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Histiocytic medullary reticulosis (HMR) is a rare, uniformly fatal, acute disease of the reticuloendothelial system. The disease is associated with fever, purpura, jaundice, hepatosplenomegaly, lymphadenopathy, and pancytopenia. A patient with HMR is described who had multiple, brown-to-violaceous tumors and plaques in the skin. A biopsy taken from a skin lesion showed the unique histologic finding of HMR, ie, phagocytosis of erythrocytes, platelets, and nuclear debris, by large, atypical histiocytes.

TO THE EDITOR.— We have recently seen three patients with allergic contact dermatitis to vitamin E aerosol deodorant. REPORT OF CASES CASE 1.— An 18-year-old white man first used vitamin E deodorant on Dec 24, 1972. The following day he noted pruritus and erythema of the axillae extending onto the proximal medial aspects of the upper extremities and onto the thorax. His eruption had almost subsided by the 28th of December 1972, when he used the deodorant again. Within 24 hours, he noted severe pruritus and erythema. By 48 hours, he had developed vesiculobullous lesions that progressed and extended over the following week. The patient was essentially incapacitated for two weeks, and his eruption took a total of three weeks to clear. The patient denied any known contact with vitamin E prior to his acute dermatitis. CASE 2.— A 22-year-old white man was seen in the Dermatology Clinic

TO THE EDITOR.— We would like to thank Dr. Fisher for his comments regarding the patient we reported with probable systemic eczematous "contact-type" dermatitis associated with parabens. We certainly agree that this must be quite rare, and probably small doses of parenterally administered parabens given intradermally or subcutaneously will not cause a flare of eczematous dermatitis in a previously sensitized patient. However, in our patient a parenterally administered dose was given for mandibular block anesthesia. Our dental colleagues state that 2 to 8 ml of anesthetic solution for dental procedures is commonly used. Also intraoral submucosal tissues are extremely vascular, and certainly a large percentage of the administered dose finds its way directly into the circulation. Nichols and Cutright reported that aramine, aminophylline, epinephrine, and wyamine have almost an identical pharmacologic action when intraoral submucosal administration is compared with intravenous administration (Oral Surg 32:677-684, 1971).We think that only