Archives of Dermatology

Bjerke, Jens Roar;Haukenes, Gunnar;Livden, John Karsten;Matre, Roald

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360001001

Abstract To the Editor.— Increasing evidence points to the importance of immune mechanisms in the pathogenesis of psoriasis. The role of humoral v cellular immune reactions in the development of psoriatic skin lesions seems still to be open for discussion. In the September Archives (1982;118:652-657), Jablonska et al claimed that the polymorphonuclear leukocytes play an important role in the earliest stages of development of psoriatic lesions. Recently, we have obtained data indicating that lymphocytes and macrophages are involved in the pathogenesis of psoriasis.Macrophages and T cells are regularly found in early psoriatic lesions. There is great variation in the relative proportions of these cells, depending on the clinical activity of the disease.1 When monoclonal antibodies against T-cell surface antigens are used, both helper-inducer and suppressor-cytotoxic T cells can be demonstrated.2 To determine the functional state of T cells in the psoriatic plaque, we have studied the presence of References 1. Bjerke JR: In situ characterization and counting of mononuclear cells in lesions of different clinical forms of psoriasis . Acta Derm Venereol 1982;62:93-100. 2. Bjerke JR: Subpopulations of mononuclear cells in lesions of psoriasis, lichen planus and discoid lupus erythematosus studied using monoclonal antibodies . Acta Derm Venereol 1982;62:477-483. 3. Reinherz EL, Kung PC, Pesando JM, et al: Ia determinants on human T-cell subsets defined by monoclonal antibody . J Exp Med 1979;150:1472-1482.Crossref 4. Sonnenfeld G: Modulation of immunity by interferon , in Pick E (ed): Lymphokine reports 1 . New York, Academic Press, Inc, 1980, pp 113-131. 5. Stanbridge EJ: A possible viral etiology for psoriasis , in Farber EM, Cox AJ (eds): Psoriasis . New York, Grune & Stratton, 1981, pp 67-70.

Chalmers, Robert J. G.;Ead, Russell D.;Ive, F. Adrian

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360002002

Abstract To the Editor.— In response to our letter in the March Archives (1982;118:141) on guttate psoriasis and renal disease, Belew reported (1983;119:3) that in her area guttate psoriasis is associated with the locally common and also potentially nephritic group A streptococcus of serotype Ml, Tl. In a recent study we found group A streptococci in nine of 34 patients with acute guttate psoriasis and four of 30 patients with acute guttate flares complicating chronic psoriasis. More than half the patients seen and all of those from whom group A streptococci were isolated had serologic evidence of recent streptococcal infection. The 13 streptococcal isolates were of ten different serotypes, the majority of which were common in the community at the time of the study. The serotype Ml, T1 was found in two patients. Our findings suggest that the ability of the group A streptococcus to trigger guttate psoriasis is not type References 1. Summerly R, Copeman PWM: Nephritis and common skin diseases . Br Med J 1964;2:1369-1371.Crossref

Fisher, Alexander A.

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360002003

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract To the Editor.— In the January Archives (1983;119:3-4), Dahl and Jordan reported the following: "(1) Prior application of medium-strength topical corticosteroids is not a contraindication to patch testing and usually allows the detection of contact allergy by the 48-hour closed-patch test system. (2) Prior application of a medium-strength topical corticosteroid may suppress the intensity or appearance of inflammation to certain allergies at certain concentrations in certain patients."With regard to these conclusions, I have recently encountered two patients with an allergic contact dermatitis due to a neomycin-nystatin corticosteroid from the presence of ethylenediamine hydrochloride, used as a stabilizer. Patch tests with the neomycinnystatin corticosteroid itself were negative, but strongly positive patch tests to the ethylenediamine hydrochloride were obtained. This shows that the triamcinolone present in the corticosteroid suppressed the patch test reaction to ethylenediamine.However, three patients were allergic to the parabens in hydrocortisone. Positive reactions were obtained to both

Fleischmajer, Raul;Perlish, Jerome S.;Duncan, Matthew

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360003004

Abstract Systemic scleroderma or progressive systemic sclerosis is a connective-tissue disease characterized by vascular alterations and severe fibrosis. The disease has a predilection for female patients and affects all races and ages, although it is more common during the third and fourth decades of life. The sites most frequently involved are the skin, esophagus, lung, and kidney. Patients with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias) seem to have a more benign clinical course than those with the diffuse form of the disease, which has a more serious prognosis owing to the high incidence of severe pulmonary fibrosis and kidney insufficiency. The pathophysiology of scleroderma remains poorly understood. Two schools of thought prevail: some believe that the primary event is vascular damage, and others propose a derangement in collagen metabolism as the initial event.1 More recently, emphasis has been placed on the presence of mononuclear cell infiltrates References 1. Fleischmajer R: The pathophysiology of scleroderma . Int J Dermatol 1977;16:310-318.Crossref 2. Fleischmajer R, Gay S, Meigel WN, et al: Collagen in the cellular and fibrotic stages of scleroderma . Arthritis Rheum 1978;21:418-428.Crossref 3. Wahl SM, Wahl LM, McCarthy JB: Lymphocyte-mediated activation of fibroblast proliferation and collagen production . J Immunol 1978;121:942-946. 4. Wahl SM, Wahl LM: Modulation of fibroblast growth and function by monokines and lymphokines . Lymphokines 1981;2:179-201. 5. Maricq HR, LeRoy EC: Patterns of finger capillary abnormalities in connective tissue disease by `wide-field' microscopy . Arthritis Rheum 1973;16:619-628.Crossref 6. Fleischmajer R, Dessau W, Timpl R, et al: Immunofluorescence analysis of collagen, fibronectin, and basement protein in scleroderma skin . J Invest Dermatol 1980;75:270-275.Crossref 7. Norton WL: Comparison of the microangiopathy of systemic lupus erythematosus, dermatomyositis, scleroderma, and diabetes mellitus . Lab Invest 1970;22:301-308. 8. Farkas TG, Sylvester V, Archer D: The choroidopathy of progressive systemic sclerosis (scleroderma) . Am J Ophthalmol 1972;74:875-886. 9. Fleischmajer R, Perlish JS: Capillary alterations in scleroderma . J Am Acad Dermatol 1980;2:161-170.Crossref 10. Fleischmajer R, Perlish JS, West WP: Ultrastructure of cutaneous cellular infiltrates in scleroderma . Arch Dermatol 1977; 113:1661-1666.Crossref 11. Kahaleh MB, Sherer GK, LeRoy EC: Endothelial injury in scleroderma . J Exp Med 1979;149:1326-1335.Crossref 12. Fleischmajer R, Perlish JS: 3H-Thymidine labeling of dermal endothelial cells in scleroderma . J Invest Dermatol 1977; 69:379-382.Crossref 13. Mackel AM, DeLustro F, Harper FE, et al: Antibodies to collagen in scleroderma . Arthritis Rheum 1982;25:522-531.Crossref 14. Woodhall PB, McCoy RC, Gunnells JC, et al: Apparent recurrence of progressive systemic sclerosis in a renal allograft . JAMA 1976;236:1032-1034.Crossref 15. Lapenas D, Rodnan GP, Cavallo T: Immunopathology of the renal vascular lesion of progressive systemic sclerosis (scleroderma) . Am J Pathol 1978;91:243-258. 16. Kahaleh MB, Osborn I, LeRoy EC: Increased factor VIII/von Willebrand factor antigen and von Willebrand factor activity in scleroderma and in Raynaud's phenomenon . Ann Intern Med 1981;94:482-484.Crossref 17. Kahaleh MB, Osborn I, LeRoy EC: Elevated levels of circulating platelet aggregates and beta thromboglobulin in scleroderma . Ann Intern Med 1982;96:610-613.Crossref 18. D'Angelo WA, Fries JF, Mast AJ, et al: Pathologic observations in systemic sclerosis (scleroderma) . Am J Med 1969;46:428-440.Crossref 19. Sackner MA: Scleroderma . New York, Grune & Stratton Inc, 1966, pp 77-81. 20. Case 2-1972, Case records of the Massachusetts General Hospital: Weekly clinicopathological exercises . N Engl J Med 1972;286:91-99.Crossref 21. Kovacs CV, Fleischmajer R: Properties of scleroderma fibroblasts in culture . J Invest Dermatol 1974;63:456-460.Crossref 22. LeRoy EC: Connective tissue synthesis by scleroderma skin fibroblasts in cell culture . J Exp Med 1972;135:1351-1362.Crossref 23. Ninomiya Y, Hota RI, Nagai Y, et al: Glycosaminoglycan metabolism by scleroderma fibroblasts in culture . Biomed Res 1982;3:70-72. 24. Fleischmajer R, Perlish JS: Glycosaminoglycans in scleroderma and scleredema . J Invest Dermatol 1972;58:129-132.Crossref 25. Uitto J, Helin G, Helin P, et al: Connective tissue in scleroderma . Acta Derm Venereol 1971;51:401-406. 26. Bashey RI, Perlish JS, Nochumson S, et al: Connective tissue synthesis by cultured scleroderma fibroblasts: II. Incorporation of 3H-glucosamine and synthesis of glycosaminoglycans . Arthritis Rheum 1977;20:879-885.Crossref 27. LeRoy EC: Increased collagen synthesis by sckeriderna skin fibroblasts in vitro: A possible defect in the regulation or activation of the scleroderma fibroblast . J Clin Invest 1974;54:880-889.Crossref 28. Perlish JS, Bashey RI, Stephens RE, et al: Connective tissue synthesis by cultured scleroderma fibroblasts: I. In vitro collagen synthesis by normal and scleroderma dermal fibroblasts . Arthritis Rheum 1976;19:891-901.Crossref 29. Buckingham RB, Prince RK, Rodnan GP, et al: Increased collagen accumulation in dermal fibroblast cultures from patients with progressive systemic sclerosis (scleroderma) . J Lab Clin Med 1978;92:5-21. 30. Tajima S, Pinnell S: Collagen synthesis by human skin fibroblasts in culture: Studies of fibroblasts explanted from papillary and reticular dermis . J Invest Dermatol 1981;77:410-412.Crossref 31. Fleischmajer R, Perlish JS, Krieg T, et al: Variability in collagen and fibronectin synthesis by scleroderma fibroblasts in primary culture . J Invest Dermatol 1981;76:400-403.Crossref 32. Botstein GR, Sherer GK, LeRoy EC: Fibroblast selection in scleroderma . Arthritis Rheum 1982;25:189-195.Crossref 33. Graves PN, Weiss IK, Perlish JS, et al: Increased procollagen mRNA levels in scleroderma skin fibroblasts . J Invest Dermatol 1983;80:130-132.Crossref 34. Vaheri A, Mosher DF: High molecular weights, cell surfaceassociated glycoprotein (fibronectin) lost in malignant transformation . Biochim Biophys Acta 1978;516:1-25. 35. Yamada KM, Olden K: Fibronectin-adhesive glycoproteins of cell surface and blood . Nature 1978;275:179-184.Crossref 36. Foidart JM, Berman JJ, Paglia L, et al: Synthesis of fibronectin, laminin, and several collagens by a liver-derived epithelial line . Lab Invest 1980;42:525-532. 37. Perlish JS, Carter V, Fleischmajer R: Scleroderma mononuclear cell factors and collagen synthesis , abstracted. J Invest Dermatol 1982;78:352. 38. Wiestner M, Krieg T, Horlein D, et al: Inhibiting effect of procollagen peptides on collagen biosynthesis in fibroblast cultures . J Biol Chem 1979;254:7016-7023. 39. Wiestner M, Rohde H, Helle O, et al: Low rate of procollagen conversion in dermatosparactic sheep fibroblasts is paralleled by increased synthesis of type I and type III collagens . EMBO J 1982;1:513-516. 40. Krieg T, Horlein D, Wiestner M, et al: Aminoterminal extension peptides from type I procollagen normalize excessive collagen synthesis of scleroderma fibroblasts . Arch Dermatol Res 1978;263:171-180.Crossref 41. Perlish JS, Fleischmajer R, Timpl R, et al: Effect of Col 1 (I) peptide on the synthesis of collagen by scleroderma skin fibroblasts in culture . Arthritis Rheum , in press. 42. LeRoy EC: Pathogenesis of scleroderma (systemic sclerosis) . J Invest Dermatol 1982;79 ( (suppl 1) ):S87-S84.Crossref 43. Postlethwaite AE, Snyderman R, Kang AH: The chemotactic attraction of human fibroblasts to a lymphocyte-derived factor . J Exp Med 1976;114:1188-1203.Crossref 44. Tsukamoto Y, Helsel WE, Wahl SM: Macrophage production of fibronectin: A chemoattractant for fibroblasts . J Immunol 1981; 127:673-678. 45. Rola-Pleszczynski M, Lieu MH, Hamel J, et al: Stimulated human lymphocytes produce a soluble factor which inhibits fibroblast migration . Cell Immunol 1982;74:104-110.Crossref 46. Wahl SM, Gately CL: Modulation of fibroblast growth by a lymphokine of human T cell and continuous T cell line origin . J Immunol 1982;130:1226-1230. 47. Postlethwaite AE, Kang AH: Characterization of fibroblast proliferation factors elaborated by antigen- and mitogen-stimulated guinea pig lymph node cells . Cell Immunol 1982;73:169-178.Crossref 48. DeLustro F, Sherer GK, LeRoy EC: Human monocyte stimulation of fibroblast growth by a soluble mediator(s) . J Reticuloendothel Soc 1980;28:519-632. 49. Schmidt JA, Mizel SB, Cohen D, et al: Interleukin 1: A potential regulator of fibroblast proliferation . J Immunol 1982; 128:2177-2182. 50. Korotzer TI, Page RC, Granger GA, et al: Regulation of growth of human diploid fibroblasts by factors elaborated by activated lymphoid cells . J Cell Physiol 1982;111:247-254.Crossref 51. Korn JH, Halushka PV, LeRoy EC: Mononuclear cell modulation of connective tissue function . J Clin Invest 1980;65:543-554.Crossref 52. Johnson RL, Ziff M: Lymphokine stimulation of collagen accumulation . J Clin Invest 1976;58:240-252.Crossref 53. Postlethwaite AE, Smith GN, Mainardi CL, et al: Characterization of a human lymphokine that stimulates fibroblasts to produce collagen , abstracted. Arthritis Rheum 1981; 24 ( (suppl) ):S20. 54. Wahl SM, Wahl LM, McCarthy JB, et al: Macrophage activation by mycobacterial water soluble compounds and synthetic muramyl dipeptide . J Immunol 1979;122:2226-2231. 55. Anastassiades TP, Wood A: Effect of soluble products from lectin-stimulated lymphocytes on the growth, adhesiveness, and glycosaminoglycan synthesis of cultured synovial fibroblastic cells . J Clin Invest 1981;68:792-802.Crossref 56. McArthur W, Derr K, Dixon M, et al: Immune modulation of connective tissue function: Studies on the production of collagen synthesis inhibitory factor by populations of human peripheral blood mononuclear cells . Cell Immunol 1982;74:126-139.Crossref 57. Clark JG, Marino BA, Kostal KM: Regulation of fibroblast proliferation and collagen synthesis by bronchoalveolar macrophages in bleomycin-induced pulmonary fibrosis in hamsters . Program and abstracts of the joint meeting of the regional connective tissue societies, St Louis, June 9-12, 1982 . 58. Schmidt JA, Mizel SB, Cohen D, et al: Interleukin I: A potential regulator of fibroblast proliferation . J Immunol 1982; 128:2177-2182. 59. LeRoy EC, Mercurio SM, Kahaleh MB: A fibroblast mitogen with protease activity in scleroderma serum , abstracted. Arthritis Rheum 1982;25( (suppl) ):S38.Crossref 60. Bashey RI, Jinenez SA: Stimulation of fibroblast collagen synthesis by serum from patients with progressive systemic sclerosis (PSS) , abstracted. Arthritis Rheum 1982:25( (suppl) ):S13. 61. Hooks JJ, Moutsopoulos HM, Geis SA, et al: Immune interferon in the circulation of patients with autoimmune diseases . N Engl J Med 1979;301:5-8.Crossref 62. Wahl SM: Immunologically induced fibrosis , in Fleischmajer R (ed): Diseases of the Skin . New York, Grune & Stratton Inc, 1983, vol 2. 63. Bitterman PB, Crystal RG: Alveolar macrophages (AM) in idiopathic pulmonary fibrosis (IPF) and sarcoidosis are spontaneously secreting a growth factor causing human lung fibroblasts to replicate . Clin Res 1981;49:443A. 64. Mayes M, Cathcart M, Dustoor M, et al: The role of immunoregulatory abnormalities in the immunopathogenesis of progressive systemic sclerosis . Proceedings of the Second International Conference on Progressive Systemic Sclerosis, Austin, Oct 20, 1982 . 65. Perlish JS, Fleischmajer R: Mononuclear cell-fibroblast interaction and collagen synthesis, abstracted . Arthritis Rheum 1982;25( (suppl) ):S14. 66. Cathcart MK, Krakauer RS: Immunological enhancement of collagen accumulation in progressive systemic sclerosis (PSS) . Clin Immunol Immunopathol 1981;21:128-133.Crossref 67. Whiteside T, Prince R, Buckingham R, et al: The effect of lymphokines from normal and PSS lymphocytes on connective tissue synthesis in vitro, abstracted . Arthritis Rheum 1982; 25( (suppl) ):S14. 68. Krakauer RS, Sundeen J, Sauder DN, et al: Abnormalities of immunoregulation in progressive systemic sclerosis: Evidence for excess helper-cell function and altered B-cell function . Arch Dermatol 1981;117:80-82.Crossref 69. Alarcon-Segovia D, Palacios R, DeKasep GI: Human postthymic precursor cells in health and disease: Immunoregulatory circuits of the peripheral blood mononuclear cell from patients with progressive systemic sclerosis . J Clin Lab Immunol 1981; 5:143-148. 70. Inoshita T, Whiteside TL, Rodnan GP, et al: Abnormalities of T lymphocyte subsets in patients with progressive systemic sclerosis . J Lab Clin Med 1981;97:264-277. 71. Salem NP, Morse JH: Lymphocyte responses to mitogens in progressive systemic sclerosis . Arthritis Rheum 1976;19:875-882.Crossref 72. Horwitz DA, Garrett MA: Lymphocyte reactivity to mitogens in subjects with systemic lupus erythematosus, rheumatoid arthritis and scleroderma . Clin Exp Immunol 1977;27:92-95. 73. Morse JH, Budi BS: Autologous and allogeneic mixed lymphocyte reactions in progressive systemic sclerosis . Arthritis Rheum 1982;25:390-395.Crossref 74. Louie JS, Kallen PS, Loper IH, et al: Decreased autologous mixed lymphocyte reaction (AMLR) in progressive systemic sclerosis (PSS) , abstracted. Arthritis Rheum 1981;24:( (suppl) ):S91. 75. Winkelstein A, Bernstein ML, Stevens MA, et al: Reduced T lymphoid colony growth in patients with progressive systemic sclerosis and rheumatoid arthritis . J Lab Clin Med 1982;100:240-247. 76. Wright JK, Hughes P, Rowell NR: Spontaneous lymphocytemediated (NK cell) cytotoxicity in systemic sclerosis: A comparison with antibody-dependent lymphocyte (K cell) cytotoxicity . Ann Rheum Dis 1982;41:409-413.Crossref 77. Segond P, Salliere D, Galanaud P, et al: Impaired primary in vitro antibody response in progressive systemic sclerosis patients: Role of suppressor monocytes . Clin Exp Immunol 1982;47:147-154. 78. Baron M, Keystone EC, Gladman DD, et al: Lymphocyte subpopulations and reactivity to mitogens in patients with scleroderma . Clin Exp Immunol 1981;46:70-76. 79. Krawitt EL, Holdstock G, Bland JH, et al: Suppressor cell activity in progressive systemic sclerosis . J Rheumatol 1982;9:263-267. 80. Gupta S, Malaviya AN, Rajagopalan P, et al: Subsets of human T lymphocytes: Imbalance of T cell populations in patients with progressive systemic sclerosis . Clin Exp Immunol 1979; 38:342-347. 81. Ehresmann GR, Bakke AC, Horwitz DA: T cell subsets in progressive systemic sclerosis , abstracted. Arthritis Rheum 1982; 25( (suppl) )S45. 82. Keystone EC, Lau C, Gladman DD, et al: Immunoregulatory T cell subpopulations in patients with scleroderma using monoclonal antibodies . Clin Exp Immunol 1982;48:443-448.

Milstone, Leonard M.;Braverman, Irwin M.;Lucky, Paul;Fleckman, Philip

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360009005

Abstract • Atrophie blanche usually appears as painful purpuric papules that evolve into ulcerations and, finally, angular scars on the lower extremities. The literature on this subject presents a confusing picture of its causes, pathogenesis, and treatment. From our review of the literature and our experience in evaluating and treating cases of atrophie blanche, we conclude that it is best categorized as a clinicopathologic entity with multiple causes. Its characteristic histopathologic features and clinical evolution indicate that the common pathologic event is occlusion of vessels in the middle and deep dermis. No single form of therapy has been consistently effective for the treatment of atrophie blanche, but drugs that inhibit platelet thrombus formation or stimulate endogenous fibrinolytic activity arrest the disease in most patients. (Arch Dermatol 1983;119:963-969) References 1. Nelson LM: Atrophie blanche en plaque . Arch Dermatol 1955; 72:242-251.Crossref 2. Gray HR, Graham JH, Johnson W, et al: Atrophie blanche: Periodic painful ulcers of lower extremities: clinical and histopathological entity . Arch Dermatol 1966;93:187-193.Crossref 3. Stevanovic DV: Atrophie blanche . Arch Dermatol 1974; 109:858-862.Crossref 4. Feldaker M, Hines EA, Kierland RR: Livedo reticularis with ulcerations . Circulation 1956;13:196-216.Crossref 5. Bard JW, Winkelmann RK: Livedo vasculitis: Segmental hyalinizing vasculitis of the dermis . Arch Dermatol 1967;96:489-499.Crossref 6. Gilliam JN, Herndon JH, Prystowsky SD: Fibrinolytic therapy for vasculitis of atrophie blanche . Arch Dermatol 1974;109:664-667.Crossref 7. Winkelmann RK, Schroeter AL, Kierland RR, et al: Clinical studies of livedoid vasculitis (segmental hyalinizing vasculitis) . Mayo Clin Proc 1974;49:746-750. 8. Dodman B, Cunliffe WJ, Roberts BE: Observations on tissue fibrinolytic activity in patients with cutaneous vasculitis . Br J Dermatol 1973;88:231-235.Crossref 9. Pandolfi M, Robertson B, Isacson S, et al: Fibrinolytic activity of human veins in arms and legs . Thromb Haemost 1968; 20:247-256. 10. Fearnley G, Chakrabarti R, Avis PRD: Blood fibrinolytic activity in diabetes mellitus and its bearing on ischaemic heart disease and obesity . Br Med J 1963;1:921-923.Crossref 11. Verstraete M: The position of long-term stimulation of the endogenous fibrinolytic system: Present achievements and clinical perspectives . Thromb Haemost 1975;34:613-622. 12. Fearnley GR, Chakrabarti R: Pharmacologic enhancement of fibrinolytic activity of blood . J Clin Pathol 1964;17:328-332.Crossref 13. Cunliffe WJ, Menon IS: The association between cutaneous vasculitis and decreased blood fibrinolytic activity . Br J Dermatol 1971;84:99-105.Crossref 14. Canadian Cooperative Study Group: A randomized trial of aspirin and sulfinpyrazone in threatened stroke . N Engl J Med 1978;299:53-59.Crossref 15. Sullivan JM, Harken DE, Gorlin R: Pharmacologic control of thromboembolic complications of cardiac valve replacement . N Engl J Med 1968;279:576-580.Crossref 16. Drucker CR, Duncan WC: Antiplatelet therapy in atrophie blanche and livedo vasculitis . J Am Acad Dermatol 1982;7:359-363.Crossref

Ljunghall, Kerstin;Scheynius, Annika;Jonsson, Jonas;Schilling, Walter;Forsum, Urban

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360016006

Abstract • In a prospective study of 51 patients with dermatitis herpetiformis (DH), the occurrence of antibodies against reticulin and gluten was investigated and the influences of gluten-free, gluten-restricted, and normal diets on the persistence of these antibodies were compared. After a period extending from 11 to 47 months, none of the patients who were eating a gluten-free diet had reticulin or gluten antibodies. The patients eating a normal diet had the same incidence of reticulin autoantibodies at the end of the study as at its beginning, and gluten antibodies developed in some additional patients during the follow-up period. Thus, we have shown that the elimination of gluten from the diet of patients with DH has an important influence on the occurrence of antibodies to both reticulin and gluten. (Arch Dermatol 1983;119:970-974) References 1. Seah PP, Fry L, Hoffbrand AV, et al: Tissue antibodies in dermatitis herpetiformis and adult coeliac disease . Lancet 1971; 1:834-836.Crossref 2. Katz SI: Dermatitis herpetiformis: The skin and the gut . Ann Intern Med 1980;93:857-874.Crossref 3. Ljunghall K, Scheynius A, Forsum U: Circulating reticulin autoantibodies of IgA class in dermatitis herpetiformis . Br J Dermatol 1979;100:173-175.Crossref 4. Seah PP, Fry L: Immunoglobulins in the skin in dermatitis herpetiformis and their relevance in diagnosis . Br J Dermatol 1975;92:157-166.Crossref 5. Kumar PJ, Ferguson A, Lancaster-Smith M, et al: Food antibodies in patients with dermatitis herpetiformis and adult coeliac disease: Relationship to jejunal morphology . Scand J Gastroenterol 1976;11:5-9. 6. Eterman KP, Feltkamp TEW: Antibodies to gluten and reticulin in gastrointestinal diseases . Clin Exp Immunol 1978; 31:92-99. 7. Menzel EJ, Pehamberger H, Holubar K: Demonstration of antibodies to wheat gliadin in dermatitis herpetiformis using 14C-radioimmunoassay . Clin Immunol Immunopathol 1978;10:193-201.Crossref 8. Huff JC, Weston WL, Zirker DK: Wheat protein antibodies in dermatitis herpetiformis . J Invest Dermatol 1979;73:570-574.Crossref 9. Unsworth DJ, Leonard JN, McMinn RMH, et al: Anti-gliadin antibodies and small intestinal mucosal damage in dermatitis herpetiformis . Br J Dermatol 1981;105:653-658.Crossref 10. Von Essen R, Savilahti E, Pelkonen R: Reticulin antibody in children with malabsorption . Lancet 1972;1:1157-1159.Crossref 11. Seah PP, Fry L, Holborow EJ, et al: Antireticulin antibody: Incidence and diagnostic significance . Gut 1973;14:311-315.Crossref 12. Ljunghall K, Tjernlund U: Dermatitis herpetiformis: Effect of gluten-restricted and gluten-free diet on dapsone requirement and on IgA and C, deposits in uninvolved skin . Acta Derm Venereol 1983;63:129-136. 13. Eterman KP, Heekens WThJM, Pena AS, et al: Wheat grains: A substrate for the determination of gluten antibodies in serum of gluten-sensitive patients . J Immunol Methods 1977;14:85-92.Crossref 14. Jonsson J, Schilling W: Some characteristics of immunofluorescence tests for antibodies against gluten, using wheat grain sections or gliadin-coated sepharose beads . Acta Pathol Microbiol Immunol Scand C 1981;89:253-262. 15. Bürgin-Wolff A, Hernandez M, Signer MJE: Immunofluorescent antibodies against gliadin: A screening test for coeliac disease . Helv Paediatr Acta 1976;31:375-380. 16. Delder AM, Ploem JS: An immunofluorescence reaction for Schistosoma mansoni using the defined antigen substrate spheres (Dass) system . J Immunol Methods 1974;4:239-251.Crossref 17. Jonsson J, Schilling W, Forsberg M: Colostral IgA-binding to wheat gluten and gliadin . Clin Exp Immunol 1982;50:203-208. 18. Alarcón-Segovia D, Herskovic T, Wakim KG, et al: Presence of circulating antibodies to gluten and milk fractions in patients with nontropical sprue . Am J Med 1964;36:485-499.Crossref 19. Signer E, Bürgin-Wolff A, Berger R, et al: Antibodies to gliadin as a screening test for coeliac disease . Helv Paediatr Acta 1979;34:41-52. 20. Stern M, Fischer K, Grüttner R: Immunofluorescent serum gliadin antibodies in childlren with coeliac disease and various malabsorptive disorders . Eur J Pediatr 1979;130:155-164.Crossref 21. Stern M, Bender SW, Grüttner R: Serum antibodies against gliadin and reticulin in a family study of coeliac disease . Eur J Pediatr 1980;135:31-36.Crossref 22. Unsworth DJ, Kieffer M, Holborow EJ, et al: IgA antigliadin antibodies in coeliac disease . Clin Exp Immunol 1981; 46:286-293. 23. Alp MH, Wright R: Autoantibodies to reticulin in patients with idiopathic steatorrhoea, coeliac disease, and Crohn's disease, and their relation to immunoglobulins and dietary antibodies . Lancet 1971;2:682-685.Crossref 24. Wright R: Immunological studies in coeliac disease . Int Arch Allergy 1973;45:216.Crossref 25. Reunala T: Gluten-free diet in dermatitis herpetiformis . Br Dermatol 1978;98:69-78.Crossref

Claudy, Alain L.;Gagnaire, Denise

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360021007

Abstract • Twenty-three patients with alopecia areata were treated with photochemotherapy combining oral or topical methoxsalen and UV-A irradiation of the scalp or of the whole body. Eleven of 17 patients with multiple plaques of alopecia areata, alopecia totalis, and alopecia universalis, who were treated with oral methoxsalen and total body irradiation, had complete or more than 90% hair regrowth. Three patients had a relapse. The mean energy required was 505 joules/sq cm. In six cases, topical applications of methoxsalen or oral methoxsalen combined with local irradiation of the scalp were treatment failures. In the patients responding to treatment, the result did not seem to depend on the age of onset or the extent or duration of disease. However, patients with long-lasting alopecia had a higher risk of recurrence notwithstanding a good initial regrowth of hair. Few side effects of psoralens and UV-A (PUVA) treatment were noted. The mean follow-up period was 18.6 months after the completion of treatment. We discuss the possible mechanisms of action of PUVA in the treatment of alopecia areata. (Arch Dermatol 1983;119:975-978) References 1. Ikeda T: A new classification of alopecia areata . Dermatologica 1965;131:421-445.Crossref 2. Unger WP, Schemmer J: Corticosteroids in the treatment of alopecia totalis . Arch Dermatol 1978;114:1486-1490.Crossref 3. Happle R, Cebulla K, Echternacht-Happle K: Dinitrochlorobenzene therapy for alopecia areata . Arch Dermatol 1978;114:1629-1631.Crossref 4. Ralfs I: Treatment of alopecia areata . Int J Dermatol 1981;20:168-170.Crossref 5. De Prost Y, Paquez F, Touraine R: Dinitrochlorobenzene treatment of alopecia areata . Arch Dermatol 1982;118:542-545.Crossref 6. Weissman I, Hofmann C, Wagner G, et al: PUVA-therapy for alopecia areata . Arch Dermatol Res 1978;262:333-336.Crossref 7. Lassus A, Kianto U, Johansson E, et al: PUVA treatment for alopecia areata . Dermatologica 1980;161:298-304.Crossref 8. Zheltakov MM, Vinokurov IN: Psoralen treatment of alopecia areata in children . Pediatria 1967;2:45. 9. Rollier R, Warcewski Z: Le traitement de la pelade par la méladinine . Bull Soc Fr Derm Syph 1974;81:97. 10. Claudy AL, Gagnaire D: Photochemotherapy for alopecia areata . Acta Derm Venereol 1980;60:171-173. 11. Burger PM, Tijssen JGP, Suurmond D: Photochemotherapy of psoriasis: Clinical study of clearing and long-term maintenance treatment . Dermatologica 1981;163:213-228.Crossref 12. Parrish JA: Phototherapy and photochemotherapy of skin diseases . J Invest Dermatol 1981;77:167-171.Crossref 13. Ortonne JP, Claudy AL, Alario A, et al: Impairment of thymus-derived rosette forming cells during photochemotherapy (psoralen-UVA) . Arch Dermatol Res 1978;262:143-151.Crossref 14. Gu SQ, Ros AM, Thyresson N, et al: Blood lymphocyte subpopulations and antibody-dependent, cell mediated cytotoxicity (ADCC) in alopecia areata and universalis . Acta Derm Venereol 1981;61:125-129. 15. Gianetti A, Di Silverio A, Castellazi AM, et al: Evidence for defective T cell function in patients with alopecia areata . Br J Dermatol 1978;98:361.Crossref

Buechner, S. A.;Winkelmann, R. K.

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360025008

Abstract • The histopathologic and clinicopathologic characteristics of 121 skin biopsy specimens from 39 patients with Sézary syndrome were reviewed. The most frequently noted histologic type was a lymphomatoid subepidermal band infiltrate, composed predominantly of atypical lymphoid cells with cerebriform nuclei, found in 53 (44%) of the skin biopsy specimens. A lymphocytic band infiltrate, characterized by a predominance of small lymphocytes and a variable admixture of atypical lymphoid cells, was found in 47 (39%) of the specimens. Only 18 (15%) of the lymphomatoid band specimens from ten patients demonstrated epidermal involvement suggesting mycosis fungoides. Twenty-one (17%) of the biopsy specimens were interpreted as showing changes consistent with those of chronic dermatitis. Despite multiple skin biopsy specimens, there was a weak association noted between the histologic patterns and the clinical stage of disease or the prognosis. (Arch Dermatol 1983;119:979-986) References 1. Sézary A, Bouvrain Y: Erythrodermie avec présence de cellules monstrueuses dans le derme et le sang circulant . Bull Soc Fr Dermatol Syphiligr 1938;45:254-260. 2. Winkelmann RK: Clinical studies of T-cell erythroderma in the Sézary syndrome . Mayo Clin Proc 1974;49:519-525. 3. Hamminga L, Hartgrink-Groeneveld CA, Van Vloten WA: Sézary's syndrome: A clinical evaluation of eight patients . Br J Dermatol 1979;100:291-296.Crossref 4. Brehmer-Andersson E: Mycosis fungoides and its relation to Sézary's syndrome, lymphomatoid papulosis, and primary cutaneous Hodgkin's disease: A clinical, histopathologic and cytologic study of 14 cases and a critical review of the literature . Acta Derm Venereol Suppl 1976;75:1-142. 5. Huhn D, Dobbelstein H, Engelhardt D: Sézary-Syndrom . Blut 1972;25:352-363.Crossref 6. Korting GW, Nürnberger F: Sézary-Syndrom . Hautarzt 1970;21:178-181. 7. Lutzner M: Cutaneous T-cell lymphomas: The Sézary syndrome, mycosis fungoides, and related disorders . Ann Intern Med 1975;83:534-552.Crossref 8. Fleischmajer R, Eisenberg S: Sézary's reticulosis: Its relationship with neoplasias of the lymphoreticular system . Arch Dermatol 1964;89:9-19.Crossref 9. Rockl MJ: Das Sézary-Syndrom, Geschichte, Klinik und nosologische Bedeutung . Hautarzt 1978;29( (suppl 3) ):53-56. 10. Duncan SC, Winkelmann RK: Circulating Sézary cells in hospitalized dermatology patients . Br J Dermatol 1978;99:171-178.Crossref 11. Holdaway DR, Winkelmann RK: Histopathology of Sézary syndrome . Mayo Clin Proc 1974;49:541-547. 12. Brouet J-C, Flandrin G, Seligmann M: Indications of the thymus-derived nature of the proliferating cells in six patients with Sézary's syndrome . N Engl J Med 1973;289:341-344.Crossref 13. Edelson RL, Lutzner MA, Kirkpatrick CH, et al: Morphologic and functional properties of the atypical T lymphocytes of the Sézary syndrome . Mayo Clin Proc 1974;49:558-566. 14. Broder S, Edelson RL, Lutzner MA, et al: The Sézary syndrome: A malignant proliferation of helper T cells . J Clin Invest 1976;58:1297-1306.Crossref 15. Berger CL, Warburton D, Raafat J, et al: Cutaneous T-cell lymphoma: Neoplasm of T cells with helper activity . Blood 1979;53:642-651. 16. Winkelmann RK, Linman JW: Erythroderma with atypical lymphocytes (Sézary syndrome) . Am J Med 1973;55:192-198.Crossref 17. Clendenning WE, Brecher G, Van Scott EJ: Mycosis fungoides: Relationship to malignant cutaneous reticulosis and the Sézary syndrome . Arch Dermatol 1964;89:785-792.Crossref 18. Vonderheid EC, Tam DW, Johnson WC, et al: Prognostic significance of cytomorphology in the cutaneous T-cell lymphomas . Cancer 1981;47:119-125.Crossref 19. Winkelmann RK, Perry HO, Muller SA, et al: Treatment of Sézary syndrome . Mayo Clin Proc 1974;49:590-592. 20. Ebner H, Kühböck J, Pietschmann H: Das Sézary-syndrom . Dermatologica 1970;141:257-269.Crossref 21. Rappaport H, Thomas LB: Mycosis fungoides: The pathology of extracutaneous involvement . Cancer 1974;34:1198-1229.Crossref 22. Hamminga L: Cutaneous T-cell Lymphoma: Clinical and Functional Studies, thesis. University of Leiden, Gravenhage, the Netherlands, 1981. 23. Civatte A: Atlas d'histopathologie cutanée: Eczéma et eczématides, verrues seniles et kératoses seniles, psoriasis, lupus érythémateux, lichen, parapsoriasis . Paris, Masson & Cie, Editeurs, 1957. 24. Buechner SA, Winkelmann RK: Pre-Sézary erythroderma evolving to Sézary syndrome . Arch Dermatol 1983;119:285-291.Crossref 25. Tan RS-H, Butterworth CM, McLaughlin H, et al: Mycosis fungoides: A disease of antigen persistence . Br J Dermatol 1974;91:607-616.Crossref 26. Civatte J, Kapetis E: Problems in histological diagnosis of mycosis fungoides . Bull Cancer 1977;64:187-190.

Zech, Loren A.;Gross, Earl G.;Peck, Gary L.;Brewer, H. Bryan

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360033009

Abstract • Twenty men with nodulocystic acne were treated with oral isotretinoin (13-cis-retinoic acid) for four months. Plasma lipids and lipoprotein determinations were obtained before and during treatment to quantitate the effects of oral isotretinoin on lipid metabolism. Maximum isotretinoin-induced elevations in plasma triglyceride and cholesterol levels were 67% and 16%, respectively. Additional maximal changes included very-low-density lipoprotein cholesterol increases of 56%, low-density lipoprotein cholesterol increases of 22%, and high-density lipoprotein decreases of 10% from pretreatment values. Chronic increases in plasma cholesterol levels, increases in low-density lipoprotein cholesterol levels, and decreases in high-density lipoprotein cholesterol levels may predispose subjects to premature atherosclerosis. Because of the potential for unmasking an occult lipid or lipoprotein disorder, the plasma lipid and lipoprotein profiles of subjects receiving isotretinoin should be carefully monitored. (Arch Dermatol 1983;119:987-993) References 1. Peck GL, Olsen TG, Yoder FW, et al: Prolonged remission of cystic and conglobate acne with 13-cis-retinoic acid . N Engl J Med 1979;300:329-333.Crossref 2. Peck GL, Yoder FW, Olsen TG, et al: Treatment of Darier's disease, lamellar ichthyosis, pityriasis rubra pilaris, cystic acne, and basal cell carcinoma with 13-cis-retinoic acid . Dermatologica 1978;157( (suppl) ):11-12.Crossref 3. Peck GL, Yoder FW: Treatment of lamellar ichthyosis and other keratinizing deratosis with an oral synthetic retinoid . Lancet 1976;2:1172-1174.Crossref 4. Peck GL: Retinoids in dermatology: An interim report . Arch Dermatol 1980;116:283-284.Crossref 5. Orfanos GE: Oral retinoids: Present status . Br J Dermatol 1980;103:473-481.Crossref 6. Blackman HJ, Peck GL, Olsen TG, et al: Blepharoconjunctivitis: A side effect of 13-cis-retinoic acid therapy for dermatologic diseases . Ophthalmology 1979;86:753-758.Crossref 7. Peck GL, Gross EG, Butkus D: Comparative analysis of two retinoids in the treatment of disorders of keratinization , in Orfanos CE, Braun-Falco O, Farber EM, et al (eds): Retinoids: Advances in Basic Research and Therapy . Berlin, Springer Verlag, 1981, pp 279-286. 8. Hulley SB, Rosenman RH, Bawol RD, et al: Epidemiology as a guide to clinical decisions . N Engl J Med 1980;302:1383-1389.Crossref 9. Gordon T, Castelli WP, Hjortland MC: Diabetes, blood lipids and the role of obesity in coronary heart disease risk for women: The Framingham study . Ann Intern Med 1977;87:393-397.Crossref 10. Gordon T, Castelli WP, Hojortland MC: Predicting coronary heart disease in middle-aged and older persons: The Framingham study . JAMA 1977;238:497-499.Crossref 11. Crepaldi G, Fellin G, Briari G: Prevalence of coronary artery disease in patients with types of primary hyperlipidemia . Atherosclerosis 1977;26:593-602.Crossref 12. Rosenman RH, Brand RJ, Jenkins CD: Coronary heart disease in Western Collaborative Group Study: Final follow up experience of 8½ years . JAMA 1973;233:872-877.Crossref 13. Kannel WB, Castelli WP, Gordon T: Cholesterol in the prediction of atherosclerosis disease . Ann Intern Med 1979;90:85-91.Crossref 14. Wilson PW, Garrison RJ, Castelli WP, et al: Prevalence of coronary heart disease in the Framingham offspring study: Role of lipoprotein cholesterol . Am J Cardiol 1980;46:649-654.Crossref 15. Goldbourt U, Medalie JH: High density lipoprotein cholesterol and incidence of coronary heart disease: The Israeli Ischemic Heart Disease Study . Am J Epidemiol 1979;109:296-308. 16. Pearson TA, Bulkley BH, Achuff SC, et al: The association of low levels of HDL cholesterol and arteriographically defined coronary artery disease . Am J Epidemiol 1979;109:285-295. 17. Castelli WP, Doyle JT, Gordon T: Alcohol and blood lipids: The cooperative lipoproteins phenotyping study . Lancet 1977; 2:153.Crossref 18. Kannel WB, McGee DL: Diabetes and cardiovascular risk factors: The Framingham study . Circulation 1979;59:8-13.Crossref 19. Schaefer EJ, Anderson DW, Brewer HB Jr, et al: Plasma triglycerides in regulation of HDL-cholesterol levels . Lancet 1978;1:391-392.Crossref 20. Nikkila EA: Metabolic and endocrine control of plasma high density lipoprotein concentration: Relation to catabolism of triglyceride-rich lipoproteins , in Gotto AM Jr, Miller ME, Oliver, MF (eds): High Density Lipoproteins and Atherosclerosis . New York, Elsevier North Holland Inc, 1978, pp 177-192. 21. Manual of Laboratory Operations , Lipid Research Clinics Program vol 1: Lipid and Lipoprotein Analysis 1974 , US Dept of Health, Education, and Welfare, publication (NIH) 75-625, 1974. 22. Burstein M, Scholnick HR: Lipoprotein: Polyanions-metal interactions . Adv Lipid Res 1973;11:67-108. 23. Brunk HD: An Introduction to Mathematical Statistics , ed 2. Waltham, Mass, Blarsdell Publishing Company, 1965, p 235. 24. Runne U, Orfanos CE, Gartman H: Perorale Applikation zWeier Derivate der Vitamin A-Saure zur internin Psoriasis-Therapie . Arch Dermatol Forsch 1973;247:171-180.Crossref 25. Zilo M, DeLuca HF: Retinoic acid: Some aspects of growth-promoting activity in the albino rat . J Nutr 1968;94:302-305. 26. DeLuca HF, Roberts AB: Pathways of retinoic acid and retinol metabolism . Am J Clin Nutr 1969;221:945-952. 27. Misra UK: Liver lipids of rats administered excessive amounts of retinol . Can J Biochem 1968;46:697-701.Crossref 28. Misra UK: Effects of retinol liver lipid metabolism of rats . Agricultural Bio Chem 1974;38:247-252.Crossref 29. Erdman JW, Solomon LW: Effects of retinoic acid feeding on rat serum and liver lipids, abstracted . Fed Proc 1977;36:1136. 30. Gerber LE, Erdman JW: Effect of retinoic acid and retinyl acetate feeding upon lipid metabolism in adrenalectomized rats . J Nutr 1979;109:580-589. 31. Gerber LE, Erdman JW: Hypertriglyceridemia in rats administered all-trans or 13-cis-retinoic-acid, abstracted . Fed Proc 1979;38:761. 32. Katz RA, Jorgenson H, Nigra TP: Elevation of serum triglyceride levels from oral isotretinoin in disorders of keratinization . Arch Dermatol 1980;116:1369-1372.Crossref 33. Dicken CH, Connolly SM: Eruptive xanthomas associated with isotretinoin (13-cis-retinoic acid) . Arch Dermatol 1980; 116:951-952.Crossref 34. Bring SV, Ricard CA, Zachringer MW: Relationship between cholesterol and vitamin A metabolism in rats fed at different levels of vitamin A . J Nutr 1965;85:400-406. 35. Gross E, Zech L, Peck G: Elevated plasma lipids with oral retinoids . J Invest Dermatol 1981;76:303. 36. Gollnick H, Tsambaos D, Orfanos CE: Risk factors promote elevations of serum lipids in acne patients under oral 13-cis-retinoic acid (isotretinoin) . Arch Dermatol Res 1981;271:189-196.Crossref 37. Fredrickson DS, Goldstein JL, Broun MS: The familial hyperlipoproteinemias , in Stanburg JB, Wyngarden JB, Fredrickson DS (eds): The Metabolic Bases of Inherited Diseases , ed 4. New York, McGraw-Hill Book Co, 1978, chap 30. 38. Rifkind BM, Levy RI: Hyperlipidemia: Diagnosis and therapy . New York, Grune and Stratton Inc, 1977. 39. Goldstein JS, Hazzard WR, Schrott HG, et al: Hyperlipidemia in coronary heart disease . J Clin Invest 1973;52:1533-1543.Crossref 40. Goldstein JL, Schrott HG, Hazzard WR, et al: HYperlipidemia in coronary heart disease . J Clin Invest 1973;52:1543-1568. 41. Hazzard WR, Goldstein JL, Schrott HG, et al: Hyperlipidemia in coronary heart disease . J Clin Invest 1973;52:1569-1577.Crossref 42. Lewis B: The Hyperlipidaemias . Oxford, England, Blackwell Scientific Publications, 1976. 43. Radford DJ, Oliver MF: Oral contraceptives and myocardial infarctions . Br Med J 1973;3:428-430.Crossref 44. Wynn V, Doar JW, Mills GL: Some effects of oral contraceptives on serum lipid and lipoprotein levels . Lancet 1966;2:720-723.Crossref 45. Gersberg H, Hulse M, Janvier M: Hypertriglyceridemia during treatment with estrogens and oral contraceptives . Obstet Gynecol 1968;31:186-189.Crossref 46. Rossner S, Larson-Cohn U, Carlson LA, et al: Effects of an oral contraceptive agent on plasma lipids, plasma lipoproteins, the intravenious fat tolerance and the post-heparin lipoproteins lipase activity . Acta Med Scand 1971;190:301-305.Crossref 47. Kekki M, Nikkila EA: Plasma triglyceride turnover during use of oral contraceptives . Metabolism 1971;20:878-889.Crossref 48. Zorilla E, Hulse M, Harmandez A, et al: Severe endogenous hypertriglyceridemia during treatment with estrogens and oral contraceptives . J Clin Endocrinol Metabol 1968;28:1793-1796.Crossref 49. Bank S, Marks IN: Hyperlipoproteinemia, pancreatitis and the pill . Postgrad Med J 1970;46:576-588.Crossref 50. Bagdade JD, Porte D, Berman EL: Steroid-induced lipemia . Arch Intern Med 1970;125:129-134.Crossref 51. El-Shalainy AM, Hayes TM: Hyperlipidemia in asthmatic patients receiving long term steroid therapy . Br Med J 1973;2:85-86.Crossref 52. Carlson LA, Bottiger LE, Per-Erick A: Risk factors for myocardial infarction in the Stockholm prospective study . Acta Med Scand 1979;206:351-360.Crossref 53. Glynn R, Rosner B, Silbert JE: Changes in cholesterol and triglycerides as predictors of ischemic heart disease in men, abstracted . Clin Res 1980;28:474. 54. Miller GJ, Miller NE: Plasma-high density lipoprotein concentrations and development of ischaemic heart disease . Lancet 1975;2:16-19.Crossref 55. Kaffarnik H, Schneider J, Schubotz R, et al: Plasma lipids, triglyceride/fatty acid pattern and plasma insulin in fasted healthy volunteers during continuous ingestion of ethanol . Atherosclerosis 1978;29:1-7.Crossref 56. Sporn MB, Harris ED Jr: Proliferative diseases . Am J Med 1981;70:1231-1236.Crossref 57. Behnke AR, Wilmore JH: Evaluation and regulation of body and composition . Englewood Cliffs, NJ, Prentice-Hall Inc, 1974.

Chanda, Joseph J.;Headington, John T.

1983 Archives of Dermatology

doi: 10.1001/archderm.1983.01650360040010

Abstract • Bacteria belonging to the Rhodochrous complex are of uncertain taxonomic status. Currently excluded from the genus Mycobacterium, these organisms are more closely allied to Nocardia. Organisms of the Rhodochrous complex have only rarely been implicated as human pathogens. An 81-year-old man had a plaquelike cutaneous granuloma from which Rhodochrous was both cultured and demonstrated in tissue section. A pathogenic role for Rhodochrous causing a primary cutaneous infection is suggested. Specific antimicrobial treatment with doxycycline hydrochloride was successful and there has been no recurrence of the infection after three years. (Arch Dermatol 1983;119:994-997) References 1. Overbeck A: Zur Kenntnis der Fettfarbstoff-Production bei Spaltpelzen . Nova Acta Leopoldina 1891;55:399-416. 2. Gordon RE: Some strains in search of a genus: Corynebacterium, Mycobacterium, Nocardia, or what? J Gen Microbiol 1966;43:329-343.Crossref 3. Gordon RE, Hihm JM: A comparison of four species of mycobacteria . J Gen Microbiol 1959;21:736-748.Crossref 4. Goodfellow M, Minnikin DE: Nocardioform bacteria . Annu Rev Microbiol 1977;31:159-180.Crossref 5. Tsukamura M: Proposal of a new genus, Gordona, for slightly acid-fast organisms occurring in sputa of patients with pulmonary disease and in soil . J Gen Microbiol 1971;68:15-26.Crossref 6. Tsukamura M: Necessity for differentiation of rhodochrous group from tubercle bacilli . Jpn J Microbiol 1974;18:94-95.Crossref 7. Porres JM: Isolation of Mycobacterium rhodochrous from a cutaneous lesion . Arch Dermatol 1973;108:411-412.Crossref 8. Haburchak DR, Jeffery B, Higbee JW, et al: Infections caused by rhodochrous . Am J Med 1978;65:298-302.Crossref 9. Schönborn C, Handrick W, Schneider P: Über den Nachweis von Mycobacterium rhodochrous als Erreger einer Perikarditis bei einem Kleinkind . Z Gesamte Inn Med 1975;30:679-683. 10. Alture-Werber E, O'Hare D, Louria DB: Infections caused by Mycobacterium rhodochrous and scotochromogens . Am Rev Respir Dis 1968;97:694-698.