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King T, Helm TN, Valenzuela R, Bergfeld WF. Diffuse intraepidermal deposition of immunoreactants on direct immunofluorescence: a clue to the early diagnosis of epidermal necrolysis. Int J Dermatol 1994; 33:634-6. [PMID: 8002159 DOI: 10.1111/j.1365-4362.1994.tb02922.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Toxic epidermal necrolysis is a distinctive disorder that is readily identified clinically and histologically in advanced cases. Early on, however, toxic epidermal necrolysis may be difficult to identify. Some consider fixed drug eruption a limited form of toxic epidermal necrolysis. METHODS Direct immunofluorescence was performed on biopsy material of erythematous skin lesions. RESULTS Diffuse deposition of immunoreactants in the midmalpighian layer was noted. This finding has not been encountered in other disorders studied in our immunopathology laboratory. CONCLUSIONS Diffuse immunoreactant deposition in the mid-epidermis should suggest a diagnosis of epidermal necrolysis either from toxic epidermal necrolysis or fixed drug eruption. Additional cases will need to be assessed to document the usefulness of this pattern for prospective diagnosis.
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Ruxin TA, Pierson JC, Helm TN, Bergfeld WF. Stump the experts. Segmental neurofibromatosis. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1994; 20:304, 351-2. [PMID: 8176040 DOI: 10.1111/j.1524-4725.1994.tb01628.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
In brief A variety of dermatologic problems affect the hands and feet of active patients, often producing significant pain and disability. Traumatic disorders include friction blisters, calcaneal petechiae, subungual hemorrhage, and plezogenic papules. Infectious disorders include hot tub folliculitis, swimming pool granuloma, tinea pedis, warts, and herpetic whitlow. Athletic shoe dermatitis is a common allergic disorder, and hand eczema is a common disorder with a strong hereditary component. Prompt diagnosis and treatment can minimize morbidity. Some traumatic disorders can be prevented.
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Helm TN, Camisa C, Liu AY, Valenzuela R, Bergfeld WF. Lichen planus associated with neoplasia: a cell-mediated immune response to tumor antigens? J Am Acad Dermatol 1994; 30:219-24. [PMID: 8288781 DOI: 10.1016/s0190-9622(94)70020-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Individual case reports have suggested an occasional association of lichen planus with internal malignancy. OBJECTIVE Our purpose was to describe five patients with a neoplastic disease in whom lichen planus developed. METHODS Serologic and immunopathologic studies were conducted. RESULTS No evidence of autoantibody production characteristic of paraneoplastic pemphigus was found, and antibodies reactive with basal cell keratinocytes were not detected. CONCLUSION Lichen planus may be rarely induced by neoplasia. A cell-mediated immune reaction possibly causes this phenomenon.
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Thorisdottir K, Camisa C, Tomecki KJ, Bergfeld WF. Necrolytic migratory erythema: a report of three cases. J Am Acad Dermatol 1994; 30:324-9. [PMID: 8294591 DOI: 10.1016/s0190-9622(94)70033-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Necrolytic migratory erythema (NME) is a cutaneous reaction pattern with specific histopathologic features that is typically associated with a functioning pancreatic islet cell neoplasm such as a glucagonoma. Three examples of NME, each associated with a different cause, are presented: glucagonoma, pancreatic insufficiency, and gluten-sensitive enteropathy. All three patients were successfully treated by surgical resection of the pancreatic tumor, total parenteral nutrition and pancreatic enzyme replacement, or a strict gluten-free diet, respectively. All remain free of skin disease more than 2 years later. Any patient with NME should be evaluated for glucagonoma and small bowel disease that may be associated with malabsorption and malnutrition.
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Patten SF, Valenzuela R, Dijkstra JW, Bergfeld WF, Slaughter S. Unmasking the presence of circulating pemphigus antibodies in a patient with coexistent pemphigus, SLE, multiple autoantibodies, and gastric carcinoma. Int J Dermatol 1993; 32:890-2. [PMID: 8125694 DOI: 10.1111/j.1365-4362.1993.tb01409.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Helm TN, Helm F, Marsico R, Bergfeld WF, Helm KF. Seborrheic keratoses with occult underlying basal cell carcinoma. J Am Acad Dermatol 1993; 29:791-3. [PMID: 8227559 DOI: 10.1016/s0190-9622(08)81708-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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59
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Taylor JS, Maibach HI, Fisher AA, Bergfeld WF. Contact leukoderma associated with the use of hair colors. Cutis 1993; 52:273-80. [PMID: 8299388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Four cases of contact leukoderma associated with the application of hair rinses and permanent and semipermanent hair colors are described. To our knowledge, this association has not been previously reported. Although none had evidence of pigment loss in other sites, Koebner-induced vitiligo cannot be excluded. In our cases hair color ingredients seem to have had a selective toxic effect on melanocytes. Further study of pigment loss from hair colors is warranted, especially in animal and in vitro assays. Patch testing with putative depigmenting agents in patients should be done with caution, so as to minimize potential for depigmentation in cosmetically important anatomic sites.
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Pathy AL, Helm TN, Elston D, Bergfeld WF, Tuthill RJ. Malignant melanoma arising in a blue nevus with features of pilar neurocristic hamartoma. J Cutan Pathol 1993; 20:459-64. [PMID: 8300932 DOI: 10.1111/j.1600-0560.1993.tb00672.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 65-year-old man presented with a history of a giant blue plaque of the parietal scalp since childhood. Biopsy revealed a cellular blue nevus. The blue nevus was observed for 10 years and thought to be unchanged until a new adjacent lesion was noted. Biopsy of the new lesion revealed metastatic malignant melanoma. A wide excision was performed of the original lesion which revealed malignant melanoma arising in a blue nevus. Areas within the blue nevus were consistent with a pilar neurocristic hamartoma, whereas other areas were consistent with a common blue nevus. Subsequent satellite metastases developed, with early metastases resembling blue nevi except for the absence of a stromal component and the presence of hyperchromatic nuclei. Later metastases were typical of metastatic melanoma. This case illustrates the uncommon evolution of malignant melanoma from a blue nevus. The histological features and relationship between melanoma, blue nevus, and pilar neurocristic hamartoma are reviewed.
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Guitart J, McGillis ST, Bailin PL, Bergfeld WF, Rogers RS. Human papillomavirus-induced verrucous carcinoma of the mouth. Case report of an aggressive tumor. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1993; 19:875-7. [PMID: 8396162 DOI: 10.1111/j.1524-4725.1993.tb01022.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Somach SC, Helm TN, Lawlor KB, Bergfeld WF, Bass J. Pretibial mucin. Histologic patterns and clinical correlation. ARCHIVES OF DERMATOLOGY 1993; 129:1152-6. [PMID: 8363399 DOI: 10.1001/archderm.129.9.1152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE We identified several patients with a histologic diagnosis of pretibial myxedema in whom thyroid disease was not found. The purpose of this study was to investigate if histologic characteristics can distinguish between pretibial mucinosis secondary to Graves' disease and that unassociated with thyroid disease. METHODS Biopsy specimens interpreted as compatible with pretibial myxedema were reviewed; these included 12 cases of pretibial mucinosis with documented Graves' disease, and six cases of pretibial mucinosis without evidence of Graves' disease. Ten specimens interpreted as compatible with stasis dermatitis were also evaluated for histologic characteristics, including the possible presence of mucin. RESULTS Features that distinguish between pretibial mucinosis associated with Graves' disease and pretibial mucinosis without Graves' disease included preservation of a zone of normal-appearing collagen in the superficial papillary dermis (12/12 with Graves' disease, 0/6 without), mucin deposition in the reticular dermis (12/12 with Graves' disease, 0/6 without), lack of mucin deposition in the superficial papillary dermis (11/12 with Graves' disease, 1/6 without), angioplasia (2/12 with Graves' disease, 6/6 without), and the presence of hemosiderin (2/12 with Graves' disease, 6/6 without). Mucin deposition in the papillary dermis was found in six of 10 specimens interpreted as stasis dermatitis. CONCLUSIONS There are patients with pretibial mucinosis in whom there is no thyroid disease. Specimens from patients without Graves' disease have features of stasis dermatitis in addition to mucinosis. We conclude that pretibial mucinosis may result from stasis or Graves' disease and that histologic differences allow for accurate differentiation.
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Helm TN, Calabrese LH, Longworth DL, Barna B, Liu AY, Bergfeld WF. Vascular nodules and plaques resembling chronic mucocutaneous candidiasis in a patient with a low interleukin 2 level. J Am Acad Dermatol 1993; 29:473-7. [PMID: 8349866 DOI: 10.1016/0190-9622(93)70214-e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 21-year-old woman had a lifelong history of widespread friable vascular nodules and plaques. Her condition had previously been diagnosed as chronic mucocutaneous candidiasis because of her clinical appearance. Routine studies of immune function were performed in addition to a comparison of cytokine secretion in mononuclear leukocytes of our patient and normal controls. Interleukin 2 secretion by phytohemagglutinin-stimulated mononuclear leukocytes was deficient when compared with six healthy donors (< 300 pg/ml vs 2108 +/- 336 pg/ml). Interleukin 2 deficiency may be a causative factor in cases of unusual vascular proliferation. Treatment with methotrexate, which increases interleukin 2 activity and inhibits neovascularization in vitro, was helpful in our patient.
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Kuhn CA, Helm TN, Bergfeld WF, McMahon JT. Acquired uncombable hair. ARCHIVES OF DERMATOLOGY 1993; 129:1061-1062. [PMID: 8352616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Helm TN, Bergfeld WF, Yen-Lieberman B. Alopecia universalis in a patient seropositive for the human immunodeficiency virus. J Am Acad Dermatol 1993; 29:283-4. [PMID: 8101531 DOI: 10.1016/s0190-9622(08)81856-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Elston DM, Bergfeld WF, McMahon JT. Aluminum tattoo: a phenomenon that can resemble parasitized histiocytes. J Cutan Pathol 1993; 20:326-9. [PMID: 8227609 DOI: 10.1111/j.1600-0560.1993.tb01270.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We present a study of aluminum tattoos that resulted from aluminum chloride cauterization of biopsy sites. The stippled macrophages were studied by light and electron microscopy and by means of X-ray energy spectroscopy (XES) analysis. The light microscopic appearance may be striking, and may mimic the appearance of parasitized histiocytes, although the particles are larger and vary in size and shape. The basophilic particles are electron dense by electron microscopy. XES analysis demonstrated distinct emission peaks corresponding to aluminum, calcium, and phosphorus. Only a minor chloride emission peak was identified. The particles may represent an inorganic precipitate or an organic compound in which aluminum, calcium, and phosphate form a complex with protein.
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Abstract
We report a schwannoma with well differentiated ducts resembling cutaneous sweat ducts. The tumor presented as a painless mass near the left knee of a 41-year-old female. The mass had been present for many years. Some increase in size had been noticed over the previous 2 to 3 yr. The bulk of the tumor was composed of spindle cells with the appearance of Antoni A and Antoni B tissue. Rare mitotic figures were noted. In several areas of the tumor, numerous well-differentiated ducts were present. Most resembled normal cutaneous sweat ducts. In some areas, cystic dilatation of the ducts was present. Focal areas demonstrated poorly formed ducts and single cells with prominent nuclei and ample cytoplasm. Well formed ducts, poorly formed ducts, and single cells marked with AE 1/3 (keratin) and epithelial membrane antigen. The spindle cell proliferation marked for S 100 protein and vimentin. Sweat duct differentiation has not been reported previously in either benign or malignant schwannoma. Light and electron microscopic features of this tumor are presented.
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Liu AY, Valenzuela R, Helm TN, Camisa C, Melton AL, Bergfeld WF. Indirect immunofluorescence on rat bladder transitional epithelium: a test with high specificity for paraneoplastic pemphigus. J Am Acad Dermatol 1993; 28:696-9. [PMID: 7684408 DOI: 10.1016/0190-9622(93)70095-b] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Paraneoplastic pemphigus is a blistering disease with specific serum immunoprecipitation findings. Although immunoprecipitation studies allow accurate diagnosis, they are time-consuming, expensive, and not readily available. In contrast, indirect immunofluorescence (IIF) testing of serum on transitional rat bladder epithelium is a simple and inexpensive method available to any immunopathology laboratory. OBJECTIVE Our purpose was to determine the specificity of positive IIF on rat bladder epithelium for paraneoplastic pemphigus. METHODS The IIF findings in four index cases of paraneoplastic pemphigus were compared with the findings in 47 patients with a variety of malignant neoplasms and no associated blistering disease as well as 49 patients with vesiculobullous or lichenoid disease but no neoplasia. RESULTS IIF was negative in all patients with neoplasia and no blistering disease and negative in all but one of the patients with vesiculobullous or lichenoid disease without neoplasia (98.9% specificity). CONCLUSION IIF on transitional rat bladder epithelium appears to be a highly specific test for paraneoplastic pemphigus. Because of its simplicity and inexpensiveness, we suggest that IIF be performed on transitional epithelium in any suspected case of paraneoplastic pemphigus.
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Abstract
Annular erythema of infancy is an uncommon, nonpruritic, figurate erythema that begins in the first year of life. Biopsy specimens reveal a perivascular and interstitial lymphocytic infiltrate with numerous eosinophils. The cause of the disorder is unknown, but a hypersensitivity response to unrecognized antigens is suspected. The disorder is self-limited, but may last for many months. In our patient the eruption continued 19 months after its onset.
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Abstract
A case of basal cell carcinoma with "monster cells" is reported. Clinically, the lesion presented as a red nodule on the forearm of a 58-year-old male. The histologic picture was striking, with large, "monstrous" nuclei scattered throughout a well defined nodule. Basal cell carcinoma with monster cells appears to represent a histologic variant of nodular basal cell carcinoma. The prognostic significance of the monster cells remains to be established.
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Andreano JM, Bergfeld WF, Medendorp SV. Tretinoin emollient cream 0.01% for the treatment of photoaged skin. Cleve Clin J Med 1993; 60:49-55. [PMID: 8443935 DOI: 10.3949/ccjm.60.1.49] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Tretinoin emollient cream 0.01% was used to treat 40 patients with photoaged skin of the face and forearms in a 48-week, randomized, double-blind, placebo-controlled study. On the face, a significant difference between treatment groups was found in the investigator's global evaluation (P < .001), and in fine wrinkling (P < .001) and coarse wrinkling (P = .02) at 24 weeks. Tretinoin-treated forearms showed significantly greater improvement in roughness, mottled hyperpigmentation, fine wrinkling, and lentigines at 24 and 48 weeks. More consistent improvement was seen on the forearms than on the face. Adverse experiences on the face in both treatment groups included dryness, peeling, and acne. No significant difference in reported adverse experiences was found between forearms in both treatment groups. On forearms, dermatitis was the most common adverse event. Tretinoin 0.01% was generally well tolerated, and skin irritation was minimal. Tretinoin emollient cream 0.01% is a potentially safe, effective treatment for photodamaged skin.
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Maceyko RF, Camisa C, Bergfeld WF, Valenzuela R. Oral and cutaneous lichen planus pemphigoides. J Am Acad Dermatol 1992; 27:889-92. [PMID: 1469153 DOI: 10.1016/0190-9622(92)70275-k] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lichen planus pemphigoides is a rare bullous disorder characterized by tense bullae on lichen planus lesions and on clinically uninvolved skin. A diagnosis of lichen planus pemphigoides is made on the basis of clinical, histologic, and immunopathologic evaluation. We describe a patient who had lichen planus pemphigoides of the skin and oral mucosa and briefly review the literature on this uncommon entity.
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Elder DE, Freeman RG, Bergfeld WF, Ackerman AB, Azar HA, Fechner RE, Caputo R, Metcalf JS, Borroni G, Burg G. Do you use the term "dysplasia"? If so, what do you mean by it, and if not, why not? Am J Dermatopathol 1992; 14:462-86. [PMID: 1415966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Nedorost ST, Bergfeld WF, Valenzuela R, Guitart J, Fleming MG. Cell cycle analysis by flow cytometry of non-exposed, sun-exposed, and tretinoin-treated skin. J Cutan Pathol 1992; 19:371-5. [PMID: 1474189 DOI: 10.1111/j.1600-0560.1992.tb00608.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The percentage of keratinocytes in the proliferative phase of the cell cycle (S + G2 + M) was measured by DNA flow cytometry in sun-exposed, non-exposed, and tretinoin-treated skin. Before tretinoin treatment, the percentage of keratinocytes actively cycling was higher in sun-exposed than in non-sun-exposed skin (p = .002) and was correlated with clinically assessed photodamage (p = .007). Subsequently, tretinoin-treated sun-exposed skin was compared to the pre-treatment sun-exposed skin. Overall, there was no statistically significant change. However, there was a trend toward a decrease in the percentage of keratinocytes in the S + G2 + M phases immediately after four months of tretinoin use that was limited to the most severely damaged patients. This effect was no longer evident two months after discontinuing treatment. This is the first study, to our knowledge, utilizing flow cytometry to investigate the effects of tretinoin in patients with varying degrees of photodamage.
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