A 43-year-old homemaker with recently diagnosed immunoblastic lymphoma, stage III-A, and chronic active hepatitis, who had recently completed her second cycle of chemotherapy (including bleomycin sulfate, doxorubicin hydrochloride, cyclophosphamide, vincristine sulfate, and prednisone), presented with a markedly pruritic eruption over the neck and back. Lesions first developed on the patient's neck and were described as "papular" and "vesicular"; subsequently the eruption spread to a large area of the back and consisted of large, brightly erythematous linear plaques and patches. There were no aggravating or alleviating factors.Physical examination revealed circumscribed wide linear erythematous plaques and patches located over the posterior aspect of the patient's neck (Fig 1) and lower part of the back (Fig 2). There was no evidence of scale or atrophy. Results of the remainder of skin and mucous membranes examination were unremarkable.What is your diagnosis? Figure 1.Figure 2.Clinicians, local and regional societies, and residents andfellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced and in triplicate. Photomicrographs and illustrations must be clear and submitted as positive color transparencies (35 mm). Do not submit color prints unless accompanied by original transparencies. If photomicrographs are not available, the actual slide from the specimen will be acceptable.
The case of a 42-year-old Caucasian male with CNS dissemination of mycosis fungoides is described. This patient developed prominent mental status changes and subtle neurologic signs, and was treated with intrathecal methotrexate and whole-brain irradiation.
We studied the immunohistologic findings of skin biopsy specimens from 21 patients with poikiloderma (14 with mycosis fungoides [MF] and seven with atrophic large-plaque parapsoriasis [ALPP]). Both types of poikiloderma were similar with regard to T-cell antigen expression. In each case, most T cells expressed the CD4+ (helper/inducer) phenotype and lacked Leu-8 antigen. T cells were also deficient in Leu-9 antigen in most cases (MF, 11/14 [79%]; ALPP, 4/7 [57%]). These T-cell antigen deficiencies are similar to those described previously in various types of MF and indicate that such deficiencies are common in minimally infiltrated, patch-stage MF lesions. Because combined Leu-8/Leu-9 antigen deficiencies are uncommon in inflammatory skin diseases, our findings are consistent with the view that ALPP is an early form of MF, as had been suggested previously by results of clinicopathologic studies.
The retention of tritium-labeled all-trans-retinoic acid (RA), 13-cis-retinoic acid (13-cis-RA), aromatic retinoid, and arotinoid ethyl ester in the epidermis and dermis of hairless mice was measured up to 24 h following a single topical application in an acetone vehicle. The radioactivity in the tissues was extractable with chloroform:methanol, and the identities of the radioactive species extracted were confirmed as retinoids using thin-layer chromatography. All the retinoids were absorbed into the skin rapidly. After an initial period of distribution and penetration (lasting for about 1 h) the amount of the applied retinoid remaining in the epidermis and dermis decreased more slowly, obeying first order (exponential) decay kinetics. Both the arotinoid and the aromatic retinoid persisted for longer in the epidermis than equivalent doses of RA or 13-cis-RA. The half-lives of the retinoids in the dermis tended to be longer than in the epidermis, except for the arotinoid. Aromatic retinoid persisted for longest in the dermis with a half-life of 11 h.
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