Celia Moss

Allergy to non-toxoid constituents of vaccines and implications for patch testing

We report 3 patients with persistent symptoms at vaccination sites. All were allergic to aluminium and one to thiomersal and neomycin too. Aluminium allergy causes false positive patch test reactions and we propose methods of patch testing patients with symptoms at vaccination sites in order to avoid this problem. The practical relevance of allergy to non‐toxoid constituents of vaccines is discussed.

Anhidrotic and achromians lesions in incontinentia pigmenti

Three women subsequently shown to have incontinentia pigmenti (IP) presented with white hairless streaks on the limbs as the predominant cutaneous abnormality. Seven other patients with IP diagnosed in infancy were reviewed to establish the frequency of this sign. It was found in all of them, and in the otherwise unaffected mother of three affected girls. A focal absence of sweating in these lesions is reported here for the first time. There are other similarities with anhidrotic ectodermal dysplasia, suggesting a genetic overlap between these two X‐linked conditions.

Rothmund-Thomson syndrome: a report of two patients and a review of the literature

Two siblings with poikiloderma, short stature and other abnormalities are described. They were originally reported as having Morquio syndrome; subsequently, mucopolysaccharidosis was excluded biochemically and they were classified as ‘a newly recognized syndrome of connective tissue dysplasia’. It is now clear that their disorder is the Rothmund‐Thomson syndrome (RTS).

A current and online genodermatosis database.

Clinical dermatologists have great difficulty keeping abreast of research in genetic skin disease. This is because there is too much information, in too many places, and in an unfamiliar language. In this review we have simplified and tabulated our current knowledge of the genodermatoses. We hope this ‘at a glance’ online guide will help dermatologists apply research findings to clinical practice and give informed advice to patients.

Compound allergy to a skin marker for patch testing: a chromatographic analysis

We present details of a patient who was demonstrated to have contact allergy to a solution used to mark sites of application of patch tests, during investigation of allergy to gold and nickel. Negative results were obtained when patch testing was performed using the individual constituents of the marker solution (gentian violet, dihydroxyacetone and acetone). Chromatographic analysis of various combinations of these chemicals did not identify a chemical derivative which might have caused this reaction.

Precocious puberty in a boy with a widespread linear epidermal naevus

Summary A 7‐year‐old boy with a systematized verrucous epidermal naevus, multiple pigmented naevocytie naevi and precocious puberty is deseribed. The possible basis for this previously unreported association of abnormalities IS discussed.

Dermatology and the human gene map

Summary Chromosomal localization has been established for many genetic traints. Gene mapping may lead to the identification of disease genes, an understanding of pathogenesis, and the development of rational therapy, as well as facilitating antenatal diagnosis and genetic counselling. ‘The new genetics’1 is therefore of great interest to the clinician. Unfortunately the complex technology and unfamiliar vocabulary of molecular biology often deter non‐specialists from keeping abreast of these developments. This account explains the principles of gene mapping, discusses its relevance to dermatologists, and lists the established loci of dermatologically important genes.

Genetic control of sebum excretion and acne—a twin study

SIR, I am puzzled by the data of Drs Walton, Wyatt and Cunliffe regarding acne in twins, and doubt the validity of their conclusions. Firstly, some of the acne grades stated in Table i and implicit in Figure 2 are inconsistent with the grading increments of the method quoted.^ Figure 2 shows that acne grade in eight pairs of twins difTered by only o i grades, yet the smallest interval between grades used by Burke and Cunliffe (1984) was o 25. The present authors do not indicate any modification of the original method or validate this degree of accuracy. Secondly, the population studied clearly did not suffer from acne. Although 16 out of 20 pairs in each group had evidence of acne, the median grade for all groups was o 25 or less, on a scale of o-io where grades of less than i represent physiological acne.^ Table i shows that none of the 40 non-identical twins had greater than grade i acne (although Figure 2 mysteriously shows a female with acne i 4 grades worse than her non-identical twin sister). Given that the greatest difference in acne grade for any of the 40 pairs of twins was only i 4 (which must be close to the limits of accuracy), the real conclusion from this study must surely be that there is concordance for acne grade in all twins. Studying a population with acne grades clustered around zero makes it difficult not to show concordance: the authors give a false impression of discordance in Figure 2 by plotting the data on a scale of o-i -6 instead of o to 10, and failing to indicate realistic limits of observer error (the unexplained hatched area must have been unwittingly copied from Figure i). Discordance can be convincingly demonstrated only by including patients with severe acne. From the report of a left-right mosaic patient with worse acne and greater sebum excretion rate (SER) on one side of the back^ the probable answer is that acne severity, like SER, is genetically controlled and will show greater concordance in monothan di-zygotic twins.

Serum 25-OH vitamin D after photochemotherapy

Patients receiving photochemotherapy (PUVA) for psoriasis were shown to have an increase in scrum 25‐OH vitamin D. The effect was not seen with UV‐A alone or 8‐MOP alone.

“NEW” SYNDROME WITH TELANGIECTASIA, DWARFISM, AND SPONDYLOEPIPHYSEAL DYSPLASIA MAY BE ROTHMUND‐THOMSON SYNDROME

To the Editor: Dermatophytic infections are rare in infancy, with only a few case reports of tinea faciei occurring in neonates (1-3). We recently examined an infant in whom the lesion on the face had started at the age of 3 days. A 1-month-old Indian female was seen for an erythematous annular lesion with central clearing on the right cheek (Fig. 1). According to the mother, the lesion was noticed on the third day of life and had been gradually increasing in size. A potassium hydroxide (KOH) examination was positive for fungal hyphae. and culture on Sabourauds medium was positive for Trichophylon rubrum. The infant was treated with clotrimazole cream 1% topically, and the lesion cleared in two weeks. Examination of the mother revealed annular lesions with active margins on the abdomen. A KOH examination ofthe material from the edge of a lesion revealed fungal hyphae. and culture grew T. rubrum. Isolation of T. rubrum from both the infant and mother is interesting. Singh (4). who produced experimental Trichophyton infection of intact human skin by putting a suspension of T. rubrum ctilture under occlusion, observed that five days were enough to produce the lesion and. under optimal conditions, the incubation period may be less. Sloper (5) reported the incubation period to be three days for the organism. In our patient, the incubation period was less than a week, as the infant most probably acquired the infection from her mother. Apart from Kamalam and Thambiah (6). who reported tinea faciei in a 2-day-oid infant, our patient is the youngest to be reported with a dermatophytic infection.