Showing papers in "Archives of Dermatology in 1971"
TL;DR: These authors demonstrate that the best age of guinea pigs for eliciting contact allergic reactions is 1 to 3 months, that males and females are equal in their potential, that pregnancy decreases the sensitization index, and that sensitization may be elicited with equal readiness in both winter and summer.
Abstract: This is a most unusual book incorporating numerous observations which have not heretofore been published together. By reading this book, one can readily recognize why it is easily possible to have an experiment fail, not because the general experimental design was poor, but because the vagaries for eliciting the reaction are not understood. For instance, these authors demonstrate that the best age of guinea pigs for eliciting contact allergic reactions is 1 to 3 months, that males and females are equal in their potential, that pregnancy decreases the sensitization index, that sensitization may be elicited with equal readiness in both winter and summer, and that ambient temperatures have no effect. They also clearly demonstrate that the best area for sensitization is the scapular and that the use of other areas is considerably less effective. They also study the influence of the concentration and frequency of application on the topical sensitization
251 citations
TL;DR: Three new cases of EBA are discussed and a review of all other reported cases shows a high incidence of associated systemic disease, amyloidosis, colitisenteritis, multiple myeloma, and diabetes mellitus.
Abstract: Epidermolysis bullosa acquisita (EBA) is a rare, nonhereditary, blistering disease with clinical features similar to epidermolysis bullosa dystrophica. The clinical features may often simulate porphyria cutanea tarda, pemphigus, or pemphigoid. Three new cases of EBA are discussed. The first patient had signs of a "lymphoma-like" disorder of lymph nodes. The other two patients had inflammatory disorders of the gastrointestinal tract. A review of all other reported cases of EBA shows a high incidence of associated systemic disease, amyloidosis, colitisenteritis, multiple myeloma, and diabetes mellitus.
240 citations
TL;DR: Of 26 patients with severe psoriasis, 20 attained 75% to 100% improvement with administration of methotrexate, and the pharmacologic rationale for this drug schedule and its value relative to other commonly used schedules is discussed.
Abstract: Therapy of patients with severe psoriasis has been facilitated in recent years by the use of systemic methotrexate. Several common schedules for drug administration include small daily oral doses and weekly intramuscular or oral doses. These schedules were empirically designed and have had reasonably good results. A new schedule of methotrexate administration is recommended for the treatment of psoriasis, based on current knowledge concerning the epidermal cell proliferation kinetics of psoriasis and chemotherapy with cell-cycle specific drugs. Methotrexate was administered orally in small doses (2.5 to 7.5 mg) at 12-hour intervals for a total of three doses at weekly intervals. Of 26 patients with severe psoriasis, 20 attained 75% to 100% improvement with administration of methotrexate. Side effects were minimal. The pharmacologic rationale for this drug schedule and its value relative to other commonly used schedules is discussed. Consideration of potential long-term risks with methotrexate must still be considered when evaluating patients for therapy.
233 citations
TL;DR: The clinical and laboratory data on 81 patients with benign mucous membrane pemphigoid seen during the years 1950 through 1968 were reviewed and systemic administration of corticosteroids, used in 33 cases, was the single treatment of greatest benefit.
Abstract: The clinical and laboratory data on 81 patients with benign mucous membrane pemphigoid (BMMP) seen during the years 1950 through 1968 were reviewed. Mucous-membrane and cutaneous involvements were variable, but the oral mucosa and conjunctivae were eventually involved in approximately 75% of the cases. Scarring was a common complication of mucosal and cutaneous lesions. The most severe sequela was blindness. Of the 81 patients in this series 21 became blind, 17 in both eyes. Systemic administration of corticosteroids, used in 33 cases, was the single treatment of greatest benefit. Daily doses equivalent to 40 mg of prednisone were required initially to retard or arrest the disease. Of the various corticosteroid preparations employed, triamcinolone was the most effective. There were no deaths attributed to BMMP, but one patient died from the side effects of corticosteroid therapy.
225 citations
TL;DR: A cell with characteristic ultrastructural features was found in tissues from all six Sezary patients studied, and it appears that the presence of this unusual cell is not absolutely specific for the diagnosis of mycosis fungoides.
Abstract: A cell with characteristic ultrastructural features was found in tissues from all six Sezary patients studied. This cell has a highly irregular, serpentine nucleus, which in three-dimensional reconstruction appears to be cerebriform and composed of highly folded sheets. Abnormal cells were also found in tissues from 34 of 38 patients with mycosis fungoides (MF). The nuclei of these MF cells were also irregular, but less so than Sezary cell nuclei. These MF cells were also found in six of eight patients with parapsoriasis en plaque. In order to determine the diagnostic specificity of these abnormal MF cells, skin from 33 control patients with a variety of malignant and benign skin diseases was studied. Cells similar to MF cells were found in skin from three of these control patients; so, it appears that the presence of this unusual cell is not absolutely specific for the diagnosis of MF.
202 citations
TL;DR: Fourteen cases of primary mucinous carcinoma of the sweat glands occurred, and the mucin is of the sialomucin type.
Abstract: Fourteen cases of primary mucinous carcinoma of the sweat glands occurred. Tumors of this type in the skin are frequently misdiagnosed as metastatic carcinoma. Histochemically, the mucin is of the sialomucin type. The tumor is commonly a round, elevated, reddish, and sometimes ulcerated mass, usually located on the face, head, or trunk. These masses tend to recur, but metastasis is infrequent.
183 citations
TL;DR: An inordinately high failure rate after treatment of recurrent basal cell epitheliomas would indicate that such lesions are more difficult to eradicate than primary basal cell encapsulation, and that their treatment should be aggressive.
Abstract: One hundred recurrent, re-treated basal cell epitheliomas were studied. The original lesions had been treated with curettage and electrodesiccation, excision, or x-radiation. The 100 recurrences were treated by these same modalities, except that five were treated with Mohs' chemosurgery. Following re-treatment, almost half (47) recurred a second time. This inordinately high failure rate after treatment of recurrent basal cell epitheliomas would indicate that such lesions are more difficult to eradicate than primary basal cell epitheliomas, and that their treatment should be aggressive.
153 citations
TL;DR: Direct immunofluorescent staining was carried out on skin biopsy specimens of patients with skin diseases (including bullous skin diseases), with use of specific antisera to human IgG, IgA, IgM, and β 1 C/β 1 A globulin.
Abstract: Direct immunofluorescent (IF) staining was carried out on skin biopsy specimens of patients with skin diseases (including bullous skin diseases), with use of specific antisera to human IgG, IgA, IgM, and β 1 C/β 1 A globulin. IgG and complement (C') were consistently found in the basementmembrane-zone area in skin lesions of patients with bullous pemphigoid. Positive direct IF staining in bullous pemphigoid may assume considerable diagnostic importance, especially in cases without demonstrable circulating antibody. IgG was consistently observed in the intercellular-substance areas in lesions of patients with pemphigus, whereas C' was not detected. IgA and IgM, encountered in a few instances only, appear to have little, if any, significance in either disease. Special studies, involving autoreactivity, were done.
148 citations
TL;DR: The clinical and histopathologic features of 25 patients with the inflammatory type of linear verrucose epidermal nevus were early age of onset, 4:1 predominance in females, frequent involvement of the left lower extremity, distinctive inflammatory and psoriasiform histologic appearance, and persistent lesions showing marked refractoriness to treatment.
Abstract: The clinical and histopathologic features of 25 patients with the inflammatory type of linear verrucose epidermal nevus were as follows: (1) early age of onset, (2) 4:1 predominance in females, (3) frequent involvement of the left lower extremity, (4) pruritus, (5) distinctive inflammatory and psoriasiform histologic appearance, and (6) persistent lesions showing marked refractoriness to treatment.
142 citations
TL;DR: It is suggested that psoriasis may be a polygenic-environmentally induced defect in the adenyl cyclase-cyclic AMP cascade, which could explain that seemingly paradoxical occurrence of the 12-fold acceleration in the rate of cell division, low phosphorylase activity, and glycogen buildup in the epidermis of a psoriatic lesion.
Abstract: Epidermal cell division appears to be slowed by beta adrenergic stimulation. The satisfaction of Sutherland's four criteria of an adenosine 3′, 5′ = monophosphate (cyclic AMP) mediated event shows that the inhibition is due to an increase intraepidermal cyclic AMP. Since increasing cyclic AMP slows epidermal cell division and mediates glycogen breakdown, we suggest that psoriasis may be a polygenic-environmentally induced defect in the adenyl cyclase-cyclic AMP cascade. Such a defect could explain that seemingly paradoxical occurrence of the 12-fold acceleration in the rate of cell division, low phosphorylase activity, and glycogen buildup in the epidermis of a psoriatic lesion. Our approach to the detection of a possibly defective adenyl cyclase-cyclic AMP-cyclic AMP dependent protein kinase cascade and how such a defect, if it is found, might be corrected by therapy is discussed.
140 citations
TL;DR: Cells with morphologically distinctive nuclei, heretofore associated only with mycosis fungoides and the Sezary syndrome, are readily detected in a variety of randomly selected nonlymphomatous dermatoses and do not provide specific cytologic evidence for the diagnosis of mycotic disease.
Abstract: Cells with morphologically distinctive nuclei, heretofore associated only with mycosis fungoides and the Sezary syndrome, are readily detected in a variety of randomly selected nonlymphomatous dermatoses. These cells, therefore, do not provide specific cytologic evidence for the diagnosis of mycosis fungoides. The significance and function of these cells need further clarification.
TL;DR: In patients with atopic dermatitis there was a strong correlation between the level of serum IgE and the severity of dermatitis, whether or not a positive history for asthma or hay fever was elicited.
Abstract: Intradermal tests with anti-IgE and measurements of serum IgE levels were done in patients with atopic dermatitis who did not have concurrent hay fever or asthma, patients with psoriasis, and nonatopic volunteers. The minimal amount of anti-IgE required to elicit a standard wheal and flare reaction 15 minutes after injection in patients with atopic dermatitis did not differ significantly from the two control groups. Also, there was no correlation between the results of the intradermal testing and severity of the dermatitis. The mean serum of IgE levels in patients with atopic dermatitis were higher than those of the two control groups. In addition, in patients with atopic dermatitis there was a strong correlation between the level of serum IgE and the severity of dermatitis, whether or not a positive history for asthma or hay fever was elicited.
TL;DR: A case of multiple glomus tumors has been studied with angiography, thermography, plethysmography, and light and electron microscopy, and electron microscopic studies confirmed that theglomus cells have the features of smooth muscle cells.
Abstract: A case of multiple glomus tumors has been studied with angiography, thermography, plethysmography, and light and electron microscopy No vascular abnormalities were found Light microscopic studies revealed typical histopathology of glomus tumors of the multiple type Electron microscopic studies confirmed that the glomus cells have the features of smooth muscle cells
TL;DR: This paper found a heterogeneous group of systemic diseases (15 to 26 cases) associated with necrotizing angiitis and showed that the immunoglobulins and complement staining were related to distribution of histologic changes but not to the severity of such changes.
Abstract: We found a heterogeneous group of systemic diseases (15 to 26 cases) associated with necrotizing angiitis. Patterns of dermal vessel immunofluorescence were related to specific clinical and histopathologic lesions in 15 of 26 cases of necrotizing angiitis, in 4 cases of livedo vasculitis, and in 3 cases of facial granuloma. The immunoglobulins and complement staining were related to the distribution of histologic changes but not to the severity of such changes. Staining of β 1 -C/β 1 -A globulin in diseased dermal vessels superimposed IgG and IgM in seven of 15 biopsies. One or more serum immunoglobulins were altered (± 2 SD) in 15 of 22 patients with necrotizing angiitis. Globulins in perivascular spaces occurred more frequently in association with elevated serum immunoglobulins.
TL;DR: The antimitotic activity of the corticosteroids seems to be related to their therapeutic efficacy, and may supplement the vasoconstrictor assay for pertinence to those diseases with increased cell turnover.
Abstract: The action of the corticoid drugs has been investigated in regard to their antimitotic activity on human skin. For topical studies two 4-mm biopsies were taken from the forearms of each volunteer to allow use of the paired comparison method; a separate control group was used for oral studies. The results indicated that orally administered triamcinolone and topically administered triamcinolone acetonide inhibited mitotic activity of the epidermis. Topically administered 0.2% fluocinolone acetonide proved equally potent, although no effect was seen when 0.025% was used. No mitotic inhibition was observed after topical administration of hydrocortisone acetate. Repeated injections of corticotropin, however, resulted in a significant fall in mitotic activity. The antimitotic activity of the corticosteroids seems to be related to their therapeutic efficacy. This may supplement the vasoconstrictor assay for pertinence to those diseases with increased cell turnover.
TL;DR: Clinical and immunologic studies have been performed in six patients with LE panniculitis recently observed and immune complexes were demonstrated by direct fluorescence in blood vessel walls in the active lesions.
Abstract: Lupus erythematosus (LE) panniculitis (profundus) is an unusual clinical variant of lupus erythematosus in which the cutaneous inflammatory reaction occurs primarily in the deeper corium. Clinical and immunologic studies have been performed in six patients with LE panniculitis recently observed. Four first degree relatives of one patient also had lupus erythematosus. Two other patients with LE panniculitis were sisters. Four of the patients also had discoid LE lesions. Five had varying systemic involvement and four had high titer antinuclear antibodies. Three had decreased serum complement. The histology is that of lymphocytic vasculitis and panniculitis. Immune complexes were demonstrated by direct fluorescence in blood vessel walls in the active lesions. In four patients trauma was apparently associated with the appearance of the lesions. Therapy with antimalarial drugs seemed beneficial. Greater clinical awareness and newer diagnostic aids have led to an increased significance and apparent incidence of LE panniculitis.
TL;DR: In a 20-year survey of 70 cases of pemphigus at the Cleveland Clinic including results of treatment with corticosteroids and immunosuppressive agents, attention is drawn to complications and the high mortality that is still associated with pemPHigus vulgaris.
Abstract: In a 20-year survey of 70 cases of pemphigus at the Cleveland Clinic including results of treatment with corticosteroids and immunosuppressive agents, attention is drawn to complications and the high mortality (45%) that is still associated with pemphigus vulgaris (57% in pemphigus foliaceus). Pemphigus erythematosus continues to be a relatively benign disease.
TL;DR: In a new surgical technique, isolated epidermis obtained by suction at 200 mm Hg is successfully used as a pigment-bearing graft to cover either achromic defects or granulating areas resulting from skin damage of diverse etiology.
Abstract: Achromic lesions are numerous and their significance is especially great in areas of the world with large numbers of dark-skinned individuals. Therapy has been difficult and discouraging. In a new surgical technique, isolated epidermis obtained by suction at 200 mm Hg is successfully used as a pigment-bearing graft to cover either achromic defects or granulating areas resulting from skin damage of diverse etiology. The procedure was useful in four typical cases.
TL;DR: The presence of the band in clinically normal skin is confirmed, confirming a clinical diagnosis of SLE even in patients without LE skin lesions, and simultaneously suggesting a poorer prognosis.
Abstract: Clinically normal skin biopsies from 220 patients were tested by the direct fluorescent antibody technique for the "band" of localized immunoglobulins found at the dermal-epidermal junction in lupus erythematosus (LE) skin. Diseases studied included systemic lupus erythematosus (SLE), discoid lupus erythematosus (DLE), rheumatoid arthritis, scleroderma, and various miscellaneous dermatoses including bullous diseases. Only SLE and bullous pemphigoid demonstrated the band. The SLE band differed morphologically from that of bullous pemphigoid. The band-positive SLE patients had severer disease and a higher incidence of certain laboratory abnormalities associated with more severe SLE than the band negatives. Kidney involvement occurred three times, fever 3 1/2 times, and marked weight loss two times as frequently in the band positive patients. The presence of the band in clinically normal skin is, therefore, both diagnostic and probably prognostic, confirming a clinical diagnosis of SLE even in patients without LE skin lesions, and simultaneously suggesting a poorer prognosis.
TL;DR: In this article, the authors evaluated 50 patients with psoriasis for possible hepatotoxicity from methotrexate therapy and found no close correlation between the total dose of methotroxate and the degree of liver abnormalities.
Abstract: Fifty patients with psoriasis were evaluated prospectively and retrospectively for possible hepatotoxicity from methotrexate therapy. Liver function studies were not reliable indicators of pathologic changes found on liver biopsy. Diabetes mellitus and obesity increased the incidence of hepatotoxicity from methotrexate. Increased alcohol consumption may not be an additive risk in producing liver damage. A variety of pathologic changes were found on liver biopsies, but none were specific for methotrexate hepatotoxicity. There is no close correlation between the total dose of methotrexate and the degree of liver abnormalities. Continued use of methotrexate for treatment of severe psoriasis will require better selectivity of patients and closer follow-up studies including liver biopsy.
TL;DR: A new autosomal recessive disorder characterized by growth retardation, progeria-like appearance, mental deficiency, nonbullous congenital ichthyosiform erythroderma, and hair shaft defects consisting of pili torti and trichorrhexis nodosa-like lesions was found in three children of a Chinese family in Singapore.
Abstract: A new autosomal recessive disorder characterized by growth retardation, progeria-like appearance, mental deficiency, nonbullous congenital ichthyosiform erythroderma, and hair shaft defects consisting of pili torti and trichorrhexis nodosa-like lesions was found in three children of a Chinese family in Singapore. It is possible that this disease is closely related to other rare ectomesodermal disorders with congenital ichthyosis, hair shaft defects, and other congenital abnormalities, and a new classification of these conditions is therefore proposed.
TL;DR: Histopathologic study showed perforation of the epidermis and release of the abnormal necrobiotic material transepithelially in two patients with granuloma annulare.
Abstract: Two patients had granuloma annulare which appeared as small nodular lesions with central umbilication on the hands and margins of the fingers. Histopathologic study showed perforation of the epidermis and release of the abnormal necrobiotic material transepithelially. This type of granuloma annulare is distinctive both clinically and histologically and is probably more common than presently recognized.
TL;DR: One hundred patients suspected of having allergic eczematous contact dermatitis due to topically administered medications were patch tested with a "vehicle tray" composed of 15 substances commonly found in vehicles of current preparations, showing sizable incidence of false-negative reactions.
Abstract: One hundred patients suspected of having allergic eczematous contact dermatitis due to topically administered medications were patch tested with a "vehicle tray" composed of 15 substances commonly found in vehicles of current preparations. Positive tests were obtained in 30 of 100 patients. There were 18 reactions to ethylenediamine; 6 to lanolin; 3 to parabens; 2 each to phenylmercuric acetate, thimerosal, dichlorophene, propylene glycol monostearate, and triethanolamine; 1 to sorbic acid for a total of 40 positive reactions. Vehicles play a significant role in producing sensitization and allergic contact dermatitis. The importance of testing with a standard concentration of each ingredient in preference to the total formulation is shown by the sizable incidence of false-negative reactions with the total formulation.
TL;DR: The capacity of orally administered antibiotics to alter the resident microbial flora of the skin was evaluated and it was concluded that this mainly happened as a result of holocrine excretion via epidermal or sebaceous cells.
Abstract: The capacity of orally administered antibiotics to alter the resident microbial flora of the skin was evaluated after three weeks of treatment with tetracyclines, penicillins, erythromycin, and a lincomycin derivative. An increase in the percentage of resistant organisms was the most sensitive indicator that an antibiotic had reached the surface; conversion from a dominantly diphtheroid to coccal flora was another evidence of substantial surface levels. It was concluded that this mainly happened as a result of holocrine excretion via epidermal or sebaceous cells. Tetracyclines and erythromycin were instances of the latter effect. Penicillins did not materially alter the microflora, except for a slight increase in resistant cells. Significant reductions in the density of Cornebacterium acnes on the forehead were produced by three of four tetracyclines and the lincomycin derivative.
TL;DR: Acquired cutis laxa is part of a generalized elastolysis with involvement of the skin and such organs as the lungs, aorta, and gastrointestinal tract and may be accompanied by skin manifestations such as erythema multiforme, urticaria, or a nonspecific dermatitis.
Abstract: Acquired cutis laxa is part of a generalized elastolysis with involvement of the skin and such organs as the lungs, aorta, and gastrointestinal tract. One patient with acquired cutis laxa died after 17 years of progressive disease leading to severe laxity of the skin, pulmonary emphysema, hiatus hernia, Zenker's bilobed diverticulum, inguinal hernia, prolapse of the gastric mucosa and gallbladder, and diverticulosis of the large bowel. The second patient 9 years of age, following a generalized vesicular eruption, developed cutis laxa of the face which has progressed despite plastic surgical repair. Acquired cutis laxa may be accompanied by skin manifestations such as erythema multiforme, urticaria, or a nonspecific dermatitis. Elastic fibers are diminished throughout the dermis with fragmentation and granularity. Elastic fibers throughout the body (the aorta and the lungs, in particular) show these same changes.
TL;DR: It is suggested that the so-called Langerhans' cell granule is just one type of plasma membrane apposition or invagination which this cell can produce.
Abstract: Intradermally injected peroxidase was found in the Langerhans' cell granules of the epidermal Langerhans' cells. As time elapsed, the number of stained granules increased, reaching the maximum at 22 hours, and tended to concentrate near the Golgi zone. Since the peroxidase molecule does not cross the plasma membrane, this suggested (1) ingestion of peroxidase by the Langerhans' cell granules at the cell periphery and (2) migration of such granules into the cell interior. At the cell periphery various types of close apposition of the plasma membrane with gap distance ranging from 30 Angstroms (gap junction) to 350 A (Langerhans' cell type) were found. They too migrated into the cell interior. This suggested that the so-called Langerhans' cell granule is just one type of plasma membrane apposition or invagination which this cell can produce.
TL;DR: Repeated careful cultural studies of the cerebrospinal fluid, urine, prostatic secretions, and sputum should be performed for early diagnosis and appropriate therapy of disseminated cryptococcosis with meningitis.
Abstract: In four cases of disseminated cryptococcosis with central nervous system (CNS) involvement, cryptococcal cutaneous lesions developed two to eight months before the diagnosis of disseminated cryptococcosis with meningitis was made. In all four patients, there was cultural or strong clinical evidence of multisystem involvement in addition to the presenting skin lesions and CNS involvement. All four patients were treated with amphotericin B intravenously. In two patients, a single course of drug therapy produced long-term apparent cure, while in the remaining two, clinical and cultural relapse occurred, resulting in death in spite of a second course of treatment. The recognition of cutaneous cryptococcal disease should alert the clinician to the probability of disseminated cryptococcosis. Repeated careful cultural studies of the cerebrospinal fluid, urine, prostatic secretions, and sputum should be performed for early diagnosis and appropriate therapy.
TL;DR: The second male patient with classical Sweet's syndrome (acute febrile neutrophilic dermatosis) is reported and the 17 previously published cases are reviewed.
Abstract: The second male patient with classical Sweet's syndrome (acute febrile neutrophilic dermatosis) is reported and the 17 previously published cases are reviewed. All of the present patient's signs and symptoms were dramatically controlled with orally administered prednisone, but temporarily recurred when treatment was discontinued prematurely. Possibly coincidentally, he was found to have a testicular tumor (embryonal carcinoma with features of teratocarcinoma) only six weeks after the onset of his dermatosis.
TL;DR: Eight members from four generations of a family had multiple superficial porokeratoses on the trunk, palms, and soles, distinct from the classic Mibelli type or the Chernosky disseminated superficial actinic porokersatosis (DSAP) type, which begins in the late teens and early twenties and affects males twice as often as females.
Abstract: Eight members from four generations of a family had multiple superficial porokeratoses on the trunk, palms, and soles. This appears to be a third type of porokeratosis, distinct from the classic Mibelli type or the Chernosky disseminated superficial actinic porokeratosis (DSAP) type. The disease begins in the late teens and early twenties, is transmitted as an autosomal dominant, and affects males twice as often as females. The hallmark of this disease is the early appearance of plantar and palmar lesions with subsequent involvement of other areas of the body including surfaces not exposed to ultraviolet radiation. Morphologically the clinical lesions resemble Chernosky's DSAP. Histologically it has the identifying features of porokeratosis with a cornoid lamella. One of our eight patients developed squamous cell carcinomas in areas of porokeratosis. No effective mode of therapy has been found.