The nature and significance of the transverse white band of human nails.

The nomenclature relating to structures at the distal part of the nail is confusing. A distal yellow line traversing the nail, described by Pinkus, has been relatively ignored in the literature and remains unnamed. Clinical and histological studies presented in this article show that this band is present in more than 90% of normal adult fingernails and represents the most proximal point of attachment of the fingertip stratum corneum to the nail plate. Therefore, it should be referred to as the onychocorneal band or junction. This region has distinctive histological features and is the first major barrier to material passing proximally beneath the nail plate. It is possible that abnormalities of this structure may result in onycholysis, pachyonychia congenita, and pterygium inversum unguis.

Polymorphonuclear leukocyte random migration and chemotaxis in psoriatic and healthy adult smokers and non-smokers.

Random migration and chemotactic responsiveness of polymorphonuclear leukocytes (PMNs) from psoriatic and control smokers and non-smokers were studied in vitro and in vivo. In vivo, but not in vitro, PMNs from psoriatic smokers responded to a significantly greater degree to a standard chemotaxin than did PMNs from psoriatic non-smokers, control smokers and control non-smokers. This suggests that smoking has a selective effect on psoriatic PMNs. The possible relevance of this to the pathogenesis of psoriasis vulgaris and to palmoplantar pustulosis is discussed.

Hydroa vacciniforme: a review of ten cases.

Ten patients with hydroa vacciniforme are reported. The condition appears to be a distinct clinical and histological entity. Haematological, biochemical, immunological, bacteriological and viral investigations were negative. Three patients demonstrated low minimal erythema doses (MEDs) following monochromatic ultraviolet (UVA) irradiation of back skin; such UVA sensitivity may be a feature of hydroa vacciniforme. Treatment was unsatisfactory, although spontaneous improvement in the condition tended to occur and regular application of sunscreens with high protection factors against both UVA and UVB was helpful.

An investigation of the angry back syndrome using Trafuril.

The angry back syndrome (ABS) was investigated using Trafuril cream and prostaglandin synthetase inhibitors. Trafuril produced an increase in the numbers and intensity of patch test reactions which was partly abrogated by aspirin and indomethacin. Irritant reactions were not affected. We suggest that Trafuril may increase the sensitivity of the patch testing system and that this may have useful clinical applications.

The nails in adult type 1 pityriasis rubra pilaris. A comparison with Sézary syndrome and psoriasis.

The fingernails of twenty-four patients with classical adult (type 1) pityriasis rubra pilaris were examined for changes in nail morphology and a comparison was made with the fingernail morphology of twenty-seven consecutive psoriatic patients with nail changes. Distal yellow-brown discoloration, subungual hyperkeratosis, nail plate thickening, and splinter hemorrhages indicate a diagnosis of type 1 pityriasis rubra pilaris rather than psoriasis, while onycholysis (particularly marginal), salmon patches, small pits, and larger indentations of the nail plate indicate a diagnosis of psoriasis. Histology demonstrated that a nail biopsy would be a useful diagnostic procedure if nails were involved in isolation but provided no additional diagnostic features to those found from biopsy specimens of involved skin in the two conditions. The similarity in nail morphology between the type 1 pityriasis rubra pilaris patients and five patients with chronic erythroderma resulting from Sézary syndrome indicated that these changes may represent a nonspecific reaction pattern that may result from prolonged erythema of the proximal nail bed and matrix. The rough nails (trachyonychia) described in advanced Sézary syndrome were not observed in any of our patients.

Dermatitis from phenyl salicylate in safety spectacle frames.

We report 3 cases of allergic contact dermatitis behind the ears from wearing the same brand of industrial safety spectacles. In each case, a positive patch test was obtained with scrapings of the plastic frame. In 2 cases further patch tests with constituents of the plastic were carried out; positive patch tests were obtained with phenyl salicylate. Phenyl salicylate is used as an ultraviolet inhibitor in some cellulose acetate butyrate and cellulose acetate propionate formulae. It has previously been reported as a contact sensitizer from its use as a sun screen in a lip salve. Positive patch test reactions were also obtained variously in these patients with balsam of Peru, resorcinol monobenzoate, and epoxy resin.

Allergic contact dermatitis from chloromethyl heterocyclic intermediates in the synthesis of a histamine antagonist.

Case reports of 3 chemists who worked in a laboratory where heterocyclic chloromethyl compounds, used as intermediates in the synthesis of a histamine antagonist, were being prepared, are here presented. The results of suitable patch tests which were applied are reported and it is concluded from the results that 3 chemical intermediates were responsible for the allergic contact dermatitis in the 3 cases.

Treatment of ingrowing toenails with liquid nitrogen spray cryotherapy.

Ingrowing toenails are a common debilitating condition and often require surgical intervention. In 44 patients liquid nitrogen spray cryotherapy produced a rate of success comparable with that of other nail sparing techniques but had the advantage of being a quick, simple, and cheap outpatient procedure that could be carried out with limited facilities and without anaesthesia.

Long term effects of cryosurgery on cutaneous sensation.

In a study of the time course and nature of the sensory loss after cryosurgery the forearms of nine normal subjects were treated with liquid nitrogen using freeze times currently employed in clinical practice in Britain. Ability to appreciate touch, pinprick, and cold in the treated areas was tested at regular intervals and biopsy samples taken to investigate the pathogenesis. Appreciation of all three modalities of sensation was initially reduced in all nine subjects for all freeze times, yet complete recovery occurred in the seven patients completing follow up. This recovery, however, took up to one and a half years for the longest freeze, with even a 10 second freeze taking up to 10 months. Patients may be reassured that sensory loss after cryosurgery for up to two periods of 30 seconds will almost certainly recover, though it may take up to 18 months to do so.

Hyperpigmentation associated with oral minocycline.

Two patient receiving minocycline developed blue-black pigmentation on the legs. Biopsies from the pigmented areas demonstrated granules containing iron, a pigment with staining properties similar to melanin, and a third pigment which may be a degradation product of minocycline. Electron microscopy showed that some, but not all the granules were membrane-bound and they were situated mainly within macrophages. Analytical electron microscopy showed that the granules contained iron, sulphur, chlorine and, in one case, calcium.

Treatment of erythroplasia of Queyrat with liquid nitrogen cryosurgery.

Erythroplasia Queyrat is now generally considered to be Bowen's disease of the glans penis. The literature is reviewed and the need for a treatment that is destructive to abnormal tissue yet cosmetically acceptable is stressed. Cryosurgery appears to be a very appropriate form of treatment for this condition--its effectiveness was demonstrated in two cases.