Faculty Bibliography

Changes of hyperpigmentation and depigmentation in systemic scleroderma have been known since the last century, but their relationship to the pathogenesis of the condition is poorly understood. Clinical, histologic, histochemical, immunopathologic, and electron microscopic studies of the depigmented lesions in seven patients with systemic scleroderma demonstrated changes similar to those of vitiligo, but with subtle differences. Immunologic mechanisms seem to be involved in the induction of depigmentation in both vitiligo and systemic scleroderma.

Complete endocrinologic evaluation of 9 women (ages 24-41) with idiopathic melasma (melasma not associated with pregnancy nor ingestion of oral contraceptives) was performed and compared to age- and sex-matched normal controls. Serum cortisol, adrenocorticotropin, plasma immunoreactive alpha and beta melanocyte-stimulating hormones, luteinizing hormone, follicular-stimulating hormone, estradiol and progesterone levels were performed in the basal state. Additionally, total T4, T3RU, FTI, prolactin, 2-h postprandial blood sugar, and 24-h urine for 17-hydroxysteroids and 17-ketosteroids were done and found to be normal. The melasma patients presented statistically significant increased levels of LH (p less than 0.001) and lower levels of serum estradiol (p less than 0.025) than normal controls. It is proposed that these hormonal alterations may represent subclinical evidence of a mild ovarian dysfunction which may underlie the pathogenesis of some cases of idiopathic melasma.

A double-blind study comparing a broad-spectrum sunscreen agent with its vehicle in the treatment of melasma was performed in fifty-three patients who were concomitantly using a depigmentating solution. In this study, 96.2 percent of those who used the sunscreen agent showed improvement as compared with 80.7 percent of those who used placebo. These results confirm the positive role of sun protection in the treatment of melasma and also establish hydroquinone as a major therapeutic agent in pigmentary disorders.

Four cases of a new entity characterized by papules that are smooth in surface and unchanged in color on the aural conchae are reported. Histologically they are characterized by sclerotic and hyalinized masses within thickened dermis and by special stains and electron microscopy are revealed to consist of altered collagen.

Three cases of congenital acral melanocytic nevi with unusual clinical characteristics are reported. In all of the cases the surface changes and their growth were clinically suggestive of acral lentiginous melanoma, but biopsies revealed their benign nature. This exceptional presentation of congenital acral melanocytic nevi merits recognition by physicians and underscores the need for histologic diagnosis prior to definitive surgery in any cases suspected of being malignant melanoma.