R.H.Meyrick Thomas

Lichen sclerosus et atrophicus and autoimmunity—a study of 350 women

A study of autoimmune related phenomena in 350 women with histologically confirmed lichen sclerosus et atrophicus revealed that 21.5% had one or more autoimmune related diseases, 21% had one or more first degree relatives with an autoimmune‐related disease, 42% had an autoantibody at a titre > 1:20, and 59.5% had one or more of these autoimmune‐relateda phenomena. No statistically significant differences in the natural history of lichen sclerosus et atrophicus were demonstrated between those patients with autoimmune‐related phenomena and those without.

The association of lichen sclerosus et atrophicus and autoimmune-related disease in males.

We have investigated the presence of autoimmune‐related diseases and autoantibodies in twenty‐five men with lichen sclerosus et atrophicus (LSA). These patients had a significantly higher incidence of autoimmune‐related disorders than a control population and a higher incidence of autoantibodies than would be expected in the normal male population.

The development of lichen sclerosus et atrophicus in monozygotic twin girls

The development of vulval lichen sclerosus et atrophicus in monozygotic twins is described. This is the first report of the occurrence of lichen sclerosus et atrophicus in two genetically identical individuals, and is considered to provide further evidence that inherited factors are of relevance in the aetiology of this disorder.

Nifedipine in the treatment of Raynaud's phenomenon in patients with systemic sclerosis

A double‐blind, placebo‐controlled, cross‐over trial of nifedipine 10 mg three times daily for 6 weeks, in 10 patients with Raynauds phenomenon secondary to systemic sclerosis, is reported. A significant reduction in the duration of attacks of Raynauds phenomenon was observed. Nifedipine therapy also reduced the number and severity of attacks of Raynauds phenomenon and the development of new digital ulcers, and increased the digital blood flow, but none of these changes was statistically significant. No alteration in red blood cell deformability or leukocyte chemiluminescence was observed during nifedipine treatment.

Oral acyclovir in the suppression of recurrent non-genital herpes simplex virus infection.

In a double‐blind, placebo‐controlled, cross‐over trial in 11 patients suffering eight or more episodes of recurrent non‐genital herpes simplex virus (HSV) infection per annum, only two patients experienced a recurrence during treatment with oral acyclovir (200 mg 4 times daily) for up to 12 weeks, compared with nine during placebo treatment (P=0.016). Although lesion development was effectively suppressed in nine of the patients whilst taking acyclovir, the development of prodromal symptoms, and occasionally erythema, was reported by five. There was no difference between acyclovir and placebo in the time to the next recurrence following completion of treatment. No patient reported any side effects of either placebo or acyclovir therapy. It is believed that this is the first report of any form of oral therapy which is effective in suppressing recurrent non‐genital HSV infection in immunocompetent patients.

Collagen and elastin changes in d‐penicillamine‐induced pseudoxanthoma elasticum‐like skin

A patient with cystinuria who was treated with large doses of d‐penicillamine for 19 years developed skin abnormalities resembling those seen in pseudoxanthoma elasticum. Biochemical and histological examination of the dermis showed that the collagen content, the ratio of the major genetic forms of collagen and the distribution of collagen types was normal. Light microscopy demonstrated the presence of vastly increased amounts of elastin in the dermis, and the individual elastin fibres were shown by electron microscopy to be abnormal; chemical analysis showed the elastin to be poorly cross‐linked. Some of the collagen also appeared structurally abnormal, and biochemically resembled that seen in the dermis of a young child with respect to cross‐linking and hexosyl‐lysine content. The therapy led to an increased deposition of collagen and elastin fibres which appeared abnormal, and resulted in an increase in total skin surface area. These data indicate that d‐penicillamine was not fully effective in inhibiting collagen and elastin cross‐linking, and appeared to prevent or inhibit the natural maturation process of the collagen.

Elastosis perforans serpiginosa and pseudoxanthoma elasticum-like skin change due to D-penicillamine

High dose D‐penicillamine is used in the therapy of Wilsons disease and cystinuria. Elastosis perforans serpiginosa (Guilaine, Benhamou & Molas, 1972), penicillamine dermopathy (Sternleib & Scheinberg, 1964; Katz, 1967; Beer & Cooke, 1967), cutis hyperelastica (Charlebois, Cadotte & Barbeau, 1972), excessive skin wrinkling (Greer, Askew & Richardson, 1976) and pseudoxanthoma elasticum‐like skin change (Meyrick Thomas et al., 1984) have all been documented as developing in consequence of such therapy.

Linear streaking due to bleomycin

Bleomycin, an anti‐neoplastic antibiotic produced by Streptomyces verticullis, is widely used in the treatment of malignant lymphomas and squamous cell carcinomas. Like other anti‐metabolite drugs it has been associated with a number of cutaneous side effects such as alopecia and stomatitis1. Bleomycin can also produce a characteristic cutaneous reaction: linear streaking2, two cases of which are reported herein.

Fixed drug eruption due to paracetamol

A patient who developed a fixed drug eruption due to paracetamol is reported. There is only one previous account of this eruption occurring as a consequence of paracetamol therapy.

Lichen sclerosus et atrophicus and autoimmunity in 250 women

Whilst the aetiology and pathogenesis of lichen sclerosus et atrophicus (LSA) remain unknown, it has been established that patients with LSA have an increased incidence of autoantibodies (Goolamali et al., 1974) and autoimmune related disorders (Harrington & Dunsmore, 1981; Meyrick Thomas, Ridley & Black, 1983, 1984).