Psychogenic purpura.

Two young women had painful ecchymoses of their extremities. In one, this purpuric syndrome followed a chronic course and resulted in severe joint disability. In the other woman, the problem was transient and relatively benign. Emotional factors in their disease were of major importance. No abnormalities of hemostasis or immune function were found. These cases demonstrate the many problems encountered in the diagnosis and management of such patients.

Attempts to enhance light microscopic diagnosis of cutaneous T-cell lymphoma (mycosis fungoides).

Precise pathologic criteria for the diagnosis of mycosis fungoides (MF) remain controversial. With the use of a specific counting technique and defined criteria for cell types, we attempted to differentiate between a series of slides from patients with eczematous dermatitis, large plaque parapsoriasis, and atypical dermatitis with features that suggest MF, the plaque stage of MF, and the tumor stage of MF. This could not be done on the basis of cellular density in e defined field in the papillary dermis or on the basis of the percentage of atypical lymphocytes in the fields counted. Furthermore, individual investigator variance was shown to be highly significant despite efforts to minimize this factor.

Topical clindamycin therapy for acne vulgaris. A cooperative clinical study.

Eleven institutions participated in an eight-week controlled clinical study to evaluate treatment of acne vulgaris with topical clindamycin hydrochloride and clindamycin phosphate. Three hundred fifty-eight patients with comparable baseline pustule, papule, and nodule counts applied 1%, clindamycin hydrochloride, 1% clindamycin phosphate, or a hydroalcoholic vehicle twice daily. Every two weeks, lesions were counted, and patients' evaluations of their acne conditions were scored. By week 8, pustule and papule counts in the groups who were receiving clindamycin were significantly lower than those in the group receiving placebo. Also, more patients who were receiving clindamycin thought their acne improved by week 8 (with significantly higher change-in-acne scores) than did the patients receiving placebo. Patients receiving clindamycin reported 12 episodes of diarrhea; only one episode was considered to be treatment related. These results substantiate the clinical impression that topical clindamycin is effective treatment for acne.

A clinical screening program for topical chemotherapeutic drugs in psoriasis.

In this national, multicenter cooperative study, a standardized drug screening program was designed and evaluated to test the clinical effectiveness of 30 topically applied chemotherapeutic drugs to psoriasis. Appropriate concentrations and vehicles for topical administration were selected with regard to clinical testing consisted of a double-blind application of test agents to psoriatic plaques under occlusion daily for up to nine days. Drugs known to be topically active in psoriasis, eg, thiotepa, fluorouracil, and betamethasone valerate, were easily detected in the clinical protocol, confirming the validity of this topical drug screening program. Seven drugs produced substantial clinical improvement with evidence of clearing; nine drugs produced slight improvement; 14 drugs had no effect. No systemic toxid reactions occurred. This screen should be useful to test other potential antipsoriatic drugs and to evaluate potential animal model screens for their predictive values with the same drugs.

Bullous erythema multiforme associated with Hemophilus influenzae pneumonia.

A 68-year-old woman with Hemophilus influenzae pneumonia experienced a bullous dermatosis. Further evaluation revealed bullous erythema multiforme of the minor type which resolved concurrently with treatment of the pneumonia. Clinicians should be aware that H. influenzae may be one of the bacterial agents known to cause erythema multiforme.

Computer-derived exposure lights for common contact dermatitis antigens.

An established computer file was searched for lists of products containing 45 antigens recognized as causes of allergic contact dermatitis. The final lists included over 8000 products. The problem, ptoential and limitations of such lists are discussed.

Mycosis fungoides d'emblée: a rare presentation of cutaneous T-cell lymphoma.

A case of the d'emblée variant of mycosis fungoides is presented to confirm the validity of this rare variant of cutaneous T-cell lymphoma. The patient had rapidly progressing cutaneous tumors of mycosis fungoides with no internal organ or nodal involvement at the onset of the disease. This was confirmed at a laparotomy, which was done to remove a uterine leiomyoma. The classic light microscopy was confirmed by electron microscopy. Postmortem findings showed a remarkable degree of "epitheliotropism." The d'emblée form of mycosis fungoides has been disputed by some who argue that these cases represent a lymphoma that begins elsewhere and has secondary skin involvement. In this patient there was an opportunity, within a few weeks of the onset of the problem, to do an extensive staging work-up, including laparotomy. No evidence of internal lymphoma was found.

Lymphomatoid papulosis terminating as cutaneous T cell lymphoma (mycosis fungoides).

The 26-year-course of a T cell dysplasia is described in a patient who during his illness showed an evolution from the clinical features of lymphomatoid papulosis to tumor-stage mycosis fungoides with dissemination to nodes and viscera.

Chronic balanitis owing to pemphigus vegetans.

Pemphigus is an autoimmune bullous dermatosis in which intercellular antibodies are associated with loss of intercellular cohesion. Pemphigus vegetans, a rare variant of pemphigus, is manifested by vegetating plaques, usually in intertriginous areas of patients who probably have an increased resistance to the disease. We report a case of chronic balanitis owing to pemphigus vegetans, and discuss proposed pathogenic mechanisms and treatment.

Preliminary evaluation of 15 chemotherapeutic agents applied topically in the treatment of mycosis fungoides.

This is an interim report of a double-blind multi-institutional study to examine the effect of chemotherapeutic agents applied topically to patients with mycosis fungoides. To date, 41 patch tests have been completed using 15 drugs. Five of the drugs produced some improvement, four were highly irritating, and six had no effect. This patch-testing study is a prelude to more extensive therapy trials.

Clinical staging for cutaneous T-cell lymphoma.

The Mycosis Fungoides Cooperative Group has been following patients with cutaneous T-cell lymphoma, including mycosis fungoides and the Sézary syndrome variant. Previous analyses identified the extent of skin involvement and the number of sites of clinically enlarged lymph nodes as important prognostic variables. These two variables were used to classify 340 patients into four clinical stages. Repeat analysis based on additional followup data shows the usefulness of this clinical staging system for identifying patients with differing survival experience. An alternative grouping suggested by fitting a survival model to the data also has been studied. Staging systems based only on skin involvement and lymph nodes are recommended for general use because the information needed is readily available, requiring only physical examination.

Prevalence and relevance of allergic reactions in patients patch tested in North America--1984 to 1985.

Between Jan. 1, 1984, and May 1, 1985, 1199 patients with suspected allergic contact dermatitis were patch tested with 32 "standard" allergens, 707 patients with 19 "vehicle and preservative" allergens, and 613 patients with 10 "special study" allergens. Ten dermatologists representing nine geographic centers collected and analyzed data with the use of the American Academy of Dermatology's mainframe computer in Evanston, Illinois. The most common sensitizers identified were nickel, p-phenylenediamine, quaternium-15, neomycin, thimerosal, formaldehyde, cinnamic aldehyde, ethylenediamine, potassium dichromate, and thiuram mix. Each positive reaction was assessed for its clinical relevance.