P.E. Hutchinson

Modern treatment of warts: cure rates at 3 and 6 months

Summary Four‐hundred consecutive referrals with viral warts of the hands and/or feet were investigated to determine the cure rate from a combination of cryotherapy, keratolytic wart paint and paring. For treatment failures after 3 months, the value of continuing cryotherapy and of additional treatment with the immunomodulator inosine pranobex were assessed.

Vitamin D analogues and psoriasis

Summary Topical vitamin D analogues offer a new, effective, more convenient and generally well‐tolerated option for the treatment of psoriasis. Only psoriasis vulgaris has been intensively studied, but other forms of the disease may also respond. Both calcitriol and calcipotriol have been shown to be effective in numerous clinical trials, and the latter has compared well with betamethasone valerate and shortcontact dithranol in controlled studies. Their mechanism of action is not yet fully understood and may prove complex. The most important effect may be a direct regulation of keratinocyte proliferation and differentiation. However, these compounds also have potent immunological properties, and may act by inhibition of cytokine production by keratinocytes or lymphocytes. Topical application of vitamin D analogues appears generally to be remarkably safe, but hypercalcaemia and hypercalciuria may develop if large quantities are used.

Minute aggregate keratoses—a report of three cases

A new, possibly genetic disorder of keratinization is described. The condition is characterized by the truncal distribution of multiple minute keratotic papules. Morphologically these may be spicular or dome‐shaped and aggregation of some of the latter creates the impression of annular and crateritbrm lesions. Histologically there are focat areas of hyperkeratosis and orthokeratosis with no dermal infiltrate. Odland bodies arc present on electron microscopy of lesional skin. The differential diagnosis of this condition is discussed.

Occlusion enhances the efficacy of topical calcipotriol in the treatment of psoriasis vulgaris

Forty‐eight patients with symmetrical chronic plaque psoriasis affecting the limbs were recruited for a single‐blind right/left within patient study to assess the effect of combining occlusion with topical calcipotriol. Subjects were randomized into two groups. Sites of similar severity on opposing limbs were selected as target areas. The first (group A) treated one side with calcipotriol alone and the opposite side with calcipotriol plus occlusion. The second (group 13) treated one side with placebo plus occlusion and the opposite side with calcipotriol plus occlusion. In group A the mean improvements were 40% (P< 0·001) for calcipotriol alone and 61% (P< 0·001) for calcipotriol plus occlusion. In group B, occlusion plus calcipotriol resulted in a mean 62% improvement (P< 0·001) while occlusion plus placebo produced no significant change. The combination of calcipotriol plus occlusion was significantly better than calcipotriol alone (P< 0·005). The results indicate that occlusion improves the response to calcipotriol by enhancing its penetration. Indices of calcium metabolsm remained unchanged throughout the study.

JUVENILE SPRING ERUPTION OF THE EARS : A PROBABLE VARIANT OF POLYMORPHIC LIGHT ERUPTION

We report 18 cases in which a pruritic, erythematosus, papular and vesicular eruption developed on the ears following sun exposure. Four of these patients had, on other occasions, suffered from typical polymorphic light eruption. The clinical features, histological changes, and results of phototesting suggest that juvenile spring eruption of the ears is a localized form of polymorphic light eruption.

Treatment of alopecia totalis with a combination of inosine pranobex and diphencyprone compared to each treatment alone

Recent developments in alopecia areata have included the use of oral inosine pranobex and the introduction of diphencyprone as a contact sensitizer. Good results have been claimed for these treatments even in severe forms of the disease. We performed a study to investigate the efficacy of a combination of these treatments in the most severe form of alopecia areata.

Cicatricial pemphigoid in D-penicillamine treated patients with rheumatoid arthritis—a report of three cases

Three patients with rheumatoid arthritis who developed cicatricial pemphigoid during treatment with D‐penicillamine are described. The possible role of this drug in the pathogenesis of the skin and mucosal lesions is discussed.

The development of scar sarcoidosis at the site of desensitization injections

Tender nodules may develop at the site of injection of allergen extracts. Some cases can he related to the aluminium contained in the preparation.

A family with palmoplantar epidermolytic hyperkeratosis

Familial epidermolytic hyperkeratosis confined to the palms and soles was first characterized by Klaus and Weinstein in 1970.1 This entity has been the subject of only tour subsequent reports.2–5