Dermatomyositis. Disease associations and an evaluation of screening investigations for malignancy.

Fifty-three adult patients (19 men, 34 women) with dermatomyositis were studied. Two had dermatomyositis associated with benign disorders. Twenty-three (43%) had a malignancy; the risk of malignancy increased with age, but there was no sex difference. Seven malignancies were recurrences and 9 were diagnosed during investigation of dermatomyositis; these 16 were suspected clinically or from abnormal results of simple investigations. Extensive screening tests did not increase the number of malignancies diagnosed. In 7 patients, a diagnosis of malignancy was made more than 9 months after onset of dermatomyositis, although a relationship between malignancy and dermatomyositis was uncertain in two cases; the diagnosis of gynecological malignancy was missed in 2 patients despite appropriate investigations, 1 patient had poorly controlled dermatomyositis, and in 2 patients late diagnosis of malignancy was due to failure to reinvestigate relapse of previously stable dermatomyositis.

Skin clips are contraindicated when there is nickel allergy.

Four patients are described who developed generalized dermatitis following surgical wound closure with disposable skin clips. In 3 of them a vesicular palmar eczema was a prominent feature. They were found to have contact allergy to nickel, a component of the clips. If skin clips are to be used to close a surgical wound, it should be established that the patient is not allergic to nickel.

An overview of experience with ketoconazole shampoo.

The spectrum of disease known as dandruff/seborrhoeic dermatitis has been shown to be due to infection of the skin by the Pityrosporon species of fungus. Ketoconazole shampoo has been shown to suppress effectively both the organism's growth and the symptoms and signs of the clinical disorder.

Follicular molluscum contagiosum.

Four cases are reported in which atypical molluscum contagiosum lesions were found, arising from follicular epithelium. All the patients were adults and two had a history of atopic dermatitis. Histology showed intradermal nodules containing typical molluscum cells but lacking normal direct communication to the skin surface. This is the first description of true follicular involvement in molluscum contagiosum.

Folinic acid rescue used routinely in psoriatic patients with known methotrexate "sensitivity".

Many combinations of methotrexate and folic or folinic acid have been used to limit the side effects of methotrexate therapy in psoriasis or psoriatic arthropathy. Methotrexate inhibits the enzyme dihydrofolate reductase and prevents the formation of DNA and RNA. Folinic acid, the 5-formyl derivative of tetrahydrofolic acid, is the active form of folic acid. We have confirmed in 5 patients that continuous administration of folinic acid with weekly oral methotrexate prevents improvement of psoriasis. When folinic acid was ceased on the day of methotrexate in these patients their psoriasis improved. Five other patients with previous sensitivity to methotrexate, forcing cessation of therapy, were given weekly oral methotrexate and folinic acid every day except the day of methotrexate. Marked improvement of psoriasis or arthropathy occurred in each case without side effects. This method precisely limits the exposure to methotrexate, allowing a therapeutic effect without complication even in those patients who exhibit methotrexate sensitivity.

Cutaneous secondary follicular centre cell lymphoma in association with lymphoedema praecox.

We report a patient who developed cutaneous metastases in a lymphoedematous leg, from a follicular centre cell lymphoma, in a setting of lymphoedema praecox and recurrent deep-vein thromboses. To our knowledge, this is the first report of such a case. We discuss the possible causes for this localization.

Allergic contact dermatitis due to highly reactive halogenated compounds.

10 cases of dermatitis in a fine organic chemicals plant are reported. These cases were all due to exposure to chemical compounds with reactive bromine or chlorine atoms. This type of chemical is always extremely irritant, but evidence is put forward to suggest that these cases were the result of allergic sensitization. Chemicals with reactive halogen atoms should always be handled with extreme care and patch testing should be approached with caution.

Tinea incognito.

Fourteen cases are described in which the local application of corticosteroid preparations to ringworm infections of the skin have resulted in unusual clinical pictures. A kerion-like lesion due to Trichophyton rubrum, intertriginous infections simulating candidiasis and due to Epidermophyton floccosum, and pictures resembling poikiloderma, papular rosacea, and indeterminate leprosy are among the changes that were seen in these patients.

PUVA treatment of scleromyxoedema.

Treatment of a 60-year-old woman with scleromyxoedema with 8-methoxypsoralen and UV-A radiation (PUVA) resulted in significant clinical and histological improvement but no change in circulating paraprotein.

Pityriasis amiantacea, an unrecognized cause of scarring alopecia, described in four patients.

Pityriasis amiantacea is not generally recognized as a cause of scarring alopecia. We describe 4 patients with scarring alopecia in the distribution of past or active pityriasis amiantacea and suggest that it is a not uncommon sequela.

Bullous pemphigoid and burns: the unveiling of the attachment plaque?

Two patients with bullous pemphigoid (BP) associated with burns are described. The case with BP lesions that were localized is the first to be described in the literature and generalized BP has been described on only one occasion previously. Both cases exhibited the clinical features of BP and settled with the use of oral prednisolone. Many extrinsic precipitants of BP have been described; however, the precise trigger of the autoimmune process is not yet understood. The authors discuss the hypothesis that as burns expose BP antigen, the association of BP with advancing years arises through exposure of BP antigen during the process of involution of the basement membrane zone seen in the normal process of ageing. BP should be considered in cases of burns associated blistering, particularly blisters occurring at distant sites, but also involving affected skin.

Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole.

A randomized, double-blind, placebo-controlled cross-over study was made of ketoconazole shampoo in the treatment of 20 subjects with seborrhoeic dermatitis of the scalp. Responses were measured by clinicians using clinical gradings, and by the patients using a linear analogue scale. Scaling and itching of the scalp improved significantly with ketoconazole and no response was seen with placebo. Topical ketoconazole appears to be an effective therapy for seborrhoeic dermatitis of the scalp, and more suitable for long-term treatment than the oral preparation.

A comparative study of the frictional properties of emollient bath additives using porcine skin.

The coefficient of friction of 14 prescribable bath emollients was determined using porcine skin attached to a loaded plunger placed through a bearing in a friction-measuring carriage, held above a reciprocating table powered by a DC motor. The carriage was mounted in low-friction rollers, and restrained by a piezo-electric force transducer connected to an amplifier and recorder. Friction was measured at room temperature, and at 45 degrees C. Emulsifying ointment and Bath E45 had the highest coefficients of friction, at room temperature and 45 degrees C, respectively, and Emmolate and Hydromol had the lowest. Nine of the 14 emollients had a lower coefficient of friction at 45 degrees C, one had a coefficient of friction which was the same at both temperatures, and four had a coefficient of friction which was higher at 45 degrees C.

The establishment and clinical value of a dermatological photobiology service in a district general hospital.

The availability of a local dermatological photobiology facility has proved to be of great value in the management of patients with photodermatoses, especially those with chronic actinic dermatitis. It is our belief that clinically useful results can only be achieved if careful attention is paid to technical factors such as radiation measurement.

Cutaneous and ocular reactions to practolol.

A total of 21 patients suffering from drug-induced rashes from practolol have been seen over the past two years. The clinical manifestations varied, with the morphological appearances of the rash resembling those of eczema, lupus erythematosus, lichen planus, and a highly characteristic toxic erythematous psoriasiform eruption. Persistent ocular damage was a feature in three cases.

Aquagenic pruritus associated with juvenile xanthogranuloma.

While the relationship of aquagenic pruritus (AP) to haematoproliferative conditions is well-recognized, an association with histiocytic disorders has not previously been described. The case of a child with both AP and juvenile xanthogranulomata (JXG) is reported. The cutaneous lesions were typical of JXG, both clinically and histologically, and in addition there were radiological changes consistent with JXG in the lungs. AP is rare in childhood and the coincidental occurrence with unusually extensive JXG seems unlikely.

Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome.

We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.