Julia A. Newton

The treatment of chilblains with nifedipine: the results of a pilot study, a double-blind placebo-controlled randomized study and a long-term open trial

A pilot study, a double‐blind placebo‐controlled randomised study and a long term open trial have indicated that nifedipine is effective in the treatment of perniosis. At a dose of 20 mg to 60 mg daily, nifedipine significantly reduced the time to clearance of existing lesions and prevented the development of new chilblains. Nifedipine also reduced the pain, soreness and irritation of the lesions. A comparison of the pre‐and post‐treatment skin biopsies showed resolution of the dermal oedema and diminution of the perivascular infiltrate. An increase in cutaneous blood flow following administration of nifedipine suggests that the vasodilator action of this drug may be important in its action.

A flow cytometric study of Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH), or histiocytosis X, is now generally considered to be a non‐malignant condition. A flow cytometric (FCM) study of a single case has, however, been published which claimed to provide evidence to contradict this. The presence of DNA‐ploidy as detected using this technique is a feature of malignant and pre‐malignant disease. In this reported single case, DNA‐ploidy was present but the clinical features of this patient were atypical for LCH. We have performed a FCM study of the DNA of nine biopsies of LCH lesions from six patients with well‐established disease. In addition, in one of these, fresh tissue studies including the use of an anti‐CD1 monoclonal antibody to specifically label the LCH cells were performed. In all cases the DNA content of the cells was entirely normal. We therefore found no evidence that LCH is a neoplastic disorder.

Familial primary cutaneous amyloidosis.

Primary cutaneous amyloidosis is uncommon in Europeans. A British family is described in which an extremely rare variant was inherited as an autosomal dominant. The subtlety of physical signs in this family contrasted with the severity of the associated pruritus. Transepidermal elimination of amyloid was a characteristic histological feature.

The flow cytometry of melanocytic skin lesions

DNA flow cytometry was performed on formalin fixed, paraffin embedded melanocytic naevi. DNA aneuploidy was detected in all three types of naevus but was significantly more frequent in those naevi accepted as precursors of malignancy: that is, dysplastic and congenital pigmented hairy naevi. It may be that the presence of DNA aneuploidy has prognostic significance in these naevi. Technical problems were encountered in the analysis of data from melanocytic lesions so that caution is recommended in interpretation of studies using formalin fixed tissue.

Cutis laxa associated with amyloidosis

A case of systemic amyloidosis associated with an atypical plasma cell dyscrasia is reported, in which the cutaneous amyloid deposits appeared to have caused elastolysis (cutis laxa).

A flow cytometric study of the significance of DNA aneuploidy in cutaneous lesions

Aneuploidy has not to date been demonstrated in any entirely benign condition and thus is held to be implicit of neoplasia. DNA flow cytometry can be used to detect DNA aneuploidy rapidly. A technique has been developed to make possible flow cytometric analysis of formalin‐fixed skin. The technique was validated by study of benign and pre‐malignant dermatoses. Further studies were performed on skin conditions of questionable malignant potential. DNA aneuploidy was demonstrated in lichen sclerosus et atrophicus. Flow cytometry was unable to distinguish keratoacanthomas from squamous cell carcinomas.

Aquagenic pruritus associated with the idiopathic hypereosinophilic syndrome

Patients with the idiopathic hypereosinophilic syndrome (HES) may develop associated skin disorders. We describe a patient who had xerosis since birth, but who first developed symptoms of aquagenic pruritus soon after he presented with HES. Photochemotherapy with psoralen and UVA treatment reduced his peripheral blood eosinophil count. The good response to treatment suggests that there was a close relationship between the dermatosis and the blood disorder.

Leucocytoclastic vasculitis and angio-oedema associated with inflammatory bowel disease

Two cases are reported in which purpuric skin plaques due to leucocytoclastic vasculitis and angio‐oedema were the presenting signs of inflammatory bowel disease. The aetiological implications are discussed. One case was controlled with oral colchicine, the other with oral Salazopyrine.

Malignant angiosarcoma of the scalp: a case report with immunohistochemical studies

A case of angiosarcoma of the scalp is reported. The histogenesis of this tumour is discussed in terms of the ultrastructural and immunohistochemical findings. This type of angiosarcoma is uncommon and carries a poor prognosis; the therapeutic alternatives are discussed.

Acropustulosis of infancy

Acropustulosis of infancy is a syndrome characterized by recurrent pruritic acral vesicopustules. It occurs primarily in black male infants and hitherto has been described mainly in the North American literature. We describe four cases seen in London. This entity, therefore, should be recognized in the U.K., particularly in the differential diagnosis of infantile scabies.