"Widespread cutaneous and systemic calcification (calciphylaxis) in patients with the acquired immunodeficiency syndrome and renal disease"Cockerell, C J; Dolan, E T
BACKGROUND: Calciphylaxis is a form of widespread calcification that may occur in patients with renal disease and hyperparathyroidism. The skin is often affected secondary to vascular compromise and ischemia. Patients infected with the human immunodeficiency virus (HIV) are predisposed to renal failure and thus may develop this serious complication. OBJECTIVE: The purpose of this article is to describe two cases of fatal calciphylaxis in patients with the acquired immunodeficiency syndrome and renal disease. METHODS: Two patients were examined clinically and through the performance of serologic studies and skin biopsies. RESULTS: Both patients had a widespread livedo reticularis-like eruption, which rapidly progressed to cutaneous gangrene. Patient 1 had elevated serum calcium and phosphorus levels whereas patient 2 had normal values but had markedly elevated serum parathyroid hormone levels. Biopsy specimens in both cases showed vascular thrombosis and soft tissue calcification. CONCLUSION: Widespread calcification may develop in patients with HIV infection and renal failure and, in some cases, calcium and phosphorus levels may be normal.
"Geriatric nail disorders: diagnosis and treatment"Cohen, P R; Scher, R K
Age-associated nail changes and disorders are common in elderly patients. Characteristic changes in color, contour, growth, surface, thickness, and histology occur in the nail unit as persons become older. Several onychodystrophies are frequently observed in these elderly patients: brittle nails, those induced by faulty biomechanics and trauma, infections, onychauxis, onychoclavus, onychogryphosis, onychophosis, splinter hemorrhages and subungual hematomas, and subungual exostosis. Awareness of the signs and symptoms of the aging nail will enable better assessment and management of the onychologic concerns of this group of older patients.
"The spectrum of nail disease in patients with human immunodeficiency virus infection"Daniel, C R 3rd; Norton, L A; Scher, R K
There are no known pathognomonic nail signs of human immunodeficiency virus (HIV) infection. However, several presentations should increase the index of suspicion. (1) Proximal white subungual onychomycosis or superficial white onychomycosis, especially of the fingernails, is present. Trichophyton rubrum appears to cause both most commonly in HIV-infected patients. Periungual dermatophyte involvement and involvement of all 10 fingernails is unusual in non-HIV-infected persons. (2) Candida is a primary pathogen of the nail bed and nail plate especially if many nails are involved. (3) A destructive, almost granulomatous-like psoriatic involvement of the nails is present. (4) Squamous cell carcinoma of the nail bed in a young adult. There are no clinical trails to confirm the efficacy of therapy mentioned in this article. The treatment suggestions are empirical and are the personal views of the authors.
"Pachydermodactyly: first report in a woman"Draluck JC; Kopf AW; Hodak E
Pachydermodactyly is a rare form of digital fibromatosis that is characterized by acquired, asymptomatic, protracted connective tissue swellings on the back and sides of a few proximal phalanges or proximal interphalangeal joints. This is the tenth reported case of pachydermodactyly. It has previously been reported only in men; to the best of our knowledge, this is the first woman described with this condition.
"A histopathologic comparison of Shulman's syndrome (diffuse fasciitis with eosinophilia) and the fasciitis associated with the eosinophilia-myalgia syndrome"Feldman, S R; Silver, R M; Maize, J C
A comparison of the histopathologic features of Shulman's syndrome (diffuse fasciitis with eosinophilia) and the fasciitis associated with the eosinophilia-myalgia syndrome is presented. The study population consisted of eight biopsy specimens of seven patients with Shulman's syndrome and 11 specimens from 10 patients with eosinophilia-myalgia syndrome. Both groups exhibited inflammatory changes in the subcutaneous fat, septa, and fascia; cutaneous changes were more prominent in cases of eosinophilia-myalgia syndrome. Eosinophils and plasma cells were not consistently present in either condition; mast cells and factor XIIIa-positive cells were consistently present in the inflammatory infiltrates. Although there was overlap in the histopathologic findings, Shulman's syndrome tends to involve the subcutis alone and the eosinophilia-myalgia syndrome tends to be a pancutaneous-subcutaneous process..
"Allergic contact dermatitis from formaldehyde resins in permanent press clothing: an underdiagnosed cause of generalized dermatitis"Fowler, J F Jr; Skinner, S M; Belsito, D V
BACKGROUND AND METHODS: Formaldehyde resins have been used to impart wrinkle resistance to clothing fabrics since 1926. After several patients with positive patch tests to formaldehyde resins had been examined, a study was undertaken of the records of all patch tests performed at the University of Louisville Patch Test Clinic and the Allergy Section of the Skin and Cancer Clinic of New York University Medical Center from January 1988 through April 1990 to determine the prevalence of positive patch-test reactions to formaldehyde-based textile resins and the clinical and demographic patterns associated with textile resin allergy. RESULTS: Seventeen patients were identified at the two centers. Twelve were allergic to formaldehyde as well as to formaldehyde textile resins. Several clinical patterns were found, including accentuation of dermatitis in areas of tight clothing, primary occurrence in clothing-covered areas, and a chronic recalcitrant course. Ethylene urea melamine formaldehyde resin was the best screening agent with 14 definite positive reactions and one equivocal reaction. CONCLUSION: Formaldehyde textile resin allergy is more common than has been previously recognized. Patch testing with one or more formaldehyde textile resins is indicated in patients with a particular pattern of dermatitis.
"Effectiveness of various barrier preparations in preventing and/or ameliorating experimentally produced Toxicodendron dermatitis"Grevelink, S A; Murrell, D F; Olsen, E A
BACKGROUND: Despite extensive research on hyposensitization and prior application of topical barrier preparations, efforts to prevent Toxicodendron dermatitis have been only minimally successful. OBJECTIVE: Seven different barrier creams were evaluated for topical protection against experimentally produced Toxicodendron dermatitis in a randomized, double-blind study. METHODS: Twenty patients had the seven barrier creams randomly applied to eight test sites (one untreated area as control) on each forearm before application of the Toxicodendron extract. Development of Toxicodendron dermatitis was followed for 8 days, with measurements of erythema, induration, vesiculation, and global severity taken at each site on days 1, 2, 3, 4, and 7 after Toxicodendron application. RESULTS: The barrier creams Stokogard, Hollister Moisture Barrier, and Hydropel significantly reduced the erythema, induration, and global severity of Toxicodendron dermatitis and did not differ from each other. The percent reductions in global dermatitis severity per day of assessment for the seven barriers in order of effectiveness were as follows: Stokogard, 59%; Hollister Moisture Barrier, 52%; Hydropel, 48%; Ivy Shield, 22%; Shield Skin, 13%; Dermofilm, 13%; and Uniderm, -9%. During the 8-day period, a significantly greater number of test sites pretreated with Stokogard, Hollister Moisture Barrier, and Hydropel were free of dermatitis compared with control sites and sites treated with the other four barriers. CONCLUSION: The results indicate that Stokogard, Hollister Moisture Barrier, and Hydropel are effective in the prevention of Toxicodendron dermatitis.
"The Tzanck smear: can dermatologists accurately interpret it?"Grossman, M C; Silvers, D N
BACKGROUND: The Tzanck preparation is a standard technique for the rapid diagnosis of herpes simplex and varicella-zoster virus infections. OBJECTIVE: This study was designed to determine the ability of practicing dermatologists to interpret Tzanck preparations accurately. METHODS: Dermatologists at different levels of training interpreted a series of Tzanck preparations under test conditions. RESULTS: Second- and third-year residents had a pooled average for correct responses of 91%; dermatologists in practice less than 10 years, 84%; dermatologists in practice more than 10 years, 67%. CONCLUSION: Dermatologists are able to use the Tzanck preparation effectively for diagnosing herpetic infections. Second- and third-year residents who are most likely to be diagnosing blistering eruptions in immunosuppressed or otherwise critically ill patients are especially accurate interpreters..
"American Academy of Dermatology Patch Testing Survey: use and effectiveness of this procedure"James WD; Rosenthal LE; Brancaccio RR; Marks JG
The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.
"Oral lesions in systemic lupus erythematosus. Do ulcerative lesions represent a necrotizing vasculitis?"Jorizzo, J L; Salisbury, P L; Rogers, R S 3rd; Goldsmith, S M; Shar, G G; Callen, J P; Wise, C M; Semble, E L; White, W L
BACKGROUND: It has been suggested that oral lesions in patients with systemic lupus erythematosus (SLE) may be grouped clinically as erythema, discoid lesions, or oral ulcerations. Oral ulcerations have been said to foretell a severe systemic disease flare and the proposal that oral ulcers represent a mucosal vasculitis has been suggested to explain this hypothesis. OBJECTIVE: Our objective was to test the hypothesis that oral ulcers in patients with SLE result from vasculitis. METHODS: We studied 10 patients with American College of Rheumatology (ACR) criteria for a diagnosis of SLE who had oral lesions of lupus (six prospectively and four retrospectively) clinically and by routine and immunofluorescence microscopy. Biopsy specimens were reviewed in a single-blinded fashion. RESULTS: In our patients, no oral lesion, regardless of morphology, demonstrated vasculitis histologically. All lesions demonstrated an interface mucositis. CONCLUSION: Our data strongly contradict the hypothesis that leukocytoclastic vasculitis explains a possible unproven correlation between oral ulceration and disease flares in patients with SLE..
"Effects of topical ammonium lactate on cutaneous atrophy from a potent topical corticosteroid"Lavker RM; Kaidbey K; Leyden JJ
BACKGROUND: Topical corticosteroids produce atrophic changes in skin, including thinning of the epidermis and decrease in dermal ground substance. We observed that 12% ammonium lactate produced an increase in the thickness of epidermis and increased amounts of dermal glycosaminoglycans. OBJECTIVE: Our purpose was to determine whether 12% ammonium lactate could minimize cutaneous atrophy produced by a potent topical corticosteroid. METHODS: Clobetasol propionate, 12% ammonium lactate, and both agents were repetitively applied under occlusive patches as well as in open patches on the forearms of human volunteers for 3 to 4 weeks. Biopsy specimens were analyzed for thickness of the epidermis and dermal glycosaminoglycans by image analysis. RESULTS: Twelve percent ammonium lactate produced a significant sparing of atrophy in both the epidermis and dermis without any influence on the bioavailability or antiinflammatory properties of the corticosteroid. CONCLUSION: Twelve percent ammonium lactate may be useful in mitigating the adverse effects of corticosteroid on skin.
"Level of education and the risk of malignant melanoma"Lee PY; Silverman MK; Rigel DS; Vossaert KA; Kopf AW; Bart RS; Garfinkel L; Levenstein MJ
GRANTS:P30 CA-16087/CA/NCI NIH HHS/United States;R0I CHOO915/HO/NHLBI NIH HHS/United States;RIO CA 1366-05/CA/NCI NIH HHS/United States
BACKGROUND: The risk for the development of malignant melanoma has been reported to be higher in persons with more formal education than in individuals with less. OBJECTIVE: To study whether those with more formal education are indeed at more risk for malignant melanoma than those with less formal education. METHODS: This case-control study explores the relation between education and melanoma risk by analyzing data collected by the American Cancer Society. A total of 1.2 million people were surveyed for a history of cancer and followed up for 6 years for the development of any cancer. In total, 2780 white persons had a history of malignant melanoma or developed malignant melanoma during the study period. The controls were age-, sex-, and geographically matched white persons selected from the remaining people enrolled. RESULTS: Both men and women were shown to have a statistically significant increase in the relative risk for malignant melanoma with increasing education level (p less than 0.001 and p = 0.001, respectively). This relation was more striking in men when the relative risk with 95% confidence interval was calculated by sex for each education level. CONCLUSION: Americans with more formal education are at greater risk for malignant melanoma than those with less education.
"Photosensitivity, abnormal porphyrin profile, and sideroblastic anemia"Lim HW; Cooper D; Sassa S; Dosik H; Buchness MR; Soter NA
GRANTS:DK-32890/DK/NIDDK NIH HHS/United States
Cutaneous photosensitivity in a 43-year-old man with idiopathic sideroblastic anemia associated with an abnormal porphyrin profile is reported. This condition was associated with elevated free erythrocyte porphyrin, plasma protoporphyrin, urine porphyrins (predominantly coproporphyrin), stool porphyrins (predominantly protoporphyrin), decreased ferrochelatase activity, and deletion of portions of the long arms of chromosomes 18 and 20. Five other patients with sideroblastic anemia and abnormal porphyrin profiles have been described; all but one of these patients had photosensitivity. The porphyrin profile of this patient is similar to that of three other previously described patients.
"Prevalence of dermatophytosis in patients with diabetes"Lugo-Somolinos, A; Sanchez, J L
BACKGROUND: Controversy still exists as to whether dermatophytic skin infection is truly more common in patients with diabetes. OBJECTIVE: The purpose of this study was to determine the true prevalence of dermatophytosis in diabetic patients as compared with a control population. METHODS: One hundred consecutive diabetic patients were examined for evidence of fungal disease of the skin and compared with nondiabetic, nonimmunocompromised patients. Potassium hydroxide preparation and fungal cultures were obtained from all suspect lesions. RESULTS: Thirty-one percent of the diabetic population had culture-proven fungal infections compared with 33% of the control group. The organism most commonly isolated was Trichophyton rubrum in both groups, and the feet were the most common site of infection. Candida albicans was more prevalent in the control group, affecting the nails in particular (24% vs 15% in the diabetic patients). CONCLUSION: This study shows that there does not seem to be an increased prevalence of dermatophytosis in diabetic patients as compared with a control, nondiabetic patient..
"Diagnosis of Acanthamoeba infection by cutaneous manifestations in a man seropositive to HIV" [Case Report]May, L P; Sidhu, G S; Buchness, M R
A case of Acanthamoeba infection with cutaneous manifestations in a man seropositive for human immunodeficiency virus is reported. The diagnosis was made by identification of amoebic trophozoites and cysts in tissue specimens. Two other cases of disseminated Acanthamoeba infection with similar skin findings in patients with acquired immunodeficiency syndrome have been previously reported. Recognition of the cutaneous manifestations of acanthamoebiasis in patients seropositive for human immunodeficiency virus may lead to earlier diagnosis and improved therapy..
"TRETINOIN EMOLLIENT CREAM - A NEW THERAPY FOR PHOTODAMAGED SKIN"OLSEN, EA; KATZ, HI; LEVINE, N; SHUPACK, J; BILLYS, MM; PRAWER, S; GOLD, J; STILLER, M; LUFRANO, L; THORNE, EG
Background: Tretinoin administered topically in 0.1% concentration has been shown to improve the wrinkling and irregular pigmentation of photoaged skin. Objective: The purpose of this study was to assess the safety and efficacy of various concentrations of tretinoin in a new emollient cream base in the treatment of photoaged skin. Methods: Three concentrations of tretinoin (0.05%, 0.01%, and 0.001%) in a new emollient cream formulation were compared with vehicle in a 24-week, double-blind, randomized, multicenter study of 296 subjects with photodamaged facial skin. Results: Tretinoin emollient cream 0.05% gave a significantly better global response to therapy than vehicle (p < 0.001), with 68% of subjects exhibiting improvement at the end of therapy, compared with 43% of subjects in the vehicle group. An excellent or good response was found in 26% of subjects treated with tretinoin emollient cream 0.05% versus 11% of vehicle-treated subjects. Fine wrinkling, mottled hyperpigmentation, and roughness were more improved in subjects who received tretinoin emollient cream 0.05% than in vehicle-treated subjects (p < 0.05). No significant difference was found between vehicle and tretinoin emollient cream 0.01% or 0.001%. Histologic examination showed increases in epidermal and granular layer thickness, decreased melanin content and compaction of the stratum corneum after therapy with tretinoin emollient cream 0.05% or 0.01%. Mild to moderate skin reactions, such as erythema, peeling, and burning, were the most common side effects and, although most prevalent in the group using the 0.05% concentration, generally did not limit tretinoin use. Conclusion: Tretinoin emollient cream 0.05% appears to be safe and effective in the treatment of photodamaged skin.
"Acne conglobata and a generalized lichen spinulosus-like eruption in a man seropositive for human immunodeficiency virus"Resnick, S D; Murrell, D F; Woosley, J
"Verification of a formula for determination of preexcision surgical margins from fixed-tissue melanoma specimens"Silverman MK; Golomb FM; Kopf AW; Grin-Jorgensen CM; Vossaert KA; Doyle JP; Levenstein MJ
GRANTS:2 RIO CA 1366-05/CA/NCI NIH HHS/United States;P30 CA-16087/CA/NCI NIH HHS/United States;R0I OH00915/OH/NIOSH CDC HHS/United States
BACKGROUND: Recently our group reported on the shrinkage of 199 malignant melanoma surgical-excision specimens. In that report, a multivariate analysis revealed that the age of the patient was the only factor that significantly affected the percentage shrinkage of a surgical specimen. In addition, a formula was presented that extrapolates the actual surgical margins (in vivo) from the (contracted) fixed-tissue pathology report measurement and the reported in vivo lesion diameter. OBJECTIVE: The goals of this study are to verify that shrinkage of surgical specimens is approximately 20% and that the margin formula can be successfully applied to a different group of patients. METHODS: Four hundred seven patients with malignant melanoma were prospectively enrolled to measure preexcision (outlined with ink) surgical margins, fixed-tissue (contracted) surgical margins, and overall specimen shrinkage. RESULTS: It is verified that overall shrinkage of cutaneous surgical specimens is approximately 20%. Surgical specimens from patients younger than 50 years of age have approximately 25% shrinkage. Those specimens from patients 50 to 59 years of age have approximately 20% shrinkage and those from patients 60 years of age or older have about 15% shrinkage. The surgical margins predicted by the margin formula were within +/- 3.5 mm of the actual measured surgical margin 86.5% of the time. CONCLUSION: The actual surgical margins (in vivo) of a malignant melanoma can be reasonably estimated from the fixed-tissue pathology measurement via the margin formula. The shrinkage of a surgical specimen is 15% to 25% depending on the patient's age.
"Elevation of fasting serum lipids in patients treated with low-dose cyclosporine for severe plaque-type psoriasis. An assessment of clinical significance when viewed as a risk factor for cardiovascular disease"Stiller MJ; Pak GH; Kenny C; Jondreau L; Davis I; Wachsman S; Shupack JL
GRANTS:AR 39749/AR/NIAMS NIH HHS/United States
BACKGROUND: Hyperlipidemia has received little attention as a side effect of cyclosporine therapy for severe psoriasis. OBJECTIVE: We report changes in fasting serum lipids in patients treated with low-dose oral cyclosporine for psoriasis and discuss their significance. METHODS: Twenty-two patients with severe, recalcitrant, plaque-type psoriasis were treated with cyclosporine, 5 mg/kg/day, for 12 to 16 weeks. Fasting serum lipid levels (triglycerides, cholesterol, and high-density lipoproteins) were measured at 2-week intervals. RESULTS: The mean serum triglyceride level increased from 117.8 +/- 11.7 mg/dl before initiation of therapy to 183.9 +/- 31.4 mg/dl after 2 weeks of treatment, without further significant change during the remainder of the study (p less than 0.007). A significant elevation of serum cholesterol from 207.1 +/- 8.1 mg/dl initially to 247.4 +/- 10.2 mg/dl after 2 weeks of treatment occurred (p less than 0.001) and persisted with continued cyclosporine therapy. No consistent alteration in high-density lipoprotein was noted (p less than 0.42). CONCLUSION: Serum lipids should be closely monitored in psoriasis patients receiving intermediate or long-term therapy with cyclosporine, especially in the presence of elevated baseline values.
"Influence of gender on survival in patients with stage I malignant melanoma"Vossaert KA; Silverman MK; Kopf AW; Bart RS; Rigel DS; Friedman RJ; Levenstein M
GRANTS:2 RIO CA 1366-05/CA/NCI NIH HHS/United States;P30 CA-16087/CA/NCI NIH HHS/United States;R0I CHOO915/HO/NHLBI NIH HHS/United States
BACKGROUND: Women with stage I malignant melanoma (MM) have a survival advantage over men as judged by univariate analysis. However, on multivariate analysis, gender was found to be an independent predictor of survival in only 8 of 14 published studies. OBJECTIVE: This study attempts to explain the disparate findings for gender as a prognostic factor in different multivariate analyses. METHODS: Univariate and multivariate analyses were performed on 832 patients with stage I MM in the New York University Melanoma Cooperative Group (NYU-MCG) data base. The results were compared with those of 14 similar studies. RESULTS: In the NYU-MCG data base, gender, age of the patient, and number of mitoses per square millimeter were not independent factors on multivariate analysis, whereas thickness, anatomic site, and presence of ulceration were. The statistically significant difference in survival by gender on univariate analysis, in the NYU-MCG data base, could be explained by the differences in thickness and anatomic site of the MMs in the sexes. Comparison of these results with the reviewed reports from the literature consistently shows thickness and ulceration to be independent prognosticators of survival. Likewise, most authors agree that age is not an independent predictor. However, there is no consensus with respect to gender and site, each of which was found to be an independent predictor of survival in only about half the studies reviewed. CONCLUSION: The disparate findings for gender in different multivariate analyses are explained by a gender-related difference in anatomic distribution of MM. Gender and site appear to have a similar influence in multivariate analysis and thus either one or the other is a dominant factor in different multivariate analyses.
"Epithelioid sarcoma: clinical and histologic characteristics" [Case Report]Zanolli, M D; Wilmoth, G; Shaw, J; Poehling, G; White, W L
Epithelioid sarcoma is a slow-growing sarcoma that typically occurs on an upper extremity of young men. It commonly arises as a deep soft tissue, subcutaneous, or as a dermal, woody, hard nodule..
"Histologic atypia in clinically benign nevi" [Letter]Ackerman, A B
"Flashlamp-pumped pulsed dye laser for port-wine stains in infancy: earlier versus later treatment"Ashinoff R; Geronemus RG
Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 +/- 1.4 [+/- standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments (+/- 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy.
"Antibiotic treatment for pregnant victims of Lyme disease" [Letter]Berger, B W
"Sexually transmitted diseases: bacterial infections. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology"Buntin DM; Rosen T; Lesher JL; Plotnick H; Brademas ME; Berger TG
This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.
"Sexually transmitted diseases: viruses and ectoparasites. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology"Buntin DM; Roser T; Lesher JL; Plotnick H; Brademas ME; Berger TG
This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.
"Induction of disseminated superficial actinic porokeratosis by phototherapy for psoriasis"Cockerell, C J
"Cutaneous multilobated T-cell lymphoma with aggressive course"Goldman BD; Bari M; Kantor GR; Kadin ME; Micaily B; Vonderheid EC
Cutaneous multilobated T-cell lymphoma is an uncommon variant of skin-based peripheral T-cell lymphoma typically characterized by cutaneous nodules in elderly patients and a chronic clinical course. We report a case of the disease that led to the patient's death within 2 years after onset. This disease may be associated with a more aggressive clinical course than generally recognized.
"Immunohistochemistry and electron microscopy in Langerhans cell histiocytosis confined to the skin"Hashimoto, K; Kagetsu, N; Taniguchi, Y; Weintraub, R; Chapman-Winokur, R L; Kasiborski, A
Four cases of benign Langerhans cell histiocytosis limited to the skin were studied. In all three self-healing cases (cases 2, 3, and 4) many dense bodies, myelin bodies, and worm bodies were found. In one chronic case (case 1) none of these was identified. In all four cases, in addition to CD1, HLA-DR, and S-100 stains, interferon-gamma and S-100 beta-subunit were positive in the dermal tumor cells. Both interferon-gamma and S-100 beta-subunits were negative in the normal epidermal Langerhans cells. A comprehensive literature review yielded 87 cases of skin-limited Langerhans cell histiocytosis. These cases could be subgrouped into three categories: (1) those that resolved spontaneously, (2) those that responded to therapy and had no recurrence, and (3) those with persistent or recurrent lesions, not responding to therapy but still limited to the skin.
"Pruritic papular eruption of the acquired immunodeficiency syndrome: a clinicopathologic study"Hevia O; Jimenez-Acosta F; Ceballos PI; Gould EW; Penneys NS
The pruritic papular eruption of the acquired immunodeficiency syndrome is characterized by generalized, pruritic, skin-colored papules and nodules. Chronic lesions are excoriated and hyperpigmented. The eruption and pruritus typically wax and wane and are resistant to oral antihistamine and topical steroid therapy. The characteristic histologic features are (1) superficial and mid dermal perivascular and perifollicular mononuclear cell infiltrate with numerous eosinophils and (2) follicular damage of varying degrees. When compared with control subjects, these patients did not demonstrate any significant difference in laboratory or demographic data.
"STAPHYLOCOCCAL SEPSIS IN HIV ANTIBODY SEROPOSITIVE PSORIASIS PATIENTS"Jaffe, D; May, LP; Sanchez, M; Moy, J
The cases of three HIV-positive men with generalized psoriasis and staphylococcal sepsis are reported. In each case the skin appeared to be the source of infection. While the patients received antibiotic therapy, the psoriatic plaques resolved despite minimal or no topical treatment.
"Low-dose weekly methotrexate for unusual neutrophilic vascular reactions: cutaneous polyarteritis nodosa and Behcet's disease" [Case Report]Jorizzo, J L; White, W L; Wise, C M; Zanolli, M D; Sherertz, E F
Low-dose weekly methotrexate therapy has been used to treat patients with psoriasis for more than 20 years. This regimen has also been used to treat rheumatoid arthritis, inflammatory bowel disease, primary sclerosing cholangitis, and corticosteroid-dependent asthma. We report two patients with Behcet's disease with cutaneous neutrophilic vascular reactions and three with cutaneous polyarteritis nodosa who responded dramatically to low-dose weekly methotrexate therapy..
"LONGITUDINAL MELANONYCHIA STRIATA - REPLY" [Letter]KECHIJIAN, P; BARAN, R
"The International Foundation for Dermatology"Kopf AW; et al
"Metastatic basal cell carcinoma: report of twelve cases with a review of the literature" [Case Report]Lo, J S; Snow, S N; Reizner, G T; Mohs, F E; Larson, P O; Hruza, G J
Metastatic basal cell carcinoma was found in 12 patients at the University of Wisconsin Mohs Surgery Clinic during the period 1936 to 1989. All patients were white men. The time of onset of the primary tumor ranged from childhood to 71 years. Eleven patients had previous treatment for basal cell carcinoma; two patients had received x-ray radiation to the face for teenage acne. The locations of the primary basal cell carcinomas were the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors ranged from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first sign of metastases ranged from 7 to 34 years. In all cases, the primary tumor was histologically identical to the metastatic lesion. Perineural extension of the basal cell carcinoma in the primary lesion was found in five cases. Regional lymph nodes were the most frequent site of metastasis. Treatment consisted of a combination of surgery, radiation, and chemotherapy. Only two patients survived more than 5 years after surgical treatment. One patient has survived 25 years and is still alive..