We believe, therefore, that it is perhaps premature to exonerate the alternative /¡-blocking agents from the cutaneous complications produced by practolol.
Rebecca E. I. Cochran, MB, MRCP John Thomson, MD, FRCP Alexander McQueen, MB, MRCpath D. Gareth Beevers, MB, MRCP Glasgow, Scotland
1. Felix RH, Ive FA, Dahl MGC: Cutaneous and ocular reactions to practolol. Br Med J 4:321\x=req-\ 324, 1974. 2. Felix RH, Ive FA, Dahl MGC: Skin reactions to beta-blockers. Br Med J 1:626, 1975. 3. Cumberbatch JB: Skin reactions to betablockers. Br Med J 4:528, 1974. 4. Leonard JC: Oxprenolol and psoriasis-like eruption. Lancet 1:630, 1975. 5. Padfield PL, Beevers DG, Cochran R, et al: Skin reactions to beta-blockers. Br Med J 1:626, 1975. 6. Cochran REI, Thomson J, Fleming K, et al: The psoriasiform eruption induced by practolol: A clinicopathologic study. J Cut Pathol 2:314-319, 1975.
Lichen Sclerosus et Atrophicus Associated With Turner Syndrome
To the
patient
Editor.\p=m-\Recently, with Turner syndrome
we saw a
and
lesions of lichen sclerosus et atrophicus (LSA) in the anogenital region. A similar association of Turner syndrome with lichen sclerosus et atrophicus could not be found in the literature.
Report of a Case.\p=m-\A woman born in 1946 had Turner syndrome. She began estrogen therapy in 1960 because of amenorrhea and lack of secondary sex characteristics. In 1966, examination of buccal smears and study of chromosomes showed a chromatinnegative nucleus and the 45-X0 chromosome. In April 1974, the patient developed itching on the left side of the vulva. This gradually became more severe and extended to the right side of the vulva and to the perianal region. Examination in November 1974 revealed areas of white discoloration with some hardening and atrophy in labia majora, labia minora, around the urethral meatus, and extending perianally. There were few superficial erosions in labia majora. Histologic examination showed a zone of homogenization in the uppermost dermis, and beneath this zone, there was a rather pronounced inflamma¬
sex hormones appear to be rele¬ vant to the age of onset. The maximal
that
incidence is in genital skin. However, it is not relieved by topically or systemically administered estrogens, although symptoms may occasionally lessen during pregnancy. In his series, 22 of 52 patients with onset of LSA between 30 and 45 years of age had a premature menopause, the vulva being affected in all. Although the unique association of LSA and Turner syndrome may be coincidence, it is worth pointing out that LSA of the female genitals most commonly arises in menopausal women (after age 45), and occasionally in prepubertal children. According to Wallace,1 LSA develops after age 45 in about 70% of women with LSA. The mean age of onset in his series was 54.2 years. In our patient, the LSA had its onset at age 29. It is thus possible that because of the presence of Turner syndrome, the LSA developed sooner than it would have in the absence of this syndrome. Jafar Koupaie, MD Boston 1. Hyman AB, Falk HC: White lesions of the vulva. Obstet Gynecol 12:407-413, 1958. 2. Nicolau SG, B\l=a%u\lusL: Sur la localisation vulvaire du lichen scl\l=e'\ro-atrophique:Consid\l=e'\rations sur les possibilit\l=e'\sde cancerition de cette lesion. Dermatologica 132:27-44, 1966. 3. Wallace HJ: Lichen sclerosus et atrophicus. Trans St Johns Hosp Dermatol Soc 57:9-30, 1971.
Changes
To the Editor.\p=m-\Forsome time, clinical has suggested that the incidence of melanoma is increasing. Certain publications confirm this
experience
opinion.1 Since pemphigus, systemic lupus erythematosus, and certain other potentially fatal dermatoses have been at least partially disarmed by the corticosteroids, melanoma has rein-
position as the killer of dermatology. According to Public forced its
Health Service statistics, the number of deaths in this country due to this
tions of betamethasone valerate cream (Valisone) greatly relieved the pruritus. to
ecologic ones (increased exposure to sunlight, tear gas, etc), possibly iatrogenic reasons (fertility drugs, diets high in polyunsaturated fatty acids, and vaccination scars), and infections (increased frequency or mutation of oncologic viruses). Methods.\p=m-\Inan attempt to establish or disprove the impression of increased frequency, the statistics of the California Tumor Registry were reviewed. Between 1960 and 1973, 691 instances of melanoma diagnosed among Alameda County resi¬ dents were reported to this agency. These were tabulated in one- to three-year peri¬ ods, and the results are presented in the Table. Since Alameda County has a relatively high proportion of blacks (15%), the racial incidence of melanoma was investigated also. The number of cases in the nonwhite groups is too small to draw any conclusions regarding the incidence trends for each group. to
Results. -The Table demonstrates increase in the annual number of cases of 40.7 (130%). If this is corrected by the population growth statistics, the incidence rose from 3.4 to 6.5 per 100,000 population, an increase of 91%. Even allowing for a 5% increment for better tracing efforts, this is still a significant factor. The Table also shows that mela¬ noma is another of the white man's burdens. Of the 691 cases studied, 680 (98%) occurred in whites, eight were in blacks (1.1%), two in Chinese patients, and one in a Japanese woman. Comment.—Regardless of the cause, the incidence of melanoma is on the rise. This is particularly striking in Alameda County because of the high proportion of blacks. Since melanomas occur rarely in this ethnic group, about 1% of the cases being in blacks, it is interesting that the incidence of melanoma is increasing so precipi¬ tously—approximately doubling in 13 years. an
Melanoma Incidence With Racial Distribution in 691 Cases From Alameda County Reported to California Tumor Registry
tory infiltrate. Frequent topical applica¬
Comment.—According
in Incidence of Melanoma
risen from approxi1956 to about 3,500 in 1974, an increase of 40%. The reasons for this elevation can be surmised only. The suggested factors include
neoplasm has mately 2,500 in
Racial Distribution"
Hyman and
Years 1960-1962 1963-1965 1966-1967 1968-1969 1969-1971 1972 1973
Falk1 and Nicolau and Bälus,2 ovarian dysfunction has been noted in a
substantial proportion of patients with LSA of the vulva. Wallace1 stated
1
Annual No. of Cases 31.3
Rates per 100,000
Population
Whites
31(4.0) 44 (5.5) 47.0_4.7 42.5 4.1 42(4.9) 47.5_4J5_47.5 (5.6) 3.4
40.3_3^8_39.6(4.6) 73.0 71.0
Numbers in parentheses
Downloaded From: http://archderm.jamanetwork.com/ by a University of Manitoba User on 06/15/2015
6.7 6.5
are
73(8.4) 68(6.3)
Blacks
0.3(0.3) 0.7 (0.3) 1(0.3)
Chinese 0 2.2 (0.2) 0
Japanese 0 3.6 (0.3) 0
0_0_n_ 0.3(0.2) 1.7(0.3) 0_ 0
2(1.2)
0 0
numbers of cases per 100,000 population.
0 0
Rebecca E. I. Cochran, MB, MRCP John Thomson, MD, FRCP Alexander McQueen, MB, MRCpath D. Gareth Beevers, MB, MRCP Glasgow, Scotland
1. Felix RH, Ive FA, Dahl MGC: Cutaneous and ocular reactions to practolol. Br Med J 4:321\x=req-\ 324, 1974. 2. Felix RH, Ive FA, Dahl MGC: Skin reactions to beta-blockers. Br Med J 1:626, 1975. 3. Cumberbatch JB: Skin reactions to betablockers. Br Med J 4:528, 1974. 4. Leonard JC: Oxprenolol and psoriasis-like eruption. Lancet 1:630, 1975. 5. Padfield PL, Beevers DG, Cochran R, et al: Skin reactions to beta-blockers. Br Med J 1:626, 1975. 6. Cochran REI, Thomson J, Fleming K, et al: The psoriasiform eruption induced by practolol: A clinicopathologic study. J Cut Pathol 2:314-319, 1975.
Lichen Sclerosus et Atrophicus Associated With Turner Syndrome
To the
patient
Editor.\p=m-\Recently, with Turner syndrome
we saw a
and
lesions of lichen sclerosus et atrophicus (LSA) in the anogenital region. A similar association of Turner syndrome with lichen sclerosus et atrophicus could not be found in the literature.
Report of a Case.\p=m-\A woman born in 1946 had Turner syndrome. She began estrogen therapy in 1960 because of amenorrhea and lack of secondary sex characteristics. In 1966, examination of buccal smears and study of chromosomes showed a chromatinnegative nucleus and the 45-X0 chromosome. In April 1974, the patient developed itching on the left side of the vulva. This gradually became more severe and extended to the right side of the vulva and to the perianal region. Examination in November 1974 revealed areas of white discoloration with some hardening and atrophy in labia majora, labia minora, around the urethral meatus, and extending perianally. There were few superficial erosions in labia majora. Histologic examination showed a zone of homogenization in the uppermost dermis, and beneath this zone, there was a rather pronounced inflamma¬
sex hormones appear to be rele¬ vant to the age of onset. The maximal
that
incidence is in genital skin. However, it is not relieved by topically or systemically administered estrogens, although symptoms may occasionally lessen during pregnancy. In his series, 22 of 52 patients with onset of LSA between 30 and 45 years of age had a premature menopause, the vulva being affected in all. Although the unique association of LSA and Turner syndrome may be coincidence, it is worth pointing out that LSA of the female genitals most commonly arises in menopausal women (after age 45), and occasionally in prepubertal children. According to Wallace,1 LSA develops after age 45 in about 70% of women with LSA. The mean age of onset in his series was 54.2 years. In our patient, the LSA had its onset at age 29. It is thus possible that because of the presence of Turner syndrome, the LSA developed sooner than it would have in the absence of this syndrome. Jafar Koupaie, MD Boston 1. Hyman AB, Falk HC: White lesions of the vulva. Obstet Gynecol 12:407-413, 1958. 2. Nicolau SG, B\l=a%u\lusL: Sur la localisation vulvaire du lichen scl\l=e'\ro-atrophique:Consid\l=e'\rations sur les possibilit\l=e'\sde cancerition de cette lesion. Dermatologica 132:27-44, 1966. 3. Wallace HJ: Lichen sclerosus et atrophicus. Trans St Johns Hosp Dermatol Soc 57:9-30, 1971.
Changes
To the Editor.\p=m-\Forsome time, clinical has suggested that the incidence of melanoma is increasing. Certain publications confirm this
experience
opinion.1 Since pemphigus, systemic lupus erythematosus, and certain other potentially fatal dermatoses have been at least partially disarmed by the corticosteroids, melanoma has rein-
position as the killer of dermatology. According to Public forced its
Health Service statistics, the number of deaths in this country due to this
tions of betamethasone valerate cream (Valisone) greatly relieved the pruritus. to
ecologic ones (increased exposure to sunlight, tear gas, etc), possibly iatrogenic reasons (fertility drugs, diets high in polyunsaturated fatty acids, and vaccination scars), and infections (increased frequency or mutation of oncologic viruses). Methods.\p=m-\Inan attempt to establish or disprove the impression of increased frequency, the statistics of the California Tumor Registry were reviewed. Between 1960 and 1973, 691 instances of melanoma diagnosed among Alameda County resi¬ dents were reported to this agency. These were tabulated in one- to three-year peri¬ ods, and the results are presented in the Table. Since Alameda County has a relatively high proportion of blacks (15%), the racial incidence of melanoma was investigated also. The number of cases in the nonwhite groups is too small to draw any conclusions regarding the incidence trends for each group. to
Results. -The Table demonstrates increase in the annual number of cases of 40.7 (130%). If this is corrected by the population growth statistics, the incidence rose from 3.4 to 6.5 per 100,000 population, an increase of 91%. Even allowing for a 5% increment for better tracing efforts, this is still a significant factor. The Table also shows that mela¬ noma is another of the white man's burdens. Of the 691 cases studied, 680 (98%) occurred in whites, eight were in blacks (1.1%), two in Chinese patients, and one in a Japanese woman. Comment.—Regardless of the cause, the incidence of melanoma is on the rise. This is particularly striking in Alameda County because of the high proportion of blacks. Since melanomas occur rarely in this ethnic group, about 1% of the cases being in blacks, it is interesting that the incidence of melanoma is increasing so precipi¬ tously—approximately doubling in 13 years. an
Melanoma Incidence With Racial Distribution in 691 Cases From Alameda County Reported to California Tumor Registry
tory infiltrate. Frequent topical applica¬
Comment.—According
in Incidence of Melanoma
risen from approxi1956 to about 3,500 in 1974, an increase of 40%. The reasons for this elevation can be surmised only. The suggested factors include
neoplasm has mately 2,500 in
Racial Distribution"
Hyman and
Years 1960-1962 1963-1965 1966-1967 1968-1969 1969-1971 1972 1973
Falk1 and Nicolau and Bälus,2 ovarian dysfunction has been noted in a
substantial proportion of patients with LSA of the vulva. Wallace1 stated
1
Annual No. of Cases 31.3
Rates per 100,000
Population
Whites
31(4.0) 44 (5.5) 47.0_4.7 42.5 4.1 42(4.9) 47.5_4J5_47.5 (5.6) 3.4
40.3_3^8_39.6(4.6) 73.0 71.0
Numbers in parentheses
Downloaded From: http://archderm.jamanetwork.com/ by a University of Manitoba User on 06/15/2015
6.7 6.5
are
73(8.4) 68(6.3)
Blacks
0.3(0.3) 0.7 (0.3) 1(0.3)
Chinese 0 2.2 (0.2) 0
Japanese 0 3.6 (0.3) 0
0_0_n_ 0.3(0.2) 1.7(0.3) 0_ 0
2(1.2)
0 0
numbers of cases per 100,000 population.
0 0
