Alexander C. Katoulis

Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea

Rosacea is a common chronic dermatosis that evolves in stages. The mite Demodex folliculorum has been implicated in its obscure aetiopathogenesis.

Development of multiple tumors in a sebaceous nevus of Jadassohn.

We report the case of a 56-year-old male with a sebaceous nevus of the scalp, complicated by multiple tumor development. Histologic examination revealed a basal cell carcinoma, a syringocystadenoma papilliferum and a proliferating trichilemmal cyst. Sebaceous nevus has a well-documented neoplastic potential. Multiple tumors may occasionally arise, but the coexistence of 3 or more tumors is extremely rare. Close monitoring and early complete surgical excision of sebaceous nevi are warranted, in order to ensure a favorable prognosis.

Classic Kaposi's sarcoma in Greece : A clinico-epidemiological profile

Background Classic Kaposis sarcoma (CKS) is not uncommon in Greece with a reported incidence of 0.20 per 100,000 per year.

Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature

A purpuric eruption may be an unusual early manifestation of mycosis fungoides (MF). On the other hand, persistent pigmented purpuric dermatoses (PPPD) may, occasionally, evolve to cutaneous T‐cell lymphoma. Coexistence of these two conditions has been reported, but it is extremely rare. We present the case of an elderly woman with a long‐standing pruritic, pigmented purpuric eruption. On 1‐year follow‐up, histological features suggesting early MF were observed and molecular analysis of the rearrangement of T‐cell receptor genes revealed clonality. Our patient may represent a case of PPPD evolving to MF, a case of MF clinically featuring PPPD, or an intermediate condition in a nosological continuity extending from PPPD to MF. A persistent pigmented purpuric eruption may rarely be a harbinger of cutaneous T‐cell lymphoma. Therefore, vigilant long‐term follow‐up of PPPD is highly recommended.

Inosiplex for Treatment of Alopecia Areata: a Randomized Placebo-controlled Study

Treatment of alopecia areata remains unsatisfactory. We decided to test if systemic therapy with inosiplex (Isoprinosine(R)), an immunomodulator could influence the disease. Thirty-two subjects with recalcitrant alopecia areata, aged 16-48 years (mean 30.3+/-5.1 years), were randomized into two treatment groups of 16 subjects each. They were assigned to receive either oral inosiplex (group 1), or placebo (group 2) on a double-blind basis. Inosiplex dosage was 50 mg/kg/day in five divided doses for 12 weeks. Of the 15 evaluable patients in group 1, 5 (33.3%) had full remission, 8 (53.3%) responded partially and 2 (13.3%) did not respond. Of the 14 evaluable patients in the placebo group, none had full remission, 4 (28.5%) responded partially and 10 (71.4%) did not respond. The therapeutic difference between patients receiving active and placebo therapy was statistically significant (?2=7.82, p<0.01). Compared with placebo, oral inosiplex showed considerable efficacy in alopecia areata with insignificant side-effects. Larger studies are required, however, before inosiplex may be recommended as an efficacious and safe alternative systemic form of therapy for recalcitrant alopecia areata.

Sun education in Greece

1. Melia J, Frost T, Graham-Brown R, et al. Problems with registration of cutaneous melanoma in England. Br J Cancer 1995;72:224–8. 2. Office of Population, Censuses and Surveys 1995 Mortality Statistics Cause: Review of the Registrar General on deaths by cause, sex, and age in England and Wales—1993. Series DH2 (20), London: HMSO. 3. Doherty VR, Mackie RM. Reasons for poor prognosis in British patients with cutaneous melanoma. Br Med J 1986; 297:388–91. 4. Graham-Brown RAC, Osborne JE, London SM, et al. The initial effects on workload and outcome of a public education campaign on early diagnosis and treatment of malignant melanoma in Leicestershire. Br J Dermatol 1990;122: 53–9. 5. Melia J, Cooper EJ, Frost T, et al. Cancer Research Campaign health education programme to promote the early detection of cutaneous malignant melanoma. I. Workload and referral patterns. Br J Dermatol 1995;132:405–13. 6. Bourke J, Healsmith MF, Graham-Brown RAC. Melanoma awareness and sun exposure in Leicester. Br J Dermatol 1995;132:251–6.

Association of Behcet's disease with hematologic malignancies.

Her paternal uncle suffered with type 1 insulin-dependent diabetes. On examination, she had a guttate pattern of lesions on her forehead (Fig. 1), shoulder, and upper arms in a light-exposed distribution. On close inspection, the lesions were found to be white atrophic macules. On her right shoulder she had a white plaque which had an atrophic cigarette paper appearance (Fig. 2). There was no anogenital involvement. A clinical diagnosis of lichen sclerosus was made, which appeared to be precipitated and aggravated by episodes of sunburn. A biopsy was taken which revealed epidermal atrophy, hyalinization of collagen in the upper dermis, and a scattered, deeper, predominantly lymphocytic infiltrate, consistent with a diagnosis of lichen sclerosus. Her routine investigations revealed that she was antinuclear antibody positive (1 : 80). Lichen sclerosus is much less common in children than in adults, and in only approximately 5% of cases are lesions seen solely outside the anogenital area. The cause of lichen sclerosus is unknown, but an autoimmune process has been proposed as there is a well-recognized association with other autoimmune diseases in patients and their relatives. It usually appears spontaneously, but there have been several reports of lichen sclerosus being precipitated by trauma. For example, lichen sclerosus has been described in an old burn scar, in a longstanding pressure sore, and following radiation therapy. To our knowledge, it has only once before been reported following sunburn. In that case, the patient was an adult male who also had genital involvement. This case represents another example of lichen sclerosus exhibiting the Koebner phenomenon.

An Overview of Classic Kaposi’s Sarcoma in Greece

Classic Kaposis sarcoma (CKS) is a rare tumor affecting mainly the elderly and running a chronic and indolent course. CKS in Greece is not uncommon with an estimated annual incidence of 0.47/1000,000 population, representing 1.35% of all malignant neoplasms. Furthermore, it is characterised by endemic clustering and clinico-epidemiological peculiaritis, supporting the speculation that it may represent a distinct form, the Mediterranean Kaposis sarcoma, or a subtype of CKS. Kaposis sarcoma is a multicentric angiomatous tumor of obscure etiopathogenesis and histogenesis. Based on clinical and epidemiological grounds, four distinct forms have been recognized: classic or sporadic, African or endemic, iatrogenic and epidemics or AIDS-associated KS [1].

A double‐blind vehicle‐controlled study of a preparation containing undecylenoyl phenylalanine 2% in the treatment of melasma in females

Undecylenoyl phenylalanine is a novel skin‐lightening agent, probably acting as α‐melanocyte‐stimulating hormone (α‐MSH) and beta‐adrenergic receptor (β‐ADR) antagonist.

Cutaneous Pseudolymphoma Following Administration of Lornoxicam

Since aspirin was introduced over a century ago, many new anti-inflammatory agents have been marketed. NSAIDs are currently the most commonly prescribed agents in Western medicine (1). Their widespread use has resulted in a number of well-documented adverse reactions. These most frequently involve the gastro-intestinal tract, causing discomfort, nausea and diarrhoea or, occasionally, bleeding and ulceration (2). Cutaneous reactions mainly include urticaria, angioedema, fixed drug eruption, pruritus, photosensitivity and, in severe cases, Stevens-Johnson syndrome and toxic epidermal necrolysis (3). Lornoxicam (chlortenoxicam) is a new selective cyclooxygenase-2 (COX-2) inhibitor of the oxicam class, with analgesic, anti-inflammatory and antipyretic properties (4). Lornoxicam has a tolerability profile characteristic of an NSAID. No pseudolymphomatous reaction has been reported before. CASE REPORT