Alopecia and drug eruption of the scalp associated with a new beta-blocker, nadolol.

Infiltrative dermatitis and marked alopecia of the scalp appeared shortly after a new beta-blocker, nadolol (Corgard), was prescribed for the treatment of a patient with hypertension. Cessation of the beta-blocker therapy, after four months of therapy, was followed by a dramatic involution of the eruption, and total regrowth of scalp hair occurred within three months. The associated eruption and rapid regrowth of hair upon discontinuation of nadolol distinguish this alopecia from the telogen effluvium previously associated with other beta-blocker drugs, such as propranolol (Inderal) and metoprolol (Lopressor).

Vascular hemodynamic impedance in congestive heart failure.

The objective of this study was to determine whether pulse-contour analysis could provide a measure of the differences in peripheral vascular state between patients with congestive heart failure (CHF) and healthy persons. Vascular hemodynamic impedance parameters were determined from brachial artery pressure waveforms recorded in 14 patients with CHF, aged 20 to 55 years (mean 36 +/- 12) and in 7 healthy control subjects, aged 22 to 55 years (mean 33 +/- 12). Cardiac output, heart sounds and electrocardiogram were also monitored.

Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome: observations on therapy.

A 79-year-old man with severe generalized pruritus and erythema annulare centrifugum as manifestations of his idiopathic hypereosinophilic syndrome slowly responded to long-term therapy with ketoconazole and dapsone. The skin lesions cleared within one month but the pruritus and eosinophilia required seven full months of therapy.

Lichen aureus: a hemosiderin tattoo associated with perforator vein incompetence.

We present evidence that lichen aureus results from extravasation of red blood cells into the dermis caused by incompetence of an underlying perforator vein. The sudden appearance of the lesion suggests a "blow out" of the microvasculature of the lower dermis caused by failure of the valves in the perforator vein. This incompetence of the perforator vein induces a permanent reversal in normal blood flow.

Mycobacterium gordonae infection of the hand.

A 70-year-old woman was seen for two chronic nodules on the dorsum of her left hand. They had a uniquely mamillated surface, but histopathologically showed nonspecific granulomatous changes with no organisms seen. Laboratory studies disclosed the lesions were due to Mycobacterium gordonae, an organism commonly ignored as a pathogen.

Drug eruptions presenting at sites of prior radiation damage (sunlight and electron beam).

Two patients are described in whom sunburn and electron beam radiodermatitis, respectively, were critical determinants in localizing the initial presentation of drug eruptions. In the first instance, a severe sunburn of the back and thighs was followed 7 months later by the appearance of a toxic epidermal necrolysis drug reaction to trimethoprim-sulfamethoxazole in the exact sites of the previous bullous sunburn reaction. In the second patient, a radiodermatitis of the left upper arm due to electron beam therapy for metastatic breast cancer was followed 7 weeks later by a codeine drug reaction confined to the area of the radiodermatitis.

Acrocyanosis of cold agglutinin disease successfully treated with antibiotics.

Two women were seen for evaluation of acrocyanosis and vasculitis limited to the toes. General studies showed only the presence of low titer cold hemagglutinins. Complete rapid clearing of the cutaneous changes was achieved after treatment with systemic cephradine in one case and penicillin in the other.

The diagnostic challenge of nonburrowing mite bites. Cheyletiella yasguri.

Endemic pruritus in a family of four proved to be caused by the "bite and run" habits of the Cheyletiella yasguri mites that lived on the family dog. The mystery was solved only after the 6-year-old daughter experienced an explosive attack of pruritic papules after taking a nap in the dog's sleeping box. Virtually invisible ectoparasites remain a common cause of endemic pruritus within families.

Urinary tract infection as a cause of lichen planus: metronidazole therapy.

A 51-year-old woman with generalized lichen planus for 23 years experienced total involution of her lesions during metronidazole therapy. Discontinuance of the treatment on two occasions led to partial recurrence of the skin lesions, which again promptly cleared on reinstitution of metronidazole. It is believed that this patient's lichen planus was an immune reaction to circulating bacterial antigen.

Focal intravascular coagulation in progressive ascending telangiectasia: ultrastructural studies of ketoconazole-induced involution of vessels.

We describe a unique form of telangiectasia that we have called progressive ascending telangiectasia. It is a noninflammatory process, characterized by the presence of greatly dilated venous capillaries in the upper dermis. By means of scanning electron microscopy, focal fibrin clots were observed in some of the dilated vessels in the skin of a patient with this disease.

Onychoschizia: scanning electron microscopy.

The distal ends of the fingernails of four women with onychoschizia were studied with scanning electron microscopy. The dorsal surface and tip of each nail showed horizontal lamellar separations representing single cell layers. Some cleavage lines extended proximally into the nail plate, revealing remarkable sculptured cell surfaces deep within the plate.

Recalcitrant unilateral infection associated with congenital leg hypertrophy cleared by control of hyperhidrosis.

A man with congenital hypertrophy of the left leg experienced concomitant fungal and gram-negative bacterial infection of the foot on the same side. Oral antibiotic therapy failed, compromised by a post-surgical short bowel. Despite two hospitalizations for intensive care with intravenous antibiotic therapy, the infection did not clear until his plantar hyperhidrosis on the affected side was eliminated by the use of topical aluminum chloride.

Survey of surgical management of malignant melanoma in Canada: optimal margins of excision and lymph-node dissection.

The feasibility of clinical trials involving the surgical management of primary melanoma was assessed through a survey of Canadian surgeons who treat this disease. Surgeons were polled as to their current practice regarding node dissection and margins of resection of the primary lesion. Their interest in randomized trials addressing these practices was also assessed.

Focal salabrasion for removal of linear tattoos.

The use of a power-driven, cotton-tipped, wooden applicator permits precision salabrasion of small or linear tattoos. Such focal salabrasion is facilitated by prior removal of the overlying epidermis by means of a rotating dental burr.

Scanning electron microscopy of the scabies burrow and its contents, with special reference to the Sarcoptes scabiei egg.

An entire burrow of a female Sarcoptes scabiei (var. hominis) mite was examined by scanning electron microscopy during serial transverse sectioning. The elevated roof and the wall were composed of compacted corneocytes.

Follicular dermographism.

Four patients who complained of an inexplicable pruritus of several weeks to several years in duration are presented. General medical studies were unremarkable and the skin was normal except for erythematous papular lesions at sites recently scratched. The skin changes could be reproduced by multiple firm strokes with the broad edge of a tongue blade.