Sir Ernest Graham-Little, MP, MD FRCP (1867-1950): dermatologist and politician.

Sir Ernest Graham-Little was not only one of the foremost British dermatologists of the first half of the 20th century but he also served from 1924 to 1950 as an Independent Member of Parliament. As a dermatologist he played a leading role in medical education, wrote a vast number of clinical papers, was the President of both the British Association of Dermatology (as it then was) and the Section of Dermatology of the Royal Society of Medicine, and he described a form of scarring alopecia that has become known as Graham-Little syndrome. He was the first to describe the syndrome later named after Waterhouse and Friedrichsen. In Parliament he expressed his opinions on a vast array of subjects, often advancing views well ahead of his time. Perhaps most remarkably, for much of his time in Parliament he was still an active dermatologist. Notwithstanding the formidable achievements in his twin careers, his name is not well known.

Anthralin-corticosteroid combination therapy in the treatment of chronic plaque psoriasis.

A prospective randomized trial of anthralin in Lassar's paste compared with anthralin in 0.0125% clobetasol propionate in the treatment of chronic plaque psoriasis was undertaken. The psoriatic skin of patients treated with the corticosteroid-anthralin combination cleared significantly more quickly than those treated with anthralin alone, with a mean time to clearance of 14.9 days compared with 18.5 days, and with lower concentrations of anthralin. No significant difference was found in the rate of relapse of the two treatment groups, with relapse occurring in over 80% of patients within one year. Anthralin in 0.0125% clobetasol propionate was found to be an effective agent in the treatment of chronic plaque psoriasis, and one that was cosmetically acceptable to patients and nursing staff. An important disadvantage, however, was the development of a staphylococcal folliculitis in four of the 35 patients in which it was used. Because of this, anthralin in Lassar's paste remains our standard inpatient therapy, although the ease of use and cosmetic acceptability of anthralin in clobetasol propionate make it a useful remedy for outpatient use.

Transcutaneous electronic nerve stimulation in the treatment of generalized pruritus.

Generalized pruritus is a notoriously troublesome condition for both patient and dermatologist. This paper describes the favourable therapeutic effect of transcutaneous electrical nerve stimulation (TENS) in two elderly patients with severe chronic generalized pruritus unresponsive to other treatment. The therapeutic application of TENS to the treatment of generalized pruritus has not previously been described.

The prevalence of splinter haemorrhages.

A study was undertaken to determine the prevalence and distribution of subungual splinter haemorrhages in healthy individuals. They were found commonly in both sexes, though significantly more frequently in males. Where present in females, they were confined to a single digit.

Patch testing in a British district general hospital.

The results of patch testing in 753 patients attending a dermatology clinic in a British district general hospital over the period 1993-96 are presented. The frequency of positive reactions, and of the relative frequency of common allergens is broadly comparable to series published from specialist contact clinics. This study suggests that nonspecialist dermatology clinics can carry out routine patch testing adequately, although there are likely to be a number of cases which will require review in a specialist clinic or specialist advice.

Contact urticaria to locusts.

We describe a case of allergic contact urticaria provoked by locusts in a laboratory research worker. One of her colleagues also had locust-induced contact urticaria, and another had asthma provoked by locust exposure. Contact urticaria to locusts is an occupational hazard apparently well known to professional entomologists, but one which has not previously been described in the dermatological literature, to my knowledge.

Delusions of parasitosis with fatal outcome.

The case of a 40-year-old man with delusions of parasitosis as the presentation of a monodelusional psychosis is reported. In spite of treatment with pimozide and depot neuroleptics the patient committed suicide. Since the introduction of pimozide, this drug has come to be regarded as the specific treatment for this disorder; this case is presented to emphasize the fact that not all cases respond, and that the disorder can have a fatal outcome.

Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of seven cases.

Seven patients with poikiloderma of Civatte were treated successfully with the pulsed dye laser. One patient's treatment was complicated by scarring, which appeared 4 months after the treatment.

Pulsed dye laser treatment of necrobiosis lipoidica: report of a case.

A 23-year-old woman with long-standing insulin dependent diabetes presented with necrobiosis lipoidica. She was particularly troubled by the telangiectatic element of the lesion and therefore underwent test treatment with the pulsed dye laser. At low fluences minimal therapeutic effect was achieved, and at higher fluences skin breakdown occurred. This resolved with conservative management. It would appear that caution is required when attempting to treat necrobiosis lipoidica with laser.