My attention was first drawn Milian's trisyndrome by Prof G. Findlay of Pretoria, South Africa. The condition consists of
an
to
H.
initial
lesion, followed by a generalized eruption, characterized by three main elements: (1) a macular rash, distributed over the trunk and limbs, which follows the lines of the skin; (2) localized, erythematous, edematous areas
that occupy considerable areas of the skin; and (3) dyshidrotic vesicles and bullae on the fingers and hands. In the discussion of the ten cases observed by Milian, he made it clear that he considered that the trisyndrome was an uncommon manifestation of pityriasis rosea and a common cause of diagnostic confusion. Andrew Griffiths, MD, MRCP
Liverpool, England
1. Milian G: Trisyndrome, in Darier J, Civatte A, Flandin C (eds): Nouvelle Pratique Dermatologique. Paris, Masson & Cie, 1936, vol IV, pp 638\x=req-\ 641.
Reply.\p=m-\DrGriffiths' comments are appreciated. Although I was unable to
In
obtain his reference, I believe my cases differed from the trisyndrome. We presented a vesicular eruption of the feet that apparently heralded the onset of pityriasis rosea, a papulodisease. Dr Griffiths squamous presents a trisyndrome consisting of a macular rash, dyshydrosis of the hands, and large areas of edematous skin. LTC Raymond L. Garcia MC, USAF Lackland AFB, Tex Skin Dermatoses in Alcoholics To the Editor.\p=m-\Inthe letter to the editor that appeared in the Archives (112:1326-1327, 1976), Margolis and Roberts gave a short report of the frequency of skin lesions in chronic drinkers. A few years ago, my associates and I undertook a study of the histological features of the skin of 55 alcoholics who had been admitted to the hospital for hepatic failure or for other complications of excessive alcoholic intake, such as polyneuritis or esogastric bleeding.1,2 The lesions we noted are atrophy of the epidermis, increase of the ground substance of collagen in the upper part of the dermis, atrophy of pilosebaceous appendages with abnormal structure of the pilomotor
muscles, and some functional troubles of eccrine sweat glands. These lesions correspond to the clinical appearance of the drinker's skin, which is smooth and fatty, with a light vascular pattern simulating silken threads on
("swiss stamp skin," "paper skin"). During this study, we did not notice any specific correlation with skin
paper money
diseases except vascular spiders and disturbance of nail and hair growth, but we did observe that psoriasis,
dermatitis, light-sensitive dermatoses, and nummular eczemas often occur in these patients. Edouard Grosshans, MD Strasbourg, France
contact
1. Grosshans E, Stahl J, Imler M, et al: Histopathologie de la peau des alcooliques chroniques. Proceedings of the International Conference on Extra-Hepatic Pathology and Liver, Montecatini-Terme, Italy, Oct 25-27, 1969. Epatologia
16:393-398, 1970. 2. Grosshans E, Stahl J, Imler M,
et al: Histo-
pathologie de la peau des alcooliques chroniques. Bull Soc Fran\l=c;\ Derm Syph 78:77-79, 1971.
Dimethylglyoxime Stick
Test for Easier Detection of Nickel
To the Editor.\p=m-\Nickelis everywhere. Consequently, the nickel-sensitive patient must constantly be on the alert
since exposure to this metal could inflict a pruritic, eczematous wound. But how can the nickel-sensitive individual know exactly what he can or cannot touch? We have found that a relatively simple modification of the
dimethylglyoxime spot test can greatly increase its usefulness and provide information that will be of help in preventing inadvertent reexposure to
nickel. The dimethylglyoxime test for detection of nickel, first described by Fleigl1 and modified by Fisher,2 consists of adding a few drops of 1% dimethylglyoxime in alcoholic solution and a few drops of 10% ammonium hydroxide solution to a test object and observing for the presence of a red precipitate. In our modification of this procedure, a few drops of dimethylglyoxime and ammonium hydroxide
successively placed on a cotton\x=req-\ tipped applicator, and the cotton tip is then rubbed against the test object. A positive result with this technique is the formation of a red precipitate on the applicator tip.
are
We have found the previously described spot test applicable for most situations. However, we believe our modification has certain advantages and can enhance what is already a very useful procedure. With our mod¬ ification it is much easier to test vertical surfaces, such as chair legs, convex surfaces, such as door knobs, and tiny objects, such as small pieces of jewelry. There is no spillage of test solutions off such objects which could occur if they were tested by the
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 06/21/2015
in petrolatum for presence of available nickel. Reaction on left produced by standard dimethylgly¬ oxime test is extremely faint due to poor admixture of nickel with test solutions. Reaction on right produced by rubbing pretreated applicator tip against nickel mixture Is much stronger.
Testing of 3% nickel sulfate
described technique. Also, rubs the applicator tip against the object (and thereby pre¬ sumably exposes more nickel to the test solution) positive reactions tend to be stronger, faster, and easier to read (Figure). This may be important with objects containing very low concentrations of soluble nickel. Inter¬ estingly, stainless steel, which con¬ tains tightly bound nickel and gener¬ ally appears safe for nickel-sensitive
previously because
one
individuals,2 produces a negative reac¬
tion with this technique. We have had several of our nickelsensitive patients use this test on a wide variety of their belongings at home and in our office to determine how they might have been exposed to nickel. Almost invariably they have discovered that they were being exposed to high concentrations of the metal through contact with scissors, a letter opener, keys, a telephone, a television dial, a table edge, a wheel¬ chair frame, and other sources they had not considered previously. In several cases such testing has pro¬ vided the explanation for what was until that time an unexplained distri¬ bution of dermatitis. A kit containing 1% dimethylglyox¬ ime and 10% ammonium hydroxide is available without charge from Westwood Pharmaceuticals, Inc. One only needs to provide cotton-tipped appli¬ cators to perform the modified proce¬ dure we have described. Ronald N. Shore, MD Silver Spring, Md Steven Binnick, MD
Philadelphia
1. Feigl F: Spot Tests in Inorganic Analysis, New York, Elsevier Pub Co, 1958, vol 1, p 149. 2. Fisher AA: Contact Dermatitis, ed 2. Philadelphia, Lea & Febiger, 1973, p 99.
an
to
H.
initial
lesion, followed by a generalized eruption, characterized by three main elements: (1) a macular rash, distributed over the trunk and limbs, which follows the lines of the skin; (2) localized, erythematous, edematous areas
that occupy considerable areas of the skin; and (3) dyshidrotic vesicles and bullae on the fingers and hands. In the discussion of the ten cases observed by Milian, he made it clear that he considered that the trisyndrome was an uncommon manifestation of pityriasis rosea and a common cause of diagnostic confusion. Andrew Griffiths, MD, MRCP
Liverpool, England
1. Milian G: Trisyndrome, in Darier J, Civatte A, Flandin C (eds): Nouvelle Pratique Dermatologique. Paris, Masson & Cie, 1936, vol IV, pp 638\x=req-\ 641.
Reply.\p=m-\DrGriffiths' comments are appreciated. Although I was unable to
In
obtain his reference, I believe my cases differed from the trisyndrome. We presented a vesicular eruption of the feet that apparently heralded the onset of pityriasis rosea, a papulodisease. Dr Griffiths squamous presents a trisyndrome consisting of a macular rash, dyshydrosis of the hands, and large areas of edematous skin. LTC Raymond L. Garcia MC, USAF Lackland AFB, Tex Skin Dermatoses in Alcoholics To the Editor.\p=m-\Inthe letter to the editor that appeared in the Archives (112:1326-1327, 1976), Margolis and Roberts gave a short report of the frequency of skin lesions in chronic drinkers. A few years ago, my associates and I undertook a study of the histological features of the skin of 55 alcoholics who had been admitted to the hospital for hepatic failure or for other complications of excessive alcoholic intake, such as polyneuritis or esogastric bleeding.1,2 The lesions we noted are atrophy of the epidermis, increase of the ground substance of collagen in the upper part of the dermis, atrophy of pilosebaceous appendages with abnormal structure of the pilomotor
muscles, and some functional troubles of eccrine sweat glands. These lesions correspond to the clinical appearance of the drinker's skin, which is smooth and fatty, with a light vascular pattern simulating silken threads on
("swiss stamp skin," "paper skin"). During this study, we did not notice any specific correlation with skin
paper money
diseases except vascular spiders and disturbance of nail and hair growth, but we did observe that psoriasis,
dermatitis, light-sensitive dermatoses, and nummular eczemas often occur in these patients. Edouard Grosshans, MD Strasbourg, France
contact
1. Grosshans E, Stahl J, Imler M, et al: Histopathologie de la peau des alcooliques chroniques. Proceedings of the International Conference on Extra-Hepatic Pathology and Liver, Montecatini-Terme, Italy, Oct 25-27, 1969. Epatologia
16:393-398, 1970. 2. Grosshans E, Stahl J, Imler M,
et al: Histo-
pathologie de la peau des alcooliques chroniques. Bull Soc Fran\l=c;\ Derm Syph 78:77-79, 1971.
Dimethylglyoxime Stick
Test for Easier Detection of Nickel
To the Editor.\p=m-\Nickelis everywhere. Consequently, the nickel-sensitive patient must constantly be on the alert
since exposure to this metal could inflict a pruritic, eczematous wound. But how can the nickel-sensitive individual know exactly what he can or cannot touch? We have found that a relatively simple modification of the
dimethylglyoxime spot test can greatly increase its usefulness and provide information that will be of help in preventing inadvertent reexposure to
nickel. The dimethylglyoxime test for detection of nickel, first described by Fleigl1 and modified by Fisher,2 consists of adding a few drops of 1% dimethylglyoxime in alcoholic solution and a few drops of 10% ammonium hydroxide solution to a test object and observing for the presence of a red precipitate. In our modification of this procedure, a few drops of dimethylglyoxime and ammonium hydroxide
successively placed on a cotton\x=req-\ tipped applicator, and the cotton tip is then rubbed against the test object. A positive result with this technique is the formation of a red precipitate on the applicator tip.
are
We have found the previously described spot test applicable for most situations. However, we believe our modification has certain advantages and can enhance what is already a very useful procedure. With our mod¬ ification it is much easier to test vertical surfaces, such as chair legs, convex surfaces, such as door knobs, and tiny objects, such as small pieces of jewelry. There is no spillage of test solutions off such objects which could occur if they were tested by the
Downloaded From: http://archderm.jamanetwork.com/ by a New York University User on 06/21/2015
in petrolatum for presence of available nickel. Reaction on left produced by standard dimethylgly¬ oxime test is extremely faint due to poor admixture of nickel with test solutions. Reaction on right produced by rubbing pretreated applicator tip against nickel mixture Is much stronger.
Testing of 3% nickel sulfate
described technique. Also, rubs the applicator tip against the object (and thereby pre¬ sumably exposes more nickel to the test solution) positive reactions tend to be stronger, faster, and easier to read (Figure). This may be important with objects containing very low concentrations of soluble nickel. Inter¬ estingly, stainless steel, which con¬ tains tightly bound nickel and gener¬ ally appears safe for nickel-sensitive
previously because
one
individuals,2 produces a negative reac¬
tion with this technique. We have had several of our nickelsensitive patients use this test on a wide variety of their belongings at home and in our office to determine how they might have been exposed to nickel. Almost invariably they have discovered that they were being exposed to high concentrations of the metal through contact with scissors, a letter opener, keys, a telephone, a television dial, a table edge, a wheel¬ chair frame, and other sources they had not considered previously. In several cases such testing has pro¬ vided the explanation for what was until that time an unexplained distri¬ bution of dermatitis. A kit containing 1% dimethylglyox¬ ime and 10% ammonium hydroxide is available without charge from Westwood Pharmaceuticals, Inc. One only needs to provide cotton-tipped appli¬ cators to perform the modified proce¬ dure we have described. Ronald N. Shore, MD Silver Spring, Md Steven Binnick, MD
Philadelphia
1. Feigl F: Spot Tests in Inorganic Analysis, New York, Elsevier Pub Co, 1958, vol 1, p 149. 2. Fisher AA: Contact Dermatitis, ed 2. Philadelphia, Lea & Febiger, 1973, p 99.
