J.J. Cream

Oral spironolactone: an effective treatment for acne vulgaris in women

The effect of oral spironolactone (200 mg daily) on acne vulgaris has been studied in 21 women in a randomized, placebo‐controlled, double‐blind crossover study using 3 month treatment periods. Compared with placebo, spironolactone produced significant improvement as assessed by subjective benefit (P<0.001), number of inflamed lesions (P<0.001) and by an independently evaluated photographic method (P<0.02). There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone. Initial plasma androgen levels were no higher in responders than in non‐responders, nor did oral contraceptive use appear to affect clinical response. Spironolactone is a useful alternative therapy for women with acne vulgaris.

The effect of methotrexate and hydroxyurea on neutrophil chemotaxis

Methotrexate depresses motility of neutrophils in chamber membranes, but does not interfere with random motility in tubes. Hydroxyurea has no such effect. The therapeutic response to methotrexate in psoriasis may be due in part to a reduction in migration of neutrophils into the epidermis.

Early warning skin signs in AIDS and persistent generalized lymphadenopathy

Cutaneous manifestations of AIDS include Kaposis sarcoma, chronic genital herpes simplex, herpes zoster, mucocutaneous candidiasis, fungal infection, pyoderma and seborrhoeic dermatitis. We have consistently seen distinctive patterns of skin disease in male homosexuals with AIDS, PGLS and in a high‐risk group who initially had neither condition. The prevalence of skin disease was assessed in nine patients with AIDS, 15 with PGLS, four in the high‐risk group and in 40 male homosexual patients acting as controls.

Molluscum contagiosum virus types in genital and non-genital lesions.

The endonuclease digest patterns of viral DNA from 48 genital and 45 non‐genital molluscum contagiosum virus (MCV) lesions were examined. The overall ratio of MCVI to MCVII was 3.23:1. There was no predominance of either MCV type in genital lesions. No obvious morphological differences were seen between MCVI and MCVII lesions. MCVII was not found in any patient under 15 years old.

Complement abnormalities in diffuse plane xanthomatosis with paraproteinaemia.

Paraproteinaemia may be associated with xanthomatous skin deposits and these can arise in the absence of elevated lipid levels. Two cases of benign monoclonal gammopathy with diffuse plane xanthomatosis are reported. Case 1 exhibited hypolipidaemia and a functional deficiency of C1 esterase inhibitor. Case 2 showed a normal lipoprotein profile, abnormal platelet aggregation, and a cutaneous vasculitis with evidence of complement consumption via the classical pathway. The significance of these abnormalities is discussed.

A novel mutation in the XPA gene associated with unusually mild clinical features in a patient who developed a spindle cell melanoma

Background  Xeroderma pigmentosum (XP) is an autosomal recessive disorder of, in most cases, defective nucleotide excision repair (NER) of ultraviolet radiation (UV)‐ and chemical‐induced DNA damage. The condition is characterized by an increased sensitivity of the skin to UV radiation, with early development of pigmentary changes and premalignant lesions in sun‐exposed areas of the skin, signs of photoageing and a greatly increased incidence from a young age of skin tumours including melanoma. Approximately 20% of patients with XP show neurological abnormalities of varying severity due to primary neuronal degeneration. Genetic analysis by somatic cell hybridization has led to the identification in the NER‐defective form of XP of seven complementation groups, designated XP‐A to XP‐G. These complementation groups correspond to different proteins involved in the NER process. XP‐A classically includes some of the most severely affected patients.

Molluscum contagiosum: characterization of viral DNA and clinical features.

Restriction endonuclease analysis of molluscum contagiosum virus DNA revealed two subtypes. In a study of 46 isolates from 41 patients, some with no other disorder and some with atopic dermatitis, the ratio of MCV I isolates to MCV II was 34:12. Multiple clustered lesions removed at the same time from an individual patient yielded only one type of MCV. Lesions induced by MCV I or MCV II were indistinguishable on the basis of size and form. Neither subtype was associated exclusively with lesions at certain sites or with other clinical features. Heterogeneity of DNA restriction endonuclease cleavage patterns amongst isolates of the same subtype was observed, this being greatest for MCV II.

(19) Arsenical keratoses‐response to etretinate and electron beam therapy

D.S., male, aged 48 years. History. This man has been asthmatic since childhood and was treated with Fowlers medicine on a regular basis between 1947 and 1957. In 1957, he noticed keratoses on the palms and soles which have gradually spread to involve his limbs and trunk. He has had several courses of X-ray therapy and cryotherapy witb only partial success. Examination. There are numerous keratoses on the trunk and limbs, but most marked on the dorsum of his forearms and hands, the lower legs, and the soles (Fig. i). Palmar pitting is present. Histology (from knee). Intra-epidermal carcinoma with epidermal thickening and parakeratosis. Treatme?it and progress. Etretinate 50 mg daily was commenced in August 1982. This produced quite marked regression of the keratoses but the dose was reduced to 25 mg on alternate days because of hair loss and cheilitis. In November 1982, he was commenced on electron beam therapy to the left arm and hand with excellent results, and is now having treatment to the right arm.

Reversible plane xanthoma, vasculitis, and peliosis hepatis in giant lymph node hyperplasia (Castleman's disease): A case report and review of the cutaneous manifestations of giant lymph node hyperplasia

A patient is described who had generalized plane xanthomas, cutaneous vasculitis, peliosis hepatis, and intraabdominal giant lymph node hyperplasia of the plasma cell type. After excision of the abdominal mass, the xanthomas resolved and the liver returned to its normal size, but the patient continued to develop skin lesions. A review is presented of the cutaneous manifestations of giant lymph node hyperplasia.

Multiple eruptive histiocytoma cutis in an atopic

A case of generalised histiocytoma cutis occurring in an atopic and mimicking widespread molluscum contagiosum is described. Immunochemical staining showed that the lesions were positive for factor XIIIa.