David L. Ramsay

Topical mechiorethamine therapy for early stage mycosis fungoides

One hundred seventeen patients with mycosis fungoides were treated with topical mechlorethamine hydrochloride. The probability of achieving a clinically apparent remission within 2 years of therapy was 75.8% in patients with stage I disease, 44.6% in patients with stage II disease, and 48.6% in patients with stage III disease. Patients with stage I disease achieved complete remission sooner (median, 6.5 months) than patients with stage II (median, 41.1 months) or stage III (median, 39.1 months) disease. The median time to relapse was 44.5 months. Sixty-eight patients (58.1%) developed a delayed hypersensitivity reaction, but only one patient had to discontinue therapy as a consequence. No appreciable differences were seen in the probability to achieve complete remission or time to complete remission as stratified by gender, substage, or the development of a delayed hypersensitivity reaction. Survival analysis revealed that the probability of surviving at 5 years was 89% for all patients. These findings compare favorably with results with other treatments for early stage mycosis fungoides.

Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection

Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for Lyme disease. Polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of Borrelia burgdorferi-specific DNA. The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot. Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure. Reinfection was not believed to have occurred. Further treatment with minocycline led to resolution of the erythema migrans.

Hypopigmented Mycosis Fungoides Associated With Human T Cell Lymphotropic Virus Type I Tax in a Pediatric Patient

* Abbreviations: MF = : mycosis fungoides • HTLV-I = : human T cell lymphotropic virus type I • NYUMC = : New York University Medical Center • UVB = : ultraviolet B • PBMC = : peripheral blood mononuclear cells • PCR = : polymerase chain reaction The cutaneous T cell lymphoma, mycosis fungoides (MF), is characterized by proliferation of atypical lymphocytes that preferentially home to the skin. Usually, afflicted patients are middle-aged and present with erythematous patches and plaques. Although often indolent, the disease may progress to a tumor stage and involve viscera. The present report concerns a 7-year-old black boy, who was born in Grenada and who presented with a 3-year history of slowly developing, hypopigmented patches scattered over his buttocks, legs, and arms involving approximately 20% of his body surface. He was serologically negative for antibodies to human T cell lymphotropic virus types I/II (HTLV-I/II). The young age of this patient, the hypopigmentation of his lesions, his origin from a region of the world where HTLV-I is endemic, and our previous studies showing an association of HTLV-I tax with MF,1 ,2 prompted us to investigate whether the patient and/or his first-degree relatives were infected with this virus. While the patients healthy mother proved to be a carrier of HTLV-I, with antibodies to the virus when tested by routine serologic methods, the patient, like other patients with MF, as well as his healthy younger brother, harbored only deleted HTLV-I proviral sequences. The possible implications of this observation are discussed. A 7-year-old black boy, born in Grenada, was referred to the Dermatology Service at New York University Medical Center (NYUMC) because of a 3-year history of hypopigmented macules and patches covering about 20% of his body (Fig 1). The hypopigmented lesions were not pruritic, scaly, or palpable to touch. He was otherwise well. His past medical history was relevant only in that he was born by spontaneous vaginal delivery and that he had been breastfed. Physical examination revealed no lymphadenopathy or organomegaly. Routine blood counts and biochemistries were all within normal range. He was serologically …

Technology in dermatology: Meeting the challenge today and tomorrow

If information technology is to enhance dermatology, physicians must adapt to new uses and forms oflanguage previouslyunconsidered and must adopt new methods and standards of communication. The American Academy of Dermatology (AAD) celebrated its fiftieth anniversary by presenting the 1988 Congress on Technology. The Congress focused on three technologic perspectives: educational applications, clinical practice, and medical information systems (medical informatics). This article considers these issues and offers highlights of the AAD Congress on Technology.

Response of Early Stage Cutaneous T-Cell Lymphoma to Ultraviolet B Phototherapy

Twenty-five (71%) of 35 patients with cutaneous T-cell lymphoma (CTCL) treated with ultraviolet B (UVB) phototherapy achieved a total remission. Median time to remission was 5 months, and median duration of the remission was 22 months. Twenty-five (83%) of patients with disease limited to patches (Stage I) achieved remission, whereas none of the patients with plaque level disease (Stage II) achieved remission. Of the 25 patients who achieved complete remission, five (20%) had a recurrence of CTCL. These results suggest that UVB phototherapy is an effective treatment for patients with early stage I disease.