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Unlabelled: Subcorneal pustular dermatosis (SPD) represents a chronic, relapsing sterile pustular eruption, involving the trunk and flexoral proximal extremities. A 54-year-old female presented with recurrent, flaccid pustules measuring several millimeters in diameter, on normal and mildly erythematous skin of the groin and submammary areas. Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated typical features of SPD, including some damage within dermal pilosebaceous units subjacent to the subcorneal blistering process. DIF revealed strong deposits of immunoreactants IgG, IgM, fibrinogen and complement/C3, present in a shaggy pattern within the subcorneal disease areas; in focal, areas of the basement membrane junction and in focal pericytoplasmic areas of epidermal keratinocytes. IHC revealed strong positivity to HLA-DPDQDR, mast cell tryptase, CD68, and ZAP-70 in the subcorneal inflammatory infiltrate, and surrounding dermal blood vessels. Myeloperoxidase was also positive. Positive staining with the anti-ribosomal protein S6-pS240 at the edges of hair follicles and sebaceous glands subjacent to the subcorneal blisters was also noted., Conclusions: We conclude that this disorder may have several components in its etiopathology, including a possible restricted immune response and a possible genetic component; these possibilities warrant further investigation.

A rapid, solventless method is described for the decoration of carbon nanotubes with metal nanoparticles. The straightforward two-step process utilizes neither reducing agents nor electric current and involves the dry mixing of a precursor metal salt (e.g., a metal acetate) with carbon nanotubes (single- or multi-walled) followed by heating in an inert atmosphere. The procedure is scalable to multigram quantities and generally applicable to various other carbon substrates (e.g., carbon nanofiber, expanded graphite, and carbon black) and many metal salts (e.g., Ag, Au, Co, Ni, and Pd acetates). As a model system, Ag nanoparticle-decorated carbon nanotube samples were prepared under various mixing techniques, metal loading levels, thermal treatment temperatures, and nanotube oxidative acid treatments. These nanohybrids were characterized by a variety of microscopic and spectroscopic techniques. For example, X-ray diffraction and scanning electron microscopy indicated that the average size of the Ag nanoparticles has little to do with the thermal treatment temperature but can be easily controlled by varying the Ag loading. Raman spectroscopy illustrated both the metal-nanotube electronic interactions and the surface enhancement effect from the Ag nanoparticle attachment. High-resolution transmission electron microscopy captured the in situ salt-to-metal conversion events on the nanotube surface. The mechanistic implications from the characterization results are discussed.

Many cutaneous and systemic disorders are associated with inflammation and necrosis of blood vessels. Several classifications of vasculitis have been used. Internists tend to utilize the classification of Fauci with modifications such as those by Cupps. Gibson and Ryan, who are dermatopathologists, have classified vasculitis based on vessel size, leukocyte type, and presence of granulomas. A more recent classification has been developed by Jennette, a pathologist, and colleagues. The etiology of vasculitis is varied; it includes bacteria, viruses, chemicals, autoimmune disease, malignancy and abnormal exogenous and endogenous proteins. Leukocytoclastic vasculitis can be experimentally reproduced by the Arthus phenomenon. IgM and C3 are found in cutaneous blood vessels and associated with circulating immune complexes. CH50, C3 and C4 may be reduced in serum. Increased incidence of nasal carriage of staphylococci is associated with higher relapse rates in Wegener's granulomatosis and toxic shock syndrome toxin from staphylococci is associated with the Kawasaki syndrome. Additionally, at least four systemic vasculitic drug reactions can be confirmed with patch testing. Antineutrophil cytoplasmic antibodies (ANCA) are found in association with certain systemic vasculitides. These may be tested with indirect immunofluorescence and enzyme linked immunosorbent assays (ELISA) with radioimmunoassays. Originally cytoplasmic ANCA (cANCA) was identified with proteinase 3 as the antigen and perinuclear ANCA (pANCA) was related to myeloperoxidase. While cANCA is very specific for proteinase 3, pANCA is associated with a number of antigens other than myeloperoxidase. pANCA is found with alcohol fixed but not formalin-fixed neutrophils. cANCA is particularly sensitive and specific for Wegener's granulomatosis and predicts prognosis and response to therapy. pANCA is not so specific and is associated with a number of other vasculitic syndromes. Cutaneous vasculitis is managed primarily with colchicine, dapsone and prednisone, with recent studies indicating that there may be a synergistic effect of pentoxifylline with dapsone. Systemic vasculitis involves treatment with various agents. Recently it has been observed that co-trimoxazole (trimethoprim/sulfamethoxazole) is useful in many cases of Wegener's granulomatosis along with other more toxic chemotherapeutic agents.

The etiology of venous ulceration is far more complex than Homans' theory of stagnation and hypo-oxygenation. Indeed, studies have shown that flow in lipodermatosclerotic limbs is actually faster than normal. We suggest, therefore, that the terms "stasis dermatitis" and "stasis ulcer" be dropped from medical parlance. The term "lipodermatosclerosis with ulceration" as used by the British, or simply "venous ulcer," would seem more appropriate. Venous hypertension, produced by incompetence of deep and communicating vein valves and thrombosis of segments of the deep system, is closely correlated with the development of venous ulcers. Precisely how this venous hypertension translates into ulceration is unclear. Burnand et al showed that fibrin cuffs are deposited around the capillaries in lipodermatosclerotic limbs. These cuffs may serve as barriers to the diffusion of oxygen, leading to local ischemia and epidermal necrosis. Others suggest that trapped leukocytes in the microcirculation alter capillary permeability by releasing various inflammatory mediators that hasten the flow of fibrinogen across the capillary membrane and promote the formation of fibrin cuffs. Proof of this hypothesis is still lacking, but may eventually come from using radioactive WBC tagging procedures. A synthesis of these two theories may in fact explain the etiology of venous ulceration.

Propylene glycol is a commonly used vehicle for topical preparations. Although it is well suited for this purpose, it is capable of producing both primary irritant skin reactions and allergic sensitization. The literature on propylene glycol is reviewed, with particular attention to the nature of these adverse cutaneous effects. Guidelines for patients sensitive to propylene glycol are discussed.

This double-blind controlled study investigated the effectiveness of 4% topical erythromycin liquid with 1.2% zinc acetate and 4% topical erythromycin gel with 1.2% zinc octoate applied twice daily in comparison with 250 mg of oral tetracycline twice daily and placebo. One hundred forty-nine patients began and one hundred forty-one completed the study. Three judges recorded acne measurements of severity grade, papule counts, pustule counts, comedo grades, and comedo counts without mutual consultation on visits at 0, 2, 4, 6, 8, and 10 weeks. Analysis of the reduction in the acne severity grade and papule count showed that the erythromycin/zinc liquid and gel were statistically significantly better than placebo and as effective as the oral tetracycline. Analysis of comedo grades showed that at weeks 8 and 10 the 4% topical erythromycin/zinc liquid showed a reduction statistically better than placebo.

Two 12-week-long double-blind placebo-controlled studies of acne treatments were performed using three judges and a total of 331 male college students. Global severity grades and papule, pustule, and comedo counts were performed every two weeks. The data were evaluated using Pearson's coefficient of correlation, and results showed a high degree of correlation between global severity grades and lesion counts, as well as among judges. These data suggest that acne grading scales and papule counts are equally reproducible methods of grading inflammatory acne and that the comedo grading scale and comedo count are equally reproducible methods of grading comedonal acne.

A serologic survey for markers of hepatitis B virus (HBV) infection was conducted in 593 dermatologists. Serologic evidence for previous infection was found in 15.4%, indicating that dermatologists are an at-risk population comparable to many other specialties of medicine. Dermatologists with a history of blood transfusion, tattoo, and homosexuality had an increased prevalence of serologic markers for HBV. The type of practice, extent of surgery, and glove-wearing practices did not correlate with HBV serologic markers.

Unilateral dermatomal superficial telangiectasia (UDST) may be congenital or acquired. Acquired UDST may occur coincident with physiologic states of estrogen increase, including puberty and pregnancy in women and adrenarche in men. Acquired UDST may also occur in estrogenized pathologic states such as chronic hepatic disease in alcoholism. The occurrence during estrogenized states, the dermatomes of distribution, and the presence of anemic halos suggest kinship with arterial spiders. UDST and some cases of benign, generalized telangiectasia may be local and universal forms, respectively, of the same pathologic process in the cutaneous microvasculature. Further, this is compatible with both the concept that UDST results from a somatic mutation and the usual nonfamilial presentation of UDST.

Acrodermatitis continua of Hallopeau is considered by many to be a variant of pustular psoriasis because of similar histologic features. Its clinical picture is unique and helps to distinguish acrodermatitis from pustular psoriasis. We present a patient with acrodermatitis continua of Hallopeau resistant to conventional therapy. We describe the beneficial effect of etretinate in this patient.

A 49-year-old man with liver disease developed a unilateral telangiectatic lesion over the left trigeminal and left C3, C4, C5, and T1 dermatomal areas. This case fulfills the criteria for unilateral nervoid telangiectatic syndrome (UNTS), and as such represents the 11th reported case of UNTS and the first case, to our knowledge, of visceral involvement associated with a similar vascular malformation. A hemorrhagic tendency is present in this syndrome when there is gastrointestinal involvement.

One hundred sixty-five subjects completed a 10-week, double-blind controlled study comparing the following: (1) a combination of 3% erythromycin and 5% benzoyl peroxide in a gel, (2) 5% benzoyl peroxide gel, (3) 3% erythromycin gel, and (4) the gel vehicle. The benzoyl peroxide gel and the erythromycin gel were superior to the control gel; however, the combination product was more effective than any of the others. This was true for both pustular and papular lesions, but the most dramatic effect was on combined inflammatory lesions, i.e., papules and pustules.

Using in vivo DNA labeling procedures, the present study makes a detailed comparative analysis of circadian rhythms in labeling indexes (Is), in mitotic indexes (Im), and in Is/Im ratios in uninvolved and in involved psoriatic epidermis in vivo (12 patients, studied at 6-hr intervals over a 24-hr period). We also provide comparable data on the rates of epidermal DNA synthesis and on the proliferative activity of dermal infiltrate cells. There are no circadian-diurnal variations in epidermal or in dermal infiltrate cell proliferation in either inactive (uninvolved) or in active (involved) lesions of psoriatic skin. The rates of epidermal DNA synthesis were lower at 9 AM and 3 PM; higher at 9 PM and 3 AM in both uninvolved and involved epidermis. The following cell kinetic information was derived from 78 biopsy samples-from epidermal mitotic and labeled nuclei counts in approximately 100 mm unit lengths of epidermis per biopsy. DNA labeling indexes, 6.1 vs. 21.2%; mitotic indexes, 0.13 vs. 0.43%; and Is/Im ratios, 152/1 vs 70/1 in uninvolved vs. involved psoriatic epidermis in vivo. There was an overall 20% decrease in the rate of cycling epidermal cell DNA synthesis involved epidermis; and 5-fold increase in the overall proliferative activity of dermal infiltrate cells in involved psoriatic skin. These results are discussed in relation to the clinical use of circadian rhythms for the "chronotherapy" of proliferative diseases in man, in relation to cell cycle aspects of psoriasis and psoriatic epidermal responses to therapy, and in relation to cell proliferation in human epidermis in vivo.

An 18-year-old white woman admitted for an incomplete septic abortion was found to have thrombocytopenia, anemia, and increased activated partial thromboplastin time (PTT). Additionally, results of nontreponemal serologic tests for syphilis were positive, and the fluorescent antinuclear antibody was weakly positive. A mixture of the patient's plasma with normal control plasma showed that the elevation in activated PTT was the result of a circulating anticoagulant, not an inherent clotting defect. Sclerodermoid features were present and consisted of bound-down, hairless skin and scattered subcutaneous indurated plaques. A faint pattern consistent with livedo reticularis was recognized on all extremities. Biopsy specimens of sclerodermoid lesions showed increased and thickened dermal collagen consistent with morphea. We believe that this patient's condition represents an unusual connective tissue disease syndrome consisting of abortion, livedo reticularis, thrombocytopenia, circulating "anticoagulant," negative or slightly positive antinuclear antibodies, and false positive results on nontreponemal serologic tests for syphilis. Sclerodermoid lesions were also a unique feature in our patient.

Development of new antifungal agents has increased significantly over the past two decades, with recent advances reflecting interest in synthetic agents as opposed to antibiotics. We review the various antifungal medications in use or under development, beginning with a discussion of over-the-counter agents, antibiotics, and older azole compounds and ending with an evaluation of newer azoles and the new class of antifungals, the allylamines.

Interferons, glycoproteins originally investigated as antiviral agents, are now known to be active as anticancer agents, immune system modulators, and growth control regulators. For these reasons, interferons have definite and documented relevance to dermatologists. In regard to viral diseases, therapeutic trials in humans have shown promising results in herpes simplex infections, vaccinia, laryngeal papillomas, and condyloma acuminatum, as well as in rabies and hepatitis B. Pilot studies with interferon treatment of melanoma have been so promising that the American Cancer Society has selected this area to receive additional research support. Also, the antiproliferative effects of interferons have potential application to proliferative diseases such as psoriasis.

A bioassay for the evaluation of certain adverse effects of various corticosteroids was performed. Twenty-eight daily topical applications of corticosteroids to young rats produced reduction in body-weight gain, atrophy of the skin as determined by double skin-fold thickness micrometer measurement, and mild to severe telangiectasia. This animal model demonstrates corticosteroid-induced skin atrophy and telangiectasia and the correlation of the degree of atrophy and telangiectasia to body-weight change. Nine corticosteroids were evaluated by this method and are listed in terms of increasing severity of side-effects as follows: 1.0% hydrocortisone cream, 0.1% betamethasone valerate cream, 0.025% betamethasone benzoate cream, 0.05% flurandrenolide cream, 0.05% fluocinonide cream, 0.1% dexamethasone cream, and 0.03% flumethasone pivalate cream. Triamcinolone acetonide cream, 0.5%, and 0.2% fluocinolone acetonide cream resulted in death of the animals prior to completion of 28 days of topical application.

Hepatitis B is now the most commonly reported hepatitis in the United States and the physician's greatest infectious occupational hazard. Although dermatologists are at increased risk for contracting and transmitting hepatitis B virus, surveys continue to indicate that a substantial number do little to decrease this risk. We have summarized the recent developments regarding the transmission, diagnosis, and clinical presentation and course of hepatitis B virus infection, and have offered specific preventive measures to assist the dermatologist in keeping hepatitis B out of his medical practice. By employing these measures, dermatologists can do their part in contributing to the future eradication of this disease.