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Notes: A case of lupus vulgaris is presented with an unusually rapid evolution and numerous tubercle bacilli on histology. The merits of different chemotherapeutic regimes are discussed.

Notes: A case of Cowden's disease with many of the characteristic mucocutaneous and systemic features is reported. A sister with partial expression of the syndrome is also described, with particular emphasis on the oral manifestations.

Notes: We report a case of the Hallermann-Strieff syndrome with focal scalp atrophy and associated patchy hair loss. Cases of the Hallermann-Strieff syndrome (a branchial arch syndrome) often present with ocular abnormalities in infancy but they also show a number of other abnormalities including a characteristic facial appearance, proportionate dwarfism, cutaneous atrophy, hypotrichosis and dental anomalies.

Notes: Eleven of 12 cases with erosive pustular dermatosis of the scalp gave a history of antecedent physical or infective trauma. We propose that this clinical disorder may be a non-specific inflammatory response to injury of ageing and sun-damaged scalps.

Notes: Two cases with exuberant papillary and nodular hyperplasia of the hard and soft palates are described. Both were elderly edentulous men with bilateral angular stomatitis. The papillary hyperplasia extended as far as the epiglottis and was associated with swelling and fissuring of the upper lip in patient 1. In patient 2, the palatal change extended to the maxillary gingiva and was associated with smooth plaques and fissuring of the dorsal tongue. Histology of both cases showed a dense polyclonal plasma-cell infiltrate with overlying epithelial hyperplasia, parakeratinization and neutrophil micro-abscesses suggesting Candida infection but fungal elements could not be demonstrated. Patient 1 also showed defective cellular immunity to Candida antigen which was reversed by treatment with ketoconazole and levamisole, antedating clinical improvement.

Notes: Two cases with nodular cutaneous amyloid on the face were treated by shave excision with excellent cosmetic results. Both showed positive thyroid microsomal and gastric parietal cell autoantibodies but no evidence of systemic amyloidosis. The presence of autoantibodies raises the possibility that primary cutaneous nodular amyloid may be associated with autoimmune disorders.Primary nodular cutaneous amyloid is an uncommon disorder. A recent view of the literature has identified 47 reported cases to date.1 The nodules are usually confined to the skin so the prognosis tends to be good, although systemic amyloidosis2 and associated monoclonal gammopathy3 have been recorded. Of 12 cases in the Japanese literature, four have been associated with Sjogren's syndrome,4 which itself is associated with the presence of specific and non-organ specific autoantibodies.

Notes: Background Histamine-releasing activity (HRA) is detectable in up to 50% of patients with chronic ordinary urticaria.  Objectives To determine the effect of cyclosporin on clinical features and HRA in patients with chronic urticaria.  Methods Thirty patients with severe unremitting disease, responding poorly to antihistamines and showing a positive autologous serum skin test (ASST) as a marker of HRA, were randomized to 4 mg kg−1 daily of cyclosporin (Sandimmun®, n = 20) or placebo (n = 10) for 4 weeks. Non-responders were offered open-label cyclosporin for 4 weeks. All were followed for up to 20 weeks or until clinical relapse; all took cetirizine 20 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score 42 per week). A positive response was defined as a reduction to 〈 25% of baseline weekly UAS and relapse as a return to 〉 75%. The effect of cyclosporin on serum HRA was assessed by in vitro basophil histamine release assays and ASSTs before and after treatment.  Results Twenty-nine patients (19 active, 10 controls) completed the randomized trial medication. Eight of 19 on active treatment but none on placebo had responded at 4 weeks (P 〈 0·05). Three others on active drug met the criterion for response at 2 weeks but not at 4 weeks. Mean reduction in UAS between weeks 0 and 4 was 12·7 (95% confidence interval, CI 6·6–18·8) for active and 2·3 (95% CI − 3·3–7·9) for placebo (P = 0·005). Seventeen non-responders (seven randomized to active and 10 to placebo) chose open-label cyclosporin and 11 responded after 4 weeks. Six of the eight randomized active drug responders relapsed within 6 weeks. Of the 19 responders to randomized and open-label cyclosporin, five (26%) had not relapsed by the study end-point. Mean in vitro serum HRA fell from 36% (95% CI 22–49%) to 5% (95% CI 1–8%) after cyclosporin treatment (n = 11, P 〈 0·0001). The ASST response to post-treatment serum was also reduced (P 〈 0·05).  Conclusions This study shows that cyclosporin is effective for chronic urticaria and provides further evidence for a role of histamine-releasing autoantibodies in the pathogenesis of this chronic ‘idiopathic’ disease.

Notes: Experimental studies in animals have highlighted the importance of essential fatty acids (EFAs) in normal epidermal structure and function, and hair growth. Recent work on EFA metabolism in man has identified certain specific abnormalities in atopic eczema1, and psoriasis, acne vulgaris and ichthyosis (unpublished observations). Dietary supplements have been shown to correct the EFA deficiency in atopic eczema and also to ameliorate the clinical disorder. We present a pictorial review of the evidence relating EFA metabolism to disorders of the skin, nomenclature of the EFA series, the main dietary sources of EFAs and the range of commercially available dietary supplements.

Notes: Contact dermatitis to bronopol has been identified in a milk recorder with hand eczema. Milk recorders are contracted by the Milk Marketing Board to sample up to eight dairy herds for quality control checks. Samples are drawn at milking using a dipper with a hole 4 cm from the bottom, which allows a stream of milk to be collected into a small transparent sample pot, usually held between thumb and forefinger. The lid is sealed by pressure from the thumb.Since 1982, the sample pots provided by the Milk Marketing Board have contained bronopol (2-bromo-2-nitropropane-1, 3-diol) as an antimicrobial preservative, kathon CG (5-chloro-2- methyl-4-isothiazolin-3-1) as an antifungal agent, cupric nitrate and a blue dye, sprayed in a dry film on to the internal surface. Accidental exposure to the preservative milk solution is relatively common in the high-speed, wet and draughty conditions of the milking parlour. Storrs and Bell (1983) have highlighted the dangers of sensitization from cosmetic products which contain bronopol. It is very likely that milk recorders, working with bronopol preservatives, are also at risk of allergic sensitization if they do not wear adequate protective clothing and gloves.