John L. Millns

The therapeutic response of urticarial vasculitis to indomethacin

Ten patients with urticarial vasculitis, characterized clinically by persistent painful urticarial lesions, angioedema, recurrent arthralgia, abdominal pain, and low-grade fever, were selected for study. All patients had histologic evidence of leukocytoclastic vasculitis in the urticarial lesions. Results of direct immunofluorescence microscopy of urticarial lesions were positive in all nine of the patients tested. Treatment with indomethacin in dosages from 25 mg three times daily to 50 mg four times daily resulted in complete clearing of all disease manifestations in six of ten patients within 17 days and partial improvement in three. In eight of the ten patients, disease activity recurred within 48 hours after discontinuation of the use of indomethacin. Gastrointestinal irritation was the only side effect noted. Indomethacin is proposed as an effective mode of therapy in a disorder unresponsive to treatment with conventional medications for urticaria, including high-dose corticosteroids.

Secondary neuroendocrine carcinomas of the skin: An immunohistochemical comparison with primary neuroendocrine carcinoma of the skin (“Merkel cell” carcinoma)

Since the initial clinical presentation of visceral neuroendocrine carcinoma is occasionally a cutaneous metastasis, diagnostic confusion with primary neuroendocrine carcinoma of the skin (Merkel cell carcinoma) may ensue. In this study, seven cases of secondary cutaneous neuroendocrine carcinoma were immunohistochemically compared with twenty-one Merkel cell carcinomas for ten antigenic moieties that have been associated with endocrine tumors. Six of seven secondary tumors stained for bombesin, leucine enkephalin, methionine enkephalin, or beta-endorphin, none of which was detected in the primary cutaneous neuroendocrine carcinomas. These data suggest that immunohistochemical study may be useful in separating primary from secondary neuroendocrine tumors of the skin and may assist in directing clinical attention to the most probable site of visceral neoplasia.

Histopathologic Considerations in the Management of Skin Cancer

As the treatment of skin cancers continues to evolve and become more sophisticated, the necessity for accurate pathologic assessment of tissue specimens is increasingly more crucial to optimal clinical management. A diversity of surgical procedures and adjuvant treatments is currently recommended for the wide range of malignant epithelial and mesenchymal neoplasms that may arise in the skin, and evaluations of the ultimate efficacy of each modality of therapy depend upon the validity of tissue diagnoses.

The complement system in bullous pemphigoid: VI. C3 fixing activity in the absence of detectable antibody

Abstract A unique subgroup of patients with clinically active bullous pemphigoid was identified immunologically. By routine direct immunofluorescent (IF) techniques, nine patients were found to have C3 deposition in a linear pattern at the basement membrane zone (BMZ) of skin lesions in the absence of detectable immunoglobulin. In five of the nine cases, fibrin deposition was noted in a similar pattern. By indirect IF staining, sera from the nine cases demonstrated negative staining reactions for immunoglobulins (IgG, IgA, IgM, and IgE) at routine serum dilutions of 1:20 on substrates of human skin and monkey esophagus. At serum dilutions of 1:4 and less, however, IgG deposition was detectable in a linear pattern at the BMZ, using normal skin as a substrate in two of the cases. All sera yielded positive BMZ immunofluorescence by in vitro C3 staining. Six of the nine sera showed linear BMZ immunofluorescence with anti-Clq and four of the nine sera displayed a similar pattern of deposition with in vitro C4 staining. Weak BMZ staining with properdin was apparent in only two cases. Blocking studies of in vitro C3 staining utilizing EDTA, MG2-EGTA, as well as substitution of C2 and properdin-deficient sera as the source of complement, implicated the classical pathway as the major source of complement activation in these cases. The immunological findings in this subgroup of bullous pemphigoid patients demonstrate a striking similarity to those found in herpes gestationis, adding further evidence that these two diseases are closely related.

Furosemide as an Adjunct in the Therapy of Bromism and Bromoderma

A patient had bromism and associated bromoderma, with the clinical appearance of pyoderma gangrenosum. The therapy of bromoderma is best approached by the rapid promotion of bromide excretion in conju