Hypopigmented mycosis fungoides: a report of 7 cases and review of the literature.

Over the last 2 decades, hypopigmented macules have been reported with increasing frequency as an initial presentation of mycosis fungoides (MF). We retrospectively reviewed 7 patients with hypopigmented MF. The mean age was 35 years at disease onset, with a mean of 5.5 years' duration of illness before presentation. All of our patients were Fitzpatrick skin type IV or V, and most reported pruritus. Histologic findings in all cases were consistent with MF. Treatment with topical nitrogen mustard produced repigmentation in 4 of 6 patients.

Routine periodic acid-Schiff staining of nail plate fragments in fungal cultures for onychomycosis: a method to increase the sensitivity of diagnosis.

We propose the routine staining of nail plate fragments with periodic acid-Schiff stain to increase diagnostic accuracy in diagnosing onychomycosis. The advantages of this method, including increasing diagnostic yield after contaminant growth, confirmation of negative culture, and low cost, are reviewed.

Secondary syphilis in persons infected with and not infected with HIV-1: a comparative immunohistologic study.

To better understand the cutaneous immune response to Treponema pallidum, we performed an immunohistologic study of skin biopsies from a total of 11 patients with secondary syphilis; biopsies from five persons infected with HIV-1 were included in the analysis to assess at the tissue level the impact of concomitant HIV-1 infection on disease expression. In all of the biopsies, staining for HLA-DR, a marker for cellular activation, was observed among infiltrating leukocytes, dermal vascular endothelial cells, and keratinocytes. Infiltrating mononuclear cells stained positively for CD4 or CD8, with CD4+ cells always being in the majority. Surprisingly, most of the CD4+ cells had histiocytic, rather than lymphocytic, morphologic characteristics. Immunostaining for CD14 confirmed that these cells were monocytic in origin, whereas immunostaining for CD3 revealed that the lymphocytes were predominantly CD8+ cytotoxic T cells. B cells were not detected despite the presence of variable numbers of plasma cells in all specimens. By immunofluorescence, all of the specimens demonstrated perivascular deposition of immunoglobulins, complement, or fibrinogen; linear staining at the dermal-epidermal junction also was observed in most of the specimens. No differences in immunocytochemical or immunofluorescence staining patterns were observed between the specimens from patients who were HIV positive and patients who were HIV negative. In addition to providing a more precise definition of the infiltrating cells in syphilitic lesions, our results, taken as a whole, indicate that cellular immune processes are largely responsible for the development of cutaneous manifestations during syphilitic infection and that coinfection with HIV-1 has little discernible effect on the cutaneous response to T. pallidum.

Eccrine syringofibroadenomatosis associated with hidrotic ectodermal dysplasia.

Eccrine syringofibroadenoma (ES) is generally regarded as a solitary benign adnexal neoplasm of the skin. Recently, the epithelial and stromal changes of this lesion have been recognized as being a reaction pattern in certain settings. We describe two individuals in whom this process was a manifestation of hidrotic ectodermal dysplasia. In both cases, the diagnosis had been missed for many years and the process had been thought to be a manifestation of an inflammatory dermatosis of the palms and soles. In both instances, other family members were found to be affected. Thus, ES may be manifested clinically as erythematous erosive plaques, especially of the palms and soles. It is important that clinicians be familiar with this disorder and be aware that it may exhibit unusual cutaneous manifestations.

Actinic keratoses. Differential diagnosis and treatment.

Actinic keratoses are extremely common premalignant keratinocytic neoplastic lesions that develop primarily in fair-complexioned individuals during midlife or beyond. Genetic, occupational and other environmental factors predispose to the development of these lesions. Without treatment, a significant number may progress to fully developed neoplasms, especially squamous cell carcinoma, over a period of 20 to 50 years. The multistep theory of carcinogenesis is helpful in understanding the pathogenesis and progression of this important and highly prevalent lesion.