Christine Jaworsky

Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis

Summary Hair‐bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the nonalopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n= 3), while transitional regions consistently showed the presence of activated T‐cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CDl epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T‐cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.

Beneficial effect of low-dose systemic retinoid in combination with topical tretinoin for the treatment and prophylaxis of premalignant and malignant skin lesions in renal transplant recipients.

Renal transplant recipients experience a greatly increased frequency of neoplastic skin lesions, including aggressive squamous cell carcinomas. Recent reports suggest that high doses of systemic retinoids may exert a chemotherapeutic and chemoprophylactic effect. Similarly, topical retinoid, especially tretinoin, has also been shown to be anti-tumoragenic in various settings. Because of the serious toxicity of high-dose systemic retinoid, a protocol was developed that combined topical tretinoin with low-dose etretinate (10 mg daily) for the treatment of frequently occurring dysplastic skin lesions in renal transplant recipients. Seven patients elected to receive combined tretinoin and etretinate therapy, and 4 were treated with tretinoin alone. Clinical evaluations were performed monthly. By 3 months of therapy, 9 of 11 patients exhibited at least a 25% decrease in the number of neoplastic growths. After 6 months, 6 of 8 evaluable patients, including 2 of 3 individuals receiving tretinoin alone, exhibited at least a 50% decrease. Three of 4 patients on the combined regimen and 2 of 3 receiving tretinoin alone for at least 9 months, exhibited a significant decrease in the rate of development of new squamous cell cancers. At the start of treatment, epidermal specimens were almost completely devoid of Langerhans cells (CD1+ cells). Their density increased greatly and in proportion to the duration of therapy. Long term topical tretinoin with or without low-dose oral etretinate seems to be an effective regimen to suppress the development of new tumors and to reduce the numbers of existing lesions in renal transplant recipients.

Pigmented malignant pilomatrixoma: report of a case and review of the literature.

An unusual variant of malignant pilomatrixoma displaying melanization of epithelial elements is described. Melanization is a rare event even in the benign form of this adnexal neoplasm. Previously reported cases of malignant pilomatrixoma are re‐viewd; none containing pigment have been previously reported to our knowledge. Possible etiologies for lack of pigment in most benign and malignant pilomatrixoma are discussed .

Analysis of cutaneous foreign bodies

Foreign materials from exogenous sources pose a constant challenge to the diagnostic skills of practicing dermatologists. Depending upon circumstances, radiologic, histologic, and ultrastructural techniques can be of assistance in ascertaining the presence and nature of the substance in question. With technologic advancements, identification of small-sized particles is no longer limited to morphologic study alone. Ultrastructural analytic techniques now permit identification of minute particles or quantities of material in tissues with relative ease. No doubt, further application of currently available and newly evolving analytic systems will expand our limits of detection and enhance our scientific knowledge.