Absolute number of circulatory sézary cells.
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Blood Cell Count↗
Biomedical subjects
R K Winkelmann
Publications and source records attributed to R K Winkelmann.
Ulcerative lichen planus. Follow-up of surgical excision and grafting.
Four patients with ulcerative lichen planus of the feet underwent total excision and split-thickness skin grafting of the affected areas. One patient underwent grafting in 1951, and remained free of recurrent ulcers for 26 years. Another, who had an 18-year follow-up after grafting, required an additional procedure. The possibility of squamous cell carcinoma in ulcerative lichen planus is considerable, lending further support to the concept that excision with grafting is the treatment of choice for these lesions.
Adult↗
Necrobiotic xanthogranuloma with paraproteinemia.
Eight patients had multiple xanthomatous plaques and subcutaneous nodules that had a predilection for the periorbital area, flexures, and trunk and that tended to ulcerate. Skin biopsy specimens showed a combination of xanthogranulomatous nodules with necrobiosis. All patients had an accompanying dysproteinemia, which was a monoclonal IgG paraprotein in six. Hyperlipidemia, low serum complement, and cryoglobulinemia were variable features. Five patients had leukopenia. Bone marrow examination showed myeloma in two patients, a lymphoproliferative process in one, and some atypical plasma cells in two. Cutaneous necrobiotic xanthogranuloma is a distinctive histologic pattern most frequently related to plasma cell dyscrasias, and it should be distinguished from normolipemic plane xanthoma and other necrobiotic granulomas.
Adult↗
Involuting common warts. Clinical and histopathologic findings.
Patterns of regression in common warts were studied. Patients with multiple verrucae vulgaris lesions applied topical agents to the warts and were observed at regular intervals until the lesions disappeared. Regression took place without the warts turning black in all but one instance. All warts did not disappear simultaneously; some lesions persisted weeks after others had disappeared. Microscopic examination in five patients of a wart persisting after most had regressed demonstrated mononuclear cell infiltration, exocytosis, and degenerative epidermal changes. Failure to demonstrate cellular infiltration in regressing common warts in earlier studies was probably due to concentration on studying only warts that had turned black. The regression of some of the warts in patients with multiple common warts may serve as an indicator that involution is in progress. Utilization of this observation to recognize clinically the period of involution may make possible studies during the critical phase of the involutionary process.
Administration, Topical↗
Inflammation in acne vulgaris: leukocyte attraction and cytotoxicity by comedonal material.
The chemoattraction of comedonal material for leukocytes was evaluated. Material from open comedones attracted mononculear leukocytes but did not attract polymorphonuclear leukocytes. At higher concentrations, comedonal material was cytotoxic for leukocytes of both types. Of the comedonal components tested, free fatty acids produced the greatest cytotoxicity. The attraction and killing of leukocytes by comedonal components may be the mechanisms for the initiation or the enhancement (or both) of inflammation in acne vulgaris.
Acne Vulgaris↗
Histologic changes in seborrheic keratoses after rubbing.
Seborrheic keratoses in five patients were rubbed and biopsied at varying intervals after injury. Microscopic examination revealed acute and chronic patterns of histologic change. Hemorrhage, hyalinization of dermal papillae, and necrosis of epithelial tips were conspicuous early changes. Specimens taken more than 48 h after rubbing showed a spectrum of changes which included: loss of epithelial mass, expansion and interconnection of keratin cysts, thinning of the epithelium, proliferation of epithelial strands from the residual epithelium, increase in size of epithelial cells, and evidence of hair follicle relationships including trichostasis spinulosa and, in one specimen, hair germ proliferation. Dermal lymphocytic infiltration was variable and only rarely involved the epithelium. These observations demonstrate a patterned response of the seborrheic keratosis to trauma, and also indicate a relationship between seborrheic keratosis and the hair follicle.
Biopsy↗
Inflammatory changes in verruca vulgaris.
Forty-one (8%) of 500 randomly selected biopsy specimens in verruca vulgaris showed evidence of inflammation. The inflammation was lymphocytic and lichenoid in 21 specimens and was associated with papillary hemorrhage and infarction in 23. Clinical review indicated that patients of all ages were represented but that there was a predominance of verrucae of the extremities in older patients. The data suggest the possibility of a distinct solitary acral verruca in the elderly.
Female↗
The Sézary cell in the blood of patients with mycosis fungoides.
A study of 96 patients with an original diagnosis of mycosis fungoides revealed that 84 did not have circulating Sézary cells. Of the 12 patients with Sézary cells, only 3 had more than 15%. The 12 patients had benign and malignant skin diseases. The Sézary cell does not seem to have any importance in the pathogenesis of mycosis fungoides.
Adolescent↗
Cutaneous periarteritis nodosa: immunofluorescence studies.
The study of ten cases of cutaneous periarteritis nodosa by direct immunofluorescence microscopy of excision biopsy specimens revealed positive findings in nine. Deposition of IgM was found in the vessel walls in six cases, and C3 was observed in four; however, only in two cases was C3 found with IgM in the vessel walls. Deposits of IgM in the superficial vessels were found in five cases, although only the deep muscular vessels showed evidence of the vasculitis in cutaneous periarteritis nodosa. Serum hepatitis B antigen was absent in the nine cases that were tested. Positive immunofluorescence findings in superficial as well as in deep vessels suggest that although periarteritis nodosa is characterized by an inflammatory panarteritis, occasional vasculitis of small vessels might be expected.
Complement C3↗
Granuloma annulare: histopathologic and direct immunofluorescent study.
Eighteen cases of granuloma annulare were classified histopathologically and examined by direct immunofluorescence. The three different histopathologic types of granuloma annulare were compared with the result of immunofluorescence examination. No features of leukocytoclastic vasculitis were seen. Direct immunofluorescence of granuloma annulare does not reveal any consistent diagnostic pattern. Dermal desposition of fibrin in necrobiotic areas were noted in 8 cases of 18. Blood vessel and/or basement membrane deposition of IgM and C3 was inconsistent and does not support an immune complex vasculitis. Direct immunofluorescence is useful in studying the pathogenesis of granuloma annulare. The finding of fibrin, together with the histology, suggests to us a delayed hypersensitivity reaction as the dominant pathogenic event.
Complement C3↗
Antideoxyribonuclease B titers in psoriasis.
Psoriatic patients were examined for serologic evidence of streptococcal infections by using antideoxyribonuclease B (ADB), which has been shown to be a more sensitive screening tool than antistreptolysin O (ASO) for detecting such evidence in other clinical circumstances. Antistreptococcal antibody titers (ASO and ADB) of 71 patients with psoriasis vulgaris, 7 with guttate psoriasis, and 6 with erythrodermic psoriasis were compared with ASO and ADB antibody titers of 25 non-psoriatic dermatologic patients hospitalized at the same time and of an adult group that was used as a control for the test itself. Thirty-six of 71 patients with psoriasis vulgaris had elevated titers of ADB or ASO (41% vs. 15%). Compared with control values the ADB titers were significantly higher in patients with psoriasis vulgaris (P less than 0.02) and patients with guttate psoriasis (P less than 0.05). The ASO titers were significantly higher in patients with psoriasis vulgaris than in controls (P less than 0.04). Within the group with psoriasis vulgaris, ADB titers were significantly higher than ASO titers (P less than 0.01). Among patients with psoriasis vulgaris, histories of sudden flares of psoriasis and early recurrences of psoriasis after previous successful hospital treatment, family histories of psoriasis, and histories of potential streptococcal infections were more frequent in those with elevated antistreptococcal antibodies.
Antibodies, Bacterial↗
Eruptive histiocytoma of childhood.
A 9-year-old girl had a widespread papular eruption that was histologically characterized by benign histiocytes that were acid phosphatase-positive, but that lacked Langerhans' granules ultrastructurally. New lesions had continued to develop since the patient was 3 months old, and individual lesions had resolved over a period of two to three months. The histopathologic, histochemical, and ultrastructural findings in this patient were similar to those previously described for eruptive histiocytomas in adults. Papular histiocytomas in childhood may be found in histiocytosis X, reticulohistiocytoma, xanthogranuloma, xanthoma disseminatum, or eruptive histiocytoma. These diseases may be differentiated on the basis of differing histiocytic populations and the clinical courses of the lesions in each disorder.
Child↗
Large cell lymphocytoma.
We studied nine cases of cutaneous lymphoproliferative disease that shared a distinct histologic pattern. The lesions consisted of red-to-violaceous, single or clustered, deep papules or nodules. They proved to be benign on long-term evaluation. Nodular infiltrates of large, pleomorphic lymphocytes, sometimes appearing to be histiocytic and often associated with frequent mitoses, led to the diagnosis of lymphoma or reticulum cell sarcoma in seven of the cases. Sharply marginated, dense clusters of small lymphocytes surrounded or infiltrated the large cell component, a juxtaposition that characterizes large cell lymphocytoma. This pattern was not found in patients with progressive malignant lymphoma. At times, multiple biopsies must be done to establish the diagnosis. All patients are alive, and none has malignant lymphoma. The follow-up periods for six of the patients have been five years or longer.
Adult↗
Disabling pansclerotic morphea of children.
Fourteen children with generalized morphea involving all levels of the skin and soft tissues were examined. The term "acral pansclerotic morphea" describes the distribution and the multiple levels of sclerosis. Lymphocytic inflammation and hyaline pannicultitis were observed on biopsy specimens in some cases. Laboratory data were characterized by a polyclonal elevation of gamma-globulin level and by peripheral eosinophilia. Pulmonary changes in five patients and esophageal changes in one imply that acral pansclerotic morphea may be assoicated with mild nonprogressive visceral change. Although cyclophosphamide may retard the process, no satisfactory treatment for progressive, mutilating acral pansclerotic morphea has been found.
Adolescent↗
Connective tissue panniculitis.
Two patients with lobular lymphohistiocytic panniculitis had chronic lesions that produced subcutaneous atrophy and that were responsive to antimalarial drugs. Massive lymphocytic infiltrate was associated with caseation necrosis of the fat lobules. In both patients, an unusual antibody to extractable nuclear antigen was seen, and antinuclear antibody was sometimes present. The unusual manifestation, course of the disease, serologic findings, and response to therapy suggest that the panniculitis is related to (but does not evolve into) lupus erythematosus panniculitis or subcutaneous morphea or both. A satisfactory term for this entity would be "connective tissue panniculitis."
Adipose Tissue↗
Cutaneous granulomas in malignant lymphoma.
Two patients are described in whom the clinical manifestation of massive, localized dermal and subcutaneous epithelioid granulomatous masses occasioned an extensive year-long search for infectious organisms. In both instances, the true diagnosis of Hodgkin's disease or lymphoma was ultimately made by means of lymph node biopsy.
Adult↗
Pityriasis rubra pilaris and celiac sprue with malabsorption.
A case is reported herein of a young man with pityriasis rubra pilaris, a disease of unknown cause, and malabsorption due to celiac bowel disease. The patient responded to high-dose vitamin A therapy (500,000 IU orally per day for fourteen days). There was complete exfoliation of the palmar-plantar keratoderma and a decrease in the peeling and follicular keratosis. He was then placed on a regimen of a gluten-free diet and 100,000 IU vitamin A per day. After seven months he had persistent erythema but minimal hyperkeratosis. The ways in which cutaneous lesions and malabsorption could be related are discussed.
Adult↗