Correspondence
2.
Lever WF, Schaumburg-Lever, Gundula JB. Histology of the skin. In: Lever WF, Schaumburg-Lever, Gundula JB, eds. Histopathology of the skin. 7th Ed. Philadelphia: JB Lippincott, 1990:6.
3.
Brown J, Winkelman RK. Acanthosis nigricans: a study of 90 cases (review). Medicine 1968:33-51. Gougerot H, Carteaud A. Papillomatose pigmentee innominee. Bull Soc Fr Dermatol Syphiligr 1927; 34: 719-721. Brown WG. Reticulated pigmented anomaly of the flexures. Case report and genetic investigation. Arch Dermatol 1982; 118:490-493.
4.
5.
Comment Upon coming across this rare finding, we wondered whether the meeting of the mite and the melanoma was merely coincidental or does the "beast" have a sixth sense that attracts it to melanoma cells? We were unable to find a report of similar findings in the English literature. Maybe, we are iust viewing a newer version of the "fatal attraction"? Baruch Kaplan, M.D. Henry Trau, M.D. Mirian Schewach-Millett, M.D. Tel Hashomer, Israel Reference 1. Head E, MacDonald M, Ewert A, Apisanthanarax P. Sarcoptes scabiei in histopathologic sections of skin in human scabies. Arch Dermatol 1990; 126:1475-1477.
The "Ugly and the Beast" To the Editor: The histopathologic examination of a pigmented lesion is crucial in diagnosing malignant melanoma. Head et al. recently described the features of histopathologic sections of the skin in scabetic infections.' We would like to share an anecdotal finding of an adult mite at the biopsy site of a melanoma.
Trace Elements in Serum of Pityriasis Alba Patients To the Editor: Thirty individuals (18 men and 12 women) with pityriasis alba were investigated in this study. The same number of healthy individuals was also selected to be a control group. Both groups were selected from out-patients clinics in United Arab Emirates hospitals and from the same age and social level. Serum samples from both groups were analyzed for determination of lead, copper, zinc, manganese, and carotenoids by use of atomic absorption spectrophotometry. The results were subjected to statistical analysis with the unpaired Student's t-test by computer.
Case Report A 73-year-old woman presented with a pigmented lesion on her forehead. At the time, she was residing in a geriatric institution and had a history of psychiatric illness. A biopsy of the lesion was performed and histopathologic examination revealed distinct features of malignant melanoma beneath an adult Sarcoptes mite (Fig. 1).
Results As shown in Table 1, there is no significant difference in the levels of zinc, lead, magnese, and carotenoids when comparing pityriasis alba patients with the normal control group. There was a significant difference in the level of copper between patients and controls (P < 0.0001). Discussion Pityriasis alba is a cutaneous eruption composed of hypopigmented scale lesions, which affects mainly exposed parts.' This disease is common in children and tends to subside spontaneously within a year.^ The etiology of pityriasis alba is far from clear. Efforts to isolate infectious agents common to this disease have not been successful.^ It has been suggested that nutritional deficiency might be an important factor,'' but this has been disputed.' Climatic factors and sunlight have also been suggested.*" Pityriasis alba has been regarded as a manifest Tahle 1. Trace Element Levels in Serum Patients (jig/dL) Control (\ig/dL) Zinc Lead Copper Manganese Carotinoids
Figure 1. Adult mite overlooking malignant melanoma, (hematoxylin and eosin, original magnification x 100)
Values are mean ± SEM.
525
105 ±2.42 4.35 ± 1.0 76.40 ±3.16 0.96 ±0.05 70.6 ±3.47
110 ±3.5 4.15 ±1.1 107 ±8.13 0.82 ±0.02 75.2 ±5.12
International Journal of Dermatology Vol. 31, No. 7, July 1992
References 1. O'Dell BL. Effect of dietary components upon zinc availability. Am J Clin Nutr 1969; 22:1315-1322.
of atopy;^ however, pityriasis alba is certainly not confined to "atopies." In this study, we have sJied more light on nutritional factors and the role of some trace elements. The serum zinc, lead, manganese, and carotenoid levels in patients with pityriasis alba were within normal levels; the differences between patients and control subjects were statistically insignificant. Surprisingly, the mean serum copper value was significantly reduced in the pityriasis alba patients (P < 0.0001) as compared with those of healthy controls. Serum copper is influenced by many factors, such as diet and age. Hypocopperemia has been reported in some genetic conditions, in malabsorption, and dietary deficiency of copper.* Copper is an important element and acts as a co-enzyme with tyrosinase in the oxidation of tyrosine in the melanogenesis process;' this may explain why pityriasis alba lesions are common on sun-exposed parts. Copper and its role in the pathogenesis of pityriasis alba is still a subject of much speculation. From this study, one may suppose or suspect that copper may play a major role in the pathogenesis, and hence in the treatment of pityriasis alba. Ebrahim Galadari, M.D. Mohammed Helmy, M.D. Mousa Ahmed, Ph.D. Dubai, United Arab Emirates
2.
Wells BT, White JH, Kierland RR. Pityriasis alba: a ten year survey and review of the literature. Arch Dermatol 1960; 82:183-189.
3.
Crawford S. Chromic symmetric impetigo. Arch Dermatol Syphilol 1949; 59:55-67.
4.
O'Earrel NM. Pityriasis alba. Arch Dermatol 1956; 73: 376-377.
5.
Bassaly M, Miale AJ, Prasad AS. Studies on pityriasis alba. Arch Dermatol 1963; 88:272-275.
6.
Zaynoun ST. Electron microscopic study of pityriasis alba. BrJ Dermatol 1983; 108:83.
7.
Watkins DB. Pityriasis alba: a form of atopic dermatitis. Arch Dermatol 1961; 85:915-919.
8.
Norris AC. Zinc and cutaneous inflammations. Acta Derm Venereol (Stockh) 1985; 121:985.
9.
Bleehen SS, Ebling FJ. Disorders of skin colour. In: Rook A, Wilkinson D, Ebling EJG, eds. Textbook of dermatology. 4th Ed. Oxford: Blackwell Scientific Publications, 1986:1549.
Annual Editorial Meeting, Adolphus Hotel, Dallas, Texas, December 8, 1991. Members and guests. Seated: Joseph A. Witkowski, Ernst H. Beutner, Orlando Cafiizares, Isabel Wrotkowski, Roberta C. Ongley, and Vincent A. Cipollaro. Standing: Maria M. Duran, Mohamed Amer, Alfredo Rebora, Eugene M. Farber, Anthony V. Benedetto, John T. Crissey, Terence J. Ryan, Torello Lotti, Larry E. Millikan, Mauricio Goihman-Yahr, Michael J. Fellner, Jere D. Guin, Vincent P. Barranco, Luciano Dominguez-Soto, and Lawrence Charles Parish. 526
2.
Lever WF, Schaumburg-Lever, Gundula JB. Histology of the skin. In: Lever WF, Schaumburg-Lever, Gundula JB, eds. Histopathology of the skin. 7th Ed. Philadelphia: JB Lippincott, 1990:6.
3.
Brown J, Winkelman RK. Acanthosis nigricans: a study of 90 cases (review). Medicine 1968:33-51. Gougerot H, Carteaud A. Papillomatose pigmentee innominee. Bull Soc Fr Dermatol Syphiligr 1927; 34: 719-721. Brown WG. Reticulated pigmented anomaly of the flexures. Case report and genetic investigation. Arch Dermatol 1982; 118:490-493.
4.
5.
Comment Upon coming across this rare finding, we wondered whether the meeting of the mite and the melanoma was merely coincidental or does the "beast" have a sixth sense that attracts it to melanoma cells? We were unable to find a report of similar findings in the English literature. Maybe, we are iust viewing a newer version of the "fatal attraction"? Baruch Kaplan, M.D. Henry Trau, M.D. Mirian Schewach-Millett, M.D. Tel Hashomer, Israel Reference 1. Head E, MacDonald M, Ewert A, Apisanthanarax P. Sarcoptes scabiei in histopathologic sections of skin in human scabies. Arch Dermatol 1990; 126:1475-1477.
The "Ugly and the Beast" To the Editor: The histopathologic examination of a pigmented lesion is crucial in diagnosing malignant melanoma. Head et al. recently described the features of histopathologic sections of the skin in scabetic infections.' We would like to share an anecdotal finding of an adult mite at the biopsy site of a melanoma.
Trace Elements in Serum of Pityriasis Alba Patients To the Editor: Thirty individuals (18 men and 12 women) with pityriasis alba were investigated in this study. The same number of healthy individuals was also selected to be a control group. Both groups were selected from out-patients clinics in United Arab Emirates hospitals and from the same age and social level. Serum samples from both groups were analyzed for determination of lead, copper, zinc, manganese, and carotenoids by use of atomic absorption spectrophotometry. The results were subjected to statistical analysis with the unpaired Student's t-test by computer.
Case Report A 73-year-old woman presented with a pigmented lesion on her forehead. At the time, she was residing in a geriatric institution and had a history of psychiatric illness. A biopsy of the lesion was performed and histopathologic examination revealed distinct features of malignant melanoma beneath an adult Sarcoptes mite (Fig. 1).
Results As shown in Table 1, there is no significant difference in the levels of zinc, lead, magnese, and carotenoids when comparing pityriasis alba patients with the normal control group. There was a significant difference in the level of copper between patients and controls (P < 0.0001). Discussion Pityriasis alba is a cutaneous eruption composed of hypopigmented scale lesions, which affects mainly exposed parts.' This disease is common in children and tends to subside spontaneously within a year.^ The etiology of pityriasis alba is far from clear. Efforts to isolate infectious agents common to this disease have not been successful.^ It has been suggested that nutritional deficiency might be an important factor,'' but this has been disputed.' Climatic factors and sunlight have also been suggested.*" Pityriasis alba has been regarded as a manifest Tahle 1. Trace Element Levels in Serum Patients (jig/dL) Control (\ig/dL) Zinc Lead Copper Manganese Carotinoids
Figure 1. Adult mite overlooking malignant melanoma, (hematoxylin and eosin, original magnification x 100)
Values are mean ± SEM.
525
105 ±2.42 4.35 ± 1.0 76.40 ±3.16 0.96 ±0.05 70.6 ±3.47
110 ±3.5 4.15 ±1.1 107 ±8.13 0.82 ±0.02 75.2 ±5.12
International Journal of Dermatology Vol. 31, No. 7, July 1992
References 1. O'Dell BL. Effect of dietary components upon zinc availability. Am J Clin Nutr 1969; 22:1315-1322.
of atopy;^ however, pityriasis alba is certainly not confined to "atopies." In this study, we have sJied more light on nutritional factors and the role of some trace elements. The serum zinc, lead, manganese, and carotenoid levels in patients with pityriasis alba were within normal levels; the differences between patients and control subjects were statistically insignificant. Surprisingly, the mean serum copper value was significantly reduced in the pityriasis alba patients (P < 0.0001) as compared with those of healthy controls. Serum copper is influenced by many factors, such as diet and age. Hypocopperemia has been reported in some genetic conditions, in malabsorption, and dietary deficiency of copper.* Copper is an important element and acts as a co-enzyme with tyrosinase in the oxidation of tyrosine in the melanogenesis process;' this may explain why pityriasis alba lesions are common on sun-exposed parts. Copper and its role in the pathogenesis of pityriasis alba is still a subject of much speculation. From this study, one may suppose or suspect that copper may play a major role in the pathogenesis, and hence in the treatment of pityriasis alba. Ebrahim Galadari, M.D. Mohammed Helmy, M.D. Mousa Ahmed, Ph.D. Dubai, United Arab Emirates
2.
Wells BT, White JH, Kierland RR. Pityriasis alba: a ten year survey and review of the literature. Arch Dermatol 1960; 82:183-189.
3.
Crawford S. Chromic symmetric impetigo. Arch Dermatol Syphilol 1949; 59:55-67.
4.
O'Earrel NM. Pityriasis alba. Arch Dermatol 1956; 73: 376-377.
5.
Bassaly M, Miale AJ, Prasad AS. Studies on pityriasis alba. Arch Dermatol 1963; 88:272-275.
6.
Zaynoun ST. Electron microscopic study of pityriasis alba. BrJ Dermatol 1983; 108:83.
7.
Watkins DB. Pityriasis alba: a form of atopic dermatitis. Arch Dermatol 1961; 85:915-919.
8.
Norris AC. Zinc and cutaneous inflammations. Acta Derm Venereol (Stockh) 1985; 121:985.
9.
Bleehen SS, Ebling FJ. Disorders of skin colour. In: Rook A, Wilkinson D, Ebling EJG, eds. Textbook of dermatology. 4th Ed. Oxford: Blackwell Scientific Publications, 1986:1549.
Annual Editorial Meeting, Adolphus Hotel, Dallas, Texas, December 8, 1991. Members and guests. Seated: Joseph A. Witkowski, Ernst H. Beutner, Orlando Cafiizares, Isabel Wrotkowski, Roberta C. Ongley, and Vincent A. Cipollaro. Standing: Maria M. Duran, Mohamed Amer, Alfredo Rebora, Eugene M. Farber, Anthony V. Benedetto, John T. Crissey, Terence J. Ryan, Torello Lotti, Larry E. Millikan, Mauricio Goihman-Yahr, Michael J. Fellner, Jere D. Guin, Vincent P. Barranco, Luciano Dominguez-Soto, and Lawrence Charles Parish. 526
