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Birt-Hogg-Dubé syndrome (BHDS) is an uncommon autosomal dominant genodermatosis characterized by a triad of skin tumors--fibrofolliculomas, trichodiscomas, and acrochordons--together with an increased risk of renal tumors and spontaneous pneumothoraces. This report describes multiple facial angiofibromas as the predominant initial manifestation of BHDS. The patient had a total of 41 facial papules removed via shave excision, initially for diagnostic and then for therapeutic purposes; histologic evaluation revealed diagnostic features of angiofibroma in 39 lesions and fibrofolliculoma in only 2. BHDS should be considered, along with tuberous sclerosis and multiple endocrine neoplasia type 1, in the differential diagnosis of multiple facial angiofibromas, particularly when onset is in adulthood.

background Hyperthermia therapy Was described previously to be effective for treating warts using a hot water technique as We as an ultrasound hyperthermia technique. Recently, two other papers described controlled localized heat therapy for cutaneous warts. A new heat-generated application system and method has been developed for treating warts using a self-administered, self-adhesive disposable exothermic patch. objective The objective of this study was to describe our clinical experience in using the exothermic patch to successfully treat patients with cutaneous recalcitrant warts who failed to respond to multiple antiwart therapy. method Two patients with recalcitrant warts that did not respond to other therapeutic modalities were treated with the exothermic patch with complete remission of their warts. Exothermic patches were used in this study that were specially constructed to provide long-lasting, continuous, and reproducible heating of the skin surface for at least 2 hours at a temperature level of 42–43°C, which will not burn or otherwise injure the skin. conclusion Warts are difficult to treat in part because there are no specific anti-Papillomavirus drugs or methods available. We describe our clinical experience in successfully treating two patients with recalcitrant warts using the exothermic patch.

background : An elderly woman with B-cell lymphoma confined to the skin of the lower extremity was treated with combination chemotherapy and radiation therapy. She relapsed with new skin lesions outside the original radiation port that responded to additional radiation therapy and remains in remission 12 months after her last treatment. objective : This article investigates the diagnosis, treatment, and prognosis of primary cutaneous B-cell lymphoma. methods : The relevant literature was researched through computer data bases and bibliographies. results : Patients who present with localized lesions of primary cutaneous B-cell lymphoma have a favorable prognosis regardless of the type of therapy, although relapses may occur in the absence of systemic disease. conclusion : Vie advocate the use of local therapies as initial treatment in patients with localized primary cutaneous B-cell lymphoma. J Dermatol Surg Oncol 1992;18:951–954.

REPORT OF A CASE A 38-year-old white man was involved in an automobile accident in 1967 with resulting damage to the T-10 vertebrae and chronic pain. Two years ago, the patient bought a chair with an electric vibrator and a heater cushion to ease his lower back pain. He started using it every night for a few hours while watching television. One month after starting the device, an eruption developed on his lower back. The eruption was sometimes accompanied by crusted areas on the location where the heater and vibrator touched his skin. Figure 1 shows the diffuse, blue-to-purple erythematous reticulated eruption, with hyperpigmentation of the lower back without vesicles or hyperkeratosis. A 3-mm punch biopsy specimen was obtained from this area. Histologic findings are demonstrated in Fig 2. What is your diagnosis? DIAGNOSIS: Erythema ab igne. DISCUSSION Erythema ab igne, otherwise known as toasted skin syndrome, 1,2 is a persistent macular erythema and hyperpigmentation occurring in a

The susceptibility of human papillomavirus infection to polyclonal human leukocyte interferon (IFN-alpha) has been evaluated in patients with epidermodysplasia verruciformis (EV), a disease with extensive chronic papillomavirus-induced warts. In a double-blind, placebo-controlled study with intralesional IFN-alpha, four of five IFN-alpha-treated warts regressed; none of the placebo-treated warts responded (p = 0.024). Three patients with EV were treated with systemic IFN-alpha for 4 weeks in an open study, achieving partial regression of warts in all three. In a double-blind, placebo-controlled study, warts in two children with EV regressed with systemic IFN-alpha while two who received placebo showed no improvement. The lesions recurred following cessation of therapy. At the completion of therapy with IFN-alpha, histologic normalization was accompanied by a 95% decrease in the number of viral antigen-containing cells in the warts (p less than 0.001). We conclude that warts in EV respond to systemic and intralesional IFN-alpha.

In ten patients with gyrate atrophy (GA) and hyperornithinemia, the head hair was fine, straight, and sparse. On microscopic examination, both scalp and pubic hair contained intermittent dark cores within the medullary zone, which was not a deposit, but appeared to be due to the unusual refractive properties of loosely formed macrofilaments amidst wide spaces containing a structureless electron lucent but compact substance, which was insoluble in both water and solvents. Seven of the ten patients had abnormal wave forms on electroencephalography. Three of the five patients who underwent muscle biopsy had tubular aggregates. Of particular interest was the toxicity of exogenous ornithine added to muscle cell culture from GA patients as compared with the lack of toxicity in muscle from control patients. What specific role the hyperornithinemia and absence of OAT is playing in the histopathology of hair and muscle and the EEG changes awaits further biochemical investigation.

† We describe a family with typical epidermodysplasia verruciformis (EV) in which only male members are affected. Whereas none of the index patient's ten children have EV, four of eight grandsons born to his daughters have inherited the disorder. All are infected with human papillomavirus (HPV) 3 and HPV 8. The inheritance in this kindred most likely results from an X-linked recessive genetic defect. Since other kindreds have been described with autosomal inheritance, this novel inheritance pattern suggests that the persistent high clinical susceptibility to HPV infection characteristic of EV may result from defects in either of at least two different genetic loci, one of which may be located on the X chromosome. (Arch Dermatol1985;121:864-868)

Idiopathic calcinosis of the scrotum, which is a rarely reported condition of unknown etiology, may be easily misdiagnosed as epidermal or pilar cysts. Histologically, the diagnosis is easy and quite typical. Report of a Case A 24-year-old man was admitted to The Chaim Sheba Medical Center in November 1975 for removal of several asymptomatic scrotal cysts of several years' duration. Examination showed several firm, non-tender nodules of various sizes on the scrotum; the larger nodules were apparently formed from several smaller ones joined together (Fig 1). The diagnosis of epidermal cysts was made and all visible lesions were surgically removed. During surgery, some of the lesions were found to contain a viscous, thick, white-yellowish fluid. None contained an obvious sac. Postoperative recovery was uneventful. Results of the following laboratory tests were found to be either within normal limits or negative: complete blood count, ESR, routine urinalysis, VDRL, blood glucose, blood