Clouston syndrome: a rare autosomal dominant trait with palmoplantar hyperkeratosis and alopecia

A caucasian family is reported in which four males and four females in two generations have exhibited alopecia, dysplastic nails, and hyperkeratosis of palmar and plantar surfaces. This type of ectodermal dysplasia, Clouston syndrome, features normal teeth with severe hair and nail dysplasia.

Juvenile dermatomyositis

Juvenile dermatomyositis is a chronic disease of childhood that is manifested by severe symmetrical progressive muscle weakness, a characteristic heliotrope colored skin rash which involves the face, and by elevated serum enzymes related to muscle damage.

Skin cancer in patients with chronic radiation dermatitis

The cases of 76 patients with chronic radiation dermatitis resulting from low-dose ionizing radiation for benign disease were reviewed retrospectively for risk factors leading to the development of neoplasia. The patients were studied with respect to original hair color, eye color, sun reactive skin type, benign disease treated, area treated, age at treatment, and age at development of first skin cancer. Analysis of data showed 37% of patients had sun-reactive skin type I, 27% had type II, and 36% had type III. Types IV through VI were not represented. There appeared to be an overrepresentation of types I and II. Increased melanin pigmentation may therefore be either directly or indirectly protective against the development of skin cancers in patients who have received low-dose superficial ionizing radiation for benign disease. The sun-reactive skin type of patients with chronic radiation dermatitis may be used as a predictor of skin cancer risk when the total dose of ionizing radiation is not known.

Locally invasive cellular blue nevus of the scalp

The cellular blue nevus, although benign by accepted pathological criteria, may behave in an aggressive fashion. Distant metastases may occur as malignant melanoma. This case illustrates the potential malignant degeneration and spread of a "benign" neoplasm. A broader definition of malignancy to include the clinical behavior of cellular blue nevus may be in order.

Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation

Chemotherapy-induced acral erythema is an uncommon and distinctive syndrome of intense macular erythema of the palms and fingers seen in patients treated with high-dose chemotherapy. It is painful, may form bullae, and heals uneventfully with desquamation. The incidence (35%) of this complication in patients receiving bone marrow transplantation at our institution is quite high and probably reflects the exceptional doses of chemotherapy and concomitant total body irradiation these patients receive. Biopsy specimens showed vacuolar change, spongiosis, necrotic keratinocytes, and epidermal atypia. These findings probably result from direct toxic effect and mimic those of acute graft-vs-host disease. Awareness of chemotherapy-induced acral erythema is important to avoid its misdiagnosis as a cutaneous sign of acute graft-vs-host disease. This distinction can usually be made on clinical grounds. If necessary, serial skin biopsy specimens are helpful.

Cutaneous inoculation tuberculosis secondary to 'jailhouse tattooing'

Cutaneous inoculation tuberculosis is rare in the United States today. When seen, it usually occurs in individuals whose occupations or environments place them at increased risk for exposure to Mycobacterium tuberculosis. The reaction of the skin to M tuberculosis infection is polymorphous and depends upon the interplay of bacterial virulence and host immunity. Thus, both a high index of suspicion and positive cultures are required to make the diagnosis. Herein, we report a case of cutaneous inoculation tuberculosis occurring in a tattoo.

Halo scalp ring: a form of localized scalp injury associated with caput succedaneum

Caput succedaneum is a common birth injury attributed to cervical, uterine, or vaginal pressure on the fetal presenting part. It usually consists of diffuse soft tissue swelling and bruising, which resolve in a few days without sequelae. We have seen two patients who had an unusual alopecic "halo" ring on the scalp associated with a caput succedaneum.

Epidermolysis bullosa--pyloric atresia. An autosomal recessive syndrome

A sister and brother each had epidermolysis bullosa and pyloric atresia at birth. Both died in early infancy of complications related to epidermolysis bullosa. Electron microscopic studies of skin biopsy specimens disclosed findings consistent with a diagnosis of epidermolysis bullosa letalis. The existence of epidermolysis bullosa-pyloric atresia syndrome as a distinct clinical entity with autosomal recessive inheritance is supported by the findings in these patients.

The keratitis, ichthyosis, and deafness (KID) syndrome

We describe here a patient with ichthyosis, keratitis, deafness, and recalcitrant cutaneous bacterial and fungal infections, who was previously described as having hereditary hypohidrotic ectodermal dysplasia. Similarly affected patients described in the literature have the following features in common: (1) a distinctive ichthyosis characterized by a fine dry scale, follicular hyperkeratotic spines, and a reticulated pattern of hyperkeratosis on the palms and soles; (2) a vascularizing keratitis that results in notable visual impairment; and (3) neurosensory deafness. One half of the affected patients also display frequent, severe cutaneous infections. We suggest that the name "the KID syndrome" to emphasize the characteristic features of the syndrome-keratitis, ichthyosis, and deafness.

Hair implant complications

Four men who underwent hair implantation for pattern baldness were treated for complications such as infection, foreign-body reaction, pruritus, and scarring. The complications were similar to those reported with synthetic modacrylic fiber implants that have been used for the same purpose. Although we believe this is the first article to report complications from hair implants, the illogical basis of the procedure suggests that complications will occur in many unsuspecting patients who undergo hair implantation.

Intestinal pseudo-obstruction in mucocutaneous lymph-node syndrome

Mucocutaneous lymph-node syndrome (MCLS) is an acute exanthem with specific clinical features, sometimes complicated by involvement of internal organs. Two patients with MCLS had clinical and radiographic evidence of mechanical small-bowel obstruction, probably on the basis of focal vascular insufficiency, as anatomic obstruction was not documented in either instance. The cases indicate that intestinal involvement in patients with MCLS can simulate intestinal obstruction, and conservative management of such patients is appropriate.

A multicentered study of lysine therapy in Herpes simplex infection

Lysine appears to suppress the clinical manifestations of herpesvirus infection. 45 patients with frequently recurring herpes infection were given 312-1,200 mg of lysine daily in single or multiple doses. The clinical results demonstrated a beneficial effect from supplementary lysine in accelerating recovery from herpes simplex infection and suppressing recurrence. Tissue culture studies have demonstrated an enhancing effect on viral replication when the amino acid ratio of arginine to lysine favors arginine. The opposite, preponderance of lysine to arginine, suppresses viral replication and inhibits cytopathogenicity of herpes simplex virus. The codons characterizing herpes simplex DNA apparently specify production of viral capsids at the expense of host cell histones.