subtropicus (LPS) from discoid lupus erythematosus (DLE). I was not given
the chance to answer him. This letter is in response to his comments. Dr Wells used Drs Lever and Schaumburg-Lever's book as reference in his letter to support his remarks. I contacted Dr Walter F. Lever and asked him if he would diagnose DLE in a nonscarring condition that has a band-like infiltration confined to the upper dermis and no follicular plugging. His answer was: "No, your two histologic pictures in the article in the Archives are typical of lichen planus and not LE. That is decisive. I accepted your article describing LPS and plan to mention it in the sixth edition." I hope this answer will satisfy both Dr Wells and Dr Tkach. Mouta S. Dilaimy, MD Baltimore
Benign Mucous Pemphigoid
Membrane
To the Editor. \p=m-\DrsNils Worsaae and Erik Dabelsteen, in a letter published in the July 1978 issue of the Archives (114:1093-1094, 1978), report the case of an 18-year-old woman with benign mucous membrane pemphigoid. They state that, to their knowledge, this is the youngest patient suffering from this entity to be described. In fact, a case of benign mucous membrane pemphigoid in a girl aged 13 years was reported at a meeting of the St John's Hospital Dermatological Society in November 1976, and subsequently reported in full by Drs D. S. Jolliffe and D. Sim-Davis in Clinical and Experimental Dermatology (2:281,
1977).
D. A. Burns, MRCP London
Reply.\p=m-\Noreference to the interesting report mentioned by Dr Burns In
made in our LETTER TO THE EDITOR since the report appeared after our letter was submitted to the Arwas
chives.
Nils Worsaae, DDS Erik Dabelsteen, DDS
ine (Capitrol Cream Shampoo). After six weeks of therapy, the patient's condition was essentially cleared; however, the results of Wood's light examination remained positive, with a yellow-green fluorescence. Due to the color of the chloroxine shampoo, I decided to perform a Wood's light examination on a normal scalp after shampooing with this shampoo. To my surprise, there was a brilliant yellowgreen fluorescence. This might be a potential problem in following up patients with tinea capitis in whom resolution of positive results of a Wood's light examination is assumed to be indicative of a cure. Michael L. Johnson, MD Tuscaloosa, Ala
Diagnosis of Angioimmunoblastic Lymphadenopathy To the Editor.\p=m-\In 1977, my colleagues and I reported four cases of cutaneous
manifestations of angioimmunoblastic lymphadenopathy1; in two patients, the manifestations were tumoral, suggestive of a lymphoma, and in the other two, the cutaneous lesions resembled a drug eruption. In one of the tumoral cases, the clinical aspect had the major histologic features that are typical of angioimmunoblastic
lymphadenopathy, ie, a telangiectatic network covering a deep, firm, palpa-
ble infiltration. The other interesting finding was that, whatever the clinical aspect of the eruption, the histologic pattern had the characteristic histologic features of angioimmunoblastic
lymphadenopathy, although obviously
the dermal infiltrates were more important in tumoral cases. Our findings fully support Drs Matloff and Neiman's statement2 that an apparently trivial eruption of a toxicodermic type that carries an unusual histo-
logic picture (polymorphic infiltrate, tuberculoid granuloma) can conceal an
unexpected diagnosis of angioimmunoblastic lymphadenopathy. This fact should be known to dermatologists. Michele Paris
Copenhagen
Fluorescence With Chloroxine
Shampoo To the Editor.\p=m-\Aninteresting problem was recently brought to my attention after I examined a young girl with tinea capitis. After positive results of Wood's light examination and a positive culture for Microsporum audouinii, she was treated with orally administered griseofulvin and asked to shampoo daily with chlorox-
Leibowitch, MD
1. Leibowitch M, Mignot L, Bloch C, et al: Manifestations cutan\l=e'\esdes lymphad\l=e'\nopathies angioimmunoblastiques. Ann Dermatol Venereol 104:603-610, 1977. 2. Matloff RB, Neiman RS: Angioimmunoblastic lymphadenopathy. Arch Dermatol 114:92-94, 1978.
Beta Carotene in
Porphyria
Congenital
To the Editor.\p=m-\Inanswer to Dr G. S. Stretcher's request for information on the use of beta carotene in congenital
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 05/16/2015
porphyria (Archives 114:1242-1243, 1978), I would like to bring to his
attention two reports of the use of beta carotene in this disease. The first is by my colleagues and myself, in which we treated two children with some success,1 and the second is by Jung, in which he reported improved light tolerance in an 18-year-old man, who had taken beta carotene for four
years.2
It would appear that beta carotene may indeed be effective in preventing the appearance of new skin lesions in
congenital porphyria, if given in high enough doses. The dose should be adjusted for each patient, until no new lesions appear. Up to 300 mg/day can be given, but experience suggests that much lower doses are adequate. I, as well as Dr Stretcher, would be interested in hearing from other physicians using beta carotene in the treatment of congenital porphyria. Micheline M. Mathews-Roth, MD Boston Name and Trademark of Drug
Nonproprietary
Beta carotene-Sotetewe. 1. Mathews-Roth MM, Haining RG, Kinney TR: Congenital erythropoietic porphyria. Am J Dis Child 131:366, 1977. 2. Jung EG: Porphyria erythropoetica congenita G\l=u"\nther.Dtsch Med Wochenschr 102:279-280, 1977.
Zinc, Essential Fatty Acids, and
Prostaglandins
To the Editor.\p=m-\Wewere interested to read the suggestion by Drs Schroeter and Tucker (Archives 114:800, 1978) that zinc may enhance the conversion of essential fatty acids to prostaglandins. They pointed out that this could explain the similar effects of essential fatty acids and zinc on the skin. We have come to a similar conclusion and have provided evidence that zinc may have a specific effect in enhancing the formation of prostaglandins of the E, series.1.2 This indicates that wherever either zinc or essential fatty acid therapy has been found effective, there may be an advantage in adding the other agent to the regimen. We have conducted preliminary studies using zinc sulfate (30 mg/day) and evening primrose oil (3.0 mL/ day). Evening primrose oil is a uniquely rich source of essential fatty acids since it contains 9% of \g=g\-linolenic acid as well as 72% of linoleic acid. Linoleic acid must be converted to \g=g\-linolenic acid in the body to be effective; this
the chance to answer him. This letter is in response to his comments. Dr Wells used Drs Lever and Schaumburg-Lever's book as reference in his letter to support his remarks. I contacted Dr Walter F. Lever and asked him if he would diagnose DLE in a nonscarring condition that has a band-like infiltration confined to the upper dermis and no follicular plugging. His answer was: "No, your two histologic pictures in the article in the Archives are typical of lichen planus and not LE. That is decisive. I accepted your article describing LPS and plan to mention it in the sixth edition." I hope this answer will satisfy both Dr Wells and Dr Tkach. Mouta S. Dilaimy, MD Baltimore
Benign Mucous Pemphigoid
Membrane
To the Editor. \p=m-\DrsNils Worsaae and Erik Dabelsteen, in a letter published in the July 1978 issue of the Archives (114:1093-1094, 1978), report the case of an 18-year-old woman with benign mucous membrane pemphigoid. They state that, to their knowledge, this is the youngest patient suffering from this entity to be described. In fact, a case of benign mucous membrane pemphigoid in a girl aged 13 years was reported at a meeting of the St John's Hospital Dermatological Society in November 1976, and subsequently reported in full by Drs D. S. Jolliffe and D. Sim-Davis in Clinical and Experimental Dermatology (2:281,
1977).
D. A. Burns, MRCP London
Reply.\p=m-\Noreference to the interesting report mentioned by Dr Burns In
made in our LETTER TO THE EDITOR since the report appeared after our letter was submitted to the Arwas
chives.
Nils Worsaae, DDS Erik Dabelsteen, DDS
ine (Capitrol Cream Shampoo). After six weeks of therapy, the patient's condition was essentially cleared; however, the results of Wood's light examination remained positive, with a yellow-green fluorescence. Due to the color of the chloroxine shampoo, I decided to perform a Wood's light examination on a normal scalp after shampooing with this shampoo. To my surprise, there was a brilliant yellowgreen fluorescence. This might be a potential problem in following up patients with tinea capitis in whom resolution of positive results of a Wood's light examination is assumed to be indicative of a cure. Michael L. Johnson, MD Tuscaloosa, Ala
Diagnosis of Angioimmunoblastic Lymphadenopathy To the Editor.\p=m-\In 1977, my colleagues and I reported four cases of cutaneous
manifestations of angioimmunoblastic lymphadenopathy1; in two patients, the manifestations were tumoral, suggestive of a lymphoma, and in the other two, the cutaneous lesions resembled a drug eruption. In one of the tumoral cases, the clinical aspect had the major histologic features that are typical of angioimmunoblastic
lymphadenopathy, ie, a telangiectatic network covering a deep, firm, palpa-
ble infiltration. The other interesting finding was that, whatever the clinical aspect of the eruption, the histologic pattern had the characteristic histologic features of angioimmunoblastic
lymphadenopathy, although obviously
the dermal infiltrates were more important in tumoral cases. Our findings fully support Drs Matloff and Neiman's statement2 that an apparently trivial eruption of a toxicodermic type that carries an unusual histo-
logic picture (polymorphic infiltrate, tuberculoid granuloma) can conceal an
unexpected diagnosis of angioimmunoblastic lymphadenopathy. This fact should be known to dermatologists. Michele Paris
Copenhagen
Fluorescence With Chloroxine
Shampoo To the Editor.\p=m-\Aninteresting problem was recently brought to my attention after I examined a young girl with tinea capitis. After positive results of Wood's light examination and a positive culture for Microsporum audouinii, she was treated with orally administered griseofulvin and asked to shampoo daily with chlorox-
Leibowitch, MD
1. Leibowitch M, Mignot L, Bloch C, et al: Manifestations cutan\l=e'\esdes lymphad\l=e'\nopathies angioimmunoblastiques. Ann Dermatol Venereol 104:603-610, 1977. 2. Matloff RB, Neiman RS: Angioimmunoblastic lymphadenopathy. Arch Dermatol 114:92-94, 1978.
Beta Carotene in
Porphyria
Congenital
To the Editor.\p=m-\Inanswer to Dr G. S. Stretcher's request for information on the use of beta carotene in congenital
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 05/16/2015
porphyria (Archives 114:1242-1243, 1978), I would like to bring to his
attention two reports of the use of beta carotene in this disease. The first is by my colleagues and myself, in which we treated two children with some success,1 and the second is by Jung, in which he reported improved light tolerance in an 18-year-old man, who had taken beta carotene for four
years.2
It would appear that beta carotene may indeed be effective in preventing the appearance of new skin lesions in
congenital porphyria, if given in high enough doses. The dose should be adjusted for each patient, until no new lesions appear. Up to 300 mg/day can be given, but experience suggests that much lower doses are adequate. I, as well as Dr Stretcher, would be interested in hearing from other physicians using beta carotene in the treatment of congenital porphyria. Micheline M. Mathews-Roth, MD Boston Name and Trademark of Drug
Nonproprietary
Beta carotene-Sotetewe. 1. Mathews-Roth MM, Haining RG, Kinney TR: Congenital erythropoietic porphyria. Am J Dis Child 131:366, 1977. 2. Jung EG: Porphyria erythropoetica congenita G\l=u"\nther.Dtsch Med Wochenschr 102:279-280, 1977.
Zinc, Essential Fatty Acids, and
Prostaglandins
To the Editor.\p=m-\Wewere interested to read the suggestion by Drs Schroeter and Tucker (Archives 114:800, 1978) that zinc may enhance the conversion of essential fatty acids to prostaglandins. They pointed out that this could explain the similar effects of essential fatty acids and zinc on the skin. We have come to a similar conclusion and have provided evidence that zinc may have a specific effect in enhancing the formation of prostaglandins of the E, series.1.2 This indicates that wherever either zinc or essential fatty acid therapy has been found effective, there may be an advantage in adding the other agent to the regimen. We have conducted preliminary studies using zinc sulfate (30 mg/day) and evening primrose oil (3.0 mL/ day). Evening primrose oil is a uniquely rich source of essential fatty acids since it contains 9% of \g=g\-linolenic acid as well as 72% of linoleic acid. Linoleic acid must be converted to \g=g\-linolenic acid in the body to be effective; this
