CORNEOCYTES IN SCALY PARAKERATOTIC DISEASES

Background and Objectives. The stratum corneum of some of the scaly (parakeratotic) diseases was examined with light and scanning electron microscopy (SEM) with the purpose to reveal the importance of this layer in the diagnosis of some of the diseases associated with the formation of scales. Materials and Methods. Two biopsies of the skin surface were taken: one, obtained from 80 patients with various parakeratotic scaly diseases and from 25 control subjects, was processed for light microscopy; the other biopsy for SEM was taken from 10 control subjects and 25 patients. The diagnoses of these patients were: psoriasis (5 patients), erythrodermic psoriasis (2 subjects), parapsoriasis (5 patients), pityriasis rubra pilaris (5 subjects), pityriasis rosea (3 subjects), and seborrheic dermatitis (5 subjects). Results. The light microscopic studies showed that normal corneocytes are of polygonal shape with their largest diameter measuring 42 μm; these cells lacked nuclei. All parakeratotic cells appeared bizarre in shape, smaller than normal, and the cells contained a nucleus. With SEM, normal cells appeared relatively regular in size and shape, trabeculated, and had a flat surface. Cells examined in all the diseases revealed various sizes, outlines, and trabeculae. Specific surface patterns (print) of diseased cells were: “fish-scale” in psoriasis; “marbled” in parapsoriasis, “rocky stone” in pityriasis rubra pilaris; “heart-shaped” in seborrheic dermatitis, and semi-crystalloid in pityriasis rosea. Conclusions. Parakeratosis is characterized not only by the retention of the nucleus in keratinocytes, but is also characterized by a cell of smaller size. The specific print of a disease helps in the diagnosis. The print will change with different stages of a disease.     

DENSITOMETRY OF PAUTRIER'S MICROABSCESS CELLS IN CUTANEOUS T CELL LYMPHOMA

Background. Epidermotropic lymphoid T cell infiltrates are part of a continuous spectrum of lesions ranging from “benign” parapsoriasis to frank cutaneous T cell lymphoma (CTCL, mycosis fungoides). Either the clinical or histologic differentiation between these entities prove often difficult and the prognosis may be difficult to assess. Patients and Methods. We studied 15 patients, men aged 50 to 81 years, mean ± SD 68 ± 12 years, with patch-plaque CTCL. Sections from punch biopsies from active lesions were stained with Feulgen reagent, coupled with a “twin” adjacent hematoxylin and eosin (H&E)-stained section and analyzed with a VIDAS Zeiss-Kontron Image Analyzer. At least 50 dermal infiltrating cells and 50 epidermotropic Pautrierian cells per specimen were counted and the biopsies were repeated periodically. Results. Nine patients with aneuploid Pautrierian cell DNA patterns did well after conventional phototherapy (dermal cell ploidy was irrelevant), whereas six patients with euploid Pautrierian cell DNA patterns had to be treated aggressively (IFN + retinoids, COP). Clinical and histopathologic aspects of the first group were comparable to those of the second group. Conclusions. The classical cytophotometric aphorism seems to be reversed in this sample: “The more abnormal the ploidy of epidermotropic Pautrierian cells, the better the prognosis.” Euploid epidermotropic cell prove more efficient in invading the skin and other areas and this efficiency may be reflected in more aggressive trends in the evolution of the lymphoma. Thus, DSM analysis of epidermotropic cells could prove very useful as an inexpensive tool for routine CTCL grading.     

Impact of pigmentary disorders on quality of life in Japan: Interest of the BeautyQoL instrument

Skin pigmentary disorders and uneven skin tone represent common cosmetic concerns in Japan where fairer skin is culturally desirable. As the demographics of Asian countries continue to evolve, there is a need to understand the impact of cosmetic skin concerns on quality of life (QoL). 199 Japanese women self-claiming facial skin pigmentation disorders were asked to complete the BeautyQoL questionnaire, and the results were compared with those of a control group of 200 women. Of the five dimensions of the BeautyQoL questionnaire, the dimension “mood” appeared to be significantly lower in the group presenting facial dark spots, as compared with the control group (p < 0.05). In the group presenting facial dark spots, the five dimensions and the global score showed that subjects concerned had lower scores than subjects less concerned, even if statistical significance was not reached.

This study confirms that common pigmentary disorders such as facial black spots may negatively impact QoL. Further comparative studies with a controlled randomized design would be necessary to confirm these findings.     

Schlafstörungen in der Dermatologie – eine umfassende Übersicht

Sleep is a normal physiological process that accounts for approximately one third of a person's life. Disruption of the normal sleep cycle, which maintains physiological homeostasis, can lead to pathology. It is not known whether sleep disturbance causes skin disease or skin disease causes sleep impairment, but a bidirectional influence is suspected. We have compiled the data from published articles on “sleep disorders in dermatology” in PubMed Central from July 2010 to July 2022 (with the option “full text available”) and provide an overview of sleep disorders associated with dermatological conditions and certain drugs used in dermatology as well as sleep disturbances for which some drugs used can cause itch or dermatological issues. Atopic dermatitis, eczema and psoriasis have been shown to be exacerbated by sleep problems and vice versa. Sleep deprivation, night-time pruritus and disrupted sleep cycles are often used to assess treatment response and quality of life in these conditions. Some medications used primarily for dermatological conditions have also been associated with alterations in the sleep-wake cycle. Addressing patients sleep disorders should be an integral part of the management of dermatological conditions. More studies are needed to further investigate the influence of sleep and skin disorders.     

Clinical features of idiopathic guttate hypomelanosis in 646 subjects and association with other aspects of photoaging

Background The lesions of idiopathic guttate hypomelanosis (IGH) are commonly seen in elderly persons, although this is an often unrecognized skin disease with an obscure etiopathogenesis. The prevalence and clinical features of IGH have not yet been well studied. Objectives The purposes of this study were to evaluate the prevalence of IGH in different age groups and to determine the association of IGH with other dermatoses related to photoaging. Methods A total of 1174 subjects were examined for IGH. A detailed history was taken and general, systemic, and cutaneous examinations were carried out on the basis of clinical features. Woods lamp examination, KOH wet mounting, and/or histopathologic examination were conducted as required. Results Of 1174 subjects, 646 showed signs of IGH. The prevalence of IGH in the group of patients aged ≥40 years was 87%. This prevalence increased with advancing age. The prevalence of IGH was 54% (n = 307) among males and 56% (n = 339) among females. Sites of frequent involvement included the distal part of the lower extremity in 93% (n = 598) of cases, the distal part of the upper extremity in 91% (n = 585), the proximal part of the upper extremity in 73% (n = 474), and the proximal part of the lower extremity in 58% (n = 376). Thirty‐nine (6%) subjects also developed IGH on the face. Frequency of dermatoses related to aging was found to be significantly associated with IGH, including numerous solar lentigo [odds ratio (OR) = 5.95] and xerosis (OR = 2.40). In addition, the subjects who used “body scrubbers” were significantly more likely to have IGH lesions (OR = 1.64). Conclusions It is very likely that IGH is a phenomenon associated with the skin’s normal aging process and repeated microtrauma to skin.     

New vision in fractional radiofrequency technology with switching,vacuum and cooling

Introduction: Since the introduction of fractional technology, various systems were launched to the market. The first generation of fractional RF systems created epidermal ablation with coagulative/necrosis of the dermis with sufficient clinical outcomes, but with some limitations. The aim of this study was to evaluate the efficacy and safety of SVC technology, based on the principle of separate biological responses. Material and methods: Fifty-two patients were treated for 3–6 sessions using fractional RF handpiece and eight patients received combination treatments with non-invasive RF handpiece. Results: All volunteers showed notable to significant improvement in the photoageing symptoms, without any significant complications or adverse events. Discussion: Due to its wide spectrum of parameters, the SVC technology can promote different biological responses. Owing to the “Switching” technology, the control of energy depth penetration enables delivery of the necessary thermal dose to the targeted skin layer. In addition, this novel technology includes the “Vacuum” and “Cooling” mechanisms, each contributing to the safety of the treatment. The Smart Heat function reduces the necessary energy levels and thereby reduces the pain level and risks for side effects.     

HYALURONIC ACID IN CUTANEOUS INTRINSIC AGING

Background. In elderly individuals all components of the skin and subcutaneous tissue undergo histologic and ultra-structural changes. The turgidity of the dermis appears decreased, presumably due to altered patterns and levels of glycosaminoglycans (GAGS), especially hyaluronic acid and dermatan sulfate that are the most common. A linear, age-related decrease in the content of GAGS (mainly hyaluronic acid) has been hypothesized in human aged skin. Methods. We used the cationic dye Alcian Blue to selectively stain hyaluronic acid within the dermis in old and young subjects to compare ultrastructurally its topography and variations with age. Results. We demonstrated a progressive reduction in the number of electron-dense granules of hyaluronic acid and of their filaments until they were completely absent in subjects aged 60. Conclusions. We propose that the variations of the levels of hyaluronic acid in the dermis in aging could account for some of the most striking alterations of the aged skin, including decreased turgidity, less support for microvessles, wrinkling, and altered elasticity.     

Post‐marketing surveillance on treatment of 5,665 patients with atopic dermatitis using the calcineurin inhibitor pimecrolimus: Positive effects on major symptoms of atopic dermatitis and on quality of life

Background: Topical application of the calcineurin inhibitors pimecrolimus and tacrolimus is a current major advance in the therapy of atopic dermatitis. The aims of this post‐marketing surveillance were: a) to acquire data on the efficacy and tolerability of pimecrolimus ointment (Elidel^®) on a very large cohort of patients from outpatient clinics, and b) to assess changes in their quality of life, a parameter not often considered in previous studies. Patients and methods: Included were 5,665 patients with atopic dermatitis. During the observation period, data on efficacy and tolerability were obtained at the beginning of the study, 3 to 10 days after initiation of therapy and after 4 to 6 weeks. Evaluation of symptoms as well as assessment of efficacy and tolerability were based on linear scales and on the percentage of the body surface area (% BSA) involved. Quality of life was assessed by the German version of the “Dermatology Life Quality Index (DLQI)” or the “Children's Dermatology Life Quality Index (CDLQI)”. Results: In this largest post‐marketing surveillance hitherto performed in Germany, the efficacy of pimecrolimus was judged as “good” by 79.3 % of physicians and by 76.5 % of patients. Tolerability was assessed as “good” by 87.2 % of physicians and by 83.1 % of patients. Major symptoms of atopic dermatitis such as pruritus, erythema or lichenification showed marked reduction after just 3 to 10 days, signalling general improvement of the skin disease. In addition, application of pimecrolimus resulted in a significant improvement of the quality of life scores in both children and adults. Conclusion: The present study demonstrates that the good efficacy and tolerability of pimecrolimus ointment which had been shown in controlled trials: i) could also be demonstrated on a very large cohort of patients with atopic dermatitis when used in the outpatient setting, and ii) were paralleled by a significant improvement in the quality of life.     

ULTRASTRUCTURAL STUDY OF HYALURONIC ACID BEFORE AND AFTER THE USE OF A PULSED ELECTROMAGNETIC FIELD, ELECTRORYDESIS, IN THE TREATMENT OF WRINKLES

Background. Treatment of wrinkles has become an increasing problem for dermatologists. Hyaluronic acid is a component of the family of glycosaminoglycans (GAGS, substances known for their property of retaining water), that significantly decreases with aging and in wrinkles. A new technique that uses a specific pulsed electromagnetic field, electrorydesis, has been introduced in the treatment of wrinkles associated with aging. The treatment is based on the reported in vitro effects of specific electromagnetic fields on fibroblast cultures (e.g., an increase in DNA synthesis and in the production of collagen and presumably also of GAGS). Methods. The in vivo effects of the electromagnetic field on aged skin (3 subjects aged 50, 56 and 60 years), with particular focus on the ultrastructural modifications and GAGS amount before and after the treatment, were evaluated by electron microscope. Results. The ultrastructural study (tissue stained with al-cian blue) showed after treatment a significant increase (p < 0.005) of the electron-dense granules (corresponding to hyaluronic acid), located in collagen elastic fibers, and in the soluble matrix. This presumably leads to subsequent edema that was clinically evident after the treatment. Conclusions. These data suggest that the increased levels of GAGS and the subsequent edema of the dermis could explain at least in part the clinical changes observed after electrorydesis treatment (e.g., swelling and “disappearance” of the wrinkle).     

SYSTEMIC LUPUS ERYTHEMATOSUS IN PATIENTS DIAGNOSED WITH TREATMENT-RESISTANT ACNE

Background. Systemic lupus erythematosus (SLE) may involve any number of organ systems and varies greatly in the severity and type of involvement. Cutaneous manifestations of SLE are equally numerous and varied throughout the course of the disease within an individual, as well as varying between patients. Cutaneous manifestations of SLE are frequently the presenting symptoms, typically noted in the classic malar “butterfly” rash; however, other cutaneous patterns are frequently observed. Methods. We present here two patients who presented with what was thought to be acne refractory to treatment. Results. These patients actually were found to have a facial eruption associated with SLE as confirmed by skin biopsy. Conclusions. The importance of investigating atypical or treatment-resistant eruptions, especially in patients experiencing other symptoms, is emphasized.     

Efficacy and safety of secukinumab in patients with generalized pustular psoriasis: A 52‐week analysis from phase III open‐label multicenter Japanese study

Generalized pustular psoriasis (GPP) is a severe inflammatory skin disease characterized by the presence of sterile pustules covering almost the entire body and systemic symptoms such as fever. Secukinumab, a fully human‐recombinant anti‐interleukin‐17A monoclonal antibody was indicated for psoriasis vulgaris and psoriatic arthritis in Japan but is not yet investigated for GPP. In this phase III, open‐label multicenter single arm study, the efficacy and safety of secukinumab as monotherapy or with co‐medication was evaluated in 12 Japanese patients with GPP. All the patients received secukinumab 150 mg s.c. at baseline, week 1, 2, 3 and 4, and then every 4 weeks. Two non‐responders were up‐titrated to 300 mg. Change in GPP severity from baseline was evaluated by clinical global impression (CGI) categorized as “worsened”, “no change”, “minimally improved”, “much improved” or “very much improved”. Treatment success was achieved by 83.3% (n = 10) of patients at week 16 (primary end‐point) with CGI evaluated as “very much improved” (n = 9) and “much improved” (n = 1). Moreover, the area of erythema with pustules improved as early as week 1 and resolved by week 16 in most of the patients. The improvements were sustained throughout 52 weeks. Over the 52‐week treatment period, secukinumab was well tolerated with no unexpected safety signals. Nasopharyngitis, urticaria, diabetes mellitus and arthralgia were the frequent adverse events reported. The data from this study shows that secukinumab can become one of the potent treatment options for GPP.     

Burden of atopic dermatitis in Japanese adults: Analysis of data from the 2013 National Health and Wellness Survey

Atopic dermatitis is a chronic inflammatory skin disease. The objective of this study was to characterize the burden of atopic dermatitis in Japanese adult patients relative to the general population. Japanese adults (≥18 years) with a self‐reported diagnosis of atopic dermatitis and adult controls without atopic dermatitis/eczema/dermatitis were identified from the 2013 Japan National Health and Wellness Survey. Atopic dermatitis patients were propensity‐score matched with non‐atopic dermatitis controls (1:2 ratio) on demographic variables. Patient‐reported outcome data on comorbidities, mood and sleep disorders, health‐related quality of life, work productivity and activity impairment, and health‐care resource utilization were analyzed in atopic dermatitis patients and matched controls. A total of 638 Japanese adult patients with atopic dermatitis were identified, of whom 290 (45.5%) rated their disease as “moderate/severe” and 348 (54.5%) as “mild”. The analysis cohort comprised 634 atopic dermatitis patients and 1268 matched controls. Atopic dermatitis patients reported a significantly higher prevalence of arthritis, asthma, nasal allergies/hay fever, anxiety, depression and sleep disorders compared with controls (all P < 0.001). Atopic dermatitis patients also reported a significantly poorer health‐related quality of life, higher overall work and activity impairment, and higher health‐care resource utilization (all P < 0.001). Self‐rated disease severity was not associated with disease burden, except for a significantly higher overall work and activity impairment. In conclusion, Japanese adult patients with atopic dermatitis reported a substantial disease burden relative to adults without atopic dermatitis, suggesting an unmet need for effective strategies targeting disease management.     

Health education about occupational allergies and dermatoses for adolescents

Background: Occupational dermatoses and allergies are frequent and often affect individuals with atopic dermatitis. Our aim was to inform adolescents about potentially dangerous occupations, risk groups and preventive measures before they started apprenticeships in order to minimize the risk of occupational allergies or skin diseases. Methods: 1015 high‐school students were instructed by two dermatologists/ allergists (Heidelberg) and a teacher (Potsdam) in a 90‐minute instructional unit.This included the exemplification of occupational skin hazards and allergies, the identification of at‐risk persons, and application of preventive measures. A questionnaire was filled in by the students prior to and at least two weeks after the training. Results: In both regions, the students showed an increase in knowledge after the training, which was statistically significant higher in the Heidelberg region (6.6 points on average vs.4.4 points). 76% of students termed the subject matter as “important”, and 67% rated the teaching unit as “very good” or “good”. Conclusions: We demonstrate that students who have not yet chosen a career are highly interested in this subject, that the developed instructional unit is widely accepted, and that it leads to an increase in knowledge. Therefore we suggest nation‐wide implementation of this primary prevention measure in high‐schools.     

Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity

Background Mesotherapy treatment of aging skin aims to replace depleting levels of minerals, vitamins, amino acids, and hyaluronic acid (HA). Aim To investigate the efficacy of 13.5 mg/g uncross‐linked HA+0.9% mannitol (HA+mannitol) on skin hydration and elasticity. Patients/Methods Four centers enrolled 34 women: Subgroup 1 comprised 27 subjects injected using a “depot” technique; Subgroup 2 comprised seven subjects injected using a “picotage” technique. Results A notable difference was seen between the two subgroups in outcome and subject satisfaction. In Subgroup 1, a significant improvement was seen in hydration, anisotropy, and skin roughness, but Subgroup 2 showed no significant improvements. Most physicians assessed HA+mannitol as “easy/very easy” to inject. Physician esthetic assessment in Subgroup 1 was “improved/very improved” for >90% of subjects at Day 60, and >80% according to subject assessment. 95% of subjects were delighted with treatment, and 85% would undergo repeat treatment and would recommend treatment to a friend. However, results for Subgroup 2 indicated 86% of subjects were unhappy with treatment and 83% would refuse to undergo repeat treatment. Conclusions HA+mannitol is effective for skin hydration, anisotropy, and roughness when treated using a depot technique.     

STATISTICAL DEFINITION OF NAILFOLD CAPILLARY PATTERN IN PATIENTS WITH PSORIASIS

Background. The microvasculature plays an important role in the pathogenesis of psoriatic skin lesions. Our purpose was to try to define a psoriatic pattern in the nailfold capillary, to clarify the relationship between nailfold capillary microscopic changes and nail involvement and to note the general clinical features of psoriasis. Methods. Image analysis of nailfold capillaries was performed in 62 patients with psoriasis. The capillary pattern was defined statistically comparing it with that of 51 healthy volunteers. We attempted to differentiate the psoriatic pattern from normal controls with “canonical discriminant analysis.” Results. Forty-nine of 62 patients with psoriasis could be differentiated from normal controls by our definition of psoriatic pattern that was significantly correlated with periungual psoriatic plaque, nail pitting, onycholysis, and the extent of the involved area. Conclusions. Our data suggest that nailfold capillary changes reflect microvascular changes of psoriasis and that the nailfold capillary pattern is a useful tool in evaluating nail involvement and the severity of psoriasis.     

Beauty from within: Improvement of skin health and appearance with Lycomato a tomato-derived oral supplement

Backround

Healthy and a youthful appearance is a common desire of the aging population. “Beauty from within” involves using nutrition and nutraceuticals to support skin function for reducing and reversing signs of aging such as wrinkles, pigmentary changes, skin laxity, and dullness. Carotenoids possess strong antioxidant and anti-inflammatory activities and are effective in improving skin barrier and could thereby stimulate “beauty from within” by providing endogenous support to reduce the expressions of aging.

Aim

This study was designed to determine whether 3-month supplementation with Lycomato would improve skin condition.

Method

A panel of 50 female subjects used Lycomato capsules as nutritional supplements for 3 months. Skin status was observed via questionnaires for the assessment of skin condition and expert visual grading of facial markers such as wrinkles, tonality, roughness, laxity, and pore size. Skin barrier was assessed using transepidermal water loss (TEWL). Measurements were obtained before treatment and after 4 and 12 weeks of use.

Results

Results indicated a statistically significant improvement (p < 0.05) in skin barrier as measured by TEWL after 12 weeks of consuming the supplement. There was also a significant improvement in skin tonality, lines and wrinkles, pore size, and skin firmness as observed by expert evaluation as well as subject self-assessment.

Conclusion

Based on the confines and conditions of this study, oral supplementation with Lycomato resulted in significant improvement in skin barrier. Visual appearance of lines and wrinkles, skin tonality, pores, smoothness, and firmness were considerably improved, and these improvements were found to be substantially discernible by the subjects.     

Effects of a Brazilian herbal compound as a cosmetic eyecare for periorbital hyperchromia ("dark circles")

Background Evidence suggests that periorbital hyperchromia (dark circles) occurs mainly as a consequence of postinflammatory hemodynamic congestion producing a typical bruising aspect on the lower eyelids. Aims To evaluate the clinical effects of Pfaffia paniculata/Ptychopetalum olacoides B./Lilium candidum L.‐associated compound (PPLAC) on periorbital hyperchromia and to study in vitro its underlying anti‐inflammatory and antioxidant mechanisms. Methods Twenty‐one volunteers presenting with periorbital hyperchromia received a serum sample containing 5.0% PPLAC, which was applied topically in the periorbital area twice a day for 28 days. Skin color was measured using variations in the individual typological angle (ΔITA⁰) and skin luminance (ΔL*) calculated in the area around the eyes and in the adjacent area. Colorimetric readings were taken at the onset and end of the 28‐day treatment. Volunteers were also asked to fill out a questionnaire concerning the improvement in “dark circles.” The anti‐inflammatory and antioxidant effects of PPLAC were measured by quantification of prostaglandin E₂, leukotriene B₄, histamine, and superoxide dismutase levels using an in vitro model of human skin culture. Results Topical application of PPLAC led to a significant improvement in skin luminance and tone in the periorbital area, which was demonstrated by increased values of ITA⁰ and L* in about 90% of volunteers. In addition, subjects reported reduced intensity and improved appearance of “dark circles.” A dose‐dependent decreased production of inflammatory mediators, concomitant to increased antioxidant enzyme levels, was observed in our in vitro studies, under basal and lipopolysaccharide‐stimulated conditions. Conclusions Although the precise mechanisms related to PPLAC remain to be clarified, our results indicate that the reduction in the inflammatory process as well as the antioxidant protection against deleterious elements may be considered as an integral approach to preserve the integrity of vascular endothelium, preventing the hemodynamic congestion that culminates in the formation of “dark circles” around the eyes.     

Clinical evaluation of the safety and efficacy of a 1060 nm diode laser for non-invasive fat reduction of the flanks

Background

Laser hyperthermia-induced lipolysis is a non-invasive method of localized fat treatment. Non-invasive approaches could be an option for a growing number of patients who are risk-averse and are seeking out non-invasive alternatives to surgical procedures such as liposuction. This study evaluated the safety and efficacy of a 1060 nm diode laser for the non-invasive fat reduction of the flanks.

Methods

A total of 30 subjects were enrolled in this prospective, single center study. Subjects received one 25-min treatment with a 1060 nm diode laser to both flanks. Follow-up visits were conducted at 6 and 12 weeks after the last treatment. Ultrasound adipose thickness, body weight, and circumference measurements were taken at baseline and at the 6- and 12-week follow-up visits. Subject satisfaction was assessed using a self-assessment of fat reduction, pain, and tolerability scales, and a subject satisfaction questionnaire. Safety was assessed via the presence or absence of any adverse events.

Results

The average age of subjects was 47.3 years. A total of 27 subjects completed the treatment and returned for both follow-up visits. An adipose reduction of 7.57 ± 1.15% at 6 weeks post-treatment (p < 0.0001) was measured using ultrasound. High subject satisfaction was seen, with 74% of subjects reporting being either “satisfied” or “very satisfied” with their results on a 5-point Likert Scale. Eighty-two percent of subjects stated they would recommend the treatment to their friends. All subjects had either mild or moderate pain, with 52% of subjects rating their pain as “mild” (1–3), while 48% rated their pain as moderate (4–7) on the Wong-Baker Scale.

Conclusions

A single treatment with a 1060 nm diode laser was both safe and effective in reducing unwanted fat in the flanks without any unanticipated adverse events. Subjects described their treatment pain as mild or moderate and were highly satisfied with their treatment outcomes.     

The Discrepancy in Hardness between Clinical and Histopathological Findings in Localized Scleroderma Treated with PUVA

Topical PUVA therapy was applied to a patient with localized scleroderma. Her localized scleroderma responded very well to the topical PUVA therapy, i.e., her sclerotic skin softened to normal skin texture. However, despite this dramatic clinical change the histopathological findings did not change at all and were still “hard”.