Detection of human papillomavirus in nongenital Bowen's disease by in situ DNA hybridization.

Genital Bowen's disease has been strongly linked in recent studies to human papillomavirus (HPV). Nongenital Bowen's disease has been less well investigated, although isolated reports, all of which involved detection of HPV after extraction of DNA from fresh-frozen tissue, have been made. We investigated 25 cases of nongenital Bowen's disease in 5 black and 20 white patients for the presence of HPV types 1, 6, 11, 16, and 18 using paraffin-embedded tissues. Human papillomavirus was present in six specimens from 3 of the 5 black patients (one previously reported to be positive on Southern blot) and 3 of the 20 white patients; HPV 16 was detected in all 6 cases on low-stringency testing, but only 4 remained positive on high-stringency testing. This suggests an HPV closely related to but not entirely homologous with HPV 16 in the 2 remaining cases. Five of the 6 positive specimens were lesions from the hands and feet and 1 was from the volar aspect of the arm. Clinical factors associated with the presence of HPV included black race, location on the palmar surface and the feet, young age, and verrucous or hyperkeratotic clinical appearance. Of the 6 positive cases, all 5 of the patients available for examination also had evidence of HPV-associated genital lesions. No specific histopathologic features were found to be indicative of the presence or absence of HPV.

Neutrophilic eccrine hidradenitis. Evidence implicating bleomycin as a causative agent.

A 13-year-old girl receiving multiple agent chemotherapy for osteosarcoma was found to have neutrophilic eccrine hidradenitis (NEH). This dermatosis is marked histopathologically by necrosis of the eccrine structures with a neutrophilic infiltrate. Clinically, the presentation is variable and the differential diagnosis is extensive. Our patient's clinical picture was unique in that she had hyperpigmented plaques instead of purpuric nodules or erythematous plaques as described previously. Currently, NEH is felt to be a complication of chemotherapy. The most likely causative agent in our patient was bleomycin. Physicians should be aware of this entity and its variable clinical presentation.

Pagetoid dyskeratosis: a selective keratinocytic response.

Pale cells that resemble those of Paget's disease have been found within apparently normal epidermis in a variety of benign papules. Although they have been considered an artifact, they show characteristic premature keratinization. In contrast to other dyskeratotic processes they mature into orthokeratotic squamae. The histopathologic, ultrastructural and immunocytochemical features of these cells are illustrated, and the differential diagnosis is reviewed.

Systemic lupus erythematosus presenting as a bullous eruption in a child.

An 8-year-old girl presented with a generalized bullous eruption clinically resembling bullous pemphigoid or chronic bullous disease of childhood. Further study revealed immunopathologic findings seen in patients with epidermolysis bullosa acquisita or bullous systemic lupus erythematosus (SLE). Although she did not fulfill the American Rheumatism Association (Atlanta) criteria for SLE at her presentation, one year later she went on to do so. As well as being the youngest patient reported with bullous SLE, our patient is noteworthy because the bullous eruption was the initial manifestation of her SLE. Bullous SLE should be considered in the differential diagnosis of children presenting with generalized bullous eruptions.

The effect of dietary fish oil supplementation on psoriasis. Improvement in a patient with pustular psoriasis.

An open study testing the effects of fish oil supplementation on psoriasis in 26 patients is described. None of the patients with plaque-type psoriasis vulgaris showed clinically significant improvement; however, a patient with generalized pustular psoriasis showed marked improvement with the fish oil supplementation. In this patient, scale leukotriene B4 levels were determined and shown to be significantly decreased after completion of the study, but the leukotriene B4 levels did not correlate with her clinical course. The results of our study are contrasted with those of a recent study that did show beneficial effects of fish oil supplementation on plaque-type psoriasis.

Cutaneous Waldenström's macroglobulinemia. A report of a case successfully treated with radiotherapy.

Waldenström's macroglobulinemia is a lymphoproliferative disorder that only rarely exhibits specific cutaneous findings. The authors present a case of Waldenström's macroglobulinemia in which the patient developed cutaneous lesions while his systemic disease seemed to be under control with chlorambucil therapy. A review of the scant literature regarding the response of cutaneous Waldenström's to treatment suggests that the skin lesions do not respond well to systemic therapy. This case was successfully treated with radiotherapy.

Seborrheic keratoses.

Seborrheic keratoses are benign tumors of the epidermis that commonly appear during middle age. They are pigmented verrucous papules with a characteristic "stuck on" appearance. The tumors enlarge and become more deeply pigmented with age. The precise etiology is unknown. Differential diagnosis includes malignant melanoma and pigmented basal cell carcinoma. Biopsy should be performed if the diagnosis is in doubt. Treatment, when indicated, includes curettage, shave excision, freezing with liquid nitrogen or the use of trichloroacetic acid.