Lymphomatoid papulosis update. A historical perspective

Soon after lymphomatoid papulosis was identified and named, it became apparent that a whole constellation of clinically benign, histologically malignant, continuing, self-healing eruptions existed. To this group of assumed entities without names, the inclusive term rhythmic paradoxical eruption spectrum was proposed. Some bands of this spectrum have since been delineated, and their surmised overt malignant potential realized. Recent immunologic studies have identified a number of shared immunologic markers among the various bands of this spectrum, which helps to explain the interrelationships and occasional coexistences among lymphomatoid papulosis, mycosis fungoides, Hodgkin's disease, and other lymphoproliferative disease states.     

Mohs micrographic surgery. A historical perspective

Excising cancer in successive layers and examining the entire underside of each layer in the microscope by the systematic use of frozen sections ensure eradication of the neoplasm, including its "silent" outgrowths, and this is accomplished with the maximal sparing of normal tissue. Fresh-tissue micrographic surgery is used for most cancers, but the fixed-tissue technique is safer for melanomas because all incisions are made through fixed (killed) tissues, avoiding the danger of disseminating highly transplantable melanoma cells from transecting silent outgrowths or clinically invisible satellites. Although the essential concept was very simple, more than a half century of continuing development was required to bring the method to its present status; further progress is an exciting prospect.     

Cosmetics and skin care products. A historical perspective

The history of cosmetics and skin care products parallels many important technologic developments in chemistry, materials, and packaging innovations. Much is revealed about ancient civilizations by the cosmetics that are uncovered in archaeologic excavations. Much can also be said about modern-day health and adornment practices based on products in the current marketplace.     

黏膜性类天疱疮一例

患者男,87岁,因面颈部反复红斑、水疱、结痂伴瘙痒2年,加重2个月,于2019年3月就诊。患者2年前出现面部、颈前区散在红斑、水疱,自行破溃,遗留疼痛性糜烂面及结痂。就诊于外院,面部皮疹组织病理提示,真皮浅层较多淋巴浆细胞及组织细胞浸润,局部纤维细胞增生;免疫组化示CD68阳性……     

良性黏膜类天疱疮一例

患者女,83岁.12年前无明显诱因于四肢出现红斑、水疱、糜烂,伴瘙痒,于我院病理诊断为大疱性类天疱疮,予泼尼松30 mg/d口服,效果良好.此后病情反复发作,冬重夏轻,渐累及躯干及腹股沟、腋下等间擦部位.10年前开始自觉眼部发痒、异物感,眨眼渐频繁,自觉睁眼困难,眼球转动稍受限,无眼干、眼痛、眼肌疲劳,无脓性分泌物、视物不清.3年前开始出现口腔内水疱、糜烂,自觉疼痛,影响进食,于我院口腔科给予复方氯己定含漱液、生理氯化钠溶液含漱等治疗稍好转.1年前于我院耳鼻喉科就诊发现食道狭窄,未予治疗.既往患高血压病10余年,药物控制后血压正常.家族中无类似疾病病史.     

The relationship between linear IgA disease and benign mucous membrane pemphigoid

Nine out of thirty-four patients with linear IgA disease (LAD) had oral ulceration. Four out of seven of these patients who were examined by an ophthalmologist had changes of a cicatrising conjunctivitis indistinguishable from those of benign mucous membrane pemphigoid (BMMP). Three of these patients gave no history of ocular symptoms up to the time of examination. These findings indicate a need for oral and ophthalmological assessment in all patients with LAD. Twenty-seven patients with a diagnosis of BMMP were also studied. Nine presented with oral symptoms alone, nine with ocular symptoms alone, seven with oral and ocular symptoms, and two with cutaneous lesions in addition to oral and ocular symptoms. All the patients were examined by the same ophthalmologist. Six of the nine patients who presented with oral symptoms alone had signs of a cicatrising conjunctivitis. Four of these six patients had the clinical pattern of erosive gingivitis which was not previously thought to be associated with a cicatrising conjunctivitis. There is a similar need, therefore, for an ophthalmological assessment in all patients presenting with oral BMMP. Three of the twenty-seven patients with BMMP had homogeneous-linear deposits of IgA in uninvolved skin. The finding of linear IgA deposits in the skin of these patients with only mucous membrane lesions, and the finding that patients with LAD have a high incidence of oral and conjunctival lesions, raise the possibility of a common pathogenic pathway but with varying clinical expressions in these two groups.     

Coexistence of mucous membrane pemphigoid and connective‐tissue disease

Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease that predominantly affects the mucosa. We report eight patients with MMP who also had systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), or both. Eight women (six white, two Hispanic; mean age of onset 53.5 years [range 44–68]) were studied. In four patients, both diseases were detected simultaneously, and in the other four patients, MMP preceded SLE or MCTD. MMP was widespread and resistant to conventional immunosuppressive therapy, but responded to intravenous immunoglobulin (IVIg). During a mean follow‐up of 10.25 years (range 6–18), three patients had stable SLE/MCTD, whereas in the other five patients the SLE/MCTD required systemic corticosteroids either with or without immunosuppressive agents. Renal, serosal, pulmonary and neurological features were not observed in any patient. At the time of reporting, the MMP was in a prolonged sustained remission in all eight patients. The SLE/MCTD remained mild, did not involve vital organs and had continued with low‐grade activity. In summary, we report the simultaneous occurrence of two rare diseases in a group of patients.     

Leg ulcers: A historical perspective

“Ulcers on the leg form a very extensive and important class of diseases … The treatment of such cases is generally looked upon as an inferior branch of practice: an unpleasant and inglorious task where much labour must be bestowed, and little honour gained.”¹

It is not surprising that the legs, exposed as they are to injury and having a circulation strained by the upright posture of human beings, should be the site of ulcers of many types. There is evidence to suggest that prior to the 19th century, leg ulcers were extremely common, certainly much more common than they are today.²