Gillian Marshman

Tea tree oil reduces histamine-induced skin inflammation

Summary Background  Tea tree oil is the essential oil steam‐distilled from Melaleuca alternifolia , an Australian native plant. In recent years it has become increasingly popular as an antimicrobial for the treatment of conditions such as tinea pedis and acne.

Pediatric Atopic Eczema: The Impact of an Educational Intervention

Abstract:  Patient education has been regarded as having a key role in the self‐management of atopic eczema. However, the relationship between the educational interventions and clinical outcomes including severity of eczema, quality of life, and family impact has not been rigorously examined. The purpose of this longitudinal randomized controlled study was to evaluate the impact of an intensive education program with a focus on dermatology and immunology designed for parents and children diagnosed with atopic eczema. The intention of this study was not to change treatment regimes prescribed by the patients physician. The Scoring Atopic Dermatitis rating system was used for assessment of disease impact, and the impact on quality of life was quantified by using the Childrens Dermatology Life Quality Index, Infants’ Dermatology Quality of Life Index, and Dermatitis Family Impact. A total of 61 pediatric patients (0–16 years) diagnosed with atopic eczema from the metropolitan area of Adelaide were randomized to either the control or intervention group. Results of the study showed that the intervention group had a significant improvement in the scoring atopic dermatitis measure when compared to the control group at week 4 and week 12. Quality of life measures did not significantly improve with decreased severity of eczema except in the group of children aged 5–16 years which, despite small numbers, showed a significant improvement in quality of life scores. These findings suggest that education provides an important role in decreasing the severity of eczema.

Subcutaneous fat necrosis of the newborn following hypothermia and complicated by pain and hypercalcaemia

A female infant was delivered at term with complications of severe meconium aspiration and birth asphyxia. Surface cooling was performed in the first 24 hours as part of the management of her birth asphyxia. Woody erythema was noted at 24 hours, followed by the formation of red–purple nodules on the 6th day. Clinical findings in the first 24 hours were suggestive of cold panniculitis. However, clinical and histological findings progressed to be in keeping with the diagnosis of subcutaneous fat necrosis of the newborn (SCFN). Furthermore, the immediate postnatal period was complicated by pain resistant to treatment with opiates. Asymptomatic hypercalcaemia was noted on periodic testing at 7 weeks and treated by rehydration, diuretics, prednisolone, etidronate and a low‐calcium and ‐vitamin D diet. A review of the clinical and histological findings of the relevant panniculitides occurring in the postnatal period is presented, as well as a review of the treatment of hypercalcaemia in SCFN.

Association between melanoma and dermal mast cell prevalence in sun‐unexposed skin

Background  Both exposure to intermittent intense sunlight during childhood and ultraviolet (UV) radiation‐induced immunomodulation have been directly associated with melanoma development. In mice, the prevalence of dermal mast cells determines susceptibility to UVB‐induced systemic suppression of contact hypersensitivity responses and thus may affect immunological responses to melanoma antigens.

Susceptibility to Basal Cell Carcinoma is Associated with High Dermal Mast Cell Prevalence in Non–sun-exposed Skin for an Australian Population¶

Abstract In a Danish population, basal cell carcinoma (BCC) patients have a higher dermal mast cell prevalence in buttock skin than controls. This finding was supported by a functional link in mice between histamine-staining dermal mast cells and the extent of susceptibility to UV-B–induced systemic immunomodulation. It was important to confirm that this association was maintained in an Australian population with very different ancestry and sun exposure patterns. Australian BCC patients (n = 26) had significantly higher densities of mast cells in the dermis of buttock skin than control subjects (n = 25) (P = 0.0003, Mann–Whitney U-test). However, this correlation was lost at the sun-exposed site of the hand (P = 0.547, Mann–Whitney U-test). To further evaluate whether a relationship exists between dermal mast cell prevalence in sun-exposed skin and incidence of BCC in a larger study, biopsies of dorsal hand skin were obtained from an age-stratified random sample of 166 Queensland subjects, together with the 51 South Australian subjects, and dermal mast cell prevalence was quantified. Older subjects (over the median age of 42 years) had a greater incidence of BCC development (P = 0.0001, chi-square test) and significantly higher mast cell densities in hand skin (P = 0.0001, chi-square test) than younger subjects. However, mast cell density in sun-exposed hand skin was not significantly associated with BCC incidence. Finally, cellular expression of c-kit correlated with mast cell prevalence in non–sun-exposed skin, thereby implicating the stem cell factor–c-kit axis in the intrinsic mechanisms that regulate prevalence. These results show that high prevalence of dermal mast cells in buttock skin but not hand is associated with BCC development in an Australian population.

Allopurinol induced generalized eosinophilic pustular folliculitis

A 71‐year‐old Cambodian man who was commenced on allopurinol for the treatment of gout developed a generalized papulopustular follicular eruption 8 weeks following introduction of the drug. The skin biopsy findings were consistent with that of eosinophilic pustular folliculitis. Resolution of the rash took place during the 8 weeks following cessation of allopurinol and treatment with oral and topical corticosteroids.

CUTANEOUS ABNORMALITIES IN ANOREXIA NERVOSA

Anorexia Nervosa (A.N.) is a relatively common eating disorder with well recognized psychological and physiological features. A study of 14 female patients with A.N. revealed a number of dermatological disorders, including lanugo hair, xeroderma and hyperpigmentation.

Prospective study of patch testing in patients with vulval pruritus

Forty‐three patients with the primary complaint of vulval pruritus were recruited to take part in this prospective patch‐testing study. A detailed questionnaire was administered to each and patch testing to an extended battery of allergens was undertaken. This included the European standard series, preservatives, corticosteroids and a battery of common over‐the‐counter topical vulval treatments. Analysis of demographic data and prior treatments used, and various other parameters, were studied in the context of patch‐test results. This prospective study reports a very high rate of contact sensitivity in patients presenting with vulval pruritus, with 81.4% of those tested having at least one contact allergen detected. One or more clinically relevant allergens were found in 44% of the subjects patch tested. The variables found to predict a greater likelihood of a contact allergy were a biopsy diagnosis of vulval dermatitis, the use of multiple topical treatments, sexual inactivity and patients with severe pruritus on a self‐reported scale. Most importantly, many clinically relevant allergens these patients reacted to were outside the European standard series. This highlights the need for an extended series in this patient population.

Folliculitis in Down's syndrome

Twenty‐two male and 20 female adults with Downs syndrome were examined. Ten of the men and two of the women had a folloicular rash consistent with Malassezia folliculitis. Oral itraconazole treatment produced a significant improvement in the rash. Accompanied by a decrease in the skin Malassezia count. Clinical relapse occurred when therapy was discontinded, and was accompanied by return of the Malassezia yeasts.

A case of Grzybowski's generalized eruptive keratoacanthomas.

We report a case of Grzybowskis generalized eruptive keratoacanthoma which demonstrates the characteristic features of this rare condition. The recurring nature of the eruption each summer supports the suggestion that UV irradiation may act as a precitating factor in eruptive keratoacanthoma.