The Rintala flap revisited.

We describe nasal tip reconstruction using a superiorly based midline Rintala flap. Good tissue coverage and excellent flap viability, color match, and nasal contour make this flap a good alternative for reconstructing large nasal tip defects without using forehead flaps. Up to half the superior columella can be reconstructed simultaneously by using this single-stage technique with the patient under local anesthesia. Adjunctive procedures such as tip rhinoplasty and bilateral cheek flap advancement can add to the utility of this flap and are discussed along with general techniques and case examples.

Pseudotumor resulting from atypical mycobacterial infection: a "histoid" variety of Mycobacterium avium-intracellulare complex infection.

A 54-year-old immunosuppressed cardiac transplant recipient with a six-month history of progressive swelling of the hand, with nodules and linear lymph node chain enlargement, diagnosed as a sporotrichoid Mycobacterium avium-intracellulare pseudotumor is described. The microscopic features closely resembled the previously described histoid variety of lepromatous leprosy. Routine hematoxylin and eosin staining suggested a spindle cell neoplasm rather than an infectious or inflammatory process. An infectious etiology was pursued on the basis of the clinical setting.

T cell subpopulations in alopecia areata.

Alopecia areata remains a disease of unknown cause and unsatisfactory treatment. Histologically it is characterized by a lymphocytic infiltrate that surrounds the lower half of the hair follicle. Our findings show that 64% to 92% of this infiltrate is composed of T lymphocytes bearing the Leu 3a (helper-inducer) phenotype. The remaining lymphocytes demonstrate the Leu 2a (cytotoxic-suppressor) phenotype. This helper T cell predominance is present in all patients, irrespective of clinical activity or duration of disease. The Leu 3a/Leu 2a ratio ranged from 2.6 to 19.8, the higher ratios being seen in patients with clinically active disease. The cutaneous infiltrate also is Ia-positive, indicating the activated nature of these lymphocytes.

The occurrence of vitiligo after psoralens and ultraviolet a therapy.

The ability of photochemotherapy with 8-methoxypsoralen in conjunction with high-intensity long-wave ultraviolet light (PUVA) to stimulate melanogenesis is well known. This effect on the pigmentary system is evidenced by the diffuse tanning of clinically normal skin in PUVA-treated patients with psoriasis and other disorders, as well as by the repigmentation of lesions in vitiligo. It is now recognized that there may be additional pigmentary effects, resulting in clinical lesions such as PUVA mottling, PUVA lentigines, and localized hypopigmentation. We have documented the occurrence of yet another association with PUVA therapy--the paradoxical appearance of widespread hypopigmentation consistent with vitiligo in three PUVA-treated patients, one with psoriasis and two with mycosis fungoides. Histologic and ultrastructural findings are presented.

Vitiligo or halo nevi occurring in two patients with choroidal melanoma.

Vitiligo frequently develops in patients with cutaneous melanomas, especially those who have survived with metastases for prolonged periods. To our knowledge, only one patient with an ocular melanoma in whom vitiligo developed has been described. We have observed a second patient in whom vitiligo developed six to eight years after he had undergone an enucleation for ocular melanoma. Multiple hao nevi developed in a third patient who had an ocular melanoma. The association of vitiligo and ocular melanomas in these patients may not be the result of chance alone.