Biomedical subjects
Publications and source records attributed to D J Elpern.
Cutaneous malignant is generally regarded as a skin cancer of Caucasians. However, one subtype, acral lentiginous melanoma (ALM), has an equal distribution among all ethnic groups and is the variant most common in non-Caucasians. In its early stage it is difficult to recognize and, unless diagnosed early, has a very poor prognosis. Herein, we present 3 cases of ALM seen on Kauai in 1990.
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Sarcoidosis is so rarely seen in residents of Hawaii that it may not be considered as a diagnostic possibility. The differential diagnosis is more complex in Hawaii due to the presence of granulomatous diseases such as tuberculosis and leprosy. We present the first known case of sarcoidosis in a Hawaii resident together with an overview of the disorder.
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We report two persons in their thirties with the shared delusion of parasitosis. Both abused cocaine, and both recovered from their delusions after a period of abstinence. Although the literature does not stress that a specific cause is usually found for delusions of parasitosis, this may be changing for persons in groups among whom cocaine and possibly other illicit drug use is common. It is a service to these desperate patients to establish their confidence and then discretely ask about the use of illegal drugs, especially cocaine.
This is the first report of travellers' skin diseases from the Hawaiian archipelago. The diagnoses of all tourists who presented to a dermatology practice on Kauai, Hawaii, were recorded over six years. The cutaneous disorders tabulated in visitors differed significantly from those observed in the local population. In visitors, over one-third of the diagnoses were of light-induced disorders. The most common disease observed was the papulovesicular variant of polymorphous light eruption. This report should serve as a guide to the skin diseases that travellers to Hawaii frequently experience.
A prospective 3-year survey of nonmelanoma skin cancer in Japanese-American residents of the Hawaiian island of Kauai was conducted beginning in January 1983. The crude rate for basal cell and squamous cell carcinoma was 123/100,000, 88 times higher than the corresponding figure from Japan. This discrepancy may be attributed to an increase in ultraviolet exposure due to lifestyle and latitude, but arsenic exposure may also have played a role. Nonmelanoma skin cancer in Japanese in Hawaii appears to be a significant problem that has not been appreciated because these malignancies are not reportable to tumor registries.
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The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.
Data on 42 patients with brachioradial pruritus seen in Hawaii over a 2-year period are presented. In contrast to previous reports, the sex ratio was 1:1 with a preponderance of patients in the younger age groups. All patients had developed the disorder after having lived in Hawaii for at least one year. More than half the cases had no history of neck trauma or arthritis, ruling out a peripheral neuropathy as the cause. Radiographs of 15 patients showed changes only in the patients in the older, arthritis-age groups. Brachioradial pruritus appears to be peculiar to the tropics.
Papulovesicular light eruption (PVLE) is a distinct clinical and histological subset of polymorphous light eruption. Biopsies from 16 patients with PVLE showed prominent epidermal and dermal changes consisting of intercellular edema, papillary dermal edema and a perivascular and interstitial infiltrate in the upper dermis.
At present any physician with the interest and relatively inexpensive hardware can access large data bases of medical literature citations from home or office. This article describes some data bases of interest to dermatologists and gives examples of search strategies. Computer-assisted medical literature searching is of inestimable value for patient care, research, and teaching.
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A patient vacationing in Hawaii in whom naproxen induced a marked photosensitivity reaction, which was later confirmed by challenge, is reported. Naproxen therefore joins the list of other nonsteroidal anti-inflammatory agents that are a hazard for the holiday traveler. We suspect that the incidence of sunlight reactions to naproxen and other members of this class of drugs is far greater than published reports indicate.
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