Erythema marginatum in rheumatic fever: early diagnosis by skin biopsy

Skin biopsy of a 10-year-old boy with a 3-week history of recurrent rash and fever demonstrated histologic changes suggesting a diagnosis of erythema marginatum associated with rheumatic fever. Subsequently, the patient developed classic cardiac and arthritic manifestations. Skin biopsy is recommended for the early diagnosis of rheumatic fever.

The color of the skin of the palms and soles as a possible clue to the pathogenesis of acral-lentiginous melanoma

It is obvious clinically that skin of the palms and soles (volar skin) of blacks is lighter in color than black glabrous skin. The same difference obtains in whites, but is much less obvious. The distribution of melanosomes within keratinocytes of the palms and thighs of blacks and whites was compared. Keratinocytes in skin from the thighs of blacks contained only individually dispersed melanosomes, but keratinocytes in skin from the palms of blacks and from the palms and thighs of whites contained complexed melanosomes. Our observation may explain why the incidence of melanoma of volar skin in blacks and whites is similar, whereas melanoma on the glabrous skin of blacks is extremely rare.

Spontaneous regression of a giant keratoacanthoma. Photographic documentation and histopathologic correlation

An 84-year-old woman developed a keratoacanthoma on the dorsum of her left hand. Photographic documentation of spontaneous resolution of the lesion over a period of eight months is presented. Biopsy of the site of the resolving lesion revealed extensive scarring and granulomatous inflammation.

Photoallergic contact dermatitis to musk ambrette. Histopathologic features of photobiologic reactions observed in a persistent light reactor

Studies concerning a patient with contact photosensitivity to musk ambrette, a commonly used fragrance, are reported. The patient had a persistent light reaction. The patient's history, clinical appearance, and phototest and photopatch test results are described. The observed patterns of these were identical to those previously noted in patients who had persistent light reactions after exposure to other photosensitizers such as the halogenated salicylanilides. The histopathologic findings in the phototest and photopatch test sites were those of an acute spongiotic dermatitis. No abnormal change was seen with ultraviolet A radiation exposure alone.

Penicillamine-associated pemphigus: is it really pemphigus?

Penicillamine-associated bullous eruptions share with spontaneously occurring pemphigus intraepidermal acantholysis, epidermal intercellular deposition of immunoglobulin, and circulating serum antibody against the intercellular regions of the epidermis. We report the case of a penicillamine-associated bullous eruption in which there were some of the histologic features of pemphigus, but none of the immunofluorescent features. Instead, the immunofluorescent findings of bullous pemphigoid were demonstrated. Review of the literature reveals that clinical and histologic features of penicillamine-associated bullous eruptions differ in important respects from those of spontaneously occurring pemphigus. Our report adds immunologic data to evidence that the penicillamine-associated bullous eruptions may not be the same disease as spontaneously occurring pemphigus.

Melanocytic nevi in neonates

The histologic features of seven congenital nevi within 3 months of birth were studied, together with the ultrastructural features of one of the lesions examined microscopically within 48 hours of birth. All seven lesions showed melanocytic hyperplasia within the epidermis and within pilosebaceous and eccrine sweat units. Nevus cells within the dermis were located in proximity to the adnexae. Melanocytic hyperplasia within the epidermis showed a variety of patterns, at least one of which simulated the atypical melanocytic hyperplasia seen in the superficial spreading type of melanoma. The fine structure of the melanosomes in one case studied by electron microscopy resembled hair-bulb melanosomes. They were distinctly different from melanosomes characteristic of epidermal melanocytes, nevus cells, or melanoma cells.

A distinctive variant of pernio. Clinical and histopathologic study of nine cases

We describe here nine women who had similar distinctive clinical features that consisted of painful red-to-purple macules, papules, and plaques on the digits, predominantly on the toes. All patients reported that exposure to cold had preceded their symptoms. Histologic study demonstrated a lymphocytic vasculitis, characterized by lymphocytes infiltrating the walls of blood vessels in eight (88%) of nine lesions. This pattern of inflammation is different from the perivascular lymphocytic infiltrate that is common to lupus erythematosus, erythema multiforme, lymphocytic infiltration of the skin (Jessner), and drug eruptions. It also serves to distinguish the disorder from other clinical conditions resembling it, such as cellulitis, herpes simplex infection, and disseminated gonococcemia. To the best of our knowledge, this lymphocytic vasculitis has not been previously described as occurring in pernio. We believe the unique disorder that we are reporting is a common, but infrequently recognized, variant of pernio.

Treatment of dermatitis herpetiformis with colchicine

Oral colchicine therapy was used successfully in the treatment of three patients with dermatitis herpetiformis, although the degree of disease control varied. The condition of a fourth patient did not improve. A trial of colchicine is suggested when conventional therapy with dapsone or sulfapyridine is contraindicated or when a gluten-free diet cannot be employed.

Cutaneous manifestations of disseminated candidiasis

Recognition of the characteristic cutaneous lesions of disseminated candidiasis may allow earlier diagnosis and treatment of this often fatal fungal infection. The skin lesion developed in patients with hematologic malignancies and compromised host defenses, at a time when they were febrile, clinically deteriorating, and failing to respond to multiple antibiotics. This report discusses two patients with acute myelogenous leukemia with cutaneous manifestations of disseminated candidiasis due to Candida tropicalis. Single or multiple erythematous or purpuric 0.5- to 1-cm papulonodules with pale centers were seen on the trunk and proximal extremities. In most reported cases of disseminated candidiasis with skin lesions, the diagnosis can be confirmed by histologic evaluation of a skin biopsy before appropriate cultures identify the organism.

Giant cells in male pattern alopecia: a histologic marker and pathogenetic clue

Twenty-one of 65 (31%) biopsy specimens from patients with male pattern alopecia demonstrated the presence of individually displaced multinucleate giant cells without a significant concomitant cellular infiltrate. This finding was absent in a diverse group of other forms of alopecia. Whether individually displaced multinucleate cells are a useful histologic marker for diagnosing early stages of androgenetic alopecia remains to be determined.

Cutaneous and vulvar melanoma: an update

In conclusion, cutaneous malignant melanoma, regardless of site, is best managed by early recognition and appropriate conservative surgical treatment. Depth of tumor invasion at the time of definitive surgical intervention is the most accurate measure of prognosis. Radical surgical measures for deeply invasive high-risk primary lesions have yet to be proven effective in altering prognosis, and the patient's quality of life should be considered when such procedures are contemplated.

Ultrastructural study of superficial spreading melanoma and benign simulants

Ultrastructural examination of the intraepidermal component of superficial spreading melanomas (SSM) and benign melanocytic lesions was undertaken to determine the diagnostic value of electron microscopy in clinically "borderline" melanoma problems. Seventeen SSMs and ten benign melanocytic nevi and lentigenes which clinically resembled melanoma were studied. Melanocytes of the intraepidermal component of the SSMs showed a greater tendency for abnormal melanosome formation than did melanocytes of the benign simulants. However, the abnormalities were variable and were not limited to the SSMs. Our observations suggest that qualitative ultrastructural evaluation cannot be reliably used differentiating SSMs from benign melanocytic lesions.

Intralesional corticosteroid therapy of chalazia

Twelve adult patients with 17 chalazia underwent trial intralesional injection of triamcinolone acetonide. Seven chalazia resolved within two weeks after only one injection, and another six after two injections. Two lesions failed to respond to two injections, and two lesions responded to one injection, but either recurred or another lesion developed. Patients were satisfied with the procedure, which appears to be a safe, convenient, and effective altefnative to chalazion surgery.

New world leishmaniasis. Serologic aids to diagnosis

The increase in travel to endemic areas of South and Central America has led to an increase in the number of cases of cutaneous leishmaniasis diagnosed in the United States. Traditional methods of diagnosis for this disease include microscopical examination of infected tissue, culture of Leishmania on special media, and the leishmanin skin test. The present communication describes a case of cutaneous leishmaniasis and the difficulties that were encountered in diagnosis. New methods of serologic testing allow more prompt and accurate diagnosis.

Ultrastructural and enzymic modulation of HeLa cells induced by sodium butyrate and the effects of cytochalasin B and colcemid

Sodium butyrate causes HeLa cells to assume an elongated and jagged shape. Ultrastructurally this change is associated with the formation of bundles of microfilaments. Desmosomes were present between adjacent cells. No increase in microtubules was observed in the butyrate-treated cells. Butyrate induces an increase in the activity of 2 membrane-bound enzymes, alkaline phosphatase and 5′-nucleotidase; however, the activity of a third membrane enzyme, acetylcholine esterase, is reduced. The activities of the several other enzymes with different subcellular localizations are not significantly increased.Colcemid and cytochalasin B prevent or reverse the butyrate-mediated change in HeLa cell morphology and also partially inhibit the induction of alkaline phosphatase activity in these cells. The effect of cytochalasin B on alkaline phosphatase induction may be caused by a reduction in protein synthesis produced by this fungal metabolite.

Familial malignant melanoma

Two sisters simultaneously developed a superficial spreading malignant melanoma on their legs. Concurrently, a brother was affected with fatal metastatic melanoma. Several explanations for familial malignant melanoma are reviewed, including: 1. Genetically determined predisposition; ,2 Phenotypic and environmental factors; and 3. Infectious etiology (virus?). Relatives of patients who develop malignant melanoma spould be aware that they have a higher risk than the general population of developing this serious type of cancer.

Potassium permeability in -thalassemia minor red blood cells

The intracellular content of K(+) in thalassemia minor red blood cells is markedly reduced after incubation in autologous serum for 24 hr at 37 degrees C. There is no compensatory increase in intracellular Na(+) concentration of the cell thus reduced. This change is due to an acquired increase in selective permeability of the membrane to K(+). This phenomenon follows the depletion of energy sources in the thalassemia minor cells but does not follow comparable depletion in normal cells. The loss of osmotically active intracellular contents probably accounts for the increased resistance of incubated thalassemia minor red blood cells to osmotic lysis.