Hereditary angioedema and thyroid autoimmunity.

Sera from 91 patients with hereditary angioedema were screened for thyroid antibodies. The results for the 77 patients more than 17 years old were compared with previously published data for the prevalence of thyroid disease in a large community (Whickham). Of the female patients with hereditary angioedema, the prevalence of thyroglobulin antibodies (TGA) was 14.0%, higher than the expected 3% (p less than 0.001). The prevalence of thyroid microsomal antibodies (TMA) was 20%, also higher than the expected 7.6% (p less than 0.01). The age distributions of the females in both groups differed: in the group with hereditary angioedema there was a greater proportion of younger patients which should have resulted in a lower prevalence of thyroid antibodies. Adjusting for related patients with hereditary angioedema, there was still an increased prevalence of TGA (p less than 0.01) and TMA (p less than 0.01).

Thirteen British cases of erythema chronicum migrans, a spirochaetal disease.

Thirteen British cases of erythema chronicum migrans are reported. An antibody to the Lyme disease spirochaete was found in three of five recent cases, but Lyme disease was not seen. The distribution and life cycle of the tick Ixodes ricinus is described and related to the occurrence of erythema chronicum migrans in Great Britain.

Emerging pattern of Lyme disease in the United Kingdom and Irish Republic.

In the past year there have been 68 cases of Lyme disease in the United Kingdom and Republic of Ireland. 41 patients had erythema chronicum migrans, and 8 of them had associated neurological disease. 13 further patients presented with neurological disease without a preceding skin lesion. Myocarditis was present in 1 patient. Ixodes ricinus was confirmed as the vector for Lyme disease. In two areas deer were found to be infected by Borrelia burgdorferi, the causative organism of Lyme disease. 86% of 45 deer sera tested had significant antibody titres against B burgdorferi.

Localized granuloma annulare is associated with insulin-dependent diabetes mellitus.

The prevalence of diabetes mellitus in 557 patients with granuloma annulare (GA) has been assessed by a retrospective study, using age-matched population data. A definite association was confirmed between GA and insulin-dependent diabetes with 16 observed cases compared with 0.9 expected, and in all but one case the diabetes was associated with the localized form of GA. Two further cases developed insulin-dependent diabetes within 5 years of presentation with GA.

Galactose tolerance in patients with atopic cataracts.

Galactosaemia has been suggested as a contributory factor in the pathogenesis of some presenile and senile cataracts. To assess whether galactosaemia plays any part in the development of atopic cataracts a galactose tolerance test was carried out in eight atopic dermatitis patients whose cataracts had appeared between the ages of 12 and 39 years. In seven patients a normal result was obtained and in one the result was just above normal. Impaired galactose tolerance appears to have no role in the pathogenesis of atopic cataract.

Essential fatty acids in the plasma phospholipids of patients with atopic cataracts.

Abnormal levels of the essential fatty acids (EFA) in plasma phospholipids have been reported in atopic dermatitis. We have compared EFA levels in 10 patients with atopic cataracts and 29 atopic dermatitis patients without cataracts and found no significant differences, with the exception that higher levels of adrenic acid occurred in those with cataracts.

Oral spironolactone: an effective treatment for acne vulgaris in women.

The effect of oral spironolactone (200 mg daily) on acne vulgaris has been studied in 21 women in a randomized, placebo-controlled, double-blind crossover study using 3 month treatment periods. Compared with placebo, spironolactone produced significant improvement as assessed by subjective benefit (P less than 0. 001), number of inflamed lesions (P less than 0 . 001) and by an independently evaluated photographic method (P less than 0 .02). There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone. Initial plasma androgen levels were no higher in responders than in non-responders, nor did oral contraceptive use appear to affect clinical response. Spironolactone is a useful alternative therapy for women with acne vulgaris.

Molluscum contagiosum: characterization of viral DNA and clinical features.

Restriction endonuclease analysis of molluscum contagiosum virus DNA revealed two subtypes. In a study of 46 isolates from 41 patients, some with no other disorder and some with atopic dermatitis, the ratio of MCV I isolates to MCV II was 34:12. Multiple clustered lesions removed at the same time from an individual patient yielded only one type of MCV. Lesions induced by MCV I or MCV II were indistinguishable on the basis of size and form. Neither subtype was associated exclusively with lesions at certain sites or with other clinical features. Heterogeneity of DNA restriction endonuclease cleavage patterns amongst isolates of the same subtype was observed, this being greatest for MCV II.

Molluscum contagiosum virus types in genital and non-genital lesions.

The endonuclease digest patterns of viral DNA from 48 genital and 45 non-genital molluscum contagiosum virus (MCV) lesions were examined. The overall ratio of MCVI to MCVII was 3.23:1. There was no predominance of either MCV type in genital lesions. No obvious morphological differences were seen between MCVI and MCVII lesions. MCVII was not found in any patient under 15 years old.

Early warning skin signs in AIDS and persistent generalized lymphadenopathy.

Distinctive patterns of skin disease other than Kaposi's sarcoma have been in patients with AIDS, in others with persistent generalized lymphadenopathy (PGL) and in a group at high risk of developing AIDS. We found a chronic acneiform folliculitis on the face, back, chest and buttocks, extensive cutaneous fungal infections and a striking neck and beard impetigo. These skin diseases were not present in asymptomatic male homosexual control subjects, 32% of whom were found to have antibodies to human T cell lymphotropic virus type III (HTLV-III). We regard these dermatoses as early warning signs of AIDS.