Squamous cell carcinoma developing in two Chinese patients with chronic discoid lupus erythematosus: the need for continued surveillance.

Squamous cell carcinoma (SCC) is a rare late sequel of chronic discoid lupus erythematosus (CDLE). We report two cases of SCC developing in Chinese patients with CDLE. The first patient had prior biopsies from the same site that showed viral warts and the second patient had multiple histologically confirmed viral warts around the vicinity of the previously excised SCC. In this paper, we emphasize the need to be suspicious of warty lesions on skin afflicted by CDLE, and repeat biopsies should be performed if there is failure to respond to conventional therapy.

Impetigo herpetiformis--a rare dermatosis of pregnancy associated with prenatal complications.

INTRODUCTION: We describe a patient who developed an acute generalised pustular eruption associated with pyrexia at 33 weeks of gestation. CLINICAL PICTURE: Her condition was complicated by preterm labour, requiring an emergency caesarean section delivery. A diagnosis of impetigo herpetiformis was made on clinicopathological grounds. TREATMENT: Initial treatment with topical and systemic corticosteroids failed and oral methotrexate was added. OUTCOME: She responded well to this therapy and required only 2 doses of weekly methotrexate. CONCLUSION: Impetigo herpetiformis is a rare dermatosis of pregnancy that requires early recognition and treatment to prevent maternal and fetal morbidity. Combination therapy using oral corticosteroids and short-term methotrexate is effective.

Comparison of immunofluorescence microscopy, immunoblotting and enzyme-linked immunosorbent assay methods in the laboratory diagnosis of bullous pemphigoid.

This prospective study investigated patients with a clinical diagnosis of bullous pemphigoid (BP) who presented to a tertiary dermatology referral centre in Singapore. All patients had blood samples and skin biopsies taken for histology, immunofluorescence (IF) and immunoblot analysis prior to initiation of treatment. We analysed 23 new cases of BP during the 1-year study period. Seventeen of 22 biopsy specimens showed subepidermal blister formation, and 12 of the 17 (71%) had a predominance of eosinophils (>50%) in the blister cavity. The dermal inflammatory infiltrate of 22 biopsy specimens was predominantly lymphocytic in nine (41%) and eosinophilic in eight (36%). The histological picture was highly suggestive of BP in 15 of 22 patients (68%), suggestive in two (9%) and poorly suggestive in five (23%). Twenty-one of 23 (91%) patients had linear deposits of IgG and C3 along the dermo-epidermal junction. Serum indirect IF was positive in 22 of 23 (96%) patients, all showing antibody binding to the roof of the induced blister on salt-split skin. All of the 23 serum samples demonstrated positive immunoblot reactivity to BP180 and/or BP230 from epidermal extracts of normal human skin. Immunoblot reactivity with BP180 and BP230 was 78% (n=18) and 52% (n=12), respectively. The BP180 NC16A antibody could be detected in 22 of 23 (96%) sera using the enzyme-linked immunosorbent assay (ELISA) technique. The sensitivity of traditional diagnostic techniques, i.e. direct IF (91%) and indirect IF (96%), was comparable with that of the newer techniques, i.e. immunoblot analysis (100%) and ELISA (96%). ELISA in combination with routine indirect IF may be a useful diagnostic tool in patients with suspected BP who refuse a skin biopsy but consent to give a serum sample.