Urticaria pigmentosa is a rare disease characterized by increase in mast cell numbers. It has been recognized for over 100 years, and there has been an increasing awareness of the importance of mast cells in health and disease. It is clear that the mast cells participate in a variety of processes through the release of preformed mediators such as histamine, protease, and heparin and the generation of leukotrienes and other lipid-derived substances. Patients with the benign and indolent forms of urticaria pigmentosa lead normal lives with proper medical control of their symptoms. Few have an aggressive form of systemic mastocytosis and have a poor prognosis. The non-sedative HI antihistamines have greatly improved the daily relief of pruritus. Intralesional, oral, and topical steroids provide significant periods of remission for some patients. The mast cell “stabilizing” drug oral disodium cromolyn is somewhat effective for systemic symptoms but has been less effective relieving pruritus and whealing. Trauma avoidance, environmental stability, and abstinence from opiates and aspirin continue to be central to the care of these patients.

BACKGROUND:Papulonecrotic tuberculid is a rarely reported cutaneous reaction to the mycobacterium bacillus. It is most often encountered in association with tuberculosis. The clinical and histologic picture of the entity is a distinctive one, but the etiology of the disease process is uncertain. Therapy directed against the causative organism is dramatically successful.METHODS:A 35-year-old white man with AIDS was referred to the Dermatology clinic for evaluation of a widespread skin eruption. The skin lesions were biopsied for histopathology and culture. From the cutaneous cultures Mycobacterium avium complex (MAC) organisms were grown.RESULTS:We report the first case of papulonecrotic tuberculid manifestation in an AIDS patient with disseminated MAC. Unusual features seen in this case include the predominance of pruritic eschars rather than asymptomatic papules and the confirmation by special stains of mycobacterium organisms within the skin biopsy. Papulonecrotic tuberculid has not been previously associated with either MAC or AIDS.CONCLUSIONS:Papulonecrotic tuberculid should be a diagnostic consideration in immunocompromised patients with MAC whose clinical and histologic features are compatible with this rare entity.

BACKGROUND Women generally regard their hair loss as socially unacceptable and go to great measures to conceal their problem. In some cases, the negative self-image brought about by hair loss may be the basis of psychiatric illness. The purpose of this study was to evaluate a 2% topical minoxidil solution (Rogaine/Regaine, The Upjohn Co, Kalamazoo, Mich) for the treatment of female androgenetic alopecia. A 32-week, double-blind, placebo-controlled trial was conducted in 11 US centers. Three hundred eight women with androgenetic alopecia were enrolled. Two hundred fifty-six of these women completed the trial. A refined photographic technique was used to objectively determine the number of nonvellus hairs regrown. RESULTS After 32 weeks of treatment, the number of nonvellus hairs in a 1-cm2 evaluation site was increased by an average of 23 hairs in the 2% minoxidil group and by an average of 11 hairs in the placebo group. The 95% confidence interval for the difference in mean hair count change between the treatment groups was 5.9 to 17.5 hairs. The investigators determined that 13% in the minoxidil-treated group had moderate growth and 50% had minimal growth. This compared with 6% and 33%, respectively, in the placebo-treated group. Similarly, 60% of the patients in the 2% minoxidil group reported that they had new hair growth (20% moderate, 40% minimal) compared with 40% (7% moderate, 33% minimal) of the patients in the placebo group. No evaluations of dense hair growth were reported for either treatment group. No clinically significant changes in vital signs were observed and no serious or unexpected medical events were reported. CONCLUSIONS Topical minoxidil was significantly more effective than placebo in the treatment of female androgenetic alopecia.

Background. Chronic myelomonocytic leukemia has been associated with various nonspecific cutaneous manifestations. Rarely has the leukemia been reported to directly affect the skin. Methods . This case documents the progression of a patient who ultimately developed chronic myelomonocytic leukemia, by clinical examination, hematologic parameters, dermatopathology, and bone marrow pathology. Results . The skin showed nonspecific cutaneous involvement, progressing to specific leukemic lesions parallel with increasing systemic and hematologic involvement. Conclusions . Chronic myelomonocytic leukemia can manifest with lesions of leukemia cutis. The possibility of nonspecific cutaneous involvement in the preleukemic phase exists.

Background: Interleukin 4 is one of many cytokines under investigation about its possible role in the pathogenesis and treatment of disease. Transient acantholytic dermatosis is of uncertain origin. It has not previously been linked to drug ingestion and is generally not believed to have an immunologic basis.Objective: Our purpose was to describe the clinical characteristics and histologic features of a cutaneous eruption caused by interleukin 4.Methods: Three patients in whom an eruption developed after they received intravenous recombinant human interleukin 4 were examined and biopsy specimens were evaluated.Results: These patients had a pruritic papulovesicular eruption that was consistent, both clinically and histologically, with transient acantholytic dermatosis. None of the other conditions believed to precipitate transient acantholytic dermatosis was present in our patients.Conclusion: This is the first report of a cutaneous side effect of interleukin 4. This may be antibody-mediated or related to increased production of tissue-type plasminogen activator.

A review of the literature reveals that of the eight reported cases of patients with acquired immunodeficiency syndrome acquiring Norwegian scabies, three of these have been complicated by sepsis. We describe such a patient who contracted sepsis from Pseudomonas aeruginosa. We propose that the fissures often seen in severe cases of Norwegian scabies may serve as a port of entry for bacteria, thus placing these patients at a high risk for sepsis. We also believe that empiric antibiotic treatment is justified in these patients and that the choice of agent should be based on the institution's bacterial flora profile.

A randomized double-blind trial of topical minoxidil was carried out during a 12-month period in 56 patients with male pattern baldness. Subjects were randomly assigned to treatment with either 2% minoxidil solution, 3% minoxidil solution, or placebo. The placebo group was switched to 3% minoxidil after the first 4 months. Subjects using the 2% and 3% solutions of minoxidil showed a significant change in terminal and indeterminate hair counts (p less than 0.05) from the placebo group at 4 months. A progressive decrease in vellus hair counts with a concomitant increase in both indeterminate and terminal hair counts was noted during the 12-month period, suggesting that minoxidil applied topically partially reverses the balding phenomenon.

Twenty-five women fulfilling the criteria for female alopecia, of either the male pattern baldness type or female pattern baldness type, were evaluated for hormone markers to delineate the clinical baldness patterns. Women with a marked increase in the 3 alpha,17 beta-androstanediol glucuronide/sex hormone binding globulin ratio and low serum sex hormone binding globulin were noted to have female pattern baldness. This pattern of baldness may represent hair loss from the influence of minimal androgen excess on genetically sensitive hair bulbs in the absence of other signs of maximal androgen excess, including hirsutism, acne, or virilism.

A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.

Two representative cases of familial Muir-Torre syndrome are presented. Multiple benign sebaceous neoplasms in both cases and a solitary keratoacanthoma in one were successfully treated with oral isotretinoin. Low-dose maintenance therapy has stabilized the cutaneous manifestations in the two patients, and no new epithelial neoplasms have appeared. This report emphasizes (1) the rationale for the use of isotretinoin in the Muir-Torre syndrome and (2) the potential for a familial pattern of inheritance and a possible association with the cancer family syndrome. It speculates on the prevention of future internal malignancies in Muir-Torre syndrome patients by maintenance oral isotretinoin treatment.

We have presented a case of acroangiodermatitis, a rare and sometimes asymptomatic disorder which may signal the presence of an arteriovenous malformation. We have discussed the histologic differentiation from Kaposi's sarcoma.

A 16-year-old girl with congenital unilateral punctate porokeratosis is described. The clinical and histopathologic findings are presented. The various clinical forms of porokeratosis and the differential diagnosis of this type of lesion are discussed. To our knowledge, this is the first case of congenital unilateral punctate porokeratosis to be reported.

A case of premature sebaceous gland hyperplasia of the face in a young man is described. The clinical and histologic differentiation from other papulonodular facial lesions is discussed. A case of premature sebaceous gland hyperplasia of the face in a young man is described. The clinical and histologic differentiation from other papulonodular facial lesions is discussed.

ABSTRACT: A 31‐year‐old man developed sudden “whitening” of scalp and body hair. There may be a relationship to alopecia areata and its pathogenesis.

The case of a 45-year-old Latin American man, who presented to the Dermatology Clinic with a 6-month history of hyperkeratotic lesions confined to the palms and the palmar aspects of the digits of both hands, is discussed. Biopsy of these lesions revealed the classic histologic findings of mycosis fungoides. The clinical and histologic differential diagnosis of mycosis fungoides is considered.