Long-term preservation of direct immunofluorescence staining in slides stored at room temperature.

To determine whether reproducible results from direct immunofluorescent tissue staining could be obtained after storing the slides at room temperature. We examined the original slides of 22 cases noted to be positive for direct immunofluorescence. Diagnoses include pemphigus, pemphigoid, lupus, dermatitis herpetiformis, lichen planus, and vasculitis. These specimens, initially evaluated during the period January 1997 to September 1998, were prepared with a standard immunofluorescence staining technique, and then a permanent aqueous mounting medium was added. All specimens were stored at room temperature in vertical slide holding trays. We focused on the presence and relative intensity of the immunofluorescence staining, as well as the final diagnosis. We then compared our readings to that of the original reports. Twenty of the 22 cases studied (91%) were read as having the same diagnosis as the initial immunopathology report. Seventeen of the 22 cases (77%) were found to have the identical or slightly less fluorescence intensity. The original reports in 3 of the cases did not comment on the original intensity of fluorescence. Thus, a comparison of fluorescence preservation could not be made. In 2 of the cases, the quality of tissue preservation was poor, and though fluorescent staining was noted, we were unable to render a diagnosis. Our results suggest that direct immunofluorescent studies, using a permanent aqueous mounting medium, can be stored over long periods of time at room temperature without significant degradation of staining.

Prevalence of occupationally related hand dermatitis in dental workers.

Occupationally related hand dermatitis has been attributed to frequent hand-washing, exposure to possible sensitizers and latex glove use. The authors conducted a study to determine the prevalence of occupationally related hand dermatitis in dental personnel. They found that 75 (19.2 percent) of 390 subjects self-reported they had a positive history of hand dermatitis. Further testing of 53 of these subjects indicated that only 9.4 percent reacted to the 45 allergens tested, and 3.8 percent had an allergy to latex.

Treatment of cutaneous hemangiomas in preterm neonatal twins with the flashlamp-pumped pulsed dye laser.

BACKGROUND AND OBJECTIVE: We report two cases of hemangiomas in twins born at a gestational age of 30 weeks who were treated with a flashlamp-pumped pulsed dye laser (FPDL) at 40 days postpartem. These were the youngest patients to our knowledge to be treated with FPDL. STUDY DESIGN/PATIENTS AND METHODS: Twin Caucasian females were born 10 weeks preterm. Twin A soon developed a 1 cm blanching erythematous patch with telangiectasia on a slightly bulbous nasal tip. Twin B developed a 6 mm erythematous papule on her forehead, a 12 x 10 cm erythematous plaque on her left shoulder, and two plaques measuring 2.5 x 2.0 cm and 1.5 x 1.0 cm on her right hip. The twins received seven monthly laser treatments. RESULTS: Several of the hemangiomas showed remarkable regression, including the lesions which became ulcerated and healed on Twin B's left shoulder and right hip. No general or topical anesthesia was used and the twins tolerated the procedure well. No significant adverse effects were encountered. The maximum single treatment dose was 7 mm spot size, 5.0 J/cm2 and 186 pulses for twin B and 6.25 J/cm2 and 16 pulses for twin A. CONCLUSION: To our knowledge, our patients are the youngest reported to be treated with FPDL at age 30 days preterm. Some of their hemangiomas responded, and no significant adverse effects were encountered. More prospective trials are needed to determine whether early treatment with FPDL accelerates regression of hemangiomas or results in a better cosmetic outcome than expectant treatment.

Skin cancer trends at Wilford Hall Medical Center.

Incidence rates for all skin cancers are increasing. The objective of this study is to review data on melanoma and nonmelanoma skin cancer from Wilford Hall Medical Center and identify and compare trends to published data. Records were reviewed by computer search of pathology records from 1986 to 1993, and analysis by total numbers diagnosed, age distribution, and site are described. Overall, our data agree with published material. We did not show an increased frequency of basal cell carcinoma, squamous cell carcinoma, or melanoma during this period.

Necrobiotic xanthogranuloma with paraproteinemia: an evolving presentation.

Necrobiotic xanthogranuloma with paraproteinemia is a progressive and destructive process that is often confused both clinically and histologically with other granulomatous and xanthomatous entities. It was first described by Kossard and Winkelmann in 1980. Prior to this, the entity was reported under a variety of names such as atypical multicentric reticulohistiocytosis with paraproteinemia, atypical xanthoma disseminatum, and atypical necrobiosis lipoidica. A 69-year-old woman experienced slightly pruritic and painful papules, plaques, and nodules. Initial biopsy specimens showed a granulomatous process consistent with granuloma annulare. Later biopsy specimens demonstrated histologic changes indicative of necrobiosis lipoidica. The most recent histologic findings are those of necrobiotic xanthogranuloma, with results of laboratory studies revealing a coexistent IgG kappa paraproteinemia. Patients with necrobiotic xanthogranuloma who demonstrate a benign monoclonal proteinemia and are evaluated for several years show a 9 to 11 percent risk of myeloma, amyloidosis, or macroglobulinemia. Multiple treatment regimens have been attempted, none of which are curative. We propose that this entity may be part of an evolutionary process that may start as a granulomatous entity and culminate in a xanthogranulomatous process with an accompanying paraproteinemia.

A comparative study of digital images versus 35-millimeter images.

Digital imaging is an alternative to 35-mm Kodachromes and may be a useful tool to the physician. The purpose of this study was to compare the quality of digital images to 35-mm images and then compare the two methods based on the ability to make the correct diagnosis. Dermatology patients were photographed with both a digital camera and a 35-mm camera. Images from 22 patients were compared and graded on four criteria (sharpness of image, contrast, depth of field, and trueness of color). Diagnoses were then made from 30 pairs of images of different patients. In all graded areas the 35-mm images scored significantly higher. The correct diagnosis was made in 69.6% of the digital images compared to 77.3% of the 35-mm images, a difference that was not statistically significant. One may conclude that digital images hold promise for present and future use in dermatology and other areas of medicine.

Epidemiology of hand dermatitis in dental personnel.

BACKGROUND: Dental personnel are prone to frequent bouts of hand dermatitis. This has been attributed to hand washing, occupational exposure to a multitude of possible sensitizers, and frequent latex glove use. There has been some conflict in the literature as to the true frequency of allergic contact dermatitis in dental personnel. OBJECTIVE: The purpose of this investigation was to quantify the frequency of allergic contact dermatitis and contact urticaria in a large group of Air Force dental personnel. METHODS: Four hundred forty-nine dental personnel were surveyed for hand dermatitis. Positive responders were interviewed and examined. Patients with histories most consistent with allergic contact dermatitis were patch tested to a standard and a dental tray. RESULTS: Of the 449 personnel completing our survey, 169 had a positive history of hand dermatitis. One hundred twenty of these were interviewed and examined, of which 27 patients gave a history most consistent with allergic contact dermatitis and were subjected to patch testing. Only 3 patients had relevant positive reactions to the allergens on the standard or dental trays. All others (93) were diagnosed with irritant contact dermatitis. None had contact urticaria to latex. CONCLUSION: The frequency of hand dermatitis in our dental personnel is consistent with that in other published studies (37.6%). The majority of hand dermatitis occurring in this group is due to irritant contact dermatitis; the frequency of allergic contact dermatitis is very low (0.67%). None had contact urticaria.

Lichen sclerosus.

Lichen sclerosus, usually appearing in the dermatologic literature under the names of lichen sclerosus et atrophicus, balanitis xerotica obliterans, and kraurosis vulvae, is an inflammatory disease with a multifactorial origin. A past association of lichen sclerosus and genital squamous cell carcinoma is not as close as once thought. Once considered primarily a surgical problem, especially when the genitals were involved, lichen sclerosus will respond to a variety of systemic and topical therapies.

Leukocyte colony-stimulating factors. A review of associated neutrophilic dermatoses and vasculitides.

BACKGROUND: Hematopoietic colony-stimulating factors are a diverse group of cytokines now commercially available through recombinant technology. The colony-stimulating factors have proven utility in a wide spectrum of cytopenic states, and their use is now common-place. Unlike many cytokines, the colony-stimulating factors are usually well tolerated. We present a dramatic case of pyoderma gangrenosum arising during granulocyte colony-stimulating factor therapy. Additionally, the relevant literature regarding cutaneous complications of colony-stimulating factor therapy is summarized. OBSERVATIONS: Including our case, two reported patients developed pyoderma gangrenosum while under colony-stimulating factor therapy. Sweet's syndrome presented in an additional three patients, and necrotizing vasculitis was precipitated in three others. The eruptions consistently developed after 1 to 2 weeks of colony-stimulating factor therapy and were apparently unrelated to the underlying systemic illness. Although most reactions developed de novo, three were superimposed on a preexisting inflammatory process. CONCLUSIONS: Serious cutaneous adverse effects of colony-stimulating factors are distinctly rare but include neutrophilic dermatoses and necrotizing vasculitis. Upregulation of neutrophilic function and secondary release of cytokines may induce these complications. Early recognition and cessation of colony-stimulating factor therapy will limit the morbidity of these adverse events.

Treatment of chronic erosions of junctional epidermolysis bullosa with human epidermal allografts.

We have successfully treated chronic central facial erosions of a patient with junctional epidermolysis bullosa using cultured epidermal allografts. Keratinocytes isolated from a skin biopsy of the patient's biological mother were used to generate the epidermal allografts. Significant re-epithelialization occurred during the course of four grafting procedures. Cultured epidermal allografts appear to be a promising method for treatment of chronic erosions of junctional epidermolysis bullosa.

Growth of human basal cell carcinomas transplanted to C57/Balb/C bgJ/bgJ nu/nu (beige-nude) mice.

The purpose of this study was to measure growth parameters of transplanted basal cell carcinoma (BCC) to beige-nude mice during a 4-month observation time. Forty male beige-nude mice were transplanted with human BCC with our reported subcutaneous implantation technique. Initial volume and wet weight were determined for each tumor. The tumors were measured every 2 weeks by calipers with a final volume determined at 120 days, at which time the tumors were harvested, weighed, and processed for routine histology. Thirty-two tumor sites were positive for persistent tumor at harvest. Tumor volumes declined by an average of 51% and average tumor weight by 33%. There were increased numbers of mast cells surrounding the BCC tumor lobules. These results indicate that BCC can survive for 120 days in the beige-nude mouse.

Immune response to basal cell and squamous cell carcinomas.

Recent studies are starting to give us some insight into the immune response to basal and squamous cell carcinomas of the skin. There appear to be local as well as systemic mechanisms that effect local tumor growth. The local response may be analogous to delayed-type hypersensitivity with recognition of tumor antigens and a subsequent cell-mediated response. This response may be blunted by suppressor cell activity that has been well documented in the animal model related to UV-induced tumors and also suggested in certain patients with multiple BCCs. Continued research efforts in these areas will help us better understand the immune response to these two very common skin cancers.

Verrucous carcinoma arising in ulcerative lichen planus of the soles.

Verrucous carcinoma is a low-grade squamous cell carcinoma. Chronic inflammation is an important factor in its pathogenesis. This is the first case of plantar verrucous carcinoma arising in a lesion of ulcerative lichen planus. This paper also lends further support to the successful use of Mohs micrographic surgical technique as the treatment of choice for verrucous carcinoma.

Familial occurrence of eruptive vellus hair cysts.

A 15-year-old white male had an extensive skin eruption that had been present since age 2 years. Physical examination revealed flesh-colored, rough-textured papules surrounded by faint erythema. These lesions were present diffusely over the upper trunk, arms, thighs, face, ears, and neck. Evaluation of four immediate family members revealed a similarly affected brother and father. A biopsy of the papules showed the presence of a mid-dermal epithelial cyst containing numerous vellus hairs.

Fibronectin extracellular matrix assembly by human epidermal cells implanted into athymic mice.

Human epidermal keratinocytes reorganize into epidermal inclusion cysts when implanted subcutaneously into athymic mice. During the organization and maturation of these cysts, fibronectin accumulates in the surrounding extracellular matrix and the basement membrane proteins bullous pemphigoid antigen and laminin appear at the epithelial-stromal interface. The sequence in which these proteins appear parallels that seen during reepithelialization of a skin wound in vivo. Fibronectin appears during aggregation of the epidermal cells and persists in the area surrounding the cysts for at least 7 days. Bullous pemphigoid antigen and laminin appear later (by 4 and 7 days, respectively) and ultimately become organized into a continuous band at the periphery of the cyst. This distribution of bullous pemphigoid antigen and laminin at the stromal-epithelial interface persists at least 5 weeks, suggesting that the implanted epidermal cells are capable of developing and maintaining a stable basement membrane zone. Fibronectin, which is abundant in the matrix adjacent to the epidermal cysts and in the surrounding stroma during cyst organization and maturation, diminishes to undetectable levels by 5 weeks. While much of the fibronectin derives from the host tissues, species-specific antibodies to human fibronectin reveal that at least a portion of this protein is synthesized and deposited by the implanted epidermal cells.

Transplantation of human basal cell carcinoma to C57/BALB/C bgJ/bgJ-nu/nu (beige-nude) mouse.

The purpose of this study was to evaluate the transplantation of BCC to the C57/BALB/C bgJ/bgJ-nu/nu (beige-nude) mouse. This animal has two gene defects which are expressed as impairment of natural killer cells (NK cells) as well as the absence of a thymus. The results demonstrate that human BCC can be successfully transplanted to the C57 beige-nude mouse without the need for supplemental immunosuppression. It may be that the impairment of NK cell activity in the beige-nude mouse model plays a significant role in tumor transplantation.