Melorheostosis and Sclerodermoid Skin Changes: In Response

318 Mayo Clin Proc, March 1996, Vol 71 LETTERS in helping the Russian people to identify, understand, and propagate the principle of individual rights. One of those rights, however, is to be able to protect their youth from the menace of the tobacco industry and its attendant death and disability. As we learn more about the inner workings of the tobacco industry through internal documents that recently have been made public, 1 it is difficult to understand how a member of the health-care profession could support the positions of the tobacco industry. These documents reveal that the industry has known for decades about the addictiveness of nicotine and the deadly effects of tobacco use. Unfortunately, Dr. Whaley seems to forget the societal responsibilities of industry to perpetuate no harm to people or the environment. Worldwide, an estimated 2 million deaths per year are due to tobacco-related diseases. This number is destined to increase as the Western tobacco companies expand their influence in the developing countries of the world. American physicians should support the efforts of individuals like Dr. Gesme in helping Russian physicians educate their youth and expose the Western tobacco companies for what they really are. Anthony Lewis,' a columnist for The New York Times, expressed it well: "Tobacco people live a dilemma. They merchandise death, and they want to prosper in their business. But they also want to look-and feel-like decent citizens. We may appreciate their dilemma. But we do not have to believe them." ing structures.' Biopsy specimens of the affected skin reveal areas of fibrosis in the subcutaneous tissue/ or dermis.l? The onset of melorheostosis occurs between infancy and adolescence. The disease is frequently progressive during the period of active growth. Roentgenographic examination reveals linear hyperostosis, usually involving the cortical bone of an extremity. Patients may be profoundly disabled and may complain of pain. Melorheostosis can manifest with restricted joint mobility, chronic dislocation of the patella, leg length discrepancy, and muscle atrophy. The cause of melorheostosis remains unknown, although a primary mesenchymal defect has been suggested." Richard D. Hurt, M.D. Mayo Clinic Rochester Rochester, Minnesota In response: We appreciate Dr. Pollock's interest in our article and agree with his comments. Although melorheostosis is a rare disorder, it should be added to the list of sclerodermoid conditions that mimic morphea. REFERENCES 1. Glantz SA, Barnes DE, Bero L, Hanauer P, Slade J. Looking through a keyhole at the tobacco industry: the Brown and Williamson documents. JAMA 1995; 274:219-224 2. Lewis A. Abroad at home: just say no. The New York Times (late edition) 1995 Oct 16; 15 Jeffrey L. Pollock, M.D. Philadelphia, Pennsylvania REFERENCES 1. Fleischmajer R, Pollock JL. Progressive systemic sclerosis: pseudoscleroderma. Clin Rheum Dis 1979 Apr; 5:243-261 2. Wagers LT, Young AW Jr, Ryan SF. Linear melorheostotic scleroderma. Br J Dermatol 1972; 86:297-301 3. Thompson NM, Allen CEL, Andrews GS, Gillwald FN. Scleroderma and melorheostosis: report of a case. J Bone Joint Surg Br 1951; 33:430-433 4. Muller SA, Henderson ED. Melorheostosis with linear scleroderma. Arch Dermatol 1963; 88:142-145 5. Soffa DJ, Sire DJ, Dodson JH. Melorheostosis with linear sclerodermatous skin changes. Radiology 1975; 114:577-578 Lynne S. Peterson, M.D. Audrey M. Nelson, M.D. W. P. Daniel Su, M.D. Mayo Clinic Rochester Rochester, Minnesota Melorheostosis and Sclerodermoid Skin Changes To the Editor: I would like to add another sclerodermoid condition that mimics morphea to those discussed in the article "Classification of Morphea (Localized Scleroderma)" by Dr. Peterson and colleagues, which was published in the November 1995 issue of the Mayo Clinic Proceedings (pages 1068 to 1076). Melorheostosis is a rare acquired disorder of bone. It has been associated with linear sclerodermatous lesions that consist of an indurated band of skin often bound to the underly- The Editor welcomes letters and comments, particularly pertaining to recently published articles in the Mayo Clinic Proceedings. A letter should be no longer than 500 words, contain no more than 5 references, and be in a doublespaced, typewritten format. The letter should be signed. It is assumed that appropriate letters may be published, at the discretion of the Editor, unless the writer indicates otherwise. The Editor reserves the right to edit letters in accordance with the Mayo Clinic Proceedings style and to abridge them if necessary. For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings.