doi: 10.1001/archderm.1985.01660120007001
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
doi: 10.1001/archderm.1985.01660120009003
Abstract To the Editor.— In the July 1985 Archives, Lamm et al1 properly and accurately call our attention to a histologic artifact associated with jet administration by Madajet.However, the Madajet is certainly not a "new needleless injection instrument," for we have used these types of instruments for many, many years (approximately 15). One must learn the proper distance from the skin from which to deliver any jet-propelled fluid, with or without particulate matter.2 In some anatomic areas, the plastic spacer provided with the instrument is adequate. In other loci, experience should quickly teach us that we must move an increased distance away from the skin to prevent largescale perforations of the epidermis and dermis. The delivery of anesthetic or dilute steroid suspensions through air space must be properly distanced, these distances varying between several millimeters to as much as 5 cm greater than the spacer would indicate. Given References 1. Lamm J, Niebyl P, Hood A: Histologic artifact due to Madajet . Arch Dermatol 1985;121:835-836.Crossref 2. Field LM: Madajet for avoiding olecranon bursitis . Schoch Lett 1982;32:7.
doi: 10.1001/archderm.1985.01660120009002
Abstract To the Editor.— In the May 1985 issue of the Archives, Kellet and Macdonald1 described a 21-year-old woman with classic confluent and reticulate papillomatosis (CRP) of nine years' duration who responded rapidly to 2% miconazole cream applied topically. They had quoted the case report by Bruynzeel-Koomen and de Wit2 of a similarly afflicted patient who responded to treatment with oral etretinate.In 1973, my colleagues and I3 reported three cases of CRP; two of the patients responded to topical selenium sulfide, and one responded to parenteral vitamin A therapy alone. On the basis of this study, we proposed that CRP is an abnormal host response to Malassezia furfur. The two popular views about the pathogenesis of CRP are those of Miescher,4 who proposed a keratinization disorder as the basic defect, and Roberts and Lachapelle,5 who suggested an abnormal host response to Pityrosporon orbiculare. Based on References 1. Kellet JK, Macdonald RH: Confluent and reticulate papillomatosis . Arch Dermatol 1985;121:587-588.Crossref 2. Bruynzeel-Koomen CAFM, de Wit RFE: Confluent and reticulated papillomatosis successfully treated with the aromatic etretinate . Arch Dermatol 1984;120:1236-1237.Crossref 3. Yesudian P, Kamalan S, Razack A: Confluent and reticulated papillomatosis (Gougerot-Carteaud): An abnormal host reaction to Malassezia furfur . Acta Derm Venereol 1973;53:381-384. 4. Miescher G: Erythrokeratodermia papillaris et reticularis . Dermatologica 1954;108:303-314.Crossref 5. Roberts SO, Lachapelle JM: Confluent and reticulate papillomatosis (Gougerot-Carteaud) and Pityrosporum orbiculare . Br J Dermatol 1969;81:841-845.Crossref
Friedman, Stephen J.;Su, W. P. Daniel;Doyle, John A.
doi: 10.1001/archderm.1985.01660120010005pmid: 4062324
Abstract To the Editor.— In their recent article, Person and Longcope1 reported no measurable estrogen or progesterone receptors in an involved lesion of a patient with generalized essential telangiectasia (GET). They suggested that GET is unrelated to the unilateral nevoid telangiectasia syndrome (unilateral dermatomal superficial telangiectasia [UDST]) because of the presence of estrogen and progesterone receptors in the latter disorder.2Review of the literature regarding UDST reveals two groups of patients: (1) a group with the onset of telangiectasia chronologically related to conditions associated with increased estrogen states, including puberty in women, pregnancy, and alcoholism with cirrhosis, and (2) a group that does not fit into an estrogen model for the onset of the lesions, including patients in which the UDST arose at birth or during childhood before puberty.3Uhlin and McCarty2 reported elevated levels of estrogen and progesterone receptors in only involved skin of a woman with References 1. Person JR, Longcope C: Estrogen and progesterone receptors are not increased in generalized essential telangiectasia . Arch Dermatol 1985; 121:836-837.Crossref 2. Uhlin SR, McCarty KS: Unilateral nevoid telangiectasia syndrome: The role of estrogen and progesterone receptors . Arch Dermatol 1983; 119:226-228.Crossref 3. Su WPD, Friedman SJ, Doyle JA: Unilateral dermatomal superficial telangiectasia (unilateral nevoid telangiectasia syndrome) . Derm Sinica 1984;2:27-34. 4. Hasselquist MB, Goldberg N, Schroeter AL, et al: Isolation and characterization of the estrogen receptor in human skin . J Clin Endocrinol Metabol 1980;50:76-82.Crossref 5. McGrae JE Jr, Winkelmann RK: Generalized essential telangiectasia: Report of a clinical and histochemical study of 13 patients with acquired cutaneous lesions . JAMA 1963;185:909-913.Crossref
Grattan, C. E. H.;Guerrier, C. J. W.
doi: 10.1001/archderm.1985.01660120010004
Abstract To the Editor.— The recent article in the Archives, "Pustular Contact Hypersensitivity to Topical Fluorouracil With Rosacealike Sequelae,"1 has prompted us to herein report an unusual case of facial lymphedema that developed after, and was presumably related to, the use of 5% fluorouracil cream (Efudex). Report of a Case.— A 68-year-old woman with multiple actinic keratoses on her left cheek applied 5% fluorouracil cream to the area twice daily for four weeks, after first using a keratolytic, 0.025% tretinoin gel (Retin-A), daily for a fortnight. Although she experienced a considerable reaction of edema, erythema, and crusting, she persevered in applying the cream for the full four weeks as initially instructed. At no time did she feel feverish or unwell. When she was examined six weeks after completion of treatment, her skin had returned to normal with the exception of a mild lymphedema of her left cheek. The swelling was unchanged References 1. Sevadjian CM: Pustular contact hypersensitivity to fluorouracil with rosacealike sequelae . Arch Dermatol 1985;121:240-242.Crossref 2. Goette DK: Topical chemotherapy with 5-fluorouracil: A review . J Am Acad Dermatol 1981;4:633-649.Crossref
doi: 10.1001/archderm.1985.01660120010006
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.— The use of plasmapheresis to treat bullous pemphigoid (BP) has been reported in the European literature,1-6 but, to our knowledge, there has been no mention of this in the American literature to date. We herein describe a patient with BP treated with plasmapheresis and also give a review of the literature. Report of a Case.— A 68-year-old woman with a diagnosis of BP initially responded to prednisone. Her course was complicated by insulin-requiring diabetes mellitus, severe fluid retention with hypertension, and a myopathy. Her ten hospital admissions for flares of BP are summarized in the Table. Her course was notable for nonhemorrhagic cystitis due to cyclophosphamide (Cytoxan) and a hepatotoxic reaction to azathioprine (Imuran). During the patient's eighth admission, an increase in prednisone dosage from 7.5 to 35 mg daily had no effect on her disease one week later. She refused another increase in the dosage
doi: 10.1001/archderm.1985.01660120012007
Abstract To the Editor.— It is our experience that prednisolone with or without methotrexate or chloroquine remains the most effective therapy available for the distressing and unsightly features of cutaneous sarcoidosis.1 Waldinger et al2 in 1983 reported the successful use of isotretinoin in a patient with relapsing cutaneous sarcoidosis yet could not exclude the possibility of spontaneous remission. Since then, there have been no further reports of the use of retinoids in sarcoidosis, to our knowledge. We herein report such a case. Report of a Case.— A 33-year-old woman weighing 82 kg was admitted, with a five-year history of chronic sarcoidosis with hilar lymphadenopathy and reticulonodular shadowing, peripheral bone cysts, upper respiratory tract involvement, and recurrent cutaneous lesions. During acute exacerbations, she was always treated with courses of systemic steroids, with complete recovery within four weeks. Unfortunately, relapse invariably occurred within two weeks after treatment was stopped. On this References 1. Spiteri MA, Matthey F, Gordon T, et al: Lupus pernio: A clinicoradiological study of 35 cases . Br J Dermatol 1985;112:315-322.Crossref 2. Waldinger TP, Ellis CN, Quint K, et al: Treatment of cutaneous sarcoidosis with isotretinoin . Arch Dermatol 1983;119:1003-1005.Crossref 3. Levin J, Almeyda J: Erythmoderma due to etretinate . Br J Dermatol 1985;112:373-374.Crossref 4. Fontan B, Benafe JL, Moatti JP: The toxic effects of the aromatic retinoid etretinate . Arch Dermatol 1983;119:187-188.Crossref
doi: 10.1001/archderm.1985.01660120012008
Abstract To the Editor.— Regional differences in responsiveness to treatment of psoriatic lesions are commonly observed. Plaques on the knees and elbows are reputed to be more resistant than those on the trunk.1 We believe that diphenoxylate hydrochloride may be useful in the treatment of these recalcitrant lesions. This hypothesis is based on our observation of a 67-year-old woman with chronic psoriasis who, having been treated for acute diarrhea, experienced a four-month remission of her psoriasis. A combination product of diphenoxylate hydrochloride and atropine sulfate (Lomotil) was prescribed for her treatment.To test this hypothesis we did a double-blind study, which compared topical preparations of diphenoxylate and its placebo. Two patients with chronic psoriatic lesions on their knees applied these preparations twice daily to separate symmetrical lesions. Both showed greater improvement on the diphenoxylate-treated knee.Subsequently, eight patients who had had lesions of psoriasis on their elbows and knees for References 1. Kaidbey KH, Petrozzi JW, Klingman AM: Topical colchicine therapy for recalcitrant psoriasis . Arch Dermatol 1975;111:33-36.Crossref
Friedman, Stephen J.;Su, W. P. Daniel;Doyle, John A.
doi: 10.1001/archderm.1985.01660120012009
Abstract To the Editor.— Occlusive dressings are effective in the healing of superficial wounds of animals and humans.1-3In animal studies, there is an increase in collagen synthesis1 and a greater rate of re-epithelialization.1,2 During the last few years, many occlusive dressings—oxygen-permeable and oxygen-impermeable—have become commercially available. Examples of oxygen-permeable dressings include polyethylene oxide hydrogel (Vigilon) and polyethylene film (Op-Site). Copolymer starch hydrogel (Bard adsorption dressing) and hydrocolloid dressings (Duo-Derm) are relatively oxygen-impermeable. The precise mechanism for the accelerated wound healing with occlusive dressings is not well understood; however, it has been proposed that the trapping of wound moisture prevents desiccation of the epidermal cells and allows their unobstructed migration across the wound surface,1-3 and the stimulation of granulation tissue growth facilitates the ulcers to heal.4We report herein two cases involving a comparison trial of hydrocolloid occlusive dressings (DuoDerm) and wet dressings in the postoperative management References 1. Alvarez OM, Mertz PM, Eaglstein WH: The effect of occlusive dressings on collagen synthesis and re-epithelialization in superficial wounds . J Surg Res 1983;35:142-148.Crossref 2. Geronemus RG, Robins P: The effect of two new dressings on epidermal wound healing . J Dermatol Surg Oncol 1982;8:850-852.Crossref 3. Winter GD: A note on wound healing under dressings with special reference to perforated-film dressings . J Invest Dermatol 1965;45:299-302.Crossref 4. Friedman SJ, Su WPD: Management of leg ulcers with hydrocolloid occlusive dressing . Arch Dermatol 1984;120:1329-1336.Crossref 5. Bennett RG: The debatable benefit of occlusive dressings for wounds . J Dermatol Surg Oncol 1982;8:166-167.Crossref
doi: 10.1001/archderm.1985.01660120013010
Abstract To the Editor.— Pentoxifylline (Trental) has been approved by the Food and Drug Administration for the symptomatic treatment of intermittent claudication. This drug lowers blood viscosity and improves erythrocyte flexibility. These effects allow increased blood flow to ischemic tissues.Therapy for pityriasis lichenoides et varioliformis, which is usually not an acute disease, has been somewhat frustrating. The therapy that I have found most useful has been very low-dose methotrexate therapy.1,2 The dosage usually adequate to control the disease is a 2.5-mg tablet taken in the morning and at bedtime over a 12-hour period once a week. Two of my patients have been treated with pentoxifylline. Report of Cases.—Case 1.— A 30-year-old woman was first seen on May 8,1985, with a skin problem of 1 ½ years' duration. She had been treated with prednisone and an antibiotic orally with no improvement.Examination revealed 15 red papules, some scaly, on the References 1. Lynch PJ, Saied NK: Methotrexate treatment of pityriasis lichenoides and lymphomatoid papulosis . Cutis 1979;5:634-636. 2. Schleicher H, Waldmann U, Knopf B: Treatment of pityriasis lichenoides et varioliformis acuta with methotrexate . Dermatol Monatsschr 1975;161:148-152. 3. Sauer GC: Sauer notes and case presentation . Read before the American Academy of Dermatology meeting discussion group, Washington, DC, Dec 4, 1984 4. at the Missouri Dermatological Society meeting, Kansas City, Mo, April 14, 1985 .
doi: 10.1001/archderm.1985.01660120022011
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 FOR CLASS 1 POTENCY1 DIPROLENE® brand of betamethasone dipropionate Ointment, USP, 0.05%— IN ACTIBASE (potency expressed as betamethasone) For Dermatologic Use Only — Not for Ophthalmic Use Summary of Prescribing Information: INDICATIONS AND USAGE DIPROLENE Ointment is indicated for relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. CONTRAINDICATIONS DIPROLENE Ointment is contraindicated in patients who are hypersensitive to betamethasone dipropionate, to other corticosteroids, or to any ingredient in this preparation. PRECAUTIONS General Systemic absorption of topical corticosteroids has produced reversible HPA axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients. Conditions which augment systemic absorption include the application of the more potent corticosteroids, use over large surface areas, prolonged use, and the addition of occlusive dressings. See DOSAGE AND ADMINISTRATION section.) Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area should be evaluated periodically for evidence of
doi: 10.1001/archderm.1985.01660120029012
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 Over 95% of American medical students intend to seek certification in some specialty, and probably fewer than 1% enter practice without some residency training. The four years of medical school, commonly called undergraduate medical education, are no longer a self-sufficient course of study. This period is now looked on principally as a basis for entry into graduate medical education. It is thus timely to reexamine the goals of undergraduate medical education, as many organizations and medical schools are doing. One objective of such reviews is to attempt to specify the basic educational goals of general medical education. It is against this background that the questionnaire survey on undergraduate dermatologic medical education reported by Ramsay and Mayer in this issue of the Archives should be examined. In brief, what is the role of dermatology and its related basic science in general medical education? Is the goal to teach the specific diagnoses
doi: 10.1001/archderm.1985.01660120030013
Abstract Many of us have been asked for our advice on or interpretation of a laboratory printout of a hair sample analysis. Despite this interest of our patients (or fellow physicians) in determining the implications for their (or their patients') hair or general health, it is well recognized by dermatologists and many nutritionists that mineral and trace element analysis of hair samples is not a clinically useful tool to assess nutritional status. The reasons for this are variability in environmental effects (hair care, occupational exposure, geographic location), differing growth rates (health, drug effect, age, gender), and lack of standardization in analysis techniques.1-4 The dangers of the current commercial availability of multimineral hair analysis are underscored in a recent article by Barrett5 in JAMA. In this study, information and instructions for submitting hair samples were obtained from 13 commercial laboratories offering hair analysis. The services offered by various laboratories included References 1. Lazar P: Hair analysis and health: A statement of the Committee on Cutaneous Health and Cosmetics . JAMA 1974;229:1908-1909.Crossref 2. Hambidge KM: Hair analysis: Worthless for vitamins, limited for minerals . Am J Clin Nutr 1982;36:943-949. 3. Rivlin RS: Misuse of hair analysis for nutritional assessment . Am J Med 1983;75:489-493.Crossref 4. Zlotkin SH: Hair analysis: A useful tool or a waste of money? Int J Dermatol 1985;24:161-164. 5. Barrett S: Commercial hair analysis: Science or scam? JAMA 1985;254:1041-1045.Crossref 6. Sherertz EF, Goldsmith LA: Nutritional influences on the skin , in Goldsmith LA (ed): Biochemistry and Physiology of the Skin . New York, Oxford University Press, 1983, vol 2, pp 1069-1081. 7. Saner G, Dagoglu T, Ozden T: Hair manganese concentrations in newborns and their mothers . Am J Clin Nutr 1985;41:1042-1044. 8. Moon C, Marlowe M, Stellern J, et al: Main and interaction effects of metallic pollutants on cognitive functioning . J Learn Disabil 1985;18:217-221.Crossref 9. Barlow PJ: A pilot study of metal levels in the hair of hyperactive children . Med Hypotheses 1983;11:309-318.Crossref 10. Rimland B, Larson GE: Hair mineral analysis and behavior: An analysis of 51 studies . J Learn Disabil 1983;16:279-285.Crossref 11. Pihl RO, Ervin FR, Pelletier G, et al: Hair element content of violent criminals . Can J Psychiatry 1982;27:533-534. 12. Medeiros DM, Pellum LK: Blood pressure and hair cadmium, lead, copper, and zinc concentrations in Mississippi adolescents . Bull Environ Contam Toxicol 1985;34:163-169.Crossref 13. Medeiros DM, Pellum LK: Elevation of cadmium, lead, and zinc in the hair of adult black female hypertensives . Bull Environ Contam Toxicol 1984;32:525-532.Crossref 14. Collipp PJ, Kuo B, Castro-Magana M, et al: Hair zinc, scalp hair quantity and diaper rash in normal infants . Cutis 1985;35:66-70. 15. Pratt WB, Phippen WG: Elevated hair copper level in idiopathic scoliosis: Preliminary observations . Spine 1980;5:230-233.Crossref 16. Maugh TH: Hair: A diagnostic tool to complement blood serum and urine . Science 1978;202:1271-1273.Crossref 17. Paisey RB, Clamp JR, Kent MJ, et al: Glycosylation of hair: Possible measure of chronic hyperglycemia . Br Med J Clin Res 1984;288:669-671.Crossref 18. Raghupathy L, Sharma VN: Zinc and copper concentration in the hair of workers from zinc-based industries in India . Sci Total Environ 1985;41:73-78.Crossref 19. Saner G, Yuzbasiyan V, Cigdem S: Hair chromium concentration and chromium excretion in tannery workers . Br J Ind Med 1984;41:263-266. 20. Carvalho F, Tavares TM, Souza SP, et al: Lead and cadmium concentrations in the hair of fishermen from the Subae River Basin, Brazil . Environ Res 1984;33:300-306.Crossref 21. Hammer DI, Finklea JF, Hendricks RM, et al: Hair trace metal levels and environmental exposure . Am J Epidemiol 1971;93:84-92. 22. Lubec G, Patrick AD, Nauer G, et al: Screening for Sanfilippo disease type A by infrared spectroscopy of hair . Lancet 1985;1:526-527.Crossref 23. Page T, Bakay B, Nyhan WL: An improved procedure for detection of hypoxanthine-guanine phosphoribosyl transferase heterozygotes . Clin Chem 1982;28:1181-1184. 24. Mudd JL: The determination of sex from forcibly removed hairs . J Forensic Sci 1984;29:1072-1080. 25. Suzuki O, Hattori H, Asano M: Detection of methamphetamine and amphetamine in a single human hair by gas chromatography/chemical ionization mass spectrometry . J Forensic Sci 1984;29:611-617. 26. Cortivo P, Biasiolo M, Scorretti C, et al: The detection of A and B antigens on human hair by the absorption-elution technique using LISS and papain-treated test cells . Z Rechtsmed 1984;91:195-199.Crossref
doi: 10.1001/archderm.1985.01660120031014
Abstract It is now six years since my colleagues and I predicted from pharmacokinetic studies that, in topical treatment, removing drugs from the skin after a short contact period should reduce side effects.1 At that time, we successfully applied this idea to the treatment of psoriasis with anthralin.1 Meanwhile, more pharmacokinetic evidence has been gained that confirms early observations with steroids2 and our first investigations3,4: "Penetration into eczematous skin is much more rapid and higher than in normal skin." Thus, if we interrupt the application early enough, we hardly interfere with the therapeutic action, but we might prevent a drug-related reaction—ie, side effects—in perilesional skin.5-9 The idea has been utilized, sometimes with modifications, by many individual dermatologic practitioners, with almost unanimous confirmation of the concept and its practicability.10-23 A restriction should be underlined immediately, that is, that the short-contact therapy needs an intelligent, motivated, References 1. Schaefer H, Farber EM, Goldberg L, et al: Limited application period for dithranol in psoriasis . Br J Dermatol 1980;102:571-573.Crossref 2. Hopsu-Havu VK, Tuohimaa P: Quantitative and radioautographic studies on the penetration kinetics of 9-α-fluoro-16-methylene-prednisolone-21-acetate-7-T in human skin . Arch Klin Exp Dermatol 1970;239:252-265.Crossref 3. Schaefer H, Zesch A, Stüttgen G: Penetration, permeation, and absorption in triamcinolone acetonide in normal and psoriatic skin . Arch Dermatol Res 1977;258:241-249.Crossref 4. Schaefer H, Zesch A, Stüttgen G: Skin Permeability . New York, Springer Publishing Co Inc, 1982. 5. Cavey D, Dickinson R, Shroot B: A comparison of continuous and short-contact application of anthralin in the hairless rat . J Invest Dermatol 1983;80:349. 6. Schaefer H, Schalla W, Shroot B: Pharmacology and kinetics of anthralin , in Farber EM, Cox AJ, Nall ML, et al (eds): Psoriasis . New York, Grune & Stratton Inc, 1982, pp 111-118. 7. Schaefer H, Schalla W, Lamaud E, et al: Pharmacological and pharmacokinetic aspects in local and systemic therapy of psoriasis , in Kröger H, Stüttgen G (eds): Current Research Problems in Psoriasis . Berlin, Grosse Verlag, 1984, pp 104-110. 8. Schalla W, Bauer E, Schaefer H: Skin permeability of anthralin . Br J Dermatol 1981;105( (suppl 20) ):104-108.Crossref 9. Schwarz T, Gschnait F: Anthralin minute entire skin treatment . Arch Dermatol 1985;121:1512-1515.Crossref 10. Brun P, Juhlin L, Schalla W: Short contact anthralin therapy of psoriasis with and without UV-irradiation and maintenance schedule to prevent relapses . Acta Derm Venereol 1984; 64:174-177. 11. Göring HD, Voss M: Erfahrungen mit der hochdosierten Dithranol-Kurzzeittherapie der Psoriasis . Hautarzt 1984;35:148-151. 12. Hindryckx P, De Bersaques J: Short-duration dithranol therapy for psoriasis . Dermatologica 1983;167:304-306.Crossref 13. Marosi I, Balogh G, Cseplak G: Experience with the `minute treatment' of psoriasis vulgaris . Orv Hetil 1984;125:1323-1325. 14. Marsden JR, Coburn PR, Marks J, et al: Measurement of the response of psoriasis to short-term application of anthralin . Br J Dermatol 1983;109:209-218.Crossref 15. Puschmann M: Das Anthralin-Erythem: Der Einfluss von Konzentration, Kontaktzeit, Oxydationsprodukten und Kortikosteroiden . Z Hautkr 1983;58:1646-1647. 16. Reshad H, Barth JH, Darley CR, et al: Does UV-A potentiate `short contact' dithranol therapy? Br J Dermatol 1984;111:155-158.Crossref 17. Runne U, Kunze J: Short-duration (`minutes') therapy with dithranol for psoriasis: A new out-patient regimen . Br J Dermatol 1982;106:135-139.Crossref 18. Runne U, Schopf U, Schopf R, et al: Short-term application of anthralin: A new therapeutic regimen for psoriasis: Three vs 24 hours of application in right-left comparison . Arch Dermatol Res 1981;270:223-224.Crossref 19. Runne U, Kunze J: Psoriasis: Die Praxis der `MinutenTherapie' mit Cignolin . Z Hautkr 1983;58:219-229. 20. Ryatt KS, Statham BN, Rowell NR: Short-contact modification of the Ingram regime . Br J Dermatol 1984;111:455-459.Crossref 21. Seville RH: Advances in the use of anthralin . J Am Acad Dermatol 1981;5:319-321.Crossref 22. Seville RH: Should general practitioners use dithranol? Br Med J 1983;287:503.Crossref 23. Verschoore M, Archer CB, Petchot-Bacque JP, et al: Anthralin short contact therapy: Clinical response in chronic plaque psoriasis . Acta Derm Venereol 1984, (suppl 113) , pp 131-134. 24. Scheuplein RJ, Blank IH: Permeability of the skin . Physiol Rev 1971;51:702-746. 25. Wester RC, Bucks DAW, Maibach HI: In vivo percutaneous absorption of hydrocortisone in psoriatic patients and normal volunteers . J Am Acad Dermatol 1983;8:645-647.Crossref 26. Maibach HI, cited by Schaefer H, Zesch A, Stüttgen G: Skin Permeability . New York, Springer Publishing Co Inc, 1982, p 753. 27. Wester RC, Bucks DAW, Maibach HI, et al: Polychlorinated biphenyls (PCBs): Dermal absorption, systemic elimination, and dermal wash efficiency . J Toxicol Environ Health 1983;12:511-519.Crossref 28. Ashton RE, Andre P, Lowe NJ, et al: Anthralin: Historical and current perspectives . J Am Acad Dermatol 1983;9:173-192.Crossref 29. Farber EM, Harris DH: Hospital treatment of psoriasis: A modified anthralin program . Arch Dermatol 1970;101:381-389.Crossref 30. Neill SM, Bugrein A, Coulson IH, et al: Toxicologic study of anthralin in an aqueous cream formulation . Therap Clin 1984; 34:563-566. 31. Freeman K, Warin AP: Staining of baths by short-contact dithranol therapy . Br J Dermatol 1984;110:246-251.Crossref 32. Farber EM, Abel EA, Charnworn A: Recent advances in the treatment of psoriasis . J Am Acad Dermatol 1983;8:311-321.Crossref 33. Lowe NJ, Ashton RE, Koudsi H, et al: Anthralin for psoriasis: Short-contact anthralin therapy compared with topical steroid and conventional anthralin . J Am Acad Dermatol 1984; 10:69-72.Crossref 34. Statham BN, Ryatt KS, Rowell NR: Short-contact dithranol therapy: A comparison with the Ingram regime . Br J Dermatol 1984;110:703-708.Crossref 35. Steiniger S, Meffert H, Miehe M: Verminderung des Dithranol-Verbrauches bei der Psoriasis-Kurzzeittherapie . Dermatol Monatsschr 1984;170:35-36. 36. Meffert H, Andersen KE, Sönnichsen N: Phototoxicity and antipsoriatic effect of a topical methoxypsoralen solution in relation to the application time . Photodermatol 1984;1:191-194. 37. Schauder S, Mahrle G: Einstundentherapie der Psoriasis mit Cignolin und UV-Licht . Z Hautkr 1982;57:861-866. 38. Steigleder GK, Schulze HJ: Ein neues Kölner Therapie Schema . Z Hautkr 1984;59:188-192. 39. Selim MM, Goldberg LH, Schaefer H, et al: Penetration studies on topical anthralin . Br J Dermatol 1981;105( (suppl 20) ):101-103.Crossref
Gorsulowsky, David C.;Voorhees, John J.;Ellis, Charles N.
doi: 10.1001/archderm.1985.01660120035015
Abstract Due to the concern regarding potential side effects of potent topical corticosteroids, attention has recently shifted to the development of other therapeutic modalities for psoriasis. Anthralin is one of the compounds proved long ago to be an effective treatment for psoriasis.1 However, the standard regimen, as described by Ingram,2 is both inconvenient and time consuming. Modifications in formulation, mode of application, and frequency of use have once again rekindled interest in the use of anthralin. A NEW LOOK In this issue of the Archives, Schwarz and Gschnait report new methods of using this old medication. Also, the history of short-contact therapy with anthralin is outlined by Schaefer. Schaefer explains the rationale for using short-contact therapy, and then traces its development and modifications during the past six years. He also describes his elaborate work on percutaneous absorption, which led to his initial use of anthralin in short-contact therapy. References 1. Unna PG: Cignolin als Heilmittel der Psoriasis . Dermatol Monatsschr 1916;62:116-137, 151-163, 175-183. 2. Ingram JT: The approach to psoriasis . Br Med J 1953;2:591-594.Crossref 3. Kemp DS: On Goa powder . Pharm J Trans 1864;23:345-347. 4. Liebermann C, Seidler P: Über Chrysarobin und die angelbliche Chrysophansaure im Goapulver . Ber Deutsch Chem Gesellsch 1878;14:1603-1605.Crossref 5. Maclennan A, Hellier FF: Treatment time in psoriasis . Br J Dermatol 1961;73:439-444.Crossref 6. Fast K: Ingram's treatment of psoriasis . Acta Derm Venereol 1960;40:516. 7. Farber EM, Harris DR: Hospital treatment of psoriasis: A modified anthralin program . Arch Dermatol 1970;101:381-389.Crossref 8. Colin M, Maignan J, Lang G, et al: Anthralin oxidation products: The role of the C10-methylene and phenol groups . Br J Dermatol 1981;105( (suppl 20) ):59.Crossref 9. Schaefer H, Farber EM, Goldberg L, et al: Limited application period for dithranol in psoriasis . Br J Dermatol 1980;102:571-572.Crossref 10. Runne U, Schopf U, Schopf R, et al: Short-term application of anthralin: A new therapeutic regimen for psoriasis: Three versus 24 hours of application in right-left comparison . Arch Dermatol Res 1981;270:223-224.Crossref 11. Runne U, Kunze J: Short-duration (`minutes') therapy with dithranol for psoriasis: A new outpatient regimen . Br J Dermatol 1982;106:135-139.Crossref 12. Miller AC: Anthralin cream as short contact therapy for psoriasis . Cutis , (June) 1985, pp 578-582. 13. Finnen MJ, Lawrence CM, Shuster S: Inhibition of dithranol inflammation by free-radical scavengers . Lancet 1984;2:1129-1130.Crossref 14. Mustakallio KK: Irritation and staining by dithranol and related compounds: II. Structure-activity relationships among 10-meso-substituted acyl analogues . Acta Derm Venereol 1979; 60:169-171. 15. Mustakallio KK: Irritation and staining by dithranol and related compounds: I. Estimation with chamber testing and contact thermography . Acta Derm Venereol 1979;59:125-132. 16. Ross JB, McElligott TF, Rout M: Histological changes in psoriasis treated with dithranol . Br J Dermatol 1964;76:74-80.Crossref 17. Suurmond D: Histologic changes in treated and untreated psoriatic lesions . Acta Derm Venereol 1965;131:357-366. 18. Baxter DL, Stoughton RB: Mitotic index of psoriatic lesions treated with anthralin, glucocorticosteroid, and occlusion only . J Invest Dermatol 1970;54:410-412.Crossref 19. Reichert U, Jacques Y, Grangeret M, et al: Antirespiratory and antiproliferative activity of anthralin in cultured human keratinocytes . J Invest Dermatol 1985;84:130-134.Crossref 20. Wilborn WH, Montes LF: Ultrastructural changes in psoriatic epidermis following anthralin treatment . J Cutan Pathol 1974;1:132-150.Crossref 21. Swanbeck G, Lundquist PG: Ultrastructural changes in mitochondria in dithranol-treated psoriatic epidermis . Acta Derm Venereol 1972;52:94-98. 22. Steigleder GK, Schumann H, Lennartz K-J: Autoradiographic in vitro examination of psoriatic skin before, during and after dithranol treatment . Arch Dermatol Res 1973;246:231-235.Crossref 23. Bohlen P, Grove J, Beya MF, et al: Skin polyamine levels in psoriasis: The effect of dithranol therapy . Eur J Clin Invest 1978; 8:215-218.Crossref 24. Saihan EM, Albano J, Burton JL: The effect of steroid and dithranol therapy on cyclic nucleotides in psoriatic epidermis . Br J Dermatol 1980;102:565-569.Crossref 25. Hammer H: Glyceraldehydephosphate dehydrogenase and glucose-6-phosphate dehydrogenase activities in psoriasis and neurodermatitis and the effect of dithranol . J Invest Dermatol 1970;54:121-125.Crossref 26. Barr RM, Misch KJ, Hensby CN, et al: Arachidonic acid and prostaglandin levels in dithranol erythema: Time course study . Br J Clin Pharmacol 1983;16:715-717.Crossref 27. Kingston T, Marks R: Irritant reactions to dithranol in normal subjects and psoriatic patients . Br J Dermatol 1983; 108:307-313.Crossref 28. Lowe NJ, Ashton RE, Koudsi H, et al: Anthralin for psoriasis: Short-contact anthralin therapy compared with topical steroid and conventional anthralin . J Am Acad Dermatol 1984; 10:69-72.Crossref 29. Statham BN, Ryatt KS, Rowell NR: Short-contact dithranol therapy: A comparison with the Ingram regime . Br J Dermatol 1984;110:703-708.Crossref 30. Marsden JR, Coburn PR, Marks J, et al: Measurement of the response of psoriasis to short-term application of anthralin . Br J Dermatol 1983;109:209-218.Crossref 31. Wilson PD, Ive FA: Dithrocream in psoriasis . Br JDermatol 1980;103:105-106.Crossref
Schwarz, Thomas;Gschnait, Fritz
doi: 10.1001/archderm.1985.01660120038016
Abstract • Anthralin minute entire skin treatment (AMEST) was developed to improve the efficacy and cosmetic results of anthralin short-contact therapy. In a split comparison study to determine the optimal period of anthralin application, ten minutes of anthralin contact time gave maximum antipsoriatic activity with minimal side effects. Dosimetry variables for AMEST were determined based on the patient's pigmentation type, the erythematous response, the therapeutic effect, and so on. Such treatment of 43 patients resulted in complete clearing in 31 patients (72%), with 90% improvement in two patients (5%) and less than 90% clearing in seven patients (16%). Psoriatic lesions disappeared, leaving no spotty pigmentation that is known to occur following conventional anthralin therapy. The dosimetry variables employed in our study allowed AMEST with minimal skin irritation. Laboratory values did not change significantly during therapy. In addition, AMEST does not involve systemic medication and is easy to perform without special equipment; therefore, it is economic and can be used for outpatients and probably for home treatment. (Arch Dermatol 1985;121:1512-1515) References 1. Schaefer H, Farber EM, Goldberg L, et al: Limited application period of dithranol in psoriasis . Br J Dermatol 1980;102:571-573.Crossref 2. Runne U, Kunze J: Short duration (`minutes') therapy with dithranol for psoriasis: A new out-patient regimen . Br J Dermatol 1982;106:135-139.Crossref 3. Brun P, Juhlin L, Schalla W: Short contact therapy of psoriasis with and without UV-irradiation and maintenance schedule to prevent relapses . Acta Derm Venereol 1984;64:174-177. 4. Goring HD, Voss M: Erfahrungen mit der hochdosierten Dithranol-Kurzzeittherapie der Psoriasis . Hautarzt 1984;35:148-151. 5. Lowe NJ, Ashton RE, Koudsi H, et al: Anthralin for psoriasis: Short-contact anthralin therapy compared with topical steroid and conventional anthralin . J Am Acad Dermatol 1984;10:69-72.Crossref 6. Wolff K, Fitzpatrick TB, Parrish JA, et al: Photochemotherapy for psoriasis with orally administered methoxsalen . Arch Dermatol 1976;112:943-949.Crossref 7. Wolff K, Gschnait F, Hönigsmann H, et al: Phototesting and dosimetry for photochemotherapy . Br J Dermatol 1977;96:1-10.Crossref 8. Ashton RE, Andre P, Lowe NJ, et al: Anthralin: Historical and current perspectives . J Am Acad Dermatol 1983;9:173-192.Crossref 9. Farber EM, Harris DR: Hospital treatment of psoriasis . Arch Dermatol 1970;101:381-389.Crossref 10. Orfanos CE, Steigleder GK: Psoriasis Therapie mit Cignolin (Dihydroxyanthranol): Das Kölner CSV-Therapie-Schema . Z Hautkr 1976;51:473-480. 11. Lowe NJ, Breeding J: Anthralin: Different concentration effects on epidermal cell DNA synthesis rates in mice and clinical responses in human psoriasis . Arch Dermatol 1981;117:698-700.Crossref 12. Pearlmann DL, Burns J, Cannon TC, et al: Paper-tape occlusion of anthralin paste: A new outpatient therapy for psoriasis . Arch Dermatol 1984;120:625-630.Crossref 13. Stathan BN, Ryatt KS, Rowell NR: Short-contact dithranol therapy: A comparison with the Ingram regime . Br J Dermatol 1984;110:703-708.Crossref 14. Gay MW, Moore WJ, Morgan JM, et al: Anthralin toxicity . Arch Dermatol 1972;105:213-215.Crossref 15. Ippen H: Toxicität und Stoffwechsel des Cignolins (Wz.) Dermatologica 1959;119:211-220.Crossref
Barton, John;Lavker, Robert M.;Schechter, Norman M.;Lazarus, Gerald S.
doi: 10.1001/archderm.1985.01660120042017
Abstract • Based on a previous observation that the long-term application of potent topical corticosteroids under occlusion to normal skin resulted in the loss of mast cells, we investigated the effects of intralesional and topical steroids in urticaria pigmentosa (UP). Three patients with UP had lesions that were injected with triamcinolone acetonide. Four weeks after injection, all patients showed a loss of Darier's sign, and, by eight weeks after injection, there was a dramatic clearing of the plaques and a decrease in brown hyperpigmentation. By 12 weeks, mast cells were undetectable by light microscopy and transmission electron microscopy (TEM). The injection sites remained dramatically improved for as long as one year after treatment, and histamine content was reduced 95% in one patient 48 weeks after injection. In six patients, the topical application of 0.05% betamethasone dipropionate under occlusion to limited areas induced almost complete clearing of UP lesions. Lesions treated with an emollient under occlusion, as a control, demonstrated no change. After treatment, no mast cells were seen by light microscopy or TEM, and this persisted for at least 24 weeks. There was also a significant decrease in tissue histamine levels in the treated areas. The treated areas remained clinically improved for at least nine to 12 months. These data indicate that steroid therapy dramatically decreases the excess number of normal-appearing mast cells in UP as well as induces a prolonged resolution of UP lesions. Local corticosteroids thus are a useful therapeutic modality for UP. (Arch Dermatol 1985;121:1516-1523) References 1. Roberts LJ, Sweetman BJ, Lewis RA, et al: Increased production of prostaglandin D, in patients with systemic mastocytosis . N Engl J Med 1980;303:1400-1404.Crossref 2. Lavker RM, Schechter NM: Cutaneous mast cell depletion results from topical corticosteroid usage . J Immunol 1985; 135:2368-2373. 3. Keyzer JJ, DeMonchy JGR, van Doormall JJ, et al: Improved diagnosis of mastocytosis by measurement of urinary histamine metabolites . N Engl J Med 1983;309:1603-1605.Crossref 4. Dyer JD, Warren K, Merlin S, et al: Measurement of plasma histamine: Description of an improved method and normal values . J Allergy Clin Immunol 1982;70:82-87.Crossref 5. Karnovsky MJ: A formaldehyde-glutaraldehyde fixative of high osmolality for use in electron microscopy . J Cell Biol 1965; 27:137A-138A. 6. Gerrard JW: Urticaria pigmentosa: Treatment with cimetidine and chlorpheniramine . J Pediatr 1979;94:843-844.Crossref 7. Feldman EJ, Isenberg JI: Effects of metiamide on gastric hypersecretion and diarrhea in systemic mastocytosis . N Engl J Med 1976;295:1178-1179.Crossref 8. Hirschowitz BI, Groarka MB: Effect of cimetidine on gastric hypersecretion and diarrhea in systemic mastocytosis . Ann Intern Med 1979;90:769-771.Crossref 9. Soter NA, Austen KF, Wasserman SI: Oral disodium cromoglycate in the treatment of systemic mastocytosis . N Engl J Med 1979;301:465-469.Crossref 10. Fairley JA, Pentland AP, Voorhees JJ: Urticaria pigmentosa responsive to nifedipine . J Am Acad Dermatol 1984;11:740-743.Crossref 11. Christophers E, Honigsmann H, Wolff K, et al: PUVA treatment of urticaria pigmentosa . Br J Dermatol 1978;98:701-702.Crossref 12. Granerus G, Roupe G, Swanbeck G: Decreased urinary histamine metabolite after successful PUVA treatment of urticaria pigmentosa . J Invest Dermatol 1981;76:1-3.Crossref 13. Väätäinen N, Hannuksela M, Karvonen J: Trioxsalen baths plus UV-A in the treatment of lichen planus and urticaria pigmentosa . Clin Exp Dermatol 1981;6:133-138.Crossref 14. Vella Briffa D, Eady RA, James MP, et al: Photochemotherapy (PUVA) in the treatment of urticaria pigmentosa . Br J Dermatol 1983;109:67-75.Crossref 15. Kolde G, Frosch PJ, Czarnetzki BM: Response of cutaneous mast cells to PUVA in patients with urticaria pigmentosa: Histomorphometric, ultrastructural and biochemical investigations . J Invest Dermatol 1984;83:175-178.Crossref 16. Bloom F: Effect of cortisone on mast cell tumors (mastocytoma) of the dog . Proc Soc Exp Biol Med 1952;79:651-654.Crossref 17. Lehmann P, Zheng P, Lavker RM, et al: Corticosteroid atrophy in human skin: A study by light, scanning and transmission electron microscopy . J Invest Dermatol 1983;81:169-176.Crossref 18. Zheng P, Lavker RM, Lehmann P, et al: Morphologic investigations on the rebound phenomenon after corticosteroidinduced atrophy in human skin . J Invest Dermatol 1984;82:345-352.Crossref
Ross, John Barrie;Allderdice, Penelope Witte;Shapiro, Larry Jay;Aveling, John;Eales, Brenda Ann;Simms, Douglas
doi: 10.1001/archderm.1985.01660120050018
Abstract • Steroid sulfatase (STS)—deficient X-linked ichthyosis was diagnosed in a man with short stature and mental retardation. His generation includes five similarly affected male members. A translocation chromosome is segregating in this Newfoundland kindred. The proband's mother and grandmother have normal skin and are of normal intelligence. From his carrier mother, the proband inherited an X short arm (Xp) to Y long arm (Yq) translocation chromosome, with the entire Y short arm and the X short arm terminal segment deleted (Xp223-pter). His cells are completely deficient in STS activity, confirming assignment of the STS locus to Xp223-pter. Effective management of his ichthyosis included treatment with 6% salicylic acid gel under plastic occlusion and removal of the scales by scrubbing. (Arch Dermatol 1985;121:1524-1528) References 1. Wells RS, Kerr CB: Clinical features of autosomal dominant and sex-linked ichthyosis in an English population . Br Med J 1966;1:947-950.Crossref 2. Ziprkowski L, Feinstein A: A survey of ichthyosis vulgaris in Israel . Br J Dermatol 1972;86:1-8.Crossref 3. Shapiro LJ, Weiss R, Webster D, et al: X-linked ichthyosis due to steroid sulfatase deficiency . Lancet 1978;1:70-72.Crossref 4. France JT, Liggins GC: Placental sulphatase deficiency . J Clin Endocrinol Metabol 1969;29:138-141.Crossref 5. Curry CJR, Magenis RE, Brown M, et al: Inherited chondrodysplasia punctata due to a deletion of the terminal short arm of an X chromosome . N Engl J Med 1984;311:1010-1015.Crossref 6. Akeson HO, Hagberg B, Wahlstrom J: Y-to-X chromosome translocation observed in two generations . Hum Genet 1980;55:39-42.Crossref 7. Tiepolo L, Zuffardi O, Fraccaro M, et al: Assignment by deletion mapping of the steroid sulfatase X-linked ichthyosis locus to Xp22.3 . Hum Genet 1980;54:205-206.Crossref 8. Muller CR, Wahlstrom J, Ropers H-H: Further evidence for the assignment of the steroid sulfatase X-linked ichthyosis locus to the telomere of Xp . Hum Genet 1981;58:446. 9. Metaxotou C, Ikkos D, Panagiotopoulou P, et al: A familial X/Y translocation in a boy with ichthyosis, hypogonadism and mental retardation . Clin Genet 1983;24:380-383.Crossref 10. ISCN (1978): An International System for Human Cytogenetic Nomenclature . Cytogenet Cell Genet 1978;21:309-404.Crossref 11. ISCN (1981): An International System for Human Cytogenetic Nomenclature: High-resolution banding (1981) Cytogenet Cell Genet 1981;31:1-23.Crossref 12. Caspersson T, Zech L, Johansson C, et al: Identification of human chromosomes by DNA reacting fluorescing agents . Chromosome 1970;30:215-227.Crossref 13. Seabright M: A rapid banding technique for human chromosomes . Lancet 1971;2:971-972.Crossref 14. Feinstein A, Ackerman AB, Ziprkowski L: Histology of autosomal dominant ichthyosis vulgaris and X-linked ichthyosis . Arch Dermatol 1970;101:524-527.Crossref 15. Fraki JE, Kuokkanen K, Hopsu Harvu VK: Morphometric analysis of the dominant and sex-linked forms of ichthyosis vulgaris . Acta Derm Venereol 1973;53:299-305. 16. Lever WF, Schaumburg-Lever G: Histopatholoyy of the Skin , ed 6. New York, Lippincott & Crowell Publishers, 1983, p 59. 17. Berger EA, Shapiro LJ: Increased cholesterol sulfate in plasma and red blood cell membranes of steroid sulfatase deficient patients . J Clin Endocrinol Metabol 1981;53:221-223.Crossref 18. Epstein EH, Krauss RM, Schackleton CHL: X-linked ichthyosis: Increased blood cholesterol sulfate and electrophoretic mobility of low-density lipoprotein . Science 1981;214:659-660.Crossref 19. Mohandas T, Shapiro LJ, Sparkes RS, et al: Regional assignment of the steroid sulfatase X-linked ichthyosis locus: Implication for a noninactivated region on the short arm human X chromosome . Proc Natl Acad Sci USA 1979;76:5779-5783.Crossref 20. Shapiro LJ, Mohandas T, Weiss R, et al: Non-inactivation of an X-chromosome locus in man . Science 1979;204:1224-1226.Crossref 21. Mohandas T, Sparkes RS, Hellkuhl B, et al: Expression of an X-linked gene from an inactive human X-chromosome in mouse-human hybrid cells: Further evidence for the non-inactivation of the steroid sulfatase locus in man . Proc Natl Acad Sci USA 1980;77:6759-6763.Crossref 22. Migeon BR, Shapiro LJ, Norum RA, et al: Differential expression of the steroid sulfatase locus on the active and inactive human X-chromosome . Nature 1982;299:838-840.Crossref 23. Traupe H, Happle R: Clinical spectrum of steroid sulfatase deficiency: X-linked recessive ichthyosis, birth complications, and cryptorchidism . Eur J Pediatr 1983;140:19-21.Crossref 24. Lykkesfeldt G, Hoyer H, Lykkesfeldt AE, et al: Steroid sulfatase deficiency associated with testis cancer . Lancet 1983;2:1456.Crossref
doi: 10.1001/archderm.1985.01660120055019
Abstract • A survey of dermatology department or section chairmen was conducted to investigate the extent of undergraduate dermatologic training in US medical schools. The median number of required hours of dermatologic training was 14, which represents 0.24% of the overall medical school curriculum time. Required dermatologic training time varied greatly among schools, but most such training occurred in the fourth year of school. Students in 53% of the schools that responded to the survey were not involved in either clinical or basic dermatologic investigative activities. (Arch Dermatol 1985;121:1529-1530) References 1. Stern RS, Johnson ML, DeLozier J: Utilization of physician services for dermatologic complaints . Arch Dermatol 1977; 113:1062-1066.Crossref 2. Menken M, Sheps C: Undergraduate education in the medical specialties: The case of neurology . N Engl J Med 1984;311:1045-1048.Crossref
Ringel, Eileen;Moschella, Samuel
doi: 10.1001/archderm.1985.01660120057020
Abstract • The physiology of the histiocyte (macrophage) in health and disease is reviewed briefly. An overview of the so-called primary malignant, pseudomalignant, and benign histiocytic disorders, excluding histiocytosis X, is presented. The malignant histiocytosis with erythrophagocytosis, the pseudomalignant histiocytic diseases (such as sinus histiocytosis with massive lymphadenopathy and regressing atypical histiocytosis), and the solitary lesions with histologic malignant and atypical storiform histiocytosis are described. Two groups of adult histiocytic diseases are reviewed; one is characterized by nonfamilial and familial histiocytic dermatoarthritis and the other by multiple widespread benign lesions, such as xanthoma disseminatum, generalized eruptive histiocytoma, nodular non-X histiocytosis, and various xanthomatous eruptions associated with paraproteinemia. Finally, multiple benign cutaneous histiocytic lesions of childhood, such as juvenile xanthogranuloma and congenital self-healing histiocytosis, are included. (Arch Dermatol 1985;121:1531-1541) References 1. Favara BE, McCarthy RC, Mierau GW: Histiocytosis X . Hum Pathol 1983;14:663-676.Crossref 2. Bökkerink JP, de Vaan GA: Histiocytosis X . Eur J Pediatr 1980;135:129-146.Crossref 3. Lipton JM: The pathogenesis, diagnosis and treatment of histiocytosis syndromes . Pediatr Dermatol 1983;1:112-120.Crossref 4. Golde DW, Cline MJ: Regulation of granulopoiesis . N Engl J Med 1974;291:1388-1395.Crossref 5. Cline MJ: Monocytes, macrophages, and their disease in man . J Invest Dermatol 1978;71:56-58.Crossref 6. Nichols BA, Bainton DF: Differentiation of human monocytes in bone marrow and blood: Sequential formation of two granule populations . Lab Invest 1973;29:27-40. 7. Meuret G, Bammert J, Hoffmann G: Kinetics of human monocytopoiesis . Blood 1974;44:801-816. 8. 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Rappaport H: Tumors of the hematopoietic systems , in Rappaport H (ed): Atlas of Tumor Pathology . Washington, DC, Armed Forces Institute of Pathology, section 3, part (8) , 1955, p 442. 62. Marshall ME, Farmer ER, Trump DL: Cutaneous involvement in malignant histiocytosis: Case report and review of the literature . Arch Dermatol 1981;117:278-281.Crossref 63. Abele DC, Griffin TB: Histiocytic medullary reticulosis: Report of two cases and review of the literature . Arch Dermatol 1972;106:319-329.Crossref 64. Natelson EA, Lynch EC, Hettig RA, et al: Histiocytic medullary reticulosis: The role of phagocytosis in pancytopenia . Arch Intern Med 1968;122:223-229.Crossref 65. Lynch EC, Alfrey CP Jr: Histiocytic medullary reticulosis: Hemolytic anemia due to erythrophagocytosis by histiocytes . Ann Intern Med 1965;63:666-671.Crossref 66. Liao KT, Rosai J, Daneshbod K: Malignant histiocytosis with cutaneous involvement and eosinophilia . Am J Clin Pathol 1972;57:428-448. 67. Engstrom PF, Aeling JL, Suringa DR: Histiocytic medullary reticulosis with cutaneous lesions . Arch Dermatol 1972;106:369-371.Crossref 68. Wick MR, Sanchez NP, Crotty CP, et al: Cutaneous malignant histiocytosis: A clinical and histopathologic study of eight cases, with immunohistochemical analysis . J Am Acad Dermatol 1983;8:50-62.Crossref 69. Persaud V, Wood JK: Histiocytic medullary reticulosis: Report of the first case in Jamaica . Am J Clin Pathol 1967;48:396-400. 70. Morgan NE, Fretzin D, Variakojis D, et al: Clinical and pathologic cutaneous manifestations of malignant histiocytosis . Arch Dermatol 1983;119:367-372.Crossref 71. Greenwood SM, Nasca D: Pericardial effusion in histiocytic medullary reticulosis . JAMA 1980;244:1784.Crossref 72. Scully RE, Galdabini JJ, McNeely BU: Case records of the Massachusetts General Hospital: Weekly clinicopathologic exercises: Case 12-1977 . N Engl J Med 1977;296:676-683.Crossref 73. Lampert IA, Catovsky D, Bergier N: Malignant histiocytosis: A clinico-pathological study of 12 cases . Br J Haematol 1978;40:65-77.Crossref 74. Robinowitz BN, Noguchi S, Bergfeld WF: Tumor cell characterization of histiocytic medullary reticulosis . Arch Dermatol 1977;113:927-929.Crossref 75. Asher R: Histiocytic medullary reticulosis: Case without lymphadenopathy . Lancet 1946;1:650-651.Crossref 76. Perry MC, Harrison EG Jr, Burgert EO, et al: Familial erythrophagocytic lymphohistiocytosis: Report of two cases and clinicopathologic review . Cancer 1976;38:209-218.Crossref 77. Ansbacher LE, Singsen BH, Hosler MW, et al: Familial erythrophagocytic lymphohistiocytosis: An association with serum lipid abnormalities . J Pediatr 1983;102:270-273.Crossref 78. Wilson ER, Malluh A, Stagno S, et al: Fatal Epstein-Barr virus-associated hemophagocytic syndrome . J Pediatr 1981; 98:260-262.Crossref 79. Risdall RJ, McKenna RW, Nesbit ME, et al: Virus-associated hemophagocytic syndrome: A benign histiocytic proliferation distinct from malignant histiocytosis . Cancer 1979;44:993-1002.Crossref 80. Winkelmann RK, Bowie EJ: Hemorrhagic diathesis associated with benign histiocytic, cytophagic panniculitis and systemic histiocytosis . Arch Intern Med 1980;140:1460-1463.Crossref 81. Jaffe ES, Costa J, Fauci AS, et al: Malignant lymphoma and erythrophagocytosis simulating malignant histiocytosis . Am J Med 1983;75:741-749.Crossref 82. Rosai J, Dorfman RF: Sinus histiocytosis with massive lymphadenopathy: A newly recognized benign clinicopathologic entity . Arch Pathol Lab Med 1969:87:63-70. 83. Rosai J, Dorfman RF: Sinus histiocytosis with massive lymphadenopathy: A pseudolymphomatous benign disorder: Analysis of 34 cases . Cancer 1972;30:1174-1188.Crossref 84. Thawerani H, Sanchez RL, Rosai J, et al: The cutaneous manifestations of sinus histiocytosis with massive lymphadenopathy . Arch Dermatol 1978;114:191-197.Crossref 85. Penneys NS, Ahn YS, McKinney EC, et al: Sinus histiocytosis with massive lymphadenopathy: A case with unusual skin involvement and a therapeutic response to vinblastine-loaded platelets . Cancer 1982;49:1994-1998.Crossref 86. Flynn KJ, Dehner LP, Gajl-Peczalski KJ, et al: Regressing atypical histiocytosis: A cutaneous proliferation of atypical neoplastic histiocytes with unexpectedly indolent biologic behavior . Cancer 1982;49:959-970.Crossref 87. Kearney MM, Soule EH, Ivins JC: Malignant fibrous histiocytoma: A retrospective study of 167 cases . Cancer 1980;45:167-178.Crossref 88. Yamamoto Y, Arata J, Yonezawa S: Angiomatoid malignant fibrous histiocytoma associated with marked bleeding arising in chronic radiodermatitis . Arch Dermatol 1985;121:275-276.Crossref 89. Goette DK, Deffer TA: Postirradiation malignant fibrous histiocytoma . Arch Dermatol 1985;191:535-538.Crossref 90. Kempson RL, Kyriakos M: Fibroxanthosarcoma of the soft tissues: A type of malignant fibrous histiocytoma . Cancer 1972; 29:961-976.Crossref 91. Weiss SW, Enzinger FM: Myxoid variant of malignant fibrous histiocytoma . Cancer 1977;39:1672-1685.Crossref 92. Enzinger FM: Angiomatoid malignant fibrous histiocytoma: A distinct fibrohistiocytic tumor of children and young adults . Cancer 1979;44:2147-2157.Crossref 93. Kyriakos M, Kempson RL: Inflammatory fibrous histiocytoma: An aggressive and lethal lesion . Cancer 1976;37:1584-1606.Crossref 94. Kemp JD, Stenn KS, Arons M, et al: Metastasizing atypical fibroxanthoma: Coexistence with chronic lymphocytic leukemia . Arch Dermatol 1978;114:1533-1535.Crossref 95. Dahl I: Atypical fibroxanthoma of the skin: A clinicopathological study of 57 cases . Acta Pathol Microbiol Immunol Scand 1976;84:183-197. 96. Jacobs DS, Edwards WD, Ye RC: Metastatic atypical fibroxanthoma of the skin . Cancer 1975;35:457-463.Crossref 97. Ehrlich GE, Young I, Nosheny SZ, et al: Multicentric reticulohistiocytosis (lipoid dermatoarthritis): A multisystem disorder . Am J Med 1972;52:830-840.Crossref 98. Albert J, Bruce W, Allen AC, et al: Lipoid dermato-arthritis: Reticulohistiocytoma of the skin and joints . Am J Med 1960; 28:661-667.Crossref 99. Orkin M, Goltz RW, Good RA, et al: A study of multicentric reticulohistiocytosis . Arch Dermatol 1964;89:640-654.Crossref 100. Barrow MV, Holubar K: Multicentric reticulohistiocytosis: A review of 33 patients . Medicine 1969;48:287-305.Crossref 101. Johnson HM, Tilden IL: Reticulohistiocytic granulomas of the skin associated with arthritis mutilans: Report of a case followed 14 years . Arch Dermatol 1957;75:405-417.Crossref 102. Taylor DR: Multicentric reticulohistiocytosis . Arch Dermatol 1977;113:330-332.Crossref 103. Hanauer LB: Reticulohistiocytosis: Remission after cyclophosphamide therapy . Arthritis Rheum 1972;15:636-640.Crossref 104. Davies NEJ, Roenigk HH, Hawk WA, et al: Multicentric reticulohistiocytosis: Report of a case with histochemical studies . Arch Dermatol 1968;97:543-547.Crossref 105. Gold KD, Sharp JT, Estrada RG, et al: Relationship between multicentric reticulohistiocytosis and tuberculosis . JAMA 1977;237:2213-2214.Crossref 106. François J: Dystrophie dermo-chondro-cornéenne familiale . Ann Ocul 1949:182:409-442. 107. Zayid I, Farraj S: Familial histiocytic dermatoarthritis: A new syndrome . Am J Med 1973;54:793-800.Crossref 108. Ruiz-Maldonado R, Tamayo L, Velazquez E: Dystrophie dermo-chondro-cornéenne familiale (syndrome de Francois) . Ann Dermatol Venereol 1977;104:475-478. 109. Altman J, Winkelmann RK: Xanthoma disseminatum . Arch Dermatol 1962;86:582-596.Crossref 110. Leibman SD, Crocker AC, Geiser C: Corneal xanthomas in childhood . Arch Ophthalmol 1966;76:221-229.Crossref 111. Mishkel MA, Cockshott WP, Nazir DJ, et al: Xanthoma disseminatum: Clinical, metabolic, pathologic, and radiologic aspects . Arch Dermatol 1977;113:1094-1100.Crossref 112. Halprin KM, Lorincz AL: Disseminated xanthosiderohistiocytosis (xanthoma disseminatum): Report of a case and discussion of possible relationships to other disorders showing histiocytic proliferation . Arch Dermatol 1960;82:171-182.Crossref 113. Lyle WH, Leonard BJ, Bowden WE, et al: Normocholesterolemic xanthomatosis: Report of a case with myocardial fibrosis and myelosclerosis . Ann Intern Med 1960;53:1260-1270.Crossref 114. Winkelmann RK, Kossard S, Fraga S: Eruptive histiocytoma of childhood . Arch Dermatol 1980;116:565-570.Crossref 115. Winkelmann RK, Muller SA: Generalized eruptive histiocytoma: A benign papular histiocytic reticulosis . Arch Dermatol 1963;88:586-596.Crossref 116. Muller SA, Wolff K, Winkelmann RK: Generalized eruptive histiocytoma: Enzyme histochemistry and electron microscopy . Arch Dermatol 1967;96:11-17.Crossref 117. Winkelmann RK, Hu C-H, Kossard S: Response of nodular non-X histiocytosis to vinblastine . Arch Dermatol 1982;118:913-917.Crossref 118. Taunton OD, Yeshurun D, Jarratt M: Progressive nodular histiocytoma . Arch Dermatol 1978;114:1505-1508.Crossref 119. Altman J, Winkelmann RK: Diffuse normolipemic plane xanthoma: Generalized xanthlasma . Arch Dermatol 1962;85:633-640.Crossref 120. Hu C-H, Winkelmann RK: Unusual normolipidemic cutaneous xanthomatosis: A comparison of two cases illustrating the differential diagnosis . Acta Derm Venereol 1977;57:421-429. 121. Moschella SL: Plane xanthomatosis associated with myelomatosis . Arch Dermatol 1970;101:683-687.Crossref 122. Kossard S, Winkelmann RK: Necrobiotic xanthogranuloma with paraproteinemia . J Am Acad Dermatol 1980;3:257-270.Crossref 123. Robertson DM, Winkelmann RK: Ophthalmic features of necrobiotic xanthogranuloma with paraproteinemia . Am J Ophthalmol 1984;97:173-183. 124. Adamson HF: Congenital xanthoma multiplex . Br J Dermatol 1905;17:222. 125. McDonagh JER: Pictures and sections from case of spontaneous disappearance of nevothelioma (nevo-xanthoma) . Br J Dermatol 1909;21:254. 126. Helwig EB, Hackney VC: Juvenile xanthogranuloma, abstracted . Am J Pathol 1954;30:625-626. 127. Rodriguez J, Ackerman AB: Xanthogranuloma in adults . Arch Dermatol 1976;112:43-44.Crossref 128. Marie J, Sée G, Watchi M: Naevo-endothélio-xanthome (xanthogranulome juvénile) . Ann Pediatr 1967;14:729-738. 129. Lottsfeldt FI, Good RA: Juvenile xanthogranuloma with pulmonary lesions: A case report . Pediatrics 1964;33:233-238. 130. Lamb JH, Lain ES: Nevo-xantho-endothelioma: Its relationship to juvenile xanthoma . South Med J 1937;30:585-594.Crossref 131. Nödl F: Systematisierte grossknotige Naevoxanthoendotheliome . Arch Klin Exp Dermatol 1959;208:601-615.Crossref 132. Saeed SM, Fine G: Xanthogranulomatous pyelonephritis . Am J Clin Pathol 1963;39:616-625. 133. Schwarzmann E, Elkan W: Xanthogranulomatosis of colon causing obstruction . J Int Coll Surg 1955;24:144-150. 134. Minkowitz S, Friedman F, Henniger G: Xanthogranuloma of the ovary . Arch Pathol Lab Med 1965;80:209-212. 135. Blank H, Eglick PG, Beerman H: Nevoxantho-endothelioma with ocular involvement . Pediatrics 1949;4:349-354. 136. Webster SB, Reister HC, Harman LE Jr: Juvenile xanthogranuloma with extracutaneous lesions: A case report and review of the literature . Arch Dermatol 1966;93:71-76.Crossref 137. Nomland R: Nevoxantho-endothelioma: Benign xanthomatous disease of infants and children . J Invest Dermatol 1954; 22:207-215.Crossref 138. Newell GB, Stone OJ, Mullins JF: Juvenile xanthogranuloma and neurofibromatosis . Arch Dermatol 1973;107:262.Crossref 139. Cooper PH, Frierson HF, Kayne AL, et al: Association of juvenile xanthogranuloma with juvenile myeloid leukemia . Arch Dermatol 1984;120:371-375.Crossref 140. Barsky BL, Lao I, Barsky S, et al: Benign cephalic histiocytosis . Arch Dermatol 1984;120:650-655.Crossref 141. Gianotti F: Cutaneous proliferative histiocytosis in children . Gior Ital Dermatol Venereol 1980;115:59-66. 142. Hashimoto K, Griffin D, Kohsbaki M: Self-healing reticulohistiocytosis: A clinical, histologic, and ultrastructural study of the fourth case in the literature . Cancer 1982;49:331-337.Crossref 143. Bonifazi E, Caputo R, Ceci A, et al: Congenital self-healing histiocytosis . Arch Dermatol 1982;118:267-272.Crossref
Helfman, Richard J.;Poulos, Evangeline G.
doi: 10.1001/archderm.1985.01660120068021
Abstract • A young man presented with a chronic, persistent reticulated dermatosis involving the groin, genitals, and thighs that was refractory to therapy. Biopsy specimen revealed multiple cornoid lamellae consistent with porokeratosis. This clinical appearance has not been previously described, to our knowledge. The other clinical forms of porokeratosis and their histology are briefly reviewed. (Arch Dermatol 1985;121:1542-1543) References 1. Mibelli V: Contributo allo studio della ipercheratosis dei canali sudoriferi . G Ital Mal Vener Pelle 1893;28:313-335. 2. Rahbari H, Cordero AA, Mehregan AH: Punctate porokeratosis: A clinical variant of porokeratosis of Mibelli . J Cutan Pathol 1977;4:338-341.Crossref 3. Mondojana RM, Katz R, Rodman OG: Porokeratosis plantaris discreta . J Am Acad Dermatol 1984;10:679-682.Crossref 4. Guss SB, Osbourn RA, Lutzner MA: Porokeratosis plantaris, palmaris, et disseminata: A third type of porokeratosis . Arch Dermatol 1971;104:366-373.Crossref 5. Shaw JC, White CR Jr: Porokeratosis plantaris palmaris et disseminata . J Am Acad Dermatol 1984;11:454-460.Crossref 6. Chernosky ME, Freeman RG: Disseminated superficial actinic porokeratosis (DSAP) . Arch Dermatol 1967;96:611-624.Crossref 7. Rahbari H, Cordero AA, Mehregan AH: Linear porokeratosis . Arch Dermatol 1974;109:526-528.Crossref 8. Wade TR, Ackerman AB: Cornoid lamellation: A histologic reaction pattern . Am J Dermatopathol 1980;2:5-15.Crossref
Cohen, Steven R.;Bilinski, Douglas L.;McNutt, N. Scott
doi: 10.1001/archderm.1985.01660120070022
Abstract • Vibration syndrome (VS), which typically presents as a variant of Raynaud's phenomenon, has been characterized recently as a multisystem disorder of the peripheral circulation, nerves, muscles, and joints. The sequelae of the disorder are irreversible, but most clinical evidence indicates that vibration injury is completely reversible by early intervention. Advanced VS occurred in a jackhammer operator; his condition went unrecognized for more than 11 years. The clinical findings illustrate the broad spectrum of pathologic abnormalities associated with VS and emphasize the need for increased physician awareness of this disabling condition. (Arch Dermatol 1985;121:1544-1547) References 1. Loriga G: Lavorca con i martelli pneumatici . Boll Inspetl Lavoro 1911;2:35-37. 2. Telford ED, McCann MB, MacCormack DH: Dead hand in users of vibrating tools . Lancet 1949;1:359. 3. Taylor W, Pelmear PL: Vibration White Finger in Industry . Orlando, Fla, Academic Press Inc, 1975, pp 21-30. 4. National Institute for Occupational Safety and Health: Vibration Syndrome , Current Intelligence Bulletin 38, Dept of Health and Human Services (NIOSH) publication No. 83-110. NIOSH, 1983. 5. Taylor W, Pelmear PL, Pearson J: Raynaud's phenomenon in forestry chain saw operators , in Taylor W (ed): The Vibration Syndrome . Orlando, Fla, Academic Press Inc, 1974, pp 121-168. 6. Wasserman DE, Badger DW, Doyle TE, et al: Industrial vibration: An overview . Am Soc Safety Eng J 1974;19:38-43. 7. Wasserman DE, Behrens V, Taylor W, et al: Vibration White Finger Disease in US Workers Using Pneumatic Chipping and Grinding Handtools: I. Epidemiology Results , Dept of Health and Human Services (National Institute for Occupational Safety and Health) publication No. 82-118, 1982. 8. Health Hazard Evaluation Report, HHE 80-189-870-Neenah Foundry Co. National Institute for Occupational Health and Safety, 1981. 9. Bovenzi M, Petronio L, DiMarino F: Epidemiologic survey of shipyard workers exposed to hand-arm vibration . Int Arch Occup Environ Health 1980;46:251-266.Crossref 10. Kasamatsu T, Miyashita K, Shiomi S, et al: Urinary excretion of hydroxyproline in workers occupationally exposed to vibration . Br J Ind Med 1982;39:173-178. 11. Hamilton A: Reports of Physicians for the Bureau of Labor Statistics: A Study of Spastic Anemia in the Hands of Stonecutters: An Effect of the Air Hammer on the Hands of Stonecutters , bulletin 236. Industrial Accidents and Hygiene Series, No. 19. Springfield, Va, US Dept of Commerce, National Technical Information Service (NTIS PB-254 601), 1918, pp 53-66. 12. Seyring M: Diseases resulting from work with compressed air tools . Arch Gewerbepathol Gewerbehygiene 1930;1:359. 13. Hunt JJ: Raynaud's phenomenon in workmen using vibrating instruments . Proc R Soc Med 1936;30:171. 14. Dart EE: Effects of high-speed vibrating tools on operators engaged in the airplane industry . Occup Med 1946;1:515-550. 15. Agate JN, Druett HA: A study of portable vibrating tools in relation to the clinical effects they produce . Br J Ind Med 1947;4:141-163. 16. Matoba T, Kusumoto H, Mizuki Y, et al: Clinical features and laboratory findings of vibration disease: A review of 300 cases . Tohoku J Exp Med 1977;123:57-65.Crossref 17. Patterson R, Mellies CJ, Blankenship ML, et al: Vibratory angioedema: A hereditary type of physical hypersensitivity . J Allergy Clin Immunol 1972;50:174-182.Crossref 18. Wener MH, Metzger WJ, Simon RA: Occupationally acquired vibratory angioedema with secondary carpal tunnel syndrome . Ann Intern Med 1983;98:44-46.Crossref 19. Welsh CL: The effect of vibration on digital blood flow . Br J Surg 1980;67:708-710.Crossref 20. Ashe WF, Cook MT, Old JW: Raynaud's phenomenon of occupational origin . Arch Environ Health 1962;5:333-343.Crossref 21. Ashe WF, Williams N: Occupational Raynaud's: II . Arch Environ Health 1964;9:425-433.Crossref 22. Griffin MJ: Vibration Injuries of the Hand and Arm: Their Occurrence and the Evaluation of Standards and Limits , Health and Safety Executive research paper No. 9. London, Her Majesty's Stationery Office, 1980. 23. Vibration syndrome again . Br Med J Clin Res 1981;282:1738-1739.Crossref
Kamanabroo, Darab;Schmitz-Landgraf, Wolfgang;Czarnetzki, Beate M.
doi: 10.1001/archderm.1985.01660120074023
Abstract • Five patients with severe drug-induced toxic epidermal necrolysis improved rapidly after one to two plasma exchanges. The improvement of all five patients treated with plasmapheresis contrasts with the disease's mortality rate of up to 50%, as reported in the literature and as observed among our previously treated patients. Since there is no effective treatment for toxic epidermal necrolysis, a controlled clinical trial to evaluate the effectiveness of plasma exchange would seem worthwhile. (Arch Dermatol 1985;121:1548-1549) References 1. Lyell A: A review of toxic epidermal necrolysis in Britain . Br J Dermatol 1967;79:662-671.Crossref 2. Kauppinen KK: Cutaneous reactions to drugs . Acta Derm Venereol 1972;52( (suppl 68) ):42-46. 3. Goerz G, Ruzicka T: Lyell-Syndrom . New York, Springer Publishing Co Inc, 1978. 4. Gerard A, Roche G, Presles O, et al: Drug-induced Lyell's syndrome: Nine cases. Therapie 1982;37:475-480. 5. Marconi M, Mercuriali F, Sirchia G: Approaching plasma exchange mathematically . Int J Artif Organ 1981;4:295-299. 6. Stein K, Schlappner OLA, Heaton C, et al: Demonstration of basal cell immunofluorescence in drug-induced toxic epidermal necrolysis . Br J Dermatol 1982;86:246-252.Crossref 7. Peck GL, Herzig GP, Elias PM: Toxic epidermal necrolysis in a patient with graft-vs-host reaction . Arch Dermatol 1972;105:561-569.Crossref 8. Tagami H, Tatsuta K, Iwatski K, et al: Delayed hypersensitivity in ampicillin-induced toxic epidermal necrolysis . Arch Dermatol 1983;119:910-913.Crossref 9. Roujeau JC, Andre C, Fabre MJ, et al: Plasma exchange in pemphigus: Uncontrolled study of ten patients . Arch Dermatol 1983;119:215-221.Crossref 10. Clemmensen OJ, Andresen R, Andersen E: Plasmapheresis in the treatment of psoriasis: A controlled clinical study . J Am Acad Dermatol 1983;8:190-192.Crossref 11. Tosokos GC, Balow JE, Huston DP, et al: Effect of plasmapheresis on T and B lymphocyte functions in patients with systemic lupus erythematosus: A double-blind study . Clin Exp Immunol 1982;48:449-457.
Tanita, Yasuo;Kato, Taizo;Hanada, Katsumi;Tagami, Hachiro
doi: 10.1001/archderm.1985.01660120076024
Abstract • Acupuncture needles implanted in the skin for more than ten years caused peculiar bluish macules, each of which clinically resembled a blue nevus in the extremities of a 63-year-old Japanese woman. Histologically, the involved skin showed deposition of fine brownish granules in the basement membrane of the eccrine sweat glands, on the inner surface of the blood vessel walls, and along elastic fibers of the superficial dermis in addition to sparse deposits noted throughout the dermis. Electron microscopy revealed deposits of electron-dense particles on the basal lamina of the secretory coils of the eccrine sweat glands, below the basal lamina of the dermoepidermal junction, and on elastic fibers. Roentgenographic microanalysis of the involved skin demonstrated that most of the granules consisted of silver and chloride; silver was a major component in the removed needles. (Arch Dermatol 1985;121:1550-1552) References 1. Yamaguchi J, Tomizawa S, Kinoshita M: A case of argyria, abstracted (Japanese) . Nippon Hifuka Gakkai Zasshi 1983; 93:1109. 2. Hiejima M, Tada S, Kikuchi I: Two cases of accidental tattoos induced by needles (Japanese) . Hifu-byo Shin-ryo 1983;5:1133-1136. 3. Pariser RJ: Generalized argyria: Clinicopathologic features and histochemical studies . Arch Dermatol 1978;114:373-377.Crossref 4. Granstein RD, Sober AJ: Drug- and heavy metal-induced hyperpigmentation . J Am Acad Dermatol 1981;5:1-18.Crossref 5. Lamar LM, Bliss BO: Localized pigmentation of the skin due to topical mercury . Arch Dermatol 1966;93:450-453.Crossref 6. Burge KM, Winkelmann RK: Mercury pigmentation: An electron microscopic study . Arch Dermatol 1970;102:51-61.Crossref 7. Bork K: Lokalisierte kutane Siderose nach intramuskularen Eiseninjektionen . Hautarzt 1984;35:598-599. 8. Buckley WR: Localized argyria . Arch Dermatol 1963;88:531-539.Crossref
doi: 10.1001/archderm.1985.01660120079025
Abstract REPORT OF A CASE A 56-year-old man had slowly proliferating and expanding asymptomatic reddish areas on his face of approximately 15 years' duration. A pink lesion first developed on his forehead, and, subsequently, multiple similar areas appeared under his left eye and on both cheeks. Most lesions remained stable, but there was some variation in progression and even rare disappearance. No specific aggravating or ameliorating agent existed. His general health was excellent, and he was taking no medications.Physical examination revealed numerous well-defined, dusky 0.5- to 3-cm erythematous papules and plaques on both malar areas, the forehead, the bridge of the nose, and the right preauricular area (Figs 1 and 2). There was follicular prominence but no follicular plugging, scarring, atrophy, or scale formation.Examination of a skin biopsy specimen disclosed a normal epidermis and a heavy polymorphous infiltrate in the upper dermis that was composed of neutrophils, lymphocytes, histiocytes, References 1. Lever WF, Leeper RW: Eosinophilic granuloma of the skin: Report of cases representing two different diseases described as eosinophilic granuloma . Arch Dermatol 1950;62:85-96. 2. Lever WF, Schaumburg-Lever G: Histopathology of the Skin , ed 6. New York, Lippincott & Crowell Publishers, 1983, pp 174-176. 3. Guill MA, Aton JK: Facial granuloma responsive to dapsone therapy . Arch Dermatol 1982;118:332-335.Crossref 4. Goldner R, Sina B: Granuloma faciale: The role of dapsone and prior irradiation on the cause of the disease . Cutis 1984;33:478-482. 5. Bergfeld WF, Scholes HT, Roenigk HH: Granuloma faciale: Treatment by dermabrasion . Cleve Clin Q 1970;37:215-218. 6. Apfelberg DB, Maser MR, Lash H, et al: Expanded role of the argon laser in plastic surgery . J Dermatol Surg Oncol 1983;9:145-151.Crossref 7. Graham GF, Stewart R: Cryosurgery for unusual cutaneous neoplasms . J Dermatol Surg Oncol 1977;3:437-442.Crossref
Flannigan, Stephen A.;Tucker, Stephen B.;Rapini, Ronald P.
doi: 10.1001/archderm.1985.01660120081026
Abstract REPORT OF A CASE A 30-year-old man reported recurrent hyperkeratotic papules in areas of trauma since early childhood. Lesions occurred almost everywhere on his body but were most prevalent on his face, arms, and hands. Each lesion increased in size for about four to five weeks and then regressed after the hyperkeratotic plug fell out. Healing resulted in mild atrophy, hypopigmentation, or hyperpigmentation. The patient could not recall a time when he was totally free of lesions. He was in excellent health, and had no history of diabetes or renal disease. His brother's daughter had similar lesions, and his parents were not consanguineous.Physical examination revealed about ten lesions scattered over the patient's hands and arms (Fig 1). Lesions ranged from 2 to 5 mm in diameter, each with a central hyperkeratotic umbilicated plug (Fig 2). Some were present in a linear configuration, suggesting a Koebner reaction.A skin biopsy References 1. Mehregan AH, Schwartz OD, Livingood CS: Reactive perforating collagenosis . Arch Dermatol 1967;96:277-282.Crossref 2. Weiner AL: Reactive perforating collagenosis . Arch Dermatol 1970;102:540-544.Crossref 3. Bovenmyer DA: Reactive perforating collagenosis: Experimental production of the lesion . Arch Dermatol 1970;102:313-317.Crossref 4. Nair BK, Sarojini PA, Basheer AM, et al: Reactive perforating collagenosis . Br J Dermatol 1974;91:399-403.Crossref 5. Mehregan AH: Perforating dermatoses: A clinicopathologic review . Int J Dermatol 1977;16:19-27.Crossref 6. Polliak SC, Lebwohl MG, Parris A, et al: Reactive perforating collagenosis associated with diabetes mellitus . N Engl J Med 1982;306:81-84.Crossref 7. Patterson JW: The perforating disorders . J Am Acad Dermatol 1984;10:561-581.Crossref 8. Cullen SI: Successful treatment of reactive perforating collagenosis with tretinoin . Cutis 1979;23:187-193.
doi: 10.1001/archderm.1985.01660120083027
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 Photobiology of the Skin is the last volume in the series Physiology and Pathophysiology of the Skin. The first six chapters of this volume are dedicated to photobiology, and the last chapter to the effects of lasers on skin. A comprehensive background on light-skin interactions is provided in chapters 1 and 2, followed by four clinically oriented chapters about the skin's abnormal reactions to light and about the application of phototherapy in the treatment of various skin diseases. For the most part, the chapters are well written, and they include excellent references in support of the text. The illustrations, other than the clinical and histologic photographs, are clear and simple. Unfortunately, the last chapter of the book is disappointing. The use of lasers in dermatology is an exciting, fast-moving area of photobiology; however, this is not projected by the author. The chapter focuses on the well-known, relatively uninteresting thermal effects
doi: 10.1001/archderm.1985.01660120083028
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 Melanoma does not respect the boundaries of any medical or surgical specialty. In recent years, physicians with a major interest in melanoma have worked together to attempt to determine the most effective ways to diagnose and treat this neoplasm. The importance of recognizing and removing thin melanomas with appropriate surgery is but one example of the progress in patient management that a multidisciplinary approach has achieved. Editors Balch and Milton and associate editors Shaw and Soong have masterfully put together a monograph that concentrates on the surgical treatment of melanoma, but that is really quite comprehensive in its scope. Although several other recent monographs have addressed the clinical and histologic aspects of cutaneous melanoma in greater detail than Cutaneous Melanoma does, this book excels in the comprehensive and open discussions of the more controversial areas of patient management such as size of margins needed for adequate local excision and the
doi: 10.1001/archderm.1985.01660120088029
This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.