Clayton E. Wheeler

Epidermolysis bullosa acquisita presenting as an inflammatory bullous disease

A patient is described with the histologic, immunohistologic, and immunoelectron microscopic features of epidermolysis bullosa acquisita (EBA). Although she eventually developed the clinical features of that disease, she differs from previously reported patients by initially having an inflammatory dermatoses and a generalized erythematous bullous eruption clinically indistinguishable from bullous pemphigoid. The presentation suggests that the clinical spectrum of EBA may include a generalized inflammatory bullous disease and that EBA should be considered in the differential diagnosis of chronic acquired inflammatory bullous dermatoses.

Lamellar ichthyosis, dwarfism, mental retardation, and hair shaft abnormalities: A link between the ichthyosis-associated and BIDS syndromes

There is an expanding list of syndromes that combine ichthyosis with neuroectodermal and mesodermal defects. We present the case of a young woman with the following features: lamellar ichthyosis, dwarfism, mental retardation, nail and dental abnormalities, unusual facies, poor sexual maturation, punctate cataracts, and hair shaft abnormalities. There were no neurologic or auditory defects. Hair examination revealed pili torti, trichoschisis, bright and dark bands with polarizing microscopy, and a low hair sulfur content. The patient did not have aminoaciduria or immunoglobulin abnormalities. We believe that this case is a link between the ichthyosis-associated syndromes and the group of syndromes that have in common abnormal hair with clean transverse fractures (trichoschisis) and low sulfur content. A more complete examination of the hair in other patients with ichthyosis and associated abnormalities will probably reveal more patients with this new syndrome.

The herpes simplex problem

Most of the worlds population is eventually infected with herpes simplex virus type 1, type 2, or both. Most infected persons harbor latent virus in nerve ganglia for the rest of their lives. True primary infections, nonprimary first-episode infections, and recurrent infections can be asymptomatic or clinical, but all of these are contagious. Past estimates of recurrent herpes affecting 20% to 40% of the population are probably low because of inadequate studies of asymptomatic shedding and genital recurrences. Herpes infections are spread primarily by close personal contact but some are contracted by fomites and medical-dental procedures. Latent virus harbored by almost everyone with frequent reactivation to produce symptomatic or asymptomatic, infectious recurrent disease poses a huge problem for control or eradication of herpes simplex infections. Public health measures will probably fail because they require too much alteration of the publics life-styles. So far, antiviral drugs do not eliminate latent virus from infected ganglia. That naturally infected persons can be reinfected, superinfected, or autoinoculated raises serious questions whether vaccines will eradicate the disease, although they might control some serious manifestations and limit some spreading. The problem of eradicating herpes is different from that of eradicating smallpox, where latent infections with infectious recurrences did not exist.

Immunology of human warts

Rapid advances have occurred in the characterization of human papilloma virus (HPV) types applying the new advanced techniques of restriction endonuclease analysis and molecular hybridization to human wart virus. Human papilloma virus can no longer be viewed as a single, homogeneous virus producing all varieties of clinical warts. At least three antigenically heterogeneous HPV types have been associated with common and plantar warts. Two additional HPV types have been found in patients with epidermodysplasia verruciformis. Condylomata acuminata and laryngeal papillomas contain viruses which are also distinct from the preceding viruses and may represent additional HPV types. This antigenic heterogeneity of HPV has important implications concerning the immunology of human warts which have not been taken into account in most previously published studies. Both antibody and cell-mediated responses may be seen in patients with active warts, but many patients with warts have no demonstrable immune reactions. The role of immunity in wart regression remains poorly understood. Nevertheless, the increased frequency of warts in patients receiving immunosuppressive drugs and with immune deficiency states and the immunologic alterations which occur in patients with regressing or cured warts compared to patients with active warts, particularly the increased frequency of cell-mediated responses and antibodies specific for viral antigens, support a possible role for immunity in the resolution of warts. The evidence to date, however, does not prove that immune mechanisms are directly responsible for the elimination of warts.

Hyperpigmentation in megaloblastic anemia

Generalized hyperpigmentation developed over 2 years in a 65-year-old woman. A diagnosis of pernicious anemia was made, and treatment with vitamin B12 led to complete reversion of her hyperpigmentation to normal. Literature pertinent to hyperpigmentation and its association with megaloblastic anemias is reviewed and several possible mechanisms are mentioned.

Diagnosis of human scabies by epidermal shave biopsy

A superficial shave biopsy is described as a simple, essentially painless, more reliable method for the demonstration of the scabies mite, eggs, and feces in human skin.

Multiple clear cell acanthomas: Case report and delineation of basement membrane zone antigens

A case of multiple clear cell acanthomas is described with a review of the literature. This benign glycogen-rich epidermal tumor is generally unable to accept melanin and lacks phosphorylase or cytochrome oxidase activity. However, the basement membrane zone appears antigenically normal, as documented by the presence of epidermolysis bullosa acquisita antigen, bullous pemphigoid antigen, heparan sulfate proteoglycan, type IV collagen, and laminin by immunofluorescence microscopy.

Shortage of full-time faculty in dermatology.

• A persistent shortage of full-time faculty exists in dermatology. Despite the addition of 124 new full-time faculty since 1971 through 1972,136 training programs in 1974 through 1975 were actively seeking 88 new full-time faculty and believed they needed 243. With a net gain of 30 new faculty a year, it will take 2.93 years to add 88 new faculty that are being actively sought and 5.16 years to add 155 more that are urgently needed. During this eight years, demand for new faculty will increase, so that figures of need may remain essentially unchanged in 1982 through 1983 as between 1971 through 1972 and 1974 through 1975. Expertise that was most needed was in immunology, electron microscopy, histopathology, microbiology, and biochemistry; many accept faculty in any area or with no special training. Measures should be taken to attract and retain more dermatologists in full-time academic positions. ( Arch Dermatol 113:297-301, 1977)

Plaque Titration of Herpes Simplex with Antibody-Free Liquid Overlay

Summary Two reliable methods for plaque titration of herpes simplex in antibody-free liquid culture medium have been described. Some advantages over plaque titrations with solid or antibody-containing overlays are elimination of inhibitory effects of agar and antiserum, greater choice in type of culture vessel which allows for saving of culture materials, technicians time, and incubator space, optional elimination of carbon dioxide incubators, greater range of magnification, and more flexibility in manipulation of cultures.

Growth of herpes simplex virus in adult human skin organ cultures.

Summary Infection of adult human skin organ cultures with HF herpes simplex virus (type 2) resulted in appearance of new virus in the culture medium in 3 or 4 days. This was associated with epidermal cell cytopa-thogenesis which resembled in vivo herpes simplex infections. Cultures consisted of 4-mm punches of split-thickness skin incubated in 1 ml of medium in 16 × 125-mm screw-capped roller tubes at 35°. Cultures were easy to prepare in numbers, manipulate, and maintain; and viral reproduction and cytopathogenesis were reproducible.