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.     

Tumor viruses, oncogenes, and human cancer

We review the biology of transforming retroviruses and their relationship to cellular transforming genes (tumor oncogenes). Evidence is discussed for the involvement of a retrovirus in a newly described syndrome, "adult T cell leukemia/lymphoma," which has a high incidence of skin involvement. This virus is related to the animal retroviruses which induce tumors in susceptible hosts after a long latent period. Cellular transforming genes encode proteins which directly change the oncogenic potential of a cell. These genes, which are altered forms of normal cellular genes, have been isolated from a wide variety of human tumors. Viral and cellular transforming genes produce their changes by at least two different mechanisms: abnormally high production of the normal protein encoded by these genes, or normal levels of an altered form of the protein.     

Angiokeratomas, connective tissue nevus, hemangioma

A 7-year-old white boy had multiple angiokeratomas, connective tissue nevus of the right foot, and cavernous hemangioma with hemiatrophy of the right lower extremity. The triad of abnormalities is distinct from previously described multiple malformation syndromes.     

The epidermal basement membrane zone--structure, ontogeny, and role in disease

Since many dermatologic diseases affect the epidermal basement membrane zone, there has been intense investigation into the role of epidermal basement membrane zone constituents in various skin diseases, particularly subepidermal blistering skin diseases. The epidermal basement membrane zone consists of four major structural components--the basal cell plasma membrane, the lamina lucida, the lamina densa, and the sublamina densa zone, which contains anchoring fibrils. The lamina lucida is composed of laminin, bullous pemphigoid antigen (a disease-specific glycoprotein identified by antibodies circulating in patients' sera), and other as yet poorly defined antigens identified by in vivo bound and circulating antibodies in the sera of patients with herpes gestationis, scarring pemphigoid, and others. The lamina densa consists of type IV collagen and KF-1 antigen, which is noncollagenous and is identified by a skin-specific monoclonal antibody. The sublamina densa zone consists of AF-1 and AF-2 antigens and the epidermolysis bullosa acquisita antigen(s). Knowledge of the structure and chemical composition of the basement membrane zone is critical to an understanding of some of the genetic and immunologically mediated blistering skin diseases.     

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.     

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.     

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.     

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.     

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.