Neutrophil dermatosis of the dorsal hands.

Neutrophil dermatosis of the dorsal hands (NDDH) is a recently described skin manifestation regarded as a subset of acute febrile neutrophilic dermatotis (Sweet syndrome). We describe 5 cases with pustular and ulcerative plaques and/or bullae and vesicles of the dorsal hands. Three of the patients also had skin changes at sides other than the hands. Associated conditions were found in two patients, one patient treated with hemo-dialysis for chronic glomerulonephritis, and one patient had suffered from a streptococcal tonsillitis prior to the eruption. Two of the patients had fever, two had neutrophil leucocytosis in peripheral blood and two had elevated sedimentation rates. Histological findings showed signs of vasculitis in biopsies from two of the patients. NDDH is discussed on the basis of prior case reports concerning the subject, and it is concluded that Neutrophil dermatosis of the dorsal hands should be regarded as a localized variety of Sweet syndrome.

Treatment of Bowen's disease of the penis with imiquimod 5% cream.

We present a case of persistent and progressive Bowen's disease (squamous cell carcinoma in situ) of the penis, in an otherwise healthy 56-year-old man. Treatment with imiquimod 5% cream was effective when applied once a day for 3 consecutive days followed by 4 days without treatment, over a period of 5 weeks.

Erythrokeratolysis hiemalis (keratolytic winter erythema): a case report from Denmark.

Erythrokeratolysis hiemalis is described as a rare autosomal dominant genodermatosis as first reported from the Oudtshoorn district of Cape Provence in South Africa, among European immigrant families. Sporadic cases have since been identified in other countries, often with a familial link to the Oudtshoorn cluster. We describe the first case observed in Denmark, presumably the result of a spontaneous mutation.

Structural asymmetry as a dermatoscopic indicator of malignant melanoma--a latent class analysis of sensitivity and classification errors.

Asymmetry of pigmented skin lesions is an important indicator of possible malignant melanoma and contributes substantially to the diagnosis of melanoma in the dermatoscopic ABCD rule for melanocytic lesions and other algorithms. However, it may be observer dependent. Dermatoscopic asymmetry cannot be assessed objectively and no golden standard of asymmetry diagnosis exists. The aim of this study was to assess the sensitivity of axis (a-) symmetry using latent class analysis. We analysed ratings from four experts in dermatoscopy of 232 pigmented lesions by latent class analysis (LCA). Possible ratings were 'no asymmetry', 'asymmetry in one axis' and 'asymmetry in two axes'. A subset of melanocytic lesions (blue naevi excluded) was analysed. Based on LCA, the asymmetry of the singular lesion was determined. The sensitivity of 'no asymmetry' was 40-77%, 40-70% for one-axis asymmetry, and 77-92% for two-axes asymmetry. Overestimation of asymmetry was more common than underestimation. Melanomas were significantly more asymmetric than pigmented naevi, atypical naevi and papillomas, but not basal cell cancers. Analysis of the melanocytic subset gave similar results. The median asymmetry of malignant melanomas (1.67, interquartile range 1.81-1.99) was higher than for melanocytic naevi. In conclusion, asymmetry and symmetry are important criteria for diagnosing or excluding malignant melanoma using the dermatoscopic ABCD rule, risk stratification and other diagnostic rules. Using LCA, we minimized observer dependence in the assessment of axis (a-) symmetry. LCA, besides conceptualizing the diagnostic process, enables the assignment of lesions to their true diagnostic class.

Dermatoscopic prediction of melanoma thickness using latent trait analysis and likelihood ratios.

Breslow thickness and Clark level can be used to determine surgical procedures for cutaneous malignant melanoma and patient eligibility for experimental adjuvant therapy. Efforts to predict the thickness of melanomas using dermatoscopy have focused on differences between single dermatoscopic findings. The aim of this study was to develop a method for preoperative identification of melanomas of > or = 1 mm Breslow thickness using the entire range of dermatoscopic findings. Sixty-five melanomas were assessed for the presence of 22 dermatoscopic features. Ten dermatoscopic features showed differences in thick and thin melanomas and were selected for further analysis. A latent trait analysis construct implied that a progression in dermatoscopic features was associated with advancement of melanomas. Early melanomas are characterized by a light brown colour, a pigment network and irregularity or heterogeneity. Gray-blue areas, white scar-like areas and an atypical vascular pattern gradually displace these features. Likelihood ratios were determined for these 6 dermatoscopic findings and an algorithm for calculating the probability of thick malignant melanoma was established.

[Skin diseases among refugees and immigrants. Four exotic case reports]. / Hudsygdomme hos flygtninge og indvandrere. Fire eksotiske eksempler.

The influx of immigrants from outside the Western world, has led to a wider spectrum of dermatological diseases seen by doctors in Denmark. We present four case histories, in which the disease was brought to Denmark from the patient's land of origin. Tropical diseases may present as a skin disease as such, or a generalised disease with skin manifestations, the commonest signs being ulcers, papules, exanthema, changes in pigmentation, and itching.

Early myotome specification regulates PDGFA expression and axial skeleton development.

Reciprocal defects in signaling between the myotome and the sclerotome compartments of the somites in PDGFRalpha and Myf5 mutant embryos lead to alterations in the formation of the vertebrae and the ribs. To investigate the significance of these observations, we have examined the role of PDGF signaling in the developing somite. PDGFA ligand expression was not detected in the myotome of Myf5 null mutant embryos and PDGFA promoter activity was regulated by Myf5 in vitro. PDGFA stimulated chondrogenesis in somite micromass cultures as well as in embryos when PDGFA was knocked into the Myf5 locus, resulting in increased vertebral and rib development. PDGFA expression in the myotome was fully restored in embryos in which MyoD has been introduced at the Myf5 locus but to a lesser extent in similar myogenin knock-in embryos. These results underscore the importance of growth factor signaling within the developing somite and suggest an important role for myogenic determination factors in orchestrating normal development of the axial skeleton.

[Sunbathing habits and risk of melanoma]. / Solvaner og melanomrisiko.

The increasing frequency of malignant melanoma (MM) is believed mainly to be due to the habit of sunbathing, which has an impact on the skin due to ultraviolet radiation, especially if intermittent and causing sunburn. Frequent use of tanning booths possibly increases the risk of MM but the question has not been settled. Use of sunscreens has a certain prophylactic effect on actinic keratoses, but no documented effect on MM. This does not imply that sunscreens are not advisable, but stresses the importance of correct use of sunscreens together with other sun protective measures. Primary prevention of MM is mainly a question of minimizing the impact of ultraviolet radiation (including tanning booths) on the skin: limit time in the sun, cover up with clothing, and use a sunscreen with a protection factor of at least 15.

[Dermatoscopic diagnosis of cutaneous malignant melanoma. Secondary prophylaxis]. / Dermatoskopisk diagnostik af kutant malignt melanom. Sekundaer profylakse.

During the last four decades the incidence of malignant melanoma has increased seven fold. Clinically, it is often difficult to distinguish malignant melanoma from a benign naevus. The macroscopic clinical ABCD rule and the Glasgow 7-point checklist are didactically helpful, but inaccurate with many false positive and negative diagnoses. Dermatoscopy performed by a trained physician has increased the diagnostic accuracy to a sensitivity of 89% and specificity of 80% (meta-analysis of 11 studies). The dermatoscopic ABCD rule and the Risk Stratification method (RS) are reviewed.

Comparison of dermatoscopic ABCD rule and risk stratification in the diagnosis of malignant melanoma.

For didactic and documentation purposes the dermatoscopic ABCD rule and the dermatoscopic risk stratification have been proposed. The aim of this investigation was to compare the ability of the 2 methods to separate patients with cutaneous malignant melanoma from individuals with other pigmented skin lesions. Three dermatologists, experienced users of dermatoscopy, assessed macroscopic clinical and dermatoscopic slides from 258 patients referred to the skin cancer outpatient clinic by the ABCD rule and risk stratification methods. Diagnostic performance of the 2 methods was compared by receiver operating characteristics curve analysis. When all pigmented skin lesions were compared, there was a trend for the observers to perform better using risk stratification. When only lesions with a well-defined pigment network were included, the diagnostic performance of the risk stratification method was superior to the dermatoscopic ABCD rule (areas under the receiver operating characteristics curve median 0.93 vs. 0.80, p<0.004) for all observers. The agreement between the 2 methods was moderate to substantial (kappa coefficient 0.53-0.62). More melanomas were identified when the rules were combined. The dermatoscopic ABCD rule has been accepted as a standard for identifying melanomas with the dermatoscope, but should be considered secondary to pigment network analysis.

Incidence and prognostic significance of skin disease in patients with HIV/AIDS: a 5-year observational study.

Mucocutaneous diseases are common in HIV-infected patients. The aim of the present study was to determine the observed frequency of skin diseases and their prognostic significance for the progression of HIV infection. In a cohort of 150 HIV-infected patients diagnosed from 1986 to 1987 the number of mucocutaneous diseases, the CD4+ cell count, time to development of AIDS and survival time were registered for a period of 5 years. Eight patients were lost for follow-up. In the remaining 142 patients the number of mucocutaneous findings increased markedly during the observation period. The most frequent registered diseases and these with the highest increase were oral candidiasis, hairy leukoplakia, seborrhoeic dermatitis and herpes simplex. On average, 5.2 different diagnoses were registered per patient at the end of the follow-up period. The study showed that the total number of mucocutaneous diseases and the CD4+ cell count were significantly correlated to survival time and time to development of AIDS. The number of mucocutaneous diseases, like the CD4+ count, is an indicator of the immune system and the prognosis of HIV infection.

[Skin disorders as markers of internal disease. Paraneoplastic dermatoses]. / Hudsymptomer som markører for intern lidelse. Paraneoplastiske dermatoser.

Paraneoplastic dermatoses are markers of internal malignancy characterised by being relatively uncommon, associated with certain forms of cancer and occurring in connection with the cancer either before, during, or after the diagnosis has been made. Furthermore, the skin symptoms typically run a parallel course with the cancer. Most paraneoplastic dermatoses disappear when the primary tumour is removed and reappear in the case of recurrence or metastases of the cancer. Adult dermatomyositis is especially associated with breast and lung cancer. Necrolytic migratory erythema is seen in patients with a glucagon-producing tumour in the pancreas. Bazex's syndrome is associated with cancer in the upper respiratory and digestive tracts. Erythema gyratum repens is an annular erythema associated with lung, breast, stomach and oesophageal cancer. Acquired hypertrichosis lanuginosa, which is extremely rare, is a specific marker of internal malignancy, especially lung and colon cancer. Acanthosis nigricans and Leser-Trélat's sign are cutaneous markers of stomach cancer. Sweet's syndrome is in some cases associated with acute myeloid leukaemia, but not as frequently as formerly believed. Acquired ichthyosis, scleromyxoedema, amyloidosis, paraneoplastic pemphigus, woody hands, and Trousseau's syndrome are mentioned.

[Zinc deficiency and pellagra in alcohol abuse]. / Zinkmangel og pellagra ved alkoholmisbrug.

We report two cases of nutritional deficiency with skin symptoms associated with excessive intake of wine and beer, causing respectively pellagra and zinc deficiency. Supplementation with niacin and zinc had a prompt effect on the skin changes. These cases emphasize the importance of keeping nutritional deficiencies in mind in patients with inadequate nutrition and alcohol abuse.

The dermatoscopic ABCD rule does not improve diagnostic accuracy of malignant melanoma.

The dermatoscopic ABCD rule has been suggested to improve diagnostic performance regarding cutaneous malignant melanoma. Using this rule, a total dermatoscopy score is calculated from the presence of various dermatoscopic elements. A total dermatoscopy score above 4.75 signifies possible and 5.45 probable melanoma. We compared the diagnostic accuracy of dermatoscopy with and without the use of the ABCD rule. Furthermore, receiver operating characteristic analysis was performed for the ABCD rule. The area under the receiver operating characteristic curve was 0.854 (range 0.777-0.906) demonstrating that in 85.4% of the cases, cutaneous malignant melanomas were rated higher than the non-melanoma skin lesions. Sensitivity for the melanoma diagnosis was higher for simple dermatoscopy than when the ABCD rule was used (p<0.05). There was no difference in specificity when a total dermatoscopy score of 4.75 was used as cut-off point, but specificity was lower for simple dermatoscopy than when the total dermatoscopy score of 5.45 was used. Diagnostic accuracy was higher for simple dermatoscopy than for the ABCD rule (p<0.01). In conclusion, the dermatoscopic ABCD rule was not superior to simple dermatoscopy, and fewer malignant melanomas were identified with this rule.