Standardizing grading subjects for clinical research studies atopic dermatitis: workshop report. Acta Derm Venereol. 1989;(suppl
2. Hanifin JM. in
Pure-Tone Thresholds (500 to 2000 Hz) in Decibels Used in Control and Vitiligo Groups
144):28-30. 3. Gundersen HJG, Jensen EB. The efficiency of systematic sampling in stereology and its prediction. J Microsc. 1987;147:229-263.
Frequency, Hz
Groups_500_1000_2000
No Evidence of Hearing Loss in Patients With Vitiligo
Controls
Vitiligo
To the Editor.\p=m-\RecentlyTosti et al1 have mentioned the possible relationship between vitiligo and hearing loss. The foundation of this hypothesis is that the probable protective role of melanocytes of the inner ear has been injured by an autoimmune mechanism. We searched the records in our dermatology department for possible auditory damage in patients with vitiligo. Written consent was obtained after the nature of the procedures had been fully explained. The group was arranged in 10-year age groups to see if there was a relationship between vitiligo with clinical evolution and localization of
pathologic findings. All patients who were exposed to known factors responsible for sensorineural hypoacusis, ie, noise, drugs, metabolic and vascular pathologic conditions, recurrent otologic infections, head trauma, family history of deafness, and patients older than 50 years were excluded from the study. The control group consisted of 35 healthy subjects, all
within the same age range and socioeconomic status, without skin diseases. Air conduction pure-tone audiometry between 125 and 8000 Hz in 5-db steps was used to test the audiologic func¬ tion. Bone conduction tests between 500 and 2000 Hz was performed. The examination was performed in a silent cabin before otoscopic examination by an experienced audiologist (Interacoustics AC 3 audiometer, TDH-49 head¬ phones and bone vibrator frequently calibrated in accor¬ dance with ANSI standards). Békésy automatic audiometry was performed in one patient whose test results were doubtful. Tympanometry was used to exclude subjects with middle ear pathologic conditions. Both groups were compared for 500-, 1000-, and 2000-Hz thresholds, which are the most representative of speech. Because of these being quantitative variables, the null hy¬ potheses of group difference were assessed by two-sided Student's t test. We studied 45 patients and control subjects. The mean age of the vitiligo group was x 24.19 years, SD 10.0 years; the mean age of the control group was x 21.94 years, SD 9.8 years. The vitiligo group included 13 male and 34 female patients. The control group included 22 male and 13 female subjects. The audiometric thresholds between 125 and 8000 Hz in the vitiligo and control groups were normal in all ears (100% ); the mean and SD of 500 to 2000 Hz is shown in the Table. No statistical difference at the P .01 level was found. We found no relationship between the duration of the disease, the distribution of vitiligo, and hearing loss (x2 0.00, P .01) Thus, in our study population, we did not find association between hypoacusis and vitiligo. The targets of injury in vitiligo, the melanocytes, also can be found in the human cochlea and vestibular labyrinth.2-3 Other pigmentary =
=
=
=
=
=
=
pathologic conditions, ie, albinism, Vogt-Koyanagi-Harada syndrome, retinitis pigmentosa, and Waardenburg syn¬ drome, clearly produce hearing loss. In our study, the possible explanation of the untouched audition is: (1) our patients are nonwhite and ethnically different affectation may result; and (2) none of our patients
14.41 ± 4.10
11.98
+
5.00
13.45 ± 4.51 11.33 ±4.78
12.39 ± 4.24 11.45 ±5.86
had retinitis pigmentosa, which is most commonly related to hearing damage.4 Another explanation is that vitiligo does not produce hearing loss as is proposed by Orecchia et al.5 We believe it is necessary that more research on the function of melanocytes in the inner ear be undertaken as part of the solution of the problem. Carlos Escalante-Ugalde, MD Adri\l=a'\nPoblano, MD Eduardo Montes de Oca, MD Instituto Nacional de la Comunicaci\l=o'\nHumana Fco de P. Miranda 177 Unidad Lomas de Plateros CP 01480, Mexico DF, Mexico Rosario Lagunes, MD Amado Sa\l=u'\l,MD Unidad de Dermatolog\l=i'\a Hospital General de la Ciudad de M\l=e'\xico Balmis 148 Col de los Doctores CP 06720, Mexico DF, Mexico A, Bardazzi F, Tosti G, Monti L. Audiologic abnormalities in cases vitiligo. J Am Acad Dermatol. 1987;17:230-233. 2. Savin C. The blood vessels and pigmentary cell of the inner ear. Ann Otol Rhinol Laryngol. 1965;74:611-623. 3. Franz P, Aharinejad S, Firbas W. Melanocytes in the modiolus of the guinea pig cochlea. Acta Otolaryngol (Stockh). 1990;109:221-227. 4. Dereymaeker AM, Fryns JP, Ars J, Andresescu J, Van der Berghe H. Retinitis pigmentosa, hearing loss and vitiligo: report of two patients. Clin Genet. 1989;35:387-389. 5. Orecchia G, Marelli MA, Fresa D, Robiolio L. Audiologic disturbances in vitiligo. J Am Acad Dermatol. 1989;21:1317-1318. 1. Tosti
of
Arising in a Zosteriform Speckled Lentiginous Nevus To the Editor.\p=m-\The development of a cutaneous melanoma within a nevus spilus, or speckled lentiginous nevus, was recently reported in the Archives.1 A unique feature in that case was the presence histologically of intraepidermal melanocytic dysplasia within the "speckled" or hyperpigmented areas. The possibility that the melanocytic dysplaFatal Melanoma
sia was a predisposing factor for the development of the melanoma was considered. In the following case report, a melanoma developed within a zosteriform speckled lentiginous nevus that had histologic features that were similar to those described by Rhodes and Mihm.1 However, in contrast to previously reported cases,1-5 this patient subsequently developed metastatic disease that proved to be fatal.
Report of a Case.\p=m-\The patient was a 43-year-old white man with history of a stage I cutaneous melanoma (Clark level III; Breslow depth, 1.6 mm) of the left posterior aspect of the neck diagnosed in 1986. His medical history was significant for mild psoriasis vulgaris treated with topical steroids. In May 1989, the patient was referred to the Yale Pigmented Lesion Clinic (New Haven, Conn) and, on physical examination, an area of tan to light brown hyperpigmena
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 05/19/2015
2. Hanifin JM. in
Pure-Tone Thresholds (500 to 2000 Hz) in Decibels Used in Control and Vitiligo Groups
144):28-30. 3. Gundersen HJG, Jensen EB. The efficiency of systematic sampling in stereology and its prediction. J Microsc. 1987;147:229-263.
Frequency, Hz
Groups_500_1000_2000
No Evidence of Hearing Loss in Patients With Vitiligo
Controls
Vitiligo
To the Editor.\p=m-\RecentlyTosti et al1 have mentioned the possible relationship between vitiligo and hearing loss. The foundation of this hypothesis is that the probable protective role of melanocytes of the inner ear has been injured by an autoimmune mechanism. We searched the records in our dermatology department for possible auditory damage in patients with vitiligo. Written consent was obtained after the nature of the procedures had been fully explained. The group was arranged in 10-year age groups to see if there was a relationship between vitiligo with clinical evolution and localization of
pathologic findings. All patients who were exposed to known factors responsible for sensorineural hypoacusis, ie, noise, drugs, metabolic and vascular pathologic conditions, recurrent otologic infections, head trauma, family history of deafness, and patients older than 50 years were excluded from the study. The control group consisted of 35 healthy subjects, all
within the same age range and socioeconomic status, without skin diseases. Air conduction pure-tone audiometry between 125 and 8000 Hz in 5-db steps was used to test the audiologic func¬ tion. Bone conduction tests between 500 and 2000 Hz was performed. The examination was performed in a silent cabin before otoscopic examination by an experienced audiologist (Interacoustics AC 3 audiometer, TDH-49 head¬ phones and bone vibrator frequently calibrated in accor¬ dance with ANSI standards). Békésy automatic audiometry was performed in one patient whose test results were doubtful. Tympanometry was used to exclude subjects with middle ear pathologic conditions. Both groups were compared for 500-, 1000-, and 2000-Hz thresholds, which are the most representative of speech. Because of these being quantitative variables, the null hy¬ potheses of group difference were assessed by two-sided Student's t test. We studied 45 patients and control subjects. The mean age of the vitiligo group was x 24.19 years, SD 10.0 years; the mean age of the control group was x 21.94 years, SD 9.8 years. The vitiligo group included 13 male and 34 female patients. The control group included 22 male and 13 female subjects. The audiometric thresholds between 125 and 8000 Hz in the vitiligo and control groups were normal in all ears (100% ); the mean and SD of 500 to 2000 Hz is shown in the Table. No statistical difference at the P .01 level was found. We found no relationship between the duration of the disease, the distribution of vitiligo, and hearing loss (x2 0.00, P .01) Thus, in our study population, we did not find association between hypoacusis and vitiligo. The targets of injury in vitiligo, the melanocytes, also can be found in the human cochlea and vestibular labyrinth.2-3 Other pigmentary =
=
=
=
=
=
=
pathologic conditions, ie, albinism, Vogt-Koyanagi-Harada syndrome, retinitis pigmentosa, and Waardenburg syn¬ drome, clearly produce hearing loss. In our study, the possible explanation of the untouched audition is: (1) our patients are nonwhite and ethnically different affectation may result; and (2) none of our patients
14.41 ± 4.10
11.98
+
5.00
13.45 ± 4.51 11.33 ±4.78
12.39 ± 4.24 11.45 ±5.86
had retinitis pigmentosa, which is most commonly related to hearing damage.4 Another explanation is that vitiligo does not produce hearing loss as is proposed by Orecchia et al.5 We believe it is necessary that more research on the function of melanocytes in the inner ear be undertaken as part of the solution of the problem. Carlos Escalante-Ugalde, MD Adri\l=a'\nPoblano, MD Eduardo Montes de Oca, MD Instituto Nacional de la Comunicaci\l=o'\nHumana Fco de P. Miranda 177 Unidad Lomas de Plateros CP 01480, Mexico DF, Mexico Rosario Lagunes, MD Amado Sa\l=u'\l,MD Unidad de Dermatolog\l=i'\a Hospital General de la Ciudad de M\l=e'\xico Balmis 148 Col de los Doctores CP 06720, Mexico DF, Mexico A, Bardazzi F, Tosti G, Monti L. Audiologic abnormalities in cases vitiligo. J Am Acad Dermatol. 1987;17:230-233. 2. Savin C. The blood vessels and pigmentary cell of the inner ear. Ann Otol Rhinol Laryngol. 1965;74:611-623. 3. Franz P, Aharinejad S, Firbas W. Melanocytes in the modiolus of the guinea pig cochlea. Acta Otolaryngol (Stockh). 1990;109:221-227. 4. Dereymaeker AM, Fryns JP, Ars J, Andresescu J, Van der Berghe H. Retinitis pigmentosa, hearing loss and vitiligo: report of two patients. Clin Genet. 1989;35:387-389. 5. Orecchia G, Marelli MA, Fresa D, Robiolio L. Audiologic disturbances in vitiligo. J Am Acad Dermatol. 1989;21:1317-1318. 1. Tosti
of
Arising in a Zosteriform Speckled Lentiginous Nevus To the Editor.\p=m-\The development of a cutaneous melanoma within a nevus spilus, or speckled lentiginous nevus, was recently reported in the Archives.1 A unique feature in that case was the presence histologically of intraepidermal melanocytic dysplasia within the "speckled" or hyperpigmented areas. The possibility that the melanocytic dysplaFatal Melanoma
sia was a predisposing factor for the development of the melanoma was considered. In the following case report, a melanoma developed within a zosteriform speckled lentiginous nevus that had histologic features that were similar to those described by Rhodes and Mihm.1 However, in contrast to previously reported cases,1-5 this patient subsequently developed metastatic disease that proved to be fatal.
Report of a Case.\p=m-\The patient was a 43-year-old white man with history of a stage I cutaneous melanoma (Clark level III; Breslow depth, 1.6 mm) of the left posterior aspect of the neck diagnosed in 1986. His medical history was significant for mild psoriasis vulgaris treated with topical steroids. In May 1989, the patient was referred to the Yale Pigmented Lesion Clinic (New Haven, Conn) and, on physical examination, an area of tan to light brown hyperpigmena
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 05/19/2015
