Disseminated granuloma annulare following erythema multiforme minor.

A 44-year-old woman presented with erythema multiforme minor followed by disseminated granuloma annulare 4 weeks later. The patient was not taking any medication and had no history of herpes simplex infection. Involvement of a delayed-type hypersensitivity reaction in the pathogenesis of these two well known disorders, as suggested by immunological investigations, may explain their concurrence in our patient. The substitution of the erythema multiforme minor lesions by an eruption of disseminated granuloma annulare at the same sites suggests the possibility of a Koebner phenomenon or an isotopic response.

Vitiligo, rheumatoid arthritis and pernicious anemia.

A patient with a 46-year history of vitiligo who also presented rheumatoid arthritis and pernicious anemia is described. Meticulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed a low CD4 cell percentage with T cells mostly composed of CD8 cells, a discrepancy between the high percentage of cumulative CD4 + CD8 cells and the measured CD3 proportions, very low NK cytotoxicity toward K562 cells, and almost negligible responses to PHA, Con A and PWM mitogens. The results point to severe T and NK cell functional defects. The pathogenetic significance of these data is discussed.

Fulminant dermatomyositis after removal of a cancer.

Dermatomyositis developed suddenly in a diabetic patient with CREST syndrome after the removal of a malignant tumor. Scrupulous physical examination excluded further systemic or cutaneous involvement. We raise certain still unsolved aspects regarding the association between dermatomyositis and neoplastic disorders.

Long-standing dermatological manifestations in a patient with chronic heavy metal intoxication.

A patient with chronic metal intoxication is described, presenting during four years after the cessation of her exposure to industrial substances, maculo-papular eruptions with several ulcerated lesions and excoriations on her abdomen and buttocks. She also had pallor of her face, greyish-dark discoloration of the hair, while the fingernails were brittle and sensitive. Scrupulous physical examination excluded further cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.

[Vitiligo and white dental discoloration].

Vitiligo is a common dermatological manifestation of obscure etiology, affecting mostly healthy people. It has also been observed in association with sunburn, various chemicals, repeated friction, physical trauma, and numerous systemic and cutaneous diseases. However, white discoloration of teeth in these patients has not yet been reported. We describe a 14-year-old boy with vitiligo who presented with white patches on the surface of his upper, central incisors. Medical history and laboratory tests excluded those complications documented in the literature known to be associated with white discoloration of the teeth, such as disturbances of calcium and phosphate metabolism (as in vitamin D refractory rickets), hypoparathyroidism, gastroenteritis, celiac disease, premature birth, hyperplasia of the enamel and prolonged ingestion during tooth formation of water containing excessive fluoride.

[Lichenoid sarcoidosis].

A rare type of cutaneous papular sarcoidosis is the lichenoid form. We describe a 36-year-old woman who presented with a symmetrical, asymptomatic lichen-like eruption on her upper limbs. The biopsy showed a non-necrotizing granulomatous infiltrate compatible with sarcoid. Chest X-ray revealed Type I bilateral, asymptomatic, hilar adenopathy with no parenchymal abnormalities. High levels of angiotensin converting enzyme and a 67gallium lung scan supported the diagnosis of sarcoidosis.

[Lupus vulgaris diagnosed after 71 years].

The commonest form of cutaneous tuberculosis is lupus vulgaris, whose incidence has steadily decreased during recent decades. We describe an 82-year-old man who presented with a large plaque of lupus vulgaris on his chin and upper neck which had been present for 71 years. This case clearly emphasizes the need for increased awareness of this disease, since its frequency may be greater than generally thought.

Psoriasis, necrobiosis lipoidica, granuloma annulare, vitiligo and skin infections in the same diabetic patient.

A diabetic patient is described presenting psoriasis, necrobiosis lipoidica diabeticorum, granuloma annulare, and vitiligo and with a history of recurrent erysipelas and mycotic infections. Scrupulous physical examination excluded further systemic or cutaneous involvement. The immunological workup revealed both phenotypic and functional defects in cellular immunity.

Simple methods for estimation of prednisone intake and metabolism.

For patients treated with high doses of prednisone (over 40 mg/day) laboratory follow-up is important, particularly when the therapeutic response does not correlate with the dose of prednisone prescribed. Taking advantage of the similarity in structure of prednisone to cortisone and of prednisolone to cortisol we evaluated simple, inexpensive methods for the assessment of prednisone and prednisolone intake and bio-availability. Free urinary prednisolone was estimated by radioimmunoassay for cortisol and found to be linearly correlated with the dose of prednisone administered (r = 0.9310). Levels of free prednisolone were 6.5-11% of the dose of prednisone per day. Free and metabolized prednisone and prednisolone were estimated as 17-OHCS in the 24-hr urine collection. Total, conjugated and free 17-OHCS were linearly correlated with the dose of prednisone, the best correlation being with total 17-OHCS (r = 0.9060). About 40% of the prednisone administered was secreted as total 17-OHCS.

Estimation of prednisone intake in pemphigus vulgaris patients with the use of simple laboratory methods.

Prednisone is a widely used medication in dermatology, particularly in pemphigus patients. Simple objective laboratory methods are suggested for the evaluation of prednisone intake, taking advantage of the similar chemical structure of cortisol and prednisolone. A linear correlation was found between the dose of prednisone, above 40 mg/day, free urinary prednisolone, measured with an radioimmunoassay kit for cortisol that cross-reacts with prednisolone, and 17-hydroxycorticosteroids, measured by Metcalf's method. Approximately 9% of the prednisone administered was recovered as free prednisolone and about 40% as 17-hydroxycorticosteroids. It is suggested that these simple laboratory methods constitute a useful substitute for the more costly, sophisticated methods available at present for determining levels of prednisone and prednisolone.

[Moniliform disease--new aspects]. / Morbus moniliformis--Neue Aspekte.

We report on a 15-year-old boy suffering from acute morbus moniliformis. To the best of our knowledge, this cutaneous eruption in its acute form has not been described before. We think that morbus moniliformis is a unique dermatosis different from keratosis lichenoides chronica or lichen planus.

Pemphigus with characteristics of dermatitis herpetiformis. A long-term follow-up of five patients.

Five patients had a form of pemphigus which in its early stages resembled dermatitis herpetiform, although the immunofluorescent findings were typical of pemphigus. Potassium iodide tests, performed for the first time in such patients, showed positive results in two patients. Follow-ups ranging from 5 to 14 years have shown a benign course with low to absent dosages of steroids.