Showing papers in "British Journal of Dermatology in 1968"

Generalized pustular psoriasis. A clinical and epidemiological study of 104 cases.

Abstract: SUMMARY.— A series of 104 cases of generalized pustular psoriasis has been studied. The syndrome occurs predominantly in the second half of life, affecting both sexes. Two quite distinct sub-groups were discernible. In the first the pre-pustular phase of psoriasis began early in life, was typical through-out and was prolonged. At least one third of these cases were apparently precipitated by the withdrawal of systemic corticosteroid therapy. Others were provoked by pregnancy or infection. It is likely that this type is usually extraneously provoked. In the second, the psoriasis was of late onset and atypical, acral or flexural patterns predominating in the pre-pustular phase. In these progress to generalized pustular disease was rapid and apparently spontaneous. Four clinical patterns of generalized pustular phase were apparent and have been named the Zumbusch, annular, localized and exanthematic types. The Zumbusch type was characterized by widespread fiery erythema, sheeted pustulation and scarlatiniform peeling, accompanied by malaise, fever and often leucocytosis. The annular type was a more low-grade sub-acute affection characterized by gyrate and annular pustular lesions and little systemic disturbance. The exanthematic type arose de novo, usually as a single short-lived episode following infection or drug exposure. In the localized type restricted areas of pustular psoriasis developed in and around ordinary psoriatic plaques. Two thirds were erythrodermic at some stage and one third had polyarthritis. Oral lesions occurred in 5 and hypocalcaemia in 5 during pustular phases. The different clinical patterns of pustular psoriasis have been interpreted in terms of the balance between vascular hypertrophy, epidermopoiesis and leucocytic immigration into the epidermis.

Vitiligo, thyroid disease and autoimmunity

Abstract: SUMMARY There is a significant association between vitiligo and thyroid disease Thyroglobulin antibodies are significantly associated with vitiligo, whether patients with psoriasis or a general practice population are taken as controls Similarly complement-fixing antibodies are significantly associated with vitiligo as compared with psoriasis There is no evidence that thyroid autoimmunity is associated positively or negatively with psoriasis Alopecia areata, pernicious anaemia and diabetes mellitus are also significantly associated with vitiligo

Immunopathological investigations in the Senear-Usher syndrome (coexistence of pemphigus and lupus erythematosus).

Abstract: SUMMARY.— In 5 of 6 cases of the Senear-Usher syndrome, in skin specimens from erythematous facial lesions, the immunofluorescence method demonstrated immunoglobulins and in vivo-fixed complement in the dermoepidermal junction, which is a finding characteristic of lupus erythematosus. Antibodies against nuclei were also present in all but one case, and in one there was coexistent systemic lupus erythematosus with positive LE phenomenon. In all 6 cases of the SU syndrome the presence of IgG as well as C′3a, C′4 was demonstrated in the intercellular spaces of the epidermis; this is a finding characteristic of pemphigus. In 6 cases of pemphigus vulgaris, which served as controls, neither immuno-globulins nor in vivo-fixed complement could be demonstrated in the dermoepidermal junction. These investigations suggest that the SU syndrome could, at least in the vast majority of cases, result from the coexistence of pemphigus and lupus erythematosus.

The mechanism of water binding in stratum corneum

Abstract: SUMMARY.— The results presented in this paper confirm the published observations by others that the hygroscopic water-soluble substances within the corneum are responsible for much of the water binding ability of the horny layer. The ability of corneum to bind water is reduced when it is extracted with solvents, which remove lipid, and then with water, which removes the water-soluble substances. Our interpretation of this is that the water-soluble substances are retained within the corneum by a lipid-containing semipermeable membrane system which allows these substances to take up water by osmosis and protects them from dissolution when the intact corneum is immersed in water. Our experiments show that isolated corneum from guinea-pig footpads and from human palms, soles and abdomen can take up and lose water by osmosis. Powdering the corneum allows water to extract the water-soluble substances without a prior solvent extraction. The powdering procedure ruptures the cell walls of the corneum cells and we propose that it is the cell walls which make up the lipid containing semi permeable membrane system. A method for measuring extensibility of isolated strips of corneum in a humid atmosphere has been developed. Using this technique it has been shown that it is the water held by the water-soluble substances that is responsible for most of the extensibility of corneum.

Dermatological manifestations of crohn's disease*

Abstract: SUMMARY— A part from occasional case reports Crohn's disease has received little attention in the dermatological literature. Of 138 cases studied 44% were found to suffer from skin complications including abscess formation and ulceration in the peri-anal regions, groins or anterior abdominal wall. Less frequent were erythema nodosum, pyoderma gangrenosum and the skin manifestations of a malabsorption syndrome. The literature on the pathology and clinical features of Crohn's disease is briefly reviewed. The skin complications encountered are described, and their diagnostic importance is emphasized since their onset may precede any clinical manifestations of intestinal disturbance.

Concepts in the pathogenesis of rosacea.

Abstract: SUMMARY. Ninety-two patients with rosacea have been studied in order to test, where necessary against control subjects, certain widely accepted hypotheses concerning its cause. No evidence was found that bacteria are implicated as a factor in papular rosacea. Rosacea patients were not found to have a personality disorder, but when tested by a neuroticism proforma were found to be more depressed than control subjects. The depression was regarded as a reaction to the cosmetic disability. There was no evidence that rosacea is linked to disorder of the gastrointestinal tract. Rosacea is not related to the seborrhoeic diathesis. There is no evidence of any important structural or functional abnormality of the small blood vessels of the face. Rosacea patients were not found to be more exposed than controls to climatic extremes. Histologically rosacea appears not to be primarily a folliculitis. Solar elastosis is often conspicuous and disorganization and atrophy of the upper dermis are frequent. The significance of these changes is uncertain. The cause of rosacea remains unknown.

Chronic hyperplasttc candidiasis—candidal leukoplakia

Abstract: SUMMARY. Twelve cases of chronic hyperplastic candidiasis of the oral mucosa are described. Clinically the lesions could not be reliably differentiated from “leukoplakia” due to other causes. All but 2 of the patients were otherwise healthy. The histological appearances were distinctive: there was invasion by hyphae of C. albicans of the superficial epithelium of an acanthotic and parakeratotic plaque, associated with a characteristic intraepithelial inflammatory reaction. In 9 cases the antibody titres to C. albicans in serum and saliva supported a diagnosis of candidiasis. The response of the lesions to oral Nystatin was good in 3 cases and incomplete in 4. The evidence that C. albicans plays an essential causative rather than a secondary role is critically discussed. Recognition of chronic hyperplastic candidiasis from other “leukoplakias” is of practical importance since this condition is potentially reversible by medical treatment.

The pathogenesis of alopecia areata

Abstract: SUMMARY.— The pathogenesis of alopecia areata was studied by plucking hairs from each of a series of concentric zones, using felt patterns placed over lesions. It was possible to group lesions according to the zone with the greatest proportion of club hairs. The results are logically interpreted to mean that a wave of hair follicle damage or arrest moves centrifugally from a focal point beyond the area of alopecia. It is suggested that follicles may react in I of 3 ways. Firstly, severe damage may weaken the hair in the keratogenous zone, this being followed by breakage when the weak zone reaches the plane of the scalp; at the same time the follicle is precipitated into catagen and the hair is extruded as an exclamation mark. Secondly, the follicle may be precipitated into catagen with loss of the club in a normal manner, followed by replacement with a dystrophic anagen hair. Thirdly, the follicle may become dystrophic without a catagen phase.

Pyogenic granuloma recukring with multiple satellites

Abstract: SUMMARY— Pyogenic granuloma is a common lesion which seldom arouses much concern The eruption of multiple angiomatous satellites around the site of a recently treated pyogenic granuloma is a rare and alarming occurrence Eleven such cases are reported and the literature is reviewed The clinical and histological features of the recurrent lesions are described The recurrences run a benign course and there is no evidence that the satellites are metastases The pathogenesis of pyogenic granuloma is considered in relationship to other connective tissue proliferative conditions and the control of the microcirculation

Tuberculosis of the skin in hong kokg (a review of 160 cases)

Abstract: SUMMARY.— 160 cases of tuberculosis of the skin seen in the Government Dermatological Clinics in Hong Kong are reviewed. Tuberculosis verrucosa was the commonest form and accounted for 46% of cases. The onset was below the age of 20 in 77% of these patients. The distribution of the lesions differed from that reported by most recent authors. The knees, thighs and buttocks were commonly affected. In 3 of 9 cases of papulonecrotic tuberculid in men the penis was involved. The degree of sensitivity to tuberculin appeared to be similar in all forms of cutaneous tuberculosis. Pulmonary infection was associated in about 10% of cases of cutaneous tuberculosis. The factors possibly responsible for the differences between the present and other series of cases are briefly discussed.

Cell replacement in the human stratum corneum in old age.

Abstract: SUMMARY. Staining of the human stratum corneum in vivo with fluorescent tetrachlorsalicylanilide has been used to measure the transit time of horny cells in the normal forearm skin of aged people. Stratum corneum thickness was estimated by counting the horny cell layers in biopsy specimens of epidermis, visualized by hydration in alkali. From the two parameters thus obtained, stratum corneum replacement rates were: calculated. In 6 aged men, transit times varied between 20 and 36 (mean 26) days, and replacement rates between 30 and 47 (mean 34) hr. per cell layer. These data suggest reduced epidermal mitotic activity compared with that of young men. In 5 aged women, transit times varied between 17 and 26 (mean 20) days and replacement rates between 16 and 31 (mean 24) hr. per cell layer. This faster replacement in old women compared with old men is not much slower than that observed in young adults.

Further observations on acute febrile neutrophilic dermatosis

Abstract: SUMMARY.— Some points of interest are discussed from studies of 4 more cases of acute febrile neutrophilic dermatosis, including the histology of a very early lesion. The belated recognition of similar microscopical appearances in a striking, localized lesion on a lady's face led to her successful treatment. It is suggested that this lesion may have been the result of a localized immune reaction similar to that occuring over wide areas in acute febrile neutrophilic dermatosis.

Some clikical aspects of cholhstergic urticaria

Abstract: SUMMARY.— Clinical observations are made on a series of 22 patients with cholinergic urticaria, representing 0·2% of total referrals to dermatological out-patients and 7% of patients with urticarial eruptions. The average age of onset was 16 and the average duration 7·5 years. The weals are widely scattered and although some coincide with follicles, others arise between them. The precipitating factors are discussed, particularly in relation to water contact; it is concluded that this acts only when heat or exercise are coincident. The fact that the same precipitating factors can play a part in other physical urticarias often leads to confusion in diagnosis. Treatment is briefly discussed and a double blind comparison of hydroxyzine with antihistamine therapy in 14 patients is described; hydroxyzine was preferred in 8 patients.

Delayed pressuke urticaria

Abstract: SUMMARY. Delayed pressure urticaria in 15 patients has been investigated. It is characterized by the development of deep painful swelling 4–6 hours after pressure has been applied to the skin. It is sometitnes accompanied by systemic manifestations such as a leucocytosis and rigors. Delayed pressure urticaria is unaffected by antihistamines but it is controlled by steroids. The injection into the skin of saline and various pharmacological agents also causes delayed wealing. Prior treatment of the skin with 48/80 prevents the reaction. Immunofluorescent studies showed that the affected tissues contained no excess fibrinogen, immunoglobulins or complement. It is suggested that delayed pressure urticaria is related to delayed dermographism and may be due to a disorder of kinin activity. The timing and depth of the changes in vascular permeability characteristic of urticaria can be correlated. They are influenced by many mediators and by the pattern of the vasculature of the skin. A change in the timing or depth of the urticaria is the most that should be expected from the use of a single pharmacological agent in the treatment of urticaria.

Vitiligo in mature-onset diabetes mellitus.

Abstract: SUMMARY. —A study has been made on the incidence of vitiligo in mature-onset diabetics attending hospital. An increased incidence of vitiligo was found in the whole group of diabetics, and in the female diabetics, when compared with controls. In more than half the patients with both vitiligo and diabetes, the vitiligo preceded the diabetes. Vitiligo begins before the age of 40 in over 80% of all cases but did so in only 24% of 25 diabetics with vitiligo.

The diurnal mitotic rhythm in the human epidermis1

Abstract: SUMMARY. —A diurnal mitotic rhythm is found in the human epidermis varying from 0·1 to 0·9 mitoses per one thousand viable epidermal cells, with a peak at 1 a.m. Sustained exercise is shown to have a profound effect on mitosis, almost completely inhibiting it. From a consideration of this and other work it is suggested that the diurnal rhythm is due to variation in the level of the corticosteroid hormones, and that adrenalin produces an additional effect during exercise

Lupus erythematosus profundus.

Abstract: SUMMARY —The clinical and histological features of 6 cases of lupus erythematosus (LE) profundus are described The disease was chronic with crops of subcutaneous nodules, usually on the head and arms, that healed with deep scarring Signs of classical discoid LE were usually few and delayed The histology showed a characteristic lower dermal and subcutaneous necrobiosis with some vasculitis and a striking lack of cellular response The dying collagen showed overlapping types of change; in some areas it stained faintly and was swollen whilst still retaining some fibrillary structure; in others it was replaced by an eosinophilic material that was either in homogenous puddles or broken into amorphous clumps The differentiation of these changes from other forms of panniculitis is discussed and it is concluded that the changes are usually sufficiently distinctive to make a diagnosis possible in what may clinically be a perplexing disease

Necrotising vasculitis associated with lethal reticuloendothelial diseases

Abstract: SUMMARY Three cases are reported of necrotising vasculitis occurring with or preceding the onset of a malignant reticular disease The vasculitis occurred at about the time lymphosarcoma was diagnosed in one patient who had received penicillin In a second patient the appearance of vasculitis preceded the diagnosis of Hodgkin's granuloma by 2 months And in a third patient, vasculitis was present about 6 years prior to the development of possible multiple myeloma These cases emphasize that vasculitis and lymphoma may coexist The clinician must be alert to the possibility of the development of lymphoma in patients with necrotising vasculitis of chronic course Treatment with immunosuppressive drugs in two patients resulted in only temporary improvement, and the skin lesions recurred in spite of continued therapy This raises some doubt concerning the immunological etiology of necrotising vasculitis

Morphology and thickness of the human stratum corneum.

Abstract: SUMMARY.— The method of exhibiting the layers of cells of the stratum corneum described by Kligman and Christophers has been employed and elaborated, and has proved to be practical and reproducible. The cells can be counted and observations made on their morphology. The shape of the cells treated by this method has been shown to be different at various sites and at different levels of the stratum corneum, and in pathological states. The stratum corneum is probably more compact than has been hitherto supposed. Differences in susceptibility to alkali have been demonstrated in the horny cells surrounding the eccrine sweat ducts and the pilosebaceous orifices. There are also age differences in the susceptibility of the stratum corneum to alkali and possibly in its thickness.

The action of chemotherapeutic agents on psoriatic epidermis.

Abstract: SUMMARY. —Mitotic counts and histological features have been studied in 35 psoriatic patients prior to treatment, and during treatment with topically applied fluocinolone acetonide, methotrexate, dithranol and coal tar. Prior to treatment there was considerable variation in the mitotic counts in the 35 biopsies. The granular layer was absent in 10 biopsy specimens, partially formed in small areas in 21, well formed in most areas in 2, and normal in 2. There was no correlation between the mitotic counts and state of the granular layer. With methotrexate and dithranol treatment the granular layer showed improvement prior to a significant fall in the mitotic counts. With fluocinolone acetonide the improvement in the granular layer appeared at the same time as a significant fall in the mean mitotic count, but the granular layer had completely reformed in 7 of the 9 patients while the mitotic count was still considerably raised compared to uninvolved psoriatic skin. With coal tar the results were not uniform; some patients showed a significant fall in mitotic counts prior to improvement in the granular layer and others first showed improvement in the granular layer. It is suggested that in clearing psoriasis these drugs have an action other than, or in addition to, inhibiting mitosis.

Recurrent neutrophilic dermatosis of the face--a variant of Sweet's syndrome.

Abstract: SUMMARY.— A syndrome which he named acute febrile neutrophilic dermatosis was described by Sweet in 1964. Two cases are reported which seem to fall into the same category, but showed recurrent involvement of the face only. One of these patients and another similar case in the literature are the only males so far recorded.

Acquired digital fibrokeratomas.

Abstract: SUMMARY.— Thirty-two cases are reported of the tumour recently described as acquired digital fibrokeratoma. The histological features are described in detail and the differentiation from other superficially similar tumours is emphasized. The possible histogenesis is discussed. Since not all such lesions are on the digits the term acquired fibrokeratoma is suggested as appropriate.

Electron microscopy of the skin in erythropoietic protoporphyria.

Abstract: SUMMARY. —An electron microscopical examination has been made of skin from 4 patients with erythropoietic protoporphyria. Both exposed areas and skin usually covered by clothing were studied. In exposed skin from the knuckle and dorsum of the hand the main abnormality is associated with small blood vessels in the upper part of the dermis. The amorphous material seen on light microscopy is found to consist of a multilayered partially fragmented basement membrane, and finely fibrillar material of moderate electron density which permeates and surrounds the vessel walls. The presence of this substance in the vessel walls and its abrupt junction with the normal dermal connective tissue supports the idea that it is derived from constituents of the blood or from the vessels themselves rather than by degeneration of dermal connective tissue. Nothing abnormal is seen in covered skin from the back.

Erythema elevatum drttinum—vesicular lesions and sulphone response

Abstract: SUMMARY. The clinical and histological features of erythema elevatum diutinum are summarised. Reported cases with bullous or vesicular lesions are reviewed, and previous therapeutic experience is discussed. A case of the bullous form is described. Attacks lasting five months recurred each winter. Dapsone was dramatically effective.

Invasion of the skin by filamentous non-dermatophyte fungi.

Abstract: SUMMARY. —Four cases of invasion of the glabrous skin by filamentous, non-dermatophyte fungi are described. Aspergillus niger was found in the toewebs of 1 patient and Allescheria boydii in those of another. Fusarium solani and F. oxysporum var. redolens were colonising necrotic skin in 2 diabetic patients. It was concluded that in all these cases the fungal invasion was purely saprophytic in nature. The difficulty of discriminating between contamination and saprophytic invasion of the skin by non-dermatophytes is discussed and criteria for making the distinction are suggested.

Skin xanthoma following erythroderma.

Abstract: SUMMARY. Four patients who developed diffuse xanthomatous lesions during the course of chronic dermatoses are described. It is suggested that the association is more than coincidental and is related to the underlying disturbance of the reticulo-endothelial system.

A review of the concept of weber‐christian panniculitis with a report of five cases

Abstract: SUMMARY —Five patients with Weber-Christian panniculitis (WCP) are described These illustrate the great variability of the clinical course of cases to which this diagnosis is applied In two (one fatal) no aetiological factor was found, one case was considered to be an artefact, one was related to tuberculosis and another was possibly a manifestation of systemic lupus erythematosus It is concluded from a survey of the literature and from these 5 cases that WCP is not nosologically distinct and that present terminology suggesting a single disease entity is undesirable A purely descriptive term like nodular panniculitis should be used while a search is made for aetiological factors In some cases these may be found to rest on a vascular basis, possibly the result of an immunological process

Sensitization induced by patch testing.

Abstract: SUMMARY.— Three hundred and seventy-nine patients with hand dermatitis were patch tested with 11 substances on 2 occasions at an interval of 6–21 months. On the first occasion 196 reactions were positive, and 164 of them remained so on the second occasion. In addition, 108 reactions negative on the first occasion were positive on the second. Sensitization was commonly produced by p-aminoazobenzene, p-phenylenediamine, diaminodiphenylmethane, cobalt and chromium. This high incidence of sensitization by patch testing, necessitates re-evaluation of this procedure.

The incidence oe buccal pigmentation in caucasoids and negkoids in bkitain

Abstract: SUMMARY. One hundred consecutive coloured and 100 consecutive white European (light skinned causasoids—LSC) patients were examined to determine the incidence of buccal pigmentation. In the coloured patients it was 38% and in the LSC patients 5%. In these 5 LSC patients general examination and investigation revealed none of the disorders usually associated with buccal pigmentation, which cannot therefore be regarded as necessarily a sign of systemic disease, notably Addison's disease. In coloured patients the presence of buccal pigmentation is rarely of diagnostic significance.