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 .
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