Long-term follow-up study of clear cell papulosis.

BACKGROUND: Clear cell papulosis (CCP) was described as a new entity in 1987. Since then, only case reports or small case series have appeared in the literature and the long-term outcome of CCP remains unknown. OBJECTIVES: The aim of this study was to review cases of CCP diagnosed at our institution and to investigate their outcome. METHODS: Nineteen patients given a diagnosis of CCP more than 6 years previously were identified. Their medical records and histopathologic findings were reviewed. RESULTS: With a median follow-up duration of 11.5 years, regression of skin lesions was observed in 85.7% of patients. Persistence of skin lesions 11.5 years after diagnosis was confirmed histopathologically in one case, with a reduction in clear cell density. LIMITATIONS: Retrospective nature of the study is a limitation. CONCLUSION: No treatment is necessary for CCP because the skin lesions are asymptomatic and most patients experience at least partial regression.

Telomerase expression in benign and malignant skin neoplasms: comparison of three major subunits.

Telomerase is a specialized ribonucleoprotein polymerase that plays an important role in maintaining cellular immortality. The multifactorial activation of telomerase, a critical step in human carcinogenesis, is not fully understood. Many studies have shown increased telomerase activity in various skin cancers. To study the regulation of telomerase in cutaneous malignancy, we used the reverse transcription polymerase chain reaction (RT-PCR) with specific primers to analyze the mRNA expression of three major telomerase subunits: human telomerase RNA (hTR), telomerase-associated protein (TP1) and human telomerase reverse transcriptase (hTERT). Clinical skin specimens were taken from 62 Taiwanese patients with a variety of skin diseases, including five from normal skin, 27 from benign tumors, 17 from malignant tumors, six from premalignant tumors, and seven from inflammatory skin diseases. TP1 was detected in 61 of 62 specimens (98.4%) and hTR was found in 58 specimens (93.6%). hTERT was more often found in specimens from malignant and premalignant tumors (73.9%, 17/23) compared to those from benign tumors (7.4%, 2/27; p < 0.0001). None of the normal skin specimens showed hTERT expression. These results indicate that expression of hTERT, but not TP1 and hTR, is highly associated with cutaneous malignancy.

Breast carcinoma in patients with dermatomyositis: a retrospective analysis of eight cases.

BACKGROUND: The association between dermatomyositis and breast carcinoma has not been fully evaluated yet. The aim of the study was to clarify characteristics of the association between these two diseases. METHODS: The medical records of 128 patients with dermatomyositis or polymyositis from 1990 to 1998 were retrospectively reviewed. Eight patients (6.3%) were identified with dermatomyositis which was associated with an underlying breast carcinoma. Clinical features, laboratory data, electromyograms, muscle biopsies, and the prognoses of these patients were assessed. RESULTS: The mean age of the 8 patients with breast carcinoma and dermatomyositis (62.1 +/- 6.7 years) was larger than that of patients with breast carcinoma without dermatomyositis (48.5 +/- 11.8 years). Dermatomyositis preceded breast carcinoma in 2 patients, was concurrent with breast carcinoma in 5 patients, and followed breast carcinoma in 1 patient. Of these 8 patients, 4 had TNM classification stage IV (M1) breast cancer, 1 had IIIA (T2N2M0) breast cancer, and 3 had IIB (T2N1M0) breast cancer. The follow-up period ranged from 2 to 79 (median, 21) months. Five patients died of recurrence or distant metastasis, and the remaining 3 patients had disease-free survival, with a follow-up period ranging from 11 to 28 (median, 20) months. Four of 5 patients had parallel improvement in dermatomyositis after surgical treatment of breast carcinoma. CONCLUSION: In Taiwan, dermatomyositis is associated with an increased incidence of breast carcinoma. The mean age of the 8 patients with breast carcinoma and dermatomyositis was significantly larger than that of patients with breast carcinoma without dermatomyositis. If present, breast carcinoma can precede, occur concurrently with, or follow the diagnosis of dermatomyositis. Surgical treatment of breast carcinoma may alleviate the course of dermatomyositis and eliminate the need for steroids in some cases.

The distribution of follicular units in the Chinese scalp: implications for reconstruction of natural-appearing hairlines in Orientals.

BACKGROUND: Follicular transplantation using hair in its naturally occurring groups, called follicular units (FUs), has become the most popular technique in hair restoration surgery. Recently follicular transplantation was performed with a qualitative and quantitative concept to achieve the best clinical result. The characteristics and distribution of FUs are well studied in Caucasians and widely applied in hair transplantation surgery. OBJECTIVE: In order to understand the normal distribution of FUs in the Chinese scalp, we counted the number of hairs and FUs in normal Chinese scalp to provide general information for surgical planning and design in bald Chinese patients. METHODS: A total of 50 normal and 50 bald Chinese adults were enrolled to count the hairs on their scalp. One hundred bald patients receiving hairline reconstruction were also prospectively quantitatively evaluated. RESULTS: In normal Chinese scalp, an average 71.78 FUs/cm(2) and 137.08 hairs/cm(2) were calculated with a follicular density of 1.91 hairs/FU. Two-hair FUs are the predominate group (50.29%). In bald patients, an average of 68.07 FUs/cm(2) was found, which was less than that of the occipital scalp in normal nonbald patients. In reconstruction of the frontal hairline, a total of 700-1000 FUs were implanted with an average density of 30 FUs/cm(2). CONCLUSION: We found the average number of FUs (0.72 FU/mm(2)) was less than that in Caucasian patients (1 FU/mm(2)). The average density of 30 FUs/cm(2) implanted was suitable to reconstruct a natural frontal hairline in bald Chinese patients, which can achieve about 40% of normal hair density. Our results could provide the hair surgeon with general information about hair distribution on the Chinese scalp for surgical planning and design in their patients.

Superficial mycosis superimposing on isolated lichen planus of the lip: a case report and review of the literature.

We report a case of superficial mycosis superimposing on isolated lichen planus (LP) of the lower lip that was successfully treated. A 36-year-old woman had 2 ulcerated, scaling, erythematous plaques on the lower lip for several months with mild painful sensation. Results of histologic study showed typical features of LP, but fungal hyphae were found in the horny layer. The lesion healed with only very mild residual erythema after 6 weeks of treatment. A review of the literature shows only one noted case of tinea of the lip, which was reported in 1968 by a dental practitioner, and only several cases of isolated LP of the lip. The possible mechanism of coexistence of tinea and LP of the lip is reviewed.

Clinicopathologic features of skin reactions to temporary tattoos and analysis of possible causes.

BACKGROUND: Recently, temporary paint-on tattoos have become increasingly popular as a safe alternative to permanent tattoos in Asia and other regions. The most common dye for such temporary tattoos is henna, a vegetable dye. Henna is considered to possess low allergenicity because the incidence of allergic contact dermatitis to henna has rarely been reported. However, recently, allergic reactions to henna used in temporary tattoos have been reported frequently. OBSERVATIONS: Ten patients developed inflamed skin eruptions after receiving temporary paint-on tattoos in either Thailand or Indonesia. The 6 patients who were patch tested all exhibited moderate to strong positive reactions to p-phenylenediamine (1% in petrolatum). Four of the 6 patients were then tested with commercial black henna obtained from Thailand, and all 4 had strong positive reactions. A skin biopsy specimen showed lichenoid dermatitis. Mass spectrometry analysis of commercial black henna for molecular weight revealed a major peak at the mass-charge ratio of 108.1, which corresponds to the molecular weight of p-phenylenediamine. CONCLUSIONS: The most likely causative agent for the lichenoid reaction associated with use of commercial black henna for temporary tattooing, currently popular in Southeast Asia, is p-phenylenediamine. With the increased popularity of temporary paint-on tattoos, clinicians should be aware of the possible associated complications.

Skin necrosis following a recombinant interferon-beta-1b injection.

Recombinant interferon beta-1b (INF-beta-1b) has been proven to be an effective means of treating relapsing-remitting multiple sclerosis (MS). Adverse reactions to interferon therapy have been well documented. The most common side effects are transient influenza-like symptoms, including fever, fatigue, nausea, and myalgia. Cutaneous necrosis has occasionally been reported, mostly involving small and limited lesions. This article describes an MS patient who developed multiple large, deep cutaneous ulcers on INF-beta-1b injection sites, which subsequently required surgical treatment. Vessel thrombosis in the subcutaneous fatty layer and the clinical appearance of livedoid erythema beside the ulcers indicated that INF-3-1b may have caused skin necrosis through its vascular effects.