Introduction The purpose of this article is twofold: first, to summarize briefly those important aspects of serotonin metabolism which may interest the dermatologist; second, to present some observations we have made on the differences in response to intradermal injection of serotonin in the skin of normal adults as compared to the skin of people with atopic dermatitis. As long ago as 1914, Masson presented the idea that cells in the wall of the intestines, which he termed argentaffin cells, might belong to an endocrine system similar to the chromaffin tissue of the adrenal medulla but differing in that the argentaffin cells are dispersed and do not form one organ.1This was perhaps the starting point of knowledge concerning the substance we now term serotonin (5-hydroxytryptamine, 5-HT, HT, 5-HTA, and Enteramine). It was not until 1948 that this physiologically active agent was successfully isolated by Rapport,
A persistent penile plaque without skin involvement elsewhere on the body presents a puzzling problem. One must rule out erythroplasia of Queyrat by biopsy, since benign lesions may clinically give the same appearance. Blau and Hyman 1 point out that three diagnoses can be made histopathologically. They are Bowen's disease of mucous membrane (erythroplasia of Queyrat), benign inflammatory dermatoses of the mucous membrane, or plasmacytoma penis. Fournier and Darier, 2 in their original description of erythroplasia, separated the disease into a benign and malignant type, depending on the presence or absence of malignant dyskeratoses. Nevertheless, the term erythroplasia has become synonymous with precancerous lesion requiring radical removal. Sachs and Sachs, 3,4 although retaining the term, have successfully treated lesions with neoarsphenamine topically, thus denoting the benign character of the lesions. Sulzberger, 5 in his excellent article on persistent penile plaques, gives the history of
In previous papersl'`' we reported that there is a specific and constant excretion of 2,5-dihydroxyphenylpyruvic acid (2,5-DHPPA), an intermediary metabolite of tyrosine, in the urine of the patients with collagen disease, and that low phenylalanine and tyrosine diet gave good results on both their clinical signs and laboratory data.Subsequently, it seemed natural to investigate the excretory behavior of general intermediary metabolites, especially monohydroxyphenyl compounds and homogentisic acid, of phenylalanine and tyrosine in the urine of the patients with collagen disease.Also, as liver is the most important organ to oxidize metabolites of tyrosine, in various liver diseases the same investigations are needed.We determined the excretory level of free tyrosine, p-hydroxyphenylpyruvic acid (p-HPA), p-hydroxyphenyllactic acid (p-HLA), and homogentisic acid (HA) in the spontaneous urine of the patients with collagen disease, liver disease, other miscellaneous diseases, and healthy individuals.Moreover, the influences of p-HPA load test and low phenylalanine and tyrosine diet on the urinary excretion level of these substances were investigated.Experimental.Methods.Quantitative assay of urinary excretory level of monohydroxyphenyl compounds and homogentisic acid per day Free tyrosine.Udenfriend and Cooper's method3?Total hydroxyphenyl compounds (tyrosine, p-HLA, and p-HPA), expressed as tyrosine equivalent.Folin and Ciocalteu's method4' modified by Medes5' and by Levine, Marples, and Gordon 6' Tyrosine and p-HLA.Folin and Ciocalteu's method modified by Medes and by Levin, Marples, and Gordon p-HPA.Expressed as a level which subtracted tyrosine and p-HLA level from total hydroxyphenyl compounds level p-HLA.Expressed as a level which subtracted tyrosine level from tyrosine and p-HLA level HA.Neuberger's iodometric micromethod 7'
A survey of the literature brings to light only four previous cases diagnosed as piedra originating in the U. S. A. This would seem to justify reporting the following case. Report of a Case The child of an "average" urban (Raleigh) family, a white girl of 4 years without siblings, was first seen in July, 1957. Her mother reported that one week previously she had noted "dark objects" attached to several hairs of the "bangs." There were no symptoms and no treatment had been employed. Children in the neighborhood had not had a similar affliction, nor had the patient been on a trip. According to the referring pediatrician, the child had always been in good health except for profound anemia at birth, apparently permanently corrected by one blood transfusion. Normal development had followed and the usual laboratory examinations were normal. Cutaneous Findings.—Cutaneous examination was normal except for the
The literature has been reviewed, and there are no reports of treatment of disseminated granuloma annulare with chloroquine phosphate (Aralen). The therapy of localized granuloma annulare is varied, and the response in each patient is unpredictable. A method of treatment may induce immediate clearing of the lesions of one patient, whereas the identical treatment in another patient will not affect the course of the eruption. Superficial x-ray, intradermal injections of hydrocortisone or prednisolone, solid carbon dioxide (Dry Ice) applied to the lesions, scalpel incisions of the papules, and punch biopsy of a papule have produced involution of the eruption. Spontaneous remission can also occur. Disseminated granuloma annulare has been treated successfully with intramuscular injections of either streptomycin 1 or bismuth. 2 Report of Case A white man, aged 26, first noticed the appearance of skin lesions on his buttocks in April, 1956. Within one
Introduction In 1959 we1reported a previously unrecognized association of Bowen's disease of the skin with primary internal cancer. This scientific exhibit includes data from a much larger group of patients and supports our initial report. Bowen,2in 1912, described 2 patients with atypical epithelial proliferation of the skin. Each patient had a chronic solitary lesion composed of lenticular papules resembling a noduloulcerative syphiloderm. Darier,3in 1914, and Bowen,4in 1915, described multiple, nonelevated, scaly or crusted plaques as a variety of Bowen's disease. Histologically, these lesions were indistinguishable from those reported originally by Bowen.
Disseminated granuloma anulare is a very rare form of this disease. Usually, the skin is involved on light-exposed areas. Most of the lesions are papules. The granulomas lie subepidermal in the upper part of the dermis. The reason for the publication of a typical case of a 57-year-old woman lies in the difficulties of the clinical and histologic diagnosis. Most of the patients are women in the 4th and 7th decade. Often there is an association with diabetes.
The development of lichen planus-like eruptions following medications is common. Gold, arsenic, and quinacrine (Atabrine) are capable of eliciting this type of cutaneous reaction. The lichen planus-like eruptions discussed in this paper appear to differ from those previously reported in that they developed after external exposure to a chemical agent which was not a drug. On Feb. 5, 1958, I had the opportunity of examining a patient presenting an extensive eruption, with residual pigmentation of the hands, forearms, neck, and face. It consisted of pinhead-sized, flat, shiny papules, clinically suggestive of lichen planus. A biopsy confirmed this diagnosis. This patient was engaged in processing color film in a plant in New York City, and he attributed the eruption to his work. Since the diagnosis of lichen planus had been confirmed by histologic examination, the disease was not initially considered as of occupational nature. However, within two months,
Acute sunburn results from overexposure to the erythemogenic rays of sunlight, which are in the spectral range from 2,900 A. to 3,150 A. 1 The following report concerns the short-term treatment of acute sunburn reactions with triamcinolone (Kenacort * ). Fourteen patients with severe sunburn were seen during July, 1958. Thirteen were adults, and one a child aged 11 years. Each adult received 16 mg. of triamcinolone, as an initial dose, followed by 12 mg. in divided doses within the next 18 hours (4 mg. every 6 hours for three doses). Nine patients required no further treatment. The remaining four patients, who were the more severely sunburned, required an additional 12 mg. over the succeeding 18 hours. The child was given an initial dose of 12 mg., followed by an additional 12 mg. in divided doses over the next 18 hours for a total of 24 mg. Results Improvement in each
Subacute Disseminated Lupus Erythematosus with Endarteritis.Presented byDr. John H. EpsteinandDr. Francis J. Sullivan(by invitation). A 14-year-old Nicaraguan school girl developed a facial eruption, purpura, and pain in the right hip in May, 1957. She was treated with atabrine for three months by her local physician and underwent a six-month remission. Severe repeated epistaxis, and normocytic, normochromic anemia developed in November, 1957. She was admitted to San Francisco General Hospital, where two L.E. preparations were positive, and the platelet count was 58,000. Prednisone, 100 mg. and chloroquin, 250 mg. daily. Transfusions were given. Steroids were gradually discontinued, and she did well until April, 1958, when purpura and thrombocytopenia reappeared, and prednisone therapy was reinstituted. She again improved, and steroids were withdrawn over a two-month period. She has since been maintained on chloroquin, 250 mg. daily. Three months ago, discrete, erythematous nodules developed on
In sensitized persons, patch tests with allergens may show a local reaction varying from a mild erythema to erythema with edema, papules, and vesicles. Such reactions are usually graded 1 to 4 plus depending upon the degree of reaction. Patch tests with many primary irritants may show somewhat similar local reactions. In some instances, however, the reactions are so severe as to produce ulcerations. These two commonly observed reaction types, however, do not appear to cover all forms of reactions that occur from patch tests. There exists still another type of patch test reaction which differs in many respects from the above mentioned. Sulzberger and Witten have called attention to a pustular type reaction which, it appears, has escaped general notice, and consequently has not had adequate work-up. These pustular patch test reactions are especially produced by certain salts of heavy metals and halogens. Usually, the pustules are small, measuring
In a recent publication Shelley and Harun1reported that triamcinolone (9-α-fluoro-16-α-hydroxy-prednisolone) has been shown to have a significant temporary supressive effect on psoriasis. While Baer and Witten do not advocate the use of steroids as a routine treatment of psoriasis they did express the hope: ". . .with the development of newer analogues of cortisone it is entirely possible that this situation may change. For example triamcinolone appears to be more effective (in equivalent doses) in the management of psoriasis than the other corticosteroid drugs. Doses as small as 8 to 16 mg. daily may produce striking improvement in psoriasis vulgaris. . . ."2 We have a patient under observation who developed his first lesions of psoriasis while taking prednisone and triamcinolone for intractable asthma. Hence, it would indicate that these steroids could not even suppress the onset of psoriasis. To our knowledge no similar case has
Massive involvement of the skin by a lymphoma occurs infrequently. The following patient is reported because of this interesting manifestation of the disease. Report of a Case A 68-year-old white man was admitted to the hospital on July 30, 1956, with a massive lesion of the face of three weeks' duration and dysphagia of one week's duration. An unknown new growth had been excised from the lower lip about eight years previously. A similar tumor was removed from the same region about four years previously. About two months before admission, a small lesion appeared on the right cheek. The patient was admitted to another hospital, where a biopsy revealed Hodgkin's disease. After a course of mechlorethamine hydrochloride (nitrogen mustard) was given intravenously, he was discharged. Rapid growth of the neoplasm followed. The patient was pale, emaciated, cachetic, and alert. A large nodular lesion covered the right side
A neurilemmoma or Schwann cell tumor is a distinctive nerve sheath tumor, characterized histologically by the regimentation of its cells. It is probably seen more commonly by surgeons than by dermatologists. While dermatology texts refer to it, no original article was found in the American dermatologic literature of the past 20 years. The following is a synopsis of statements found in several books. 1-10 Neurilemmomas usually are solitary and affect women more frequently than men in a mean ratio of about 7:4, 11,12 without particular affinity for any age group. They occur commonly on the cranial nerves (except the olfactory and optic), with the acoustic nerve being the one most frequently affected in its vestibular branch. When peripheral neurilemmomas are found, they are seen to occur on nerves in the scalp, face, sides of the neck, tongue, flexures of the arms, wrists, knees and
