Biomedical subjects
Publications and source records attributed to R S Basler.
Acne mechanica is a papulopustular eruption caused by the physical factors of pressure, occlusion, friction, and heat acting upon the skin, either separately or in unison. Athletes in certain sports are at particular risk for this condition. Dermatologists, if familiar with its presentation, can play a critical role in relieving its distracting symptoms during a competitive season, and eliminating it completely at the season's end.
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Mycosis fungoides is a cutaneously-derived malignant lymphoma which, without effective treatment, may run an unrelenting, rapidly lethal course. Often beginning as a nonspecific skin eruption, easily misdiagnosed as a common eczema or psoriasis, the disease progresses through a plaque stage to the tumor stage with the appearance of the mushroom-like growths for which the entity was originally named. Because of the dismal outlook in uncontrolled cases, newer, more aggressive approaches to therapy are being developed and are being instituted earlier in the course of the disease.
The treatment of psoriasis with psoralen and direct sunlight has been reported as successful but unpredictable because of its dependence on prevailing weather conditions which are subject to marked daily and seasonal variations. A study carried out in a locale nearly ideal because of its reliable year-round sunshine produced complete remission of all exposed plaques in twelve consecutive patients.
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Dark blue-black pigmentation has persisted in areas of previous acne scarring in a young woman. By histologic and electron microscopic examination, the pigment is demonstrated to represent hemosiderin. Much of the hemosiderin is lying free within macrophages, not bound by lysosomal membranes that normally would protect the cell from this toxic material.
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According to a popular system of classification, the term ichthyosis hystrix denotes an organoid epidermal nevus composed of hyperkeratotic papules with a bilateral distribution. Our patient had dramatic disfiguring epidermal changes of this type covering nearly all of her body. Although this abnormality began at the age of 2, she does not exhibit any of the various neurological or skeletal derangements that have been reported to be associated with the condition.
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Whenever lesions resembling psoriasis or nummular eczema remain unchanged for several months or do not respond to topical steroid therapy, mycosis fungoides should be suspected and multiple biopsies performed. Early diagnosis increases the possibility of destroying malignant cells before they involve internal organs. Early treatment is usually conservative, with topical steroids and occlusion. Topical nitrogen mustard, oral psoralens, long-wave ultraviolet light, and--ultimately--radiation are used as the disease progresses. Use of whole-body electron beam therapy appears promising.
Cutaneous calcium deposition can occur in long-term inflammation. The deposition of calcium in long-standing acne may produce either small pigmented nodules or no visible lesions. The former type is or no visible lesions. The former type is much less common, with the nodules containing particulate spheres of mineral which probably represent true osteomas. Both types of calcification can be demonstrated roentgenographically and may occur in as many as half of all cases of severe long-standing acne.
The association between ulcerative colitis and various abnormalities of the skin, especially pyoderma gangrenosum, has been accepted for many years. The underlying aberrations in either of the organ systems, as well as the basis of their association, however, remain obscure. Several large series of ulcerative colitis patients are reviewed to emphasize the important concomitant cutaneous findings, and investigations into the pathogenesis of pyoderma gangrenosum are discussed.
In the course of the last two years, a tremendous amount of controversy has been raised over dangers accompanying the use of the antibiotic clindamycin. The controversy has been stimulated by recent reports of fatalities from pseudomembraneous colitis associated with clindamycin therapy. Varying greatly in degree of severity, the colitis has been reported in as high as 10% of all patients using the drug. The pertinence of such data, however, in a young, healthy acne population receiving small maintenance doses is questionable. Nevertheless, because of these reports, the use of clindamycin in the treatment of many of the conditions for which it was previously considered indicated, including acne, is being seriously reevaluated.
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