Common dermatoses in the elderly.

Common dermatoses in the elderly include xerosis, pruritus, contact dermatitis, acne rosacea, stasis dermatitis, bullous pemphigoid and herpes zoster. Physicians must be able to recognize these pathologic changes superimposed on the intrinsic and extrinsic effects of aging. Diagnosis is dependent on clinical appearance and supportive laboratory studies. Management is based on correct diagnosis.

Common skin tumors in the elderly.

Skin tumors can have an epidermal, melanocytic or mesodermal origin. Lesions frequently encountered in elderly patients include benign tumors such as seborrheic keratoses, lentigo, keratoacanthoma, epidermal cyst and sebaceous hyperplasia. Premalignant and malignant tumors that often occur in the elderly include actinic keratosis, Bowen's disease, basal cell carcinoma, squamous cell carcinoma and melanoma. Diagnosis depends on the tumor's characteristics and morphology, although in some cases biopsy is required. Treatment depends on the character of the lesion, its location and the patient's general condition and includes curettage, cryosurgery, chemosurgery, excision and radiotherapy.

Solar-induced epidermal tumors in the elderly.

Solar lentigo, actinic keratosis and Bowen's disease are common, solar-induced epidermal tumors in the elderly. Management of these lesions depends on the correct diagnosis, which may require biopsy. Treatment of solar lentigo includes cryosurgery followed by topical tretinoin and topical hydroquinone. Actinic keratosis may be treated with cryosurgery, topical 5-fluorouracil, topical tretinoin and, rarely, oral isotretinoin. Bowen's disease requires excision, cryosurgery, electrodesiccation with curettage, or chemosurgery; close follow-up examination is necessary, regardless of the type of treatment. Use of sunscreen products should be stressed as an important preventive measure for all three conditions.

Circumoral dermatitis and cheilitis caused by tartar control dentifrices.

Twenty women had similar symptoms and clinical findings related to the use of tartar control toothpaste. Each had burning and itching around the corners of the mouth, followed by pruritic perioral patches of erythema 4 to 14 days later. All patients had begun using tartar control toothpaste 1 to 2 weeks before onset and had brushed their teeth at least three times per day. The typical findings included a moderately severe perioral erythema with fissuring of the angles of the mouth; scaling erythematous patches, separated by normal skin lateral to the initial erythema, were also present. No vesiculation or crusting was noted, and involvement of the gingiva and buccal mucosa was noted in only one case. On discontinuation of the tartar control toothpaste, marked improvement was seen within 1 to 6 weeks with, in most instances, either no treatment or 1% hydrocortisone cream.

Adverse effects of isotretinoin therapy.

The clinical and laboratory toxic findings of ninety-four patients receiving systemic isotretinoin therapy for cystic acne are listed. A comparison of the toxicity for two different dosage schedules is made. Coexistent diseases such as ulcerative colitis, manic depression psychoses, Gilbert's disease and cluster headaches are unaffected by this systemic medication.

Sarcoidosis presenting with erythema multiforme-like cutaneous lesions.

Sarcoidosis is a systemic disease that involves the skin in approximately 35 percent of cases. Typical cutaneous lesions are violaceous or hyperpigmented papules, plaques, or nodules. Less commonly, cutaneous lesions of sarcoidosis simulate the lesions of other cutaneous diseases such as psoriasis, ichthyosis, and erythroderma. We report on a patient who presented with cutaneous sarcoidal lesions resembling the target lesions of erythema multiforme (EM).

Vaccination of the African white-tailed rat, Mystromys albacaudatus, with sonicated Leishmania braziliensis panamensis promastigotes.

The usefulness of sonicated Leishmania braziliensis panamensis promastigotes for vaccination was evaluated in Mystromys albacaudatus, the African white-tailed rat. Thirty-two animals received three intradermal injections of 2 x 10(6) sonicated promastigotes derived from L. braziliensis panamensis at weekly intervals. One month after completion of the immunization schedule, the experimental group of animals was challenged in vivo with 2 x 10(6) live L. braziliensis panamensis promastogotes. At the same time, a matched group of 40 control animals was similarly challenged. Within 2 months, 35 of the 40 animals (87.5%) the control group developed ulcers, while only 14 of 32 previously vaccinated animals (43.7%) developed ulcers at the site of challenge within the same time period. The remaining 18 vaccinated animals (56.2%) remain free from ulcers 7 months after challenge. When lymphocytes from the spleens of vaccinated and control animals were challenged in vitro with antigen derived from sonicates of varying numbers of promastigotes, only cells from immunized animals responded vigorously to the antigenic challenge, a response which was not enhanced by the addition of immune antiserum to the reaction.

Cutaneous histoplasmosis after renal transplantation.

A 21-year-old woman with a renal allograft presented with cellulitis of the right foot as the first manifestation of disseminated histoplasmosis. Disseminated histoplasmosis is more common in immunosuppressed hosts, and there is a trend toward more frequent cutaneous manifestations in transplant recipients (47%). Biopsy of cellulitis in these patients may lead to early diagnosis and curative amphotericin therapy.

Bullous amyloidosis.

The variety of cutaneous lesions in primary systemic or multiple myeloma-associated amyloidosis is impressive and includes purpura, waxy papules, tumors, plaques, alopecia, and, rarely, bullae. We report a patient in whom the diagnoses of amyloidosis and multiple myeloma were established after he presented with bullae and extensive infiltrated, purpuric plaques. Immunoelectrophoresis of the blister fluid revealed an IgA kappa monoclonal protein similar to that found in the patient's serum and urine.

Equestrian cold panniculitis in women.

We describe four patients with panniculitis attributable to a combination of cold exposure and equestrian activities. All were young, healthy women who rode horses for at least two consecutive hours per day throughout the winter. Initially, several small, erythematosus, pruritic papules appeared on the superior-lateral portions of one or both thighs. During one week, the lesions progressed to indurated, red-to-violaceous,tender plaques and nodules. Studies for cryofibrinogens and cryoglobulins were negative. The histologic picture was that of a panniculitis with prominent inflammation of veins most notable at the dermal-subcutaneus fat junction. Cold panniculitis is not limited to infancy and childhood. The distribution of lesions in our patients may have been caused, in part, by the use of tight-fitting, uninsulated riding pants. Such attire may have slowed blood flow through the skin, thereby further reducing tissue temperature.

Benign mucous membrane pemphigoid in association with internal malignancy.

A patient with benign mucous membrane pemphigoid was found to have metastatic carcinoma of the lung. With so few similar case reports in the literature, the possible association of this blistering disorder with internal malignancy cannot be disclaimed totally, as appears to be the case for bullous pemphigoid which has been studied much more extensively.

Intracranial calcifications and dyskeratosis congenita.

We describe two brothers with dyskeratosis congenita and intracranial calcifications. The calcifications were massive, approximately symmetric, and showed a predilection for the basal ganglia and dentate nuclei. No underlying causes for this finding were identified. Idiopathic familial intracranial calcification of this type has been described, but an association with dyskeratosis congenita has not previously been observed.

Hydrogen sulfide intoxication. A case report and discussion of treatment.

The toxicity of hydrogen sulfide is thought to be due primarily to reversible inactivation of the respiratory enzyme, cytochrome oxidase, with resultant inhibition of aerobic metabolism. A patient with severe hydrogen sulfide poisoning and consequent profound metabolic acidosis was treated successfully with nitrites and oxygen. The nitrite-induced methemoglobin, by competitively binding the toxic hydrosulfide anion until detoxified, presumably reactivated and protected cytochrome oxidase and therby aided the patient's recovery by enhancing aerobic metabolism. His rapid recovery adds clinical support to the efficacy of nitrite therapy in sulfide poisoning. Therefore, we recommend that severe cases of sulfide poisoning be treated with nitrite-induced methemoglobinemia in addition to vigorous supportive care.