Joel E. Bernstein

Unilateral linear nevoidal syringoma

We here report the unusual occurrence of syringoma in a unilateral linear nevoid distribution in a 32-year-old woman. The papules were located on the right side of the chest and right arm. These lesions need to be distinguished from other linear papular eruptions.

Inhibition of histamine-induced pruritus by topical tricyclic antidepressants

Frequent antihistaminic side effects noted during treatment of depression by tricyclic drugs, as well as the high affinity of tricyclic antidepressants for H1 receptors in mouse neuroblastoma cells, suggest possible useful antihistaminic properties. We investigated the antipruritic activity of topically applied 5% solutions of doxepin hydrochloride (Adapin; Sinequan) and amitriptyline hydrochloride (Elavil) and compared such activity to that of a 5% solution of diphenhydramine and vehicle alone. Test solutions were applied to 25-cm2 areas on the flexor forearms of forty subjects, and the development of itch to single drops of eight dilutions of histamine phosphate instilled in each area was reported over a 3-minute period. The lowest concentration of histamine able to elicit unequivocal itching in each treated area was the histamine itch threshold (HIT). Doxepin, amitriptyline, and diphenhydramine all produced significantly higher mean and median HITs (p less than 0.01 than did vehicle control. Sixty-eight percent of subjects had a HIT greater than or equal to 2 x 10(-4) mg/ml in doxepin-treated areas versus 58% for amitriptyline, 53% for diphenhydramine, and 25% for vehicle. Our data suggest that tricyclic antidepressants are effective topical antipruritic agents.

Eruptive nevocytic nevi following erythema multiforme

A patient with erythema multiforme developed many nevocytic nevi, including a large cluster of such lesions at the sites of healed blisters. The development of eruptive nevocytic nevi in this pattern suggests that cutaneous injury plays a role in their pathogenesis.

Reduced threshold to suction-induced blister formation in insulin-dependent diabetics

Diabetics may have an increased susceptibility to cutaneous blister formation clinically manifest as the bullous eruption of diabetes. We evaluated the mechanical force necessary to induce suction blisters in fifteen insulin-dependent diabetics and twenty age-matched normal controls. The mean suction blister threshold for the diabetics was 31.9 minutes versus 68.0 minutes for the controls, a highly significant difference (p less than 0.01). Histologic appearance of suction blisters was similar in diabetic and normal skin, under both light and electron microscopic examination, with a noninflammatory subepidermal separation in the lamina lucida between the cell membrane and the basal lamina. These results demonstrate that insulin-dependent diabetics have a marked reduction in suction blister threshold as compared to age-matched controls.

Topically applied erythromycin in inflammatory acne vulgaris

We evaluated the effectiveness of 2% erythromycin and its alcohol/propylene glycol vehicle in the treatment of three hundred forty-eight patients with inflammatory acne vulgaris. A significantly greater reduction was noted in the papulopustule count for the erythromycin-treated group compared to the vehicle-treated group. Additionally, clinical improvement, as measured by physician global ratings, was significantly greater in the erythromycin-treated group. A lower adverse reaction rate observed in the erythromycin-treated patients may result from previously demonstrated anti-inflammatory properties of this antibiotic.

Cutaneous manifestations of angioimmunoblastic lymphadenopathy

Angioimmunoblastic lymphadenopathy (AIL) is an uncommon immunoproliferative disorder with a presentation similar to malignant lymphoma but with a benign histopathologic picture. We report a case of a 49-year-old woman with AIL who manifested a pruritic maculopapular eruption as her presenting complaint and whose disease pursued an aggressive clinical course. Forty-four percent of patients with AIL experience a nonspecific dermatitis that in general is maculopapular and precedes other clinical symptoms by at least several weeks. AIL should be included in the differential diagnosis of any maculopapular eruption of unknown etiology accompanied by lymphadenopathy.

Cutaneous Immunofluorescence Studies to Adult Rheumatoid Arthritis in Sun‐exposed and Non‐sun‐exposed Areas

ABSTRACT: The incidence and significance of positive cutaneous immunofluorescence findings were assessed in biopsy specimens of both sun‐exposed and non‐sun‐exposed skin of 34 adult patients with rheumatoid arthritis (RA) who were not receiving systemic corticosteroids. The incidence of lupus erythomatosus (LE)‐band was low (8.6%) in both groups. Twenty‐eight percent of the patients had perivascular IgM and lor C3 deposits, and 74% had cytoid bodies in the papillary dermis. These studies indicate that the incidence of LE band is low in RA and that the detection of such a band in normal skin warrants close follow‐up of RA patients for possible development of LE.

Prognostic Implications of Cutaneous Immunoglobulin Deposits In Systemic Lupus Erythematosus

The class of immunoglobulin (Ig) deposited at the dermal‐epidermal junction (DEI) of the skin in patients With systemic lupus erythematosus (SLE) has been proposed to have prognostic implications. The authors studied disease activity in 51 SLE patients with a positive lupus band. Patients with cutaneous IgM deposits had significantly more severe disease than those with only IgG or with mixed immunoglobulin deposits. While their data suggest an association between IgM depostis, severe disease and a poor prognosis, they urge caution in utilizing Ig deposits as a prognostic indicator.