Argyria following the use of dietary supplements containing colloidal silver protein.

The onset of argyria following the use of dietary supplements containing colloidal silver protein is presented. The patient was using a silver-containing product for cold and allergy prophylaxis. We review the past and present medicinal roles of silver and include a differential diagnosis for argyria. The hyperpigmentation of argyria is usually permanent, and it follows a sun-exposed distribution. This case report highlights the potential for toxicity following the use of dietary supplements and demonstrates the importance of physician inquiry regarding alternative medicines. Finally, we examine the limited role of the Food and Drug Administration (FDA) in regulating alternative medicines marketed as dietary supplements.

1992 AAD Award for Excellence in Education: The Integrated Basic and Clinical Science Conference Series at the University of Texas Southwestern Medical Center.

This article was written to share information concerning the establishment and implementation of a successful, integrated basic and clinical science conference series for resident trainees in dermatology. We discuss the underlying philosophy and describe the concepts employed in, and the dynamics that have resulted from, this educational experiment. Finally, we include the schedule and references for the 1993-1994 academic year.

Disseminated epidermolytic acanthoma.

A 57-year-old man developed hundreds of light brown, slightly atrophic papules, which were distributed diffusely over the back. Although clinically the lesions resembled seborrheic keratoses, histologic examination demonstrated changes of epidermolytic hyperkeratosis. The patient had neither a personal nor a family history of ichthyosiform disorders. The diagnosis of disseminated epidermolytic acanthoma was made in the context of the clinical, histologic, and historical features. Disseminated epidermolytic acanthoma is a rare condition that is readily diagnosable using clinicopathologic correlation; it is important to exclude it from other more serious conditions associated with epidermolytic hyperkeratosis.

Prevalence and significance of acanthosis nigricans in an adult obese population.

BACKGROUND AND DESIGN: Acanthosis nigricans develops commonly in obese individuals, yet its prevalence and significance in an unselected adult obese population has not been determined. To address these issues, 34 patients enrolled in the Adult Obesity Clinic at Parkland Memorial Hospital (Dallas, Tex) were chosen at random and examined. RESULTS: Acanthosis nigricans was observed in fully 74% of patients; its prevalence correlated positively with severity of obesity. Black obese patients demonstrated a greater propensity for manifesting the cutaneous disorder than did white obese individuals. Patients with acanthosis nigricans exhibited fasting plasma insulin levels that were markedly higher than those of nonacanthotic cohorts. CONCLUSIONS: Obesity is a significant risk factor for the development of acanthosis nigricans. Conversely, acanthosis nigricans is a reliable cutaneous marker of hyperinsulinemia in obese individuals.

Excess insulin binding to insulin-like growth factor receptors: proposed mechanism for acanthosis nigricans.

Clinical and epidemiologic evidence has shown acanthosis nigricans to be closely related to defective tissue utilization of insulin in a number of previously recognized (e.g., obesity, lipodystrophy, and leprechaunism) as well as recently characterized (e.g., type A and type B syndromes) disorders. This article reviews the relationship of acanthosis nigricans to these insulin-resistant states. It also focuses attention on the possibility that interaction between excessive amounts of circulating insulin with insulin-like growth factor receptors on keratinocytes and dermal fibroblasts leads to the development of acanthosis nigricans.