A. M. A. archives of dermatology

Recently Tas and Weissberg 1 reported a case of allergic sensitivity to aminophylline in a 52-year-old pharmacist. For about one year he had prepared 600 aminophylline suppositories a week. Some weeks, after the start of this work, he had complained of an itching skin disorder on his hands, arms, and face. On examination there was redness and swelling, accompanied by papules, vesicles, and weeping on the hands and arms together with slight redness and papule formation on the face and scaling of the lips. Patch tests with many materials, but not including aminophylline, were negative. When the patient's work changed and he was no longer exposed to aminophylline his skin cleared. Several months later he again prepared aminophylline suppositories. After the first new contact he began to sneeze and wheeze, and his skin eruption reappeared. A patch test to 1% aminophylline was strongly positive. A patch test

RUDOLF L. BAER

A M A Archives of Dermatology

Allergic Eczematous Sensitivity to Aminophylline

氨茶碱的过敏性湿疹敏感性

Dermatomyositis is a disease of various cutaneous manifestations associated with an unpredictable degree of nonsuppurative polymyositis. Involvement of the skeletal muscles is always a factor and is responsible for the varying degrees of disability. The characteristic and unusual features of this disease have been described elsewhere.1-4Important among these is calcinosis cutis. As a result of our recent review of calcinosis in scleroderma,5 we decided to extend these investigations to include dermatomyositis. It was our purpose to examine the relationship of calcinosis to prognosis in dermatomyositis as well as to contrast its pattern of occurrence to that in scleroderma. From the records of approximately 260 patients seen at the Mayo Clinic from 1945 to 1955 with the diagnosis of dermatomyositis, sclerodermatomyositis, poikilodermatomyositis, and polymyositis, we selected 182 as representative of classic dermatomyositis; we rejected any case in which clinical and laboratory features

SIGFRID A. MULLER

Calcinosis in Dermatomyositis

皮肌炎中的钙质沉着

In recent years increased recognition of internal medical counterparts of urticaria pigmentosa (mastocytosis) has been recorded. Nickel's 1 comprehensive review summarized the frequency with which visceral and osseous lesions of mastocytosis are encountered, if searched for. To be sure, a purely cutaneous form of urticaria pigmentosa is still identified, but the possibility is not excluded that even these cases may have subclinical, inconspicuous, and hidden foci of the disease in locations elsewhere than the skin. Proof of the latter conjecture is not readily available, as opportunities for autopsy examination of this benign disease are extremely rare. Simply to authenticate the fact that the skin may indeed be the organ exclusively involved in urticaria pigmentosa, even when of severe degree, is the purpose of this paper. We wish to report a case of congenital urticaria pigmentosa in an infant, studied clinically and at autopsy. Report

ROBERT J. DAVIS

Urticaria Pigmentosa

色素性荨麻疹

A 32-year-old native of Thailand presented himself at the office on May 29, 1957, with the complaint of rash on the right arm. It had started four months before as a small asymptomatic red spot on the right elbow and had rapidly progressed to its present large size. Two weeks before this visit, while pressing clothes, he had burned part of the eruption with a hot flat-iron and was unaware of doing so until he saw the burned skin later. Past history revealed that six to seven years ago he had had an asymptomatic red patch on the same elbow, which had cleared without treatment within a year. At the time of this visit he had been in the United States for almost a year. Neither his wife nor their three children in Thailand had any cutaneous or neurological disorders. The patient had no systemic

MARC ALLEN WEINER

Leprosy

麻风病

In the following two cases which clinically were diagnosed as fungus infection of the nail, Fusarium oxysporum was isolated. Both cases were of long standing and the use of a wide range of fungicides, and even removal of the nail in one case had been ineffective. In the following study results of sensitivity tests of F. oxysporum to various fungicides lead to cure in both cases. Report of Cases A 48-year-old white housewife, whose hobby was gardening, was seen in March, 1956, for a recurrent infection of the right thumbnail of five years' duration (Fig. 1). During this time her family physician had used a wide range of fungicides and had removed the nail twice. The entire nail plate was thin and flexible and undermined at the distal third, the nail bed being thickened and covered by dirty debris. Proximal to the undermined part, there was a half-moon-shaped, sharply

EARL B. RITCHIE

Fusarium Oxysporum Infection of the Nail

尖孢镰刀菌感染指甲

The importance of primary irritation of the skin in producing an eczematous dermatitis by itself, as well as influencing the engendering of an allergic eczematous contact dermatitis is well documented. The recent literature is replete with articles adding to the fund of observations on mechanisms of pathogenesis of the eczematous sensitization and various aspects of dermatitis and eczema, but relatively few references are found under the heading of primary irritation as such. At present much of this information is found under such topics as contact dermatitis due to specific agents, thermal injuries, industrial dermatitis, and eczemas of various sorts, and it is inseparably linked with studies on allergic reactions in the skin. This is quite understandable since the need for such a term arose from the introduction of the concept of allergy which called for a designation to distinguish allergic from nonallergic forms

JOHN B. HAEBERLIN

Primary Irritation of the Skin

皮肤原发性刺激

The importance of those remarkable cytological units, the tissue mast cells, has soared in recent years. This paper reviews briefly some of the newer concepts of these cells and reports on the author's experience with histological techniques for the study of mast cell acid polysaccharides in the cutaneous lesions of urticaria pigmentosa. Some Newer Concepts of Tissue Mast Cells Although the distribution of mast cells varies from species to species, their characteristic location in warm-blooded vertebrates is the loose fibrillary tissue which surrounds small blood vessels and underlies epithelial, serous and synovial membranes.1,13In general, parenchymatous organs are poor in mast cells, a noteworthy exception being the widespread distribution of mast cells throughout the parenchyma of the dog's liver.1Urticaria pigmentosa, the lesions of which are featured by agglomerations of mast cells, has been known for many years. Only recently, however,

EDWARD P. CAWLEY

The Remarkable Tissue Mast Cells

显著的组织肥大细胞

Epidermolysis bullosa is generally considered an inherited process beginning early in life, characterized by bulla formation and by erosions of the skin secondary to minor trauma. Occasionally this symptom complex begins in adulthood with no pertinent familial background. A few of these cases of the so-called tardive or acquired form apparently follow severe drug reactions. 1,2 More commonly, however, the syndrome is found with porphyria cutanea tarda. 3-5 The differentiation of the idiopathic acquired variety and that associated with porphyria may lead to some diagnostic confusion. We have recently had an opportunity to study concurrently a case of idiopathic epidermolysis bullosa acquisita with no associated familial or toxic background, and a patient with porphyria cutanea tarda. It is the purpose of our report to compare these two patients, not only to establish differentiating features, but if possible to shed some light on the mechanism or mechanisms

JOHN H. EPSTEIN

Epidermolysis Bullosa Acquisita (Tardive) and Porphyria Cutanea Tarda

获得性大疱性表皮松解症（迟发性）与迟发性皮肤卟啉病

In sensitized persons, patch tests with allergens may show a local reaction varying from a mild erythema to erythema with edema, papules, and vesicles. Such reactions are usually graded 1 to 4 plus depending upon the degree of reaction. Patch tests with many primary irritants may show somewhat similar local reactions. In some instances, however, the reactions are so severe as to produce ulcerations. These two commonly observed reaction types, however, do not appear to cover all forms of reactions that occur from patch tests. There exists still another type of patch test reaction which differs in many respects from the above mentioned. Sulzberger and Witten have called attention to a pustular type reaction which, it appears, has escaped general notice, and consequently has not had adequate work-up. These pustular patch test reactions are especially produced by certain salts of heavy metals and halogens. Usually, the pustules are small, measuring

ALEXANDER A. FISHER

Pustular Patch Test Reactions

脓疱性斑贴试验反应

Melanotic freckle is a pigmented, precancerous lesion that is clinically distinctive, sometimes difficult to interpret histopathologically, and which presents a problem in histological diagnosis, prognosis, and in treatment. It progresses slowly, sometimes to a malignant tumor stage (superficial melanocarcinoma) which may be indistinguishable from malignant melanoma, and yet its prognosis as to metastasis, morbidity, and mortality is comparatively favorable. Dermatologic literature contains several comprehensive reports of this unusual entity since its original description by Hutchinson. 1 Noteworthy are those of Dubreuilh, 2,3 Meischer, 4,5 Justitz, 6 and more recently, Klauder and Beerman. 7 There have been two hundred cases reported in all. The purpose of this presentation is to record twelve additional cases seen in private practice and clinic practice. Nomenclature Melanotic freckle has been described under many names, such as senile freckle, infective melanotic freckle, melanose circonscrite precancereuse, lentigo malin des vieillards,

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A. M. A. archives of dermatology

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Allergic Eczematous Sensitivity to Aminophylline

Calcinosis in Dermatomyositis

Urticaria Pigmentosa

Leprosy

Fusarium Oxysporum Infection of the Nail

Primary Irritation of the Skin

The Remarkable Tissue Mast Cells

Epidermolysis Bullosa Acquisita (Tardive) and Porphyria Cutanea Tarda

Pustular Patch Test Reactions

Melanotic Freckle