doi: 10.1001/archderm.1985.01660010017001
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DiGiovanna, John J.;Blank, Harvey
doi: 10.1001/archderm.1985.01660010025003
Abstract In Reply.— As Dr Kagan has carefully noted, we failed to indicate the isometric form of lysine. The pure L-isomer of lysine hydrochloride was used in our study and we should have stated that in the original article.Kagan states that the lysine dosage used in our study was "low." We chose this dosage because of Kagan's study, in which this was the highest dosage administered ("312-1,200 mg of lysine daily").1 With doses of this magnitude or less, the results reported from the article were described as follows. The pain disappeared abruptly overnight in virtually every instance, new vesicles failed to appear, and resolution in the majority was considered to be more rapid than in their past experience. The most encouraging finding... was the reduction in frequency of recurrences. Taking therapeutic doses of 500-1,000 mg or increasing the maintenance dose would invariably abort recurrence.Since our dose (1,200 mg) References 1. Griffith RS, Norins AL, Kagan C: A multicentered study of lysine therapy in herpes simplex infection . Dermatologica 1978;156:257-267.Crossref
doi: 10.1001/archderm.1985.01660010025002
Abstract To the Editor.— In the January Archives, DiGiovanna and Blank1 reported failure of lysine in frequently recurrent herpes simplex infection. Caution is urged in the interpretation of their results. The L-isomer allosterically inhibits herpes in vitro,2,3 while the D-isomer is biologically inactive. It is not stated whether the lysine used was pure L-isomer. Assuming it was, the small number of patients (ten control, ten treated), the severity of the cases (patients had lesions present more than 40% of the time), and the low dosage (1,200 mg/day) all raise questions. In severe cases, high doses (3 g/day) are often required. In addition, there was no true control group, since all the patients were arginine restricted, an integral part of the therapy. This may explain why "most of our patients did indeed think that they were receiving the active medication and that it was having a beneficial effect." Thus the References 1. DiGiovanna JJ, Blank H: Failure of lysine in frequently recurrent herpes simplex infection . Arch Dermatol 1984;120:48-51.Crossref 2. Tankersley RW Jr: Amino acid requirements of herpes virus in human cells . J Bacteriol 1964;87:609-613. 3. Griffith RS, Delong D, Nelson J: Relation of arginine-lysine antagonism to herpes simplex growth in tissue culture . Chemotherapy 1981;27:209-213.Crossref 4. Griffith RS, Norins AL, Kagan C: A multicentered study of lysine in herpes simplex infection . Dermatologica 1978;156:257-267.Crossref 5. Walsh DE, Griffith RS, Behforooz A: Subjective response to lysine in the therapy of herpes simplex . J Antimicrob Ther 1983;12:489-496.Crossref 6. Peng Y, Gubin J, Harper AE, et al: Food intake regulation: Amino acid toxicity and changes in rat brain and plasma amino acids . J Nutr 1973;103:608-617.
doi: 10.1001/archderm.1985.01660010025004
Abstract To the Editor.— In the May Archives, Kumari1 described 75 patients with vitiligo treated with clobetasol propionate. Twenty-five patients with facial involvement, including the eyelids, were treated with a 0.05% ointment, applied twice daily for a period of eight weeks. The maximum amount was 25 g (12.5 mg clobetasol propionate) per course. The amounts applied to the eyelids are not stated. When needed, a second course was given after an interval of four months without treatment. The report stated that these patients were carefully observed for ocular side effects and that none were noted. It is presumed, but not specifically stated, that intraocular pressure was measured in these patients.Howell2 recommended that patients receiving topical steroid treatment to eyelids for longer than one to two weeks should be monitored for IOP by an ophthalmologist. If indeed there were no measurable (even though transient) increases in IOP in Kumari's References 1. Kumari J: Vitiligo treated with topical clobetasol propionate . Arch Dermatol 1984;120:631-635.Crossref 2. Howell JB: Eye diseases induced by topically applied steroids . Arch Dermatol 1976;112:1529-1530.Crossref
Christensen, Patricia;Barr, Ronald J.
doi: 10.1001/archderm.1985.01660010026006
Abstract To the Editor.— A wattle is a rare congenital anomaly occurring much less frequently than branchial cysts or sinuses. Wattles are found on satyrs and fauns of Greek and Roman mythology. Statues of these creatures are probably the earliest shown cases. The term is usually applied to the dewlap of birds such as turkeys. In mammals, a wattle is a fleshy appendage beneath the throat consisting of skin, subcutaneous fat, striated muscle, and a strip of cartilage. Report of a Case.— A 12-year-old boy was seen with a congenital tumor on the neck. On physical examination, a 15 × 6-mm soft, flesh-colored, elongated tumor hung from the patient's anterior neck (Fig 1). The lesion was completely excised, and there was no evidence of recurrence on follow-up examination.The microscopic sections exhibited a pedunculated lesion with an essentially normal epidermis, with the exception of mild hyperkeratosis. Numerous hair follicles were present References 1. Hogan D, Wilkinson RD, Williams A: Congenital anomalies of the head and neck . Int J Dermatol 1980;19:479-486.Crossref 2. Albers GD: Branchial anomalies . JAMA 1963;183:103-113.Crossref 3. Clarke JA: Are wattles auricular or branchial origin? Br J Plast Surg 1976;29:238-244.Crossref
doi: 10.1001/archderm.1985.01660010025005
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 In Reply.— The average amount of 0.05% clobetasol propionate in paraffin base was 2.5 g every four weeks, when applied to whole of the skin of upper and lower eyelids of one eye. The amount was correspondingly lower when applied to smaller areas of the eyelids. Patients were instructed to apply the ointment sparingly and to avoid seepage of ointment in the eye. No routine IOP studies were undertaken, as our ophthalmologist did not think it necessary because of the small amount of ointment used.
Serrano, Gabriel;Aliaga, Adolfo;Febrer, Isabel;Bonillo, Juan;Pelufo, Cristina;Otero, Dolores
doi: 10.1001/archderm.1985.01660010027007
Abstract To the Editor.— Neonatal gangrene of the buttock is a rare condition mainly due to iatrogenic causes. Most cases occur after umbilical artery catheterization,1,2 exchange transfusions,3 and cord injections by means of syringes.4 Exceptional causes of gangene during the neonatal period include infections and hypernatraemic dehydration of infancy.5 The following case supports that perinatal gangrene of the buttock may also arise as a spontaneous condition. Report of a Case.— A 2-day-old male was delivered spontaneously at term with vertex presentation. His birth weight was 3,100 g. The mother, a 23-year-old woman (gravida 1), had no known medical problems prior to the delivery. Approximately 30 minutes after birth, a nurse noted a red patch on the left buttock and perineal region of the infant. During the next hours, the lesion became swollen, and a purple discoloration appeared and extended to the scrotum (Fig 1). Examination revealed a References 1. Rudolph N, Wang HH, Dragutsky D: Gangrene of the buttock: Complication of umbilical artery catheterization . Pediatrics 1974;53:106-109. 2. Book LS, Herbs JJ, Stewart D: Hazards of calcium gluconate therapy in the newborn infant: Intra-arterial injection producing intestinal necrosis in rabbit ileum . J Pediatr 1978;92:793-797.Crossref 3. Origel AV, Guzman LM, Gutierrez LJ: Necrosis glutea: Complicación rara de la exanguinotransfusión . Rev Med del IMSS 1979;18:127-130. 4. Bonifazi E, Meneghini C: Perinatal gangrene of the buttock: An iatrogenic or spontaneous condition? J Am Acad Dermatol 1980;3:596-598.Crossref 5. Comay SC, Karabus CD: Peripheral gangrene in hypernatraemic dehydration of infancy . Arch Dis Child 1975;50:616-619.Crossref
Clement, Michele;Guy, R.;Pembroke, A. C.
doi: 10.1001/archderm.1985.01660010028008
Abstract To the Editor.— Although the development of squamous cell carcinoma at sites of chronic skin damage is a well-recognized phenomenon, to our knowledge there is only one previous report in the literature of its appearing in an area of necrobiosis lipoidica. We would like to report another case. Report of a Case.— A 59-year-old woman had suffered from insulin-dependent diabetes mellitus since 1932. In 1944, extensive necrobiosis lipoidica of the legs and feet developed, and, in 1947, granuloma annulare of the hands. The granuloma annulare cleared but the necrobiosis lipoidica persisted and extended. Ulceration of the lesions first occurred in 1975 but healed in a few months. In 1977, an ulcer developed above the right lateral malleolus in an area of necrobiosis lipoidica that had been noted by a dermatologist in 1944 and recorded on several occasions since. This ulcer persisted and continued to enlarge despite four months' inpatient treatment References 1. Byrd BF Jr, Munoz AJ, Ferguson H: Carcinoma of the skin following acute and chronic trauma . South Med J 1961;54:1262-1267.Crossref 2. Giblin T, Pickrell K, Pitts W, et al: Malignant degeneration in burn scars: Marjolin's ulcer . Ann Surg 1965;162:291-297.Crossref 3. Rossis CG, Yiacoumettis AM, Elemenoglou J: Squamous cell carcinoma of the heel developing at site of previous frostbite . J R Soc Med 1982;75:715-719. 4. Hejna WF: Squamous cell carcinoma developing in the chronic draining sinuses of osteomyelitis . Cancer 1965;18:128-132.Crossref 5. Muller SA, Winkelmann RK: Necrobiosis lipoidica diabeticorum: A clinical and pathological investigation of 171 cases . Arch Dermatol 1966;93:272-281.Crossref
doi: 10.1001/archderm.1985.01660010029010
Abstract To the Editor.— Dr Bargman1 was unable to find a previous reference to trichomycosis of the scrotal hair: perhaps we can help him. In our study of the bacterial flora of trichomycosis axillaris2 we examined 874 patients in an institute for the mentally retarded. We recorded that 14 (5%) of the 265 women, and 216 (35%) of the 609 men, had trichomycosis of the armpits. Sixteen (2.6%) of the men had trichomycosis of the scrotal hair, and three of these had no associated trichomycosis of the armpits. There is little new under the sun, or even below the belt. References 1. Bargman H: Trichomycosis of the scrotal hair . Arch Dermatol 1984;120:299-300.Crossref 2. Savin JA, Somerville DA, Noble WC: The bacterial flora of trichomycosis axillaris . J Med Microbiol 1970;3:352-356.Crossref
Rosove, Michael H.;Harwig, Sylvia S. L.;Ahmed, Razzaque A.
doi: 10.1001/archderm.1985.01660010029009
Abstract To the Editor.— Dapsone (4,4′-diaminodiphenylsulfone) causes dose-limiting hemolysis and methemoglobinemia, with formation of Heinz bodies (denatured hemoglobin particles) and characteristic poikilocytes.1 It has been proposed that Heinz body testing during dapsone treatment might be useful2; we have found it to be of restricted value.Twelve clinically stable, nonsplenectomized patients with normal erythrocyte glucose-6-phosphate dehydrogenase levels3 had been treated with constant dosage of dapsone for various skin disorders for at least one month. Mean (±SD) daily drug dosage was 122 (±69) mg. Complete blood cell counts, methemoglobin levels,4 reticulocyte counts,5 and Heinz body quantifications6 were performed two to four times (mean interval [±SD], 6.9 ± 5.7 weeks, minimum interval, one week, 35 studies).Normal values used for hemoglobin levels, reticulocyte count, methemoglobin levels, and Heinz body counts are 13 to 17 g/dL, 25,000 to 75,000/cu mm, less than 1.0%, and none detected, respectively. Respective mean References 1. DeGowin RL: A review of therapeutic and hemolytic effects of dapsone . Arch Intern Med 1967;120:242-248.Crossref 2. Smith RS, Alexander S: Heinz-body anaemia due to dapsone . Br Med J 1959;1:625-627.Crossref 3. Beutler E: Erythrocyte enzyme assays , in Williams WJ, Beutler E, Erslev AJ, et al (eds): Hematology , ed 3. New York, McGraw-Hill Book Co, 1983, pp 1623-1626. 4. Beutler E: Carboxyhemoglobin, methemoglobin, and sulfhemoglobin determinations , in Williams WJ, Beutler E, Erslev AJ, et al (eds): Hematology , ed 3. New York, McGraw-Hill Book Co, 1983, pp 1632-1634. 5. Erslev AJ, Atwater J: Reticulocyte staining , in Williams WJ, Beutler E, Erslev AJ, et al (eds): Hematology , ed 3. New York, McGraw-Hill Book Co, 1983, pp 1604-1605. 6. Schwab MLL, Lewis AE: An improved stain for Heinz bodies . Am J Clin Pathol 1969;39:93-95.
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