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Notes: Summary Cutis marmorata telangiectatica congenita and vascular twin naevi are rare vascular anomalies in which focal acantholytic dyskeratosis is usually not observed. We describe a 44-year-old-man who presented for evaluation of skin lesions that had been present since birth. Physical examination revealed anaemic macules adjacent to a naevus telangiectaticus on the chest. Naevus anaemicus was also seen on the shoulders, arms, and left leg. There was bluish–reddish reticulate marking of the skin and cutaneous atrophy. Shortening and hypoplasia of the left leg was observed. Histologic examination of two biopsy specimens revealed focal acantholytic dyskeratosis. In vivo confocal laser scanning microscopy showed dilated capillaries and vessels of the upper dermal plexus in the telangiectatic and decreased capillary blood flow in the anaemic skin sites. The findings were consistent with a diagnosis of cutis marmorata telangiectatica congenita, vascular twin naevi, and incidental focal acantholytic dyskeratosis. The particularities of the present case are the following: firstly, the association of two rare vascular anomalies to which the genetic concept of mosaicism can be applied; secondly, the occurrence of incidental focal acantholytic dyskeratosis in sites of vascular naevi.

Notes: We report a 31-year-old Caucasian woman presenting with remarkable wrinkling on her trunk and proximal extremities. Diagnosis of mid-dermal elastolysis (MDE) was confirmed by Van Gieson's staining. Immunohistochemical investigations revealed enhanced expression of CD34+ and CD68+ cells accompanied by slightly increased expression of CD3+ and CD4+ lymphocytes in lesional skin. Furthermore an elevated cellular expression of matrix metalloproteinase (MMP)-1 and slightly increased presence of MMP-12 positive cells combined with a decrease of tissue inhibitor of metalloproteinases 1 (TIMP-1) positive cells was observed in lesional skin as compared with a control specimen obtained from nonlesional skin. Our data may indicate inflammatory processes and an altered balance between MMPs and TIMPs in MDE. Furthermore CD34+ dendritic fibroblasts and/or histiocytes are possibly involved in the pathogenesis of MDE.

Notes: The superior vena cava syndrome occurs when extrinsic compression or intraluminal occlusion impedes blood flow through this vessel. Detecting the characteristic cutaneous features can lead to an early diagnosis of this condition. We report a 73-year-old patient with a 4-year-history of erythematous oedema of the face. The underlying cause was a large restrosternal goitre obstructing the superior vena cava. Subtotal thyroidectomy led to dramatic improvement of all dermatologic symptoms.

Notes: Background  Combinations of topical treatments and ultraviolet (UV) B phototherapy for plaque psoriasis may be more beneficial than either type of treatment used alone. Objectives  To determine the efficacy of calcitriol 3 µg g−1 ointment in combination with UVB phototherapy in treating plaque psoriasis. Methods  Calcitriol ointment with UVB was compared with vehicle plus UVB in a randomized, double-blind study in 104 patients. Results  Mean global improvement scores for both groups increased over the 8-week study period; there was a statistically significant difference (P 〈 0·05) in favour of the calcitriol/UVB combination from week 1. At end-point, 45% of the calcitriol/UVB group showed considerable improvement or clearing of psoriasis, compared with 21% of the control group. The superiority of calcitriol plus UVB was also reflected in the global severity and Psoriasis Area and Severity Index (PASI) scores; at end-point the mean percentage decrease in PASI score was 65% for the calcitriol/UVB group and 43% for vehicle/UVB (P = 0·0014). The incidence of skin-related adverse events was low (〈 12%) and similar in the two treatment groups. No clinically significant changes in blood chemistry, in particular calcium levels, occurred. The greater efficacy of combined calcitriol and phototherapy allowed a 34% decrease in total UVB exposure. Conclusions  Calcitriol 3 µg g−1 ointment and UVB phototherapy in combination provides a promising therapy for managing chronic plaque psoriasis.

Notes: Background  Apart from sunscreen lotions, clothing provides protection from acute and chronic sun damage. Therefore, it is very important to know the ultraviolet (UV) protection factor (UPF) of textiles, in particular of lightweight summer clothing. Usually, the UPF of a textile is determined by spectrophotometric assessment of the UV transmission (in vitro method). Objectives  To compare the relationship between in vitro tests and in vivo tests of UPF using solar simulators for determination of the minimal erythema dose (MED), applied to 30 different summer textiles. Methods  Thirty summer textiles were spectrophotometrically assessed, and UPFs were calculated with respect to the International Commission on Illumination (CIE) erythemal action spectrum.1 Based on the in vitro UPFs ‘on skin’ and ‘off skin’, in vivo testing was performed using a solar simulator for the determination of the MEDunprotected and MEDprotected. Results  The UPFs obtained from in vivo‘on skin’ testing were significantly (r = 0·95; P 〈 0·001) lower than the predicted in vitro UPFs. This disparity was also confirmed by chromometric assessment of the MED testing; the erythemal responses measured after textile protection were significantly (P 〈 0·001) higher than those obtained without protection. However, the in vivo‘off skin’ UPFs did not significantly (r = 0·98; P 〉 0·05) differ from the in vitro UPFs; comparison of the chromometrically assessed erythemal responses was also insignificant (P 〉 0·05). Conclusions  The different correlation between in vitro and in vivo measurements of the UPF may be due to the optical–geometrical properties of textiles and the different amount of direct and diffuse radiation passing through the spaces between the yarns. As spectrophotometric measurements of a textile may generally yield lower UPFs than those obtained under average field conditions, the in vitro test method provides ‘safe’ UPF values representing a ‘worst-case scenario’. In contrast to in vitro testing, in vivo methods are much more expensive and time-consuming. Thus, with respect to practicality, spectrophotometric measurements seem to be most suitable for the evaluation of UV protection of textiles.

Notes: In psoriatic lesions. capillaries in the papillary bodies seem elongated and increased in number. Most researchers postulate that there is angiogenesis of intrapapillary capillaries in psoriatic plaques. In this study we will show, by means of computer-aided three-dimensional reconstructions in four patients suffering from chronic plaque-type psoriasis, and in a healthy volunteer. that the elongation and increase of intrapapillary capillaries are not the result of angiogenesis. Our threedimensional reconstructions show that the papillary body of psoriasis contains lymph capillaries besides the blood capillaries. Additionally. an inclusion of two tips of papillary bodies into one papilla at the base of the rete ridges becomes obvious. The vessel of the two tips are connected by a hrizontal vessel. At the level of the horizontal connecting vessel there is the blind begining of a lymphatic vessel. The connecting blood vessel. as well as the lymph capillary. belong to the horizontal subpapillary venous plexus but lie within the papillary body. The three-dimensional reconstructions show that by growing towards the dermis, the rete ridges include the vessels of the horizontal plexus. Surrounded by rete ridges, these vessels appear as intrapapillary capillaries.

Notes: Reactions of the cutaneous microcirculation to local stimuli have been quantitated in terms of area of erythema (planimetry), change in colour (colorimetry) and time-dependent changes in perfusion (one-dimensional laser Doppler fluxmetry (LDF)). Using the new technique of laser Doppler scanning (LDS) it is now possible to quantify and demonstrate two-dimensional patterns of microvascular perfusion in terms of intensity and extent. The precision of this new technique was compared with the previously established techniques by examining the reactions of 15 healthy volunteers to the intracutaneous injection of carbacholin and isotonic NaCl solutions. Both stimuli were applied paravertebrally, on the left and right side. Reactions were examined alter 10 min. As a control for temporal reproducibility the examination was repeated on another dayAll methods allowed the differentiation of reactions to carbacholin from those to NaCl (P〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:les" location="les.gif"/〉 0·0001). Only colorimetry and I.DS provided data that were unequivocally reproducible when comparing both sides (r 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:ges" location="ges.gif"/〉 0·78). Using LDF or planimetry, reproducibility of values was lower (r 〈inlineGraphic alt="leqslant R: less-than-or-eq, slant" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:les" location="les.gif"/〉 0·58). When looking; at measurements performed on different days, only values of LDS were reproducible (r 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:03076938:CED371:ges" location="ges.gif"/〉·). Hyperaemic areas seen with LDS were significantly larger than those determined by planimetry.Results of LDS are reproducible spatially and temporally: the technique will allow time-course observations of skin reactions that are accompanied by medium-term changes in perfusion.

Notes: We present a 35-year-old patient with acquired immunodeficiency syndrome who had demodicidosis on his face, characterized by multiple papules and papulopustules, associated pruritus, numerous mites on skin-surface biopsy and in biopsy specimens, and rapid response to topical treatment with permethrin. It seems likely that Demodex infestation does not manifest unless local or systemic immune function is altered, leading to the proliferation of the organism and subsequent disease.