Dry skin, water, and lubrication.

Lubrication of the skin will become more important as our population ages. Many excellent moisturizers are available for lubrication. Individual ingredients that are touted heavily are not as important as the total mixture. The single most important factor is the regular use of the products to prevent overdrying of the skin. How should we use this information to achieve our aims? 1. The frequency of bathing, showering, and cleansing should be reduced. The water should be kept at the coolest temperature practical, and one should get out as soon as possible. Sponge bathing should be encouraged. Bath oils make tubs slippery and are wiped off by towels. It is better to apply an emollient directly on skin that is still damp. 2. Room temperatures should be kept low and comfortable and humidity should be kept as high as possible without causing damage. 3. Overdrying should be avoided by limiting the exposure to soap, detergents, solvents, and water. In addition, friction from washcloths, rough clothing, and abrasives should be avoided. 4. Emollients should be used frequently and selected to be compatible with the individual's situation. Bedridden individuals should use petrolatum, whereas the ambulatory would be better served by the use of lotions and creams. 5. If itching is present or reticulated cracking (eczema craquelé) is seen, more aggressive treatment is indicated, including possible use of topical steroid preparations. 6. A preparation that is cosmetically acceptable, so that it will be used regularly, should be prescribed. One must emphasize its importance so that the individual avoids serious and chronic dermatitis.

Parapsoriasis and mycosis fungoides: the Northwestern University experience, 1970 to 1985.

One hundred sixty skin biopsy specimens from 89 patients with the clinical diagnosis of large plaque parapsoriasis and 240 specimens from 106 patients with mycosis fungoides were reviewed. Through the use of chart reviews and a retrospective questionnaire, various factors (sex, age, history of eczema/atopy, occupation) were examined in these two patient groups. Mycosis fungoides developed in 30% of the patients in the parapsoriasis group. Nineteen percent of patients in the mycosis fungoides group had worked in industry. Once the clinical diagnosis of mycosis fungoides was considered, an average of four biopsy specimens were needed to establish the diagnosis. The average interval from the initial visit to the diagnosis of mycosis fungoides from examination of biopsy specimens was 22 months. These findings support further the view that large plaque parapsoriasis represents an important precursor of mycosis fungoides. A designation of premycosis fungoides would emphasize this relation more than the term parapsoriasis.

Streaky pigmentation in a patient with acquired immune deficiency syndrome (AIDS).

We report a case of hyperpigmentation due to bleomycin treatment in a patient with acquired immune deficiency syndrome (AIDS). Although this type of hyperpigmentation has been previously seen in patients with cancer who are receiving bleomycin, this is, to our knowledge, the first reported case of bleomycin-induced hyperpigmentation in an AIDS patient and should be added to the growing list of cutaneous eruptions seen in these patients.

An unanticipated use of a topical cream.

A sixteen-year-old black male, distraught over his acne, injected his face via syringe and needle with a topical cream. Within twelve hours, the injected lesions became red and edematous, and later tender. After treatment with oral prednisone and erythromycin, the lesions resolved. This case serves to illustrate the unexpected misuses of cosmetics, in this instance, a patient anxious only to improve his acne problem.

Sinus histiocytosis clinically limited to the skin.

Sinus histiocytosis with massive lymphadenopathy is a rare clinicopathologic entity that affects mainly children and young adults. Although the lymph nodes are the most common sites of involvement, extranodal infiltrates may arise in the orbits, skin, upper respiratory tract, and bone, as well as other organs. Approximately 10% of patients have had cutaneous infiltrates, but very few of them have had lesions limited to the skin. We treated a 15-year-old female with cutaneous nodules as the sole manifestation of the disease.

AIDS and psoriasis.

Seven patients with acquired immunodeficiency syndrome (AIDS)/AIDS-related complex (ARC) and psoriasis are reported. The psoriasis first presented in close association with the AIDS/ARC. The cutaneous lesions were difficult to control with systemic antipsoriatic therapy when patients' immune functions were depressed. Isolation of patients with psoriasis and AIDS from psoriatic patients without AIDS should be considered. The use of immunosuppressive therapy to control psoriasis in patients at high risk for AIDS, as well as those who already have AIDS, is controversial. An understanding of how viral, fungal, and bacterial infections trigger outbreaks of psoriasis could help us to discover the pathogenesis of this condition.