Arthur C. Huntley

A double-blind, vehicle-controlled study evaluating masoprocol cream in the treatment of actinic keratoses on the head and neck

This double-blind, vehicle-controlled, multicenter study evaluated the efficacy and safety of a new topical antineoplastic agent, masoprocol, in the treatment of actinic keratoses of the head and neck. Of the 113 patients who applied topical masoprocol twice a day for 14 to 28 days, there was a mean decrease in actinic keratoses from 15.0 to 5.4 and a median percent reduction from baseline actinic keratosis count of 71.4% at the 1-month follow-up visit. Comparable numbers for the vehicle-treated group were 13.4 to 11.1 actinic keratoses and 4.3% median percent reduction. Irritation, as manifested by erythema or flaking, occurred in 61.5% of topical masoprocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response. Topical masoprocol appears to be useful in the treatment of actinic keratoses.

Segmentation of skin cancer images

An automatic method for segmentation of images of skin cancer and other pigmented lesions is presented. This method first reduces a color image into an intensity image and approximately segments the image by intensity thresholding. Then, it refines the segmentation using image edges. Double thresholding is used to focus on an image area where a lesion boundary potentially exists. Image edges are then used to localize the boundary in that area. A closed elastic curve is fitted to the initial boundary, and is locally shrunk or expanded to approximate edges in its neighborhood in the area of focus. Segmentation results from 20 randomly selected images show an average error that is about the same as that obtained by four experts manually segmenting the images.

The cutaneous manifestations of diabetes mellitus

In the last 10 years many new associations between diabetes mellitus and the skin have been noted. Diabetes mellitus is a common disease, and the cutaneous manifestations of it are frequently encountered by the practicing dermatologist. This article reviews the spectrum of dermatologic signs and symptoms of diabetes mellitus, with special emphasis on those manifestations newly discussed in the literature of the last decade. (J AM ACAD DERMATOL 7:427-455, 1982.)

Lyme disease: A rigorous review of diagnostic criteria and treatment

Lyme disease was originally identified in Lyme, Connecticut, based upon an unusual cluster of what appeared to be patients with juvenile rheumatoid arthritis. It was subsequently identified as a new clinical entity originally called Lyme arthritis based on the observation that arthritis was a major clinical feature. However, Lyme arthritis is now called Lyme disease based upon the understanding that the clinical features include not only arthritis, but also potential cardiac, dermatologic and neurologic findings. Lyme disease typically begins with an erythematous rash called erythema migrans (EM). Approximately 4-8% of patients develop cardiac, 11% develop neurologic and 45-60% of patients manifest arthritis. The disease is transmitted following exposure to a tick bite containing a spirochete in a genetically susceptible host. There is considerable data on spirochetes, including Borrelia burgdorferi (Bb), the original bacteria identified in this disease. Lyme disease, if an organism had not been identified, would be considered as a classic autoimmune disease and indeed the effector mechanisms are similar to many human diseases manifest as loss of tolerance. The clinical diagnosis is highly likely based upon appropriate serology and clinical manifestations. However, the serologic features are often misinterpreted and may have false positives if confirmatory laboratory testing is not performed. Antibiotics are routinely and typically used to treat patients with Lyme disease, but there is no evidence that prolonged or recurrent treatment with antibiotics change the natural history of Lyme disease. Although there are animal models of Lyme disease, there is no system that faithfully recapitulates the human disease. Further research on the effector mechanisms that lead to pathology in some individuals should be further explored to develop more specific therapy.

Keratotic lupus erythematosus: Treatment with isotretinoin

We describe a patient with a distinct verrucous variant of chronic discoid lupus erythematosus manifested by skin lesions resembling keratoacanthomas. The diagnosis of keratotic lupus was confirmed by characteristic immunofluorescence and ultrastructural findings and by an initial response to antimalarial therapy. Combination therapy with isotretinoin and hydroxychloroquine resulted in control of her previously refractory skin lesions, and the isotretinoin apparently played a key role in this improvement.

The autoimmune basis of alopecia areata: A comprehensive review

Alopecia areata (AA) is a common, non-scarring dermatologic condition regularly distinguished by patches of hair loss on the scalp also manifesting in other, severe forms, including alopecia totalis (total loss of hair on the scalp) and alopecia universalis (complete loss of hair on the scalp and body). AA is a clinically heterogeneous disease with greatly varying yet typical symptoms, but the etiology for AA remains an enigma. However, clinical and experimental studies have pointed to autoimmune involvement, specifically regarding immune privilege sites of the hair follicles and the infiltration of CD4+ and CD8+ T cells and a predominant Th1 cytokine profile. Environmental insults, such as viral infections, trauma and genetic predisposition are also believed to contribute to the disease process. Multiple treatment options including the use of broad acting corticosteroids appear to be relatively effective in mild cases, however the clinical management of more severe forms of AA is much more difficult. Recent studies suggest that intervention of the JAK pathway may have a potential therapeutic efficacy for AA.

Cutaneous manifestations of diabetes mellitus

Diabetes mellitus is a common condition, and persons who have this ailment are commonly encountered by dermatologists and primary care physicians. Because glucose attaches to long-lived proteins, it may have a profound effect on the tertiary structure of the protein. Chronic hyperglycemia may be responsible for the pathogenesis of many diabetic complications. It has been suggested that increased cross-linking of collagen in diabetic patients is responsible for the fact that their skin is generally thicker than that of nondiabetics. Advanced glycosylation end-products are probably responsible for yellowing of skin and nails. Increased viscosity of blood caused by stiff red blood cell membranes results in engorgement of the postcapillary venules in the papillary dermis, which is detected as erythema of the face or as periungual erythema. It is suggested that these skin changes may eventually be used as a reflection of the patients current (as well as past) metabolic status.

Finger pebbles: A common finding in diabetes mellitus

Several authors have now described the relatively common occurrence of thickening of the skin on the dorsum of the fingers and hands in persons with diabetes mellitus, and skin thickening in these patients has been documented histologically for other body locations. To date, the presence of finger and hand skin thickening has been determined by an examination difficult to objectify--palpation and attempted tenting of the affected area. In a survey of sixty subjects with diabetes, it was found that forty-five patients (75%) have a visual marker for skin thickening, that is, a pebbly appearance of the knuckle and distal finger skin. Similar changes were present in eleven of control subjects (21%). A limited histologic study indicates that the epidermis and papillary dermis are primarily responsible for this thickening. A pebbly appearance of volar finger skin may be a more easily recognized marker of diabetic skin thickening.

Configuring for the World Wide Web: Recommendations for dermatologists

Physicians have become increasingly interested in obtaining the hardware, software, and connection necessary to take advantage of the educational and practice material available on the World Wide Web (WWW) (i.e., on the Internet). The related ongoing development of unique on-line resources promises to provide a compelling force for change in the way in which information is accessed and medicine is practiced. WWW applications created for dermatologists often include high-quality images, and proper viewing is critical to use this information. Because images tend to be large files, and dermatology resources tend to have from several up to hundreds of images, the speed of transfer and display and the quality of the display are important factors to consider. This study was an evaluation of some of the current options in the hardware, software, and Internet connections to determine desirable configurations for accessing image-rich, on-line dermatology WWW applications.

Internet resources for dermatology

Accessible today, through the use of a computer with a modem, are many new Internet resources that represent major advances in information management. These resources, which are available at little or no expense, are of special value to physicians and scientists. This article describes many of the more basic and valuable Internet services with an emphasis on applications for dermatologists.