Faculty Bibliography

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Except for urticarial vasculitis, histopathological studies on the different types of urticaria are scant in the medical literature. With the purpose of evaluating the histopathological changes that occur in chronic urticarial eruptions, and to correlate the histopathological findings with the clinical presentation of the patients, skin biopsy studies were done in 36 patients with chronic urticaria. Three well-defined histopathological patterns were found: namely neutrophilic, lymphocytic, and mixed type. No cases of vasculitis were found. No specific association to the clinical presentation of the patient was found.

BACKGROUND: Controversy still exists as to whether dermatophytic skin infection is truly more common in patients with diabetes. OBJECTIVE: The purpose of this study was to determine the true prevalence of dermatophytosis in diabetic patients as compared with a control population. METHODS: One hundred consecutive diabetic patients were examined for evidence of fungal disease of the skin and compared with nondiabetic, nonimmunocompromised patients. Potassium hydroxide preparation and fungal cultures were obtained from all suspect lesions. RESULTS: Thirty-one percent of the diabetic population had culture-proven fungal infections compared with 33% of the control group. The organism most commonly isolated was Trichophyton rubrum in both groups, and the feet were the most common site of infection. Candida albicans was more prevalent in the control group, affecting the nails in particular (24% vs 15% in the diabetic patients). CONCLUSION: This study shows that there does not seem to be an increased prevalence of dermatophytosis in diabetic patients as compared with a control, nondiabetic patient.

Cutaneous lesions can be a significant problem in kidney transplant recipients. Factors such as climate and skin types have been implicated as modifiers of these clinical manifestations. With the purpose of determining the prevalence and clinical spectrum of skin diseases in a group of Hispanic kidney transplant recipients in a tropical climate, 82 serial unselected patients were examined. Seventy-eight were found to have some type of skin disease. Infections of the skin were the most common, followed by drug-induced changes and malignant or premalignant cutaneous tumors. Except for the preponderance of superficial mycotic infections, the overall results in our population are in agreement with other series.

Persons who sunbathe or engage in other activities at the beach are exposed to large amounts of UV radiation. Four hundred seven adults who visited the beaches of Puerto Rico were surveyed to determine their knowledge about the risks of sun exposure and to evaluate sunscreen use. The group consisted of 195 year-round Puerto Rican residents and 212 tourists. Ninety-five percent believed that the sun can cause skin cancer, although only half of the subset who lived all year in Puerto Rico believed that they personally received enough exposure to be at risk. The majority of the group (83%) understood the meaning of the sun protection factor numbers, although 35% used either nothing or a nonscreening oil. Half of Puerto Rican residents rarely or never used sunscreen protection while sunbathing. When sunscreen was used, the most important factor sought was given as sun protection factor (64%), followed by a perceived ability to aid in tanning (26%).

Morphea and lichen sclerosus et atrophicus are cutaneous diseases that are manifest by an early edematous stage, followed later by sclerosis and atrophy. They share features with acrodermatitis chronica atrophicans and erythema chronicum migrans, diseases that have been linked to infection by the spirochete Borrelia burgdorferi. A modified silver stain was used to identify the presence of spirochetes in skin biopsy specimens of patients with morphea and lichen sclerosus et atrophicus. Spirochetal forms were identified in the lesional skin of 10 of 25 patients with morphea and in 10 of 21 cases of lichen sclerosus et atrophicus. These spiral forms of bacteria had a significant tendency to occur in early and fully developed lesions of morphea and in early lesions of lichen sclerosus et atrophicus, whereas they tended to be absent in lesions demonstrating late pathological changes.

Tender erythematous nodules and plaques developed on the abdomen and legs of two women, 45 and 48 years of age, with hyperparathyroidism as a result of chronic renal failure caused by polycystic kidney disease. The histopathologic findings of these lesions were characterized by a calcifying panniculitis. Laboratory tests disclosed normal calcium levels and hyperphosphatemia with an elevated level of calcium phosphate product. Calciphylaxis appeared to be the mechanism of soft tissue calcification in these patients.

Three cases of rheumatoid neutrophilic dermatitis, a specific entity that occurs in association with rheumatoid arthritis, are presented. Clinically, the condition presents as papules and nodules on the dorsal aspect of the fingers, the extensor aspect of the forearms, and the thighs. Like some other neutrophilic dermatitides, it is characterized histologically by a dense, diffuse infiltrate of neutrophils throughout the dermis. The cause of this neutrophilic infiltrate is not known.