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A case of Kaposi's disease is reported with a lesion in the buccal mucosa, and the history, classification, signs and symptoms, and treatment of this disease are described.

The authors report a case of oral submucous fibrosis and present a review of the literature available on this subject. Oral submucous fibrosis is rare outside South-East Asia where it affects from 0.2 to 1 p. 100 of the population. A few cases have been described among Europeans. The disease seems to be specific to the oral and upper respiratory mucosae. It is characterized by the progressive development of subepithelial fibrosis and the subsequent occurrence of leukoplakia which may undergo transformation into epidermoid carcinoma. It initially presents as a non-specific stomatitis, sometimes with vesicles and ulcerations. Very gradually thereafter the buccal mucosa becomes pale in parts, as well as thicker and fibrous, while leukoplakia develops. These lesions progress slowly and may eventually result in complete and irreducible trismus. Histologically, oral submucous fibrosis is characterized by chronic subepithelial inflammatory reaction followed by hyalinization. Subsequently, the fibrosis extends to the underlying muscles. The epithelium is diversely affected: atrophy is thought to be the first lesion to appear; secondarily, and under the influence of various irritant factors, epithelial hyperplasia, ortho- or parakeratosis of the stratum corneum, or even cellular abnormalities may develop.(ABSTRACT TRUNCATED AT 250 WORDS)

A progressive papular eruption on the face, limbs and vulva had been present for seven years in a 38-year old female patient. Some papules were small and confluent while others were sparse, as in nodular prurigo. Histology showed massive proliferation of the follicular sheath epithelium, connected to the lower surface of the epidermis. The lesion formed a plate-like area very similar to that observed in superficial basal cell carcinoma and corresponding to a tumour of the follicular infundibulum. Remarkable features of this case were the large number of lesions, their photosensitivity (they became pruriginous and increased in size after exposure to the sun), the presence of eccrine sweat glands beneath a skin lesion of the thigh, the basal cell degeneration of two lesions and the slight improvement observed after etretinate therapy. To our knowledge, such findings have not yet been reported in tumours of the follicular infundibulum.

Pyritinol is presently prescribed in rhumatoid polyarthritis because of its structural analogy to D-penicillamin. Only benign cutaneous side effects had been mentioned up to now. We report two cases of pemphigus occurring during pyritinol therapy given in one case for rhumatoid polyarthritis, in the other case for memory deficiency. Clinical aspect was that of a superficial pemphigus. The histologic picture was in some instances that of a superficial acantholysis, and in other instances, that of an eosinophilic spongiosis. Definite proof of pemphigus was shown by presence of anti-intercellular substance antibodies in the serum and in the skin of both patients.

This study involved 10 patients having, in direct immunofluorescence, with covered healthy skin, a speckled IgG (+/-IgM) staining of the epidermal nuclei. The chief clinical signs seen and their respective percentages were: Raynaud's syndrome (80%), arthralgia (80%), diffuse or localised alopoecia (60%), muscular disease (40%), swollen fingers (40%), sclerodactylie (20%), cutaneous sclerosis extending beyond the extremities (30%), cutaneous signs of lupus erythematosus (30%), renal involvement (10%). In nine cases out of ten there were circulating anti-ENA antibodies at high levels, divided into anti-RNP antibodies (7/10), anti-Sm antibodies (1/10) and anti-RNP and anti-Sm antibodies (1/10). Diagnoses were divided into: lupus erythematosus (3/10), systemic scleroderma (3/10), Sharp's mixed connective tissue disease (MCTD) (3/10) and non-classified connective tissue disease (1/10). The combination of speckled staining of epidermal nuclei and circulating anti-ENA antibodies cannot be considered to be specific of any particular type of connective tissue disease and the prognosis of the disease does not appear to differ from that of the usual prognosis of connective tissue disease with anti-ENA antibodies.

Normal structure of nail fold capillaries as observed by capillaroscopy and fluoroscopy is recalled. A procedure of proximal nail fold biopsy is described. The technique is simple without disadvantage for patients. Tissue from the proximal nail fold is studied in three different ways: light microscopy with histochemistry, electron microscopy and direct immunofluorescence. In the two normal cases studied, usual epidermal and dermal components are found. Some particular point may be emphasized: sweat's droplets draining of distal part of proximal nail fold, numerous and large nervous structures, capillaries basal lamina multiplication.

The case report describes a patient hospitalized for multiple subcutaneous abscesses who presented a four-year history of recurrent skin lesions and a fifteen-year history of non specific bronchopulmonary infections requiring segmental resection. The diagnosis of actinomycosis, A. israeli species, was established by culture of surgical drainage material from a thoraco-abdominal wall abscess. Muscle and bone involvement of the right thigh was subsequently demonstrated. There was no evidence of pulmonary infection at the time of hospitalization. Treatment with Penicillin G was curative. A review of the literature is presented together with a summary of thirteen reported cases. Although disseminated actinomycosis has become very rare since the introduction of antibiotic therapy, patients share similar features and a common clinical pattern which are highly evocative of the disease. All patients described had preceding pleuropulmonary disease, characteristically chronic. Evolution of cutaneous lesions was subacute or chronic. In all cases, there was significant delay (months to years) between the initial appearance of skin lesions and subsequent diagnosis. In most cases, actinomycosis had not been suspected. Diagnosis was usually established by isolation and identification of the micro-organism in cultures of purulent material obtained from cutaneous lesions. Despite the probability of hematogenous disease dissemination, pleuro-pulmonary foci were only rarely demonstrated. Prolonged antibiotic therapy was curative in all treated cases.

Epidermal nucleolar IgG deposition on direct immunofluorescence of covered normal skin was found in two patients with scleroderma and high serum concentrations of antibody to nucleolar antigen. Epidermal homogeneous and peripheral IgG deposition was also observed in two patients with systemic lupus erythematosus, antinuclear antibody of homogeneous staining pattern, but without antibody to extractable nuclear antigen. Epidermal nuclear IgG deposition in a speckled, nucleolar, homogeneous or peripheral pattern appears to correlate with high titer serum antinuclear antibody giving on immunofluorescence the same staining pattern. These immunopathologic findings cannot be considered as being specific of a subset of connective tissue disease.

Two new cases of cutaneous pigmentation induced by minocycline are reported, in addition to the 38 cases collected in the literature. Our first case was a 50-year old man with a history of multiple orthopaedic operations for injuries sustained in road accidents. Arthritis of the elbow, probably of bacterial origin, was treated with cephalexin and gentamicin, followed by minocycline 300 mg/day. After a total dose of 60 g of minocycline had been reached, a bluish-grey pigmentation was observed on the internal aspect of the left tibia and on the scars left by the orthopaedic operations. Subsequently, lenticular lesions of the hands developed, together with a blue area on the palate. Our second case was an 18-year old girl who presented initially with nodulo-cystic acne. Minocycline 200 mg/day was prescribed, then withdrawn on account of dizziness; no pigmentation was observed. The acne was cured after 7 months of treatment with 13-cis-retinoic acid in doses of 30 mg/day (for a patient's weight of 50 kg). A second course of minocycline 100 mg/day was prescribed; after a total dose of 3 g all the acne scars had become pigmented. A pathological study performed in the first case confirmed the data found in the literature: light microscopy displayed hyperpigmentation of the basal layer of the epidermis with Masson's silver stain, and an intrahistiocytic pigment coloured by Turnbull's stain; electron microscopy showed an increase in melanosomes within the basal keratinocytes, and a pathological accumulation of pigment in the dermis in the form of electron-dense granules usually surrounded by a membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Biologic hepatitis is common in secondary syphilis. Six cases are reported, in which stereotyped biologic changes were found. These consisted of very high alkaline phosphatase levels and gamma GT levels, with definite inflammation. Cytolysis was moderate or absent. Diagnosis can be established when these biologic anomalies are associated with strongly positive serologic tests for syphilis and rapid recovery under adequate treatment. In these cases, hepatic biopsy is unnecessary.

In a prospective randomized study, the effect of chemotherapy (either systemic or combined intraarterial and systemic) was studied in 117 patients undergoing a curative resection of Clark's level III, IV or V malignant melanoma. Systemic chemotherapy was started one month after surgery one week courses with an I.V. injection of Vinblastin 6 mg/m2, Thiotepa 6 mg/m2, Rufocromomycine 60 microgram/m2, Methotrexate 15 mg/m2 on day one with procarbazine 30 mg/m2 orally daily were given every other week for three months and later every four weeks. Intraarterial chemotherapy of DTIC 80 mg/kg day for ten days was given 28 days prior to surgery. 65 patients with limb malignant melanoma were treated either by surgery only (27 patients), or by systemic chemotherapy (23 patients) or by preoperative intraarterial chemotherapy and systemic chemotherapy (15 patients): 52 patients with non limb malignant melanoma were treated either by surgery only (28 patients) or by systemic chemotherapy (24 patients). We drew curves of disease free survival following surgery and studied the levelling off of the curves, 24 months after surgery 65% of the patients treated by surgery alone were alive and free of disease whereas 81% of the patients treated by surgery and chemotherapy were alive and free of disease (p less than 0.05) suggesting a possible benefit of adjuvant chemotherapy. Intraarterial preoperative chemotherapy has not proved of additional benefit to date.

In 1971, four cases of a new dermatosis were described by Wells, under the name of recurrent granulomatous dermatitis with eosinophilia. In 1978, eight additional cases were reported by Wells and Smith and three authors suggested a shorter title: eosinophilic cellulitis for this syndrome. Since then, four additional cases were published in the literature. We report here two additional cases. From these eighteen upto now published cases, there is no doubt that this dermatosis, as initially described by Wells, is a distinct entity. Clinical course is characterized by sudden eruption of large infiltrated, itchy and/or painful plaques. Blisters are often associated. During the two or three weeks following the initial rash, the inflammatory aspect disappears. Lesions become indurated, and may resemble morphea. Spontaneous resolution occurs after about six weeks. Recurrences are constantly observed. Histologic features are a striking eosinophilic infiltrate associated with eosinophilic deposits constituting flame figures. Blood eosinophilia is present in most cases. Etiology of this entity remains unknown.

The authors report 2 cases of lupus erythematosus (LE) with deep cutaneous lesions. In both cases the lupus panniculitis presented as hard, infiltrated subcutaneous plaques situated symmetrically on the external aspect of both arms and on the upper parts of the buttocks. The diagnosis was confirmed on clinical, histological, immunohistological and therapeutic data. These 2 reports and the 43 cases in the literature dating from 1967, illustrate the main features of lupus panniculitis. The clinical appearances and sites are very stereotyped and immediately suggest the diagnosis even in the absence of other clinical and/or biological signs of lupus. The evolution is very slow and is characterised by dramatic regression of the inflammatory signs with synthetic antimalarial drugs. These deep skin lesions are observed in both purely cutaneous chronic lupus and in systemic lupus which is usually relatively inactive. This prevents the identification of a special form of this disease with a specific evolution and prognosis.

The authors report a case of ulcerovegetating lesions of the buccal mucosa in a patient with confirmed cutaneous and biological secondary syphilis, and discuss the diagnostic features of ulcerovegetating mucous syphilids which correspond to the lesion originally described by Milian, and to the diagram illustrating the work by Grinspan quoted in the references.

Following their use of immunofluorescent methods for establishing a diagnosis in about fifteen cases of mainly inflammatory disorders of the buccal mucosa, the authors discuss the procedures used and their value in buccal bullous diseases, and also in lupus erythematosus, lichen, and aphthosis.

Juvenile spring eruption is seen in early spring and needs a combination of different factors such as light exposure and chilling. It affects mainly boys aged 5-15 or young male adults. It involves the ears in most of the cases and may itch. The helix develops reddish papules, many of which becoming vesicular and later on crusty. Sometimes papular lesions appear on the back of the hands. The lesions heal within 2 weeks without scarring. Recurrences during following springs can be seen. Juvenile spring eruption cannot be reproduced. Histopathology study performed on 2 cases reveals a picture close to erythema mulutiforme and confirms Burckhardt's findings.