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We describe the first case of unilateral spiny hyperkeratosis (SH) of the left hand, review the literature and discuss possible patho- mechanisms. SH can be sporadic or familial, often appearing in healthy individuals. However, there is an association with various malignancies in a significant number of the sporadic cases. Although there is no satisfactory explanation of this association, we agree with previous authors that a patient with SH appearing in adult life should be evaluated and followed for the presence of malignancy. Other patients with SH may suffer from a variety of nonmalignant diseases, which may be coincidental or causally related. SH is not a premalignant lesion of the skin and should not be confused with porokeratosis which has a malignant potential. Except for excision of individual lesions, there is no permanent cure., ((c) 2008 S. Karger AG, Basel.)

A 13-year-old boy with typical peeling skin syndrome (PSS) is described. The clinical picture corresponded to the inflammatory variant of PSS (type B). In addition, the patient had gross and microscopic hair anomalies such as trichorrhexis invaginata-like changes, irregular hair shaft torsions and moniliform hair shaft diameter reductions. The observed dysmorphic hair changes are discussed and interpreted as being an integral component of the dermatosis in this case. To the best of our knowledge, such hair anomalies have not yet been described in PSS.

Background: Classic Kaposi's sarcoma, a rare form of cancer, has no definitive cure. A beneficial effect of low-dose interferon (IFN) alfa was indicated by some case reports. In the present report, we summarize the results of our experience with subcutaneous low-dose IFN alfa treatment of 11 patients with extensive classic Kaposi's sarcoma and review the literature., Design: Eleven patients, 56-96 years old, were treated: 10 men, 1 woman, 3 of whom had an associated malignancy. Subcutaneous injections of IFN alfa were given, starting with 3 million units 5 times a week, and modified according to side effects and response after 2 weeks (2-6 million units, 3-6 times a week). This treatment was continued for 6 months, except for 1 patient who died after 4 months and another who stopped treatment at 4 months due to surgery but was treated again after recurrence. Treatment was continued after 6 months when a partial response was noted, but further improvement was desired (1 patient)., Results: In 9 out of the 11 patients, initial response was noted after 3-13 weeks of treatment. This was manifested by a reduction of lesion size and fading of color, leading to a partial resolution. Maximum response was achieved after 4-6 months. Remission lasted 4-72 months. Recurrences were retreated, with additional remissions after only 5-8 weeks of treatment. Side effects included fever and fatigue, which were overcome by dose reduction., Conclusion: Whereas in AIDS-related Kaposi's sarcoma patients become refractory to IFN, this was not observed in our patients with classic Kaposi's sarcoma. Moreover, unlike AIDS-related Kaposi's sarcoma, continuous treatment was not needed in classic Kaposi's sarcoma, and recurrences were responsive to retreatment.

Background: Twelve cases of contact dermatitis provoked by Agave americana are described, 10 with systemic signs and symptoms and 8 with abnormal laboratory results., Results: Patient history revealed a background of intentional exposure among soldiers seeking sick leave. Treatment with oral antihistamines and topical saline compresses resulted in subsidence of the systemic symptoms within 24 h of hospitalization and regression of cutaneous manifestations in 7-10 days., Conclusion: The importance that dermatologists be alert to the possibility of self-inflicted contact dermatitis induced by exposure to plants is stressed, especially to A. americana. Systemic signs are not rare accompanying findings with this plant.

A case of subacute cutaneous lupus erythematosus (SCLE) associated with lung carcinoma is presented. A review of the literature revealed only 5 other cases of SCLE associated with internal malignancy. The tumor in the described case most probably developed before the appearance of the eruption. Cancer chemotherapy was followed by shrinkage of tumor mass and regression of the skin lesions. The sequence of these events corresponds to the definition of paraneoplastic dermatoses.

Many drugs have been shown to induce pemphigus, including thiol and nonthiol drugs. We present a case of pemphigus vulgaris where a nonsteroidal anti-inflammatory medication, diclofenac in suppositories and topical gel preparations, is suspected of having triggered the disease. The temporal relationship between drug and outbreak of disease together with the positive migration inhibition factor test to diclofenac point to the possible involvement of this drug in triggering pemphigus vulgaris.

The effect of five selected minerals abundant in the Dead-sea brine was studied on proliferation of fibroblasts grown from psoriatic and healthy skin biopsy specimens in cell culture. The reason for carrying out this study was looking for the mechanism of the antiproliferative effect of selective Dead-sea minerals in improving the psoriatic condition. Psoriatic skin shave biopsy specimens (both from involved and uninvolved areas of the body) as well as healthy skin (obtained from amputated limbs) were incubated in tissue culture, and their outgrowing fibroblasts were used for this study. The number of cells and their cyclic AMP content were used as parameters for cell division and for proving the selective involvement of magnesium salts in the antiproliferative effect. It is shown that the inhibitory effects of magnesium bromide and magnesium chloride on cell growth were significantly stronger than those of their corresponding potassium salts or of sodium chloride. These results were obtained with both psoriatic and healthy skin fibroblasts, indicating that the inhibitory effect of the selected Dead-sea minerals is present in healthy and psoriatic skin cells.

Background: Pyoderma gangrenosum is an uncommon skin disease usually treated with systemic drugs, most frequently corticosteroids. Isolated topical treatment is usually considered unsatisfactory., Objective: To evaluate the effect of topical 1% sodium cromoglycate solution on pyoderma gangrenosum in 5 patients 25-30 years of age., Methods: 5 patients, including 2 under systemic steroid treatment, hospitalized in our department from 1992 to 1993 because of pyoderma gangrenosum, were treated with topical 1% sodium cromoglycate solution. Systemic corticosteroids were further added in 2 patients whose initial improvement was inadequate., Results: Initial improvement was noted in all 5 patients after 3-7 days of sodium cromoglycate treatment. Complete healing of the ulcers occurred within 5-8 weeks., Conclusions: Topical treatment with sodium cromoglycate can be effective as adjunctive or sole treatment in pyoderma gangrenosum.

An experimental investigation has lately shown that certain allyl compounds of garlic are able to provoke acantholysis in normal human skin cultured in vitro. The acantholytic effect has been more prominent in the samples from DR4+ donor. We here report a case of superficial pemphigus which appeared spontaneously in a DR4,14+, 49-year-old man and which ran a course that proved to be affected by dietary factors, in particular by the consumption of garlic. In the absence of a conventional treatment and on a garlic-free diet only, the disease ceased for several months. Soon after an unintentional dietary test with a strongly and presumable garlic-spiced fish meal, the pemphigus recurred. Nutritional factors should be added to the ever-growing list of exogenous factors capable of inducing or perpetuating pemphigus in genetically predisposed individuals.

Background: Today it is generally accepted that every drug that possesses an active thiol group in its molecule is capable of inducing pemphigus in vivo and provoking acantholysis in vitro. We therefore suggested that plants, in particular those belonging to the Allium group, that contain several active compounds with stable disulfide and thiol groups in their molecule may cause the same., Objective: To verify this hypothesis by investigating the in vitro acantholytic effect of three compounds of garlic., Methods: Skin samples from donors were cultured in the presence of three compounds of garlic (i.e. allylmercaptan, allylmethylsulfide and allylsulfide) for 3 days. The skin samples were then processed for microscopic control for acantholysis., Results: Results indicate that, indeed, the three garlic compounds tested are capable of inducing acantholysis in vitro. Focal and diffuse acantholysis was observed in the specimens from 4 out of 7 donors cultured in the presence of 6 and 9 mM of each of the allyl compounds for 3 days. Interestingly, tissues from a DR4+ donor proved to be more acantholysis prone than others, showing large blistering due to diffuse acantholysis, thus indicating that individual susceptibility plays a crucial role also in vitro., Conclusion: Garlic compounds with stable disulfide and thiol groups in their molecule are capable of inducing acantholysis in vitro. These findings lend further support to the theory that 'harmless' nutritional factors are capable of inducing acantholysis in vitro and possibly also in vivo. In view of these findings, it is suggested that nutritional factors should be added to the ever-growing list of exogenous factors capable of inducing pemphigus.

Traditionally, drugs that are capable of inducing pemphigus are divided into two main groups according to their chemical structure, in particular, the existence of a sulfhydryl group in their molecule. Thus, two groups are formed: (1) drugs containing a sulfhydryl radical (thiol drugs or SH drugs) and (2) nonthiol or other drugs. Much emphasis has been put on the role of the sulfhydryl group in the pathogenesis of drug-induced pemphigus. The effects of this group have been extensively studied, and a logical paradigm on the mode of its action has been created. However, no attempt has been made to search for other biochemical radicals which might have an influence on the activation/triggering of this disease. The aim of the present report is to draw attention to a chemical group common to the molecule of several drugs that have been associated with the induction of pemphigus. Careful analysis of the chemical structure of nonthiol drugs known to induce pemphigus revealed that several of them share an active amide group in their molecule. We believe that this group might be responsible for the induction of the disease; thus, a third group of drugs capable of triggering pemphigus can be formed, namely drugs containing an active amide group. Several drugs of this group are discussed.

Today it is generally accepted that every drug that possesses an active thiol group in its molecule is capable of inducing pemphigus. Some plants, in particular those belonging to the Allium group, contain several active compounds with stable disulfide and thiol groups in their molecule. The Allium group contains many important vegetables like onion, leek and garlic. Examples of molecules with an active thiol group are: CH2 = CH-CH2-S-S-CH2-CH = CH2 (diallyl disulfide) or CH2 = CH-CH2-S(O)S-CH2-CH = CH2 (allicin). It is suggested that some foods, in particular vegetables of the Allium group that contain active thiol groups in their molecule, could contribute to the induction of pemphigus. In general, nutritional factors should be added to the list of exogenous factors that are capable of inducing pemphigus.

Four women with pustulosis palmoplantaris (PPP) and associated sternocostoclavicular hyperostosis are described. The connection between the two diseases is not coincidental: it is encountered in 9.4% of PPP patients, and was reported in the French literature as part of the SAPHO (synovitis acne pustulosis hyperostosis osteomyelitis) syndrome. This syndrome is linked to the spondyloarthropathies, having an increased prevalence of HLA B27 and occurrence of sacroiliitis. None of our patients had HLA B27, but HLA A26 was found in the 3 patients examined. No conclusion can be drawn from this finding, however, since this antigen is found in 21.7% of Ashkenazi Jews. Recognition of this syndrome by dermatologists will improve diagnosis and treatment.

A 40-year-old patient developed a 5-mm-deep melanoma from a lesion on her chest which had been treated with Solcoderm 10 years previously. We recently described 3 other cases of melanoma that evolved in a lesion treated by Solcoderm. Much debate surrounds the recommendation as to the appropriate method for treatment of pigmented lesions when the removal is indicated for cosmetic reasons only. Most of the authors agree that any pigmented lesion which merits excision merits submission for histological examination. The aim of the present report was to express a warning regarding what we think is an inappropriate and hazardous method of treating pigmented lesions, namely their chemical destruction with Solcoderm. In view of the reported cases of melanoma evolving in lesions treated previously with Solcoderm, we believe that this treatment is absolutely contraindicated for pigmented lesions.

This work assesses cutaneous blood flow measurements as an adjunct in the differentiation between malignant and benign pigmented skin lesions. Blood flow in pigmented lesions and in their vicinity was measured by laser Doppler flowmetry (LDF), which measures the superficial skin blood flow. The lesions were then excised and histologically examined. While LDF readings for most of the benign lesions did not differ from those of control measurements, basal cell carcinomas showed a significant elevation and so did the melanomas (p less than 0.0001). Moreover, comparing the two groups of malignant lesions, namely the melanomas and basal cell carcinomas, the melanomas showed a significantly higher elevation (p less than 0.02). These results suggest that LDF may serve as an additional tool in the diagnosis of pigmented skin lesions: the probability of malignancy is low when LDF readings show no difference from adjacent normal skin; on the contrary, elevated readings suggest an increased likelihood of malignancy.

112 cases of induced pemphigus were reviewed. The causative drugs were divided into three groups according to their chemical structure, and the clinical, prognostic and laboratory characteristics were analyzed and compared. Our literature screening indicates that the biological progress and clinical course of the disease depend upon the type of the inducing/triggering drug in the majority of patients. Patients with penicillamine-induced pemphigus or with pemphigus induced by SH drugs (drugs containing a sulfhydryl radical) showed spontaneous recovery in 39.4 and 52.6%, respectively, once the drug was discontinued. Patients whose pemphigus was induced by other drugs showed spontaneous recovery in only 15% of the cases. These results indicate that in patients with pemphigus induced by penicillamine (or SH drugs), the drug plays a major role in the pathogenesis of the disease, as compared to patients with pemphigus induced by other drugs. It seems that penicillamine (and SH drugs) actually induces pemphigus in most of the cases, whereas other drugs only trigger the disease in patients with a previous predisposition.

Persistent deep-seated folliculitis and impaired chemotaxis are described in a 24-year-old woman with situs inversus, bronchitis and sinusitis, i.e. the three characteristics of Kartagener's syndrome. While patients with chemotactic defects not associated with the syndrome often suffer from skin infections, to the best of our knowledge this is the first report of a Kartagener patient with cutaneous manifestations.

Although in the area of incisional surgery the level of sterile techniques has improved in recent years and approaches that of the surgical standards in other specialties, one cannot say the same with regard to some of the nonsurgical or semisurgical procedures. Here, unfortunately, there are even no standards to aim for and no guidelines to adopt. Since in the field of nonsurgical cosmetic skin care dermatologists have a unique position, we alone must shoulder the responsibility for setting the standards and determining the appropriate conditions for carrying out these procedures. Unfortunately, it appears that in certain of the dermatologic procedures not involving actual skin incision, the level of sterility has not improved for decades. In such dermatologic procedures there are marked discrepancies between the care taken to maintain a high degree of sterility of instruments that penetrate the skin, compared with the lack of attention to sterility of instruments that do not directly penetrate the skin and the area surrounding the procedure site. It seems that the guiding principle we must strive for is to prevent the transmission of infection from one patient to another. The emphasis should be not on sterility per se but on the prevention of transmission of disease from patient to patient.

Two mechanisms have been proposed for the pathogenesis of eruptions induced by angiotensin-converting enzyme (ACE) inhibitors: (1) an allergic, immune-mediated reaction and (2) a pharmacologic, dose-dependent response. Two cases of palmoplantar psoriasis are presented, which can be attributed to the induction (case 1) and exacerbation (case 2) of ACE inhibitors. The first patient developed his eruption 2 months after he had received captopril, probably as a result of an allergic immunologic mechanism. This has been based mainly on circumstantial evidence and is further strengthened by the positive result of the mast cell degranulation test. The second patient developed an atenolol-induced, mild plantar psoriasis. She experienced a dramatic flare-up of her psoriatic lesions shortly after she had received an ACE inhibitor. It is suggested that her reaction occurred as a result of the enalapril-induced augmentation of kinin levels in the skin. These 2 patients represent deductive and unusual examples of the two different mechanisms that are responsible for the cutaneous complications of ACE inhibitors.

A 65-year-old patient developed nonpruritic purpuric skin eruptions following 10 days of coumadin treatment. Skin biopsy revealed vasculitis and immunofluorescent studies demonstrated the presence of IgM and C3 deposits in the walls of the affected blood vessels. Rechallenge with coumadin was followed by reappearance of the skin eruptions. Indirect mast cell degranulation test and migration inhibiting factor test were positive in the presence of coumadin. These findings strongly suggest that the skin lesions were induced by an immunologic reaction to warfarin.

A case of anetoderma is described in which progressive protrusion of the anterior teeth was a concomitant finding. A possible interrelationship between these two conditions is suggested, based upon the anatomy and physiology of the oxytalan fibers of the periodontal ligament.

In 13 patients with psoriasis a lower total cholesterol (TC) concentration was found compared to healthy controls of the same population. No differences in the concentration of serum triglyceride (TG) or phospholipids (PL) were detected between these two groups. In the same patients, serum triglyceride fatty acid analyses showed a reduced concentration of linoleic acid and a raised level of palmitoleic and myristic acids. No differences were detected in the major phospholipid fractions. The increase in plasma free fatty acids (FFA) following intravenous heparin was comparable in the psoriatic patient and in the controls. It is concluded that no basic abnormality of serum lipids exists and that the changes described were due to a selective loss via the scales or due to malabsorption.

A case of familial pemphigus vulgaris is described in an uncle and his niece who developed the disease 18 years apart. The man died from pemphigus in 1964. The diagnosis was confirmed histopathologically in both cases, but immunofluorescent microscopic studies were performed only in the woman because the technique was not available in 1964. HLA typing in the woman and her daughter and sister showed A 26, BW 38 and DRW 4 in all of them. Clinical disease did not develop in the other family members.

Multiple agminated and two isolated juvenile melanomas in a 4 1/2-year-old boy, which appeared on apparently normal skin after sunburn, are described. Cases in the literature are reviewed.

We describe a pruritic rash that appears to be associated with pediculosis capitis. We suggest calling it ' pediculid ' since it appears to be an -id reaction to pediculosis capitis.

The unusual association of macular atrophy--Jadassohn type of anetoderma, bilateral subcapsular ocular cataracts and keratoconus--is described in an otherwise healthy adult male. This association has not, to the best of our knowledge, been previously described. The possibility that this is not a chance association is discussed.

A case of acute cutaneous leishmaniasis is reported in which skin biopsy of the lesion revealed deposits of IgM, fibrinogen and C3 in the blood vessel wall and granular deposits of IgG and C3 at the dermoepidermal junction. No immune complexes were detected in the healthy unaffected skin in the same patient and no circulating immune complexes were found in the blood. This case demonstrates tissue-bound immune complexes in cutaneous leishmaniasis.

A case is described in which a papulonodular eruption developed all over the body. Histologic examination of one of the lesions revealed the dermis to contain mucin (hyaluronic acid). In some areas there was perforation through the epidermis of the mucinous material.