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In a patient with subcorneal pustular dermatosis (SPD) the appearance of new pustular lesions characteristic of the disease was triggered by two episodes of drug eruption (induced by dapsone and quinidine sulphate respectively) and by the intra-dermal injection of the recall antigens Candida and streptokinase-streptodornase, performed for evaluation of delayed hypersensitivity. Both episodes of drug eruption were probably the result of an immediate-type hypersensitivity reaction towards the offending drugs, as indicated by positive mast cell degranulation tests.

Cowden's disease was diagnosed in three siblings (two sisters and a brother) in a Jewish Israeli family of Yemenite origin. The typical mucocutaneous lesions of the disease were present in all three cases. There were hamartomas involving other body systems, including euthyroid multinodular goiter (in all 3 cases), gastrointestinal polyposis (in 2 cases) and hemangioma (in one case). Developmental anomalies were found in all 3 cases. Histological examination of mucocutaneous lesions was in accordance with previous descriptions, including the findings compatible with trichilemmoma observed in cutaneous facial papules. Extensive electron-microscope studies of these facial lesions yielded no evidence of viral particles. Immunological studies, carried out mainly in two cases, revealed a decrease in complement level in the serum and impairment of T cell function.

Circulating anticoagulant (CA) and particularly lupus anticoagulant are commonly associated with biological false-positive tests for syphilis (BFP-STS) in patients with collagen diseases. CA was presently found in the sera of 8 out of 30 subjects with chronic BFP-STS without collagen or autoimmune diseases. It was not found in any of the 21 patients with various stages of syphilis. In 5 out of 21 elderly subjects (age greater than 70 years) in whom a positive BFP-STS was detected, there was no CA. It is concluded that the association between CA and BFP-STS is found only in patients with collagen and autoimmune diseases and in some of the younger chronic BFP-STS reactors. It is not detected in syphilitic patients or elderly subjects in whom a high incidence of BFP-STS can be found. The difference in the incidence of this association is probably due to the differing biologic behaviour of these autoantibodies.

In two Arab brothers presenting the characteristic clinical picture of epidermodysplasia verruciformis (EV), histological examination revealed large clear cells in the granular layer and uppermost part of the prickle cell layer of the epidermis. The report of this histological picture in two cases by other authors in the past had aroused considerable discussion as to the true diagnosis. The finding of large clear cells in our two confirmed cases of EV supports the opinion that this does not necessarily contradict the diagnosis of EV. Electron microscope investigation revealed groups of particles in the nuclei of a few keratinocytes in the granular layer which were compatible with papova virus particles. The changes seen in the clear cells support the theory of the viral etiology of EV. Ehe immunological studies showed intact humoral immunity but impaired cellular immunity.

A study was made of 52 patients with lichen planus. Abnormal oral glucose tolerance was found in 19 (36%), including 5 with overt diabetes. The criteria for abnormality were based on an age-related score method. A family history of diabetes was found to be present in 14 (26%). The most common abnormality observed in the glucose tolerance test was an elevation of the blood glucose level 2 hours after administration of the glucose. These results further support the supposition of a disorder in carbohydrate metabolism associated with lichen planus.

A 63-year-old female who had been suffering from intractable palmoplantar keratoderma for 13 years was found to have myxedema. Shortly after institution of substitution therapy with thyroid hormone there was a striking improvement in her condition. The possibility of a causal relationship between hypothyroidism and hyperkeratosis is suggested.

A study of platelet function and whole-blood viscosity in 11 patients with the confirmed diagnosis of psoriasis revealed a significant elevation in whole-blood viscosity (3.33 +/- 0.37 cP) as compared with that found in a control group (2.80 +/- 0.1 cP). The platelet count and platelet aggregation with ADP, epinephrine and collagen as well as platelet malonyldialdehyde were all within the normal range in all the patients. It is suggested that the increased blood viscosity may contribute to the higher incidence of occlusive vascular disease occurring in patients with psoriasis.

Five psoriatic patients developed papular lesions of palms and soles, shortly after beginning treatment with etretinate. Histological examination in two cases was insignificant. The lesions disappeared without tapering the dose of etretinate. The fact that lesions appeared and subsided within a short period may explain why this unusual adverse reaction of etretinate therapy has not been reported previously.

Specimens of uninvolved skin of 20 patients with systemic lupus erythematosus (SLE) were studied using a direct immunofluorescent technique (IF) and the electron microscope (EM). EM examination revealed deposits of electron-dense material below the basal membrane, among collagen fibers in the dermis and in the walls of dermal blood vessels. The direct IF technique revealed granular "band" deposition of immunoglobulins and complement at the dermo-epidermal junction as well as granular deposition in the walls of blood vessels. There was close correlation between the IF and EM findings. It was concluded that the EM is of particular value in precisely delineating the location and ultrastructural pattern of skin deposits. The IF technique is not limited in relation to the size of area which can be studied and makes it possible to identify the specific immune fractions present. It is suggested that these two methods are mutually complementary in providing information concerning the deposition of immunoglobulins taking place in the uninvolved skin of SLE patients.

The case is presented of a patient with histiocytosis X of the skin of some 25 years' duration. Extensive investigation failed to reveal any other signs of the disease in other organs. The light and electron microscope findings are described. The electron microscope study revealed an abundant cytoplasm with numerous mitochondria, vacuoles, dense bodies, a well-developed Golgi apparatus and numerous Langerhans' cell granules.