Neuroma of the vulva. A case report.

Even in the definitive textbook on vulvar conditions edited by Ridley no description of neuroma of the vulva exists, although neural tumors and neurofibroma are considered. The medical literature covering the past 25 years records only one case of terminal fiber neuroma in an episiotomy scar and one neuroma of the clitoris. The latter occurred in a patient with neurofibromatosis. This report documents a symptomatic neuroma of the labia minora considered to be the result of a vulval injury. It is postulated that dyspareunia related to episiotomy may be associated with disorganized proliferation of proximal nerve stumps. Because of the rarity and lack of expertise on management of vulval neuroma, we suggest that the International Society for the Study of Vulvar Disease (ISSVD) further investigate this condition.

Botryomycosis. Some African cases.

Botryomycosis is a rare and chronic but readily treatable form of mycetoma. It is caused by a persistent bacterial infection and is distinguished by the formation of grains and multiple sinuses in the skin. The most usual cause is caused by Staphylococcus aureus. The authors' experience with four Transvaal cases is reported. In one case there was destruction of the skull and penetration of the cranial cavity by the botryomycotic process. Treatment with a range of common antistaphylococcal antibiotics led to astonishingly rapid recovery. Among the drugs used, cotrimoxazole was, perhaps, the most practical.

Multiple infundibular tumours of the head and neck.

A condition of multiple benign and sometimes self-healing infundibular tumours of the skin is described. It effects the sun-exposed areas of the head and neck in Caucasians. The individual lesions consist of a cluster of thick pockets, representing in many details the supra-sebaceous portions of the follicular unit. Follicular poroma, tumours of the deeper part of the follicular infundibulum, virus warts, inverted follicular keratosis and prurigo nodules do not correspond adequately with the appearance described in the present series of six cases.

Acquired symmetrical lipomatosis of the hands--a distal form of the Madelung-Launois-Bensaude syndrome.

Non-encapsulated lipomatosis of symmetrical distribution may be acquired in middle age. A case is described in which the hands are affected.

Carbon monoxide poisoning: optics and histology of skin and blood.

In 10 fatal cases of carbon monoxide poisoning an optical study of the skin colour was made by reflectance spectrophotometry, and the values converted to their visual equivalents. Several circumstances contribute to the difficulty of identifying the cherry-red colour in the skin, such as a low CO concentration, skin pigmentation, washing out of a previously high concentration of CO, and deep venous dilatation with superficial vasoconstriction producing the impression of cyanosis. The colour of the altered blood depends on the way the red cells are massed together, their depth below the surface, and the brightness of the background against which they are viewed. These phenomena were compared with the dichroism of oxyhaemoglobin. Damage to eccrine sweat acini was noted early in CO-poisoning. It was probably intensified, in those surviving longer, at skin sites of intermittent pressure anoxia.

Superficial fungal infections in the Transvaal. A contemporary analysis of dermatophytoses in this region.

An 8-year survey of patients from hospital clinics and private practices in Pretoria seeking specialist dermatological advice for dermatophytoses revealed almost 500 cases, which were confirmed by mycological study. Correlation of the data with other localities was made to illustrate the epidemiology for several common dermatophytes in the Transvaal. Trichophyton rubrum (27%) proved to be the most prominent dermatophyte, followed by T. mentagrophytes (23%), Microsporum canis (19%), T. violaceum (18%) and Epidermophyton floccosum (12%), while M. gypseum occurred in only 1% of the cases. Mapped lists of the published dermatophyte species isolated in southern Africa over the past three decades are presented.

Dithranol mediates pro-oxidative inhibition of polymorphonuclear leukocyte migration and lymphocyte proliferation.

Dithranol (0.01-1 micrograms/ml), but not the auto-oxidized form, caused a dose-related enhancement of the generation of reactive oxidants by leukoattractant-activated polymorphonuclear leukocytes (PMNL) in vitro. At the same concentrations dithranol inhibited both PMNL migration to leukoattractants and mitogen-stimulated mononuclear leukocyte (MNL) proliferation. Catalase (50-100 units/ml) protected both PMNL migration and MNL proliferation from dithranol whilst ascorbate and cysteine (1 mM), which maintain dithranol in the biologically active reduced state, potentiated the inhibition. To establish the molecular mechanism of the pro-oxidative activity of dithranol its effects on cytosolic protein kinase C (PKC) activity were investigated. Dithranol caused a dose-related activation of PKC by apparent substitution for 1,2-diolein. These results demonstrate that dithranol, but not its auto-oxidation products, activates PKC which in turn initiates the generation of reactive oxidants by PMNL. Since reactive oxidants are immunosuppressive the therapeutic mechanisms of dithranol may be related to pro-oxidative interactions of this agent with skin phagocytes.

The septal ontogeny, germination and electron microscopy of Microsporum gypseum macroaleurioconidia.

Microsporum gypseum strains obtained from human and animal cases of dermatophytosis were used to study the septal ontogeny, the germination, and the electron microscopy of the macroaleurioconidia, which are produced so abundantly by this organism. It was found that the number of septa in a macroaleurioconidium depends upon the stage of development, and that their order of formation remains relatively constant. The macroaleurioconidial cell wall proved to be impressive on electron microscopy. The use of a wetting agent (Tween 80) and negative pressure proved necessary for adequate fixation. Poor penetration of the fixing agent is attributable to the electron-dense encrustations over the entire surface of the macroaleurioconidium.

Samuel Patton Impey, M.D. (Aberdeen) (1856-1928). Cape Town's primordial leprologist, dermatologist, radiotherapist and rock-art enthusiast.

Samuel Impey was a noteworthy medical pioneer of the Cape Colony. He was the author of what was probably the first medical textbook of note to be written in South Africa, a Handbook of Leprosy, published in London in 1896. He carried much of the frontier spirit into the medical life of the time, entering vigorously into controversy and fresh developments. As an amateur artist, he also put forward some individual views on rock paintings.

An in vivo and in vitro investigation of the phototoxic potential of tenoxicam, a new non-steroidal anti-inflammatory agent.

The phototoxic potential of tenoxicam, a new non-steroidal anti-inflammatory drug (NSAID), was investigated following oral and intradermal administration of the drug. No hypersensitivity responses to ultraviolet radiation (UVR) were observed for either orally or intradermally administered tenoxicam. In a parallel in vitro study, human polymorphonuclear leucocytes (PMNL) and mononuclear leucocytes (MNL) were exposed to UVR in the presence and absence of the NSAIDs tenoxicam, piroxicam and benoxaprofen (10-40 micrograms/ml). The generation of reactive oxidants by control and UVR-treated human PMNL and MNL in the presence and absence of the NSAIDs was measured according to the extent of luminol-enhanced chemiluminescence. Only benoxaprofen activated reactive oxidant generation by PMNL and MNL. The results of these in vitro and in vivo studies show that phototoxicity is unlikely to complicate chemotherapy with tenoxicam.

Studies in sporotrichosis: fungal morphogenesis and pathogenicity in differing environments.

Sporothrix schenckii exhibits different morphology and pathogenic properties according to the source and circumstances of its growth. The present study considers the morphology and experimental pathogenicity in relation to - the 'wild' strains; the possible circumstances enhancing pathogenicity in strains recovered from the soil; the rate and nature of the transformational steps in morphology, in human and experimental infections by established pathogenic strains; the elimination of pathogenic strains to the surface of clinical lesions, enabling a simplified diagnostic proof of infection; the rate and nature of the reversion of pathogenic forms to the 'wild' type when the constraints of the host are lessened; the plasticity of conidium-pigmentation as a sign of pathogenicity; the morphological conversions on moist wattle-wood as occur in the Gold Mines; and a note on the therapeutic value of itraconazole. Host resistance is seen to play a larger part in morphology of the pathogenic phase, and exhaustion of natural food resources as the generator of potentially pathogenic forms.

Morbilliform erythrodermic fever with purpura. A benign eruptive fever occurring in 6 elderly women.

A febrile exanthem, hitherto unfamiliar, is reported in 6 elderly women. The rash itself is rather characteristic, and remarkable for its striking extent. It is a purpuric, morbilliform eruption dependent upon arteriocapillary damage in the skin, followed by the development of vast sheets of cyanotic erythema and an ultimate scarlatiniform desquamation. Cerebral and renal changes accompany the exanthem. At present the cause is not established. Drugs and viruses are to be considered. The disease is readily halted in the latter stages by systemic corticosteroids.

Sporotrichosis research in the Transvaal--how it began 60 years ago.

The Transvaal was once known as an area with a high incidence of sporotrichosis in workers on the goldmines. The nature of the infection was not understood before the disease was first clinically identified 60 years ago by the pathologist, Dr B. D. Pullinger. Working with Dr A. Pijper in Pretoria, she demonstrated the presence of a pathogenic Sporothrix fungus. Now in retirement, Dr Pullinger has told how this discovery was made.

Studies on sporotrichosis. Pathogenicity and morphogenesis in the Transvaal strains of Sporothrix schenckii.

In the Transvaal, two epidemiologic patterns of Sporothrix infection occur in man. Evidence gathered from nature, the clinic and the laboratory suggests that these patterns are not the result of either a fixed strain specificity or a random mutation. The differences represent a developmental trend, determined by environmental factors, which gradually transform the wild strains of Sporothrix schenckii into variants resembling the earlier descriptions of Sporothrix beurmannii. This change, moreover, is regular and predictable.

History of medicine. Alphonse Loewenthal (1903-1983)--the uncrowned king of dermatology in Africa.

The career and achievements of Dr L. J. A. Loewenthal, M.D., F.R.C.P., as a dermatologist in Africa are sketched. He made notable contributions to local dermatology. Starting in 1931 in Uganda with studies on tropical ulcer and vitamin A deficiency, he ended his career in Johannesburg 40 years later with investigations on the skin of miners. Over this period it is doubtful whether any dermatologist on the African continent equalled his accomplishments.

Intractable skin disorders treated with the aromatic retinoid etretinate (Tigason). Two and a half years' experience in the Transvaal.

A trial of etretinate (Tigason) for keratinizing disorders of the skin yielded prolonged improvements beyond any results hitherto obtained. The disorders included psoriasis of severe degree, keratosis obturans, ichthyosis vulgaris, follicular ichthyosis, porokeratosis of Nékam, disseminated superficial actinic porokeratosis. Darier's disease, palmoplantar keratoderma, Oudtshoorn disease, lamellar ichthyosis, 'badpak' ichthyosis, epidermolytic hyperkeratosis, the 'half-baby' syndrome, exfoliative dermatitis, hair dystrophy and selected precancerous conditions. A method of management which worked well under local conditions is outlined.