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• A patient had papular and nodular cutaneous deposits of mucin and cutaneous and systemic manifestations of lupus erythematosus (LE). Since many of the mucinous deposits occurred at sites that were clinically free of skin lesions of LE, we considered initially that the patient had both LE and papular mucinosis. However, after a review of the English literature and further study of the patient, it seemed more likely that the papular and nodular deposits of mucin were secondary to LE and not a previously unreported simultaneous occurrence of the two diseases in the same patient.To our knowledge, this is the third case report of a patient with papular and nodular cutaneous mucinosis secondary to LE. In addition to the case report, this article is concerned with a discussion of cutaneous mucinosis in LE and other "collagen vascular" diseases.(Arch Dermatol 114:432-435, 1978)

† Herpes simplex usually presents with fairly characteristic skin lesions that are localized to small area. A less well appreciated presentation for herpes simplex is a varicelliform eruption that may be difficult to differentiate from chickenpox. We treated a patient with such an eruption who had systemic lupus erythematosus and was receiving oral prednisone. We also review seven other cases from the literature of varicella-like herpes simplex and discuss the role played by immunosuppression in herpetic infections.(Arch Dermatol 114:406-409, 1978)

• Most dermatologists are familiar with the manifestations of neonatal herpes simplex infections. Few, however, are acquainted with the concept of intrauterine herpes simplex infections.This article describes two additional cases of intrauterine herpes simplex infections with congenital malformations. Common features included intrauterine growth retardation, microcephaly, encephalitis, chorioretinitis, psychomotor retardation, and recurrent, grouped, cutaneous vesicles. Seven similar cases with congenital malformations are reviewed as well as cases of intrauterine herpes simplex infection without congenital malformations.We propose that intrauterine herpes simplex infections be termed "early" when there is evidence of disturbed embryogenesis or "late" when congenital malformations are less specific or inapparent. We further suggest that the spectrum of intrauterine infections is similar to that of neonatally acquired infections.(Arch Dermatol 113:918-922, 1977)

• A persistent shortage of full-time faculty exists in dermatology. Despite the addition of 124 new full-time faculty since 1971 through 1972,136 training programs in 1974 through 1975 were actively seeking 88 new full-time faculty and believed they needed 243. With a net gain of 30 new faculty a year, it will take 2.93 years to add 88 new faculty that are being actively sought and 5.16 years to add 155 more that are urgently needed. During this eight years, demand for new faculty will increase, so that figures of need may remain essentially unchanged in 1982 through 1983 as between 1971 through 1972 and 1974 through 1975. Expertise that was most needed was in immunology, electron microscopy, histopathology, microbiology, and biochemistry; many accept faculty in any area or with no special training. Measures should be taken to attract and retain more dermatologists in full-time academic positions.(Arch Dermatol 113:297-301, 1977)

• Five patients with disseminated cryptococcosis had lesions on the extremities resembling cellulitis, which evolved into areas of blistering and ulceration in three patients. All had underlying disease and were medically immunosuppressed. Disseminated cryptococcosis appears to present with cellulitis or herpes-like vesiculation more commonly than is currently appreciated.India ink preparations of aspirates from areas of cellulitis or Tzanck preparations from blisters may show characteristic organisms, and makes possible an immediate diagnosis of cutaneous cryptococcosis. If cutaneous infection is confirmed by performing biopsies and growing cultures, dissemination must be presumed and the patient treated with a full course of systemic antifungal therapy. With increasing awareness of cutaneous involvement, some cases of disseminated cryptococcosis will be diagnosed sooner, leading to earlier therapy and improved prognosis.(Arch Dermatol 112:1734-1740, 1976)

• We encountered an unusual case of pemphigus foliaceus in which there were early clinical signs of dermatitis herpetiformis with eosinophilic spongiosis histologically. Numerous authors have appreciated that eosinophilic spongiosis occurs in early pemphigus foliaceus, usually in the preacantholytic stage when the lesions may clinically simulate dermatitis herpetiformis. Recognition of eosinophilic spongiosis may help differentiate early pemphigus from other vesiculobullous disorders.(Arch Dermatol 112:1148-1152, 1976)

A woman with cutaneous vasculitis had a severe bullous eruption that was suggestive of erythema multiforme. The patient also had a history of recurrent urticaria that continued intermittently for over a year of follow-up examination. Skin biopsy specimens of both urticarial and erythema and multiforme lesions showed leukocytoclastic vasculitis. An illness resembling systemic lupus erythematosus (SLE) is suggested by transient, lowtiter, positive antinuclear antibody tests, persistent deposits of immunoglobulin and complement in normal skin, arthralgias, circulating immune complexes, and chronic hypocomplementemia.This case is similar to cases previously reported as "hypocomplementemic vasculitis," an "unusual SLE-related syndrome," and "urticaria with vasculitis."(Arch Dermatol 115:76-80, 1979)

A shortage of full-time faculty exists in dermatology. In 1971 through 1972, 62 units were seeking 96 new full-time faculty and 119 units stated they needed 268 new full-time faculty. The areas of expertise most needed in new full-time faculty were immunology, electron microscopy, histopathology, microbiology, and biochemistry. Many flexible units would accept faculty with special training in any area and some units required no special training. Wouldbe full-time faculty members are urged to correspond with any actual or prospective training unit to explore opportunities. Residents and trainees considering full-time academic careers should identify special areas of interest early in their training and acquire expertise in these areas. Studies should be done to devise ways to attract dermatologists into full-time academic positions.

Three patients with long-standing, severe, complicated diabetes mellitus developed skin changes of scleredema adultorum of Buschke. The scleredema showed no tendency to resolve. Acid mucopolysaccharides were demonstrated histochemically in the dermis. The possibility is discussed that there may be some association between diabetes mellitus and scleredema.

An outbreak of contact dermatitis from hydrazine hydrobromide solder flux occurred in an electronics plant. The dermatitis involved exposed skin surfaces, disappeared when the person stopped working, and reappeared when he returned; patch tests were positive in concentrations which were not irritating to controls. Most of the individuals were engaged in soldering when the dermatitis appeared, but once they were sensitized, the dermatitis was kept active by handling contaminated materials.Hydrazine is a primary irritant and a very potent contact sensitizer. It, or its derivatives, is widely used in industry, and apparently this use is increasing. It seems reasonable that dermatitis caused by hydrazine will increase. In addition, there is a good possibility that a number of derivatives of hydrazine will cross-react in their contact sensitivity. Protective measures are extremely important in prevention of toxic or allergic manifestations of hydrazine exposure.The capacity of hydrazine to sensitize a high percentage of persons makes it seem likely that it could be used in experimental study of delayed hypersensitivity.

Five patients in a mental hospital developed a bluish coloration of exposed areas which resembled argyria. All were white women who had taken relatively large amounts (500 to 3,000 mg daily) of chlorpromazine for one to five years. Microscopically, the major abnormal finding was clumps of chromatophores in the dermis containing yellowish-brown pigment which had histochemical characteristics of melanin.

Leukonychia totalis is described in a mother and leukonychia partialis in her two daughters. This is the first report of hereditary leukonychia of two different types in one family. A survey of reported cases of hereditary, congenital, and acquired leukonychia is included.There are four major types of leukonychia: Total, partial, striate, and punctate. All but the punctate type may be congential or hereditary. Inheritance appears to be of the autosomal dominant type.All four forms may be acquired. Total and partial leukonychia usually follow a severe, long-standing systemic disorder or local insult. Leukonychia striata may follow either a relatively short or recurrent systemic disorder or local trauma. Leukonychia punctata is a very common phenomenon and appears to result from periodic minor local trauma to the nail matrix.Pathogenesis of leukonychia is not established with certainty. Opacity of the nail plate due to abnormal keratinization probably is the primary defect.

The importance of those remarkable cytological units, the tissue mast cells, has soared in recent years. This paper reviews briefly some of the newer concepts of these cells and reports on the author's experience with histological techniques for the study of mast cell acid polysaccharides in the cutaneous lesions of urticaria pigmentosa.Some Newer Concepts of Tissue Mast CellsAlthough the distribution of mast cells varies from species to species, their characteristic location in warm-blooded vertebrates is the loose fibrillary tissue which surrounds small blood vessels and underlies epithelial, serous and synovial membranes.1,13 In general, parenchymatous organs are poor in mast cells, a noteworthy exception being the widespread distribution of mast cells throughout the parenchyma of the dog's liver.1 Urticaria pigmentosa, the lesions of which are featured by agglomerations of mast cells, has been known for many years. Only recently, however,

Persons who suffer from recurrent herpes simplex infections have neutralizing or complement-fixing antibodies to herpes simplex virus in their sera, usually in high titer.4,6-9,11-16,18-20 The antibody level in the sera of these patients, according to available evidence,6,9,11-16,19 does not fluctuate in response to the recurrent infection. (The anibody level is as high before the recurrence as it is during or after.) These observations suggest that a high level of specific antibody in the serum is incapable of eradicating the herpes virus even though it may limit its spread.The influence of specific antibody upon the course of experimental herpes infections in tissue cultures has been studied by two groups of investigators. Andrewes3 showed that herpes simplex infections could develop in tissue cultures in the presence of specific antibody providing the virus was added one-half hour before the addition of the antibody. Black and

Milkers' nodules is a self-limited, inflammatory disease which is characterized by the appearance of nodules on the exposed skin surfaces of persons who milk cows. Important features in a consideration of the etiology of the disease will be presented in this report in the following order:(1) historical note; (2) clinical and epidemiological features of milkers' nodules which suggest its etiology; (3) relationship of milkers' nodules to vaccinia; (4) attempts to transmit milkers' nodules experimentally; (5) comment, and (6) summary and conclusions.1. Historical NoteA. Spurious (or False) Cowpox.—The writings of Edward Jenner suggests that the disease which is now called milkers' nodules was either identical with or included in the disorder (or disorders) which Jenner called spurious cowpox. Jenner discussed the subject of spurious cowpox in four of his major writings and in several letters to his contemporaries.7,16

GYNECOMASTIA is known to occur in conjunction with a variety of diseases, including testicular tumor, hepatic cirrhosis and hepatitis, bronchogenic carcinoma, lung abscess, carcinoma of the adrenal cortex, transverse myelitis, hyperthyroidism, and chronic ulcerative colitis.1 In addition, gynecomastia is a common manifestation of puberty and starvation, and it can be produced by the administration of certain hormones, including estradiol, diethylstilbestrol (Stilbestrol), methyltestosterone, desoxycorticosterone acetate, adrenal cortex extract, and chorionic gonadotropin.2The purpose of this paper is (a) to report seven patients in whom gynecomastia developed in conjunction with generalized dermatologic disorders, (b) to discuss briefly the etiology of gynecomastia, and (c) to consider the significance of gynecomastia when it occurs in association with generalized cutaneous diseases.REPORT OF CASESCase 1.—Generalized Atopic DermatitisThis patient, a white man, had atopic dermatitis during the summer months only when between the ages of 9 and

Infection of the skin with herpes simplex assumes a variety of forms which are classified as either primary or recurrent.1 Primary infection is the initial infection, whereas recurrent disease represents activation of a herpetic focus which has lain dormant for weeks, months, or sometimes years.Cutaneous involvement in primary herpes simplex may accompany gingivostomatitis, keratoconjunctivitis, vulvovaginitis, balanitis, or urethritis.1 In visceral herpes of the newborn, hepatitis of the malnourished, or herpetic meningoencephalitis, skin lesions are too inconspicuous and occur too infrequently to be of much diagnostic value.1-4 Localized primary infections in which the skin is the portal of entry are probably most common on the hand, especially about the fingers, although they may occur anywhere. The so-called herpetic whitlow is a special hazard for dentists, nurses, and physicians who work about the mouths of persons who harbor the virus.5,6 Primary Kaposi's varicelliform eruption is a generalized

ORIGINALLY believed to be an excessively rare heredofamilial disorder, Werner's syndrome has been recognized with increasing frequency in recent years. The syndrome is featured by the unique combination of physical immaturity, early senescence, premature cataracts, scleroderma-like skin changes, and a tendency toward development of diabetes mellitus.1 This multiplicity of clinical manifestations makes Werner's syndrome of interest to physicians in various branches of medicine.2The varied components of Werner's syndrome do not appear in an orderly sequence and not all cases exemplify the syndrome in its entirety.3 Evidences of physical immaturity in Werner's syndrome are the short stature, slender, tapering extremities, and stocky trunk surmounted by a protuberant abdomen.4 Underdevelopment of the genitalia, as well as menstrual disturbances and a low degree of fertility, occurs commonly as part of the syndrome.5 Signs of premature senescence appear in the third or fourth decade.4 These include dry, wrinkled skin, gray hair,8 cataracts, a

• Rocky Mountain spotted fever was diagnosed in 74 patients at the University of Virginia Hospital from 1945 through 1954. During the same 10-year period the total number of cases reported in Virginia was 744 and the total for the United States was 4,517. Four case histories are given to illustrate the course of the disease, the history of exposure to tick bites, the recovery of youthful patients without specific treatment, and the fatal outcome in an older patient despite treatment. Persistent fever and a cutaneous eruption were the earliest dependable clinical findings suggesting the diagnosis. Among diagnostic tests, the Proteus-agglutination reaction is the most widely used, and the results were almost always positive by the 10th to 15th day of the disease. Treatment should be undertaken promptly without waiting for final diagnosis. The advent of the antibiotics, particularly chlortetracycline hydrochloride, oxytetracycline, and chloramphenicol, has greatly improved the prognosis.

Fatal pulmonary herpes simplex of the newborn was acquired during passage through the birth canal of a mother with primary herpetic vulvovaginitis. Administration of gamma globulin to the mother before delivery and to the infant after delivery failed to prevent the disease in the infant or to alter its fatal course. Vulvovaginitis in the mother did not appear to be altered. Gamma globulin given to mother and infant contained significant amounts of herpes-neutralizing antibody and low, yet easily detectable, titers were present in the infant's serum. The probability that premature and newborn infants will develop serious or fatal herpes simplex infection after exposure makes it necessary to isolate these infants from persons with known herpes simplex. In addition to large doses of gamma globulin, cesarian section should be considered in future instances of this type.

Two cases of eczema herpeticum are reported. Because of widespread vesicular eruption, high fever, and severe, prolonged disease both were thought to be primary infections. Laboratory examination found one to be a primary infection and the other recurrent. This emphasizes the necessity for laboratory study in differentiation of these two types of eczema herpeticum. In the infant there was no apparent influence of 77 ml of γ-globulin given in eight day's time on the course of a primary infection despite significant herpes neutralizing titers in the γ-globulin and in the child's serum. Severe and extensive eczema herpeticum developed in an adult despite high neutralizing antibody content of her serum. Although conventional neutralizing antibody probably plays some role in cure or control of herpes simplex infections, other largely unknown mechanisms may be equally important.

One of the important consequences of accidental inoculation of the vaccinia virus into the skin, mucous membranes, or cornea is a localized regional infection, called localized accidental vaccinia. Localized accidental vaccinia occurring in unusual sites or modified in appearance by localization on mucous membranes may at times present a confusing clinical picture. The observation of several children with localized accidental vaccinia led to the present report which will be presented in the following order: (1) Report of Cases, (2) General Features of Localized Accidental Vaccinia, (3) Features of Localized Accidental Vaccinia Involving Special Sites, (4) Comment, (5) Summary. REPORT OF CASES CASE 1.— A Negro girl, age 5, was seen on Nov. 2, 1958, because of painful vulvar lesions and pain on urination. Symptoms were of three days' duration. The vulva was edematous and there were 12 painful lesions on the labia majora, labia minora, and posterior fourchet. The lesions, which

Hydroa aestivale is characterized by the occurrence during the spring and summer months of polymorphous lesions on the exposed skin of persons who are usually in the younger age group. The lesions include macules, papules, vesicles, blebs, eczematous patches, and wheal-like areas, and the sites of predilection are the face, ears, neck, hands, and forearms. Several separate areas of skin are usually involved rather than diffuse involvement of large exposed regions. Some of the lesions, especially the blebs, become crusted and heal with vaccinia-like scars. Although there is some controversy in regard to the sex incidence,* males seem to predominate.5 The disorder frequently improves or disappears at puberty although persistence into the fourth or fifth decade has been recorded. (We suspect that some of the older patients may have had porphyria.) Another symptom complex, hydroa vacciniforme, is regarded by some authors as only a more severe form of hydroa

In a previous study9,10 HeLa cultures were inoculated with herpes simplex virus and nourished with growth medium which contained neutralizing antibody. These cultures could be serially subcultured without loss of the cells or elimination of the virus as long as the growth medium contained a high level of neutralizing antibody. At the 17th subculture of one group of cultures it was noted that the appearance of the plaques of infected cells had changed. The plaque was no longer made up of small multinucleated giant cells and rounded cells lying singly or in clumps but was composed almost entirely of a plaque of large multinucleated syncytial giant cells. Since preliminary cross neutralization tests indicated the virus which produced the syncytial giant-cell plaque was herpes simplex virus, it was decided to study this strain in more detail.The history of the origin of the syncytial giant-cell-forming strain of herpes virus follows

Developmental anomalies of the branchial apparatus appear as cysts, sinuses, and skin tabs containing cartilage.14 These anomalies usually present on or near the skin surface in a line extending from a point anterior to the external ear to the anterior border of the sternomastoid muscle at the level of the angle of the mandible and thence along the anterior border of this muscle to a point near its attachment to the sternum.5 In the following discussion, anomalies which are found near the ear will be excluded, and only the cysts, sinuses, and skin tabs which appear in the lateral portion of the neck will be considered.Branchial cysts may be found in the skin or pharyngeal mucosa or at any level between these two structures.2,6 They usually consist of encapsulated collections of fluid which is high in cholesterol, but the contents may at times be chiefly

Recent investigations have demonstrated a notable increase of certain polysaccharides in the cutaneous lesions of myxedema as compared with normal skin.1-3 In the present study Alcian blue (AB), which stains substances believed to be acid mucopolysaccharides,4-6 was combined with the periodic acid-Schiff (PAS) stain, which colors 1,2glycols, for the microscopical examination of normal skin and skin from patients with circumscribed or pretibial myxedema, true myxedema, and lichen myxedematosus.Materials and MethodsFormalin-fixed specimens6 of involved skin from four patients with circumscribed or pretibial myxedema, three with true myxedema, one with lichen myxedematosus, and several of normal skin (all specimens were from adults) were sectioned and treated with the Alcian blue-periodic acidSchiff combination (AB-PAS) according to the technique of Mowry.7ObservationsMowry's fundamental work with Alcian blue alone and in combination with other stains6-8 has demonstrated that the AB-PAS combination stains

Ecthyma contagiosum, also known as orf* and ovine pustular dermatitis, is a virus disease of sheep and goats which is occasionally transmitted to man. The purpose of this communication is to (a) report the occurrence of ecthyma contagiosum in an 18-year-old woman; (b) describe the disease as it occurs in man, and (c) consider briefly the salient features of the disorder in animals.REPORT OF A CASEM. L., an 18-year-old white woman, was admitted on the Dermatology Service of the University of Virginia Hospital on May 9, 1953, because of a lesion on the dorsum of the right forearm near the wrist. The patient had scratched the site three weeks previously on a wire fence that constituted a pen for pet lambs. The scratch appeared to be healing in the usual manner, but erythema and slight elevation appeared in it approximately one week after the

INFRARED spectroscopy has been successfully applied to a multitude of qualitative and quantitative analyses and investigations in the fields of chemistry and physics over a period of several years. Infrared spectroscopic studies in the fields of medicine and biology are of recent inception, by way of comparison. Pigmented skin tumors were examined in the infrared spectrometer during the course of this investigation, the objective of which was to study the infrared transmission and absorption of these lesions in the region of 2 to 16 μ. In succeeding paragraphs will be presented first an introduction to the subject of infrared spectroscopy, followed by an account of its use in the study of pigmented skin tumors.INFRARED SPECTROSCOPYThe infrared spectrometer is a physical tool which is used for measuring and recording the infrared transmission and absorption of solids, liquids, and gases,1 while the procedure itself is referred to as