Journal of the American Academy of Dermatology
In our study, we found that clindamycin 1% solution twice daily is as effective as tetracycline 250 mg twice daily, and both more effective than placebo. This is the only conclusion that can be drawn from our study, and at no time was bias or prejudice used during this study in favor of either product, as Dr. Epstein has suggested.
Giles P-Raymond, M.D. Department of Dermatology Saint-Luc Hospital 1058 St-Denis Montreal H2X 3J4 Quebec, Canada
REFERENCE 1. Freinkel RK, Strauss JS, Yips SY, Pochi PE: Effect of tetracycline in the composition of sebum in acne vulgaris. N Engl J Med 273:850-854, 1965.
corticosteroid therapy was not mentioned as a treatment modality for pernio due to wetness. About 9 years ago I reported, in a preliminary communication, the treatment of pernio with 0.025% fluocinolone acetonide cream under occlusive dressing. 1 (The disease is common and chronic in Jerusalem winters. Its occurrence probably is due to big differences between night and day temperatures, and not mairfly to wetness.) Since then, many colleagues in Jerusalem and I have treated hundreds of patients who had pernio with fluorinated corticosteroids under occlusive dressing nightly. The itch disappears as a rule within days, and the pernio within 1 or 2 weeks. Maintenance therapy one or more times a week during winter may be necessary.
S. Ganor, M.D. 23 Keren Hayesodstreet Jerusalem 94 188 Israel
P r e m a t u r e sebaceous gland h y p e r p l a s i a
To the Editor: We have read with great interest the article entitled "Premature Sebaceous Gland Hyperplasia," by De Villez and Roberts, in the May, 1982, issue of the JOURNAL(6:933-935). Recently, we saw a 39-year-old white man who presented with multiple 1- to 2-ram yellowish papules with central umbilication on the forehead, cheeks, and nose. These lesions started at the age of 18 and slowly increased in number and size. The patient was otherwise in good health. History of unusual sun exposure or radiation was absent. A 2-ram punch biopsy of one of the lesions of the forehead showed sebaceous gland hyperplasia. No solar elastosis was present. Our case thus confirms the observations of De Villez et al, who reported premature sebaceous gland hyperplasia. It is interesting to point out, however, that when we presented the patient in one of our conferences, some dermatologists felt that they had previously seen such patients, although no biopsy was performed to confirm their suspicions.
Jag Bhawan, M.D. Departments of Dermatology and Pathology Jean Calhoun, M.D. Department of Pathology Boston and Tufts Universities Boston, MA 02111
Corticosteroid therapy for p e r n i o To the Editor: In the answers to the Self-Assessment examination (J AM ACAD DERMATOL 6:36A, March, 1982), local
REFERENCE 1. Ganor S: The treatment of chilblains with fluocinolone cream under occlusive dressing. Harefuah 84:163, 1973.
Vitiligo and psoriasis To the Editor: We read with interest the recent report of seven cases of vitiligo and psoriasis by Joel S. Koransky and Henry H. Roenigk (J AM ACAD DERMATOL 7:183-189, 1982), and we agree with their conclusion that the concurrence of both diseases is not uncommon and that they do not appear to be pathogenetically linked. Ninety-five patients with psoriasis and vitiligo have been seen at the Mayo Clinic between 1950 and 1981. This represents 2.7% of all patients with vitiligo seen at the Clinic (an incidence of psoriasis similar to the normal population) and 0.55% of all psoriatic patients (similar to the incidence of vitiligo in the normal population), indicating that these diseases do not occur together with increased frequency. We have recently reviewed in detail twenty-nine of these cases who were seen since 1976.1 We did not find any specific interrelationship of the onset or course of these diseases, nor was there a particular pattern of involvement, psoriasis occurring with equal frequency on normal and vitiliginous skin. The presence of vitiligo did not influence the type or severity or response to therapy of the psoriasis, but there was a higher than expected number of associated diseases in this group of psoriatics. These included thyroid disease, diabetes, alopecia areata, and pernicious anemia. Arthritis was particularly prominent in our patients,