Robert Jackson

The lines of Blaschko, a review and reconsideration

Blaschkos lines are the pattern assumed by many different naevoid and acquired skin diseases on the human skin and mucosae. They were described and drawn by Blaschko 75 years ago. These lines are to be distinguished from other linear patterns such as Voights lines, Langers lines, and the lines of innervation of the spinal nerves. They do not follow any known nervous, vascular or l5rmphatic structures in the skin. The epidermis and its appendageal structures, the melanocytes, the vascular system, and the fatty hypoderm, all, separately or in combination, may be involved in the morpho‐logical manifestations which follow Blaschkos lines. Many of the naevoid skin conditions are lifelong (e.g. linear sebaceous naevus, unilateral naevoid telangiectasia); many of the acquired skin diseases (e.g. lichen striatus, linear psoriasis) are of relatively short duration (e.g. 1–2 years). The cause of the distribution pattern is unknown. It is possibly a form of human‘mosaicism’ where certain specific cells or groups of cells react differently from other cells due to chromosomal abnormalities. The embryological explanation of Blaschkos lines is not at all clear. Other markers in addition to the skin findings are needed to determine the time and the nature of the change responsible for these lines. The main purpose of this article is to introduce the concept of Blaschkos lines into the medical, paramedical, and general biological fields of science. In this way, it is hoped that some inter‐reaction can occur between those who regularly see Blaschkos lines and those who regularly see and study other chromosomal and embryological abnormalities.

Neonatal lupus erythematosus progressing into systemic lupus erythematosus

An infant with neonatal lupus erythematosus developed systemic lupus erythematosus at the age of 13. The clinical distinction between neonatal lupus erythematosus and familial lupus erythematosus may not be as clear cut as previously reported.

Nevoid basal cell carcinoma syndrome: A 15-year follow-up of cases in Ottawa and the Ottawa Valley

The nevoid basal cell carcinoma syndrome is an autosomal dominant condition that consists of multiple basal cell carcinomas of the skin, odontogenic keratocysts, pits of the hands and feet (especially the palms and soles), various ectopic calcifications, notably lamellar calcification of the falx cerebri and skeletal anomalies. As well as these major findings, there are many other associated abnormalities. This paper is a 15-year follow-up study on twelve cases from the Ottawa Valley with details on nine new cases discovered during that time. Sixteen were males; 5, females. The number of basal cell cancers requiring removal varied greatly from patient to patient. There was one patient with a horror lesion; none had metastatic disease. (J Am Acad Dermatol 1987;16:964-70.)

Observations on the Procedural Aspects and Health Effects of Scarification in Sub-Saharan Africa

Background: Scarification involves cutting or making an incision into the skin and then allowing the wound to heal, leaving a permanent scar. The purpose of this article is to examine the origins of scarification and its social and medical significance in sub-Saharan Africa. Methods: We conducted a computerized search in the MEDLINE electronic database with combinations of the following terms: scarification, tribal marks, keloid, hypertrophic scar, Africa, and sub-Saharan Africa. Inclusion criteria were studies published in English involving human participants. We reviewed the bibliography of each article that met our inclusion criteria for additional relevant studies. We abstracted data on the historical, social, and medical aspects of scarification from eligible studies. Results: This review of scarification in sub-Saharan Africa highlights the complex interplay that exists between biology and society. Photographs, artwork, and literary descriptions reveal that scarification results in hypertrophic or atrophic scars, although these types of scars are often mistakenly referred to as keloids. In terms of the procedural aspects of scarification, specific tools and substances were consistently used by various ethnic groups. Although much is known about the history of scarification as a form of identification in Africa, it appears that the practice also had medical applications. Scarification was used to treat conditions such as epilepsy, although it was also known to exacerbate conditions such as sarcoidosis, lichen planus, and psoriasis. Evolving cultural beliefs, in addition to the association of scarification with an increased risk of contracting hepatitis B and human immunodeficiency virus (HIV), are contemporary threats to this long-standing practice. Conclusions: Given the remarkably consistent appearance of scars that are described in the literature and depicted in images, scarification does not appear to be a random or accidental occurrence. Instead, it is a deliberate attempt to reproduce a custom that has been perfected after many years of practice in sub-Saharan Africa.

Geographic pathology of skin cancer.

Background: The development of knowledge concerning the role of sun exposure in causing skin cancer has been a gradual one. Objective: This article reviews the article by Urbach who used manikin coated with an ultraviolet dosimeter to see exactly where on the head and neck the exposure was greatest. Conclusion: Urbach showed that the areas of greatest sun exposure on his manikins corresponded with the location of 95% of squamous cell carcinoma and 66% of basal cell carcinoma. He also clearly showed the importance of scattered sky and reflected radiation.

The natural history of Strawberry Naevi

Background: The field of dermatology was developed by clinicians with keen observational skills, who identified the natural history of clinical conditions through morphologic features. Objective: This article reviews the 1938 article published by Lister in which the natural history of hemangiomas are reviewed. Conclusion: Lister concluded “that drastic measures for the destruction of these naevi are inadvisable and treatment should be expectant and conservative.” With the advent of new laser treatments for hemangiomas, early aggressive treatment is suggested for a subgroup of these problems. However, it still holds true in 1997 that for many of these smaller lesions, treatment should be “expectant and conservative.”

Definitions in dermatology. A dissertation on some of the terms used to describe the living gross pathology of the human skin.

The author attempts to put order into current usage of dermatological definitions of a selected group of morphological lesions occurring on and in the skin. Those terms in which there is no concensus as to meaning are the eczemas, erythemato‐squamous, vesicles and bullae, papules, nodules, nodes, tumours and granulomas. A working definition based on size, level, location in the skin and tissue type involved, is proposed in some detail for this group.

Becker nevus on the lower limb: case report and review of the literature.

Background: Becker nevus is a hamartoma with brown hyperpigmentation and hypertrichosis that usually affects young males. It has a predilection for the upper half of the trunk and proximal upper extremity. Objective: This is a case report of a 38-year-old male with a Becker nevus without hypertrichosis on the lower limb and a review of the literature. Results: Including our case report, 12 cases of Becker nevus on the lower limb were identified in the English literature (8 males and 4 females). It has never been reported below the knee. In males, the lesion was not associated with other anomalies, and all but two showed hypertrichosis (six of eight). In 50% (two of four) of women, it was associated with localized lipoatrophy. In one woman, it presented without hypertrichosis. Conclusion: The presence of Becker nevi on the lower limb is unusual, and hypertrichosis is not always a feature. Larger studies are required to look into the true prevalence of this presentation and its prognostic value as a marker for other anomalies.

Electrodesiccation and Curettage

Electrodesiccation is the effect produced by a highfrequency (500,000-1,000,000 Hz) alternating electrical current of comparatively high voltage (2,000 or more volts) and low amperage (100-1,000 mA) using one active electrode (1). The oscillations are damped, that is, the intensity of the voltage rapidly diminishes with each oscillation followed by a gap when there is no voltage, the cycle then being repeated. The active or operating electrode is in contact with the tissue. The sparkgap apparatus is used to produce electrodesiccation.

An early selective Medline : Henry stelwagon's 1916 textbook of dermatology

Background: With the rapidly increasing amount of surgical and laser knowledge that has to be learned, we run the risk of not spending enough educational efforts on the morphologic findings on which the specialty of dermatology is based. Objective: To briefly review and evaluate a 1916 dermatology text by Henry Stelwagon. Conclusion: This text has excellent clinical descriptions of diseases. As a bonus, we can find a succinct summary of the world literature up to 1916 on each topic presented.