Dermatologic therapy: December, 1981, through November, 1982

In this paper I have reviewed the literature on dermatologic therapy from December, 1981, through November, 1982. This information was presented to a forum at the 41st Annual Meeting of the American Academy of Dermatology in New Orleans in December, 1982. Readers should review the original article in toto before attempting any new, experimental, or controversial therapy summarized.     

Reusable ultraviolet monitors: design, characteristics, and efficacy

Reusable ultraviolet dosimetry badges have been developed that provide a visual indication of daily cumulative ultraviolet (UV) exposure. These two-sided, tapelike devices measure UV radiation emitted by sunlight or an artificial UV light source exposure by means of a photochromic aziridine color change reaction that is UV-integrating but optically reversible. UV radiation falling on the exposure side of the badge generates a color change that can be seen from the opposite or readout side. End points are indicated by a visual match of the photochromic with a surrounding reference. This paper describes the construction, component characteristics, and clinical testing of two versions of a new photochromic dosimeter that selectively responds to either UVB (280-320 nm) radiation or UVA (320-400 nm) radiation of the solar spectrum. One version of this monitor, sensitive only to the mid-range UVB, has a peak sensitivity to 300 nm and has four end point markers revealing color changes corresponding to 0.4, 0.8, 2.2, and 6.5 times the minimal erythema dose of an average Caucasian. A second version, sensitive only to UVA, has a peak sensitivity at 355 nm and can monitor exposures ranging from 0.8 to 10 joules/cm2. Outdoor efficacy testing has shown that the UVB monitor is an effective predictor of UV dose-related 24-hour erythema response induced by sunlight. Following a measurement, these monitors can be rezeroed by exposing the readout side to sunlight for a few minutes. They can be reused for eight to ten times. The limitation of the sunlight-calibrated UVB monitor tag is its failure to predict erythema response produced by artificial UVB sources such as FS40 sunlamps.     

Hair casts: classification, staining characteristics, and differential diagnosis

Considerable confusion exists in the literature regarding hair casts. A variety of different disorders have been grouped and reported as if they were a single entity. This nonspecificity in terminology accounts for the vast discrepancy in their reported incidence, size, configuration, etc. A specific classification for hair casts is proposed to clarify the situation. This article presents a practical staining technic, which readily differentiates peripilar keratin casts from other hair disorders. Clinical and microscopic characteristics of peripilar keratin casts and peripilar nonkeratin casts are illustrated.     

Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis, and mycology

The nomenclature for the mycoses caused by dematiaceous fungi should represent the combined clinical, pathologic, and mycologic relationships exhibited in the diseases. Chromoblastomycosis encompasses chronic, localized infections of the cutaneous and subcutaneous tissues that contain sclerotic bodies and histologically show hyperkeratotic pseudoepitheliomatous hyperplasia with keratolytic microabscess formation in the epidermis. In contrast, phaeohyphomycosis is a collective term for a heterogeneous group of mycotic infections that contain dematiaceous yeastlike cells, pseudohyphae-like elements, hyphae, or any combination of these forms in tissue. The terms superficial, cutaneous and corneal, subcutaneous, and systemic phaeohyphomycosis are proposed for the major categories of phaeohyphomycosis. The term chromomycosis is rejected for mycoses caused by the dematiaceous fungi.     

Nodular lymphoid disease of the head and neck: lymphocytoma cutis, benign lymphocytic infiltrate of Jessner, and their distinction from malignant lymphoma

Skin biopsy specimens from six patients with nodular lymphoid disease of the head and neck were studied by routine histology, direct immunofluorescence microscopy, and leukocyte monoclonal antibodies to T and B cell subsets and monocytes. Initially, these lesions were clinically considered to be benign lymphocytic infiltrates of Jessner, lymphocytoma, or lymphoma. Direct immunofluorescence was negative or showed nonspecific staining in all four patients in whom it was performed. Leukocyte monoclonal antibody stains revealed two distinct patterns of lymphocytes. Lymphocytoma was represented by nodular masses of B lymphocytes with peripheral and intervening zones of T cells. The second pattern consisted of solid nodular masses of T lymphocytes occupying the dermis and subcutaneous tissue. In the specimens interpreted as benign lymphocytic infiltration, the T cells were composed equally of helper and suppressor cells.