Patients with hidradenitis suppurativa experience significant life impact related to their diseas... more Patients with hidradenitis suppurativa experience significant life impact related to their disease. Younger age, Black race, high BMI, active smoking, flares, depression, anxiety, high comorbidity burden, disability, and difficult access to a dermatologist adversely influence life impact related to having hidradenitis suppurativa. Attention to these factors, particularly modifiable ones, may reduce overall impact of disease.
| http://medcraveonline.com primary auxiliary hyperhidrosis. Qbrexa (pronounced kew brex'zah) is ... more | http://medcraveonline.com primary auxiliary hyperhidrosis. Qbrexa (pronounced kew brex'zah) is sold commercially as individually packed cloth or swipes. It is self administered home medication that may be applied by any patient 9years old and above. Side effects included local erythema (17%), burning or stinging (14%) and dry mouth in one fifth of the patients. 1,2
Earlier studies on the treatment of congenital melanocytic nevi have reported the efficacy of Q-s... more Earlier studies on the treatment of congenital melanocytic nevi have reported the efficacy of Q-switched ruby laser and Nd:YAG lasers. In this study we evaluated the clinical and the histological effects of a single treatment of normal mode (3 msec) alexandrite laser (755 nm) on small melanocytic nevi. Fourteen patients having 40 nevi entered into the study. Twenty six nevi were clinically followed up after laser treatment for 4 months. Fourteen nevi were biopsied after laser treatment: 8 nevi immediately, 3 nevi after 10 days and 3 nevi after 1 month. At the end of 4 months, 20 (76.92%) nevi attained moderate to significant lightening of color, 5 (19%) nevi had their color matching that of the surrounding skin, one nevus (3.85%) showed very mild hypopigmentation, and 18 (69%) nevi had a surface level similar to the surrounding skin. One nevus healed with keloid formation. Histologically, immediately following laser, there was necrosis of nevus cells in the papillary and uppermost reticular dermis. Nevus cells in the deeper layers of the dermis were not affected. Ten days following laser, the upper dermis showed granulation tissue. One month after laser, there was mild fibrosis in the upper dermis and persistence of nevus cells in the middle and deep dermis. These results suggest that normal mode alexandrite laser may clear or cosmetically improve small melanocytic nevi whether congenital or acquired. However, the concern about the recurrence of the nevi and the potential for malignant transformation should be addressed by long-term follow-up studies.
A 50-year-old diabetic female presented with highly pruritic vesicles and excoriated lesions over... more A 50-year-old diabetic female presented with highly pruritic vesicles and excoriated lesions over the anterior aspect of both lower legs. The lesions were recurrent over the last two years. She received a lot of medications with partial response. Hb A1c was 10.8% (normal up to 7%). CBC showed microcytic, hypochromic anemia. Serum zinc, folate, IgE, TSH and T4 were all within normal ranges. Biopsy showed epidermal separation secondary to keratinocyte necrosis and minimal monocytic, perivascular infiltrate. Direct immunofluorescence was negative for intraepidermal and subepidremal deposition of immunoglobulin. The dermis was positive for mucin deposition stainable by both PAS and Alcian blue while it was negative for Congo red and APC immunoperoxidase staining for amyloid material. In conclusion, the case was diagnosed as bullosis diabeticorum by distinctive clinical and pathological features and after exclusion of other possible differentials. Pruritus was partially controlled by top...
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as wh... more Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's l& also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment ...
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCo... more This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCo... more This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Infantile hemangioma affects about 10% of neonates, but usually involutes without significant com... more Infantile hemangioma affects about 10% of neonates, but usually involutes without significant complications. Complications may include disfigurement, bleeding, and ulceration, along with airway, cardiac, hepatic, and spinal complications depending upon site. Oral propranolol is now the treatment of choice in many situations. Herein we present an infant with a large hemangioma on the nose tip and show the dramatic results with the use of propranolol. The patient received seven months of therapy at 2 mg/kg/day propranolol orally in three divided doses. The response started within a few weeks and by the eighth week ulceration had healed completely without scarring.
International Journal of Research in Dermatology, 2020
Background: Childhood vitiligo although clinically similar to adult onset vitiligo but it has dis... more Background: Childhood vitiligo although clinically similar to adult onset vitiligo but it has distinct clinical, epidemiological and prognostic features compared to adult onset vitiligo.Methods: This is a retrospective study that was carried out on 85 pediatric patients up to age of 18 years old with the diagnosis of vitiligo, where the clinical and epidemiological data including clinical type of vitiligo, family history of autoimmune diseases like thyroid disorders and diabetes mellitus and laboratory results including anti-thyroid peroxidase antibodies (anti-TPO antibodies), anti-parietal cell antibodies, antinuclear antibodies (ANA), Vitamin D and Vitamin B12 were retrieved from the files of these patients.Results: The mean age of the children affected by vitiligo was 10.4 years, the mean age of onset of vitiligo was 5.4 years, 54 (63.5%) percent were girls and 31 (36.5%) were boys. A positive family history of vitiligo was found in 44.7% of the participants, family history of D...
Journal of the American Academy of Dermatology, 2019
Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advan... more Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.
Journal of the European Academy of Dermatology and Venereology, 2017
Materials and method Patients were recruited from 17 dermatological centers from 4 continents. A ... more Materials and method Patients were recruited from 17 dermatological centers from 4 continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35. Results Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient reported severity, p < 0.001 for all). There was no difference in smoking (p = 0.783) nor in family history (p = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (p < 0.001, for each). For low BMI patients, an increase in BMI significantly increased patient reported severity (p < 0.001). For patients with a high BMI, number of pack years significantly increased patient reported severity (p = 0.001). Cluster analysis of eruption patterns were location specific for low BMI patients but severity specific for high BMI patients. Discussion Patients with a low and high body mass index could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.
ejd.2013.1926 Auteur(s) : Hussein Al Sada, Madiha Emran Soofi, Hassan Riad [email protected] POB 3... more ejd.2013.1926 Auteur(s) : Hussein Al Sada, Madiha Emran Soofi, Hassan Riad [email protected] POB 3050, Dermatology Department Rumailah Hospital, Doha, Qatar A 31-year old, single, uncircumcised, Nepalese male patient presented with two penile, non-ulcerating, nodular lesions of 3 months’ duration. The first nodule was annular, on the left side of the glans penis, 6 mm in diameter, with a raised edge and indurated base (figure 1A). The second nodule was periuretheral and larger in size (8 mm), mildly [...]
Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune co... more Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune comorbidities. Many studies show colocalization of these diseases at the same anatomical site. Here, we have a case where both disorders were reported to present in the same patient. Diphenylcyclopropenone (diphencyprone, DCP) is used in the treatment of alopecia areata and may induce vitiligo in some patients. We report on one case of vitiligo that was induced by DCP during therapy for alopecia universalis. Alopecia areata and vitiligo share many susceptibility genes. Follicular melanocyte destruction may represent the link between the two diseases.
Biologics are very useful medications that changed the lives of many patients in the last decade.... more Biologics are very useful medications that changed the lives of many patients in the last decade. However, we still do not know about the long-term side effects of these drugs. Infliximab is an anti-TNF chimeric antibody widely used and approved for the treatment of many diseases. Lupus-like syndrome and hepatitis are among the uncommon side effects of infliximab. Most of the written literature was published for cases of rheumatology and gastroenterology. We report here a case of both hepatitis and lupus-like syndrome that occurred sequentially in the same patient and compare our finding with two case reports of the same side effects, drug and disease.
A malignant transformation is known to occur in many nevi such as a sebaceous nevus or a basal ce... more A malignant transformation is known to occur in many nevi such as a sebaceous nevus or a basal cell nevus, but a verrucous epidermal nevus has only rarely been associated with neoplastic changes. Keratoacanthoma, multifocal papillary apocrine adenoma, multiple malignant eccrine poroma, basal cell carcinoma and cutaneous squamous cell carcinoma (CSCC) have all been reported to develop from a verrucous epidermal nevus. CSCC has also been reported to arise from other nevoid lesions like a nevus comedonicus, porokeratosis, a sebaceous nevus, an oral sponge nevus and an ichthyosiform nevus with CHILD syndrome. Here we report a case of progressive poorly differentiated CSCC arising from a localized verrucous epidermal nevus, which caused both spinal cord and brain metastasis.
The pathology of 61 cases of disseminated superficial actinic porokeratosis was reviewed and the ... more The pathology of 61 cases of disseminated superficial actinic porokeratosis was reviewed and the relative frequency of the histological features associated with the cornoid lamella and the pathology within and outside the porokeratotic rim were assessed. Papillary dermal lymphocytic infiltrate (97%), spinous layer vacuolar changes (90%), dyskeratotic cells in the epidermis (77%), and liquefaction degeneration of the basal layer (67%) were frequently seen under the cornoid lamella. Papillary lymphocytic infiltration was seen more frequently inside the porokeratotic ring in comparison to the outer skin. Lymphocyte marker studies in nine cases showed a predominance of activated T lymphocytes with positive LN3 and UCHL-1 staining. Together with the finding of a lichenoid reaction pattern, these results lend support to the hypothesis that actinic porokeratosis represents a migrating clone of abnormal keratinocytes with an associated immunological host response.
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as wh... more Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's l& also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment ...
www.karger.com/cde This is an Open Access article licensed under the terms of the Creative Common... more www.karger.com/cde This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Patients with hidradenitis suppurativa experience significant life impact related to their diseas... more Patients with hidradenitis suppurativa experience significant life impact related to their disease. Younger age, Black race, high BMI, active smoking, flares, depression, anxiety, high comorbidity burden, disability, and difficult access to a dermatologist adversely influence life impact related to having hidradenitis suppurativa. Attention to these factors, particularly modifiable ones, may reduce overall impact of disease.
| http://medcraveonline.com primary auxiliary hyperhidrosis. Qbrexa (pronounced kew brex'zah) is ... more | http://medcraveonline.com primary auxiliary hyperhidrosis. Qbrexa (pronounced kew brex'zah) is sold commercially as individually packed cloth or swipes. It is self administered home medication that may be applied by any patient 9years old and above. Side effects included local erythema (17%), burning or stinging (14%) and dry mouth in one fifth of the patients. 1,2
Earlier studies on the treatment of congenital melanocytic nevi have reported the efficacy of Q-s... more Earlier studies on the treatment of congenital melanocytic nevi have reported the efficacy of Q-switched ruby laser and Nd:YAG lasers. In this study we evaluated the clinical and the histological effects of a single treatment of normal mode (3 msec) alexandrite laser (755 nm) on small melanocytic nevi. Fourteen patients having 40 nevi entered into the study. Twenty six nevi were clinically followed up after laser treatment for 4 months. Fourteen nevi were biopsied after laser treatment: 8 nevi immediately, 3 nevi after 10 days and 3 nevi after 1 month. At the end of 4 months, 20 (76.92%) nevi attained moderate to significant lightening of color, 5 (19%) nevi had their color matching that of the surrounding skin, one nevus (3.85%) showed very mild hypopigmentation, and 18 (69%) nevi had a surface level similar to the surrounding skin. One nevus healed with keloid formation. Histologically, immediately following laser, there was necrosis of nevus cells in the papillary and uppermost reticular dermis. Nevus cells in the deeper layers of the dermis were not affected. Ten days following laser, the upper dermis showed granulation tissue. One month after laser, there was mild fibrosis in the upper dermis and persistence of nevus cells in the middle and deep dermis. These results suggest that normal mode alexandrite laser may clear or cosmetically improve small melanocytic nevi whether congenital or acquired. However, the concern about the recurrence of the nevi and the potential for malignant transformation should be addressed by long-term follow-up studies.
A 50-year-old diabetic female presented with highly pruritic vesicles and excoriated lesions over... more A 50-year-old diabetic female presented with highly pruritic vesicles and excoriated lesions over the anterior aspect of both lower legs. The lesions were recurrent over the last two years. She received a lot of medications with partial response. Hb A1c was 10.8% (normal up to 7%). CBC showed microcytic, hypochromic anemia. Serum zinc, folate, IgE, TSH and T4 were all within normal ranges. Biopsy showed epidermal separation secondary to keratinocyte necrosis and minimal monocytic, perivascular infiltrate. Direct immunofluorescence was negative for intraepidermal and subepidremal deposition of immunoglobulin. The dermis was positive for mucin deposition stainable by both PAS and Alcian blue while it was negative for Congo red and APC immunoperoxidase staining for amyloid material. In conclusion, the case was diagnosed as bullosis diabeticorum by distinctive clinical and pathological features and after exclusion of other possible differentials. Pruritus was partially controlled by top...
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as wh... more Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's l& also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment ...
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCo... more This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCo... more This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Infantile hemangioma affects about 10% of neonates, but usually involutes without significant com... more Infantile hemangioma affects about 10% of neonates, but usually involutes without significant complications. Complications may include disfigurement, bleeding, and ulceration, along with airway, cardiac, hepatic, and spinal complications depending upon site. Oral propranolol is now the treatment of choice in many situations. Herein we present an infant with a large hemangioma on the nose tip and show the dramatic results with the use of propranolol. The patient received seven months of therapy at 2 mg/kg/day propranolol orally in three divided doses. The response started within a few weeks and by the eighth week ulceration had healed completely without scarring.
International Journal of Research in Dermatology, 2020
Background: Childhood vitiligo although clinically similar to adult onset vitiligo but it has dis... more Background: Childhood vitiligo although clinically similar to adult onset vitiligo but it has distinct clinical, epidemiological and prognostic features compared to adult onset vitiligo.Methods: This is a retrospective study that was carried out on 85 pediatric patients up to age of 18 years old with the diagnosis of vitiligo, where the clinical and epidemiological data including clinical type of vitiligo, family history of autoimmune diseases like thyroid disorders and diabetes mellitus and laboratory results including anti-thyroid peroxidase antibodies (anti-TPO antibodies), anti-parietal cell antibodies, antinuclear antibodies (ANA), Vitamin D and Vitamin B12 were retrieved from the files of these patients.Results: The mean age of the children affected by vitiligo was 10.4 years, the mean age of onset of vitiligo was 5.4 years, 54 (63.5%) percent were girls and 31 (36.5%) were boys. A positive family history of vitiligo was found in 44.7% of the participants, family history of D...
Journal of the American Academy of Dermatology, 2019
Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advan... more Background: A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy.
Journal of the European Academy of Dermatology and Venereology, 2017
Materials and method Patients were recruited from 17 dermatological centers from 4 continents. A ... more Materials and method Patients were recruited from 17 dermatological centers from 4 continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35. Results Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient reported severity, p < 0.001 for all). There was no difference in smoking (p = 0.783) nor in family history (p = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (p < 0.001, for each). For low BMI patients, an increase in BMI significantly increased patient reported severity (p < 0.001). For patients with a high BMI, number of pack years significantly increased patient reported severity (p = 0.001). Cluster analysis of eruption patterns were location specific for low BMI patients but severity specific for high BMI patients. Discussion Patients with a low and high body mass index could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.
ejd.2013.1926 Auteur(s) : Hussein Al Sada, Madiha Emran Soofi, Hassan Riad [email protected] POB 3... more ejd.2013.1926 Auteur(s) : Hussein Al Sada, Madiha Emran Soofi, Hassan Riad [email protected] POB 3050, Dermatology Department Rumailah Hospital, Doha, Qatar A 31-year old, single, uncircumcised, Nepalese male patient presented with two penile, non-ulcerating, nodular lesions of 3 months’ duration. The first nodule was annular, on the left side of the glans penis, 6 mm in diameter, with a raised edge and indurated base (figure 1A). The second nodule was periuretheral and larger in size (8 mm), mildly [...]
Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune co... more Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune comorbidities. Many studies show colocalization of these diseases at the same anatomical site. Here, we have a case where both disorders were reported to present in the same patient. Diphenylcyclopropenone (diphencyprone, DCP) is used in the treatment of alopecia areata and may induce vitiligo in some patients. We report on one case of vitiligo that was induced by DCP during therapy for alopecia universalis. Alopecia areata and vitiligo share many susceptibility genes. Follicular melanocyte destruction may represent the link between the two diseases.
Biologics are very useful medications that changed the lives of many patients in the last decade.... more Biologics are very useful medications that changed the lives of many patients in the last decade. However, we still do not know about the long-term side effects of these drugs. Infliximab is an anti-TNF chimeric antibody widely used and approved for the treatment of many diseases. Lupus-like syndrome and hepatitis are among the uncommon side effects of infliximab. Most of the written literature was published for cases of rheumatology and gastroenterology. We report here a case of both hepatitis and lupus-like syndrome that occurred sequentially in the same patient and compare our finding with two case reports of the same side effects, drug and disease.
A malignant transformation is known to occur in many nevi such as a sebaceous nevus or a basal ce... more A malignant transformation is known to occur in many nevi such as a sebaceous nevus or a basal cell nevus, but a verrucous epidermal nevus has only rarely been associated with neoplastic changes. Keratoacanthoma, multifocal papillary apocrine adenoma, multiple malignant eccrine poroma, basal cell carcinoma and cutaneous squamous cell carcinoma (CSCC) have all been reported to develop from a verrucous epidermal nevus. CSCC has also been reported to arise from other nevoid lesions like a nevus comedonicus, porokeratosis, a sebaceous nevus, an oral sponge nevus and an ichthyosiform nevus with CHILD syndrome. Here we report a case of progressive poorly differentiated CSCC arising from a localized verrucous epidermal nevus, which caused both spinal cord and brain metastasis.
The pathology of 61 cases of disseminated superficial actinic porokeratosis was reviewed and the ... more The pathology of 61 cases of disseminated superficial actinic porokeratosis was reviewed and the relative frequency of the histological features associated with the cornoid lamella and the pathology within and outside the porokeratotic rim were assessed. Papillary dermal lymphocytic infiltrate (97%), spinous layer vacuolar changes (90%), dyskeratotic cells in the epidermis (77%), and liquefaction degeneration of the basal layer (67%) were frequently seen under the cornoid lamella. Papillary lymphocytic infiltration was seen more frequently inside the porokeratotic ring in comparison to the outer skin. Lymphocyte marker studies in nine cases showed a predominance of activated T lymphocytes with positive LN3 and UCHL-1 staining. Together with the finding of a lichenoid reaction pattern, these results lend support to the hypothesis that actinic porokeratosis represents a migrating clone of abnormal keratinocytes with an associated immunological host response.
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as wh... more Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's l& also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment ...
www.karger.com/cde This is an Open Access article licensed under the terms of the Creative Common... more www.karger.com/cde This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
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