Severe cutaneous reactions to captopril and enalapril; histological study and comparison with early mycosis fungoides.

A severe non-dose related skin eruption attributable to treatment with captopril was recently reported: this is distinct from the dose related rashes that have been widely described. Ultrastructural and immunohistochemical studies were carried out to determine in detail the histological features of this eruption: the histological appearances were similar to those found in early mycosis fungoides, so that this disease was erroneously diagnosed in one case. Unlike most other complications resulting from treatment with Captopril, an indistinguishable rash can result from treatment with enalapril, a newer angiotensin converting enzyme inhibitor.

Abnormal laboratory test results and their relationship to prognosis in discoid lupus erythematosus. A long-term follow-up study of 92 patients.

Investigation of 92 patients with discoid lupus erythematosus, manifested initially by localized cutaneous lesions only, showed abnormal laboratory test results for 57 patients (62%) on admission and for 62 patients (67.4%) on review 16 to 20 years later. Patients with discoid lesions confined to the head and neck (DLE) showed fewer laboratory abnormalities than those patients with disseminated lesions involving trunk and limbs (disseminated discoid lupus erythematosus [DDLE]). Systemic lupus erythematosus (SLE) eventually developed in six (6.5%) of the patients, and all had shown persistent multiple abnormal laboratory findings from the beginning. Complete remission occurred in 46.7%. A persistent positive antinuclear factor of either speckled or homogeneous pattern with a titer greater than 1:50, leukopenia, thrombocytopenia, or a false-positive Wassermann reaction indicated those patients who may progress to DDLE or SLE.

Dermatological pathomimicry: a form of patient maladjustment.

Thirteen patients (eleven female, two male; aged 19-72 years) who mimicked their original dermatological disease by reproducing the original mechanisms of disease or by interfering with therapy were seen over a period of 5 years. Six patients had exacerbations of eczema, four drug reactions, and three non-healing leg ulcers. Exacerbations of dermatological disease were related to the patient's need for a sickness role. This maladjustment responded to positive directive psychotherapy rather than a superficial sympathetic approach which tended to reinforce the maladjustment. Eleven patients admitted their part in actively producing their disease, and the outcome was good. This clinical syndrome appears to be predominantly an opportunist reaction although one patient was depressed and one had early dementia. The syndrome should not be confused with dermatitis artefacta.

A haemorrhagic bullous eruption of the hands caused by phenylbutazone: a report of 3 cases.

Three patients developed a haemorrhagic eruption on the hands after taking phenylbutazone. The reaction appeared within two weeks of taking the drug and is probably an allergic capillaritis. All patients showed generalised capillary fragility with a positive Hess test which became negative within a week of stopping the drug. A mechanism is suggested for the development and distribution of the blisters.

Norwegian scabies developing during treatment with fluorinated steroid therapy.

A fit, normally intelligent young man developed Norwegian scabies after prolonged treatment with large quantities of clobetasol propionate ointment. The development of this overwhelming infestation from the normal eruption of scabies may be related to the local immunosuppressive effect of this potent topical steroid.

Systemic sclerosis in association with multiple primary pulmonary malignancy--a marker of internal malignancy?

Multiple pulmonary malignancy is uncommon and has not been reported in association with systemic sclerosis. We now report such a case in which it is likely that the connective tissue disease occurred as a marker of the internal malignancy. Systemic sclerosis is not generally a reliable indicator of malignant change, but it is possible that in patients who are immunosuppressed, either therapeutically or inherently, the onset of systemic sclerosis should prompt investigation for an underlying cause.

Pyoderma gangrenosum--a complication of chronic venous leg ulceration?

Three patients whose chronic venous leg ulcers were complicated by pyoderma gangrenosum are reported. Illnesses which may have predisposed to the development of pyoderma gangrenosum included Crohn's colitis, rheumatoid arthritis and small bowel perforation. Pyoderma gangrenosum should be suspected in susceptible patients whose venous leg ulcers undergo inexplicable and painful deterioration.

Chilblain lupus erythematosus (Hutchinson). A clinical and laboratory study of 17 patients.

Chilblain lupus erythematosus (LE) is a chronic unremitting form of LE ssen predominantly in women. It occurs commonly on the digits, calves and heels. Nasal lesions are rare. Chronic facial discoid LE usually appears before the chilblain form but, in most instances, resolves even though the chilblain lesions persists. Transformation to systemic LE occurs more often in those who develop both forms of cutaneous LE simultaneously and in the erythema multiforme syndrome. The chilblain lesions are the result of microvascular injury secondary to exposure to cold and possibly hyperviscosity from immunological abnormalities, Elevated serum gammaglobulins, positive latex factor and speckled pattern antinuclear factor are common. None of the usual treatments for cutaneous LE is effective for the chilblain lesions, probably because none is directed towards prevention and treatment of the microvascular stasis.

Primary amyloidosis and myelomatosis associated with excessive fibrinolytic acitivty.

A case of primary amyloidosis is described in association with Bence-Jones myeloma and increased fibrinolytic activity. Epsilon aminocaproic acid reversed the fibrinolytic activity and clinical improvement was maintained with melphalan and prednisolone.

Sarcoidosis and thyrotoxicosis: A study of five patients.

Five patients with sarcoidosis and thyrotoxicosis have been studied. Autoimmunity resulting from loss of thymus-derived lymphocyte control is suggested as a cause common to both.

Severe halogen acne due to a trifluoromethylpyrazole derivative and its resistance to isotretinoin.

We report a case of severe chloracne, with systemic involvement, following occupational exposure to dihydrotrifluoromethylphenyl benzothiopyranopyrazolone, which, to our knowledge, has not been previously reported as a cause of chloracne. Aggressive drug treatment, including high-dose oral isotretinoin was of limited benefit in suppressing the disease activity.

The effect of PUVA therapy on glycoprotein biosynthesis in uninvolved psoriatic epidermis.

Protein and N-linked glycoprotein biosynthesis was studied in the uninvolved epidermis of patients with psoriasis by the incorporation of radiolabelled leucine and mannose prior to and during PUVA treatment. Analysis of the polyacrylamide gel electrophoresis (PAGE) patterns of the 3[H]-labelled proteins and glycoproteins showed that the major changes in untreated uninvolved psoriatic epidermis compared to normal epidermis were: (a) a shift towards the synthesis of low-molecular-weight glycoproteins; (b) the absence of a 48-kDa peak labelled with mannose; (c) the appearance of 3[H]-mannose-labelled peaks at 40-36 kDa. PUVA treatment gradually changed the PAGE profile back more towards that expected for normal epidermis, with the reintroduction of a 52-48-kDa glycoprotein and reduction of the peaks in the 40-34-kDa region. This effect was dependent on uninterrupted treatment. The PUVA-treated PAGE profiles were compared to those expected in skin tumours (i.e. increased 3[H]-mannose-labelled peaks at 95 and 40-34 kDa with an absence of 62-kDa peaks). It appeared that these criteria were not seen generally as a result of PUVA treatment. However, the results indicate that tumour development may be possible if a patient responds to PUVA treatment by showing an increased peak at 95 and 40-34 kDa in association with a loss of an 3[H]-mannose-labelled peak at 62 kDa.

Information leaflets in the dermatology out-patient waiting area.

Patients' attitudes to the supply and quality of information provided about their condition were examined by questionnaire before (n = 852) and after exposure to an information leaflet campaign (n = 560) in the dermatology out-patient waiting area. A high expectation of this service was demonstrated, particularly from patients under 60 years of age with chronic diseases. A variety of information sources, other than doctors, were identified which could be improved (video-systems, specialist nurses, leaflets, posters). The campaign significantly increased the percentage of patients who derived information from the leaflet source (5.6-18.8%, P < 0.001) and it reduced a demand for leaflets (16.4-9.1%, P < 0.001). However, the campaign did not alter patients' perceived need to spend more time with a dermatologist. In order to achieve a greater impact on patient satisfaction, a combination of information sources in the out-patient department should be targeted at young adults with chronic diseases.

Acute graft-versus-host disease with unusual cutaneous intracellular vacuolation in an infant with severe combined immunodeficiency.

We report an infant with severe combined immunodeficiency (SCID) who had cutaneous manifestations of acute graft-versus-host disease (GVHD) due to maternofetal lymphocyte engraftment. Histologic and ultrastructural examinations of the skin revealed intracellular vacuoles resembling lipid droplets in the epidermis and dermis, which is not a recognized feature of acute GVHD or SCID.

Histocompatibility antigens in discoid and systemic lupus erythematosus.

A study of histocompatibility (HLA) antigens in 69 patients with discoid lupus erythematosus (DLE) showed an increased incidence of HLA-B7 and HLA-B8 related to the age at onset and sex of the patient. Young females and males aged 15-39 years at onset were associated with HLA-B7 and females aged over 40 years with HLA-B8. This supports previous studies concerning sex and age specific onset rates in DLE which suggests that there is more than one genotype in this disorder. Female patients with systemic lupus erythematosus (SLE) at all ages of onset showed a significant association with HLA-B8. Female patients, with onset 15-39 years, with either SLE or DLE which has transformed to SLE, show a significant increase in HLA-B8 compared with the females in the same age onset group who have the discoid disease. The presence of HLA-B8 in a young female with DLE may represent a risk factor for the development of the systemic disease.

An unusual case of acquired localized argyria.

We report an unusual cause of localized cutaneous argyria, due to the cutaneous implantation of a silver earring back.