Anthony Yung

Microbiological effect of photodynamic therapy (PDT) in healthy volunteers: a comparative study using methyl aminolaevulinate and hexyl aminolaevulinate cream

Background.  Acne vulgaris is a common skin problem that affects up to 90% of adolescents. Colonization of the duct with Propionibacterium species is one of the factors implicated in the development of acne. Owing to the increasing incidence of antibiotic resistance, there has been an greater interest in the development of new methods to treat acne. Early studies have shown that photodynamic therapy (PDT) with aminolaevulinic acid (ALA) can lead to prolonged improvement in acne. Newer derivatives of ALA such as methyl aminolaevulinate hydrochloride (MAL) and hexyl aminolaevulinate hydrochloride (HAL) have been developed for use in PDT, with the potential benefits of higher lipophilicity and penetration potential.

A case of isolated cutaneous pseudo-inflammatory tumour

Pseudo‐inflammatory tumours are a poorly defined group of tumours, with indeterminate malignant potential, which can occur at almost any site of the body. The optimal treatment of inflammatory pseudo‐tumours is yet to be elucidated. Surgical excision has been the most frequently reported treatment in the literature. We report a case of solitary cutaneous inflammatory pseudo‐tumour.

A trial of low-dose UVA1 phototherapy for two patients with recalcitrant discoid lupus erythematosus

a clinical improvement with no adverse reaction. After a second session with the QSRL, the patient developed some textural change and postinflammatory hyperpigmentation. The fluence was therefore reduced to 2.7 J ⁄ cm with a 6-mm spot diameter. He has now had four sessions with good clearance (Fig. 1b) and continues with QSRL to the remaining areas. In the few previous cases reported, this localized pigmentation was described histologically as lentigines or as hyperpigmentation of the basal layer of the epidermis with no increase in numbers of melanocytes. The underlying mechanism for the formation is unknown, but the majority of cases arose during phototherapy. Earlier cases were noted with psoralen ultraviolet A and later cases with ultraviolet B phototherapy. This pigmentation can arise without phototherapy and has been suggested to be a type of postinflammatory hyperpigmentation. Longterm follow-up has not previously been reported. In one case, the pigmentation disappeared within 4 months from some areas of the patient’s body but remained on the legs. In another case, the freckling resolved after 4 weeks with topical calcipotriol. Our patient is the first reported describing persistence of these lesions for years. It is unknown whether this localized pigmentation will be a marker for cutaneous malignancy. Dark irregular lentigines confined to existing psoriatic plaques have also been described and felt to be an under-reported phenomenon. The cause was also unknown, although it was noted that patients had been treated topically with tar or dithranol. The lesions differ from our case as they arose within present psoriasis plaques rather than areas where plaques had resolved. Both the QSRL and the QSFDNYL are known to be effective in clearing pigmented skin lesions. It is difficult to explain why the QSFNDNYL did not clear the pigmentation in our case. To our knowledge, this is the first report describing the successful use of a QSRL for clearing pigmentation within resolved psoriatic plaques.

Streptococcus induced pustular vasculitis affecting the hands resembling pustular vasculitis of the hands – first reported case

Pustular vasculitis of the hands is a distinctive clinical entity. It has recently been proposed by some authors to rename pustular vasculitis of the hands as ‘neutrophilic dermatosis of the hands’ to reflect its histological resemblance to the neutrophilic dermatoses. We report the case of a 66‐year‐old woman who presented with clinical appearances resembling pustular vasculitis of the hands associated with palmo‐plantar pustulosis due to Streptococcus‐induced ‘pustular vasculitis’.

Flushing Due to Solitary Cutaneous Mastocytoma can be Prevented by Hydrocolloid Dressings

Abstract:  Solitary mastocytomas occur commonly and can occasionally be associated with troublesome flushing related to rubbing. We report a child with a solitary mastocytoma who repeatedly and reproducibly caused flushing only with rubbing and scratching. Conventional treatment with antihistamines was not completely effective and caused sedation. A trial application of double‐layer hydrocolloid dressing led to complete abolition of flushing episodes until the child reached an age where he could peel off the dressings. This treatment is particularly suited to very young children with solitary mastocytomas whose parents do not feel comfortable with antihistamine treatment, topical or intralesional corticosteroids, or surgical interventions. This treatment may be used alone or in conjunction with conventional therapy where there has been a failure to achieve complete control of flushing and/or blistering.

An erythematous nodule on the eyelid

A 43-year-old white woman with autism presented with a 5-month history of a slow-growing asymptomatic lesion on the left lower eyelid. Her mother thought it might have arisen following a bee sting. There was no other medical history of note and the patient was otherwise well. On examination, an indurated erythematous nodule measuring 15 mm with oedema was found on the left lower eyelid (Fig. 1). A punch biopsy was performed.