J.S. Ross

Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis. A randomized, double-blind, placebo-controlled trial.

A multicentre, randomized, double‐blind, controlled crossover clinical trial was conducted on 33 patients with severe refractory atopic dermatitis, to determine the effects of cyciosporin (5 mg/kg/day) on their health‐related quality of life. Treatments were administered for 8‐week periods. One group (n=16) received placebo followed by cyclosporin, and the other (n=17) received cyclosporin and then placebo. Health‐related quality of life was assessed at o, 8 and 16 weeks using a general measure, the United Kingdom Sickness Impact Profile (UKSIP), an eczema‐specibic measure, the Eczema Disability Index (EDI), and a global 5‐point rating scale of overall health (very good to very poor). In addition, clinical assessments (i.e. extent and activity of disease) were made by the investigators.

Contact and photocontact sensitization in chronic actinic dermatitis: sesquiterpene lactone mix is an important allergen

Summary Eighty‐nine patients with chronic actinic dermatitis (CAD) were retrospectively studied: 69 (78%) male and 20 (22%) female, with mean ages of 66 and 64 years, respectively; nine (10%) were dark skinned. Eight (9%) were abnormally sensitive to UVB wavelengths alone, 74 (83%) to UVB and UVA, and seven (8%) to UVB, UVA and visible radiation. Eighty‐six patients were patch tested to an extended standard European series of contact allergens, including in 80 cases a 0.1% mix of three sesquiterpene lactones, and photopatch tested to a standard photopatch series. Sixty‐four of these 86 patients (74%) had positive patch or photopatch tests; 36% (29 of 80) were sensitive to the sesquiterpene lactone mix, 21% (18 of 86) to fragrance compounds, 20% (17 of 86) to colophony, and 14% (12 of 86) to rubber chemicals. Ten (12%) had positive photopatch tests; five (6%) to musk ambrette, six (7%) to sunscreens and one to both. Fourteen of the eighty‐nine patients with CAD (16%) had preceding endogenous eczema. In 18 of 86 patients (21%), CAD occurred alone, with neither detectable contact nor photocontact allergy, nor a preceding history of endogenous eczema. This study confirms the association between Compositae (sesquiterpene lactone) dermatitis and CAD.

Dermatitis caused by physical irritants

Summary Backgroundu2003Although physical irritant contact dermatitis (PICD) is a common occupational dermatosis, it is one of the least well understood because of its multiple types, lack of diagnostic test, and the many mechanisms involved in its production.

Changing frequency of thiuram allergy in healthcare workers with hand dermatitis

Backgroundu2002Healthcare workers (clinical, allied/paramedical professions and ancillary workers) may have prolonged contact with natural rubber latex devices, particularly in the form of natural rubber latex gloves.

Cutaneous malignant melanoma and human immunodeficiency virus (HIV) infection: a report of three cases

Cutaneous malignant melanoma was diagnosed in three patients suffering from human immunodeficiency virus (HIV) infection. Staging at presentation inversely correlated with absolute CD4 count. In addition, a notably sparse lymphocytic inflammatory response to the melanoma was observed in two cases. Established data on melanoma in non‐HIV immunosuppressed patients suggests a poor prognosis for melanoma in HIV disease.

An unusual case of transient papular mucinosis associated with carpal tunnel syndrome

Summary A 67‐year‐old man presented with discrete mucinous papules on the scalp and fingers, and bilateral carpal tunnel syndrome. Both features remitted spontaneously within several months. The acral distribution, and histopathological features, were in keeping with the recently described acral persistent papular mucinosis. Involvement of the scalp, however, has not previously been described, and transient mucin deposition is unusual. The history of bilateral carpal tunnel compression raises the possibility of extracutaneous involvement, not previously reported in this group of patients.

Long-term cyclosporin A in eczematous disorders

antibodies (Dako and Becton-Dickinson reagents). Double-labelling techniques allowed the identification of both T-cell subsets and activated T cells. Labelled cells were counted by a fluorescence-activated cell sorter and the absolute lymphocyte count was measured by Coulter analysis. In patients with AD, the total T, CD4 and CD8 cell numbers and the CD4/CD8 ratio were all within the normal range. Although the numbers of activated (DR +) CD4 cells were elevated (P<oo5), levels of activated (DR+) CD8 cells were normal. Increasing disease activity was associated with an increase in the numbers of DR + CD4 cells (P< o 05) with no change in the levels of DR+CD8 cells. The DR + CD4/DR+CD8 ratio increased in proportion to disease activity (P<o-O5), The absolute increase in activated CD4 cells in relation to disease activity suggests a major role for CD4 cells in the pathogenesis of AD.

9) Chromate dermatitis from cement causing a tattoo reaction

Historif. This patient was originally referred in 1986 with a burning sensation in both legs and feet diagnosed as erythromelalgia. Since the age of 4 he had suffered with hot feet and used to walk around barefoot whenever he could. He then started to obtain relief by immersing his feet in cold water. The problem escalated gradually until he was having up to 45 soaks in an evening and was not attending school. Treatment with aspirin, ketanscrln and beta blockers had been unsuccessful.