New articles from Acta Dermato-Venereologica http://www.medicaljournals.se/acta/ Acta Dermato-Venereologica is an international peer-review journal for clinical and experimental research in the field of dermatology and venereology. 95:6 2015 - ERRATUM http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2136
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2015-06-23 Erratum
95:6 2015 - Linear Skin-coloured Papules on Scrotum: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2024
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2015-03-02 Quiz
95:6 2015 - Yellow Changes of the Skin: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2066
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2015-03-05 Quiz
95:6 2015 - Pruritic Papules Following Lumbar Corset Use: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2071
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2015-03-02 Quiz
95:6 2015 - Bilateral Sporotrichoid Cutaneous Infection by Mycobacterium haemophilum in a Chinese Patient with Systemic Lupus Erythematosus http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2076
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2015-03-04 Shortcom
95:6 2015 - Cutaneous Rosai-Dorfman Disease Located on the Breast: Rapid Effectiveness of Methotrexate After Failure of Topical Corticosteroids, Acitretin and Thalidomide http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2057
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2015-03-03 Shortcom
95:6 2015 - Annular Elastolytic Giant Cell Granuloma Successfully Treated with Minocycline Hydrochloride http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2056
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2015-02-27 Shortcom
95:6 2015 - A Case of Felty’s Syndrome Associated with Skin Ulcers and Extranodal NK/T-cell Lymphoma http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2067
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2015-02-27 Shortcom
95:6 2015 - Skin Abnormalities in CHILD Syndrome Successfully Treated with Pathogenesis-based Therapy http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2044
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2015-02-24 Shortcom
95:6 2015 - Screening for Neuropathic Pain, Anxiety and Other Associated Chronic Pain Conditions in Vulvodynia: A Pilot Study http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2053
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2015-02-13 Shortcom
95:6 2015 - ABCA12-deficient Congenital Ichthyosiform Erythroderma in a Boy with an Intellectual Developmental Delay http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2062
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2015-02-11 Shortcom
95:6 2015 - Detection of Human Papillomavirus Type 67 in Subungual Bowen’s Disease Presenting as Longitudinal Melanonychia http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2054
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2015-02-10 Shortcom
95:6 2015 - Acquired Idiopathic Generalized Anhidrosis: An Immunohistopathological Investigation of Peri-glands Infiltrated with Immunoreactive Cells http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2034
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2015-02-09 Shortcom
95:6 2015 - Tick Attachment Cement with a Feeding Cavity in the Deep Dermis of the Penis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2021
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2015-02-03 Shortcom
95:6 2015 - Transdermal Methyl Alcohol Intoxication: A Case Report http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2043
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2015-02-03 Shortcom
95:6 2015 - Ultrastructural Investigations in an Autosomal Recessively Inherited Case of Dyschromatosis Universalis Hereditaria http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2030
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2015-02-03 Shortcom
95:6 2015 - Chitinase-3-like Protein 1 (YKL-40): Novel Biomarker of Hidradenitis Suppurativa Disease Activity? http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2061
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2015-02-11 Shortcom
95:6 2015 - Mass Spectrometry of Flame Figures http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2050
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2015-02-10 Shortcom
95:6 2015 - Spontaneous Regression of Untreatable Mycoplasma genitalium Urethritis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2055
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2015-02-10 Shortcom
95:6 2015 - Five-day Azithromycin Treatment Regimen for Mycoplasma genitalium Infection Also Effectively Eradicates Chlamydia trachomatis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2108
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2015-04-14 Shortcom
95:6 2015 - A Repeat Validated Population Questionnaire of a Defined Swedish Population Verifies Reduction in Leg Ulcer Prevalence Over Time http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2060
This study was performed to measure if the introduced interventions in leg ulcer care in a selected Swedish county yield a detectable reduction in leg ulcer prevalence in the population. A validated postal questionnaire sent to 10,000 (9,868) randomly selected 30–89 year olds in the Skaraborg county (255,042 inhabitants). All positive responders were telephone interviewed and verified ulcer patients were clinically examined including assessment of arterial/venous circulation with hand-held Doppler and, where indicated, duplex ultrasound scanning. All results were compared with numbers from 1990 (initial study). The response rate was 82% (8,070/9,868), 200 active ulcers and 290 previous ulcers. The calculated prevalence was 0.75% for 30–89 years and 1.05% for 50–89 years (2.1% in 1990). The leg ulcer prevalence was reduced by 32% (0.52% compared to 0.77% in 1990), and the relative risk was reduced by 50% (95%, CI 0.36–0.69). The study shows a true reduction in leg ulcer prevalence detectable in the population supporting a successful care of leg ulcer patients.]]>
2015-03-04 Clinical
95:6 2015 - Ichthyosis Linearis Circumflexa as the Only Clinical Manifestation of Netherton Syndrome http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2075
Ichthyosis linearis circumflexa (ILC) presents as serpiginous and migratory erythematous patches with double-edged scales. ILC is rarely an isolated skin manifestation, but most commonly a part of Netherton syndrome (NS). NS is caused by SPINK5 mutations, which lead to absent or sometimes reduced expression of the serine protease inhibitor LEKTI. NS is characterised by congenital ichthyosiform erytroderma, trichorrhexis invaginata (TI) and atopy. We report 2 children who presented since the first months of life cheek erythema followed by the appearance of sparse ILC lesions on the face, trunk and proximal extremities. Erythroderma at birth, TI and atopy were absent. LEKTI immunoreactivity was reduced in patient epidermis, and serine protease activity was modestly increased, while desmoglein-1 expression remained unaffected. SPINK5 mutation and expression analysis in patient keratinocytes revealed compound heterozygous splicing variants, which allowed residual LEKTI secretion. Our results show that ILC can be the only clinical manifestation of NS.]]>
2015-03-03 Clinical
95:6 2015 - Swedish Experiences From Patch Testing Methylisothiazolinone Separately http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2029
The preservative methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) is a well-known sensitiser and present in the Swedish baseline series since the 1980s. The proportions of MCI/MI are 3:1. MI alone has been used as a preservative since less than 10 years. This study was conducted on behalf of the Swedish Contact Dermatitis Research Group to evaluate inclusion of MI in the Swedish baseline series since the preparation of MCI/MI might fail to detect contact-allergic reactions to MI alone. Patients with suspected allergic contact dermatitis at 5 Swedish dermatology departments were consecutively patch tested with MI 2,000 ppm aq and MCI/MI 200 ppm aq. The number of cases with exclusive contact allergy to MI varied between 0.8–4.2%. In total, 1.9% reacted exclusively to MI and not to MCI/MI. Due to the considerable frequency of contact allergy to MI not traced by MCI/MI, MI 2,000 ppm aq is included in the Swedish baseline series from January 2014. This corresponds to a dose of 60 μg/cm2]]>
2015-01-29 Clinical
95:6 2015 - Risk Factor Analysis for the Immunogenicity of Adalimumab Associated with Decreased Clinical Response in Chinese Patients with Psoriasis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2069
Although anti-drug antibodies against biologics have been associated with decreased clinical efficacy, the immunogenicity of biologics seems to vary between drugs, diseases and ethnicities. This study aims to investigate the predictors for the formation of anti-adalimumab antibodies (AAA) and the clinical consequences of AAA formation. In 53 Chinese psoriatic patients treated with adalimumab, AAA was detected in 50.9%. Differences in Psoriasis Area and Severity Index 75 (PASI75) response rates among patients with and without AAA were significant (44.4% vs. 88.5%; p = 0.001). Patients with AAA had significantly lower trough concentrations of adalimumab than those without AAA. Risk factor analysis showed that treatment interruption, low trough adalimumab concentration, absence of concomitant methotrexate use and biologics switching were associated with a higher AAA titre. The treatment pattern of biologics influences the risk of AAA formation, thereby leading to reduced efficacy of adalimumab. ]]>
2015-02-27 Clinical
95:6 2015 - Burden of Illness in Hereditary Angioedema: A Conceptual Model http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2014
The objective of the Hereditary Angioedema Burden of Illness Study in Europe was to assess the real-world experience of hereditary angioedema (HAE) from the patient perspective. Based on open-ended qualitative interviews with 30 patients from Spain, Germany and Denmark, 5 key themes emerged characterizing the impact of HAE on health-related quality of life (HRQoL): (i) unnecessary treatments and procedures, (ii) symptom triggers, (iii) attack impacts, (iv) caregiver impacts, and (v) long-term impacts. Patients for example experience unnecessary medical procedures due to diagnostic delays; anxiety and fear about attacks, and passing HAE to children; reduced work/school productivity; and limited career/educational achievement. Patient caregivers also experience worry and work/activity interruption
during the attacks. In conclusion, a conceptual model was developed illustrating the hypothesized relationships among the wide-ranging short- and long-term HRQoL impacts of HAE. These findings can be used to highlight important issues in clinical management, raise awareness of the patients’ experience among policymakers and help guide measurement of HRQoL outcomes in future studies in HAE.]]>
2015-02-03 Clinical
95:6 2015 - Atopic Dermatitis Burden Scale for Adults: Development and Validation of a New Assessment Tool http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1945
Atopic dermatitis (AD) occurs in approximately 2–3% of adults. The aim of this study was to develop and validate the self-administered Atopic Dermatitis Burden Scale for Adults (ABS-A). Patients were enrolled consecutively from those attending the Station Thermale Avène for a diagnosis of AD. ABS-A was developed using standard methodology, and consisted of 3 phases: exploratory, development, and validation. Internal consistency (Cronbach’s α), concurrent validity (Spearman’s correlation between ABS-A, SF-12 and Dermatology Life Quality Index [DLQI)]), and discriminant validity, were analysed. A total of 128 adults (68.8% females) completed the ABS-A, consisting of 18 items grouped into 4 domains. ABS-A showed good internal coherence (Cronbach’s α, 0.89) and was correlated with both SF-12 components [r = –0.36, p < 0.0001 (Physical); r = –0.52, p < 0.0001 (Mental)] and DLQI (r = 0.78; p < 0.0001). The ABS-A score varied significantly according to AD severity. To our knowledge, ABS-A is the first specific tool for assessing AD burden in adult patients.]]>
2015-02-23 Clinical
95:6 2015 - Maternal and Perinatal Factors of Importance for Occurrence and Severity of Infantile Haemangioma http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2042
To determine which patient and maternal factors are associated with the occurrence and the severity of infantile haemangioma (IH), a single-centre retrospective observational study was conducted with 96 haemangioma patients and 143 age-matched control babies, born in the same hospital between March 2012 and March 2013. The IH patients were selected according to diagnosis from dermatologists, either consulted from the department of paediatrics or in outpatient setting. Unplanned female children whose mothers smoked and/or consumed alcohol when pregnant was more likely to have IH (p < 0.0.05). The higher the birth weight, the more superficial the haemangioma (p = 0.023), and localised lesions were more common in singleton babies (p = 0.023) and babies conceived by normal fertilisation (p = 0.002). The occurrence and severity of IH is not only influenced by patient factors but also by maternal factors especially care during pregnancy period. By controlling these factors, the incidence and severity of IH may be lowered.]]>
2015-02-12 Clinical
95:6 2015 - Psychological Stress and Immunological Modulations in Early-stage Melanoma Patients http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2045
Mental stress may have a negative impact on the immune state of cancer patients, in whom immunologic surveillance is essential for survival. This study investigated the immunological response of 19 patients with early-stage melanoma and a matched control group undergoing the Determination Stress Test before surgery. Cytokine and chemokine levels and lymphocyte subpopulations were measured at baseline and post-stress test time-points. Following the stress test lower levels of interleukin (IL)-6 were observed in the melanoma group compared with healthy volunteers (p = 0.044). IL-10 increased significantly in the control group 30 min after the stress test (p = 0.002) in comparison with the melanoma group (p = 0.407). CCL5/Rantes decreased significantly in the melanoma group, whereas CD16/CD56+ natural killer cells increased in both groups, with a sharp decrease below baseline after stress in the melanoma group (p = 0.001). This pilot study shows an altered immunological response to stressors in melanoma patients.]]>
2015-02-04 Clinical
95:6 2015 - Malignant Melanoma Arising in Patients with a Large Congenital Melanocytic Naevus: Retrospective Study of 10 Cases with Cytogenetic Analysis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2049
Large congenital melanocytic naevi (LCMN) represent the main risk factor for development of melanoma in childhood. This retrospective study of 10 cases of melanoma in patients with LCMN used fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH) (6 cases) to elucidate the clinical, histological, and cytogenetic characteristics of this rare disorder. Six melanomas were found within the LCMN, the others in lymph nodes, subcutis and brain. The LCMN was located on the trunk in 8 cases, with satellite naevi in 6 cases. Two distinct groups emerged: 5 melanomas that developed before the age of 10 years and the other after 20 years. The mortality rate was 60% and clearly correlated with clinical stage at diagnosis. Histological diagnosis was difficult in only 2 patients in whom neither immunohistochemistry nor FISH were helpful. Otherwise, CGH showed a high number of chromosomal aberrations leading to a formal diagnosis.]]>
2015-02-13 Clinical
95:6 2015 - Viewing Exemplars of Melanomas and Benign Mimics of Melanoma Modestly Improves Diagnostic Skills in Comparison with the ABCD Method and Other Image-based Methods for Lay Identification of Melanoma http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2058
Using an experimental task in which lay persons were asked to distinguish between 30 images of melanomas and common mimics of melanoma, we compared various training strategies including the ABC(D) method, use of images of both melanomas and mimics of melanoma, and alternative methods of choosing training image exemplars. Based on a sample size of 976 persons, and an online experimental task, we show that all the positive training approaches increased diagnostic sensitivity when compared with no training, but only the simultaneous use of melanoma and benign exemplars, as chosen by experts, increased specificity and diagnostic accuracy. The ABCD method and use of melanoma exemplar images chosen by laypersons decreased specificity in comparison with the control. The method of choosing exemplar images is important. The levels of change in performance are however very modest, with an increase in accuracy between control and best-performing strategy of only 9%.]]>
2015-02-13 Investigative
95:6 2015 - Low-dose Anti-thymocyte Globulin Inhibits Human B-cell Differentiation into Antibody-Secreting Cells http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2046
Anti-thymocyte globulin (ATG) is used in the treatment of acute organ rejection. We studied in vitro the effect of low-dose ATG on B-cell activation and differentiation to antibody-secreting cells, as this may have an effect on B cell-driven autoimmune diseases, such as pemphigus vulgaris. Immunoglobulin production was analysed in the supernatants of peripheral blood mononuclear cells (PBMC) and CD19+ B cells from healthy donors and from patients with different autoimmune diseases. B-cell proliferation, viability and differentiation were analysed using flow cytometry. Differentiation of B cells to immunoglobulin G (IgG) secreting cells was significantly reduced by ATG, but not by control unspecific IgG from non-immunized rabbits (rIgG). B-cell viability was not altered by sub-depleting concentrations of ATG. In contrast, B-cell proliferation was enhanced by ATG. When PBMC from patients with autoimmune diseases were studied, specific autoantibodies could be detected in 1 out of 10 patients. In this patient, who had pemphigus vulgaris, ATG not only decreased total IgG, but decreased also specific anti-desmoglein-3. In conclusion, these data suggest that ATG at low concentrations inhibits B-cell differentiation and function.]]>
2015-02-13 Investigative
95:6 2015 - Dermoscopy of Naevus-associated Melanomas http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2009
In order to determine dermoscopic parameters, a case-control test set of naevus-associated melanomas vs de novo melanomas paired by Breslow thickness and histopathological subtype was analysed by 2 blinded experienced dermoscopists, according to presence of naevus, pattern analysis and ABCD dermoscopy score. The ability to identify naevus-associated melanomas by pattern analysis was low for both blinded dermoscopists (κ < 0.2). Dermoscopy features associated with naevus-associated melanomas were: presence of negative pigment network (OR 9.915, CI 95% 2.182–45.049), globules (OR 2.383, CI 95% 1.15–4.95) and streaks (OR 2.439, CI 95% 1.271–4.680). In contrast, the presence of blue-white veil was related to absence of associated naevus (OR 0.520, CI 95% 0.273–0.991). With the results obtained, 2 different algorithms were proposed. The use of the proposed algorithms could help raise awareness of naevus-associated melanomas and avoid the possibility of incorrectly diagnosing a naevus-associated melanoma if partial biopsies are performed.]]>
2015-02-24 Investigative
95:6 2015 - Interferon-gamma Inhibits Melanogenesis and Induces Apoptosis in Melanocytes: A Pivotal Role of CD8+ Cytotoxic T Lymphocytes in Vitiligo http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2080
Increased expression of the cytokine interferon (IFN)-γ plays a pivotal role in vitiligo-induced depigmentation. However, the major source of IFN-γ in vitiligo patients and the mechanisms underlying melanocyte destruction are unknown. In this study, a large number of skin infiltrating IFN-γ+ cells and CD8+ T cells were detected in progressive vitiligo. Among the peripheral blood mononuclear cells (PBMCs) of vitiligo patients, CD8+ cytotoxic T lymphocytes (CTLs) that express IFN-γ exhibited significant expansion, which suggests that activated CTLs are the main source of increased IFN-γ in progressive vitiligo. An in vitro analysis demonstrated that IFN-γ inhibits melanogenesis in primary cultured human melanocytes by altering melanogenic enzyme mRNA expression and, more importantly, that IFN-γ directly induces melanocyte apoptosis. Our data indicate that vitiligo pathophysiology may be linked to globally activated CD8+ CTL subpopulations, which produce increased IFN-γ and induce melanocyte dysfunction and apoptosis.]]>
2015-03-16 Investigative
95:6 2015 - Acid-coated Textiles (pH 5.5–6.5) – a New Therapeutic Strategy for Atopic Eczema? http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1916
Increased transepidermal water loss (TEWL) and decreased skin capacitance are characteristic features of the disturbed epidermal barrier in atopic eczema (AE). The “acid mantle”, which is a slightly acidic film on the surface of the skin has led to the development of acidic emollients for skin care. In this context, the effect of citric acid-coated textiles on atopic skin has not been examined to date. A textile carrier composed of cellulose fibres was coated with a citric acid surface layer by esterification, ensuring a constant pH of 5.5–6.5. Twenty patients with AE or atopic diathesis were enrolled in the study. In a double-blind, half-side experiment, patients had to wear these textiles for 12 h a day for 14 days. On day 0 (baseline), 7 and 14, tolerability (erythema, pruritus, eczema, wearing comfort) and efficacy on skin barrier were assessed by TEWL skin hydration (corneometry/capacitance), pH and clinical scoring of eczema (SCORAD). Citric acid-coated textiles were well tolerated and improved eczema and objective parameters of skin physiology, including barrier function and a reduced skin surface pH, with potential lower pathogenic microbial colonisation.]]>
2015-02-12 Investigative
95:6 2015 - Comparing the Effect of a Twice-weekly Tacrolimus and Betamethasone Valerate Dose on the Subclinical Epidermal Barrier Defect in Atopic Dermatitis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2048
The proactive use of topical anti-inflammatory (TAI) therapy to address subclinical inflammation is an effective, contemporary clinical strategy for the management of atopic dermatitis (AD). The interaction of a proactive TAI dose with the subclinical epidermal barrier defect in AD is yet to be determined. A randomised, observer-blind, functional mechanistic study in 17 subjects with quiescent AD was performed to compare the effect of a twice-weekly dose of betamethasone valerate (0.1%) cream (BMVc), against tacrolimus (0.1%) ointment (TACo) on the biophysical and biological properties of the epidermal barrier. Application of BMVc preserved epidermal barrier function and stratum corneum (SC) integrity, but significantly elevated skin-surface pH with concomitant loss of SC cohesion. By contrast, TACo improved SC integrity, exerted an overall hydrating action, and significantly reduced caseinolytic and trypsin-like protease activity. The differential effects reported support the proactive use of TACo to promote reparation of the subclinical barrier defect in AD.]]>
2015-02-23 Investigative
95:6 2015 - Cerebral Networks Linked to Itch-related Sensations Induced by Histamine and Capsaicin http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2006
This functional magnetic resonance imaging (fMRI) study explored the central nervous processing of itch induced by histamine and capsaicin, delivered via inactivated cowhage spicules, and the influence of low-dose naltrexone. Scratch bouts were delivered at regular intervals after spicule insertion in order temporarily to suppress the itch. At the end of each trial the subjects rated their itch and scratch-related sensations. Stepwise multiple regression analyses were employed for identifying cerebral networks contributing to the intensities of “itching”, “burning”, “stinging”, “pricking” and “itch relief by scratching”. In the capsaicin experiments a network for “burning” was identified, which included the posterior insula, caudate and putamen. In the histamine experiments networks for “itching” and “itch relief” were found, which included operculum, hippocampus and amygdala. Naltrexone generally reduced fMRI activation and the correlations between fMRI signal and ratings. Furthermore, scratching was significantly less pleasant under naltrexone. ]]>
2015-02-12 Investigative
95:6 2015 - Therapy for Gonococcal and Non-gonococcal Genital Infections is a Major Problem for Clinicians http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2120
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2015-05-07 Inthisissue
95:6 2015 - IFN-γ in vitiligo, is it the fuel or the fire? http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2137
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2015-05-25 Inthisissue
95:5 2015 - Self-healing Eyelid Nodule: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2001
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2014-11-18 Quiz
95:5 2015 - Widespread Crusted Skin Ulcerations in a Man with Type II Diabetes: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1999
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2014-11-17 Quiz