Intravascular papillary endothelial hyperplasia: Multiple lesions simulating Kaposi's sarcoma

We describe a 69-year-old woman who developed multiple violaceous papules and nodules on both lower extremities. The clinical impression was Kaposi's sarcoma, but the lesions proved to represent multiple ectatic venules that contained papillary endothelial hyperplasia and small foci of an unorganized thrombus. The lesions persisted during a 6-month period of observation. Intravascular papillary endothelial hyperplasia can be observed as an unusual pattern of organization of arterial and venous thrombi or as a focal, incidental microscopic finding in hemangiomas. When lesions of intravascular papillary endothelial hyperplasia cause clinical signs, they characteristically appear as solitary, slowly growing nodules, usually on the upper extremities or head. Intravascular papillary endothelial hyperplasia has not previously been noted to simulate Kaposi's sarcoma.     

An accounting of governmental liaison activities of the American Academy of Dermatology, 1977-1982

The major governmental liaison activities for the period 1977–1982 are briefly summarized.     

What's new in dermatopathology?

This review emphasizes the important work in dermatopathology reported in the past 3 years. In reviewing the recent contributions in the field, four areas appear to have received particular attention: (1) new information concerning the histogenesis of cutaneous tumors based on the dual functional capacities of cells; (2) the Langerhans cell and its role in inflammatory and neoplastic processes; (3) prognostic factors in stage I malignant melanoma; and (4) the use of new immunofluorescent and immunohistochemical technics as diagnostic tools in cutaneous pathology.     

Nickel feeding in nickel-sensitive patients with hand eczema.

Ten women with vesicular hand eczema and delayed hypersensitivity to nickel were given 0.5 mg nickel supplements to their diets. The double-blind controlled supplements were given on Monday and Tuesday of each week for at least 1 month. The nickel supplement was lower than that used in previous studies, and only one subject had reproducible flaring of her vesicular dermatitis. We conclude that dietary restriction of nickel is not warranted based on nickel supplement studies, but nickel's role in hand eczema could be clarified by depleting nickel from body stores with chelating agents.     

Sulfone treatment of granuloma annulare

Although spontaneous remission of granuloma annulare is not uncommon, most cases are chronic and resistant to a variety of therapeutic modalities. In our study we confirm the beneficial effect of dapsone treatment in patients with localized or generalized granuloma annulare. The results indicate that dapsone is a useful drug to control or at least to improve skin lesions in the majority of patients.     

Threshold responses in formaldehyde-sensitive subjects.

Patch tests with three low concentrations of formaldehyde were applied continuously in formaldehyde-sensitive subjects for 1 wk. The closed patch test method produced a response to 30 parts per million (ppm) in some subjects by 120 continuous hours of testing. Thirteen subjects then sprayed a 30-ppm formaldehyde solution in an axilla on a double-blind, controlled, 2-wk-use test. Their responses to 30 ppm aqueous formaldehyde indicate that levels below this concentration should be tolerated by sensitive subjects if repeatedly applied to normal skin. Popular formaldehyde-releasing preservatives can be above or below this threshold-eliciting response.     

Bullous pemphigoid and multiple autoimmune diseases. Alopecia universalis, bullous pemphigoid, hypothyroidism, rheumatoid arthritis, and neutropenia in one patient

A 57-year-old white man developed Hashimoto's thyroiditis, bullous pemphigoid, and autoimmune neutropenia during the last year of his life. In addition, he had alopecia universalis since the age of 21 and rheumatoid arthritis since the age of 38. This unique constellation of autoimmune diseases has not been reported previously. Its significance is discussed in relation to the polyglandular failure syndrome and thymoma-related autoimmune disease.     

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.     

PUVA treatment of erythrodermic and plaque type mycosis fungoides

Five patients with plaque type mycosis fungoides (MF) and five patients with erythrodermic MF responded favorably to oral psoralen photochemotherapy (PUVA). The mean total UVA irradiation dose was less for erythrodermic than for plaque type MF, but the mean number of treatments to achieve clearing was greater in the erythrodermic patients. Histologic examination at clearing revealed persistence of an inflammatory infiltrate in the lower dermis in most cases. Subsequent recurrent lesions in five patients revealed a more extensive dermal inflammatory infiltrate, although findings were not always diagnostic of MF due to a lack of epidermal involvement. Resumption of more intensive PUVA therapy again resulted in clinical clearing in all five patients. The follow-up period for six patients who received long-term PUVA maintenance ranged from 1 1/2 to 3 1/2 years. During PUVA therapy, five of ten patients developed epithelial malignancies or premalignancies, and one patient developed a malignant fibrous histiocytoma. Most of these patients had received prior treatment with electron beam and topical nitrogen mustard.