Eleasar J. Feuerman

Coexistence of psoriasis vulgaris and bullous diseases

The coexistence of psoriasis vulgaris and bullous diseases has been described in the literature, mainly with bullous pemphigoid. In the majority of cases the bullous eruption has been thought to be related to antipsoriatic treatment. We describe nine cases of psoriasis vulgaris that were associated with bullous diseases: five bullous pemphigoid, one cicatricial pemphigoid, and three pemphigus vulgaris. The association between psoriasis vulgaris and these bullous diseases may be explained on an immunologic basis.

A STUDY OF THE EFFECT OF PKEDNISONE AND AN ANTIHISTAMINE ON PATCH TEST REACTIONS

SUMMARY.— A study was carried out to observe the effect of the administration of varying amounts of prednisone, as well as of the antihistamine Incidal, upon the patch test reaction in patients who had previously shown a positive or strongly positive reaction with different substances. A daily dose of 40 mg prednisone given to 12 patientswasfound tosuppressthetest reaction completely in 3 patients and to diminish it in 8; in 1 case there was no change. With a daily dose of 30 mg given to 18 patients, the reaction was suppressed in 4 and diminished in 6 patients; in 8 no difference could be detected. In the 16 patients who were given a daily dose of 20 mg predispose, the test was completely suppressed in only 1, was diminished in 5 patients, and was unchanged in 10. In all of the 10 patients who were given the antihistamine Incidal (mebhydrolin napadisylate) no difference could be seen in the patch test reactions.

Induction of pemphigus by X‐ray irradiation

A 70–year‐old female who had been suffering from psoriasis vulgaris for 20 years, and from lymphoma for 5 years, developed a vesiculo‐bullous eruption two weeks after exposure to radiotherapy. The historical and immunofluorescent findings confirmed the clinical diagnosis of pemphigus vulgaris. Immunological tests revealed impaired cell‐mediated immunity. It is suggested that the X‐ray irradiation may have served as a provoking factor for the development of the pemphigus in a patient with underlying immunological disturbances.

The Sign of Leser-Trélat in Association with Lymphocytic Lymphoma

The sign of Leser-Trélat was observed in a patient with multiple seborrheic keratoses and hemangiomata. The increase in these lesions of the skin preceded the development of a poorly differentiated lymphocytic lymphoma, a type of malignancy which has not yet been reported in association with this sign.

Disseminated granuloma annulare following erythema multiforme minor

A 44‐year‐old woman presented with erythema multiforme minor followed by disseminated granuloma annulare 4 weeks later. The patient was not taking any medication and had no history of herpes simplex infection. Involvement of a delayed‐type hypersensitivity reaction in the pathogenesis of these two well known disorders, as suggested by immunological investigations, may explain their concurrence in our patient. The substitution of the erythema multiforme minor lesions by an eruption of disseminated granuloma annulare at the same sites suggests the possibility of a Koebner phenomenon or an isotopic response.

Appearance of Lupus erythematosus in a Patient with Lichen planus Treated by Isoniazide

We hereby present a case report of a patient suffering from lichen planus and who, while under treatment with isoniazide, developed skin lesions and serologic abnormality which were typical of lupus e

The prevalence of pathogentic and potentially pathogenic fungi on the apparently healthy skin of patients with neoplastic diseases

A group of 83 patients (45 females, 38 males) suffering from various cancerous diseases were investigated for the presence of fungi, specimens being obtained from the intertriginous areas of the body and toe and fingernails as well as areas of apparently healthy skin at sites less prone to fungal infection, including the abdomen, thorax and interscapular area. A group of 25 patients with non-cancerous disease served as controls Examination of the KOH-treated scrapings and cultures revealed that the nails were affected in 85 % of the neoplastic patients, the toe-webs and soles in 79 %, the groin in 72 % and the inframmammary fold in 33 %. T. rubrum was the predominant organism found in the nails and soles, C. albicans in the groin and breast T. mentagrophytes (interdigitale) was second in order of frequency and E. floccosum was found in only a few cases. Of note was the finding of these fungi in areas with no visible changes, particularly on the abdomen (in 23 patients), the back (in 17 cases) and thorax (in 11 cases). The latter areas also were found to harbour the blastospores of Pityrosporum spp. in 22 patients. There was a negative response to trichophytin and candidin antigens in all the patients. The tests for cell-mediated immunity performed in 22 patients provided no significant data. In the control group of non-cancerous patients there was no evidence for any of the above fungi on the back, abdomen or thorax area. The findings of this study indicate that the apparently healthy skin of cancerous patients shows a higher incidence of fungal invasion in both areas usually affected by fungi as well as those usually found not to be affected in non-cancerous individuals.

Lupus erythematosus profundus (Kaposi-Irgang) with monoclonal gammopathy.

The appearance of subcutaneous nodules of lupus erythematosus profundus on the face and neck of a woman with a long history of lupus erythematosus (LE) is reported. Of note were the three distinct stages in the course of the disease:

Nikolsky's or Pseudo-Nikolsky's sign in bullous pemphigoid.

Nikolsky’s sign is important in the clinical diagnosis of bullous diseases. Slight pressure or rubbing the skin causes separation of the upper layers, leaving a raw, moist abrasion. It i s classically present in pemphigus vulgaris, especially near an active and widespread lesion, and represents lack of cohesion between epidermal cells. It is caused by acantholysis that eventually produces vesicle formation. Nikolsky‘s sign has been demonstrated “through rarely, if ever, in uninvolved skin in bullous pemphigoid,”’ and it also could be elicited in polydysplastic epidermolysis bullosa, Toxic epidermal necrolysis, and Porphyria variegata.’ During the years 1982-1 983, 23 patients with bullous pemphigoid were admitted to the Department of Dermatology of the Beilinson Medical Center. In all cases, the diagnosis was confirmed by histologic and immunofluorescent criteria. Three of the patients (1 3%) had positive Nikolsky’s sign even in areas distant from active lesions. Histologic examination of the site where the skin was rubbed in one patient showed separation of the entire epidermis from dermis, leaving the basal cell layer attached to the epidermis (Fig. 1 ). This phenomenon seems not to be as uncommon in bullous pemphigoid as reported in the literature. It is preferable to use the term “pseudo-Nikolsky’s sign” in cases in which subepidermal separation of skin occurs, as in bullous pemphigoid, polydysplastic epidermolysis bullous, and toxic epidermal necrolysis and porphyria variegata3 and to reserve the term “Nikolsky’s sign” for those cases in which the lack of cohesion i s between epidermal cells, as in pemphigus.

Solcoderm in the Treatment of Solar and Seborrheic Keratoses

Solcoderm treatment was applied to 46 patients with solar keratosis and 40 with seborrheic keratosis. Evaluation at regular follow-up over a 10-week period showed disappearance of the lesions without any remnant in most cases. Treatment was found to be effective, convenient, and with essentially no side effects.