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Hidrocystomas are benign cysts of sweat duct epithelium that can present as single or multiple lesions, with or without pigmentation. The size is typically 1-3mm in diameter. Although hidrocystomas commonly occur in most parts of the head and neck region, occurrence on the scalp is rare. Herein, we present a 29-year-old woman with a giant pigmented apocrine hidrocystoma of the scalp, which, to our knowledge, represents the largest of its kind reported to date.

Masks are coverings of the face that serve a variety of purposes. Throughout history, they have been used for religious ceremonies, theatric entertainment, protection of identity, and as a tool to limit the spread of infectious diseases. The development of masks in the medical setting has evolved along with our understanding of the mode of disease transmission, material science, and population health dynamics. The simple barrier face mask, surgical mask, and filtering facepiece respirator are each appropriate in different settings. Establishing evidence-based guidance behind the use of masks is essential, particularly in public health crises.

Hidrocystomas are benign cysts of sweat duct epithelium that can present as single or multiple lesions, with or without pigmentation. The size is typically 1-3mm in diameter. Although hidrocystomas commonly occur in most parts of the head and neck region, occurrence on the scalp is rare. Herein, we present a 29-year-old woman with a giant pigmented apocrine hidrocystoma of the scalp, which, to our knowledge, represents the largest of its kind reported to date.

Eruptaneous metastasis is an uncommon presentation of colorectal adenocarcinoma that can occur years after diagnosis of the primary cancer or manifest as the first sign of malignancy. It is essential to diagnose these metastases immediately, as this late-stage development carries a poor prognosis. The scalp is one of the less common sites for skin metastases and nodules may be mistaken for benign entities. In this case report, we report on the case of a 61-year-old woman with CREST syndrome who presented with a cutaneous metastasis to the scalp as the first sign ofcolorectal adenocarcinoma.

Papillary thyroid carcinoma, the most common subtype of thyroid malignancy, rarely presents with cutaneous metastatic spread. Despite metastatic cutaneous lesions presenting as slow and indolent growing nodules of the head and neck, such lesions most frequently appear in the setting of diffuse and dramatic metastatic disease and a bleak prognosis. Given the rarity of these metastatic lesions, the diagnosis may be delayed, and often the initial diagnosis is incorrect. Several case reports have been published in the literature noting unusual or interesting presentations of thyroid carcinoma with cutaneous metastasis. Here we present a classic case of a patient with a prior diagnosis of thyroid carcinoma presenting with a slowly growing ulcerated lesion on the neck nine years after partial thyroidectomy and characteristic histopathology on microscopic examination. Furthermore we review the literature regarding papillary thyroid carcinoma with cutaneous metastasis and the diagnostic challenge these lesions present to practitioners.

Hidradenitis suppurativa (HS) is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring.We reviewed the literature to identify reliable information regarding epidemiology, pathogenesis, clinical manifestations, evaluation and differential diagnosis, treatment, complications, and prognosis.Hidradenitis suppurativa usually affects young women, with a prevalence of 0.3% to 4% in industrialized countries. Once considered to be "apocrine acne," HS is actually a defect of terminal follicular epithelium. Obesity, chemical irritants, or hyperandrogenism are not consistently associated; bacterial involvement is secondary. Hidradenitis suppurativa should be suspected in young adults with recurrent, deep furuncular lesions in flexural sites, especially when such lesions respond poorly to antibiotic therapy. Clindamycin and isotretinoin may be useful, though wide excision with healing by granulation is considered most efficacious. Anemia, arthropathy, and squamous cell carcinoma are potential complications.Since spontaneous resolution is rare and progressive disability the rule, early definitive surgical treatment of HS is advisable.

Desmoplastic leiomyosarcoma is a rare histologic variant of cutaneous leiomyosarcoma seen more commonly in men in their 50s and 60s. This neoplasm typically presents as a solitary, enlarging red-pink nodule or plaque on the extensor surfaces of lower extremities. Its unusual histology mimics other cutaneous desmoplastic lesions and the knowledge of this entity and use of an appropriate immunohistochemical panel is essential to arrive at the correct diagnosis. We report a rare case of desmoplastic leiomyosarcoma of the left flank in a 66-year-old male who presented with itching and pain in a long-standing skin lesion. Histopathology showed the presence of individual and small aggregates of spindle to pleomorphic cells with numerous mitoses in a densely fibrotic stroma. Immunohistochemically, the cells were positive for smooth muscle actin, heavy chain myosin, and desmin, confirming their smooth muscle origin. A diagnosis of desmoplastic leiomyosarcoma was made. We discuss the case with a short review of the literature.

Irritant contact dermatitis (ICD) from plants is a very common phenomenon as potentially irritant plants and plant products are commonly found in the everyday environment, including the home, garden, workplace, and recreational setting. It is therefore essential to have a basic understanding of the various plant-derived physical and chemical irritants. ICD from plants is commonly divided into mechanical irritant contact dermatitis (MICD) and chemical irritant contact dermatitis (CICD). The common mechanical plant irritants include thorns, spines, glochids, trichomes, and sharp-edged leaves. Many chemical irritants have yet to be elucidated, but known culprits include calcium oxalate, protoanemonin, isothiocyanates, bromelain, diterpene esters, alkaloids, and other chemical irritants such as naphthoquinone and acids. This review details the major plant contributors to MICD and CICD, along with their respective irritants. The clinical presentations seen in ICD (versus other plant dermatoses) will also be described, along with diagnostic considerations and exposure data. We also review mechanisms for the development of ICD and current treatments for ICD from plants.

Tungiasis is a cutaneous infestation caused by the burrowing flea, Tunga penetrans. This infection typically results in the development of one or more wart-like fibrous papulonodules. The causative flea is endogenous to Central and South America, sub-Sarahan Africa and portions of India; consequently, tungiasis is rarely reported in North America. However, because of increasing air travel to and from endemic areas due to business and pleasure, it is imperative that this entity remain in the differential diagnosis when evaluating clinically suggestive lesions in a patient who also has a history of recent travel. We report a case of tungiasis in a 24-year-old Caucasian woman who presented with 7-week history of a non-healing, eroded nodule on the medial aspect of her left great toe. Significant history included travel to Tanzania during three months immediately prior to presentation. Following the presumptive clinical diagnosis of tungiasis, surgical removal of the flea and its contents was performed and the base of the lesion was curetted, without complication. The specimen was sent for histopathologic correlation which confirmed the diagnosis.

A simple maneuver is presented which simultaneously facilitates both adequate surgical site exposure and sufficient traction. A single suture with high tensile strength can be utilized to this end. This technique is especially helpful when the cutaneous surgeon is operating alone.

Atypical fibroxanthoma (AFX) is a rare cutaneous spindle-cell neoplasm. The tumor occurs most commonly in sun-damaged skin of the head and neck in elderly patients. A small subset of patients (approximately one in five cases) is middle-aged and presents with AFX of the trunk or extremities in areas without evidence of actinic damage. We report an unusual case of AFX of the lower leg in an 81-year-old woman with extensive actinic damage.

Sinus histiocytosis with massive lymphadenopathy, or Rosai-Dorfman disease, is a benign idiopathic histiocytic proliferative disorder that commonly involves the lymph nodes but secondarily may involve the skin. However, purely cutaneous disease without lymphadenopathy or internal organ involvement rarely may occur. We present case reports of three patients who presented with asymptomatic nonspecific enlarging skin nodules without evidence of lymphadenopathy or internal disease. Histopathologic examination of skin lesions in all patients showed proliferation of large histiocytes with phagocytosed inflammatory cells characteristic of Rosai-Dorfman disease. However, the diagnoses of dermatofibroma, other spindle cell neoplasm, infectious granulomatous process, and other xanthohistiocytic proliferations were also considered due to the presence of storiform spindle cells and foamy cells in the first case. One patient experienced regression during a course of oral steroids, while another patient cleared spontaneously. In the absence of massive lymphadenopathy characteristic of Rosai-Dorfman disease, the diagnosis of purely cutaneous Rosai-Dorfman disease may be complicated by the rarity, non-specific clinical appearance of skin lesions, and broad histopathological differential diagnosis of this disorder. A high index of suspicion of the clinician and pathologist is often required.

Hereditary papulotranslucent acrokeratoderma is a rare autosomal-dominant syndrome of the hands and feet characterized by persistent, asymptomatic, yellowish to white papules and plaques associated with fine-textured scalp hair and an atopic diathesis. Histopathologically, focal hyperkeratosis, hypergranulosis, and acanthosis of the epidermis are seen. We present a case of hereditary papulotranslucent acrokeratoderma in a young adult woman. The literature of this unusual condition is reviewed, and its relationship to acquired papulotranslucent acrokeratoderma is discussed.

Background: Certain histologic subtypes of basal cell carcinoma (BCC) behave more aggressively and require more aggressive treatment. Objective: The aim of this study was to see whether certain subtypes of BCC require more Mohs stages to achieve tumor-free margins. Methods: A retrospective study of 342 primary BCCs treated with Mohs micrographic surgery (MMS) was performed identifying the histologic subtype of BCC present and the number of stages required to clear the tumor. Results: The aggressive subtypes (infiltrative, morpheaform, micronodular, and mixed) were most frequently found when high numbers of Mohs stages were required for cure. Conclusion: The more aggressive subtypes of BCC require more MMS stages to achieve tumor-free margins, which is consistent with the concept that these subtypes usually require more aggressive treatment from the start. (J Am Acad dermatol 1997;37:395-7.)

Punch biopsy is a standard method for obtaining tissue sample in dermatology.The objective is to convey the use of towel clips when forceps are not available in performing a punch biopsy.After informed consent, a punch biopsy was performed when clinically indicated, using towel clips in place of forceps to aid in removal of the specimen from the patient.The biopsy sample was satisfactory without tissue trauma or crush artifact.A towel clip is a reasonable alternative when forceps are not available when performing a punch biopsy.

Multiple advances in the field of transplantation over the last several decades have resulted in a significant increase in the number of surgeries performed and in years of life extended. However, with the success of transplant comes the dilemma of potential complications of lifelong immunosuppressive therapy. An enormous increase in skin cancer, especially highly-aggressive squamous cell carcinoma, may affect this special population of patients. This review article discusses the main etiologic theories of squamous cell carcinoma, characteristics of skin cancer in the immunosuppressed patient, differences in skin cancer amongst three types of solid-organ transplantation (kidney, heart, and liver), and established and new treatments.

This article presents information regarding the anatomic and physiological basis of hypnotic type trances and dissociation. Conjugated upward deviation of the eyes, as well as the so-called "rolling of the eyes" (explained in the text), which are present during trances, are suitable entry points for the study of the anatomic substrate underlying these experiences. The thalamus, posterior commissure, pretectal zone, and Cajal and Darschewitsch nuclei are the anatomic zones related with the upward gaze, "eye rolling" and trance type changes of consciousness. Independently of these facts, at least three different types of trance behavior can be differentiated: the form that we call passive is present in physiological sleep, and consists of the eyes turning upwards spontaneously. In the form called active, the trance is linked clearly to the upward stare and ocular rotation. Finally, a form that we call intermediate in this study accompanies personality changes in multiple personality disorder and some cases of psychogenic flight. This study attempts to demonstrate that the conjugated upward deviation of the eyes can be, in the absence of another disorder, a first-order indicator of disorder of consciousness of the type found in dissociative disorders.

Desmoplastic malignant melanoma is an uncommon neoplasm that presents both as a clinical and diagnostic challenge. Prognosis is frequently adversely affected by misdiagnosis and delayed diagnosis of this tumor, which is often amelanotic. We report a case of an amelanotic desmoplastic malignant melanoma that presented as an erythematous nodular tumor.

Bernstein and Putnam's Dissociative Experiences Scale is a standarized, often validated instrument, useful in the screening of dissociative symptoms. We applied the scale in a Spenish population sample in order to obtain baseline data regarding dissociative experiences in our country. On the other hand, we persued a transcultural validation of the scale. We found in our sample similar data as those obtained in other American and European studies, although Spanish psychiatric patients seem to have a notable difficulty in handling with the concept of "amount of time" used in the scale as a cuantification of the different dissociative experiences.

Although most victims of disasters recover on their own, a minority of survivors, uniformed services, and relatives develop long-term disaster related psychic disorders such as Posttraumatic Stress Disorder (PTSD). Especially this subgroup should receive timely and appropriate psychosocial help. In many EU countries is offered post-disaster psychosocial care by a variety of caregivers (i.e. professionals and volunteers, NGOs, church or commercial organizations). Therefore, European standardization of providing post-disaster psychosocial support is currently required. The presentation describes the project supported by the European Commission and named European Guideline for Target Group Oriented Psychosocial Aftercare – Implementation (EUTOPA-IP), supported by the European Commission. EUTOPA-IP has integrated two materials: German “Target Group Intervention Programme” and Dutch “Multidisciplinary guideline”, also with the experiences of experts in the area of psychosocial support from the EU countries. Main target is to develop a guideline for the uniformed services on the basis of the Multidisciplinary guideline for early psychosocial interventions, the adaptation of the Target group Oriented Intervention Program (TGIP) to the International Classification of Functioning, Disability and Health (ICF) and preparation and implementation of training program for various professional groups. The project aims at standardization of psychosocial aftercare in case of disasters as well as at the development of European network based on current findings in psychotraumatology. Early screening, supportive context, early preventive and curative psychosocial interventions, management of interventions, implications for the clinical field and future research are topics discussed in the project. Project consortium: – City of Cologne (Germany)– Centre of Psychotraumatology (Germany)– Impact (The Netherlands)– Spanish Society for Psychotraumatology and Traumatic Stress (Spain)– Charles University in Prague (Czech Republic)– Capital City of Dusseldorf, Department of Public Health (Germany).

Tumors of the nail unit are often initially misdiagnosed or diagnosed later in their course than their skin counterparts. This is probably because the nail can obscure the lesion or many nail tumors mimic inflammatory dermatoses of the nail unit. Both benign and malignant tumors of the nail unit are described.

Mammalian adenosine deaminase has been shown by genetic and biochemical evidence to be essential for the development of the immune system. For the purpose of studying the function and structure of this enzyme, we have isolated by genetic selection a mouse cell line, B-1/50, in which adenosine deaminase levels were increased 4,300-fold over the parent cell line. The enzyme was purified from these cells in large quantity and high yield by a simple two-step purification scheme. The enzyme derived from the B-1/50 cells was indistinguishable from that of the parental cells as judged by several biochemical criteria. The Km (30 microM) and Ki (4 nM) values using adenosine as substrate and 2'-deoxycoformycin as inhibitor, respectively, were identical for the enzyme derived from the parental cells as well as the adenosine deaminase gene amplification mutants. The enzyme from both cell types exhibited multiple isoelectric focusing forms which co-purified using our purification protocol. Electrophoretic analysis using sodium dodecyl sulfate-polyacrylamide gels showed that adenosine deaminase migrated with an apparent molecular weight of 41,000 or 36,000 depending on whether the enzyme was reduced or oxidized, respectively. This shift was reversible, indicating that proteolysis was not responsible for the faster migrating form. Monospecific antibodies raised against purified adenosine deaminase cross-reacted with the enzyme derived from the parental cells and precipitated 37% of the total soluble protein in the B-1/50 cells. Continued genetic selection resulted in the isolation of cells in which adenosine deaminase was overproduced by 11,400-fold and accounted for over 75% of the soluble protein.

Mammalian adenosine deaminase has been shown by genetic and biochemical evidence to be essential for the development of the immune system. For the purpose of studying the function and structure of this enzyme, we have isolated by genetic selection a mouse cell line, B-1/50, in which adenosine deaminase levels were increased 4,300-fold over the parent cell line. The enzyme was purified from these cells in large quantity and high yield by a simple two-step purification scheme. The enzyme derived from the B-1/50 cells was indistinguishable from that of the parental cells as judged by several biochemical criteria. The Km (30 microM) and Ki (4 nM) values using adenosine as substrate and 2'-deoxycoformycin as inhibitor, respectively, were identical for the enzyme derived from the parental cells as well as the adenosine deaminase gene amplification mutants. The enzyme from both cell types exhibited multiple isoelectric focusing forms which co-purified using our purification protocol. Electrophoretic analysis using sodium dodecyl sulfate-polyacrylamide gels showed that adenosine deaminase migrated with an apparent molecular weight of 41,000 or 36,000 depending on whether the enzyme was reduced or oxidized, respectively. This shift was reversible, indicating that proteolysis was not responsible for the faster migrating form. Monospecific antibodies raised against purified adenosine deaminase cross-reacted with the enzyme derived from the parental cells and precipitated 37% of the total soluble protein in the B-1/50 cells. Continued genetic selection resulted in the isolation of cells in which adenosine deaminase was overproduced by 11,400-fold and accounted for over 75% of the soluble protein.

An open study testing the effects of fish oil supplementation on psoriasis in 26 patients is described. None of the patients with plaque-type psoriasis vulgaris showed clinically significant improvement; however, a patient with generalized pustular psoriasis showed marked improvement with the fish oil supplementation. In this patient, scale leukotriene B4 levels were determined and shown to be significantly decreased after completion of the study, but the leukotriene B4 levels did not correlate with her clinical course. The results of our study are contrasted with those of a recent study that did show beneficial effects of fish oil supplementation on plaque-type psoriasis.

The solitary brown macule is a common skin lesion that may be benign or malignant. The lesion may represent a disorder of melanocytes, nervus cells or hemosiderin. Clinical differentiation can be difficult, and biopsy may be necessary for a definitive diagnosis.

Monozyten (MO)/Makrophagen (MO) nehmen im unspezifischen wie im spezifischen Abwehrgeschehen eine zentrale Stellung ein (s. Referenz 7). Bei entzundlichen Prozessen kann daher stets eine Aktivierung von MO/ MO angenommen werden. Ein Mas fur Aktivitat von MO/MO stellt die „burst“-Aktivitat (bA) dar. In einer kurzlich publizierten Arbeit (2) haben wir die bA beschrieben und kritische Bedingungen fur ihre Messung aufgezeigt. Hier soll am Beispiel einer Patientin mit lymphozy-tarer Meningoenzephalitis sowie zweier MS-Patienten paradigmatisch die Beziehung der bA zu anderen Laborparametern sowie dem klinischen Krankheitsverlauf dargestellt werden.

Waldenström's macroglobulinemia is a lymphoproliferative disorder that only rarely exhibits specific cutaneous findings. The authors present a case of Waldenström's macroglobulinemia in which the patient developed cutaneous lesions while his systemic disease seemed to be under control with chlorambucil therapy. A review of the scant literature regarding the response of cutaneous Waldenström's to treatment suggests that the skin lesions do not respond well to systemic therapy. This case was successfully treated with radiotherapy.