Dermal melanocytosis: a clinical spectrum.

While most dermal melanocytoses are congenital or have an onset in early childhood, there is a group which is clearly acquired, with an onset in adult life. While the Mongolian spot typically disappears in childhood, other dermal melanocytoses persist for life. A brief review of the clinical spectrum of the dermal melanocytoses is undertaken and three illustrative cases are described: a case of congenital naevus of Ota, a case of acquired bilateral naevus of Ota-like macules, and an unusual case of a congenital dermal melanocytotic lesion on the left had which began to spread in adulthood. The possibilities regarding the pathogenesis of this intriguing group of disorders are considered.

Ehlers-Danlos syndrome type II: importance of recognition.

We report a case of Ehlers-Danlos syndrome Type II presenting with subtle clinical features and discuss the importance of early recognition of this disorder. A 16 year old Caucasian schoolgirl presented with soft tissue swellings on her fingers. There was a history of poor wound healing and prematurity and a family history of miscarriages. Clinical examination revealed hypermobile joints, hyperelastic skin and a 'cigarette paper' scar at the site of a previous minor surgical excision. Management consisted of genetic counselling and advice concerning career choice, recreational activities, as well as future pregnancy and surgery. This subtype of Ehlers-Danlos syndrome is probably fairly common in the community. While it may present with subtle clinical features, recognition is important so that counselling can be offered at a young age in order to avoid the major consequences that may arise during pregnancy and surgery.

Skin disorders in Indo-Chinese immigrants.

OBJECTIVE: To define and assess the relative frequency of the skin disorders which were seen in Indo-Chinese immigrants, and to describe in detail some of the interesting cases encountered. DESIGN: Retrospective review of case records of Indo-Chinese immigrants referred to the Lidcombe Hospital Dermatology Centre between October 1987 and March 1991. SETTING: Lidcombe Hospital. PATIENTS: Indo-Chinese immigrants assessed at the Lidcombe Hospital Dermatology Centre. RESULTS: One hundred and ninety patients were identified. The most common categories of skin disorders were disorders of pigmentation, disorders of sebaceous glands, and dermatitides. Disorders not often seen in the non-Indo-Chinese population (e.g., naevus of Ota, cutaneous tuberculosis and primary skin-limited amyloidoses) were also identified. No cutaneous malignant conditions were encountered. CONCLUSIONS: Chloasma and acne vulgaris are common dermatological disorders in Indo-Chinese immigrants. Cutaneous malignant diseases do not appear to be common in this population, in contrast to their common occurrence in Caucasian patients.

Oestrogen dermatitis.

A 56-year-old woman presented with a recurrent itchy eruption mainly involving her face and upper trunk for 5 years. The rash flared cyclically 3 days before her menstruation and improved 5-10 days after the onset of her period. Examination revealed erythematous maculopapules, vesicles and crusting mainly on her face and upper trunk. Biopsy from a papule revealed spongiotic dermatitis. Intradermal testing with oestrogen was positive. There was marked improvement with tamoxifen. Sensitivity to oestrogen and progesterone is rare in women and the clinical presentation may be similar. Positive intradermal testing is diagnostic. Tamoxifen is effective in treating oestrogen sensitivity.

Sun protective clothing in Australia and the Australian/New Zealand standard: an overview.

Clothing has been part of the sun protection strategy for many years. However, it is only recently that studies have been undertaken to investigate the protectiveness of fabrics and to place clinical advice on a sound scientific basis. Fabrics can now be rated and an ultraviolet protection factor assigned. Several factors influence photoprotection such as construction, stretch, hydration, colour, fibre type and various manufacturing processes. In 1996 the Australian/New Zealand Standard for sun protective clothing was published. This is the first of its kind in the world.

Recurrent cutaneous erythralgia and arthralgia.

Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.

Sun protection by a summer-weight garment: the effect of washing and wearing.

OBJECTIVE: To assess the effect of use (washing and wearing) on the photoprotection provided by a cotton fabric. METHODS: Twenty jersey-knit pure cotton T-shirts were worn for 4-8 hours per week and washed weekly for 10 weeks. Fabric samples taken before and after use were compared. MAIN OUTCOME MEASURES: Fabric ultraviolet protection factor (UPF) was calculated from spectrophotometric ultraviolet radiation transmission data. Changes in fabric structure and hole size were determined for samples from one T-shirt by light microscopy and image analysis. RESULTS: UPF increased consistently and significantly after use, from a mean of 19.0 to 40.6. A corresponding reduction in fabric hole area was seen under the light microscope and confirmed on image analysis (from 8.0% to 3.9% of total image area). CONCLUSION: UPF of pure cotton garments may improve after use, at least in the short term. The increase is mostly accounted for by reduction in fabric hole area due to shrinkage.

Raimer's bands: case report with a review of solar elastosis.

Raimer's solar elastotic bands of the forearm are a rarely described clinical variant of severe solar elastosis. We report a case of Raimer's bands on the forearm of a 43-year-old woman. Light microscopy demonstrated solar elastosis and electron microscopy revealed activated fibroblasts appearing to secrete the elastotic material. The clinical variants of solar elastosis are outlined and the possible pathogenesis of the elastotic material is discussed.

Unilateral facial actinic elastotic plaque--a new clinical variant of actinic elastosis.

The case is reported of an 82-year old woman with a four month history of an erythematous indurated plaque on the left cheek. Light and electron microscopy demonstrated the presence of solar elastosis alone. We believe that this is a new clinical variant of solar elastosis. The spectrum of cutaneous actinic damage is reviewed.

Skin reactions to diltiazem.

A survey of Australian dermatologists was conducted into skin reactions observed to diltiazem. These have included: erythema multiforme, subcorneal pustular dermatosis, photosensitive erythroderma, macular exanthem, allergic vasculitis and urticarial vasculitis. The range of clinical and histopathological features are described. A review of the literature is presented. Photosensitive erythroderma and urticarial vasculitis have not, to our knowledge, been reported in the literature previously.

Systemic treatment of severe psoriasis.

Severe psoriasis presents a difficult therapeutic challenge. Some modalities such as synthetic retinoids, phototherapy and methotrexate have been available for many years and need reappraisal, cyclosporin has only recently become available and requires careful administration. In this article we focus on the therapeutic modalities available to the dermatologist in Australia.

Toxic streptococcal syndrome.

The reappearance of more virulent strains of exotoxin-producing streptococci over the past decade has led to the re-emergence of invasive Group A streptococcal infections and the recognition of a new syndrome resembling staphylococcal toxic shock syndrome. Toxic streptococcal syndrome is characterized by fever, shock, multiorgan system failure and a desquamating scarlatiniform rash. It usually occurs in otherwise healthy young adults, often in association with a severe soft tissue infection and has a 30% mortality rate. The case of a 37-year-old obese man, who rapidly developed features of this syndrome after an antecedent pharyngitis and cellulitis, is presented. There was serological evidence of a recent Group A streptococcal infection. Intensive organ supportive measures and intravenous antibiotic therapy led to his gradual recovery.

Skin phototyping in Asian Australians.

Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.

A comparative study of fabric protection against ultraviolet-induced erythema determined by spectrophotometric and human skin measurements.

Historically, a textile's ability to protect against ultraviolet radiation (UVR)-induced erythema has been based on its UVR transmission. However, due to the nonuniformity of the fabric structure of a textile and its resultant nonuniform transmission, the above prediction may not hold. The fabric protection factors (FPF) of 5 metal meshes, to simulate the weave pattern and yarn dimensions of typical fabrics, and 6 textiles with variable construction (woven and knitted), fibre type and dye were determined using a spectrophotometric assay and human skin testing. All 5 meshs and 5 of the 6 textiles allowed spectrophotometric prediction of their FPF compared with off-skin (2 mm) human testing. However, on-skin human testing FPF were generally significantly lower than both the off-skin and spectrophotometric estimates. Although evidence is presented that the nonuniform nature of a textile's structure does influence its FPF predictability, in practice, properly conducted spectrophotometric analysis may yield the most typical indication of the protectiveness of a fabric against UVR-induced erythema.

Intratumoral chemotherapy with fluorouracil/epinephrine injectable gel: a nonsurgical treatment of cutaneous squamous cell carcinoma.

BACKGROUND: We attempted to originate a nonsurgical treatment alternative for cutaneous squamous cell carcinoma (SCC), and we evaluated intratumoral modified-release chemotherapy with fluorouracil/epinephrine injectable gel (5-FU/epi gel). OBJECTIVE: To assess the safety and efficacy, we conducted an open-label pilot study of 5-FU/epi gel in 25 patients with biopsy-proven SCC lesions on the face, head, neck, trunk, arms, and hands. METHODS: Each tumor site was injected intradermally with up to 1.0 ml of 5-FU/epi gel. One SCC per patient was treated weekly for up to 6 weeks, then observed for 4 months at which time the tumor site and margins were excised for histologic examination. RESULTS: Overall, 96% (22 of 23) of evaluable treated tumors had histologically confirmed complete tumor clearing. No clinically significant systemic reactions or unexplained treatment-related adverse medical events occurred. The evaluations of the cosmetic appearance of the treated sites, judged subjectively by clinicians and patients, were mostly good to excellent and generally in close agreement. CONCLUSION: Treatment of superficial SCC with 5-FU/epi injectable gel results in a high rate of histologically confirmed complete tumor responses and may provide a nonsurgical treatment alternative in selected patients.