Research Original Investigation
Dermatology Consultation for Diagnostic Accuracy
REFERENCES 1. Arakaki RY, Strazzula L, Woo E, Kroshinsky D. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial
[published online August 20, 2014]. JAMA Dermatol. doi:10.1001/jamadermatol.2014.1085. 2. Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6): 1326-1328.
3. Hirschmann JV, Raugi GJ. Lower limb cellulitis and its mimics, part II: conditions that simulate lower limb cellulitis. J Am Acad Dermatol. 2012;67(2):e1-e9, 185-186.
NOTABLE NOTES
Famous Lines in History Blaschko Lines Mohammad-Ali Yazdani Abyaneh, BS; Robert Griffith, MD; Leyre Falto-Aizpurua, MD; Keyvan Nouri, MD
The lines of Blaschko describe a linear pattern of distribution of various congenital, nevoid, and acquired skin disorders with their suspected embryological origins not yet well understood. These lines were painstakingly and thoroughly documented first by German dermatologist Alfred Blaschko. Blaschko was the son of a physician and was born in 1858 in Freienwalde and died in 1922 in Berlin. He was a private practitioner in Berlin, where his dermatologic interests ranged from dermatitis herpetiformis, leprosy, and, later in his career, occupational skin diseases to social hygiene and venereal diseases.1 Blaschko studied the distribution of various nevoid disorders, such as epidermal and sebaceous nevi, as well as acquired disorders, such as linear psoriasis, eczema, lichen planus, lichen simplex chronicus, and scleroderma. He transposed the pattern of these lesions in more than 140 patients onto dolls and statues and eventually produced complete illustrations of his famous lines all over the body. His findings were published in 1901 as a supplement to the Proceedings of the German Dermatological Society’s meeting held in Breslau that year. The publication included 26 pages of hand drawings, the first 9 of which were illustrations of herpes zoster. Although we now know that zoster follows the distribution of cutaneous dermatomes and not Blaschko lines, the 2 distributions were commonly confused at the time.2 In 1902, Blaschko helped in the founding of the German Society for the Fight against Venereal Diseases along with Albert Neisser, a leading expert in venereology and the discoverer of the Neisseria gonorrhoeae bacterium. He served as general secretary for the organization and led efforts to educate the public regarding venereal diseases by distributing pamphlets and leaflets, organizing lectures all over the country, of-
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fering seminars for teachers, and lobbying for sex education in classes.3 After reviewing Blaschko’s writings during this time, Robert Jackson,1 who in 1976 published a detailed review of Blaschko’s seminal findings, suggests he was perhaps among the first advocates of the women’s liberation movement. For instance, in an address in 1903 Blaschko argued that the best form of prophylaxis against venereal disease was improvement of the economic condition of women, which would only be possible in a genuinely free and democratic state. In 1913, he countered previous legislative efforts to ban advertising for contraceptives by calling these efforts extremely dangerous, and championed the “recommendation of prophylactics until the whole population is fully informed from the onset of puberty.”3 Clearly, Blaschko’s legacy is as impressive for his diligent work as a dermatologistandeminenteyeforpatternrecognitionasitisforhiscourageous championing of social health reforms at the turn of the 20th century. Author Affiliations: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida. Corresponding Author: Mohammad-Ali Yazdani Abyaneh, BS, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Second Floor, Miami, FL 33136 (myazdani@med .miami.edu). 1. Jackson R. Correspondence. Br J Dermatol. 1977;97(3):341-342. 2. Jackson R. The lines of Blaschko: a review and reconsideration: observations of the cause of certain unusual linear conditions of the skin. Br J Dermatol. 1976; 95(4):349-360. 3. Dickinson ER. Sex, Freedom, and Power in Imperial Germany, 1880–1914. Cambridge, England: Cambridge University Press; 2014.
JAMA Dermatology October 2014 Volume 150, Number 10
Copyright 2014 American Medical Association. All rights reserved.
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Dermatology Consultation for Diagnostic Accuracy
REFERENCES 1. Arakaki RY, Strazzula L, Woo E, Kroshinsky D. The impact of dermatology consultation on diagnostic accuracy and antibiotic use among patients with suspected cellulitis seen at outpatient internal medicine offices: a randomized clinical trial
[published online August 20, 2014]. JAMA Dermatol. doi:10.1001/jamadermatol.2014.1085. 2. Levell NJ, Wingfield CG, Garioch JJ. Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care. Br J Dermatol. 2011;164(6): 1326-1328.
3. Hirschmann JV, Raugi GJ. Lower limb cellulitis and its mimics, part II: conditions that simulate lower limb cellulitis. J Am Acad Dermatol. 2012;67(2):e1-e9, 185-186.
NOTABLE NOTES
Famous Lines in History Blaschko Lines Mohammad-Ali Yazdani Abyaneh, BS; Robert Griffith, MD; Leyre Falto-Aizpurua, MD; Keyvan Nouri, MD
The lines of Blaschko describe a linear pattern of distribution of various congenital, nevoid, and acquired skin disorders with their suspected embryological origins not yet well understood. These lines were painstakingly and thoroughly documented first by German dermatologist Alfred Blaschko. Blaschko was the son of a physician and was born in 1858 in Freienwalde and died in 1922 in Berlin. He was a private practitioner in Berlin, where his dermatologic interests ranged from dermatitis herpetiformis, leprosy, and, later in his career, occupational skin diseases to social hygiene and venereal diseases.1 Blaschko studied the distribution of various nevoid disorders, such as epidermal and sebaceous nevi, as well as acquired disorders, such as linear psoriasis, eczema, lichen planus, lichen simplex chronicus, and scleroderma. He transposed the pattern of these lesions in more than 140 patients onto dolls and statues and eventually produced complete illustrations of his famous lines all over the body. His findings were published in 1901 as a supplement to the Proceedings of the German Dermatological Society’s meeting held in Breslau that year. The publication included 26 pages of hand drawings, the first 9 of which were illustrations of herpes zoster. Although we now know that zoster follows the distribution of cutaneous dermatomes and not Blaschko lines, the 2 distributions were commonly confused at the time.2 In 1902, Blaschko helped in the founding of the German Society for the Fight against Venereal Diseases along with Albert Neisser, a leading expert in venereology and the discoverer of the Neisseria gonorrhoeae bacterium. He served as general secretary for the organization and led efforts to educate the public regarding venereal diseases by distributing pamphlets and leaflets, organizing lectures all over the country, of-
1062
fering seminars for teachers, and lobbying for sex education in classes.3 After reviewing Blaschko’s writings during this time, Robert Jackson,1 who in 1976 published a detailed review of Blaschko’s seminal findings, suggests he was perhaps among the first advocates of the women’s liberation movement. For instance, in an address in 1903 Blaschko argued that the best form of prophylaxis against venereal disease was improvement of the economic condition of women, which would only be possible in a genuinely free and democratic state. In 1913, he countered previous legislative efforts to ban advertising for contraceptives by calling these efforts extremely dangerous, and championed the “recommendation of prophylactics until the whole population is fully informed from the onset of puberty.”3 Clearly, Blaschko’s legacy is as impressive for his diligent work as a dermatologistandeminenteyeforpatternrecognitionasitisforhiscourageous championing of social health reforms at the turn of the 20th century. Author Affiliations: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida. Corresponding Author: Mohammad-Ali Yazdani Abyaneh, BS, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1475 NW 12th Ave, Second Floor, Miami, FL 33136 (myazdani@med .miami.edu). 1. Jackson R. Correspondence. Br J Dermatol. 1977;97(3):341-342. 2. Jackson R. The lines of Blaschko: a review and reconsideration: observations of the cause of certain unusual linear conditions of the skin. Br J Dermatol. 1976; 95(4):349-360. 3. Dickinson ER. Sex, Freedom, and Power in Imperial Germany, 1880–1914. Cambridge, England: Cambridge University Press; 2014.
JAMA Dermatology October 2014 Volume 150, Number 10
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a University of Texas at Austin User on 06/06/2015
jamadermatology.com
