Management of cutaneous verruciform xanthoma.

Verruciform xanthoma is an uncommon mucocutaneous condition of uncertain cause that only occasionally affects the skin. The histopathology is distinctive for the presence of foamy histiocytes present within elongated dermal papillae. Although simple excision of intraoral lesions is reportedly curative, treatment of cutaneous lesions has not been previously reported. We describe a 62-year-old man with a large lesion of verruciform xanthoma affecting both inguinal folds. Immunohistochemical staining, reverse transcriptase polymerase chain reaction for human papilloma virus, and ultrastructural analysis were performed to investigate the pathogenesis of this lesion. The results of these studies support the theory that the source of lipid in dermal histiocytes is degenerating keratinocytes. Initial treatment with wire loop electrosection, pulsed dye (585 nm) laser, and x-ray therapy of this patient proved unsuccessful. Preliminary success has been achieved using wide surgical excision with primary closure.

Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations.

BACKGROUND: It has previously been shown that a combination of erythromycin and benzoyl peroxide is superior to either ingredient when used alone in the treatment of acne. A clindamycin/benzoyl peroxide combination gel might have an advantage over erythromycin/benzoyl peroxide gel because the former does not require refrigeration after it is dispensed. OBJECTIVE: Our purpose was to determine the efficacy and safety of a combination clindamycin/benzoyl peroxide gel when compared with benzoyl peroxide, clindamycin, or vehicle gels. METHODS: In two double-blind, randomized, parallel, vehicle-controlled trials, patients were treated for 11 weeks with once-nightly application of one of the above preparations. Evaluations were performed at 2, 5, 8, and 11 weeks and included lesion counts and assessment of global responses and irritant effects. RESULTS: A total of 334 patients completed the study. All three active preparations were significantly superior to the vehicle in global improvement and in reducing inflammatory lesions and noninflammatory lesions. The combination gel was significantly superior to the two individual agents in global improvement and reduction of inflammatory lesions and also to the clindamycin gel in reducing noninflammatory lesions. There was no significant difference in tolerance to the active gels versus the vehicle gel. CONCLUSION: In the treatment of acne, topical clindamycin/benzoyl peroxide combination gel is well tolerated and superior to either individual ingredient.

Efficacy and safety of twice-daily augmented betamethasone dipropionate lotion versus clobetasol propionate solution in patients with moderate-to-severe scalp psoriasis.

This 2-week, randomized, multicenter, investigator-blinded, parallel-group study was conducted to compare the efficacy and safety of augmented betamethasone dipropionate 0.05% lotion and clobetasol propionate 0.05% solution in the treatment of moderate-to-severe scalp psoriasis among 197 (193 assessable) healthy adult patients with at least 20% scalp-surface involvement. The patients received one of two treatments applied twice a day for 2 weeks. Signs and symptoms were evaluated at baseline, after 3 days (day 4), and after weeks 1 (day 8) and 2 (day 15) of treatment. As early as 3 days after treatment, scaling and induration were improved significantly faster by betamethasone dipropionate than by clobetasol propionate. Both treatments also reduced erythema and pruritus. Patients receiving betamethasone dipropionate had a significantly greater mean percent improvement in total sign/symptom scores (P < or = 0.015) at all visits and better mean global clinical response scores at the early visits (days 4 and 8) (P < or = 0.017). At the end of the study, only mild disease was present in both groups. Adverse events were reported by 34.0% and 36.4% of patients receiving betamethasone dipropionate and clobetasol propionate, respectively. All events were transient, most were mild and local, and no discontinuations resulted. The effects of treatment on the hypothalamic-pituitary-adrenal axis were not measured. In conclusion, augmented betamethasone dipropionate lotion and clobetasol propionate solution were equally effective, but betamethasone dipropionate lotion provided a faster onset of relief for scaling and induration, which may enhance patient compliance and patient satisfaction with treatment.

Ki-1-positive cutaneous large cell lymphoma of T cell type: report of an indolent subtype.

T cell lymphomas that demonstrate skin involvement include not only mycosis fungoides and Sézary syndrome but also a wide variety of other T cell neoplasms. Whether any specific clinicopathologic associations exist for nonmycosis fungoides/Sézary syndrome cutaneous T cell lymphomas is not known, and whether they represent distinct entities or a spectrum of a similar disease process also is not known. We describe a patient with a localized cutaneous large cell lymphoma with a Ki-1-positive "aberrant" T helper/inducer phenotype. Clonal rearrangement of the T cell receptor gene was documented. Although these histologic characteristics and immunophenotype are usually associated with high-grade lymphomas, the patient appears clinically to have a much less aggressive neoplasm. The possible relationship of this overt lymphoma to lymphomatoid papulosis is discussed.

Skin surface lipids of the mink.

Skin surface lipids from mink (Mustela vison) were collected in acetone and analyzed by thin-layer chromatography and gas chromatography. The principal components were wax monoesters (92%), cholesteryl esters (5%), free fatty acids (1%), fatty alcohols (1%) and cholesterol (1%). The fatty acids and alcohols contained in these lipids were composed principally of homologous series of straight chained omega 7-unsaturated structures (C16-C24), accompanied by lesser proportions of homologous series of saturated (C14-C22) and omega 9-unsaturated (C18-C22) structures.

Skin surface lipids of the cow.

1. Lipids extracted from the skin surface of cows (Bos taurus) with chloroform were analyzed by quantitative thin layer chromatography and found to contain at least 12 classes of lipids. 2. The major constituents were, in order of increasing polarity: cholesteryl esters, 3%; wax diesters Type I, 37.9%, wax dieters Type II, 7.9%; wax triesters, 29.9%; and triglycerides, 3.6%. 3. Each of the remaining constituents formed less than 5% of the lipid mixture and appeared to be derived from the above materials by loss of acyl groups. 4. With the exception of the triglycerides, all of the aliphatic constituents were composed of saturated, unbranched hydrocarbon chains having an even number of carbon atoms. 5. The triglycerides contained a high proportion of mono- and di-enoic C18 acids, suggesting that they are derived from the epidermis rather than from sebaceous glands.

Occurrence of squalene in skin surface lipids of the otter, the beaver and the kinkajou.

In a previous survey of the skin surface lipids of 46 mammalian species, it was found that only 3, the otter, the beaver and the kinkajou, contained components with chromatographic mobility similar to squalene, and in each case, this material was the predominant constituent. The materials in question have now been isolated from each of these species and identified as squalene by thin layer chromatography, gas chromatography and infrared spectroscopy. The occurrence of squalene in the surface lipids of these particular species cannot be examined on the basis of either their evolutionary relationship or ecological niche.