K.V. Sanderson

Can mycosis fungoides begin in the epidermis? A hypothesis

On the basis of clinical, histological and electron microscopical findings, we are proposing that mycosis fungoides can begin in the epidermis. Early involvement of the basal layer of the epidermis is emphasized by the pigmentary changes which herald the onset of about half the cases. The formation of new fibrous tissue above the subepidermal elastic garland and the presence of PAS‐positive globules above the epidermal basement membrane, support the view that the primary change is on the epidermal side of the elastic garland and basement membrane. The predominantly epidermal distribution of the mycosis cell in many early cases suggests that it stems from a cell normally present in the epidermis. The likeliest candidate appears to be the Langerhans cell. A derivation from this cell would explain many puzzling features of mycosis fungoides and in particular the affinity of the mycosis cell for the epidermis.

The natural history of trichilemmal cysts

The histological features of 149 trichilemmal cysts removed from sixty‐five patients are reviewed and related to the clinical findings. These cysts, which may be solitary or multiple, gradually increase in size and number, and may produce daughter cysts by budding. When a breach occurs in the wall, inflammatory cells pour in but do not replace the cyst wall. This event may be followed by healing from the margins of the breach, by marsupialization to the overlying epidermis and thus natural resolution, or by proliferation to produce a pseudo‐epitheliomatous change which can be confused with a well differentiated squamous cell carcinoma.

Angioleiomyoma of the skin

The clinical and histological features of eighteen cases of angioleiomyoma are reported and the literature is reviewed. It is apparent that despite consistent characteristics these tumours continue to pose diagnostic problems to clinicians.

Subungual Malignant Melanoma: Difficulty in Diagnosis

Subungual malignant melanoma developed on both great toes of a 61-year-old woman. The lesions had been diagnosed elsewhere as ingrowing toenails and had been treated as such for two years. The difficulty in clinical diagnosis is illustrated by the description of three other patients with subungual malignant melanoma. The tumour should be considered as a possible cause of any persistent abnormality of the nail bed or the nail itself, especially if it is pigmented.

Hereditary trichilemmal cysts. Hereditary pilar cysts.

One hundred and fifteen individuals from 60 families are described who had trichilemmal cysts. These were solitary or multiple intradermal cysts and occurred most frequently on the scalp. A punctum leading from the skin surface to the cyst was not seen in any patient. Because they are encapsulated they are easily removed. Histologicaily they resemble the external root sheath in the region of the follicular isthmus and are quite different from epidermoid cysts. They are not associated with Gardners syndrome or any other diseases. In 46 of the 60 families an autosomal dominant mode of inheritance was demonstrated.

THE STRUCTURE OF SEBORRHOEIC KERATOSES

SUMMARY. A series of different types of seborrhoeic keratosis has been dissected after maceration in acetic acid and dermo‐epidermal separation. In all lesions the dermal papillae are enlarged and in many they are branched. The underside of the keratosis has slits and channels from which the papillae have been extracted.

Skin changes caused by D-penicillamine treatment of arthritis. Report of three cases with immunological findings.

The clinical, histological and immunopathological details of three cases with a d‐penicillamine‐induced eruption are presented. The skin changes included (1) pemphigus erythematosus, (2) pemphigus foliaceus, (3) a bizarre localized pruritic papular eruption, the immunopathology of which was characteristic of lupus erythematosus and (4) fragility due to loss of dermal collagen. Circulating IgA was abnormally low in two cases and circulating immune complexes were demonstrated in the third case.

Chronic benign familial pemphigus. Induction of lesions by Herpesvirus hominis.

A case of chronic benign familial pemphigus (CBFP) is described in which a severe exacerbation was associated with infection with Herpesvirus hominis. This occurrence, which has a bearing on treatment, may not be as uncommon as the absence of previous reports would suggest.

Retinoid-induced skin fragility in a patient with hepatic disease

A patient with psoriasis and alcoholic cirrhosis developed increased skin fragility, blistering and leg ulceration whilst taking etretinate (Tigason‐Roche). The aromatic retinoids frequently cause dose‐related side‐effects such as cheilitis, palmar‐plantar desquamation, conjunctivitis and hair loss. Skin fragility has also been previously reported but not accompanied by blistering as in this patient. Long‐term therapy in our case resulted in excessive accumulation of the drug and, because of pre‐existing liver disease, excretion was further delayed and tosicity enhanced.

32) Painful bruising syndrome with vasculitis treated by plasmapheresis

V,M., female, aged 38 years. Housewife, Hospital case no. G.73001. History. Since 1964 she has had recurrent episodes of tender lumps in the skin, often associated with acute dyspnoea. Less frequently she has had haemoptysis, dysphagia and abdominal pain with melaena. The skin lesions have usually started as tender erythematous oedema, becoming purpuric and sometimes ulcerating. Individual lesions last upwards of several days. They vary in size from 2 to 20 cm across, occurring particularly on the legs, trunk and arms but no part ofthe skin surface has been spared (Fig. i). Similar lesions have been seen by indirect laryngoscopy in the pharynx and larynx.