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Notes: A case of cutaneous cryptococcosis is described in an immunocompromised patient. The initial lesion developed on the dorsum of the hand following trauma and was initially thought to be neoplastic. Satellite subcutaneous lesions developed in a ‘sporotrichoid’ pattern along the forearm. Treatment with oral fluconazole resulted in the complete resolution of the lesions. This is the first published report of the use of fluconazole in the treatment of cutaneous cryptococcosis.

Notes: It is well recognized that patients who have undergone renal transplantation are at an increased risk of developing cutaneous malignancy. The incidence of this problem rises as survival time increases, and multiple dysplastic lesions may develop, especially on sun-exposed sites. Conventional treatment by excision, curettage, cryotherapy or topical cytotoxic agents is often unsatisfactory because of the number and extent of lesions present. In non-immunosuppressed patients, treatment with etretinate has been shown to be helpful in treating both basal cell carcinomas and solar keratoses. There are, however, no previous studies of its safety or efficacy in renal transplant patients who have developed dysplastic lesions, and the immuno-adjuvant effect of retinoids is a potential limitation to this type of treatment. We have therefore undertaken a study in which patients with functioning renal allografts who had developed multiple dysplastic lesions were treated with etretinate, 1 mg/kg/day for a period of 6 months. Six patients (five males, one female), who had been immunosuppressed for between 166 and 240 months (mean 210 months), were entered into the study. All patients had histological evidence of severe epidermal dysplasia, and four patients had previously developed invasive squamous cell carcinomas. In addition, all patients had numerous viral warts, some of which showed evidence of dysplastic change. No deterioration of renal function was detected in any of the patients during treatment, as measured by serial plasma creatinine estimations. Circulating lymphocyte numbers were unaffected by treatment and there was no consistent change in the relative numbers of T helper or suppressor cells. Intradermal challenge with multiple antigens was undertaken at o and 6 months, and all patients remained completely anergic. Serum cholesterol and triglyceride levels were monitored throughout the study, and only one patient had a rise in lipid values which did not respond to dietary manipulation. Four patients had almost complete clearing of hyperkeratotic lesions, one patient had a partial response, and one patient developed two further squamous cell carcinomas during treatment. Side-effects were no more severe than those normally encountered with retinoid therapy. Etretinate appears to be a safe and useful treatment in this group of patients. Fears concerning its immuno-modulating effects proved groundless, and its effects on a heavily suppressed immune system appear to be negligible.

Notes: The prevalence of cutaneous fungal infection was studied in 72 patients who had undergone renal transplantation and compared with a group of age and sex matched controls. Samples were obtained from toe nails, toe webs, and the upper back; clinically suspicious lesions from other areas were also examined. A total of 576 sites were sampled (288 in each group). Pathogenic fungi were identified from 44 sites (15%) in the renal transplant (RT) group compared with 26 sites (9%) in the control group, (P 〈 0.05). However, site-specific differences were less marked; no difference was found between the RT group and controls when the results from the toe nails and toe webs were analysed separately. Trichophyton mentagrophytes was the most common species isolated from both groups.Colonization of the back with Pityrosporum yeasts was significantly more common in the RT group, but few patients in either group had tinea versicolor.‘Mixed infections, with more than one species of fungus isolated in an individual, were only found in the RT group.We also examined the relationship between the presence of fungal infection and the presence or absence of cutaneous malignancy in the renal transplant group. No increase in the prevalence of fungal colonization was found in those patients who had developed cutaneous malignancy compared with those who had not.

Notes: Fifty-four patients with lichen planus (LP) and 54 age- and sex-matched controls were studied. No increase in the incidence of autoimmune disease was found in the patients with LP or their relatives. There was no increase in the frequency of autoantibodies in the LP group and serum immunoglobulin levels were not altered significantly. In the majority of cases, LP is not part of a generalized autoimmune disturbance.

Notes: The adequacy of hospital note-keeping in 100 patients presenting with psoriasis at two teaching hospitals has been assessed. The criteria used were defined in consultation with a peer group of 60 British dermatologists. The pattern of record keeping was similar in both centres. Where differences existed between consultant (C) and non-consultant (J) staff, non-consultant staff completed the records more fully. There were differences between centres in the recording of patients' symptoms and disability, psoriasis type, and in the number of visits before discharge to general practitioner care. Both centres had a poor record of communication to general practitioners following patient default from the clinic. In both centres, the patient had only a one in 8 chance of subsequently being seen by a consultant if at the first visit they had been seen by a non-consultant. This simple case-note audit has highlighted the similarity of practice in the two centres and has resulted in practical improvements in record keeping.

Notes: A patient with type V hyperlipidaemia is described, who developed acanthosis nigricans when treated with nicotinic acid and in whom resolution of the skin lesions and successful lipid control was achieved with an analogue of nicotinic acid (acipimox).

Notes: The effectiveness of a eutectic mixture of the local anaesthetics lignocaine and prilocaine (EMLA® cream) in relieving artificially induced pruritus was examined in 20 volunteers. The study was conducted in two parts. In part one, the effect of EMLA on the threshold concentration of histamine necessary to induce pruritus was assessed by a double-blind placebo controlled method. In part two, the effect of EMLA on the perception of pruritus induced by the artificial pruritogens cowhage and papain was assessed by a single blind method.Some subjects were less sensitive to histamine after placebo cream treatment, but all subjects showed a marked reduction in sensitivity to histamine after EMLA treatment. The difference between EMLA and the placebo treatment was statistically significant.The EMLA preparation was found to be effective in alleviating pruritus induced by cowhage and papain and this effect was also statistically significant.Thus, EMLA cream was found to be effective in reducing experimentally induced pruritus and, therefore, may be useful in some clinical circumstances where persistent itch is a distressing symptom.

Notes: A patient with hyperimmunoglobulin E syndrome is described. Recurrent cutaneous staphylococcal abscesses were a prominent feature and had been resistant to treatment with antibiotics and surgical drainage. Following a 4-month course of treatment with isotretinoin, he developed no further abscesses over a 6-month follow-up period. Detailed immunological investigations were undertaken before and after treatment and no change was found to account for his improvement. We consider that the beneficial effects of isotretinoin in this situation are likely to be due to a reduction in sebaceous gland size and activity, rather than to any effect on the underlying disorder.