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• We report four newborn infants with a distinctive evanescent cutaneous eruption that clinically and histologically resembled lupus erythematosus; two of the mothers had undifferentiated connective tissue disease. The tendency for lesions to occur in a periorbital location and the association of prominent telangiectasias were characteristic clinical signs in our patients. Immunoglobulin deposition at the basement membrane was demonstrated in one patient. Cytogenetic studies, done to exclude Bloom syndrome, revealed only nonspecific chromosomal abnormalities. A brief review of the literature, with speculations on the possible relationship of these changes to the occurrence of connective tissue disease in the mothers, is included in the discussion.(Arch Dermatol 112:698-705, 1976)

This study indicates that accurate diagnosis can be made by both cytologic study of Papanicolaou stained smears and frozen tissue sections prepared from specimens of cutaneous premalignant, malignant, and benign lesions. Both techniques are of distinct advantage over the paraffin-block method in making a rapid presumptive diagnosis because of the short time required and the high degree of specificity. In some instances, rapid diagnosis permits more prompt institution of therapy and reduction of the period of hospitalization. Disadvantages are the need for trained personnel and the difficulty of specifically diagnosing premalignant lesions. The smear technique has certain advantages over frozen section method in that it is equally reliable, requires only limited equipment, and is simple and highly adaptable.

Since 1969, seven cases of pityrosporum folliculitis have been observed at the Skin and Cancer Hospital of Philadelphia. The clinical and histologic features of this recently recognized entity are discussed and a clinicohistopathologic correlation between the occurrence of folliculitis and the regular presence of the Pityrosporum organism is demonstrated. The Pityrosporum organism and its association with cutaneous disease is discussed.

A histopathological and histochemical evaluation of biopsy material from 53 patients with tinea capitis due to Microsporum audouini, Trichophyton schoenleini, Trichophyton tonsurans, Trichophyton sulfureum, and Trichophyton violaceum shows fungal elements rich in polysaccharides. An abundance of hyaluronic acid is present in the stroma, in the outer root sheath of anagen hair follicles, and around the fungal elements in M audouini and T schoenleini infections. It is shown that the latter two organisms cause endo-ectothrix infections, and the other dermatophytes in the study are true endothrix parasites. Observations suggest that the survival and propagation of the dermatophytes is pH dependent, and this may be related to the presence of large amounts of hyaluronic acid. The noninflammatory clinical appearance of infections due to M audouini contrasts sharply with the intense histopathologic changes.

• The course of herpes zoster was studied in a series of 206 patients that included infants and octogenarians. There were 32 patients under the age of 20; in 30 of these (94%) the condition cleared up in 14 days or less. The infection was more severe and prolonged in older patients. In four elderly patients symptoms persisted six months or longer. The relative frequency with which the various parts of the nervous system were involved varied from youth to old age. No instance of involvement of the ophthalmic division of the trigeminal nerve was observed in patients under the age of 20, but ocular complications did not appear to be related to the aging process. Postherpetic neuralgia did not occur in patients under 20 but was frequent in patients over 50. Sex, race, and season did not perceptibly influence the incidence of infection in this series.

A clinicopathologic and histochemical study of ten patients with atrophie blanche indicate the disease is a distinct entity and not a variation of stasis dermatitis. Atrophie blanche is characterized by the development of periodic painful ulcers on the lower extremities. Telangiectatic pupuric areas appear and subsequently central ulcerations develop. The ulcers heal slowly and leave residual white atrophic scars. Striking histopathologic changes occur and consist of the presence of fibrinoid material in the superficial blood vessels and stroma, and infarction of the epidermis and superficial corium. Response to treatment is not satisfactory, but the lesions usually heal after several months. The etiology of atrophie blanche is not known but our abservations indicate a high incidence of atopic reactivity, eczematous eruptions, and systemic disease. The histopathologic changes suggest that atrophie blanche represents a localized hypersensitivity type vasculitis.

A two-year-old Negro patient with multiple nonpigmented nevi is reported. Our histopathological and histochemical studies indicate an active melanin-producing system within the nevus cells. Hypopigmentation and failure of the lesions to repigment may be due to a defect in melanogenesis or faulty transfer of melanin to epidermal cells. Rapid dropping off of pigment into the corium may be another contributory factor.

The present evaluation of the role of vitamin A in the treatment of skin diseases characterized by abnormal keratinization and the problem of its toxicity are the first phase of a study in depth of the modulating effect of vitamin A on epithelial cells of the skin in vivo and vitro. In this study, the clinical and histopathological effects of vitamin A on keratosis follicularis, ichthyosis, congenital ichthyosiform erythroderma, psoriasis, and pityriasis rubra pilaris were determined.Christian Eijkman's discovery in 1897 of a factor in rice polishings which was essential for growth and development opened a new era in the understanding of the role of vitamins in the treatment and prevention of disease. Search for additional factors led to the discovery of vitamin A in 1913, but its chemical configuration was not known until 1931.1 The fact that vitamin A is an old story does not dim, but rather

Superficial dermatophytic infection of the scalp was first described as a clinical entity by Willan in 1808.21 The histopathologic alteration of the hair follicle produced by the dermatophytes has been a neglected field of investigation except for the pioneer studies of Gruby7 and Sabouraud.20The recent upsurge in investigation aimed at exploring some of the mysteries of dermatophytic infection of the skin and dermal appendages has shaken many of the time-honored but false concepts concerning these infections. Important contributions to our knowledge have been the demonstration of fungistatic activity of long-chain, odd-numbered fatty acids which are increased in post-pubertal sebaceous glands19; the presence in the serum globulin fraction of potent antidermatophytic activity which limits dermatophytic growth to those layers of the skin outside the epidermal water barrier zone1,2,11,16,18; the natural history of infection in the human volunteer8,9; the graphic demonstration of the fallacy of

Three patients are described with mast cell disease characterized by blisters superimposed on widespread skin involvement. The skin changes are present in the newborn and are invariably associated with involvement of the internal organs. The skin lesions regress slowly with age, but the visceral infiltration of mast cells may progress slowly, resembling a type of reticulosis. Skin changes may be the only expression of the disease so that complete medical evaluation is desirable.The genetic implications of this type of disease in father and daughter are discussed.Our three patients, and the five reported previously in the literature indicate a strong interrelationship between this type of skin involvement and mast cell infiltration of other systems. Prognosis in this variety of mast cell disease should be guarded, for two of these eight patients have died; five of the remaining six have histopathologic evidence of mast cell infiltration of the reticuloendothelial system; one of these six has gastrointestinal tract involvement and increasing numbers of mast cells in his bone marrow with spillage of mast cells into the peripheral blood.The structural features of the mast cells were studied in three patients by histology, electron microscopy, and histochemical staining techniques. The mast cell granule contains a sulfated acid mucopolysaccharide.

Unique changes occur in epithelial cells infected with herpes simplex, herpes zoster, and varicella. Although characteristic epithelial cell forms have been observed in these diseases for many years,1 only recently has their diagnostic value been emphasized.2The diagnostic microscopic findings in herpes simplex, herpes zoster, and varicella are seen in ordinary hematoxylin and eosin stained sections. Within this group of diseases, the changes are identical but are unlike those found in other vesicular diseases of the skin. Current studies have demonstrated that epithelial cells infected with one of these viruses undergo a series of morphologic and tinctorial transformations.3 All cells are not simultaneously infected; as a result, various stages of this cellular change and accumulation of inclusion material are seen in any single specimen.In the past, the small, eosinophilic, intranuclear inclusion body of Lipschütz has received the most attention. This probably represents one of the last

A 1-year-old girl developed a lesion in the skin of the right forearm. The lesion slowly increased in size and was removed when the girl was 6 years old. On removal the lesion was circumscribed, partially encapsulated, and was composed of wavy fibrils, cells with serpentine nuclei, and numerous large round to oval ganglion cells. The patient has no other tumors at this time, but had multiple papular lesions of the feet at birth, which spontaneously regressed before the age of 1 year. The exact nature of these lesions was not determined.

TO THE EDITOR:— Virus causation of recurrent aphthous ulcers has not been proved. As recently as Oct. 1, 1949 (J. A. M. A. 141: 362, 1949) and Sept. 24, 1949 (J. A. M. A. 141:299, 1949) in "Queries and Minor Notes" the consultants repeated the erroneous concept that this disease is caused by the virus of herpes simplex. In addition, one of the writers misquoted studies from this laboratory by indicating that there is significant alteration in antibody titer in patients with recurrent herpes simplex. We are taking this opportunity to correct these errors and to present a brief summary of our combined clinical and laboratory observations which are pertinent to the problem of recurrent ulcers of the mouth.As part of a larger joint study of virus diseases of the skin by the departments of dermatology and pediatrics of the University of Pennsylvania at the Children's Hospital of