Progression of IgA gammopathy to myeloma following infliximab treatment for pyoderma gangrenosum.

Pyoderma gangrenosum (PG) may be associated with inflammatory disorders and haematological conditions such as monoclonal gammopathy of uncertain significance (MGUS). We report the case of a 53-year old man who had PG and MGUS. After treatment with infliximab for the PG, he developed myeloma. The course of events in this case suggests that infliximab facilitated the progression from MGUS to myeloma.

Nicorandil-induced leg ulceration without mucosal involvement.

We report a case of leg ulceration occurring in a patient without mucosal ulcers, in whom nicorandil appeared to be the main aetiological factor. Having failed to heal on compression therapy, the ulcer rapidly improved and healed after the discontinuation of nicorandil. Most cases of nicorandil-induced ulcers reported in the literature develop on mucosal surfaces, including oral, vulval, perianal and peristomal ulcers. There are rare reports of cutaneous ulceration attributable to nicorandil, occurring concurrently with mucosal ulcers. To our knowledge, this is the first case of nicorandil-induced leg ulceration affecting the skin without mucosal involvement.

Bacteriology and antibiotic treatment of perineal suppurative hidradenitis.

A plausible bacterial pathogen (Streptococcus milleri, Staphylococcus aureus, anaerobic streptococcus, or Bacteroides species) was isolated at least once in 26 of 32 patients with active perineal suppurative hidradenitis. The main pathogen was S milleri, whose presence was significantly associated with disease activity and whose disappearance significantly correlated with clinical improvement; S aureus nd anaerobic streptococci were also implicated.

An interesting response to diphencyprone (DPC) sensitization on facial warts: review of DPC treatment for viral warts.

BACKGROUND: This paper highlights the sometimes impressive effect of diphencyprone (DPC) sensitization on warts resistant to other treatments and is interesting in view of the fact that all the warts apparently responded, despite only a very small area being treated. METHODS: A 31-year-old woman with a 5-year history of widespread facial plane warts that had proved resistant to repeated treatments with cryotherapy and topical preparations was sensitized to diphencyprone. RESULTS: After application of DPC to the warts within only a 1-cm(2) area of the face, all the facial warts became inflamed and resolved, including those not actively treated. Complete clearance occurred with no recurrence. CONCLUSION: DPC appears to be a valuable, safe and well-tolerated treatment for resistant viral warts and can be considered as a first line treatment. We review its use and action in this paper

Acute psoriasis associated with Lancefield Group C and Group G cutaneous streptococcal infections.

Involvement of Streptococcus pyogenes (beta haemolytic streptococcus, Lancefield Group A) infection, usually of the throat, in acute exacerbations of psoriasis is well known. We report here two cases of an acute psoriatic eruption associated in one patient with Group C streptococcal cellulitis and in another with Group G streptococcal intertrigo.

Treatment of cold urticaria.

In a single patient with severe essential acquired cold urticaria, the following drug regimes were assessed: diphenhydramine, cyproheptadine, hydroxyzine, terbutaline, cimetidine, hydroxyzine plus cimetidine, and hydroxyzine plus terbutaline. Each regime showed favourable results, but a significance level of P = 0.01 was reached only for (a) hydroxyzine plus cimetidine in the suppression of erythema, and (b) the histamine H1 antagonists in the suppression of wealing.

The use of topical glycopyrrolate in the treatment of hyperhidrosis.

The use of an aqueous solution of 0.5% topical glycopyrollate was effective in the treatment of hyperhidrosis of the scalp and forehead after other treatments had proved ineffective; this appears to be the first report of its use in this condition.

Urticaria associated with thyrotoxicosis.

We report a patient with chronic urticaria which was closely associated with elevated levels of thyroxine. The urticaria responded poorly to antihistamines and only partially to systemic steroids, but resolved consistently when the thyroxine level was reduced to normal. The mechanism for the association may involve modulation of the cyclic AMP levels within mast cells.

Scleredema associated with paraproteinaemia treated by extracorporeal photopheresis.

Scleredema is a rare disease characterized by extensive cutaneous woody, non-pitting induration that spreads throughout the body. We describe a patient with scleredema associated with paraproteinaemia who was successfully treated by extracorporeal photopheresis.

Pyoderma gangrenosum associated with paroxysmal nocturnal haemoglobinuria.

A case of pyoderma gangrenosum of the lip occurring in association with paroxysmal nocturnal haemoglobinuria is described. This is an extremely rare association, which has been documented in the literature on only two previous occasions. Pyoderma gangrenosum (PG) is an uncommon ulcerative skin disorder of unknown aetiology. Its clinical appearance is often distinctive, with established lesions consisting of a necrotic ulcer surrounded by a ragged undermined violaceous edge. Lesions are usually painful and are most often found on the lower limbs but can occur on the trunk, head and neck. The diagnosis is essentially clinical as there are no characteristic histopathological changes. Since its original description in 1930, PG has been frequently associated with a number of underlying systemic diseases. Foremost among these are inflammatory bowel disease and inflammatory polyarthritis. The association with haematological disorders is also well recognized, and includes acute and chronic lymphocytic and myeloid leukaemias, polycythaemia rubra vera, myelofibrosis, myelodysplastic syndrome, essential thrombocythaemia, hypogammaglobinaemia, monoclonal gammopathy, multiple myeloma and non-Hodgkin's lymphoma. We report a case of PG occurring on the lower lip of a 26-year-old man recently diagnosed as having paroxysmal nocturnal haemoglobinuria (PNH).

Myxoedematous infiltrate of the forehead in treated hypothyroidism.

A 42-year-old man presented with a 3 month history of erythema and thickening of the forehead skin. He had been diagnosed as hypothyroid 10 years previously and treated with thyroxine at adequate dosage, according to thyroid function tests. Histology confirmed a myxoedematous infiltrate. The forehead is an unusual site for deposition of mucin and the late appearance, 10 years after treatment, is also uncharacteristic. Myxoedema in the usual pretibial site is a feature of Graves' disease. This man, however, had been hypothyroid with no features of Graves' disease suggesting that there are additional factors other than thyroid status and thyroid autoimmune disease which may be important in the development of myxoedematous infiltrates.

Notalgia paraesthetica--report of an association with macular amyloidosis.

We report three patients with notalgia paraesthetica. In two of our cases amyloid deposits were found on skin biopsy. Symptoms had been present in both cases for a number of years. It is well recognized that the amount of amyloid present in macular amyloid is often very small and difficult to detect. We suggest that many cases of long-standing notalgia paraesthetica may result in the formation of amyloid, possibly secondary to chronic friction.

Acrokeratoelastoidosis.

A case of acrokeratoelastoidosis (AKE) is reported. A review of the literature has established that at least three clinicopathological entities have been reported under this term. Two of the entities show a combination of hyperkeratosis with fragmentation of dermal elastic tissue, which justifies the designation AKE. The first, for which the term familial AKE is perhaps appropriate, though many cases have been sporadic, begins in childhood or early adult life, and there is no evidence that trauma or light exposure are factors in its production. The second is a more variable clinical syndrome occurring in middle or late adult life, and both physical trauma and light exposure appear to be concerned in its induction. The third syndrome to be reported under the designation AKE shows no abnormality of elastic tissue and appears to be a separate entity.

Apert's syndrome and androgen receptor staining of the basal cells of sebaceous glands.

We report two cases of Apert's syndrome, each of whom developed the severe acne in adolescence which is a feature of this disorder. Both responded to isotretinoin therapy. Immunohistochemical techniques, using a mouse monoclonal antibody, were employed to stain sebocyte androgen receptors in the two patients, and in five controls. This showed no difference in the number of cells with androgen receptor expression between the patients with Apert's syndrome and controls. These results support the concept that the underlying problem in Apert's syndrome is an abnormal sensitivity to normal circulating levels of androgens, and not an excess number of androgen receptors.