Clinical and Experimental Dermatology

OLIVER, F.; AMON, E. U.; BREATHNACH, A.; FRANCIS, D. M.; SARATHCHANDRA, P.; KOBZA BLACK, A.; GREAVES, M. W.

doi: 10.1111/j.1365-2230.1991.tb00282.xpmid: 2025924

SummaryA frequent cause of contact urticaria is skin exposure to the common stinging nettle (Urtica dioica). The urticaria is accompanied by a stinging sensation lasting longer than 12 h. Little is known of the cellular and molecular mechanism of stinging‐nettle urticaria. After preliminary pharmacological analysis of pro‐inflammatory activity in nettle stings, the cellular response of mononuclear cells, polymorphonuclear cells and mast cells was examined in six people 5 min and 12 h after nettle contact. Only mast cell numbers were significantly increased at 12 h. Ultrastructurally, some mast cells showed evidence of degranulation at 5 min and 12 h. At 12 h mast cells were closely associated with dermal dendritic cells and lymphocytes suggesting a functional unit. The mean histamine and serotonin contents of a nettle hair were found to be 6.1 ng and 33.25 pg, respectively. Nettle‐sting extracts did not demonstrate histamine release from dispersed rat mast cells in vitro. These results suggest that part of the immediate reaction to nettle stings is due to histamine introduced by the nettle. However, the persistence of the stinging sensation might suggest the presence of substances in nettle fluid directly toxic to nerves or capable of secondary release of other mediators.

KORSTANJE, M. J.; VAN DE STAAK, W.J.B.M.

doi: 10.1111/j.1365-2230.1991.tb00283.xpmid: 1902760

SummaryFourteen patients with psoriasis received long‐term treatment with cyclosporin (CsA). Among patients there was great variability in the minimal effective CsA dose. In most patients long‐term treatment was limited due to dose reductions made necessary because of side‐effects. The therapeutic window for CsA seems small. CsA blood levels associated with side‐effects and with the minimal effective dose are in the same range and correlation between CsA blood levels and effectiveness in psoriasis is weak. Therefore, in CsA therapy for psoriasis, without concomitant medication which may influence CsA blood levels, the measurement of CsA blood levels is not necessarily helpful in optimizing therapy or preventing side‐effects.

BUNKER, C. B.; MAURICE, P. D. L.; LITTLE, S.; JOHNSON, N. McI.; DOWD, P. M.

doi: 10.1111/j.1365-2230.1991.tb00284.xpmid: 2025925

SummaryDuring an open prospective study of the synthetic retinoid isotretinoin in ten patients with systemic sclerosis, one patient developed an eosinophilic pleural effusion and two patients were noticed to have asymptomatic deterioration in pulmonary function tests. The pulmonary function of all treated patients was then compared retrospectively with a similar control group of patients not treated with isotretinoin. There was a significantly greater decrease in the l‐s forced expiratory volume and transfer coefficient in the patients with systemic sclerosis being treated with isotretinoin in comparison to the untreated control patients. Studies of lung function in patients treated with isotretinoin for other indications are required.

BERTH‐JONES, J.; GRAHAM‐BROWN, R. A. C.; BURNS, D. A.

doi: 10.1111/j.1365-2230.1991.tb00285.xpmid: 2025926

SummaryWe report a series of 15 girls who developed lichen sclerosus between the ages of 18 months and 9 years. Only five of these were initially referred to a dermatologist and the diagnosis was made promptly in these cases on the first visit to the clinic. The diagnosis was usually delayed under disciplines less familiar with the disease. We encountered a high level of parental anxiety regarding the possibility of misdiagnosis of lichen sclerosus as childhood sexual abuse. Dysuria and pain on defaecation were common and prominent symptoms which have not previously been stressed adequately. The clinical features were diagnostic in all our cases, although three had undergone vulval biopsy under general anaesthesia prior to being seen by a dermatologist. There was a trend towards improvement with increasing age.

VERALDI, S.; GIANOTTI, R.; PABISCH, S.; GASPARINI, G.

doi: 10.1111/j.1365-2230.1991.tb00286.xpmid: 2025927

SummaryTwo cases of pigmented apocrine hidrocystoma in two women aged 47 and 60 years are reported. In both patients the lesion was located in the temporal region, Histopathological examination did not show the nature of the pigment present in both lesions. It is suggested that the pigmentation observed clinically is due to the Tyndall phenomenon.

YUTANI, Y.; KONO, T.; ISHII, M.; CHANOKI, M.; CHANOKI, Y.; ASADA, K.; SHIMAZU, A.; HAMADA, T.

doi: 10.1111/j.1365-2230.1991.tb00287.xpmid: 2025928

SummaryArticular tissue was obtained at surgery for a femoral neck fracture in a patient with psoriasis without arthritis. The proteoglycan of the cartilage of the sample was analysed biochemically. Normal cartilage is known to produce two types of proteoglycan monomers (fast‐ and slow‐sedimenting groups), which are distinguishable by density‐gradient ultracentrifugation. In the psoriatic cartilage analysed in the present study, it was shown that the former group was absent and only the latter group remained.

MCGRATH, J.; CERIO, R.; WILSON‐JONES, E.

doi: 10.1111/j.1365-2230.1991.tb00288.xpmid: 2025929

SummaryWe present a family with an inherited disorder of cornification. The clinical features are much less severe and developed much later in life than is usual in bullous ichthyosis. Skin biopsy demonstrated epidermolytic hyperkeratosis, a feature typical of bullous ichthyosis. The family is reported both to highlight the wide interfamilial variation that may occur in this condition and the value of histology in classifying this form of ichthyosis.

LAWRENCE, P.; ARONSON, I.; SAXE, N.; JACOBS, P

doi: 10.1111/j.1365-2230.1991.tb00289.xpmid: 2025930

SummaryRefractory leg ulcers in two patients healed following splenectomy. Neither patient had the ethnic background or family history of haematological abnormalities to suggest a haemoglobinopathy.

NORRIS, J. F. B.; HUGHES, B. R.; BASEY, A. J.; CUNLIFFE, W. J.

doi: 10.1111/j.1365-2230.1991.tb00290.xpmid: 1827368

SummaryA proprietary topical tetracycline preparation (Topicyc‐line) was compared with an alcohol‐based 5% benzoyl‐peroxide gel and with oral oxytetracycline (250 mg twice daily) using a randomized group‐comparative double‐blind study in 69 patients with mild to moderate acne. Facial acne grades improved significantly in all three treatment groups over the 12‐week study period but chest acne grades did not change significantly and only oxytetracycline produced a significant improvement in back grade. All three treatment groups produced a significant reduction in facial inflamed and non‐inflamed lesions apart from oxytetracycline which failed to produce a significant reduction in inflamed lesions. However, there were no overall significant differences between the three treatment groups either in improvement of acne grade or in reduction of inflamed and non‐inflamed lesions. We conclude that topical tetracycline is as effective as either 5% benzoyl‐peroxide gel or 250 mg oxytetracycline twice daily in the treatment of mild to moderate acne.

OBASI, O. E.

doi: 10.1111/j.1365-2230.1991.tb00291.xpmid: 2025931

SummaryFive patients (four black Nigerian males and one Polynesian) with pyoderma gangrenosum (PG) were seen between May 1974 and March 1984, at the Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria. Their age range was 12–42 years (mean 25.6 years). The female expatriate Polynesian patient had PG localized to the upper back while the other four patients had severe and extensive PG lesions. Local cleansing and dressing of the ulcers combined with appropriate systemic antibiotics produced healing in two of these patients. The empirical addition of dapsone and rifampicin led to complete healing in two others, but only transient remission in one patient who, after 22 years of disease activity, died at home from an aggressive and accelerated form of the disease best described as‘malignant pyoderma’gangrenosum.