Author Institution: Department of Medicine, The Ohio State Universit

Heisel, Eldred B.

The Ohio Journal of Science

KnowledgeBank at OSU

DERMATOLOGY AND SYPHILOLOGYELDRED B. HEISEL,Department of Medicine, The Ohio State UniversityWith the advent of the war in the South Pacific, medication for the preventionand cure of malaria was given to large numbers of men. During the past twoyears, atabrine (Quinacrine Hydrochloride) has been the drug most commonly used.Sulzberger reviewed the literature concerning a peculiar lichenoid eruptionwhich occurred in individuals in the armed forces who were receiving atabrine.The eruption began from a few days to several months after the patients begantaking the medication. It was common for the eruption to begin with eczematoidchanges on the extremities, face and neck, and in some cases it began as a gen-eralized exfoliative erythroderma. Usually after the type of onset, lichenplanus-like lesions appeared. These varied from typical, angular, violaceouspapules to large hypertrophic lichen planus-like plaques, which later often showedatrophy, pigmentation or depigmentation. Some cases had leukoplakia-like lesionson the buccal mucosa and others had scalp lesions which at times caused permanentalopecia. At the Naval Medical Center in Bethesda, Maryland, atabrine wasadministered to a group of these patients with quiescent lesions, causing a highpercentage of focal flareups of the eruption, and in some cases widespreadeczematoid and exfoliating reactions. It is felt that there is little doubt that thispeculiar lichenoid dermatitis is a drug eruption due to atabrine.There are increasing reports of dermatitis due to the use of penicillin. Binkleyand Brockmale reported a case of epidermal and dermal sensitivity to sodiumpenicillin, as proven by patch, scratch and intradermal tests. They reportedanother case who developed a dermatitis about six weeks after first exposure topenicillin but in whom the patch and scratch tests were negative. However, in thispatient when penicillin was injected intramuscularly, there was edema and aconfluent papular eruption involving the hands and feet. The skin of the feet hadnever been previously exposed to penicillin but had been the site of a chronicdermatophytosis. Other cases of a dermatitis developing at the site of previousfungous infections have been reported, and Sulzberger suspects that this localizationmay be due to a common allergenic fraction in the fungi found on the skin and inpenicillium notatum. Cormia reported a serum sickness-like syndrome withgeneralized urticaria, mild arthralgia, and lymphadenopathy. This is now knownto be a common reaction to penicillin. Miliaria-like and erythrema nodosum-likeeruptions have also been reported.About five years ago, there began on the East Coast of the United States anepidemic of ring worm of the scalp involving boys and girls of prepuberty. Thishas gradually spread to the Midwest and within the past eighteen months hasassumed epidemic proportions in the State of Ohio. There are two organismswhich commonly cause ring worm of the scalp: Microsporon audounini and Micro-sporon lanosum. These two organisms differ in that infections due to Microsporonlanosum commonly cause a severe inflammatory reaction and can be cured withease by local medication; whereas those due to Microsporon audounini show almostno inflammatory response and are most resistant to any local therapy. In thisepidemic, the first of its kind in the United States, the offending agent has beenMicrosporon audonini. The Wood's light, which is ultraviolet light filtered throughcobalt glass, causes infected hairs to shine with a bright green flourescence, and is anindispensable diagnostic tool. At the present time, the treatment which is acceptedand efficacious in these cases, is temporary epilation by means of x-ray.Urbach recently described a syndrome usually presenting a clinical picture offurnuculosis, sweat gland abscesses, eczema and pruritis, in which there was a188No. 4 DERMATOLOGY AND SYPHILOLOGY 189normal blood sugar curve but microchemical examination of the skin itself showedthe sugar content to be higher than normal. A low carbohydrate diet sometimescombined with insulin, caused marked improvement in the dermatoses.Kaposi in 1897 described a varicella-like eruption which occurred in infantsas a complication of eczema. Some authors have stated that this entity is thesame as eczema vaccinatum. In December, 1944, Lane and Herold describedfive patients with this type of eruption, only one of whom could possibly have beeninfected with the vaccinia virus. In February, 1945, Lynch described a group offour cases with a herpetic eruption complicating atopic eczema. In three cases,he showed presumptive evidence that the herpes simplex virus was the causativeagent-and in one case, laboratory studies permitted the conclusion that the virusof herpes simplex caused the eruption. He suggested the name "eczema her-peticum." Blattner, et al., reported a case of a boy, age fifteen months, who hadhad atopic eczema since the age of six weeks, had never been vaccinatedagainst smallpox, and who developed fever and an acute exanthema of the herpetictype. By animal experimentation, histo-pathologic and immunologic studies, theyestablished the causative agent to be the herpes simplex virus. There seemsto be little doubt that the herpes virus has been proven to be the causative agentof a varicella-like eruption, complicating atopic dermatitis.Stryker and Halbeisen described a group of cases with cutaneous lesions con-sisting of a patchy or diffuse, scaly erythroderm involving the sides of the neckand anterior shoulders. These patients also exhibited a few signs of a mild vitamindeficiency, although all declared their diets to be adequate. Blood studies revealeda macrocytic anemia. Crude liver injections caused a disappearance of theeruption and a return to normal of the blood picture. These studies may throwlight on some of the bizarre eruptions appearing around the shoulder girdle whichcommonly have been called neuro dermatitis.In dermatologic therapy, a few new, useful agents have been introduced.Penicillin has been most promising in the treatment of the pyodermas. As inother fields of medicine, it has been tried indiscriminately in the treatment ofdermatologic entities in which therapy has been unsatisfactory. It is not efficaciousin pemphigus vulgaris, dermatitis herpetiformis, eczema, seborrheic dermatitis,acne vulgaris and the chronic dermatoses involving the hands.Two new fatty acids, namely, propionic acid and undecylenic acid, have beenintroduced and widely used as a treatment for superficial fungus infections.Eddy and his workers at the U. S. Bureau of Entomology, have developedformulas containing benzyl benzoate, pyrethrins, undecylenic acid, 2-4 dinitroanisole and DDT, in the treatment and control of head lice, crab lice and scabies.They have been largely responsible for the excellent control of these conditions inthe armed forces.The combination of Vitamin B complex and hydrochloric acid has been reportedby at least three workers, to be helpful in the treatment of vitiligo.Two new preparations, pyribenzamine (Ciba) and benadryl (Parke, Davis),appear to be useful drugs in the control of reactions caused by histamine. Theyare especially promising in the treatment of urticaria and although they are non-specific as far as the allergens producing the urticaria are concerned, they appearto be specific as far as the mechanism by which some of these allergens producethe disease.Peters, after studying the chemical content of the exfoliated skin from patientswith exfoliative dermatitis, treated them with cystine with good results. Hesuggested that in an attempt to restore the epithelium, the body had depleted itssulfur containing amino acids.Cannon reported successful results in five cases of acute disseminated lupuserythematosus by the oral administration of iodine. He tried the treatmentwhen he noted improvement in a case of acute disseminated lupus erythematosus190 ELDRED B. HEISEL Vol. X L V Iwho had been given a dye containing iodine preceding roentgenograms of thegall bladder.The most important advance in the field of syphilology is treatmentwith penicillin which appears to be most valuable in the treatment of early syphilis.The trend in treatment is to use a combination of penicillin and the heavy metals.Eagle, et al., have shown penicillin and Mapharsen to be synergistic in the treat-ment of experimental syphilis. Platou, et al., treated sixty-nine infants with earlycongenital syphilis and reported the immediate response to be encouraging. Rose,et al., gave a preliminary report on seventy cases of central nervous system syphilistreated with penicillin. The greatest improvement was in patients with generalparesis. Dolkart and Schwemlein found it necessary to discontinue penicillin inthe treatment of two cases of cardio-vascular syphilis because of the developmentof severe anginal pain. In general, it may be said that penicillin is a useful agentin the treatment of syphilis, but that no long term evaluation can be made as yet.The incubation period of syphilis is considerably longer than that of gonorrheaand the effective dose of penicillin for syphilis is much larger than for gonorrhea.The small doses of penicillin which are successful in the treatment of gonorrheamay in a concomitant case of syphilis temporarily suppress the primary, secondaryand serologic manifestations of early syphilis. This makes it mandatory that allcases of gonorrhea treated with penicillin be followed serologically for six months toone year, rather than three months as has been previously recommended.Some important work has been done on the serologic verification tests. Reinand Elsberg examined six verification tests to determine their value. They foundnone of these methods to be of value in distinguishing consistently between truepositive (syphilitic) and false positive or non-syphilitic reactions. It was theirfeeling that present verification tests are of no value in the sero diagnosis of syphilis.Scott, et al., in another study came to the same conclusion.BIBLIOGRAPHYAllison, J. R. Relation of Hydrochloric Acid and Vitamin B Complex Deficiency in CertainSkin Diseases. South. M. J., 38: 225-241 (April) 1945.Bagby, J. W. Tropical Lichen Planus-like Disease. Arch. Dermat. & Syph., 52: 1-5 (July)1945.Binkley, George W., and Brockmale, Arnold. Dermatitis from Penicillin. Arch. Dermat. &Syph., 50: 326-327 (November) 1944.Cannon, A. B. Treatment of Lupus Erythematosus Disseminatus by Internal Administration ofIodine. Arch. Dermat. & Syph., 51: 26-31 (January) 1945.Carpenter, C. C, and Hall, W. H., Jr. Treatment of Dermatitis Herpetiformis with Penicillin.Arch. Dermat. & Syph., 51: 241-242 (April) 1945.Cohen, T. M., and Pfaff, R. O. Penicillin in Dermatologic Therapy. Arch. Dermat. & Syph.,51: 172-177 (March) 1945.Cormia, Frank, Jacobsen, L. Y., and Smith, E. L. Reactions to Penicillin. Bull. U. S. Army,M. Dept., Carlisle Barracks, 4: 694-702 (December) 1945.Dolkart, R. E., and Schwemlein, George X. The Treatment of Cardiovascular Syphilis withPenicillin. J.A.M.A., 139: 515-516 (October 13) 1945.Eagle, H., Magnuson, H. J., and Fleishman, R. The Synergistic Action of Penicillin andMapharsen in the Treatment of Experimental Syphilis. Jr. Ven. Dis. Inf., 27: 3-9 (January)1946.Eddy, Gaines W. Treatment of Head Lice, Crab Lice and Scabies. War Med., 6: 319-322(November) 1944.Hathaway, J. C. Vitamin B Complex for Vitiligo. Arch. Dermat. & Syph., 52: 117-118 (August)1945.Kieney, E. L., Ajello, L., and Brayles, E. N. Propionate and Undecylinate Ointments in Treat-ment of Tinea Pedis. Bull. John Hopkins, 75: 417-430 (December) 1944.Lynch, F. W. Kaposi's Varicelliform Eruption: Extensive Herpes Simplex as Complication ofEczema. Arch. Dermat. & Syph., 51: 129-137 (February) 1945.Morginson, W. J. Clinical Use of Penicillin in Dermatology. South. M. J., 38: 320-326 (May)1945.Peters, B. A. Exfoliative Dermatitis Treated with Cystine. Lancet, 1: 264-265 (March 3) 1945.No. 4 ANATOMY 191Platou, R. V., Hill, A. J., Ingraham, N. R., Goodwin, M. S., Wilkinson, £. E., and Hansen, A. £.Penicillin in the Treatment of Infantile Congenital Syphilis. J.A.M.A., 127: 582 (March10) 1945.Rein, C. R., and Elsberg, E. S. Are Current Verification Tests of Practical Value in SeroDiagnosis of Syphilis? J. Invest. Dermat., 6: 113-127 (April) 1945.Rose, A. S., Trevett, L. D., Hindle, J. A., Prout, C, and Solomon, H. C. Penicillin Treatment ofNeuro Syphilis: Preliminary Report of Seventy Cases Followed 4-12 Months. Am. J.Syph. Gonor. & Ven. Dis., 29: 487-493 (September) 1945.Scott, V., Schamberg, I. L., Moore, J. E., Eagle, H., and Rein, C. R. Serologic Differentiation ofSyphilitic and False Positive Serums. Am. J. Syph. Conor. & Ven. Dis., 29: 505-528(September) 1945.Sieve, B. F. Further Investigations in the Treatment of Vitiligo. Virginia M. Monthly,72: 7-17 (January) 1945.Stryker, G. V., and Halbeisen, W. A. Determination of Macrocytic Anemia as an Aid in theDiagnosis of Certain Deficiency Dermatoses. Arch. Dermat. & Syph., 51: 116-123 (Feb-ruary) 1945.Urbach, E. Skin Diabetes: Hyperglycodermia without Hyperglycemia. J.A.M.A., 129:438-440 (October) 1945.Walker, A. E., and Barton, R. L. Treatment of Gonorrhea with Penicillin during the IncubationPeriod or Early Phase of Syphilis: A Review. Jr. Ven. Dis. Inf., 26: 241-244 (November)1945.Yearbook of Dermat. & Syph., 1945.

Dermatology and Syphilology

https://kb.osu.edu/bitstream/1811/3534/1/V46N04_188.pdf

Dermatology and Syphilology

Abstract

Similar works

Full text

Available Versions

KnowledgeBank at OSU