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1. Vera-Ke llet C, Peters L, Elwood K, Dutz JP. Usefulness of Interferon - re-
lease assays in the diagno sis of erythema induratum. Arch Dermatol. 2011;
147 (8):949-952.
2. Milstone LM, Waksman B H. Re lease of vir us inhi bitor from t uberculin -
sensitiz ed peritoneal cells stimula ted by ant igen. J Immun ol. 1970;105(5):
1068-1071.
3. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K; IGRA Ex -
pert Committee; Ce nters for Disease Control and Prevention (CDC).
Updated guidelines for using interferon gamma re lease assays to detect My-
cobacterium tuberculosis infection—United States, 2010. MMWR Recomm Rep.
2010;59(RR-5):1-25.
VIGNETTES
Resolution of Skin Maladies
of the Trapped Chilean Miners:
The Unplanned Underground
Copper-Impregnated Antifungal
Socks “Trial”
Report of a Case. In August 2010, a collapse occurred
in a mine in Chile, trapping 33 miners about 700 m be-
low ground. The miners were discovered 17 days later
via a drilled borehole. The underground conditions were
very harsh, with high temperatures (
34°C) and high
humidity (approximately 85%). Within 2 weeks, most
miners were experiencing skin problems, mostly in their
feet. An antifungal cream, clotrimazole, was delivered to
the miners through the borehole, but their skin mala-
dies did not improve.
Thirty-six days after being trapped, each miner re-
ceived 3 pairs of socks containing copper oxide par-
ticles. The potent antifungal and antimicrobial proper-
ties of copper are very well documented.
1
When the
polyester yarn component of socks is permanently im-
pregnated with copper oxide particles , the socks
are imbued with copper’s potent biocidal properties2 and
have been shown to successfully treat fungal infections.3
When rescued, after being 69 days underground, 3
miners had tinea pedis; 7 had plantar xerosis; 2 had pity-
riasis versicolor; 3 had dyshidrotic eczema; and 1 had ony-
chomycosis. Overall, their skin condition, especially on
their feet (Figure 1), was extremely good despite 69 days
of exposure to an environment that promoted the growth
of skin-damaging microbes. The miners reported that a
significant improvement in their skin diseases had oc -
curred while they were still underground after they be-
gan to use the socks.
To understand the effect of the Cupron socks (Cu-
pron Inc), a questionnaire was completed by 19 miners,
most of whom had experienced significant discomfort,
skin irritation, dry skin, and/or skin scaling in their feet
(
Figure 2
) after they were trapped underground.
These are all characteristics of fungal infections but
may be a component of irritant dermatitis. Remarkably,
after beginning to use the socks while still under-
ground, the miners reported that these skin maladies
disappeared, in most cases within 4 to 7 days. Based on
the severity scores given by the miners, there was a sta-
tistically significant reduction (P .001) in these para-
meters and in the general discomfort they felt after
using the socks (Figure 2B). Almost all miners reported
that they had also experienced a bad smell from their
feet, which also disappeared a few days after they began
to use the socks.
Comment.
While this was not a planned experiment,
and no diagnosis was conducted prior to treatment, the
relief of the foot skin maladies experienced by the min-
ers while they were trapped underground in conditions
Figure 1.
Representative pictures of the feet of 2 miners 1 day after they were rescued from the mine.
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Yes
No
Don’t know
A
100
80
60
40
20
0
100
80
60
40
20
0
B
10
5
0
10
5
0
Discomf ort
Before
Dry skin
Before
Irritation
1 2 3 4 5 6 7 8 9
10 11
Miners, No.
Dry skin
1 2 3 4 5 6 7 8 9
10 11
Miners, No.
100
80
60
40
20
0
After
100
80
60
40
20
0
After
10
5
0
12 13 14 15 16 17 18 19
12 13 14 15 16 17 18 19
Irritation
Before
After
Scaling
Before
After
Scaling
1 2 3 4 5 6 7 8 9
10 11 12 13 14 15 16 17 18 19
Miners, No.
Before using the sock s
After using the socks
Figure 2.
Miners’ self-reported scores of whether (A) and to what degree (B) they experienced indicated skin conditions before and after they received the copper
oxide-containing socks. 0 Indicates absent condition; 10, most severe condition. Rank sum t tests were conducted to compare between scores for the various
attributes before and after using the socks.
very favorable for fungal and bacterial growth is prob-
ably the best clinical trial possible to demonstrate the
high efficacy of Cupron socks in treating foot skin in-
fections. Socks are universally used. The copper oxide-
containing socks feel exactly like any regular sock.
Thus, using such a simple, widely used “device” may be
extremely useful in protecting the feet of about 20% of
the world’s population who experience athlete’s foot,4
and miners in particular, who have high rates of ath-
lete’s foot infections (80%-90%).5 Many other individu-
als who are regularly exposed to very harsh conditions
might also benefit, including policeman, sailors, and
soldiers.
Gadi Borkow, PhD
Juan Carlos Mellibovsky, MD
Author Affiliations:
Cupron Inc, Modi’in, Israel (Dr
Borkow); Department of Dermatology, Regional Hospi-
tal of Copiapo, Atacama, Chile (Dr Mellibovsky).
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©2012 American Medical Association. All rights reserved.
A
Correspondence: Dr Borkow, Hameyasdim 44, Gibton
76910, Israel (gadi@cupron.com).
Financial Disclosure: Dr Borkow is employed by Cu-
pron Inc. Cupron owns the patents for the technology
used to impregnate polymeric materials with copper ox-
ide. The socks were donated to the trapped miners by
Cupron’s agent in Chile.
1. Borkow G, Gabbay J. Copper as a biocidal tool. Curr Med Chem. 2005;12(18):
2163-2175.
2. Borkow G, Gabbay J. Putting copper into action: copper-impregnated prod-
ucts with potent biocidal activities. FASEB J. 2004;18(14):1728-1730.
3. Zatcoff RC, Smith MS, Borkow G. Treatment of tinea pedis with socks con-
taining copper-oxide impregnated fibers. Foot (Edinb). 2008;18(3):136-141.
4. Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin my-
coses worldwide. Mycoses. 2008;51(Suppl 4):2-15.
5. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of der-
matophyte infections. Mycopathologia. 2008;166(5-6):335-352.
An Acrochordon-Like
Melanoma Metastasis
crochordons are generally assumed to be benign
and might not be submitted for pathologic analy-
reported receiving therapeutic excision with primary
closure of the left arm and left back sites. Her skin con-
dition remained within normal limits until December
2009, when she developed multiple-pinpoint blue-
brown “blood blister” lesions on her trunk and extremi-
ties, which grew in diameter and number over the fol-
lowing 6 months. At this time a skin tag -like lesion of
the right hip and blue subcutaneous nodules of the bi-
lateral breasts were biopsied, revealing metastatic
melanoma.
At presentation in 2010, the patient pointed out a new
lesion of her anterior left axillary vault, which she be-
lieved was similar to the initial appearance of the right
hip metastasis. The area of concern was a hyperpig-
mented 2-mm soft, pedunculated papule without sur-
rounding macular erythema or pigmentation that clini-
cally appeared consistent with a benign acrochordon
(
Figure 1
, inset). Dermoscopy revealed a mobile, sac-
cular lesion with globular architecture without discern-
ible vascularity (Figure 1).
Reflectance confocal microscopy (RCM) examina-
tion of the epidermis revealed a slightly broadened hon-
sis. One study of 1335 clinically diagnosed acro-
eycomb pattern without ulceration or pagetoid cells.
chordons found only 5 malignant tumors.1 Both squa-
mous cell carcinoma and basal cell carcinoma have been
reported in acrochordon-like lesions.1,2 We report herein a
case of acrochordon-like melanoma metastasis.
Video available online at
www.archdermatol.com
Report of a Case. A 77-year-old white woman was di-
agnosed as having a melanoma in 1986. Although these
medical records were unavailable for review, she self-
Figure 1.
Clinical (inset) and dermoscopic images. Clinical image shows the
hyperpigmented pedunculated metastatic melanoma lesion of the axillary vault
to be similar in appearance to a pigmented acrochordon. Dermoscopic image
of the pigmented saccular lesion without obvious vasculature (Canon Rebel
SXi camera; 3Gen DermLite FOTO Dermatoscope with 30 -mm polarized lens)
(original magnification 8).
The dermoepidermal junction and superficial dermis
revealed rare, bright dendritic processes and extensive
dense and sparse dermal nests with many large refrac-
tile atypical-bizarre cells consistent with melanocytes.
Multiple horizontally oriented and convoluted vessels
were also noted in close proximity to the tumor nests,
consistent with the previously described vascular-tu-
mor interface phenomenon3 (Figure 2A and B) (a video
is available at http://www.archdermatol.com).
Histopathologic review demonstrated a well -
circumscribed pedunculated lesion with overlying epi-
dermal thinning and effacement of the rete. No ulcer-
ation or melanocytic proliferation was noted in the
epidermis. Multiple discohesive nests of severely atypical
melanocytes were noted in the papillary dermis with closely
interposed vessels. The overall picture was consistent with
metastatic malignant melanoma (Figure 2C and D).
A positron emission tomography (PET) computed to-
mography scan demonstrated multiple PET-avid areas;
fine needle aspiration confirmed the presence of meta-
static melanoma in the left axillary lymph node. The pa-
tient started oral temozolomide therapy and was subse-
quently lost to follow-up.
Comment.
While it is widely believed that acrochor-
dons are unlikely to be clinically significant and that they
may be discarded instead of submitted for pathologic re-
view, cutaneous malignancy may present as an acrochor-
don mimicker or arise within an existing acrochordon.
Patients with Gorlin syndrome (basal cell nevus) may de-
velop acrochordon-like basal cell carcinomas at a fairly
young age; invasive squamous cell carcinoma has been
reported to develop within an acrochordon; and there is
1 case report of melanoma presenting as an infarcted ac-
rochordon-like lesion.4,5 While the medical history of the
present patient prompted removal of the lesion in ques-
tion, RCM revealed a concerning architecture that con-
trasted with the lesion’s benign clinical features. Reflec-
tance confocal microscopy may provide additional
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