S. Georgala

Coping with acne: beliefs and perceptions in a sample of secondary school Greek pupils

Background  Information on the understanding of acne in adolescents has only occasionally been reported in the medical literature.

Frontal fibrosing alopecia: treatment with oral dutasteride and topical pimecrolimus

© 2008 The Authors JEADV 2009, 23, 570–620 Journal compilation

The role of inflammatory markers in assessing disease severity and response to treatment in patients with psoriasis treated with etanercept

Background.  Psoriasis is a chronic, systemic, inflammatory disease. Inflammatory markers are used in clinical practice to detect acute inflammation, and as markers of treatment response. Etanercept blocks tumour necrosis factor (TNF)‐α, which plays a central role in the psoriatic inflammation process.

Bullous Erysipelas: Clinical Presentation, Staphylococcal Involvement and Methicillin Resistance

Background: Erysipelas is a bacterial infection of the dermis and hypodermis, mostly of streptococcal origin. Bullous erysipelas represents a severe form of the disease. Objective: To evaluate the clinical and microbiological characteristics and treatment of bullous erysipelas. Methods: Patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, University Hospital of Heraklion, Crete, Greece, between the years 1996 and 2001 were retrospectively studied. Results: Fourteen patients (11 women, 3 men) with bullous erysipelas were evaluated. The lesions were located on the legs and face in 9 and 4 patients, respectively. The median duration of disease before hospital admission was 4 days. Eight patients had fever at presentation. Local trauma and various lesions were common causes for pathogen entry. The initial empirical antibiotic treatment included intravenous β-lactams and was modified according to the sensitivities of the isolated strains. Staphylococcus aureus was isolated from 7 (50%), while S. warneri, Streptococcus pyogenes and Escherichia coli grew from the lesions of 3 other patients. Six out of 7 S. aureus strains were methicillin resistant (MRSA) but susceptible to several other non-β-lactam antibiotics such as quinolones, vancomycin, rifampicin and trimethoprim/sulfamethoxazole. Conclusion: Our findings suggest that S. aureus is frequently involved in and probably contributes in synergy with β-hemolytic streptococci to the complicated course of bullous erysipelas. The frequency of MRSA isolation suggests that β-lactam antibiotics may not be sufficient for the treatment of bullous erysipelas anymore, at least in areas with a high incidence of MRSA strains. The role of other classes of antibiotics providing adequate coverage for MRSA has to be evaluated in prospective clinical trials.

Immunophenotypic analysis of the p53 gene in non-melanoma skin cancer and correlation with apoptosis and cell proliferation

Background   Sunlight precipitates a series of genetic events that lead to the development of skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The p53 tumour suppressor gene, which plays a pivotal role in cell division and apoptosis, is frequently found mutated in sunlight‐induced skin tumours.

Papulonodular Lichenoid and Pseudolymphomatous Reaction at the Injection Site of Hepatitis B Virus Vaccination

Immunization with the hepatitis B virus (HBV) is effective and safe with an estimated incidence of adverse reactions, either local or systemic, of less than 0.1%. Cutaneous side effects are rare and include lichen planus (LP) and lichenoid reactions. We report the case of a 21-year-old female, in whom a persistent, papulonodular lesion developed at the site of the injection, 6 weeks after the second dose of the HBV. Histological examination revealed lichenoid and pseudolymphomatous features. In addition, sensitization to thiomersal, a vaccine constituent, was documented by patch testing. The association of LP with chronic liver disease is well established. Furthermore, less than 20 cases of lichen or lichenoid reactions, following HBV vaccination, have been reported. Although several arguments have been presented, it is still debated whether there is a causal association or the occurrence of LP following HBV vaccination is a simple coincidence. It has been speculated that a T-cell-mediated, graft-versus-host-like reaction, triggered by a sensitizing protein, is directed against keratinocytes expressing an epitope of hepatitis B surface antigen or a similar epitope. Our case may represent a localized lichenoid reaction to HBV vaccination, a local reactive hyperplasia or a persisting delayed hypersensitivity reaction to a vaccine constituent. This is the first case of a local lichenoid reaction at the injection site of the HBV vaccine, providing further documentation for a causal association linking the HBV vaccine with LP.

Poikiloderma of Civatte: a clinical and epidemiological study.

Background  Although a common dermatosis, idiopathic poikiloderma of the face and neck has not been studied in depth for decades.

Biologic Agents and Alopecia Areata

hibited hair growth and EGF, TNFand IL-1 completely abrogated it. All these evidences are in favor of an autoimmune phenomenon occurring in AA, with the TNFappearing as a potent inhibitor of hair growth. In the last few years, several biologic agents acting on TNFor involving ICAM 1-LFA1 or CD2-LFA3 interactions have been considered as possible treatments for AA. Cases of AA have been described in which etanercept has been proven ineffective, or AA recurred during etanercept therapy for other disease [5] . Strober et al. [6] found that no hair regrowth occurred after treatment of AA with etanercept in 17 otherwise healthy patients. In addition, infliximab did not prevent AA development in a patient with no previous history of this disease [7] . Fabre and Dereure [8] reported worsening of AA in a patient receiving infliximab. Adalimumab is a fully humanized recombinant anti-TNFmonoclonal antibody which has been approved for rheumatoid arthritis, active ankylosing spondylitis, psoriatic arthritis and Crohn’s disease. To our knowledge, our patient is the third reported case of AA developing during adalimumab therapy. Pelivani et al. [9] described a case of AA universalis elicited after 6 months of adalimumab monotherapy in a patient with a longstanding history of psoriatic arthritis and psoriasis. Garcia Bartels et al. [10] published a case of AA universalis, occurring 4 months after adalimumab was added to a regimen of prednisone and leflunomide. In our patient, apart from the introduction of adalimumab, other factors, namely serious psychological stress, might have played an important part in eliciting AA. Our patient is the second reported case in which the introduction of adalimumab in a patient already under treatment with leflunomide was followed by AA development. Leflunomide is a new immunomodulatory drug that selectively acts on activated autoimmune lymphocytes by inhibiting dihydroorotate dehydrogenase, an enzyme required for de novo pyramidine synthesis. These 2 cases suggest that leflunomide has probably no prophylactic or therapeutic effect on AA. On the other hand, there is evidence suggesting that other biologic therapies that target T cells may represent an effective treatment modality for AA. Heffernan et al. [11] tried alefacept in 4 patients with AA. All 4 patients improved, indicating that alefacept may be effective. A case of AA successfully treated with efalizumab has been reported [12] , however subcutaneous injections of efalizumab did not seem to be effective in 62 patients with AA [13] . Furthermore, in one case of AA, efalizumab was proven ineffective [7] . In light of the suggested pathogenetic relationship of AA and TNF, it is noteworthy to report cases of AA that occurred and progressed during treatment with TNF-blocking agents. The understanding gained from this experience should redirect the therapeutic aims toward alternate interventions.

Oral isotretinoin in the treatment of recalcitrant condylomata acuminata of the cervix: a randomised placebo controlled trial

Background: Conventional therapies for human papillomavirus (HPV) infection are often associated with unsatisfactory response rates and high recurrence rates. The use of a systemic agent may more effectively control the virus. Objectives: To investigate the efficacy and safety of low dose oral isotretinoin in recalcitrant condylomata acuminata (RCA) of the cervix. Methods: Double blind placebo controlled clinical trial. 60 women, aged 21–43 years, with RCA of the cervix, refractory to at least one conventional therapy, were randomly assigned to receive either isotretinoin, 0.5 mg/kg daily for 12 weeks (group 1), or placebo (group 2). Results: Of the 28 evaluable group 1 patients, nine (32.1%) responded to the treatment completely, 11 (39.2%) responded partially, and eight (28.5%) did not respond. Of the 25 group 2 patients, no one responded to the treatment completely, two (8%) responded partially, and 23 (92%) did not respond. The therapeutic difference between patients receiving active and placebo therapy was statistically significant (χ2 = 19.35, p<0.001). Only one (11.1%) of the complete responders experienced recurrence during the 12 month follow up. Side effects were generally mild and resolved upon completion of therapy. Conclusions: Compared to placebo, low dose oral isotretinoin showed considerable efficacy with insignificant and reversible side effects and a low recurrence rate. Isotretinoin may represent an efficacious and safe alternative systemic form of therapy for RCA of the cervix.

Eruptive Large Melanocytic Nevus in a Patient with Hereditary Epidermolysis bullosa simplex

Hereditary epidermolysis bullosa (HEB) is a group of genetically determined mechanobullous disorders characterized by blister formation following minor trauma. Unusual melanocytic lesions may be a rare feature of all major categories of HEB. We report a large melanocytic nevus, clinically simulating malignant melanoma, which developed at a site of healing blisters in an 8-year-old male with recessive generalized epidermolysis bullosa simplex (EBS). Histological findings were consistent with a compound nevus. This is the third reported case of an eruptive melanocytic nevus developing in EBS. Due to their unique features, it has been suggested that these nevi may represent a distinct variant, referred to as epidermolysis bullosa nevi. Despite the atypical picture, no malignant transformation of HEB nevi has been seen. Therefore, after histologic verification, regular long-term follow-up rather than radical surgery is recommended.