Onycholysis of the fingernails: evaluation and management

Onycholysis (ONY) of the fingernails is a common disorder that is diagnosed with ease but often managed with great difficulty. The full spectrum of causes is broad and not always readily apparent. In this review, an approach to the evaluation and management of ONY is offered.     

Scanning electron microscopy of the scabies burrow and its contents, with special reference to the Sarcoptes scabiei egg

An entire burrow of a female Sarcoptes scabiei (var. hominis) mite was examined by scanning electron microscopy during serial transverse sectioning. The elevated roof and the wall were composed of compacted corneocytes. The floor had a smooth surface except at the anterior end. Here it was made up of nucleated stratum granulosum cells, etched in appearance, presumably having been chewed by the mite. The female mite, the larvae, scybala, and eggs were also examined. The ultrastructure of the eggshell surface revealed it to have a distinctive geometric patterning. Cross-sectioning showed this shell or chorion to be composed of an outer layer of minute, closely packed penta- and hexahedrons resting on a thin inner homogenous layer. The polyhedric surface pattern was exactly replicated in the cement substance which attached the egg to the burrow floor. Observations were made on the embryonic positioning which permitted the larvae to emerge from the eggshells in a uniform manner.     

Eradication of scabies with a single treatment schedule

A single application (16 to 20 hours) of 1% gamma benzene hexachloride (GBH) lotion, when applied to a total island population of 178 persons in which seventy-four clinically had scabies, resulted in a cure rate of over 98%. Re-examination of the population at 10 and 21 weeks revealed only one remaining individual still having scabies. On a neighboring island, only those with clinical evidence of scabies were treated (140 persons). Applications of 1% GBH lotion were applied with the same methods used on the first island. When the population was re-examined at 10 weeks, the prevalence of scabies was reduced by only 50%. Successful eradication of scabies from a population should include treatment of all contacts, whether clinically infected or not. Treatment of the entire population at risk at one time is preferable. Coexistent pyoderma should be treated, and a second treatment for scabies may be needed when the pyoderma has cleared.     

Erythromelanosis follicularis faciei et colli: A case report

The thirteenth case of erythromelanosis follicularis of the face and neck is reported and attention is called to this entity. Characteristically, it affects males in adolescence or young adulthood. It begins symmetrically on the preauricular cheeks and imperceptibly spreads onto the temples and lateral aspects of the neck. It presents as an irregularly marginated, red-brown pigmentation with fine telangiectasia, small, pale, slightly scaly, follicular papules, and patchy alopecia of vellus hair. The histologic features, although nondiagnostic, correlate well with the clinical features. The possible relationship to keratosis pilaris rouge is discussed.     

Treatment of lichen sclerosus with potassium para-aminobenzoate

In five patients with symptomatic lichen sclerosus, significant clinical improvement was obtained following the administration of potassium para-aminobenzoate. Improvement was characterized by a marked decrease or absence of symptoms and a flattening of skin lesions.     

Acanthosis nigricans presenting as hyperkeratosis of the palms and soles

A patient with an unusual form of palmoplantar hyperkeratosis is described. On thorough physical examination, widespread acanthosis nigricans was discovered. We believe this patient's distinctive keratoderma represents acanthosis nigricans.     

Treatment of chromomycosis with ketoconazole and 5-fluorocytosine

Chromomycosis is a disfiguring cutaneous mycosis that is often recalcitrant to therapy. We describe a case of chromomycosis of the lower extremities that is being successfully treated with ketoconazole and 5-fluorocytosine (5-FC) after treatment with ketoconazole alone had failed. In vitro studies showed that the drugs acted synergistically against the strain of Fonsecaea pedrosoi which was isolated from the patient's lesion.     

The problem of lindane

The human clinical use of 1% lindane formulations has become somewhat controversial during the past five years. This review is an in-depth report of the efficacy and safety of 1 % lindane compared with the agents that have been preferred as alternative. Almost all of the suspected adverse drug reactions (ADR) from 1% lindane have involved substantial misuse. The number of suspected ADRs remains small, especially when compared with the magnitude of human clinical use of 1% lindane preparations in the United States (50 million ounces during the past five years). One percent lindane should continue to remain the preparation of choice for nearly all patients with scabies and lice, but dermatologists should appreciate that these views are not necessarily shared by all health professionals. Consequently, it is most appropriate to explain the possible side effects from misuse of lindane to each patient. This brief period of patient education is time well spent—it will help maintain proper compliance and allay the upset that many of your patients may have if they encounter negative opinions about lindane in the lay and medical press or from other health professionals.     

Menkes' syndrome: an updated review

Menkes' syndrome is an X-linked recessive multisystem disease which is usually fatal prior to 5 years of age. Though originally felt to be a disorder of copper deficiency, it now appears to be a copper storage disease, with the observed defects resulting from inappropriate systemic copper distribution. Disorders in the metabolism of metallothionein, a metalloprotein involved in cellular copper transport, may be the primary defect in this syndrome. This review summarizes the relevant clinical and pathologic findings seen in this condition to date. It also describes some of the abnormalities in the metabolism of copper and metallothionein in these infants.