Acneiform dermatoses

Acneiform dermatoses are follicular eruptions. The initial lesion is inflammatory, usually a papule or pustule. Comedones are later secondary lesions, a sequel to encapsulation and healing of the primary abscess. The earliest histological event is spongiosis, followed by a break in the follicular epithelium. The spilled follicular contents provokes a nonspecific lymphocytic and neutrophilic infiltrate. Acneiform eruptions are almost always drug induced. Important clues are sudden onset within days, widespread involvement, unusual locations (forearm, buttocks), occurrence beyond acne age, monomorphous lesions, sometimes signs of systemic drug toxicity with fever and malaise, clearing of inflammatory lesions after the drug is stopped, sometimes leaving secondary comedones. Other cutaneous eruptions that may superficially resemble acne vulgaris but that are not thought to be related to it etiologically are due to infection (e.g. gramnegative folliculitis) or unknown causes (e.g. acne necrotica or acne aestivalis)

Effects of Dermatitis, Stripping, and Steroids on The Morphology of Corneocytes. a New Bioessay

This study was designed to investigate the effects of increased or decreased epidermal turnover on the morphology of human corneocytes. The desquamating portion of the stratum corneum was sampled with the detergent scrub technique using Triton X-100. The following parameters were measured: size (surface μ2), shape (regular, irregular), nuclear inclusions, trabeculae, and numerical counts. Specimens were obtained from adult males with allergic contact dermatitis (N = 18); with tretinoin-induced dermatitis (N = 11); after cellophane stripping (N = 11); and after treatment of these conditions with topical steroids (N = 40). Data from 250,000 cells were analyzed statistically. The reproducibility of the method is good (r = 0.934). Corneocytes from skin of patients with allergic contact dermatitis differed from those of normal skin: they were 15% smaller and of irregular shape with asymmetrical trabeculae; 50% were nucleated and about 3 times as many cells were collected per cm2 skin surface. Tretinoin and stripping produced similar but more pronounced effects. Topical steroids significantly improved all parameters (p < 0.01). Betamethasone-17-dipropionate was more effective than the valerate. This bioassay permits sensitive measurements of corneocyte morphology in conditions with altered epidermal cellular kinetics. It provides a method to evaluate steroid effectiveness

Regional Differences of Cell Sizes in the Human Stratum Corneum. Part I

Individual non-damaged horny cells can be removed from the human stratum corneum by a modification of the corneocyte count technique. Nine sites from four men were sampled and 50 cells from each specimen measured with a filar micrometer eyepiece. The longest and shortest diameters in micra and the surface area, calculated as an ellipse in square micra, were determined. Individual horny cells are much larger than previously described in the literature. Small cells, 34 μ to 36 μ in diameter were found on forehead and hand, larger cells, 41 μ to 44μ are typical for thigh axilla. Highly significant statistical differences for multiple sites of the human body were found when t-tests and the analysis of variance were applied. The regional differences in cell sizes are discussed

Progressive Macular Hypomelanosis: A Rarely Diagnosed Hypopigmentation in Caucasians

A 35-year-old woman who developed whitish macules on trunk and limbs at 12 years of age and observed a remarkable increase of the hypopigmentated lesions after her pregnancies at ages 29 and 32 years. Because of the highly characteristic clinical aspect and the light- and electron-microscopic histopathologic findings, we diagnosed progressive macular hypomelanosis (PMH). It is a nonscaly disorder with hypopigmented macules mainly on the trunk and is more often seen in young women. In contrast to some authors assuming the presence of Propionibacterium spp. as a matter of principle in PMH, we report a case with no evidence for Propionibacterium spp

Successful treatment of granulomatous reactions secondary to injection of esthetic implants

In recent years, various injectable materials have come into use to improve esthetic appearance. OBJECTIVE: We describe the clinical and histopathologic aspects of two patients who received intradermal injections of an unknown dermal filler and the different diagnostic tools used to identify the unknown injected material (reflexion electron microscopy, electron dispersing x-ray) and discuss the possibility of a metastatic granulomatous reaction in one patient. We also describe two treatments for this complication and evaluate the legal considerations of the use of materials that have been adulterated and/or whose composition is unknown to the patient. METHODS: We present two patients who developed a granulomatous foreign-body reaction after the subcutaneous injection of an esthetic implant. We treated patient 1 with isotretinoin and 2 months later with doxycycline. We administered isotretinoin to patient 2. RESULTS: We observed a partial improvement in patient 1 after isotretinoin treatment and a remarkable improvement after administration of doxycycline. In patient 2, we observed an excellent response to isotretinoin. CONCLUSION: Isotretinoin and doxycycline, when administered separately, seem to offer effective treatment for reactions resulting from silicone implants. However, further studies that include a larger number of patients and those with reactions secondary to other fillers are clearly needed before the effectiveness of this treatment can be confirmed

Percutaneous drug penetration: Choosing candidates for transdermal development

There is currently a high level of interest in using the skin as a route for delivering drugs. One hears the questions: What are the attributes of a drug that make it a serious candidate for transdermal delivery? By what a priori analysis might one zero in on the best transdermal candidate within a family of drugs? Answers to these questions lie in understanding the molecular factors that make a drug a facile permeant of the skin. Among other properties, it must have a high absolute affinity for the skin's phases, which provide for its diffusive conduction. Other factors in evaluation are the potency of the drug and the relative efficiency of the drug's systemic presentation once it has gained access to the body. One also considers the potential for the drug to elicit adverse responses in the skin. Fortunately, parallels between the drug's ability to partition between oil and water and its ease of mass transfer across the skin can be used to ferret out a working mass transfer coefficient. If not already known, solubilities are easily experimentally deduced. The extent of first-pass metabolism by the oral route, presumed to be a known quantity, is compared with the relative amount of metabolism of the drug in the course of its diffsion through the skin, an experimentally determined quantity, in order to set the transdermal dose. These bits of information can then be used to form an early, reasonably faithful picture of the feasibility of delivering a particular drug transdermally and to make a first estimate of the size of patch required for the drug.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50213/1/430130209_ftp.pd

Steatocystoma Multiplex Confined to the Scalp with Concurrent Alopecia

Steatocystoma multiplex (SM) is an uncommon disorder of the pilosebaceous unit characterized by the development of numerous sebum-containing dermal cysts which rarely involves the scalp. Here, we report a case of a 50-year-old man with multiple cystic nodules and alopecic patches on his scalp. On histopathological examination, the folded cyst was found to be lined by stratified squamous epithelium, while flattened sebaceous gland cells were identified in the cystic wall. Pigment casts were present in the hair papillae and perifollicular regions, suggesting trichotillomania as a possible cause of the observed alopecia. This case appears to represent an unusual clinical manifestation of SM