Sclerosing B-cell lymphoma involving the skin.

We report a case of sclerosing B-cell lymphoma involving the skin. The patient is a 43-year-old man who came to our institution with a 4-year history of multinodular masses in the back. A thoracic CT scan demonstrated subcutaneous masses with extension to the posterior parietal pleura and compression of several epidural spaces. An incisional biopsy was performed and demonstrated an infiltrative process in the lower dermis composed of interconnected thick sclerosing bands forming compartments around groups of large neoplastic cells. These neoplastic cells were shown to be B lymphocytes using immunohistochemical stains. A diagnosis of diffuse sclerosing B-cell lymphoma, large cell type, was made. Our case is reported to alert dermatologists and dermatopathologists to the occurrence of this neoplasm in the skin which could be confused with a deep inflammatory process or other neoplastic conditions.

Parmesan cheese and vegetable-induced histaminuria in a thermal flusher.

Flushing disorders are associated with sweating (wet flushes) or without sweating (dry flushes). When associated with systemic symptoms and histaminuria, flushing reactions may easily be confused with mastocytosis or pheochromocytoma. We report a case of a woman with significant transient histaminuria that could be dissociated from episodes of thermal wet flushing. Treatment with clonidine led to a decrease in both frequency and intensity of the flushing reactions.

Uterine adenocarcinoma metastatic to the skin responsive to megestrol acetate.

BACKGROUND: Although endometrial carcinoma is the most common gynecological cancer, it only rarely metastasizes to the skin, with a reported prevalence of 0.8%. We report a case of an elderly lady who recently developed cutaneous metastases from an endometrial primary diagnosed 7 years earlier. OBJECTIVE: Our purpose was to determine if the oral administration of megestrol acetate would be effective in the treatment of uterine adenocarcinoma metastatic to the skin. METHODS: The index case was given oral megestrol acetate over a period of 9 months. Pre- and posttreatment skin biopsies were performed and analyzed. RESULTS: During treatment with megestrol acetate, the cutaneous metastases in the abdominal skin decreased in area to less than 10% of the pretreatment surface area correlating with a marked histopathologic decrease in adenocarcinomatous glandular structures. CONCLUSION: Megestrol acetate can be successfully utilized in the treatment of endometrial adenocarcinoma metastatic to the skin as well as ostensibly in the treatment of other progesterone-sensitive metastatic cutaneous carcinomas.

Treatment of rosacea: topical clindamycin versus oral tetracycline.

BACKGROUND: A new topical antibiotic preparation, clindamycin in a lotion base, was compared with oral tetracycline in the treatment of rosacea. Forty-three patients clinically diagnosed as having rosacea were examined in an investigator-blinded study. METHODS: Patients used topical clindamycin lotion applied twice daily or the usual oral dose of tetracycline hydrochloride (250 mg four times a day for 3 weeks, then 250 mg twice a day for the remaining 9 weeks). Patients' lesions were examined clinically at 3-week intervals over a period of 12 weeks. RESULTS: Topical clindamycin treatment produced similar clinical results to oral tetracycline and was superior in the eradication of pustules. CONCLUSIONS: These results show topical clindamycin in a lotion base to be a safe and effective alternative to oral tetracycline therapy in the treatment of rosacea.

Flushing and rosacea: overview and nursing interventions.

Rosacea is a dynamic facial dermatosis characterized by exacerbations and remissions which affects middle-aged men and women, most of whom flush easily. It is a conspicuous, yet treatable condition. Oral and topical antibiotics, as well as changes in lifestyle and elimination of aggravating factors, are necessary for control. Nurses facilitate compliance with the treatment regimen and optimize patient self-esteem.

Poiseuille, periodicity, and perfusion: rhythmic oscillatory vasomotion in the skin.

Cutaneous vasomotion has not been actively investigated until recently. This is hardly surprising, as it has not been a reproducible phenomenon. During recent studies on various physiological and pharmacological vascular problems, we identified experimental conditions in which cutaneous vasomotion commonly occurred. We then characterized four methods that routinely provoke human cutaneous vasomotion in vivo, in order to further characterize this physiological phenomenon. Although several adaptive advantages may exist for vasomotion, the most compelling theory can be derived mathematically from Poiseuille's law. Because the flow of a liquid through a vessel is proportional to the fourth power of the radius, it can be demonstrated that the resistance of a vessel with a constant diameter is greater than that of a vessel of the same average diameter in which the diameter changes sinusoidally. Importantly, the rhythmicity originates within the vascular tissue, and there appears to be electromechanical coupling. The cation effluxes demonstrate oscillatory behavior that may be driven by the availability of adenosine triphosphate. Substrate and product concentrations can alter the activity of the allosteric enzyme, phosphofructokinase, which may control the oscillations in ATP concentration. Despite the qualitatively different provocative agents, the cutaneous rhythmic oscillatory vasomotion always first appears after a peak in erythrocyte flux, and it disappears before reaching resting flux levels. Thus, cutaneous rhythmic oscillatory vasomotion is a midrange phenomenon, most likely corresponding to the "oscillatory domain" of glycolysis. Finally, a common feature of tissue preparations for the study of vasomotion is that anesthesia was not used. We have shown that this inhibitory effect of anesthetic agents may persist well beyond "anesthesia," and this suppression may be of clinical importance in the patient with microcirculatory compromise undergoing surgery.

Red lunulae revisited: a clinical and histopathologic examination.

Red lunulae are associated with rheumatoid arthritis, systemic lupus erythematosus, alopecia areata, cardiac failure, hepatic cirrhosis, lymphogranuloma venereum, psoriasis, carbon monoxide poisoning, twenty-nail dystrophy, and reticulosarcoma. We examined four patients with red lunulae. Three had chronic obstructive pulmonary disease. Two of these three were alcohol abusers and were without any of the conditions previously associated with red lunulae. Two of the four also had palmar erythema. Histopathologic examination of the red lunula in one of the four cases did not show signs of neovascularization. We report our findings in these patients, which suggest that red lunulae result from increased arteriolar blood flow, a vasodilatory capacitance phenomenon, or changes in the optical properties of the overlying nail so that normal blood vessels become more apparent.

Effect of nadolol on flushing reactions in rosacea.

The effect of nadolol versus placebo on both flushing provoked in a laboratory setting and spontaneous flushing was studied in 15 patients with erythematous telangiectatic rosacea. The intensity of the flushing reactions was assessed in the laboratory by the cutaneous perfusion index method with laser-Doppler velocimetry. No effect of nadolol on the flushing reactions provoked in the laboratory was detected.

4-Methylpyrazole and the cutaneous vascular sensitivity to alcohol in Orientals.

Twelve healthy subjects of Oriental ancestry were challenged with topical applications of lower aliphatic alcohols and aldehydes after topical pretreatment consisting of 4-methylpyrazole in hydrophilic ointment on the volar aspect of one forearm and hydrophilic ointment alone on the contralateral volar forearm. Cutaneous blood flow was monitored by laser Doppler velocimetry. Pretreatment with 4-methylpyrazole, a specific inhibitor of alcohol dehydrogenase, led to a significant decrease in the cutaneous vascular response to the alcohols as a group, but did not lead to changes in the cutaneous vascular response to the aldehydes as a group. Among the individual alcohols, pretreatment with 4-methylpyrazole reduced the response significantly to all concentrations of 1-propanol and 1-butanol. The means of the vascular response to the different concentrations of ethanol decreased, but not significantly. Additionally, 4-methylpyrazole did not have an independent effect on cutaneous blood flow. These results are consistent with the view that the cutaneous vascular reaction to primary alcohols applied topically to the skin of Orientals is provoked, in large part, by the corresponding aldehyde.

Why is flushing limited to a mostly facial cutaneous distribution?

Despite the systemic nature of many agents that provoke flushing reactions, the erythema is most prominent in the "blush area." To elucidate the physiologic basis for such a limited distribution, two types of flushing challenges were studied in normal volunteers. Nicotinic acid provokes flushing through a direct action of vasodilator prostaglandins on vascular smooth muscle. The flushing reaction provoked by oral thermal challenge is mediated via neural mechanisms. Both agents led to increases in cutaneous blood flow at both malar and forearm sites. Both absolute and proportional increases were consistent with the view that the greater vascular capacitance in the visible, superficial cutaneous vasculature in the blush area accounts for the limited distribution of flushing in response to a systemic stimulus.

Periodic cutaneous blood flow during aldehyde-provoked hyperemia.

Forearm cutaneous blood flow was monitored continuously by laser Doppler velocimetry in 12 normal human subjects before and after a 5-min topical challenge with 5 M propionaldehyde. The aldehyde challenge routinely provoked an increase in cutaneous blood flow. During the recovery phase from peak stimulated blood flow to a lower, stable, resting level of flow, the cutaneous blood flow exhibited rhythmic oscillatory activity. Three stages of oscillatory vasomotion were defined to characterize changes: the first 5 min after onset (I), the 5-min span bracketing the temporal midpoint (II), and the final 5 min (III). The average period, wave height, and erythrocyte flux decreased during these three stages of oscillatory vasomotion. These changes and the temporal characteristics of onset and disappearance of oscillatory vasomotion suggest an origin of the oscillations in the slow wave activity of vascular smooth muscle.