PJ, Matz LR, Blackwell JB, et al. Inter-observer variation between pathologists in the classification of cutaneous malignant melanoma in Western Australia . Histopathology. 1984;8:717-729.Crossref 16. Colloby PS, West KP, Fletcher A. Observer variation in the measurement of Breslow depth and Clark's level in thin cutaneous malignant melanoma . J Pathol. 1991; 163:245-250.Crossref 17. Walter SD, Marrett LD, Hertzman C. Reliability of interviewer and subject assessments of nevus counts in a study of melanoma . J Clin Epidemiol. 1991;44: 633-640.Crossref 18. Leffell DJ, Chen Y-T, Berwick M, Bolognia JL. Interobserver agreement in a community skin cancer screening setting . J Am Acad Dermatol. 1993;28:1003-1005.Crossref 19. Carli P, Urso C, De Giorgi V, Biggeri A, Bondi R, Giannottii B. Sensitivity and specificity of clinical criteria in the detection of histologic atypia in nevi . Eur J Dermatol. 1994;4:35-39. 20. de Vet HCW, Knipschild PG, Schouten HJA, et al. Interobserver variation in histopathological grading of cervical dysplasia . J Clin Epidemiol. 1990;43:1395-1398.Crossref 21. Stanganelli I, Burroni M, Rafanelli S, Bucchi L. Intraobserver agreement in interpretation of digital epiluminescence microscopy . J Am Acad Dermatol. 1995; 33:584-589.Crossref 22. Whited JD, Horner RD, Hall RP, Simel DL. The influence of history on interobserver agreement for diagnosing actinic keratoses and malignant skin lesions . J Am Acad Dermatol. 1995;33:603-607.Crossref 23. Meyer LJ, Piepkorn M, Goldgar DE, et al. Interobserver concordance in discriminating clinical atypia of melanocytic nevi, and correlations with histologic atypia . J Am Acad Dermatol. 1996;34:618-625.Crossref 24. Lock-Andersen J, Hou-Jensen K, Hansen JPH, Jensen NK, Sogaard H, Andersen PK. Observer variation in histological classification of cutaneous malignant melanoma . Scand J Plast Reconstr Hand Surg. 1995;29:141-148.Crossref 25. Schmoeckel C. How consistent are dermatopathologists in reading early malignant melanomas and lesions 'precursor' to them? an international survey . Am J Dermatopathol. 1984;6( (suppl) ):13-24. 26. Krieger N, Hiatt RA, Sagebiel RW, Clark WH, Mihm MC. Inter-observer variability among pathologists' evaluation of malignant melanoma: effect upon an analytic study . J Clin Epidemiol. 1994;47:897-902.Crossref 27. Corona R, Mele A, Amini M, et al. Interobserver variability on the histopathologic diagnosis of cutaneous melanoma and other pigmented skin lesions . J Clin Oncol. 1996;14:1218-1223. 28. Duray PH, DerSimonian R, Barnhill RL, et al. An analysis of interobserver recognition of the histopathologic features of dysplastic nevi from a mixed group of nevomelanocytic lesions . J Am Acad Dermatol. 1992;27:741-749.Crossref 29. Duncan LM, Berwick M, Bruijn JA, Byers HR, Mihm MC, Barnhill RL. Histopathologic recognition and grading of dysplastic melanocytic nevi: an interobserver agreement study . J Invest Dermatol. 1993;100( (suppl) ):318S-321S.Crossref 30. Ahmed I, Peipkorn MW, Rabkin MS, et al. Histopathologic characteristics of dysplastic nevi: limited association of conventional histologic criteria with melanoma risk group . J Am Acad Dermatol. 1990;22:727-733.Crossref 31. de Wit PEJ, van't Hof-Grootenboer B, Ruiter DJ, et al. Validity of the histopathological criteria used for diagnosing dysplastic naevi: an interobserver study by the pathology subgroup of the EORTC Malignant Melanoma Cooperative Group . Eur J Cancer. 1993;29A:831-839.Crossref 32. Hastrup N, Clemmensen OJ, Spaun E, Sondergaard K. Dysplastic naevus: histologic criteria and their inter-observer reproducibility . Histopathology. 1994; 24:503-509.Crossref
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Lichen Planus—Like Histopathologic Characteristics in the Cutaneous Graft-vs-Host Reaction: Prognostic Significance Independent of Time Course After Allogeneic Bone Marrow Transplantation

Horn, Thomas D.;Zahurak, Marianna L.;Atkins, Debra;Solomon, Alvin R.;Vogelsang, Georgia B.

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440027003

Abstract Background: The discrimination between acute and chronic graft-vs-host disease (GVHD) after allogeneic bone marrow transplantation (BMT) is important because the treatment regimens and prognosis differ. Objectives: To identify whether accepted histopathologic criteria of a graft-vs-host reaction (GVHR) alone or in combination accurately reflect clinical phase of disease, to correlate patterns with clinical outcome, and to identify any concordance between inflammation and epidermal changes of a GVHR. Design: Skin biopsy specimens were analyzed according to histologically defined standards. Settings: This study was performed in a tertiary care hospital. Patients: One hundred seventy-three skin biopsy specimens (10 days before to 1326 days after BMT) from 83 patients undergoing allogeneic BMT for various malignant neoplasms were selected for study. A consecutive 12-month sample was used. Main Outcome Measures: The main measures in this study were statistical correlations between histopathologic findings and time after BMT, the outcome of BMT, and the correlations between selected histopathologic criteria. Results: Fully evolved histologic features of chronic lichenoid GVHR in the specimens occurred across a wide time range (33-832 days after BMT) and were associated with a 5.6-fold increased risk for death (P=.02) from GVHD. Histologic features of acute GVHR in the specimens also occurred across a wide time range (14-481 days after BMT) and were associated with a 2.2-fold increased risk for death; this finding was not statistically significant (P=.11). Inflammation of the upper dermis was significantly associated with acanthosis and epidermal cell necrosis (P<.001 and P<.001, respectively, for bandlike pattern), confirming the importance of this finding as a criterion for the diagnosis of a GVHR. Blinded evaluation of a subset of specimens for the diagnosis of acute vs chronic GVHR resulted in wide interobserver variation. Conclusions: This study demonstrates the following: specific histologic parameters in skin biopsy specimens do not consistently separate acute from chronic GVHD as defined by days after BMT; independent of time course, fully evolved histopathologic characteristics of a lichen planus—like GVHR is associated with a greater likelihood of death from GVHD; and identification of upper dermal inflammation correlates with the epidermal features of GVHR and should be included in the diagnostic scheme.Arch Dermatol. 1997;133:961-965 References 1. Horn TD. Graft-versus-host disease . In: Arndt KA, LeBoit PE, Robinson JK, Wintroub BU, eds. Cutaneous Medicine and Surgery . Philadelphia, Pa: WB Saunders Co; 1996:225-234. 2. Snover DC. Acute and chronic graft versus host disease: histopathological evidence for two distinct pathogenetic mechanisms . Hum Pathol. 1984;15:202-205.Crossref 3. Farmer ER. Human cutaneous graft-versus-host disease . J Invest Dermatol. 1985; 85( (suppl) ):124S-128S.Crossref 4. Lerner KG, Kao GF, Storb R, et al. Histology of graft-versus-host reaction (GvHR) in human recipients of marrow from HLA-matched sibling donors . Transplantation. 1974;4:367-371. 5. Saurat JH, Gluckman E, Bussel A, et al. The lichen planuslike eruption after bone marrow transplantation . Br J Dermatol. 1975;93:675-681.Crossref 6. Weiden PL, Sullivan K, Flournoy N, et al. Anti-leukemic efect of chronic graft-versus-host disease: contribution to improved survival after allogeneic bone marrow transplantation . N Engl J Med. 1981;304:1529-1533.Crossref 7. Darmstadt GL, Donnenberg AD, Vogelsang GB, Farmer ER, Horn TD. Clinical, laboratory, and histopathologic indicators of the development of progressive acute graft-versus-host disease . J Invest Dermatol. 1992;99:397-402.Crossref 8. Horn TD, Bauer DJ, Vogelsang GB, Hess AD. Reappraisal of histologic features of the acute cutaneous graft-versus-host reaction based upon an allogeneic rodent model . J Invest Dermatol. 1994;103:206-210.Crossref 9. Cox DR. The Analysis of Binary Data . London, England: Meuthen; 1970. 10. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models . Biometrika . 1986;73:13-22.Crossref 11. Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach . Biometrics. 1988;44:1049-1060.Crossref 12. Wingard JR, Piantadosi S, Vogelsang GB, et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation . Blood. 1989;74: 1428-1435.
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Ultrasound Examination of Hair Follicles in Hidradenitis Suppurativa

Jemec, Gregor B. E.;Gniadecka, Monika

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440033004

Abstract Objective: To describe the in vivo skin echostructure, hair follicle shape, and dermal thickness in hidradenitis suppurativa. Design: Qualitative and quantitative assessment of highfrequency (20-MHz) B-mode ultrasound images of lesional and paralesional skin. Setting: University hospital. Patients: Age- and sex-matched outpatients with hidradenitis suppurativa (n=15) and healthy control subjects (n=13). Median age was 34 years (range, 31-38). Results: Clinically normal paralesional hair follicles in hidradenitis have an abnormal shape. The follicles appear to be wider in the deep dermis, the difference being statistically significant in the genitofemoral region (P=.007). Patients with hidradenitis have larger follicles in the axilla than controls (P=.002). Mature acne and hidradenitis lesions are indistinguishable, but both are different from epidermal cysts. Mean axillary and genitofemoral skin was significantly thicker in patients than in controls. Conclusions: In vivo ultrasonography shows characteristic differences in the shape of hair follicles in hidradenitis. The general underlying abnormalities appear to occur in the deep part of the follicle. The mature lesions are indistinguishable from acne, but are clearly different from epidermal cysts. A thickened skin may play a pathogenic role in the development of hidradenitis.Arch Dermatol. 1997;133:967-970 References 1. Rodder Wehrmann O, Kuster W, Plewig G. Acne inversa: diagnosis and therapy [in German] . Hautarzt. 1991;42:5-8. 2. Jemec GB, Hansen U. Histology of hidradenitis suppurativa . J Am Acad Dermatol. 1996;34:994-999.Crossref 3. Ramasastry SS, Conklin WT, Granick MS, Futrell JW. Surgical management of massive perianal hidradenitis suppurativa . Ann Plast Surg. 1985;15:218-223.Crossref 4. Jemec GB. Effect of localized surgical excisions in hidradenitis suppurativa . J Am Acad Dermatol. 1988;18:1103-1107.Crossref 5. Alexander H, Miller D. Determining skin thickness with pulsed ultrasound . J Invest Dermatol. 1979;72:17-19.Crossref 6. Serup J, Keiding J, Fullerton A, et al. High-frequency ultrasound examination of skin: introduction and guide . In: Serup J, Jemec G, eds. Handbook of Noninvasive Methods and the Skin . Boca Raton, Fla: CRC Press Inc; 1995:239-256. 7. Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach . In: Roenigk RK, Roenigk HH Jr, eds. Dermatologic Surgery . New York, NY: Marcel Dekker Inc; 1989:717-743. 8. Burke BM, Cunliffe WJ. The assessment of acne vulgaris: the Leeds technique . Br J Dermatol. 1984;111:83-92.Crossref 9. Gniadecka M, Gniadecki R, Serup J, Sondergaard J. Ultrasound structure and digital image analysis of the subepidermal low echogenic band in aged human skin: diurnal changes and intraindividual variability . J Invest Dermatol. 1994; 102:362-365.Crossref 10. Gniadecka M, Serup J, Sondergaard J. Age-related changes of skin oedema by high-frequency ultrasound . Br J Dermatol. 1995;131:849-855.Crossref 11. Jansen T, Plewig G. Classification of suppurative hidradenitis [in German] . Hautarzt. 1994;45:652-653.Crossref 12. Attanoos RL, Appleton MA, Douglas Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands . Br J Dermatol. 1995;133:254-258.Crossref 13. Gniadecka M, Omskeff B. Assessment of dermal water by high-frequency ultrasound: comparative studies with nuclear magnetic resonance . Br J Dermatol. 1996;135:218-224.Crossref 14. Serup J, Staberg B. Ultrasound for assessment of allergic and irritant patch test reactions . Contact Dermatitis. 1987;17:80-84.Crossref 15. de Rigal J, Escoffier C, Querleux B, Faivre B, Agache P, Leveque J. Assessment of ageing of the human skin in vivo: ultrasound imaging . J Invest Dermatol. 1989; 93:621-625.Crossref 16. Gniadecka M, Danielsen L. High-frequency ultrasound for torture-inflicted skin lesions . Acta Derm Venerol (Stockh) . 1995;75:375-376. 17. Harrison BJ, Mudge M, Hughes LE. Recurrence after surgical treatment of hidradenitis suppurativa . BMJ. 1987;294:487-489.Crossref 18. Priesack W, Maroske D, Hamelmann H. Results of multiple surgical therapy in pronounced acne conglobata [in German] . Chirurg. 1984;55:343-346. 19. Overgaard Olsen L, Takiwaki H, Serup J. High-frequency ultrasound characterization of normal skin: skin thickness and echographic density of 22 anatomical sites . Skin Res Technol. 1995;1:74-81.Crossref
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Clinical Implications

Plewig, Gerd

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440036005

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Ultrasound examination of the skin is becoming more and more important in dermatology. The use of noninvasive 20-MHz sonography is a well-established procedure in dermatology. It can be used to determine tumor thickness in malignant melanoma and basal cell carcinoma before treatment. The use of 20-MHz sonography permits the determination of skin thickness and density in patients with scleroderma and other connective tissue diseases. A reproducible evaluation of the effects of drugs on the skin is possible. In this article, Jemec and Gniadecka describe a new indication for using 20-MHz sonography in the diagnosis of hidradenitis suppurativa, a variant form of acne.
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Examination of Baseline Levels of Carboxypeptidase N and Complement Components as Potential Predictors of Angioedema Associated With the Use of an Angiotensin-Converting Enzyme Inhibitor

Sigler, Catherine;Annis, Karen;Cooper, Kevin;Haber, Harry;Van deCarr, Stephen

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440040006

Abstract Objective: To determine if mean levels of complement components and carboxypeptidase N differed when comparing patients who exhibited angioedema following angiotensin-converting enzyme inhibitor therapy to those who received angiotensin-converting enzyme inhibitor therapy but did not have angioedema. Design: Case-control study nested within an 8-week, open-label study of the use of quinapril hydrochloride for hypertension in 12 275 patients. Setting: Multicenter, with sites throughout the United States. Patients: Of the 36 patients with angioedema described, 22 participated in the study. They were matched to 48 controls by age, sex, race, length of follow-up, and geographical region. Intervention: All patients received quinapril therapy prior to participation in this case-control study. Main Outcome Measures: Levels of carboxypeptidase N, total hemolytic complement, Cl esterase inhibitor, and C4, along with questionnaire data, including a history of angioedema-like episodes and family history of angioedema. Results: The 22 patients had significantly lower mean levels of carboxypeptidase N (kininase I) (P=.03) and Cl esterase inhibitor (P=.04) compared with the 48 matched controls, but all mean values were within normal laboratory ranges. A history of prior angioedema-like episodes was associated with an approximate 6-fold increase in the subsequent risk of angioedema following angiotensin-converting enzyme inhibitor therapy. Conclusions: Small differences in levels of carboxypeptidase N or Cl esterase inhibitor may contribute to an increased risk of angioedema with angiotensinconverting enzyme inhibitor therapy. Given the large overlap in the distributions of carboxypeptidase N and Cl esterase inhibitor levels, prior testing could not be used to evaluate angioedema risk for an individual patient considering angiotensin-converting enzyme inhibitor therapy. A history of prior angioedema-like episodes was associated with increased risk, but this result should be interpreted with caution because of possible recall bias.Arch Dermatol. 1997;133:972-975 References 1. Slater EE, Merrill DD, Guess HA, et al. Clinical profile of angioedema associated with angiotensin-converting enzyme inhibition . JAMA. 1988;260:967-970.Crossref 2. Physician's Desk Reference. 49th ed. Montvale, NJ: Medical Economics Data Production Co; 1995:710, 724, 887, 1124, 1618, 1650, 1814, 2448. 3. McEvoy GK, ed. American Hospital Formulary Service Drug Information . Bethesda, Md: American Society of Health System Pharmacists; 1994:1201. 4. Singer DR, Macgregor GA. Angioneurotic oedema associated with two angiotensin converting enzyme inhibitors . BMJ. 1986;293:1243.Crossref 5. Wood SM, Mann RD, Rawlins MD. Angio-oedema and urticaria associated with angiotensin converting enzyme inhibitors . BMJ. 1987;294:91-92.Crossref 6. Mathews KP, Pan PM, Gardner NJ, Hugli TE. Familial carboxypeptidase N deficiency . Ann Intern Med. 1980;93:443-445.Crossref 7. Bokisch VA, Muller-Eberhard HJ. Anaphylatoxin inactivator of human plasma: its isolation and characterization as a carboxypeptidase . J Clin Invest. 1970;49: 2427-2436.Crossref 8. Erdos EG. Conversion of angiotensin I to angiotensin II . Am J Med. 1976;60: 749-759.Crossref 9. Erdos EG. Bradykinin, Kallidin, and Kallikrein: Handbook of Experimental Pharmacology . Berlin, Germany: Springer-Verlag; 1979:427-487. 10. Yang HY, Erdos EG. Second kininase in human blood plasma . Nature. 1967;215: 1402-1403.Crossref 11. Yang HY, Erdos EG, Levin Y. Characterization of a dipeptide hydrolase (kininase II: angiotensin I converting enzyme) . J PharmacolExp Ther. 1971;177:291-300. 12. Landerman NS, Webster ME, Becker EL, Ratcliffe HE. Hereditary angioneurotic edema . J Allergy. 1962;33:330-341.Crossref 13. Donaldson VH, Evans RR. A biochemical abnormality in hereditary angioneurotic edema: absence of serum inhibitor of C1-esterase . Am J Med. 1963;35:37-44.Crossref 14. Agostoni A, Cicardi M, Porreca W. Peripheral edema due to increased vascular permeability: a clinical appraisal . Int J Clin Lab Res. 1992;21:241-246.Crossref 15. Megerian CA, Arnold JE, Berger M. Angioedema: 5 years' experience, with a review of the disorder's presentation and treatment . Laryngoscope. 1992;102:256-260.Crossref 16. Erdos EG, Sloane E. An enzyme in human blood plasma that inactivates bradykinin and kallidins . Biochem Pharmacol. 1962;11:585-592.Crossref 17. Schweisfurth H, Reinhart E, Heinrich J, Brugger E. A simple spectrophotometric assay of carboxypeptidase N (kininase I) in human serum . J Clin Chem Clin Biochem. 1983;21:605-609. 18. Fleiss JL. The Mantel-Haenszel estimator in case-control studies with varying numbers of controls matched to each case . Am J Epidemiol. 1984;120:1-3.
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Missing Photo Credit

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440043007

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract On the cover of the April issue of the Archives and in the article entitled "About the Cover" (1997;133:422-423), the photo credit was inadvertently omitted. Both photographs were taken by Phil Gunby of JAMA.
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Critical Effects of Intense Sun Exposure on the Expression of Epiluminescence Microscopy Features of Acquired Melanocytic Nevi

Stanganelli, Ignazio;Bauer, Paolo;Bucchi, Lauro;Serafini, Monica;Cristofolini, Paolo;Rafanelli, Silvia;Cristofolini, Mario

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440049008

Abstract Background: Current knowledge of the histologic counterparts of epiluminescence microscopy (ELM) features in pigmented skin lesions is limited. As a particular aspect of this problem, the transient effects of intense sun exposure on the morphological characteristics of melanocytic nevi may influence the expression of ELM features as well as the demonstration of stable and consistent histologic correlates. Observations: Forty melanocytic nevi from 11 subjects living in Northern Italy were examined by digital ELM before and after 5 to 13 days of sun exposure at latitudes of 5° north to 3° south. A number of multifaceted changes were observed. In particular, 3 lesions showed the expression of some structures compatible with radial streaming, pseudopods, and gray-blue areas. These features are considered to have often severe histologic correlates. In a third image, obtained 5 to 6 weeks later, they showed partial or total regression. Another case showed a massive regression of the pigment network as a result of a progressive inflammatory reaction with marked asymmetry in the distribution of pigmentation. Conclusions: Digital ELM has the potential to detect subtle changes in the structure of nevi after intense sun exposure. The transient observation of certain ELM features often associated with severe histologic substrates casts doubts on the ability of ELM to characterize sunexposed nevi by a single examination.Arch Dermatol. 1997;133:979-982 References 1. Pehamberger H, Steiner A, Wolff K. In vivo epiluminescence microscopy, I: pattern analysis of pigmented skin lesions . J Am Acad Dermatol. 1993;17:571-583.Crossref 2. Pehamberger H, Binder M, Steiner A, Wolff K. In vivo epiluminescence microscopy: improvement of early diagnosis of melanoma . J Invest Dermatol. 1983; 100:356S-362S.Crossref 3. Steiner A, Pehamberger H, Wolff K. In vivo epiluminescence microscopy, II: diagnosis of small pigmented skin lesions and early detection of malignant melanoma . J Am Acad Dermatol. 1987;17:584-591.Crossref 4. Steiner A, Binder M, Schemper M, Wolff K, Pehamberger H. Statistical evaluation of epiluminescence microscopy criteria for melanocytic pigmented skin lesions . J Am Acad Dermatol. 1993;29:581-588.Crossref 5. Soyer HP, Smolle J, Hodl S, Pachernegg H, Kerl H. Surface microscopy: a new approach to the diagnosis of cutaneous pigmented tumors . Am J Dermatopathol. 1989;11:1-10.Crossref 6. Soyer HP, Kerl H. Microscopie de surface des tumeurs cutanées pigmentées . Ann Dermatol Venereol. 1993;120:15-20. 7. Kenet RO, Kang S, Kenet BJ, Fitzpatrick TB, Sober AJ, Barnhill RL. Clinical diagnosis of pigmented lesions using digital epiluminescence microscopy . Arch Dermatol. 1993;129:157-174.Crossref 8. Bahmer FA, Fritsch P, Kreusch J, et al. Terminology in surface microscopy . JAm Acad Dermatol. 1990;23:1159-1162.Crossref 9. Yadav S, Vossaert KA, Kopf AW, Silverman M, Grin-Jorgensen C. Histologic correlates of structures seen on dermoscopy (epiluminescence microscopy) . Am J Dermatopathol. 1993;15:297-305.Crossref 10. Sober AJ. Digital epiluminescence microscopy in the evaluation of pigmented lesions: a brief review . Semin Surg Oncol. 1993;9:198-201. 11. Stanganelli I, Burroni M, Rafanelli S, Bucchi L. Intraobserver agreement in interpretation of digital epiluminescence microscopy . J Am Acad Dermatol. 1995; 33:584-589.Crossref 12. Epstein A. Instrumentation for epiluminescence microscopy: the gap between research and practice . Arch Dermatol. 1996;132:91-92.Crossref 13. Stanganelli I, Rafanelli S, Bucchi L. Seasonal prevalence of digital epiluminescence microscopy patterns in acquired melanocytic nevi . J Am Acad Dermatol. 1996;34:460-464.Crossref 14. Holman CDJ, Heenan PJ, Caruso V, Glancy RJ, Armstrong BK. Seasonal variation in the junctional component of pigmented naevi . Int J Cancer. 1983;31:213-215.Crossref 15. Tronnier M, Smolle J, Wolf HH. Ultraviolet irradiation induces acute changes in melanocytic nevi . J Invest Dermatol. 1995;104:475-478.Crossref 16. Caputo R, Ackerman AB, Sison-Torre EQ. Pediatric Dermatology and Dermopathology . Philadelphia, Pa: Lea & Febiger; 1990:37-47. 17. Stolz W, Braun-Falco O, Bilek P, Landthaler M, Cognetta AB. Color Atlas of Dermatoscopy . Cambridge, Mass: Blackwell Publishers; 1994. 18. Stierner U, Augustsson A, Rosdahl I, Suurkula M. Regional distribution of common and dysplastic naevi in relation to melanoma site and sun exposure . Melanoma Res. 1991;1:367-375.Crossref 19. Kopf AW, Linsay AC, Rogers GS, Friedman RJ, Rigel DS, Levenstein M. Relationship of nevocytic nevi to sun exposure in dysplastic nevus syndrome . J Am Acad Dermatol. 1985;12:656-662.Crossref 20. Gallagher RP, McLean DI, Yang CP, et al. Suntan, sunburn, and pigmentation factors and the frequency of acquired melanocytic nevi in children . Arch Dermatol. 1990;126:770-776.Crossref 21. Rivers JK, Kelly JW, MacLennan R. The Eastern Australian Mole Study: constitutional factors and latitude considerations . Melanoma Res. 1993;3:57-58.Crossref 22. Fleming MG, Swan LS, Heenan PJ. Seasonal variation in the proliferation fraction of Australian common nevi . Am J Dermatopathol. 1991;13:463-466.Crossref 23. Armstrong BK, Heenan PJ, Caruso V, Glancy RJ, Holman DJ. Seasonal variation in the junctional component of pigmented nevi . Int J Cancer. 1984;34:441-442.Crossref 24. Stierner U, Rosdahl I, Augustsson A, Kagedal B. UVB irradiation induces melanocyte increase in both exposed and shielded human skin . J Invest Dermatol. 1989;92:561-564.Crossref 25. Elder DE. Human melanocytic neoplasms and their etiologic relationship with sunlight . J Invest Dermatol. 1989;92( (suppl 5) ):297S-303S.Crossref
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Viral Folliculitis: Atypical Presentations of Herpes Simplex, Herpes Zoster, and Molluscum Contagiosum

Weinberg, Jeffrey M.;Mysliwiec, Angela;Turiansky, George W.;Redfield, Robert;James, William D.

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440053009

Abstract Background: Viral folliculitis is an infrequently reported entity. The patients described herein were seen over a 12-year period of practice in a referral dermatologic setting. The cases involve a variety of viral infections limited to the hair follicle. Observations: We describe 5 patients with a variety of viral folliculitides: 2 with herpetic sycosis caused by herpes simplex; 1 with herpex simplex folliculitis (this patient also had human immunodeficiency virus); 1 with herpes zoster without blisters; and 1 with molluscum contagiosum. Conclusions: These 5 cases demonstrate that viral folliculitis has varied causes and presentations. Clinicians should consider viral agents in the differential diagnosis of superficial infectious folliculitis, especially in cases that are refractory to antibacterial or antifungal therapy.Arch Dermatol. 1997;133:983-986 References 1. Izumi AK, Kim R, Arnold H Jr. Herpetic sycosis: report of two cases . Arch Dermatol. 1972;106:372-374.Crossref 2. Miliauskas JR, Leong AS-Y. Localized herpes simplex lymphadenitis: report of three cases and review of the literature . Histopathology . 1991;19:355-360.Crossref 3. Sexton M. Occult herpesvirus folliculitis clinically simulating pseudolymphoma . Am J Dermatopathol. 1991;13:234-240.Crossref 4. Muhlemann MF, Anderson MG, Paradinas FJ, et al. Early warning skin signs in AIDS and persistent generalized lymphadenopathy . Br J Dermatol. 1986;114: 419-424.Crossref 5. Barlow RJ, Schulz EJ. Necrotizing folliculitis in AIDS-related complex . Br J Dermatol. 1987;116:581-584.Crossref 6. Jacobson MA, Berger TG, Fikrig S, et al. Acyclovir-resistant varicella-zoster infection after chronic oral acyclovir therapy in patients with the acquired immunodeficiency syndrome (AIDS) . Ann Intern Med. 1990;112:187-191.Crossref 7. Crowe SM. Unusual features of herpes simplex or zoster infection that suggest HIV infection . Med J Aust. 1993;158:186-187. 8. Cockerell CJ. Human immunodeficiency virus and the skin . Arch Intern Med. 1991; 151:1295-1303.Crossref 9. Lewis GW. Zoster sine herpete . BMJ. 1958;2:418-421.Crossref 10. Krishnamurthy J. Viral sycosis . Arch Dermatol. 1974;109:578.Crossref 11. Schwartz JJ, Myskowski PL. Molluscum contagiosum in patients with human immunodeficiency virus infection: a review of twenty-seven patients . J Am Acad Dermatol. 1992;27:583-588.Crossref 12. McSorley J, Shapiro L, Brownstein MH, Hsu KC. Herpes simplex and varicellazoster: comparative histopathology of 77 cases . Int J Dermatol. 1974;13:69-75.Crossref
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Resolution of Recalcitrant Molluscum Contagiosum Virus Lesions in Human Immunodeficiency Virus-Infected Patients Treated With Cidofovir

Meadows, Kappa P.;Tyring, Stephen K.;Pavia, Andrew T.;Rallis, Tena M.

1997 Archives of Dermatology

doi: 10.1001/archderm.1997.03890440061010

Abstract Background: Molluscum contagiosum virus (MCV) causes cutaneous skin growths that mainly affect children, sexually active adults, and immunocompromised individuals. Lesions of MCV in patients infected with human immunodeficiency virus can be large and numerous, and response to available treatments is often unsatisfactory. Observations: We describe 3 men infected with human immunodeficiency virus who presented with extensive MCV lesions that were not responsive to various treatments. Patient 1 demonstrated dramatic clearing of his MCV lesions when intravenous cidofovir therapy was started for his treatment-resistant bilateral CMV retinitis and because of cidofovir's possible activity against MCV. In case 2, cidofovir was compounded as a 3% cream in a combination vehicle (Dermovan) for extensive facial involvement, and complete resolution of MCV was seen after 1 month of therapy. In case 3, intravenous cidofovir therapy was started both for CMV retinitis and in an attempt to clear 90% facial MCV involvement; after 1 month of treatment, all clinical evidence of MCV had resolved.All 3 patients remain clear of recurrence. Conclusions: Cidofovir, a nucleotide analog of deoxycytidine monophosphate, appears to have contributed to clearing of advanced MCV lesions in these 3 patients, thus providing suggestive evidence of clinical activity against MCV. Controlled trials of cidofovir therapy for MCV in persons infected with human immunodeficiency virus are warranted.Arch Dermatol. 1997;133:987-990 References 1. Gottlieb SL, Myskowski PL. Molluscum contagiosum . Int J Dermatol. 1994;33: 453-461.Crossref 2. Schwartz JJ, Myskowski PL. Molluscum contagiosum in patients with human immunodeficiency virus infection: a review of twenty-seven patients . J Am Acad Dermatol. 1992;27:583-588.Crossref 3. Buller RM, Burnett J, Chen W, Kreider J. Replication of molluscum contagiosum virus . Virology. 1995;213:655-659.Crossref 4. Sonntag KC, Clauer U, Bugert JJ, Schnitzler P, Darai G. Identification and properties of the genes encoding the poly(A) polymerase and a small (22 kDa) and the largest subunit (147 kDa) of the DNA-dependent RNA polymerase of molluscum contagiosum virus . Virology. 1995;210:471-478.Crossref 5. Senkevich TG, Bugert JJ, Sisler JR, Koonin EV, Darai G, Moss B. Genome sequence of a human tumorigenic poxvirus: prediction of specific host responseevasion genes . Science . 1996;273:813-816.Crossref 6. Cherrington JM, Miner R, Hitchcock MJ, Lalezari JP, Drew WL. Susceptibility of human cytomegalovirus to cidofovir is unchanged after limited in vivo exposure to various regimens of drug . J Infect Dis. 1996;173:987-992.Crossref 7. Cronin TA, Resnik BI, Elgart G, Kerdel FA. Recalcitrant giant molluscum contagiosum in a patient with AIDS . J Am Acad Dermatol. 1996;35:266-267.Crossref 8. Bartlett JG. Protease inhibitors for HIV infection . Ann Intern Med. 1996;124: 1086-1088.Crossref 9. Benhamou Y, Katlama C, Lunel F, et al. Effects of lamivudine on replication of hepatitis B virus in HIV-infected men . Ann Intern Med. 1996;125:705-712.Crossref 10. Havlir D, Cheeseman SH, McLaughlin M, et al. High-dose nevirapine: safety, pharmokinetics, and antiviral effect in patients with HIV infection . J Infect Dis. 1995; 171:537-545.Crossref 11. De Castro LM, Kern ER, De Clercq E, et al. Phosphonylmethoxyalkyl purine and pyrimidine derivatives for treatment of opportunistic cytomegalovirus and herpes simplex virus infections in murine AIDS . Antiviral Res. 1991;16:101-114.Crossref 12. Gordon YJ, Romanowski EG, Araullo Cruz T. Topical HPMPC inhibits adenovirus type 5 in the New Zealand rabbit ocular replication model . Invest Ophthalmol Vis Sci. 1994;35:4135-4143. 13. Lalezari JP, Stagg RJ, Jaffe HS, Hitchcock MJM, Drew WL. A preclinical and clinical overview of the nucleotide-based antiviral agent cidofovir (HPMPC) . In: Mills J, ed. Antiviral Chemotherapy 4 . New York, NY: Plenum Publishing Corp; 1996: 105-115. 14. Van Cutsem E, Snoeck R, Van Ranst M, et al. Successful treatment of a squamous papilloma of the hypopharynx-esophagus by local injections of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine . J Med Virol. 1995;45:230-235.Crossref 15. Neyts J, De Clercq E. Efficacy of (S)-1-(3-hydroxy-2-phosphonylmethoxypropyl) cytosine for the treatment of lethal vaccinia virus infections in severe combined immune deficiency (SCID) mice . J Med Virol. 1993;41:242-246.Crossref 16. Earl P, Jones E, Moss B. Homology between DNA polymerases of poxviruses, herpesviruses, and adenoviruses . Proc Natl Acad Sci U S A. 1986;83:3659-3663.Crossref 17. Kriesel J, Douglas J, Corey L, et al. A phase I/II study of cidofovir topical gel for refractory condyloma acuminatum in patients with HIV infection . Presented at the Fourth Conference on Retroviruses and Opportunistic Infections; January 23, 1997; Washington, DC .
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