The beneficial effect of smoking on pemphigus might be explained by its effect on the immune system. In addition, smoking has an antiestrogenic effect, while pesticides have an estrogenic effect. The lower numbers of smokers among patients, the higher exposure rates to pesticides, and the higher number of female patients who had been pregnant may point to the contribution of estrogens to the disease process. It remains to be determined whether measures, such as avoiding exposure to pesticides or metal vapor, may be beneficial in the clinical context. As the present study was a survey, more definitive studies should be conducted to validate the results.

Our study indicates that in intertriginous regions, skin surface pH of diabetic patients is significantly higher than in normal control subjects and implies the significance of skin pH as a possible factor promoting host susceptibility to skin candidal infection.

Noninvasive optical techniques of photopulse plethysmography (PPG) and laser Doppler velocimetry (LDV) have been used to identify regional variations in the basal skin blood flow of humans. The procedures assess either the volume (PPG) or the volume-velocity product (LDV) of cutaneous blood vessel perfusion. Fifty-two anatomic positions have been studied in 10 normal subjects resting horizontally. The mean perfusion levels were ranked to reveal the variations in cutaneous blood flow as a function of body site. Groups of data were collected into cohorts and average perfusion values for the subjects within each cohort were compared by the Newman-Keuls multiple comparison test. Most transparently, the results reveal a collection of regions (fingers, palms, face, ears) for which cutaneous perfusion is much higher than all other positions. More subtle differences and some unexpected similarities, however, are also apparent and, in some cases, agree or, in others, conflict, with previously published information. With some exceptions, good general agreement between the two techniques was observed.

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A laser Doppler flowmeter was used to assess blood flow changes in habitual smokers, as compared with nonsmokers, where members of both groups were young and healthy. Acute and chronic effects of cigarette smoking were measured by using the cutaneous postischemic reactive hyperemia test. Basic flow was recorded in four sites: forehead, postauricular, forearm, and finger. Recovery time from reactive hyperemia was longer in habitual smokers than in nonsmokers. Peak flow during reactive hyperemia was significantly lower after smoking. Basic blood flow during smoking did not show significant variation in the sites tested. The authors conclude that skin microvasculature is influenced by acute and chronic effects of cigarette smoking in young subjects; they discuss some of the possible mechanisms and their implications.

Postischemic hyperemia tests in diabetic patients reveal cutaneous microcirculatory changes in the forearm (lower P). Advanced retinopathy is associated with functional disturbances (lower K), especially when combined with a low BMI (less than 25; longer Tp).