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In this review of oral precancerous lesions, leukoplakia, erythroleukoplakia/erythroplakia and the least common variant proliferative verrucous leukoplakia will be focused with their clinical characteristics and their potential to develop oral squamous cell carcinoma and related factors will be discussed.

Antecedents: La dermatose erosive et pustuleuse est une entite clinique distinctive qui a ete decrite au niveau du cuir chevelu et du genou. Des erosions chroniques et superficielles, couvertes par une croute jaune, se developpent sur la peau atrophiee et fibreuse. Bien que le cuir chevelu soit le site le plus frequent, plusieurs cas de dermatose erosive et pustuleuse au niveau de la jambe ont ete notes. L'histopathologie est non specifique et la maladie est generalement consideree comme un diagnostic d'exclusion. Objectif et conclusion: Nous rapportons le cas de deux patients presentant une dermatose erosive et pustuleuse a la jambe. Le traitement aux agents antibacteriens et antifongiques n'a pas donne de resultats alors que les stetroides systemiques combines, dans un cas, au pimecrolimus topique et, dans l'autre, au clobetasol topique se sont averes efficaces. Nous pensons que cette affection n'a simplement pas recu l'attention necessaire d'ou les rares descriptions publiees a son sujet.

Background Systemic antibiotics currently used in the treatment of rosacea are sometimes associated with uncomfortable side-effects. Therefore, a need for an effective agent with few side-effects and good patient compliance exists. Azithromycin, a macrolide antibiotic with prolonged mode of action, has recently been found to be an effective alternative in the treatment of inflammatory acne. We planned a study to evaluate the efficacy and safety of azithromycin in rosacea. Methods An open-labeled study was performed in a population of 18 patients, with Plewig-Kligman stage 2 rosacea. Patients were given oral azithromycin for 12 weeks in decreasing doses. Results Fourteen subjects completed the trial. The treatment produced therapeutic benefits with regard to total scores as well as inflammatory lesion scores. At the end of 12 weeks, there was a 75% decrease in total scores (P

Background: Heat shock protein (60 kd HSP) has been implicated in the etiology of Behcet's disease, but its expression at sites of inflammation is unknown. Objective: Our aim was to investigate local HSP 60 expression and to quantify T-cell receptor (TCR) γδ-positive cells, which are known to respond to HSP peptides. Methods: Patients with active Behcet's disease (n = 21) and controls (n = 18) were included. Flow cytometric analysis was performed on peripheral blood to investigate TCR γδ-positive cell counts. Biopsies were performed on active skin lesions, and immunohistochemical analysis was performed by a streptavidin-biotin method using the monoclonal ML-30 antibody; HSP staining intensity and distribution were evaluated in a blinded fashion. Immunhistochemical studies were performed to quantify TCR γδ-positive cells at lesional sites. Results: Mucocutaneous lesions of patients with Behcet's disease had statistically significantly increased expression of HSP 60/65. Peripheral blood TCR γδ-positive cell counts were similar in both groups. However, lesional skin of patients with Behcet's disease had significantly increased γδ-positive T-cell counts. Conclusion: Up-regulation of HSP expression was found at lesional skin sites in Behcet's disease. The increased number of TCR γδ-positive cells, which are known to respond to HSP peptides, may support the function of HSPs in the etiology of Behcet's disease. However, these findings may also be an epiphenomenon that needs to be further investigated. (J Am Acad Dermatol 2001;45:904-9.)

Objective: To compare the efficacy of finasteride and spironolactone in the treatment of idiopathic hirsutism. Design: Prospective, randomized, single-blind study. Setting: A tertiary hirsutism clinic. Patient(s): Forty women with idiopathic hirsutism were selected. Intervention(s): Patients were assigned randomly to receive either 5 mg of finasteride or 100 mg of spironolactone for 9 months. Main Outcome Measure(s): Hirsutism scores were measured according to the Ferriman-Gallwey scoring system, and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. Result(s): Hirsutism scores were decreased significantly in both groups at the end of 9 months. The mean percent change (±SD) in hirsutism scores in the finasteride and spironolactone groups was as follows: 5.91% ± 7.18% and 20.60% ± 12.59% at 3 months, 10.61% ± 12.18% and 32.57% ± 15.68% at 6 months, and 15.15% ± 15.38% and 42.36% ± 12.31% at 9 months, respectively. There was a significantly better response with spironolactone treatment at the end of 9 months. Eleven (55%) of 20 patients in the spironolactone group experienced side effects. However, none of them stopped treatment because of side effects. Conclusion(s): The present data suggest that both finasteride and spironolactone are effective in the treatment of idiopathic hirsutism. However, it appears that the spironolactone group responded significantly better.

Objective To compare the efficacy of two antiandrogens, spironolactone and flutamide, in the treatment of hirsutism. Patients, Participants Twenty women with idiopathic hirsutism were randomized to receive either flutamide or spironolactone. Design Twenty hirsute women were recruited from patients presenting to the hirsutism clinic in Marmara University, Istanbul. Each patient underwent a complete medical and gynecological examination as well as endocrine profile, hematologic, hepatic, and renal function analyses. Hirsutism scores were determined according to the Ferriman-Gallwey scoring system. These tests were then repeated at 3, 6, and 9months of therapy. Ten patients received 250mg of flutamide two times per day, and 10 patients received 100mg of spironolactone for 9months. Results Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9months. The percent of change in hirsutism scores in flutamide and spironolactone group were as follows: 26.4% and 20.9% at 3months; 39.5% and 32.9% at 6months; and 46.4% and 39.6% at 9months, respectively. There was a trend toward a better response with flutamide that did not achieve significance. None of the hormonal parameters changed significantly during this period of time. Irregular bleeding was observed in five patients (50%) of the spironolactone group, whereas none of the patients in the flutamide group experienced menstrual irregularity. Conversely, dry skin and increased appetite were experienced by two patients (20%) in the flutamide group but not in the spironolactone group. Conclusion These data suggest that both spironolactone and flutamide were similarly effective in treatment of hirsutism, and the pure antiandrogen flutamide is a safe and effective alternative in treatment.

WOS: 000244244200008, PubMed ID: 17309456, Background Recently, two placebo-controlled studies have shown that topical metronidazole was effective in the treatment of seborrheic dermatitis. Objective To compare the efficacy and safety of metronidazole 0.75% gel with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis. Methods A total of 60 consecutive patients with facial seborrheic dermatitis were included. Patients were randomized into two groups. One group used ketoconazole 2% cream with metronidazole gel as vehicle; the other group used metronidazole 0.75% gel with ketoconazole cream as vehicle for a 4-week treatment period. Main outcome measures were change in clinical severity scores, patients' and investigator's global evaluation of improvement and frequency of side-effects. Results All the assessments were made by an investigator who was unaware of which group the patients were allocated to. Mean percentage decrease in clinical severity scores from baseline to last available visit was 63.4% (95% CI 57.7-69) and 54.4% (95% CI 47.9-61) in the ketoconazole- and metronidazole-treated patients, respectively (P = 0.31). Eighty-two per cent of patients in the ketoconazole group vs. 79% of patients in the metronidazole group rated their global improvement as significant or moderate (P > 0.05). No statistically significant difference in the frequency of side-effects was detected between the two groups. The results of this study need to be confirmed in further studies involving large numbers of patients. Conclusion Our data demonstrated that metronidazole 0.75% gel had a comparable efficacy and safety profile with that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

Promising results have been published in the past with the use of sulfasalazine in alopecia areata. We also observed maintenance of hair growth in refractory alopecia areata patients who were treated with sulfasalazine in combination with oral corticosteroids for 2 to 6 months and sulfasalazine alone for 4 to 12 months while steroids were being tapered. We believe that, because of the small series reported herein, additional larger prospective studies should be conducted to validate these results.

Cicatricial pemphigoid is a rare disease primarily affecting the elderly. Only a few cases of childhood cicatricial pemphigoid have been reported in the literature. We present a case of cicatricial pemphigoid involving the vulvar region in a child.

SummaryIn a patient with multiple myeloma, numerous indurated, subcutaneous nodules and pyomyositis due to Pseudomonas aeruginosa were noted. These lesions resolved with ciprofloxacin plus ceftazidime therapy without surgical incision and drainage. Despite another course of cancer chemotherapy after total disappearance, there were no recurrences at the end of 3 months. Quinolones initially combined with other antipseudomonal s-lactam agents may be the drugs of choice in the management of patients with subcutaneous nodules caused by P. aeruginosa.

Background: Although antiandrogens are frequently and successfully used to treat hirsutism, little attention has been paid to optimal duration of treatment and recurrence rate after cessation of therapy. Objective: Our purpose was to determine the recurrence rate of hirsutism after 3 different antiandrogen therapies. Methods: Eighty-one hirsute women referred to a tertiary hirsutism clinic were assigned to one of three regimens: spironolactone 100 mg/day with an oral contraceptive, cyproterone acetate 50 mg/day on days 1 to 10 with an oral contraceptive, or flutamide 250 mg twice a day. Hirsutism scores according to the Ferriman-Gallwey scoring system and endocrine parameters were evaluated before, during, and 1 year after withdrawal of treatment regimens. Results: Hirsutism scores decreased significantly and similarly in spironolactone, flutamide, and cyproterone acetate treatment groups. However, 1 year after withdrawal of treatment in all antiandrogen therapy groups, hirsutism returned. Conclusion: Antiandrogens are effective in the treatment of hirsutism. However, cessation of antiandrogen therapy is followed by recurrence. (J Am Acad Dermatol 1999;41:64-8.)

BackgroundPapulopustular lesions are common in Behcet’s syndrome (BS). A debate exists as to whether they are different from ordinary acne. This has important clinical and pathophysiologic implications. ObjectiveThe aim of this study was to evaluate the histopathologic features of papulopustular lesions seen both in BS and acne vulgaris (AV). MethodsRepresentative samples were obtained from 17 patients with BS and six patients with AV. The detailed histopathologic features were evaluated by a dermatopathologist blinded to the diagnoses. ResultsConsidering the epidermis, follicle epithelium, and dermis separately, no differences could be found between the two groups. ConclusionsThe papulopustular lesions seen in these two disorders cannot be distinguished on the basis of clinical and histopathologic findings.

Background Chemotherapy-induced acral erythema is a distinct localized cutaneous response to certain systemic chemotherapeutic agents. Methods Between January 1990 and December 1994, from a total of 76 leukemic patients who have received combination chemotherapy consisting of cytosine arabinoside and anthracycline antibiotics, 15 patients developed chemotherapy-induced acral erythema. Fourteen of the patients had acute myelocytic leukemia, and one of them had chronic myelogenous leukemia in blast phase. Clinical features of these 15 patients have been analysed. Biopsy specimens obtained from eight of the patients were also evaluated for histopathologic alterations. Results The overall incidence of this reaction was found to be 19.7% in our group of patients receiving this chemotherapy protocol. The onset of reaction varied from the fourth to the seventeenth days of the chemotherapy and resolved within 2 weeks in most of the patients. Lesions appeared as well-defined erythema and edema involving the palmar surfaces in all of the patients. In nine of the patients the reaction recurred with subsequent chemotherapies. Scattered necrotic keratinocytes, vacuolar alterations of the basal layer, and mild to moderate perivascular lymphocytic infiltration in the dermis were the histopathologic findings observed in the biopsy specimens. Conclusions Chemotherapy-induced acral erythema is a frequent reaction in patients who are receiving high-dose chemotherapy. For patients in whom this self-limited condition develops, reassurance is the mainstay of therapy. Awareness of this reaction is also important to be able to differentiate it from acute graft versus host disease in patients who receive bone marrow transplants.

To compare the efficacy of two antiandrogens, cyproterone acetate (CPA) and spironolactone, in the treatment of hirsutism.Prospective randomized single-blinded study.A tertiary hirsutism clinic.Forty-two premenopausal patients with hirsutism were selected.Subjects were randomized to receive either 100 mg spironolactone and an oral contraceptive (OC) containing 150 microg desogestrel and 30 microg ethinyl E2 or 50 mg CPA daily on days 1 to 10 of the menstrual cycle, which was administered with 35 microg ethinyl E2 daily on days 1 to 21.Hirsutism scores were measured according to Ferriman-Gallwey scoring system and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters.Hirsutism scores were decreaded significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in CPA and spironolactone group were as follows: 19.23% +/- 14.77% and 24.48% +/- 14.27% at 3 months; 39.01% +/- 19.77% and 37.46% +/- 16.90% at 6 months; and 51.89% +/- 20.87% and 46.39% +/- 16.10% at 9 months, respectively. There was a trend toward a better response with CPA treatment, which did not achieve significance. None of the patients stopped treatment because of side effects.The present data suggest that both spironolactone and CPA were similarly effective in treatment of hirsutism.The authors compared the efficacy of two antiandrogens, cyproterone acetate (CPA) and spironolactone, in the treatment of hirsutism. 42 premenopausal patients with hirsutism were randomized to receive either 100 mg spironolactone and an oral contraceptive (OC) containing 150 mcg desogestrel and 30 mcg ethinyl E2 or 50 mg CPA daily on the first 10 days of the menstrual cycle, which was administered with 35 mcg ethinyl E2 daily for the first 21 days. Hirsutism scores were measured according to the Ferriman-Gallwey scoring system and side effects monitored for nine months of treatment. Blood samples were taken at each visit to assess endocrine, biochemical, and hematologic parameters. Hirsutism scores were significantly lower in both groups at the end of nine months. The percent of change in hirsutism scores in the CPA and spironolactone groups were as follows: 19.23% and 24.48% at 3 months, 39.01% and 37.46% at 6 months, and 51.89% and 46.39% at 9 months, respectively. The trend toward a better response with CPA treatment was insignificant. No patient stopped treatment because of side effects.