Eugene J. Van Scott

Cutaneous Hypersensitivity and Desensitization to Mechlorethamine in Patients with Mycosis Fungoides Lymphoma

Excerpt Mechlorethamine (nitrogen mustard, HN2) has been employed in the therapy of mycosis fungoides lymphoma for many years, most often by the intravenous route (1, 2). More recently, the agent h...

Normal immunologic reactivity in patients with the lymphoma mycosis fungoides.

Patients having the lymphoma, mycosis fungoides, make circulating antibodies to parenterally administered antigens in all stages of the illness. The titers are normal or slightly reduced in these patients. There is little, if any, alteration of delayed hypersensitivity responses in patients with mycosis fungoides. Serum immunoglobulin G levels are normal in patients with mycosis fungoides whereas the immunoglobulin A levels are elevated markedly. Serum immunoglobulin M levels are within normal limits. Possible reasons for these phenomena are discussed.

Alterations of lesions of mycosis fungoides lymphoma by direct imposition of delayed hypersensitivity reactions.

Plaque lesions of mycosis fungoides lymphoma in six patients sensitized to both 2‐4 dinitrochlorobenzene (DNCB) and S, 2‐aminoethylisothiuronium (AET) were treated topically with varying doses of the chemicals to evoke delayed hypersensitivity reactions. Complete or partial clearing of lesions, lasting several months, was observed in 22 of 31 plaques treated. No clinical benefit was observed following applications of a cutaneous irritant, sodium lauryl sulfate, nor with four chemical congeners of DNCB not cross‐antigenic with DNCB. Cutaneous lymphoma lesions of one patient anergic to DNCB did not regress following large topical doses of the chemical. This evidence indicates that lesions of the lymphoma mycosis fungoides may be altered significantly by delayed hypersitivity responses, an event of seeming importance to understanding the pathogenesis of this disease.

EVALUATION OF DISTURBED HAIR GROWTH IN ALOPECIA AREATA AND OTHER ALOPECIAS

Many specific chemical and physical agents, as well as disease conditions, are known to interfere with the growth of hair in man. With several of these the pathological changes in thc scalp and the pathogenesis of the disturbed function of the hair follicle and hair root have been sufficiently studied to permit identification of the defect in each case and to allow classification of hair loss into several general types. In no instance, however, have specific biochemical or biophysical mechanisms of interference been fully established. The etiology of alopecia areata is unknown even though speculations on causes of the disease may be somewhat numerous. The essential nahre of the defect in hairs and hair follicles was recorded thirty years ago by Sabouraud, who made the significant observation that hair follicles in this disease continually, although abortively, attempt to produce hair. The pathological state of the hair follicle in relation to its environmental connective tissue has been studied recently2,3 in an attempt to understand more fully the nature of the defect in hair growth in alopecic states. This paper endeavors to evaluate and interpret the problem of alopecia areata by comparing findings in this disease, of unknown cause, with findings in alopecic states where the etiology is known. Baldness in this disease is generally first noticed on the scalp as small circular areas, which remain circular in configuration as they enlarge. Similar areas of baldness simultaneously occur on other areas of the body but often arc unnoticed a t the onset of the disease. Baldness of the entire body surface may occur, and develops generally by coalescence of ever-enlarging balding patches, although the progress of the disease may be so rapid that loss of hair seems to occur on all parts of the body almost simultaneously. The configuration and variable size of the bald areas is not correlated with known anatomical divisions of the skin (for example, dermatomes, nerve supply, vascular supply, body region). There may be persistent localized areas of baldness, or large segments of the body may become bald, or hair may regrow in all areas, after which loss of hair may or may not recur again a t a later time. No objective systemic abnormalities indicative of a general toxicity, such as infection, fever, allergy, depressed formation of cells by the bone marrow, or abnormal endocrine states arc known to be associated with the disease. Detectable abnormalities of the scalp seem to make their appearsncc abruptly, inasmuch as clinically uninvolved scalp adjacent to enlarging bald areas is found to be histologically normal. I have observed such a histologically normal scalp to become totally alopecic within a two to three week period following biopsy. The rapid development of a lesion thus makcs it difficult to dctermine the sequential

Cells in lesions of mycosis fungoides lymphoma following therapy. Changes in number and type.

The cellular infiltrate in mycosis fungoides lymphoma was evaluated by a quantitative morphologic technique prior to, during, and after therapy with various antilymphoma agents. Prior to therapy plaques of disease differed from tumors in having fewer total cells and fewer atypical cells per unit field. Both types of lesions responded very well to each treatment modality employed with clinical regression occurring in 30 of 32 areas. After therapy there was a marked reduction in the total number of cells and of atypical cells. The number of lymphocytes remained constant. These changes are discussed with reference to their significance to the course of the disease.

Integument—The Hide in Seeking*

One year ago, Dr. Irvin Blank (1), in his presidential address before this Society spoke of cutaneous barriers, the properties of the skin which protect the organism from its environment, maintain it in relative isolation, and which in consequence in many ways insulate it against outside influences. He also spoke of the intangible barriers of dermatology, properties of the specialty which tend to maintain the discipline of dermatology in relative isolation, and in consequence insulate it against outside influences. In turn, on this occasion of the presidential address, it is my intention to talk of the skin as a highly functional intercommunicating and interrelating medium which mediates an intimate relationship of the organism with its environment. I wish also to direct attention to properties of the skin which similarly may be operable to induce dermatology into greater functional identities in interdisciplinary environments.