J. S. C. English

Long-term efficacy and safety of cyclosporin in severe adult atopic dermatitis.

A prospective, open, multicentre study was performed to investigate the efficacy and safety of longterm treatment with cyclosporin in adults with severe atopic dermatitis. Subjects were treated for a maximum of 48 weeks. For the first 8 weeks, cyclosporin was administered at 2.5 mg/kg per day. The dose was then adjusted according to response. Disease activity was monitored using the six‐area. six‐sign score and the proportion of skin involved. Pruritus and sleep disturbance were assessed using four‐point scales. Response was further evaluated on a five‐point scale. Adverse events. blood pressure and serum biochemistry were monitored. Tolerability was assessed on a five‐point scale.

Hydrocortisone: an important cutaneous allergen

We have found a high incidence (4.8%) of allergy to hydrocortisone in patients with suspected allergic contact dermatitis. In view of this finding we would suggest that, in any condition that does not improve or that deteriorates after administration of hydrocortisone, allergy to this compound should be considered.

Azathioprine in dermatology: a survey of current practice in the U.K.

Azathioprine has an important role in treatment of many inflammatory dermatoses. In view of the current emphasis on evidence‐based medicine, we performed a questionnaire‐based survey to establish current practice in the use of azathioprine by consultant dermatologists and associate specialists in the U.K. The response rate was 68%. In contrast with the manufacturers recommendation, our data provide evidence that azathioprine is useful in the treatment of a wide variety of dermatological diseases. However, there is still a need for controlled trials in some conditions. The most common conditions treated were pemphigoid, pemphigus and atopic eczema. In addition, we found that only 13% of dermatologists prescribe azathioprine according to body weight. Most dermatologists felt that azathioprine was well tolerated. No one tested for thiopurine methyltransferase (TPMT) activity, which is thought to be a predictor of severe myelosuppression. The combination of prescribing azathioprine according to body weight and measuring TPMT activity would optimize efficacy and minimize potential severe myelotoxicity.

Erosive and generalized lichen planus responsive to azathioprine

Systemic corticosteroids are of value in severe lichen planus which interferes with the patients life or is ulcerative or where there in nail destruction. Azathioprine has been shown to be effective steroid sparing treatment for generalized lichen planus. We report two patients with severe lichen planus who responded to azathioprine alone and suggest it may be an alternative therapy, especially when there are risk factors against corticosteroid use.

Acute febrile neutrophilic dermatosis in association with erythema nodosum and sarcoidosis

We report two cases of simultaneous Sweets syndrome and erythema nodosum. We believe this to be a real association rather than the extension of the neutrophilic infiltrate of Sweets syndrome into the subcutaneous fat.

Porokeratosis of Mibelli and immunosuppression

Immunosuppression is recognized to predispose to the development of disseminated superficial actinic poro‐keratosis and to cause the spread of pre‐existing lesions. Porokeratosis of Mibelli has been less frequently described following immunosuppression and we report a further case.

Transient re‐emergence of oil of turpentine allergy in the pottery industry

Allergy to oil Of turpentine has diminished largely due to the use of cheaper substitutes in many occupations. However, 2 particular areas still reliant on real oil of turpentine are those of the perfume industry and ceramic decoration. We report 24 cases of hand dermal it is in pottery workers involved in ceramic decoration, paintresses, liners, gilders, enamellers and a line china painter. seen in a 6‐month period following a change from Portuguese to Indonesian turpentine, of whom 14 were sensitive to Indonesian turpentine. 8 to α‐pinene. 4 to Δ‐3‐carene and 2 positive to turpentine peroxides, Previous reports suggest that, Δ‐3‐carene is the main allergen and reports of sensitivity to α‐pinene in the absence of sensitivity to Turpentine peroxide, in particular to the hydro‐peroxide of. Δ‐3‐carcne. are few. Turpentine allergy continues Lo be a problem in The pottery industry and is more common than allergy to the heavy metals of the colours used in ceramic decoration. α‐pinene, an unusual allergen, appears to he the most common in our area. Reversion to Portuguese turpentine seems to have alleviated the problem.

In vitro evidence of delayed-type hypersensitivity to hydrocortisone.

Hypersensitivity to topical hydrocortisone is becoming increasingly recognized. We present further evidence that this is mediated via a delayed‐type hypersensitivity reaction. A hydrocortisone: albumin complex was able to induce a proliferative response in the peripheral blood mononuclear cells of patients allergic to hydrocortisone. Protein binding of hydrocortisone or a degradation product may be important in the development of corticosteroid allergy.

The significance of tixocortol-pivalate-positive patch tests in leg ulcer patients

Belladonna alkaloids are extracted from the deadly nightshade plant Atropa belladonna. The Atropa part of the botanical name denotes its potential as a lethal poison, after Atropos the oldest of the Fates. The belladonna part recalls the practices of Italian women, who, centuries ago, applied decoctions of deadly nightshade to their eyes, giving them a lustrous wide-eyed and alluring appearance: hence, the name beiiadonna (beautiful lady) (I). Belladonna alkaloids consist mainly of atropine ( a racemic mixture of Land D hyoscyamine) and hyoscine (scopolamine). Our patient demonstrated allergic contact dermatitis from atropine, a relatively infrequent finding, possibly becaue the substance is seldom applied topically to the skin except in the case of atropine eye drops, where a characteristic periocular contact dermatitis has been described (2). Many cases of contact dermatitis from the closely-related compound hyoscine have been recorded, however, especially since the introduction of transdermal hyoscine patches in the treatment of motion sickness (3). Although erythema and oedema followed by a vesicular dermatitis have been reported after contact with the deadly nightshade plant (4), this is the first report to our knowledge of proven contact dermatitis from belladonna plaster. Apart from the distress of eczema and the postinflammatory pigmentation, systemic absorption of atropine through inflamed skin is an additional danger posed by such plasters. A case was described by Sims (5) in 1954 of a 67-year-old woman who developed blurred vision and dizziness whilst using a belladonna plaster. She was later admitted in an SHORT COMMUNICATIONS

Risk Factors for Ischaemic Heart Disease in Patients with Dermatitis Herpetiformis

For reasons that are unclear, patients with dermatitis herpetiformis (DH) have a lower than expected mortality rate from ischaemic heart disease. We have compared risk factors for ischaemic heart disease (lipids, fibrinogen levels, smoking history and social class) in 29 DH patients and 57 controls matched for age and sex. Patients with DH had significantly lower cholesterol, triglycerides, apolipoprotein B and fibrinogen and higher HDL2; they also smoked less and were of higher social class. The mechanisms underlying these observations merit further investigation. Intestinal abnormalities or gluten-free diet may account for differences in lipid fractions, and the immunomodulatory properties of cigarette smoke may protect against the development of DH.