Skin type, minimal erythema dose (MED), and sunlight acclimatization

Minimal erythema doses (MEDs) of individuals with different skin types were compared. Each skin type was shown to be statistically different from each other skin type in terms of sunburn sensitivity. Individuals of each skin type who primarily stayed indoors were compared with those who attempted to be outdoors. In the winter there was no difference between the sunburn sensitivity (MEDs) of these groups. During the summer, those who went outdoors were more resistant to sunburn than those who stayed indoors. In effect, acclimatization makes an individual respond to sunlight like a less sensitive skin type. However, acclimatization appears transitory, and benefits can be lost within a month or two.     

Glucagonoma syndrome. A clinicopathologic, immunocytochemical, and ultrastructural study

Necrolytic migratory erythema has been considered to be a paraneoplastic dermatosis. Although some individuals have had no associated neoplasm, a pancreatic glucagonoma is typically found in the vast majority. We describe a 71-year-old woman with findings strongly suggestive of the glucagonoma syndrome. The plasma glucagon level was modestly elevated. Special studies of the pancreas, including computerized axial tomography and selective angiography, did not demonstrate a tumor. Surgery, however, revealed a 5-cm tumor in the head of the pancreas. Although immunocytochemical stains showed only rare, weakly reactive cells, the electron microscopic study confirmed the diagnosis of an islet cell tumor and revealed characteristic morphologic features of glucagonoma.     

Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids)

This study was designed to look at the effect of evening primrose oil (linoleic and gamma-linolenic acids) as an oral supplement for patients with atopic eczema. We used a double-blind, blocked crossover design with random assignment of patients to treatment groups. We used Wilcoxon's signed-ranks method of comparing changes during the trial. We observed no significant effect on erythema, scale, excoriation, lichenification, or overall severity in 123 patients with atopic eczema of average severity while they took oral doses of evening primrose oil (2 or 4 gm in children, 6 or 8 gm in adults).     

The skin, touch, and human development

Most of us take our skin for granted, except when it breaks out in pimples, wrinkles, or otherwise becomes blemished. At such times we tend to become somewhat irritated with it, and wish it would go away. Most people seem to think of the skin as a sort of binding or wrapper that keeps the skeleton from falling apart, or out of which, at least in other animals, shoes and various leather articles are made. In hot weather the skin sweats unpleasantly, and in cold weather it grows uncomfortably chilly. Perhaps worst of all, it sprouts hairs in the wrong places, which have to shaved, and where hair is desired most thickly it grows most thinly, and only too early takes on the color least desired. And this is the skin.     

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.     

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.     

Comedogenicity of current therapeutic products, cosmetics, and ingredients in the rabbit ear

Cosmetics continue to be used by acne-prone individuals. Often as more acne develops, more cosmetics are applied. In order to protect against this natural tendency, physicians should provide more patient information on the currently available products and ingredients. This presentation is designed to help in that effort. The data presented were gleaned from the rabbit ear assay, which is not an ideal animal model but is the best we have. If an ingredient is negative in the rabbit ear assay, we feel it is safe on the acne-prone skin. A strong, positive ingredient or cosmetic should be avoided. Ingredient offenders include isopropyl myristate and its analogs, such as isopropyl palmitate, isopropyl isostearate, butyl stearate, isostearyl neopentanoate, myristyl myristate, decyl oleate, octyl stearate, octyl palmitate or isocetyl stearate, and new introductions by the cosmetic industry, such as propylene glycol-2 (PPG-2) myristyl propionate. Lanolins continue to be a problem, especially derivatives such as acetylated or ethoxylated lanolins. Our most troublesome recent finding is the comedogenic potential of the D & C Red dyes. They are universally used in the cosmetic industry, especially in blushers. This may explain the predominance of cosmetic acne in the cheekbone area. All of these D & C Red dyes tested to date, the xanthenes, monoazoanilines, fluorans, and indigoids, are comedogenic. Actually, this is not surprising as they are coal tar derivatives. The natural red pigment, carmine, is noncomedogenic and can serve as a substitute for D & C dyes in blushers. Many finished products are comedogenic. Most troublesome to the dermatologists are the therapeutic tools that we use, such as Liquimat, Retin-A cream, Hytone, Staticin, Sulfoxl, Desquam-X, and Persadox HP cream. These should be reformulated. We have been unable to confirm that precipitated sulfur (U.S.P.) is a potent comedogen in the rabbit ear assay. Clinically, we still find sulfur quite effective as an adjuvant to the benzoyl peroxide therapy for the treatment of acne vulgaris. We would suggest that the bias against sulfur be reconsidered.     

Abnormal biomechanics of feet and their cause of hyperkeratoses

A brief review of pedal anatomy and the mechanisms enabling feet to function as organs of locomotion is presented. The importance of the subtalar joint is emphasized. Four major abnormalities disturbing normal foot function are noted, and the most commonly encountered of these alterations, rearfoot varus, is discussed in some detail. A series of pedal abnormalities in rearfoot varus occurs because in the foot's attempt to overcome its imbalance, it pronates excessively and causes development of callus, corn, hallux valgus, and even ingrown toenail. Haglund's deformity, soft corn, and tailor's bunion are also secondary to the abnormality. Attempts to restrict the germinal compensatory pronation by various forms of padding of the medial aspect of the foot are frequently rewarded by restoration of asymptomatic feet. Surgical means of restoring normal function are briefly discussed.