Rapidly metastatic carcinoma in lupo in a patient with lupus vulgaris for more than 50 years.

According to current statistics of the WHO, tuberculosis is the infectious disease that causes the most deaths worldwide. Its most common cutaneous manifestation is lupus vulgaris which is seldom diagnosed today. A 69-year old immunocompetent woman complained of a partly elevated, partly sclerotic plaque on her left thigh which had been present for more than 55 years before slowly becoming ulcerated. After biopsy and subsequent excision of the 13 cm ulcer, the diagnosis of carcinoma in lupo with lymph node metastasis was made. Cutaneous and additional nodal metastases appeared rapidly. Tuberculostatic therapy was initiated. Despite systemic chemotherapy the tumor subsequently progressed and the patient died of metastatic carcinoma in lupo 15 months after the initial diagnosis. Early diagnosis and treatment of lupus vulgaris might have prevented the development of carcinoma in lupo and ensuing metastatic death of the patient.

[Dithranol in the treatment of scalp psoriasis]. / Die Behandlung der Psoriasis capillitii mit Dithranol.

Dithranol in its usual petrolatum base cannot be effectively applied to the scalp. The washable cream base is not often employed in Germany, both because this form of application is not well-known and because the positive effects are underestimated while the adverse effects are overestimated. Therefore we have searched the literature for appropriate studies, application recommendations and reports on side effects. We list scalp preparations containing dithranol available in neighbouring European countries together with recommendations and warning notes. Since the dithranol molecule contains hydrophilic and lipophilic parts, it can be easily incorporated into soaps. The stability of such preparations is limited; their effectiveness is supported by the usage of dithranol in an emulsifying oil base in the Charité Department of Dermatology for more than twenty years. The special vehicle used, bio-wash-oil, is an oily fluid soap which was designed for cleaning the heavily soiled hands of factory workers. It can be easily applied to the scalp and washed off with water. Here we re-examine the original study on dithranol in bio-wash-oil published by Meffert et al. in 1979, summarize our subsequent experience and present a recent comparative study paying special attention to side effects, practical notes, and patient comfort and satisfaction.