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DISCRETE KERATODERMA (MICHAEL). PRESENTED BY DR. GEORGE H. CURTIS AND DR. E. W. NETHERTON. H. N. W., a white man aged 38, has had lesions on the dorsa of the hands for eight years. There have been periods of improvement and exacerbation. During the exacerbations the lesions are thickened and tend to become fissured. They have never been pruritic and are not affected by the seasons, nor do they improve when he is away from work for from a few weeks to a year at a time.There are a number of dry brownish red and fairly well demarcated plaques on the dorsa of the hands and knuckles. They vary from 1 to 3 cm. in diameter, the smaller lesions being roughly circular and the larger ones irregular in shape. The surfaces vary from slightly scaly to mildly verrucous. The lesions on the knuckles show a tendency toward fissuring. The

PEMPHIGUS VULGARIS. PRESENTED BY DR. R. E. BARNEY. Mrs. S. L., a woman aged 70, was first seen on Nov. 5, 1940. She stated that she had had an intermittent itchy eruption over the body for the past three years. In September 1940 blisters had developed on her trunk and extremities.Examination reveals pea-sized to plum-sized bullous lesions on the arms, thighs and, to a less extent, trunk. For the most part they seem to arise from normal skin. Some are tense while others are flaccid. The contents of most of the bullae are serous, but a few contain blood and others pus. Some have ruptured, leaving erosions and crusts. On the trunk and extremities there are dime-sized to silver dollar—sized erythematous areas, which are the sites of previous blebs.The mucous membranes are not involved. Nikolsky's sign cannot be elicited. Constitutional signs are absent, but the itching is so

PYODERMA FACIALE. PRESENTED BY DR. H. N. COLE AND DR. JAMES R. DRIVER. H. M. L., a single, obese woman aged 42, was treated by us in 1927, at the age of 29, for severe acne vulgaris of the face, chest and back. The response to roentgen ray therapy was satisfactory, and for the following twelve years she had no exacerbations.On about March 10, 1940 a diffuse redness appeared over the central portion of the face. In the following two weeks the eruption became deeper red, almost a cyanotic color, associated with the development of superficial and deep abscesses, pustules and cystic areas. This development was almost explosive, very severe and associated with considerable pain and swelling. Many of the pustules and abscesses ruptured, discharging a yellowish purulent material.The eruption is limited to the central portion of the face, involving the forehead, nose, cheeks and chin. The sharply

MULTIPLE EPITHELIOMAS; ULCERATION FOLLOWING THE USE OF A "CANCER PASTE." PRESENTED BY DR. C. G. LAROCCO. J. E. H., a healthy, vigorous man aged 77, has an ulcer on his back of about eighteen years' duration. His past history has no bearing on the present condition. He believes that his maternal grandmother died of cancer of the nose. Twenty years ago he had a carbuncle in the right scapular area. This was treated surgically, healed and left a circular scar with a radiating keloid. Because of his work as a planer in a wood mill he has had sores on his back frequently from splinters of wood. He has treated these himself. About eighteen years ago a sore developed in the midline of the interscapular region which has persisted.Early in August 1939 a black "cancer paste" was applied to this area by a "cancer specialist," after which the area

A CASE FOR DIAGNOSIS. PRESENTED BY DR. FISHER. Mrs. B., aged 39, said that large vesicles and bullae had suddenly appeared on the back of her left shoulder five weeks previous to presentation. There had been no pain or itching. New vesicles had continued to appear for three weeks, arising from apparently normal skin. Many small and medium coin-sized superficial crusted ulcers persisted, the affected area being about 12 cm. in diameter. DISCUSSION Dr. Parkhurst: The localization is suggestive of zoster, even in the absence of subjective symptoms. However, the lesions may be factitial.Dr. Littman: I agree to a diagnosis of zoster.Dr. Netherton: It may be zoster, but there was no pain and the bullae were rather large. The present lesions suggest dermatitis factitia. EXTENSIVE SECONDARY SYPHILID. PRESENTED BY DR. COLE AND DR. DRIVER. Mrs. F. G., a white woman, aged 34, presented a generalized small macular eruption

XANTHOMA DIABETICORUM CHIEFLY LIMITED TO THE PALMS. PRESENTED BY DR. W. F. SCHWARTZ. M. D., a woman aged 51, was first seen in the dermatologic clinic at the City Hospital on Feb. 16, 1939, complaining of yellow streaks in the palms. She stated that these had been present for five months. She was known to have had diabetes for nearly three years, which had been controlled chiefly by dietary methods except for a period beginning nine months ago, when insulin was given for three months. She admits that since then she has not followed the recommended diet. About one month after the insulin was discontinued the yellow streaks appeared in the palms.There is an orange-yellow ribbon-like infiltration in all the flexor folds on the fingers, palms and wrists. A nodule 2 mm. in diameter, of similar color, is situated on the tip of the left elbow. There is no

SPOROTRICHOSIS (LYMPHANGITIC TYPE WITH PRIMARY LESION ON THE FINGER). PRESENTED BY DR. E. W. NETHERTON AND DR. GEORGE HASKEL CURTIS (BY INVITATION). C. E., a nursery man aged 48, states that on Dec. 5, 1938, he ran a rose thorn into the tip of the left ring finger. The distal portion of the finger became swollen and red. A seropurulent exudate was obtained when the swelling was incised. Three weeks later small cutaneosubcutaneous painless nodules appeared on the inner surface of the left forearm, and during the past week several new nodules have appeared on the dorsal surface of the left hand and on the left forearm.There is a crusted incision on the tip of the left ring finger. The distal portion of this finger is slightly swollen, and the skin on the dorsal surface is slightly erythematous. There are several cutaneosubcutaneous painless soft or doughy nodules varying in

A CASE FOR DIAGNOSIS (TUBERCULOSIS VERRUCOSA CUTIS? VERRUCA VULGARIS?). PRESENTED BY DR. C. L. CUMMER AND DR. C. G. LAROCCO. T. M., a Negro aged 27, presented from the department of dermatology and syphilology of St. Vincent Charity Hospital, has an irregular scar situated in the median line about 2 cm. above the tip of the nose. At the upper pole is a verrucous lesion about 1 cm. in diameter, surrounded by a slightly elevated border.The patient states that he had had a wart or mole on the tip of the nose for several years. In August 1940 he scraped it, as a result of a fall. This was followed by a scar and the appearance of the growth.The Wassermann reaction of the blood was negative, but because of a positive Kline reaction of the blood antisyphilitic treatment was administered and resulted in no change in the lesion.

TERTIARY SYPHILIS OF THE SKIN (GUMMA OF THE LIP). PRESENTED BY DR. MAX E. KRAUSE AND DR. E. B. HEISEL. J. J., a Negro aged 50, presented from the department of dermatology and syphilology, City Hospital, complains of a progressive, painless enlargement of the lower lip of two months' duration. He was seen first in the syphilis outpatient clinic in January 1939, at which time he had a positive serologic reaction of the blood for syphilis. He did not return for further observation until November 1941.He presents a diffusely enlarged, everted lower lip, which is approximately twice the normal size. The right three quarters of the lip is composed of a firm, nontender, flat mass, 2 by 6 cm. The left one quarter of the lip is soft and elastic. The vermilion border is smooth but considerably enlarged. There is no break in the mucous membrane, but there is

Presents several letters to the editor referencing articles and topics published in earlier issues of the journal. Focuses on issues relating to American women; Comment on the article "How to Cook by the Book," by Craig Claiborne; Discussion on the qualities of American countrymen.

The advent of any new drug creates the necessity of being alert to a complicating eruption.While the possibility of a sulfanilamide eruption is well known, I have found only casual reference in the American literature to dermatitis caused by sulfapyridine. Therefore, the following report is made. REPORT OF CASES CASE 1.— T. L., a white boy aged 13, was admitted to the medical service of Dr. Edward W. Parsons at St. Vincent Charity Hospital on Feb. 5, 1940, because of a cold and cough. Six days later a diagnosis of pneumonia was made (no specific type), at which time sulfapyridine was ordered, 15 grains (1 Gm.) every four hours. On February 18, one week after administration of the drug, a morbilliform eruption appeared. This rash was generalized, symmetric and macular. On the face and trunk it was almost solid and there was dusky erythema, while on the abdomen and

Granted that pityriasis rosea is a relatively common dermatosis and that instances are on record of two attacks, the occurrence of three episodes is sufficiently uncommon to merit recording. Engman and Kile1 reported a similar experience, and Allen2 made casual reference to six outbreaks in the same person. REPORT OF A CASE J. C. J., a white youth aged 17, was referred by his father, a physician. He was first seen with a typical pityriasis rosea in December 1940. His second attack was observed in March 1941 and his third in July 1941.A tonsillectomy was performed when he was 5 years of age. He had mumps, varicella and pertussis at 6 to 7 years of age, ethmoiditis with abscess formation and surgical drainage at the age of 9 years and bilateral mastoiditis at 15, with recovery following administration of sulfanilamide.Each attack of pityriasis rosea was ushered