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Sulphur for rosacea: Are we reinventing the wheel?
White fibrous papulosis of the chest and back
The power of grease
(Poster reference number 4837)
(Poster reference number 5469)
Wan-Lin Teo, MBBS, Singapore General Hospital, Singapore; Shiu Ming Pang, MD, Singapore General Hospital, Singapore White fibrous papulosis (WFP) is an extremely rare condition affecting the neck that is predominantly described in elderly Asians, particularly the Japanese. We report an unusual case of WFP occurring on the chest and back on an Asian male. A 52-year-old Chinese man with no significant medical history presented with an increasing number of asymptomatic white papules on his chest and back for 2 years. Examination revealed numerous white, well circumscribed, nonfollicular papules measuring 2-3 mm distributed over the upper chest and back. Histopathologic examination with Weigert elastic stain revealed thinned collagen bundles and loss of elastic fibers in isolated foci of the mid and lower dermis. Elastic fibers were present in other sites of the dermis. WFP was diagnosed, with unique involvement of the chest and back. The patient was reassured of its benign nature but was cautioned about further spread. WFP of the neck (WFPN) and pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis were classified under the diagnostic term fibroelastolytic papulosis (FEP) by Jagdeo, as a group of rare disorders with predominantly papillary dermis involvement. The pathogenesis has been linked to mechanisms underlying intrinsic aging. FEP runs a benign course but is nonetheless cosmetically troubling for the patient. There is no effective treatment, although surgical excision and the use of tretinoin have been reported.
Val Loftus, Betsi Cadwaladr University Health Board, Denbighshire, North Wales, United Kingdom Robert Chesebrough was a chemist who was born in London to American parents in 1837. As a young adult, he worked in the chemical industry, distilling kerosene from the oil of sperm whales. Following the discovery of petroleum, Chesebrough set off to Pennsylvania (United States) in 1859 to seek his fortune. Whilst working on oil rigs, workers noted a greasy black material that formed on the rods of the rigs (referred to as ‘‘rod wax’’ by the drillers). This was found to have healing properties and drillers who sustained industrial cuts and burns applied the ‘‘rod wax’’ to their injuries and noted that the healing process was accelerated. This was an exciting find for Chesebrough, and he set about his work purifying the substance to finally develop a colorless and odorless gel 10 years later. In the early 19th century, skin care was smelly, colorful, and sometimes tasty. Goose grease was applied to lips and moustaches and lard to clear acne. By 1870, Chesebrough had opened his first factory producing petroleum jelly known as ‘‘Vaseline,’’ a semisolid mixture of hydrocarbons promoted as a topical ointment with healing properties. Unfortunately, there was little interest in his product and sales were poor. However, Chesebrough had great faith and belief in his product and set out to travel around the United States promoting the petroleum jelly. Chesebrough gave demonstrations by self-inflicting injuries then applying the petroleum jelly and giving out free samples. By the early 1880s, the power of Vaseline had been heard worldwide, and in 1883 he was honored with a Knighthood by Queen Victoria for his great work and dedication. In 1913, a young man named Thomas Williams was watching his sister mix Vaseline with coal dust to brush onto her eyelashes and eyebrows to make them appear darker and thicker. He later produced and marketed the product as Lash Brow line presently known as Maybelline. During a lifethreatening illness of pleurisy, Chesebrough drenched himself in Vaseline, making a complete recovery. Chesebrough claimed that he consumed a spoonful of Vaseline each day and lived to the grand age of 96 years old and was laid to rest in Bronx County, New York. Today, petroleum jelly is still used by primary care physicians in the management of early stage eczema, psoriasis, and actinic keratoses.
Commercial support: None identified.
Commercial support: None identified.
ARTS, HISTORY, & HUMANITIES OF DERMATOLOGY Sulphur for rosacea: Are we reinventing the wheel?
The role of syphilis in the establishment of the specialty of dermatology
Catherine McKay, MBBS, Skin and Cancer Foundation, Darlinghurst, Australia; Keiron Leslie, MD, Department of Dermatology, San Francisco, CA, United States; Leone Snowden, NSW Medicines Information Centre, Darlinghurst, Australia; Margot Whitfeld, MBBS, Department of Dermatology, Darlinghurst, CA, United States Rosacea is a common, chronic inflammatory facial condition that affects approximately 13 million individuals in the United States alone. It has been a human affliction since time immemorial. Despite this, the pathogenesis remains largely unclear. Cutaneous Demodex mites, altered vascular reactivity, alcohol ingestion, Helicobacter pylori, and Staphylococcus epidermidis have all been implicated. The therapeutic armamentarium to treat rosacea is extensive, and some rosacea remedies date back to before the Middle Ages. Sulphur, as a treatment for cutaneous disease, was described in the Ebers Papyrus, an ancient Egyptian medical scroll, dated circa 1550 BC. James Morris in Lancet describes the first effective sulphurcontaining formulation to treat rosacea in 1855. This was followed by a modification of the Danish formula, originally used to treat scabies, by Ayers and Ayers in 1932. This formulation contained 11% sublimed sulphur. In the 1950s, 10% sulphur with 5% Peruvian balsam was used for Demodex-associated eruptions. Modern sulphurcontaining formulations for rosacea incorporate 10% sodium sulfacetamide combined with 5% sulphur. The new foam formulations are easier to apply and exude fewer odors. Antiseptic, antibacterial, and antifungal properties have been attributed to sulphur. These antibacterial properties have been demonstrated against Propionibacterium acnes, some Streptococci, and Staphylococcus aureus. Sulphur has also been shown to kill Demodex mites, which have been implicated as a possible causative factor in rosacea. In recent times, sulphur has declined in popularity, largely because of its odor. With the emergence of antibacterial resistance to other agents, as well as sensitivity to other topical antibiotics, topical sulphur has once again become a useful therapeutic option. We have translated these older formulations into modern recipes that can be compounded today. The aim of this poster is to remind the modern dermatologist of a safe, affordable and currently underused ‘‘remedy’’ for the treatment of an age old dermatologic condition.
Melinda B. Chu, MD, St. Louis, MO, United States; Michelle Tarbox, MD, St. Louis, MO, United States
Commercial support: None identified.
Commercial support: None identified.
(Poster reference number 5503)
APRIL 2012
(Poster reference number 5095)
The early history of dermatology, the specialty associated with celebrities and Botox, is far from glamorous. In fact, venereal diseases, especially syphilis, figure prominently in the field’s development as distinct from general medicine. Although the discussion of venereal disease was considered clandestine, the public health risks of syphilis in the late 1800s demanded attention. Dermatologists rose to the task of caring for these underserved patients, and this expertise in syphilis actually helped to establish dermatology as a legitimate medical specialty. Dermatology had been derided by general practitioners as a field that lacked substance or real science. Advances in the pathology of syphilis showcased the field’s scientific nature. By emphasizing the disease’s multisystem effects, dermatologists were able to highlight the relationship of skin diseases to the rest of the body. It was not only the conditions that were reframed in these terms, but the dermatologists themselves—as one put it ‘‘The true dermatologist is an internist who knows the skin’’ (Highman, 1921). Syphilis was not only an intellectual matter between physicians, of course: its epidemiology and management was wrought with ethical and moral dilemmas. Should prostitution be regulated by the state? Should physicians inform the patient’s family? Did the afflicted deserve to suffer? These were the topics that led to heated discussions behind closed doors and to newspaper headlines across the country. As a result, dermatologists were at the center of the public debate over moral decency and the government’s role. Dermatologists recognized the importance of syphilis to the advancement of the field. The names of dermatology textbooks and journals began to highlight their special expertise in ‘‘Syphilology.’’ Perhaps more telling, they called themselves Professors of Dermatology and Syphilology. In 1878, at the first annual American Association of Dermatology meeting, the president, Dr James C. White, proclaimed ‘‘This meetings marks an important era in American dermatology—that of its fully recognized, independent position’’ (White, 1878). The reality was far different. Dr White could not have imagined that venereal diseases would be vital to the field’s development. However, by asserting themselves as the authority on syphilis, dermatologists became leaders in the discussion of the dominant public health menace at the turn of the century.
J AM ACAD DERMATOL
AB33
The power of grease
(Poster reference number 4837)
(Poster reference number 5469)
Wan-Lin Teo, MBBS, Singapore General Hospital, Singapore; Shiu Ming Pang, MD, Singapore General Hospital, Singapore White fibrous papulosis (WFP) is an extremely rare condition affecting the neck that is predominantly described in elderly Asians, particularly the Japanese. We report an unusual case of WFP occurring on the chest and back on an Asian male. A 52-year-old Chinese man with no significant medical history presented with an increasing number of asymptomatic white papules on his chest and back for 2 years. Examination revealed numerous white, well circumscribed, nonfollicular papules measuring 2-3 mm distributed over the upper chest and back. Histopathologic examination with Weigert elastic stain revealed thinned collagen bundles and loss of elastic fibers in isolated foci of the mid and lower dermis. Elastic fibers were present in other sites of the dermis. WFP was diagnosed, with unique involvement of the chest and back. The patient was reassured of its benign nature but was cautioned about further spread. WFP of the neck (WFPN) and pseudoxanthoma elasticum (PXE)-like papillary dermal elastolysis were classified under the diagnostic term fibroelastolytic papulosis (FEP) by Jagdeo, as a group of rare disorders with predominantly papillary dermis involvement. The pathogenesis has been linked to mechanisms underlying intrinsic aging. FEP runs a benign course but is nonetheless cosmetically troubling for the patient. There is no effective treatment, although surgical excision and the use of tretinoin have been reported.
Val Loftus, Betsi Cadwaladr University Health Board, Denbighshire, North Wales, United Kingdom Robert Chesebrough was a chemist who was born in London to American parents in 1837. As a young adult, he worked in the chemical industry, distilling kerosene from the oil of sperm whales. Following the discovery of petroleum, Chesebrough set off to Pennsylvania (United States) in 1859 to seek his fortune. Whilst working on oil rigs, workers noted a greasy black material that formed on the rods of the rigs (referred to as ‘‘rod wax’’ by the drillers). This was found to have healing properties and drillers who sustained industrial cuts and burns applied the ‘‘rod wax’’ to their injuries and noted that the healing process was accelerated. This was an exciting find for Chesebrough, and he set about his work purifying the substance to finally develop a colorless and odorless gel 10 years later. In the early 19th century, skin care was smelly, colorful, and sometimes tasty. Goose grease was applied to lips and moustaches and lard to clear acne. By 1870, Chesebrough had opened his first factory producing petroleum jelly known as ‘‘Vaseline,’’ a semisolid mixture of hydrocarbons promoted as a topical ointment with healing properties. Unfortunately, there was little interest in his product and sales were poor. However, Chesebrough had great faith and belief in his product and set out to travel around the United States promoting the petroleum jelly. Chesebrough gave demonstrations by self-inflicting injuries then applying the petroleum jelly and giving out free samples. By the early 1880s, the power of Vaseline had been heard worldwide, and in 1883 he was honored with a Knighthood by Queen Victoria for his great work and dedication. In 1913, a young man named Thomas Williams was watching his sister mix Vaseline with coal dust to brush onto her eyelashes and eyebrows to make them appear darker and thicker. He later produced and marketed the product as Lash Brow line presently known as Maybelline. During a lifethreatening illness of pleurisy, Chesebrough drenched himself in Vaseline, making a complete recovery. Chesebrough claimed that he consumed a spoonful of Vaseline each day and lived to the grand age of 96 years old and was laid to rest in Bronx County, New York. Today, petroleum jelly is still used by primary care physicians in the management of early stage eczema, psoriasis, and actinic keratoses.
Commercial support: None identified.
Commercial support: None identified.
ARTS, HISTORY, & HUMANITIES OF DERMATOLOGY Sulphur for rosacea: Are we reinventing the wheel?
The role of syphilis in the establishment of the specialty of dermatology
Catherine McKay, MBBS, Skin and Cancer Foundation, Darlinghurst, Australia; Keiron Leslie, MD, Department of Dermatology, San Francisco, CA, United States; Leone Snowden, NSW Medicines Information Centre, Darlinghurst, Australia; Margot Whitfeld, MBBS, Department of Dermatology, Darlinghurst, CA, United States Rosacea is a common, chronic inflammatory facial condition that affects approximately 13 million individuals in the United States alone. It has been a human affliction since time immemorial. Despite this, the pathogenesis remains largely unclear. Cutaneous Demodex mites, altered vascular reactivity, alcohol ingestion, Helicobacter pylori, and Staphylococcus epidermidis have all been implicated. The therapeutic armamentarium to treat rosacea is extensive, and some rosacea remedies date back to before the Middle Ages. Sulphur, as a treatment for cutaneous disease, was described in the Ebers Papyrus, an ancient Egyptian medical scroll, dated circa 1550 BC. James Morris in Lancet describes the first effective sulphurcontaining formulation to treat rosacea in 1855. This was followed by a modification of the Danish formula, originally used to treat scabies, by Ayers and Ayers in 1932. This formulation contained 11% sublimed sulphur. In the 1950s, 10% sulphur with 5% Peruvian balsam was used for Demodex-associated eruptions. Modern sulphurcontaining formulations for rosacea incorporate 10% sodium sulfacetamide combined with 5% sulphur. The new foam formulations are easier to apply and exude fewer odors. Antiseptic, antibacterial, and antifungal properties have been attributed to sulphur. These antibacterial properties have been demonstrated against Propionibacterium acnes, some Streptococci, and Staphylococcus aureus. Sulphur has also been shown to kill Demodex mites, which have been implicated as a possible causative factor in rosacea. In recent times, sulphur has declined in popularity, largely because of its odor. With the emergence of antibacterial resistance to other agents, as well as sensitivity to other topical antibiotics, topical sulphur has once again become a useful therapeutic option. We have translated these older formulations into modern recipes that can be compounded today. The aim of this poster is to remind the modern dermatologist of a safe, affordable and currently underused ‘‘remedy’’ for the treatment of an age old dermatologic condition.
Melinda B. Chu, MD, St. Louis, MO, United States; Michelle Tarbox, MD, St. Louis, MO, United States
Commercial support: None identified.
Commercial support: None identified.
(Poster reference number 5503)
APRIL 2012
(Poster reference number 5095)
The early history of dermatology, the specialty associated with celebrities and Botox, is far from glamorous. In fact, venereal diseases, especially syphilis, figure prominently in the field’s development as distinct from general medicine. Although the discussion of venereal disease was considered clandestine, the public health risks of syphilis in the late 1800s demanded attention. Dermatologists rose to the task of caring for these underserved patients, and this expertise in syphilis actually helped to establish dermatology as a legitimate medical specialty. Dermatology had been derided by general practitioners as a field that lacked substance or real science. Advances in the pathology of syphilis showcased the field’s scientific nature. By emphasizing the disease’s multisystem effects, dermatologists were able to highlight the relationship of skin diseases to the rest of the body. It was not only the conditions that were reframed in these terms, but the dermatologists themselves—as one put it ‘‘The true dermatologist is an internist who knows the skin’’ (Highman, 1921). Syphilis was not only an intellectual matter between physicians, of course: its epidemiology and management was wrought with ethical and moral dilemmas. Should prostitution be regulated by the state? Should physicians inform the patient’s family? Did the afflicted deserve to suffer? These were the topics that led to heated discussions behind closed doors and to newspaper headlines across the country. As a result, dermatologists were at the center of the public debate over moral decency and the government’s role. Dermatologists recognized the importance of syphilis to the advancement of the field. The names of dermatology textbooks and journals began to highlight their special expertise in ‘‘Syphilology.’’ Perhaps more telling, they called themselves Professors of Dermatology and Syphilology. In 1878, at the first annual American Association of Dermatology meeting, the president, Dr James C. White, proclaimed ‘‘This meetings marks an important era in American dermatology—that of its fully recognized, independent position’’ (White, 1878). The reality was far different. Dr White could not have imagined that venereal diseases would be vital to the field’s development. However, by asserting themselves as the authority on syphilis, dermatologists became leaders in the discussion of the dominant public health menace at the turn of the century.
J AM ACAD DERMATOL
AB33