Tricholemmoma of the eyelid.

Tricholemmoma is a benign cutaneous tumor that shows differentiation characteristic of the outer hair sheath. The usual site of occurrence is the face, including the nose and eyelid. Four cases of tricholemmoma involving the eyelid margin to a variable extent are presented and the clinical and pathologic findings are reviewed. In three of the four cases, a histopathologic misdiagnosis of squamous cell carcinoma was initially made. In one case, this resulted in a greater sacrifice of normal lid tissue than was necessary, although the reconstruction yielded a good result. In the subsequent cases, the entity of tricholemmoma was well appreciated before definitive oculoplastic surgery and the referring diagnosis of squamous cell carcinoma was refuted.

Insect bites and stings.

This article summarizes the clinical presentation and treatment of common bites and infestations in the United States. A survey of this complex and interesting area of medicine should help the emergency physician to diagnose and treat many patients who present with "nonspecific" bites and rashes.

Ro 20-1724: an agent that significantly improves psoriatic lesions in double-blind clinical trials.

Two double-blind studies comparing the effectiveness of the cyclic nucleotide-altering agent (4-[3-butoxy-4-methoxybenzyl]-2-imidazolidinone) (Ro 20-1724) vs vehicle have demonstrated that this compound can improve psoriatic lesions. Although Ro 20-1724 was not as effective as intensive occlusive treatment of psoriatic lesions with 0.025% triamcinolone acetonide, Ro 20-1724 had no adverse systemic or cutaneous effects. Ro 20-1724 and other cyclic nucleotide-altering agents may have therapeutic potential in the future treatment of psoriasis.

Malignant melanoma and its therapy: a review.

Malignant melanoma (MM) is an important cutaneous neoplasm. In classic cases, histologic levels of tumor invasion have been used as indicators of prognosis. Recent research suggests that vertical tumor thickness may be an equally valuable guide to prognosis and also to therapy. The standard surgical approach of wide excision and regional lymph node dissection may not be mandatory for all patients with MM. Regional perfusion of accessible primary tumors as an adjunct to surgery has yielded encouraging results. Immunotherapy of MM alone and in combination with chemotherapy may improve the poor outlook for disseminated MM.

Skin manifestations of leukemias and lymphomas.

The diseases discussed in this paper include chronic lymphocytic leukemia, monocytic leukemia, chronic granulocytic leukemia, acute leukemias, Hodgkin's disease, and lymphosarcoma. Cutaneous manifestations of these disorders are often sufficiently different to indicate a certain leukemia or lymphoma. The cutaneous manifestations of leukemias and lymphomas may help the clinician suspect the diagnosis.

Basal cell carcinoma: a practical approach to diagnosis and therapy.

Basal cell carcinoma is the most common cancer of the skin, and the majority of those afflicted are elderly Caucasians with sun-damaged skin. Knowledge of the indications for and contraindications to the various treatment modalities is required in order to choose the proper treatment for each patient. Only long-term follow-up can detect recurrent or new lesions.

Glucocorticoid in inflammatory proliferative skin disease reduces arachidonic and hydroxyeicosatetraenoic acids.

Psoriasis is a prototype of several common, glucocorticoid responsive, inflammatory proliferative skin diseases. Within 28 hours, glucocorticoid reduced the increased concentration of free arachidonic acid in diseased tissue. This reduction was observed prior to visible improvement of disease and may be an important molecular mechanism for the therapeutic efficacy of glucocorticoids in psoriasis and similar inflammatory diseases.

Cutaneous signs of diabetes mellitus.

Cutaneous signs of diabetes mellitus are extremely valuable to both the clinician and the researcher. Lesions such as necrobiosis lipoidica diabeticorum, diabetic dermopathy, carotenemia idiopathic bullous eruptions of granuloma anulare alert the physician to consider the diagnosis of diabetes mellitus. Xanthomas reflect the status of glucose and lipid metabolism. Diabetic dermopathy might be a useful monitor of angiopathic changes in the heart, kidney and brain. Finally, the accessibility of the skin makes it an ideal organ for studying the pathogenesis of diabetes and the effect of medications on the vascular and neurological complications of diabetes.

Papaverine: its effects on cyclic AMP in vitro and psoriasis in vivo.

Psoriatic epidermis shows excessive cell proliferation, incomplete morphogenesis, and glycogen accumulation. These three features may result from coordinate misregulation by the previously reported abnormal lesional ratio of cyclic AMP/cyclic GMP. If so, it is possible that psoriasis might improve by topical application of an agent known to alter cellular levels of cyclic nucleotides. In the present study papaverine (3.0 x 10-4 m) produced a 210percent increase (.02 smaller than p smaller than .05) in epidermal cyclic AMP levels in vitro. Therefore, 1 percent papaverine cream (approximately 2.7 x 10-2m papaverine) was chosen to establish whether a cyclic AMP elevating agent could improve a soriatic lesion. A double-blind comparison of 1 percent papaverine cream versus cream alone was conducted on matched lesions in 45 patients. Of those patients showing differential improvement (i.e., only one lesion of the pair improved), 81 percent (p=0.011) of those showing a response in the center of the lesion and 77 percent (p=0.046) of those improving at the edge had applied papaverine. Although no attempts were made to develop a papaverine formulation with immediate therapeutic utility, the numerically significant papaverine results suggest future therapeutic developments.