Porokeratosis of Mibelli on the penis, scrotum and natal cleft.

Genital porokeratosis of Mibelli is rare. We report a patient with lesions affecting the penis, scrotum and natal cleft and discuss the aetiology, clinical presentation and treatment of the condition.

Follicular mucinosis presenting as acute dermatitis and response to dapsone.

Follicular mucinosis is usually regarded as an eruption consisting of follicular papules or infiltrated plaques with prominent follicular openings associated with loss of hair. We describe a patient who presented with an acute extensive dermatitis confined to the face which was later diagnosed as follicular mucinosis. We believe that such a florid presentation has not previously been reported in the literature and serves to illustrate the difficulty in distinguishing acute follicular mucinosis from acute eczematous dermatitis, pyogenic infections and inflammatory fungal infections.

A prospective study of the effects of weekly oral methotrexate on liver biopsy.

The results are reported of a prospective study of liver histological findings in twenty-five patients with severe psoriasis subjected to liver biopsy before and at intervals after the onset of treatment with methotrexate by an intermittent dosage schedule. The pre-methotrexate liver biopsy findings in forty-one other severe psoriatics are also summarized. Of the twenty-five treated patients, four showed a mild inflammatory cell infiltrate and two mild fibrosis before treatment. During treatment only one developed a grade 2 infiltrate and one other grade 2 fibrosis. None has developed cirrhosis. Where minor abnormalities developed, their fluctuating and reversible nature is demonstrated.

Ultrasound as a screening procedure for methotrexate-induced hepatic damage in severe psoriasis.

Methotrexate has been of proven value in the management of patients with severe psoriasis. Its long-term use, however, can be complicated by progressive hepatic damage which has necessitated regular liver biopsies. We have looked into the efficacy of liver ultrasonography as a non-invasive screening procedure to select those patients who may be developing liver changes. Eighty-seven investigations on 82 patients were performed, comparing liver ultrasound results with liver biopsy. Eight of these showed a degree of hepatic damage which was sufficient to indicate cessation of methotrexate, and all of these were detected by ultrasonography. Our results indicate that patients whose last liver biopsy was normal could be allowed an extended interval between biopsies provided their intervening ultrasound scans remained normal.

Sunbed-induced pseudoporphyria.

The clinical details of four fair-skinned women with recurrent blistering and skin fragility are presented. All had considerable sun-exposure and had used sunbeds for years. Specific causes of bullous dermatoses including drug ingestion, porphyria, cutaneous amyloidosis and epidermolysis bullosa acquisita were excluded. Long-term recurrent exposure to high doses of sunbed radiation in chronically sun-damaged skin appears to be a further cause of pseudoporphyria.