J. Garioch

Acne in schoolchildren: no longer a concern for dermatologists.

OBJECTIVE--To determine the prevalence and severity of acne among schoolchildren in Glasgow. DESIGN--Secondary schools in Glasgow were divided by postcode into five socioeconomic cluster groups. Different numbers of schools were selected at random from the five groups to ensure proportional representation. One class from each registration year of the chosen schools was selected at random and the whole class recruited into the study. SETTING--15 Secondary schools in Glasgow. SUBJECTS--2014 Randomly selected schoolchildren aged 12-17 (5% of total secondary school roll). INTERVENTIONS--None. END POINT--Assessment of facial acne by two independent examiners by a recognised acne scoring system. MEASUREMENTS AND MAIN RESULTS--The prevalence of acne in boys increased from 40% (75/189) at age 12 to 95% (108/114) at age 16, and in girls it increased from 61% (114/187) at age 12 to 83% (136/164) at age 16. On a scale of 0 to 10 only 18 boys (1.8%) and three girls (0.3%) had grades of acne of 1.0 or greater; most of the pupils had grade 0.05-0.375 (minimal) acne. Nine per cent of boys (88/973) and 14% of girls (145/1041) had visited their general practitioner specifically for advice on and treatment for acne; only five pupils (0.3%) had been referred to a dermatologist. CONCLUSIONS--Both the prevalence and severity of acne have decreased over the past 20 years. This has probably been due to improvement of treatment for acne by primary care doctors and the greater availability and use of over the counter preparations for acne.

Contact sensitivity to menthol and peppermint in patients with intra‐oral symptoms

We report 12 cases of contact sensitivity to the flavouring agents menthol and peppermint oil in patients presenting with intra‐oral symptoms in association with burning mouth syndrome, recurrent oral ulceration or a lichenoid reaction. The patients were referred from the Glasgow Dental Hospital over a 4‐year period for assessment of the possible contribution of contact sensitivity to their complaints. 5 patients with burning mouth syndrome demonstrated contact sensitivity to menthol and/or peppermint, with 1 patient sensitive to both agents, 3 positive to menthol only and 1 to peppermint only. 4 cases with recurrent intra‐oral ulceration were sensitive to both menthol and peppermint. 3 patients with an oral lichenoid reaction were positive to menthol on patch testing, with 2 also sensitive to peppermint. 9 of the 12 cases demonstrated additional positive patch test results. After a mean follow‐up of 32.7 months (range 9–48 months), of the 9 patients that could be contacted, 6 patients described clearance or improvement of their symptoms as a consequence of avoidance of menthol/peppermint.

Thermographic assessment of patch‐test responses

Infra‐red thermography was used to quantify, at patch test sites, the allergic responses to experimental preparations of nickel sulphate and primary irritant responses to sodium lauryl sulphate in small groups of volunteers. The technique was also used to assess the patch‐test responses in a much larger group of patients who had undergone routine patch testing for contact allergy with a wide range of test substances and among which there were large numbers of allergic, irritant and equivocal reactions. Thermographically, when compared to the surrounding normal skin surface, the sites of allergic reactions appeared as hot areas, the temperature and area of which were apparently dependent on the severity of the response. For allergic responses, there was a good correlation between the clinical assessment and either of two thermographic parameters, temperature and area of involvement. Compared with an aqueous solution of nickel sulphate, ‘poor’ formulations of the allergen, such as a suspension in soft paraffin base, elicited smaller and cooler reactions. Irritant reaction sites were not ‘hot’ and the temperature at such sites was no different from that of the surrounding normal skin. Infra‐red thermography is a convenient non‐invasive technique which apparently can be used to discriminate between irritant and allergic responses and to quantify the latter type of response.

Dermatoses in five related female carriers of X‐linked chronic granulomatous disease

Eight female members of a family with X‐linked chronic granulomatous disease were identified. Five were shown to be carriers of the disease gene. Each of these female carriers of the gene had a history of skin eruptions. The identification of the carrier state is important as genetic counselling should be offered and the prenatal diagnosis of this disorder is possible.

Pachyonychia congenita complicated by hidradenitis suppurativa: a family study

A family is described in which five of the six members with the Jackson–Lawler type of pachyonychia congenita also had varying degrees of hidradenitis suppurativa. We suggest an association between this type of pachyonychia congenita and hidradenitis suppurativa.

T-cell lymphoma presenting with severe digital ischaemia.

We report a case of T‐cell lymphoma which presented with sudden severe digital ischaemia.

Malignant melanoma and systemic mastocytosis a possible association

Lymphoproliferative and myeloproliferative malignancies have been noted in patients with systemic mastocytosis1 and urticaria pigmentosa.2 However, to our knowledge an association between mastocytosis and malignant melanoma has not been reported previously.

The relevance of elevated Borrelia burgdorferi titres in localized scleroderma

A 46-year-old man with a 2-year history of localized scleroderma of his right upper arm and elevated Borrelia burgdorferi titres is described. The association of Borrelia burgdorferi infection and localized scleroderma is discussed.

Patch testing in lichenoid reactions of the mouth and oral lichen planus

The role of allergic contact dermatitis in the pathogenesis of orai iichen pianus/lichenoid reactions remains controversial. The standard European, dental (Chemotechnique), organic mercurial and food batteries were appiied to 53 patients with biopsy proven, symptomatic oral lichen pianus (or iichenoid reactions in the mouth) between 1983 and 1988. There were 91 positive reactions in 39 patients: mercury/organic mercurials (22 positives in 15 patients), fragrances (20 reactions in 13 patients), foods (12 reactions in 10 patients: eight cinnamaidehyde, four benzoic acid), medicaments (11 positives in seven patients), metals (19 positives in 17 patients: nine CUNO3, six nickei, four other), rubber mixes (four reactions in four patients), and coiophony (three patients). In addition, there were several irritant reactions, mostiy to mercury and CUNO3. The patch test reactions were thought to be reievant in 21 patients, not relevant in 10 and undetermined in eight patients. Ofthe 21 patients with relevant positive reactions, 13 were thought primariiy to be due to mercury (seven patients had amaigams repiaced and all improved, three patients deciined replacement and three were lost to followup), four to cinnamaldehyde/benzoic acid (ail improyed on dietary restriction/change in toothpaste), two to rubber mixes (both improved on replacement of rubber pillows), one to nickel (patient with rheumatoid arthritis on gold injections who fiared after each injection) and one to formaidehyde (improved after change in toothpaste). Although the aetioiogy of oral lichen planus is still unknown the results of the present study would support the view that contact aiiergy plays a significant roie in its pathogenesis.

Cyclosporin and gingival hyperplasia.

SIB, GinjiCival hyperplasia is a well-recognized side-effect of cyclosporin therapv. As cyclosporin is being used more frequently in tbe management of dermatological conditions, tbose prescribing this drug should be aware of this side-effect and seek early specialist advice for ibeir patients. We sbould like to report a recent case wbicb illustrates tbis feature. In June 1988, a 28-year-old Caucasian female was admitted to our ward as an emergency witb an acute onset of acbing limbs, genera! malaise and abdominal pain. Examination revealed a peri-orbital beliotrope rasb and a maculopapular erythematous rash on ber forehead, anterior cbest, dorsal surface nf ber fingers and metacarpophalangeal joints. Sbe bad periungual erythema and capillary dilatation, .\ symmetrical proximal muscle weakness and tenderness was noted in both upper and lower limbs. Extensive investigations confirmed tbe clinical diagnosis of dermatomyositis. Treatment was commenced with high doses of steroids, but despite tbis ber myositis worsened rapidly, and in July 1988 cyclosporin (oral suspension) was introduced at a dose of 5 mg/kg body wt daily. A furtber deterioration in ber condition in August 1988 prompted an increase in tbe cyclosporin (oral suspension) dose to 7-5 mg/kg daily, which was followed by marked, sustained improvement in ber condition. In October 198S ber cyclosporin was changed to tbe capsular form and, as tbis caused an elevation in whole blood levels of cyclosporin above tbe recommended target concentrations suggested by Sandoz, ber cyclosporin was reduced to 3 mg/kg daily, resulting in acceptable cyclosporin levels, Sbe developed bypertension, and metoprolol was commenced in January 1989, Beta blockers did not adequately control her hypertension, so nicardipine was added in February 1989 at a dose of 20 mg t,d,s. Nicardipine caused a further increase in her cyclosporin levels necessitating an additional reduction in ber cvclosporin dose to 2 mg/kg daily. Currently sbe is maintained in remission on this do.se of cyclosporin, prednisolone baving been discontinued December 1989,