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Objective To compare physician and patient impressions and interphysician diagnostic agreement between live teledermatology and in-person examinations. Design Paired video and in-person examinations with different dermatologists. Setting An urban Veterans Affairs dermatology clinic. Patients One hundred thirty-nine patients. Main Outcome Measures Satisfaction questionnaires and interphysician diagnostic agreement. Results Patient and physician satisfaction was high. Agreement between video and in-person diagnoses was 80%. Conclusions Physicians and patients were satisfied with teledermatology examinations. Diagnostic agreement between in-person and video dermatologists was high.

Invisible marine organisms episodically inflict nuisance cutaneous stings on oceanic bathers. An example is seabather's eruption, which was recently found to be produced by injuries from swarms ofLinuche unguiculatajellyfish planula larvae, off the southeast Florida Atlantic coast between midMay and mid-June.1This particular disease was thought to be caused by many forms of marine life, including coelenterates. Report of a Case. Between December 26 and 28, 1994, from Boca Raton to Pompano Beach, Fla, numerous instances of minor cutaneous stings and irritations were reported during daylight hours. Very few swimmers exhibited an eruption. One 6-year-old healthy boy had four 2- to 4-cm linear erythematous urticarial lesions across his torso and thigh. At that time, small 1- to 2-mm-diameter, slightly opaque strips of coiled tissue with black dotted centers were also seen in the surf. Microscopic examination of these structures revealed fragments of tentacles containing bean-shaped spirocysts and

Five new cases of lymphomatoid papulosis are reported. This entity can apparently be divided into at least two subtypes. In one group of patients, papulopustular lesions resembling those of pityriasis lichenoides develop that resolve spontaneously within a few weeks. The lesions contain an epidermotropic dermal infiltration composed predominantly of abnormal lymphocytes. The other group of patients displays larger, more persistent lesions that contain a nonepidermotropic dermal infiltration composed predominantly of histiocytes. Lymphoma eventually develops in about 10% of the patients with lymphomatoid papulosis.

Since the demonstration by Whitby 1 of the effectiveness of sulfapyridine against pneumococcic infections in mice, many clinical reports have shown that the drug is of definite value in the treatment of pneumonia in man. It appears that the mortality rate from pneumonia in both children and adults is reduced when sulfapyridine is used. 2 Reports have appeared which indicate that the drug may be of value also in pneumococcic meningitis. 3 However, the number of cases thus far described is so small that one cannot be certain that the prognosis in this disease will be, in general, altered by the use of sulfapyridine. There are published in the literature the records of only fourteen patients with pneumococcic meningitis who were treated with sulfapyridine alone. Eight of the fourteen recovered. The present communication deals with the use of sulfapyridine and its sodium salt 4 in the treatment of seventeen patients with pneumococcic meningitis admitted to the Sydenham Hospital between October 1938 and May 1939. Eight of these seventeen (47 per cent) recovered completely. Antipneumococcic serum

To the Editor.— Cutaneous microbiology has made great strides in the past decade, thanks in part to a taxonomic scheme for the micrococcal family proposed in 1963 by Baird-Parker. 1,2 Recently, however, the system has undergone a series of changes, 3,4 especially in nomenclature, 5 and entirely new classifications also have been offered. 6-9 The rapid succession of reports has resulted in some confusion and threatens the effective communication of clinical and research data. If the situation is not remedied soon, Cowan's 10 warning may come to pass: "... the biochemically minded bacteriologists, who have been showing us the light and guiding our steps to a more rational taxonomy, may undo all the good they have done and create a new era of nomenclatural chaos." A solution, however, is found with the publication of the eighth edition of Bergey's Manual of Determinative Bacteriology , 11 the recognized standard reference of most of

To the Editor.— The topical administration of fluorouracil in 1% to 5% preparations is a current popular method of removing actinic keratoses. Fortunately, few side effects have arisen. Local tenderness, chapping, edema, photosensitivity, lacrimation, hyperpigmentation, and suppuration have been previously reported in theArchives(88:247,1963; 92:410,1965). I have found two more complications of this form of therapy: prolonged telangiectasia and herpes labialis. Report of Cases.—Case 1.— A healthy 51-year-old man applied a 1% solution of fluorouracil in propylene glycol to his entire face three times daily for treatment of multiple facial keratosis. Ten days after the onset of therapy, at a time when the keratoses were inflamed, grouped vesicular lesions appeared on the left and lateral area of the lower lip. Cytopathological changes typical of herpes simplex virus were seen on Wi-28 cell cultures two days after inoculation with the crusts from the lip lesion. Case 2.— A

• Five new cases of lymphomatoid papulosis are reported. This entity can apparently be divided into at least two subtypes. In one group of patients, papulopustular lesions resembling those of pityriasis lichenoides develop that resolve spontaneously within a few weeks. The lesions contain an epidermotropic dermal infiltration composed predominantly of abnormal lymphocytes. The other group of patients displays larger, more persistent lesions that contain a nonepidermotropic dermal infiltration composed predominantly of histiocytes. Lymphoma eventually develops in about 10% of the patients with lymphomatoid papulosis. ( Arch Dermatol 1983;119:189-197)

To the Editor.— In this column in the past 1 I reported two unusual complications of topical fluorouracil therapy—the activation of herpes labialis and the development of telangiectasia. The subsequent course of patient 4 has been interesting. Report of a Case.— A 35-year-old healthy woman, in whom infraorbital telangiectasia had developed as a consequence of the chemotherapeutic treatment, had noticed gradual fading of this cosmetic defect within three years. Recently, however, another case of herpes labialis, proved by cell culture, was diagnosed in a 64-year-old healthy woman who had been examined at the University of Maryland Hospital, Baltimore, three days after she completed a seven-day course with 5% fluorouracil cream that was applied three times daily. The topical fluorouracil therapy had produced considerable erythema and edema in the area later affected by the viral disease. Cultures that were positive for herpes simplex virus were obtained in HeLa cells for vesicle

Photochemotherapy has become an accepted form of treatment of severe cases of psoriasis.1Recent attention to the complications of this procedure has focused on possible subsequent carcinogenic effects.2-4Nausea, gastric irritation, exfoliative dermatitis, and ultraviolet (UV) burns are also recognized untoward results. The case reported herein describes an additional unusual complication. Report of a Case A 48-year-old man, who had psoriasis for 35 years, was admitted to the University of Maryland Hospital, Baltimore, in June 1976 because of a generalized edematous, erythematous eruption of six weeks' duration. He had previously received oral and topical steroids for his psoriasis. In 1974, the patient had had an exacerbation of his psoriasis, which was accompanied by acute gouty arthritis. At that time, his joint pains were relieved promptly by colchicine, and his skin disease responded to topical and oral corticosteroids. In 1975, a duodenal ulcer developed that was demonstrated by roentgenographic

Reports of infections caused by unusual bacteria are becoming more common. Nonetheless, they are repeatedly misdiagnosed. It is the purpose of this paper to delineate the methods by which a correct diagnosis can be made of an unusual infection in the skin. The problem of separating the pathogen from the contaminant can be difficult. A positive culture in pure growth from a cutaneous lesion is not always sufficient to implicate an organism as a pathogen. It is necessary to have a rising antibody titer or to culture a bacteria from several sources or from an unbroken lesion before it can be regarded as a proven pathogen. Because of this, many cases reported in the literature as lesions due to rare bacteria must be disregarded as probable coincidental eruptions in patients from whom carrier organisms were cultured on the skin. Cutaneous manifestations of infections are of 2 types: primary or secondary.

Familial Brachydactylia and Hemangiectasia (Type Undetermined). Presented by R. C. V. Robinson, MD. Two years ago, a 17-year-old boy was noted to have a peculiar redness surrounding the eyes. This appeared suddenly, but has persisted, with color variations from pink to almost purple. It is apparently worse when he is warm or perspires. There is no history of a similar condition in other members of the family. There is no familial history of other systemic diseases. This patient, his 22-year-old sister, his mother, and his maternal grandmother have `short fingers.' It has not appreciably affected his physical activities. Physical Findings.— Involving both periorbital areas and the adjacent tissues, there is mottling similar to, if not identical with, that seen in nevus flammeus. There is no obvious thickening of the tissues. Funduscopic examination reveals no abnormalities. There is a peculiar stubbiness of the fingers. Laboratory Data.— X-ray examination of the skull

A case of Kaposi's varicelliform eruption complicating pemphigus foliaceus is reported. The patient was taking 200 mg of prednisone daily throughout her herpetic infection in order to control her pemphigus. It cannot be stated with certainty that prednisone influenced the course of the recurrent viral disease.

The effects of light and hematoporphyrin on pooled human sera with elevated titers of antistreptolysin O, heterophil and "immune" anti-A antibodies, and high concentrations of rheumatoid factor were studied. In all experiments, the paper electrophoretic pattern of irradiated specimens containing porphyrin demonstrated a loss of definite globulin peaks and a decrease in albumins. Associated with this change was a reversal in the albumin/globulin (A/G) ratio in all specimens studied. Heterophil and immune anti-A antibodies were apparently very sensitive to light and hematoporphyrin, whereas the antistreptolysin O antibodies were not decreased. Hematoporphyrin caused nonspecific agglutination of latex particles. The combined action of light and porphyrins produced a striking and significant destruction of all three immune globulins.

A case rather confusing to the practitioner, yet highly interesting because of its comparatively rare occurrence but far reaching effect, is that one of a young child brought to me for examination by Dr. Burnett. History. —E. P., aged 4 months; Italian. The infant's mother and father were alive and well. One sister of the patient, 18 months old, was enjoying good health. The mother had had no miscarriages, the father denied specific infection and there was no history of tuberculosis in the family. The child was born after a period of normal gestation and after an uneventful confinement. Labor was easy and of short duration, no instruments were used and there is no history of trauma. He had been fed on the breast and, with the exception of an occasional vomiting spell, which the mother attributed to "too much milk," the infant had had no grave physical disturbances. The

Experimental, superficial, streptococcal cutaneous infections were produced by repeated stripping of the skin of hairless mice before inoculation with a broth containing streptococci. Fifteen or more strippings were necessary to produce a crusted lesion. Pathological examination of biopsies taken from the denuded skin of mice inoculated with live streptococci immediately after stripping, showed that the bacteria delayed the process of reepithelialization in the stripped wound.

A reproducible technique for stinging guinea pigs with Chrysaora quinquecirrha has been described. A linear urticarial eruption which persists for approximately 24 hours appears within two to four hours. Motionless jellyfish tentacles must be in contact with the skin more than 15 seconds to produce an eruption. This interval can be shortened by moving the tentacle. The amount of petrolatum necessary to prevent the eruption was quantitated and appears to be inversely related to motion of the tentacle. The incorporation of strong base or polysorbate 20 at suprathreshold concentrations increased the blocking efficiency of petrolatum. Unfortunately, because the former agent produces irritation and the latter washes out of the ointment, these compounds are not acceptable blockers. A silicone containing form of stopcock grease was also an effective blocking agent, however, its use will be limited since it cannot be easily removed from the skin.