Showing papers in "Archives of Dermatology in 1985"
TL;DR: The vasoconstrictor assay is an inexpensive and reliable method for screening glucocorticosteroid formulations for clinical activity in psoriasis.
Abstract: • A large group of glucocorticosteroid formulations were assayed by the vasoconstriction test in normal skin sites and paired comparison studies in patients with psoriasis. Excellent correlation between the vasoconstriction assay and selected paired comparison studies occurred in 20 of 23 instances. In three instances, involving two glucocorticosteroid formulations tested, correlation was absent. The vasoconstrictor assay is an inexpensive and reliable method for screening glucocorticosteroid formulations for clinical activity in psoriasis. (Arch Dermatol1985;121:63-67)
191 citations
TL;DR: These clinical, histologic, and biochemical findings provide useful guidelines to differentiate CIE from LI and strongly suggest that autosomal recessive primary ichthyosis comprises two distinct diseases.
Abstract: • Nonbullous congenital ichthyosiform erythroderma (CIE) and classic lamellar ichthyosis (LI) can be distinguished by clinical, histopathologic, and biochemical findings reported herein. Whereas all patients with CIE (n = 12) had fine white scales, they were heterogeneous with respect to degree of erythroderma, ectropion, and prognosis. In contrast, all patients with LI (n = 6) had large, dark, platelike scales, severe ectropion that showed no improvement with age, and minimal erythroderma. Although the stratum corneum of patients with LI was two to three times thicker than that of those with CIE, the latter group demonstrated more acanthosis, parakeratosis, hypergranulosis, and less prominent dermal capillaries. Studies of scale-lipid content have indicated biochemical correlates of this clinical heterogeneity. These clinical, histologic, and biochemical findings provide useful guidelines to differentiate CIE from LI and strongly suggest that autosomal recessive primary ichthyosis comprises two distinct diseases. ( Arch Dermatol 1985;121:477-488)
161 citations
TL;DR: The results indicate that the sun protection factor under ad libitum conditions is only 50% of what would be achieved using a layer thickness of 2 mg/sq cm.
Abstract: • To achieve a good sun protection, a layer thickness of 2 mg/sq cm is often recommended. Fifty individuals were asked to apply five different sunscreens ad libitum. Ten percent dihydroxyacetone was added to the sunscreens in order to make them fluoresce when irradiated with Wood's light. The layer thickness was calculated by dividing the amount applied by the area. The thicknesses of the sunscreen layers varied little between different parts of the body and different brands; in general it was close to 1 mg/sq cm. The corresponding protection factor was measured for two sunscreens on 20 persons. The results indicate that the sun protection factor under ad libitum conditions is only 50% of what would be achieved using a layer thickness of 2 mg/sq cm. ( Arch Dermatol 1985;121:1400-1402)
151 citations
TL;DR: The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi.
Abstract: • Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type"). There were 47 invasive melanomas, two in situ melanomas, and three severe focal melanocytic dysplasias. All melanomas were of "epidermal" origin and primarily of the superficial spreading type. The age at diagnosis ranged from 18 to 79 years. Prepubertal melanomas were not observed. Melanoma may also arise on small CMN. The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi. ( Arch Dermatol 1985;121:1274-1281)
144 citations
TL;DR: This study reviews 39 cases of anogenital bowenoid papulosis lesions in 22 individuals of both sexes that were analyzed clinically, histologically, immunocytochemically, and virologically for papillomavirus-specific sequences.
Abstract: † This study reviews 39 cases of anogenital bowenoid papulosis lesions in 22 individuals of both sexes that were analyzed clinically, histologically, immunocytochemically, and virologically. Macroscopically, three different types of lesions were demonstrated: erythematous macules; papules (lichenoid and/or pigmented papules); and leukoplakialike lesions. Microscopically, bowenoid papulosis fulfills the criteria of a squamous cell carcinoma in situ. Much like oral precancers, three distinct growth patterns (flat, endophytic, and exophytic) could be differentiated, which did not correlate with the clinical aspect of the lesions. In only two (5.12%) of the 39 cases of bowenoid papulosis could structural antigens of papillomaviruses be detected immunocytochemically (peroxidase-antiperoxidase technique). The DNA from 12 lesions that were analyzed for the presence of papillomavirusspecific sequences hybridized stringently in all cases with the human papillomavirus 16 specific DNA probe labeled with phosphorus 32. ( Arch Dermatol 1985;121:858-863)
144 citations
TL;DR: A time course study of transepidermal water loss and functional analysis of stratum corneum by an in vivo water sorption-desorption test performed on the experimentally induced scaly lesions after adhesive-tape stripping demonstrated that such pathologic stratum Corneum is characterized by a water-holding defect that is associated with increased TEWL.
Abstract: • Scaly skin lesions are caused by decreased water content of the stratum corneum, despite the well-known fact that they usually show increased water passage. By performing simultaneous measurements of transepidermal water loss (TEWL) to check the water-barrier function of the stratum corneum and cutaneous conductance to the high-frequency electric current of 3.5 MHz, which is an indicator of skin-surface hydration state, in patients with psoriasis who had lesions of various grades of severity, we obtained data indicating that there is an inverse relationship between these functions of the stratum corneum. Furthermore, a time course study of TEWL and functional analysis of stratum corneum by an in vivo water sorption-desorption test performed on the experimentally induced scaly lesions after adhesive-tape stripping demonstrated that such pathologic stratum corneum is characterized by a water-holding defect that is associated with increased TEWL. ( Arch Dermatol 1985;121:642-645)
142 citations
TL;DR: A 29-year-old Haitian man with the acquired immune deficiency syndrome (AIDS) developed disseminated cryptococcosis with an unusual cutaneous presentation that clinically resembled molluscum contagiosum.
Abstract: • A 29-year-old Haitian man with the acquired immune deficiency syndrome (AIDS) developed disseminated cryptococcosis with an unusual cutaneous presentation. He had numerous hypopigmented papules over his face that clinically resembled molluscum contagiosum. To our knowledge, cutaneous cryptococcosis resembling molluscum contagiosum has not been previously reported. The patient had a T-cell defect consistent with AIDS and belonged to a high-risk group. To our knowledge, this is the second report of cutaneous cryptococcosis in a patient with AIDS. (Arch Dermatol1985;121:901-902)
135 citations
TL;DR: A 1-year-old Japanese girl who, since birth, has had three nevoid skin disorders: nevus flammeus, neVus spilus, and aberrant mongolian spots is described.
Abstract: • Phakomatosis pigmentovascularis was first reported in 1947. We describe a 1-year-old Japanese girl who, since birth, has had three nevoid skin disorders: nevus flammeus, nevus spilus, and aberrant mongolian spots. No systemic disease of any kind has been present. We believe that this phakomatosis, which we have named phakomatosis pigmentovascularis type IVa, does not reflect the merely coincidental coexistence of three kinds of nevi. ( Arch Dermatol 1985;121:651-655)
128 citations
TL;DR: The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi.
Abstract: Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type"). There were 47 invasive melanomas, two in situ melanomas, and three severe focal melanocytic dysplasias. All melanomas were of "epidermal" origin and primarily of the superficial spreading type. The age at diagnosis ranged from 18 to 79 years. Prepubertal melanomas were not observed. Melanoma may also arise on small CMN. The most frequent origin of the melanomas in small CMN and the preferred age at manifestation seem to be different from that for giant nevi.
127 citations
TL;DR: Five patients with severe drug-induced toxic epidermal necrolysis improved rapidly after one to two plasma exchanges, and a controlled clinical trial to evaluate the effectiveness of plasma exchange would seem worthwhile.
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)
119 citations
TL;DR: Two histologic features were particularly notable in view of the clinical findings: vasculitis extending deep into the reticular dermis or subcutaneous tissue seemed to be associated more often with systemic disease such as malignancy or connective tissue disease, and the inflammatory infiltrate in patients with hypocomplementemia was composed almost exclusively of neutrophils.
Abstract: • Clinical and histopathologic features of 101 cases of necrotizing vasculitis were selected on the basis of the following histopathologic criteria: fibrinoid necrosis of blood vessel walls, endothelial cell hyperplasia, and an infiltrate within and around the blood vessel walls predominantly of polymorphonuclear leukocytes. There were three clinical patterns of vasculitis: (1) associated with other coexistent disease, (2) associated with known precipitating events, and (3) idiopathic. Two histologic features were particularly notable in view of the clinical findings. First, vasculitis extending deep into the reticular dermis or subcutaneous tissue seemed to be associated more often with systemic disease such as malignancy or connective tissue disease. Second, in biopsy specimens from patients with hypocomplementemia, the inflammatory infiltrate was composed almost exclusively of neutrophils, as compared with the mixed infiltrate seen in normocomplementemic vasculitis. ( Arch Dermatol 1985;121:220-224)
TL;DR: Review of the medical literature shows a high association between SPG and DIC, and Symmetrical peripheral gangrene should be considered a cutaneous marker of DIC.
Abstract: † Symmetrical peripheral gangrene (SPG) is a rare syndrome associated with a multitude of underlying medical problems. We are adding three cases of SPG to the medical literature, all of which had disseminated intravascular coagulation (DIC). Each had an underlying illness that, to our knowledge, has not been previously associated with SPG: Hodgkin's lymphoma,Escherichia coliurinary tract infection with septicemia, and polymyalgia rheumatica. Review of the medical literature shows a high association between SPG and DIC. Symmetrical peripheral gangrene should therefore be considered a cutaneous marker of DIC. Early recognition and treatment of the underlying medical problem and DIC could be lifesaving. (Arch Dermatol1985;121:1057-1061)
TL;DR: A family with typical epidermodysplasia verruciformis in which only male members are affected suggests that the persistent high clinical susceptibility to HPV infection characteristic of EV may result from defects in either of at least two different genetic loci, one of which may be located on the X chromosome.
Abstract: † We describe a family with typical epidermodysplasia verruciformis (EV) in which only male members are affected. Whereas none of the index patient's ten children have EV, four of eight grandsons born to his daughters have inherited the disorder. All are infected with human papillomavirus (HPV) 3 and HPV 8. The inheritance in this kindred most likely results from an X-linked recessive genetic defect. Since other kindreds have been described with autosomal inheritance, this novel inheritance pattern suggests that the persistent high clinical susceptibility to HPV infection characteristic of EV may result from defects in either of at least two different genetic loci, one of which may be located on the X chromosome. (Arch Dermatol1985;121:864-868)
TL;DR: In vitro, both wavelengths performed comparably, removing tissue precisely and cleanly, and leaving minimal thermal damage to the surrounding tissue, and the krypton-fluoride excimer laser beam at 248 nm has great potential as a surgical instrument.
Abstract: • We report on the use of pulsed ultraviolet-laser irradiation at 193 nm from an argon-fluoride laser and at 248 nm from a krypton-fluoride laser to ablate skin. In vitro, both wavelengths performed comparably, removing tissue precisely and cleanly, and leaving minimal thermal damage to the surrounding tissue. In vivo, the 193-nm laser radiation failed to remove tissue after bleeding began. The 248-nm radiation, however, continued to remove tissue despite bleeding and left a clean incision with only minimal thermal damage. The krypton-fluoride excimer laser beam at 248 nm, which should be deliverable through a quartz optical fiber, has great potential as a surgical instrument. ( Arch Dermatol 1985;121:609-617)
TL;DR: Results indicate that wheat allergens are reinforced in the stomach and destroyed in the jejunum, and type I hypersensitivity to wheat is confirmed.
Abstract: • Six patients had type I hypersensitivity to wheat. Three cases were exercise-induced anaphylaxis to wheat, one was exercise-induced urticarial reaction to wheat (with angioedema), and the remaining two were exercise-accentuated urticarial reaction to wheat. Elimination of wheat from the diet completely cleared these symptoms. Allergens were prepared from wheat, gluten, gliadin, and glutenin by simple extraction and enzyme digestion, and these preparations were used in skin tests. The allergens obtained from gluten, gliadin, and glutenin by pepsin digestion were qualitatively different from wheat and gluten allergens obtained by simple extraction and were more related to exercise-induced anaphylaxis. Trypsin digestion showed no such effect and abolished all these allergens. These results indicate that wheat allergens are reinforced in the stomach and destroyed in the jejunum. ( Arch Dermatol 1985;121:355-360)
TL;DR: Skin biopsy specimens and discolored fingernails from minocycline-treated patients were examined and Elemental analysis showed that both pigment deposits and stratum corneum of hyperpigmented skin samples contained iron and calcium.
Abstract: Skin biopsy specimens and discolored fingernails from minocycline-treated patients were examined by light and electron microscopy, histochemistry, and energy-dispersive x-ray analysis. Both hyperpigmented and adjacent normally pigmented skin samples contained pigment-laden macrophages in the dermis, although these cells were more numerous in the hyperpigmented skin samples. Elemental analysis showed that both pigment deposits and stratum corneum of hyperpigmented skin samples contained iron and calcium. Discolored areas of fingernails from a minocycline-treated patient also contained iron and calcium. Both skin and nail discoloration were possibly due to the presence of an iron chelate of minocycline and/or quinoid derivatives of minocycline. The presence of iron-containing pigment in normal as well as hyperpigmented skin may have predisposed to formation of minocycline-associated pigment in these patients.
TL;DR: Differences found between the nevi from pregnant and control women suggest that a mild degree of histopathologic atypia or "activation" is associated with pregnancy, however, in the population studied, these changes were never of sufficient degree to result in diagnostic confusion.
Abstract: • A detailed histopathologic study was performed on 128 nevi removed from 86 pregnant white patients. None of the patients had clinical evidence of the dysplastic nevus syndrome, and none of the excised nevi were clinically suspicious for melanoma. One third of patients reported some change in nevi during pregnancy. Nevi from an age-matched male control population (50 patients) had a spectrum of histologic features essentially identical to the pregnant patients, while nevi from a female control population (51 patients) showed slightly less atypia according to our criteria. The differences found between the nevi from pregnant and control women suggest that a mild degree of histopathologic atypia or "activation" is associated with pregnancy. However, in the population studied, these changes were never of sufficient degree to result in diagnostic confusion. ( Arch Dermatol 1985;121:350-354)
TL;DR: The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area.
Abstract: A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.
TL;DR: The results of this study can be used neither to support nor to refute a histologic association between cutaneous melanoma and congenital NMN, as well as a precise estimate of predictive value for diagnosing a given NMN as congenital or acquired based on histologic features alone.
Abstract: • A reliable microscopic differentiation of nevomelanocytic nevi (NMNs) as congenital or acquired would be useful in defining a histogenic relationship between cutaneous melanoma and congenital NMN. In order to delineate histologic differences between congenital NMN and acquired NMN, a standardized assessment was conducted blindly, using a sample of consecutive surgical specimens of NMN submitted to a children's hospital pathology file. Despite significant histologic differences between congenital NMN and acquired NMN, the lack of a reliable prevalence rate for the proportion of congenital NMNs among all NMN specimens submitted for pathologic examination precludes a precise estimate of predictive value for diagnosing a given NMN as congenital or acquired based on histologic features alone. The results of this study can be used neither to support nor to refute a histologic association between cutaneous melanoma and congenital NMN. (Arch Dermatol1985;121:1266-1273)
TL;DR: A differential modulation of connective tissue metabolism by retinoids in keloid cell cultures is indicated, indicated by the results demonstrated that collagen production was markedly reduced in cultures treated with either one of theretinoids.
Abstract: • Recent observations have suggested that retinoids might affect the metabolism of the extracellular matrix of connective tissues. In this study, we examined the effects of tretinoin (all- trans -retinoic acid) and isotretinoin (13- cis -retinoic acid) on the production of procollagen in keloid fibroblast cultures that were characterized by enhanced procollagen synthesis in vitro. The activities of three enzymes relevant to connective tissue metabolism, prolyl hydroxylase, collagenase, and an elastaselike neutral protease were also determined. The results demonstrated that collagen production was markedly reduced in cultures treated with either one of the retinoids. The activity of prolyl hydroxylase, a key enzyme in the intracellular biosynthesis of collagen, was not affected, while the production of collagenase was markedly reduced by the retinoids. In contrast, the activity of an elastaselike neutral protease in the cell culture medium was markedly enhanced by both retinoids. The results, therefore, indicate a differential modulation of connective tissue metabolism by retinoids in keloid cell cultures. ( Arch Dermatol 1985;121:632-635)
TL;DR: Two patients had pitch-black pigmentation and colloid milium formation following the use of 2% hydroquinone-containing bleaching creams, among the first known cases in American blacks, although this phenomenon has been recognized previously in African blacks.
Abstract: Two patients had pitch-black pigmentation and colloid milium formation following the use of 2% hydroquinone-containing bleaching creams. These are among the first known cases in American blacks, although this phenomenon has been recognized previously in African blacks. Ultrastructural studies indicated that the pigment was due to the formation of elastotic fibers. These fibers attained an enormous size and disintegrated, leaving irregular fibers and fragments dispersed in the dermis. It is important that this clinical picture be recognized, since the use of these bleaching creams is widespread.
TL;DR: Skin biopsy material from three family members of a Palestinian kindred with a multisystem disorder of altered lipid metabolism, ichthyosis, and deposition of fat droplets in multiple tissues is examined to provide strong support for the concept that lamellar body-derived lipids influence stratum corneum desquamation and suggest that abnormalities of neutral lipid-alkane metabolism influence normal epidermal shedding.
Abstract: Although the link between epidermal lamellar body lipids and stratum corneum barrier function is well established, a role for lamellar body lipids in desquamation remains unproved. We examined skin biopsy material from three family members of a Palestinian kindred with a multisystem disorder of altered lipid metabolism, ichthyosis, and deposition of fat droplets in multiple tissues (Chanarin-Dorfman syndrome, neutral lipid storage disease). Thin-section and freeze-fracture ultrastructural studies revealed a distinctive lamellar body abnormality: multilaminated spherules that distorted and displaced the normal internal disk structure of these organelles. Whereas these spherules remained interspersed with secreted lamellar body contents within the intercellular spaces of the outer epidermis, at the stratum granulosum-stratum corneum interface they apparently dispersed into electron-lucent "slits." These studies therefore provide strong support for the concept that lamellar body-derived lipids influence stratum corneum desquamation and further suggest that abnormalities of neutral lipid-alkane metabolism influence normal epidermal shedding.
TL;DR: Seven cases of transient acantholytic dermatosis (Grover's disease) are reported to exemplify a causal association with heat and sweating.
Abstract: • We report seven cases of transient acantholytic dermatosis (Grover's disease) to exemplify a causal association with heat and sweating. The excessive heat and sweating was related to the use of a hot tub, a hot water bottle, a steam bath, an electric blanket, the prolonged wearing of a polyester suit, and postoperative bed confinement. (Arch Dermatol1985;121:1439-1441)
TL;DR: To determine the clinical prevalence of medium-sized congenital-nevus-like nevi (CNLN), a consecutive series of 601 patients had total cutaneous examinations and nevi spili and café au lait spots were found, suggesting that these are different types of lesions.
Abstract: • To determine the clinical prevalence of medium-sized (1.5- to 19.9-cm-diameter) congenital-nevus-like nevi (CNLN), a consecutive series of 601 patients (mostly adults) had total cutaneous examinations. In this series, 15 (2.5%) were found to have such lesions. In addition, 14 (2.3%) had nevi spili and 83 (13.8%) had cafe au lait spots. All three types of lesions were equally represented in both sexes and tended to spare the head, neck, and upper extremities. Compared with CNLN, nevi spili were found to have significantly larger diameters and lower mean age, suggesting that these are different types of lesions. Some recommend the surgical removal of all congenital nevocytic nevi because of their malignant potential. Since it is not possible to clinically distinguish congenital nevocytic nevi and CNLN and since the observed prevalence of these lesions in adults is over four times that previously reported in newborns, such a recommendation becomes less feasible. ( Arch Dermatol 1985;121:766-769)
TL;DR: Ichthyosis follicularis with alopecia and photophobia appears to be a familial disorder, but too few cases have been reported to establish the exact mode of inheritance.
Abstract: • We treated two unrelated boys with ichthyosis follicularis, a rare skin disorder characterized by extensive noninflammatory spiny follicular hyperkeratoses, severe photophobia, and generalized noncicatricial alopecia. This disorder must be differentiated from keratosis follicularis spinulosa decalvans; ulerythema ophryogenes; keratosis pilaris rubra atrophicans faciei; atrichia with papular lesions; atrophodermia vermiculata; and keratitis, ichthyosis, and deafness syndrome, all of which share some clinical features. Ichthyosis follicularis with alopecia and photophobia appears to be a familial disorder, but too few cases have been reported to establish the exact mode of inheritance. (Arch Dermatol1985;121:1167-1174)
TL;DR: Patients described as having lamellar ichthyosis (LI) may not all have the same disorder, and the hypothesis that LI and CIE are separate disorders is supported.
Abstract: • Patients described as having lamellar ichthyosis (LI) may not all have the same disorder. We studied nine patients, four of whom had erythroderma and generalized fine scaling, while the remainder had more marked scaling and hyperkeratosis without erythema. The former group is referred to as having nonbullous congenital ichthyosiform erythroderma (CIE), and the other is said to have LI. The clinical differences were paralleled by cell kinetic and histologic differences. The mean tritiated thymidine autoradiographic labeling indices were 9.36 ± 4.05 and 19.70 ± 5.84 for the LI and CIE groups, respectively. The histologic differences were delineated using 10-cm analogue scales and showed statistically significant differences for hyperkeratosis and parakeratosis. These data support the hypothesis that LI and CIE are separate disorders. ( Arch Dermatol 1985;121:489-493)
TL;DR: The preponderance of data from the literature, supported by this study, indicates that regression has no prognostic importance in the vast majority of thin melanomas, and observations to suggest that in rare cases, regression may negate the prognostic value of microstaging of a thin melanoma.
Abstract: Forty-eight malignant melanomas of the extremities, 1 mm or less in maximal thickness, were studied to better define microscopic criteria of regression in thin melanomas. Eleven tumors (23%) exhibited definite regression in the form of one or more segmental areas (defects) where the invasive component was replaced by mononuclear cell infiltrate and fibrosis. Thirteen other tumors (27%) had diffuse, nonsegmental changes classified as probable regression. Nineteen lesions (40%) lacked regression, although 14 of these contained focal evidence of host response. Five melanomas (17% of lesions less than 0.75 mm thick) were equivocal for regression. There were no recurrences or metastases. The histologic diagnosis of regression in thin melanomas requires subjective judgments, but segmental defects represent a potentially reproducible criterion. Their width can be measured, and the proportion of the melanoma that has undergone regression can be estimated. The preponderance of data from the literature, supported by this study, indicates that regression has no prognostic importance in the vast majority of thin melanomas. There are observations, however, to suggest that in rare cases, regression may negate the prognostic value of microstaging of a thin melanoma. To date, the type and extent of such regressive changes have not been adequately defined.
TL;DR: Several years after postmastectomy radiation therapy, lichen sclerosus et atrophicus (LSA) developed in two patients within the radiation fields, suggesting LSA might be an isomorphic response to the trauma of radiation therapy.
Abstract: • Several years after postmastectomy radiation therapy, lichen sclerosus et atrophicus (LSA) developed in two patients within the radiation fields. This sequence, to our knowledge, has not previously been described. The etiology of LSA is largely unknown, but trauma has been implicated as a provoking factor in some cases, and LSA might be an isomorphic response to the trauma of radiation therapy. ( Arch Dermatol 1985;121:1044-1047)
TL;DR: A black male newborn delivered by cesarean section developed large bullae on his extremities and in other friction areas soon after birth, which revealed a subepidermal bulla that was ultrastructurally a subbasal lamina separation.
Abstract: • A black male newborn delivered by cesarean section developed large bullae on his extremities and in other friction areas soon after birth. No significant family history was obtained. The bullae healed rapidly, leaving hypopigmentation but no scars or milia. Occasional new lesions continued to appear for four months but not after. Reexamination 12 months later showed a normal healthy infant with only residual hypopigmentation in some of the previously involved areas. Histologic and electron microscopic examinations revealed a subepidermal bulla that was ultrastructurally a subbasal lamina separation. Collagenolysis and damage to the anchoring fibrils were found to be responsible for this separation. Perifollicular collagen sheath was also damaged, but periductal collagen of eccrine duct was intact. Keratinocytes in the lower epidermis showed large, dilated rough endoplasmic reticulum (RER), which contained electron-dense stellate bodies. The contents of these RER vacuoles were discharged into the papillary dermis through the rupture of the basal lamina. The number and size of RER vacuoles in the lower epidermis correlated with the severity of collagenolysis in the underlying papillary dermis. The outer root sheath keratinocyte in the upper hair follicle contained RER vacuoles, but the eccrine duct keratinocyte did not. We suspected that the RER vacuoles contained proteolytic enzymes, which were responsible for the collagenolysis. ( Arch Dermatol 1985;121:1429-1438)
TL;DR: In the armamentarium of systemic antimicrobials used to treat the more severe forms of acne, minocycline holds a prominent position and the finding of particles with positive iron-staining characteristics within macrophages in the affected tissue has been a consistent observation of most investigators.
Abstract: In the armamentarium of systemic antimicrobials used to treat the more severe forms of acne, minocycline holds a prominent position. Generally considered more effective than the first-line antibiotics, tetracycline and erythromycin, 1-3 minocycline is often administered at various dosages over relatively long periods of time to patients with acne who have not responded to more conservative regimens. A small number of these patients may eventually exhibit the unique, yet dramatic, complication of darkly pigmented staining of various body tissues, especially the skin. Since it was brought to the attention of the medical community in 1978, 4-6 minocycline-related pigmentation of the skin has been described in a variety of forms, and involvement of other organs has been reported as well. The finding of particles with positive iron-staining characteristics within macrophages in the affected tissue has been a consistent observation of most investigators and has been reproduced in the sophisticated studies of