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Maurice Raynaud initiated the discussion of cold-induced vasospasm over 125 years ago. Research has shown that the physiology of Raynaud's involves a complex interaction in both local and systemic factors. Although a multitude of laboratory tests are available to help evaluate the prognosis of Raynaud's phenomenon, patient history remains the most reliable method of diagnosis. There are a variety of treatment modalities available. The treatment program should be tailored to the severity and etiology of the disease.

Aging of the skin is still an inevitable and unavoidable process. The cutaneous problems associated with aging can be annoying, cosmetically unacceptable, or, in some cases, life-threatening. The characteristic clinical appearance and etiology of these disorders are described in this article, and a summary of the lastest medical and surgical management of these entities is presented.

Histiocytosis X (HX) is a rare disorder of histiocytic proliferation characterized by a broad spectrum of clinicopathologic disease. An unusual case of Letterer-Siwe disease (LSD) or subacute disseminated HX in a 71-year-old woman is presented. The patient had a 3-year history of splenomegaly before skin lesions developed. She presented to our clinic at 1.5 years later and the diagnosis of HX was made by skin biopsy. Topical nitrogen mustard (NM) therapy resulted in complete clearing of cutaneous lesions. Her condition was stable over the next 10 months. However, she subsequently suffered a rapid and fatal dissemination of her disease. Systemic treatment with prednisone, vinblastine sulphate, and suppressin A (SA) (a calf thymus derived hormone preparation that specifically induces suppressor T-cells) was ineffective. Characteristic histopathologic, immunohistochemical, and electron microscopic findings of HX are illustrated. A review of the adult cases of LSD and treatment options for HX are presented and discussed.

We present a case report of a young woman who developed earlobe nodules subsequent to the piercing of her ears. Clinically the nodules appeared to be keloids. Surgical intervention demonstrated the nodules to consist of the embedded backings of her pierced earrings.

• We studied serum samples from 106 patients, including 80 in the scleroderma spectrum, by indirect immunofluorescent microscopy, using PtK, rat kangaroo tissue culture cells as substrate. Anticentromere (Kinetochore) antibodies were present in 28 patients, and anticentriole antibodies were present in four patients. Anticentromere antibodies were usually present in patients with a benign, chronic form of systemic scleroderma, which has been termed the CREST (Calcinosis, Raynaud's phenomenon, esophageal involvement, sclerodactyly, and telangiectasia) syndrome. The four patients with a previously undescribed anticentriole antibody were all in the scleroderma spectrum. Possibly, these antibodies may have diagnostic and prognostic importance. Further, they will be useful in studying the structure and function of these cellular organelles. ( Arch Dermatol 1983;119:560-566)

In Reply.— We doubt that any form of systemic scleroderma is a benign entity. However, we agree in part with Dr Brown's comments. The classification of systemic scleroderma, as stated, is difficult and arbitrary. In accordance with current usage, we attempted to classify patients with systemic scleroderma into those with the "CREST syndrome," "diffuse" scleroderma, and "inflammatory" scleroderma. The distinction is often difficult, and standardized criteria do not exist. Perhaps the anticentromere antibody and other autoantibodies will aid in the classification of scleroderma, so that it will not be based solely on a clinical differentiation. The "true speckles" or anticentromere antibody, frequently found in patients with CREST syndrome, has not been associated with renal involvement. 1 Therefore, although there have been reports of primary biliary cirrhosis and pulmonary hypertension in some patients with the CREST syndrome, this scleroderma variant is still relatively benign. In a previous study of 727

• Antinuclear antibody (ANA) test results were correlated with the clinical status of 56 patients with systemic scleroderma. Three groups were identified. (1) The speckled pattern represented a benign clinical subset. Acrosclerosis, Raynaud's phenomenon, calcinosis, and esophageal dysmotility characterized this group. None of these patients had pulmonary, renal, or cardiac disease. (2) Two patterns and ANA-negative test results were associated with a different incidence of certain clinical characteristics. The thready pattern was associated with pulmonary involvement. Diffuse skin involvement and Raynaud's phenomenon were found with the nucleolar pattern. Patients with ANA-negative test results had the most severe disease, including renal failure. (3) Two patterns were not associated with different clinical characteristics. These were the small speckle-like thready pattern and the homogeneous pattern. This study supports the theory that ANA patterns may be used as imunologic markers for different clinical characteristics of patients with scleroderma as they have already been used in lupus erythematosus. ( Arch Dermatol 1982;118:882-885)