L.S. Ostlere

Neuropeptides in the skin of patients with atopic dermatitis

There is increasing evidence that neuropeptides may be involved in the pathogenesis of atopic dermatitis (AD). This study examines whether neuropeptide distribution in the skin of patients with AD differs from normal controls. The distribution and density of several neuro‐peptides were examined in lesional and non‐lesional skin of AD patients (n= 5) and in normal controls (n= 4) using indirect immunofluorescence and image analysis. Cholinergic innervation was studied using cholinesterase histochemistry.

Follow‐up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year

Adult patients with severe atopic eczema who had completed a double‐blind placebo‐controlled crossover trial of a specific formulation of Chinese herbal therapy were offered continued therapy for 1 year. Of 31 patients who completed the original placebo‐controlled study and after a washout period and 2 months of further treatment, 17 continued treatment (group 1), 11 chose not to continue treatment (group 2), one was lost to follow‐up and two patients originally in group 1 decided to stop treatment and became pregnant. At the end of the year, 12 of the patients in group 1 had greater than 90% reduction and the remaining five had greater than 60% reduction in clinical scores compared with baseline values. Clinical scores of patients in group 2 gradually deteriorated so that by the end of the year the difference between groups 1 and 2 was highly significant (P=0·005 and P=0·002 for erythema and surface damage, respectively).

Carrier status for steroid 21‐hydroxylase deficiency is only one factor in the variable phenotype of acne

Previous endocrine studies of women with acne have produced diverse results. This study was designed to seek evidence, from endocrine and genetic studies, for impaired steroid biosynthesis in patients with acne.

Punctate palmoplantar keratoderma and malignancy in a four-generation family

Summary We report a large kindred in which a punctate palmoplantar keratoderma (PPK) is associated with malignancy, including Hodgkins disease, renal, breast, pancreatic and colonic adenocarcinomas. The family was traced through four generations, and over 520 individuals were identified, of whom 49 had punctate PPK. The punctate PPK appeared to be inherited as an autosomal dominant trait with variable penetrance. Ten of the 43 adults (23%) with punctate PPK developed malignancies, and five of these developed before the age of 50. Of the 271 unaffected individuals, six (2%) have developed malignancies, one prior to the age of 50. The association of keratoderma and malignancy is discussed.

Phenytoin-induced pseudolymphoma. A report of a case and review of the literature.

Summary We report a patient with phenytoin‐induced pseudolymphoma mimicking cutaneous T‐cell lymphoma (CTCL). Despite withdrawal of phenytoin, there was persistence of the cutaneous eruption and lymphadenopathy. Southern blot analysis of immunoglobulin and T‐cell receptor genes was therefore used to assess whether there was a clonal lymphoid expansion. However, no rearrangement of the beta T‐cell receptor gene or immunoglobulin heavy‐chain gene was detected in tissue DNA from skin and lymph nodes. One year later the patient became asymptomatic, although he is still at risk of developing a true malignant lymphoma in the future, a condition known as pseudo‐pseudolymphoma. It is suggested that genotypic studies may help in the initial diagnosis and the subsequent management of such patients.

Eosinophilic pustular folliculitis in an HIV-positive man: response to cetirizine

Eosinophilic pustular folliculitis is a rare condition which is being increasingly reported in HIV‐positive patients. Many therapies have been used to treat this condition. We report the first successful use of the H1 antihistamine cetirizine to treat the condition and postulate that the specific antieosinophilic action of this drug may explain the beneficial clinical effect seen in our patient.

Systemic lupus erythematosus in association with ulcerative colitis: related autoimmune diseases

Summary We report a patient who developed urticaria, angio‐oedema and polyarthropathy secondary to the hypocomplementaemic urticarial vasculitis syndrome, a year prior to the onset of ulcerative colitis. Ten years later, primary sclerosing cholangitis and the antiphospholipid syndrome developed concomitantly. We believe this patient represents only the second reported case of idiopathic systemic lupus erythematosus (SLE) occurring in association with ulcerative colitis.

Pellagra secondary to 5‐fluorouracil

The development of pellagra in a patient treated with 5‐fluoroiiracil for malignant disease is reported. The aetiology of pellagra in this patient is discussed, and the reasons for possible under‐diagnosis of pellagra in association with malignant disease considered. We report a patient who presented with the typical skin changes of pellagra. The rash, and an associated acute deterioration in cerebral function, were exacerbated by treatment with 5‐fluorouracil. The importance of considering nicotinic‐acid deficiency in patients with malignant disease has not been emphasized in the literature.

Bullous pemphigoid in infancy-a case report including new immunoblotting observations

A 1‐year‐old boy developed bullous pemphigoid. Immunoblotting, which has not been previously reported in childhood pemphigoid, showed the serum reacted to a 190 kDa band only. Bullous pemphigoid is rare in infancy and childhood with only 40 cases previously reported. A brief review of the literature is given and treatment of childhood bullous pemphigoid is discussed.

Cutaneous granulocytic sarcoma (chloroma) presenting as the first sign of relapse following autologous bone marrow transplantation for acute myeloid leukaemia

Summary A 25‐year‐old man suffering form acute myeloid leukaemia developed a solitary lesion on the upper abdominal wall 6 months after receiving an autologous bone marrow transplant. These lesion was a chloroma and proved to be the only evidence of clinical relapse. This is the first reported case of this rare condition occurring following bone marrow transplantation.