Topical salicylic acid gel as a treatment for molluscum contagiosum in children.

OBJECTIVE: To determine if the application of salicylic acid gel or phenol solution affected resolution of molluscum contagiosum (MC) lesions in children. PATIENTS AND METHODS: This was a randomized, prospective controlled trial with two treatment arms and one vehicle arm for treatment of MC in children. The trial was set in the dermatology outpatient clinics of a teaching hospital and a district general hospital. A total of 114 children were enrolled in the study (age range 1-15 years) over a 4-year period; 83 of the children completed the study. Patients were randomized to receive one of three possible treatments: monthly vehicle application of 70% alcohol, monthly application of 10% phenol in 70% alcohol once or twice weekly 12% salicylic acid gel. All patients also received treatment with daily aqueous cream to reduce eczema. They returned monthly to the clinic for treatment and counting of MC lesions. They were reviewed either until complete resolution or up to 6 months, whichever occurred sooner. The main outcome measure was the time taken for complete resolution of MC lesions. RESULTS: In the intention-to-treat analysis there was no difference between treatment arms when the 31 non-completers were analysed as failures (log-rank test: p = 0.38). In an 'as treated' analysis, 16 of 27 children (59.2%: 95% confidence interval 30.2-88.3) had cleared with vehicle, 18 of 32 (56.3%, 30.3-82.2) with phenol solution and 21 of 24 (87.5%, 50.1-124.9) with salicylic acid gel (log-rank test: p = 0.03). On an as treated basis, salicylic acid was significantly better at clearing MC than dilute phenol (p = 0.006). The treatment in all groups was very well tolerated or acceptable in 93% of children. CONCLUSION: Our results suggest that topical salicylic acid may be beneficial in speeding resolution of MC in children. Dilute phenol application does not appear to affect the disease course.

Differentiated chondrocytes for cartilage tissue engineering.

Trauma to the articular cartilage surface of the joint represents a challenging clinical problem due to the very limited ability of this tissue to self-repair. Moreover, repair techniques such as microfracture, which introduce cells into the joint, have unpredictable clinical outcomes as they produce a fibrocartilage tissue that degenerates with time. Alternative treatments include tissue reconstruction with autograft and allograft tissue. However, these procedures are restricted by the availability of suitable donor tissue. These limitations have been the driving force behind the emerging field of articular cartilage tissue engineering. This paper will highlight and contrast the key challenges associated with the tissue engineering of this neo-tissue using differentiated adult cells. The various components of the tissue engineering process will be described including the choice of donor cell/tissue type and the selection of scaffolds that guide the formation of tissue. The ability of the tissue engineered implants to stimulate the repair of defects in vivo will also be discussed. Tissue engineering approaches may, in the future, provide an ideal alternative to the current surgical treatments for cartilage repair.

Amiodarone-induced vasculitis and a review of the cutaneous side-effects of amiodarone.

Amiodarone is a valuable agent, used in the management of intractable cardiac arrhythmias. Its widespread use persists despite a list of well recognized side-effects. Skin reactions are common, usually presenting as photosensitivity or less frequently as a blue/grey pigmentation on light-exposed sites. Leucocytoclastic vasculitis following treatment with amiodarone has been reported rarely. We describe a further case and briefly review the unwanted cutaneous manifestations of amiodarone therapy.

Pubic osteomyelitis presenting as irritable hip.

Two cases of pubic osteomyelitis presenting as a painful hip are reported. In both cases the diagnosis was delayed by the unusual presentation and by the limited radiological investigation. Pubic osteomyelitis is rare in childhood but should be considered in the differential diagnosis of the 'irritable hip'.

The influence of isotretinoin upon fibrinolysis in patients with acne.

A patient with haemophilia A and acne was recently reported to have experienced increased bleeding during therapy with isotretinoin. The aim of the present study was to investigate the influence of isotretinoin upon fibrinolysis, and more specifically upon tissue plasminogen activator (tPA) and tissue plasminogen activator inhibitor (PAI) levels, in haemostatically normal individuals. Thirteen patients with severe acne received a 4-month course of isotretinoin at a dose of 1 mg/kg per day. In all cases, the acne responded to therapy, and the patients did not show any evidence of unexpected bleeding or bruising throughout the study. Although all investigations remained within the normal range, tPA measurements rose significantly (P < 0.001) after 3 months' therapy compared with pretreatment values. Retinoids have been shown to stimulate tPA production in vitro from human endothelial cells. Our results confirm that this can be demonstrated in vivo. Prior to therapy with isotretinoin, when all patients had inflammatory acne, PAI measurements were elevated in 12 of 13 individuals. The mean measurement of PAI decreased from 98.38 +/- 63.30 ng/ml prior to treatment, to 24.63 +/- 15.2 ng/ml (P < 0.01) in the eight patients who returned for blood tests 6 weeks after completing therapy. The decline in PAI levels appears to reflect the resolving cutaneous inflammation following treatment with isotretinoin, rather than a direct effect of isotretinoin on the synthesis or release of PAI. This study provides further evidence that tPA production is stimulated by isotretinoin, and that this, together with falling PAI levels, may accelerate fibrinolysis. There was no clinical evidence that haemostasis was impaired in these haematologically normal individuals.(ABSTRACT TRUNCATED AT 250 WORDS)

The practice of ultraviolet phototherapy in the United Kingdom.

A survey, using a postal questionnaire, was carried out to examine the current practice of UVB phototherapy in dermatology centres in the U.K. The questionnaire was sent to 115 dermatology departments, and sought information regarding the type and age of each machine used for ultraviolet B (UVB) phototherapy, methods of prescribing, recording and terminating patient exposure, and the skin conditions treated. Completed questionnaires were received from 87 of the 115 centres, giving a response rate of 76%. The survey showed that an appreciable number of U.K. phototherapy centres are using equipment which is both old, and suboptimal in producing a therapeutic response. There appeared to be a wide variation in the approach to phototherapy, both in terms of prescribing initial and incremental exposure, and in terminating treatment. The findings suggest that effectiveness and efficiency might be improved, and the risk/benefit ratio of phototherapy further reduced, by some rationalization of treatment protocols.

Childhood vulval pemphigoid: a clinical and immunopathological study of five patients.

We describe five girls with vulval pemphigoid: two had bullous pemphigoid confined to the vulva and three had cicatricial pemphigoid. They demonstrate a spectrum of severity from localized disease to extensive vulval scarring necessitating long-term immunosuppressive therapy and surgical correction. The age at onset of their disease ranged between 6 and 13 years. All presented with vulval discomfort and erosions. Three had oral lesions, two perianal and one eye and cutaneous involvement. Two girls with only vulval lesions and one with vulval and oral lesions responded well to topical steroids. In two, systemic treatment with prednisolone and dapsone or azathioprine was required. The diagnosis was made on the basis of histology and immunofluorescence (IF). All had positive direct IF with IgG and C3. Indirect IF demonstrated circulating IgG binding to the basement membrane zone in four, with dermal or epidermal binding on salt-split skin substrate. Immunoblotting revealed antibodies to the BP230 and BP180 antigens. Immunoelectron microscopy in the child with dermal binding IgG and BP180 and BP230 on immunoblotting showed labelling at the lamina densa-lamina lucida interface adjacent to hemidesmosomes.

Flow cytometric analysis of basophil numbers in chronic urticaria: basopenia is related to serum histamine releasing activity.

BACKGROUND: Peripheral blood basophils are reduced in some chronic urticaria patients when counted with granule stains. Approximately 30% of patients with severe chronic urticaria have functional autoantibodies which release histamine from healthy donor basophils in vitro but the relationship between basophil numbers in vivo and serum histamine releasing activity has not been studied. OBJECTIVE: To determine the relationship between basophil numbers and serum basophil histamine releasing activity and to assess whether basophils are present, but undetectable, in peripheral blood with granule stains by using a new flow cytometric method based on surface immunophenotype. METHODS: Basophils were counted manually by a chamber method using a granule stain and by flow cytometry using dual staining with anti-IgE and anti-Fc epsilonRI in 25 chronic idiopathic urticaria patients and 25 healthy controls. Serum histamine releasing activity was assessed on healthy donor basophils in vitro and by the weal response to autologous serum skin testing in vivo (patients only). RESULTS: Basophils were significantly reduced in chronic urticaria by manual counting and flow cytometry. A subgroup of seven patients with in vitro histamine releasing activity showed a marked reduction or absence of basophils by both methods. There were no obvious distinguishing clinical characteristics between these patients and the others; six of them showed positive autologous serum skin-test responses. On comparing the two methods, the manual basophil counts were generally lower than flow cytometric counts. Agreement over the full range of values was not strong and therefore counts obtained by the two methods are not directly interchangeable. CONCLUSION: Basopenia in chronic idiopathic urticaria is associated with serum basophil histamine releasing activity in a subgroup of patients. The lack of granule and surface immunophenotype staining suggests a reduction in numbers rather than an inability to detect circulating degranulated cells by conventional counting methods.