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Notes: In the present retrospective study we investigated the effect of smoking on the moisture and surface lipid levels of the skin. We analysed data from the files of 576 female clients treated in a Tel-Aviv cosmetic parlour. Measurements have been conducted by the same cosmetician, by commercially available equipment, on every client receiving cosmetic treatment, regardless of the nature of the treatment.Results demonstrated a significant difference of skin moisture in the various smoking groups: women who smoked 11–20 cigarettes per day showed significantly lower mean values than the non-smoker group, as expected. Moreover, women before or after menopause showed no significant differences in their moisture measurements.The surface lipid variables showed no significant differences in mean over the four smoking groups.We believe that the objective of the study was achieved, and that the results, indicating decreased skin moisture in smokers, will serve well in anti-smoking campaigns. We also believe that the present study will stimulate other investigators to conduct similar studies that will provide answers to the many questions which still remain open.

Notes: Background Many comprehensive review articles on the adverse effects of cigarette smoking on health have been published, but relatively few have focused on the effect of smoking on erectile function and fertility. Data substantiating the damage caused by smoking to the reproductive system may be helpful in enhancing anti-smoking campaigns.Aim To critically review the literature on the effects of smoking on erectile function and fertility.Observations Whilst most of the studies were performed on groups of men with sexual and reproductive disorders and none included a control for alcohol consumption, it appears that the association between cigarette smoking and impotence is significant. The pathogenetic mechanism of smoking-induced erectile dysfunction is associated with vascular (arterial and venous) dysfunction. The biochemical defects remain to be determined. Endothelium-derived relaxing factor, nitric oxide, prostaglandin, prostacycline and thromboxane-changes may explain smoking-induced impotence. Studies concerning the endocrine profile showed elevated serum estradiol levels in smokers. The results of testosterone levels were contradictory. Mosl studies on the association between cigarette smoking and sperm density indicated a 13% to 17% decrease in smokers compared to nonsmokers. Cigarette smokers had also greater numbers of leukocytes in (he seminal fluid and lower sperm penetration assay scores. Although the studies conducted to date do not indicate lhat smoking among males is a risk factor for delayed or difficult conception, this might not be the case in men with marginal semen quality and other risk factors.Conclusions Cigarette smoking is associated with vascular (arterial and venous) impotence, elevated serum estradiol levels and lowered sperm density. These associations are of greater relevance in patients with pre-existing impaired function, as compared to healthy, potent and fertile individuals.

Notes: Background With the introduction of systemic steroids to control pemphigus vulgaris the prognosis and survival of these patients has changed dramatically. However, in contrast to their beneficial effects, in a once almost inevitably fatal disease, the steroid therapy has created other problems, including cases of mortality.Objective To analyze the possible factors influencing the course and prognosis of the disease and to review the steroid complications in our patients.Methods 53 patients with pemphigus, admitted to the Department of Dermatology of Ichilov Hospital between 1965 and 1989, were studied.Results The total mortality rate of 26.4% (14 patients of 53) in the present study is within the range found by others. A long pretreatment period did not lead to a worse prognosis. Patients with a pretreatment period longer than 6 months had a lower mortality rate than patients with a pretreatment period shorter than 6 months. The age of the patient played a role in determining the outcome of the disease as patients older than 60 years had a worse prognosis compared with patients younger than 50 years, 37.5% of the patients over 60 years died, as compared with a mortality rate of zero in patients younger than 50. This is in accordance with data found by others. Adjuvant therapy with azathioprine was found to improve the prognosis. Patients receiving azathioprine in addition to steroids had a significantly lower mortality rate and fewer exacerbations. Patients with involvement of the mucosa alone had a higher mortality rate than patients with involvement of the skin only and those with involvement of both skin and mucosa had the highest mortality rate.Conclusions Early treatment of pemphigus does not improve the prognosis. Therefore, immediate high-dose treatment in every case of pemphigus doesn't seem absolutely essential any more.

Notes: Background. The occurrence of a new skin disorder exactly at the site of another one, already healed and unrelated, was first described in 1955. In 1985, Wolf et al. recognized that we are dealing with a dermatologic phenomenon and established a precise definition for this phenomenon. Fifty-eight cases corresponding to the definition of this phenomenon have been reported until now. Methods. The new phenomenon, for which the term “isotopic response” has been suggested, has been defined. Cases corresponding to the definition have been analyzed with special emphasis on the diseases involved, the time intervals, and the locations of the diseases. Eight new cases are described. Results. A total of 58 cases of isotopic response have been described. The first disease in most of the patients was herpes zoster; in three cases it was herpes simplex, in two varicella, and in one, thrombophlebitis. The second disease, which appeared exactly at the site of the first, already healed disease, was in most reported cases a carcinoma (26 cases, in particular 15 cases of breast carcinoma, 5 basal cell carcinomas (BCC), 4 squamous cell carcinomas (sec), 2 basosquamous carcinomas), or granuloma annulare (16 cases). Additional diseases were Kaposi's sarcoma (2 cases), pseudolymphoma (2 cases), sarcoid (2 cases), tinea (2 cases), tuberculoid and vasculitis granuloma (1 case), angiosarcoma, metastasis, Bowen's disease, lymphoma, leukemia cutis, and acne (1 case each). The diseases did not show any predilection for a particular location. The interval between the first and second disease was extremely variable (ranging from days to years) and showed no particular features.In the eight additional cases described in the present report, the first disease was herpes simplex (6 cases) or herpes zoster (2 cases). The second disease was viral warts (3 cases) or squamous cell carcinoma (2 cases). Additional diseases were furunculosis, contact dermatitis, and molluscum contagiosum (1 case each). Conclusions. The new term, “isotopic response,” describes the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease.It is suggested that the term “isotopic response” be included in the lexicon (glossary) of dermatology.Introducing the new term and classifying all the cases under a single key word, will make it possible to locate and collect them easily and to search for the mechanism underlying this phenomenon.

Notes: Background. The ability of β-adrenergic blocking agents to induce psoriasis as an adverse effect prompted us to use such an agent to induce psoriasis in guinea pigs. Methods. Thirty female albino guinea pigs were divided into four groups. Group 1 received propranolol, 0.1 mg/day, dissolved in 2 mL of normal saline, orally by gavage for 30 days. Group 2 was given the same treatment, but in addition intradermal injections of propranolol with Freund's complete adjuvant, injected at weekly intervals. Group 3 (five animals) received 2 mL saline, and group 4 additional injections of adjuvant without propranolol. Groups 3 and 4 served as normal controls. Results. All animals of group 2 (which received propranolol orally and in addition intradermal injections of adjuvant) developed psoriasiform epidermal hyperplasia with acanthosis. Parakeratosis, papillomatosis, and formation of microabscesses, all characteristic signs of psoriasis, have not been seen in any of the skin samples of this group. Skin samples from group 1 animals receiving propranolol orally showed normal epidermis and dermis. They showed exactly the same histologic picture as the control groups 3 and 4. Conclusions. Beta-blockers given orally for 30 days do not cause any significant skin changes in guinea pigs. When given with a weekly intradermal injection of Freund's complete adjuvant, they cause psoriasiform epidermal hyperplasia. Although the overall histologic appearance of the skin of group 2 resembled psoriasis, it lacked important histologic features characteristic of this disease. It seems, therefore, that the model, per se, does not fulfill the initial expectations as an experimental model for psoriasis; however, this model has potential in the study of adverse drug reactions. Perhaps by introducing modifications to the experimental protocol, we may succeed also in developing a better model for experimental psoriasis.

Notes: Three patients had a rare form of bullous pemphigoid, clinically similar to the erythematous type of bullous pemphigoid without vesiculobullous lesions. All the patients displayed immunofluorescence features of bullous pemphigoid. This form of the disease presents a substantial diagnostic problem because it lacks the principal morphologic feature of bullous pemphigoid, namely the vesicles and bullae.