Margaret C. Douglass

Seborrheic dermatitis in patients with acquired immunodeficiency syndrome

Many cutaneous disorders are associated with acquired immunodeficiency syndrome. We prospectively evaluated eighteen patients with acquired immunodeficiency syndrome and twelve patients with the immunodeficiency syndrome-related complex for dermatologic disorders. A high prevalence of seborrheic dermatitis was found in patients with acquired immunodeficiency syndrome--83%, in comparison with 1% to 3% of historic control subjects. Patients with the related complex also had an increased incidence of 42%. Seborrheic dermatitis in this population was often more explosive, inflammatory, and severe than is usually seen in otherwise healthy patients. Severity of seborrheic dermatitis correlated with a poor overall prognosis in our patients. Additionally, seborrheic dermatitis may be one of the most common cutaneous manifestations of acquired immunodeficiency syndrome.

Hypopigmented mycosis fungoides: Treatment and a 6 ½-year follow-up of 9 patients

BACKGROUND The clinical course of hypopigmented mycosis fungoides has not been well described. OBJECTIVE AND METHODS We sought to review the management and follow-up of patients with hypopigmented mycosis fungoides evaluated between January 1990 and August 1998. RESULTS There were 7 African American and 2 Asian patients (5 male and 4 female patients); 8 had stage Ia and 1 had stage Ib disease. The mean age at diagnosis was 34.4 years, the mean latent period was 9.2 years, and the mean follow-up period after diagnosis was 6.5 years. Treatment modalities used included psoralen UVA, UVB, and topical mechlorethamine. Eight had complete clinical responses, and another had a partial response. The remission period ranged from 2 months to 3 years. In all but one patient, lesions recurred; all responded rapidly to another course of therapy. CONCLUSION Hypopigmented mycosis fungoides is characterized by early onset, occurrence in dark-skinned individuals, and good response to therapy. Recurrences are common. In most, it has a biologically benign course.

Chronic cutaneous lupus erythematosus presenting as periorbital edema and erythema.

We report two unusual cases of cutaneous lupus erythematosus presenting as dramatic eyelid edema and erythema. Neither patient had evidence of systemic or other significant cutaneous involvement. The eyelid edema and erythema were unilateral in one case and bilateral in the other. Both cases responded to therapy with antimalarial drugs.

Topical photochemotherapy for alopecia areata

Twenty-two patients with alopecia areata were treated with a combination of topical 0.1% 8-methoxypsoralen and UVA (PUVA). Eight of the twenty-two patients (36.3%) responded with excellent regrowth (terminal hair in at least 75% of the treated scalp), and two patients (9.1%) showed good regrowth (terminal hair in 50% to 75% of the treated scalp). The mean total UVA exposure and the mean total number of treatments for the entire treatment course for these responders was 171.7 joules/cm2 and 47.4 treatments, respectively. Eight of the nine responders available for follow-up experienced some degree of relapse when PUVA treatments were tapered or during a follow-up period (mean, 8.3 months) after treatment was discontinued. Despite the failure of topical PUVA to change the long-term course of alopecia, the combination of PUVA with other therapeutic modalities may result in the prolongation of the beneficial effect in selected patients. The mechanism of action of PUVA in alopecia areata might involve an immunomodulatory effect.

Cutaneous larva migrans in northern climates: A souvenir of your dream vacation

Three young women recently returned to the metropolitan Detroit area with cutaneous larva migrans. All three had vacationed at a popular club resort on the Caribbean island of Martinique. Cutaneous larva migrans is frequently seen in the southern United States, Central and South America, and other subtropical areas but rarely in northern climates. Several organisms can cause cutaneous larva migrans, or creeping eruption. The larvae of the nematode Ancylostoma braziliense are most often the causative organisms. Travel habits of Americans make it necessary for practitioners in northern climates to be familiar with diseases contracted primarily in warmer locations. The life cycle of causative organisms and current therapy are reviewed.

Necrotizing cellulitis caused by Legionella micdadei

Legionella micdadei is primarily considered a pathogen of the pulmonary tract of immunocompromised patients, the majority of whom have been renal transplant recipients. We report the case of a necrotizing soft tissue infection in a cadaveric renal transplant recipient resulting in amputation of the left arm. Only one other extrathoracic bacteriologically documented L. micdadei infection has been reported in the literature.

Syringolymphoid hyperplasia with alopecia: two case reports and review of the literature

Syringolymphoid hyperplasia with alopecia is an uncommon, but histopathologically distinct, skin disorder that has been reported to occur with and possibly represent a syringotropic variant of cutaneous T-cell lymphoma. We report 2 patients with syringolymphoid hyperplasia with alopecia. Both had CD4-positive infiltrates; 1 also demonstrated loss of CD7. One patient had evidence of T-cell clonality by gene rearrangement studies, but neither had histologic evidence of cutaneous T-cell lymphoma. Because the natural progression of syringolymphoid hyperplasia with alopecia remains to be fully explained, close follow-up of patients is advised.

Calciphylaxis: A cause of necrotic ulcers in renal failure

Background: Calciphylaxis is a rare and life-threatening condition occurring in patients with end-stage renal disease on dialysis. The diagnosis is frequently delayed or missed and therapy is often unsuccessful. Objective: The clinical and pathological components of calciphylaxis are emphasized in a patient that may facilitate early diagnosis and initiation of therapy. Results: Early recognition of the clinical signs and symptoms of calciphylaxis is crucial. The tissue diagnosis requires large elliptical biopsies because histological findings are segmental and often missed. Conclusion: Early diagnosis and intervention in calciphylaxis is critical. Parathyroidectomy should be considered in all cases.