David A. Fisher

6-Thioguanine treatment of psoriasis: Experience in 81 patients

BACKGROUND Despite recent innovations a considerable number of patients with psoriasis cannot be successfully treated by current therapies. OBJECTIVE Our purpose was to summarize our 18-year experience with the antimetabolite 6-thioguanine in the management of patients with psoriasis. METHODS We retrospectively studied 81 patients who were treated with 6-thioguanine. A variety of schedules were used to find the optimal schedule. Forty-eight percent of the patients either had been treated with methotrexate or were excluded from receiving methotrexate because of liver or kidney disease. RESULTS Forty-nine percent of patients with plaques were effectively maintained with 6-thioguanine for a median of 33 months. Four of five patients with palmoplantar pustular psoriasis experienced substantial benefit. The most common side effect was myelosuppression. CONCLUSION 6-Thioguanine is an effective therapy for psoriasis and should be considered for patients who have failed to respond to other systemic agents.

Pruritus as a symptom of hepatitis C.

Recent isolation, cloning, and sequencing of the hepatitis C genome, which has led to the development of an enzyme-linked immunosorbent assay, has produced increasing recognition of a hepatic disease that frequently leads to potentially lethal, chronic active hepatitis. We describe four patients who had pruritus or in whom pruritus developed as a consequence of hepatitis C. The symptom of pruritus should be added to a growing list of cutaneous manifestations of this newly recognized inflammatory viral hepatitis.

Solitary plexiform neurofibroma is not pathognomonic of von Recklinghausen's neurofibromatosis: a report of a case

A 42‐year‐old Caucasian man presented with a 1.8‐cm nodule in the proximal thigh (Fig. 1) that had been slowly enlarging for approximately 5 years. The patient had no family history of neurofibromatosis. Physical examination revealed none of the other stigmata of this neurocutaneous disorder. D.A.F. performed an elliptical excision as an out‐patient procedure. Grossly, the lesion was homogeneously opalescent and gelatinous. The tissue was fixed in 10% formalin and embedded in paraffin. Routine hematoxylin and eosin stained sections were prepared. The most notable feature on low power magnification was a large, circumscribed, lobular proliferation of spindle cells in a loose fibrillar background that distorted much of the dermis and subcutaneous fat (Fig. 2). On high power magnification, a population of cells with ovoid and S‐shaped nuclei admixed within densely packed eosinophilic collagenous material was seen at the center of the lobule (Fig. 3A). A small amount of mucin was also present. Within this cellular area, a dense population of S‐shaped spindle cells with eosinophilic cytoplasm was arranged in a parallel array forming microfascicles. At the periphery of this cellular component, a similar population of cells was arranged against a loose fibrillar background of abundant mucin (confirmed by colloidal iron stain) and scattered mast cells (Fig. 4). Lining the lobule was a compressed rim of thin, delicate collagen bundles and perineurial cells. Pleomorphic nuclei and mitotic figures were not observed. The surrounding dermis and subcutaneous tissue were unremarkable. Thickened collagen bundles at the center of the lobule could be seen with a frichrome stain. An S‐100 protein immunoperoxidase stain highlighted scattered Schwann cells within the lobule (Fig. 3B), and nerve bundles adjacent to the neurofibroma served as infernal positive controls.

Oral hairy leukoplakia unassociated with human immunodeficiency virus: Pseudo oral hairy leukoplakia

Oral hairy leukoplakia (0HL) was first reported in 1984 by Greenspan et aU Since then it has become widely recognized as a stigma of human immunodeficiency virus (HIV) infection. It most commonly affects the lateral tongue, but it has also been described on the buccal mucosa, floor of the mouth, soft palate, and oropharyruc2,3 Examination by in situ hybridization and other techniques have identified the presence of EpsteinBarr virus (EBV) in the lesions, but the earlier reports of the presence of human papillomavirus have not been corroborated.4, 5 The response of OHL to acyclovir would appear to confirm that it is associated with EBV.6,7 Green et al.8 reported 11 patients with the clinical and microscopic features ofOHL who were HIV antibody-negative and whose lesional biopsy tissue was negative for EBV DNA. They named this disorder pseudo hairy leukoplakia. We report a patient with the clinical, microscopic, serologic, and virologic findings of pseudo hairy leukoplakia.