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Notes: In order to examine whether anti-androgen therapy was effective in hidradenitis suppurativa (HS), ethinyloestradiol 50μg/cyproterone acetate 50 mg in a reverse sequential regimen was compared with ethinyloestradiol 50μg/norgestrel 500μg (Eugynon 50) in 24 female patients. Both treatments produced substantial improvement in disease activity. Seven patients cleared and have remained free of disease for 18 months, five patients improved, four remained unchanged, while two deteriorated. Cyproterone acetate was not clinically significantly more effective than E50, and both gave a similar reduction in free androgen index. Anti-androgen therapy appears to be beneficial in the treatment of hidradenitis suppurativa.

Notes: One of the difficulties dermatologists encounter when attempting to diagnose rare scalp hair abnormalities is knowing where to start. Faced with a patient presenting with ‘frizzy’ hair it is helpful to have a systematic approach rather than simply ‘thumb through the books'. Price (1979) classifies anomalies of the hair shaft in to those associated with increased fragility which consequently give rise to alopecia, and those which are not thus associated. There is a significant group of disorders which present with unruly hair, and these have been described under all manner of titles, including crinkly, woolly, kinky, crimped, frizzly, steely, spunglass, in an attempt to define their clinical appearance. This only serves to confuse the issue as no one word adequately describes many of these abnormalities. I would like to suggest an approach for categorizing and diagnosing unruly hair forms, based on a review of the literature as well as on experience with such cases. This is a modified and extended version of the only previous classification of unruly hair proposed by Lantis and Pepper (1978). I accept that there are some individual cases which are difficult to classify and remain unique.

Notes: Elastic fibres lie in intimate contact with dermal lymphatics. Demonstration of elastic by an orcein stain enables lymphatics to be identified and differentiated from blood capillaries. The finding of elastic suggests it plays an important role in the normal functioning of lymphatics.

Notes: Background Elongated and tortuous capillary loops are distinctive features of psoriasis. The significance of these microvascular changes in the pathogenesis of plaques, however, remains unclear.Objectives To determine what part the expanded superficial capillary bed plays in the pathogenesis of clinical lesions by selectively thermolysing psoriatic capillaries with a pulsed dye laser (PDL).Methods Cutaneous lesions were biopsied before and after treatment and sections assessed by standard immunohistochemical techniques for changes in known indicators of angiogenesis, including endothelial surface area, endothelial cell proliferation and endothelial cell expression of adhesion molecules. We also measured lymphocytic infiltration and epidermal thickness, and quantified the presence of a marker of keratinocyte proliferation before and after treatment.Results The effect of the PDL was limited to the superficial capillary bed, with no changes in the microvessels (including venules and arterioles) of the upper reticular dermis. Although there was significant clinical improvement in plaques after treatment (P = 0·02), complete clearance of lesions was not achieved. Thermolysis of psoriatic capillaries caused a reduction in both endothelial surface area (P 〈 0·01) and endothelial cell proliferation in the superficial dermis (P = 0·04). Endothelial expression of surface adhesion molecules (integrins and E-selectin) important in angiogenesis was not, however, altered by treatment. The CD4+ and CD8+ T-cell infiltrate was significantly reduced in the superficial papillary dermis (P = 0·02 and P = 0·04, respectively), but not in the epidermis or upper reticular dermis. Laser treatment significantly reduced epidermal thickness (P = 0·001), but did not alter epidermal keratinocyte proliferation (P = 0·2).Conclusions The results demonstrate that dermal capillary changes alone are unlikely to be causal in psoriasis. They indicate that the expanded psoriatic capillaries may be important in facilitating the access of activated T cells to the skin and in maintaining the psoriatic plaque. These results do not refute the consensus view that plaque formation may be mediated by the release of growth factors/cytokines from activated epidermal T cells/keratinocytes.

Notes: Distichiasis–lymphoedema is a rare variant of the genetically determined lymphoedemas; distichiasis is the abnormal development of the meibomian glands causing aberrant growth of eyelashes. However, a better understanding of this clinically distinct subgroup may provide useful information on the genetic inheritance of all types of lymphoedema. This report provides phenotype data on a very large family with distichiasis–lymphoedema. Lymphoscintigraphy and light reflection rheography (venous function) were undertaken to identify the phenotype more clearly. As a result of lymphoscintigraphy several subjects were reclassified phenotypically (unaffected or affected) with implications for genetic linkage studies. Associated congenital abnormalities were found and venous abnormalities were almost always present in affected limbs. A dominant inheritance with incomplete penetrance was confirmed.

Notes: A 66-year-old woman had a long-standing, scaly erythematous lesion on her left temple which histologically showed features of amelanotic lentigo maligna. It had recurred on numerous occasions over a period of 17 years, in spite of multiple attempts at curative surgery. There were also recurrences within a skin graft which, to our knowledge, has not been documented previously with lentigo maligna. In spite of the prolonged course, and extensive intraepidermal melanocytic proliferation amounting to melanoma in situ, there has been no evidence of dermal invasion. The lack of pigmentation in such lesions means that clinical definition of margins is highly inaccurate. In view of the aggressive horizontal growth phase of this lesion, with rapid recurrence following surgery, it was treated with electron beam therapy, and this has resulted in complete clinical remission. This most unusual case illustrates the potential difficulties in diagnosis and management of amelanotic lentigo maligna.

Notes: Dermal capillaries in the gaiter area of the lower leg were examined by video-microscopy before and after the administration of intravenous fluorescein in 13 patients with chronic venous insufficiency (CVI) who were at risk of developing leg ulceration. and in 13 normal controls. The influence of posture on capillary perfusion was determined by viewing the same area of skin with the leg in both the supine and dependent positions. Capillary density was lower in patients than in controls, irrespective of the position of the leg (P〈0.01). Fluorescence angiography studies in normal controls showed a reduction in capillary density with dependency (P〈0.01). but patients with CVI showed no significant change. Fluorescence angiography revealed a greater numher of capillaries than seen during native capillaroscopy (P〈0.05). The decreased capillary density, and the loss of the postural vasoconstrictor reflex in patients with chronic venous incompetence may play a role in the pathogenesis of ulceration.