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Notes: We report a case where occurrence of linear Darier's disease along Blaschko's lines followed radiotherapy due to the subject's recurrence of a longstanding carcinoma of the bladder. Scattered papules on the chest and hack preceded the exacerbation of the disease. In this case, localised linear disease may he triggered on a background of a more disseminated disease which raises the possibility that linear keratosis follicularis is a separate entity of cutaneous mosaicism for the mutation responsible for Darter's disease.

Notes: We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H1antihistamine. Revision of the literature in order to allocate the frequency of pruritus in EV and discussion of this association will follow.

Notes: Hereditary hypotrichosis of Marie Unna type is a rare distinctive syndrome of hair loss which is inherited with an autosomal dominant gene. We report a family with more than half affected individuals in 4 subsequent generations which supports the very strong autosomal dominant pattern of inheritance.

Notes: We report clearance of pigmented macules on the lips of two subjects with Laugier–Hunziker syndrome using the Q-switched Alexandrite laser. Recurrence of two macules was noticed in one case 6 months after treatment and the lesions were successfully retreated. This report evaluates the efficacy and side-effect profile of the Q-switched Alexandrite laser in the treatment of lentigines in this syndrome.

Notes: We report a patient with a symmetrical presentation of HSV infection on both pinna, recurrent since his childhood. Our patient used to play rugby as a student and we feel that the symmetrical and unusual distribution for his viral infection may be related to direct inoculation due to trauma sustained in contact sports and subsequent autoinoculation. To our knowledge, no similar symmetrical presentation of HSV infection has been reported in the literature.

Notes: Chromoblastomycosis is a chronic cutaneous and subcutaneous fungal infection in man most commonly occurring in tropical and sub-tropical climates. It is rarely seen in the United Kingdom. Response to treatment is slow but there have been recent reports of successful treatment with itraconazole. We report a case in a 70-year-old Bangladeshi man who presented with a recurrence of a long-standing lesion on his forearm.

Notes: Summary Background Data on the benefits, adverse effects and appropriate types of laser treatment for angiofibromas (AF) in patients with tuberous sclerosis (TS) are limited. Objectives To evaluate the efficacy and side-effect profile of carbon dioxide (CO2) 10 600 nm wavelength and flashlamp-pumped pulsed dye (FLPDL) 585 nm wavelength lasers in a retrospective study of 29 patients with TS aged 9–48 years. Methods Long-term results, based on clinical improvement of the vascular, fibrous or protuberant types of AF and the presence or absence of side-effects on follow-up visits, were classified as excellent, moderate or poor. Results Results were excellent in most patients with vascular-type AF treated with one or two sessions of FLPDL, but some required up to six treatment sessions. CO2 lasers produced excellent results with considerable long-term improvement in 10 of 13 (77%) patients with fibrous or protuberant AF, specifically in all (three of three) protuberant and 70% (seven of 10) of fibrous AF. Persistent hypertrophic scarring was seen in three of 13 (23%) patients with either fibrous or protuberant AF treated with the continuous wavelength CO2 laser. Treatment with both lasers used in four patients with combined vascular and non-vascular AF components was excellent in three of four (75%) patients. Significant relapse was seen in one patient treated with the CO2 laser. Conclusions CO2 or FLPDL laser treatment should be considered as an effective treatment for patients with disfiguring TS. A combination of lasers may be required to achieve optimal results.

Notes: Background Failure of E-cadherin and its associated proteins α-, β- and γ-catenin is believed to lead to disruption of cell–cell adhesion and to contribute to neoplasia. Objectives To determine the pattern of E-cadherin and α-, β- and γ-catenin immunostaining in keratoacanthoma (KA) and to evaluate its potential value in routine histopathology in differentiating KA with benign from that with malignant biological behaviour. Methods We examined the expression of E-cadherin and α-, β- and γ-catenin in KA and correlated the histopathological features with the immunohistochemical findings. Next, we compared the immunohistochemical findings of KA with those found in malignant (squamous cell carcinoma, SCC) and benign (warts) lesions. In addition to the established histopathological criteria we used the Ki-67 index, a well-known marker of cell proliferation. Immunoperoxidase staining of E-cadherin and α-, β- and γ-catenin, and Ki-67 determination, were performed in paraffin-embedded sections of 12 KAs taken from archival material. On reviewing the histology, seven of the 12 KAs were characterized as ‘classical’ KA, and the rest as ‘borderline’ KA or KA resembling SCC. Additionally, 28 well, nine moderately and five poorly differentiated SCCs and 20 warts were examined. Results Most ‘classical’ KAs (79–86%) showed normal membranous immunostaining and a low Ki-67 index. The remaining ‘classical’ KAs showed abnormal expression, in a staining pattern resembling that of well-differentiated SCC. All ‘borderline’ KAs showed a high Ki-67 index (〉 40%) and abnormal expression of the adhesion molecules studied, identical to that of poorly differentiated SCC. Expression of E-cadherin and α-, β- and γ-catenin was found to be more frequently abnormal in ‘borderline’ KA compared with that in ‘classical’ KA (P 〈 0·05). Among E-cadherin and α-, β- and γ-catenin expression and Ki-67 index, only the expression of β-catenin was more frequently found to be abnormal in total SCC than in total KA (P 〈 0·05). Expression of E-cadherin and α-, β- and γ-catenin was more frequently found to be abnormal in well-differentiated SCC than in ‘classical’ KA (P 〈 0·05). In total, as well as in ‘classical’ or ‘borderline’ KA, an agreement between expression of E-cadherin and of catenins was seen. Conclusions These findings suggest that E-cadherin and catenins may be very helpful in distinguishing between ‘classical’ and ‘borderline’ KA, as the expression of these adhesion molecules in ‘classical’ KA is identical to that found in normal epidermis, overlapping with well-differentiated SCC in some cases. In ‘borderline’ KA, expression of adhesion molecules is identical to that in poorly differentiated SCC.

Notes: We describe three patients who initially presented with both clinical and immunological findings to support a diagnosis of bullous pemphigoid but whose subsequent course has been that of cicatricial pemphigoid. Mucosal scarring was accompanied by a fall in autoantibody titres in our three patients. These cases illustrate the difficulties clinicians may experience in assigning a specific diagnosis to patients. They also support the concept that bullous pemphigoid and cicatricial pemphigoid are part of a single disease spectrum. The most intriguing question is what specific factors determine the expression of a particular disease phenotype as bullous pemphigoid and cicatricial pemphigoid share target antigens and also the DQ7 allele.