Multiple pilomatricomas and myotonic dystrophy

Multiple pilomatricomas are rare. However, among patients with myotonic dystrophy, the occurrence is higher. The authors report a patient, to their knowledge the 11th case of multiple pilomatricomas associated with myotonic dystrophy, to emphasize that these tumors may be associated with the disease.

Cicatricial pemphigoid

Cicatricial pemphigoid is a subepidermal blistering disease that involves the mucous membranes and the skin. The oral cavity and the eye are most frequently involved. The clinical course is of long duration, and often there is significant scarring that can have devastating sequelae. The majority of the patients are elderly. The disease is characterized by the in vivo deposition of an anti-basement membrane zone antibody. The anti-basement membrane zone antibody cannot be detected in the circulation by routine laboratory techniques. The pathogenesis is poorly understood, and the cause is not known. Cicatricial pemphigoid may remain localized to the oral cavity or the eye or the skin (Brunsting-Perry variety), or it may be generalized. It rarely occurs in children, and it may be drug induced. Efforts must be made to differentiate cicatricial pemphigoid from bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA bullous disease, and other vesiculobullous disease. Early recognition and treatment can improve the prognosis and avoid surgical intervention. Topical therapy is beneficial and expedites healing. Intralesional corticosteroids are effective and can help reduce the dose of systemic steroids. Most patients require systemic corticosteroid therapy. Dapsone is also useful in treating cicatricial pemphigoid, especially in patients in whom systemic steroids are ineffective or in whom they have to be discontinued because of side effects. Immunosuppressive agents (azathioprine or cyclosphosphamide) are indicated in patients with progressive disease. Occasionally both drugs may be needed.

Evaluation of ammonium lactate in the treatment of seborrheic keratoses

A double-blind, paired comparison study was used to evaluate treatment effects of 12% ammonium lactate lotion (Lac-Hydrin) against its vehicle on seborrheic keratoses. Fifty-eight volunteer patients, 37 to 82 years of age, were studied for 16 weeks. The patients had a minimum of two seborrheic keratoses at least 10 cm apart. They applied the medication twice daily. The lesions were evaluated for height, surface characteristics, color, and length with the use of 7X calibrated loupe, a template, skin replicas, and scanning electron microscopy. Lac-Hydrin 12% lotion significantly reduced the height (elevation) of seborrheic keratoses, and two seborrheic keratoses cleared completely; however, there was no statistically significant difference in the length, color, and surface characteristics between the study group and the control group. Skin replicas and scanning electron microscopy can be used to evaluate lesion surface characteristics, dimensions, and therapeutic effects.

Woolly hair nevus

Woolly hair nevus is a rare, nongenetically determined condition in which unruly and tightly curled hair is localized on one or several areas of the scalp. We report the first case of woolly hair nevus with onset during adolescence. Marked improvement was evident 5 years after onset. Light microscopic examination of a biopsy specimen from the scalp showed a curved hair follicle. Scanning electron microscopic examination revealed slight fluting and marked flattening of the hair shafts. A discussion of these results and a comparison with those of the previously reported cases suggest that woolly hair nevus correlates with a variety of structural changes in the hair.

Melkersson-Rosenthal syndrome: a review of 36 patients

The Melkersson-Rosenthal syndrome is an uncommon condition of uncertain pathogenesis and cause. The classic triad of signs includes recurrent orofacial edema, recurrent facial nerve palsy, and lingua plicata. We retrospectively reviewed the medical records of 36 patients (24 women and 12 men) with elements of the Melkersson-Rosenthal syndrome. The complete triad was present in 9 (25%) patients. Orofacial involvement was the dominant feature; it occurred in all 36 patients and was the presenting sign in 15 (42%). Lingua plicata occurred in 18 (50%) patients, and peripheral facial paralysis was present in 17 (47%). Fourteen biopsy specimens were obtained, all from the orofacial region. Eight specimens revealed the classic pathologic picture of granulomatous cheilitis. No etiologic agent was identified in any of the patients. Diagnosis is difficult when all features of the triad are not present. A conservative treatment approach is recommended.

Comparative efficacy of 12% ammonium lactate lotion and 5% lactic acid lotion in the treatment of moderate to severe xerosis

This double-blind study was designed to evaluate treatment results and time effects of 12% ammonium lactate and 5% lactic acid lotion for moderate to severe xerosis. Results showed 12% ammonium lactate lotion was significantly more effective than 5% lactic acid lotion in reducing the severity of xerosis in both the 3-week, twice-a-day treatment period and the following 3-week, no-treatment (regression) period.

Erythema nodosum-like lesions in Behçet's syndrome: a histopathologic study of 30 cases

Thirty patients who fulfilled the criteria for complete and incomplete types of Behçet's syndrome were studied to determine the histopathologic changes of erythema nodosum-like lesions. Lymphocytic vasculitis was observed in 12 (40%) of the cases, but it was only focal in areas of severe lymphocytic inflammation and only mild in degree. No diffuse vasculitis was seen. It is our opinion that the observed lymphocytic vasculitis is only secondary to moderate or severe lymphocytic inflammation. Twelve cases (40%) revealed septal panniculitis, 10 cases (33%) demonstrated lobular panniculitis with moderate to marked inflammation and fat cell necrosis, and 8 cases (27%) showed mild and nonspecific inflammation in the panniculus. Therefore, there is a spectrum of histopathologic changes of erythema nodosum-like lesions in Behçet's syndrome, similar to that of erythema nodosum secondary to other systemic disorders.

Clinical correlations of linear IgA deposition at the cutaneous basement membrane zone

To determine the specificity of linear IgA deposition at the cutaneous basement membrane zone for primary bullous disease, we reviewed the results of all direct immunofluorescence studies of skin biopsy specimens taken from patients seen at Mayo Clinic during the period 1982 through 1986. Of 4642 specimens submitted for direct immunofluorescence during this 5-year period, 44 from 42 patients showed linear IgA deposition at the basement membrane zone, with or without other immunoglobulins. Of these 42 patients, 36 (86%) had primary subepidermal bullous disease. Of the 36, 20 had linear IgA without IgG at the basement membrane zone (10 with clinical adult linear IgA bullous dermatosis, 2 with chronic bullous disease of childhood, and 8 with cicatricial pemphigoid). Sixteen had linear IgA and IgG at the basement membrane zone (10 with clinical cicatricial pemphigoid, 5 with bullous pemphigoid, and 1 with epidermolysis bullosa acquisita). There was a high frequency of mucosal involvement (67% of the 36 patients) and a somewhat higher frequency of ocular involvement in patients with cicatricial pemphigoid who had linear IgA without IgG at the basement membrane zone (6 of 8) than in those who had both immunoglobulins at the basement membrane zone (4 of 10). These results show that the direct immunofluorescence finding of linear IgA deposition at the basement membrane zone correlates with primary subepidermal bullous disease in a high percentage of patients but reflects a heterogeneous group of blistering disorders.

Pernicious anemia with associated glossodynia

Glossitis and glossodynia are commonly seen by the dental practitioner. The awareness that these symptoms in conjunction with other oral signs indicate pernicious anemia is important for the clinician. Correct diagnosis can be made, and neurological complications avoided. Two case reports are presented and typical oral and systemic features of pernicious anemia are discussed.

Dapsone therapy of cicatricial pemphigoid

Dapsone and the related sulfapyridine have been valuable therapeutic agents in many inflammatory disease states although the exact mechanism of action remains unclear. In patients with mild CP or the localized (gingival or ocular) variants, dapsone has been shown to be a relatively safe, first drug of choice in therapy before commencing treatment with systemic corticosteroids and/or immunosuppressive agents. In patients with extensive, severe, or rapidly progressive CP, initial therapy with corticosteroids in a dose of 1 to 2 mg/kg/d of prednisone plus immunosuppressive agents such as azathioprine or cyclophosphamide in a dose of 2 to 3 mg/kg/d are recommended.

Upper aerodigestive tract manifestations of cicatricial pemphigoid

Cicatricial pemphigoid is a chronic mucosal blistering disorder with a predilection for subsequent scar formation. Many physicians may be unaware of the various presentations and sequelae of this uncommon disease. This report of the largest series to date focuses on the upper aerodigestive tract manifestations of this disease. During the years 1975 to 1985, 142 patients with cicatricial pemphigoid were seen at the Mayo Clinic. There were 93 women and 49 men; the age range was 21 to 92 years. Mucosal lesions occurred most often in the mucous membranes of the oral cavity and conjunctiva. Involvement of the pharynx, larynx, and esophagus was less common. Stenosis of the nasopharynx or larynx necessitated surgical repair in several persons and caused obstructive sleep apnea in two. The otolaryngologist can make an important contribution to the early recognition, diagnosis, and management of the complications of cicatricial pemphigoid.

Cellular autoimmunity in psoriasis and lichen planus

The objective of this investigation was to determine whether specific cellular recognition of the epidermis is associated with the human skin diseases, psoriasis and lichen planus. Epidermal cells (EC) obtained from biopsies of involved and uninvolved skin of patients with these diseases were used as stimulators and targets for autologous peripheral blood mononuclear cells (PBMC) in assays of three conventional manifestations of cellular immunity: lymphocyte transformation, leukocyte migration-inhibition and cell-mediated cytotoxicity. Parallel tests were conducted with autologous PBMC as stimulators to ascertain the tissue specificity of the reactions evoked by autologous EC. Similar assays were conducted with EC and PBMC from a large group of normal subjects, and the results were compared to those of the dermatology patients by rigorous statistical analyses. No evidence of lymphocyte-mediated cytotoxicity towards autologous EC was obtained with any of the subject groups, but autologous EC, and to a lesser extent PBMC, of the psoriasis patients, but not of the other two groups, evoked significant lymphocyte transformation. These results were obtained only with patients on Goeckerman therapy, raising the possibility that they were a manifestation of the treatment (topical coal-tar and ultraviolet light irradiation) rather than of the disease, although reasons are presented why this is unlikely. Clearer evidence of disease-associated autoimmunity was obtained in the leukocyte migration-inhibition assays, where autologous EC, and to a lesser extent, PBMC, of the psoriasis patients in general, not just those on Goeckerman therapy, and not those of the lichen planus patients or of the normal subjects, stimulated the release of a leukocyte migration-inhibition factor. These results support the concept of a central role for T-cell mediated autoimmunity in the pathogenesis of psoriasis.

Immunopathology of oral mucosal inflammatory diseases

Many inflammatory conditions of oral mucous membranes are the end result of altered immune reactivity. Lesions from these disorders, as well as a wide variety of infectious, irritant, and idiopathic conditions, appear clinically similar in the mouth and are difficult to differentiate. New and improved immunologic laboratory techniques have helped to further our understanding of the pathogenesis of many of these disorders and have proved to be valuable in clarifying the diagnosis underlying many of these difficult dermatoses.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis is the most common ulcerative disease of the oral mucosa. The lesions of aphthous stomatitis are mucosal manifestations of a variety of conditions, 30 per cent of which may be discerned by history, physical examination, and appropriate laboratory testing. Correction of underlying conditions or deficiencies results in improvement or remission in aphthous disease activity. Treatment of lesions for which an underlying cause cannot be discerned is discussed.

Power meter for optical efficiency measurements of laser-induced plasmas

A power meter was constructed to measure the power being deposited in transient laser-induced plasmas (LIP). The design rejects the radiation scattered from the laser beam by the LIP and that transmitted past the LIP. The power meter is constructed from a small metal-capped flask placed in an evacuated chamber. The steady-state heat production in the flask is determined from measurements of the temperature gradient on a thermal resistance connecting the top of the flask with a heat sink. The design worked well and should be applicable to a wide variety of situations if the dimensions of the system are adjusted to compensate for power levels substantially different from those used here.

Oral drug reactions

Oral drug reactions have many clinical manifestations and are produced by numerous medications. These reactions may be the result of an allergic reaction to systemically administered drugs or as an indirect effect of the action of the drug on other tissues. Other oral drug reactions may be the result of local or topical medications. These reactions are either a result of an allergic, delayed-type hypersensitivity, or a local primary irritation. The appearance may be nonspecific or it may resemble several distinct clinical entities. The diagnosis of these oral drug reactions is made with a good clinical history and examination, along with a high index of suspicion. Often there are multiple factors involved that complicate the clinical picture. The clinician who is familiar with the types of oral drug reactions caused by medications, the mechanisms by which these reactions occur, and which medications are most likely to cause the reaction will be prepared to make the correct diagnosis and treatment recommendations.

The treatment of desquamative gingival lesions

The treatment of desquamative gingival lesions is dependent on the correct diagnosis of the underlying disease, which is frequently dermatologic. This is determined by clinical observations, as well as by histologic and immunologic examination of gingival biopsy specimens. The recommended treatment of desquamative lesions caused by lichen planus, cicatricial pemphigoid (benign mucous membrane pemphigoid), pemphigus, and psoriasis, the most common dermatoses causing gingival lesions, is summarized on the basis of 62 cases and reports in the literature.

An association between HLA DRI and lichen planus

Serological typing for HLA Class II antigens in 72 patients with lichen planus (LP) revealed a highly significant association with HLA DRI and MTI (DQWI). DRI was present in 80% of patients with generalized LP, 54% with localized LP, 56% of patients with drug-induced LP and in 31% of patients with mucosal LP, compared with 25% of normal controls. MTI (DQWI) was found in 83% of the LP group and 62% of the normal controls. These findings strongly suggest a genetic predisposition or susceptibility to the development of generalized LP and perhaps also to drug-induced LP.