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Serum from seven patients with ordinary scabies and six with crusted scabies were screened by immunoblotting for IgE- and IgG-specific proteins in an extract of the mite, Sarcoptes scabiei variety canis. Sera from atopic individuals without sensitivity to house dust mites were used as controls. Serum from all of the patients with crusted scabies showed strong IgE binding to 11-21 and IgG binding to 1-7 scabies proteins. In contrast, three of the seven patients with ordinary scabies showed IgE binding to one to six scabies proteins, and their antibody binding was much weaker. Patients with crusted scabies had serum antibody that reacted with larger molecular weight proteins compared with patients with ordinary scabies. The results of this study indicate that patients with crusted scabies showed a pronounced IgE response to scabies mites, whereas patients with ordinary scabies did not.

Lipedematous alopecia is an unusual disorder characterized by short, brittle scalp hairs associated with thickening of the scalp by adipose tissue. All except one reported case have been in African-American females. It is our purpose to report the seventh case of this condition.

Cutaneous granulomatous vasculitis manifesting as a postherpetic reaction pattern is uncommon hand has previously been reported as a delayed complication of varicella-zoster virus infection. We describe three patients who had persistent, painful, postherpetic papules in a zosteriform distribution that histologically demonstrated a small vessel granulomatous vasculitis. Herpes simplex virus DNA detected by the polymerase chain reaction technique was demonstrated in two cases.

The scabies mite Sarcoptes scabiei and the Dermatophagoides house dust mites (HDM) are related phylogenetically and are the sources of several cross-reactive antigens. The purpose of this study was to investigate the immune response to S. scabiei and HDM in scabietic patients. Skin test sensitivity and serum IgE to both S. scabiei and HDM were determined for patients who had or previously had confirmed ordinary scabies. A retrospective group included nine subjects who had received successful treatment three weeks to one year prior to the study. A prospective group included 16 subjects with active scabies. Allergic histories were obtained, serum was collected, and skin prick tests (SPTs) were performed at enrollment for all and periodically over the next 12 months for the prospective patients. None of the individuals in either group reported a known sensitivity to HDM. Six of the nine retrospective patients were SPT positive to both S. scabiei and HDM and two of these showed circulating IgE specific for these antigens. At diagnosis, 13 of 16 patients with active scabies were SPT positive to S. scabiei and 12 of these were also SPT and/or radioallergosorbent test positive to HDM. Six patients had circulating IgE directed at both S. scabiei and HDM antigens while one subject had IgE to S. scabiei only and another had IgE directed at HDM only. Twelve of the 15 subjects tested also showed IgE and/or IgG binding to one or more bands on Western blots of an S. scabiei-specific protein fraction. This study indicated that approximately half of the patients with active scabies had S. scabiei- and HDM-specific circulating IgE while most patients cured of scabies lacked S. scabiei- and HDM-specific serum IgE. The data also suggested that antibodies to S. scabiei in scabietic patients also recognize HDM; however, some antibodies were directed at scabies-specific antigens.

The life cycle of canine scabies has been studied extensively. Currently studies are focusing on mite behavior, physiological requirements, host specificity, mite survival, and clinical complications of scabies. Investigations are giving insight into immunologic responses to infestation and cross-reactivity with house dust mites. A diagnostic blood test or vaccine may become a future reality, if a unique antibody response can be isolated. Can scabies transmit the human immunodeficiency virus (HIV)? This controversial area needs prompt definitive exploration.

Scabies epidemics in nursing homes, acute and chronic care hospitals, residential facilities, and communities have become commonplace. Patients with keratotic (crusted, Norwegian) scabies are highly contagious and often initiate outbreaks in institutions. This is a review of problems associated with the management of scabies epidemics in health care facilities. A model treatment plan, readily customized to suit specific epidemic scenarios, is detailed.

This study demonstrated that antigens of the parasitic mite Sarcoptes scabiei (SS) cross-react with antigens of the house dust mite Dermatophagoides pteronyssinus (DP). Crossed immunoelectrophoresis (CIE) reaction of SS extract with rabbit anti-DP serum resulted in multiple immunoprecipitates. Reciprocal CIE reactions gave similar results. Immunoprecipitates from both reactions bound IgE in the sera of dust-mite-sensitive patients who had no history of scabies. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis resolved protein/peptide bands of both SS and DP also bound serum IgE from dust-mite-allergic patients following immunoblotting. Non-allergic control sera gave no IgE binding to either SS or DP antigens. These results indicate that patients with atopy to dust mites exhibit circulating antibodies built to DP but that recognize determinants on SS antigens. It is highly probable that scabietic patients build antibodies to SS antigens that also recognize DP antigens. These results raise questions concerning the reported isotypic antibody responses to SS because the sensitivity of scabietic patients to house dust mites has not been previously evaluated. This cross-reactivity may play an important role in the susceptibility to scabies and its clinical manifestations.

Porokeratosis plantaris, palmaris, et disseminata is a unique clinical entity characterized by the familial occurrence of multiple porokeratoses predominantly on the palms and soles but also on both sun-exposed and non-sun-exposed areas of the body. Since its original description in 1971 by Guss and colleagues, there has been only one other report of this syndrome. We have discovered a third family with this disorder and have used isotretinoin successfully to control the condition in one of the family's symptomatic members.

Erysipelothrix infections have been a well-known clinical entity for over a century. Only a few cases have been studied histologically, and the agent has rarely been cultured from infected patients. We present here a case of erysipeloid of Rosenbach, in which histologic study and electron microscopy document the presence of microorganisms. We also present a complete review of the clinical and pathologic features of Erysipelothrix infections and their treatment. Our observations suggest that Erysipelothrix rhusiopathiae is capable of producing L forms that may revert to a bacterial form and produce sepsis at a later time.

Sarcoptes scabiei var. canis served as a suitable model for the study of S. scabiei var. hominis survival. S. scabiei var. canis and var. hominis mites were found to survive off the host for 24 to 36 hours at room conditions (21 degrees C and 40% to 80% relative humidity [RH]), and the canine variety survived 19 days at 10 degrees C and 97% RH. Female mites survived decidedly longer than male mites at comparable conditions. Generally, higher RH values and lower temperatures favored survival, whereas higher temperature and lower RH led to early death. Most canine scabies mites that were held off the host for 36 hours at 75% RH and 22 degrees to 24 degrees C remained infective and penetrated when returned to the host. Live mites of the human variety that were recovered from bed linen slept on by infested patients would also penetrate a host after being held off a host for 96 hours in alternating 12-hour periods of room conditions and refrigeration. Penetration required less than 30 minutes for all life stages of both varieties, and it was accomplished by a mite secretion that dissolved the host tissue. Dislodged mites, particularly those in close proximity to the source, can be a likely source of infestation.

This study determined the prevalence of Sarcoptes scabiei in the home environment of 37 confirmed cases of scabies and in five nursing homes with scabietic patients. Dust samples from 44% of infested patients' homes contained scabies mites. Live mites at the time the dust samples were analyzed were present in 64% of these homes. Live mites were recovered most often from bedroom floors or overstuffed chairs and couches. The density of live and dead mites ranged from 1 to 5 mites/0.1 gm of dust or 1 to 9 mites/m2 of surface area sampled. The presence of mites in fomites coupled with survival and host-seeking behavior indicate that it is possible for a person to become infested by dislodged mites in contaminated home, school, and work environments. By contrast, only a small number of mites were recovered from beds, furniture, and floors of scabies-infested nursing homes. Mite-contaminated fomites may be less important in the transmission of scabies in nursing homes than in private homes.

A case of pemphigus vulgaris confined to the oral cavity, larynx, and hypopharynx for two years with subsequent involvement of the entire esophagus is presented. Histopathology and direct immunofluorescence of the esophagus confirmed the diagnosis.

Two patients with delayed pressure urticaria were studied to define some of the physical parameters related to experimental lesion induction using a pressure-testing device. Graded pressures from 48 to 234 gm/mm2 were applied for 1 to 180 seconds on several anatomic areas. Experimentally induced lesions were symptomatically, clinically, and histologically identical to spontaneous wheals and reached a maximum size 9 hours after the stimulus. The threshold response found was related to the amount of pressure, the duration it was applied, and the anatomic area tested. Sites that previously reacted to pressure were refractory to additional stimuli for at least 24 to 48 hours. The mediator for delayed pressure urticaria remains unknown, and some patients do not respond to oral corticosteroids.

Starving Psoroptes cuniculi were found to survive off the host for 4 to 21 days at relative humidities between 20% and 99% and temperatures between 5 and 30 C. Within these extremes, survival was greatest at low temperature and high relative humidity (RH). Mites were infestive for at least 50% of their survival times and may have infested new hosts in contaminated facilities. A temperature of 40 C and 20% RH maintained for 24 hours caused 100% mortality in test mites. Other selected combinations of temperature above 40 C and RH less than or equal to 75% also caused 100% mortality in 2 days or less. These conditions could be used to control these mites in vacated contaminated premises.

Urticaria is caused by physical factors in almost 12 percent of cases. These factors include pressure. Dermographism is the appearance of whealing and erythema within minutes where skin has been exposed to pressure or mechanical irritation. Symptomatic dermographism is present when "normal" pressures, such as those encountered in the activities of daily living, cause urticaria. Individuals with symptomatic dermographism can be shown to have a lower pressure threshold for the production of dermographism than normal individuals. A case of symptomatic dermographism is presented, and the differential diagnosis is discussed.

Adult female Sarcoptes scabiei var. canis mites were applied to human skin for 96 hours in an experimental chamber. Clinical lesions produced during this period were studied histologically. The organisms burrowed, defecated, and laid up to nine eggs that developed normally. Two eggs hatched after removal from the host. A life cycle was not completed during this short experiment, but these results suggest canine scabies are capable of such activities on human skin.

Sarcoptes scabiei var. canis was successfully transferred from the dog to New Zealand White Rabbits, Oryctologus cuniculus. Natural and experimental transfers were accomplished between rabbits. The dog strain transferred to rabbits showed no morphologic changes and was readily transferred back to dogs. Experimental transfer of var. canis to guinea pigs and pigs resulted in only temporary infestation. Attempts to infest haired and hairless mice, thymus-deficient (nude) mice, and rats were unsuccessful. The unsuccessful or transient nature of cross-infestations between some host species and complete cross-infestation in others leads to the conclusion that all S. scabiei varieties are not host-specific but that they do possess some degree of host preference and that physiologic differences between varieties exist.

A patient developed a painful subungual lesion which was an epidermal cyst on biopsy. The incidence and pathogenesis of subungual epidermal cysts are reviewed. This usually asymptomatic tumor should be considered in the differential diagnosis of subungual lesions.

A 6-year-old boy with acute monocytic leukemia and therapy-induced leukopenia developed multiple necrotizing skin lesions where an intravenous administration unit had been secured to his arm and hand. Biopsy and cultures demonstrated Aspergillus flavus as the etiologic agent without evidence of systemic dissemination. Resolution of the infection occurred following systemic amphotericin B therapy and a granulocyte transfusion.

A primary cutaneous lesion in a 5-year-old boy who had recently received chemotherapy for acute lymphocytic leukemia was found to be caused by a dematiaceous fungus, Drechslera spicifera. The lesion was an erythematous macule that rapidly developed necrotic ulcerations. The fungus, which is commonly found in soil and as a plant pathogen, was isolated from cultures of the lesion and from an excisional biopsy specimen. Hyphae and swollen hyphal cells resembling chlamydospores were observed in the biopsy specimen. Septate pigmented hyphae were found in the tissue, which is consistent with phaeohyphomycosis. Resolution of the infection occurred following excisional biopsy and systemic amphotericin B therapy. There was a concomitant recovery from neutropenia.

We report on a young man with a congenital mutilating keratoderma in whom three epitheliomata cuniculata occurred during a two-year period. The clinical findings, associated disease states, and treatment of epithelioma cuniculatum (EC) are reviewed.

Familial multiple glomus tumors are rare. A family is reported here with the disease documented in three generations. While this type of glomus tumor is not classically associated with pain, all members of this family who exhibited multiple glomangioma were symptomatic. Treatment with both the argon laser and carbon dioxide laser was successful in relieving symptoms and improving the appearance of only the more superficial glomus tumors.

We report here a case study in which behavior therapy techniques were used to treat the persistent and severe scratching of a patient with long-standing exfoliative dermatitis. A multiple-baseline clinical design across different body areas was used to evaluate the behavioral treatment program. This program consisted of (1) training the patient to monitor his scratching behavior and to use an incompatible response and distraction procedure contingent on the occurrence of scratching, and (2) differential attention by the therapist, so that the therapist's attention was contingent on intervals of nonscratching, and the therapist ignored the patient when he did scratch. The results indicated that the program was effective in almost completely eliminating scratching when a variety of therapists were and were not present. This suggests that the procedures used might easily be taught to the nursing staff.

Sarcoptes scabiei mites perceive specific host stimuli and are attracted to the host. Mites dislodged from the host respond to both host odor and a thermal stimulus and seek its source. The response to thermal and host odor stimuli are independent. Mites in close proximity to the body respond to both stimuli and show no preference for either. At greater distances from the host, odor is the more important stimulus.

Relapsing polychondritis is a systemic disorder characterized by recurrent inflammation and degeneration of cartilaginous tissue. The eyes, ears, nose, larynx, trachea, and articular areas are commonly involved. While ocular involvement, hearing, and vestibular dysfunction are frequently present, aortic valve and root disease as well as vasculitis also may occur. While the cause remains unknown, an autoimmune pathogenesis appears likely. Thus, dapsone and/or systemic corticosteroids remain the predominant effective therapies. Another case of relapsing polychondritis with an associated vasculitis syndrome is presented as well as a review of the current literature.