Regressing atypical histiocytosis. Aberrant prothymocyte differentiation, T-cell receptor gene rearrangements, and nodal involvement.

Two cases of regressing atypical histiocytosis were studied. New findings reported include the presence of CD1 epitope on large atypical histiocytoid cells and apparent early lymph node involvement. Because regressing atypical histiocytosis may demonstrate aberrant thymic differentiation antigen expression and T-cell receptor gene rearrangements, initial lymph node involvement, and eventuation in conventional lymphoma in some cases, the alternative term regressing-phase anaplastic lymphoma is proposed as a more accurate designation for this entity.

UVB maintenance phototherapy in psoriasis.

Twenty-six patients with generalized stable plaque-type psoriasis were treated three to five times weekly with midwave fluorescent ultraviolet radiation (UVB) combined with either tar or lubricants. After clearing, patients received maintenance treatment with lubricant and UVB for a minimum of four weekly exposures, which were subsequently decreased in frequency. A shielded control site was observed.

Possible drug-induced pemphigus-like antibodies with the clinical manifestation of erythema multiforme.

A patient with bullae and target lesions on the extremities and mucous membranes was seen with the clinical picture of erythema multiforme following an episode of pneumonia and a course of penicillin G potassium and tobramycin sulfate therapy. An unusually high titer of intercellular circulating (IC) antibodies was identified in the serum by indirect immunofluorescence (IF) microscopy, but direct lesional IF microscopy study results were negative. These IC antibodies were not true pemphigus antibodies and can best be termed pemphigus-like antibodies.

Lupus erythematosus arising in striae distensae.

A 21-year-old man with systemic lupus erythematosus presented with a prominent inflammatory dermatitis confined primarily to steroid-induced striae. To the best of our knowledge, this cutaneous manifestation of lupus erythematosus has not been previously reported. Koebner's phenomenon is suspected to be the underlying mechanism.

Topical steroids and UV radiation in psoriasis.

This study evaluates the benefits of a potent and midstrength topical steroid compared with simple lubricating agents when used in combination with erythemagenic doses of sunlamp fluorescent UV irradiation in psoriasis. Twenty-six patients were studied in a bilateral symmetrical comparison. No significant differences were observed between topical corticosteroids and lubricants in the number of patients achieving a 75% or greater resolution of psoriasis.

Ultraviolet phototherapy in psoriasis with hydrophilic ointment alone or with crude coal tar.

Plaques of 12 psoriatic patients treated with crude coal tar and ultraviolet irradiation were compared with symmetric areas treated with the same ultraviolet light (UVL) source and a hydrophilic ointment vehicle. Of the 12 patients, 10 received 75-100% clearing at both sites regardless whether the tar or the vehicle was applied. Treatment three times weekly was as effective as five times weekly.

Comparison of once-daily and twice-daily ultraviolet radiation treatments in psoriasis.

Nine patients with chronic, stable, plaque-type psoriasis were treated with coal tar and sunlamp fluorescent irradiation. Symmetrical plaques were used to compare the effects of one ultraviolet radiation (UVR) treatment daily with two UVR treatments daily. We could not demonstrate any substantial difference in response.

Comb and brush acne.

Frequent combing or brushing of the hair may result in an exacerbation of existing acne or be the cause of localized acne. Because of today's hair styling habits and methods, this type of acne is commonly encountered but poorly appreciated by physicians. Patient education is the most important factor in the management of this condition.

Cutaneous Hodgkin's disease.

The case reported herein documents the occurrence of cutaneous involvement in a patient with a long history of Hodgkin's disease. Despite severe pruritus and intermittent exacerbations of a multitude of specific and nonspecific skin lesions, associated with his underlying malignancy, the patient has done remarkably well for more than seven years. This demonstrates quite well that cutaneous involvement in Hodgkin's disease is not necessarily an ominous prognostic indicator.

Verrucae planae spread by electrolysis.

The following case report presents a patient in whom flat warts were spread by electrolysis. Since electrolysis is a common procedure, physicians should be aware of such an occurrence. Adequate examination and treatment before the patient undergoes electrolysis can eliminate this unwanted side effect.

Comparison of crude coal tar and topical methoxsalen in treatment of psoriasis.

Fluorescent sunlamp bulbs have been an effective light source for treatment of psoriasis when they are used in combination with crude coal tar. In addition to their ultraviolet B (UVB) emission, the spectral output of these bulbs contains a substantial amount of ultraviolet A (UVA). Prior testing with this light source and topically applied methoxsalen achieved excellent results in psoriasis.

Palmar-plantar lichen sclerosus et atrophicus.

A 57-year-old woman has had lichen sclerosus et atrophicus confined to the palms and soles for the past six years. Diagnosis was confirmed by histologic study. Our patient's disease has been resistant to therapy.

An immunosuppressive serum factor in widespread cutaneous dermatophytosis.

A patient had a widespread dermatophytosis and a serum factor that specifically suppressed his T-cell rosette formation and the phytohemagglutinin responsiveness of his lymphocytes. The patient was also unable to mount a delayed hypersensitivity reaction to a standard anergy panel, although he did exhibit an immediate type hypersensitivity reaction to the trichophytin skin test antigen. Although many immunosuppressed patients succumb to severe bacterial and fungal infections, it is our contention that in certain cases the infectious process itself may generate a serum factor that is capable of inducing immunosuppression, thereby rendering the patient susceptible to further spread of the infection.

Topical methoxsalen administration and sunlamp fluorescent irradiation in psoriasis.

Analysis of standard fluorescent sunlamps (Westinghouse) indicates that in addition to UVB (290 to 320 nm), a considerable amount of UVA (320 to 400 nm) is also present in their emissions. Since the benefits of topical psoralen administration and UVA have already been demonstrated, and prior experience by ourselves and others with UVB has indicated that some psoriasis benefited from UVB alone, localized areas and plaques of 20 patients were treated with topical administration of psoralens and fluorescent sunlamp bulbs to determine if such a light source with this emission spectrum would be advantageous. Results indicated a total resolution in 17 of 20 patients after an average of 18 treatments.

Updating the Goeckerman regimen for psoriasis.

Various components of the Goeckerman regimen were analysed. Although our findings are preliminary, they indicate several important observations: (1) Irradiation of tar treated patients with UVA compared to UVB showed the most efficacious wavelengths to be in the erythemic range (UVB). (2) A 1% concentration of crude coal tar was as effective as 5 and 25%.

Photochemotherapy of psoriasis (PUVA) without specialized equipment.

High intensity long ultraviolet light (UV-A) systems along with oral methoxsalen (8-methoxypsoralen [8-MOP]) have been dramatically successful in clearing long-standing psoriasis. Since this equipment is beyond the reach of many dermatologists, we have examined alternate ways of achieving the benefits of PUVA photochemotherapy. A total of 24 patients with psoriasis have been treated with ordinary fluorescent blacklights in a conventional Zimmerman cabinet.

Pseudomonal balanitis.

Significant ecologic changes in the cutaneous flora during treatment may present a challenge both diagnostically and therapeutically. The development of an erosive balanitis due to Pseudomonas aeruginosa presented an example of such a microbiologic shift in the case reported. The eruption developed during treatment with topical antibacterial, antifungal, and corticosteroid agents.

Topical methoxsalen and blacklight in the treatment of psoriasis.

Thirty patients with recalcitrant psoriasis were treated with topical methoxsalen and blacklight (UVA). A 1% concentration either in an acetone, alcohol, propylene glycol vehicle, or hydrophilic ointment, USP, applied two hours before light exposure was highly effective. Twelve patients were completely cleared and nine were markedly improved in three to five weeks.

Keratosis lichenoides chronica. Possible variant of lichen planus.

A chronic, asymptomatic, keratotic, papular eruption, present for 15 years and resistant to all modes of therapy, was observed in a 49-year-old woman. Many of the papules formed a reticulated configuration over the arms and legs. This case resembles several others that have been described in the literature under different names, ie, keratosis lichenoides chronica, porokeratosis striata, and lichen verrucosus et reticularis.

Generalized exfoliative dermatitis from ethylenediamine.

A patient with a history of allergic reaction to an antibiotic cream (Mycolog [mixture of nystatin, neomycin sulfate, gramicidin, and triamcinolone acetonide]) was treated with aminophylline. A generalized exfoliative dermatitis resulted. The reaction was attributable to ethylenediamine hydrochloride, which is a component of both agents.