Median raphe cysts of the penis.

The occurrence of a ventral cystic lesion of the penis should alert the clinician to the diagnosis of a median raphe cyst. The lesions, which are most common near the glans penis, may occur anywhere from the urethral meatus to the anus. Cysts of the median raphe represent defects in the embryologic development of the genitalia and are usually lined by entodermal epithelium. Surgical excision is the treatment of choice.

Dermatoses of pregnancy.

Hormonal alterations contribute to the physiologic skin changes in pregnancy, which include hyperpigmentation and melasma, striae gravidarum and vascular phenomena, such as spiders, palmar erythema and varicosities. Hair, nails and sweat glands may also be affected. Dermatoses associated with pregnancy include herpes gestationis, impetigo herpetiformis, pruritic urticarial papules and plaques of pregnancy and papular dermatitis of pregnancy. Some skin tumors are affected by or are unique to pregnancy.

Pseudomonas folliculitis acquired from a health spa whirlpool.

Three cases of an unusual Pseudomonas skin infection acquired from a health spa whirlpool were reported, and an epidemiologic survey showed 17 additional cases. This dermatosis is characterized by the abrupt onset of urticarial papules and superficial and deep papulopustules that spare only the head and neck and occur eight to 48 hours after using the whirlpool. Cultures from one patient's pustules and from the spa whirlpool environment were positive for P aeruginosa, serotype O-11. The condition cleared in all but one patient, without treatment, within seven to ten days. This patient continues to have recurrent follicular pustules three months after exposure. Samples from whirlpools at six other selected establishments were also positive for P aeruginosa.

Small vessel vasculitis caused by hepatitis B virus immune complexes. Small vessel vasculitis and HBsAG.

In a comprehensive study of 80 patients with vasculitis, 4 had concurrent hepatitis B virus (HBV) infection. Polyarteritis nodosa was present in 2 and in the other 2, cutaneous vasculitis, presenting clinically as palpable or Henoch-Schönlein purpura. In one of these patients skin biopsies demonstrated granular deposits of IgM, C3, C4, and the hepatitis B surface antigen (HBsAg) and electron-dense deposits of aggregated 20-nm particles resembling HBsAg in postcapillary venules. Evidence for circulating HBsAg-immune complexes included increased serum Clq binding activity, decreased serum complement, and a cryoprecipitate containing both HBsAg and IgM anti-HBs. Aggregated 20-nm particles resembling intact HBsAg were also seen by negative staining electron microscopy of the serum cryoprecipitate. This patient fulfills all the criteria for a specific immune complex vasculitis caused by his immune response to a chronic HBV infection. These findings emphasize that HBV infection may be associated with small vessel vasculitis as well as polyarteritis nodosa, mixed cryoglobulinemia, and glomerulonephritis. A similar immune response to other viral infections may be expressed as palpable (Henoch-Schönlein) purpura also.