Diagnostic accuracy of punch biopsy in subtyping basal cell carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer in humans. The histological subtype reported by punch biopsy may influence the type of treatment. Few studies have investigated the accuracy of punch biopsy in diagnosing the true BCC subtype. OBJECTIVE: To determine the accuracy, sensitivity and specificity of punch biopsy in BCC subtype diagnosis. METHODS: In this retrospective study, 333 biopsy specimens and excisions were reviewed. Histological subtypes present in the initial biopsy were compared with tumour subtypes of the total excision. RESULTS: The concordance between the BCC subtype present in the biopsy specimen and in the subsequent excision specimen was 72.3%. The most common BCC patterns were nodular (158, 47.5%) and mixed subtype (90, 27%). Most mixed tumours contained one or more aggressive subtype (63/90, 70%). In 47/120 (39.1%) aggressive tumours (14.1% of the total), punch biopsy failed to correctly identify the aggressive component. The most commonly missed aggressive subtype was mixed aggressive including nodular/micronodular and nodular/infiltrative (30/47, 63.8%). In 45/213 (21.1%) non-aggressive BCCs (13.5% of total cases), punch biopsy incorrectly reported an aggressive subtype. The most commonly misidentified non-aggressive subtype was nodular (39/45, 86.6). The sensitivity and specificity of punch biopsy in diagnosing aggressive vs. non-aggressive BCC subtypes 60.8% (95% CI, 51.9-69.1) and 78.9% (95% CI, 72.8-83.8), respectively. The positive and negative predictive values were 61.9% and 78.1%, respectively. CONCLUSION: Punch biopsy has serious pitfalls in differentiating aggressive and non-aggressive BCC subtypes. Dermatologists should consider the possibility of aggressive components within non-aggressive BCCs reported using punch biopsy.

Randomized double blind trial of prednisolone and azathioprine, vs. prednisolone and placebo, in the treatment of pemphigus vulgaris.

BACKGROUND: The classic treatment for pemphigus vulgaris is prednisolone. Immunosuppressive drugs can be used in association. OBJECTIVE: To compare the efficacy of Azathioprine in reducing the Disease Activity Index (DAI). PATIENTS AND METHODS: A double blind randomized controlled study was conducted on 56 new patients, assigned to two therapeutic groups: (i) prednisolone plus placebo; (ii) prednisolone plus Azathioprine. Patients were checked regularly for 1 year. 'Complete remission' was defined as healing of all lesions after 12 months, and prednisolone <7.5 mg daily, (DAI ≤ 1). Analysis was done by 'Intention To Treat' (ITT) and 'Treatment Completed Analysis' (TCA). RESULTS: Both groups were similar in age, gender, disease duration, and DAI. Primary endpoint: By ITT and TCA, the mean DAI improved in both groups with no significant difference between them. The difference became significant for the last trimester (3 months; ITT: P = 0.033, TCA: P = 0.045). Secondary endpoint: The total steroid dose decreased significantly in both groups, with no significant difference between them, except for the last trimester (ITT: P = 0.011, TCA: P = 0.035). The mean daily steroid dose decreased gradually in both groups becoming statistically significant in favour of azathioprine, in the last trimester, especially at 12th months (ITT: P = 0.002, TCA: P = 0.005). Complete remission was significant at 12 months only for TCA (AZA/Control: 53.6%/39.9%, P = 0.043). LIMITATIONS: Sample size was rather small to demonstrate all differences. Other limitations include the choice of primary and secondary endpoints and the unavailability to measure thiopurine methyltransferase activity. CONCLUSION: Azathioprine helps to reduce prednisolone dose in long-run.

Comparison of the therapeutic effects of narrow band UVB vs. PUVA in patients with pityriasis lichenoides.

BACKGROUND AND AIMS: Pityriasis lichenoides (PL) is a self-limiting papulosquamous skin disorder with chronic course. Best therapeutic options are yet to be defined. Phototherapy is one of the most prevalent treatments and the aim of this study was to compare the therapeutic effects of the two main phototherapy options: psoralen plus ultraviolet A (PUVA) and narrow band UVB (NB-UVB). MATERIAL AND METHODS: Patients with PLC based on clinical findings and pathology, involving at least 60% of total body surface, were enrolled if they were not pregnant, lactating women and had not contraindication for phototherapy. Based on simple randomization, they received either PUVA or NB-UVB, and patients' responses were recorded. RESULTS: A total of 15 patients including eight males (53%) and seven females (47%) were enrolled in the study and were randomized into groups A and B, each including four patients. In group A, seven patients had complete response (87.5%) and one patient had partial response (12.5%). Among patients in group B, five patients had complete response (71.4%) and two patients (28.6%) had partial response (P > 0.05). CONCLUSION: As the difference between the two groups is insignificant, it seems that both options are acceptable for treating this disorder.

The effects of vitamins e and d supplementation on erythrocyte superoxide dismutase and catalase in atopic dermatitis.

BACKGROUND: Atopic dermatitis is a public health problem worldwide. Increment of reactive oxygen species (ROS) production may be one of the contributing factors of tissue damage in atopic dermatitis. The present study was designed to determine the effect of vitamins E and/or D on erythrocyte superoxide dismutase and catalase activities in patients with atopic dermatitis. METHODS: In a randomized, double blind, placebo controlled clinical trial 45 atopic dermatitis patients were divided into four groups. Each group received one of the following supplements for 60 days: group A (n=11) vitamins E and D placebos; group B (n= 12) 1600 international unit (IU) vitamin D3 plus vitamin E placebo; group C (n=11) 600 IU synthetic all-rac-α tocopherol plus vitamin D placebo; group D (n=11) 1600 IU vitamin D3 plus 600 IU synthetic all-rac-α tocopherol. Erythrocyte superoxide dismutase (SOD) and catalase activities, serum 25 (OH) D, plasma α-tocopherol were determined. The data were analyzed by analysis of variance (ANOVA) and paired t-test. RESULTS: After 60 days vitamin D and E supplementation, erythrocyte SOD activities increased in groups B, C and D (P= 0.002, P= 0.016 and P= 0.015, respectively). Erythrocyte catalase activities increased in groups B and D (P= 0.026 and P= 0.004, respectively). The increment of erythrocyte catalase activity was not significant in group C. There was a positive significant correlation between SOD activity and serum 25 (OH) D (r= 0.378, P= 0.01). CONCLUSIONS: It is concluded that vitamin D is as potent as vitamin E in increasing the activities of erythrocyte SOD and catalase in atopic dermatitis patients.

Biophysical characteristics of skin in diabetes: a controlled study.

BACKGROUND: Cutaneous complications are common in diabetes. Previous assays suggest that hyperglycemia and decreased insulin signal are involved in the impairment of skin function. The aim of this study was to evaluate the biophysical characteristics of skin in patients with diabetes mellitus and compares them with healthy non-diabetic controls. OBJECTIVE: To measure biophysical characteristic of skin including transepidermal water loss (TEWL), water content, sebum and skin elasticity in patients with diabetes mellitus and compare them with healthy non-diabetic controls. METHODS: This case-control study was conducted on 38 patients with diabetes and 40 age- and sex-matched healthy people. The biophysical properties of skin including stratum corneum (SC) hydration, sebum content, TEWL and skin elasticity were measured and compared between the two groups at three different locations of the body. RESULTS: The measurement of SC hydration and TEWL showed no significant difference between diabetics and controls. The skin surface lipids on the forehead but not other sites were significantly lower in the diabetics than in the controls. Acoustic wave propagation speed, a measurement related to skin elasticity, was significantly lower in forearm and forehead of diabetics. CONCLUSION: Diabetes affects some functional properties of epidermis and dermis that may responsible for many cutaneous manifestations of diabetes. These results suggest that patients with diabetes mellitus tend to show a normal hydration state of the SC together with decreased sebaceous gland activity and impaired skin elasticity, without any impairment of the SC barrier function.

A novel feeding method in commercial Baker's yeast production.

AIMS: The aim of this investigation was to determine a better leavening ability and shelf life for the same biomass yield of final product. METHODS AND RESULTS: A commercial fed-batch bioreactor equipped with circulation loop was used to study the effect of carbon source, molasses, profile on dough-leavening ability, shelf life and biomass yield of Baker's yeast, Saccharomyces cerevisiae. A set of 32 commercial batches were performed to investigate the effect of sugar concentration and compare with 32 control experiments. CONCLUSIONS: Higher local sugar concentration in circulation loop resulted in a better leavening ability and shelf life for the same biomass yield of the final product. In addition, this method improved nitrogen assimilation which resulted in higher protein content. Increase in leavening ability and protein content could be a result of the higher levels of glycolytic enzymes. SIGNIFICANCE AND IMPACT OF THE STUDY: It was observed that this change resulted in considerable improvement in leavening ability and shelf life at a commercial scale. It must be emphasized that to improve product quality, it is not necessary to pursue classical mutagenesis and selection strategies. A high-quality product can be achieved only by optimizing the feeding profile and strategy.

Diffuse plane xanthoma in an otherwise healthy woman.

We report a case of diffuse plane xanthoma in a 40-year-old otherwise healthy woman. Her disease began 18 years ago as xanthelasma and progressed to involve large areas of her face, neck and trunk. No associated diseases were detected on repeated laboratory testing.