C.D. Calnan

Thalidomide in actinic prurigo

Fourteen patíents sufferíng from actíníc prurígo were treated with thalidomide. Eleven patients showed lasting improvement on the drug and three of these remained symptom‐free after discontinuing therapy. No major side‐effects were observed. Thalidomide is an effective drug in the treatment of actinic prurigo but it must be used with adequate contraception in women of child‐bearing age.

Lichen aureus: A localized persistent form of pigmented purpuric dermatitis

Localized persistent pigmented macules and plaques due to a chronic form of pigmented purpuric dermatitis are described in forty‐two patients. The designation ‘lichen aureus’ for this eruption can be justified because of the striking yellowish or bronze‐like colour assumed by many of the lesions. The lower legs were the commonest sites but other body regions can be affected also. Histologically lichen aureus differs from other pigmented purpuric dermatoses in the density of the lichenoid tissue reaction and the marked accumulation of pigment‐containing macrophages. Recently developed endothelial cell markers have been studied in selected cases.

Contact and photocontact allergy to musk ambrette.

Musk ambrette, a contact and photocontact allergen, is a synthetic fragrance present in aftershave lotions and many toiletries. Thirty‐four patients with contact and photocontact allergy to musk ambrette were studied. All had a facial eczema. Four distinctive clinical pictures were seen. These were plaques of eczema, jawline (mandibular) dermatitis, acute contact dermatitis and chronic actinic dermatitis. Twenty‐six patients were light sensitive by history and 10 were diagnosed by clinical criteria as having chronic actinic dermatitis. Patch and photopatch testing to musk ambrette showed that seven patients had pure photocontact dermatitis to musk ambrette. Eight patients had contact dermatitis to musk ambrette but this was exacerbated by irradiation. Cross reaction with moskene occurred. Scrupulous avoidance of musk ambrette has resulted in clinical resolution in most patients.

Trichophyton soudanense in Britain.

IVE diseases in man have undergone remarkable eindemiological changes during tbe ])resent century. SuperHcial dcrmatomycoses are no exception. In Britain tlie once almost imiversal Microsporum audouini has been displaced by Microsporum canis as a major cause of tinea capitis : it is possible that Trichophyton tonsurans (or the closely related T. sulphureum.) may supercede M. canis in the next decade. Infection with T. tonsurans is gradually increasing in incidence from south to north over the United States, in a similar way to that in which Trichophyton rubrum. has si)read east and west over most if the world from China and Eastern Asia. The incidence of candidiasis also appears to be increasing in many countries, including Great Britain. I t is by no means easy to aeeount for such changes in the incidence of fungi causing human disease, although a number of possible factors may be suggested, such as the speed of modern travel and the movement of populations ; antibiotic therapy may also be important. We wisli to rei)ort here the isolation from three patients in London of Trichophyton soudanensc, a species new to Britain. All the patients were immigrants from West Africa.

A clinicopathological study of reactive perforating collagenosis: report of 10 cases

The histogenesis of 10 patients with reactive perforating collagenosis (RPC) has been studied. All patients had had recurrent keratotic papules on exposed surfaces leaving varioliform scars since childhood. Seven patients were male and three female, ages ranging from 9–56 years (median 24 years) at presentation. Seven patients were Caucasian (two Portuguese) and three Asian. A familial history of RPC was obtained in two patients. The hands, forearms and, less frequently, the legs, face and trunk were affected. A striking event in one patient was the occurrence of widespread eruptive lesions of RPC on the trunk and limbs, following total body irradiation and cytotoxic therapy for leukaemia.

Unsolved problems in occupational dermatology

Most medical publications understandably describe the authors successes, whether in diagnosis, treatment or research progress. But in the real world most of us are regularly conscious of failure. I shall briefly record just 4 recent unsolved problems in occupational dermatology because, even though many dermatologists will encounter the same problems, none usually feels able to record them for public scrutiny.

10) Relapsing polychondritis

elbow fiexure showed some dermal scarring with a moderately dense lympho-histiocytic infiltrate containing several hypcrchromatic cells. Course and treatment. Electron beam therapy or topical nitrogen mustard therapy were both considered but he was treated instead with bleomycin i mg daily sub-cutaneously. He responded very well; the lesions cleared though occasional new ones appeared and lasted for a week or two. There was some hyperpigmentation at the sites of previous lesions (as shown in Fig. i), which is a feature of bleomycin therapy. Comment. This patients mycosis fungoides with generalized infiltrated plaques responded well to bleomycin therapy. Spigel & Coltman (1973) reported two cases of mycosis fungoides refractory to all other modes of therapy, who went into remission with bleomycin. They recommended that maintenance of remission should be with a combination of bleomycin and cyclical prednisone and cyclophosphamide. Blum, Carter & Agre (1973) reviewed data from 1174 patients treated with bleomycin and concluded that its use as a single antineoplastic agent should be in end stage patients resistant to conventional therapy or disabled by side effects, especially myelotoxicity. They found it to be uniformly active against all types of lymphoma, with a 5% complete response rate and a 33% partial response rate for the 198 patients evaluated.