Historical outline of attempts to classify skin diseases

Over the years physicians have attempted to classify skin diseases. Plenck and Willan were the first to outline clearly the basic components of skin diseases and to devise classifications based on living gross pathologic features. With the development of molecular biology, etiologic classification--a system unrelated to that of clinical appearance--was begun. Most current textbooks present combinations of these two systems and those based on location or on other concepts.

Immunological concept for Bell's palsy: further experimental study

This report concerns itself with additional experimental evidence to support the immunologic concept for the pathogenesis of Bell's palsy, using the mast cell as an index of immunological activity. In a previous experimental study, we postulated that degranulation of mast cells activated by complement or specific allergens with release of histamine and other substances may be the mechanism leading to nerve edema, ischemia, and paralysis. In this study we observed a loss of granulated mast cells in the more severely damaged facial nerves of immunized dogs after the intrafallopian canal injection of various substances, in contrast with the relative abundance of these cells in nerves that showed little or no evidence of injury. In addition, we demonstrated that cromolyn sodium, a mast cell degranulation inhibitor, when infused intravenously at the time of the intrafacial canal injection of horse serum, very effectively lessened the degree of experimental paralysis and histologic nerve injury.

Neurosyphilis and penicillin levels in cerebrospinal fluid

Because neurosyphilis may progress despite therapy with the recommended penicillin regimens, 15 subjects with positive tests for syphilis in the serum and cerebrospinal fluid (CSF) were studied. All of these patients had CSF pleocytosis. Two received penicillin G (5 and 10 million units per day intravenously, respectively) and 13 received benzathine penicillin G, 3.6 million units per week intramuscularly; treatment lasted four weeks. During intravenous and after intramuscular penicillin therapy, a spinal tap was performed on all subjects; later, assays were done. Of two patients who received intravenous penicillin G, one had 0.3 mug/ml and the other had 2.4 mug/ml penicillin in the CSF. Twelve of 13 patients who received benzathine penicillin G had no detectable penicillin in the CSF; one patient had 0.1 mug/ml penicillin in the CSF.

The lines of Blaschko: a review and reconsideration: Observations of the cause of certain unusual linear conditions of the skin

Blaschko's lines are the pattern assumed by many different naevoid and acquired skin diseases on the human skin and mucosae. They were described and drawn by Blaschko 75 years ago. These lines are to be distinguished from other linear patterns such as Voight's lines, Langer's lines, and the lines of innervation of the spinal nerves. They do not follow any known nervous, vascular or lymphatic structures in the skin. The epidermis and its appendageal structures, the melanocytes, the vascular system, and the fatty hypoderm, all, separately or in combination, may be involved in the morphological manifestations which follow Blaschko's lines. Many of the naevoid skin conditions are lifelong (e.g. linear sebaceous naevus, unilateral naevoid telangiectasia); many of the acquired skin diseases (e.g. lichen striatus, linear psoriasis) are of relatively short duration (e.g. 1-2 years). The cause of the distribution pattern is unknown. It is possibly a form of human 'mosaicism' where certain specific cells or groups of cells react differently from other cells due to chromosomal abnormalities. The embryological explanation of Blaschko's lines is not at all clear. Other markers in addition to the skin findings are needed to determine the time and the nature of the change responsible for these lines. The main purpose of this article is to introduce the concept of Blaschko's lines into the medical, paramedical, and general biological fields of science. In this way, it is hoped that some inter-reaction can occur between those who regularly see Blaschko's lines and those who regularly see and study other chromosomal and embryological abnormalities.

Systemic drug rashes: pitfalls in diagnosis and treatment

Some of the unusual findings in eruptions from systemically administered drugs are localization to areas of trauma and localization in the mucosae. Systemic drug eruptions must be distinguished from autosensitization eczema, lesions produced by scratching, by application of drying preparations and from all the other causes of sudden widespread erythema. A calendar of the dates on which all the drugs were given is suggested to help find the causative drugs. In general, almost all drugs should be stopped and a period of time should be allowed to pass before a decision is made as to whether or not a particular drug can be implicated. Rarely, coricosteriods will have to be given. Consultation with physicians who have day-to-day experience in handling systemic drug reactions should be obtained if you are not sure of the diagnosis or management.

Serum chloride analysis, bromide detection, and the diagnosis of bromism

Current methods for determining serum chloride concentration vary in specificity. Laboratory detection of bromide in serum is usually dependent on spuriously high chloride values. In the absence of historical information, the chemical identification of bromide in serum may be the only diagnostic sign of bromism. Bromide may be found in as many as 1% of sera obtained from inpatients of a general hospital. Ion-selective electrodes and some thiocyanate methods for chloride analysis can be highly sensitive to bromide (interference). Chloride electrodes are also sensitive to iodide.

Differential diagnosis of some common skin lesions: a morphological viewpoint

Illustrative skin lesions are described and depicted in order to show the importance of seeing in making a diagnosis. Seeing is being neglected in the art and science of medicine - it needs to be revived.

Management of Candida peritonitis by prolonged peritoneal lavage containing 5-fluorocytosine

A 55 year old woman on chronic maintenance peritoneal dialysis developed Candida albicans peritonitis. This was successfully treated by continous five day peritoneal lavage containing 5-fluorocytosine. By this technique stable serum levels of the drug (58 mug/ml +/- 3.2 SEM) could be maintained. The peritoneal clearance of 5-fluorocytosine was found to be 7.5 ml/min (for peritoneal dialysis flow rate 1.2 1/hr) and the serum half-life 34 hours. The use of this drug in renal failure and its kinetics are reviewed.

Arsenic and cancer

Palmar and plantar keratoses developed in seven patients many years after ingeston of trivalent inorganic arsenic. Six had basal cell carcinoma (superficial multicentric type in five), carcinoma "in situ" or squamous cell carcinoma of the skin. Two had systemic carcinoma--one, bilateral breast adenocarcinoma and one, carcinoma of the colon. From these observations and from the findings of a review of the literature, there seems no question that long-term arsenic ingestion can cause palmar and plantar keratoses and skin cancer, particularly basal cell carcinoma of the superficial multicentric type, usually on the torso. It is suspected but not proved to cause other cancers. Although over the last 50 years general exposure to arsenic has greatly decreased, particularly that from insecticides, this element is still found occasionally in drinking water (naturally or as a smelter byproduct), in certain foods and in cigarette smoke.

The importance of being visually literate. Observations on the art and science of making a morphological diagnosis in dermatology

Morphology (or living gross pathology) is being neglected in contemporary dermatology. It is high time for a renaissance of the teaching of the art and science of seeing, so that students, residents, and physicians can learn about basic morphological changes in the skin, the raison d'etre of the speciality of dermatology. How do we see? How can what we see be recorded? What do these recordings tell us when applied to morphological diagnosis? Basing my arguments on the studies of Thomas and others, I will discuss the significance of how much a physician actually sees, the effect of certain emotional states and blind spots, the ability to synthesize visually, and the influence of prior knowledge.

Saint Peregrine, O.S.M.--the patron saint of cancer patients

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Nonbacterial pus-forming diseases of the skin

The formation of pus as a result of an inflammatory response to a bacterial infection is well known. Not so well appreciated, however, is the fact that many other nonbacterial agents such as certain fungi, viruses and parasites may provoke pus formation in the skin. Also heat, topical applications, systemically administered drugs and some injected materials can do likewise. Numerous skin diseases of unknown etiology such as pustular acne vulgaris, pustular psoriasis and pustular dermatitis herpetiformis can have bacteriologically sterile pustules. The importance of considering nonbacterial causes of pus-forming conditions of the skin is obvious from a diagnostic and therapeutic point of view.

Early clinical descriptions of skin cancer

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Nevoid basal cell carcinoma syndrome

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Fairy rings

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