Keratosis lichenoides chronica: proposal of a concept.

It has been a subject of controversy whether keratosis lichenoides chronica (KLC) is a distinctive inflammatory disease of the skin or whether it represents a manifestation of another well-known disease, such as lichen planus, lupus erythematosus, or lichen simplex chronicus. In search of clear criteria for diagnosis of KLC the entire literature pertinent to the subject was studied and findings clinical and histopathologic as they were telegraphed in them were compared with a patient of my own experience. Review of the literature reveals more than 60 patients in whom the diagnosis of KLC was made. Three categories emerge based on whether the findings presented in a particular article (1) do not permit any diagnosis to be rendered; (2) do allow a diagnosis specific to be made, such as of lichen simplex, lichen planus, or lupus erythematosus; or (3) do not correspond to any disease well defined, such as lichen simplex, lichen planus, lupus erythematosus, but seem to show attributes morphologic, clinically and histopathologically, that are repeatable. Patients diagnosed as having KLC obviously represent a potpourri of different diseases, the most common of them being lichen simplex chronicus, lichen planus, and lupus erythematosus. Fewer than 25 patients reported on, however, presented themselves with lesions very similar to one another clinically, namely, an eruption that involved the face in a manner reminiscent of seborrheic dermatitis and with tiny papules on the trunk and extremities, which assumed linear and reticulate shapes by way of confluence of lesions. Individual papules were infundibulocentric and acrosyringocentric. Findings histopathologic were those of a lichenoid interface dermatitis affiliated with numerous necrotic keratocytes and covered by parakeratosis housing neutrophils in staggered fashion. These patients seem to have an authentic and distinctive condition that is exceedingly rare. In conclusion, the diagnosis of KLC should be made only for patients who present themselves with features clinical and findings histopathologic that resemble closely those of what is summarized in this article under category 3.

Lupus eritematoso discoide crónico en la infancia. Presentación de dos casos / Chronic discoid lupus erythematosus in childhood. Report of two cases

El lupus eritematoso discoide es un cuadro infrecuente en la infancia que presenta algunas características diferenciales con la forma de los adultos como el predominio masculino, la baja incidencia de fotosensibilidad y la frecuente progresión a lupus eritematoso sistémico. Describimos dos casos de lupus eritematoso discoide en niñas, de comienzo a los 4 y 9 años de edad, una con un lupus cutáneo generalizado y la otra localizado, que han mostrado respuesta favorable al tratamiento con antipalúdicos de síntesis (AU)

Hutchinson's Archives of Surgery revisited.

I present a bried review of Hutchinson's Archives of Surgery. I have listed most of his well-known and not-so-well-known early clinical descriptions. To this list can be added descriptions of Peutz-Jegher syndrome, lipomelanic reticulosis, telangiectatic lupus erythematosus, temporal arteritis, and recurrent herpes simplex on the thigh and buttocks. The characteristics of Hutchinson's writing are the use of catchy, descriptive terms, his use of patients' names for diseases, his belief in the effectiveness of illustrations, superb clinical observation but faulty conclusions, and a lack of humor. Seventy-two years after his death, there is still much that can be learned about clinical disease from Hutchinson.