Role of histology in providing prognostic information in mycosis fungoides.

Many patients who present with patch and early plaque stage mycosis fungoides follow an indolent course and survive for many years following diagnosis. A certain subset of patients, however, have rapidly progressive disease leading to accelerated demise. We examined 21 histologic sections from initial biopsies taken from patients with stable disease and 26 from patients with rapidly progressive disease in order to evaluate the role of histology in predicting the disease course. Two or three authors examined each case and scored each of 24 histologic parameters using a previously described four-point scale with no knowledge of the patients' clinical courses. Interobserver agreement was quite high. The only histologic parameter that demonstrated statistical differences between the two groups of patients was degree of acanthosis. The degree of spongiosis, number of eosinophils, amount of hyperconvolution of dermal lymphocytes and density of the dermal infiltrate approached statistical significance but did not attain this level. All of these differences were quite small. No differences were seen for the other 19 parameters. Patients with rapidly progressive disease tended to have more acanthosis, a few more hyperconvoluted dermal lymphocytes, a slightly greater number of eosinophils and perhaps a slightly more dense dermal infiltrate than patients who had stable disease. However, as all of these changes were very slight, it appears unlikely that evaluation of any single biopsy specimen for the histologic parameters we studied is helpful in predicting the prognosis for a specific patient.

Bubble hair. Case caused by an overheating hair dryer and reproducibility in normal hair with heat.

BACKGROUND: Bubble hair is an acquired hair shaft deformity characterized by bubble-like areas in the hair shaft seen with light microscopy and corresponding cavitary defects with scanning electron microscopy. OBJECTIVE: Our purpose was to report the fourth case of bubble hair, to demonstrate a cause, and to determine whether the cavities contain gas or liquid. METHODS: Light and scanning electron microscopy were performed. The patient's hair dryer was examined. We applied heat to normal hair of the patient and that of 16 human volunteers. Approximate temperatures for bubble formation were measured. The bubble contents were investigated by applying aqueous and nonaqueous liquids to affected hairs. RESULTS: No person's hair failed to develop bubbles when subjected to sufficient heat. The cause of bubble hair in the patient was an overheating hair dryer. The cavitations contained a gas. CONCLUSION: Bubble hair is a reproducible hair shaft defect caused by heat. The use of overheating hair dryers, or any other hair care equipment that overheats, should be avoided.

Physically induced pemphigus after cosmetic procedures.

BACKGROUND: Pemphigus is a vesiculobullous autoimmune disease characterized by acantholysis due to antibodies against epidermal antigens. CASE REPORTS: We report the first two cases of pemphigus in which lesions appeared in areas traumatized by cosmetic procedures. In one case, the patient had a history of pemphigus under excellent control; pemphigus lesions appeared only in her surgical scars 2 months after a reduction mammoplasty and facelift. The other patient presented with an outbreak of pemphigus 4 weeks after a chemical peel. CONCLUSIONS: Physical agents including infrared and ionizing radiation as well as ultraviolet light are known triggers of pemphigus. We suggest that cosmetic procedures can initiate pemphigus and that this change must be differentiated from postoperative wound infections and other reasons for poor wound healing.