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The aim of the above authors is primarily to encourage the reader to think about physical signs as the basic approach to make a dermatologie diagnosis. This has been the traditional teaching approach for students, residents, and fellows throughout their dermatologie training in an associated dermatologie training program. There are 20 chapters that address the basic morphologic appearance of lesions and describe the shapes of lesions and geographic patterns of skin diseases as well as the colors of lesions and the skin, especially hyperpigmentation and hypopigmentation. The regional distribution of skin diseases are demonstrated by clinical photographs presented in color; there are no graphic anatomic figures to demonstrate the regional distribution of the more common dermatoses. The diagnostic significance of scales and crusts, plaques, papules and nodules, eruptions that are macular and papular or macular, ulcers, blisters and vesicles, pustules, excoriations, itch and the associated eczematization, wheals, and erythema are presented. Disorders of the vascular system, hair, and nails

To the Editor.— Immune surveillance is the mechanism by which the immune system is thought to monitor tissues for evidence of malignant transformation.1Twenty years have passed since it was first confirmed that prolonged iatrogenic immunosuppression, as in renal transplant recipients, results in an increased incidence of skin cancer.2We report the first case of common variable immunodeficiency (a primary immunodeficiency) associated with multiple squamous cell cancers of the skin. Report of a Case.— A 48-year-old white woman first presented to the Lahey Clinic, Burlington, Mass, in 1971 with a history of deafness from recurrent ear and mastoid infections, recalcitrant pneumonias, and diarrhea. In 1977, serum protein electrophoresis revealed agammaglobulinemia. In 1980, after suffering from recurrent respiratory infections and a bowel infection withGiardia lamblia, monthly injections of gammaglobulin were begun. At that time, the leukocyte count and cell differential were normal. The absolute number of

An attempt was made to evaluate the therapeutic effectiveness and toxicity of hydroxyurea administered in intermittent courses over a period of 18 months for the treatment of 60 patients with severe or incapacitating psoriasis. Hydroxyurea produced satisfactory results (good to excellent) in 63% of the patients in the first six weeks of therapy and remained similarly effective in 50% of the patients given intermittent therapy over the 18-month study period. The eruption relapses almost always upon the discontinuance of the drug with the development of resistance to further therapy in 13% of patients. Fifteen percent of the patients experienced severe enough drug toxicity to necessitate its discontinuance. Hydroxyurea should be reserved for patients who have extensive psoriasis and need clinical response because of special circumstances.

The physiology of the histiocyte (macrophage) in health and disease is reviewed briefly. An overview of the so-called primary malignant, pseudomalignant, and benign histiocytic disorders, excluding histiocytosis X, is presented. The malignant histiocytosis with erythrophagocytosis, the pseudomalignant histiocytic diseases (such as sinus histiocytosis with massive lymphadenopathy and regressing atypical histiocytosis), and the solitary lesions with histologic malignant and atypical storiform histiocytosis are described. Two groups of adult histiocytic diseases are reviewed; one is characterized by nonfamilial and familial histiocytic dermatoarthritis and the other by multiple widespread benign lesions, such as xanthoma disseminatum, generalized eruptive histiocytoma, nodular non-X histiocytosis, and various xanthomatous eruptions associated with paraproteinemia. Finally, multiple benign cutaneous histiocytic lesions of childhood, such as juvenile xanthogranuloma and congenital self-healing histiocytosis, are included.

For over a century, sarcoidosis has been recognized and written about. Izumi, as guest editor and contributor to this issue of Dermatology Clinics entitled "Sarcoidosis," has attempted to give us an overall update of this disease through contributions from authorities in specific areas of this disease or related conditions. The subjects reviewed are as follows: sarcoidosis: past, present, and future concepts; experimental granulomatosis; granuloma formation and fibrosis in sarcoidosis; cutaneous sarcoidosis: definitions and types of lesions; relationship of cutaneous sarcoidosis to systemic disease; immunologic studies on cutaneous lesions in sarcoidosis; the diagnosis and differential diagnosis of cutaneous sarcoidosis; cutaneous sarcoidosis: prognosis and treatment; erythema nodosum; pulmonary sarcoidosis: radiographic features; pathology of pulmonary sarcoidosis; activity of pulmonary sarcoidosis; pulmonary sarcoidosis: steroid treatment; ocular sarcoidosis; sarcoidosis of the head and neck; cardiac sarcoidosis; sarcoidosis in various organs; the Kveim-Siltzbach test; and diagnosis of sarcoidosis. Boros gives an excellent review of experimental granulomatosis

• The physiology of the histiocyte (macrophage) in health and disease is reviewed briefly. An overview of the so-called primary malignant, pseudomalignant, and benign histiocytic disorders, excluding histiocytosis X, is presented. The malignant histiocytosis with erythrophagocytosis, the pseudomalignant histiocytic diseases (such as sinus histiocytosis with massive lymphadenopathy and regressing atypical histiocytosis), and the solitary lesions with histologic malignant and atypical storiform histiocytosis are described. Two groups of adult histiocytic diseases are reviewed; one is characterized by nonfamilial and familial histiocytic dermatoarthritis and the other by multiple widespread benign lesions, such as xanthoma disseminatum, generalized eruptive histiocytoma, nodular non-X histiocytosis, and various xanthomatous eruptions associated with paraproteinemia. Finally, multiple benign cutaneous histiocytic lesions of childhood, such as juvenile xanthogranuloma and congenital self-healing histiocytosis, are included. (Arch Dermatol1985;121:1531-1541)

There is a need for a concise, practical, informative, and fiscally reasonable dermatologic textbook for the medical neophyte, particularly the medical student. Drs Lookingbill and Marks have combined these qualities in their textbook Principles of Dermatology . The authors emphasize and, whenever possible, utilize the sign-oriented teaching approach, and they organize the diseases into those of neoplastic and inflammatory reactions. They also emphasize the importance of the recognition of primary and secondary lesions for the diagnosis of skin diseases and the appreciation of pathophysiology of the common skin disorders to understand pathogenesis, therapy, and use of diagnostic laboratory tests. The use of quick reference tables at the beginning of each chapter and the handy marginal highlights are very effective not only for quick succinct and important information but also to reinforce essential features of the described disease. Ending each chapter is a case presentation in question-and-answer form to test your acquired

REPORT OF A CASE A 36-year-old woman presented with a four-week history of gingival enlargement. She had no history of periodontal procedures or local radiation and was taking no medications. She had a 15-pack-per-year history of cigarette smoking. Aside from a vague low-grade fever and night sweats for one to two months, she felt well. As an outpatient, she had been treated with very brief courses of oral penicillin and tetracycline without improvement. A gingival biopsy specimen was said to show nonspecific changes. Shortly before her first hospitalization, an "abscess" on the back had been drained and treated with dicloxacillin. Additional "boils" were noted about this time. She was admitted to the hospital for evaluation. Physical examination revealed marked gingival hyperplasia, forming spongy bluish-red masses. The process was somewhat more extensive in the mandibular gingivae than in the maxillary gingivae and was especially prominent at the interdental papillae (Fig 1).

A case of sensory radicular neuropathy of the hereditary type is reported. This disease was described as "hereditary perforating ulcer of the foot" by Hicks in 1922, as "acropathie ulcero-mutilante familiale" by Thevenard in 1942, and as "hereditary sensory radicular neuropathy" by Denny-Brown in 1951. The patient has the striking and characteristic indolent, ulcerative, mutilatory acropathy of the feet with the underlying dissociated sensory neuropathy. A chart of the differential diagnosis of ulcerative mutilatory acropathy is presented.

A severe case of perifolliculitis capitis abscedens et suffodiens, refractory to the usual therapy, is reported. Because the disease is chronic, and the excellent results obtained in the excision and graft of axillae with severe hidradenitis suppurativa, the patient was scalped therapeutically with excellent results.

A second case of Sweet's syndrome occurred in a male; it is the 20th to appear in the literature. Tender, red plaques in centrifugal distribution appeared in association with fever, leukocytosis, and an elevated erythrocyte sedimentation rate. The process represents an inflammatory vascular reaction pattern of unknown etiology with pathologic changes occurring mainly in the upper and mid dermis. Erythema elevatum diutinum is to be considered in the differential diagnosis. Lesions respond to corticosteriod therapy.

The primary diffuse (the pure and primitive) lepromatous leprosy is a subtype of lepromatous leprosy. Necrotic skin lesions appear rarely in lepra reactions. They are characteristic of the Lucio phenomenon which occurs in patients with diffuse lepromatous leprosy but may be seen in patients who have a severe attack of erythema nodosum leprosum or its variants, erythema multiforme leprosum and an eruption which resembles the allergic vasculitis of Ruiter. Six cases of lepra reaction with necrotizing skin lesions are reported and their clinical features are emphasized.