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`Dermatolog
`
`July 1974 Volume 110, Number 1
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`Familial Hyperlipidemias .
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`. ..H. Fleischmaier, Y. Dowlati, .1. R. T. Reeves
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`Bullous Pemphigoid and Dermatitis Herpetiformis .
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`. .A. M. Eng, B. Moncada
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`Erythropoietic Protoporphyria .
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`. ..H. Schmidt, G. Snitker, K. Thomsen,
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`.1. Lintrup
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`. .L. L. Bushkell, R. E. Jordon, R. W. Goltz
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`Herpes Gestationis .
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`Effects of Methotrexate and Hydroxyurea on Psoriatic Epidermis .
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`. .0. Smith,
`S. Gelfant
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`Formaldehyde Allergy .
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`. .W. F. Schorr, E. Keran, E. Plotka
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`Cephalexin Therapy for Infectious Syphilis .
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`. .w. C. Duncan, J. M. Knox
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`Haloprogin and Nystatin Therapy for Cutaneous Candidiasis .
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`. .v. H. Carter,
`S. Olansky
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`. .J. E. Fulton, Jr., G. Pablo
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`Topical Antibacterial Therapy for Acne .
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`Cafe au Lait Spots Without Giant Pigment Granules .
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`. .0. N. Silvers,
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`Fl. S. Greenwood, E. B. Helwig
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`congenital, Painful, Aberrant Hyponychium .
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`. .n. B. Odom, K. M. Stein,
`H. I. Maibach
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`Dermatitis Herpetiformis With Discoid Lupus Erythematosus .
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`. .P. R. Vandersteen,
`R. E. Jordon
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`Thymoma With Systemic Lupus Erythematosus, Red Blood Cell Aplasia,
`and Herpesvirus Infection .
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`. ..M. Takigawa, M. Hayakawa
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`Fumigant-Induced Toxic Epidermal Necrolysis .
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`. .G. F. Radimer, J. H. Davis,
`A. B. Ackerman
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`. .K. Fisher,
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`Subepidermal Bullae Secondary to Escherichia coli septicemia .
`B. W. Berger, G. T. Keusch
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`A Family Outbreak of Oral Accidental Vaccinia .
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`. .K. E. Greer, c. N. Sheap
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`. .W. R. Hubler, Jr., A. H. Rudolph, E. F. Daugherty
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`Dermal Myiasis .
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`Human Envenomation by a Lycosid .
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`. ..J. F. Fledman
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`Postacne Osteoma Cutis .
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`. .Fl. 8. W. Basler, W. B. Taylor, D. R. Peacor
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`. .w. B. Reed,
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`Kaposi Sarcoma, With Emphasis on the Internal Manifestations .
`H. M. Kamath, L. Weiss
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`AMK
`PUBLICATION
`T
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`
`in
`to persist
`hyperesthesia tends
`some patients, and the pain continues
`in spite of the therapeutic efforts.
`In our patients suffering from the
`pain of herpes zoster, we were often
`able to give immediate relief by
`painting the lesions and the immedi-
`ately surrounding area with flexible
`collodion. Reapplication of the collo-
`dion was necessary every 12 hours for
`prolonged results.
`When applied to the skin, the ether
`of collodion evaporates and a trans-
`parent film is left. The adhesiveness
`and contractility of this film has a
`protective effect on the herpes zoster
`lesions, preventing irritation.
`Flexible collodion contains at least
`5% by weight of pyroxylin. It is color-
`less or slightly yellowish and has the
`odor of ether; on exposure to the air, a
`transparent, tenacious film forms.‘
`For years, collodion has been used
`topically for its mechanical properties
`and to hold some medications locally
`in contact with the skin. In the treat-
`ment of herpetic neuralgia, the use of
`flexible collodion successfully may res-
`urrect a valuable therapeutic tool?
`LEOPOLD KRULIG, MD
`PAUL H. JACOBS, MD
`Stanford, Calif
`
`1. Berry H, Goodwin LG: Observations on py-
`roxylin and pharmaceutical collodions. Q J Year-
`Book Pharmacy 10:23-29, 1937.
`2. Andrews GC: Diseases of the Skin. Phila-
`delphia, WB Saunders Co, 1946.
`
`Nail Damage Caused by Weed
`Killers and Insecticides
`
`To the Editor-The onychopathy
`described here, first noted by Sam-
`man and Johnston in 1969,‘
`is not
`common but very characteristic.
`On Feb 15, 1972,
`a 65-year-old
`white man used a phytosanitary prod-
`uct (Winter Volck Yellow, Sopra) for
`the treatment of fruit trees. He ne-
`glected the recommendation on the
`label and instead of mixing 1 liter of
`the product with 50 liters of water, he
`handled the chemical in a pure state
`for three hours.
`After 15 days, he noticed some
`change in the color of his nails. Two
`months later, the nails appeared to be
`made up of two portions: the proximal
`third of the nail plate was yellow and
`the distal two thirds was pink. The
`cuticle was absent and there was a
`slight painless paronychia (Figure).
`Seven months later, edema of
`the
`proximal nail fold had not completely
`
`Arch Dermatol/Vol 110, Sept 1974
`
`nail surface; irregularity of surface;
`transverse ridging and furrowing.
`Grade IV: Grossly irregular defor-
`mity of nail plate and/or loosening,
`and beginning onycholysis.
`Grade V: Loss of nail.
`The distribution of the nail lesions
`confirms that these are the result of a
`local action. The index, middle, and
`ring fingers of the right hand were
`predominantly affected and this could
`be ascribed to leakage from the knap-
`sack sprayer. Eleven of the affected
`spray operators also showed minor
`nail damage affecting the toes. How-
`ever, the only cases of toenail dam-
`age occurred in workers wearing gum
`boots, suggesting leakage from the
`sprayer down into the boots. Toenail
`damage has been encountered in bare-
`foot sprayers on coffee plantations in
`Kenya? These observations by Hearn
`and Keir“ show that dilute solutions
`in repeated use can produce the same
`damages as the concentrated ones on
`brief contact.
`Contact with weed and insect kill-
`ers in concentrated solutions or on re-
`peated usage of diluted solutions can
`produce a distinctive damage and dis-
`coloration of the nails. The proximal
`part of the nail plate becomes yellow
`or whitish. Deformity of the plate can
`lead to its loss.
`
`ROBERT L. BARAN, MD
`Cannes, France
`
`1. Samman, PD, Johnston ENM: Nail damage
`associated with handling of paraquat and diquat.
`Br Med J 1:818-819, 1969.
`2. Clarck DG, Hurst EW: The toxicity of di-
`quat. Br J Ind Med 27:51-55, 1970.
`3. Hearn CED, Keir W: Nail damage in spray
`operators exposed to paraquat. Br J Ind Med
`28:399-403, 1971.
`
`Need for Action
`
`To the Editor.—The special editorial
`by Peyton Weary that appeared in
`the April
`issue of
`the ARCHIVES
`(109:499, 1974) contained some of the
`most important information for der-
`matologists that has appeared any-
`where at any time.
`It is essential that we, as physi-
`cians and dermatologists, cooperate
`with and work with the National Pro-
`gram for Dermatology because our
`future depends on our actions in a
`myriad of ways. We whould read and
`reread this editorial to find out what
`we might and should do, and then, af-
`ter reading it, do something about it.
`ROBERT R. KIERLAND, MD
`Sun City, Ariz
`
`Letters to the Editor 467
`
`Appearance of nails after two months.
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`disappeared. A whitish sebaceous-like
`material could be squeezed from it,
`which showed isolated or grouped ke-
`ratinocytes under microscopical ex-
`amination. There were no bacteria or
`fungi present. At this stage, the prox-
`imal yellow area made up about half
`the nail plate, indicating a slowing of
`the nail growth. The product used by
`our patient was 5% dinitro-orthocre-
`sol, which acts both as an insecticide
`and as a weed killer.
`Our patient’s condition resembled
`those of the patients who had handled
`diquat and paraquat, as described by
`Samman and Johnston. One of their
`patients had the same yellowish dis-
`coloration of the proximal part of his
`nails, whereas the two others had a
`whitish discoloration.
`Possibly, damage and discoloration
`of the nails are caused by chemicals
`reaching the nail matrix by entering
`the proximal nail fold.
`Clarck and Hurst” have studied the
`toxicity of diquat. A 20% solution
`can cause disturbance of nail growth
`when put in contact with the base of
`the nail for a few minutes. A white,
`opaque, area appears that gradually
`moves up with the growth of the nail
`until it is shed. On histologic exami-
`nation, this focus of leukonychia con-
`sists of a collection of cells that have
`retained their nuclei.
`Exposure to dilute solutions used
`for spraying may lead to harmful ef-
`fects on the nail. Hearn and Keir“ de-
`scribed nail damage in 55 out of 296
`spray operators who were exposed
`daily to diluted paraquat while work-
`ing on a sugar estate in Trinidad.
`Five grades of severity of nail dam-
`age were recognized:
`Grade I: Localized discoloration or
`transverse
`band
`of white
`dis-
`coloration affecting nail plate only.
`Grade
`II: Transverse bands of
`white discoloration afiecting two or
`more nails (the commonest lesions).
`Grade III: Nail deformity of the
`
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`CFAD v. Anacor, IPR2015-01776 ANACOR EX. 2197 - 2/2