Biomedical subjects
Publications and source records attributed to D W Pryce.
Zoophilic dermatophyte infections are often inflammatory but severe widespread inflammatory lesions of glabrous skin, as in the female patient described, are unusual. Most cases of M. canis ringworm can be traced to an infected animal. This dermatophyte is associated with a variety of clinical presentations on glabrous skin and is being isolated with increasing frequency in some countries.
A retrospective study of 643 cutaneous horns examined in our department between 1970 and 1989 revealed that 38.9% were derived from malignant or premalignant epidermal lesions, and 61.1% from benign lesions. Four main features were associated with premalignant or malignant histopathological change at the base of a cutaneous horn (base pathology). These were: (i) age--the mean age of the patients whose cutaneous horns showed premalignant or malignant base pathology was 8.9 years greater than the mean age of the patients where base pathology was benign (P less than 0.0005); (ii) sex--males were more likely to develop a cutaneous horn with (pre)malignant base pathology (P less than 0.001); (iii) site--over 70% of all (pre)malignant lesions were found on the nose, pinnae, backs of hands, scalp, forearms and the face; a cutaneous horn found at these sites was 2.1 times more likely to have derived from a (pre)malignant base than from any other part of the body (P less than 0.0001); (iv) geometry of the lesion--lesions with a wide base or a low height-to-base ratio were significantly more likely to show (pre)malignant base pathology. Of those solar keratoses giving rise to cutaneous horns, 8.9% also showed histological evidence of change to squamous cell carcinoma (SCC); this figure was not significantly different from the 6.2% of solar keratoses without horns that showed SCC change during the same period (1970-89).
Orofacial granulomatosis is a distinct clinical and pathological entity characterized by swelling of the lips and lower half of the face. Ulceration of the oral mucosa may also occur. Granulomas are seen histologically. Orofacial granulomatosis may occur in the Melkersson-Rosenthal syndrome, granulomatous cheilitis of Miescher, oral Crohn's disease, sarcoidosis and focal dental sepsis. The increased prevalence of atopy in patients with orofacial granulomatosis and the association with food intolerance suggests the possibility of a role for allergy in at least some cases.
Cutting fluid technology has rapidly developed, presenting dermatologists and occupational physicians with a changing pattern of skin disease. The use of soluble oils has increased, and has been followed by an increase in the incidence of eczematous dermatitis. This is usually an endemic, chronic, irritant contact dermatitis, but thorough patch testing can also reveal allergic contact dermatitis. In conditions of heavy exposure, the prevalence of dermatitis can be as high as 30 per cent. Individual susceptibility is very variable. Research into resistance factors in those who do not develop dermatitis, and susceptibility factors in those who do, may elucidate basic mechanisms of irritancy. Efforts must continue to be directed at prevention because, once established, soluble oil dermatitis can be slow to resolve, even after specialist treatment and change of job. Prevention can be directed at the machine operative, the soluble oil, and the machine.
A pilot follow-up study of patients with soluble oil dermatitis was designed to investigate the effects on prognosis of aetiology and of stopping working with soluble oils. A questionnaire was sent to 121 machine operators who had been diagnosed over a 5-year period. Life table analysis of the 100 replies (83%) revealed a poor prognosis both for those who had continued to work with soluble oils and for those who had stopped. 78% (95% confidence intervals: 63%-94%) of those who continued to work with soluble oils had not healed 2 years after diagnosis. 70% (95% confidence intervals: 56%-83%) of those who stopped working with soluble oil had not healed 2 years after discontinuing contact. Both groups were divided into 4 subgroups with different combinations of aetiological components: allergic and endogenous, non-allergic and endogenous, allergic and non-endogenous, non-allergic and non-endogenous. No significant difference in outcome emerged in either the discontinued contact group or the continued contact group between any aetiological subgroups. Patients who discontinued contact with soluble oils fell into 2 groups: those who healed rapidly and those who developed a chronic dermatitis. 11 of the 15 patients who had healed after 2 years had done so within the first 3 months following cessation of contact. No factor could be identified to distinguish those with the more favourable prognosis. The implications of this study for the management of soluble oil dermatitis are discussed.
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