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Background: Androgenetic alopecia is a common condition of adult men. Finasteride, a type 2 5α-reductase inhibitor, decreases the formation of dihydrotestosterone from testosterone. Objective: Two separate clinical studies were conducted to establish the optimal dose of finasteride in men with this condition. Methods: Men from 18 to 36 years of age with moderate vertex male pattern hair loss received finasteride 5, 1, 0.2, or 0.01 mg/day or placebo based on random assignment. Efficacy was determined by scalp hair counts, patient self-assessment, investigator assessment, and assessment of clinical photographs. Safety was assessed by clinical and laboratory measurements and by analysis of adverse experiences. Results: Efficacy was demonstrated for all end points for finasteride at doses of 0.2 mg/day or higher, with 1 and 5 mg demonstrating similar efficacy that was superior to lower doses. Efficacy of the 0.01 mg dose was similar to placebo. No significant safety issues were identified in the trials. Conclusion: Finasteride 1 mg/day is the optimal dose for the treatment of men with male pattern hair loss and was subsequently identified for further clinical development.

Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia.We attempted to determine the effect of finasteride on scalp skin and serum androgens.Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days.Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively.In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.

Atrophoderma elastolytica discreta is the clinicopathologic name for a unique entity herein first described in a patient with cutaneous lesions simulating atrophoderma of Pasini and Pierini but coupled with histopathologic changes of anetoderma. The clinical and histological findings seen here have not been previously seen in the many variants of anetoderma, and, as such, they are sui generis evidence of a new entity in clinical dermatology.

A 69-year-old man presented to the dermatology clinic with chronic swelling of the lower legs accompanied by pruritus and scaling. He had noticed a gradual increase in pigmentation of the lower part of his left leg. His medical history included congestive heart failure, hypertension, and protein C deficiency with deep venous thrombosis of the lower part of the left leg. Physical examination revealed bilateral ( 2) pitting edema of the legs extending proximally to his knees, associated with violaceous erythematous scaling patches and superficial erosions of the right lower extremity. On the left anterior tibial surface were brown hyperpigmented patches with fine scale admixed with speckled black pigment (Figure1). There were no other skin findings. A punch biopsy specimen was obtained from both lower parts of the legs and stained with hematoxylineosin, melanin, and iron stains (Figure 2 and Figure 3). What is your diagnosis?

background. Deep penetrating dermatofibroma is an unusual and histologically distinctive form of dermatofibroma that usually occurs on the lower extremities of adults. objective. The dermatologic surgeon and pathologist should be aware of this entity to prevent excessive treatment of a benign condition. methods. We are reporting a case of deep penetrating dermatofibroma with the results of histologic examination and immunohistochemical studies. results. The neoplasm consisted of a fibrohistiocytic tumor penetrating into the subcutis accompanied by scalloped extensions along the septae. Immunohistochemical stains were positive for Factor XIIIa and negative for CD34. conclusion. Recognition of the histologic pattern is important in distinguishing deep penetrating dermatofibroma from dermatofibrosarcoma protuberans.

A 62-year-old white woman presented with a 1-year history of a recalcitrant diabetic foot ulcer on the plantar aspect of her left foot. She had recently seen an orthopedic surgeon who recommended amputation. The dermatology service was consulted after the patient refused to undergo surgery. The ulcer first developed during cast placement for Charcot arthropathy. After failing to respond to treatment with numerous topical debriding and antibacterial agents (concomitantly with wet-to-dry dressings), the patient underwent her first surgical debridement approximately 7 months before she presented to our clinic. She subsequently underwent 2 additional surgical debridements of the ulcer, at 3 and then 2 months, before she was seen in the dermatology department. Histopathologic review of all excised tissue failed to show evidence of malignancy. Two of the debridements were performed with the patient under general anesthesia. Of note, the use of chemical cauterizing agents, such as silver nitrate, was not attempted in the outpatient setting in this case.

Background. “Breaks” in barrier precautions are a definite abrogating influence on the effectiveness of “universal precautions.” Dermatologists and dermatologic surgeons are exposed to significant infectious agents on a daily basis, especially due to the high number of minor surgical procedures performed. Backsplash, spray, and eye splash of bodily fluids during these procedures place the surgeon at a high risk of contamination/infection via the conjunctival membranes. The surgical looking glass is a simple utility based on inexpensive equipment already in place in the physician's office which protects the eyes and face during infiltrative anesthesia or incision of cysts and other lesions. Objective. To offer a simple and inexpensive utility to assist with protection from and reduction of contamination/infection of the ocular mucous membranes during surgical procedures. Methods. Utilizing one or two readily available microscope slides overlying the injection site during local infiltrative anesthesia, backsplash or spray can be contained. Results. This utility is effective in containment of backsplash or spray of anesthesia or bodily fluids during even minor surgical procedures. Conclusion. The surgical looking glass can enhance safety and promote “universal precautions” during even minor surgical procedures or infiltration of anesthesia into more porous areas or lesions for the practicing dermatologist or dermatologic surgeon. The pragmatic, practical, and inexpensive nature of the surgical looking glass invites its use on a daily basis by the practicing dermatologist.

Background: There are two standard ways to obtain tissue for histologic classification of a clinically suspected basal cell carcinoma: shave and punch biopsy. However, information on the value of each method is limited. Objective: The purpose of this study was to identify accuracy rates of two standard biopsy techniques in diagnosing subtypes of basal cell carcinoma. Methods: A total of 86 cases were identified that had received either a punch or a shave biopsy with subsequent total excision of tumor. The biopsy specimens and excisions were compared for histologic correlation. Results: Analysis of specimens from punch and shave biopsies produced equivalent diagnostic accuracy rates: 80.7% and 75.9%, respectively. There was no statistically significant tendency to overcall or undercall any particular tumor subtype on the basis of the type of biopsy procedure used. Conclusion: For histologic classification of basal cell carcinoma, there is an approximately 80% accuracy rate with both the shave and the punch biopsy. Therefore either biopsy technique is appropriate. (J Am Acad Dermatol 1999;41:69-71.)

Background Although Ixodes ticks are considered the chief vector for Borrelia burgdorferi in the USA, B. burgdorferi has also been identified in mosquitoes, horse flies, and deer flies. We examined the possibility of these organisms being harbored in two species of spider in central Arkansas. Methods Ten wolf spiders (Lycosa gulosa) and two brown recluse spiders (Loxosceles reclusa) were collected in central Arkansas during early summer and fixed in formalin. Paraffin-embedded sections of the spiders were examined for spirochetes using the modified Steiner spirochete staining method and examined for B. burgdorferi using immunohistochemistry. Results All 12 spiders from both species were found to be negative for all spirochetes including B. burgdorferi. Conclusions Spiders in our sample appeared not to harbor B. burgdorferi. Further studies utilizing larger sample sizes, more sensitive testing measures, or spiders from an area more endemic with B. burgdorferi may further prove or disprove that spiders are capable of harboring this organism.

Cellulitis of the skin is most commonly a bacterial infection caused by either staphylococcal or streptococcal species. However, in immunocompromised patients, cellulitis may be a harbinger of more ominous disease. In these patients, rapid clinical diagnosis and treatment is necessary. We describe an immunosuppressed renal transplant recipient with the clinical diagnosis of cryptococcal cellulitis who was found to have a heretofore unreported dermal mucinosis of the upper chest associated with milia. We believe that cyclosporine was a significant pathogenic factor. This entity, which should be included in the clinical differential diagnosis of cryptococcal cellulitis, has a benign nature and does not require treatment.

We report the case of an 84-year-old white male who underwent vermilionectomy for removal of a tumor, which proved to be squamous cell carcinoma. Chelitis glandularis related to marked actinic damage was noted at a subsequent visit. The presence of chelitis glandularis should be investigated for the presence of neoplasia, immunosuppression, or inflammatory diseases related to extremely poor oral hygiene.

Background. Widespread hypopigmented macules are rarely seen in heavily pigmented patients with Darier's disease. Previous hypotheses concerning the cause of decreased pigmentation suggest it is a postinflammatory phenomenon or that the hypomelanosis is evidence of sub-clinical acantholysis. Patients. This report presents 2 patients: a new case of disseminated guttate leukoderma in a black patient with Darier's disease and the first such case in a patient with transient acantholytic dermatosis (Grover's disease). Direct immunofluorescence and electron-microscopic studies were carried out on lesional biopsies. Observations. Numerous small hypopigmented macules were observed in two black patients followed for acantholytic disorders. Three biopsies of the hypopigmented macules revealed acantholysis, while one showed only decreased melanin. Direct immunofluorescence studies were negative. Electron-microscopic studies of the leukodermic macules showed sparse melanocytes and melanosomes that were mostly pigmented stage IV melanosomes. Conclusions. Disseminated guttate leukoderma can occur in transient acantholytic dermatosis, as well as in Darier's disease. It is readily apparent on darkly pigmented skin because of contrast. The etiology of this phenomenon is still unknown.

We describe a patient with trichorhinophalangeal syndrome type I (TRPS-I) who had been previously diagnosed as having anhidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome). The TRPS-I phenotype is characterized by fine, sparse, brittle hair in association with a bulbous pear-shaped nose, tented alae, a long extended philtrum, a thin upper lip, and a horizontal groove on the chin. There may be clinobrachydactyly with ulnar deviation and dystrophic nails. The radiographic findings include cone-shaped epiphyses of the middle phalanges with shortened metacarpals. Genetic findings include deletion of chromosome band 8q24.12. Patients with all variants of TRPS need prompt and accurate assessment because musculoskeletal dysplasia is a universal feature in this syndrome. We review TRPS and similar syndromes to assist the accurate diagnosis of these lifelong maladies. (J Am Acad Dermatol 1994;31:331-6.)

REPORT OF A CASE A 19-year-old mestizo Chippewa Indian woman presented with a lifetime history of a recurrent springtime pruritic eruption on her arms and face. Her father and brother had histories of a similar rash. Physical examination disclosed multiple excoriated erythematous papules on the extensor surfaces of the arms that appeared somewhat urticarial (Fig 1). A small plaque was noted on the right malar area of the face (Fig 2). Cheilitis of the lower lip was present (Fig 3). Laboratory data, including complete blood cell count, blood chemistry, urinalysis, and erythrocyte protoporphyrin levels, were normal. Rapid plasma reagin and antinuclear antibodies were negative. Representative sections of the biopsy specimen are shown in Fig 4. What is your diagnosis? DIAGNOSIS: Polymorphous light eruption (PMLE). HISTOPATHOLOGIC FINDINGS There was marked edema of the papillary dermis, and a dense lymphocytic perivascular infiltrate in the

• Various types of cysts that originate in embryonal remnants may be observed in the neck. Among these, branchial cleft and thyroglossal duct cysts are more commonly observed, whereas thymic cysts are rare. Most patients with a cervical thymic cyst complain of a painless, enlarging mass in the neck. The histopathologic features of thymic cysts are diagnostic. Cystic thymomas, which seem to have a more aggressive clinical behavior in children, should be differentiated from the benign cervical thymic cyst. Thymic cysts most probably arise from embryonic remnants of the thymopharyngeal duct. Our patient had a cervical thymic cyst with neurofibromatosis. ( Arch Dermatol 1982;118:122-124)