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• A 20-year-old man had systemic lupus erythematosus (SLE) and a skin eruption that consisted of pruritic, tense, clear, bullous, and vesicular lesions. Histopathological examination of the bullous lesions disclosed papillary microabscesses of neutrophils and subepidermal bulla formation. Direct immunofluorescence microscopy demonstrated linear bandlike depositions of IgA and IgG at the basement membrane zone in both peribullous and normal-appearing skin. By immunoelectron microscopy, the IgA and IgG deposits were found beneath the basal lamina, extending beyond the anchoring fibril zone into the deeper portion of the dermis. The immunoelectron microscopic features supported the conclusion that this patient had SLE with vesiculobullous lesions rather than SLE concurrent with dermatitis herpetiformis, linear IgA bullous dermatosis, or bullous pemphigoid. Oral dapsone therapy gave the patient dramatic relief from the cutaneous lesions, although he was unable to tolerate extended treatment with the drug.(Arch Dermatol 1984;120:1497-1501)

• Immune electron microscopic data are presented of a typical case of localized chronic pemphigoid (LCP) of Brunsting-Perry. The peroxidase-antiperoxidase multistep method for the electron microscopic localization of immunoglobulins and complement components showed that IgG, C3, and C4 were distributed in the lamina lucida and on the undersurface of the basal keratinocytes. These findings support the concept that LCP, bullous pemphigoid, and benign mucosal pemphigoid are closely related diseases. Unlike in bullous pemphigoid, however, complement was occasionally found in this case of LCP beyond the basal lamina in the uppermost portion of the dermis. This finding may explain the occurrence of scar formation in LCP.(Arch Dermatol 1983;119:921-924)

• Lesions from a patient affected with multicentric reticulohistiocytosis (MR) were studied by ultracytochemical techniques to determine the relationship of PAS-positive materials and/or acid phosphatase (AP) activity to electron-dense granules found in the large mononucleated or multinucleated giant cells that are characteristic of this entity. The lead phosphate reaction products that mark the sites of AP activity were found in the electron-dense granules. The granules were also PAS positive by the periodic acid-thiosemicarbazide-silver proteinate method. These findings suggest that the PAS-positive and diastase-resistant materials in the large mononucleated or multinucleated giant cells of MR are not phagocytized materials but are preexisting lysosomes.(Arch Dermatol 1981;117:495-499)

TO THE EDITOR.— There have been some reports of internal malignancy associated with nonfamilial palmoplantar keratoderma of late onset,1-4 as well as of esophageal squamous cell carcinoma in association with familial keratosis palmaris et plantaris of early onset.5 We describe a patient who had developed nonfamilial, acquired diffuse palmoplantar keratoderma of late onset as a cutaneous manifestation of primary bronchial carcinoma. A review of the literature on similar cases1-4 disclosed a possible relationship between late-onset, nonfamilial palmoplantar keratoderma and intrathoracic squamous cell carcinoma. REPORT OF A CASE.— A 49-year-old man presented to our clinic in June 1985, with a three-month history of progressive thickening of his palms and soles. Physical examination revealed diffuse keratoderma of both palms and soles with dry, thick, and yellowish scales (Figure). Repeated microscopic examinations and cultures of scales for fungi gave negative findings. A skin biopsy specimen obtained from the palmar skin