Elastolysis of the earlobes.
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Biomedical subjects
Publications and source records attributed to C H Dicken.
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Port-wine stains, especially of the face, are frequently a severely disfiguring lesion. Previous treatment modalities have not produced satisfactory results. The argon laser can be of benefit: in more than 70% of patients who undergo this treatment, the lesion becomes lighter. Three cases are presented to illustrate the range of clinical results.
The term "neutrophilic dermatosis" has been suggested for a spectrum of skin lesions that have been noted in some patients with myeloproliferative diseases. These cutaneous conditions vary from plaques typical of Sweet's syndrome to bullous and pyodermatous lesions. We describe two patients with neutrophilic dermatoses and myeloproliferative disorders. Distinctive features included concurrent bullous pyodermatous lesions and characteristic lesions of Sweet's syndrome in one patient and overwhelming sterile pulmonary infiltration in the other patient. These disorders may be difficult to distinguish from acute infectious processes, and they may have systemic components, including pneumonitis. Possible therapeutic alternatives to systemic corticosteroid therapy are suggested.
Malignant pyoderma is a destructive, ulcerating skin disease that occurs chiefly in young adults. Only eight cases of this rare disease have been reported. The head and neck have been involved in all cases, and a predilection for the periauricular region has been noted in several of the cases. Although the disease is progressive and chronic, responses to high-dose systemic corticosteroids have been noted, but usually a flare is associated with a reduction in dose. An additional case is described in which therapy with isotretinoin and sulfapyridine led to complete remission.
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A syndrome consisting of a flulike illness with fever, chills, malaise, and inflammatory papules and pustules of 2 to 4 mm in diameter occurs in up to 20% of patients who have had a jejunoileal bypass operation. During most of these episodes, myalgias and polyarthralgias occur. An identical clinicopathologic syndrome may occur in association with other gastrointestinal diseases. In the patient described in this report, this syndrome developed after a gastrointestinal surgical procedure that resulted in a small stomach (70% removed) and a Roux-en-Y jejunostomy.
Five patients with the yellow nail syndrome triad are described; all five had yellow nails, primary lymphedema, and respiratory tract involvement. Four of the patients noted the onset of the syndrome after an episode of pneumonia. Four patients had a chronic productive cough, two had bronchiectasis, two had chronic sinusitis, and one had chronic pleural effusion. Two of the five had spontaneous improvement of their yellow nails.
Eight patients with a long-standing hidradenitis suppurativa were treated with isotretinoin, 0.71 to 1.2 mg/kg/day, as a single agent for 4 months and have had follow-up of at least 2 months. The clinical status was judged as cleared in one patient, almost cleared in three patients, improved in one patient, not changed in two patients, and worse in one patient.
The retinoids are synthetic derivatives of vitamin A. Isotretinoin (13-cis-retinoic acid) is now being widely used in the United States for severe acne and etretinate is available in Europe and other countries for psoriasis. These drugs are also effective for a number of other skin diseases. This is an attempt to review basic knowledge of retinoids with which the practicing dermatologist should be familiar, to review the current status of studies, and to speculate on the present and future roles of these drugs in dermatology.
Acne fulminans is characterized by highly inflammatory ulcerative lesions and systemic manifestations. We report a case of acne fulminans and myositis. In addition to having typical skin changes, the patient was unable to walk and electromyographic studies showed significant changes.
Six patients (four male and two female) with factitious cheilitis are described. All had personality disturbances as well as crusted lip lesions that varied in severity from thin serous crusts to thick hemorrhagic crusts. This entity must be distinguished from infectious cheilitis, contact cheilitis, actinic cheilitis, photosensitivity dermatoses, exfoliative cheilitis, and cheilitis glandularis on the basis of the history and laboratory evaluation.
Twenty-nine patients with vitiligo and psoriasis observed over a 5-year period were reviewed. The incidence of concurrence of both diseases was not increased, and the onset and course of the psoriasis and vitiligo were separate. Psoriatic lesions occurred on vitiliginous areas and normal skin with equal frequency. These patients had a larger number of associated diseases than normally seen in psoriatics.
Urticarial skin lesions may occur in patients as a manifestation of necrotizing vasculitis. We describe a series of forty patients with idiopathic chronic urticaria and histologic features of necrotizing vasculitis. On the basis of clinical evaluation, we have classified urticarial vasculitis into two major groups: (1) hypocomplementemic (sixteen patients, ten of whom had evidence of renal disease) and (2) normocomplementemic (twelve patients with systemic disease and twelve with only cutaneous involvement). Most patients with hypocomplementemia presented with arthritis, and some had abdominal pain or airway compromise. Although patients with normocomplementemia and systemic disease had a less severe clinical course, four exhibited renal disease that was characterized by microhematuria and proteinuria. Direct immunofluorescence microscopy of the skin aids in assessing renal involvement in some cases of hypocomplementemic urticarial vasculitis, particularly when IgG and IgM are deposited at the basement membrane. There seems to be a spectrum of disease in urticarial vasculitis, ranging from benign cutaneous lesions to systemic disease.
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Orally administered retinoids are synthetic derivatives of vitamin A. This new group of drugs (not yet available for general use in the United States) has been effective in experimental trials for treatment of a wide range of skin diseases. The current status of two of these drugs, isotretinoin (13-cis-retinoic acid) and etretinate (Ro 10-9359), is herein reviewed.
The question of whether epidermolysis bullosa acquisita (EBA) is a distinct entity prompted a review of the Mayo Clinic experience. Twelve patients with this diagnosis were seen from 1955 through 1979, and their records were reviewed. Particular attention was directed to immunofluorescence microscopy (IF), which had been performed in seven patients. Direct IF was positive in seven patients, and indirect IF was positive in four patients. Although many cases of EBA may remain distinct, we believe that the morphologic appearance known as EBA may represent a final common pathway of disease expression in a heterogeneous group of patients with a variety of more specific diseases and that trauma serves as a localizing factor. Our findings indicate that cicatricial pemphigoid probably is the most common specific diagnosis but that all cases of EBA are not represented by this diagnosis. Furthermore, we conclude that when IF is performed, exclusion of other bullous diseases, which is a key criterion for the diagnosis of EBA, is more difficult than previously recognized.