SENILE DRY SKIN TYPE SJÖGREN'S SYNDROME

Background. Elderly patients may show asteatotic dermatitis complicating Sjögren's syndrome (sjs) that we have named “senile dry skin type sjs.” To define the condition further, we have examined a group of patients with sjs and have recorded clinical and laboratory findings in these patients. Patients and Materials. Of the 36 patients, 11 were men and 25 were women, with a mean age of 72 years. In addition to the subjective sensation of dryness of the eyes and oral cavity and objective signs of dryness revealed by the Schirmer test, the rose bengal test, minor labial gland biopsy, and sialography were carried out, as well as other hematologic and immunologic tests. Results. The following abnormal laboratory tests were found: elevated erythrocyte sedimentation rate (85%), mild hepatic dysfunction (50%), and anemia (45%), leukopenia (42%), and thrombocytopenia (16%). Immunologic abnormalities were also observed, such as: positive antinuclear antibody (55%), an increase in gamma globulin (28%), and a positive rheumatoid factor (20%). In 11 of the 36 patients (30%), the subjective sensation of dryness was absent and only objective signs of dryness were present. Conclusions. The present study suggests that dry–skin–dermatitis associated with sjs is rather common in the elderly.     

PREVALENCE OF EYELID DERMATITIS IN PRIMARY SJÖGREN'S SYNDROME

Background. The eyelid dermatitis seen in elderly patients is a relatively heterogenous and troublesome disease. Most cases seem to be idiopathic and show resistance to standard dermatologic therapy. Methods. Fifty-two patients with primary definite Sjögren's syndrome (4 men, 48 women, mean age 54 years) were enrolled in this study, and the prevalence of eyelid dermatitis was investigated. Diagnostic criteria for Sjögren's syndrome were based on the criteria proposed by the Japanese Ministry of Health and Welfare. Patch test was performed using ICDRG-European standard allergens and/or eye drops, hair dye, and cosmetics. Results. Of the 52 patients, 22 showed eyelid dermatitis. These changes were much more frequent in elderly patients and showed a good correlation with the presence of ocular dry sensation. No significant difference was observed in clinical and other laboratory findings between patients with or without eyelid dermatitis. Although 8 of the 13 patients showed positive patch test reaction to various allergens, no close relationship existed between the use of a suspected substance and the onset or severity of eyelid dermatitis. Conclusions. These results suggest that the presence of rubbing dermatitis of the eyelid may be one of the cutaneous manifestations of Sjögren's syndrome.     

PERIPHERAL VASCULAR DISEASE AND ANNULAR ERYTHEMA WITH SELECTIVK IgA DEFICIENCY AND MIXED CRYOGLOBULTNAEMIA

Summary.— A patient with peripheral vascular disease, annular erythema and Sjögren's syndrome is described. A selective IgA deficiency, which was not apparent on routine serum protein electrophoresis, and mixed cryoglobulinaemia were additional features of her autoimmune disease.     

SKIN LESIONS ASSOCIATED WITH SJÖGREN'S SYNDROME AND ANTICYTOPLASMIC ANTIBODIES IN SLE PATIENTS

Among forty-two systemic lupus erythematosus patients, three had antibodies against cytoplasmic antigens SSA and SSB. All three patients showed annular nonscarring erythema as a sign of their illness. The most predominant site of skin lesions was the face, but trunk and extremities were involved as well. All of the patients had clinically distinct Sjögren's syndrome following the onset of their skin lesions. These findings suggest that systemic lupus erythematosus patients with anticytoplasmic antibodies might often have accompanying clinical features of nonscarring erythema and Sjögren's syndrome.     

DERMATOMYOSITIS AND CARCINOMA

SUMMARY. A man aged 56 complained of itching, and subsequently erythema of the face, orbits and other areas exposed to light. Six weeks later, he developed haematuria, and in the following week, a rapidly progressive weakness of the shoulder girdle muscles.
He was found to have a rising titre of complement fixing antibody in his serum to an extract of his own bladder tumour. Immunofluorescent tests showed deposits of γ-globulin around muscle bundles and in the upper cutis.     

ERYTHEMA ELEVATUM DRTTINUM—VESICULAR LESIONS AND SULPHONE RESPONSE

SUMMARY. The clinical and histological features of erythema elevatum diutinum are summarised.
Reported cases with bullous or vesicular lesions are reviewed, and previous therapeutic experience is discussed.
A case of the bullous form is described. Attacks lasting five months recurred each winter. Dapsone was dramatically effective.     

DERMATOMYOSITIS AND POLYMYOSITIS UPDATE ON CURRENT CONTROVERSIES

Polymyositis and dermatomyositis are syndromes of unknown aetiology which are systemic in their nature involving prominent skin disease and prominent muscle disease. Classification is important particularly since dermatomyositis may be associated with malignancy more frequently than polymyositis, and certain subsets such as overlap syndromes less frequently harbour malignancy. Poor prognosic signs include pulmonary disease, the presence of malignancy, the severity of the weakness, and the presence of oesophageal disease. Therapy with corticosteroids is generally effective. In those patients who develop steroid side effects, immunosuppressive agents may be of use. Cutaneous disease may be controlled with hydroxychloroquine therapy.     

CARCINOMA OF THE BREAST, PEMPHIGUS VULGARIS AND GYRATE ERYTHEMA

ABSTRACT: Pemphigus vulgaris and erythema gyratum repens were found to coexist in a woman with recurrent carcinoma of the breast. Biopsy sections of the figurate cutaneous lesions contained metastatic adenocarcinoma. Depression of both humoral and cell mediated immunity was demonstrated to exist in this patient.     

ORF AND ERYTHEMA MULTIFORME IN A CHILD

Abstract: Letters to the Editor are welcomed tor publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed tuo pages of text including references. Two copies of all letters should be submitted. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.     

SENEAR—USHER SYNDROME AND INTERNAL MALIGNANCY

Summary.— Three cases of Senear—Usher syndrome are reported. All 3 had immunological evidence of co-existing pemphigus and lupus erythematosus. Two patients died of bronchial carcinoma. One surviving patient has probable metastatic neoplasia in the liver.     

ERYTHEMA MULTIFORME: EPIDEMIOLOGY, CLINICAL CHARACTERISTICS AND NATURAL HISTORY IN FIFTY-NINE PATIENTS

In this paper we report fifty-nine patients with erythema multiforme. Thirty-four of the patients were classified as erythema multiforme major (EM major) or Stevens- Johnson syndrome and the other twenty-five erythema multiforme minor (EM minor). The overall features of this group of fifty-nine patients are discussed and the significant differences between the two sub-groups (EM major and EM minor) highlighted.