Hermann Pinkus

Multiple Fibrofolliculomas (Birt-Hogg-Dubé) Associated with a Large Connective Tissue Nevus

Multiple follicular tumors of the type recently described by Birt and colleagues as fibrofolliculomas were observed in the dorsal skin of a white man in association with a large connective tissue nevus. No signs of systemic disease or phakomatosis were present. This type of lesion represents benign neoplasia of the fibrous root sheath of the hair follicle in association with proliferations of the infundibular portion of the outer epithelial root sheath. Its existence supports the view that the mesodermal portions of the pilar apparatus can become neoplastic, and also provides another example of the close interactions existing between the ectodermal and mesodermal components of the hair follicle.

Differential Patterns of Elastic Fibers in Scarring and Non‐Scarring Alopecias

Elastic fiber stain (acid alcoholic orcein) reveals diagnostically significant differences between several types of alopecia of the scalp. A short outline of elastic fiber distribution on the normal hair follicle emphasizes the elastic coat of the follicular isthmus, the sparsity of elastic fibers on the cyclic lower portion of the hair root, and the presence in the neck of the dermal papilla of an elastin‐like body which is formed anew with each hair cycle. This body provides a marker of the gradual shortening of successive anagen hairs in male pattern alopecia. Patterns of elastic fibers in the perifollicular and interfollicular dermis are helpful in differentiating idiopathic pseudopelade of Brocq from pseudopeladic states secondary to lupus erythematosus and other disease processes. Within the idiopathic group, the development of elastic fibres on the lower cyclic portion of the hair root identifies a sub‐group that may have a different, non‐inflammatory pathogenesis and is provisionally designated as fibrosing alopecia.

Histopathological spectrum of erythema multiforme.

Lesions of erythema multiforme from seventy‐five patients have been studied histologically. In addition to peculiar intercellular epidermal oedema, subepidermal separation and a Lymphohistiocytic inflammatory infiltrate in the papillary dermis, epidermal cell necrosis was observed in a variable percentage of the lesions. While dermal disturbance was a predominant finding in the macular lesions, focal or generalized keratinocytic necrosis was seen in the macular, papular, bullous and iris lesions in that order of frequency. Significant numbers of eosinophils were present in the inflammatory infiltrate in 60% of the bullous and 28% of the macular lesions. Our findings suggest that erythema multiforme represents a tissue reaction with spectral expression, one end presenting as a predominantly dermal disturbance and the other merging into the adult type of toxic epidermal necrolysis. Yet, the histological features remain sufficiently characteristic for differentiation from other erythematous and vesiculobullous eruptions.

Trichoadenoma of Nikolowski.

Trichoadenoma of Nikolowski is a rare benign tumor of the skin with hair follicle‐like direction of differentiation. This tumor is less mature than trichofolliculoma and more differentized than tri‐choepithelioma. Probably because of its rarity it has not been a well recognized tumor. We are reporting on eight cases of trichoadenoma to further define this benign growth.

Volar melanotic macules.

Asymptomatic light brown or tannish‐gray macules are seen on palms and/or soles of black patients, and occsionally on the volar surfaces of whites. They may be mistaken for lesions of secondary syphilis or other postinflammatory hyperpigmented dermatoses. Histologic examination of 14 specimens obtained at necropsy showed purely epidermal hyperpigmentation of all epidermal layers; or β) melanin restricted to large dendritic melanocytes without appreciable transfer to keratinocytes. The number of melanocytes was not significantly increased, and with one exception, there were no nevus cells. These volar melanotic macules have close clinical and histologic resemblance to melanotic macules observed occasionally on the vermillion area of the lips.

A case of biphasic ichthyosiform dermatosis: Light and electron microscopic study

ZusammenfassungDie klinischen, histologischen und feingeweblichen Besonderheiten eines ungewöhnlichen Falles von ichthyosisähnlicher Dermatose werden beschrieben. Der Patient war ein 44 Jahre alter, intelligenter, weißer Amerikaner, der seit früher Kindheit an allen vier Extremitäten Ichthyosis hystrix-ähnliche Veränderungen aufwies, die die Streckseiten bevorzugten. Im Alter von über 40 Jahren entstanden plötzlich als eine zweite Phase der Krankheit schuppende Herde am ganzen Körper, die trotz klinischer Verschiedenheit histologisch den alten Läsionen glichen. Die Epidermis war aufgebaut aus abnorm großen Stachelzellen, die ohne gut ausgebildete Körnerschicht in eine dicke, meist orthokeratotische Hornschicht übergingen, und deren Cytoplasma durch eine schalenartige Scheidewand in eine innere und äußere Zone getrennt war. Die äußere Zone sah unter dem Elektronenmikroskop ziemlich normal aus und zeigte gut entwickelte Tonofilament-Desmosomen-Komplexe. Die innere Zone besaß keine Tonofilamente, aber reichlich Mitochondrien und endoplasmatisches Reticulum. Die die Innenzone begrenzende Schale schien aus wirr angeordneten Tonofilamenten zu bestehen, zu denen sich in höheren Lagen der Epidermis kleine Keratohyalinkörnchen gesellten. Obwohl die cytoplasmatischen Zonen nicht durch strukturierte Membranen voneinander getrennt waren, schien eine Phasengrenze zu existieren, die Keratohyalinkörnchen und Tonofilamenten den Eintritt in das Endoplasma verwehrte. Der Ausdruck zweiphasige ichthyosisähnliche Dermatose läßt sich daher sowohl auf das klinische wie auf das feingewebliche Bild dieses Falles anwenden.SummaryThe clinical, light microscopic, and fine structural features of an unusual case of ichthyosiform dermatosis are presented. Clinically, this 44 year old Caucasian male had been affected by stable ichthyosis hystrix-like lesions on his extremities since infancy. In middle age, clinically different, but histologically similar lesions developed in the form of scaly plaques all over his trunk as a second phase. Microscopically, the epidermis consisted of abnormally large prickle cells, which faded without formation of a distinct granular layer into a thick and mainly orthokeratotic stratum corneum. The cytoplasm of the prickle cells showed division into inner and outer zones separated by a peculiar shell. While the exoplasmatic zone had fairly normal structures including well developed tonofilament-desmosome complexes, the inner zone was devoid of tonofilaments, but rich in mitochondria, endoplasmic reticulum, and other organelles. The shell appeared to consist of disorganized tonofilaments associated in higher layers with small keratohyalin granules. While no structured membranes divided the zones, there seemed to be a phase boundary which prevented keratohyalin granules and tonofilaments from entering the endoplasm. The term biphasic ichthyosiform dermatosis thus seems applicable on the clinical as well as on the fine structural level.

Anatomy of the Skin

Skin is the largest organ of the body. The average adult has 18 square feet of skin which account for 16% of the total body weight. Skin acts as a physical barrier for you to the outside world. Skin protects you against infection and injury. Skin provides for a water tight barrier. It acts as a barrier for the environment to you, the patient, in everything you do. Lacerations, abrasions or burns alter this ability to protect and buffer you from your surroundings. Skin helps regulate body temperature. Skin contains glands that lubricate and moisturize your skin. Skin undergoes constant repair and regeneration. Skin determines your physical identity.

THE DIRECTION OF GROWTH OF HUMAN EPIDERMIS

A review of epidermal and dermal architecture and biology provides an array of facts supporting the classical concept that movement of cells in the human epidermis is in an outward direction in the steady state as well as in the development of non‐neoplastic acanthosis. The review provides no data which would require an adjustment of our thinking to accept Ryans (1966) hypothesis of inward migration.

Creeping Eruption Due to Gnathostoma Spinigerum in a Taiwanese Patient

In March 1975, |,F. was consulted by a 45-year-old Chinese man because of a pruritic eruption on his back. The patient reported that he had been traveling in the southern, tropical part of Taiwan when he developed an iichy sensation on his back. The pruritus persisted, and he observed red streaks in the involved region. The eruption persisted tor about two weeks before he saw a physician. On examination, there was an erylhematous linear and slightly infiltrated eruption between and below the scapulae. It was 2-3-mm wide and almost encircled an area 7 by 8 cm in size, in an irregular serpiginous fashion |Hg. 11. What appeared to be the oldest portion was slightly pigmented. The lesion became brighter red in color along its course and ended in two tiny papules, each the size of a pinhead (approx 1 mm). A provisional diagnosis of creeping eruption due to worm infestation was made and a course of diethylcarbamazine

Rhodamin B Stain for Keratin: Evaluation of its Specificity and its Application in Dermal Pathology

We used Rhodamin B stain in sections of normal skin, benign and malignant epithelial tumors and dermatoses. Keratin staining was uneven and showed variation in different lesions. While tricho‐hyalin of the anagen hair follicle stained with intensity, keratohyalin granules failed to show similar reaction.