Showing papers in "Journal of The American Academy of Dermatology in 1991"
TL;DR: A subcommittee was established by the National Epidermolysis Bullosa Registry to summarize the current literature and to make recommendations as to the best clinical and laboratory criteria for the practical diagnosis and subclassification of patients with inherited epiderMolysis bullosa.
Abstract: Inherited epidermolysis bullosa encompasses a number of diseases, with the common finding of blister formation, after minor mechanical trauma to the skin. In some forms significant, if not eventually fatal, extracutaneous disease activity may occur. In recent years application of newer technologies has contributed substantially to an overall understanding of this collection of inherited diseases. Concurrently, many new phenotypes have been recognized, in part the result of ongoing prospective patient registries in the United States and abroad. Unfortunately, this has resulted in a massive literature that may appear to be confounded by seemingly excessive or arbitrary subdivision of epidermolysis bullosa variants. With these concerns in mind a subcommittee was established by the National Epidermolysis Bullosa Registry to summarize the current literature and to make recommendations as to the best clinical and laboratory criteria for the practical diagnosis and subclassification of patients with inherited epidermolysis bullosa.
477 citations
TL;DR: The role that hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of this neoplasm are examined.
Abstract: Host-tumor relationships involve several factors that can enhance or suppress neoplastic growth. This second part of a review of basal cell carcinoma biology examines the role that hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of this neoplasm. Theories of etiology and pathogenesis are discussed, and transplantation and cell culture techniques used to study this cancer are explored. Valuable second-line therapies for treatment of multiple tumors are reviewed, and important areas of present and future research are emphasized.
393 citations
TL;DR: Dermatologists in their follow-up of patients with large or multiple congenital melanocytic nevi should be aware of this condition, to aid in prompt diagnosis and because the treatment of cutaneous lesions may be altered in the presence of symptomatic neurocutaneous melanosis.
Abstract: Neurocutaneous melanosis is a rare congenital syndrome characterized by the presence of large or multiple congenital melanocytic nevi and benign or malignant pigment cell tumors of the leptomeninges. The syndrome is thought to represent an error in the morphogenesis of the embryonal neuroectoderm. We review 39 reported cases of neurocutaneous melanosis and propose revised criteria for diagnosis. Most patients with neurocutaneous melanosis presented in the first 2 years of life with neurologic manifestations of increased intracranial pressure, mass lesions, or spinal cord compression. Leptomeningeal melanoma was present in 62% of the cases, but even in the absence of melanoma, symptomatic neurocutaneous melanosis had an extremely poor prognosis. Useful diagnostic procedures include cerebrospinal fluid cytology and magnetic resonance imaging with gadolinium contrast. Patients may be aided by palliative measures such as shunt placement to reduce intracranial pressure. Dermatologists in their follow-up of patients with large or multiple congenital melanocytic nevi should be aware of this condition, to aid in prompt diagnosis and because the treatment of cutaneous lesions may be altered in the presence of symptomatic Nurocutaneous melanosis.
367 citations
TL;DR: Metastatic basal cell carcinoma was found in 12 patients at the University of Wisconsin Mohs Surgery Clinic during the period 1936 to 1989 and one patient has survived 25 years and is still alive.
Abstract: Metastatic basal cell carcinoma was found in 12 patients at the University of Wisconsin Mohs Surgery Clinic during the period 1936 to 1989. All patients were white men. The time of onset of the primary tumor ranged from childhood to 71 years. Eleven patients had previous treatment for basal cell carcinoma; two patients had received x-ray radiation to the face for teenage acne. The locations of the primary basal cell carcinomas were the face (n = 10), back (n = 1), and arm (n = 1). The primary tumors ranged from 3.6 x 3.0 to 20.0 x 7.0 cm. The interval from onset to the first sign of metastases ranged from 7 to 34 years. In all cases, the primary tumor was histologically identical to the metastatic lesion. Perineural extension of the basal cell carcinoma in the primary lesion was found in five cases. Regional lymph nodes were the most frequent site of metastasis. Treatment consisted of a combination of surgery, radiation, and chemotherapy. Only two patients survived more than 5 years after surgical treatment. One patient has survived 25 years and is still alive.
321 citations
TL;DR: Topical masoprocol appears to be useful in the treatment of actinic keratoses andIrritation, as manifested by erythema or flaking, occurred in 61.5% of topical masop rocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response.
Abstract: This double-blind, vehicle-controlled, multicenter study evaluated the efficacy and safety of a new topical antineoplastic agent, masoprocol, in the treatment of actinic keratoses of the head and neck. Of the 113 patients who applied topical masoprocol twice a day for 14 to 28 days, there was a mean decrease in actinic keratoses from 15.0 to 5.4 and a median percent reduction from baseline actinic keratosis count of 71.4% at the 1-month follow-up visit. Comparable numbers for the vehicle-treated group were 13.4 to 11.1 actinic keratoses and 4.3% median percent reduction. Irritation, as manifested by erythema or flaking, occurred in 61.5% of topical masoprocol-treated patients versus 26.7% of those treated with vehicle and did not correlate with clinical response. Topical masoprocol appears to be useful in the treatment of actinic keratoses.
317 citations
TL;DR: Six patients with the classic cutaneous findings of dermatomyositis who did not develop clinical or laboratory evidence of muscle disease for at least 2 years after onset of their skin manifestations are reported, challenging the commonly held notion that muscle disease always develops within 2 years of onset of skin disease.
Abstract: We report six patients with the classic cutaneous findings of dermatomyositis who did not develop clinical or laboratory evidence of muscle disease for at least 2 years after onset of then-skin manifestations. Such patients represent 11% of our total experience with dermatomyositis patients during a 15 year period. All six patients had Gottron's paules, periungual erythema/telangiectasia, and violaceous discoloration of the face, neck, upper chest, and back at some time during the course of their disease. In addition, all complained of pruritus and photosensitivity. None of the patients had evidence of malignancy. Each of five patients treated with oral corticosteroids for their cutaneous disease had marked improvement and did not develop myositis. These cases further emphasize that the cutaneous manifestations of dermatomyositis are pathognomonic of this disease and challenge the commonly held notion that muscle disease always develops within 2 years of onset of skin disease.
261 citations
TL;DR: The addition of an anti-platelet-derived growth factor antibody to wound fluid resulted in a 45% mean reduction in its stimulatory effect on fibroblast growth (p less than 0.02), suggesting that platelet- derived growth factor contributes to the observed effect.
Abstract: One proposed mechanism for the beneficial effect of occlusive dressings on healing is the maintenance of contact between the wound bed and accumulated wound fluid, which is thought to contain growth stimulatory substances. We have examined the effect of human wound fluid on the in vitro growth of human dermal fibroblasts and umbilical vein endothelial cells. Acute wound fluid was collected from six patients undergoing split-thickness skin grafting. The acute wound fluid was sterilely collected daily from underneath a vapor-permeable membrane applied to the donor site and changed every 24 hours for 3 days postoperatively. After seeding in optimal growth media (control) on day 0, cultures of human dermal fibroblasts and umbilical vein endothelial cells were supplemented with or without acute wound fluid on the next day (day 1) and on day 3. As determined by cell counts, 2% acute wound fluid stimulated the growth of human dermal fibroblasts (p less than 0.05) and umbilical vein endothelial cells (p less than 0.01) when these cells were cultured in 2% fetal bovine serum and endothelial growth medium, respectively. Wound fluid from postoperative days 1 or 3 caused the same level of stimulation. The addition of an anti-platelet-derived growth factor antibody to wound fluid resulted in a 45% mean reduction in its stimulatory effect on fibroblast growth (p less than 0.02), suggesting that platelet-derived growth factor contributes to the observed effect.(ABSTRACT TRUNCATED AT 250 WORDS)
256 citations
TL;DR: Quantitative methods were developed to assess the interrelation between age and sunlight on the facial skin of healthy women living in the same sunny area and those with greater sun exposure looked older and had more wrinkles, more severe elastosis, increased elastin, and decreased collagen.
Abstract: Quantitative methods were developed to assess the interrelation between age and sunlight on the facial skin of healthy women living in the same sunny area. The women were grouped into the following categories: young versus old and low versus high solar exposure. The features evaluated were perceived age, amount of facial wrinkling, skin color, and skin elasticity. A punch biopsy specimen of cheek skin was obtained and prepared histologically for evaluation of solar elastosis. The histologic examination was complemented by quantification of collagen and elastin by computer-assessed image analysis. Perceived age was estimated by untrained women viewing high quality photographs. As expected, those with greater sun exposure looked older and had more wrinkles, more severe elastosis, increased elastin, and decreased collagen.
252 citations
TL;DR: The results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy and there was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas.
Abstract: Twelve children, 6 to 30 weeks of age (average 14.9 weeks), with port-wine stains of the head and neck were treated with the flashlamp-pumped pulsed dye laser at 585 nm and 450 microsecond pulse duration. Ten of 12 patients (83%) showed more than 50% lightening of their port-wine stains after 2.9 treatment sessions (2.9 ± 1.4 [±standard deviation]). Forty-five percent of the patients demonstrated 75% or more lightening of their lesions after a mean of 3.8 treatments ( ± 1.6). No lesions in this group cleared completely after a mean of 2.8 treatments. Treated skin was identical in texture to normal skin in all patients. There was no evidence of depressed scars, atrophy, hyperpigmentation, or hypopigmentation in the treated areas. These results indicate that pulsed dye laser treatment of port-wine stains can be undertaken safely in infancy.
250 citations
213 citations
TL;DR: Findings suggest a relation between B. burgdorferi infection and cutaneous B cell lymphoma and some immunohistologic heterogeneity may indicate the development of monoclonal proliferation that originated from different phases of B lymphocytic differentiation.
Abstract: Four patients with low-grade malignant B cell lymphoma of the skin in association with chronic Borrelia burgdorferi infection are presented Plaque-shaped or nodular erythematous lesions with ill-defined borders were seen Clinical progression was slow; the skin tumors occurred for up to 7 to 15 years Extracutaneous involvement was found in only one case Immunohistologic investigations showed an expression of B cell markers with restriction to only one light chain type and absence of T cell antigens The growth fraction was 5% to 30%, as shown with the monoclonal antibody Ki-67 The immunoarchitecture of the tumors in three patients was unusual compared with established criteria for cutaneous B cell lymphoma and revealed similarities to mucosa-associated B cell lymphoma Some immunohistologic heterogeneity may indicate the development of monoclonal proliferation that originated from different phases of B lymphocytic differentiation In three cases no clinical signs of B burgdorferi infection were found; in one patient acrodermatitis chronica atrophicans was present The occurrence of acrodermatitis chronica atrophicans and malignant lymphomas was frequently reported in the European literature before B burgdorferi was recognized These findings suggest a relation between B burgdorferi infection and cutaneous B cell lymphoma In geographic regions where infected ticks are present, borreliosis should be considered in patients with cutaneous B cell lymphoma
TL;DR: This study yielded the following findings on the morphologic facial skin differences between black and white women: the epidermis of black skin has more and larger singly distributed melanosomes in the keratinocytes and corneocytes than that of white skin.
Abstract: This study yielded the following findings on the morphologic facial skin differences between black and white women: The epidermis of black skin has more and larger singly distributed melanosomes in the keratinocytes and corneocytes than that of white skin. The stratum lucidum in black skin is not altered by sunlight exposure. The epidermis of black skin rarely shows atrophied areas. The elaunin and oxytalan fibers in black skin are not disposed in candelabra-like formations. Black skin has minimal elastosis and elastic fibers stain pink or red with the hematoxylin and Lee procedure; none stain lilac or blue. The dermis of black skin contains many more fiber fragments composed of collagen fibrils and glycoproteins. Fibroblasts are more numerous, larger, have more biosynthetic organelles than white skin, and are often binucleated and multinucleated. The dermis of black skin has many binucleated and multinucleated macrophages and multinucleated giant cells. Black skin has many more mixed apocrine-eccrine sweat glands than does white skin and more blood and lymphatic vessels.
TL;DR: The nitroblue tetrazolium chloride method, when compared with hematoxylin and eosin staining, allowed an easier and more accurate definition of laser injury because of the color difference between damaged and normal tissue.
Abstract: Reduction of nitroblue tetrazolium chloride, a redox indicator, by nicotinamide adenine dinucleotide diaphorase produces in frozen tissue sections an intense blue cytoplasmic pigment. The activity of this enzyme has been shown to subside immediately upon cell death. Twelve patients with port-wine stains were treated with an argon laser. Frozen tissue sections from biopsy specimens obtained before and 10 minutes, 24 hours, and 48 hours after laser application were processed for nitroblue tetrazolium chloride staining. In normal skin all epidermal and dermal cells displayed dense cytoplasmic blue granular pigment that spared the nuclei. In port-wine stains the laser-induced coagulation necrosis was first seen as an arc-shaped, sharply demarcated, unstained, nitroblue tetrazolium chloride-negative area. Initiation of epidermal repair could be observed in all 48-hour sections. The nitroblue tetrazolium chloride method, when compared with hematoxylin and eosin staining, allowed an easier and more accurate definition of laser injury because of the color difference between damaged and normal tissue.
TL;DR: It is suggested that different mechanisms may be responsible for the clinically heterogeneous array of acral changes in patients treated with chemotherapy regimens.
Abstract: Chemotherapy-induced acral erythema has been described in association with several different chemotherapy regimens. We review the literature on this topic and suggest that different mechanisms may be responsible for the clinically heterogeneous array of acral changes.
TL;DR: Treatment regimens can be tailored to the underlying kinetics of the target population when the pharmacokinetics and potential toxicity of this drug are understood, and toxicity can be avoided in all but the most unusual of circumstances.
Abstract: Methotrexate is a useful antimetabolite for the treatment of both benign and malignant proliferative disorders. When the pharmacokinetics and potential toxicity of this drug are understood, treatment regimens can be tailored to the underlying kinetics of the target population. With the appropriate knowledge of the importance of urinary excretion of methotrexate and factors that influence this and with the ready availability of leucovorin, toxicity can be avoided in all but the most unusual of circumstances.
TL;DR: Evidence strongly suggests that the increased vulnerability of the glabellar region is due to its unique vascular distribution, and is probably the result of local vascular interruption and not hypersensitivity.
Abstract: The incidence, clinical presentation, pathophysiology, and possible treatment of two rare but clinically meaningful complications of tissue augmentation with Zyderm and Zyplast Collagen Implant are described. Abscesses as a manifestation of hypersensitivity to bovine collagen occur rarely (4 in 10,000 cases) and may persist for days to weeks. Periods of remission and exacerbation may occur from 1 month to more than 24 months. Localized tissue necrosis also occurs rarely (9 in 10,000 cases) after implantation and is probably the result of local vascular interruption and not hypersensitivity. The incidence varies greatly between the anatomic sites of implantation; more than half the reported cases involve the glabella. Evidence strongly suggests that the increased vulnerability of the glabellar region is due to its unique vascular distribution.
TL;DR: Tumor necrosis factor is important in systemic and cutaneous defense, homeostasis, and many disease states as discussed by the authors, and its effects are best understood when considered as concentration-dependent.
Abstract: Tumor necrosis factor is important in systemic and cutaneous defense, homeostasis, and many disease states. The numerous and diverse effects of tumor necrosis factor are best understood when considered as concentration-dependent, with normal homeostasis progressing to defense followed by toxic effects. Understanding tumor necrosis factor is important for the dermatologist as more studies appear in our literature and potential clinical uses of tumor necrosis factor (and possible anti-tumor necrosis factor agents) are realized.
TL;DR: The psoriatic disease cleared to a greater degree in patients treated with acitretin-UVB with fewer treatments and smaller amounts of UVB radiation than in patientstreated with either placebo-UVBs or acitretsin alone.
Abstract: UVB radiation is beneficial for the treatment of psoriasis vulgaris. Patients with recalcitrant disease, however, are slow to respond to UVB phototherapy with and without the use of coal tars or emollients. Etretinate and, more recently, acitretin have proved useful, but clinical improvement is slow when they are used as monotherapy in plaque psoriasis. Each drug also produces side effects, some of which are dose related. This study was designed to compare results of treatment with UVB combined with either acitretin (50 mg/day) or placebo to determine if psoriasis would respond faster and to less cumulative exposure to UVB and acitretin. The psoriatic disease cleared to a greater degree in patients treated with acitretin-UVB with fewer treatments and smaller amounts of UVB radiation than in patients treated with either placebo-UVB or acitretin alone.
TL;DR: It is suggested that typical acute hemorrhagic edema should be regarded as a separate clinical entity, which allows an appropriate prognosis to be made for this generally benign disease of infants.
Abstract: Infantile acute hemorrhagic edema of the skin is not included as a separate entity in the current English-language literature as it is in continental Europe. Therefore we have attempted to clarify the nosologic position of acute hemorrhagic edema among cutaneous vasculitides in children, on the basis of our experience in 10 cases. Our study confirms that acute hemorrhagic edema affects infants between 4 and 24 months of age. The two main features are an ecchymotic purpura, often in a cockade pattern, and an inflammatory edema of the limbs and face. Visceral involvement is uncommon. Spontaneous and complete resolution occurs within 1 to 3 weeks; one to four attacks may occur. Histopathologic examination demonstrates a leukocytoclastic vasculitis. Perivascular IgA deposits can occasionally be found. Besides typical acute hemorrhagic edema, some cases in 2- to 4-year-old children appear to overlap with Schonlein-Henoch purpura. We suggest that typical acute hemorrhagic edema should be regarded as a separate clinical entity. This allows an appropriate prognosis to be made for this generally benign disease of infants.
TL;DR: A new classification of hypoallergenic gloves according to their basic materials and ingredients is introduced to provide a guideline for individual therapy and introduce a comprehensive schedule of diagnostic tests.
Abstract: Delayed-type allergies account for most reactions to gloves. These have been found in 32 of 39 patients (82%) attending our department with occupationally induced contact dermatitis to gloves. Accelerators, mainly of the thiuram group, antioxidants, vulcanizers, organic pigments, and, presumably, glove powder ingredients are known responsible allergens. In contrast, immediate-type allergies to rubber gloves were less frequent (13 of 39 patients [33%] with occupationally induced glove allergies), They usually present as contact urticaria. Responsible allergens are latex, glove powder, and accelerators. On the basis of the numerous glove-related allergens, a comprehensive schedule of diagnostic tests is proposed. In addition, we introduce a new classification of hypoallergenic gloves according to their basic materials and ingredients and thus provide a guideline for individual therapy.
TL;DR: As the width of surgical margins declines, histologic evaluation of the margins is needed to assess the completeness of excision of a malignant melanoma.
Abstract: As the width of surgical margins declines, histologic evaluation of the margins is needed to assess the completeness of excision of a malignant melanoma. We studied 221 specimens in 59 patients and compared the interpretations of frozen and paraffin sections from the same block. Frozen sections had a sensitivity of 100% in detecting melanoma when present and a specificity of 90%.
Journal Article•
TL;DR: The role of hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of basal cell carcinoma as discussed by the authors.
Abstract: Host-tumor relationships involve several factors that can enhance or suppress neoplastic growth This second part of a review basal cell carcinoma biology examines the role that hormones, cytokines, local and systemic immunity, congenital and genetic syndromes, and environmental factors play in the development of this neoplasm Theories of etioloy and pathogenesis are discussed, and transplantation and cell culture techniques used to study this cancer are explored
TL;DR: The rational evaluation of hair disorders requires familiarity with follicular anatomy, and hair structure can be easily examined by studying clipped hair shafts, entire hairs gently pulled or forcibly plucked from the scalp, and scalp biopsies.
Abstract: The rational evaluation of hair disorders requires familiarity with follicular anatomy. Hair structure can be easily examined by studying clipped hair shafts, entire hairs gently pulled or forcibly plucked from the scalp, and scalp biopsies (sectioned vertically or transversely). Anatomic features will be different depending on whether a given hair is in the anagen, catagen, or telogen phase. Follicle size will also vary, from the minute vellus hair to the long, thick terminal hair. Each follicle can be divided into distinct regions—bulb, suprabulbar zone, isthmus, and infundibulum. Activity growing (anagen) hairs are characterized by a hair matrix surrounding a dermal papilla; inner. and outer root sheaths are present and well developed. A catagen hair can be identified by its markedly thickened vitreous layer and fibrous root sheath, which surrounds an epithelial column; above this column, the presumptive club forms. A telogen hair is distinguished by its fully keratinized club, which is surrounded by an epithelial sac. Below this lies the secondary hair germ and condensed dermal papilla, waiting for the mysterious signal that initiates a new life cycle.
TL;DR: It is concluded that acitretin substantially augments the efficacy of photochemotherapy in the treatment of severe psoriasis.
Abstract: In a randomized, double-blind comparative study 60 patients with severe, widespread psoriasis were treated either with photochemotherapy (PUVA) alone or in combination with acitretin. Forty-eight patients completed the study; of these, 25 received placebo combined with PUVA and 23 received acitretin with PUVA. Marked or complete clearing of psoriasis occurred in 80% of the patients (20 of 25) without acitretin and in 96% of the patients (22 of 23) with adjunctive acitretin administration. The mean cumulative UVA dose given to patients in the acitretin-PUVA group was 42% less than that required for patients in the placebo-PUVA group. We conclude that acitretin substantially augments the efficacy of photochemotherapy in the treatment of severe psoriasis.
TL;DR: Because V. vulnificus septicemia is a highly fatal disease, persons with liver disease or alcoholism should avoid eating or handling raw seafood.
Abstract: We studied the clinical characteristics and the epidemiology of primary septicemia associated with Vibrio vulnificus in 70 patients. All patients came from the western and southern coastal areas of Korea. Most cases (96%) occurred during the summer months, in men (96%), and in persons 40 or more years of age (90%). The illness in 46 patients (66%)began with septicemia, often within 2 days of the consumption of raw seafood. Forty-seven patients (67%) had preexisting hepatic disease, and 49 (70%) had a history of alcoholism. Of the 70 patients, 45 (79%) died. The cutaneous lesions that were present on admission in 64 patients (91%) appeared on the legs in 51 of the cases. V. vulnificus was isolated from the blood of 65 patients tested and from the skin lesions of 51 of 55 patients tested. The histopathologic findings differed according to the clinical stage of lesions. Because V. vulnificus septicemia is a highly fatal disease, persons with liver disease or alcoholism should avoid eating or handling raw seafood.
TL;DR: Type I cryoglobulinemia is suggested by noninflammatory hyaline thrombosis, cutaneous infarction, hemorrhagic crusts, skin ulcerations, and lesions of the head and neck and of oral or nasal mucosa.
Abstract: In the 72 cases of cryoglobulinernia reviewed, erythematous to purpuric macules or papules were present in 92%. Infarction, hemorrhagic crusts, and ulcers were present in 10% to 25% of the patients and were relatively more common in type I cryoglobulinemia than in the other types. Postinflammatory hyperpigmentation was noted in 40%. Lesions on the leg were common in all types of cryoglobulinemia; however, lesions on the head and mucosal surfaces suggested type I cryoglobulinemia. Histopathologic features were classified as vasculitis in 50%, inflammatory or noninflammatory purpura in 15%, noninflammatory hyaline thrombosis in 10%, and postinflammatory sequelae in 10%. Noninflammatory hyaline thrombosis was relatively more frequent in type I. Thus erythematous to purpuric lesions on the legs and leukocytoclastic vasculitis are the common cutaneous findings in cryoglobulinemia. Type I cryoglobulinemia is suggested by noninflammatory hyaline thrombosis, cutaneous infarction, hemorrhagic crusts, skin ulcerations, and lesions of the head and neck and of oral or nasal mucosa.
TL;DR: It is shown that acitretin is an effective and acceptable therapy for severe cases of lichen planus and during the subsequent 8-week open phase, 83% of previously placebo-treated patients responded favorably to acitretsin therapy.
Abstract: Sixty-five patients with lichen planus were included in a multicenter trial of acitretin. At the end of an 8-week placebo-controlled, double-blind phase, a significantly higher number of patients treated with 30 mg/day acitretin (64%) showed remission or marked improvement compared with placebo (13%). Furthermore, during the subsequent 8-week open phase, 83% of previously placebo-treated patients responded favorably to acitretin therapy. Typical retinoid adverse reactions were present in all patients on active drug. Laboratory studies did not show any clinically significant changes. This study shows that acitretin is an effective and acceptable therapy for severe cases of lichen planus.
TL;DR: The many facets of toxic epidermal necrolysis are reviewed, with emphasis on the importance of early diagnosis, burn unit placement, supportive care, and avoidance of systemic steroids.
Abstract: This article reviews the many facets of toxic epidermal necrolysis. Emphasis is placed on the importance of early diagnosis, burn unit placement, supportive care, and avoidance of systemic steroids. Discussion also includes other therapeutic options and the pathophysiology of the disease.
TL;DR: Lichen striatus is the most common acquired self-limited linear eruption in childhood that follows Blaschko's lines and a new acronym is proposed to emphasize the developmental background of the disease: BLAISE for Blaise linear acquired inflammatory skin eruption.
Abstract: An illustrative case report and a series of 18 well-documented cases of lichen striatus are presented. The mean age at diagnosis was 3 years (6 months to 14 years; median 2 years). The lesions were predominantly distributed on the trunk in 33% of cases and on the limbs in the remaining two thirds (upper limb: 48%; lower limb: 19%). Pruritus was noted in only 1 of 18 cases. Six cases were associated with clinical features of atopy and/or minor signs of atopic dermatitis (e.g., pityriasis alba). Two cases were considered to be clinically associated with lesions consistent with psoriasis. The mean duration was 9.5 months (4 weeks to 3 years; median 6 months). In one patient, two relapses occurred in 4 years. Hypochromic sequelae were noted in 50% of cases. Lichen striatus is the most common acquired self-limited linear eruption in childhood that follows Blaschko's lines. A new acronym is proposed to emphasize the developmental background of the disease: BLAISE for Blaschko linear acquired inflammatory skin eruption.