Faculty Bibliography

Skin biopsy specimens from four patients with erythema nodosum leprosum, when examined as Epon-embedded, 1-micron sections, exhibited a necrotizing vasculitis involving capillaries, venules, and small-to-medium arteries and veins. In the superficial dermis, affected venules and capillaries showed endothelial cell enlargement and focal necrosis associated with perivascular infiltrates of lymphocytes. In the deep dermis and subcutaneous tissue, affected venules, arterioles, and arteries exhibited endothelial cell necrosis and matted fibrin in the vessel walls associated with perivascular infiltrates of neutrophils. Throughout the dermis, mononuclear phagocytes with vacuoles containing numerous fragmented organisms were observed. By electron microscopy, electron-dense material resembling immune complexes was observed in the walls of these vessels. These observations support the concept that erythema nodosum leprosum is an immune complex-mediated necrotizing vasculitis involving capillaries, arterioles, arteries, venules, and veins

This is a report of the histopathologic findings of melanocytic nevi in patients with oculocutaneous albinism. Seven albino patients, four tyrosinase positive and three tyrosinase negative, with a total of 34 melanocytic lesions were available for examination. The specimens were examined histopathologically for the presence of intranuclear pseudoinclusions, giant melanocytic cells, eosinophilic globules, features of congenital nevi, and atypical changes. A statistically significant increased number of giant melanocytic cells were found in intradermal nevi (p less than 0.0025), compound nevi (p less than 0.01), and junctional nevi of the patients with albinism compared with controls. Eosinophilic globules were found in 17% of the 34 nevi, and congenital features in 8.8%. All lesions showed adequate maturation of cells with no atypical changes. Marked solar elastosis was found in the dermis around and beneath the nevi, even though most lesions were in covered areas.

A study of the causative agents of tinea corporis and pedis in Puerto Rico in 1982 disclosed four different dermatophytes from a total of 97 cases. Among the total of 49 fungus specimens collected in tinea corporis, the mycologic flora consisted of four different fungus species: Trichophyton rubrum, 42 isolates (85.7%); Epidermophyton floccosum, 4 (8.1%); Trichophyton mentagrophytes, 2 (4%); and Microsporum ferrugineum, 1 (2%). Among the total of 48 fungus specimens collected in tinea pedis, the mycologic flora consisted of 3 different fungus species as follows: T. rubrum, 35 isolates (72.9%); T. mentagrophytes 8 (16.6%); and E. floccosum, 5 (10.4%). Trichophyton rubrum caused 77 of 97 fungal isolates (79.3%). One surprising finding was the isolation of M. ferrugineum in a case of tinea corporis, documenting the first autochtonous case of this species in the island. This dermatophyte had previously been known only in Japan and adjacent areas of the Far East, Southern Europe, and Africa.

The safety of topical selenium sulfide lotion in man has been demonstrated previously. Twenty male patients with a diagnosis of tinea versicolor were randomly assigned to two parallel groups who applied selenium sulfide lotion or the vehicle to the entire skin surface, excluding mucous membranes, for 10 minutes once daily for 7 consecutive days. Blood and urine selenium levels were determined before and after treatment and showed no significant differences between the active drug and vehicle groups on any study day. It would appear that no significant absorption of selenium took place as a result of this treatment regimen.

Selenium sulfide (2.5%) lotion applied daily for 10 minutes for 7 consecutive days was found to be an effective therapeutic agent, significantly superior to the vehicle, in a double-blind study in the treatment of tinea versicolor. Mild transitory contact dermatitis of the primary irritant type occurred in all the treatment groups and was apparently due to the detergent base.

Two patients with lepromatous leprosy were treated with weekly intra-venous infusions of leukocyte concentrates for a period of 12 consecutive weeks. A reversal reaction was induced in one of the patients, and it was possible to control chronic erythema nodosum leprosum in the other subject. Possible pathogenetic mechanisms involved in the induction of these changes include the action of transfer factor, interactions between B- and T-lymphocytes or the mediation of a lymphokine necessary for the effective function of the cell-mediated immunity. Immunotherapy for chronic infections, such as leprosy, still has not become a reality.

Nineteen Puerto Rican patients with malignant melanomas in volar and subungual areas were evaluated to define their clinical and histologic characteristics. Ten were male and nine female, with an age span of 36 to 113 years and a median age of 71 years. Sixteen of the lesions were located on the soles or heels of the feet, and three were subungual. Histologically, all nineteen patients exhibited a radial growth phase diagnostic of acral lentiginous melanoma, and twelve of nineteen were Clark's level IV or V. Tumor thickness fluctuated between 0.27 mm and 13.6 mm, with a total of twelve lesions greater than 6 mm. Eleven patients had regional lymph node enlargement at the time of diagnosis; two had regional skin metastasis and one had metastasis to the liver. Survivals ranged from 7 months to 7 years, with an average duration of 2.76 years and an overall mortality of 66% in those patients after a 3-year follow-up. Based on this study, we conclude that the biologic behavior of acral lentiginous melanoma in Puerto Ricans is similar to that reported in other series, with most of the lesions being deeply invasive and correlating with a poor prognosis.

Three hundred eighty-nine pregnant women were interviewed and examined for the purpose of determining the incidence and quality of changes that may have occurred in their pigmented cutaneous lesions during their pregnancies. Somewhat more than 10% of them reported changes had occurred in their pigmented lesions, most in the first trimester of pregnancy. However, in 26 lesions that had been biopsied, no significant histologic changes were found when compared with comparable pigmented lesions from age-matched women who were not pregnant.

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.