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A 73-year-old African American female presented to our clinic with painful lower extremity lesions of 2 weeks duration. She was in her usual state of health until 3 months prior to presentation when she reported symptoms of fatigue and weakness. She also noticed an enlarging mass on the left side of her neck. She denied fevers, chills, night sweats or cough. Her symptoms were unresponsive to a course of oral dicloxacillin. The neck mass enlarged over 8 weeks and she was referred to our institution for evaluation. CT scan of the neck showed an enlarged lymph node. Ten days prior to her presentation in dermatology, a fine needle aspirate of the enlarging lymph node revealed necrotizing granulomas. Tissue was sent for routine mycobacterial and fungal cultures. Routine blood work, chest radiograph, and a tuberculin skin test were also performed. At the time of her dermatology visit she described the development of multiple new painful, non-pruritic lesions, bilaterally on the lower extremities. She also reported a red crusted area that appeared at the site of her tuberculin test that was placed subsequent to the development of her lower extremity lesions. Her past medical history was significant for Parkinson's disease, hypothyroidism and hypertension. Her current medications included L-thyroxine, estrogen and diltiazem. Her travel history was only remarkable for a trip to Jamaica the previous spring. She was born and raised in Haiti. She reported a history of a positive tuberculin skin test 20 years ago, but received no therapy. Physical examination revealed a 2 x 3 centimeter firm, nontender left lateral neck mass (Fig. 1). Her right forearm revealed an erythematous, ulcerated, indurated plaque 1.5 cm in diameter (Fig. 2.). Her lower extremities revealed tender 0.5 to 1 cm erythematous nodules below the knees bilaterally (Fig. 3). A punch biopsy of a lower extremity nodule revealed a mild pervisacular dermal infiltrate. Within the subcutaneous tissue there was... [ABSTRACT FROM AUTHOR]

Scrofula usually develops in the immunocompromised patients, which include patients with human immunodeficiency virus infection, patients taking immunosuppressive agents or biologic DMARD for rheumatic disorders. A 73-year-old woman with diabetes mellitus and rheumatoid arthritis (RA) had intermittent fever and painful right neck masses that were enlarging 2 weeks prior to admission. The patient thus took a 6-month isoniazid as treatment for latent TB infection. [Extracted from the article]

The article presents information on tuberculosis (TB) of the skin and its treatment. Researcher Robert Koch reported on his bacteriological findings on TB in 1882. He stained and cultured tubercle bacilli and reported the transfer of TB to animals with these cultures. With these methods, he demonstrated that tubercle bacilli cause the various lesions of TB, including scrofula, associated with lupus vulgaris. Koch's postulates, which derive from his findings on tubercle bacilli, provide the key methods for identifying the causative agent of scrofula, lupus vulgaris, and related forms of TB of the skin.

The article presents information on extracorporeal photopheresis (ECP) which is a relatively new and promising alternative therapeutic modality. It simply is the extracorporeal treatment of a particular subset of cells with psoralen and ultraviolet A. It is rather unique in that the technique provides marked selectivity in treating the diseased cells only. It was discovered that sunlight is a therapeutic agent in the treatment of rickets, scrofula, rheumatism, paralysis etc. So phototherapy became popular.

The article discusses dermatology throughout the dark ages. The Anglo-Saxon Herbal, from about 1000 A.D. shows a genuine interest in the curative properties of herbs and gives the conditions for which they were used. The physician was known as the Leech in Anglo-Saxon times. He was adjunct to the priest, who was ordained as the overall spiritual power. Records show that from the 7th to the 11th century, leprosy was rife, as were psoriasis, eczema, scrofula and syphilis. A ban against noise was employed in certain inflammatory skin conditions, with beneficial effect. The Arabians, who exhibited a remarkable devotion to scientific truth introduced a number of effective remedies for certain skin diseases.

The article focuses on the history of cutaneous tuberculosis. Tuberculosis has been a well-known affliction of mankind from antiquity. Lung fever and lung cough with accompanying symptoms of emaciation and hemoptysis have been mentioned in the old Chinese writings. Lupus vulgaris seemed to have been prevalent in Palestine before and during the time of Christ, and was included in the conditions termed Tsara'ath in the Old Testament and Gospels. Scrofuloderma was described by the ancient French writers who called it scrofulous gumma. For many centuries, scrofula along with lupus vulgarisand other non-pulmonary manifestations of tuberculosis was considered curable by the touch of a reigning monarch, hence was also known as Kiing's Evil.

Cervicofacial actinomycosis is an uncommon, chronic, suppurative, and granulomatous bacterial infection. It is often of dental origin and tends to mimic other dental infections, granulomatous disorders, and cancers. The initial diagnostic workup, predicated upon imaging and tissue biopsies, is frequently nonspecific. A definitive diagnosis is usually rendered only after surgical excision and histologic examination of the cervicofacial mass. We propose a classification of three stages: localized infection without sinus involvement, localized infection with sinus involvement, and disseminated infection, to facilitate recognition, diagnosis, and early aggressive treatment. Untreated infection may be life‐threatening. Therapy may require long‐term antibiotics; however, many cases may also necessitate complete surgical excision. [ABSTRACT FROM AUTHOR]

The article presents a case of gonococcal arthritis. The patient discussed in the article, first came at the Hospital for Sick Children in November 1870. The patient was then suffering from chronic synovitis of the right knee. The patient appeared moderately healthy and exhibited no sign of scrofula or tubercle. The knee disease was of twelve months duration and had its origin in a fall, by which he injured the joint. He was kept at rest and discharged in January 1871 free from pain, with the joint in a splint. The joint had in the meantime become rapidly worse, abscess had formed and burst and his health had much deteriorated.

Background 'Tender cutaneous nodules of the legs' is a common manifestation in dermatology. Histopathological investigation is usually required for this condition, because clinical data are frequently insufficient to make a definite diagnosis. Objective To identify and analyze the causes of patients presenting with tender leg nodules and to reveal clinical clues that could help to differentiate causes. Materials and methods The medical records and histopathological slides of patients presenting with tender cutaneous nodules of the legs between January 2005 and December 2007 were retrospectively reviewed. Results Of the total of 154 patients, 122 (79.2%) were female. Definite diagnoses were categorized into four groups: inflammation (84.4%); infection (5.8%); tumor (6.5%); and nonspecific (3.2%). The most common cause in the inflammation group was erythema nodosum. The infections found were Acremonium spp., Penicillium sp., Mycobacterium abscessus, Mycobacterium fortuitum and Mycobacterium leprae. The tumors included leiomyoma, leukemia cutis, and lymphomas. Clinical data that correlated with and could be used as clues for the inflammation group were female sex ( P = 0.03, OR 6.43) and lower leg involvement ( P = 0.03, OR 7.14). Limitations The retrospective manner of this study is a limitation. Conclusion Various inflammatory conditions, infections, and tumors can present as tender cutaneous nodules of the legs. Female sex and lower leg involvement were clinical data that could be used as clues for the diagnoses in the inflammation group. However, histopathological investigation is still crucial to determine a definite diagnosis in patients presenting with tender cutaneous nodules of the legs. [ABSTRACT FROM AUTHOR]

Scientific research has greatly expanded the therapeutic options for patients with cutaneous disease. This expansion, however, has not been without its drawbacks. While newer medications and procedures not only typically offer better disease control but they are also often associated with increased expense and problematic toxicities. Older medications often relegated to the dustbin of history may provide effective treatment of common dermatologic maladies and deserves reconsideration. Ichthammol, derived from shale oil, has been employed in the therapy of psoriasis, eczematous dermatitis, leg ulcers, seborrheic dermatitis, and furuncles for over a century and remains a useful topical medicament. [ABSTRACT FROM AUTHOR]

Background According to the World Health Organization (WHO), 80% of the world's population uses medicinal plants in the treatment of diseases and, in African countries, this rate is much higher. In recent years, however, medicinal plants have represented a primary health source for the pharmaceutical industry. No less than 400 compounds derived from plants are currently used in the preparation of drugs, such as vincristine and vinblastine used in the treatment of cancer. Nigerians still depend largely on crude herbal remedies or traditional medicine. They also use wild plants for cosmetics and perfumery. Some of these herbal remedies have been observed to be effective in certain skin diseases. Methods The data were obtained from history questionnaires completed by patients at the Dermatology Clinic, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria, and from oral interviews with vendors and prescribers of herbal preparations at major markets at Lagos and Ijebu-Ode in south-west Nigeria, between July 2004 and July 2006. Photographs of plants were taken at private residences at Lagos, Ibadan, and Ijebu-Ode in south-west Nigeria. A literature search was conducted on 38 of the plants. The data are presented in tabular form. Results Sixty-five per cent of patients had applied some form of herbal remedy before attending our clinic. The reasons for consultation included relapses, unsustained relief, incomplete resolution, and post inflammatory hyperpigmentation. Lesions for which herbs were successfully applied included infantile eczema and seborrhoiec dermatitis, atopic eczema, impetigo, impetiginized eczema, tinea capitis, scabies, erythema multiforme, leg ulcers, localized vitiligo, and sexually transmitted diseases. Partial relief was achieved in dermatophytoses, ichthyosis, leprosy, and systemic lupus erythematosus (SLE). Some forms of alopecia, onychomycosis, and vitiligo, as well as allergic dermatoses, were not improved by herbal medicines. The preparation of the remedies was mostly by heating and boiling, infusion, and maceration. In most cases, mixtures of plants or other substances were used. The preparations were applied as poultices, ointments, baths, soaks and soaps, and oral fluids. The plants used included Adansonia digitata, Aframomum melegueta, Aloe species, Azadirachta indica, Cassia alata, Alstonia boonei, Ficus asperifolia, Cocos nucifera, Jatropha gossypyfolia, Ocimum gratissimum, Ricinus communis. A literature search on 38 of the plants used by herbal prescribers revealed the presence of established antimicrobial agents, immune modulating agents, antioxidants, other vitamins and minerals, volatile oils and emollients, and anti-inflammatory agents. Some of the plants may be contaminated by mycotoxins because of poor storage. Conclusion There appears to be clinical, scientific, and pharmacologic basis for the use of herbal preparations. Nigeria needs to provide effective coordination of the practice of herbal medicine to ensure safety, standardization, and preservation of the flora. [ABSTRACT FROM AUTHOR]

Abstract Background The number of aged people is increasing. It is conceivable that we will be treating considerably more aged patients with more surgical risk factors in the very near future. Methods During the period between 1976 and 1996, 212 patients of 80 years of age and older underwent skin surgery at the Mie University Hospital, Japan. Among them, 25 patients of 90 years of age and over were studied. Results Fourteen patients (56.0%) have undergone skin surgery in the past 5 years; 22 patients (88.0%) had skin tumors on the face and ears; squamous cell carcinoma was found in 17 patients (68.0%), while basal cell carcinoma was seen in four patients (16.0%). Despite their advanced ages, half of the patients had no medical contraindications to performing surgery. Conclusions Careful preoperative management may allow more cutaneous surgery to be carried out in aged people. [ABSTRACT FROM AUTHOR]

Background A series of clinical trials lasting up to 4 years had demonstrated that topical tretinoin improves facial appearance by reducing the visible signs of photodamage. Objective This paper reviews the studies designed to explore the relationship between clinical improvement and histologic changes. Methods Histologic changes in biopsies taken at various time points from clinical trial participants were examined by pathologists blinded to treatment regimens. Results Histologic evaluations of photodamaged skin during the course of treatment with tretinoin have revealed an array of time-dependent morphologic changes which can be classified as early, intermediate, and late. Initial changes in fine wrinkling and texture appear to correlate with epidermal mucin and compaction of the stratum corneum, but the latter is transient and ultimately returns to pre-treatment levels. Alterations in dermal matrix components have been noted with prolonged treatment. Partial restoration of the dermal collagen by new synthesis may contribute to the sustained improvement in fine wrinkling noted even when the treatment frequency is reduced from daily to three times weekly. As treatment is continued beyond 24 months, the collagen organization continues to improve and elastosis continues to decrease. Increases in epidermal and dermal mucin and decreases in epidermal melanin are consistent throughout the treatment period. The reduction in the hyperpigmentation of photodamage is comparable with the histologic and clinical improvements seen when tretinoin is used to treat conditions such as melasma. No adverse effects on the histopathology of the skin are noted with long-term exposure to tretinoin. Neither keratinocyte nor melanocyte atypia is detected. Conclusions Although there does not seem to be a direct correlation between histologic changes and clinical improvement, the major structural changes appear to be directed at restoring the skin to the pre-sun-damaged state. [ABSTRACT FROM AUTHOR]

The article presents a bibliography of secondary sources on the history of dermatology. Some of the articles are: "Trends in Medical Education"; "Naming Acquired Melanocytic Nevi, Common and Clysplastic, Normal and Atypical or Unna, Miescher, Spitz, and Clark?"; "Scurvy in Medical Dissertations of the 17th and 18th Centuries"; "Dermatology 50 years Ago"; "The History of the Space Dermatology Foundation" etc.

The article focuses on the use of thermal baths in the treatment of skin disease in old time Ethiopia. The Ethiopians, who live in a region of intense past and present volcanic activity, have long made use of hydrotherapy in the treatment of skin disease and leprosy, as well as syphilis, rheumatism, and other complaints. Thermal springs were used throughout the Ethiopian region. Some of the best known were situated, between Lake Tana and the old town of Debra Tabor. Several of the most celebrated bubbled up near the Gumara River in Fogara.

There presents information about cutaneous manifestations of the Acquired Immunodeficiency Syndrome (AIDS) and related diseases. The infections such as histoplasmosis, cryptococcosis and herpes simplex may be present as skin lesions that clinically mimic another disease. Neoplastic processes such as Kaposi's sarcoma and lymphoma may appear on the skin as small, benign-looking and inconspicuous lesions. Biopsy, acid-fast and fungal staining and appropriate culture of all skin lesions in AIDS patients are mandatory even if the clinical diagnosis seems certain. The article further suggest when a patient at high risk for AIDS presents with any of the above mentioned cutaneous manifestations, the clinician should be alert to the possibility of this disease.

The article presents perceptions regarding syphilis, leprosy, tuberculosis and medical therapy. Syphilis was a subject of major interest in medicine and certainly dermatology because of its cutaneous manifestations. The study of the cutaneous symptoms of leprosy was of great value to dermatology as it fostered a more intense interest in skin diseases as well as a more careful observation and recording of symptoms. Medical therapy itself is rooted in magic and superstition, a jungle of spell casting and sorcery, astrology, mystical devotions and incantations, botanical medicine and bloodletting.

Presents a review of literature on pediatric dermatology. Illustrations of various dermatologic lesions by Walter C. Dendy; Monograph by Heinrich Bohn on diseases of the skin; Publication of the illustrated book "Skin Affections of Childhood," based on H. G. Adamson's own experiences.

Describes various cases of skin diseases in homosexual patients with acquired immune deficiency syndrome. Diagnosis of cutaneous disorders; Clinical manifestations of the disease; Infections and syndrome related to AIDS.

Discusses the pathology of epitheloid granulomas classified under group 1. Similarity of the microscopic tissue morphology of well-organized granulomas containing large numbers of epitheloid cells of these diseases; Characteristics of sarcoidosis; Difficulty of the histologic differentiation of lesions of sarcoidosis from tuberculoid leprosy, lupus vulgaris, berylliosis, and zirconium granuloma.

Aims to understand the relationship between microorganisms and the diseases with which they appeared to be associated. Observations on the use of the microscope in investigations connected with anatomy, physiology and pathology; Attitudes towards host-parasite relationship; Focus on the pioneers of medical mycology. INSET: Dermatology 1904.

Provides clinical information on dermatitis herpetiformis. Association of dermatitis herpetiformis with gluten-sensitive enteropathy (celiac sprue); Symptoms of the disease; Types of therapy for the disease.

This article focuses on the state of dermatology in earlier Mexican history, during pre-Columbian period. The Indians of Mexico, the Nahuas and specially the Aztecs, recognized many dermatoses and devised for their treatment specific and evidently adequate remedies. Many of these, mainly resins and the leaves of and extracts of plants are still in use. The Nahuas classified cutaneous diseases into traumatic, inflammatory, and nutritional dermatoses. The Nahuas also had an elaborate classification of ulcers, with separate methods of therapy for each kind.

The article presents a historical account of dermatology in Buddhist Sri Lankan literature. It provides a background of the origins of Buddhism in Sri Lanka during the era of the Indian Emperor King Asoka. It looks at writings of interest and relevance to dermatology in Buddhist teachings, including the "Girimananda Sutra." The description of psychodermatology in Buddhist philosophy is also presented.

This article presents the different topics which were discussed by the members of the American Academy of Dermatology in their 30th annual meeting in the Palmer House in Chicago. Arthur Kornberg, professor of Biochemistry at Stanford, spoke on DNA, deoxyribonucleic acid which carries all the details of where we came from and of where we are going. Chief of the Division of Geographic Pathology in the Mined Forces Institute of Pathology, Daniel H. Connor spoke on five dermatoses he had studied in tropical Africa.

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Baciliary angiomatosis (BA) is a newly described, newly recognized bacterial infection that commonly involves the skin. A monoclonal antibody directed against the cat scratch bacillus was found to react with the organisms in tissue. The causative organism of BA was identical to that which causes cat scratch disease (CSD). Although the CSD bacillus had been cultured, neither definitive biochemical tests nor genetic studies had been performed on it. Broth cultures could hardly be maintained and subculture to semisolid media had been accomplished but once with a single subculture possible.

This article sites a study on a 45-year-old white woman suffering from pyostomatitis vegetans (PSV). PSV is a rare form of stomatitis, which is considered a marker for inflammatory bowel disease. The primary lesion of PSV is a small 2-3 mm pustule. As the disease progresses, these lesions coalesce with resulting mucosal ulcerations that have a distinctive "snail track" appearance. Pyostomatitis vegetans occurs mostly over the anterior portion of the oral mucosa, particularly over the gingivae and sulci and on the labial and buccal mucosae. The case described herein demonstrates that pemphigoid may mimic the distinctive "snail track" appearance of pyostomatItis vegetans in a patient with inflammatory bowel disease.

The article reports a case of Verruca vulgaris inoculated during tattoo placement. A 27-year-old black man who was incarcerated at the time of presentation complained of small raised lesions that had begun approximately 2 months previously in the lines of a tattoo placed 8 years before. Physical examination revealed a black man with a tattoo in the shape of a butterfly on the right scapular area. The tattoo consisted of dark blue lines outlining the wings and body of the butterfly and the lettering of the name. The clinical appearance suggested filiform verrucae vulgaris. Although the infectious nature of human papilloma virus has been well established, patients are usually unaware of the mode or time of exposure and inoculation.

Presents the table of contents for the March 2002 issue of the periodical 'International Journal of Dermatology.'

Observations yet want which would justify researchers in believing that any special tendencies to disease are implied by differences in the pigmentation of the hair and skin. It is in external diseases chiefly, such as lupus, psoriasis, and the like, of which the diagnosis is easy, that researchers should find the best opportunities for testing prevalence in relation to complexion.

The article discusses that in the early periods of life, eruptions of various sorts make their appearance, of which it is impossible to convey an accurate idea, by mere description, divested of technical terms. Some resemble measles, others the small pox; some have the appearance of nettlerash, and others of what has been vulgarly called Scurvy, and technically called herpes: all these eruptions, however different in appearance, yield to a well-regulated use of the warm or medicated bath, with occasional calomel purgatives.

Reports on the inaugural lecture of dermatologist M. Lailler on the general principles of cutaneous affections. Category of the new class of cutaneous diseases; Terminologies for the disease; Manifestations of a general affection or diathesis.