Bowen's disease and arsenism from tobacco smoke: an association?

Bowen's disease has long has been associated with arsenic ingestion. Due mostly to arsenic-containing insecticides, the arsenic content of American tobacco was quite high until the early 1960s. A chart review of sixteen patients seen with Bowen's disease in the past five years showed that eleven (including five women) had been smokers in the 1950s. While these data may be insignificant, this possible association deserves further analysis. Arsenism from tobacco might explain the discordant results of the studies on the carcinogenicity of psoralen/ultraviolet A.

Autointoxication revisited.

The pustular dermatitis associated with small bowel bypass surgery and the cutaneous manifestations of inflammatory bowel disease are well known and generally assumed to be due to the absorption of microbial antigens from the bowel. Monomeric serum IgA is assumed to originate in the gastrointestinal tract, and circulating IgA immune complexes, as seen in dermatitis herpetiformis, should make us suspicious of a gastrointestinal tract source. These circulating immune complexes and perhaps polyclonal increases in serum IgA may be the result of minor perturbations of mucosal permeability or the failure of locally produced dimeric serum IgA to inactivate bacterial or dietary antigens. Such disparate entities as Reiter's syndrome, psoriasis, pyoderma gangrenosum, and ankylosing spondylitis, as well as the pustular eruptions of Behçet's syndrome, pustular psoriasis, and lithium therapy, may share this common pathogenesis.

Becker's nevus: an androgen-mediated hyperplasia with increased androgen receptors.

Becker's nevus is an uncommon, unilateral, hyperpigmented, hairy cutaneous hamartoma which usually begins in adolescence. Its clinical features and its occurrence mainly in male individuals suggest that androgen stimulation may play a role in its pathogenesis. Androgen receptor assays were performed in a 16-year-old patient with a Becker's nevus. The patient coincidentally had acanthosis nigricans. Lesional tissue showed an androgen receptor level of 634.1 fm/mg protein. A specimen from the contralateral left pectoral area showed no dectectable androgen receptor activity (less than 2.0 fm/mg protein). These results suggest that exquisite androgen sensitivity and stimulation may explain the clinical manifestations of Becker's nevus.