Photodynamic therapy with BF-200 ALA gel for the treatment of actinic keratosis, Bowen´s disease and basal cell carcinoma in long term immunosuppressed patients after organ transplantation.

Continuous immunosuppression after organ transplantation is associated with an increased risk of developing keratinocyte neoplastic lesions. Topical photodynamic therapy represents a therapeutic approach for different keratinocyte neoplastic lesions. However, the specific efficacy and safety of this treatment in this immunocompromised population remains largely unknown. In this case report series, we show the efficacy and safety of photodynamic therapy with BF-200 ALA gel using red-light and daylight in immunocompromised patients. Out of 8 patients presented here, 1 was treated for 8 basal cell carcinomas, 1 for 2 Bowen´s disease lesions and 6 were treated for field cancerization including 4 to 10 actinic keratoses. Treatment response rates were above 75 %. The adverse events, including pain, did not differ from those already described for PDT. These data suggest that PDT with BF-200 ALA gel could be an effective and safe option to add to the treatment portfolio for neoplastic keratinocyte lesions in this high-risk population.

Quality of life in children with skin disease: A Spanish sample.

INTRODUCTION: The impact of skin diseases on quality of life varies widely, and some can have an impact similar to that of asthma or cystic fibrosis. MATERIAL AND METHODS: We conducted a cross-sectional, observational and descriptive study with the aim of describing the degree to which quality of life was affected in paediatric patients managed in a dermatology clinic by means of the Children's Dermatology Life Quality Index (CDLQI). RESULTS: In our study, the skin disease with the greatest impact on quality of life was atopic dermatitis, chiefly on account of symptoms like pruritus and insomnia. It was followed by acne, mainly due to the associated negative feelings (shame, sadness, etc.). Quality of life in patients with viral warts and molluscum contagiosum was mostly affected by the treatment, chiefly based on cryotherapy. Most patients with nevi or café-au-lait spots did not have a decreased quality of life, although up to one third of them had negative feelings in relation to their skin disease. DISCUSSION: Atopic dermatitis was the common skin disease that caused the greatest impairment in quality of life in our sample, although other diseases also had an impact on different dimensions of quality of life. We ought to underscore the recommendation to use less painful treatments than cryotherapy for viral warts and molluscum contagiosum, as the impairment in quality of life in paediatric patients with these conditions was mainly due to the treatment.

Revisión sistemática de estudios sobre intervenciones que promueven la salud en conductores profesionales

Resumen: Introducción: Los trabajadores que se dedican al rubro de conducción están expuestos a factores que dificultan su quehacer laboral, tales como: problemas asociados a la temperatura, ruidos y vibraciones, ventilación insuficiente e ineficiente, atascos y relacionamientos interpersonales con los pasajeros. Objetivo: Identificar, en el estado del arte disponible, qué intervenciones promueven la salud de los conductores profesionales. Material y método: Revisión sistemática, siguiendo las recomendaciones de Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), orientada por la pregunta: ¿qué intervenciones promueven la salud de los conductores profesionales? Resultados: La búsqueda arrojó 1303 artículos, de los cuales se incluyeron 11; las intervenciones identificadas se asociaron a dispositivos portátiles y mensajería de salud móvil, entrevistas motivacionales, documentos interactivos, exposición a entornos naturales, programas intensivos, asesoramiento, cambios a nivel de políticas, cambios ambientales y de sistemas. Conclusión: Se identificaron intervenciones que incluyeron a la tecnología, entrevistas, el ambiente y control estratégico. Se recomienda la implementación de las intervenciones identificadas, pues se torna perentorio el abordaje de la salud de los conductores profesionales, considerando las características descritas en el presente estudio.

Resumo: Introdução: Os trabalhadores envolvidos na condução estão expostos a fatores que dificultam o seu trabalho, tais como: problemas associados à temperatura, ruído e vibrações, ventilação insuficiente e ineficiente, engarrafamentos e relações interpessoais com os passageiros. Objetivo: Identificar, a partir do estado da arte disponível, quais as intervenções que promovem a saúde dos condutores profissionais. Método: Revisão sistemática, seguindo as recomendações dos itens Preferred Reporting Items for Systematic Reviews e Meta-Analyses (PRISMA), orientada pela pergunta: Quais intervenções promovem a saúde dos condutores profissionais? Resultados: A pesquisa produziu 1303 artigos, dos quais 11 foram incluídos; as intervenções identificadas foram associadas a dispositivos portáteis e mensagens de saúde móveis, entrevistas motivacionais, documentos interativos, exposição a ambientes naturais, programas intensivos, aconselhamento, mudanças a nível político, mudanças ambientais e de sistemas. Conclusão: Foram identificadas intervenções que incluíram tecnologia, entrevistas, ambiente e controle estratégico; recomenda-se a implementação das intervenções identificadas, pois é imperativo abordar a saúde dos condutores profissionais, considerando as características descritas no presente estudo.

Abstract: Introduction: Workers engaged in the driving field are exposed to factors that hinder their work tasks, such as: problems associated with temperature, noise and vibrations, insufficient and inefficient ventilation, traffic jams and interpersonal relationships with passengers. Objective: To identify, in the available state of the art, which interventions promote the health of professional drivers. Method: Systematic review, following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), guided by the question: what interventions promote the health of professional drivers? Results: The search yielded 1303 articles, of which 11 were included; the interventions identified were associated with handheld devices and mobile health messaging, motivational interviewing, interactive documents, exposure to natural environments, intensive programs, counseling, policy-level changes, environmental and systems changes. Conclusion: Interventions were identified that included technology, interviews, the environment and strategic control; the implementation of the identified interventions is recommended, since it is urgent to address the health of professional drivers, considering the characteristics described in this study.

Within- and between-subject biological variation data for tumor markers based on the European Biological Variation Study.

OBJECTIVES: Reliable biological variation (BV) data are required for the clinical use of tumor markers in the diagnosis and monitoring of treatment effects in cancer. The European Biological Variation Study (EuBIVAS) was established by the EFLM Biological Variation Working Group to deliver BV data for clinically important measurands. In this study, EuBIVAS-based BV estimates are provided for cancer antigen (CA) 125, CA 15-3, CA 19-9, carcinoembryonic antigen, cytokeratin-19 fragment, alpha-fetoprotein and human epididymis protein 4. METHODS: Subjects from five European countries were enrolled in the study, and weekly samples were collected from 91 healthy individuals (53 females and 38 males; 21-69 years old) for 10 consecutive weeks. All samples were analyzed in duplicate within a single run. After excluding outliers and homogeneity analysis, the BVs of tumor markers were determined by CV-ANOVA on trend-corrected data, when relevant (Røraas method). RESULTS: Marked individuality was found for all tumor markers. CYFRA 21-1 was the measurand with the highest index of individuality (II) at 0.67, whereas CA 19-9 had the lowest II at 0.07. The CV I s of HE4, CYFRA 21-1, CA 19-9, CA 125 and CA 15-3 of pre- and postmenopausal females were significantly different from each other. CONCLUSIONS: This study provides updated BV estimates for several tumor markers, and the findings indicate that marked individuality is characteristic. The use of reference change values should be considered when monitoring treatment of patients by means of tumor markers.

The European Biological Variation Study (EuBIVAS): a summary report.

Biological variation (BV) data have many important applications in laboratory medicine. Concerns about quality of published BV data led the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) 1st Strategic Conference to indicate need for new studies to generate BV estimates of required quality. In response, the EFLM Working Group on BV delivered the multicenter European Biological Variation Study (EuBIVAS). This review summarises the EuBIVAS and its outcomes. Serum/plasma samples were taken from 91 ostensibly healthy individuals for 10 consecutive weeks at 6 European centres. Analysis was performed by Siemens ADVIA 2400 (clinical chemistry), Cobas Roche 8000, c702 and e801 (proteins and tumor markers/hormones respectively), ACL Top 750 (coagulation parameters), and IDS iSYS or DiaSorin Liaison (bone biomarkers). A strict preanalytical and analytical protocol was applied. To determine BV estimates with 95% CI, CV-ANOVA after analysis of outliers, homogeneity and trend analysis or a Bayesian model was applied. EuBIVAS has so far delivered BV estimates for 80 different measurands. Estimates for 10 measurands (non-HDL cholesterol, S100-ß protein, neuron-specific enolase, soluble transferrin receptor, intact fibroblast growth-factor-23, uncarboxylated-unphosphorylated matrix-Gla protein, human epididymis protein-4, free, conjugated and %free prostate-specific antigen), prior to EuBIVAS, have not been available. BV data for creatinine and troponin I were obtained using two analytical methods in each case. The EuBIVAS has delivered high-quality BV data for a wide range of measurands. The BV estimates are for many measurands lower than those previously reported, having an impact on the derived analytical performance specifications and reference change values.

Condiciones laborales, salud y calidad de vida en conductores / Working Conditions, Health and Quality of Life among Drivers / Condições de trabalho, saúde e qualidade de vida em motoristas

Objetivo: Conocer las condiciones laborales, salud y calidad de vida de los trabajadores que se dedican al rubro de la conducción. Materiales y Métodos: Se realizó revisión integrativa en las bases de datos Medline/PUBMED, BVS, WEB OF SCIENCE, SCOPUS, referente a artículos publicados desde el año 2010 a 2019, en relación a la temática de salud, condiciones laborales y calidad de vida de trabajadores que se desempeñan en el área de la conducción, siguiendo los lineamientos planteados según Ganong. Resultados: 29 estudios cumplieron con los criterios seleccionados, los cuales fueron realizados en población trabajadora del ámbito de locomoción colectiva como buses, taxis, motocicletas y en el área de transportes, como camiones. Discusión: La realidad que experimentan estos trabajadores crea consciencia y abre un espacio para implementar políticas de salud que busquen su bienestar, y a la vez es una puerta de entrada a crear conocimiento sobre la necesidad de estudiar a este grupo poblacional. Conclusiones: La calidad de vida y las condiciones laborales de estos conductores, en su mayoría es deficiente y esto los afecta de manera negativa en distintos ámbitos. Por otra parte, la salud de este grupo de trabajadores se ve perjudicada por las condiciones en el trabajo que muchos de ellos puedan tener, así mismo la mayoría carece de buenas prácticas de salud, teniendo hábitos poco saludables, que se relacionan directamente con la labor que realizan.

Objetive: This study is aimed to determine the working conditions, health and quality of life of workers involved in the driving industry. Materials and Methods: An integrative review was carried out in the Medline/PubMed, VHL, Web of Science, and Scopus databases, referring to articles related to working conditions, health, and quality of life of workers in the driving industry which had been published between 2010 and 2019, following the guidelines set forth by Ganong. Results: 29 studies met the selected criteria, which were conducted in the driver population working in the area of means of transport such as buses, taxis, motorcycles and the area of cargo transport such as trucks. Discussion: The reality experimented by these workers creates awareness and opens up a space to implement healthcare policies that seek their wellbeing, and at the same time, it is a gateway to creating knowledge about the need to study this population group. Conclusions: The quality of life and working conditions of these drivers are mostly inadequate, affecting them negatively in different ways. Moreover, the health of this group of workers is getting affected by the working conditions that many of them may have, and most of them lack good health practices, having unhealthy habits that are directly related to the work they do.

Objetivo: Conhecer as condições de trabalho, a saúde e a qualidade de vida dos trabalhadores dedicados ao campo da direção. Materiais e Métodos: Foi realizada uma revisão integrativa nas bases de dados Medline/PubMed, BVS, Web of Science, Scopus, referente a artigos publicados de 2010 a 2019, em relação à saúde, condições de trabalho e qualidade de vida de trabalhadores que trabalham na área de direção, seguindo as diretrizes estabelecidas de acordo com Ganong. Resultados: 29 estudos atenderam aos critérios selecionados, realizados na população trabalhadora no campo da locomoção coletiva, como ônibus, táxis, motocicletas e na área de transporte, como caminhões. Discussão: A realidade vivenciada por esses trabalhadores gera conscientização e abre espaço para a implementação de políticas de saúde que busquem seu bem-estar e, ao mesmo tempo, é uma porta de entrada para a criação de conhecimento sobre a necessidade de estudar esse grupo populacional. Conclusões: A qualidade de vida e as condições de trabalho desses motoristas são principalmente ruins e isso os afeta negativamente em diferentes áreas. Por outro lado, a saúde desse grupo de trabalhadores é prejudicada pelas condições de trabalho que muitos deles podem ter, assim como a maioria carece de boas práticas de saúde, possuindo hábitos pouco saudáveis, diretamente relacionados ao trabalho que realizam.

Impact of surgically operated hip fracture on the quality of life, functional status and mood of the elderly. / Impacto de la fractura de cadera intervenida quirúrgicamente sobre la calidad de vida, el estado funcional y el estado de ánimo del anciano.

OBJECTIVES: To determine the quality of life related to health, functional capacity and mood to hip fracture and one month after surgery. METHOD: Prospective and descriptive study developed from January 2015 to January 2016 in Campo Arañuelo Hospital (Navalmoral de la Mata, Cáceres, Spain). Sociodemographic variables, functional capacity (Barthel Index), dependence (Lawton and Brody Scale), quality of life related to health (Questionnaire Euroqol-5D) and on mood (Yesavage geriatric depression scale GDS15) were collected, prior to the hip fracture and one month after the intervention. RESULTS: Significant decrease in functional capacity (Barthel), the mean score was 86.66 before the fracture, compared to 58.72 at the month after surgery (P<.001). Regarding the Lawton and Brody Scale, the mean was 4.95 and at 2.24months (P<.001). The mean scores on health related quality of life, baseline and post-intervention in the analog visual scale of the EQ-5D questionnaire were 72.95 vs 59.45 respectively (P=.004). Although before the fracture, 94.10% had no alteration in mood, one month after the intervention there was a possible depression of 20.50% and an established depression of 11%. CONCLUSIONS: The fracture of the head affects the functionality of the elderly, causing dependence for the basic and instrumental activities of daily life. It also affects the quality of life related to health and this decreases significantly in the month after surgery. Depressive mood is inversely related to perceived perceived quality of life.

European Biological Variation Study (EuBIVAS): Within- and Between-Subject Biological Variation Data for 15 Frequently Measured Proteins.

BACKGROUND: The European Biological Variation Study (EuBIVAS) was established to deliver rigorously determined data for biological variation (BV). Here, EuBIVAS-based BV estimates are provided for α1-acid glycoprotein, α1-antitrypsin, albumin, ß2-microglobulin, ceruloplasmin, complement component 3, complement component 4, C-reactive protein (CRP), cystatin C, haptoglobin, IgA, IgG, IgM, soluble transferrin receptor (sTfR), and transferrin (Trf), together with their associated analytical performance specifications (APSs) and reference change values (RCVs). METHOD: Serum samples from weekly blood samplings of 91 healthy study participants (38 males and 53 females, ages 21-69 years old) over 10 consecutive weeks in 6 European laboratories were stored at -80 °C before duplicate analysis on a Roche Cobas c702. Outlier and variance homogeneity analyses were performed followed by CV-ANOVA on trend-corrected data if relevant, to determine BV and analytical variation estimates with CI and the associated RCV. RESULTS: For the acute phase proteins, several participants experienced mild inflammatory episodes during the study, requiring exclusion of 7% of the 25290 results. Within-subject BV (CVI) estimates for specific proteins obtained in our study were lower than those available in the online 2014 BV database, except for Trf, whereas between-subject BV (CVG) estimates were similar. CVI and CVG estimates for sTfR, which have not previously been published, were 6.0% and 19.1%, respectively. CONCLUSIONS: In addition to new BV estimates for sTfR, this EuBIVAS substudy generated more demanding APS for frequently requested plasma specific proteins. APS for CRP should not be calculated from BV data except when CRP is used as a risk factor for cardiovascular disease.

Biological variation estimates for prostate specific antigen from the European Biological Variation Study; consequences for diagnosis and monitoring of prostate cancer.

BACKGROUND: Prostate-specific antigen (PSA) is central in the diagnosis of prostate cancer. However, high-quality biological variation (BV) estimates for PSA are scarce. Here BV estimates from the European Biological Variation Study (EuBIVAS) for total (tPSA), free (fPSA), conjugated PSA (cPSA), and percent free PSA (%fPSA) are provided. METHOD: EuBIVAS samples were collected weekly from thirty-seven healthy males (22-59 years) for 10 weeks. All samples, stored at -80 °C, were measured in duplicate with a Roche Cobas e801. Outlier and homogeneity analysis were performed followed by CV-ANOVA to determine BV, analytical variation, analytical performance specifications (APS), reference change values (RCV) and the number of samples required to estimate the homeostatic set points. RESULTS: Within-subject BV estimates were for tPSA 6.8% (6.1-7.4); fPSA 7.1% (6.5-7.7) cPSA: 8.8% (8.0-9.7) and %fPSA 5.3% (4.8-5.8), delivering RCV for increase of 15-20% and indicating that one sample is sufficient to estimate the homeostatic set points within ±15%. BV estimates for tPSA were lower than previously published estimates. Estimates for fPSA, cPSA and %fPSA have not previously been reported in healthy subjects. CONCLUSIONS: Highly powered EuBIVAS BV estimates of tPSA, fPSA, cPSA and %fPSA provide updated APS and RCV for monitoring for prostate cancer.

Bilateral clear cell acanthoma of the areola and nipple: good response to topical corticosteroids.

Clear cell acanthoma is a rare, epidermal tumor not common in the area of the nipples; indeed, the literature describes only 8 cases, all showing unilateral presentation. We here report the first case of bilateral clear cell acanthoma with good response to topical corticosteroids. CASE REPORT: A sixteen-year old girl presented with 2 excrescent, fleshy, and exudative tumor masses in both nipples and areola mammae. A biopsy was conducted and confirmed clear cell acanthoma histopathologically. Treatment with strong corticosteroids resulted in rapid improvement and resolution. After one year of follow-up, the patient developed atopic dermatitis. DISCUSSION: We describe the first case of bilateral clear cell acanthoma localized in the nipple/areola that resolved with powerful corticosteroids, suggesting a reactive etiology of the lesion.

Local skin reactions following the administration of topical ingenol mebutate for actinic keratosis.

Actinic keratoses are cutaneous lesions that appear as the result of the proliferation of atypical keratinocytes. These lesions are considered pre-malignant and they can progress to squamous cell carcinoma. Ingenol mebutate has been approved as an effective treatment for AK on the face and trunk. We studied the local skin reactions to this therapy. Data about local skin reactions were collected in a series of 5 patients with photographic documentation, a visual analog scale, and a ranking of satisfaction of the patient. Moderate to severe reactions were reported in most of patients, but only one stopped treatment early. The short duration of treatment contributes to high adherence to the therapy.

Bilateral clear cell acanthoma of the areola and nipple: good response to topical corticosteroids

Abstract: Clear cell acanthoma is a rare, epidermal tumor not common in the area of the nipples; indeed, the literature describes only 8 cases, all showing unilateral presentation. We here report the first case of bilateral clear cell acanthoma with good response to topical corticosteroids. Case report: A sixteen-year old girl presented with 2 excrescent, fleshy, and exudative tumor masses in both nipples and areola mammae. A biopsy was conducted and confirmed clear cell acanthoma histopathologically. Treatment with strong corticosteroids resulted in rapid improvement and resolution. After one year of follow-up, the patient developed atopic dermatitis. Discussion: We describe the first case of bilateral clear cell acanthoma localized in the nipple/areola that resolved with powerful corticosteroids, suggesting a reactive etiology of the lesion.

Emotional and psychopathological disorders in laryngectomized oncological patients.

INTRODUCTION AND OBJECTIVES: It is unknown if patients who suffer from laryngeal cancer and undergo total laryngectomy experience as much emotional shock and psychological distress as patients with cancers in other locations do. The aim of the study was to identify the incidence of emotional and psychological disorders in laryngectomized patients and describe their symptomatological nuances. METHODS: A descriptive cross-sectional study of emotional and psychopathological response of 100 cancer patients undergoing total laryngectomy was performed. The patients were evaluated immediately after surgery (n=35), when initiating communicative rehabilitation (n=23) and 5 years after diagnosis (n=42), versus a control of 55 healthy subjects. Psychopathological assessment battery for anxiety, depression, intrusion, avoidance, arousal and posttraumatic stress disorder consisted of a specific interview, the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-Revised (IES-R). RESULTS: Laryngectomized patients had low incidence of emotional and psychological disorders such as anxiety (6.9%), depression (5.9%) and/or posttraumatic stress disorder (28.4%), but with sufficient intensity to constitute a psychopathological diagnosis. A significant level of distress was found in 57.4% of patients, with clear diffuse traumatic nature in 52.6% of them, which was more prevalent and intense in the rehabilitation group. CONCLUSIONS: Symptoms of anxiety, depression and posttraumatic stress disorder during different stages after total laryngectomy are not of sufficient intensity and quality to be diagnosable clinical entities; they can be considered an adaptive disorder. The symptoms are less than those of patients with cancer in other locations and appear mostly in the rehabilitation stage, where preventive performances and psychological support should be focused.

Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial.

IMPORTANCE: Transcatheter aortic valve replacement (TAVR) is an effective treatment option for high-risk patients with severe aortic stenosis. Different from surgery, transcatheter deployment of valves requires either a balloon-expandable or self-expandable system. A randomized comparison of these 2 systems has not been performed. OBJECTIVE: To determine whether the balloon-expandable device is associated with a better success rate than the self-expandable device. DESIGN, SETTING, AND PATIENTS: The CHOICE study was an investigator-initiated trial in high-risk patients with severe aortic stenosis and an anatomy suitable for the transfemoral TAVR procedure. One hundred twenty-one patients were randomly assigned to receive a balloon-expandable valve (Edwards Sapien XT) and 120 were assigned to receive a self-expandable valve (Medtronic CoreValve). Patients were enrolled between March 2012 and December 2013 at 5 centers in Germany. INTERVENTIONS: Transfemoral TAVR with a balloon-expandable or self-expandable device. MAIN OUTCOMES AND MEASURES: The primary end point was device success, which is a composite end point including successful vascular access and deployment of the device and retrieval of the delivery system, correct position of the device, intended performance of the heart valve without moderate or severe regurgitation, and only 1 valve implanted in the proper anatomical location. Secondary end points included cardiovascular mortality, bleeding and vascular complications, postprocedural pacemaker placement, and a combined safety end point at 30 days, including all-cause mortality, major stroke, and other serious complications. RESULTS: Device success occurred in 116 of 121 patients (95.9%) in the balloon-expandable valve group and 93 of 120 patients (77.5%) in the self-expandable valve group (relative risk [RR], 1.24, 95% CI, 1.12-1.37, P < .001). This was attributed to a significantly lower frequency of residual more-than-mild aortic regurgitation (4.1% vs 18.3%; RR, 0.23; 95% CI, 0.09-0.58; P < .001) and the less frequent need for implanting more than 1 valve (0.8% vs 5.8%, P = .03) in the balloon-expandable valve group. Cardiovascular mortality at 30 days was 4.1% in the balloon-expandable valve group and 4.3% in the self-expandable valve group (RR, 0.97; 95% CI, 0.29-3.25; P = .99). Bleeding and vascular complications were not significantly different, and the combined safety end point occurred in 18.2% of those in the balloon-expandable valve group and 23.1% of the self-expandable valve group (RR, 0.79; 95% CI, 0.48-1.30; P = .42). Placement of a new permanent pacemaker was less frequent in the balloon-expandable valve group (17.3% vs 37.6%, P = .001). CONCLUSIONS AND RELEVANCE: Among patients with high-risk aortic stenosis undergoing TAVR, the use of a balloon-expandable valve resulted in a greater rate of device success than use of a self-expandable valve. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01645202.

Immunohistochemical study of calretinin in normal skin and cutaneous adnexal proliferations.

Calretinin is a calcium-binding protein member of the EF-hand family. The presence of calretinin has been demonstrated in certain stages of the cellular cycle in a wide variety of normal and neoplastic tissues. The main aims of our study were (1) to investigate what structures of the normal skin and cutaneous adnexal proliferations express immunoreactivity for calretinin and (2) to determine the value of immunohistochemical expression for calretinin as a marker for follicular, sebaceous, apocrine, and eccrine differentiation in cutaneous adnexal proliferations. We studied 139 biopsy specimens, including 10 cases of normal skin of different locations and 129 benign and malignant cutaneous adnexal proliferations. In normal skin, we found that calretinin is expressed in the innermost cell layer of the outer root sheath in anagen hair follicle, in both the duct and sebolemma of the sebaceous gland, in the secretory portion of eccrine glands, and in mast cells of the stroma. In cutaneous adnexal proliferations, we found strong immunoreactivity for calretinin in tricholemmal cysts, tricholemmomas/inverted follicular keratoses, tumors of follicular infundibulum, and in some basal cell carcinomas. Focal positivity was also seen in trichoadenomas, trichoblastomas/trichoepitheliomas, pilomatricomas, proliferating tricholemmal tumors, pilar sheath acanthomas, trichofolliculomas, follicular hybrid cysts, cutaneous mixed tumors, steatocystomas, sebaceous hyperplasias, and sebaceomas. These results demonstrate that immunohistochemical study for calretinin may be helpful to identify the innermost cell layer of the outer root sheath in anagen hair follicle and the cutaneous adnexal proliferations showing differentiation toward this structure. Calretinin immunoreactivity supports eccrine differentiation in some sweat gland neoplasms, and it is also useful in identifying neoplasms with ductal sebaceous differentiation.