- Email: [email protected]
Melanosis of undetermined cause: Lichen planus
1146
ABSTRACTS
area and its relation to masticatory ment of the mandible to the skull condyle on sensory nerve branches. temporomandibular joint dysfuuction occlusion.
OF
CURREKT
LITERATURE
apparatus is mandatory, as the anatomy of the attach provides very obvious chances for impingement of the The basis of this report iuvolves correctiou Of the and rehabilitation of these patients by the proper dental T. J. C.
Melanosis Syph.
of Undetermined 67: 343, March,
Cause:
Lichen
Planus.
J. Lowry
Miller.
Arch.
Dermat.
8:
1953.
“I. S., a Jewish woman, aged 63, for the past 10 year8 has noticed tiny red spots within her mouth which would appear like Lblood clots’ but would soon disappear, leaving only They occurred on the lips, tongue, pigmentation at the sites. The lesions were asymptomatic. and buccal mucosa. In the past few months the patient has noticed dark spots on her neck and chest which were preceded by itching. For the past year there have been changes in the fingernails and toenail8 consisting of discoloration, thickening and roughness. This began on the third finger of the right hand, and within a month the remaining fingernail8 became affected. The toenails became involved subsequently. The patient was seen by a dermatologist, and a diagnosis of nail dystrophy due to nail polish base was made. Treatment There is no consisted of four x-ray exposuresl but this produced no change in the nails. history of drug ingestion. The patient has had three uneventful pregnancies. There have been no previous skin maladies. Two year8 ago she had a cough and sinusitis treated with penicillin injections and cough medicine. An x-ray of the chest at that time was normal. It is presumed that the patient has lost 20 lbs. (9.1 kg.) during the last two years owing to strict dieting. On the lips and the bucval and vaginal mucosae are numerous brown-black, irregular patches showing no activity or atrophy. There is a pigmented patch on the left side of the neck. Between the breasts are a few pigmented, slightly scaly maculopapules. The fingernails and toenails show dystrophie changes with loss of luster, fragmentation, thickening and brittleness. “Serologic tests for syphilis were negative. IIemoglobin was 14.4 gm. per 100 C.C. of blood; there were 7,600 white blood cells, with 65 per cent poIymorphonuclear Ieucocytes and 35 per rent lymphocytes. Results of urinalysis were normal. The serum sodium and chlorides were 142.3 and 107 meq. por liter, respectively. The plasma carbon-dioxide combining power was 59.8 volumes per 100 C.C. Culture from the fingernails showed a nonpathogenic Candida. Discussion “Dr. Frank C. Combes: I think this is a case of drug eruption of the lichenoid type with pigmentation. I have never seen this type of melanotic pigmentation following licheu planus, but I have seen it following intake of gold. I think it is typical of the pigmentation seen with gold intoxication. The possibility of absorption from the extensive gold dentures she has worn for 20 years should be considered. If you go over the entire body you cant find lanugo hairs except for two or three on one toe. 1 think the nail changes and hair loss are also due to gold. “Dr. Euggeae F. Trau.b: This is the first time 1 have heard of absorption of gold from a gold filling or inlay, and I wouldn’t believe it possible. She may have pigmentation from gold, but not from dentures. You can get mercury dermatitis when amalgam filling8 are placed in the teeth, but this occurs only in the process of filling the teeth and not after the metal has been set. There is no later absorption of the mercury nor can there be from the metallic gold. “Dr. J. Lowry Niiller: Diagnosis is difficult in this case. 1 put lichen planus down because it was the one possibility to explain the entire picture-the nails, lesions in the mouth, and possibly the pigmentation. We went carefully into the history of drug ingestion, and she is an intelligent patient. The one exception to drug8 was a cough medicine given two years ago, and at that time she already had pigmentation of the mouth. ”
T. J. C
ABSTRACTS
area and its relation to masticatory ment of the mandible to the skull condyle on sensory nerve branches. temporomandibular joint dysfuuction occlusion.
OF
CURREKT
LITERATURE
apparatus is mandatory, as the anatomy of the attach provides very obvious chances for impingement of the The basis of this report iuvolves correctiou Of the and rehabilitation of these patients by the proper dental T. J. C.
Melanosis Syph.
of Undetermined 67: 343, March,
Cause:
Lichen
Planus.
J. Lowry
Miller.
Arch.
Dermat.
8:
1953.
“I. S., a Jewish woman, aged 63, for the past 10 year8 has noticed tiny red spots within her mouth which would appear like Lblood clots’ but would soon disappear, leaving only They occurred on the lips, tongue, pigmentation at the sites. The lesions were asymptomatic. and buccal mucosa. In the past few months the patient has noticed dark spots on her neck and chest which were preceded by itching. For the past year there have been changes in the fingernails and toenail8 consisting of discoloration, thickening and roughness. This began on the third finger of the right hand, and within a month the remaining fingernail8 became affected. The toenails became involved subsequently. The patient was seen by a dermatologist, and a diagnosis of nail dystrophy due to nail polish base was made. Treatment There is no consisted of four x-ray exposuresl but this produced no change in the nails. history of drug ingestion. The patient has had three uneventful pregnancies. There have been no previous skin maladies. Two year8 ago she had a cough and sinusitis treated with penicillin injections and cough medicine. An x-ray of the chest at that time was normal. It is presumed that the patient has lost 20 lbs. (9.1 kg.) during the last two years owing to strict dieting. On the lips and the bucval and vaginal mucosae are numerous brown-black, irregular patches showing no activity or atrophy. There is a pigmented patch on the left side of the neck. Between the breasts are a few pigmented, slightly scaly maculopapules. The fingernails and toenails show dystrophie changes with loss of luster, fragmentation, thickening and brittleness. “Serologic tests for syphilis were negative. IIemoglobin was 14.4 gm. per 100 C.C. of blood; there were 7,600 white blood cells, with 65 per cent poIymorphonuclear Ieucocytes and 35 per rent lymphocytes. Results of urinalysis were normal. The serum sodium and chlorides were 142.3 and 107 meq. por liter, respectively. The plasma carbon-dioxide combining power was 59.8 volumes per 100 C.C. Culture from the fingernails showed a nonpathogenic Candida. Discussion “Dr. Frank C. Combes: I think this is a case of drug eruption of the lichenoid type with pigmentation. I have never seen this type of melanotic pigmentation following licheu planus, but I have seen it following intake of gold. I think it is typical of the pigmentation seen with gold intoxication. The possibility of absorption from the extensive gold dentures she has worn for 20 years should be considered. If you go over the entire body you cant find lanugo hairs except for two or three on one toe. 1 think the nail changes and hair loss are also due to gold. “Dr. Euggeae F. Trau.b: This is the first time 1 have heard of absorption of gold from a gold filling or inlay, and I wouldn’t believe it possible. She may have pigmentation from gold, but not from dentures. You can get mercury dermatitis when amalgam filling8 are placed in the teeth, but this occurs only in the process of filling the teeth and not after the metal has been set. There is no later absorption of the mercury nor can there be from the metallic gold. “Dr. J. Lowry Niiller: Diagnosis is difficult in this case. 1 put lichen planus down because it was the one possibility to explain the entire picture-the nails, lesions in the mouth, and possibly the pigmentation. We went carefully into the history of drug ingestion, and she is an intelligent patient. The one exception to drug8 was a cough medicine given two years ago, and at that time she already had pigmentation of the mouth. ”
T. J. C