Drugs causing fixed eruptions: a study of 450 cases

Background Drug eruptions are among the most common cutaneous disorders encountered by the dermatologist. Some drug eruptions, although trivial, may cause cosmetic embarrassment and fixed drug eruption (FDE) is one of them. The diagnostic hallmark is its recurrence at previously affected sites. Objective We evaluated 450 FDE patients to determine the causative drugs. Results The ratio of men to women was 1:1.1. The main presentation of FDE was circular hyperpigmented lesion. Less commonly FDE presented as: nonpigmenting erythema, urticaria, dermatitis, periorbital or generalized hypermelanosis. Occasionally FDE mimicked lichen planus, erythema multiforme, Stevens–Johnson syndrome, paronychia, cheilitis, psoriasis, housewife’s dermatitis, melasma, lichen planus actinicus, discoid lupus erythematosus, erythema annulare centrifugum, pemphigus vulgaris, chilblains, pityriasis rosea and vulval or perianal hypermelanosis. Cotrimoxazole was the most common cause of FDE. Other drugs incriminated were tetracycline, metamizole, phenylbutazone, paracetamol, acetylsalicylic acid, mefenamic acid, metronidazole, tinidazole, chlormezanone, amoxycillin, ampicillin, erythromycin, belladonna, griseofulvin, phenobarbitone, diclofenac sodium, indomethacin, ibuprofen, diflunisal, pyrantel pamoate, clindamycin, allopurinol, orphenadrine, and albendazole. Conclusions Cotrimoxazole was the most common cause of FDE, whereas FDE with diclofenac sodium, pyrantel pamoate, clindamycin, and albendazole were reported for the first time. FDE may have multiform presentations.     

Skin penetration of antimicrobial agents in rats

Skin penetration of various antimicrobial agents was studied in rats. Skin concentration/serum concentration ratios were classified into three groups, i.e. group I with ratio greater than or equal to 0.7, group II with the ratio 0.7-0.4 and group III with the ratio less than or equal to 0.4. The drugs of group I were OFLX, CPFX, LFLX, FLRX, SPFX, AMK, EM, RXM, CAM, CLDM. The drugs of group II were ABPC, CVA/AMPC, CVA/TIPC, CEX, CED, CXD, CTM-HE, CXM-AX, CPZ, CBPZ, TFLX, ASTM, MINO. The drugs of group III were AMPC, CCL, CDX, CPDX-PR, CFTM-PI, CTZ, CEC, CEZ, CTM, CMZ, CZON, MCR, IPM/CS. Factors which may influence the skin penetration were discussed, but no definite conclusion has not been obtained.     

Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosa

BACKGROUND: In recessive dystrophic epidermolysis bullosa (RDEB), a good nutritional balance is necessary to obtain healing of the chronic wounds. However, involvement of the oral mucosa and oesophagus stenosis may be responsible for severe nutritional deficiencies. OBJECTIVE: In order to propose an adapted nutritional management, we studied the vitamin and trace metal status of 14 RDEB patients. METHODS: Height and weight were measured. Plasma levels of albumin, iron, ferritin, calcium, parathyroid hormone (PTH), folates, vitamins C, D, B12, A, E, B1, B6, PP and B2, zinc, selenium, carnitine and copper were measured. RESULTS: Most patients had a significant growth retardation. We found iron, vitamin D, C, B6, PP, zinc and selenium deficiencies in 36-70% of the patients, without clinical expression, except in one case. Vitamin B1, 12, B2, A/RBP, E/lipids and carnitine were normal. The three patients with gastrostomy feeding had better growth but still a protein deficiency and sometimes vitamin C, B6, PP, zinc and carnitine deficiencies. CONCLUSION: Vitamin and trace metal deficiencies are frequent in RDEB, even in patients receiving gastrostomy feeding, and often go unrecognized. Regular nutritional evaluation is necessary. Dietary advice and supplements should be given. Enteral feeding by gastrostomy should be discussed in early childhood.     

Melasma: treatment strategy

Melasma, a hypermelanosis of the face, is a common skin problem of middle-aged women of all racial groups, especially with dark complexion. Its precise etio-pathogenesis is evasive, genetic influences, exposure to sunlight, pregnancy, oral contraceptives, estrogen-progesterone therapies, thyroid dysfunction, cosmetics, and drugs have been proposed. Centro-facial, malar, and mandibular are well-recognized. Epidermal pigmentation appears brown/black, while dermal is blue in color, and can be distinguished by Wood's lamp illumination. The difference may be inapparent with mixed type of melasma in skin types V and VI. An increase in melanin in epidermis: basal and suprabasal layers and/or dermis is the prime defect. There is an increased expression of tyrosinase related protein-1 involved in eumelanin synthesis. The use of broad-spectrum sunscreen is important, lightening agents like retinoic acid (tretinoin), azelaic acid, and combination therapies containing hydroquinone, tretinoin, and corticosteroids, have been used in the treatment of melasma, and are thought to have increased efficacy as compared with monotherapy. Quasi-drugs, placental extracts, ellagic acid, chamomilla extract, butylresorcinol, tranexamic acid, methoxy potassium salicylate, adenosine monophosphate disodium salt, dipropyl-biphenyl-2,2'-diol, (4-hydroxyphenyl)-2-butanol, and tranexamic acid cetyl ester hydrochloride, in addition to kojic and ascorbic acid have been used. Chemical peeling is a good adjunct. Laser treatment is worthwhile.     

First epidemiological study of contact dermatitis in Spain - 1977. Spanish Contact Dermatitis Research Group.

The present work is the first epidemiological study carried out by the Spanish Contact Dermatitis Research Group during 1977. During this year 2806 patients were studied with patch test among 30873 dermatological patients. The 60-62% of the totality had reactivity to one or more patches. Four major groups of allergens were able to consider, following the incidence in their power of sensitize. First group with strong incidence include: Nickel, Chromate, Cobalt, T.M.T.D.,P.P.D.A., Mercapto mix., and Wood tars. Second and third groups with medium incidence contain: Caines, Carbonates, Neomycin, Balsam of Peru, Mercury, Lanolin, Naphtyl mix., Formaldehyde, Benzalkonium chloride, P. P. D. A. mix, and Turpentine. Four group show very low incidence substances, as: Epoxi, Sulfonamides, Etilendiamine, Parabens, Chinoform, Colophony and Cinnamon oil. Few comments about age and occupations are included.     

Evaluation and management of the dysesthetic patient

Dysesthesia is symptomatology that includes but is not limited to sensations of pain, burning, crawling, biting, numbness, piercing, pulling, cold, shock-like, pulling, wetness, and heat. These sensations can cause significant emotional distress and functional impairment in affected individuals. Although some cases of dysesthesia are secondary to organic etiologies, most cases exist without an identifiable infectious, inflammatory, autoimmune, metabolic, or neoplastic process. Ongoing vigilance is required for concurrent or evolving processes, including paraneoplastic presentations. Elusive etiologies, unclear treatment regimens, and stigma leave patients and clinicians with a difficult path forward marked by “doctor shopping,” lack of treatment, and significant psychosocial distress. We address this symptomatology and the psychosocial burden that often comes with it. Although notoriously labeled as “difficult to treat,” dysesthesia patients can be effectively managed, making life-changing relief possible for patients.     

Mammary and extramammary Paget's disease

Paget''s disease, described by Sir James Paget in 1874, is classified as mammary and extramammary. The mammary type is rare and often associated with intraductal cancer (93-100% of cases). It is more prevalent in postmenopausal women and it appears as an eczematoid, erythematous, moist or crusted lesion, with or without fine scaling, infiltration and inversion of the nipple. It must be distinguished from erosive adenomatosis of the nipple, cutaneous extension of breast carcinoma, psoriasis, atopic dermatitis, contact dermatitis, chronic eczema, lactiferous ducts ectasia, Bowen''s disease, basal cell carcinoma, melanoma and intraductal papilloma. Diagnosis is histological and prognosis and treatment depend on the type of underlying breast cancer. Extramammary Paget''s disease is considered an adenocarcinoma originating from the skin or skin appendages in areas with apocrine glands. The primary location is the vulvar area, followed by the perianal region, scrotum, penis and axillae. It starts as an erythematous plaque of indolent growth, with well-defined edges, fine scaling, excoriations, exulcerations and lichenification. In most cases it is not associated with cancer, although there are publications linking it to tumors of the vulva, vagina, cervix and corpus uteri, bladder, ovary, gallbladder, liver, breast, colon and rectum. Differential diagnoses are candidiasis, psoriasis and chronic lichen simplex. Histopathology confirms the diagnosis. Before treatment begins, associated malignancies should be investigated. Surgical excision and micrographic surgery are the best treatment options, although recurrences are frequent.     

Enzyme histochemistry of the small intestine in inherited ichthyosis.

Enzyme histochemistry of biopsies from the small intestine of 5 patients with different forms of inherited ichthyosis and of 2 normal volunteers was performed. Two of the patients had ichthyosis vulgaris, two had non-bullous congenital ichthyosiform erythroderma and one had X-linked ichthyosis. The following enzymatic activities were examined: G6P-D, 6PG-D, NADPH2-TR, ALD-A, L-D, C-A, IC-D, S-D, M-D, NADH2-TR, ATP-AI, ATP-A II, ATP-A III, ATP-A IV, R5P-A, DHO-D, alphaGP-D, betaHOB-D, MAO, GL-D alphaGP-A I, alphaGP-A II, betaGP-A II, N.EST-A. No significant variations in the different enzymatic activities were found for the ichthyosis vulgaris and non-bullous C.I.E. cases. More pronounced variations were found in X-linked ichthyosis, with a decrease in C-A, IC-D, R5P-A, betaHOB-D, GL-D, alphaGP-A II and N.EST-A activity. Succinic dehydrogenase activity has been reported in the literature to be reduced in ichthyosis vulgaris and bullous C.I.E. However, the results obtained for our patients showed equal or higher reaction levels than in the controls.     

Complications of lasers and light treatments

Cutaneous lasers and lights, and also more novel cutaneous energy modalities like radiofrequency and ultrasound, are in general very safe interventions with an associated rapid healing time. Posttreatment sequelae are usually mild and spontaneously resolving, with erythema and edema lasting hours to days. More troublesome, less common short-term adverse events include urticaria, erosions, crusting, ecchymoses, blistering, and infection. Medium-term adverse events include hyperpigmentation, hypopigmentation, a line of demarcation, burns, textural imperfections, and delayed reepithelialization. Long-term to permanent adverse events, which are fortunately rare, include indentation, scar, and ocular damage. With few exceptions, there are management strategies for avoiding laser adverse events, and, if they do occur, for mitigating their impact.     

Nail involvement in leprosy

Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M. leprae infection.     

BOOK REVIEWS

Color Atlas of Cutaneous Infections . Lawrence Charles Parish, Joseph A. Witkowski, and Sjejina Vassileva .
Color Atlas of Dermatoscopy . W. Stolz, O. Braun-Falco, P. Bilek, M. Landthaler, and A.B. Cognetta .
Atlas of Cutaneous Surgery. June K. Robinson, Kenneth A. Arndt, Philip E. LeBoit, and Bruce U. Wintroub .     

Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review

Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.     

Late-onset Rothmund-Thomson syndrome

A 43-year-old woman presented with complaints of exfoliation of the skin and mottled pigmentation all over the body, intolerance to sunlight for the last 14 years, and swelling on the lower one-third of the neck for 15 years. She was apparently well until the age of 29 years when she noticed redness on her shins which later progressed to involve the upper limbs, chest, and face. Three months later, she observed multiple, small, brownish plaques over the erythematous areas, which gradually spread to the sun-exposed areas, namely the face, forearms, hands, and nape of the neck. The erythema disappeared within 5 months of onset. The patient experienced redness of the face, intolerance to the sun, and reduced sweating, particularly during the summer. There was no history of bullous eruption, difficulty during deglutition, tremors, or pedal edema. She suffered five miscarriages and, ultimately, was successful in delivering a normal boy who is now 16 years of age. She had menarche at the age of 14 years and her menstrual cycle was regular. There was no history of similar illness in the family. On cutaneous examination, the skin on the face, neck, trunk, buttocks, and limbs was found to be dry, lusterless, thin, and covered with fine scales. Mottled hyperpigmentation was observed all over the body. Atrophy and telangiectasia were seen over the neck (Fig. 1), face (Fig. 2), nape of the neck, upper and lower limbs, back, and chest. Mild erythema was observed over the face, nose, ears, and forearms. The hair on the scalp, eyebrows, axillae, and pubic area was sparse and thin. The teeth were loose and discolored due to caries, and a foul odor emanated from the mouth. The nails were lusterless and centrally depressed. The thyroid gland was enlarged, smooth, nontender, and moved with deglutition. No bruit was heard over it. No ocular abnormality was detected. The patient had a haemoglobin level of 7.6 g%, total serum iron binding capacity of 70 micromol/L (normal, 45-66 micromol/L), and serum ferritin level of 10 microg/L (normal, 15-200 microg/L). Peripheral blood smear showed hypochromic microcytic red blood cells. Total and differential leukocyte counts, erythrocyte sedimentation rate (ESR), blood glucose, serum electrolytes, total and differential serum proteins, liver function tests, blood urea, and microscopic examination of urine and stools were within normal limits. The thyroid profile and complement C3 and C4 levels were within normal limits. Rheumatoid factor, antinuclear factor and LE cells were absent. Abdominal ultrasonogram was normal. Fine needle aspiration cytology from the thyroid gland showed features suggestive of colloid goiter. Skin biopsy revealed thinning of the epidermis, flattening of the rete ridges, and hydropic degeneration of the basal cell layer. The dermis was edematous with dilated capillaries, melanophages, and a band-like mononuclear infiltrate. The sweat glands were reduced in number.     

罗格列酮对2型糖尿病患者血清脂联素、超敏C-反应蛋白水平的影响

目的探讨2型糖尿病（T2DM）患者及肥胖患者血清脂联素、超敏C-反应蛋白（hs—CRP）与胰岛素敏感性的相关性及罗格列酮对脂联素、hs—CRP水平的影响。方法测定30名2型糖尿病患者（A组）、30名T2DM合并肥胖患者（B组）、30名单纯性肥胖患者（C组）及30名正常对照者（D组）的空腹血糖（FPG）、空腹胰岛素（FINS）、脂联素及超敏C反应蛋白（hs—CRP），计算稳态模型评估法胰岛素抵抗指数（HOMA—IR）及胰岛素敏感指数（ISI）。前三组给予罗格列酮治疗8周后，重复测定，并对前后数据进行统计学比较。结果与D组相比，前三组FINS、hs—CRP、和HOMA—IR较高，脂联素、ISI较低；给予罗格列酮8周后，FINS、hs—CRP、HOMA—IR明显下降，脂联素、ISI明显升高f均P〈0、05）。在A组和B组，hs—CRP与FPG、FINS、HOMA—IR呈正相关，与脂联素、ISI呈负相关。结论血清标志物hs—CRP、脂联素检测对2型糖尿病早期诊断、治疗、预后、胰岛素抵抗及生理机制的研究具有重要意义。     

Lower-face and neck antiaging treatment and prevention using onabotulinumtoxin A: the 2010 multidisciplinary French consensus--part 2

Background Onabotulinumtoxin A has been used for many years in the aging face treatment. A survey was organized to identify current practices in France. Objective To develop consensual recommendations for treating aging lower face and neck with onabotulinumtoxin A. Methods and materials Fifty‐seven participants to six regional surveys reviewed practices and techniques for each individual treatment indication. From conference summaries and data from a questionnaire, consensual recommendations were developed. Results General considerations, key treatment rules, injection specifics (dose, site, and techniques), associated procedures/treatments, and procedure follow‐up were defined by indication, i.e., nasolabial angle, nasal tip repositioning, dilated nostrils, lips and perioral area, Marionette lines and depressor anguli oris, gingival smile, risorius and zygomatic perioral muscles, masseters, chin, and platysma. For the consensus participants, current onabotulinumtoxin A use is a global preventive and corrective treatment. Overall, judicious treatment of multiple sites and adjunctive modalities, such as fillers, peels, and laser, leads to satisfactory results with a youthful, harmonious, animated, and natural‐looking face. Conclusion Years of experience using onabotulinumtoxin A result in sophisticated treatment approaches, more specific targeted injections, and better understanding of lower facial and neck aging, leading to satisfying therapeutic results for patients and clinicians.     

Nail changes and disorders among the elderly

Nail disorders are frequent among the geriatric population. This is due in part to the impaired circulation and in particular, susceptibility of the senile nail to fungal infections, faulty biomechanics, neoplasms, concurrent dermatological or systemic diseases, and related treatments. With aging, the rate of growth, color, contour, surface, thickness, chemical composition and histology of the nail unit change. Age associated disorders include brittle nails, trachyonychia, onychauxis, pachyonychia, onychogryphosis, onychophosis, onychoclavus, onychocryptosis, onycholysis, infections, infestations, splinter hemorrhages, subungual hematoma, subungual exostosis and malignancies. Awareness of the symptoms, signs and treatment options for these changes and disorders will enable us to assess and manage the conditions involving the nails of this large and growing segment of the population in a better way.     

Disseminated histoplasmosis presenting as pyoderma gangrenosum-like lesions in a patient with acquired immunodeficiency syndrome

A 33-year-old Hispanic woman with newly diagnosed human immunodeficiency virus (HIV) infection, a CD4 T-lymphocyte count of 2, viral load of 730,000 copies/mL, candidal esophagitis, seizure disorder, a history of bacterial pneumonia, and recent weight loss was admitted with tonic clonic seizure. On admission, her vital signs were: pulse of 88, respiration rate of 18, temperature of 37.7 degrees C, and blood pressure of 126/76. Her only medication was phenytoin. On examination, the patient was found to have multiple umbilicated papules on her face, as well as painful, erythematous, large, punched-out ulcers on the nose, face, trunk, and extremities of 3 months' duration (Fig. 1). The borders of the ulcers were irregular, raised, boggy, and undermined, while the base contained hemorrhagic exudate partially covered with necrotic eschar. The largest ulcer on the left mandible was 4 cm in diameter. The oral cavity was clear. Because of her subtherapeutic phenytoin level, the medication dose was adjusted, and she was empirically treated with Unasyn for presumptive bacterial infection. Chest radiograph and head computed tomography (CT) scan were within normal limits. Sputum for acid-fast bacilli (AFB) smear was negative. Serologic studies, including Histoplasma antibodies, toxoplasmosis immunoglobulin M (IgM), rapid plasma reagin (RPR), hepatitis C virus (HCV), and hepatitis B virus (HBV) antibodies were all negative. Examination of the cerebrospinal fluid was within normal limits without the presence of cryptococcal antigen. Blood and cerebrospinal cultures for bacteria, mycobacteria, and fungi were all negative. Viral culture from one of the lesions was also negative. The analysis of her complete blood count showed: white blood count, 2300/microl; hemoglobin, 8.5 g/dL; hematocrit, 25.7%; and platelets, 114,000/microl. Two days after admission, the dermatology service was asked to evaluate the patient. Although the umbilicated papules on the patient's face resembled lesions of molluscum contagiosum, other infectious processes considered in the differential diagnosis included histoplasmosis, cryptococcosis, and Penicillium marnefei. In addition, the morphology of the ulcers, particularly that on the left mandible, resembled lesions of pyoderma gangrenosum. A skin biopsy was performed on an ulcer on the chest. Histopathologic examination revealed granulomatous dermatitis with multiple budding yeast forms, predominantly within histiocytes, with few organisms residing extracellularly. Methenamine silver stain confirmed the presence of 2-4 microm fungal spores suggestive of Histoplasma capsulatum (Fig. 2). Because of the patient's deteriorating condition, intravenous amphotericin B was initiated after tissue culture was obtained. Within the first week of treatment, the skin lesions started to resolve. Histoplasma capsulatum was later isolated by culture, confirming the diagnosis. The patient was continued on amphotericin B for a total of 10 weeks, and was started on lamivudine, stavudine, and nelfinavir for her HIV infection during hospitalization. After amphotericin B therapy, the patient was placed on life-long suppressive therapy with itraconazole. Follow-up at 9 months after the initial presentation revealed no evidence of relapse of histoplasmosis.     

Smoking and the skin

Smoking is the main modifiable cause of disease and death in the developed world. Tobacco consumption is directly linked to cardiovascular disease, chronic bronchitis, and many malignant diseases. Tobacco also has many cutaneous effects, most of which are harmful. Smoking is closely associated with several dermatologic diseases such as psoriasis, pustulosis palmoplantaris, hidrosadenitis suppurativa, and systemic and discoid lupus erythematosus, as well as cancers such as those of the lip, oral cavity, and anogenital region. A more debatable relationship exists with melanoma, squamous cell carcinoma of the skin, basal cell carcinoma, and acne. In contrast, smoking seems to protect against mouth sores, rosacea, labial herpes simplex, pemphigus vulgaris, and dermatitis herpetiformis. In addition to the influence of smoking on dermatologic diseases, tobacco consumption is also directly responsible for certain dermatoses such as nicotine stomatitis, black hairy tongue, periodontal disease, and some types of urticaria and contact dermatitis. Furthermore, we should not forget that smoking has cosmetic repercussions such as yellow fingers and fingernails, changes in tooth color, taste and smell disorders, halitosis and hypersalivation, and early development of facial wrinkles.     

Comedogenicity of current therapeutic products, cosmetics, and ingredients in the rabbit ear

Cosmetics continue to be used by acne-prone individuals. Often as more acne develops, more cosmetics are applied. In order to protect against this natural tendency, physicians should provide more patient information on the currently available products and ingredients. This presentation is designed to help in that effort. The data presented were gleaned from the rabbit ear assay, which is not an ideal animal model but is the best we have. If an ingredient is negative in the rabbit ear assay, we feel it is safe on the acne-prone skin. A strong, positive ingredient or cosmetic should be avoided. Ingredient offenders include isopropyl myristate and its analogs, such as isopropyl palmitate, isopropyl isostearate, butyl stearate, isostearyl neopentanoate, myristyl myristate, decyl oleate, octyl stearate, octyl palmitate or isocetyl stearate, and new introductions by the cosmetic industry, such as propylene glycol-2 (PPG-2) myristyl propionate. Lanolins continue to be a problem, especially derivatives such as acetylated or ethoxylated lanolins. Our most troublesome recent finding is the comedogenic potential of the D & C Red dyes. They are universally used in the cosmetic industry, especially in blushers. This may explain the predominance of cosmetic acne in the cheekbone area. All of these D & C Red dyes tested to date, the xanthenes, monoazoanilines, fluorans, and indigoids, are comedogenic. Actually, this is not surprising as they are coal tar derivatives. The natural red pigment, carmine, is noncomedogenic and can serve as a substitute for D & C dyes in blushers. Many finished products are comedogenic. Most troublesome to the dermatologists are the therapeutic tools that we use, such as Liquimat, Retin-A cream, Hytone, Staticin, Sulfoxl, Desquam-X, and Persadox HP cream. These should be reformulated. We have been unable to confirm that precipitated sulfur (U.S.P.) is a potent comedogen in the rabbit ear assay. Clinically, we still find sulfur quite effective as an adjuvant to the benzoyl peroxide therapy for the treatment of acne vulgaris. We would suggest that the bias against sulfur be reconsidered.     

2002-2003年中国部分地区甲真菌病致病菌流行病学调查报告

目的：调查2002-2003年我国甲真菌病致病菌流行情况。方法：在全国进行多中心开放性研究，自2002年5月-2003年11月，采用统一培养基，多点接种法进行研究。结果：从1084例患者965个培养基中分离出739株致病菌．其中皮癣菌占首位，而皮癣菌中红色毛癣菌占56．4％，须癣毛癣菌占5．5％，犬小孢子菌占0．3％，石膏样小孢子菌占2．6％．絮状表皮癣菌占1．5％，紫色毛癣菌占0．1％等；酵母菌居第2位，其中白念珠菌占10．0％，光滑念珠菌占5．1％，热带念珠菌占4．5％．近平滑念珠菌占5．8％，克柔念珠菌占1．9％等；霉菌居第3位。结论：甲真菌病致病菌中酵母菌类日益增多，故治疗应个体化．宜选用广谱抗真菌药物治疗。