Arthur L. Norins

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.

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.

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.

Vesicular cutaneous T cell lymphoma presenting with gangrene

1. Black MM. Lichen planus and lichenoid eruptions. In: Rook A, Wilkinson DS, Ebling FJG, et ai, eds. Textbook of dermatology. Oxford: Blackwell Scientific Publications, 1986: 1665-85. 2. Peachey JE, Brien JF, Roach CA, et al. A comparative review of the pharmacological and toxicological properties of disulfiram and calcium carbimide. J Clin Psychopharmacol 1981;1 :21-6. 3. Jobard-Drobacheff C, Blanc D, Quencez E, et al. Lichen planus of the oesophagus. Clin Exp Dermatol1988; 13:38-41. 4. Sheehan-Dare RA, Cotterill JA, Simmons AV. Oesophageallichen planus. Br J Dermatol 1986;115:729-30.

Zosteriform transient acantholytic dermatosis

A 33-year-old white woman with acute lymphocytic leukemia was treated with total body irradiation, chemotherapy, and an allogenic bone marrow transplantation. Two days after transplant, 9 days after total body irradiation, and 3 days after chemotherapy with thiotepa, cytarabine, and cyclophosphamide, an asymptomatic papulovesicular eruption developed in her right axilla and on her upper chest and arm (Fig. I). The distribution corresponded to dermatome TI, and some lesions had a herpetiform grouping. She was severely neutropenic (leukocytes Stedmans <IOO/mm3) and had been intermittently febrile. A Tzanck preparation revealed binucleate cells,but the viral culture was negative. A biopsy specimen obtained 3 days later revealed acantholysis, dyskeratotic cells, and a suprabasilar cleft, consistent with TAD (Fig. 2). The eruption progressed to involve much of the right side of the back and chest, but did not cross the midline. Resolution took place in 3 weeks without treatment or residual scarring.

The Management of Persistent Pediatric Skin Problems

Skin disease poses an additional problem not usually found in diseases of other systems because the skin is visible, making support and counseling of the parents important. This article deals specifically with management of disorders such as fungus infections of the scalp, acne, urticaria, staphylococcal infection, among others.

How We Treat Seborrheic Dermatitis

Seborrheic dermatitis usually presents as scaling lesions of the scalp, nasolabial folds, ears and presternal skin. Although often present in patients with acne vulgaris, rosacea or Parkinsons disease, it is not regularly associated with systemic disease. Local steroids help most with inflamed lesions, but nonprescription proprietary agents:, if continually used, are generally effective.