David S. Hallegua, MD

• Assistant Professor of Medicine, Cedars-Sinai
• Medical Center, David Geffen School of Medicine
• at UCLA, Los Angeles, CA, USA

Subungual melanoma: A study of 124 cases highlighting features of early lesions bipolar depression 75 purchase abilify 15mg with visa, potential pitfalls in diagnosis depression test crying cheap abilify 15 mg online, and guidelines for histologic reporting depression symptoms guilt purchase abilify 5mg without a prescription. Childhood subungual melanoma in situ in diffuse nail melanosis beginning as expanding longitudinal melanonychia depression lack of motivation purchase abilify online. Presentation depression definition geology proven abilify 10 mg, histopathologic findings anxiety kids cheap 10mg abilify with mastercard, and clinical outcomes in 7 cases of melanoma in situ of the nail unit. Specific dermoscopy patterns and amplifications of the cyclin D1 gene to define histopathologically unrecognizable early lesions of acral melanoma in situ. Malignant melanoma of mucous membranes: A clinicopathologic study of 13 cases in Japanese patients. Histopathological characteristics of malignant melanoma affecting mucous membranes: A unifying concept of histogenesis. Oral malignant melanoma associated with pseudoepitheliomatous hyperplasia: Report of a case. Malignant melanoma of the vulva in a nationwide, 25-year study of 219 Swedish females: Predictors of survival. Desmoplastic malignant melanoma on the buttock of an 18-year-old girl: Differentiation from desmoplastic nevus. Desmoplastic malignant melanoma of the lip: A report of 6 cases and review of the literature. Desmoplastic and neurotropic melanoma: Analysis of 33 patients with lymphatic mapping and sentinel lymph node biopsy. Desmoplasia and neurotropism: Prognostic variables in patients with stage 1 melanoma. Desmoplastic melanoma: A pathologically and clinically distinct form of cutaneous melanoma. Cutaneous desmoplastic melanoma: Reappraisal of morphologic heterogeneity and prognostic factors. Lessons from tumor progression: the invasive radial growth phase of melanoma is common, incapable of metastasis, and indolent. Lessions from tumor progression: the invasive radial growth phase of melanoma is common, incapable of metastasis, and indolent. Angiogenesis and malignant melanoma: Angiogenesis is related to the development of vertical (tumorigenic) growth phase. Cutaneous malignant melanoma: Correlation between neovascularisation and peritumor accumulation of mast cells overexpressing vascular endothelial growth factor. Immunoreactivity of -melanocytestimulating hormone, adrenocorticotrophic hormone and -endorphin in cutaneous malignant melanoma and benign melanocytic naevi. Expression of the mast cell growth factor interleukin-3 in melanocytic lesions correlates with an increased number of mast cells in the perilesional stroma: Implications for melanoma progression. Melanocytes in nevi and melanomas synthesize basement membrane and basement membrane-like material: An immunohistochemical and electron microscopic study including immunoelectron microscopy. Protocol for the examination of specimens from patients with melanoma of the skin. Histopathologists can diagnose malignant melanoma in situ correctly and consistently. Melanoma histopathology reporting: Are we complying with the National Minimum Dataset When to ask your dermatopathologist to evaluate for surgical margins and when not: A matter of confusion for dermatologists and dermatopathologists alike. Discordance in the histopathologic diagnosis of difficult melanocytic neoplasms in the clinical setting. Pathology review of cases presenting to a multidisciplinary pigmented lesion clinic. Expert review remains important in the histopathological diagnosis of cutaneous melanocytic lesions. Pitfalls in the diagnosis of malignant melanoma: Findings of a risk management panel study. Incomplete biopsy of melanocytic lesions can impair the accuracy of pathological diagnosis. Morphometric discrimination of melanoma in situ of sun-damaged skin from chronically sun-damaged skin. Melanoma in situ versus melanocytic hyperplasia in sun-damaged skin: Assessment of the significance of histopathologic criteria for differential diagnosis. Histologic similarities between lentigo maligna and dysplastic nevus: Importance of clinicopathologic distinction. The starburst giant cell is useful for distinguishing lentigo maligna from photodamaged skin. The impact of in vivo reflectance confocal, microscopy on the diagnostic accuracy of lentigo maligna and equivocal pigmented and nonpigmented macules of the face. Consumption of the epidermis: A criterion in the differential diagnosis of melanoma and dysplastic nevi that is associated with increasing Breslow depth and ulceration. Cleft formation and consumption of the epidermis in cutaneous melanocytic lesions [and reply]. Subepidermal cleft formation as a diagnostic marker for cutaneous malignant melanoma. Verrucous naevoid and keratotic malignant melanoma: A clinico-pathological study of 20 cases. Cutaneous malignant melanoma associated with extensive pseudoepitheliomatous hyperplasia: Report of a case and discussion of the origin of pseudoepitheliomatous hyperplasia. Pseudoepitheliomatous hyperplasia in cutaneous malignant melanoma: A rare and misleading feature. Histological and genetic evidence for a variant of superficial spreading melanoma composed predominantly of large nests. Automated detection of malignant features in confocal microscopy on superficial spreading melanoma versus nevi. Early detection of thick melanomas in the United States: Beware of the nodular subtype. Nodular type and old age as the most significant associations of thick melanoma in Victoria, Australia. Erythrophagocytic tumour cells in melanoma and squamous cell carcinoma of the skin. Nestin expression is associated with aggressive cutaneous melanoma of the nodular type. Prognostic importance of the mitotic marker phosphohistone H3 in cutaneous nodular melanoma. Blue-black rule: A simple dermoscopic clue to recognize pigmented nodular melanoma. Early acral melanoma in situ: Correlation between the parallel ridge pattern on dermoscopy and microscopic features. The expression of human high molecular weight melanoma-associated antigen in acral lentiginous melanoma. Malignant melanoma on the sole showing prominent neural differentiation and perineural infiltration. Comparison of S-100 versus hematoxylin and eosin staining for evaluating dermal invasion and peripheral margins by desmoplastic malignant melanoma. S100-positive spindle cells in scars: A diagnostic pitfall in the re-excision of desmoplastic melanoma. Desmoplastic melanoma: A clinicopathologic study of ten cases with electron microscopy and immunohistology. Melan-A/Mart-1 expression in various melanocytic lesions and in nonmelanocytic soft tissue tumours. Microphthalmia transcription factor and melanoma cell adhesion molecule expression distinguish desmoplastic/spindle cell melanoma from morphologic mimics. Diagnostic utility of microphthalmia transcription factor in malignant melanoma and other tumors. Microphthalmia transcription factor in the immunohistochemical diagnosis of metastatic melanoma: Comparison with four other melanoma markers. Analysis of microphthalmia transcription factor expression in normal tissues and tumors, and comparison of its expression with S-100 protein, gp100, and tyrosinase in desmoplastic malignant melanoma. Microphthalmia transcription factor: Not a sensitive or specific marker for the diagnosis of desmoplastic melanoma and spindle cell (non-desmoplastic) melanoma. Evidence that the p75 neurotrophin receptor mediates perineural spread of desmoplastic melanoma. Desmoplastic and spindle cell melanomas express protein markers of the neural crest but not of later committed stages of Schwann cell differentiation. The p75 neurotrophin receptor, relative to other Schwann cell and melanoma markers, is abundantly expressed in spindled melanomas. Minimal deviation melanoma: A histologic variant of cutaneous malignant melanoma in its vertical growth phase. The spectrum of minimal deviation melanoma: A clinicopathologic study of 21 cases. Cutaneous malignant melanoma in South Sweden 1965, 1975, and 1985: A histopathologic review. Nevomelanocytic proliferations in association with cutaneous malignant melanoma: A multivariate analysis. Melanocytic nevi in histologic association with primary cutaneous melanoma of superficial spreading and nodular types: effect of tumor thickness. Histological regression in primary cutaneous melanoma: Recognition, prevalence and significance. Tumoral melanosis as a manifestation of a completely regressed primary melanoma with metastases. Nodular melanosis due to epithelial neoplasms: A finding not restricted to regressed melanomas. Persistent microscopic primary melanoma in patients presenting with node-positive disease. Solitary melanoma confined to the dermal and/or subcutaneous tissue: Evidence for revisiting the staging classification. Immunohistochemical staining with Melan-A of uninvolved sun-damaged skin shows features characteristic of lentigo maligna. Expression of soluble adenylyl cyclase in lentigo maligna: Use of immunohistochemistry with anti-soluble adenylyl cyclase antibody (R21) in diagnosis of lentigo maligna and assessment of margins. Macromelanosomes: Their significantly greater presence in the margins of a lentigo maligna versus solar lentigo. Unusual histological variants of cutaneous malignant melanoma with some clinical and possible prognostic correlations. Melanoma associated with a dysplastic, nevus: Report of two cases with unusual sebocyte-like melanocytes in the nevus part of the lesion. Syringotropic melanoma: A variant of melanoma with prominent involvement of eccrine apparatus and risk of deep dermal invasion. Follicular malignant melanoma: A variant of melanoma to be distinguished from lentigo maligna melanoma. Follicular malignant melanoma: A case report of a metastatic variant and review of the literature. Primary cutaneous myxoid melanoma: Immunohistologic clues to a difficult diagnosis. Myxoid metastases of melanoma: Report of three cases and review of the literature. Melanoma with second myxoid stromal changes after personally applied prolonged phototherapy. Cutaneous melanoma with myxoid features: Twelve cases with differential diagnosis. Balloon cell malignant melanoma of the skin: A clinicopathologic study of 34 cases with histochemical, immunohistochemical, and ultrastructural observations. Balloon cell melanoma: A case report with polarized and non-polarized dermatoscopy and dermatopathology. Signet-ring cell melanoma: Light microscopic, immunohistochemical and ultrastructural features. Primary cutaneous signet-ring cell melanoma: A clinico-pathologic and immunohistochemical study of two cases. Signet-ring cell melanoma with sentinel lymph node metastasis: A case report with immunohistochemical analysis and review of the clinicopathological features. Primary cutaneous signet-ring cell melanoma with pseudoglandular features, spindle cells and oncocytoid changes. Metastatic malignant melanoma showing a, rhabdoid phenotype: Further evidence of a non-specific histological pattern. Primary malignant melanoma with rhabdoid features: A histologic and immunocytochemical study of three cases. Histologic, immunohistochemical, and ultrastructural study of a case and review of the literature. Metastatic rhabdoid melanoma: Report of a case with a comparative review of the literature.

For that reason depression counseling buy abilify 10 mg low price, serologic studies are advised depression sous jacente definition order 5 mg abilify overnight delivery, and the possibility of a falsenegative rapid plasma reagin due to a prozone phenomenon (secondary to antigen excess) must also be kept in mind depression symptoms medscape purchase abilify with mastercard. There is usually prominent endothelial swelling and sometimes proliferation involving small vessels anxiety problems generic 20 mg abilify with visa. One case involving the scalp also showed a lymphoplasmacellular folliculitis with vacuolar alteration of outer root sheath epithelium and numerous apoptotic cells anxiety chest pains cheap abilify online visa. There is a superficial and deep mixed inflammatory cell infiltrate depression storage definition buy line abilify, which usually includes plasma cells and tuberculoid granulomas. It consists of chronic gummatous ulcers that occur on the central face or over long bones, often with involvement of the underlying bones. Oral azithromycin has been shown to be as effecteve as intramuscular penicillin in the treatment of this disease. There are intraepidermal abscesses and a heavy superficial and mid-dermal infiltrate of plasma cells, lymphocytes, macrophages, neutrophils, and often a few eosinophils. The disease occurs in the Caribbean area, Central America, and areas of tropical South America. Initial lesions are erythematous maculopapules, which grow by peripheral extension and often coalesce. These lesions merge with the late stage, in which depigmentation resembling vitiligo occurs, and sometimes epidermal atrophy. Alternative therapies, as in other treponematoses, are tetracycline or erythromycin. Yaws is contracted usually in childhood and spreads by direct contact, perhaps aided by an insect vector. It develops into a chronic ulcerating papillomatous mass that may persist for months. In warm moist areas, such as mucocutaneous junction areas, large condylomatous lesions may develop. Periods of exacerbation and Histopathology147 Primary and secondary lesions are identical and show hyperkeratosis, parakeratosis, and acanthosis. There is exocytosis of inflammatory cells, sometimes with intraepidermal abscesses. Hypochromic areas show loss of basal pigmentation with numerous melanophages in the upper dermis. The dermal infiltrate, like the other changes, is heavier in established than in early lesions, and it includes lymphocytes, plasma cells, and sometimes neutrophils. The treponemes can be demonstrated by silver methods: they are present mainly in the upper epidermis and are seldom, if ever, found in the dermis. Three genospecies of Borrelia burgdorferi have been identified as human pathogens: B. The genetic diversity of this species complex is considerable, with more than 100 different strains identified in the United States and more than 300 worldwide. Occasional cases of Lyme disease are seen in travelers returning to Australia, particularly from Europe. Australia does not have the species of ticks responsible for the transmission of B. Rarely, patients who have never left Australia present with clinical features suggestive of an atypical borreliosis. The author has been shown two such cases in which spirochetes appeared to be present in tissue sections of a skin biopsy from such patients. It has been suggested that an as yet undiscovered spirochete may be responsible for these Australian cases. If such an organism exists, the disease it produces shares few of the epidemiological or clinical characteristics of Lyme disease as seen in Europe and the United States. Using focus floating microscopy, a sensitive technique for detecting Borrelia species in tissue sections (see later), spirochetal microorganisms have been detected in cases of necrobiotic xanthogranuloma. The trunk is the favored site of lesions in immunosuppressed patients, and the legs are the favored site in immunocompetent patients. It is possible that the bites of this tick transmit other, as yet unidentified, spirochetes. The small size of the organism places some limits on its identification using conventional microscopic techniques. Areas resembling lichen sclerosus et atrophicus, sclerodermatous patches, and linear fibrotic bands over the ulna and tibia may also be found. Whereas interferon- is produced in lesions of erythema migrans, it is lacking in acrodermatitis chronica atrophicans. Plasma cells are usually, but not invariably, found in lesions of secondary syphilis. Examples of erythema migrans with vacuolar alteration of the basilar layer, a superficial perivascular lymphocytic infiltrate without plasma cells, and possibly eosinophils would require inclusion of drug eruption, viral exanthem, or id reactions in the list of diagnostic possibilities. There can be considerable background staining with these methods; Borrelia organisms in tissue sections often have wavy rather than tightly coiled contours, and therefore they tend to be overlooked or misinterpreted. Better results can be obtained with specific immunoperoxidase methods if available, but often the pathologist can only suggest the diagnosis, which can then be confirmed by serologic methods. Histopathology the early stages of the disease show a superficial and deep chronic inflammatory cell infiltrate in the dermis that is moderately heavy and composed predominantly of lymphocytes with some histiocytes and plasma cells. There is often accentuation around blood vessels, which may show telangiectasia, and also around adnexae. Sometimes there is a superficial band-like infiltrate of inflammatory cells with a thin zone of collagen separating the inflammatory cells from the basal layer. This is usually accompanied by loss of elastic fibers and pilosebaceous follicles, atrophy of the subcutis, and variable epidermal atrophy with loss of the rete pegs. The juxta-articular fibrous nodules show broad bundles of homogeneous collagen in the upper subcutis enclosing islands of fatty tissue. Of eight cases with a mycosis fungoides-like configuration, the one tested showed a polyclonal T-cell receptor gene rearrangement; of three cases with nodular dermal infiltrates, all expressed both and light chains with a polyclonal pattern. Acrodermatitis chronica atrophicans usually occurs in the elderly and is rare in childhood. Electronmicroscopy Degenerative changes have been reported in collagen, elastic tissue, and nerve fibers. This entity is considered in Chapter 41 with other cutaneous lymphocytic infiltrates. Of the 106 patients studied at the University of Graz (Austria), 63 cases involved the nipple,229 whereas another European study found evidence of Borrelia infection in 47% of 56 cases with lymphoid hyperplasia of the nipple. Interferon-2A can be used to treat this condition in patients unresponsive to antibiotics. However, Borrelia-associated lymphocytoma cutis (pseudolymphoma) can closely simulate a primary cutaneous large B-cell lymphoma, and it has been suggested that antibiotic therapy should be considered in suspected cases of primary cutaneous B-cell lymphoma in regions with endemic B. Molecular characterization and analysis of a gene encoding acid repeat protein (Arp) of Treponema pallidum. Treponema pallidum induces up-regulation of interstitial collagenase in human dermal fibroblasts. Epidemiology of sexually transmitted infections and human immunodeficiency virus in Europe. Congenital syphilis presenting with nephrotic syndrome and leucocytoclastic vasculitis. Congenital syphilis presenting with a generalized bullous and pustular eruption in a premature newborn. Late congenital syphilis presenting as deletion of uvula and cardiovascular disease. A case of extragenital chancre on a nipple from a human, bite during sexual intercourse. Hepatitis and bone destruction as uncommon, manifestations of early syphilis: Report of a case. Vesiculobullous syphilis: A case involving an unusual cutaneous manifestation of secondary syphilis. Seronegative secondary syphilis in 2 patients coinfected with human immunodeficiency virus. An unusual presentation of secondary syphilis in a patient with human immunodeficiency virus infection. Alopecia syphilitica, a simulator of alopecia areata: Histopathology and differential diagnosis. The moth-eaten alopecia of secondary syphilis: A histopathological study of 12 patients. Diffuse pattern essential syphilitic alopecia: An unusual form of secondary syphilis. Aquilina C, Viraben R, Denis P Secondary syphilis simulating oral hairy leukoplakia. Cutaneous secondary syphilis: Preliminary immunohistopathologic support for a role for immune complexes in lesion pathogenesis. Secondary syphilis with an interstitial granuloma annulare-like histopathologic pattern. Immunoperoxidase technique for detecting spirochetes in tissue sections: Comparison with other methods. Ultrastructural changes of Treponema pallidum isolated from secondary syphilitic skin lesions. An epidemiological study of syphilis incognito, an emerging public health problem in Greece. Osteomyelitis as the only manifestation of late latent syphilis: Case report and literature review. Demonstration of Treponema pallidum in a cutaneous gumma by indirect immunofluorescence. Comparative analysis of immunohistochemistry, polymerase chain reaction and focus-floating microscopy for the detection of Treponema pallidum in mucocutaneous lesions of primary, secondary and tertiary syphilis. Disseminated early yaws: Report of a child with a remarkable genital lesion mimicking venereal syphilis. Infection with multiple strains of Borrelia burgdorferi sensu stricto in patients with Lyme disease. Borrelial fasciitis: Diffuse fasciitis and peripheral eosinophilia associated with Borrelia infection. Focus-floating microscopy for detecting Borrelia, species in tissue sections: Back to basics. Neonatal skin lesions due to a spirochetal infection: A case of congenital Lyme borreliosis Clinical and microbiologic findings in six patients with erythema migrans of Lyme disease. Lyme disease with facial nerve palsy: Rapid diagnosis using a nested polymerase chain reaction-restriction fragment length polymorphism analysis. Solitary erythema migrans: A clinical, laboratory and epidemiological study of 77 Dutch patients. Prospective study comparing the diagnostic accuracy of general practitioners and dermatologists in an area where Lyme borreliosis is endemic. Cultivation of Borrelia burgdorferi from human tick bite sites: A guide to the risk of infection. Lyme disease presenting with multiple erythema migrans lesions: an illustrative case. The impact of immunosuppression on erythema migrans: A retrospective study of clinical presentation, response to treatment and production of Borrelia antibodies in 33 patients. Failure of Borrelia burgdorferi to survive in the skin of patients with antibiotic-treated Lyme disease. Cultivation of Borrelia burgdorferi from the blood of two patients with erythema migrans lesions lacking extracutaneous signs and symptoms of Lyme disease. Molecular subtyping of Borrelia burgdorferi in erythema migrans and acrodermatitis chronica atrophicans. Lymphoproliferative responses to Borrelia, burgdorferi in patients with erythema migrans, acrodermatitis chronica atrophicans, lymphadenosis benigna cutis, and morphea. Clinical comparison of borreliacidal-antibody test with indirect immunofluorescence and enzyme-linked immunosorbent assays for diagnosis of Lyme disease. Long-term serological follow-up of patients treated for chronic cutaneous borreliosis or culture-positive erythema migrans. Erythema migrans: A reassessment of diagnostic criteria for early cutaneous manifestations of borreliosis with particular emphasis on clonality investigations.

These may persist for several days or longer and be followed by postinflammatory pigmentation or keloid formation root depression definition generic abilify 5mg line. Another highly venomous mollusc is the blue-ringed octopus (Hapalochlaena maculosa) mood disorder 6 gameplay buy 15 mg abilify with visa. When disturbed bipolar depression treatments 15mg abilify with mastercard, this octopus flashes multiple iridescent blue rings as a warning display depression test health canada buy abilify master card. An erythematous eruption depression hotline chat buy cheap abilify 20 mg on-line, including facial flushing bipolar depression or major depression trusted abilify 5mg, accompanied by systemic symptoms may follow the eating of spoiled fish of the families Scomberesocidae and Scombridae (tuna, mackerel, skipjack, and bonito). Bacterial proliferation allows the conversion of histidine in the fish into histamine, which is thought to be responsible for the symptoms. Their brittle spines break off in the skin, where they may produce several different lesions. The resulting dermal reaction has been reported as sarcoidal granulomas,41 although the illustrations suggest noncaseating tuberculoid granulomas. Cutaneous manifestations of marine animal injuries including diagnosis and treatment. Epidemiology of the cnidarian Physalia physalis stings attended at a health care center in beaches of Adicora, Venezuela. Comparative dermatology: Skin lesions produced by attack of jellyfishes (Physalia physalis). Comment on the article "Comparative dermatology: Skin lesion produced by attack of jellyfishes (Physalia physalis). Systemic reaction associated with Iramo scyphopolyp, Stephanoscyphus racemosum Komai. Cell-mediated sensitization to jellyfish antigens confirmed by positive patch test to Olindias sambaquiensis preparations. Recurrent dermatitis after solitary envenomation by jellyfish partially responded to tacrolimus ointment 0. Mucocutaneous junctional and flexural paresthesias caused by the holoplanktonic trachymedusa Liriope tetraphylla. Cutaneous light microscopic and ultrastructural changes in a fatal case of jellyfish envenomation. Dogger Bank itch in the eastern English Channel: A newly described geographical distribution of an old problem. Studies on the mechanism of death from stingray venoms: A report of two fatal cases. Barss P Wound necrosis caused by the venom of stingrays: Pathological findings and. Urticarial lesions associated with the dissemination of the cercariae or the laying of eggs by the adult flukes 3. Papular, granulomatous, and even warty vegetating lesions of the genital and perineal skin secondary to the deposition of ova in dermal vessels13,17,18 4. Extragenital lesions show numerous ova in the superficial dermis associated with necrobiosis and palisading granulomas. The dermal reaction is mild, with edema, vascular dilatation, and a mild perivascular inflammatory cell infiltrate and some interstitial eosinophils. Histopathology There is a subcutaneous, partly granulomatous, inflammatory mass composed of lymphocytes, plasma cells, neutrophils, and variable numbers of eosinophils. A longitudinal excretory canal is also present, and basophilic calcareous corpuscles, a characteristic feature of cestodes, may also be seen scattered in varying numbers throughout the matrix. The same investigators developed an immunofluorescence method directed toward the tegument of the parasite. Bisection of the nodule after excision will reveal a white thread-like worm approximately 1 mm in width and from a few centimeters to 50 cm in length. The global burden for human (cystic) echinococcosis due to Echinococcus multilocularis has been estimated to be more than that for onchocerciasis, although incidence figures do not seem to reflect this (see later), and similar to that due to African trypanosomiasis (see p. The nodules, which may occur anywhere on the body, are either isolated or grouped in large conglomerations. The adult worms produce microfilariae, which are found in the neighboring lymphatics. Visual impairment and blindness (river blindness) is an important complication of onchocerciasis. Genetic resistance to infection with this parasite appears to be linked to chromosome 2p. In onchocercal dermatitis, there is a light superficial and deep infiltrate of chronic inflammatory cells and eosinophils in the dermis. The infiltrates were composed mostly of eosinophils with some admixed lymphocytes and a few neutrophils. Focal spongiosis was present in some cases, and edema of the papillary dermis was observed in 36 of the 66 biopsies. Larvae were found in 15 cases, and in 12 cases, the worm was retrieved during the biopsy procedure. In a recent case, the larva was found in a necrotic focus in the reticular dermis; it featured lateral cords, a muscular esophagus, and an intestine containing a brush border and multinucleate cells. There is usually central suppuration, and neutrophils may extend out into the adjacent inflammatory zone. The disease has a limited duration because the larvae are unable to complete their life cycle in the human body and usually die within weeks to months. A deep subcutaneous form of larva migrans may be seen with Gnathostoma spinigerum. In some individuals with strongyloidiasis, a variant of larva migrans is found with a rapidly progressing linear urticarial lesion, which may extend at up to 10 cm per hour. There may be a diffuse spongiotic dermatitis, with intraepidermal vesicles containing some eosinophils. There is a predilection for the feet and other exposed sites, although in one study from an urban slum in Brazil in which 3. This was confirmed by near-infrared fluorescence imaging, which showed oval bright spots in the same location and orientation as the dermoscopic structures. The adult worms of Loa loa, which is endemic in the rain forests of West and Central Africa, live in the subcutaneous tissue and migrate, producing fugitive (Calabar) swellings and temporary inflammation. Dracunculus medinensis may produce a blistering lesion due to the migration of the worm, which will eventually be extruded through rupture of the bleb. The anterior end is surrounded by granulation tissue containing a mixed inflammatory infiltrate, and there is fibrosis and some inflammation in the deeper parts. Trichinella spiralis may produce variable clinical lesions ranging from urticaria to maculopapular lesions following its development in striated muscle. There are rare reports of larvae of the soil nematode Pelodera (Rhabditis) strongyloides producing nodular lesions associated with a heavy mixed dermal inflammatory infiltrate and the presence of larvae in tissue sections. Such was the case in a patient with multiple papules and nodules on the face and neck, with a noncreeping eruption. Assessment of frequency, transmission, and genitourinary complications of enterobiasis (pinworms). Schistosomiasis: Clinical relevance to surgeons in Australasia and diagnostic update. Large water management projects and schistosomiasis control, Dongting Lake Region, China. Ectopic cutaneous schistosomiasis: Extragenital involvement with progressive upward spread. Late cutaneous schistosomiasis representing an isolated skin manifestation of Schistosoma mansoni infection. Cercarial dermatitis contracted via contact with an aquarium: Case report and review. Cutaneous paragonimiasis with flare-up after, treatment: A clinical case from Laos. A case of subcutaneous sparganosis: Therapeutic assessment by an indirect immunofluorescence antibody titration using sections of the worm body obtained from the patient. Sparganosis mansoni on abdominal skin, mimicking folliculitis and diagnosed by analysis of the mitochondrial cytochrome c oxiddase subunit 1 gene, using polymerase chain reaction. Case report: Molecular diagnosis of subcutaneous Spirometra erinaceieuropaei sparganosis in a Japanese immigrant. A clinical classification and grading system of the cutaneous changes in onchocerciasis. Cutaneous pathology in onchocerciasis associated with pronounced systemic T-helper 2-type responses to Onchocerca volvulus. Human genetic resistance to Onchocerca volvulus: Evidence of linkage to chromosome 2p from an autosome-wide scan. Stingl P Onchocerciasis: Clinical presentation and host parasite interactions in patients of. Cutaneous gnathostomiasis: Report of 6 cases with emphasis on histopathological demonstration of the larva. Subcutaneous dirofilariasis caused by Dirofilaria (Nochtiella) repens in a Belgian patient. Dirofilariasis due to Dirofilaria repens in Italy, an emergent zoonosis: Report of 60 new cases. Subcutaneous dirofilariasis caused by Dirofilaria immitis mimicking a large epidermal cyst. Creeping eruption: A review of clinical presentation, and management of 60 cases presenting to a tropical disease unit. Widespread and unusual presentations of cutaneous larva migrans acquired in tropical sandy beach resorts. Cutaneous larva migrans with folliculitis: Report of seven cases and review of the literature. Cutaneous larva migrans with folliculitis: A new clinical presentation of this infestation. Cutaneous larva migrans: Clinical features and management of 44 cases presenting in the returning traveller. Loffler syndrome caused by extensive cutaneous larva migrans: A case report and review of the literature. Disseminated strongyloidiasis with cutaneous manifestations in an immunocompromised host. Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome. Strongyloides stercoralis infection presenting as generalized prurigo nodularis and lichen simplex chronicus. Molecular characterization of Ancylostoma braziliense larvae in a patient with hookworm-related cutaneous larva migrans. Follicular cutaneous larva migrans: A report of three cases and review of the literature. Simultaneous larva migrans and larva currens caused by Strongyloides stercoralis: A case report. Interdigital lesions and frequency of acute dermatolymphangioadenitis in lymphoedema in a filariasis-endemic area. The first genetically confirmed case of Dioctophyme renale (Nematoda: Dioctophymatida) in a patient with a subcutaneous nodule. Multiple papules and nodules on the face and neck caused by the larvae of an unknown nematode: A noncreeping type eruption. Furthermore, immunological reactions to the parasite or its parts may result in more widely disseminated cutaneous lesions. Specific examples of arthropodrelated diseases include mosquito-borne diseases such as malaria, dengue, and viral encephalitides; fly-borne diseases such as leishmaniasis, bartonellosis, and sleeping sickness; and tick-associated diseases such as Rocky Mountain spotted fever, Lyme disease, and tick paralysis. The class Crustacea, which includes lobsters, crabs, and shrimps, and the classes Diplopoda and Chilopoda, which include millipedes and centipedes, respectively, are not of major dermatopathological importance and are not considered in detail. These include erythema, urticaria, and purpura in the case of millipedes and centipedes. Mention should also be made of the comprehensive monograph on arthropods and the skin by Alexander7 and the review on venomous arthropods by Vetter and Visscher. Erythema, purpura, bullae, necrosis, ulcers, lymphadenitis, and systemic symptoms may develop. More than 90 species of ticks, both hard- and soft-bodied varieties, have been identified in Australia. Amblyomma americanum, the lone star tick, is the most common species of this genus found in the United States. Mouthparts contain a thick hyaline structure representing the chitinous wall of the hypostome; this structure contains barb-like projections that act as an anchor during feeding.

Occupational argyria; Light and electron microscopic studies and X-ray microanalysis depression definition according to dsm iv buy abilify with visa. Silver retention anxiety attack symptoms discount abilify 10 mg with visa, total body silver and tissue silver concentrations in argyria associated with exposure to an anti-smoking remedy containing silver acetate depression definition with reference order abilify 5mg without a prescription. Two unusual cases of argyria: the application of an improved tissue processing method for X-ray microanalysis of selenium and sulphur in silver-laden granules mood disorder drugs list order cheap abilify on line. Activation of mast cells by silver particles in a patient with localized argyria due to implantation of acupuncture needles depression movies 10mg abilify overnight delivery. Localized argyria with low ceruloplasmin and copper levels in the serum: A case report with clinical and microscopical findings and a trial of penicillamine treatment geriatric depression definition purchase abilify with amex. Chrysiasis: Transmission electron microscopy, laser microprobe mass spectrometry and epipolarized light as adjuncts to diagnosis. Development of chrysiasis after Q-switched ruby laser treatment of solar lentigines. Orange-red birefringence of gold particles in paraffin wax embedded sections: An aid to the diagnosis of chrysiasis. Drug rash with eosinophilia and systemic symptoms caused by topical application of mercury. Cutaneous mercury granuloma: A, clinicopathologic study and review of the literature. Skin manifestations in acute arsenic poisoning from the Wakayama curry poisoning incident. Aluminium hydroxide granulomas: Light and electron microscopic studies and X-ray microanalysis. Speckled posttraumatic hyperpigmentation by foreign bodies on the lower legs after welding. Persistent subcutaneous nodules in patients hyposensitized with aluminum-containing allergen extracts. Identification of titanium in human tissues: Probable role in pathologic processes. Hydroxychloroquine-induced pigmentation in two patients with systemic lupus erythematosus. Imipramine hyperpigmentation: A slate-gray discoloration caused by long-term imipramine administration. Photoinduced dermal pigmentation in patients taking tricyclic antidepressants: Histology, electron microscopy, and energy dispersive spectroscopy. Photodistributed blue-gray pigmentation of the skin associated with long-term imipramine use. Cutaneous hyperpigmentation induced by doxycycline: Histochemical and ultrastructural examination, laser microprobe mass analysis, and cathodoluminescence. Pigment deposits in eyes and light-exposed skin during long-term methacycline therapy. Minocycline-related cutaneous hyperpigmentation as demonstrated by light microscopy, electron microscopy and X-ray energy spectroscopy. Minocycline hyperpigmentation localized to the lips: An, unusual fixed drug reaction Minocycline, perinuclear antineutrophilic cytoplasmic antibody, and pigment: the biochemical basis. Treatment of minocycline-induced cutaneous pigmentation with the Q-switched Alexandrite laser and a review of the literature. Ultrastructural and X-ray microanalytical observations of minocycline-related hyperpigmentation of the skin. Photosensitivity and hyperpigmentation in amiodarone-treated patients: Incidence, time course, and recovery. Photodistribution of blue-gray hyperpigmentation after amiodarone treatment: Molecular characterization of amiodarone in the skin. Hypomelanosis due to block of melanosomal maturation in amiodarone-induced hyperpigmentation. Marked and restricted cutaneous pigmentation induced by selective intra-arterial cisplatin infusion. Flaggelate hyperpigmentation following intralesional bleomycin treatment of verruca plantaris. Delayed immune-mediated adverse effects of polyalkylimide dermal fillers: Clinical findings and long-term follow-up. Facial granulomas secondary to dermalive microimplants: Report of a case with histopathologic differential diagnosis among the granulomas secondary to different injectable permanent filler materials. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Hydroxyethyl starch-induced pruritus relieved by a combination of menthol and camphor. Severe granulomatous reaction and facial ulceration occurring after subcutaneous silicone injection. A diagnostic trap for the dermatopathologist: Granulomatous reactions from cutaneous microimplants for cosmetic pruposes. Silicone granulomas in acral skin in a patient with silicone-gel breast implants and systemic sclerosis. Silicone deposition in reconstruction scars of women with silicone breast implants. Metastatic silicone granuloma: Lupus miliaris disseminatus faciei-like facial nodules and sicca complex in a silicone breast implant recipient. Talc deposition in skin and tissues surrounding silicone gel-containing prosthetic devices. Reactions to a bovine collagen implant: Clinical and immunologic study in 705 patients. Abscess formation and local necrosis after treatment with Zyderm or Zyplast collagen implant. A foreign body granuloma produced by an injectable collagen implant at a test site. Histologic and immunohistochemical features in biopsy sites in which bovine collagen matrix was used for hemostasis. Injectable collagen implant: Histopathologic identification and longevity of correction. A light and electron microscopic evaluation of Zyderm collagen and Zyplast implants in aging human facial skin. Dermal implants: Histopathologic identification and comparison of four commercially available products [Abstract]. Secondary cutaneous oxalosis: Cutaneous deposition of calcium oxalate dihydrate after long-term hemodialysis. Unusual painful sclerotic plaques on the legs of a patient with late diagnosis of primary hyperoxaluria type I. Livedo reticularis, ulcers, and peripheral gangrene: Cutaneous manifestations of primary hyperoxaluria. Primary hyperoxaluria: Report of a patient with livedo reticularis and digital infarcts. Fatal cutaneous necrosis mimicking calciphylaxis in a patient with type 1 primary hyperoxaluria. Localized cutaneous polyvinylpyrrolidone storage disease mimicking cheilitis granulomatosa. Hamartomas and some related congenital malformations are included with the appendageal tumors in Chapter 33 (pp. Before considering these diseases, a brief account is given of the normal hair follicle. Because the changes that occur during the hair cycle are relevant to the alopecias, this aspect is discussed on page 481. The follicle and its attached sebaceous gland and arrector pili muscle form a structural unit. In some parts of the body (axilla and genitocrural region), an apocrine gland is connected to the upper part of the sebaceous duct. Hair follicles produce a hair shaft, which arises from the deep portion of the follicle. Two distinct types of hair shaft are recognized: terminal hair, a heavily pigmented, thick shaft arising from a terminal hair follicle, which projects into the deep dermis and even into the subcutis; and vellus hair, a short, fine, lightly pigmented shaft that arises from a vellus hair follicle; it only extends into the upper reticular dermis. The infundibulum extends from the skin surface to the point of entry of the sebaceous duct. Below this is the isthmus, the short portion between the entry of the sebaceous duct and the attachment of the arrector pili muscle. Another bulge in the outer root sheath in this same region has been called the follicular trochanter. The bulb is the expanded lower end of the follicle that includes the dermal papilla; it is surrounded on its top and sides by the hair matrix, the part of the bulb that is the actively growing portion of the hair shaft. It is not present in all human hairs, although it is an important structure of some animal hairs, such as wool. The hair cortex is covered by a single row of overlapping cells, the shaft cuticle. The three layers blend together with keratinization and are no longer distinct by the mid-follicle. It is only one cell thick at the level of the bulb; it is thickest at the isthmus, where it starts to keratinize, forming a narrow zone of trichilemmal keratinization. The single-cell inner layer of the outer root sheath undergoes specialized keratinization mediated by apoptosis. Beyond this is the fibrous root sheath, which is continuous below with the follicular papilla; it blends above with the collagen of the papillary dermis. All stain for involucrin, including the matrical cells, which stain for nothing else. Some muscle fibers can be found admixed with the connective tissue sheath encircling the follicle. The anchor between the distal arrector pili and the extracellular matrix includes both 51 integrin and fibronectin. The distal part of the human hair follicle appears to represent a specialized area of the skin immune system with interacting intraepithelial T cells and Langerhans cells. The inflammatory process frequently extends into the adjacent dermis with the formation of pustules, draining sinuses, and subsequent scarring. Comedones are not confined to acne, being found in senile skin,45 in a rare congenital form,46 in nevus comedonicus, and following exposure to certain chemicals such as coal tar. It often assists in arriving at a specific diagnosis if the various inflammatory diseases are subdivided into six categories, although it should be recognized at the outset that this subdivision is somewhat arbitrary. Acneiform lesions combine inflammation of the pilosebaceous apparatus with the presence of comedones and often scarring as well. Comedones are dilated and plugged hair follicles that may have a small infundibular orifice (closed comedo) or a wide patulous opening (open comedo). Comedones are not confined to acne, being found in senile skin and certain other circumstances (see later). The term folliculitis refers to the presence of inflammatory cells within the wall and lumen of a hair follicle, whereas perifolliculitis denotes their presence in the perifollicular connective tissue, sometimes extending into the adjacent reticular dermis. Folliculitis and perifolliculitis are often found together because an inflammatory process in the follicle spills over into the adjacent connective tissue. If the inflammatory process is severe enough, destruction of the hair follicle will ensue. Etiologyandpathogenesis Acne vulgaris is of multifactorial origin with both intrinsic and extrinsic factors contributing to the final outcome. The initial event is abnormal keratinization of the infrainfundibular portion of sebaceous follicles, leading to the impaction of adherent horny lamellae within the follicle. Impacted follicles, which are the precursors of comedones and inflammatory lesions, are not detectable clinically. Propionibacterium acnes biofilm produces a biological glue that holds corneocytes together to form the keratin plug, which leads to the infundibular obstruction. It is probably of multifactorial origin, with chlorine being only one of many contributing factors. Topical therapies have included adapalene, retinoids, benzoyl peroxide, erythromycin or clindamycin, and salicylic acid.

A recent study described patients with photoallergic contact dermatitis to 8-methoxypsoralen in the sap of the common fig depression symptoms college students order cheap abilify on line, Ficus carica depression vs bipolar buy cheap abilify online. Photoallergy was demonstrated through patch testing with serial dilutions of this plant material depression test channel 4 order abilify 5 mg online. These observations are based on the consequences of drug cessation but not subsequent rechallenge treatment of bipolar depression an update trusted abilify 5mg. Drugs that may produce a lichenoid photoallergic reaction include depression game buy abilify with mastercard, in addition to thiazide diuretics (discussed previously) mood disorder 8 year old purchase 20 mg abilify with visa, demeclocycline, enalapril, quinine, quinidine, and chloroquine. Although it is usually taught that the dermal infiltrate is both superficial and deep in the lightrelated dermatoses, this is not always so, particularly in acute lesions. Pigment incontinence is sometimes present,233 whereas in late lesions of phytophotodermatitis there is also basal hyperpigmentation. In bullous phototoxic reactions (pseudoporphyria), there is a subepidermal blister with only rare inflammatory cells in the base (see p. In cases of long standing, the blisters may heal with scarring and milia formation. Fibroblasts and dendrocytes are also increased in photosensitivity reactions of some duration. Small amounts of IgG and sometimes C3 are found adjacent to vessels and near the basement membrane zone in chronic states. It involves the use of a photosensitizing agent that is applied to , or accumulates in, malignant tissue, followed by the application of a light source that activates the photosensitizer. Side effects reported with photodynamic therapy include erythema, pain, burning, edema, itching, scaling, and pustule formation. There is a moderately heavy infiltrate of lymphocytes, mainly in a perivascular location in the upper dermis. In some instances, the dermal reaction differs from that seen in contact allergic dermatitis by deeper extension of the infiltrate. Stellate cells and telangiectasia may be prominent, reflecting the photosensitive component. The lichenoid papules show a lichenoid tissue reaction with a superficial and mid-dermal inflammatory cell infiltrate. Ear mutilation has been reported as a consequence of recurrent lesions with scarring. Geographic necrosis and reactive germinal centers have been described in some cases,365 and angiocentricity or angioinvasion may be prominent. Direct immunofluorescence sometimes shows scattered granular deposits of C3 at the dermoepidermal junction. They include common variable hypogammaglobulinemia,399 thyroid disease,400 and lupus erythematosus. In the rare erythema multiforme-like lesions, this may be so marked that subepidermal bullae form. Extravasation of red cells is sometimes seen in the upper dermis, particularly in the papulovesicular form. The epidermis may be normal or show slight changes such as very mild spongiosis, focal parakeratosis, or acanthosis. In the papulovesicular form, there is invariably spongiosis leading to spongiotic vesiculation. Scattered apoptotic keratinocytes are often present in the papulovesicular variant. Focal perivascular and interstitial deposits of fibrin and perivascular C3 or IgM have all been recorded in a few cases. Papillary dermal edema has been touted as a characteristic feature of polymorphic light eruption (at least in plaque-type lesions), but as noted by Pincus et al. However, a fairly constant feature (in keeping with the mnemonic mentioned on page 22) is the presence of a dermal inflammatory cell infiltrate that is both superficial and deep, although if early lesions are biopsied, it may not extend below the mid dermis. Studies of lymphocyte subpopulations do not allow a clear separation among these dermatoses, with the exception of a significant B-cell component in lymphocytoma cutis. Actinic prurigo is characterized by onset in childhood; female preponderance; a familial tendency, which is quite high in some communities; and severe pruritus. Other treatments that have been used include phototherapy, topical corticosteroids, azathioprine, mycophenolate mofetil, and topical tacrolimus. The lesions may be confined to the area of application of the agent or be more generalized. Musk ambrette, which is used not only in aftershave lotions and various cosmetics but also in certain foodstuffs, is often involved. The cellular infiltrate is usually confined to the superficial plexus, but extension around mid-dermal vessels may occur. A report of the phototest results of 86 patients with this condition showed that 74% had a positive result: 36% of these positive patients were sensitive to sesquiterpene lactone mix (the main allergenic constituent of Compositae plants), 21% to fragrance compounds, 20% to colophony, and 14% to rubber chemicals. A moderately dense perivascular inflammatory cell infiltrate involves the upper and mid dermis. Superficially, the infiltrate may be more diffuse, and there may be exocytosis of inflammatory cells, particularly in the thiaziderelated cases. In cases of long standing, basophilic fibers, resembling those seen in solar elastosis except for their lack of coiling, extend into the lower dermis. This entity should be distinguished from those eczematous processes that may be exacerbated by light, such as seborrheic dermatitis and some cases of atopic dermatitis. It appears that chronic actinic dermatitis is increased in patients with atopic dermatitis. The infiltrate is composed of lymphocytes; a variable number of large lymphoid cells with hyperchromatic, convoluted nuclei; scattered stellate fibroblasts; and a few plasma cells and sometimes eosinophils. Under lower power magnification, the impression is often of a chronic eczematous dermatitis, but with minimal spongiosis and an excessive number of dermal cells for such a process. The finding of scattered hyperchromatic cells and stellate fibroblasts completes the picture. The infiltrate extends deeper in the dermis than is usual in contact allergic dermatitis. Actinicreticuloid Actinic reticuloid has been separated from the other chronic photodermatoses on the basis of its histopathological picture, which shows a variable resemblance to a T-cell lymphoma. Trisomy 9p associated with self-injured behaviour and multiple intractable keloids. Dermatitis artefacta in pediatric patients: Experience at the National Institute of Pediatrics. Monosymptomatic hypochondriacal psychosis presenting with recurrent oral mucosal ulcers and multiple skin lesions responding to olanzapine treatment. A case with an indolent course of subcutaneous panniculitis-like T-cell lymphoma demonstrating Epstein-Barr virus positivity and simulating dermatitis artefacta. Reflex sympathetic dystrophy with, mutilating ulcerations suspicious of a factitial origin. Dermatitis artefacta as the presenting feature of autoerythrocyte sensitization syndrome and naproxen-induced pseudoporphyria in a single patient. Factitial cutaneous ulcers and nodules: the use of electron-probe microanalysis in diagnosis. Perforated ischioglutreal bursitis mimicking a gluteal decubitus ulcer in patients with spinal cord injury: Report of 2 cases. Beneficial effect of resin salve in treatment of, severe pressure ulcers: A prospective, randomized and controlled multicentre trial. Allogeneic platelet leucocyte-gel to treat occipital decubitus ulcer in a neonate: A case report. Disseminated punctate intraepidermal haemorrhage: A widespread counterpart of black heel. Benzidine stain for the histochemical detection, of hemoglobin in splinter hemorrhage (subungual hematoma) and black heel. A follow-up study of superficial radiotherapy for benign dermatoses: Recommendations for the use of X-rays in dermatology. Incidence of malignant skin tumors in 14,140 patients after grenz-ray treatment for benign skin disorders. Radiation recall dermatitis, panniculitis, and myositis following cyclophosphamide therapy: Histopathologic findings of a patient affected by multiple myeloma. Radiation recall dermatitis in a patient affected with pheochromocytoma after treatment with lanreotide. Sorafenib-triggered radiation recall dermatitis with a disseminated exanthematous reaction. Levofloxacin-induced radiation recall dermatitis: A case report and a review of the literature. Ultraviolet recall reaction after total body irradiation, etoposide, and methotrexate therapy. Dynamic skin changes of acute radiation dermatitis revealed by in vivo reflectance confocal microscopy. Modulation of skin collagen metabolism by irradiation: Collagen synthesis is increased in irradiated human skin. Subacute radiation dermatitis: A histologic imitator of acute cutaneous graft-versus-host disease. Two cases of radiation-induced skin injuries occurring after radiofrequency catheter ablation therapy for atrial fibrillation. Histological and ultrastructural evaluation of the effects of a radiofrequency-based nonablative dermal remodeling device. Chronic radiodermatitis following repeated percutaneous transluminal coronary angioplasty. Fluoroscopy-induced chronic radiation skin injury: A disease perhaps often overlooked. Chronic radiodermatitis following percutaneous coronary interventions: A report of two cases. The radiation accident in Georgia: Clinical, appearance and diagnosis of cutaneous radiation syndrome. Topical corticosteroid therapy for acute radiation dermatitis: A prospective, randomized, double-blind study. Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: Evidence for cytotoxic lymphocyte mediated apoptosis. Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience. Delayed effects of accidental cutaneous, radiation exposure: Fifteen years of follow-up after the Chernobyl accident. Fluoroscopy-induced chronic radiation dermatitis: A report of two additional cases and a brief review of the literature. Late irradiation damage to the skin caused by soft X-ray radiation therapy of cutaneous tumors. Squamous cell carcinoma, malignant melanoma and malignant fibrous histiocytoma arising in burn scars. An unusual long-term complication of burn injury: Malignant fibrous histiocytoma developed in chronic burn scar. Histologic evaluation of preauricular and postauricular human skin after high-energy, short-pulse carbon dioxide laser. Cold injury of the knee and lower aspect of the leg after knee surgery and use of a cold therapy system. An unusual reaction to cold: A sporadic case of familial polymorphous cold eruption Photodermatosis: Part I: Photobiology, photoimmunology, and idiopathic photodermatoses. Photosensitive Smith-Lemli-Opitz syndrome is not caused by a single gene mutation: analysis of the gene encoding 7-dehydrocholesterol reductase in five U. Ultraviolet radiation in alpine skiing: Magnitude of exposure and importance of regular protection. Photodermatoses in African Americans: A retrospective analysis of 135 patients over a 7-year period. Assessing the role of race in quantitative measures of skin pigmentation and clinical assessments of photosensitivity. Photodermatitis with minimal inflammatory infiltrate: Clinical inflammatory conditions with discordant histologic findings. Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: Child abuse and herpes simplex virus infection. Photo-onycholysis caused by an unusual beach game activity: A pediatric case of a side effect caused by doxycycline. A randomized controlled trial (volunteer study) of sitafloxacin, enoxacin, levofloxacin and sparfloxacin phototoxicity. Photoaging and phototoxicity from long-term voriconazole treatment in a 15-year-old girl. Ultraviolet-B-induced apoptosis of keratinocytes: Evidence for partial involvement of tumor necrosis factor- in the formation of sunburn cells.

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