Disseminated superficial actinic porokeratosis in pemphigus foliaceus.
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Biomedical subjects
Publications and source records attributed to R A Neumann.
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We describe a 97-year-old woman who presented to our clinic with an unusually large pendulous asymptomatic soft tumor on the left side of her nose. History revealed a 40-year course, with accelerated growth in the last 9 years. Histology of this 7 x 3-cm large tumor revealed vascular structures composed of densely aggregated thick- and thin-walled vessels, separated by fibrous tissue. These features are characteristic for an arteriovenous hemangioma, also called cirsoid aneurysm. The distal part of the tumor showed nearly total fibrosis and at the proximal end of the tumor signs of incipient basal cell carcinoma were observed. In spite of the accelerated growth, unusual size, and the presence of a basal cell carcinoma at the base of this tumor, giant cirsoid aneurysms appear to be of a benign nature and thus conservative, nonradical surgical treatment can be performed. The tumor was removed by argon laser surgery with excellent results and no sign of recurrence after 1 year.
45 patients (34 patients with PLE, 11 with phototoxic or photoallergic dermatitis) were photopatch tested to tiaprofenic acid. In 23 patients (51%), phototoxic reactions were found. Positive reactions appeared within 0.5 to 48 h of irradiation. Although each patient was irradiated with 2 different UVA light sources, with significantly different energy outputs (10 J/cm2 against 72 J/cm2), the intensity and duration of positive reactions was virtually the same. We found a considerably higher rate of positive reactions than other investigators, independent of the light energy delivered. None of the patients gave a history of previous tiaprofenic acid exposure.
In a randomized double blind study, we investigated the systemic effects of 3 different ointments containing corticoids. Every 7 patients out of a total of 21 patients suffering from various skin diseases were daily treated with 40 g of one of the 3 corticoid preparations over 8 days (group A: 0.05% clobetasol-17-propionate; group B: 0.25% fluocortolone trimethyl acetate; group C: 0.25% fluocortolone trimethyl acetate + 0.25% fluocortolone capronate). The plasma cortisol levels were determined by radioimmune assay. In group B and C, we did not observe any effect on the pituitary-adrenal axis, whereas in group A the plasma cortisol levels were extremely low already after 1 day of corticoid application. This adrenal suppression did not return to normal within 4 days after discontinuation of the corticoid. Our results suggest that highly potent topical corticoids are capable of adrenal suppression even without occlusive dressing and even in healthy persons.
We present a patient who developed skin lesions typical of disseminated superficial porokeratosis (DSP) while on immunosuppressive therapy for pemphigus foliaceus. Phototesting with artificial light sources did not have any effect on the DSP lesions. The literature describing occurrence of DSP on immunosuppression is reviewed and possible pathogenetic mechanisms are discussed.
Fifty patients suffering from polymorphous light eruption (PLE), selected by criteria pointing to UVA sensitivity, were phototested with 2 different polychromatic UVA sources for reproduction of skin lesions. To simulate natural conditions, the patients were whole-body irradiated for up to 5 consecutive days. In 64% of the patients successful reproduction of PLE lesions was obtained by 1 to 4 irradiations. The total dosage ranged from 20 to 280 J/cm2, and the total exposure times from 10 to 60 min. Our results suggest that irradiation of the whole body in UVA-sensitive PLE patients does not provide more convincing test results than phototesting of small previously involved skin sites, as has been done by other groups.
The authors report on a retrospective study of the occurrence of chancroid in the city of Vienna during the past 10 years. After identifying two patients at the authors' department with chancroid in March 1988, the authors investigated the frequency with which this disease presented during the last 10 years. Of 32 patients, six presented between 1977 and 1980, and one patient in 1987. The remaining 25 patients were diagnosed within a 4-month period in 1981, suggesting a limited outbreak. The source of this infection could be traced to Turkey; infected prostitutes contributed to further spread in Vienna. All patients were treated successfully with sulfamethoxazole/trimethoprim. Efficient control of this outbreak can be attributed to inpatient treatment of the prostitutes. Appropriate and timely treatment must be preceeded by careful and exact diagnosis of this disease whose clinical picture is constantly diverging from its classical form.