Showing papers in "Archives of Dermatology in 1976"
TL;DR: This work reviewed 464 references from the world literature and found 653 apparently valid reports of patients with incontinentia pigmenti, which is an uncommon genodermatosis that usually affects female infants.
Abstract: • Incontinentia pigmenti (Bloch-Sulzberger syndrome) is an uncommon genodermatosis that usually affects female infants. I reviewed 464 references from the world literature and found 653 apparently valid reports of patients with incontinentia pigmenti. Skin manifestations were found to be somewhat more common than previously reported, and systemic manifestations were found in 79.8% of the patients. (Arch Dermatol112:535-542, 1976)
353 citations
TL;DR: Fregert's Manual of Contact Dermatitis is packed with useful information and is highly recommended as a primer for those learning dermatology and as a brief refresher text for the practicing clinician.
Abstract: Fregert'sManual of Contact Dermatitisis packed with useful information and is highly recommended as a primer for those learning dermatology and as a brief refresher text for the practicing clinician. Of special usefulness to the clinician are tables of suitable patch test concentrations, a compilation of irritants and sensitizers in common occupations, and excellent discussions about where the more common allergens may be encountered. Every dermatologist would benefit from reading this succinct and well written manual.
221 citations
TL;DR: In the corticosteroid era, complications of therapy were the most frequent causes of death and Mortality and morbidity closely correlated with the cortICosteroid dosage used to attain control.
Abstract: † We review 107 consecutive cases of pemphigus. The mortality for pemphigus vulgaris and pemphigus vegetans was 46% between 1949 and 1959 and 24% between 1960 and 1970. The overall mortality for all types of pemphigus was 32%. In the corticosteroid era, complications of therapy were the most frequent causes of death. Mortality and morbidity closely correlated with the corticosteroid dosage used to attain control. This dosage proved to be variable and could not be predicted at the outset in any given patient. (Arch Dermatol112:962-970, 1976)
210 citations
TL;DR: A paired comparison study showed photochemotherapy to be far more effective than ultraviolet light emitted by fluorescent bulbs or a xenon source, and eighty-five percent of the patients receiving outpatient maintenance treatment have remained in remission for periods up to 400 days.
Abstract: • Photochemotherapy denotes a therapeutic approach that is based on the interaction of light and a photoactive drug. This study describes the efficacy of photochemotherapy, using orally administered methoxsalen and long-wave ultraviolet light in 91 patients with severe, generalized psoriasis. Oral administration of methoxsalen was followed by exposure to a high-intensity long-wave ultraviolet light source, emitting a continuous spectrum between 320 and 390 nm (peak, 365 nm) and an energy of 5.6 to 7.5 mw/sq cm at 15 cm. There was complete clearing of 82 patients (90%), a 90% to 100% clearing in seven (8%), and a satisfactory improvement in two (2%). A paired comparison study in 54 patients showed photochemotherapy to be far more effective than ultraviolet light emitted by fluorescent bulbs or a xenon source. Eighty-five percent of the patients receiving outpatient maintenance treatment have remained in remission for periods up to 400 days. ( Arch Dermatol 112:943-950, 1976)
207 citations
TL;DR: With artificial UVA and similar treatment conditions, the two psoralen derivatives were compared in the treatment of vitiligo; TMP stimulated repigmentation as well as 8-MOP and caused fewer side effects.
Abstract: • A new light source that provides highintensity ultraviolet light (UVA) (300 to 400 nm) to the entire body surface makes orally administered psoralen treatment of vitiligo with an artificial light practical. In the 26 patients studied, the degree of repigmentation with either trioxsalen (TMP) or methoxsalen (8-MOP) and high intensity UVA was at least as great as that with the same oral agents and sunlight. With artificial UVA and similar treatment conditions, the two psoralen derivatives were compared in the treatment of vitiligo; TMP stimulated repigmentation as well as 8-MOP and caused fewer side effects. (Arch Dermatol112:1531-1534, 1976)
173 citations
TL;DR: Serum IgE levels were elevated in each patient, but did not correlate with the degree of cutaneous anergy or altered leukocyte function, and Chemotactic studies during clinical remissions disclosed notable improvement in cell migration.
Abstract: † Various reports have indicated assorted immune defects in atopic dermatitis, but the prevalence and degree of the defects remain unclear. We assessed various immunological factors in 14 patients with atopic dermatitis to determine whether immunodeficiencies were present consistently and were reflected by the patients' clinical characteristics. A high incidence of cutaneous infection was noted. Cutaneous delayed-hypersensitivity testing showed anergy in eight (67%) patients. Only the seven patients with the most severe condition showed altered leukocyte function, as determined by polymorphonuclear and mononuclear leukocyte chemotaxis and by lymphocyte responsiveness to phytohemaglutinin. All three cell types were shown to be simultaneously dysfunctional during severe atopic flares. Chemotactic studies during clinical remissions disclosed notable improvement in cell migration. Serum IgE levels were elevated in each patient, but did not correlate with the degree of cutaneous anergy or altered leukocyte function. ( Arch Dermatol 112:1391-1396, 1976)
131 citations
TL;DR: If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy, leading to earlier therapy and improved prognosis.
Abstract: • Five patients with disseminated cryptococcosis had lesions on the extremities resembling cellulitis, which evolved into areas of blistering and ulceration in three patients. All had underlying disease and were medically immunosuppressed. Disseminated cryptococcosis appears to present with cellulitis or herpes-like vesiculation more commonly than is currently appreciated. India ink preparations of aspirates from areas of cellulitis or Tzanck preparations from blisters may show characteristic organisms, and makes possible an immediate diagnosis of cutaneous cryptococcosis. If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy. With increasing awareness of cutaneous involvement, some cases of disseminated cryptococcosis will be diagnosed sooner, leading to earlier therapy and improved prognosis. ( Arch Dermatol 112:1734-1740, 1976)
126 citations
TL;DR: Findings from the skin examinations suggest that immunologic factors might contribute to the increased incidence of vitiligo and alopecia areata seen in the Down syndrome.
Abstract: The skin of 214 institutionalized patients with the Down syndrome was carefully examined. There were 19 cases of alopecia areata and four cases of vitiligo. Since persons with the Down syndrome are predisposed to immunological deficiency in thymus-dependent (T-cell) function, findings from the skin examinations suggest that immunologic factors might contribute to the increased incidence of vitiligo and alopecia areata seen in the Down syndrome. Syringoma was also common and affected female patients twice as frequently as male patients.
123 citations
TL;DR: Both techniques are highly reliable; for example, in two consecutive series of basal cell carcinomas treated chemosurgically, the five-year rate of cure was 99.3% for the 9,351 lesions removed by the fixed tissue technique and 97% forThe 127 lesions removal by the fresh tissue technique.
Abstract: • Complete microscopical control of the excision of cancer of the skin is achieved by removing tissues layer by layer and examining the undersurface of each layer by means of frozen sections. If the cancer is extensive and complicated or if it is of a type readily spread over an excisional surface, the tissues are fixed in situ with zinc chloride prior to excision (chemosurgery, fixed tissue technique). If the cancer is not too extensive or complicated, the tissues are excised in the fresh, unfixed state (chemosurgery, fresh tissue technique). Both techniques are highly reliable; for example, in two consecutive series of basal cell carcinomas treated chemosurgically, the five-year rate of cure was 99.3% for the 9,351 lesions removed by the fixed tissue technique and 97% for the 127 lesions removed by the fresh tissue technique. ( Arch Dermatol 112:211-215, 1976)
116 citations
TL;DR: Nine cases of cutaneous xanthogranuloma in adults were reported and, like those in the young, they were not associated with abnormalities of serum lipids, and in this small sample there was no concomitant involvement of the eye.
Abstract: † Nine cases of cutaneous xanthogranuloma in adults are reported. These lesions were histologically indistinguishable from the xanthogranulomas in infants and children (juvenile xanthogranuloma), and, like those in the young, they were not associated with abnormalities of serum lipids. Unlike juvenile xanthogranuloma, however, in our small sample there was no concomitant involvement of the eye in adult xanthogranuloma. (Arch Dermatol112:43-44, 1976)
101 citations
TL;DR: Five patients manifested cutaneous changes indistinguishable from those noted in some porphyric disorders, consisting of fragility, denudation, and blister formation of sun-exposed skin, which were concluded to result from a low-grade photosensitization by tetracycline hydrochloride.
Abstract: • Five patients manifested cutaneous changes indistinguishable from those noted in some porphyric disorders, consisting of fragility, denudation, and blister formation of sun-exposed skin. Microscopical examination showed subepidermal bulla formation and the desposition of PAS-positive, diastase-resistant material and IgG in or around the upper dermal blood vessel walls. There was also electron microscopical evidence of vascular basal lamina reduplication and the deposition of a fine fibrillar material in and around these vessels. However, no abnormal porphyrin formation was noted. All five patients had been receiving 250 mg of tetracycline hydrochloride twice a day for at least six months and had had extensive sun exposure prior to the onset of the condition. For four patients, discontinuing the medication led to complete remission, despite subsequent sun exposure; the fifth patient was much improved, but her skin was still somewhat fragile seven months later. We concluded that these cutaneous changes resulted from a lowgrade photosensitization by tetracycline hydrochloride. ( Arch Dermatol 112:661-666, 1976)
TL;DR: The effect of this drug was remarkably good, with rapid healing of the lesions commencing 3 to 14 days after treatment was started, and the mechanism for the effect of clofazimine in pyoderma gangrenosum is not known.
Abstract: • Eight patients had pyoderma gangrenosum. They were given a phendimetrazine tartrate derivative, clofazimine (Lamprene [Britain]), which is a chemotherapeutic agent used mainly in certain mycobacterial infections and which also has phagocytosis-enhancing properties. The effect of this drug was remarkably good, with rapid healing of the lesions commencing 3 to 14 days after treatment was started. The mechanism for the effect of clofazimine in pyoderma gangrenosum is not known. ( Arch Dermatol 112:344-349, 1976)
TL;DR: It is concluded that the occasional overlapping of BP and DH should not lead to dropping the distinction between the two entities, and the term "intermediate or mixed form of DH and BP" seems to be most suitable.
Abstract: • Nine patients had clinical and histological features suggestive of both dermatitis herpetiformis (DH) and bullous pemphigoid (BP). Five patients responded to treatment with sulfapyridine or sulfones: in two the response was inconsistent, and the disease was controlled by combined treatment with prednisone; in one patient, there was no response to sulfapyridine or sulfones. Immunofluorescence studies showed IgA deposits in a linear homogeneous pattern at the basement membrane zone in all patients, and IgG was present in five. No circulating anti-basement membrane antibodies were detected by repeated immunofluorescence examinations. The authors conclude that the occasional overlapping of BP and DH should not lead to dropping the distinction between the two entities. For overlap cases that cannot be classified as BP or DH, the term "intermediate or mixed form of DH and BP" seems to be most suitable. (Arch Dermatol112:45-48, 1976)
TL;DR: Hairdressers should be made aware that these ammonium persulfate hair bleach preparations may provoke severe reactions and should seek medical attention if the client complains of severe itching, tingling, a burning sensation, hives, dizziness, or weakness.
Abstract: † Ammonium persulfate is widely used to "boost" peroxide hair bleaches. These persulfates can produce a variety of cutaneous and respiratory responses, including allergic eczematous contact dermatitis, irritant dermatitis, localized edema, generalized urticaria, rhinitis, asthma, and syncope. Some of these reactions appear to be truly allergic while others appear to be due to the release of histamine on a nonallergic basis. Patch tests may be performed with 2% to 5% aqueous solution of ammonium persulfate. Scratch tests may result in asthma and syncope. In some patients, merely rubbing a saturated solution of ammonium persulfate into the skin will evoke a large urticarial wheal. Hairdressers should be made aware that these ammonium persulfate hair bleach preparations may provoke severe reactions and should seek medical attention if the client complains of severe itching, tingling, a burning sensation, hives, dizziness, or weakness. (Arch Dermatol112:1407-1409, 1976)
TL;DR: Treatment resistance appeared due to handling certain foods that produced burning and stinging in the chronically eczematous skin and not in otherwise normal skin, and avoiding these foods, as contactants, led to resolution of the dermatitis.
Abstract: A patient had a chronic hand eczema, presumably as a manifestation of atopy. Treatment resistance appeared due to handling certain foods that produced burning and stinging in the chronically eczematous skin and not in otherwise normal skin. Selected tests for delayed hypersensitivity and for immediate hyper sensitivity on intact skin of the back produced negative results, but on chronically inflamed skin of the arm and back, application of the pertinent foods produced a wheal and flare response. On intact skin, scratch tests with the foods produced positive results. Intradermal tests with commercial antigens were negative. Avoidance of these foods, as contactants, led to resolution of the dermatitis. Reappraisal of the role of immediate-type hypersensitivity in chronic hand eczema is important.
TL;DR: The high remission rate associated with gold therapy and the infrequent side-effects during maintenance therapy suggest that systemically given gold therapy may be the treatment of choice for the management of pemphigus, following initial therapy with corticosteroids when necessary.
Abstract: Fourteen of 15 patients with pemphlgus have responded successfully to systemically administered gold therapy for up to four years. Eight of the 15 (56%) are in remission, requiring no therapy (mean, 21 months). The remaining seven patients are receiving maintenance systemic gold therapy. Only one instance of toxicity was seen during maintenance therapy. The high remission rate associated with gold therapy and the infrequent side-effects during maintenance therapy suggest that systemically given gold therapy may be the treatment of choice for the management of pemphigus, following initial therapy with corticosteroids when necessary.
TL;DR: At first, topically applied steroids cause profound inhibition of DNA synthesis and mitosis in the epidermis, but with continued treatment, DNA synthesisand mitosis recover and the tissue becomes insensitive to further stimulation.
Abstract: • Acute tolerance to the vasoconstrictive effect of topically applied glucocorticoids in humans has recently been described. Similar acute tolerance to the antiproliferative properties of topically applied steroids in proliferating and normal hairless mouse epidermis is now shown to occur. Thus, at first, topically applied steroids cause profound inhibition of DNA synthesis and mitosis in the epidermis, but with continued treatment, DNA synthesis and mitosis recover and the tissue becomes insensitive to further stimulation. This suggests that there is an optimum approach to therapy with topically applied steroids that might reduce the incidence of side effects and improve therapeutic efficacy. ( Arch Dermatol 112:1245-1248, 1976)
TL;DR: Topical antibiotics used on patients with acne vulgaris gave a substantial improvement of the disease on the treated side as compared with paired untreated sides of the face and back.
Abstract: • Topical antibiotics were used on patients with acne vulgaris.Corynebacteriumacnes organisms from open comedones were quantitated during treatment, and the progress of the disease was evaluated. Clindamycin lotion completely suppressed the growth ofC acnesorganisms, whereas erythromycin and tetracycline did not depress theC acnescounts. Taken as a group, these antibiotics gave a substantial improvement of the disease on the treated side as compared with paired untreated sides of the face and back. (Arch Dermatol112:182-184, 1976)
TL;DR: A group of 75 subjects with moderate or severe acne was divided by random selection into three treatment groups and there was no significant difference between the effects of topically and orally administered tetracycline hydrochloride.
Abstract: † A group of 75 subjects with moderate or severe acne was divided by random selection into three treatment groups. One group was treated with a topically applied placebo liquid and with 500 mg of orally administered tetracycline hydrochloride daily; one group received orally administered lactose capsules and topically applied placebo liquid each day; and one group was treated with orally administered lactose capsules and with a topical preparation containing tetracycline hydrochloride and n-decylmethyl sulfoxide, an agent intended to enhance antibiotic penetration. At the conclusion of the 13-week study and at several points during the study, the conditions of the subjects receiving topically or orally administered tetracycline hydrochloride were significantly ( P ( Arch Dermatol 112:971-973, 1976)
TL;DR: Three patients with relapsing polychondritis were treated successfully with dapsone, andMounting evidence suggests an immune-related pathogenesis for relapses in these patients.
Abstract: • Three patients with relapsing polychondritis were treated successfully with dapsone. Mounting evidence suggests an immune-related pathogenesis for relapsing polychondritis. Dapsone may be effective in certain immune-related diseases because of its inhibition of lysosomal enzymes. ( Arch Dermatol 112:1286-1288, 1976)
TL;DR: The studies demonstrate that the increased number of scalp microorganisms found in dandruff occurs as a secondary event to increased nutrients and that scalp organisms play no primary role in the pathogenesis of d andruff.
Abstract: • The role of microorganisms in dandruff was studied, by suppressing individually and then collectively the three major components of the scalp microflora. The effect on dandruff was assessed subjectively by clinical grading and objectively by the corneocyte count. No effect on dandruff was demonstrated when scalp organisms were suppressed. In the second group of experiments, dandruff was suppressed by selenium sulfide shampooing and the effect of continued suppression of Pityrosporum with topically applied amphotericin was measured. According to our criteria, dandruff returned to pretreatment levels, despite continued suppression of Pityrosporum . The studies demonstrate that the increased number of scalp microorganisms found in dandruff occurs as a secondary event to increased nutrients and that scalp organisms play no primary role in the pathogenesis of dandruff. ( Arch Dermatol 112:333-338, 1976)
TL;DR: Blue nevus may rarely appear in plaque form and seems to be a benign and asymptomatic lesion, but because of its rarity, no definite prognosis can be given.
Abstract: Blue nevus may rarely appear in plaque form. It seems to be a benign and asymptomatic lesion, but because of its rarity, no definite prognosis can be given. Only through reporting of additional cases and their follow-up will the prognosis become clear.
TL;DR: A 78-year-old woman with Parkinson disease developed tense bullous lesions on the chest, arms, and in the groin that were diagnosed as bullous pemphigoid and furosemide (Lasix) was suspected primarily.
Abstract: • A 78-year-old woman with Parkinson disease developed tense bullous lesions on the chest, arms, and in the groin that were diagnosed as bullous pemphigoid. Histologic examination, as well as immunofluorescence tests, confirmed this diagnosis. The possibility of a drug-induced disease was considered because she was taking seven different medications. Furosemide (Lasix) was suspected primarily. Complete clearing occurred with prednisone therapy, but readministration of furosemide resulted in bulla formation. ( Arch Dermatol 112:75-77, 1976)
TL;DR: Observations suggest a relationship between chronic dermatitis, elevated serum IgE level, eosinophilia, defective neutrophil chemotactic responsiveness, and recurrent pyogenic infections of skin and lungs.
Abstract: † Eleven patients with recurrent bacterial infections were found to have impaired neutrophil chemotaxis. The infections were primarily staphylococcal abscesses involving the skin and the respiratory tract. All patients had chronic eczematous dermatitis and an elevated level of serum IgE. The peripheral blood eosinophil count was equal to or greater than 10% of the circulating leukocytes in 10 of 11 patients. Associated findings in some patients included urticaria and oral or cutaneous Candida infection. These observations suggest a relationship between chronic dermatitis, elevated serum IgE level, eosinophilia, defective neutrophil chemotactic responsiveness, and recurrent pyogenic infections of skin and lungs. ( Arch Dermatol 112:1387-1390, 1976)
TL;DR: Blood immunological studies revealed an increase in B-lymphocytes, IgG, and IgA and the presence of antinuclear and antismooth muscle antibodies and autoradiography with tritiated thymidine showed a marked increase in endothelial and periendothelial cell labeling.
Abstract: Skin biopsy specimens obtained from involved and noninvolved areas in a patient with early diffuse systemic scleroderma were processed for histology, electron microscopy, and "in vitro" autoradiography with tritiated thymidine. The affected area revealed cellular infiltrates around the eccrine sweat glands, consisting of plasma cells and lymphocytes. The capillaries showed thickening of the basement lamina, damage of endothelial cells, and obstruction of their lumens. However, in some vessels, endothelial cells were preserved and appeared in prophase. Autoradiography with tritiated thymidine showed a marked increase in endothelial and periendothelial cell labeling. Blood immunological studies revealed an increase in B-lymphocytes, IgG, and IgA and the presence of antinuclear and antismooth muscle antibodies.
TL;DR: An approach is described that is based on the thesis that dermatologists can and often should treat patients with delusion of parasitosis, by considering each patient as an individual, and by working to build rapport, the dermatologist is in the best position to offer help.
Abstract: • One of the most frustrating problems in clinical dermatology is the patient with a delusion of parasitosis. Over the years, very little realistic and practical advice has been offered to the perplexed dermatologist. We describe an approach that is based on the thesis that dermatologists can and often should treat such patients. By considering each patient as an individual, and by working to build rapport, the dermatologist is in the best position to offer help. We report two illustrative cases and discuss guidelines to treatment. ( Arch Dermatol 112:1745-1748, 1976)
TL;DR: Several large series of ulcerative colitis patients are reviewed to emphasize the important concomitant cutaneous findings, and investigations into the pathogenesis of pyoderma gangrenosum are discussed.
Abstract: • The association between ulcerative colitis and various abnormalities of the skin, especially pyoderma gangrenosum, has been accepted for many years. The underlying aberrations in either of the organ systems, as well as the basis of their association, however, remain obscure. Several large series of ulcerative colitis patients are reviewed to emphasize the important concomitant cutaneous findings, and investigations into the pathogenesis of pyoderma gangrenosum are discussed. ( Arch Dermatol 112:531-534, 1976)
TL;DR: Cutaneous lesions of herpes gestation is developed in a newborn on the fifth day of life and disappeared spontaneously after three weeks and the immunologic phenomena were analogous in the mother and child.
Abstract: • Cutaneous lesions of herpes gestationis developed in a newborn on the fifth day of life and disappeared spontaneously after three weeks. The immunologic phenomena were analogous in the mother and child. No circulating or in vivo-bound immunoglobulins were demonstrated, but components 3 and 4 of complement were present at the basement membrane zone. We discuss a possible passive transfer of the disease to the newborn, and a supposedly pathogenetic role of immunologic phenomena in herpes gestationis. ( Arch Dermatol 112:1129-1131, 1976)
TL;DR: Because of the potentially serious side effects and the lack of substantial improvement in the eventual course, alternate-day prednisone therapy is not recommended for long-term use in AA.
Abstract: • Eighteen patients treated with prednisone on alternate days for varying degrees of alopecia areata (AA) were examined a mean of 15 months after discontinuation of the drug Despite an initial response to the therapy, long-term benefit was not thought to be substantial Numerous side effects related either to systemic corticosteroids or to AA were apparent during the course of therapy, as well as at the time of the evaluation reported herein Acne, obesity, lenticular opacities, mild hypertension, and impaired adrenocorticotropic hormone (ACTH) reserve were among the findings noted Long-term treatment was not accompanied by an obvious beneficial change in the natural course of AA Because of the potentially serious side effects and the lack of substantial improvement in the eventual course, alternate-day prednisone therapy is not recommended for long-term use in AA (Arch Dermatol112:1549-1552, 1976)
TL;DR: The favorable response of the pyodermatous lesions to azathioprine therapy suggests that this drug may be of value in treating this disorder in patients for whom corticosteroid therapy produces no benefit or is contraindicated because of side effects.
Abstract: • In two patients, active chronic hepatitis was complicated by the development of pyoderma gangrenosum. The favorable response of the pyodermatous lesions to azathioprine therapy suggests that this drug may be of value in treating this disorder in patients for whom corticosteroid therapy produces no benefit or is contraindicated because of side effects. Azathioprine, too, is a potentially toxic drug and may need to be discontinued. Possible causal relationships between pyoderma gangrenosum and active chronic hepatitis are discussed. ( Arch Dermatol 112:1297-1301, 1976)