Uncommon finding of a "black node" in a patient with malignant melanoma and arthroplasty: A case report.

Postarthroplasty lymphadenopathy should be kept in mind particularly in patients with tumor (eg, melanoma) with a long-term history of total joint replacement therapy. Microscopy is mandatory in establishing diagnosis and is thus helpful for therapy.

Reticulated acanthoma with apocrine differentiation.

Reticulated acanthoma with apocrine differentiation (RAAD) represents a rare variant of adnexal neoplasm first described by Ackerman et al. in 1998. It consists of cords and columns of adnexal keratinocytes that form a reticulated pattern. Variable signs of apocrine, sebaceous and follicular differentiation may be present. Since 1998, no further cases of this condition have been published. We report on a lesion excised from the leg of a 46-year-old man, which displayed histopathological features diagnostic of RAAD. Criteria for diagnosis and differential diagnoses are discussed.

Lipoatrophy associated with the use of insulin analogues: a new case associated with the use of insulin glargine and review of the literature.

IMPORTANCE OF THE FIELD: Any insulin formulation can in principle cause lipoatrophy; even cases associated with recombinant human insulin have been reported. An increasing number of case reports have been published indicating that lipoatrophy also develops after treatment with various insulin analogues. AREAS COVERED IN THIS REVIEW: In this review, we summarise the literature on lipoatrophy associated with the use of insulin analogues published to date. A new case of lipoatrophy associated with the use of glargine is presented. WHAT THE READER WILL GAIN: Readers will gain insight into: i) pathogenesis of lipoatrophy associated with the use of insulin analogues and ii) clinical features of lipoatrophy. TAKE HOME MESSAGE: Twelve cases with lipoatrophy under treatment with insulin analogues have been reported so far. The exclusive occurrence in lean type 1 diabetic patients, its overlap with further autoimmune diseases and the overrepresentation of female individuals point to an immune pathogenesis. The respective exposition to the analogues lispro, aspart, glargine and detemir prior to lipoatrophy development varied considerably between 4 weeks and 2 years. No spontaneous substantial recovery of lipoatrophic areas has been reported. Frequent use of the same pen needle and lack of rotating of insulin injection sites seem to favour the development of lipoatrophy.

Infrared radiation-induced matrix metalloproteinase in human skin: implications for protection.

Human skin is exposed to infrared radiation (IR) from natural and artificial sources. In previous studies, near IR radiation (IRA; 760-1,440 nm) was shown to elicit a retrograde mitochondrial signaling response leading to induction of matrix metalloproteinase-1 (MMP-1) expression. These studies, however, have exclusively employed cultured human skin fibroblasts ex vivo. Here, we have assessed the in vivo relevance of these observations by exposing healthy human skin in vivo to physiologically relevant doses of IRA. Eighty percent of the tested individuals responded to IRA radiation by upregulating of MMP-1 expression. Specifically, IRA irradiation caused increased expression of MMP-1 in the dermis, but not in the epidermis. Raman spectroscopy revealed that IRA radiation also caused a significant decrease in the antioxidant content of human skin. In vitro studies had previously shown that IRA-induced MMP-1 expression was mediated through an oxidative stress response, which originates from the mitochondrial electron transport chain. We now report that incubation of cultured human dermal fibroblasts or treatment of human skin with specific antioxidants prevented IRA radiation-induced MMP-1 expression in vitro and in vivo. Thus, IRA irradiation most likely promotes premature skin aging and topical application of appropriate antioxidants represents an effective photoprotective strategy.

Cutaneous lymphatic malformations in disappearing bone (Gorham-Stout) disease: a novel clue to the pathogenesis of a rare syndrome.

BACKGROUND: Gorham-Stout disease is an unusual, progressive syndrome of unknown etiology characterized by mono- or polyostotic osteolysis most often affecting children and young adults. The onset is insidious and the disease progresses to extensive and potentially disabling osteolysis often unresponsive to therapeutic intervention. Although bone and soft tissue lesions are the most frequent manifestations of Gorham-Stout disease, skin lesions can occur and may provide a clue to the pathogenesis of this rare syndrome. OBJECTIVE: Our aim was to describe characteristics of vascular skin lesions of this rare condition using magnetic resonance imaging and histomorphological analysis. METHODS: The case of a 36-year-old man with Gorham-Stout disease of the left leg and foot is reported. RESULTS: This case was remarkable for its prominent lymphatic vascular malformations involving the skin and soft tissues adjacent to the diseased bone-a previously undescribed abnormality, which preceded osteolysis for several years. Magnetic resonance imaging played a key role in defining the extent of disease in skin and soft tissues. LIMITATIONS: It is difficult to assess the true incidence of hemangiomatosis in the earlier reports on Gorham-Stout disease in which hemangiomatous cutaneous lesions were mentioned but not described or illustrated. CONCLUSION: A vascular process with angiomatous histological features is considered to be the pathological hallmark of Gorham-Stout disease, but the specific type of this vascular process is still under debate. Our report highlights a lymphatic malformative nature of Gorham-Stout disease, thereby contributing to a better understanding and characterization of this rare disease entity.

The effect of amelogenins (Xelma) on hard-to-heal venous leg ulcers.

With an aging population venous ulceration is likely to become an increasing problem. Despite improvements in care and the widespread introduction of compression bandaging, the mainstay of current management, a significant proportion of venous leg ulcers remain hard to heal. Therefore, a single-blinded, randomized multicenter study was performed to compare wound size reduction using amelogenin proteins (Xelma) formulated into a solution which forms a temporary extracellular matrix on contact with the wound bed. Propylene glycol alginate 7% served as a control. Patients were randomized to receive either amelogenin protein or control treatment. The investigational products were applied weekly under soft silicone secondary dressings for up to a maximum of 12 weeks. Compression therapy was maintained throughout the investigation. Wound size reduction was measured by tracing and all wounds were photographed. In total 123 patients were recruited, 62 patients in the amelogenin group, and 61 in the control group, respectively. Subgroup analyses were performed for ulcers with a size>10 cm2 at baseline and for ulcers of duration of >12 months. The wound size reduction was greatest in the group treated with amelogenin (33.8 vs. 25.6%, n=117), this difference being greatest for larger ulcers (25 vs. 7.9% for ulcers>10 cm(2), n=61) and those of long duration (29.3 vs. 10.9% for ulcers>12-month duration, n=61). We conclude that this product may be clinically useful in the treatment of these venous leg ulcers.

Plantar warts in twins after successful bone marrow transplantation for severe combined immunodeficiency.

Nine-year-old twin sisters presented with long-standing severe plantar warts following bone marrow transplantation for severe combined immunodeficiency (SCID). Combination therapy with keratolysis, cidofovir and water-filtered infrared coagulation (WIRA) led to complete clearance after 8 months of therapy. This dermatologic problem and the treatment of SCID including gene therapy are discussed.

Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA.

Palmoplantar psoriasis is a chronic disease, which is very resistant to treatment and often leads to severe disabilities. Photochemotherapy employing psoralens combined with UVA irradiation (PUVA) is a well-accepted therapy for palmoplantar psoriasis. Its topical application (bath PUVA; cream PUVA) avoids the typical side effects of orally applied psoralens. We compared the efficacy of cream PUVA therapy with monochromatic excimer light therapy, a treatment modality employing 308-nm UVB radiation generated by a new kind of light source. Ten patients with psoriasis of the palms and soles were randomly assigned to receive cream PUVA on one side and 308-nm UVB on the contralateral side. Based on the psoriasis area and severity index (PASI) score, clinical assessment was carried out before and 5 weeks after the beginning of the study. At the end of the treatment period both test groups showed a remarkable PASI score reduction (308-nm UVB, 63.57%; cream PUVA, 64.64%). No relevant adverse effects were observed, except for mild irritation in a few patients. After a 12-week follow-up, a relapse of the disease was only observed in one patient. Thus, mono-chromatic excimer light cleared palmoplantar psoriasis as rapidly as cream PUVA. In contrast to cream PUVA, monochromatic excimer light therapy is not associated with prior drug application. This might lead to a lower incidence of adverse reactions and better compliance. Therefore, monochromatic excimer light therapy seems to be a useful new therapeutic option for palmoplantar psoriasis.

Efficacy of topical pale sulfonated shale oil in the treatment of venous leg ulcers: a randomized, controlled, multicenter study.

BACKGROUND: Venous leg ulcers are a growing socioeconomic burden. Pale sulfonated shale oils (PSSO) are used for therapy of inflammatory skin diseases and have been shown to enhance wound healing in vitro and in vivo. The aim of this study was to investigate whether PSSO is capable of enhancing venous ulcer healing beyond compression therapy alone. METHODS: One hundred nineteen patients were enrolled in this randomized, multicenter, observer-blind study. In the treatment group, PSSO 10% was applied daily for 20 weeks, and the control group received the vehicle only. Wounds were covered by a nonadherent gauze dressing, and compression therapy with short-stretch elastic bandages was performed in an outpatient setting. The primary study end point was defined as cumulative reduction in wound area; the secondary study end point was treatment success as assessed by both physicians and patients. Additionally, adverse events, including changes with respect to physical examination and vital signs, were documented. RESULTS: At the end of the study period, ulcer size was significantly more reduced in the PSSO group compared with the vehicle group (15 +/- 15.9 to 6.2 +/- 12.9 cm(2) vs 11.4 +/- 14.5 to 10.8 +/- 15.7 cm(2); P = .0005). The cumulative relative reduction in ulcer area was significantly higher in the PSSO group (-4391 +/- 4748.7 vs -231.9 +/- 6283.6 % x days; P < .0001). Relative reduction in wound area was significantly greater in the PSSO group as early as 6 weeks after the beginning of treatment (-47.4 +/- 28.4 vs -23.8 +/- 42.2%; P < .001). PSSO was judged successful both by physicians and patients. There were no significant differences in adverse events (PSSO, 9 [12.2%]; vehicle, 7 [11.1%]. Similarly, tolerability of PSSO was equal to the tolerability of the vehicle. CONCLUSION: Pale sulfonated shale oils were capable of favoring venous ulcer healing in addition to compression therapy. PSSO should be considered for future wound care protocols for treatment of venous leg ulcers.

Infrared-A radiation-induced matrix metalloproteinase 1 expression is mediated through extracellular signal-regulated kinase 1/2 activation in human dermal fibroblasts.

In addition to ultraviolet radiation, human skin is exposed to infrared radiation from natural sunlight as well as artificial ultraviolet and infrared irradiation devices used for therapeutic or cosmetic purposes. The molecular consequences resulting from infrared exposure are virtually unknown. In this study we have investigated whether infrared has the capacity to affect gene expression in human skin cells. Exposure of cultured human dermal fibroblasts to infrared in the range of 760-1400 nm (infrared-A) induced the expression of matrix metalloproteinase 1 at the mRNA and protein level in a time- and concentration-dependent manner. Expression of tissue inhibitor of matrix metalloproteinase 1 remained unaltered. These effects were not mediated by the generation of heat by infrared-A. Furthermore, infrared-A did not induce heat shock protein 70 expression in human dermal fibroblasts under conditions that increased matrix metalloproteinase 1 expression. Here we provide evidence that infrared-A activated mitogen-activated protein kinase pathways. Extracellular signal-regulated kinase 1/2 and p38-mitogen-activated protein kinase were rapidly activated after infrared-A exposure. The mitogen-activated protein kinase/extracellular signal-regulated kinase inhibitor PD 98059, which specifically blocked the extracellular signal-regulated kinase pathway, prevented infrared-A-induced matrix metalloproteinase 1 expression. Upregulation of matrix metalloproteinase 1 expression by infrared-A was thus shown to be dependent on extracellular signal-regulated kinase 1/2 activation. In conclusion, this study demonstrates that infrared-A is capable of inducing matrix metalloproteinase 1 expression in human dermal fibroblasts via activation of the extracellular signal-regulated kinase 1/2 signaling pathway. This previously unrecognized property of infrared-A points to its possible role in the photoaging of human skin.