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Office surgical management of recalcitrant axillary lesions.

Hidradenitis suppurativa, hyperhidrosis, and Fox-Fordyce disease represent some of the surgical conditions seen by the dermatologist in office practice. These chronic, distressing, socially inhibiting diseases are extremely difficult to treat conservatively and ultimately require surgical intervention. Using local anesthesia, we have successfully managed these disorders on an outpatient basis by surgical excision, achieving excellent cosmetic and functional results, minimal discomfort, and absence of recurrence.

Adolescent↗

Syringoma of the vulva: incidence, diagnosis, and cause of pruritus.

Syringoma of the vulva is a rare disorder. The patient presented here is the seventh case in the American literature; she is the only patient with this condition in a series of 1132 women with vulvar disease. Differential diagnosis includes epidermal cyst, cherry hemangioma, angiokeratoma, comedo, soft fibroma, Fox-Fordyce disease, steatocystoma multiplex, and lymphangioma circumstriptum. Although syringoma is usually an incidental finding, the diagnosis should be considered in patients with pruritus vulvae. In such cases, examination of the skin around the eyelids and malar areas where syringoma occurs more commonly may suggest a diagnosis of vulvar syringoma that can be confirmed by histologic examination. Inspection of the vulva in cases with extragenital involvement may lead to a more frequent diagnosis of vulvar syringoma.

Adenoma↗

[Dermatoses of the nipple and the areola].

Dermatoses of the nipple and areola are rare. The commonest dermatosis is Paget's disease, which presents in the form of a well demarcated erythematous area, sometimes erosive, oozing or hyperkeratotic. Histological examination reveals an intraepidermal proliferation of large clear cells, either isolated or grouped in clumps, predominantly in the suprabasal layers. Immunohistochemistry shows that these cells express low molecular weight cytokeratins and the epithelial membrane antigen, fairly frequently carcinoembryonic antigen. In 96% of cases, Paget's disease is associated with underlying breast carcinoma, either in situ or invasive. Erosive adenomatosis presents in the form of an erosion of the nipple, which is sometimes increased in size. Histologically, it consists of a benign tumour which may ulcerate the epidermis, composed of tubes and papillae lined by a double layer of epithelial and myoepithelial cells. The syringomatous tumour is exceptional. In places, it forms rudimentary sweat ducts and is considered to have an intermediate malignancy; its resection must be complete. Other tumours may also be observed in this site: leiomyoma, leiomyosarcoma, benign cutaneous lymphocytoma, basal cell carcinoma, naevoid areolar hyperkeratosis. They are exceptional except areolar neurofibromas in case of neurofibromatosis. Infectious dermatoses (viral warts, molluscum contagiosum, scabies) are accompanied by lesions in other sites. They same applied to the majority of inflammatory dermatoses such as eczema or Fox-Fordyce disease. Supernumerary nipples are situated on a line extending from the anterior part of the axillary crease to the medial part of the inguinal crease.

Adenomatoid Tumor↗

[Dermatologic indications for anti-androgenic treatment].

In spite of remarkable therapeutic results obtained by gestagens with antiandrogenic activity, usually combined with estrogen, in oily seborrhea, acne, Fox-Fordyce disease, androgenetic alopecia and hirsutism many dermatologist still hesitate to treat the named disorders by hormones. The reason for their hesitation appears to be the erroneous belief, that the named disturbances represent hormonal disorders the treatment of which does not belong to dermatology. After a survey on the mechanism of action of antiandrogens the basic difference between androgen dependent skin disorders and endocrinopathies with manifestation on the skin and its appendages is explained. Androgen dependent skin disorders, like oily seborrhea and most cases of acne are not the result of endocrine disturbances in the sense of an pathologically increased or decreased production of sexual hormons. Administering sexual hormons the physician takes advantage of the sebosuppressive effect of female sexual hormons as he does of the antiallergic activity of the hormon cortisol (and related compounds) in the treatment of eczemas. The antiandrogenic treatment of androgenetic alopecia, hirsutism and androgenetic acne--with their underlying hormonal disturbance, consisting in an increased production of androgens, represents an quasi etiological therapy. As in these cases the hormonal disturbances finds its expression mainly or exclusively in disorders of the skin or hair growth, the dermatologist, preferentially in cooperation with endocrinogists and/or gynacologists remains entitled to take over the treatment. The available drugs are discussed and suggestions are made for their appropriate use.

Acne Vulgaris↗

Hidradenitis suppurativa following acanthosis nigricans. Report of two cases.

Two overweight male patients developed acanthosis nigrican of the axillae. Seven to nine months later, the patients developed hidradenitis suppurativa deep within the areas of acanthosis nigricans. On examination of biopsy specimens, the hyperkeratosis of acanthosis nigricans was found to extend into the follicles. In previous reports, Fox-Fordyce disease and pityriasis rubra pilaris have preceded the onset of hidradenitis suppurativa.

Acanthosis Nigricans↗

Vulvar pruritus--a symptom, not a disease.

Because the underlying causes are so varied, vulvar pruritus must be understood as a symptom and not as a disease entity in itself. Successful treatment depends on proper identification of the underlying disorder.

Candidiasis, Vulvovaginal↗

Ectopic epibulbar Fordyce nodules in a buccal mucous membrane graft.

A 70-year-old man underwent oral mucous membrane grafts to the right eye for presumed trachoma at the ages 26 and 32 years. A superior limbic mass within the site of the graft was found in 1983; the mass was composed of mature sebaceous glands compatible with the lesions called Fordyce nodules when located in the buccal mucosa. Recession of the levator aponeurosis and partial excision of the mass restored the upper eyelid's normal position, and visual acuity in this eye improved from 20/300 to 20/40.

Aged↗

The therapeutic uses of topical vitamin A acid.

Topical vitamin A acid (VAA) has various mechanisms of action which may be responsible for its therapeutic success in many different disorders. Although the absorption, metabolism, and excretion of VAA are not completely understood, VAA appears to remain mainly on the skin surface. The question of carcinogenicity is unresolved, and more research is needed to clarify this problem. This article reviews the literature regarding the therapeutic uses of VAA and summarizes various investigators' experiences with VAA.

Acne Vulgaris↗