Minocycline and generalized cutaneous pigmentation

The recent literature contains sporadic mention of localized pigmentary accumulations in skin, bones, teeth, and thyroid tissue, presumably related to the use of systemic minocycline hydrochloride. It is our purpose to report the occurrence of generalized, cutaneous, dark blue-gray hyperpigmentation that developed in a woman while she was being treated with minocycline (Minocin) for acne vulgaris. We believe this pigmentary change to be minocycline-induced.     

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.     

Immunosuppression: A cause of porokeratosis?

Two patients are reported in which the development of porokeratosis occurred following chemotherapy for systemic malignancy. Immunosuppression associated with malignancy and chemotherapy may exacerbate or initiate the development of porokeratosis in patients predisposed to alterations of cutaneous growth dynamics.     

Neonatal lupus erythematosus, multiple thromboses, and monoarthritis in a family with Ro antibody

We describe a family afflicted with striking clinical and serologic autoimmune features. The mother and maternal uncle of a patient with neonatal lupus had rheumatic disease manifestations. All three had Ro antibodies (SS-A) in their sera, as well as La antibody (SS-B). The 17-year-old mother developed postpartum inflammatory monoarthritis of the right knee and had a positive lupus band test. The uncle at the age of 26 developed a fulminant disease most consistent with systemic lupus erythematosus (SLE); initial manifestations were myocardial infarction, deep vein thrombosis, and the nephrotic syndrome. Although it is known that mothers of neonatal lupus infants can develop SLE postpartum, the development of severe disease in the maternal uncle suggests the relevance of identifying seropositive relatives of individuals with neonatal lupus.     

DermRx. An experiment in computerizing information on dermatologic therapy

The Task Force for Creating a Biomedical Communications System for Dermatology was commissioned by the American Academy of Dermatology to develop an experimental segment of a computerized data bank on dermatologic therapy. The Task Force has completed such a "first generation" system and has named it DermRx. Its data bank carries the following information on each entry: the name of the disease; topical, systemic, physical, and other kinds of treatment; caveats; references to the literature; and the date and reviewer(s). The DermLit and DermRx programs are two components of a projected broader concept of an eventual comprehensive Biomedical Communications System for Dermatology. Such a system is envisaged as a means of making available to dermatologists diverse data relevant to practice, teaching, research, and business aspects of the specialty. At the moment, access to the stored information on dermatologic literature and therapy is by telephone call to, or by correspondence with, the central computer facility at Northwestern University. Eventually it is projected to be accessible by dedicated microcomputers housed in the physician's office. This preliminary report on DermRx is presented to review the progress of the project to date and to elicit comment upon its structure and value.     

Cutaneous clinicopathologic correlation of allergic granulomatosis

Allergic granulomatosis is a distinct clinical syndrome occurring in adults with asthma, eosinophilia, and multisystem vasculitis. Atopy and drug sensitivity are other important features. The skin reactions are most commonly nodular and inflammatory lesions. A unique feature is the deep papulonodules, which may occur singly on the scalp or symmetrically on the extremities. Cutaneous findings may range from purpura to urticaria and ulceration. The most common histologic finding is the extravascular granuloma; however, necrotizing vasculitis of small vessels is seen, as well as periarteritis nodosa involving larger vessels of the skin. This varied histologic and clinical spectrum seen in patients with systemic allergic granulomatosis is a reflection of a unique host response to multiple antigens. The cutaneous findings imply that allergic granulomatosis probably represents a unique host response to the same causative and pathogenetic factors as are usually found in periarteritis nodosa and necrotizing vasculitis.     

Bleomycin in the treatment of recalcitrant warts

Bleomycin is gaining increasing popularity in the treatment of warts, but its efficacy has not been examined in well-controlled studies. We evaluated bleomycin in a double-blind placebo-controlled crossover study in recalcitrant warts treated unsuccessfully by conventional methods. Patients were assigned alternately to placebo or bleomycin groups and treated by intralesional injections of bleomycin, 1 U/ml, or saline, at 2-week intervals. If warts persisted, patients were changed after two injections to the alternate group and retreated with up to two further injections. Forty patients entered the study. Of 151 warts treated with intralesional bleomycin, 123 were cured after one or two injections (81%). The cure rate for plantar warts (60%) was lower than that for periungual warts (94%) and warts elsewhere on the extremities (95%). Fifty-five warts were injected with normal saline; none was cured. Responding warts showed a hemorrhagic eschar and healed without scarring, atrophy, or pigmentary change. Pain was usually mild and patient acceptance superior to that with liquid nitrogen. There was no evidence of systemic toxicity. Bleomycin is highly efficacious in the treatment of recalcitrant warts, is convenient, and has high patient acceptance. Long-term safety requires further study.     

Penicillin and vitamin A as possible therapeutic agents in pityriasis rubra pilaris

Pityriasis rubra pilaris (PRP) is a rare skin disorder with versatile clinical presentations. A 62‐year‐old Caucasian woman with progressive erythroderma and classic adult (type I) PRP is presented. Treatment with systemic steroids and methotrexate produced no improvement. Clinical remission was achieved after systemic therapy with penicillin (both intravenous and intramuscular) and vitamin A. The therapy of PRP is reviewed, focusing on a possible infectious genesis of PRP as well as the role of antibiotics in its management.     

Universal cutaneous depigmentation following phenytoin-induced toxic epidermal necrolysis

A 10-year-old black girl with a severe hypersensitivity reaction to phenytoin is described. Adverse effects included interstitial nephritis, hepatitis, and toxic epidermal necrolysis. An apparently permanent sequela of universal cutaneous depigmentation developed. Although the presence of clear cells in the basal layer of the epidermis suggested that melanocytes might still be present, these clear cells were shown, by electron microscopy, to be Langerhans cells and not melanocytes. This patient demonstrates a unique outcome, not previously described in the literature.     

Generalized pruritus and systemic disease

A retrospective study of 44 cases of generalized pruritus (GP) was undertaken to determine the incidence of systemic disease in this population. This data was compared to that of a group of 44 age- and sex-matched psoriatic controls. We found 13 (30%) of the GP cases to have a systemic disease that in the literature is believed to be associated with GP, versus 10 (23%) in the psoriasis group. Excluding hypothyroidism and diabetes mellitus, two disorders with questionable relationship to GP, the number of pruritus patients with an associated systemic disease was reduced to 8 (18%) compared to only 1 (2%) psoriatic patient, a difference which is statistically significant (p less than 0.02). In 6 (14%) of the GP patients a temporal relationship of systemic disease and GP was suggested. Recommendations for outpatient workup of GP are given. Patient follow-up of 1 to 6 1/2 years revealed that 29 (66%) of the patients had persistent itching. The mean duration of itching to the time of the present follow-up was 57.7 months.     

Ultraviolet A1 phototherapy for the treatment of localized scleroderma

Ultraviolet (UV)A1 phototherapy is effective for T-cell-mediated skin diseases such as atopic dermatitis and mast cell-mediated skin diseases such as mastocytoma. UVA1 phototherapy is also effective against the sclerotic lesions of systemic sclerosis and morphea. Currently, in Japan, access to UVA1 phototherapy is limited because the UVA1 phototherapy device has not yet been approved. On the basis of our experience, we report three patients with localized scleroderma who responded successfully to UVA1 phototherapy. Efficacy was assessed by histological analysis and elastography. UVA1 successfully ameliorated sclerotic lesions, including morphea, linear scleroderma and morphea lesions in a patient with limited cutaneous systemic sclerosis. No side-effects were observed during UVA1 phototherapy.     

Phototherapy in systemic sclerosis: Review

Systemic scleroderma—also known as systemic sclerosis (SSc)—is a chronic systemic connective tissue disease characterized by collagen deposition in cutaneous and internal organs, leading to skin sclerosis and multiple organ fibrosis. The pathogenesis is complex and remains poorly understood. Treatment is based on organ involvement and requires a multidisciplinary approach. Skin sclerosis can cause disability, leading to decreasing quality of life. Various systemic antifibrotic therapies have been used; however, most have unsatisfactory results. Recently, phototherapy and in particular ultraviolet A (UVA) has been used to treat skin sclerosis in SSc patients with satisfactory results. The main mechanisms include lymphocyte apoptosis, cytokine alteration, inhibition of collagen synthesis and increased collagenase production, and neovascularization, leading to the breakdown of collagen fibrils resulting in skin softening or even healing digital ulcers. Most studies reported that psoralen plus UVA (PUVA) and UVA1 phototherapy improved clinical outcomes vis‐à‐vis skin sclerosis, joint mobility, ulcers, and histopathology. PUVA and UVA1 phototherapy therefore have potential as an alternative or adjunctive therapy for patients with SSc.     

Chloracne and chloracnegens

Chloracne, an acneform eruption resulting from poisoning by halogenated aromatic compounds, has been a considerable problem over the last 40 years. The condition is always a symptom of systemic poisoning and should be familiar to all practitioners, particularly dermatologists. It is difficult to treat and can last for long periods without known additional exposure to chloracnegens. Some chloracnegens are capable of causing a variety of systemic signs and symptoms and may be oncogenic. Although there are probably fewer than 4,000 persons with chloracne worldwide, those found with the disorder should be evaluated medically on a regular basis and followed, if possible, throughout their lives.     

系统性真菌感染的药物治疗进展

随着系统性真菌感染的发病率急剧上升,寻找新型抗真菌药物,特别是对耐唑类菌株有效的药物研究已成为临床治疗系统性真菌感染的迫切需要。本文分类综述近年来临床常用的以及最新研究开发的抗真菌药物,为临床治疗系统性真菌感染提供新的选择。     

趋化因子与系统性红斑狼疮的关系

趋化因子（chemokines）是一类能够调控细胞定向迁移的细胞因子,广泛存在于白细胞、单核细胞、巨噬细胞、T细胞和B细胞,并且通过与相应的趋化因子受体结合从而介导对白细胞的趋化作用。一种趋化因子能与多个趋化因子受体相结合,而一个趋化因子可能有多个高亲和性受体,它们共同构成复杂的网络系统,在系统性红斑狼疮的发生发展中起到重要作用。本文主要对不同趋化因子及受体与系统性红斑狼疮关系进行综述。