Biomedical subjects
Publications and source records attributed to G W Beveridge.
Milia en plaque is an unusual eruption typically occurring in the retroauricular area. Two cases of this disorder occurring in a novel position and treated with oral minocycline are now reported.
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Bone marrow transplant (BMT) recipients frequently develop rashes as a consequence of their disease, its treatment or because of a complication such as infection. These rashes are often clinically atypical, yet appropriate management is dependent upon correct diagnosis and therefore a skin biopsy is often performed. In a group of 101 consecutive BMT recipients, 25 patients had a total of 34 skin biopsies. A specific histopathological diagnosis was made in 65% (22/34), including graft vs. host disease (GVHD) (15 cases), infection (4 cases), drug reaction (1 case) and recurrent lymphoma (1 case). Therapy was changed following the biopsy in 77% (17/22) of these cases. In 35% (12/34) the histological changes were non-specific, however, in 10 of these cases GVHD had been suspected clinically and its exclusion was therefore useful. Skin biopsy is of considerable value in the diagnosis and subsequent management of BMT recipients who develop a rash.
A 40-year-old man developed multiple longitudinal pigmented streaks in his nails. His sister was also found to have a single streak on a fingernail. Neither had any history of drug ingestion or recent illness and examination failed to reveal any other signs in the skin or mucosal surfaces. A biopsy of the nail matrix at the base of one streak showed no evidence of a naevus or lentigo, the principal finding being pigmentary incontinence and excess macrophages.
We report the pathology of benign and malignant skin lesions from 13 renal allograft recipients. The 59 lesions included 18 squamous carcinomas, 16 verrucous keratoses, 19 warts with varying dysplasia, three plaque lesions resembling those found in epidermodysplasia verruciformis, two non-specific keratoses and one basal cell carcinoma. We delineate criteria for histological assessment of the presence of human papilloma virus (HPV) and use the term verrucous keratosis for lesions in which there is a putative viral contribution. Our findings emphasize the lack of correlation between clinical and histological assessment of the lesions. We note the variable and significant dysplasia within otherwise typical viral warts and the architectural features suggestive of HPV presence in the dysplastic lesions and in in situ and invasive squamous carcinomas. Parallel virological studies have revealed the presence of HPV 5/8 in over 60% of the invasive and in situ carcinomas probed. These HPV types have previously been isolated from squamous carcinomas of epidermodysplasia verruciformis, a condition whose defective cell-mediated immunity may be compared with that of the immunosuppression in our patients.
Conventional histology and immunoperoxidase staining for fibrin, immunoglobulins, and complement components were used to look for evidence of cutaneous vasculitis and immune complex deposition in Sweet's syndrome. These features were not identified in any of the 15 cases studied. The lack of any vasculitis emphasises the distinctive character of Sweet's syndrome when compared with certain spontaneous and experimentally induced inflammatory skin lesions, and may imply a similarly distinctive pathogenesis.
Twenty-three patients with severe longstanding discoid lupus erythematosus, unresponsive to conventional treatments, were treated with oral gold in a multicentre open study. Nineteen patients showed clinical improvement and in four of these there was complete resolution of lesions. Adverse reactions were generally mild and self limiting.
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A young woman with inactive discoid lupus erythematosus (LE) gave birth in three successive pregnancies to four male infants who showed cutaneous, and in one case cardiac, signs of neonatal LE. The mother had Ro and La antibodies although the anti-nuclear factor (ANF) was not consistently detectable. Three of the infants received phototherapy for neonatal jaundice. Maternal discoid LE may give rise to neonatal LE, and successive siblings can be affected.
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In a multi-centre double-blind trial, 31 patients with proven bilateral candidal lesions of the flexures were treated for 14 days with nystatin cream on one side and with a combination of nystatin and triamcinolone acetonide cream on the other. Both treatments proved equally effective in terms of mycological cure and clinical improvement. There was a trend in favour of the combination preparation being preferred by both patients and physicians because of more rapid relief of symptoms.
An episode of acute pustular psoriasis in a middle-aged man was associated with cholestatic jaundice and followed by acute tubular necrosis. It is suggested that renal failure was due to oligaemia after the loss of albumin into and from the skin. Fluid balance, central venous pressure, and arterial blood pressure should be monitored in patients with acute pustular psoriasis.