Biomedical subjects
Publications and source records attributed to H Plotnick.
This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.
We observed a 40-year-old woman with necrobiotic xanthogranuloma from the inception of indurated eyelid and periorbital infiltrates and concurrent stage I multiple myeloma to resolution of infiltrates in skin and bone marrow after pulsed high-dose oral dexamethasone therapy. Ultrastructural studies revealed lipid vacuoles in epidermal keratinocytes, in dermal histiocytic macrophages, and in vascular and lymphatic endothelial cells. The presence of lipid vacuoles in epidermal keratinocytes has not been reported previously in xanthogranuloma.
This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.
We report the cases of three patients with polypoid melanoma. In no case was there microscopic evidence of melanoma cell invasion below the papillary dermis. In the polypoid variant of nodular melanoma, melanoma cells accumulate in large volume above the skin's surface. This increase in tumor volume encourages dislodgment of melanoma cells that are carried to superficial lymphatic vessels without invading the reticular dermis; this feature differentiates polypoid melanoma from the nonpolypoid nodular variant. Although polypoid melanoma is considered the most malignant form of melanoma, our findings, albeit limited to three cases, suggest that early diagnosis and prompt surgical excision may provide a favorable 5-year survival rate.
Two hundred fifty individuals who filed claims for workers' disability compensation benefits for work-related dermatoses were evaluated in the private-practice setting of the author. Preset standard guidelines were used to assess the validity of work relevancy for each claimant. The findings in this retrospective study that included workers from 14 different industrial milieus revealed that 127 of 250 examinees had skin findings that were consistent with the respective workplace exposure.
Occupational contact dermatitis is recognized by its history, appearance, and location. The leading causes of work related skin disease are chemical agents that include primary irritants, allergic- and photosensitizers, and systemic intoxicants that are absorbed through the skin. Recognized guidelines must be used to determine work relevancy: either the skin eruption if related directly to a specific workplace exposure or the work environment caused an aggravating effect on a preexisting non-work related skin disorder. The health care provider's role in industry is not only to examine, diagnose, and treat an injured person's dermatitis, but to identify the cause of the skin eruption and make recommendations for protective measures to prevent recurrent morbidity.
A middle-aged black woman presented initially with painful cutaneous plaques that were located at various sites and that were diagnosed histologically as lichen planus. Standard light microscopic examination showed histopathologic variants of lichen planus. Direct immunofluorescence of a skin lesion had negative results for any of the lupus erythematosus bands but did reveal hyaline bodies in the deep cellular layer of the epidermis and the superficial layer of the dermis. These findings were compatible with either lichen planus or lupus erythematosus. However, both the clinical course of the eruption and the antinuclear antibody tests showed that the immunofluorescent antinuclear antibody pattern of large, speckle-like threads were consistent with lupus erythematosus. Furthermore, the large, speckle-like, thready antinuclear antibody pattern, which has been shown to be a marker for a benign subset of lupus erythematosus, is not seen in lichen planus. Lichen planus--like lupus erythematosus was therefore the more likely diagnosis.
We present the identification and characterization of two patients with xeroderma pigmentosum (XP) and squamous cell carcinoma of the tongue. Dermal fibroblasts from two black siblings with XP were shown to be hypersensitive to ultraviolet (UV) light measured by colony-forming ability. UV-induced unscheduled deoxyribonucleic acid synthesis was reduced significantly when compared with normal levels for both strains. The strains were assigned to complementation group C on the basis of cell fusion studies. Patients with XP have a marked increase over normal persons for developing skin cancer, presumably because of their extreme sensitivity to UV light. Our results may have applicability in explaining the in vivo development of epidermoid carcinoma in the partially shielded tongue of some XP patients.
Five patients with melanoacanthoma are reported. The skin lesions consisted of a single, round plaque measuring several centimeters in diameter. Histologic findings were characterized by formation within an acanthotic epidermis, of many islands of small basaloid cells and highly dendritic melanocytes. Electron microscopic examination of one lesion revealed a disturbance of melanin transfer from the highly dendritic melanocytes to the neighboring keratinocytes.
Electron microscopic observations of both sun-exposed and sun-protected skin from a black patient with xeroderma pigmentosum (XP) revealed abnormal ultrastructural changes in the melanin pigmentary system, tonofibrillar-desmosome complexes, endoplasmic reticulum, mitochondria, and nucleoli of all keratinocytes. The difference between the cellular changes in the sun-exposed skin and that protected from sunlight was quantitative rather than qualitative in character. The most salient changes were seen in sun-exposed specimens: melanosomes limited by a membrane showed a high degree of polymorphism with a tendency to form large complexes, and many fibroblast-like cells displayed an intense phagocytic activity for melanosomes, the latter finding not previously reported. The present study supports the conclusions of other investigators that XP is a heterogeneous disease. Clarification of the XP entities by continued research may identify the defective gene and lead to methods of correction by the molecular biologist.
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The term dyshidrosis describes a nonspecific tissue pattern reaction characterized by a noninflammatory, pruritic (and sometimes burning) intraepidermal vesicular dermatosis involving selected areas of the fingers, palms, and soles. It should be distinguished from various pustular and vesicular dermatoses of the palms and soles with or without associated lesions elsewhere. When dyshidrotic lesions appear in areas where friction or pressure from the handling or wearing of sport gear occurs, the discomforting symptoms are noticeably accentuated and can thus interfere with the participant's effectiveness in the performance of the sport. A composite approach of dermatologic therapeutic acumen and physician-sponsored emotional support is essential in effectively handling this problem so that dyshidrosis does not "handicap" the patient.
The essence of this report is to apprise the dermatologist of this fascinating but unusual complication of herpes zoster and to underscore the help he may give in establishing the diagnosis along with assisting in the management of this disorder.