Seminars in dermatology
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Seminars in dermatology · Jun 1995
Eosinophilic vasculitis syndrome: recurrent cutaneous eosinophilic necrotizing vasculitis.
We recently identified a syndrome of recurrent cutaneous eosinophilic vasculitis in three patients. These patients had in common widespread pruritic, erythematous, purpuric papules and angioedema of face and hands associated with peripheral blood eosinophilia. Eight skin biopsies from these three patients all showed necrotizing vasculitis of the small vessels of the skin, with exclusively eosinophilic infiltration and minimal or no leukocytoclasis. ⋯ Eosinophil-active cytokine IL-5 was detected in the serum of one patient. Expression of the vascular cell adhesion molecule-1 for eosinophil adherence was detected on the endothelium of the affected vessels. Because this disease showed distinctive clinical manifestations and characteristic histopathological features, we believe it is a distinct entity and should be distinguished from other types of vasculitis.
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Aproximately 1% of the population will have had alopecia areata by the age of 50 and the peak incidence occurs in children and young adults. All body hair may be affected including lashes and brows. Alopecia areata is a systemic disease with frequent involvement of nails or eyes. ⋯ There is no excellent therapy for alopecia areata although many interventions are tried. Immunotherapy with diphenylcyprone is currently being optimistically evaluated. The harmful psychological effects of alopecia areata in children must be anticipated and prevented.
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Seminars in dermatology · Dec 1994
ReviewThe politics of acquired immune deficiency syndrome/human immunodeficiency virus.
The political process is a decisive factor in determining how governmental funds are allocated for control of all diseases especially one as highly politicized as AIDS/HIV. This article discusses how this process works and how various community groups such as homosexual men, women, African-Americans, and the elderly are affected by the outcome.
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A review of current therapy for cutaneous T-cell lymphoma (CTCL) (mycosis fungoides and erythrodermic CTCL) is presented. Treatments for mycosis fungoides limited to the skin include topical steroids, mechlorethamine (nitrogen mustard) and carmustine (BCNU), electron beam radiation, low-dose methotrexate, and interferon-alpha (IFN). Treatments for erythrodermic CTCL include low-dose methotrexate, IFN, extracorporeal photopheresis, and single agent or combination chemotherapy. ⋯ Whereas prognosis for patients with disease limited to the skin is generally good, that for those with nodal or visceral lymphoma is mostly unfavorable. Controversial issues relating to total skin versus local treatment, prolonged maintenance versus intermittent therapy, and aggressive versus conservative treatment of early stage disease are discussed. The UCSF approach to treatment of CTCL and lymphomatoid papulosis is presented.
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The majority of dermatologic procedures are performed in the sun-damaged regions of the head and neck. These regions have special cosmetic and functional importance, and dermatologists should become familiar with the underlying structures. Even though all the major nerves and vessels arborize below the superficial fascia, cutaneous atrophy and fibrosis from previous surgeries can make these neurovascular structures susceptible to damage from superficial procedures. Hence, it is advisable to utilize blunt dissection whenever possible, and to identify vital structures when working in their vicinity.