Julian Verbov

Near fatal drug interactions with methotrexate given for psoriasis.

In this study children were more commonly exposed to pertussis by a sibling (22/26) than a parent, and 25 ofthe 26 children and adults responsible for transmitting the infection had typical disease. Atypical disease occurred in older children and parents but was almost exclusively associated with secondary rather than primary infection. Furthermore, isolation of B pertussis (which may reflect a persons infectiousness) was more common in those with typical pertussis (l6 of46 who had swabs taken) than in those who were asymptomatic or had atypical pertussis (one of 25 who had swabs taken). These results could not have -been influenced by erythromycin treatment as the only family members treated in this way were children with typical pertussis (17/43). We suggest that pertussis is most commonly transmitted by subjects with typical disease and that atypical disease and asymptomatic infection are not an important source of pertussis in this community. Thus a greater uptake of pertussis vaccination would probably affect transmission of the disease sufficiently to reduce its incidence.

Trauma-induced bullous pemphigoid

We describe three patients with bullous pemphigoid who presented with bullae at sites of trauma and with little spread of the condition outside such areas. The diagnosis was confirmed by histology and direct and/or indirect immunofluorescence; electron microscopy was performed in two cases to rule out the diagnosis of epidermolysis bullosa acquisita (EBA). Treatment was with either systemic steroids or ACTH in all three cases. Trauma‐induced bullous pemphigoid should be included in the differential diagnosis of localized blistering eruptions.

Buschke-Ollendorff syndrome--disseminated dermatofibrosis with osteopoikilosis.

The case is reported of a woman aged 47 years with disseminated dermatofibrosis associated with osteopoikilosis. Her two children also showed skin lesions typical of the Buschke--Ollendorff syndrome and these lesions were said to have been present at birth.

Fixed Drug Eruption Due to a Drug Combination But Not to Its Constituents

A fixed drug eruption due to a paracetamol-chlormezanone combination but not to either drug separately is described.

Stevens-Johnson syndrome due to tetracyclines—a case report (doxycycline) and review of the literature

A young adult female with Stevens‐Johnson syndrome due to doxycycline is described. Other reports of Stevens–Johnson syndrome due to tetracyclines are also reviewed.

Serum IgG antibodies to gliadin and other dietary antigens in adults with atopic eczema

Fifty‐six adult patients with atopic eczema have been evaluated for scrum antibodies reactive with wheat gliadin, bovine milk or chicken ovalbumin using a solid‐phase enzyme‐linked immunoassay (ELISA). Of the atopic eczema sera 35·7% were positive against gliadin and/or milk, compared with 9·2% of the control adult blood donor sera (P < 0·0005). In particular, 30·4% of atopic eczema patients had detectable IgG antibodies reactive with gliadin in contrast to 6·5% of the controls (P < 0·0005). These findings suggest that antigen absorption from the gut may play a role in the aetiopathogencsis of atopic eczema, and lend some support for the use of elimination diets in this condition.

Purpuric pityriasis rosea.

Occasional cases of pityriasis rosea show few or many purpuric lesions and 3 patients with such lesions are described.

Hereditary diffuse hyperpigmentation

A healthy white female of normal intelligence aged 33 years, who presented with scalp hair thinning, showed congenital mottling of the skin more marked over the trunk and with epidermal atrophy on histology, smooth fingertips, brittle finger nails some split at the free end, and warty palmar keratoses. She gave a history of frictional blisters over the heels in the first few years of life only. Blood picture, sweating, buccal mucosa and teeth were normal. Her son, aged 7 years, showed similar mottled skin over the trunk and this was first noticed at the age of 6 months. He also had a tendency to form blisters over the heels up to 21 years of age. At least four other male members of the family had the abnormality of pigmentation and other changes but unfortunately all persistently refused to permit examination. Inheritance was in keeping with an autosomal dominant pattern.

Pruritus ani and its management—a study and reappraisal*

In a survey of 3000 patients, forty‐seven (1.6%) had pruritus ani as the major (thirty‐eight) or a minor (nine) symptom. Pruritus ani may be either constitutional or secondary, but there is often a tenuous line separating these two groups. Management of this common symptom is discussed.

Necrotizing cutaneous vasculitis occurring as an early feature of ‘shunt nephritis’

A patient is described in whom cutaneous vasculitis was a feature of chronic bacteraemia due to infection of a ventriculo‐artrial shunt inserted for hydrocephalus. Surgical removal of the infected shunt lead to resolution of the vasculitis and the associated glomeruloncphritis.