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Notizen: Pityriasis rosea is a relatively common skin disorder. In its typical form it is easily recognizable; however, atypical forms can pose diagnostic problems. We report a 44-year-old woman with an acute onset of a localized eruption on her left breast. The morphology of the rash and the time course were typical of pityriasis rosea. Localized pityriasis rosea is an unusual variant, which has been described previously.

Notizen: Background Viral warts represent a large workload for dermatology departments. Cryotherapy with liquid nitrogen is the most widely used method of treatment by dermatologists and is increasingly used by general practitioners in the U.K. Existing data relating to the response to cryotherapy are virtually all derived from the use of a cotton wool bud as the applicator. There is an increasing trend to use the cryo-spray to freeze warts and it has been assumed that this is equally effective. In view of the workload involved it is important to test this assumption. Objectives This prospective study was undertaken to compare these two methods of liquid nitrogen cryotherapy with regards to cure rate after 3 months of treatment. Methods Patients referred to two hospital dermatology departments with hand or foot warts were allocated to have liquid nitrogen applied with either a cryo-spray or with a cotton wool bud. Using either technique, liquid nitrogen was applied until ice-ball formation had spread from the centre to include a margin of 2 mm around each wart. Treatment was done fortnightly for up to 3 months. Plantar warts were pared and treated with a double freeze–thaw cycle. The endpoint of the study was complete clearance of all warts. Results Three hundred and sixty-three patients were enrolled, mean age 21 years (range 3–75), 188 male and 175 female. The mean duration of the warts was 98 weeks (median 78, range 2–936). The number of warts on the hands and feet varied from one to 80 (mean 5). The treatment groups were comparable with regards to baseline demographics. Two hundred and seven patients were evaluable. Cure rates at 3 months were 47% in the cotton wool bud group and 44% in the cryo-spray group (P = 0·8). Warts that had been present for 6 months or less (n = 31) had a greater chance of clearance (84%) compared with warts that had been present for more than 6 months (39%, n = 176) (P 〈 0·0005). Conclusions Cryotherapy with liquid nitrogen for hand and foot warts in our study was equally effective when applied with a cotton wool bud or by means of a spray.

Notizen: Lentigo maligna is the in situ phase of lentigo maligna melanoma, and if left untreated it may progress to invasive melanoma. It most commonly occurs on the exposed sites of the face and neck of middle-aged or elderly patients. Conventional surgery using a 5–10 mm margin is the recommended treatment; however, lesions can be quite large and surgical removal may involve extensive plastic repair. We report an elderly patient with a large lentigo maligna on the scalp who was reluctant to have surgery. We tried topical imiquimod 5% cream (Aldara®), a local immunomodulator, which has recently become available for the treatment of external genital and perianal warts. Initially used over a test area and then over the whole of the lesion, for a total of 7 months, the imiquimod cream resulted in complete clinical and histological cure. The patient has been followed up for 9 months without evidence of recurrence.

Notizen: Optimum ration size of Indian major carp, Cirrhinus mrigala fingerlings was determined by feeding purified diet (40% crude protein (CP); 3.61 kcal g−1) at five ration sizes (2%, 4%, 6%, 8% and 10% of body weight per day) for 6 weeks. Feeding trial was conducted in triplicate. Fishes were randomly stocked at the rate of 20 fish per trough fitted with water flow-through system. The best feed conversion ratio (FCR), specific growth rate (%) and protein efficiency ratio (PER) were evident at the ration size of 4–6% body weight. Second-degree polynomial regression analysis of the FCR, PER, and protein and energy retention data indicated the breakpoints at ration size of 5.16%, 5.24%, 5.52% and 5.42% body weight per day. Carcass composition of fish fed different ration sizes varied significantly. Maximum carcass protein and minimum moisture content were noticed at 4% and 6% ration levels. A linear increase in fat content was evident with increasing ration levels up to 6% body weight. Ash content remained insignificantly different among various ration levels except at 2%, showing the significantly highest value. Water temperature, dissolved oxygen, free carbon dioxide, pH and total alkalinity were recorded regularly during the length of the experiment. No mortality was observed during the feeding trial. Based on the above results, it is recommended that feeding in the range of 5–5.5% body weight per day corresponding to 20 g protein and 181 kcal energy to 22 g protein and 199 kcal energy per kg of the diet per day is optimum for the growth and efficient feed utilization of C. mrigala.

Notizen: Cyclosporin (CyA) has been shown to be highly effective and well tolerated in the short-term treatment of severe childhood atopic dermatitis; however, there is limited experience in its longer-term use. The aim of this study was to compare multiple short courses of CyA with continuous therapy for 1 year, with respect to efficacy, safety, tolerability and quality of life. Children aged 2–16 years, with a diagnosis of severe atopic dermatitis refractory to topical steroid therapy, were randomly assigned to receive short course therapy (multiple courses of 12 weeks) or continuous therapy. The starting dose and maximum dose for all patients was 5 mg/kg per day. Disease activity was monitored using the Six Area Six Sign Atopic Dermatitis score and the ‘Rule of Nines’ area score. Pruritus, sleep disturbance and irritability were measured using visual analogue scales, and topical therapy was monitored. Safety measurements included monitoring of serum creatinine, blood pressure and adverse events. Forty patients were included in the efficacy analysis, 21 of whom were randomized to the short course group (of whom six were withdrawn) and 19 to the continuous group (of whom five were withdrawn). Significant improvements were seen in all efficacy parameters at every time-point. There were no significant differences between groups, although the improvement was more consistent in the continuous arm. In the short course arm, 7 out of 21 patients could be managed by at least two short courses. The remaining 14 patients includes 12 who could not be controlled by at least two short courses, one patient who failed to return after week 12 and another patient who was withdrawn at week 4 due to an adverse event. Quality of life improved for both the children and their families. Tolerability was considered good or very good in at least 80% of the patients at week 12 and at the end of the study. No clinically significant change was seen in mean serum creatinine and no change was seen in mean blood pressure in either group. CyA is effective in controlling severe atopic dermatitis in children over a 1-year period and is well tolerated. More consistent control is achieved with continuous treatment; however, short course therapy was adequate for some patients, indicating that treatment should be tailored to the individual patient’s needs. Short course treatment may produce prolonged remission in some cases and reduce the cumulative exposure to the drug.

Notizen: Background In our departments, curettage and cautery (C&C) and liquid nitrogen cryotherapy are the preferred methods of treatment for Bowen’s disease (BD). Objectives We aimed to compare these two treatments with regard to efficacy, time to heal, morbidity and recurrence rate. Methods Cryotherapy was performed using a liquid nitrogen spray giving two freeze–thaw cycles, each freeze cycle being maintained for 5–10 s after the formation of an ice ball to the intended margin. Curettage was performed with a conventional disposable curette under local anaesthesia, and electrocautery was then used for haemostasis. Results Eighty lesions in 67 patients (55 female) were analysed. The mean age of the patients was 74 years (range 46–89). The most frequent site was the lower leg, below the knee (n = 59, 74%). The average time taken for complete healing after the procedure was 60 days. The mean size of the lesions was 336 mm2 (range 30–1890). The patients were followed up for a mean of 22 months (range 6–24, median 2 years). In the cryotherapy group (n = 36 lesions), the median time to complete healing was 46 days (range 14–210; mean 69). Twelve lesions took more than 90 days to heal. Infection requiring antibiotics developed in four patients. Thirteen of the treated lesions had recurred by 24 months. In the C&C group (n = 44 lesions), the median time to healing was 35 days (range 14–330; mean 53). Six of the lesions took more than 90 days to heal. Infection developed in two patients. Recurrence occurred in four lesions over the follow-up period. Considering BD on the lower legs separately, lesions took on average 90 days to heal in the cryotherapy group (n = 23), whereas in the C&C group (n = 36) they took 39 days to heal (P 〈 0·001). During the procedure and the subsequent 24 h, patients were 10·4 times more likely to report pain of any degree for lesions treated by cryotherapy than by C&C (P 〈 0·001). Conclusions This study suggests a superiority of C&C over cryotherapy in the treatment of BD, especially for lesions on the lower leg. Curettage of lesions of BD is associated with a significantly shorter healing time, less pain, fewer complications and a lower recurrence rate when compared with cryotherapy.