Antinuclear antibodies as immunologic markers for a benign subset and different clinical characteristics of scleroderma.

Antinuclear antibody (ANA) test results were correlated with the clinical status of 56 patients with systemic scleroderma. Three groups were identified. (1) The speckled pattern represented a benign clinical subset. Acrosclerosis, Raynaud's phenomenon, calcinosis, and esophageal dysmotility characterized this group. None of these patients had pulmonary, renal, or cardiac disease. (2) Two patterns and ANA-negative test results were associated with a different incidence of certain clinical characteristics. The thready pattern was associated with pulmonary involvement. Diffuse skin involvement and Raynaud's phenomenon were found with the nucleolar pattern. Patients with ANA-negative test results had the most severe disease, including renal failure. (3) Two patterns were not associated with different clinical characteristics. These were the small speckle-like thready pattern and the homogeneous pattern. This study supports the theory that ANA patterns may be used as immunologic markers for different clinical characteristics of patients with scleroderma as they have already been used in lupus erythematosus.

Anticentromere and anticentriole antibodies in the scleroderma spectrum.

We studied serum samples from 106 patients, including 80 in the scleroderma spectrum, by indirect immunofluorescent microscopy, using PtK1 rat kangaroo tissue culture cells as substrate. Anticentromere (Kinetochore) antibodies were present in 28 patients, and anticentriole antibodies were present in four patients. Anticentromere antibodies were usually present in patients with a benign, chronic form of systemic scleroderma, which has been termed the CREST (Calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) syndrome. The four patients with a previously undescribed anticentriole antibody were all in the scleroderma spectrum. Possibly, these antibodies may have diagnostic and prognostic importance. Further, they will be useful in studying the structure and function of these cellular organelles.

Raynaud's phenomenon and disease.

Maurice Raynaud initiated the discussion of cold-induced vasospasm over 125 years ago. Research has shown that the physiology of Raynaud's involves a complex interaction in both local and systemic factors. Although a multitude of laboratory tests are available to help evaluate the prognosis of Raynaud's phenomenon, patient history remains the most reliable method of diagnosis. There are a variety of treatment modalities available. The treatment program should be tailored to the severity and etiology of the disease.

Common skin problems in the elderly.

Aging of the skin is still an inevitable and unavoidable process. The cutaneous problems associated with aging can be annoying, cosmetically unacceptable, or, in some cases, life-threatening. Fortunately, with the increased interest in geriatric medicine, a much broader range of therapeutic modalities is now available to treat these disorders.

Common skin problems in the elderly.

Aging of the skin is still an inevitable and unavoidable process. The cutaneous problems associated with aging can be annoying, cosmetically unacceptable, or, in some cases, life-threatening. Fortunately, with the increased interest in geriatric medicine, a much broader range of therapeutic modalities is now available to treat these disorders.

Embedded foreign bodies presenting as earlobe keloids.

We present a case report of a young woman who developed earlobe nodules subsequent to the piercing of her ears. Clinically the nodules appeared to be keloids. Surgical intervention demonstrated the nodules to consist of the embedded backings of her pierced earrings.

Letterer-Siwe disease in adults.

Histiocytosis X (HX) is a rare disorder of histiocytic proliferation characterized by a broad spectrum of clinicopathologic disease. An unusual case of Letterer-Siwe disease (LSD) or subacute disseminated HX in a 71-year-old woman is presented. The patient had a 3-year history of splenomegaly before skin lesions developed. She presented to our clinic at 1.5 years later and the diagnosis of HX was made by skin biopsy. Topical nitrogen mustard (NM) therapy resulted in complete clearing of cutaneous lesions. Her condition was stable over the next 10 months. However, she subsequently suffered a rapid and fatal dissemination of her disease. Systemic treatment with prednisone, vinblastine sulphate, and suppressin A (SA) (a calf thymus derived hormone preparation that specifically induces suppressor T-cells) was ineffective. Characteristic histopathologic, immunohistochemical, and electron microscopic findings of HX are illustrated. A review of the adult cases of LSD and treatment options for HX are presented and discussed.