[Differential diagnosis of interface dermatitis]

Interface-dermatitis is defined as a type of cutaneous inflammation in which the dermo-epidermal junction is obscured. It is associated with vacuolar alteration at the dermo-epidermal junction, necrosis of individual keratinocytes, and melanophages in the papillary dermis. Differentiation between the large number of diseases characterized by an interface dermatitis can be accomplished by analysis of the density, localization, and composition of the infiltrate, number and localization of necrotic keratinocytes, and alterations of the epidermis (hyperplastic vs. atrophic). Several methods for a systematic approach to the diagnosis of interface dermatitides have been proposed; an own scheme combining different aspects of those methods is presented.

[Therapeutic use of dapsone in dermatitis herpetiformis (Duhring) and in certain inflammatory skin diseases]

After a historical review the authors give a summary about the possibility of clinical practice of Dapson dependly on 20 year literature. They emphasize the newest knowledge of the mechanism of action. The diseases in which the Dapson may be successful are expounded. The adverse effects are presented. In the centre--like the prototype of Dapsone-therapy--there is the dermatitis herpetiformis.

[Current eczema therapy]

The diagnostic term eczema refers to a group of skin diseases defined by the morphological criteria of erythema, papules, papulovesicles and, in the chronic stage, lichenification and desquamation. While the diagnostic workup should lead to a more specific diagnosis (irritant or allergic contact dermatitis, atopic, seborrheic or nummular dermatitis), the therapeutic approach is similar for most forms of eczema. In the present review, traditional and innovative therapeutic options are presented and discussed.

[How I managed peristomal dermatitis]

Peristomal skin irritation is one of the most frequent complication in the ostomate's rehabilitation process. It can and must be avoid through a specialized care. The author makes a literature revision and approaches the causative and associated factors to the skin damage, its classification and the preventive and therapeutical principles in Nursing Stomal therapy.

Urostomy appliances and stoma care routines. The relation to peristomal skin complications

The aim of the study was to describe types of appliances and stoma care routines and evaluate their relation to peristomal skin complications. Sixty-six patients with a cutaneous uretero-ileostomy were interviewed and the peristomal skin was assessed according to Classification of Peristomal Skin (CPS). The results show a conservatism regarding the types of appliance and the stoma care routines. More than half of the patients used the same product at follow-up as they were initially fitted with three to 14 years earlier. The routines adopted by the patients were often inadequate, resulting in skin complications. Continuous exposure of the skin to urine by creation of a too wide opening in the face-plate and infrequent changing of the appliance resulted in development of pseudoverrucose skin lesions.

Lichenoid dermatitis: a clinicopathologic and immunopathologic review of sixty-two cases

We reviewed 62 cases (26 men and 36 women, median age 55 years) of previously diagnosed lichenoid dermatitis and correlated the histologic and immunodermatologic findings with the clinical diagnosis and course. The clinical diagnostic groups were contact dermatitis (6 cases), drug eruption (14), lupus erythematosus (6), lichen planus (3), cutaneous T cell lymphoma (3), chronic dermatitis or neurodermatitis (19), and miscellaneous dermatologic disorders (11). With the use of individual histologic features, a correlation with specific clinical conditions was possible, and the clinical groups of dermatitis, drug eruption, lupus erythematosus or lichen planus, and T cell infiltration could be selected histologically. Direct immunofluorescence studies were of most help in the diagnosis of lupus erythematosus and atypical lichen planus, but these studies should be performed in all cases involving lichenoid inflammation. Although previously the nonspecific term lichenoid dermatitis was used to classify the histologic features in these cases, we found that by careful correlation of histologic, immunodermatologic, and clinical features, we were often able to provide a specific diagnosis.

[Specific pregnancy dermatoses--a simplified clinical classification]

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.

Classification of urticaria and the reactive inflammatory vascular dermatoses

The common feature of all the conditions discussed in this article is that they are inflammatory vascular dermatoses that may occur as reactive processes in association with other diseases. The histopathologic characteristics of the lesions range from mild, perivascular dermal infiltration with inflammatory cells and vasodilation to various degrees of vessel damage (endothelial swelling to fibrinoid necrosis). The vessel damage is reflected in varying degrees of secondary changes including extravasation of edema fluid, extravasation of erythrocytes, epidermal necrosis, separation of the dermal-epidermal junction zone, and widespread tissue necrosis. The etiology of most of these conditions is still unknown, although strong evidence indicates that type III (circulating immune-complex-mediated) pathogenesis may be responsible for necrotizing venulitis (leukocytoclastic vasculitis) and that a type I (IgE-mediated) pathogenesis may be involved in some types of urticaria. For many of the reactions described, the patients have serum sickness-like systemic signs and symptoms in addition to cutaneous lesions, and a circulating immune-complex-mediated pathogenesis has been considered. Future investigations must address the types of antigens and antibodies present in the circulating immune complexes, the detection of specific antigen in cutaneous blood vessels, the reproduction of lesions in experimental animals, and the mechanisms responsible for the spectrum of clinicopathologic lesions produced, with special attention to the possibility that vessel damage results from circulating immune complex-induced lymphocytic rather than only leukocytoclastic vasculitis.

The nosology of parapsoriasis

Parapsoriasis is a group of uncommon but not rare disorders that was created in 1902 as part of a now long forgotten scheme to classify all inflammatory dermatoses. This artificial grouping has led to an enormously confused nosology of these disorders, that are, for the most part, otherwise unrelated. The use of a number of different terms at different institutions and by different physicians to denote the same diseases, together with the use of particular, single terms to denote different diseases, has caused much unnecessary confusion. In this review these terms are examined and an attempt is made to propose a new, unambiguous classification. Using this system, physicians with different views regarding which of the parapsoriases constitute distinct entities should have not difficulty communicating, and should have clearer frame of reference within which to work. An attempt is made to evaluate critically which of the parapsoriases are distinct entities and whether one or more of them should be considered an early form of cutaneous lymphoma in light of currently available data.

Papular eruption in black men

A persistent papular eruption in black men characterized clinically by small, pruritic papules and histologically by a mononuclear cell-eosinophil perivascular infiltrate is described. This disorder, seen only in young black men, is not readily classifiable within existing dermatologic taxonomy.