Andrew P. Warin

Extramammary Paget's disease

Extramammary Pagets disease remains a difficult clinical diagnosis and, though biopsy readily establishes the presence of a tumour with an intraepidermal spread, this needs further study so that other tumours with a similar pattern of spread may be excluded. We advocate the use of a panel of readily available peroxidase‐labelled antisera to cell markers and antigens in addition to conventional special stains to achieve this purpose. The disease often extends beyond the clinically abnormal area and an underlying sweat gland carcinoma may be present: this was so in five of the six cases presented. Wide surgical excision with a check on limits of clearance is recommended.

Contact dermatitis due to Bisphenol A in semi-synthetic waxes

A 53-year-old man who had worked with liquid waxes for the previous 5 years, producing moulds for turbine blades, presented with an acute dermatitis of his right hand and a less florid dermatitis of his nose and nasolabial folds. The dermatitis first appeared 6 months earlier, and on 3 occasions rapidly settled when he was off work, only to relapse on his returning to work. He was right-handed and habitually rubbed his nose. He did not wear gloves at work and was not exposed to irritant chemicals. There was no past or family history of skin disease. An allergic reaction to a substance at his workplace was suspected. He was patch tested to the ICDRG standard allergens with no positive reactions. Patch testing against the substances he handled at work gave the following results.

Acute myelomonocytic leukaemia developing in a patient with psoriasis treated with oral 8-methoxypsoralen and longwave ultraviolet light.

Acute myelomonocytic leukaemia developed in a patient with psoriasis treated with oral 8–methoxypsoralen and longwave ultraviolet light (PUVA). The possibility that PUVA may induce haematological malignancies by damaging the DNA of cirulating multipotential haemopoietic stem cells is discussed. We advise increased attention to the haemopoietic system of patients treated with PUVA.

Photochemotherapy in the treatment of psoriasis and mycosis fungoides

In the past 20 years, three chronic photodermatoses that have a number of features in common have been deli nceated. These conditions were given the title of ‘persistent light reactivity’ (Wilkinson, 1962a), ‘actinic reticuloid’ (Ive et al., 1962)and ‘Photosensitive eczema’(Ramsay & Kobza Black, 1973). Patients with these diseases are almost always male and they are usually in the middle‐age to elderly age group. The morphology of the eruption is similar in each condition. It is usually eczematous with the addition of changes that resmble a cutaneous reticulosis in some patients. These facts would probably be accepted by most physicians who care for these patients but here agreement ends. Opinion varies on whether these are three separate diseases or different facets of the same disease. Some new observation have recently been made and this would seem to be a suitable time to review the problem of chronic photosensitivity, to discuss the nomenclature, and to try to gain some insight into the aetiology of the condition.

Dermatology day care treatment centres

Day care treatment centres provide the best solution for the treatment of most patients with psoriasis. The centre is not only ideal for treatment but has other roles, such as education of patients and nurses. The specialist dermatology nurse is the key to success. Out patient treatment of psoriasis is less expensive than in patient treatment. The development of a treatment centre should be seen as an additional facility and not as a substitute for in patient beds.

Allergic contact dermatitis from cobalt in a beauty product

A 21-year-old beauty therapist presented with severe hand eczema. She was not an atopic but gave a history of nickel dermatitis. Patch testing with the European standard series (Hermal) showed ππ reactions to nickel and cobalt only. Among her numerous products tested, the only ones to react were Galvaderm galvanic gel D (ππ) and galvanic gel E (ππ). Both these products contain cobalt (0.22% solution of cobaltous chloride in

Allergic contact dermatitis from dyes in wigs following diphencyprone treatment

A patient received an anaesthetic injection for a biopsy of a suspected basal cell carcinoma on the left forearm. The local anaesthetic consisted of, among other constituents, lidocaine 2% with adrenaline (1 : 100 000). According to the patient, a burning sensation developed around the site of the injection after 7 hr, itch after 24 hr and swelling and erythema after 48 hr. The form of the erythema was round and not that of the plaster that had been there. The symptoms and signs had disappeared in about a week. Patch tests were performed with the European standard series, lidocaine 2%/adrenaline from an ampoule, lidocaine 2% from an ampoule and all the ingredients in an ampoule of lidocaine 2%/adrenaline (lidocaine 2% in pet., adrenaline 2% pet., sodium metabisulfite 2% pet. and ethylenediaminetetraacetic acid 1% pet.). Positive reactions to nickel (þþ), lidocaine 2%/ adrenaline from the ampoule (þ) and sodium metabisulfite (þþ) were observed on day 3. Patch tests with sodium metabisulfite in 3 healthy volunteers were negative. Prick tests were performed with sodium metabisulfite (0.05%, 0.1%, 1% and 10% in water). All these were negative. Provocation test (subcutaneous injection) was performed with lidocaine 2%/adrenaline from an ampoule. The patient experienced a burning sensation, erythema and swelling at site of the injection after 48 hr. The symptoms lasted for a week. Provocation test with lidocaine 2% from an ampoule was negative.

Hypersensitivity reactions to latex in patients having topical treatment applied by health professionals wearing latex gloves.

Latex allergy is a Type 1 reaction, causing contact urticaria and even anaphylaxis (1), which is currently a particular problem among health care and dental professionals (2). Their patients may also experience such reactions, one source being the wearing of latex gloves by nurses applying medicaments.