Poikiloderma of Civatte: a histopathological and ultrastructural study

BACKGROUND: Poikiloderma of the face and neck (Civatte) has not been studied in depth for decades, especially as far as the histopathology is concerned. MATERIAL AND METHODS: We studied 50 consecutive patients with poikiloderma of Civatte (PC). Their evaluation included: history, physical examination, lesional skin biopsy and histological examination of sections stained with hematoxylin-eosin, PAS, Fontana-Masson, acid orcein Giemsa for elastic fibers and toluidine blue for mast cells. In 10 randomly selected subjects, a second skin biopsy was performed and specimens were examined under the electron microscope. RESULTS: There were 34 females (68%) and 16 males. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. Histological examination revealed an atrophic (62%), flattened (84%) epidermis with hyperkeratosis (92%) and occasional follicular plugging (34%). In some cases, mild hydropic degeneration of the basal cell layer was evident (46%). Melanin was irregularly distributed in the lower epidermis (94%), and melanophages were often present in the dermis (92%). The most prominent and constant feature (100%) was solar elastosis of the papillary dermis. The blood vessels were almost invariably dilated (96%) with a mild perivascular lymphohistiocytic infiltrate (78%), sometimes with plasmacytes (56%). At the ultrastructural level, the epidermis showed only minor changes. The dermoepidermal junction was intact. The most constant findings were swelling and disruption of the collagen fibers as well as focal degeneration of the collagen bundles. Occasionally, several vacuolar spaces were found just under the basal lamina. Melanin-laden macrophages scattered in the dermis were also detected. CONCLUSIONS: PC shows distinct histological and ultrastructural features, supporting the theory that it represents a separate entity. The histology of PC is characteristic but not pathognomonic. On this basis, the differential diagnosis from Riehl's melanosis, poikiloderma atrophicans et vasculare and other acquired poikilodermas can be made. Ultrastructural findings were consistent with the histological findings. Changes of the dermal connective tissue (solar elastosis) predominated, providing morphological evidence for the role of ultraviolet radiation in the pathogenesis of PC.     

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte

BACKGROUND: Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE: To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS: Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS: Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS: Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.     

655例孢子丝菌病临床流行病学特征分析

 目的:分析孢子丝菌病临床流行病学特征,为孢子丝菌病诊疗及流行提供依据。 方法:回顾性分析2016年6月至2018年6月确诊且资料完整的655例皮肤型孢子丝菌病患者,分析患者一般资料、临床表现、皮损分布、既往诊治情况等。结果： 655例患者中,男253例,女402例,男女比例1  ∶1.59;年龄3个月~81岁,36~65岁占67.79%;病程4天~8年,2~4个月占60.92%。临床以固定型（77.25%）和淋巴管型（21.83%）为主,以丘疹结节损害居多,主要分布于面部（51.45%）和四肢（43.82%）。133例有明确外伤史。499例（76.18%）患者有该病既往外院就诊史,其中误诊293例（58.72%）。误诊疾病以皮肤感染、皮炎诊断最多。结论:孢子丝菌病临床表现多样,以固定型和淋巴管型表现为主,主要累及面部、躯干,误诊率高,临床医师应提高对该病的认识。     

Treatment of recalcitrant vitiligo by autologous non-cultured and trypsinized melanocyte grafting in the west of Iran

BackgroundVitiligo is a common disease with a high burden, and its recalcitrant type is unresponsive to current medical treatments. Autologous non-cultured and trypsinized melanocyte grafting, which is a simple and experience-based procedure, has been suggested for the treatment of vitiligo.ObjectiveTo assess autologous non-cultured and trypsinised melanocyte grafting in recalcitrant vitiligo.MethodsThis clinical trial was done on 28 patients (20 females and 8 males). After demarcation and preparation of both donor and recipient sites, both sites were shaved by a curette. The materials harvested from the donor site were trypsinized and centrifuged. The resulting suspension was mixed with hyaluronic acid gel and was spread over the shaved recipient area.ResultsTwenty-eight patients with a total of 108 lesions and a mean age of 25.93 ± 7.11 years were included in the present study. Generalized vitiligo (57.1%) was the most common clinical type and the face and neck regions (38%) were the most frequent treated sites. Good to excellent repigmentation was seen in the face and neck, trunk, upper extremity, and genitals in 31 (57.4%), 11 (20.4%), 9 (16.7%) and 3 (5.5%) patients, respectively. Face and neck showed significantly better results (p < 0.05).Study limitationsLow sample size and single-center study.ConclusionAutologous non-cultured and trypsinized melanocyte grafting is a safe method with satisfactory outcomes in recalcitrant vitiligo. Appropriate training of physicians and proper use of specialists’ experiences can be effective in increasing the improvement rate.     

基底细胞癌组织病理类型与性别、年龄及部位的相关性分析

目的 分析基底细胞癌(BCC)组织病理类型与性别、年龄及部位的相关性.方法 回顾性分析2000年1月到2009年4月共243例BCC的临床病理资料,应用SPSS 13.0软件对资料进行分析.结果 243例BCC中,男118例,女125例,男女比例为0.94:1;平均年龄(65.16±12.62)岁;好发于头颈部,占77.4%;结节型是最常见的病理类型,占53.9%,其次为浅表型和浸润-硬化型,分别占18.9%和18.5%.女性患者就诊年龄早于男性(P＜0.05).不同组织病理类型BCC的性别构成差异无统计学意义(P＞0.05).浅表型BCC好发于躯干部位,就诊年龄早于非浅表型,女性就诊年龄早于男性,差异均有统计学意义(P＜0.05).结节型、浸润-硬化型及微小结节型BCC好发于头颈部,就诊年龄较晚,男女患者就诊年龄无差异(P＞0.05).结论 不同组织病理类型BCC的临床特征不同,可能存在不同的发病机制.

Abstract：

Objective To analyze the relationship of histopathological subtypes of basal cell carcinoma (BCC) with gender,age and anatomical location of skin lesions.Methods The clinical and histopathological data on 243 cases of BCC collected from Jan 2000 to Apr 2009 were reviewed retrospectively.Data analysis was carried out by using SPSS 13.0 software.Results A total of 243 patients were included in this study,including 118 males and 125 females with the male/female ratio being 0.94:1.The average age of patients was 65.16 ± 12.62 years.Head and neck were the predilection (77.4%) sites of BCC in these patients.Nodular type (53.9%) was the most common type,followed by the superficial type (18.9%) and infiltrative-morphoeic (sclerosing) type (18.5%).The age at visit was younger in female patients than in male patients(P ＜ 0.05),no significant difference was observed in the gender composition among patients with different subtypes of BCC (P ＞ 0.05).Superficial BCC was more common on the trunk; the age at visit was younger in patients with superficial BCC than in those with other subtypes of BCC,and younger in female patients than in male patients (all P ＜ 0.05).Nodular,infiltrative-morphoeic and micronodular subtypes of BCC showed a predilection for the head and neck with an old age at visit,and no differences were observed in the age at visit between female and male patients with these subtypes of BCC (au P ＞ 0.05).Conclusions Different subtypes of BCC show different clinical features,which may be attributed to their different pathogenesis.     

Eczema of the Face,Scalp and Neck: An Epidemiological Comparison by Site

Fifteen percent of 3684 patients with eczema attending a contact clinic presented with head and/or neck eczema. There were epidemiological differences among eczema rashes occurring on different parts of the head and neck. Of the 538 patients with head and/or neck eczema, 345 (64%) occurred solely on the face, 52 (10%) on the eyelids, 49 (9%) on the lips, 20 (4%) on the ears, 22 (4%) on the scalp, and 21 (4%) on the neck. Twenty-nine (5%) had eczema on more than one area of the head/neck. The mean age was lowest in patients with lip eczema (27.5 years) and highest in patients with eyelid eczema (37 years) (p=0.0056). The proportion of females with eczema was higher than males in all groups except the scalp eczema group. Contact dermatitis was more prevalent in the ear eczema (80%) and neck eczema (76%) groups, while endogenous/unclassifiable eczema was more prevalent in the lip eczema (72%) and scalp eczema (73%) groups (p<0.0001). Allergic contact dermatitis was more common than irritant contact dermatitis.     

10例毛母质瘤的皮肤镜特征分析

目的:对毛母质瘤的皮肤镜特征进行总结,为提高毛母质瘤的临床诊断率提供一些线索。方法:收集分析行病理学检查及皮肤镜检查的毛母质瘤患者临床资料。结果:共收集10例毛母质瘤患者,其中男5例,女5例,年龄3～22岁。7例(70%)毛母质瘤位于头面部,2例(20%)位于上肢,1例(10%)位于肩颈部。初步临床诊断包括毛母质瘤、皮肤肿物、瘢痕疙瘩、化脓性肉芽肿、表皮囊肿、传染性软疣、皮脂腺增生、Spitz痣,临床诊断符合率仅为20%。毛母质瘤最常见的皮肤镜特征包括黄白色无结构区(90%)、紫红色均质区域(80%)、不规则分枝状血管(60%)及白色条纹(60%)。结论:毛母质瘤初步诊断误诊率高,皮肤镜常见表现为黄白色无结构区、紫红色均质区域、不规则分枝状血管及白色条纹等。     

Incidence of xeroderma pigmentosum in Larkana, Pakistan: a 7-year study

Xeroderma pigmentosum (XP) is a rare autosomal recessive inherited disorder caused by a defect in the normal repair of DNA of various cutaneous cell types damaged by exposure to ultraviolet radiation. We present our 7-year experience with 36 XP patients who either visited the Department of Dermatology or were seen in the medical camps arranged in remote areas for patients' welfare, from 1995 to 2001. For ease of discussion we classified all cases into the following subgroups on clinical grounds only: mild, those with light brown freckles on the face alone; moderate, those with dark brown freckles with burning on the face, neck, ears, chest, hands and photophobia but without other associated obvious cutaneous and ocular changes; severe, those with extensive dark brown freckles with burning on the exposed parts as well as on the unexposed parts of the body, i.e. the chest, back, abdomen and arms including other associated cutaneous and ocular changes such as ulcers and malignancy. Of 36 patients, three (8.3%) were classified as mild, nine (25%) moderate and 24 (66.7%) severe; there were 18 males and 18 females, age range 2-30 years (mean 8.9 years). Seventeen patients had cutaneous changes: actinic keratosis, keratoacanthoma, fissures and ulcerative nodules on the exposed parts of the body. Four patients had wide ulcers, along with mass formation and severe pigmentation on the face, neck and head. Twenty-nine patients developed ocular symptoms: photophobia, conjunctivitis, corneal keratitis and lid ulcer. One patient had complete loss of vision. Histopathological findings revealed that six patients had squamous cell carcinoma (SCC) on the face, head, ear or lip. More than one sibling (two to four) was affected in four families. The majority of cases (20/36, 55.6%) were from the Brohi tribe (skin type III), while the remaining cases (16/36, 44.4%) were from the Sindhi population (skin type IV). The large number of XP patients seen in those with skin type III (Brohi tribe) compared with skin type IV (Sindhi population) indicates that the skin type and the race has a considerable value in the pathogenesis of XP. Furthermore, 24 of 36 patients were in the severe group and six of these had SCC. Moreover, no neurological abnormalities were observed in our patients. All patients were treated according to disease severity by prescribing oral antibiotics, local steroids, sunscreens and/or chemotherapy followed by irradiation in malignant cases. Two patients died because of extensive SCC.     

A study of the sensitization rate to sesquiterpene lactone mix in Singapore

We report a study of the sensitization rate to sesquiterpene lactone (SL) mix at the National Skin Centre, Singapore. This is a retrospective review of 1256 patients who were patch tested to SL mix (0.1%) from January 1995 to December 1997. 18 out of 1256 patients (1.43%) reacted positively to SL mix. Their ages ranged from 13 to 58 years (average 33.8 years). There were 15 Chinese, 2 Indian and 1 Malay patients. There was a female preponderance, with a female: male ratio of 3.5:1. The most common clinical presentation were dermatitis of the hands (8; 44%), face (5; 28%), and generalized involvement (5; 28%). After extensive evaluation, only 2 patients had a positive patch test reaction that was of current clinical relevance. 13 patients had concomitant sensitization to other allergens. The 3 commonest concomitant allergens were nickel, balsam of Peru and fragrance mix. In our series, SL allergy is observed to be more common in females and the mean age is lower compared to the classical Compositae dermatitis. The sensitization rate is comparable to other studies, although the clinical relevance is only 11%.     

Clinicopathological study of neurofibromatosis type 1: an experience in Nigeria

BACKGROUND: Neurofibromatosis type 1 (NF1) is the commonest single gene autosomal dominant disorder, and its diagnosis is usually composed of a set of clinical criteria. Histological examination of skin lesions is often neglected. This study was designed to evaluate the clinical and pathologic pattern of NF1 among Nigerians and to emphasize the place of histological examination. METHODS: A retrospective case study of 98 clinically diagnosed NF1 patients whose dermal mass lesions (neurofibromas) were excised and processed for histological diagnosis over a period of 22 years (1980-2001) at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. RESULTS: There were 98 patients: 60 males and 38 females (ratio 3 : 2) aged 1-99 (mean +/- S.D. = 3.4 +/- 1.7) years. All patients had neurofibromas, which were benign in 95 patients (96.9%) and malignant in three (3.1%) patients, while 94 (96%) patients had cafe-au-lait spots. Benign neurofibromas were clinically cutaneous [50 (51%)], subcutaneous [37 (37.8%)] and plexiform [8 (8.2%)]. Site distribution of the neurofibromas included the extremities (50%), trunk (20.4%), head and neck (19.4%), and multiple sites (10.2%). Three patients presenting with neurofibosarcomas were aged 4, 23 and 27 years, respectively. Their deaths were responsible for the mortality rate of 3.1% recorded in this study. CONCLUSIONS: In our setting, NF1 is more common among males, with the highest density of neurofibromas covering the extremities.     

Vitiligo in the Nigerian African: a study of 351 patients in Benin City, Nigeria

BACKGROUND: There is a paucity of reports on vitiligo in sub-Saharan Africa. AIM: To define the clinical and epidemiologic pattern of vitiligo in the Nigerian African. METHODS: We examined all new cases of vitiligo seen in the Dermatology Unit of the University of Benin Teaching Hospital (UBTH) over a 14-year period: January 1985 to December 1998. RESULTS: Three hundred and fifty-one patients with vitiligo, representing 3.2% of new dermatologic cases, were enrolled. The study group was made up of 153 males and 198 females, giving a sex ratio of 1 : 1.3. The peak incidence of vitiligo was in the second and third decades of life, and the most common form of presentation was the localized focal type (77%), followed by the segmental type (12.5%) and the generalized form (10.5%). Common sites affected were the limbs (32%), trunk (23.8%), face (18.2%), head and neck (9.1%), and the mucous membranes (7.4%). There was a positive family history of vitiligo in 18% of subjects and 3.4% had systemic diseases, such as diabetes mellitus (1.7%), anemia (0.8%), hyperthyroidism (0.6%), and leukemia (0.3%). CONCLUSIONS: Vitiligo on darkly pigmented skin is often a very striking disease. Our findings show that the pattern of vitiligo is similar to that reported from other parts of the world. The high level of social stigmatization is due to confusion with leprosy.     

Basal cell carcinoma in Turkey

Basal cell carcinoma (BCC) is the most common form of cancer in Caucasians. This study was undertaken to define clinical features of BCC treated by surgical excision in Turkish patients. One-hundred and ninety-eight patients with 216 BCC, all treated by surgical excision, were studied prospectively. Age and sex distribution, personal and family history, skin type, site and size of the lesions, clinical type of the lesions, status of surgical margins and incidence of recurrence were analyzed. The male to female ratio was 9:10, and the average age of the patients was 64.5 years. Of the tumors, 91.5% occurred on the head and neck. There was also personal and/or family history of cancer in 24.8% of our cases. Of all BCC treated, 83.8% had a noduloulcerative clinical appearance. The vast majority of our patients were Fitzpatrick type 3 (53.0%) and type 2 (41.5%). There were seven recurrences after follow-up periods varying between 3 months and 2 years. In conclusion, clinical characteristics of BCC in Turkish patients have both similarities and differences compared with other countries.     

上海某社区雄激素源性秃发患病率调查

目的 了解上海地区雄激素源性秃发（AGA）的患病率、脱发类型。方法 采用整群抽样的方法。按照统一制定的表格,对上海市长宁区北新泾社区居民进行问卷调查,并由皮肤科医生进行诊断确认,对雄激素源性秃发患者采用Norwood-Hamilton和Ludwig标准分级。所有数据录入EpiData数据库,运用SPSS11.5软件进行统计学分析。结果 本次调查回收有效问卷7056份（男3519份,女3537份）,应答率72.5%。确诊AGA患者809例,其中男701例,平均年龄（64.16 ± 11.98）岁,年龄范围19 ～ 91岁,女108例,平均年龄（70.46 ± 18.89）岁,年龄范围35 ～ 91岁。总标化患病率为9.47%,男性和女性标化患病率分别为15.73%和2.73%,两者间差异有统计学意义（χ2 = 356.00,P < 0.001）。52.7%的患者有AGA家族史,其中男为55.78%,女为32.41%。男性AGA患者70岁以上年龄脱发类型以Ⅵ级最多,而20 ～ 70岁年龄脱发类型以Ⅲv级最多。女性AGA脱发类型以Ⅰ级和Ⅱ级最多。结论 上海地区男性雄激素源性秃发患病率显著高于女性,男性和女性雄激素源性秃发的患病率随年龄增长而增加。     

Clinical efficacy of a 308 nm excimer laser in the treatment of vitiligo

Objective: To investigate the clinical efficacy and safety of the treatment of vitiligo using a 308 nm excimer laser. Method: Thirty‐six patients with 44 vitiligo patches were treated using a 308 nm excimer laser, which was performed twice a week, for a total of 30 treatments. The therapeutic efficacy and safety were then evaluated. Results: After 30 treatments:
(1) 27/44 patches (61.4%) achieved more than 75% repigmentation, 4/44 lesions (9.1%) showed 51–75% repigmentation, 10/44 (22.7%) showed 26–50% repigmentation and 3/44 (6.8%) showed 1–25% repigmentation.
(2) Of the 44 patches of vitiligo, 20/27 (74.1%) lesions on the face/neck, 9/9 (100%) on the trunk and 2/8 (25.0%) on the extremities showed ≥50% repigmentation. The repigmentation (≥50%) in face/neck and trunk were much higher than that in the extremities (P<0.05).
(3) The repigmentation (≥50%) in disease duration of ≤2 years and >2 years were 100.0% and 46.2% (P<0.05).
(4) The average cumulative doses in the face/neck, trunk and extremities were 7.92±5.26, 9.93±7.36 and 22.13±8.15 J/cm². The doses in the face/neck and trunk were much lower than those in the extremities. (P<0.05). Side effects were limited mainly to symptomatic erythema. Conclusion: The clinical data indicate that the treatment of vitiligo using a 308 nm excimer laser is safe and effective. However, lesion location and disease duration may be the key factors affecting the clinical outcome.     

Microbiology of infected poison ivy dermatitis

We report the aerobic and anaerobic microbiology of secondarily infected poison ivy dermatitis. The study involved retrospective review of clinical and microbiology laboratory records of patients with secondarily infected poison ivy lesions. Bacterial growth was noted in 33 specimens. Aerobic or facultative anaerobic bacteria only were present in 18 (55%) patients, anaerobic bacteria only in seven (21%), and mixed anaerobic-aerobic bacteria in eight (24%). Forty-five isolates were recovered (1.4 per specimen): 27 aerobic or facultative anaerobic bacteria, and 18 strict anaerobes. The predominant aerobic and facultative anaerobic bacteria were Staphylococcus aureus (13 isolates) and group A beta-haemolytic streptococci (six). The predominant anaerobes were Peptostreptococcus spp. (seven isolates), pigmented Prevotella and Porphyromonas spp. (four) and Fusobacterium spp. (two). Single bacterial isolates were recovered in 18 (55%) patients, eight of which were S. aureus. Nineteen of the organisms isolated from 16 (48%) patients produced the enzyme beta-lactamase. Organisms that resided in the mucous membranes close to the lesions predominated in those infections. Enteric gram-negative rods and Bacteroides fragilis group predominated in leg and buttock lesions. Group A beta-haemolytic streptococci, pigmented Prevotella and Porphyromonas and Fusobacterium spp. were most frequently recovered from lesions of the finger, face and neck. The polymicrobial aetiology of secondarily infected poison ivy lesions, and the association of bacterial flora with the anatomical site of the lesions, are demonstrated.     

Rothmund-Thomson综合征2例及家系调查

报告2例Rothmund Thomson综合征病例,为表兄弟,分别3岁5个月和2岁8个月。他们的母亲是姐妹关系。2个病例都是在出生后的3-4个月时发病,主要表现为面部的皮肤异色症及身材稍矮小,智力和发育仍属正常。包括两病例在内,整个家系中在2-5代共有10人发病,全是男性患者。本家系的遗传方式与通常认为的常染色体遗传方式不符,而与性连锁隐性遗传较为吻合,该综合征是否也存在着多种遗传方式值得进一步探讨。     

大疱性表皮坏死松解型药疹23例临床分析

目的：探讨大疱性表皮坏死松解型药疹的临床特征及治疗效果以指导今后临床。方法：对23例大疱性表皮坏死松解型药疹的临床资料进行了回顾性分析。结果：23例中男13例，女10例，年龄1月～66岁。致病药物以解热镇痛药，抗癫痫药，磺胺药为主。皮损累及全身者18例(78．3％)，所有患者均有粘膜损害。经糖皮质激素，局部护理及抗感染支持治疗后，治愈21例(91．3％)，死亡2例。结论：大疱性表皮坏死松解型药疹皮损范围广泛，粘膜损害严重，早期足量糖皮质激素和局部护理是治疗成功的关键因素。     

Clinical analyses of atopic dermatitis in the aged

The aim of the present study was to analyze the characteristics of atopic dermatitis (AD) in the senile phase. Subjects were comprised of 16 patients investigated for clinical features, serum immunoglobulin (Ig)E levels and skin manifestations. Mean age was 76.9 +/- 6.2 years (range, 68-87), with a man : woman ratio of 3:1. Mean age at onset was 67.7 +/- 15.7 years. Eight patients (50%) had personal histories of chronic eczema until the young adult phase and three patients (18.8%) showed the classic course of child AD. Eczematous erythroderma in 10 patients (62.5%) and unclassified chronic eczema in five patients (31.3%) were the predominant clinical presentations. Mean total IgE level in sera of the 16 patients was 8810 +/- 13 511 IU/mL (range, 5-53 605). Fourteen patients showed positive results for antigen-specific IgE antibodies, and the mean total IgE level for these patients was 10 056 +/- 14 044 IU/mL. Specific IgE to the main antigen, Dermatophagoides farinae, was observed in 12 patients (85.7%), representing the principal antibody in eight patients (57.1%). Eczematous dermatitis manifested predominantly in the face and neck, trunk and extensor and flexure sites of extremities, and less commonly in the antecubital and popliteal areas. Other stigmata of AD were observed as follows: red face in 10 patients (62.5%); Hertoghe's sign in six (37.5%); goose-skin in four (25%); facial pallor in three (18.8%); and dirty neck in one (6.3%). These results indicate that senile-type AD represents a characteristic subgroup of AD that appears in the last stage of life in AD patients.     

Basal cell carcinoma: histological classification and body-site distribution

BACKGROUND: Basal cell carcinoma (BCC) is the most common cancer worldwide in white-skinned populations. Recent studies suggest that BCC is not a single entity and that different histological subtypes show different clinical behaviour and might have different aetiology. OBJECTIVES: To provide information on the incidence of BCC by histopathological subtype and body site. METHODS: A case series of BCC from a prospective population-based register study collecting information on all excised and histologically confirmed skin cancers in Townsville, north Australia between 1997 and 1999. RESULTS: Age-standardized incidence rates for nodular BCC were 727.1 per 100 000 inhabitants per year for males and 411.8 for females, while rates for superficial BCC were 336.5 for males and 251.4 for females. Incidence rates for 'high risk' BCC were 261.3 for males, 146.5 for females with infiltrative, and 156.7 for males and 100.2 for females with micronodular types. Superficial BCC occurred at a younger age, particularly in female patients. For all histological subtypes and both genders relative tumour density was highest for the face, followed by the neck. An exception was superficial BCC in males, where the posterior trunk was second, followed by the neck. CONCLUSIONS: The study found a higher rate of superficial BCC than previous studies from less sun-exposed countries, and a more equal distribution of superficial BCC on face, trunk and limbs. These results seem to blur the difference between intermittent and continuous sun exposure as the causative environmental agents. The clinical implications of 'high risk' BCC rates are discussed.     

Clinical study on psoriasis patients for past 30 years (1982–2012) in Seoul National University Hospital Psoriasis Clinic

Psoriasis is a chronic relapsing disorder which shows variable clinical features. The long‐term clinical study with many patients is important to elucidate the epidemiologic characteristics and clinical features of psoriasis. The purpose of this study was to analyze the epidemiologic characteristics and clinical features of psoriasis in Korean patients. Epidemiologic and clinic data and assessments for severity of extent and activity of psoriasis were collected from the medical records of 5084 patients, who had been newly diagnosed with psoriasis in the Psoriasis Clinic of Seoul National University Hospital between 1982 and 2012. The sex ratio of the psoriasis patients was 1.2:1 (male 54.6%, female 45.4%). The peak age of onset in males was 20s, while it was the teenage years in females. A total of 63.5% of patients developed psoriasis before 30 years of age. Family history of psoriasis was observed in 26.0% of patients. Moderate to severe extent of involvement were more frequently observed in male patients and patients under 30 years of onset age than in females and patients 30 years or over of onset age, respectively. Moderate to severe disease activity were also more frequently presented in male patients, but not in patients under 30 years of onset age. The most common morphological type was nummular (56.7%), followed by large plaque (28.5%) and guttate (8.5%). Nail involvement accompanied in 26.4% of patients. We demonstrated the epidemiologic and clinical characteristics of psoriasis in Korean patients.