Correspondence Nalmefene and pruritus To the Editor: I was interested in the report by Monroe (J AM ACAD DERMATOL 1989;21:135-6) about the effects ofnalmefene on pruritus. We studied 19 patients (12 with psoriasis and 7 with eczema) who were randomly selected to receive either nalmefene (20 mg daily) or placebo for 3 weeks.' We were unable to demonstrate any alleviation of pruritus from nalemefene, which suggests that the improvement described by Monroe and others is likely to be short-lived; presumably tolerance develops. We confirmed the high incidence of side effects in 70%of our patients who received nalmefene. We do not recommend nalmefene for routine use for the management of pruritus, although we do support the need for more investigations on the relation between opiates and the skin. P. V. Harrison, MRCP Department of Dermatology, Beaumont Hospital, Lancaster LA] 2JF, tis:
REFERENCE
Pemphigus vulgaris and squamous cell carcinoma of the lung To the Editor: What happened to the patient with pemphigus vulgaris and squamous cell carcinoma of the lung reported by Barnadas et al. (1 AM ACAD DERMATOL 1989;21:793-5) during the 4 years since his detailed original workup? We reported a patient with similar characteristics whose inoperable lung cancer regressed spontaneously when pemphigus developed, and who remained cured of both 7 years later.' This led to the speculation that antiepithelial antibodies might destroy the cancer. Yelva L. Lynfield, MD Chief, Dermatology Service Brooklyn VA Medical Center 800 Poly Place, Brooklyn, NY 11209
REFERENCE, 1. Lynfield YL, Pertschuk LP. Pemphigus vulgaris following squamous cell carcinoma of the lung. Int J Dermatol 1984;23:147-8.
1. Burch JR, Harrison PV. Opiates, sleep and itch. Clin Exp Dermatol 1988;13:418-9.
Reply Reply To the Editor: The study by Burch and Harrison is interesting. Our results were based on a single-dose, 6-hour study and demonstrated a significant antipruritic effect from nalmefene. The same results in a similarly designed study were reported by Banerji et al. 1 Because our study was only a limited single-dosing protocol, I cannot comment on whether tolerance to nalmefene is likely to develop. Although the authors did not observe overall alleviation of pruritus from nalmefene during the 3-week study, it would be worthwhile to know whether positive responses were initially seen (e.g., after the first dose) as in our study. The composition of patients was also different in the two studies because our study included patients with atopic dermatitis and urticaria, whereas two thirds of the patients described by Harrison had psoriasis. We believe that further studies with nalmefene are justifiable (if a safe dose can be found) to determine whether central opioid antagonists can contribute to therapy for pruritus. Eugene w: Monroe, MD 3003 w: Good Hope Rd. Milwauke~ RfI53217
REFERENCE 1. BanerjiD, Fox R, Seleznick M, et al. Controlled antipruritic trial ofnalmefenein chronic urticaria and atopicdermatitis [Abstract]. J Allergy Clin Immunol 1988;81:252.
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To the Editor: Because of space limitations in the JOURNAL the follow-up of our patient had to be omitted. He had a left superior lobectomy in May 1985. Pathologic studies disclosed tumor involvement of the mediastinal fat. Cobalt therapy was started in August 1985 and it was continued for 5 months. In December 1985 it was stopped because brain metastases were discovered. The patient died 2 months later. Our experience does not support the hypothesis that the immunoglobulins present in the squamous cell carcinoma of our patient influenced the behavior of his tumor. Maria A. Bamadas, MD,a Carmen Gelpi. MD, b Jose L. Rodriguez. MD,b M. Jose Gonzalez, MD,a and Jose M. de Moragas, MD,a Departments of Dermatology" and Immunology, b Hospital Sta. Creu i St. Pau, Barcelona, Spain
Acral persistent papular mucinosis: A distinct entity To the Editor: The recent article by Flowers et al. (1 AM ACAD DERMATOL 1989;21:293-7) provides a unique op-portunity to understand better the clinical and histopathologic features of acral persistent papular mucinosis (APPM), a distinct entity wedescribed in three women 1,2
REFERENCE
Pemphigus vulgaris and squamous cell carcinoma of the lung To the Editor: What happened to the patient with pemphigus vulgaris and squamous cell carcinoma of the lung reported by Barnadas et al. (1 AM ACAD DERMATOL 1989;21:793-5) during the 4 years since his detailed original workup? We reported a patient with similar characteristics whose inoperable lung cancer regressed spontaneously when pemphigus developed, and who remained cured of both 7 years later.' This led to the speculation that antiepithelial antibodies might destroy the cancer. Yelva L. Lynfield, MD Chief, Dermatology Service Brooklyn VA Medical Center 800 Poly Place, Brooklyn, NY 11209
REFERENCE, 1. Lynfield YL, Pertschuk LP. Pemphigus vulgaris following squamous cell carcinoma of the lung. Int J Dermatol 1984;23:147-8.
1. Burch JR, Harrison PV. Opiates, sleep and itch. Clin Exp Dermatol 1988;13:418-9.
Reply Reply To the Editor: The study by Burch and Harrison is interesting. Our results were based on a single-dose, 6-hour study and demonstrated a significant antipruritic effect from nalmefene. The same results in a similarly designed study were reported by Banerji et al. 1 Because our study was only a limited single-dosing protocol, I cannot comment on whether tolerance to nalmefene is likely to develop. Although the authors did not observe overall alleviation of pruritus from nalmefene during the 3-week study, it would be worthwhile to know whether positive responses were initially seen (e.g., after the first dose) as in our study. The composition of patients was also different in the two studies because our study included patients with atopic dermatitis and urticaria, whereas two thirds of the patients described by Harrison had psoriasis. We believe that further studies with nalmefene are justifiable (if a safe dose can be found) to determine whether central opioid antagonists can contribute to therapy for pruritus. Eugene w: Monroe, MD 3003 w: Good Hope Rd. Milwauke~ RfI53217
REFERENCE 1. BanerjiD, Fox R, Seleznick M, et al. Controlled antipruritic trial ofnalmefenein chronic urticaria and atopicdermatitis [Abstract]. J Allergy Clin Immunol 1988;81:252.
530
To the Editor: Because of space limitations in the JOURNAL the follow-up of our patient had to be omitted. He had a left superior lobectomy in May 1985. Pathologic studies disclosed tumor involvement of the mediastinal fat. Cobalt therapy was started in August 1985 and it was continued for 5 months. In December 1985 it was stopped because brain metastases were discovered. The patient died 2 months later. Our experience does not support the hypothesis that the immunoglobulins present in the squamous cell carcinoma of our patient influenced the behavior of his tumor. Maria A. Bamadas, MD,a Carmen Gelpi. MD, b Jose L. Rodriguez. MD,b M. Jose Gonzalez, MD,a and Jose M. de Moragas, MD,a Departments of Dermatology" and Immunology, b Hospital Sta. Creu i St. Pau, Barcelona, Spain
Acral persistent papular mucinosis: A distinct entity To the Editor: The recent article by Flowers et al. (1 AM ACAD DERMATOL 1989;21:293-7) provides a unique op-portunity to understand better the clinical and histopathologic features of acral persistent papular mucinosis (APPM), a distinct entity wedescribed in three women 1,2
