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Dermatoses of pregnancy are relatively rare. The terminology becomes increasingly confusing, as only few of these skin eruptions are proved entities. Apart from pruritus gravidarum and herpes gestationis (pemphigoid gestationis), the symptoms of dermatoses of pregnancy should be classified according to polymorphic exanthema, which are characterized by urticarial lesions, or according to prurigo gravidarum, predominantly characterized by excoriated papules.
The terminology of the specific pregnancy dermatoses is confusing. Several names have been used for the same clinical conditions or individual reports have been described as special entities. In order to get a more practical classification from the clinical point of view, four broad categories of specific dermatoses of pregnancy are proposed: herpes gestationis, polymorphic eruption of pregnancy, prurigo gravidarum and autoimmune progesterone dermatitis.
The purpose of this presentation is to offer a classification of psychocutaneous disease and to examinine factors which result in itching and scratching becoming chronic. Pruritus is a very common sensation in dermatoses. All forms of itching, whatever the cause, may be intensified by emotional stress. The patient sample of my own study consisted of seven diagnostic groups, giving a total of 99 patients. The dermatoses were: dermatitis herpetiformis, lichen ruber planus, chronic eczema, atopic eczema, neurodermatitis circumscripta, lichen corneus obtusus and pruritus psychogenes. The principal findings were as follows: 1. Many of the different mechanisms by which skin diseases became chronic had a psychological background. 2. Psychiatric disturbances were clearly more common than in the average population. Possibilities of psychiatric treatment were evaluated. The results confirm the hypothesis that in those skin diseases in which the disease mechanism is not yet sufficiently understood, psychosomatics is of considerable importance or offers an easier way to explain the mechanism.
It appears certain that the causes of self-destructive dermatoses are many and complex. The disorder spans diagnostic categories and varies from unconscious picking at the skin to severe self-destructive actions. Although not limited to any one diagnosis, skin disorders appear to be more prevalent in depression. This association may involve activation of the hypothalamic-pituitary-adrenal axis commonly found in depression. Two specific types of commonly occurring dermatoses-neurotic excoriations and dermatitis artefacta-are reviewed in this article. The major distinction of these disorders centers on whether the patient can admit to self-mutilation. Because of the difficulties in dermatitis artefacta with insight and body-image, it has been compared with anorexia nervosa. Often, dermatitis artefacta coexists with anorexia nervosa. In both disorders, neurotic excoriations and dermatitis artefacta, the personality style tends to be introverted with emotional immaturity. These patients have difficulty when they are under stress; the problem is compounded because of poor communication skills. Pharmacotherapy is of limited usefulness, and psychotherapy is often times hindered by strong resistance to exploring long-standing emotional issues. Once an alliance is established with the therapist, however, these issues may be examined. Prognosis is variable but does seem to directly correlate with the duration of the illness. Young individuals may experience alleviation of symptoms after one session of psychotherapy, whereas older patients may never have resolution. Dermatologic abuse involving psychosis has many presentations; one of the most common involves infestation. Organic causes must always be excluded as part of the differential diagnosis. In schizophrenia, this presentation has one of the highest incidences of suicide.(ABSTRACT TRUNCATED AT 250 WORDS)
The varied histopathology of the reactive inflammatory vascular dermatoses requires close cooperation between the clinician and the pathologist. This article presents an overview of the histology of this group of dermatoses, including the figurate erythemas, the pigmented purpuric eruptions, urticaria and urticarial vasculitis, Sweet's syndrome, erythema multiforme, and erythema nodosum.
Biopsies of skin lesions from 50 cases of psoriasis and from 42 cases with other dermatoses were studied by the methods described in the foregoing report, that is by the four-compartment by the methods described in the foregoing report, that is by the four-compartment immunofluorescent (IF) system for detecting stratum corneum autoantibodies and in vivo binding of IgG in psoriatic scales at the site of the stratum corneum antigen. They were also studied histologically. Early and fully developed psoriatic lesions tended to have more widespread deposits of IgG in the stratum corneum than receding lesions. In biopsies with widespread IgG deposits the stratum corneum antigen usually could not be demonstrated because of blocking by in vivo bound IgG. Of the 42 control biopsies of skin lesions from patients with other dermatoses which were examined with this system two gave the IF staining patterns which were seen most commonly in psoriatic lesions. In these two cases strong widespread IgG deposits occurred in compartment 3, and 4 was very similar to compartment 3. One case was diagnosed as lichen planus and one as cornu cutaneum. Comparisons of the IF findings in psoriatic and control lesion biopsies indicate that significantly more of the former have: (1) IgG deposits at the combining sites of stratum corneum antibodies (92 vs. 50%) and (2) no demonstrable stratum corneum antigen because of 'blocking' by in vivo bound IgG, i.e. compartment 3 like 4 (56 vs. 7%). A highly significant inverse relation between the in vivo deposits of IgG and demonstrability of stratum corneum antigen appeared regardless of the clinical condition. This observation lends support to the view that the IgG which is bound to the sites of the stratum corneum antigen in ski; lesions may in fact be in vivo bound stratum corneum antoantibody.
A study was done to determine the frequency of common dermatoses seen in private dermatology practices composed of predominantly black patients. This was then compared to similar previous studies. New trends in common dermatoses in private black patients were found. The most common dermatosis noted was acne vulgaris, followed by eczema, pigmentary disorders, seborrheic dermatitis, and alopecias.
In vitro monocyte chemotaxis towards leukotriene B4(LTB4) and platelet activating factor (PAF) was studied with cells from 51 patients with various inflammatory dermatoses and 12 normal volunteers. Monocytes from normal subjects responded poorly to LTB4 (10(-8)-10(-12) M) and PAF (10(-6)-10(-10) M), and cells from patients with urticaria pigmentosa and vericella were even less responsive, while monocytes from patients with severe psoriasis and atopic eczema exhibited markedly enhanced chemotaxis. These changes persisted during high dose therapy with oral steroids, but returned to normal with healing of the skin lesions. Pre-incubation of monocytes with histamine, LTB4, PAF, lymphokines or sera from patients and normal controls did not result in enhanced chemotaxis of the cells. The chemotactic activity of monocytes did not correlate with that of neutrophils in the same patients (r = 0.08). Altered monocyte chemotaxis in patients with inflammatory dermatoses is therefore a reversible process that is related to the severity of the cutaneous inflammation but is not limited to a specific disease.
The analysis of the total of 76 occupational dermatoses registered after 1962 in the pharmaceutical industry of the district of Dresden results in the following statements: The morbidity must be regarded as three times higher than in other branches of the chemical industry. Compared with the average dates of all occupational dermatoses, those in the pharmaceutical industry need a shorter induction time for starting. On the other hand, they are to be cured faster and with less recurrences. The lists of causal agents are heterogeneous and differ largely from those of drug induced eczemas of our clinical patients or of employees in public health services. Examples are given for a predictive recognizing of strong contact sensitizers by means of their chemical structure.
Allergological examination of 88 patients with pruritic dermatoses (eczema and neurodermite) and 55 control subjects has demonstrated an important role of food allergy in the pathogenesis of these dermatoses as well as a high percentage of latent food sensitization. Strawberry, citrus and chicken meat appeared to be the most frequently occurring food allergens. Gastrointestinal diseases identified in part of the patients were found to be conducive to the development of food allergy.
Clinical investigations of ITCL drug ("Polfa") were carried out on 50 patients (15 women, 16 men, 19 children, at the age of 4-80). ITCL has been successful in non-specific inflammations accompanying some virus dermatoses (zoster, herpes simplex), in streptococcal pyoderma (impetigo, ecthyma), and in some allergic dermatoses (disseminated eczema and atopic dermatitis). Encouraging results were obtained with ITCL in the treatment of psoriasis. It seems that the further attempts with this should be continued in psoriasis. The capillaroscopic examinations in 6 patients revealed ITCL to have vasoconstrictive effect on the nail wall cutis capillaries 6 h after its application. This may be associated with the anti-inflammatory effect of the drug.
The efficacy of halcinonide cream, 0.1 percent, was evaluated in 101 patients with moderate or severe dermatoses. Conditions of these patients included contact dermatitis, atopic dermatitis, nummular eczema, neurodermatitis, stasis dermatitis, dyshidrosis, and various combinations of these disorders. Halcinonide cream was prescribed twice or three times a day for three weeks, and patients were followed-up weekly during this period. Sixteen patients stopped treatment after two weeks because their lesions had cleared. By the end of three weeks, the condition in 46 of the patients had completely resolved, the condition in 39 showed marked improvement, the condition in 10 had improved moderately, the condition in 5 showed mild improvement, and the condition in 1 did not show any improvement. No local or systemic side effects were reported. We conclude that halcinonide cream is an effective and safe topical therapy in the short-term treatment of a variety of moderate to severe steroid-responsive dermatoses.
Recalcitrant dermatoses may be a manifestation of a symbolic transition object. Psychologically, the patient uses his skin eruption to assure himself that he is a separate person with his own boundaries. A method is presented which describes a way in which to control recalcitrant dermatoses without using potentially dangerous drugs.
Although the balance between the number of primary care physicians and the number of specialists has been the subject of much attention, there has been little investigation of the quality and cost-effectiveness of various provider groups. To a large extent, dermatologic care is rendered by primary care physicians. In this study, the ability of primary care physicians to recognize the 20 most frequently encountered dermatoses was examined. Results indicate that, in comparison to dermatologists, primary care physicians are deficient in their ability to recognize common dermatoses. This study emphasizes the need for reevaluation of the training and, possibly, manner in which health care is delegated to personnel who deal with cutaneous disease.
Airborne dermatoses in general often cause diagnostic problems and are a puzzle not only to the patient but also to the doctor. This article focuses on the diagnosis of industrial airborne dermatoses, including all cutaneous reactions due to chemicals and various other agents transported by air.
Forty biopsies of granulomatous dermatoses, 12 of which were tuberculoid leprosy (TL), were studied for patterns of nerve twig distribution using an immunoperoxidase technique for S-100 protein. Four distinct patterns of nerve twigs were identified: 1) within granulomas, 2) between granulomas, 3) within and between granulomas, and 4) undetectable nerve twigs in an adequate biopsy. Pattern 4 was seen exclusively in TL (p < 0.05). The other patterns occurred in nonleprosy dermatoses as well, suggesting that pattern 4 is the best indicator toward a diagnosis of TL. The granules of mycetoma and Mycobacterium leprae also stained positively with the S-100 stain.
In order to ascertain whether patients with eczema are more prone to being bitten by insects than those with other dermatoses, data were collected by interview and questionnaire from 496 patients attending the outpatient department of a hospital in Sydney and a general dermatological practice in Geelong, Australia. Of the 93 patients with eczema 65% claimed they were prone to insect bite and that they were bitten in preference to other people when in a group, compared with 17% of the 403 patients with other chronic dermatoses. Similar proportions of both groups (approximately 50%) had used insect repellents. Excluding those with eczema 30% of the 149 patients with a family history of atopy claimed they were prone to being bitten by insects compared with 8% of the 254 patients without a family history of atopy. There was no difference in the prevalence of eczema or family history of atopy between men and women, but more women felt themselves to be susceptible to insect bites than men. There is evidence that patients with eczema and those with a family history of atopy are prone to being bitten by insects. Further confirmatory work, perhaps using volunteers and mosquitoes, is indicated. However, patients with severe eczema or a family history of atopy should take care when travelling to areas where disease-carrying insects are prevalent.
Besides the well-known methods applied for the treatment of chronic recurrent dermatoses, the authors propose to use laser therapy for management of its coexistent diseases. The article contains data which prove the high efficiency of laser therapy for treatment of chronic recurrent dermatoses with such coexistent diseases as tonsillitis, hymoritis, gastroduodenal erosion, ulcers and respiratory diseases. Methods of laser therapy are enclosed.