Pedunculated proliferative papillomatosis.

Skin tags (soft fibromas) are benign connective tissue neoplasms of the dermis. As a rule they occur as soft, skin-colored, filiform, often pedunculated growths in intertriginous areas. The classification and naming of these lesions is somewhat arbitrary due to their banal clinical and histological spectrum of characteristics. We report an unusual case of a peculiar proliferation of dermal and epidermal components that clinically and histologically appears to fit into this category of soft fibroma.

Cutaneous photosensitivity to medications.

Photosensitivity induced by exogenous agents accounts for an increasing portion of the total undesirable effects caused by environmental chemicals. The exponential increase in the number of new drugs each year is responsible for a significant rise in the incidence of and disability caused by these reactions. An extensive drug history must be taken whenever a patient presents with a reaction limited to or accentuated in light-exposed areas. These reactions may present with a wide morphologic spectrum ranging from sunburn-like responses to eczematous, lichenoid, and even bullous lesions resembling porphyria cutanea tarda.

Drug-induced pemphigus related to angiotensin-converting enzyme inhibitors.

We report a case of drug-induced pemphigus caused by an angiotensin-converting enzyme inhibitor, captopril. The cutaneous reaction remitted after withdrawal of captopril therapy. Unique to this case, however, was the substitution of another angiotensin-converting enzyme inhibitor, enalapril, without exacerbation of the pemphigus. To the best of our knowledge, this is the first reported patient with captopril-induced pemphigus in whom no new lesions developed after subsequent treatment with enalapril. A difference in chemical structure between these two drugs, particularly of a sulfur moiety, may help explain why the drug-induced disease did not recur.

Increased glycosaminoglycans production in sclerosing basal cell carcinoma-derived fibroblasts and stimulation of normal skin fibroblast glycosaminoglycans production by a cytokine-derived from sclerosing basal cell carcinoma.

Sclerosing basal cell carcinoma (S-BCC) is characterized by an abundant stroma. There is evidence that some tumor cells secrete cytokines that are mitogenic for stromal fibroblasts (FBs). From this study we report increased glycosaminoglycan (GAG) production by cultures of S-BCC FBs in comparison to cultures of nodular BCC (N-BCC) FBs and normal skin FBs. GAG production was measured by cetylpyridinium chloride precipitation of incorporated [3H]-glucosamine. The sclerosing BCC FBs demonstrated a significant increase in production of GAG over control FBs (P <.001) and over N-BCC FBs (P<.001). Values reported as a mean percentage +/- SEM for GAG production by S-BCC over control normal skin FBs are 359+/-28 and over N-BCC FBs are 266+/-27. In additional experiments, cell extract dilutions from S-BCC tumor, normal dermis, and normal epidermis were incubated with cultures of normal skin FBs. S-BCC-conditioned media was also incubated with normal FBs and GAG production was measured. For both S-BCC extracts and conditioned media, a dose response curve was established showing increased GAG production by normal FBs in relation to increasing the concentration of S-BCC extract or conditioned media. When S-BCC extract was added to normal FBs there was increased GAG production in comparison to normal FBs incubated with dermal or epidermal extracts (P<.001) for both. Two growth factors, transforming growth factor-beta (TGF-beta) and platelet-derived growth factor (PDGF), already known to be mitogenic for FBs, were incubated with N-BCC and normal FBs in an effort to elucidate the potential cytokine(s) released by S-BCC, causing increased GAG production by surrounding FBs. Neither of these cytokines proved to be effective in promoting a significant increase in GAG production. Our findings support the hypothesis that BCCs release factors that alter stromal FB production of GAG.

Cutaneous Pneumocystis carinii and Cryptococcus neoformans in AIDS.

A patient with AIDS was found to have skin lesions which contained the organisms Pneumocystis carinii and Cryptococcus neoformans. Both organisms were identified using haematoxylin and eosin, Gomori methenamine silver, Giemsa and mucicarmine stains. Electron microscopy was performed and confirmed their presence. The clinical presentation, histopathology, differential diagnosis and treatment of cutaneous P. carinii and C. neoformans in AIDS is presented.