Michelle J Hunt

Regression in basal cell carcinoma: an immunohistochemical analysis

Summary Spontaneous regression of some cutaneous tumours is well recognized, and is thought to result from an immunological response to the tumour, Regression has previously been noted in basal cell carcinomas, but no studies defining the role of the immune response in the regression of this malignancy have been performed. We have examined 45 primary basal cell carcinomas (BCCs) (20 nodular, 25 superficial) and identified the cellular phenotypes and activation states of the cells infiltrating primary regressing and non‐regressing BCCs, by immunocytochemistry. We have found a significantly increased number of CD3+ and CD4+ T cells infiltrating regressing compared with non‐regressing tumours, and the expression of interleukin‐2 receptor (an early activation marker for T cells) was also increased. There were no significant differences in class II major histocompatibility complex (MHC), CD1, or macrophage antigen expression in these groups. These findings suggest that activated CD4+ cytokine‐secreting cells are important in the regression of BCCs.

Vesiculobullous Hailey-Hailey disease: Successful treatment with oral retinoids

A 56‐year‐old male presented with a pruritic, generalized vesiculobullous eruption. His past history revealed classical symptoms of limited Hailey‐Hailey disease for 34 years. Clinically, vesicles, bullae and occasional pustules were present and multiple biopsies confirmed this to be an unusual presentation of Hailey‐Hailey disease. Various therapeutic modalities including topical and oral antibiotics, oral prednisone and dapsone failed to achieve sustained remission. Treatment with lowdose oral etretinate (25 mg daily) produced marked clinical improvement with complete suppression of new vesicle formation after 6 weeks.

Black breast milk due to minocycline therapy.

Summary We report the unusual case of a 29‐year‐old female who developed black discoloration of breast milk 3 weeks after commencing oral minocycline therapy for acne vulgaris. Histochemical analysis of the breast milk revealed the presence of pigment particles within macrophages with iron staining characteristics. We propose that the pigment may represent an iron chelate of minocycline or one of its derivatives.

Generalized pustular psoriasis responsive to PUVA and oral cyclosporin therapy

A patient with acute generalized pustular psoriasis was successfully treated with a combination of oral cyclosporin (6 mg/kg per day) and photochemotherapy (PUVA). Although early inpatient treatment with weak topical steroids and PUVA produced initial improvement, the patients clinical condition fluctuated, with the subsequent development of erythroderma. The addition of oral cyclosporin produced dramatic improvement within 1 week of its commencement. The patient remained in remission 12 months following cessation of therapy.

Minocycline-induced hyperpigmentation in leprosy.

Summary A 36‐year‐old man was treated with dapsone. rifampicin and diazirines for borderline lepromatous leprosy. After 9 months, his leprosy plaques became progressively more red and after 23 months, tau diazirines was stopped and he was given minocydine instead. Six weeks later, he developed blue hack pigmentation in his leprosy lesions. The histology was consistent with minocydine‐indicted hyperpigmentation. This is the first report of minocycline‐induced pigmentation in leprosy. We suggest it is important to consider this side‐effect before the administration of minocydine in leprosy, particularly if it is prescribed in place of clofazimine.

Reconstruction of the nasal tip using a nasalis myocutaneous flap

Reconstruction of nasal tip defects is a technical and aesthetic challenge for dermatological surgeons, due to the limited reservoir of available skin and its thick, inflexible nature. The myocutaneous flap described in this paper, using the vascular pedicle of the transverse nasalis muscle, is an excellent option for repair of defects of the nasal tip. It provides a cosmetically superior result to skin grafting, particularly in noses of ‘sebaceous’ quality, by providing similar local skin. The flap maintains normal nasal tip contour and, being an axial pattern flap, its blood supply is reliable.

Pustular psoriasis of pregnancy

The case of an 18 year old woman who developed generalized pustular psoriasis of pregnancy in the 23rd week of her first pregnancy is reported. Treatment with topical therapies was unsuccessful and oral steroids were introduced with rapid response.

Wet gauze in CO2 laser resurfacing

The development of scanning CO2 laser systems has enabled rapid and uniform facial resurfacing in photoaged and acne scarred skin. A problem faced by the laser surgeon is making the scanner pattern produced by these lasers fit the cosmetic unit to be resurfaced. This may be achieved by the use of wet gauze to absorb the energy of the unwanted portion of the scanner pattern. The wet gauze is folded to lie along the cosmetic unit boundary and the scanner pattern rotated until it conforms to the required shape.