International Journal of Dermatology

Background Bacterial infections occur frequently on the skin of atopic dermatitis (AD) patients. The objectives of this study were to evaluate the microbiology of the skin of AD patients for staphylococci, the frequency and density of each species, and their susceptibility to antimicrobial drugs.

Methods To study the staphylococci present on the skin of 21 AD outpatients and of 12 healthy subjects (HS), cutaneous organisms were obtained using the contact‐plate method.

Results Staphylococcus aureus was isolated in 85.7% of AD patients (mild type, 77.8%; moderate type, 87.8%; and severe type, 100%) and in 25% of HS, while Staphylococcus epidermidis was isolated in 83.3% of HS and in 38.1% of AD patients. Among the coagulase‐negative staphylococci (CNS) identified, S. epidermidis was the common type and several other CNS were detected in both AD patients and HS. As the eruption grade of dermatitic skin became more severe, the average density of S. aureus increased (severe, 2.68 ± 0.86; moderate, 2.49 ± 0.48; mild, 2.28 ± 0.44). A reversed tendency was seen in S. epidermidis (severe, 1.80; moderate, 1.90; mild, 2.10). Among nine antimicrobial drugs tested against S. aureus, S. epidermidis, and some other types of CNS isolates, vancomycin (VCM) and minocycline (MINO) were the most active, gentamycin (GM) was the less active, and ampicillin (ABPC) was the least active.

Conclusions The skin of AD patients was more frequently colonized with S. aureus than that of normal controls. As the severity of the AD lesions increased, the numbers of S. aureus isolated increased. The skin of HS was more colonized with S. epidermidis. Other species of CNS were isolated from several cases of AD patients and HS. In addition, S. aureus, S. epidermidis, and the other CNS showed poor susceptibility to some of the tested antimicrobial drugs.

Background. Phenytoin, introduced in 1937 as an antiseizure medication, has since been reported to promote wound healing when applied as a topical agent. This study was undertaken to evaluate its effectiveness in chronic skin ulcers.

Methods. Seventy‐five inpatients with chronic skin ulcers were included in this controlled trial. Forty patients were treated with topical phenytoin, and 35 patients with conventional saline dressings. Assessment of the wounds included wound area, bacteriologic cultures, and clinical assessment by blind observers at baseline and every 7 days thereafter over the 4‐week treatment period.

Results. Wound area reduction was greater in the phenytoin group than in controls. Fifty percent of phenytoin‐treated wounds had negative cultures by day 7, compared to 17% of controls. Healthy granulation tissue appeared earlier with phenytoin. At the end of the fourth week, 29 of 40 phenytoin‐treated ulcers had healed completely versus 10 of 35 controls.

Conclusions. Topical phenytoin appears to be an effective, inexpensive, and widely available therapeutic agent In wound healing. Further clinical use and evaluation is merited.

Background. Trophic ulceration, one of the most common complications of leprosy, is disabling, distressing, and demoralizing for the patient.

Methods. The wound healing effects of topical phenytoin powder were compared with those of normal saline in a controlled in‐patient study of 100 patients with 110 trophic leprosy ulcers of varying chronicity, over a 4‐week study period. Fifty patients were assigned to the topical phenytoin group and 50 to saline therapy group. Ten patients had two ulcers each, and, in these cases, one ulcer was treated with phenytoin and the other with saline.

Results. Over the 4‐week treatment period healthy granulation tissue appeared earlier, and mean percentage of ulcer volume reduction was greater, in the phenytoin group (72.1 ± 19.9% versus 55.5 ± 21.6%) compared with the control group.

Conclusions. This difference was statistically significant at the level of P < 0.001. Phenytoin appears to be a useful agent for the promotion of healing of trophic leprosy ulcers.

Background and objective In recent years, many reports have suggested an active role of neuropeptides in the pathogenesis of psoriasis. Increased numbers of neuropeptide‐containing nerves positive for substance P (SP), vasoactive intestinal polypeptide (VIP), and calcium gene‐related peptide (CGRP) have been reported in psoriatic tissue. As psoriatic epidermis has a larger mass/volume, however, it is expected to have more nerves and a higher number of neuropeptergic fibers. Therefore, instead of demonstrating a larger number of neuropeptergic fibers, a more significant study is to investigate whether the neuropeptergic fibers are denser in psoriatic tissue. In this study, we applied a double labeled immunofluorescence technique. This method allows the identification of the total number of nerve fibers and the number of nerves positive for specific neuropeptides.

Materials and methods We obtained biopsies from nine lesional and seven non‐lesional psoriatic skins and six normal controls. Biopsies were snap frozen and then cut into 14 μm cryosections. The tissues were first treated with anti‐microtubule associated protein (MAP)2 antibody to stain the nerves. This was followed by a second set of stainings for SP, VIP, and CGRP. Primary antibodies were used in dilutions of 1 : 200 for anti‐MAP2, 1 : 200 for anti‐SP, 1 : 800 for anti‐VIP, and 1 : 400 for anti‐CGRP.

Results We found that the percentage of SP‐positive fibers was twofold greater and the percentage of CGRP‐positive fibers was 2.5 times greater in the psoriatic epidermis than in the epidermis of normal skin. Psoriatic epidermis had 30.1 ± 3.9% SP‐positive nerve fibers compared with 15.7 ± 3.7% in the normal control. The corresponding values for CGRP‐positive nerve fibers were 30.1 ± 3.9% and 12.0 ± 4.2%.

Conclusions The results of our study suggest that SP‐ and CGRP‐containing neuropeptide nerve fibers are more dense in the psoriatic epidermis. Both SP and CGRP are chemotactic to neutrophils and mitogenic to keratinocytes and endothelial cells. In addition, SP activates T lymphocytes and induces adhesion molecules on the endothelial cells. Our observations suggest that neuropeptides may play a significant role in the inflammatory and proliferative process of psoriasis.

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).^3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.⁴¹ There is a paucity of evidence‐based guidelines to assist with appropriate follow‐up for patients with BXO.

Abstract

Background  In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably.

Aim  To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer.

Methods  Four hundred and ninety‐three patients were seen by one of two dermatologists over a 1‐year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery.

Results  The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty‐eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%.

Conclusions  In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.

Background. Behçet's disease is a chronic, relapsing disease, about which information on its clinical course in juveniles is only available from small groups of patients.

Materials and Methods. Patients suffering from Behçet's disease who had their first lesion at or before the age of 16 were evaluated in terms of: age at onset, mucocutaneous signs, and findings related to systemic involvement. Ninety‐five patients, evaluated as having juvenile Behçet's disease (JBD), were detected among 1784 Turkish Behçet's patients. The mean age of these 95 patients (51 boys or men, 44 girls or women) who had JBD was 26.8 ± 7.1 years.

Results. The difference between sexes in terms of age at onset, development period of second lesions, and systemic involvement was not found to be significant in JBD. Patients were divided into two groups, one showing severe disease (N = 27) and the other mild disease (N = 68). There was no significant difference between the two groups with respect to age, age at onset, and sex distribution. The interval between the development of the first and second lesions was shorter in the patient group with severe disease (P < 0.001) and the development of second lesion was most frequently seen in the first 5 years (P < 0.05). Systemic involvement developed also in a shorter time in the group with the severe disease (P < 0.01) and was most frequently encountered during the first 5 years (P < 0.05). Conversely, patients with the mild disease developed systemic involvement more frequently after 6 years or later.

Conclusions. Severe Behçet's disease in children and juveniles shows no age or sex predilection, but leads to an earlier recurrence and more severe systemic signs than the mild form.