The Largest Mass Poisoning in History: Arsenic Contamination of Well Water in Bangladesh.

Arsenic is a naturally occurring compound that is widely distributed in trace quantities in the environment. Levels toxic to humans have been found contaminating certain regions of the world and their groundwater, leading to deleterious effects. In fact, an estimated 150 million people are affected by arsenic contamination worldwide.1 Arsenic poisoning leads to several adverse health effects, including cancer of the lung, bladder, and kidney, neurologic disorders, cardiovascular disease, peripheral vascular disease, hypertension, pulmonary disease, and diabetes mellitus.2 Skin lesions are a common manifestation of arsenic poisoning. Early findings include diffuse or spotted melanosis, leukomelanosis, and depigmentation. Years of chronic arsenic poisoning can lead to acral keratoses and squamous cell carcinoma of the skin.3.

Pellagra.

Pellagra was first described in the 18th century as an epidemic in the poverty-stricken Spanish countryside by Gaspar Casal. Pellagra did not appear in the United States until the turn of the 20th century. It then ravaged the Southern United States and was not eliminated until the 1940s. This short report will redact the descriptions of pellagra in two early textbooks of dermatology. The first, published in 1897 before cases of pellagra were recognized in the United States, and, the second, published in 1915 in the midst of the epidemic. The text published in 1915 described in detail the medical signs and symptoms of pellagra particularly as they relate to the skin, as well as speculations as to its cause. The complicated story of the socioeconomic situation of the Southern United States and the hunt for the cause of pellagra will also be discussed briefly.

Mnemonics in dermatology.

An Internet search has provided many examples of mnemonics. These are readily available, so we thought of composing new mnemonics that included information about the authors who first described the disease or are associated with the disease in question. We found this a pleasurable experience, because one of the authors (C.S.) either knew or knew of many of those who were responsible for the first writing of the diseases.

Dermatopathology in historical perspective: the Montgomery giant cell of lichen simplex chronicus.

In this short historical review, we will discuss the origin and references to the giant cell that is sometimes histopathologically present in the dermis of lichen simplex chronicus that was first described by Hamilton Montgomery, MD. A photomicrograph of the giant cell was included by Montgomery in his text Dermatopathology published in 1967. We will then provide a short biography of Montgomery.

The men behind the eponym--Abraham Buschke and Ludwig Lowenstein: giant condyloma (Buschke-Loewenstein).

In 1925 Abraham Buschke and Ludwig Loewenstein described a neoplasm of the penis (carcinomähnliche condylomata acuminata des penis), which, to them, bore resemblances to common condyloma acuminatum and squamous cell carcinoma, but it had histopathologic and clinical characteristics that differed from these 2 proliferations. Later Lauren V. Ackerman described a similar neoplasm of the oral mucosa that he termed "verrucous carcinoma." I have previously reviewed that neoplasm, now referred to as "oral verrucous carcinoma of Ackerman." Still later Aird and his colleagues described a unique neoplasm of the foot, "carcinoma cuniculatum." These 3 have been grouped generically as "verrucous carcinoma." Verrucous carcinomas occur at many sites including the female genitalia and the aerodigestive system. This report will synopsize the lives of Abraham Buschke and Ludwig Loewenstein, review their original articles, and mention the changing concepts over time concerning condylomata, particularly large condylomata. Some other reports of giant condyloma (verrucous carcinoma of the penis) will be discussed, emphasizing the histopathology of this neoplasm and its differentiation from "warty-like" carcinomas of the penis. Verrucous carcinoma of other sites and epithelioma (carcinoma) cuniculatum will not be discussed.

Dermatopathology in historical perspective: epithelioma cuniculatum (Aird).

Professor Ian Aird, a renowned British surgeon of the mid-twentieth century, described a peculiar neoplasm of the foot in 3 patients under the term epithelioma cuniculatum, now more commonly called carcinoma cuniculatum. I will recount the life of Professor Aird and then summarize his original report emphasizing the clinical and more particularly the histopathologic criteria of epithelioma cuniculatum as described by Aird et al. Then I will summarize some of the subsequent reports of epithelioma (carcinoma) cuniculatum. Authors have grouped carcinoma cuniculatum with giant condyloma of the penis of Buschke-Loewenstein and oral verrucous carcinoma of Ackerman and similar neoplasms at other sites under the generic title "verrucous carcinoma." Although this classification has been accepted, I will stress that the clinical picture and histopathology described by Aird et al differ from those in later reports of carcinoma cuniculatum. These correspond to descriptions of the verrucous carcinomas of Buschke-Loewenstein and Ackerman. Finally, I will conclude that carcinoma cuniculatum as delineated by Aird and his colleagues is an extremely rare, indolent, nonmetastasizing squamous cell carcinoma composed of banal keratinocytes with unique clinical and histopathologic features that almost always arises on the foot. If a neoplasm on the foot has the characteristics of verrucous carcinoma that occurs at others sites, but not those of Aird et al, it should be called verrucous carcinoma of the foot, and not "epithelioma (carcinoma) cuniculatum."

The man behind the eponym dermatology in historical perspective: Albert Sézary and the Sézary syndrome.

In a series of papers from 1938 to 1949, Albert Sézary, a French dermatologist and syphilologist, described erythroderma with cellules monstrueuses (monster cells) in the skin and blood, which is now known as Sézary syndrome or Sézary disease. This historical note reprises the life and work of Sézary. It outlines his original reports and his thoughts about the pathogenesis of the disease as a reticulosis, and lists a composite classification of the reticuloses, which includes that of Sézary. We touch briefly on the articles that first used the terms Sézary reticulosis and Sézary syndrome and the changing concepts of the reticuloses and the reticuloendothelial system. We conclude that Sézary syndrome (Sézary disease, Sézary reticulosis) cannot be separated from mycosis fungoides clinically, histopathologically, hematologically, or viscerally and, therefore, is not a disease sui generis. Despite our conclusions, present day consensus defines Sézary disease clinically as a generalized pruritic erythroderma: histopathologically with an epidermal and dermal infiltrate, lymphadenopathy and visceral involvement all containing monster cells (Lutzner/Sézary cells) in the skin, peripheral blood, lymph nodes, and viscera, a disease different and separate from mycosis fungoides.

Why a historical approach has clinical benefits: John Hinchman Stokes and George Miller MacKee.

John Hinchman Stokes studied syphilis intensely, and George Miller MacKee studied and wrote texts on x-ray and radium therapy for skin diseases. This review will encapsulate their lives and note the effect that the demise of their fields of interest had on them.

Ketron-Goodman disease, Woringer-Kolopp disease, and pagetoid reticulosis.

In this historical review I will synopsize the original articles by Lloyd W. Ketron and M.H. Goodman who described Ketron-Goodman disease, by Frederic Woringer and Pierre Kolopp who described Woringer-Kolopp disease, and by Otto Braun-Falco and colleagues who described pagetoid reticulosis. In their publications, each of these authors reported on one patient. I will review the clinical picture of the three patients, their histopathology, and the pathogenesis of each disease as suggested by the above authors. Then the views of others that have written on the subject recently will be reviewed particularly as to their conception of the diseases. Publications that describe the histopathology of the patch (early) stage of mycosis fungoides will be redacted to compare it to the histopathology of Ketron-Goodman disease, Woringer-Kolopp disease, and pagetoid reticulosis. I will discuss whether any or all of them are diseases sui generis, whether they are one, two, or three entities, or whether any or all are but forms of mycosis fungoides.

Frédéric Woringer: Pautrier-Woringer disease (lipomelanotic reticulosis/dermatopathic lymphadenitis).

This historical perspective will introduce Frederic Woringer and review the original article by Lucien-Marie Pautrier and Woringer on Pautrier-Woringer disease (reticulose lipo-melanique, lipomelanotic reticulosis, dermatopathic lymphadenitis). The current status of dermatopathic lymphadenitis is synopsized.

Louis-Frédéric Wickham and the Wickham's striae of lichen planus.

In 1895, Louis-Fédéric Wickham described whitish streaks, now known as Wickham's striae, on the surface of lichen planus papules. This historical note reprises the original article by Wickham, discusses his life and work, and describes the clinical picture and histopathologic foundation of the striae. The clinical feature, the histopathology, and the pathogenesis of lichen planus are not discussed.

The man behind the eponym: Lauren V. Ackerman and verrucous carcinoma of Ackerman.

In 1948, Lauren V. Ackerman described a neoplasm of the oral mucous membrane, which he thought represented a unique type of squamous cell carcinoma and that is now termed verrucous carcinoma of Ackerman. "Verrucous carcinoma" has also been used as a generic term under which are placed giant condyloma of Buschke-Loewenstein and carcinoma cuniculatum. This report will synopsize the life of Lauren Vedder Ackerman, review the original and subsequent report by Ackerman, and discuss some other reports of oral verrucous carcinoma. Because this review is directed to histopathologists, the histopathology will be emphasized. Other aspects of the neoplasm (eg, clinical picture, incidence, etiopathogenesis, and treatment) will not be discussed, or if so, only briefly. Giant condyloma acuminatum of Buschke-Loewenstein and carcinoma cuniculatum and studies that mention the occurrence of Ackerman's verrucous carcinoma in the pharynx, larynx, and esophagus will be mentioned only in the section on classification.