430 Correspondence Journal of the

American Academy of Dermatology

Fig. 2. The epithelial roof of the bulla shows marked spongiosis and keratinocyte necrosis. (Hematoxylin- eosin stain.)

mainly mononuclear, inflammatory infiltrate in the upper and mid dermis, Infiltrate was predominantly present around blood vessels and appendages. (3) Leu- kocytes (mainly mononuclear) were present inside the blister fluid. (4) The epidermis had hydropic degenera- tion of the basal cell layer, necrosis of keratinocytes, and focal spongiosis.

Ketotifen was stopped and oral prednisone (25 mg daily) plus antacids and a low salt diet were prescribed. Lesions faded after 5 days' therapy. Prednisone was tapered off and the patient was discharged. A telephone follow-up in July, 1982, indicated that no more ketoti- fen had been taken. Rhinitis was much abated and con- trolled by oral dexchlorpheniramine maleate (Polar- amine). She continued to avoid the sun. The patient agreed to submit to ketotifen challenge. She took a single tablet of ketotifen. Lesions were reported to ap- pear one and one-half days after intake. They were similar to those of the previous episode but milder.

Comment. Relationship between ketotifen and ery-

thema multiforme was initially circumstantial. Results of the challenge test add further credence to the rela- tionship between drug intake and appearance of le- sions. Family and personal history are much weighed toward a history of diverse hypersensitivities. This is not exceptional in patients likely to receive ketotifem True incidence of erythema multiforme and other skin lesions in relation to ketotifen therapy must be small but will be better appreciated as the drug is employed more widely.

Mauricio Goihman-Yahr, M.D., Ph.D. Instituto Nacional de Dermatologia and

Catedra de Dermatologia School of Medicine Central University of Venezuela

Caracas, Venezuela

Alex Rothemberg, M.D. Instituto Nacional de Tuberculosis

Ministerio de Sanidad y Asistencia Social Venezuela

Ervin Essenfeld-Yahr, M.D. Departmento de Anatomia Patologica

Hospital "Padre Machado" Caracas, Venezuela

REFERENCES 1. Craps L: Ketotifen in the oral prophylaxis of bronchial

asthma: A review. Pharmatherapeutica 3:18-35, 1981. 2. Tanser AR, Elmes J: A controlled trial of ketotifen in

exercise-induced asthma. Br J Dis Chest 74:398-402, 1980.

3. Wuethrich B, Radielovic P, Debelic M: The protective effect of a new oral anti-asthma agent (ketotifen, HC20- 511) against experimentally induced bronchospasm (5 dif- ferent models). Int J Clin Pharmacol 16:424-429, 1978.

4, Beumer HM; Bronchial reactivity in asthma to inhaled histamine during treatment with ketotifen. Respiration 37:271-277, 1979.

5. Weheba AS: Prophylactic treatment of bronchial asthma in children with a new, orally active agent, ketotifen. Pharmatherapeutica 2:147-152, 1979.

6. Dubois de Montreynaud JM, Artigas C: Le K6totif6ne dans le traitement de fond de la maladie asthmatique (ketotifen in basic treatment of asthmatic disease). Rev Fr Allergol 19: I 01 - 104, 1979.

7. Haahtela T: Comparisons among HC 20-511 (ketotifen), clemastine, DSCG and beclomethasone dipropionate in nasal challenge. Ann Allergy 41:345-347, 1978.

Hair examination using double-stick tape

To the Editor Microscopic examination of hair placed on a slide

under a coverslip can be frustrating. Not only does one have to follow a changing axis, but movement o f the coverslip or the exposed strands causes the hair to twist,

Volume 8 Number 3 March, 1983

Correspondence 431

Fig. 1. Human hair mounted on a glass slide on central strip of transparent double-stick tape. This allows ease of microscopic examination, labeling, and filing. Assuming a growth rate of 0.37 mm/day, this specimen permitted inspection of 500 days of growth. Tapering of tip at distal end on lower right indicates hair had never been cut. (Magnifica- tion, x 1.5.)

squirm, and wriggle out of sight. The following technic has served well in eliminating these frustrations.

Double-stick transparent tape* is applied to the sur- face of a microscope slide. The hair root is placed on the upper left corner of the tape and held there by the edge of a glass slide grasped by the left hand. The hair shaft held between the right thumb and middle finger is made taut, aligned, and then pressed down with a stroke of the right index finger. The free hair shaft is then cut at the edge of the slide and the maneuver repeated until the hair is neatly and sequentially ar- ranged in parallel for its entire length (Fig. 1).

Slides so prepared allow swift, systematic examina- tion of the entire length of the hair shaft for morphologic changes as well as alterations in diameter associated with disease,~ malnutrition, z and cytotoxic agents.'~ The cuticle is especially well visualized in its natural state, using phase or, with very black hair, epi-illumination. Xylene or potassium hydroxide (KOH) may be applied under a coverslip for clearing hairs to be examined for fungal or bacterial infection.4 Fluorescent dye and im- munofluorescence studies may also be facilitated by this technic. 's

Moreover, a double-stick tape preparation can be made and gold-coated on a slide broken in half. By inserting this half-slide into the viewing chamber of a scanning electron microscope, it is possible to survey in complete continuity the gross and ultrastructure of the hair surface for the preceding months and years. Such "biologic archeology" discloses, for example, the

*Double-stick tape--Scotch brand, Catalogue No. 136, Minnesota Mining & Manufacturing Co., St. Paul, MN 55101.

waxing and waning of the hair shaft diameter during the course of alopecia areata. Weathering of the hair, as well as periods of systemic illness, becomes equally visible. Finally, the double-stick tape facilitates perma- nent filing of complete hair specimens in slide boxes.

Next time you have to look at hairs closely, re- member that double-stick tape could cut your troubles in half.

Walter B. Shelley, M.D., Ph.D. University of Illinois

College of Medicine at Peoria One lllini Drive, P.O. Box 1649

Peoria, IL 61656

REFERENCES 1. Rook A, Dawber R: Diseases of the hair and scalp. Lon-

don, 1982, Blackwell Scientific Publications, pp. 1-571. 2. Bradfield RB, Jeflift? EFP: Early assessment of malnutri-

tion. Nature 225:283-284, 1970. 3. Maibach HI, Maguire HC: Acute hair loss from drug-

induced abortion. N Engl J Med 270: [ 1112-I113, 1964. 4. Shelley WB, Wood MG: New technic for instant vi-

sualization of fungi in hair. J AM ACAD DERMA'rot. 2:69- 71, 1980.

5. Elias PM: Membranes, lipids, and the epidermal perme- ability barrier, in Marks R, Christophers E, editors: The epidermis in disease. Philadelphia, 1981, J. B. Lippincott Co., pp. 1-30.

Topical clindamycin versus sys temic tetracycline To the Editor:

I read with interest the article in the July, 1982, issue of the JOURNAL about topical clindamycin versus sys-