Bubble hair

An unusual hair dystrophy was studied by means of light and electron microscopy. Hair fibers demonstrated a boomerang deformity containing small and large "bubbles". Electron microscopy revealed a loss of cortical cells and medulla at these sites. Cross-section images showed either a single large cavity or a reticulated, "swiss cheese-like" loss of cells. These two cases represent the second and third reported cases of bubble hair deformity. We present the second light and electron microscopic study of this disorder, including new electron microscopic findings. The cause of bubble hair deformity remains obscure. The involved tufts of wiry hair resolved with gentle hair care. This suggests that trauma to the hair shaft may play a role. It is likely that additional cases of bubble hair remain unrecognized. Investigation of other patients with localized tufts of wiry hair is likely to reveal additional cases.

Angiotropic lymphoma: malignant angioendotheliomatosis

Malignant angioendotheliomatosis is an angiotropic lymphoma that may present with clinical findings suggestive of thrombophlebitis or vasculitis. Examination of a biopsy specimen with special stains for leukocyte common antigen establishes the diagnosis. Although malignant angioendotheliomatosis is usually fatal, early treatment with chemotherapeutic agents is helpful. We review the characteristics and treatment of this uncommon disorder and present an illustrative case.

Relapsing polychondritis: a case diagnosed by direct immunofluorescence and coexisting with pseudocyst of the auricle

A case of relapsing polychondritis with perichondrial IgG and C3, dermoepidermal IgG, and a coexisting pseudocyst of the auricle is reported. The use of direct immunofluorescence testing in establishing a diagnosis of relapsing polychondritis and the expected findings are reviewed. In some cases direct immunofluorescence may allow a diagnosis of relapsing polychondritis before clinical criteria or a routine histologic evaluation suggests a definite diagnosis.

Chemical and traumatic alopecia from thioglycolate in a black woman: a case report with unusual clinical and histologic findings

We report an unusual case of verrucal alopecia occurring on the vertex scalp of a black woman, which was presumed to be secondary to use of a thioglycolate permanent wave preparation. We describe the clinical and histologic features of this chemical and traumatic alopecia as well as that of frontotemporal chronic traction alopecia resulting from use of sponge rollers. Common hair care practices are a frequent cause of alopecia in black women. Familiarity with these hair practices will aid in the accurate diagnosis, prevention, and proper management of this problem. The evaluation, causes, and differential diagnosis of alopecia in a black woman are discussed.

Fibrous papule of the nose with granular cells: two cases

Two cases of fibrous papule of the nose (FPN) with granular cell features are presented and discussed. Both lesions have classic architectural features of FPN; however, the main stromal cells show large cytoplasmic granules of the type seen in granular cells. We are uncertain of the significance of these findings. Our hypotheses include a perifollicular granular cell reaction and a granular degenerative change of local dermal dendrocytes.

Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency and cutaneous vasculitis. Report of a case with exacerbation of a cutaneous neoplasm during immunosuppressive therapy

We describe a patient with both Muir-Torre syndrome and alpha 1-antitrypsin deficiency. A keratoacanthoma developed after immunosuppressive therapy for necrotizing vasculitis. To our knowledge, this is the first reported case of Muir-Torre syndrome associated with alpha 1-antitrypsin deficiency.

Magnetic resonance imaging of cutaneous neoplasms: clinicopathologic correlation

Recently, magnetic resonance imaging (MRI) has been reported to be clinically useful, in selected cases, in patients with melanocytic skin lesions. This report describes good resolution, clinically useful MRI scans of squamous cell carcinoma, dermatofibroma, and primary cutaneous B-cell lymphoma. The tumor depth measured by MRI was in excellent correlation with Breslow's depth measurements, indicating that MRI is probably the radiologic technique of choice for preoperative evaluation of the extent and depth of primary and recurrent skin tumors. This report also provides the authors' recommendations for obtaining optimal MRI images of cutaneous lesions.

Diffuse dermal histiocytosis. A variant of generalized granuloma annulare

A young man had asymptomatic, confluent, annular erythematous/violaceous plaques on the trunk and extremities. Pathology showed a moderately dense dermal infiltrate of spindle cells characterized as non-X histiocytes by immunohistology and ultrastructural analysis. We believe this is an unusual form of diffuse histiocytosis and should be classified as a variant of generalized granuloma annulare.

The cosmetic ingredient review self-regulatory safety program

The CIR's 13-year history of cosmetic-ingredient safety review appears to have successfully accomplished its goal of reviewing in a scientific manner the safety of cosmetic chemical ingredients. The method of prioritization has allowed for the identification of the most frequently used and the most biologically active chemicals. To date, 310 cosmetic ingredients have been reviewed, and 33 ingredients are under current review. Although CIR does not have a safety-evaluation report available for every cosmetic ingredient in use, it has proved that CIR is a system of documentation, review, and analysis that can be used to address any safety problem that may exist with any cosmetic ingredient.

Reticulate nonmelanocytic hyperpigmentation anomaly. A probable variant of Dowling-Degos disease

A 26-year-old white woman had reticulate nonmelanocytic hyperpigmentation anomaly characterized by partially blanching red-brown papules and macules and a histologic picture of digitate epithelial budding proliferation with lightly pigmented rete ridges. Except for the classically described hyperpigmentation at the rete ridge tips, the patient has Dowling-Degos disease. This case of a reticulate nonmelanocytic hyperpigmentation anomaly is probably a variant of Dowling-Degos disease.

Virilization secondary to topical testosterone

Topical testosterone is recognized as a standard treatment for vulvar lichen sclerosus et atrophicus. Systemic androgenic side effects of this medication are widely believed to be uncommon and mild. A case is reported of severe hirsutism with other signs of virilization and markedly elevated serum testosterone levels secondary to use of topical testosterone propionate for vulvar lichen sclerosus et atrophicus. Caution is necessary in the use of topical testosterone, with close monitoring for signs of virilization. Alternative treatments for this condition, such as intralesional corticosteroids or topical progesterone, are recommended to avoid the risk of androgenic side effects.

Myelodysplastic syndrome and transient acantholytic dermatosis

Focal acantholytic dyskeratosis consistent with the clinical and histological features of Darier's type of transient acantholytic dermatosis occurred in a man with myelodysplasia. Topical steroids and systemic antihistamines provided temporary and moderate relief from pruritus, but failed to control the dermatosis.

Squamous cell carcinoma of the nail bed: a clinicopathological study of 12 cases

Twelve cases were reviewed of squamous cell carcinoma of the nail bed, with emphasis on the aetiological role of human papillomavirus (HPV) infection and radiation damage. Using a hybridization technique, similar HPV genomes were detected in a uterine cervical neoplasia and a subungual squamous cell carcinoma in the same patient.

Prevention of hair growth in myocutaneous flap reconstruction

Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncologic procedures in the head and neck. Transfer of hair-bearing skin into the reconstructed upper digestive tract can be a major disadvantage associated with the pectoralis major flap. De-epithelialization of skin to the dermal level, removing the majority of skin appendages, can convert a myocutaneous flap to a "myodermal" flap. Platysma myocutaneous and myodermal flaps were grafted into the oral cavity of 13 dogs. Gross and histologic evaluation confirmed decreased hair growth in the experimental myodermal flap. Wound complications and graft survival were similar for both techniques. Diminished hair growth further supports the utility of myodermal flaps in hairy male patients undergoing upper digestive tract reconstruction.

Treatment of androgenic disorders in women: acne, hirsutism, and alopecia

Androgen excess disorders--acne, alopecia, and hirsutism--can be treated effectively with endocrine therapy such as androgen receptor blockers or antagonists, or with androgen suppression. Spironolactone, estrogen, and dexamethasone are considered the most effective approaches to treatment. Whatever the modality, careful planning is key to success, with recognition that response rates vary from patient to patient. A treatment regimen generally continues for at least 2 years.

Diagnostic approach to androgen disorders in women: acne, hirsutism, and alopecia

The most common signs of androgen excess in women are acne, alopecia, and hirsutism. Less common manifestations include android obesity, virilization, and acanthosis nigricans. These changes appear to be the result of excessive androgen production or increased target organ sensitivity. To evaluate excessive androgen production, an androgen screening protocol is recommended that includes measurement of dehydroepiandrosterone sulfate, testosterone, androstenedione, prolactin, follicular stimulating hormone, and luteinizing hormone. When androgen excess is confirmed, dexamethasone suppression is recommended to determine the source of the androgen(s). Once excessive androgen production is confirmed, more specific therapies can be administered.

Reticulate pigmented anomaly of the flexures (Dowling-Degos disease): a case report associated with hidradenitis suppurativa and squamous cell carcinoma

We report the first case of reticulate pigmented anomaly of the flexures (Dowling-Degos disease) associated with hidradenitis suppurativa. Our patient also showed a squamous cell carcinoma of the groin, which is a rare complication of hidradenitis suppurativa. The relationship between Dowling-Degos disease and hidradenitis is discussed and the literature on squamous cell carcinoma and hidradenitis suppurativa is reviewed.

Mosaic hair color changes in alopecia areata

This paper documents the mosaic hair color changes in two patients with extensive alopecia areata. The authors suggest that these changes are the end result of localized immunologic reactions directed against the melanocyte, resulting in a cytotoxic effect on the melanocytes and altering the hair color. Visually, the change is identified as patchy lightening, occasional depigmentation, and whitening of existing scalp hair. These changes reflect increased activity and progression of alopecia areata.

A simple immunochemical technique for distinguishing melanocytes and melanophages in paraffin-embedded tissue

We describe an immunoperoxidase technique for distinguishing melanocytes and melanophages in paraffin-embedded tissue. Two primary antibodies were used: anti-S100 and HAM-56, a monoclonal antibody directed against macrophages. In a variety of pigmented lesions, HAM-56 labelled melanophages while S100 labelled cells of melanocytic lineage.