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A CASE FOR DIAGNOSIS (NEUROTIC EXCORIATIONS WITH PIGMENTATION? URTICARIA PIGMENTOSA?). PRESENTED BY DR. E. WILLIAM ABRAMOWITZ. Miss E. B., a private patient aged 22, presents pea-sized areas of pigmentation all over the trunk. The eruption has been appearing for the past eleven years and was first accompanied by itching, but this has been absent for the past few years.When she was first seen on Jan. 17, 1941 she presented small red papular lesions with central bleeding points and crusts. These left pigmentary stains with a central depigmentation.The patient admitted picking these lesions when they first started to appear, but she has not done this in the past few years. She is of a nervous temperament and has been rubbing herself vigorously with a towel after bathing. Since she stopped this practice the new lesions are fewer and the pigmentation is less noticeable.Her menstrual periods were irregular a

PSORIASIS IN A SYPHILITIC PERSON. PRESENTED BY DR. GEORGE M. LEWIS. J. B., a man aged 43, first had an eruption on the left palm five years ago. The left sole became affected soon afterward, and the condition has not improved since then. For two years the right palm was also involved. There was no troublesome pruritus; some tenderness of the affected skin was present. Therapy from four physicians included various local medications, ultraviolet radiation and three hundred and sixty injections (presumably of trichophytin). The patient had continuous treatment for one and a half years for syphilis about ten years ago; three years ago a short series of injections of arsphenamine was administered.No nails are involved. The interdigital tissues are unaffected. The left sole and to a lesser degree the right palm show a subacute erythematous keratotic and scaly eruption. There are no vesicles.There was no obvious focus

In 1928 one of the present authors1 reported and discussed the first case of the rare and peculiar dermatosis incontinentia pigmenti. His detailed report originated in the department of dermatology of the University of Zurich, Switzerland, and the patient had previously been presented by Bloch,2 of Zurich, at the meeting of the Swiss Dermatologic Society in 1925.Subsequently, at the tenth meeting of the Swiss Dermatologic Society, Naegeli,3 of Berne, Switzerland, reported three analogous cases. In Naegeli's brief report familial occurrence, as well as the combination of the pigmentary anomaly with another familial dermatosis, was demonstrated for the first time. A father and two daughters, 12 and 9 years of age, presented the pigmentary dermatosis, while a third child suffered from a cutaneous disease which Naegeli diagnosed as hydroa vacciniforme.A fifth case of incontinentia pigmenti was reported by Almquist.4 In Almquist's case a boy of

LYMPHANGITIS AND SYCOSIS OF THE UPPER LIP. PRESENTED BY DR. HOWARD FOX. H. J. H., was first presented for this condition on April 22, 1930. Dr. Binford Throne suggested that vaccines be injected intradermally into the lesions. This was carried out, and a vaccine similar to that used by Dr. Throne was given twice a week for one month, with slight temporary benefit after the first two or three injections. From this course of treatment no permanent benefit was obtained. The patient was then given autogenous vaccines subcutaneously for one month, which did not give relief. ULCER OF THE HAND AND FOOT. PRESENTED BY DR. HOWARD FOX. H. J. H. had previously been presented on Oct. 28, 1930, as having a case for diagnosis. Histologic examination of lesions on the hands and feet showed prickle cell epithelioma. A CASE FOR DIAGNOSIS (LYMPHOGRANULOMA?). PRESENTED BY DR. EUGENE F. TRAUB. In I.

Many theories as to the cause of psoriasis have been proposed, but none has found general acceptance. Its etiology at present is so obscure that it would seem desirable to continue investigating the condition from every aspect, with the hope that a promising lead may develop in one or another of the methods of approach. Apparently little or no attention has hitherto been given to the character of the intestinal flora in this disease. It would seem possible that it might harbor some organism or organisms that produce a toxin acting on the skin, or there might be a sensitization to or allergy toward the protein of certain intestinal organisms. That such sensitiveness may occur is suggested by the recent observations of Famulener and Davis in regard to skin reactions following intradermal injections of vaccines prepared from intestinal bacteria. They found that organisms belonging to the B. coli group gave

ERYTHEMA MULTIFORME. PRESENTED BY DR. J. FRANK FRASER. In a man, aged 53, changes in the skin first appeared in February, 1929, as ring-shaped erythematous lesions situated on the abdomen and on the back. The case was presented as an example of erythema multiforme figuratum perstans. There was no history of the ingestion of drugs. DISCUSSION Dr. Walter J. Highman: I agree with the diagnosis. I have no idea why the eruption is present. I have seen cases of this sort in patients with false teeth and no tonsils.Dr. Fred Wise: Have you tried injections of whole blood?Dr. Walter J. Highman: It might help to give calcium intravenously.Dr. George M. MacKee: I should first try a more simple treatment. Eruptions due to drugs have been ruled out, I understand, so that the condition is probably one of erythema multiforme due to toxemia of some sort. It may

DERMATITIS VENENATA. PRESENTED BY DR. WISE. J. F., a photographer, aged 27, from the Post-Graduate Skin Clinic, with no allergic history, began working with chemicals ten years before presentation. Two years before presentation an eruption started on the forehead and later spread to all parts of the body. In 1928, when the patient went to the mountains the eruption disappeared, but reappeared when he returned to work. In April, 1929, he went to Florida and the eruption cleared up in a few days; it reappeared two weeks after he returned to work. In July, 1929, he went away again and the eruptions on his face cleared up, but this time there was no improvement on the body.The patient presented a generalized eruption, the appearance resembling mycosis fungoides; his chief complaints were extremely severe itching and insomnia. Biopsy and tests at the Vanderbilt Clinic were not decisive according to the

In view of recently reported cases of mycosis fungoides showing the histologic picture of lymphosarcoma, it seems opportune to record two additional instances, particularly since one of them has to do with the relationship between mycosis fungoides and lymphatic leukemia. CASE 1.— H. L., a man, aged 42, married, a cabinet maker, was in good health until April, 1920. At that time a scaling, itchy eruption appeared on the palms, that eventually spread to the trunk and extremities. About two years later, raised, circular swellings occurred on the forehead, scalp and thighs. On July 14, 1922, the patient was admitted to the Dermatologic Clinic of the University and Bellevue Hospital Medical College. He said that he had previously visited several other institutions, and had received roentgen-ray treatment, without beneficial results.The cutaneous picture, on the day of his admission, was that of a generalized eruption which consisted of areas of

Mycosis fungoides is a term which was applied by Alibert1 to a clinical syndrome which included a group of lesions having their origin in the papillary layer of the skin. Two types of the disease were described. The first began as a diffuse dermatosis which might simulate eczema, urticaria, lichen planus or even pemphigus and ended by the formation of fungoid tumors. The second, the so-called d'emblée type, was characterized by tumor development without any previous cutaneous manifestations. The dermatoses preceding tumor development are known as prefungoid or premycotic lesions (premycosis). Histologically, these premycotic dermatoses may show evidence of the same essential changes as those found in the tumor lesions, namely, cells or groups of cells showing neoplastic features (Fig. 1). When these features are present they are characteristic, but when they are absent, as they frequently are, it is precarious to make a diagnosis based on the histologic

In dermatologic practice the opportunities for postmortem investigation are infrequent and clinical observations are limited largely to a consideration of the appearances presented by lesions occurring in a single organ, the skin.In a field thus restricted, it is not surprising to find a natural tendency among those of us who confine our activities to the dermatologic branch of medical art to overlook the importance of studying disease from the point of view of its effects on the body as a whole, and to content ourselves with the mental picture of a pathologic process obtained from the visualization of its external manifestations in one organ only, while we neglect to take into consideration the equally important pathologic changes that may be taking place in those organs or tissues which are beyond the realm of external inspection.The case that forms the basis for this presentation serves to illustrate the importance

NEUROGENIC SARCOMA OF THE SKIN. PRESENTED BY DR. J. FRANK FRASER. V. M., a man aged 40, of Italian parentage, presented himself at the Skin and Cancer Unit with a walnut-sized nodule on the right cheek near the margin of the upper lip. The lesion first appeared four years ago, at which time it was removed surgically and the site was treated with roentgen rays (the dose is unknown). The growth promptly recurred and was again removed, but it reappeared at the margin of the original site a year after the second operation.The results of laboratory tests were negative. Microscopic examination showed the histologic picture of fibrosarcoma of neurogenic origin. DISCUSSION Dr. Edward R. Maloney: In view of the pathologic report presented by the chairman, I think the diagnosis made must be accepted.Dr. George M. MacKee: Clinically the growth might be an epithelioma. Histologically, of course, it is

In this paper we propose to present a case, with necropsy observations, of reticulo-endothelial disease showing features of mycosis fungoides, Hodgkin's disease and reticular cell lymphosarcoma, the first signs being lesions of the skin with rapid coalescence and extension and involvement of the entire lymphatic system.REPORT OF A CASEHistory.—S. O., a 36 year old woman, was admitted to the New York Hospital on Dec. 24, 1932, because of a distressing indurated erythematous cutaneous lesion extending over the lower part of the abdomen and in the axillae. Until the onset of this condition early in October 1932, the patient had always enjoyed good health. The first cutaneous lesion appeared as a streaky or linear swelling of the skin in the left groin. This was accompanied by some pain and followed in about two weeks by redness over the same area. Three or four weeks later the

ErythemaPapulatumCircinatum (Darier). Presented by Dr. F. C. Combes.C. C., a girl, aged 3 years, born in the United States, had an eruption of approximately six months' duration on both lower extremities. The family and personal histories were of no significance.On both thighs and legs were several plaques of erythema with irregular festooned borders varying in diameter up to 10 cm. The plaques were brownish red, and the borders raised, rounded and cordlike. The outer margins of the borders were of brighter color, and the lesions were sharply defined. There were a few smaller lesions, particularly about the ankles, which were distinct, flattened nodules. The mother of the patient volunteered the information that all the lesions began as small papules. There were no scaling and no subjective symptoms. The lesions had gradually enlarged, and new lesions had appeared from time to time.DISCUSSIONDr. Binford Throne: I

The term dyskeratosis, as defined by Darier,1 "represents a faulty development of the epidermis in the course of which a certain number of malpighian cells become isolated and differentiated from their fellows, undergoing an abnormal, premature and imperfect keratinization. These dyskeratotic cells are present in the layers of the epidermis, as far as in the horny layer, in the form of 'round bodies' (corps ronds), granules (grains), globes or corpuscles, with or without nuclei, easily distinguished from the still normal cells as well as from the parakeratotic cells."In 1914, Darier1 designated a group of dermatoses under the general heading of "the dyskeratoses." The classification was based on the assumption that the primary and characteristic histologic feature of the lesion in these diseases was dyskeratosis. The diseases classified as belonging to the group are:Bowen's precancerous dermatosis.Paget's disease of the nipple.Dyskeratosis follicularis (Darier's disease).Dyskeratosis follicularis (Darier's disease).Molluscum contagiosum.

Urticaria pigmentosa is a rare disease; probably less than 350 cases have been reported in the literature. The first case was described by Nettleship1 in 1869. Since that date, Little,2 in 1905, has collected reports of 154 cases and Finnerud,3 reports of 141 cases occurring between the years 1905 and 1923. CLINICAL FEATURES The disease usually begins in infancy and frequently disappears at puberty, but it may continue into adult life. Little states that 14 per cent of the cases do not develop until after the patients have reached the age of puberty, while Finnerud's figures show 33.9 per cent of cases of this type. In a few instances, cases have been observed following vaccination and varicella; others have followed a fright (Little). In the majority of cases, especially those developing in infancy, the earliest visible lesions are urticarial. These are soon followed by either macules, nodules

On May 14, 1940 Dr. Charles N. Sullivan, of New Britain, Conn., forwarded to me for histologic diagnosis a lymph node removed from the left subclavicular region of a patient having generalized exfoliative dermatitis, peripheral lymphadenopathy and a blood picture suggestive of lymphatic leukemia. Microscopic study of sections showed no evidence of leukemia or other specific disease. The histologic diagnosis was chronic lymphadenitis. In this paper I propose to present this case as an example of generalized exfoliative dermatitis of unknown origin which was erroneously diagnosed as lymphatic leukemia because of the presence of a leukemic blood picture and clinical features (enlargement of the liver and spleen and generalized adenopathy) suggestive of that disease.REPORT OF A CASEHistory.—A 39 year old man, born in the United States of Irish parentage, was admitted to the New York Post-Graduate Medical School and Hospital on June 15, 1940. There was