Sexually transmitted diseases: viruses and ectoparasites. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology.

This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.

Periorbital necrobiotic xanthogranuloma and stage I multiple myeloma. Ultrastructure and response to pulsed dexamethasone documented by magnetic resonance imaging.

We observed a 40-year-old woman with necrobiotic xanthogranuloma from the inception of indurated eyelid and periorbital infiltrates and concurrent stage I multiple myeloma to resolution of infiltrates in skin and bone marrow after pulsed high-dose oral dexamethasone therapy. Ultrastructural studies revealed lipid vacuoles in epidermal keratinocytes, in dermal histiocytic macrophages, and in vascular and lymphatic endothelial cells. The presence of lipid vacuoles in epidermal keratinocytes has not been reported previously in xanthogranuloma.

Sexually transmitted diseases: bacterial infections. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology.

This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.

Polypoid melanoma: a virulent variant of nodular melanoma. Report of three cases and literature review.

We report the cases of three patients with polypoid melanoma. In no case was there microscopic evidence of melanoma cell invasion below the papillary dermis. In the polypoid variant of nodular melanoma, melanoma cells accumulate in large volume above the skin's surface. This increase in tumor volume encourages dislodgment of melanoma cells that are carried to superficial lymphatic vessels without invading the reticular dermis; this feature differentiates polypoid melanoma from the nonpolypoid nodular variant. Although polypoid melanoma is considered the most malignant form of melanoma, our findings, albeit limited to three cases, suggest that early diagnosis and prompt surgical excision may provide a favorable 5-year survival rate.

Evaluating work relevancy of dermatitis. Basic cognitive skills.

Occupational contact dermatitis is recognized by its history, appearance, and location. The leading causes of work related skin disease are chemical agents that include primary irritants, allergic- and photosensitizers, and systemic intoxicants that are absorbed through the skin. Recognized guidelines must be used to determine work relevancy: either the skin eruption if related directly to a specific workplace exposure or the work environment caused an aggravating effect on a preexisting non-work related skin disorder. The health care provider's role in industry is not only to examine, diagnose, and treat an injured person's dermatitis, but to identify the cause of the skin eruption and make recommendations for protective measures to prevent recurrent morbidity.

Analysis of 250 consecutively evaluated cases of workers' disability claims for dermatitis.

Two hundred fifty individuals who filed claims for workers' disability compensation benefits for work-related dermatoses were evaluated in the private-practice setting of the author. Preset standard guidelines were used to assess the validity of work relevancy for each claimant. The findings in this retrospective study that included workers from 14 different industrial milieus revealed that 127 of 250 examinees had skin findings that were consistent with the respective workplace exposure.

Testicular effects of bis(2-methoxyethyl) ether in the adult male rat.

The onset of testicular pathology in the rat and possible recovery over an 8-week period were evaluated after the administration of up to 20 daily oral doses of bis(2-methoxyethyl) ether (diglyme) at 5.1 mmol/kg bw (684 mg/kg bw). Primary and secondary spermatocyte degeneration and spermatidic giant cells were observed after six to eight treatments. In addition, the testes-to-body weight ratio was significantly reduced by the tenth day of treatment and continued to be depressed eight weeks after discontinuation of the treatment. Testicular LDH-X activity, a pachytene spermatocyte marker enzyme, was significantly decreased in animals by the eighteenth day of treatment with diglyme.

Lichen planus and coexisting lupus erythematosus versus lichen planus-like lupus erythematosus. Clinical, histologic, and immunopathologic considerations.

A middle-aged black woman presented initially with painful cutaneous plaques that were located at various sites and that were diagnosed histologically as lichen planus. Standard light microscopic examination showed histopathologic variants of lichen planus. Direct immunofluorescence of a skin lesion had negative results for any of the lupus erythematosus bands but did reveal hyaline bodies in the deep cellular layer of the epidermis and the superficial layer of the dermis. These findings were compatible with either lichen planus or lupus erythematosus. However, both the clinical course of the eruption and the antinuclear antibody tests showed that the immunofluorescent antinuclear antibody pattern of large, speckle-like threads were consistent with lupus erythematosus. Furthermore, the large, speckle-like, thready antinuclear antibody pattern, which has been shown to be a marker for a benign subset of lupus erythematosus, is not seen in lichen planus. Lichen planus--like lupus erythematosus was therefore the more likely diagnosis.

Xeroderma pigmentosum and squamous cell carcinoma of the tongue. Identification of two black patients as members of complementation group C.

We present the identification and characterization of two patients with xeroderma pigmentosum (XP) and squamous cell carcinoma of the tongue. Dermal fibroblasts from two black siblings with XP were shown to be hypersensitive to ultraviolet (UV) light measured by colony-forming ability. UV-induced unscheduled deoxyribonucleic acid synthesis was reduced significantly when compared with normal levels for both strains. The strains were assigned to complementation group C on the basis of cell fusion studies. Patients with XP have a marked increase over normal persons for developing skin cancer, presumably because of their extreme sensitivity to UV light. Our results may have applicability in explaining the in vivo development of epidermoid carcinoma in the partially shielded tongue of some XP patients.

Large melanoacanthomas: a report of five cases.

Five patients with melanoacanthoma are reported. The skin lesions consisted of a single, round plaque measuring several centimeters in diameter. Histologic findings were characterized by formation within an acanthotic epidermis, of many islands of small basaloid cells and highly dendritic melanocytes. Electron microscopic examination of one lesion revealed a disturbance of melanin transfer from the highly dendritic melanocytes to the neighboring keratinocytes.

Metabolism and excretion of 2-ethoxyethanol in the adult male rat.

The routes of 14C excretion following the administration of a single oral 230 mg/kg body weight dose of 2-ethoxyethanol [ethanol-1,2-14C] or 2-ethoxyethanol [ethoxy-1-14C] to male Sprague-Dawley rats were investigated. Elimination of the 14C by the urinary route accounted for 76 to 80% of the dose within 96 hr. The main pathway of biotransformation is oxidation to the corresponding acid, with some subsequent conjugation of the acid metabolite with glycine. The major metabolites, ethoxyacetic acid and N-ethoxy-acetyl glycine, representing 73 to 76% of the administered dose, were eliminated in the urine. The major difference in the metabolic profiles of the two radiochemicals was in the rate and amount of 14CO2 expired via the lung. Of the administered 14C, 11.7% of the ethoxy-labeled and 4.6% of the ethanol-labeled compounds were eliminated as CO2. The biological half-time was 9.9 +/- 1.5 hr for the ethoxy-labeled compound and 12.5 +/- 1.9 hr for the ethanol label. After administration of the ethanol-labeled compound, the only radiolabeled component found in the rat testes was identified as ethoxyacetic acid. Results of this study suggest that the reported testicular effects in the rat may be a result of tissue levels of ethoxyacetic acid.

Ultrastructural studies of xeroderma pigmentosum.

Electron microscopic observations of both sun-exposed and sun-protected skin from a black patient with xeroderma pigmentosum (XP) revealed abnormal ultrastructural changes in the melanin pigmentary system, tonofibrillar-desmosome complexes, endoplasmic reticulum, mitochondria, and nucleoli of all keratinocytes. The difference between the cellular changes in the sun-exposed skin and that protected from sunlight was quantitative rather than qualitative in character. The most salient changes were seen in sun-exposed specimens: melanosomes limited by a membrane showed a high degree of polymorphism with a tendency to form large complexes, and many fibroblast-like cells displayed an intense phagocytic activity for melanosomes, the latter finding not previously reported. The present study supports the conclusions of other investigators that XP is a heterogeneous disease. Clarification of the XP entities by continued research may identify the defective gene and lead to methods of correction by the molecular biologist.

The effect of dietary disulfiram upon the tissue distribution and excretion of 14C-1,2-dibromoethane in the rat.

Dietary disulfiram enhances the toxicity of inhaled 1,2-dibromoethane in rats. This study was undertaken to determine whether the differential toxicity noted was associated with alterations in the levels of the compound and/or its metabolites in the target organs. A comparison of the levels of 14C in selected tissues of male rats, with and without dietary disulfiram, following the oral administration of 14C-1,2-dibromoethane was made. The results indicated that levels of radioactivity in the target organs of animals in the disulfiram group were significantly elevated both at 24 and 48 hours following compound administration. The data indicate a direct correlation between tissue levels and the enhancement of toxicity noted in the disulfiram-treated rats in the inhalation study. A significant elevation in the levels of radioactivity in washed liver nuclei obtained from animals receiving dietary disulfiram was also noted, suggesting a relationship between nuclear uptake and the increased incidence of liver tumors appearing in the disulfiran group in the inhalation study.

Tissue distribution and excretion of 14c-styrene in male and female rats.

The tissue distribution and excretion of an oral dose of 20 mg/kg of 14C-styrene was studied in both male and female rats at various time intervals after administration. Peak tissue levels were attained at or before 4 hours post administration. The organ with the highest concentration of radioactivity per unit weight was the kidney, followed, in order of decreasing concentration, by the liver and the pancreas. The data suggest a relationship between tissue distribution and kidney and liver toxicity. The high levels also found in the pancreas may bear some relationship to the reported increase in glucose tolerance in workers exposed to styrene. The principal route of excretion was via the kidneys, with 90% of the dose appearing in the urine within 24 hours of administration. Less than 2% of the dose was recovered from the feces.