Richard L. Spielvogel

In vivo optimization of a living dermal substitute employing cultured human fibroblasts on a biodegradable polyglycolic acid or polyglactin mesh.

The design of a skin-substitute must address the need for a dermal component, as this mesenchymally-derived tissue is important in maintaining the integrity and function of skin. An in vivo study was undertaken to assess the use of two biodegradable meshes, polyglycolic acid and polyglactin-910, as carriers for cultured human fibroblasts in a living dermal replacement. The consistent vascularization and epithelialization of these grafts placed on athymic mice showed that this has potential in re-creating the dermis in a skin-substitute.

Frey's syndrome

ABSTRACT: Freys syndrome is a form of gustatory hyperhidrosis that develops following surgery, trauma, or disease of the parotid gland area. Several theories have been proposed to explain the resulting symptomatology. Treatment often is difficult or ineffective. An unusual case is presented involving a patient with delayed onset of symptoms who responded well to topical application of 20% aluminum chloride in an‐hydrous ethyl alcohol.

Dermatologic problems of musicians

The unique occupational dermatologic disorders of musicians are reviewed and compiled to provide the clinician with a reference list. Our results were obtained by a survey of 24 members of a professional symphony orchestra. The results of the survey revealed a significant incidence of occupationally related skin problems in musicians.

Serum androgens and depression in women with facial hirsutism

BACKGROUND Studies on the psychopathologic aspects of hirsutism are sparse. Attempts to correlate these aspects with either the extent of the facial hirsutism and/or circulating serum androgens are virtually nonexistent. This study evaluates the psychopathologic aspects of hirsutism and correlates these findings with the extent of the facial hirsutism as well as with the circulating serum androgens. OBJECTIVE Our purpose was to assess the psychopathologic aspects of facial hirsutism and to determine whether any correlation exists between these findings and either the extent of the facial hirsutism or the circulating serum androgens. METHODS Twenty consecutive women with facial hirsutism were studied by administration of psychologic tests (DeRogatis Symptom Inventory and the Affects Balance Scale). The results of these tests were correlated with the grade of facial hirsutism as well as serum levels of total testosterone (T), biologically active testosterone (BT), free testosterone (FT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), and androstenedione (A-dione). RESULTS Significant levels of depression were found. No correlation was found between the psychopathologic measurements and the extent of facial hirsutism or serum levels of T, DHEA, DHEA-S, and A-dione. Significant correlations were found between depression and serum levels of FT and BT. CONCLUSION There is an increased incidence of depression in facially hirsute women and this correlates with their circulating active testosterone levels and not with the extent of their facial hirsutism.

Cutaneous epithelioid hemangioendothelioma without systemic involvement.

Epithelioid hemangioendothelioma (EH) is a unique vascular tumor characterized histologically by epithelioid endothelial cells. A case of EH arising from the dermis and presenting as a nodule of the palm is described. To our knowledge, this is the third report of a cutaneous presentation of EH and the first report of a patient with this rare neoplasm with solitary cutaneous involvement. A review of the literature is also presented.

Oral isotretinoin therapy for familial Muir-Torre syndrome

Two representative cases of familial Muir-Torre syndrome are presented. Multiple benign sebaceous neoplasms in both cases and a solitary keratoacanthoma in one were successfully treated with oral isotretinoin. Low-dose maintenance therapy has stabilized the cutaneous manifestations in the two patients, and no new epithelial neoplasms have appeared. This report emphasizes (1) the rationale for the use of isotretinoin in the Muir-Torre syndrome and (2) the potential for a familial pattern of inheritance and a possible association with the cancer family syndrome. It speculates on the prevention of future internal malignancies in Muir-Torre syndrome patients by maintenance oral isotretinoin treatment.

Recurrent neutrophilic eccrine hidradenitis

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands, and most commonly seen in patients undergoing chemotherapy for treatment of a malignancy. Rapid diagnosis may avert unnecessary changes in therapy to treat conditions which clinically mimic NEH. We describe a patient who developed NEH on three separate occasions provoked by two different chemotherapeutic agents—cytarabine and mitoxantrone. The lesions were morphologically distinct and differed in their anatomical distribution during each episode. The response to intravenous corticosteroids was dramatic, but lesions recurred after their withdrawal. This case illustrates the potential diversity of clinical lesions in a single patient with NEH, and its response to systemically administered corticosteroids.

Nevus comedonicus of the palm and wrist: Case report with review of five previously reported cases

Nevus comedonicus (NC) is an uncommon condition consisting of grouped comedo-like papules. Rarely, NC is associated with other structural abnormalities and diseases. Lesions of the palms or soles are distinctly unusual. Histopathologic findings support the concept of a developmental abnormality of the dermal components of the pilosebaceous apparatus with subsequent imperfect differentiation of the epidermal components. Therapy is often unrewarding, although topical tretinoin may be of value.

Artificial skin for wound healing

Abstract The care of burn patients is a difficult task. Although burn care over the last two decades has shown major advancements, the ability to treat consistently those patients with significant tissue damage and loss remains a challenge. A crucial step contributing to decreased morbidity and mortality of burn patients has been the practice of early wound excision. 1–4 Removal of nonviable tissue rids the patient of local toxic mediators and the potential for colonization with subsequent local and systemic sepsis. Topical antimicrobials decrease the rate of colonization of a wound, but do not prevent microbial invasion and proliferation. Therefore, it is essential to close these wounds.

Mononuclear cell stimulation of fibroblast collagen synthesis

Accumulating evidence suggests that there may be a relationship between inflammatory responses and enhanced collagen synthesis in certain skin diseases. In our experiments, unstimulated normal human lymphocytes and phytohaemagluttinin (HA‐17) stimulated lymphocytes were cultured for 72 h and then added to normal human foreskin fibroblast monolayer cultures. The various groups tested included medium and sera alone, medium and lymphocytes ± HA‐17, and HA‐17 alone. Five to 10 μCi of (2, 3‐3H)‐proline were added to each monolayer containing 2·5‐3·5 × 106 fibroblasts along with cultured lymphocytes, HA‐17 alone, or HA‐17 cultured lymphocytes. After an incubation period (pulse) of 24 h 3H hydroxyproline was separated and assayed using a modification of the method of Switzer & Summer (1971). The conversion of 3H proline to 3H hydroxyproline was used as a measure of collagen synthesis. The results demonstrated that the addition of unstimulated cultured lymphocytes stimulated fibroblast collagen synthesis. HA‐17 alone is also capable of stimulating collagen synthesis in vitro. The greatest stimulation (counts/min 3H hydroxyproline) was seen when fibroblasts were incubated with lymphocytes previously activated by HA‐17. These results are consistent with the hypothesis that activated mononuclear cells may stimulate collagen synthesis by fibroblasts in vivo in such diseases as scleroderma and chronic graft‐versus‐host disease.