CaRLO

Notes: A measurement method for determination of 2-aminoethanol in 2,2’,2’’-nitrilotriethanol by reversed-phase high-performance liquid chromatography (HPLC) with an ultraviolet detector has been developed using o-phthalaldehyde as a pre-column derivatizing reagent. As a result, the calibration curve of 2-aminoethanol standard solutions was linear over the range of 1.0 × 10 – 5 – 5.0 × 10 – 3 mol L–1 with a correlation coefficient of 0.996 and the detection limit, defined as S/N = 3, was 7.5 × 10 – 7 mol L–1. The relative SD at 5.0 × 10 – 5 mol/ L–1 of 2-aminoethanol standard solution was 6.0% (n = 6). This measurement method was applied to the determination of 2-aminoethanol in several commercial 2,2’,2’’-nitrilotriethanol samples and it was found that both the calibration curve method and the standard addition method based on the peak height are available for the determination of 2-aminoethanol. These results suggest that the method reported here will be useful for determination of 2-aminoethanol in 2,2’,2’’-nitrilotriethanol.

Notes: A new method for optimizing the glossy appearance of facial make-up is proposed. Reflections from skin make-up comprise two components, specular and diffuse. Glossiness of the skin can be optimized by controlling the magnitude of the specular component in applied cosmetic foundation. To determine optimal appearance of glossiness, a series of images of a woman's face with make-up varying in the magnitude of specular reflection were synthesized using computer-graphics techniques, and 15 female volunteers selected the most beautiful skin from among those simulated faces. For calculating the specular component of the facial images, six bidirectional reflectance distribution functions (BRDFs) were generated from the goniophotometric spectra of two foundation membranes that differed in reflectivity from each other. Results of the image evaluations on dark, normal or bright skin are shown. In addition, evaluation of images in which the specular component was shifted to blue caused by blue pearl pigments is shown.

Notes: The best pulverization of emulsions that can be achieved using conventional mixing blades is in the micrometer realm. Now, with our new ‘thin-film spin system’ high-speed mixer, it is possible to attain pulverization in the nanometer realm. The particle size distribution can now be controlled to achieve an almost single distribution state. Particles can be pulverized without being severed, preventing secondary agglomeration after processing. This new mixing system also solves many of the problems common to conventional pulverization processes.

Notes: Regional Meeting of the International Society for Bioengineering and the Skin, Orlando, Florida, October 28–30, 2004.Gynoid lipodystrophy (cellulite) is the irregular, dimpled skin surface of the thighs, abdomen, and buttocks in 85% of post-adolescent women. The distinctive surface morphology is believed to result when subcutaneous adipose tissue protrudes into the lower reticular dermis, thereby creating irregularities at the surface. The biomechanical properties of epidermal and dermal tissue may also influence severity. Cellulite-affected thigh sites were measured in 51 females with varying degrees of cellulite, in 11 non-cellulite controls, and in 10 male controls. A non-contact high-resolution three-dimensional laser surface scanner was used to quantify the skin surface morphology and determine specific roughness values. The scans were evaluated by experts and naїve judges (n = 62). Body composition was evaluated via dual-energy X-ray absorptiometry; dermal thickness and the dermal-subcutaneous junction were evaluated via high-resolution 3D ultrasound and surface photography under compression. Biomechanical properties were also measured. The roughness parameters Svm (mean depth of the lowest valleys) and Sdr (ratio between the roughness surface area and the area of the xy plane) were highly correlated to the expert image grades and, therefore, designated as the quantitative measures of cellulite severity. The strength of the correlations among naїve grades, expert grades, and roughness values confirmed that the data quantitatively evaluate the human perception of cellulite. Cellulite severity was correlated to BMI, thigh circumference, percent thigh fat, architecture of the dermal-subcutaneous border (ultrasound surface area, red-band SD from compressed images), compliance, and stiffness (negative correlation). Cellulite severity was predicted by the percent fat and the area of the dermal-subcutaneous border. The biomechanical properties did not significantly contribute to the prediction. Comparison of the parameters for females and males further suggest that percent thigh fat and surface area roughness deviation are the distinguishing features of cellulite.

Notes: Cyclic voltammetry and linear sweep voltammetry were preliminarily used in order to evaluate the global antioxidant properties of dermocosmetic creams. Experiments were performed by introducing electrodes directly into the creams without any pretreatment of the samples. Current–potential curves showed significant anodic current depending on the antioxidant-containing cream studied. In comparison, little amperometric response was recorded with an antioxidant-free cream base. Aqueous solutions of the corresponding antioxidants showed analogous anodic waves and similar peak potentials. A correlation between the global anodic peak and the presence of the antioxidant species in the cream was made with eleven skin creams, attesting to the reliability of the method. Among the tested electrode materials, platinum gave the best results in terms of electrochemical kinetics and measurement precision (current peak standard deviation 〈5%). Exposure of a depilatory cream to oxidizing agents (e.g. hydrogen peroxide, air, or light) caused a decrease in peak current as expected. This methodology enabled us to evaluate the evolution of the total antioxidant capacity under oxidative stress and gives encouragement to further development of a voltammetric method to quantify cream antioxidant power.

Notes: In this feasibility study, changes in the elastic properties of skin following various skin treatments (e.g. water, skincare ingredients, etc.) were investigated using a new in vivo tensile testing method. The properties of human skin in vivo, and in particular the properties of the stratum corneum, were studied using a combined experimental-numerical approach. Tests on a small number of volunteers indicated that the in vivo testing method was sensitive to the effect of skin treatments and could distinguish their relative performances. The ingredients tested effectively made skin less stiff. Preliminary results showed that stratum corneum is highly anisotropic and that the data was in general agreement with some but not all published in vitro results, although this is the first time ever that Poisson ratios for human stratum corneum are presented.

Notes: In this communication, penetration of vegetable oils into hair fibers has been investigated by the TOF-SIMS (Time-Of-Flight Secondary Ion Mass Spectrometry) method. In earlier work [1], the method was found suitable to study the penetration of coconut and mineral oils into human hair. Therefore, the study has been extended to a group of vegetable oils with different types of unsaturation in the fatty acid components. Different patterns of penetration have been observed for oils of different molecular structure. The general pattern which emerges from this study is that polyunsaturated oils do not penetrate at all, or do so only sparingly into the structure of hair. Most of these molecules seem to penetrate only into the cuticular region of the hair fiber. Oils with polyunsaturated fatty acids seem to have difficulty in penetrating hair. It is possible that these molecules do not fit into the fiber's cell membrane complexes, which are known to be the diffusion pathways in the keratin fiber. On the other hand, monounsaturated oils, such as olive oil, with more compact molecular structure seem to penetrate readily into the hair fiber.

Notes: It has been demonstrated for visual and olfactory stimuli that an increase in heart rate, skin conductance, facial electromyogram activity and breathing rate correlates with negative and/or excited emotional states and a decrease with positive and/or relaxed emotional states. It was the aim of this study to explore the psychophysiological status of emotional moods associated with use of a men's skincare range. Therefore, in a 5-day habituation phase 19 male volunteers (mean age 32 years) used three perfumed products (a shaving mousse, cleansing gel and hydrating cream) for their morning shaving routine and assessed their mood before and after by means of self-assessment manikins and a general mood estimate questionnaire. In a second study phase the psychophysiological parameters heart rate, skin conductance and facial electromyogram activity of the resting subjects were recorded after exposure to three different odors, the fragrance of the men's products of the habituation phase, a control fragrance and the solvent dipropylene glycol. During the habituation phase the cosmetics had positive effects on the mood behavior of the subjects. These positive effects could be confirmed by the objective measurements of peripheral nervous system parameters in the second study phase.

Notes: The ability to continuously examine the interior hair structure throughout a treatment process is very important in designing effective hair products. Microscopy is commonly used to observe the interior of hair, but this method requires a sliced sample, making continuous observation impossible. Use of X-ray computed tomography (CT) as a non-destructive measurement has been proposed, but this method has a disadvantage in that it is impossible to obtain full-color interior images of the sample. Thus, a non-destructive method for continuous, full-color examination of the interior hair structure has been lacking. In this study a new method is proposed that enables non-destructive and continuous measurement of the interior hair structure with color information. In our method, optical CT is used for reconstruction of the interior hair structure. Our new theories enabled us to solve the crucial problem of the large observational error of traditional optical CT systems caused by internal light scattering and to make its practical application possible. A new optical CT system based on our method was implemented. This system displayed sufficient accuracy when the phantom image was measured, and clear and full-color cross-sectional images were obtained without destruction of the sample when human hair was observed. When the bleaching and dyeing processes were continuously measured, changes in the interior hair with time could be observed. These results clearly indicate that our new method provides a powerful tool for research and product development.

Notes: Previous methods for skin compatibility testing of colored cosmetics were limited by their ability to detect erythema reactions (reddening) underneath non-transparent products. The objective of this study is to present a new spectroscopic method to quantify reddening of human skin in vivo below colored cosmetics (e.g. hair dye, lipstick, makeup). The skin compatibility of non-transparent cosmetic products was determined by detection of a remission band in the near-infrared spectral region.In this study a spectrophotometer with a short arc xenon lamp and a single monochromator on the excitation side as well as an emission monochromator with a near-infrared photodiode (NIR photodiode) on the detection side was used. To induce an erythema reaction different test areas were treated with a 1 molar solution of ammonia. Afterwards they were colored with a permanent oxidative hair dye or lipstick. Before the coloring procedure, the baseline state of the test areas was documented by measuring the remission in the range from 1050 nm to 1250 nm. This measurement was repeated after the erythema reaction had been covered by a colored cosmetic.The results of data analysis revealed a remission band at approximately 1150 nm that was directly linked to the intensity of the erythema reaction. Non-visible reddening of the skin thus becomes measurable with this new method regardless of the optical properties of the product tested.

Notes: Intersensory phenomena frequently occur during the subjective assessment of consumer products and are very difficult to measure properly in an objective way. In earlier studies, the objective emotional assessment (OEA) technique based on the evaluation of psycho-physiological reactions and parameters had proven to be highly suitable for determining emotional consumer response. The aim of the present study was to assess the intersensory effects of color and scent via OEA. The experiment was designed in a way that matched combinations of color and fragrance were compared with apparently mismatched combinations in transparent gels. A special apparatus was constructed for presentation of the various stimuli to the volunteers. Furthermore, the order of stimuli presentation was varied according to a prime-probe concept. Data analysis was carried out with multivariate statistics, which allowed identification of characteristic discriminant functions for thevarious experimental conditions and interpretation of their practical meaning in a straightforward way. In summary, we found that OEA could be successfully applied to such weak stimuli as color and scent and there was a good differentiation of matched and mismatched combinations with respect to their activation and emotional effect on volunteers. A very subtle separation of stimuli was achieved, which allows deep insight into the mutual interdependency of color and scent.

Notes: Oat beta-glucan is a water soluble, linear polymer of glucose consisting of 1,4 (70%) and 1,3 (30%) linkages with an average molecular weight of 1 × 106 Da. Scientific reports indicate beta-glucan is a film-forming moisturizer, a biological response modifier, and a promoter of wound healing. Our objective was to study the penetration of oat (1,4:1,3) beta-glucan in human skin models and to evaluate clinically its efficacy for reducing fine-lines and wrinkles. Penetration studies performed on human abdominal skin used a single application of 0.5% beta-glucan solution at a dose of 5 mg per cm2. The results showed that beta-glucan, despite its large molecular size, deeply penetrated the skin into the epidermis and dermis. A clinical study of 27 subjects was performed to evaluate the effects of beta-glucan on facial fine-lines and wrinkles. After 8 weeks of treatment, digital image analysis of silicone replicas indicated a significant reduction of wrinkle depth and height, and overall roughness.This work is the first ex vivo and in vivo demonstration of the physiological effects of beta-glucan in the penetration and restructuring of human tissue. The study supports the use of oat beta-glucan in the care and maintenance of healthy skin and the cosmetic treatment of the signs of aging.

Notes: Colombia has the third greatest biodiversity in the world and many plants have yet to be studied. Laurel wax is obtained from the fruit of Myrica pubescens, a small tree that can be found in some rural zones in the Nariño department. The main objective of this investigation is to contribute to the development of sustainability of the communities that produce laurel wax in Colombia by proposing possible uses in personal care products. This work involves: 1. Determining the physicochemical properties of wax obtained from the fruit of Myrica pubescens, which is known in the region as laurel wax, 2. Proposing applications and uses of this wax in personal care products on the basis of the results of comparative stability and sensory studies with other natural waxes. 3. Performing a safety evaluation using the Het-Cam test and thereby avoiding animal experiments. Emulsions and color cosmetics can be developed with laurel wax. Replacement of beeswax with laurel wax in lipsticks was studied using analytical sensory techniques with the help of a trained panel; this change improved the slipperiness and uniformity. According to a safety evaluation based on the Het-Cam test, laurel wax should not be an irritant in vivo.

Notes: This in vitro study was performed to elucidate the reaction mechanism of sodium fluoride (NaF), which is added to tooth-bleaching agents to lessen the adverse effect of hydrogen peroxide (H2O2) on teeth. Both hydroxyapatite (HAP) and dihydrated dicalcium phosphate (DCPD), model substances for dental hard tissues, dissolved easily in a simple H2O2 solution. In the H2O2/NaF solutions, however, fluorine compounds that could not be identified by X-ray diffraction (XRD) due to the smallness of the products were formed on the surface of the HAP. X-ray photoelectron spectroscopy (XPS) studies demonstrated that fluoridated hydroxyapatite (FHAP) was formed on HAP, and that calcium fluoride (CaF2) formation was accelerated by increasing the concentrations of fluorine and H2O2 along with the partial dissolution of HAP. In H2O2/NaF solution, DCPD also transformed easily to FHAP and CaF2, which are favorable to the remineralization process on the tooth surface. Thus, the mechanism of NaF was elucidated, and its use together with H2O2 for tooth bleaching was proved to be effective. Methodologically, the XPS two-dimensional plot made it possible for the first time to directly estimate the ratio of FHAP and CaF2 in the reaction products, in contrast to the conventional wet-analytical method, which is simply based on the difference in solubility of the two components.

Notes: Gynoid lipodystrophy (cellulite) is the irregular, dimpled skin surface of the thighs, abdomen, and buttocks in 85% of post-adolescent women. The distinctive surface morphology is believed to result when subcutaneous adipose tissue protrudes into the lower reticular dermis, thereby creating irregularities at the surface. The biomechanical properties of epidermal and dermal tissue may also influence severity. Cellulite-affected thigh sites were measured in 51 females with varying degrees of cellulite, in 11 non-cellulite controls, and in 10 male controls. A non-contact high-resolution three-dimensional (3D) laser surface scanner was used to quantify the skin surface morphology and determine specific roughness values. The scans were evaluated by experts and naїve judges (n = 62). Body composition was evaluated via dual-energy X-ray absorptiometry; dermal thickness and the dermal–subcutaneous junction were evaluated via high-resolution 3D ultrasound and surface photography under compression. Biomechanical properties were also measured. The roughness parameters Svm (mean depth of the lowest valleys) and Sdr (ratio between the roughness surface area and the area of the xy plane) were highly correlated to the expert image grades and, therefore, designated as the quantitative measures of cellulite severity. The strength of the correlations among naїve grades, expert grades, and roughness values confirmed that the data quantitatively evaluate the human perception of cellulite. Cellulite severity was correlated to BMI, thigh circumference, percent thigh fat, architecture of the dermal–subcutaneous border (ultrasound surface area, red-band SD from compressed images), compliance, and stiffness (negative correlation). Cellulite severity was predicted by the percent fat and the area of the dermal–subcutaneous border. The biomechanical properties did not significantly contribute to the prediction. Comparison of the parameters for females and males further suggests that percent thigh fat and surface area roughness deviation are the distinguishing features of cellulite.

Notes: Organic–inorganic ultraviolet (UV) active hybrid materials have been prepared by a sol-gel process from benzophenone derivatives and tetraethylorthosilicate. The silica particles are spherical in shape and have a narrow size distribution which remains unchanged up to organic chromophore concentrations of 0.2 mmol g−1. At higher concentrations the spheres become less regular and fuse. A dependence of the material absorption properties on the particle size (at the same organic chromophore concentration) and on the concentration of surface grafted chromophores was noted. The most effective UV filter materials were found in a combination of silica incorporated chromophores and surface grafted chromophores at an overall low chromophore concentration. A comparison of the photostability of chromophores at standardized UV irradiation revealed an increase in stability for silica incorporated and surface immobilized benzophenone compared to benzophenone in a homogeneous solution.

Notes: LipowheatTM is an entirely biodegradable 100% natural active ingredient, extracted from non-transgenic wheat. Thanks to its very interesting properties, it can integrate the composition of most cosmetic and pharmaceutical products. The aim of this work was first to realize a large range of stable simple or multiple emulsions, in order to determine and evaluate the ability of a new glucolipidic surfactant LipowheatTM to form and stabilize emulsions. The rheological properties of these emulsions were tested during a 30-day storage period at three different storage conditions (cold, room temperature and at 40°C). In addition to dynamic and static rheological tests, droplet size distribution of the cream was also determined. Furthermore, a stable simple emulsion was selected to realize percutaneous absorption and evaluate the properties of LipowheatTM.

Notes: It was once widely believed that standards of beauty were arbitrarily variable. Recent research suggests, however, that people's views of facial attractiveness are remarkably consistent, regardless of race, nationality or age. Facial characteristics are known to influence human attractiveness judgements and evolutionary psychologists suggest that these characteristics all pertain to health, leading to the conclusion that humans have evolved to view certain bodily features as attractive because the features were displayed by healthy others. Here we review some of the fundamental principles of sexual selection theory that apply to human beauty and summarize the major findings of human beauty perception.

Notes: The aim of this study was to develop rapid and accurate procedures to identify microorganisms contaminating cosmetic products, based on the identity of the nucleotide sequences of the internal transcribed spacer (ITS) region of the ribosomal RNA coding DNA (rDNA). Five types of microorganisms were isolated from the inner portion of lotion bottle caps, skin care lotions, and cleansing gels. The rDNA ITS region of microorganisms was amplified through the use of colony-direct PCR or ordinal PCR using DNA extracts as templates. The nucleotide sequences of the amplified DNA were determined and subjected to homology search of a publicly available DNA database. Thereby, we obtained DNA sequences possessing high similarity with the query sequences from the databases of all the five organisms analyzed. The traditional identification procedure requires expert skills, and a time period of approximately 1 month to identify the microorganisms. On the contrary, 3–7 days were sufficient to complete all the procedures employed in the current method, including isolation and cultivation of organisms, DNA sequencing, and the database homology search. Moreover, it was possible to develop the skills necessary to perform the molecular techniques required for the identification procedures within 1 week. Consequently, the current method is useful for rapid and accurate identification of microorganisms, contaminating cosmetics.

Notes: Evaluation studies in the development of new types of cosmetics are divided into exploratory and confirmatory research. The exploratory evaluation aims to discover the unknown characteristics of tested products, whereas the confirmatory evaluation aims to examine the attainment of their designed quality. This report presents an evaluation method to achieve simultaneously the two objectives using the think-aloud method with the paired comparisons method. The results obtained for two foaming cleansers possessed both exploratory aspects and confirmatory ones, and were straightforward in demonstrating the features of the foaming cleansers, because the think-aloud method was not restricted by a complicated evaluation procedure. The method proposed from the discussions can be readily applied to the process of new product development.

Notes: There is an increasing demand in general population regarding skin healthiness and improvement of aesthetical appearance, indicating that people require more information about how to treat healthy skin and to prevent skin disease. This study is the result of a campaign on healthy skin organized by the International Society of Plastic Dermatology. This campaign was at the same time an occasion to perform an epidemiological study on Italian population and was conducted during only one month (March 2004) throughout Italy. In total, 462 dermatologists all over Italy joined the project. Study protocol and diagnostic kits were provided to all adhering dermatologists. After signing an informed consent, subjects were assigned to undergo anamnesis, medical examination and stinging test with 10% lactic acid at the level of nasolabial fold. A total of 2101 duly compiled case record forms were sent back by the dermatologists. The analysis of the demographic features and lifestyle of the subjects who were attracted by the campaign allows us to draw the identikit of people interested in the maintenance of a healthy skin, i.e. mainly young women, who already lead a healthy life and took care of their skin. Sensitive skin was common in this healthy population.

Notes: The Traditional Chinese Medicine (TCM) is considered medical treatment for constitutions (Shou). In women, who are healthy volunteers living in Tokyo, we investigated the relationship among the four types of skin condition and six types of constitution, which are based on the general idea of TCM. As a result, it is clear that skin types are composed of several constitutions. The constituent proportions of damp heat constitution and yin deficient constitution are high in the case of active skin (this type of skin tends to turn red and is easily partially inflamed). The constituent proportions of qi-blood deficient constitution and yang deficient constitution are high in the case of inactive skin (this type of skin tends to be pale). The proportion of phlegm dampness constitution is high in the case of damp skin (this type of skin looks greasy and tends to break out in acne). The constituent proportions of qi-blood deficient constitution and yin deficient constitution are high in the case of dry skin (this type of skin looks dry and rough). In other words, it is suggested that the features of the four types of skin are signified as the sum total of local symptoms composed of the constitutions. Furthermore, we trialled the external prescriptions of TCM, which changed the features of the four types of skin. It is proved that each of the external prescriptions of TCM can change the skin features according to the effective result of all of types of skin. Consequently, it is considered to be appropriate to classify skin type on the basis of TCM.

Notes: Although some data on the skins of Japanese, Korean and Chinese people have appeared recently, few studies have examined the skin of south-east Asians.The population of the Philippines results for centuries of intermarriage between Chinese, Spanish and Malays. Filipino skin is different from that of Malayan Indonesians or Malaysians.Because little is known about how Filipinos skin changes with aging, we have collected data on the clinical and histological characteristics of the skin of Filipino women living in Manila. We recorded skin colour, pigmentation disorders, skin hydration, firmness, slackness, wrinkle status and carried out a histological and immunochemical evaluation of the difference between skin exposed to and protected from sunlight.〈section xml:id="abs1-1"〉〈title type="main"〉MethodsA total of 30 healthy Filipino women (mean age: 44 years) took part in this study of the clinical and histological features of their skin, and a comparison of areas protected from and exposed to sunlight was performed. All gave their informed consent. The subjects were assigned to one of the five age groups (20–30, 30–40, 40–50, 50–60 and 〉60). Overall, 52% had a dry skin and 48% had oily skin. Twelve women were in menopause. According to the Fitzpatrick classification [1], 47% of the skins were phototype IV, 50% were phototype V and 3% were phototype VI. Eleven women (37%) were former smokers and five (16%) still smoked.Facial skin colour, hydration and wrinkles were all assessed by a dermatologist. The overall severity of facial wrinkles and pigmentation brown spots were photograded using the Jin Ho Chung photograding scale [2]. Skin elasticity, firmness and slackening (face ovale shape) were also evaluated on using a scale of 0-10 [3]. The colour (Mexameter MX18) and hydration (corneometer CM820) of the skin on the left upper cheek were measured and skin replicas (Silflo/silicone resin) of the right eye contour were made. Image analysis was used to measure the number of wrinkles, total wrinkled area (mm²), total length of wrinkles (mm), mean length of wrinkles (mm) and mean depth of wrinkles (μm).Data were analysed by analysis of variance (anova) and linear regression statistical significance was taken as P 〈 0.05.Punch biopsies (4 mm) were taken from photoprotected areas (buttocks) and photoexposed regions (preauricular face). Samples were fixed in formalin and embedded in paraffin for histological and immunohistochemical evaluation. Sections were stained with Fontana Masson, Masson trichrome, orcein, haematoxylin-phloxin-safran (HPS) by standard procedures. Immunohistochemistry was carried out to detect type IV collagen and metallothionein expression.〈section xml:id="abs1-2"〉〈title type="main"〉Results〈section xml:id="abs1-3"〉〈title type="main"〉Clinical evaluationThere was a significant change in the severity of facial wrinkles with age between the women of three age groups, 20–30, 31–60 and 〉60 years. Women aged 20–30 years had very few if any wrinkles (mean grade: 0.7), those aged 31–60 years had a similar degree of wrinkling (mean grade: 2.8), while those aged over 60 years had significantly more severe wrinkles (mean grade: 4.4). The crow's feet area was the major site of wrinkles in all age groups.Women aged less than 30 years had no facial dyspigmentation (mean grade: 0.2). Those aged 31–50 years had a similar degree of pigmentation spots (mean grade: 1.25). Women over 50 years had significantly more severe dyspigmentation (mean grade: 2.2) (〈link href="#f1-6"〉Fig. 1). The patterns of facial dyspigmentation were similar in all the age groups. Women younger than 30 years had no spots on their hands; those aged 31–50 years had a similar degree of pigmentation spots (mean grade: 0.6); while those over 50 years old had significantly more severe dyspigmentation of their hands (mean grade: 1.25). The overall distribution of the spots on the face (cheeks, periocular and forehead) was similar to that found for Asian women. The hands had fewer spots than the face, as found for Chinese women.〈figure xml:id="f1-6"〉1〈mediaResource alt="image" href="urn:x-wiley:01425463:ICS254_6_6:ICS_254_f1-6"/〉Photograding of facial pigmentation.The skin of the women studied showed significantly decreases in elasticity and firmness and increased slackening with age.〈section xml:id="abs1-4"〉〈title type="main"〉Skin featuresMexameter measurements showed no correlation between the erythemal index and age all the women had comparable erythemal indexes. However, the melanin index seemed to increase with age. There was a significant difference in the melanin indexes for 20–30-year-old women and women over 60 years (P ?≤ 0.05), but no difference between the indexes for women aged 20–30 and those aged 40–60. Skin hydration measured with corneometer decreased with age, being significantly different between women aged 20–40 and those 〉60. The total wrinkled area, total length of wrinkles and mean depth of wrinkles all increased significantly with age, while the number and mean length of wrinkles did not.〈section xml:id="abs1-5"〉〈title type="main"〉HistologyThe histology of the skin from areas protected from sunlight and areas exposed to sunlight was compared. Masson trichrome staining of protected skin showed a decrease in epidermis thickness with age, which was much more sever in areas exposed to sunlight. In contrast, the stratum corneum was thinner in photo-exposed areas.The structure of the keratinocytes appeared to be normal, with the overall organisation and epidermal differentiation being better and more regular in areas protected from sunlight. The basal layer was more continuous and regular and the granulous layer slightly thicker. Fontana Masson staining showed no difference in distribution of melanin in areas exposed to sunlight with aging.The collagen in dermo epidermal junction (DEJ) was more dense in the sun-exposed areas of older patients. There was a general flattening of the DEJ in the sun-protected skin of older patient. This flattening was also increased in skin exposed to sunlight. These findings are similar to those of other skin aging studies [4, 5]. Immunohistochemistry showed that the amount of type IV collagen did not vary with age or exposure to sunlight. There was also no correlation between the amount of type IV collagen and skin elasticity, firmness, slackening, or the number and length of wrinkles. However the dermis of skin exposed to sunlight had heavier deposits of elastotic material (Orcein staining). The network of elastic fibers in the superficial papillary dermis (oxytalan fibers) of skin exposed to sunlight was diminished (­50%) or absent, but it was present in skin protected from sunlight (〈link href="#f2-6"〉Fig. 2).〈figure xml:id="f2-6"〉2〈mediaResource alt="image" href="urn:x-wiley:01425463:ICS254_6_6:ICS_254_f2-6"/〉Orcein staining. (A) age: 42 years, sun-protected; (B) age: 42 years, sun-exposed; (C) age: 64 years, sun-protected; (D) age: 64 years, sun-exposed. e, epidermis; d, dermis.The metallothioneins (MTs) are low molecular weight cysteine-rich, proteins that bind heavy metals; they are produced in response to a variety of stress signals [6, 7]. There are no published data on the effect of chronic exposure to UV light on metallothioneins. We therefore measured their abundance in the skin of six subjects, in areas protected from sunlight and areas exposed to sunlight (〈link href="#f3-6"〉Fig. 3). The six chosen subjects had similar good skin tolerance of sunlight. Metallothionein expression was restricted to the keratinocytes and some dermal cells. The basal layer consistently immunostained more intensely for MT than did the suprabasal layers. There was MT immunoreactivity in both the cytoplasm and nucleus of keratinocytes. The numbers of MT-positive cells in the epidermis of areas exposed to sunlight and those protected from the sun were significantly different.〈figure xml:id="f3-6"〉3〈mediaResource alt="image" href="urn:x-wiley:01425463:ICS254

Notes: Korea is located between Japan and Mainland China. The people of these three countries have similar appearances and it is difficult to differentiate between them. Although the population of Asia is more than half of the total population of the Earth, the inherent characteristics of Asian skin have not been well investigated. Commercial markets for cosmetics and drugs for photoaged skin are rapidly expanding in many Asian countries. Therefore, many investigators in the field of dermatology and cosmetology have become interested in brown Asian skin.〈section xml:id="abs1-2"〉〈title type="main"〉Clinical characteristics of skin aging and photoaging in AsiansSkin aging can be divided into two basic processes: intrinsic aging and photoaging [1]. Intrinsic aging is characterized by smooth, dry, pale, and finely wrinkled skin, whereas photoaging, which indicates premature skin aging in chronically photodamaged skin, is characterized by severe wrinkling and irregular pigmentation. The pattern of wrinkling in Asians seems to differ from that in Caucasians. Asians have coarser, thicker and deep wrinkles, particularly in the forehead, perioral and Crow's foot areas. In contrast, Caucasians usually have relatively fine cheek and Crow's foot wrinkles. The reasons for these differences are not known and need further investigation.There are racial, ethnic and genetic differences, and differences of skin structure and function, between the brown skin of Asians and the white skin of Caucasians. As Asian skin is more pigmented, acute and chronic cutaneous responses to UV irradiation differ from those in white skin. Many people believe, based on clinical impressions, that the main process of photoaging in Asians involves pigmentary changes, rather than wrinkling. However, no study has been performed to confirm this belief.〈section xml:id="abs1-3"〉〈title type="main"〉Risk factors for skin wrinkles and their relative risks in Korean skin [2]Various factors such as age, sun-exposure, and smoking are known to be important risk factors for wrinkles. However, the relative risks of each factor on wrinkles in the brown skin of Asians have not been investigated, and they could differ from those in Caucasians.An evaluation system for skin wrinkling is necessary for Asian skin [3]. Thus, we developed an eight-point photographic scale for assessing wrinkles in both Korean genders [2]. This scale can probably be applied to the populations of other Asian countries, at least to the Japanese and Chinese. The pattern of wrinkles in both genders appears to be similar.〈section xml:id="abs1-4"〉〈title type="main"〉AgeAge is an important risk factor for wrinkling in Asians, as in Caucasians. Korean subjects in their 60s showed a 12-fold increased risk of wrinkling, while subjects in their 70s have a 56-fold increased risk compared with young age group.〈section xml:id="abs1-5"〉〈title type="main"〉UV lightIt is well known that the UV component in sunlight can cause and accelerate photoaging. The pigmented skin of Asian may better protect skin from acute and chronic UV damage. However, we found a strong association between sun-exposure and the development of wrinkling in Koreans. It was found that sun exposure of more than 5 h per day was associated with a 4.8-fold increased risk in wrinkling versus less than 2 h of sun-exposure in Koreans.〈section xml:id="abs1-6"〉〈title type="main"〉Estrogen deficiencyKorean females have more wrinkles than men, after controlling for age, sun exposure, and smoking, it was found that they have a 3.6-fold increased risk of developing wrinkles than their male counterparts [2]. It has also been reported, that the relative risk for wrinkling in women is higher than in men as for in white Caucasians [4]. The reason why women show more wrinkles remains to be determined. It is possible that a reduction in skin collagen because of estrogen deficiency in postmenopausal woman may aggravate wrinkling severity. Korean women with more than 10 years since menopause showed a 3.9-fold higher risk of wrinkling than the women 5 years of beyond menopause [5]. We demonstrated that women with a history of HRT have a significantly lower risk, more specifically, one fifth of the risk of facial wrinkling relative to those who had no history of HRT. Interestingly, we found that wrinkle severity significantly increased with an increasing number of full term pregnancies. The relative risk for severe wrinkling is increased by approximately 1.8-fold per full term pregnancy.〈section xml:id="abs1-7"〉〈title type="main"〉SmokingIt is known that smoking causes skin wrinkling in Caucasians, and that it plays no role in Blacks [6, 7]. Koreans with have a smoking history of more than 30 pack years showed a more than 2.8-fold increased risk of wrinkles [2]. The relative risks of wrinkles associated with a 30–50 pack-years history of smoking were 2.8- and 5.5-fold, respectively.〈section xml:id="abs1-8"〉〈title type="main"〉Dyspigmentation in Asian skinTo follow pigmentary changes, six photographic standards for both genders were developed for Korean skin, to produce a 6-point scale [2, 8]. Hyperpigmented spots, mostly lentigines, were prominent among women, while seborrheic keratosis tended to be more prominent in men.〈section xml:id="abs1-9"〉〈title type="main"〉Seborrheic keratosis in Korean menSeborrheic keratoses (SKs) are benign cutaneous tumors. They have diverse clinical and histopathological appearances and are very common in the elderly (over 50 years old). The etiology of SKs is not well understood, although patients with a great number of lesionsshow a familial trait with an autosomal dominant pattern, and human papilloma virus has been suggested as possible cause because of verrucous appearance of the lesions. Exposure to sunlight has been suggested to be a risk factor for SKs. However, there is still some debate in terms of the role of sunlight. Recently, we have investigated the clinical characteristics of SKs and relationship between SKs and sunlight exposure in Korean males [9].The prevalence of SKs in Koreans increases with age; it rose from 78.9% at 40 years, to 93.9% at 50 years and 98.7% in those over 60 years. Exposed areas, i.e. the face, neck and dorsum of the hands, demonstrate a significant increase in the prevalence of SKs by decade, whereas partly exposed areas, although SKs tended to increase in prevalence with age, this trend was not significant. When the estimated body surface area (BSA) is taken into account, the number of SKs on both the face and dorsum of the hands (0.51 ± 0.08 per 1% BSA) was over-represented compared with the trunk. SKs were also concentrated on the neck (0.38 ± 0.07 per 1% BSA) and in the V-area (0.47 ± 0.09 per 1% BSA). Outer forearms also showed 3-fold more SKs per unit area than neighboring arms and inner forearms, which are classified as partly exposed area (0.09 ± 0.02, 0.03 ± 0.01, respectively). The total area covered by SKs on exposed area also became significantly larger with aging than on intermittently exposed areas. These results indicate that exposure to sunlight might be related to SK growth.Our results indicated that excessive sun exposure is an independent risk factor of SKs. After controlling for age, smoking, and skin type, subjects with a sun exposure history of more than 6 hours per day showed a 2.28-fold increased risk of having severe SKs (n ≥ 6) compared with those exposed for less that 3 h per day. These findings indicated that sun-exposure may play an important role in SK development.In summary, SKs are very common in Korean males and represent one of the major pigmentary problems. SKs concentrate on exposed skin, especially on the face and dorsum of the hands. Both age and lifetime cumulative sunlight exposure are important contributing factors and may work in a synergistic manner.〈section xml:id="abs1-10"〉〈title type="main"〉ConclusionMany people tend to believe that wrinkles are not a prominent feature of Asian photoaged skin, and

Notes: Background  Ointments, classically used for the treatment of dermatological diseases, are monophasic viscous semisolid formulations. According to the proportion of their compounds, they have physicochemical and organoleptic properties and when applied on skin show a specific behaviour allowing to be spread more or less easily.Objective  To measure in vitro rheological characteristics of three vitamin D derivative ointments prescribed for the treatment of psoriasis, and to compare their viscosity and clinical acceptability when applied on the diseased skin.Methods  Rheological characteristics of tacalcitol 4 µg/g, calcipotriol 50 µg/g and calcitriol 3 µg/g ointments were assessed by measuring the oscillatory viscoelastic parameters and the permanent flow analysis. Clinical acceptability was studied in 20 psoriatic male or female subjects, aged 18 years or older. A survey evaluated the acceptability of calcitriol vs. tacalcitol and calcipotriol. Questions included information about fluidity, spreading capacity and stickiness after application.Results  We demonstrated that viscoelastic parameters were four times higher for ointment tacalcitol than for calcipotriol and calcitriol, corresponding to a higher consistency of ointment tacalcitol compared to calcipotriol and calcitriol showing both similar results; better fluidity was demonstrated by calcitriol than by tacalcitol and calcipotriol. Comparable results were obtained for the quality to be spread. The sensation of stickiness, significantly different between tacalcitol and calcitriol, was not different between calcipotriol and calcitriol.Conclusion  The above results confirm the relationship between rheological in vitro and sensorial in vivo results: variations between different formulations may have an important influence on non-adherence and treatment failure.

Notes: Objectives  To review recent data – what is new in the epidemiology of onychomycoses? To identify the most relevant diagnostic criteria for effective therapy.Methods  The preliminary results of the European Onychomycosis Observatory (EUROO) study were analysed. In this international study, physicians completed questionnaires concerning patient profile and the disease.Results  One of the most interesting novel findings was that sampling requests were often not made [only 3.4% of general physicians (GPs) and 39.6% of dermatologists]. This means that no information about causative agent(s) was available, hindering appropriate treatment choice. Furthermore, contrary to previous findings, 70.7% of participants did not practice sports. Lastly, these preliminary findings showed that treatment strategy depends largely on the type of treating physician, with GPs preferring monotherapy and dermatologists preferring combination therapy.Conclusions  A consensus was reached that treatment strategy should depend on the severity of nail involvement and the causative fungus. It is thus important to promote the importance of sampling. To simplify the choice of an appropriate treatment, onychomycosis may be divided into just two clinical groups: onychomycosis with and without nail matrix area involvement. However, the distinct clinical findings (number and type of affected nails, multimorbidity, drug interaction, etc.) in each individual case must be taken into account to ensure an appropriate treatment decision.

Notes: Objectives  To review methodological approaches used in recent publications in onychomycosis clinical research. To identify key methodological criteria to ensure conclusive and reliable clinical results.Methods  A Medline search for recent articles on onychomycosis treatment revealed considerable variation in inclusion criteria, definitions and methodology, rendering comparisons difficult.Results  Careful diagnosis at trial entry is critical and predisposing factors affecting overall results are rarely considered at enrolment. Clear definitions are required, notably for the terms mycological, clinical and total cure.A consensus was reached that only studies that are evidence-based, controlled and double-blind with less than 10–15% of patients lost to follow-up should be accepted.Results should be interpreted with caution if a given treatment is found to be less effective than previously reported, even if the results are published in a recognized journal.It was agreed that an explanatory/pilot study should be done initially to determine whether there is a reason to believe that a new therapy is effective. If promising results are obtained, a double-blind, randomized study comparing the new therapy with either an existing therapy (preferably) or a placebo may be initiated.Conclusions  Sample size, and inclusion and exclusion criteria should be clearly determined. Efficacy criteria should include mycological, clinical and total cure rates. Finally, studies of toenail and fingernail onychomycosis must last at least 18 and 9 months, respectively.

Notes: We present a case of an intriguing mesenchymal neoplasm of the scalp that recurred several times over 10 years before a final diagnosis was possible. The case was sent for expert opinions to various international dermatopathological authorities and was, for a long time, unanimously interpreted as malignant melanoma. This diagnosis was supported by immunohistochemical examinations demonstrating S-100 positivity. Nevertheless, the clinical behaviour, as well as some histopathological features raised doubt regarding the diagnosis. Only after the last recurrence, followed by a repeat extensive immunohistochemical study, the diagnosis of epithelioid angiosarcoma was made. Histologically malignant melanoma can be highly misleading and in literature, reports of misinterpreted cases of melanoma are published. In contrast, tumours that can simulate melanoma are also not infrequent and it is essential to perform immunohistochemistry to confirm diagnosis and exclude a melanocytic lesion.

Notes: Basis  The Spanish Academy of Dermatology and Venereology (SADV) consists of a large majority of Spanish dermatologists. Their track record and history can be considered as parallel to that of female dermatologists. The aim of this study is to determine the role of women in the SADV throughout its history, both in terms of their involvement and their positions of responsibility.Materials and methods  To obtain data, we consulted the SADV archives from the year of its foundation until 2001. We also consulted other Spanish medical societies, receiving responses from three of them.Results  Until 1964, no woman had ever become a member of the SADV. Since then, the percentage began to increase slowly (5.5% in 1975). Over the last decade, their involvement has increased rapidly, reaching 41.34% in 2001. During this time, only 11 women have held positions on the Board of Directors, and in all cases in nonpresidential positions. The percentage of women in paediatrics, ophthalmology and pathologic anatomy is similar.Conclusions  During this time, the number of female dermatologists in the SADV has gradually increased. This increase is, nonetheless, not uniform, with the greatest growth being seen during the last decade. Women in positions of responsibility have been scarce and, to date, there has been no female national president. These results coincide with statistics revealed in other areas of the medical society.

Notes: Parry–Romberg syndrome (PRS) is a rare and puzzling disorder that is characterized by progressive hemifacial atrophy. It involves mainly some or all tissues of one side of the face. A case of 21-year-old Caucasian man with hemifacial atrophy in the right facial region is reported. Serological studies with anti-single-stranded DNA (anti-ssDNA), anti-double-stranded DNA (anti-dsDNA), anticentromere (ACA) and antinuclear (ANA) antibodies were done. Anti-dsDNA antibodies was found positive, but the others were negative. Rheumatoid factor (RF) was also negative. Since PRS is rare and its association with anti-dsDNA antibodies was not reported before, this case appears to be the first report.

Notes: Background  Vitiligo is an acquired idiopathic hypomelanotic disorder characterized by circumscribed depigmented macules resulting from the loss of cutaneous melanocytes.Objective  In order to evaluate the immune system of Iranian patients with vitiligo, this study was accomplished.Methods  Fifty-five Iranian patients with vitiligo and 60 healthy persons as control were investigated in this study. The laboratory techniques were included: antimelanocyte antibody (AMA) and antinuclear antibody (ANA) with indirect immunoflorescent test, C3 and C4 levels with single radial immunodiffusion (SRID), and rheumatoid factor (RF) with enzyme-linked immunosorbent assay (ELISA).Results  AMA was positive in 17 patients (30.9%) and was negative in the entire control group (P 〈 0.0001). ANA was positive in 4 patients (7.3%), which was insignificantly higher than control group (1.7%). IgM-RF was positive in 6 patients (10.8%) while it was negative in the entire control group (P = 0.027). C3 and C4 values decreased in 14 patients (25.5%), which was significantly higher than control group (P 〈 0.001).Conclusion  The important role of the immune system in the pathogenesis of vitiligo could be suggested. In addition, the autoimmune hypothesis of vitiligo could be confirmed based on the results of this study.

Notes: Rosai–Dorfman disease in soft tissue without nodal disease has been recognized as a distinct clinicopathologic entity. It may represent a diagnostic challenge and the natural history and optimal treatment has not been well clarified. We investigated a patient in whom Rosai–Dorfman disease was confined to the subcutis of the abdominal wall and recurred after incomplete excision. Complete resolution was achieved by wide surgical excision with negative margins. Pathologic examination confirmed the diagnosis of extranodal Rosai–Dorfman disease. The patient is disease-free after 1 year of follow-up. Despite the possibility that spontaneous remission may occur, our results suggest that when anatomically feasible, complete excision can be a treatment option for persistence or recurrence of exclusively extranodal disease. Larger case series and longer follow-up are needed to assess the long-term efficacy in these patients.

Notes: Objectives  To evaluate the effect of patient satisfaction on health-related quality of life among dermatological outpatients, independently of patients’ sociodemographic, and clinical characteristics.Design  Prospective cohort study. Satisfaction was evaluated with a standardized questionnaire three days after the visit by telephone interview. Quality of life and psychiatric disorders were measured with validated instruments (Skindex-29 and Ghq-12) before the dermatological visit and after four weeks. At the four week interview also self-reported medication adherence was assessed.Setting  Outpatient clinics of a large dermatological hospital in Rome, Italy.Patients  A consecutive sample of 1389 outpatients was approached, and 52% agreed to participate. Inclusion criteria were met by 424 patients, and 396 (93%) of them completed the study.Main outcome measures  Improvement in health related quality of life.Results  At multivariate analysis satisfied patients have approximately twice the odds for an improved quality of life on the emotions scale (OR = 1.99; 95%CI 1.1 to 3.7; P = 0.03) and on the functioning scale (OR = 2.2; 95%CI 1.1 to 4.7; P = 0.03). Patients with psychiatric disorders at baseline were less likely to have an improved quality of life on the functioning scale (OR = 0.3; 95%CI 0.2 to 0.8; P = 0.01).Conclusions  This is the first prospective study showing that patient satisfaction and psychiatric disorders have a significant effect on quality of life improvement among dermatological patients, independently of patient characteristics. Particular attention should be devoted to improving physicians’ interpersonal skills, the major component of patient satisfaction.

Notes: We report the case of a 33-year-old patient who had had insulin-dependent diabetes mellitus (IDDM) since he was 11 months old, and who presented with major perforating necrobiosis lipoidica (PNL) complicated by a well-differentiated epidermoid carcinoma. PNL is a rare clinical form of NL, always associated with diabetes. Only seven cases have been reported to date in the literature, and to the best of our knowledge, an association of epidermoid carcinoma and PNL has never been described. The development of a tumoral transformation on a classical NL plaque has only been described 12 times. The presence of an epidermoid carcinoma on a weakened background with permanent ulceration suggests that early surgical excision of the tumour and of the NL followed by a skin graft might be the treatment of choice. Radiotherapy seems to be a poor therapeutic option.

Notes: Background  There are numerous factors that predispose to onychomycosis including genetic predisposition, diabetes mellitus, immunosuppression, vascular disease and psoriasis.Objectives  The aims of this workshop were to discuss current knowledge of genetic risk factors and the approaches that should be used to investigate underlying mechanisms.Results  The high prevalence of onychomycosis within certain families was initially attributed to intrafamilial transmission. However, the low prevalence of infection in people marrying into infected families together with the high prevalence among their offspring suggested a genetic basis.The state-of-the-art pedigree study by Zaias et al. suggested that Trichophyton rubrum infection shows an autosomal dominant pattern of inheritance. A consensus was reached that epidemiological and genetic studies are required to investigate this issue further.For epidemiological studies, families in which two or three generations are infected with T. rubrum should be selected. Patients with T. rubrum on different body sites should be included, and the presence of associated diseases or other common features in these individuals should be investigated to identify trigger factors.Conclusion  Genetic studies should explore the mode of inheritance of onychomycosis and look for the disease gene(s). Serum samples from patients and age–sex matched controls must be analysed centrally.The results of these studies will make it possible to develop therapeutic, preventive and prophylatic measures and to provide patients and their families with information.

Notes: The frequency of occurrence of malignant neoplasms in the cases of pyoderma gangrenosum is not exactly determined, but it can be assessed to be at 7%.The aim of the study was to report a 26-year-old male patient with pyoderma gangrenosum coexisting with acute myelogenous leukaemia.The first skin lesions on both tibia occurred in June 2001. Prior to the proper diagnosis of pyoderma gangrenosum, the patient was treated surgically. Because of the dramatic dermatological and general condition in November 2001, the patient was admitted to the Dermatological Department of the Silesian Medical Academy in Katowice where the diagnosis of pyoderma gangrenosum was established.On the clinical and biochemical picture, the diagnosis of pyoderma gangrenosum within acute myelogenous leukaemia was made.Initially, cyclosporin A 200 mg orally per day in the therapy of pyoderma gangrenosum was administered to achieve a slight clinical improvement. Although chemotherapy leukaemia was performed, the patient died after 4 months of the confirmation of the acute myelogenous leukaemia diagnosis.

Notes: We report a case of classical Kaposi's sarcoma involving multiple sites of the penis in a 62-year-old male who was treated with sildenafil citrate-aided electron beam therapy, resulting in complete resolution of the lesions.

Notes: Neurofibromatosis (NF) is considered to be a heterogeneous neuroectodermal disease clinically defined by the presence of neurofibromas, multiple café-au-lait spots, intertriginous freckles and Lisch nodules. Mosaicism explains atypical presentations of the disease. Early mutations, before tissue differentiation, give rise to generalized disease. We report an atypical presentation of neurofibromatosis with an unusual distribution of neurofibromas, a peculiar, clinically and pathologically, neurofibroma on the trunk and the association with an ovarian serous cystoadenofibroma.

Notes: 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.

Notes: Background  Treatment of nail psoriasis is difficult. Several topical therapies have been employed with poor results because drug penetration is limited in this localization. Recently, a new formulation containing 8% clobetasol-17-propionate in a colourless nail lacquer vehicle has shown good results in the control of nail psoriasis.Objective  To determine the efficacy and safety of 8% clobetasol-17-propionate in a lacquer vehicle in nail psoriasis.Methods  Ten patients with both nail bed and matrix psoriasis were included in the study. They were treated with a colourless nail lacquer containing 8% clobetasol-17-propionate that was applied once daily for 21 days and then twice weekly for 9 months.Results  Within 4 weeks of therapy there was a reduction of all the nail alterations, including nail pain. Therapeutic response was directly related to the length of therapy. The nail parameters that responded best to therapy were onycholysis, pitting and salmon patches. Subungual hyperkeratosis and splinter haemorrhages on the other hand had moderate and poor improvement, respectively. The treatment was well tolerated in all of the patients and there were no local (i.e. atrophy and sobreinfection) or systemic secondary effects.Conclusions  The formulation containing 8% clobetasol-17-propionate is a safe, effective and cosmetically highly acceptable treatment for nail bed and matrix psoriasis.

Notes: Over-expression of bcl-2 in lymphocytes has an important role in some immunological and inflammatory diseases. Fas (CD95) is a cell surface molecule that mediates receptor-triggered apoptosis in various cells including autoreactive T cells. In this study we investigated bcl-2 and Fas (CD95) expression in dermal lymphocytes in active skin lesions of Behçet's disease (BD) and in skin biopsy samples with chronic, non-specific inflammations. Tissue sections of 29 skin lesions of Behçet's disease and of 10 chronic non-spesific inflammatory process cases from the archives of the Ondokuz Mayıs University's Pathology Department were immunohistochemically stained for bcl-2 and Fas (CD95), and lymphocytes in the dermal infiltrate were evaluated for cytoplasmic staining. bcl-2 staining was observed in the skin lesions of 22 cases (75.8%) of Behçet's disease. bcl-2 staining was detected in two (20%) control skin biopsy samples with non-specific chronic inflammation. Fas (CD95) positivity was not detected in lymphocytes in Behçet's disease-related skin lesions. Fas (CD95) staining was observed in only three skin biopsy samples with non-specific chronic inflammation. bcl-2 and Fas (CD95) staining values in Behçet's and non-specific inflammation groups were significantly different (P 〈 0.01); differences in the bcl-2 staining values between Behçet's patients with mucocutaneous involvement only and mucocutaneous and other systemic involvements were not significant (P 〉 0.05). Expression of bcl-2 and loss of Fas (CD95) expression in dermal lymphocytes may play a role in the development of skin lesions and may account for the chronic course with periodic exacerbations in BD.

Notes: The emergence of bacterial resistance to commonly used antibiotics is not new. In this review we have tried to cover the ever increasing problems facing the treatment and containment of bacterial skin infections. We have tried to give an overview of the varied mechanisms by which bacteria gain and spread antimicrobial resistance, whilst dealing with the patterns of resistance exhibited by some of the commonly encountered organisms. Where there is evidence, we have formulated an approach on how to tackle antibiotic resistance. Where there is a lack of evidence we have formulated what we perceive to be appropriate guidelines.

Notes: Amyloidosis is characterized by the deposition of a group of unrelated proteins leading to changes in tissue architecture and function. The nodular variant is the rarest form of the cutaneous amyloidoses. We report a patient with localized nodular amyloidosis without systemic amyloid involvement or paraproteinaemia after 6 years of follow-up. The unusual aspects of our case were a plaque presentation rather than nodular, and the disseminated pattern observed.

Notes: Prurigo pigmentosa is a rare inflammatory disease of unknown origin, first reported from Japan, with only 33 cases described in non-Japanese patients. We describe a 13-year-old girl with a pruriginous symmetrical eruption of papules and vesicles affecting her back, neck and chest of 1 month duration. She remembered a similar, but lighter eruption, 2 months before. As the initial diagnosis was of a vesiculobullous form of Darier disease, treatment with isotretinoin 40 mg/day was started with good response. Histological study showed a superficial perivascular and interstitial dermatitis composed predominantly of lymphocytes. The epidermis was spongiotic, with exocytosis of lymphocytes and some neutrophils and necrotic keratinocytes. All these findings were consistent with prurigo pigmentosa. The lesions resolved leaving a light brown reticulate hyperpigmentation. Prurigo pigmentosa has never been reported in prepubescent patients, the vesiculobullous forms are unusual, and the only treatments used previously are sulphonamides, tetracyclines and macrolides. We report a 13-year-old Caucasian girl with vesiculobullous prurigo pigmentosa successfully treated with isotretinoin.

Notes: Mitochondrial DNA (mtDNA) A7445G point mutation has been shown to be responsible for familial nonepidermolytic palmoplantar keratoderma (NEPPK) associated with deafness without any additional features. To date, only a few cases have been described. We report a Portuguese pedigree presenting an inherited combination of NEPPK and sensorineural deafness compatible with maternal transmission. Clinical expression and age of onset of NEPPK and deafness were variable. Normal expression patterns of epidermal keratins and filaggrin, intercellular junction proteins including connexin 26, loricrin and cornified envelope proteins, were observed. Molecular analysis revealed that all the affected members, previously screened for Cx26 mutations with negative results, presented the mtDNA A7445G point mutation in the homoplasmic form. To our knowledge, this is the fifth family in whom inherited NEPPK and hearing loss are related to this mitochondrial mutation.

Notes: We present a new case of semicircular lipoatrophy whose lesions disappeared after 2 months of avoiding a repeated trauma in that area. It seems that this is the only associated aetiological factor, and this entity is perhaps a consequence of certain postural habits. The repeated microtraumas would damage the fatty tissue giving rise to the histopathological findings described, which are compatible with traumatic panniculitis. In conclusion, repeated microtraumas may be the aetiological factor in these cutaneous lesions. Other data in favour of this hypothesis are the disappearance of the lesions after avoiding the mechanical trauma, the fact that there were other affected people at work, and that this factor has also been identified in the majority of cases reported previously.

Notes: Impetigo herpetiformis (IH) is a rare pustular dermatosis that shares striking clinical and histological similarities to generalized pustular psoriasis. The case of a 26-year-old primigravida with IH progressing in the 30th week of her pregnancy is presented. The peculiarity of our presentation relies on the reappearance of the disease postpartum. Monthly exacerbations during menstruation lasted for 7 years. Some probable clues regarding the pathogenesis of IH are suggested.

Notes: α1-Antitrypsin deficiency, a relatively frequent mutation in the population, is associated with the development of panlobular emphysema and liver cirrhosis. The deficiency is in rare cases associated with the development of panniculitis, and very differentiated clinical courses have been reported in the literature. We report a case of panniculitis in a patient with α1-antitrypsin deficiency and describe briefly the pathophysiology of the disease and current treatment possibilities.

Notes: Aim  The aim of this study was to evaluate the effect of psoriasis treatment on plasma concentrations of metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) with respect to disease severity.Methods  MMP-1 and TIMP-1 were measured using an enzyme immunoassay in plasma of 32 patients before and after topical treatment. Data were analysed with respect to baseline values of the Psoriasis Area and Severity Index (PASI).Results  Baseline plasma concentrations of both TIMP-1 and MMP-1 (1487 ± 102 and 21.0 ± 2.5 ng/mL, respectively) were significantly higher (P = 0.02 and 0.03, respectively) than normal. Both TIMP-1 and MMP-1 decreased significantly after completion of treatment to values similar to normal (1112 ± 127 and 11.3 ± 1.3 ng/mL, respectively). There was a significant positive correlation (r = 0.522) between baseline PASI and TIMP-1 values. Significant differences were observed between baseline TIMP-1 concentrations in groups with PASI 〈 15 and PASI 〉 20. Baseline values (1697 ± 162 ng/mL) in patients with severe course of the disease (PASI 〉 20) were significantly elevated in comparison to normal values. Treatment caused a decrease in TIMP-1 plasma concentrations in all groups, but a significant difference was noted only in patients with pretreatment PASI 〉 20. Baseline MMP-1 concentrations exceeded significantly normal values only in patients with PASI 〈 15 (27.2 ± 6.3 ng/mL) and 15–20 (18.4 ± 1.4 ng/mL). Treatment caused a significant decrease in MMP-1-values in all groups to levels similar to normal.Conclusions  Our results confirm the role of TIMP-1 and MMP-1 in the pathogenesis of psoriasis. Pretreatment plasma TIMP-1 increased whereas MMP-1 decreased in patients with a more severe course of the disease. However, successful treatment causes normalization of these plasma protein concentrations irrespective of psoriasis baseline activity.

Notes: Objective  To determine the effectiveness and safety of ravuconazole in the treatment of toenail onychomycosis.Design  A phase I/II randomized, double-blind, double-dummy, placebo-controlled, dose-ranging study. Four 12-week dosing regimens were used: 200 mg/day; 100 mg/week; 400 mg/week and placebo. Subjects returned at weeks 2, 4, 6, 8, 10, 12, 14, 16, 24, 36 and 48 for assessment. Subjects were enrolled at 10 dermatology practices (seven in the United States, one in Canada, two in France).Subjects  Adults with distal subungual onychomycosis of one great (hallux) toenail (minimum area of 25%), and at least 2 mm of proximal nail clear of disease were selected. Onychomycosis was confirmed by direct microscopy and/or fungal culture. Subjects with conditions known to produce abnormal-appearing nails were excluded. One hundred and fifty-one subjects were randomized in a 2 : 2 : 2 : 1 ratio to the treatments above.Main Outcome Measures  Primary efficacy was the effective cure rate at week 48 (mycological cure, and clinical cure or 〉 30% improvement).Results  Effective cure was found in 56% of subjects using 200 mg/day. Effective cure was 10% in subjects receiving 100 mg/week, 8% of subjects using 400 mg/week, and 15% of subjects using placebo. Mycological cure was seen in 59% of subjects in the 200-mg/day group, which was significantly higher than the rates found in the other groups. Drug-related adverse events were infrequent in all treatment arms. Headache was the most frequently reported event. Abnormal laboratory tests were infrequent over the 12 weeks of dosing. Abnormal laboratory findings with increases beyond normal of Grade 2, 3 or 4 were found in 8/148 subjects (5.4%). Only the 200 mg daily regimen had a mean plasma steady state concentration of ravuconazole exceeding the MIC90 adjusted for 98% protein binding (3000 ng/mL).Conclusions  For the treatment of onychomycosis, ravuconazole 200 mg/day for 12 weeks is the most effective of the regimens investigated. The safety of all regimens was acceptable. The concentrations of ravuconazole in the plasma compared to the adjusted MIC90 may be useful in predicting the clinical and mycologic response of therapy.

Notes: As the current antipsoriatic medications are commonly associated with deleterious side-effects, a determined search for safer agents, which could be used alone or in combination with current antipsoriatic drugs, would be very imperative. Psoriasis is believed to be characterized by a type 1 cytokine pattern; interferon-γ, interleukin (IL)-2 and tumour necrosis factor (TNF)-α are predominantly expressed in this disorder. Nitric oxide, reactive oxygen species, histamine, leukotriene B4, and increased keratinocyte cyclic adenosine monophosphate/cyclic guanosine monophosphate (cAMP/cGMP) ratio are supposed to play roles in the pathogenesis of this disorder. Based on the immunopathogenesis of psoriasis, this paper introduces three novel, potential treatments for this clinical conundrum: (i) cannabinoids, which exert inhibitory effects on antigen processing and macrophage/T-cell interaction and also on the release of IL-2, TNF-α and nitric oxide from immune cells; (ii) loratadine, which is an antihistamine capable of decreasing the cAMP/cGMP ratio and the production of leukotriene B4; and (iii) allopurinol, which scavenges free radicals, inhibits the production of TNF-α, and downregulates the expression of intercellular adhesion molecule-1 and P2X7 receptors on monocytes/macrophages, which are involved in antigen presentation and production of the inflammatory response, respectively. Importantly, allopurinol, especially in combination with cyclosporin, has been shown to be effective against experimental autoimmune uveitis, which, like psoriasis, is a cell-mediated autoimmune disorder.

Notes: Background  Candidoses are infections caused by yeasts of the genus Candida. ‘Decubital candidosis’ is a particular form of cutaneous candidosis that occurs on the dorsal skin of chronically bedridden patients; there are very few studies about this presentation in the medical literature.Objective  To study the clinical, mycological and histopathological features of 26 cases of ‘decubital candidosis’ along with factors that may predispose to it.Methods  Twenty-six patients were included and their general characteristics and clinical lesions were carefully studied. The presence of candidosis in other organs and the occurrence of predisposing factors were searched by reviewing the medical records. Mycological studies were performed and cutaneous biopsies were taken.Results  Median age of patients was 46 years, 11 were male and 15 were female, 25 were caucasian, one was Asian and no one was Afro-Carribean. This finding suggests a greater resistance of Afro-Carribean skin to this form of candidosis. The median time of hospitalization until rash occurrence was 24.8 days. Clinical lesions consisted of erythema, erosions, pustules, papules and desquamation. The most significant predisposing factors for this eruption were prolonged bedrest and broad-spectrum antibiotics. Candidosis on other body sites was diagnosed in 10 cases and additional specific predisposing factors were observed in all 10. Potassium hydroxide examination was a reliable test for diagnosing this disease. Candida albicans was the agent in all 26 cases. Spongiform pustules were the most significant histopathological findings and yeasts were restricted to the horny layer in all biopsied cases.Conclusion  ‘Decubital candidosis’ is probably induced by prolonged bedrest and facilitated by long-term use of antibiotics. This cutaneous infection does not seem to predispose to systemic candidosis.

Notes: Background  Rosacea is a chronic inflammatory disorder that affects 10% of the population. The prevalence of rosacea is highest among fair-skinned individuals, particularly those of Celtic and northern European descent. Since a cure for rosacea does not yet exist, management and treatment regimens are designed to suppress the inflammatory lesions, erythema, and to a lesser extent, the telangiectasia involved with rosacea.Objectives  This review outlines the treatment options that are available to patients with rosacea.Methods  Published literature involving the treatment or management of rosacea was examined and summarized.Results  Patients who find that they blush and flush frequently, or have a family history of rosacea are advised to avoid the physiological and environmental stimuli that can cause increased facial redness. Topical agents such as metronidazole, azelaic acid cream or sulfur preparations are effective in managing rosacea. Patients who have progressed to erythematotelangiectatic and papulopustular rosacea may benefit from the use of an oral antibiotic, such as tetracycline, and in severe or recalcitrant cases, isotretinoin to bring the rosacea flare-up under control. Treatment with a topical agent, such as metronidazole, may help maintain remission. Patients with ocular involvement may benefit from a long-term course of an antibiotic and the use of metronidazole gel. A surgical alternative, laser therapy, is recommended for the treatment of telangiectasias and rhinophyma. Patients with distraught feelings due to their rosacea may consider cosmetic camouflage to cover the signs of rosacea.Conclusions  With the wide variety of oral and topical agents available for the effective management of rosacea, patients no longer need to feel self-conscious because of their disorder.

Notes: Pityriasis versicolor alba is a hypopigmented or depigmented variant of pityriasis versicolor characterized by maculous, partly pityriasiform, scaly depigmented lesions occurring particularly in seborrhoeic areas. Long-persisting hypopigmentation after healing of the pityriasis versicolor was first described by Gudden in 1853. Hypopigmentation and depigmentation were later differentiated as an independent variant of the disease. In 1848, Eichstedt recognized the pathogen-related character of pityriasis versicolor in its hyperpigmented form. Today it is generally accepted that the disease is caused by yeasts of the genus Malassezia, of which nine species are differentiated. It is controversial whether a single species is responsible for the disease. The pathogenesis of depigmentation has not been established. A screening effect by the scale layer as well as toxic effects on pigment synthesis by fungal metabolites have been discussed. With regard to the second mechanism, the newly discovered tryptophan-derived metabolites of M. furfur might be significant. Evidence-based data concerning the therapy of pityriasis versicolor alba do not exist. According to current recommendations, pityriasis versicolor should be rapidly treated with antimycotics, followed by ultraviolet therapy to induce maturation of existent melanosomes and accelerate repigmentation. However, depigmented lesions are difficult to improve by ultraviolet therapy.