- Email: [email protected]
Second Inter-American Congress of Dermatology
M e e t i n g rel ort I
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Second Inter-American Congress of Dermatology Caracas, Venezuela, Feb. 9-12, 1985 Susan C. Hurt, M.D. Augusta, GA
The Second Inter-American Congress of Dermatology was held in Caracas, Venezuela, Febmary 9-12 of this year, the first such Congress having been held in the same location some 2 years previously. The topic of this year's conference was "Dermatological Therapy for the Twenty-first Century." The Congress was co-sponsored by the College of Physicians of Philadelphia and the Centro Mrdico Docente La Trinidad, in cooperation with the Venezuelan Society of Dermatology and the Department of Dermatology of the University of Puerto Rico School of Medicine. The first three days of didactic sessions were held a.t the Centro Mrdico Docente La Trinidad in Caracas and brought together a collection of prominent dermatologists discussing such diverse aspects of cutaneous therapy as topical minoxidil, the new retinoids, management of nail disorders, collagen injection, dermabrasion, laser therapy, and eyelid surgery. Although the majority of speakers were from Venezuela and the United States, representatives from Germany, Italy, and Israel made this in many respects an international conference, and one that drew participants from northern, southeastern, and western areas in the United States and Puerto Rico, as well as throughout South America. In large part, this year's Congress was directed toward the discussion of dermatologic therapy from a cosmetic approach. Following a keynote address by Dr. Giinter Stiittgen of the Free University of Berlin, the first opening hours of the Congress were devoted to a discussion of cosmetics, both from a historical and a psychological Reprint requests to: Dr. Susan C. Hurt, Medical College of Georgia, Augusta, GA 30912.
1100
perspective. The following are highlights from some of the lectures delivered at this year's meeting. Disorders of Facial Pigmentation were considered by Dr. Nestor Sanchez of Puerto Rico. Melasma, Riehl's melanosis, melanodermatitis toxica lichenoides, poikiloderma of Civatte, pigmented peribuccal erythema of Brocq, and erythromelanosis follicularis of the face and neck comprise those conditions of facial melanosis most commonly encountered in routine dermatologic practice. Among these, melasma is perhaps that most frequently observed. Dermatologists at the University of Puerto Rico have taken a special interest in this condition. Employing a combination of routine histologic examination and Wood's light evaluation in the analysis of lesions of melasma, they have correlated these findings with clinical response to topical hydroquinones. A brief summary of their results follows: Lesions exhibiting predominantly an epidermal pattern of increased melanization by light microscopy demonstrate accentuation of the skin lesion when viewed under Wood's light. Lesions with these characteristics evidenced the most favorable response to topically applied hydroquinone preparations. Those with a predominantly dermal pattem of melanization were not augmented by Wood's light examination and demonstrated a re, sponse to topical therapy that was only fair to poor. Similarly, lesions displaying a mixed histologic pattern gave variable results on Wood's light evaluation and evidenced at best a fair response to topical hydroquinones. Accordingly, Wood's light examination of lesions of melasma, in order to gain some insight into potential response to topical hydroquinone preparations, is advocated prior to
Volume 14 Number 6 June, 1986
Second Inter-American Congress of Dermatology 1101
institution of therapy. Still, it is conceded that in many cases, particularly those instances of a dermal or mixed pattern of melanosis, there is yet no effective therapy. One additional note, Dr. Sanchez has encountered problems with dermabrasion in the management of dermal lesions of melasma. Hormonal manipulation of the skin in the management of hirsutism, a condition of cosmetic concern to many women, was discussed by Dr. Mariela Bajares De Lilue of Venezuela. Once a neoplastic origin for the hirsutism can be excluded, treatment of the condition via hormonal manipulation to reduce the level of circulating androgens may be undertaken. There is still debate as to which source, ovarian or adrenal, is paramount in contributing to the androgen excess observed in hirsute patients. For the patient desiring pregnancy, a rational approach to therapy would be the prescription of Clomid (clomiphene citrate), a nonsteroidal estrogen analog. For those women who do not wish to become pregnant, oral contraceptives are perhaps the logical choice. Preparations with minimal androgenic progestins should be selected. Serum-free testosterone levels may be used to monitor response to therapy. It should be emphasized that both of these methods act to suppress ovarian production of androgens--the adrenal contribution to testosterone and dehydrotestosterone production will be unaffected. To influence adrenal androgen output, one needs to employ synthetic glucocorticoids, such as prednisone or dexamethasone. In addition to hormonal manipulation through various preparations that affect production of circulating androgens, the problem of hirsutism may be approached by utilization of peripheral androgen blockers, which interfere with binding of androgens to the hair follicles, thereby exerting a favorable response in cases of hirsutism. Familiar agents in this category include spironolactone, cyproterone acetate, and cimetidine. Another topic of interest was the discussion of cutaneous implant therapy with a new preparation, Fibrel. This formulation consists of an absorbable gelatin sponge to allow entrapment of fibrin and aminocaproic acid to inhibit fibrinolysis, combined with human serum. This suspension, when injected intradermally under scars, apparently attracts fibroblasts to the area, enhancing the body's
own natural ability to 1/ly down collagen and thereby achieving remodeling of dermal defects. The potential advantages of Fibrel in the recontouring of dermal defects resides in the fact that with this preparation one is injecting a small protein that is therefore potentially less antigenic; hence one is less likely to encounter possible allergic reactions. Effects apparently are immediate, although one still needs to overcorrect the defect as with Zyderm, and at least one to two treatment sessions are required to achieve optimal cosmetic results. It is anticipated results with Fibrel will be more enduring than those achieved with conventional bovine collagen injection, which often requires subsequent injections to maintain the desired level of cosmetic correction. Although preliminary results are encouraging, this latter statement still needs further verification through clinical trials. Dr. Gilberto Castro Ron, of Venezuela, emphasized the cosmetic value of cryosurgery. He has achieved excellent cosmetic results employing cryotherapy in the management of lesions of acne vulgaris, melasma, and vascular tumors, such as cavernous hemangiomas. Dr. Francisco Kerdel-Vegas, of Venezuela, reviewed liposuction, a technic that he feels has a definite place in the practice of dermatology. The ideal surgical candidate for this procedure is less than 40 years of age. Optimal cosmetic results are observed 6 months to 11A years postoperatively. This observation is due to the fact that the cannula traumatizes the subcutaneous tissues, so that one gets necrosis and edema. These take time to subside fully--hence the delay before full cosmetic results are appreciated. Postoperatively, pressure bandages must be worn at least 8 days to collapse the tunnels created by the removal of subcutaneous tissue. It is generally recommended that no more than 1 kg of tissue be removed during a single outpatient procedure. Further removal usually dictates hospitalization for monitoring and management of the patient's fluid status. In addition to conventional use of this modality for contouring areas of the body with excessive subcutaneous tissue, Dr. Kerdel-Vegas has employed liposuction in the management of lipomas, with good results. A topic of particular relevance for those interested in the cutaneous aspects of dermatologic sur-
1102
Hurt
gery was Dr. Daniel E. Gormley's discussion of scar revision by flap design. Dr. Gormley, of Los Angeles, tailored his talk primarily to the use of flaps for coverage after skin cancer resection, and his discussion of the mechanics involved in executing wound closure via rhomboid, bi-lobed, or single rotational flaps, A to T closure, Z-plasty, and conventional sliding advancement flaps provided a concise review of these surgical technics. In addition to coverage of cosmetic aspects of dermatologie therapy, several topics relating to clinical aspects of dermatology were discussed as well. Dr. Homayoun Aram, of Israel, delivered an update on parasitology, with the discussion primarily focused on leishmaniasis, with which Dr. Aram is especially familiar. The acute form of cutaneous leishmaniasis, caused by Leishmania tropica, has a high prevalence in his country, particularly in the area around the Dead Sea. It is recommended that cases of leishmaniasis exhibiting exclusively limited cutaneous involvement be treated when any of the following criteria are present: (1) cosmetically unacceptable lesions, (2) lesions without evidence of.spontaneous healing, (3) satellite or multiple lesions, or (4) instances when L. brasiliensis is demonstrated to be the causative agent. Dr. Aram has successfully treated limited cutaneous lesions with topical heat therapy. The mechanism of benefit is largely related to the fact that heat is eytocidal to the Leishmania organisms. Topical heat has also been employed with success in the management of cutaneous lesions caused by sporotrichosis, chromomycosis, and Mycobacterium marinum. Dr. Neil S. Penneys, of the University of Miami, discussed recent advances in immunoperoxidase technics in the diagnosis of various cutaneous tumors, which in certain instances defy identification by conventional light microscopic diagnosis (i.e., in the case of poor differentiation of the cells). To date, more than one hundred fifty to two hundred different primary antibodies directed toward various histologic constituents are available for use with the peroxidase-antiperoxidase (PAP) technic, Among those currently employed on a regular basis to help establish a diagnosis in equivocal histologic specimens are antibodies directed against carcinoembryonic an-
Journal of the American Academy of Dermatology
tigen, S-IO0 protein, myelin basic protein, bovine papilloma antigen, factor VIII, and prekeratin antibodies. Carcinoembryonic antigen is normally present in apocrine and eccrine glands, as well as in other glandular tissue, and antibodies directed against carcinoembryonic antigen may be helpful in diagnosing cases of Paget's disease of the breast as well as extramammary Paget's disease, certain sweat gland tumors, and metastatic colon carcinoma. S-100 protein, so named because it is soluble in 100% ammonium sulfate, is an acidic calciumbinding protein present in melanoma cells, nevus cells, Langerhans cells, Schwann cells, and cells of sweat glands. It may be of value in identifying cases of malignant melanoma and tumors of neural origin, such as neuromas, neurilemmomas, and neurofibromas. In histiocytosis X, positive S-100 staining lends further support for a Langerhans cell origin of the histiocytic proliferations. For the diagnosis of neural-derived tumors, one may employ antibodies directed against myelin basic protein. Use of such antibodies in the study of granular cell tumors has now established that the cell of origin in this tumor is the Schwann cell. By extrapolation then, these tumors should also stain positively with S-t00 protein, which is also present in Schwann ceils, and this is the case. Positive staining of lesions of bowenoid papulosis of the genitalia with antibodies directed against bovine papilloma antigen suggests that such lesions are probably papillomavirus-derived. Factor VIII, important in the process of blood clotting, is a component of vascular endothelial cells. Employing antibodies directed against this constituent via the peroxidase-antiperoxidase technic has its application in the diagnosis of lesions of Kaposi's sarcoma and similar vascular-derived tumors. Finally, prekeratin antibodies may be helpful in diagnosing malignant proliferations of squamous epithelium, such as squamous cell carcinoma, when histologic criteria alone are not sufficient. Perhaps one of the highlights of the Congress was a visit to the National Institute of Dermatology at the Vargas Hospital of the Central University of Venezuela on the final day of the conference, where participants had the opportunity to view firsthand case presentations of diverse dermato-
Volume 14 Number 6 June, 1986
Second Inter-American Congress o f D e r m a t o l o g y
logic entities such as leishmaniasis, paracoccidioidomycosis, chromomycosis, and leprosy, correlated with representative histologic specimens and smears. The subsequent clinical discussion period provided participants unique insights into the nature of these infectious diseases with characteristic cutaneous manifestations. These diseases are endemic to this area o f South America and probably pose little diagnostic challenge or engender very little novelty among our South American friends who might routinely observe several such cases a month in their daily practice. However, they provided intellectual stimulation to those American
1103
participants north o f the C a r i b b e a n - - p a r t i c u l a r l y those such as myself, a resident in training, whose only previous encounter with these entities had been within the realms o f a textbook. While in Caracas, our Venezuelan hosts were most cordial, providing opportunities for cultural and social exchange b e t w e e n two groups of dermatologists who are similar in so m a n y respects except for the language they speak. Certainly, at least one North American participant felt like a true Caraqueno (Caracan), though it was for but a brief 4 days!
ABSTRACTS Hypertrichosis due to primary hypothyroidism Stern SR, Kelnar CJ: Arch Dis Child 60:763-766, 1985 When children are remarkably hairy, consider hypothyroidism, the author advises. Philip C. Anderson, M.D.
The frequency of malignant neoplasms in patients with polymyositis-dermatomyositis. A controlled study Manchul LA, Jin A, Pritchard KI, et al: Arch Intern Med 145:1835-1839, 1985 Using carefully matched control groups and computing statistical expectations, this Canadian team did not find that malignant neoplasms were associated with dermatomyositis more than with the other illnesses in the control greups. Philip C. Anderson, M.D.
other malignant tumors. Obviously this gives emphasis to the need for long-term follow-up because some recurrences may be treatable. Survival after late relapse is short. In this study of 1,283 patients the incidence of late relapse was almost 3%. Risk factors were not detected, Philip C. Anderson, M.D.
Erythema nodosum heralding recurrent Hodgkin's disease Simon S, Azevedo S J, Byrnes JJ: Cancer 56:14701472, 1985 In older persons almost exclusively the presence of chronic erythema nodosum may indicate a neoplasm, usually a lymphoma. Hodgkin's disease, as reported here in two cases, may be the cause. Philip C. Anderson, M.D.
Acne urticaria associated with chronic myelogenous leukemia
Peripheral neuropathy in cerebrotendinous xanthomatosis
Brydon J, Lucky PA, Duffy T: Cancer 56:20832086, 1985
Katz DA, Scheinberg L, Horoupian DS, et al: Arch Neurol 42:1008-1010, 1985
This intensely pruritic and chronic papulopustular eruption was the marker of leukemia. The pustules contained many eosinophils. Philip C. Anderson, M.D.
Nerve biopsy may be helpful in this diagnosis by finding abnormal deposits of cholestane. Philip C. Anderson, M.D.
Neurofibromatosis and malignancy
Late relapse from cutaneous Stage I malignant melanoma
Warrier RP, Kini KR, Raju U, et al: Clin Pediatr 24:584-585, 1985
Shaw HM, Beattie CW, McCarthy WH, et al: Arch Surg 120:1155-1159, 1985
The point is repeated that with neurofibromatosis a great variety of different cutaneous tumors may occur, some malignant and some very rare types. Philip C. Anderson, M.D,
Late relapse defined as first evidence of metastasis coming after 10 years is characteristic of melanoma and only a few
II III
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II
11111
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Second Inter-American Congress of Dermatology Caracas, Venezuela, Feb. 9-12, 1985 Susan C. Hurt, M.D. Augusta, GA
The Second Inter-American Congress of Dermatology was held in Caracas, Venezuela, Febmary 9-12 of this year, the first such Congress having been held in the same location some 2 years previously. The topic of this year's conference was "Dermatological Therapy for the Twenty-first Century." The Congress was co-sponsored by the College of Physicians of Philadelphia and the Centro Mrdico Docente La Trinidad, in cooperation with the Venezuelan Society of Dermatology and the Department of Dermatology of the University of Puerto Rico School of Medicine. The first three days of didactic sessions were held a.t the Centro Mrdico Docente La Trinidad in Caracas and brought together a collection of prominent dermatologists discussing such diverse aspects of cutaneous therapy as topical minoxidil, the new retinoids, management of nail disorders, collagen injection, dermabrasion, laser therapy, and eyelid surgery. Although the majority of speakers were from Venezuela and the United States, representatives from Germany, Italy, and Israel made this in many respects an international conference, and one that drew participants from northern, southeastern, and western areas in the United States and Puerto Rico, as well as throughout South America. In large part, this year's Congress was directed toward the discussion of dermatologic therapy from a cosmetic approach. Following a keynote address by Dr. Giinter Stiittgen of the Free University of Berlin, the first opening hours of the Congress were devoted to a discussion of cosmetics, both from a historical and a psychological Reprint requests to: Dr. Susan C. Hurt, Medical College of Georgia, Augusta, GA 30912.
1100
perspective. The following are highlights from some of the lectures delivered at this year's meeting. Disorders of Facial Pigmentation were considered by Dr. Nestor Sanchez of Puerto Rico. Melasma, Riehl's melanosis, melanodermatitis toxica lichenoides, poikiloderma of Civatte, pigmented peribuccal erythema of Brocq, and erythromelanosis follicularis of the face and neck comprise those conditions of facial melanosis most commonly encountered in routine dermatologic practice. Among these, melasma is perhaps that most frequently observed. Dermatologists at the University of Puerto Rico have taken a special interest in this condition. Employing a combination of routine histologic examination and Wood's light evaluation in the analysis of lesions of melasma, they have correlated these findings with clinical response to topical hydroquinones. A brief summary of their results follows: Lesions exhibiting predominantly an epidermal pattern of increased melanization by light microscopy demonstrate accentuation of the skin lesion when viewed under Wood's light. Lesions with these characteristics evidenced the most favorable response to topically applied hydroquinone preparations. Those with a predominantly dermal pattem of melanization were not augmented by Wood's light examination and demonstrated a re, sponse to topical therapy that was only fair to poor. Similarly, lesions displaying a mixed histologic pattern gave variable results on Wood's light evaluation and evidenced at best a fair response to topical hydroquinones. Accordingly, Wood's light examination of lesions of melasma, in order to gain some insight into potential response to topical hydroquinone preparations, is advocated prior to
Volume 14 Number 6 June, 1986
Second Inter-American Congress of Dermatology 1101
institution of therapy. Still, it is conceded that in many cases, particularly those instances of a dermal or mixed pattern of melanosis, there is yet no effective therapy. One additional note, Dr. Sanchez has encountered problems with dermabrasion in the management of dermal lesions of melasma. Hormonal manipulation of the skin in the management of hirsutism, a condition of cosmetic concern to many women, was discussed by Dr. Mariela Bajares De Lilue of Venezuela. Once a neoplastic origin for the hirsutism can be excluded, treatment of the condition via hormonal manipulation to reduce the level of circulating androgens may be undertaken. There is still debate as to which source, ovarian or adrenal, is paramount in contributing to the androgen excess observed in hirsute patients. For the patient desiring pregnancy, a rational approach to therapy would be the prescription of Clomid (clomiphene citrate), a nonsteroidal estrogen analog. For those women who do not wish to become pregnant, oral contraceptives are perhaps the logical choice. Preparations with minimal androgenic progestins should be selected. Serum-free testosterone levels may be used to monitor response to therapy. It should be emphasized that both of these methods act to suppress ovarian production of androgens--the adrenal contribution to testosterone and dehydrotestosterone production will be unaffected. To influence adrenal androgen output, one needs to employ synthetic glucocorticoids, such as prednisone or dexamethasone. In addition to hormonal manipulation through various preparations that affect production of circulating androgens, the problem of hirsutism may be approached by utilization of peripheral androgen blockers, which interfere with binding of androgens to the hair follicles, thereby exerting a favorable response in cases of hirsutism. Familiar agents in this category include spironolactone, cyproterone acetate, and cimetidine. Another topic of interest was the discussion of cutaneous implant therapy with a new preparation, Fibrel. This formulation consists of an absorbable gelatin sponge to allow entrapment of fibrin and aminocaproic acid to inhibit fibrinolysis, combined with human serum. This suspension, when injected intradermally under scars, apparently attracts fibroblasts to the area, enhancing the body's
own natural ability to 1/ly down collagen and thereby achieving remodeling of dermal defects. The potential advantages of Fibrel in the recontouring of dermal defects resides in the fact that with this preparation one is injecting a small protein that is therefore potentially less antigenic; hence one is less likely to encounter possible allergic reactions. Effects apparently are immediate, although one still needs to overcorrect the defect as with Zyderm, and at least one to two treatment sessions are required to achieve optimal cosmetic results. It is anticipated results with Fibrel will be more enduring than those achieved with conventional bovine collagen injection, which often requires subsequent injections to maintain the desired level of cosmetic correction. Although preliminary results are encouraging, this latter statement still needs further verification through clinical trials. Dr. Gilberto Castro Ron, of Venezuela, emphasized the cosmetic value of cryosurgery. He has achieved excellent cosmetic results employing cryotherapy in the management of lesions of acne vulgaris, melasma, and vascular tumors, such as cavernous hemangiomas. Dr. Francisco Kerdel-Vegas, of Venezuela, reviewed liposuction, a technic that he feels has a definite place in the practice of dermatology. The ideal surgical candidate for this procedure is less than 40 years of age. Optimal cosmetic results are observed 6 months to 11A years postoperatively. This observation is due to the fact that the cannula traumatizes the subcutaneous tissues, so that one gets necrosis and edema. These take time to subside fully--hence the delay before full cosmetic results are appreciated. Postoperatively, pressure bandages must be worn at least 8 days to collapse the tunnels created by the removal of subcutaneous tissue. It is generally recommended that no more than 1 kg of tissue be removed during a single outpatient procedure. Further removal usually dictates hospitalization for monitoring and management of the patient's fluid status. In addition to conventional use of this modality for contouring areas of the body with excessive subcutaneous tissue, Dr. Kerdel-Vegas has employed liposuction in the management of lipomas, with good results. A topic of particular relevance for those interested in the cutaneous aspects of dermatologic sur-
1102
Hurt
gery was Dr. Daniel E. Gormley's discussion of scar revision by flap design. Dr. Gormley, of Los Angeles, tailored his talk primarily to the use of flaps for coverage after skin cancer resection, and his discussion of the mechanics involved in executing wound closure via rhomboid, bi-lobed, or single rotational flaps, A to T closure, Z-plasty, and conventional sliding advancement flaps provided a concise review of these surgical technics. In addition to coverage of cosmetic aspects of dermatologie therapy, several topics relating to clinical aspects of dermatology were discussed as well. Dr. Homayoun Aram, of Israel, delivered an update on parasitology, with the discussion primarily focused on leishmaniasis, with which Dr. Aram is especially familiar. The acute form of cutaneous leishmaniasis, caused by Leishmania tropica, has a high prevalence in his country, particularly in the area around the Dead Sea. It is recommended that cases of leishmaniasis exhibiting exclusively limited cutaneous involvement be treated when any of the following criteria are present: (1) cosmetically unacceptable lesions, (2) lesions without evidence of.spontaneous healing, (3) satellite or multiple lesions, or (4) instances when L. brasiliensis is demonstrated to be the causative agent. Dr. Aram has successfully treated limited cutaneous lesions with topical heat therapy. The mechanism of benefit is largely related to the fact that heat is eytocidal to the Leishmania organisms. Topical heat has also been employed with success in the management of cutaneous lesions caused by sporotrichosis, chromomycosis, and Mycobacterium marinum. Dr. Neil S. Penneys, of the University of Miami, discussed recent advances in immunoperoxidase technics in the diagnosis of various cutaneous tumors, which in certain instances defy identification by conventional light microscopic diagnosis (i.e., in the case of poor differentiation of the cells). To date, more than one hundred fifty to two hundred different primary antibodies directed toward various histologic constituents are available for use with the peroxidase-antiperoxidase (PAP) technic, Among those currently employed on a regular basis to help establish a diagnosis in equivocal histologic specimens are antibodies directed against carcinoembryonic an-
Journal of the American Academy of Dermatology
tigen, S-IO0 protein, myelin basic protein, bovine papilloma antigen, factor VIII, and prekeratin antibodies. Carcinoembryonic antigen is normally present in apocrine and eccrine glands, as well as in other glandular tissue, and antibodies directed against carcinoembryonic antigen may be helpful in diagnosing cases of Paget's disease of the breast as well as extramammary Paget's disease, certain sweat gland tumors, and metastatic colon carcinoma. S-100 protein, so named because it is soluble in 100% ammonium sulfate, is an acidic calciumbinding protein present in melanoma cells, nevus cells, Langerhans cells, Schwann cells, and cells of sweat glands. It may be of value in identifying cases of malignant melanoma and tumors of neural origin, such as neuromas, neurilemmomas, and neurofibromas. In histiocytosis X, positive S-100 staining lends further support for a Langerhans cell origin of the histiocytic proliferations. For the diagnosis of neural-derived tumors, one may employ antibodies directed against myelin basic protein. Use of such antibodies in the study of granular cell tumors has now established that the cell of origin in this tumor is the Schwann cell. By extrapolation then, these tumors should also stain positively with S-t00 protein, which is also present in Schwann ceils, and this is the case. Positive staining of lesions of bowenoid papulosis of the genitalia with antibodies directed against bovine papilloma antigen suggests that such lesions are probably papillomavirus-derived. Factor VIII, important in the process of blood clotting, is a component of vascular endothelial cells. Employing antibodies directed against this constituent via the peroxidase-antiperoxidase technic has its application in the diagnosis of lesions of Kaposi's sarcoma and similar vascular-derived tumors. Finally, prekeratin antibodies may be helpful in diagnosing malignant proliferations of squamous epithelium, such as squamous cell carcinoma, when histologic criteria alone are not sufficient. Perhaps one of the highlights of the Congress was a visit to the National Institute of Dermatology at the Vargas Hospital of the Central University of Venezuela on the final day of the conference, where participants had the opportunity to view firsthand case presentations of diverse dermato-
Volume 14 Number 6 June, 1986
Second Inter-American Congress o f D e r m a t o l o g y
logic entities such as leishmaniasis, paracoccidioidomycosis, chromomycosis, and leprosy, correlated with representative histologic specimens and smears. The subsequent clinical discussion period provided participants unique insights into the nature of these infectious diseases with characteristic cutaneous manifestations. These diseases are endemic to this area o f South America and probably pose little diagnostic challenge or engender very little novelty among our South American friends who might routinely observe several such cases a month in their daily practice. However, they provided intellectual stimulation to those American
1103
participants north o f the C a r i b b e a n - - p a r t i c u l a r l y those such as myself, a resident in training, whose only previous encounter with these entities had been within the realms o f a textbook. While in Caracas, our Venezuelan hosts were most cordial, providing opportunities for cultural and social exchange b e t w e e n two groups of dermatologists who are similar in so m a n y respects except for the language they speak. Certainly, at least one North American participant felt like a true Caraqueno (Caracan), though it was for but a brief 4 days!
ABSTRACTS Hypertrichosis due to primary hypothyroidism Stern SR, Kelnar CJ: Arch Dis Child 60:763-766, 1985 When children are remarkably hairy, consider hypothyroidism, the author advises. Philip C. Anderson, M.D.
The frequency of malignant neoplasms in patients with polymyositis-dermatomyositis. A controlled study Manchul LA, Jin A, Pritchard KI, et al: Arch Intern Med 145:1835-1839, 1985 Using carefully matched control groups and computing statistical expectations, this Canadian team did not find that malignant neoplasms were associated with dermatomyositis more than with the other illnesses in the control greups. Philip C. Anderson, M.D.
other malignant tumors. Obviously this gives emphasis to the need for long-term follow-up because some recurrences may be treatable. Survival after late relapse is short. In this study of 1,283 patients the incidence of late relapse was almost 3%. Risk factors were not detected, Philip C. Anderson, M.D.
Erythema nodosum heralding recurrent Hodgkin's disease Simon S, Azevedo S J, Byrnes JJ: Cancer 56:14701472, 1985 In older persons almost exclusively the presence of chronic erythema nodosum may indicate a neoplasm, usually a lymphoma. Hodgkin's disease, as reported here in two cases, may be the cause. Philip C. Anderson, M.D.
Acne urticaria associated with chronic myelogenous leukemia
Peripheral neuropathy in cerebrotendinous xanthomatosis
Brydon J, Lucky PA, Duffy T: Cancer 56:20832086, 1985
Katz DA, Scheinberg L, Horoupian DS, et al: Arch Neurol 42:1008-1010, 1985
This intensely pruritic and chronic papulopustular eruption was the marker of leukemia. The pustules contained many eosinophils. Philip C. Anderson, M.D.
Nerve biopsy may be helpful in this diagnosis by finding abnormal deposits of cholestane. Philip C. Anderson, M.D.
Neurofibromatosis and malignancy
Late relapse from cutaneous Stage I malignant melanoma
Warrier RP, Kini KR, Raju U, et al: Clin Pediatr 24:584-585, 1985
Shaw HM, Beattie CW, McCarthy WH, et al: Arch Surg 120:1155-1159, 1985
The point is repeated that with neurofibromatosis a great variety of different cutaneous tumors may occur, some malignant and some very rare types. Philip C. Anderson, M.D,
Late relapse defined as first evidence of metastasis coming after 10 years is characteristic of melanoma and only a few