bluuebunny/crossref_metadata_2025 huggingface dataset:
Oestrogen dermatitis
Authors: Kumar Ajay , Georgouras Katherine Evelyn
Published: March 2003

A 36‐year‐old woman presented with a recurrent itchy eruption mainly involving her face and upper trunk for 5 years. The rash flared cyclically 3 days before her menstruation and improved 5–10 days after the onset of her period. Examination revealed erythematous maculopapules, vesicles and crusting mainly on her face and upper trunk. Biopsy from a papule revealed spongiotic dermatitis. Intradermal testing with oestrogen was positive. There was marked improvement with tamoxifen. Sensitivity to oestrogen and progesterone is rare in women and the clinical presentation may be similar. Positive intradermal testing is diagnostic. Tamoxifen is effective in treating oestrogen sensitivity.
Cardiofaciocutaneous (CFC) syndrome
Authors: Schepis Carmelo , Greco Donatella , Romano Corrado
Published: March 2003

An 11‐year‐old boy affected by mental retardation and seizures demonstrates congenital heart defect, many dysmorphic features and dry skin. His hair is sparse over the vertex with alopecia of the eyebrows and eyelashes. There are horny small papules evident in those areas. The diagnosis of cardiofaciocutaneous syndrome has been made. The relationship between cardiofaciocutaneous and Noonan syndrome is discussed.
Acquired perforating dermatosis in diabetes mellitus: An unusual case
Authors: Wong Kenneth C , Fryer Judith A , Li Michael , Crosland Greg
Published: March 2003

A case of elastosis perforans serpiginosa in a patient who presented with insulin‐dependent diabetes mellitus secondary to pancreatic insufficiency in a background of common variable immunodeficiency and endocrinopathy, as evidenced by pernicious anaemia and growth hormone deficiency, is described. In acquired perforating dermatosis occurring in patients with diabetes or renal failure, there is a spectrum of changes that may show an overlap of histological features of the four classic perforating diseases. The biopsy changes of the patient described in the present study most closely resembled those of elastosis perforans serpiginosa.
Basal cell carcinoma of the scrotum
Authors: Gómez José I Esquivias , González‐López Antonio , Velasco Encarnación , Pozo Tomás , Villar Araceli del
Published: March 2003

An 80‐year‐old man with a 7 year history of a slowly enlarging, asymptomatic scrotal nodule is presented. He had a negative history for sexually transmitted disease, trauma to the area, radiotherapy and chemical or arsenic exposure. The lesion was excised with a margin of 0.8 cm of normal skin. Examination of the specimen revealed a basal cell carcinoma.
Cryosurgery of benign skin lesions
Authors: Thai Keng‐Ee , Sinclair Rodney D
Published: March 2003

Cryosurgery is a widely used treatment modality in dermatology. Its place in cutaneous malignant and premalignant disease is well established; however, it also has great utility with benign lesions. Vascular, infectious, fibrotic diseases, solar damage, acne, as well as some cosmetic defects are amenable to freezing. The mechanism of treatment involves inducing tissue damage, vascular stasis and occlusion, as well as inflammation, to destroy unwanted tissue. After destruction of epidermal lesions, healing involves rapid re‐epithelialization over a relatively cold‐ insensitive dermal network. Side effects are common but shortlived and are rarely severe. The equipment required is relatively economical and readily available. The technique is straightforward and reproducible, making cryosurgery an attractive option for many commonly encountered benign skin conditions. This review outlines treatment with the timed spot freeze technique of some commonly encountered benign lesions.
Pustular vasculitis of the hands
Authors: Hall Anthony P , Goudge Russell J , Ireton H John C , Burrell Louise M
Published: March 2003

A case of pustular vasculitis of the hands with evidence of systemic involvement is described. A 64‐year‐old woman presented with a 2‐day history of large, tense bullae arranged symmetrically over the dorsum of the three radial digits and extending on to the radial aspect of the dorsum of each hand. The bullae caused some discomfort and prevented normal use of her hands. There was no response to antibiotic therapy initiated prior to referral to hospital. Initial investigations revealed a raised white cell count with a neutrophilia, a raised erythrocyte sedimentation rate and a raised C‐reactive protein. Abnormalities of liver function were detected. Aspirates from the bullae and blood cultures were sterile. The histology of debrided tissue demonstrated a florid neutrophilic dermal infiltrate with many blood vessels associated with prominent fibrin. A diagnosis of pustular vasculitis of the hands was made. The bullae were surgically debrided and treatment with oral corticosteroids was started. Two days after commencement of oral prednisolone, a crusted pustule appeared on her upper cutaneous lip. There was rapid resolution of both the vasculitis of the hands and the pustule on her upper lip following an increase in the dose of oral prednisolone. The patient was discharged on the seventeenth day following admission.
Night blindness precipitated by isotretinoin in the setting of hypovitaminosis A
Authors: Welsh Belinda M , Smith Arnold L , Elder James E , Varigos George A
Published: March 2003

A 16‐year‐old male developed night blindness 2 weeks after starting isotretinoin at a dose of 20 mg per day for cystic acne. He also had cystic fibrosis, complicated by hepatic cirrhosis. Despite long‐term oral vitamin A supplementation, serum vitamin A levels were found to be 0.3 μmol/L (normal range 0.9–2.5 μmol/L). Oral vitamin A replacement was instituted with resolution of his visual symptoms in 6 months. Isotretinoin therapy was successfully continued with no deterioration in liver function. Isotretinoin has been reported to cause deterioration in night vision. In vitro evidence suggests isotretinoin may interfere with the processing of endogenous vitamin A in the retina. This case highlights the need for careful monitoring of serum vitamin A status in patients with malabsorptive states on isotretinoin therapy.
A case of spontaneous mutation in the keratin 9 gene associated with epidermolytic palmoplantar keratoderma
Authors: Morgan Vanessa A , Byron Keith , Paiman2 Lisa , Varigos1 George A
Published: March 2003

Epidermolytic palmoplantar keratoderma appears to be due to defects in keratin 9, the palmoplantar specific type 1 keratin. We report a case of spontaneous mutation, a C to T transition at codon 162, resulting in an arginine to tryptophan substitution in the 1 A region of the alpha helical rod domain of keratin 9. This provides further evidence that this codon is an important spot for mutation in keratin 9.
Toxic epidermal necrolysis in Western Australia
Authors: Brand Roland , Rohr James B
Published: March 2003

Toxic epidermal necrolysis is a severe, life‐threatening illness with up to one‐third mortality. We report a retrospective analysis of all cases treated in Royal Perth Hospital over a 20‐year period from July 1978 to June 1998, by analysis of medical records. A total of 12 patients with an age range of 23–73 years was identified. The female to male ratio was 2:1, with age of onset earlier in females. All cases were associated with medications, most commonly antibiotics, anticonvulsants and allopurinol. The mortality rate was one‐third (four deaths), mostly resulting from cardiorespiratory failure, renal failure and sepsis. Risk factors for death were advanced age and severe underlying disease, including diabetes, alcoholic liver disease, sepsis and malignancy. Among the six patients treated with systemic corticosteroids there was only one death. Treatment with corticosteroids appeared to be beneficial, with such patients having both fewer complications and a lower mortality rate.
Acute generalized exanthematous pustulosis associated with oral terbinafine
Authors: Hall Anthony P , Tate Bruce
Published: March 2003

A case history of acute generalized exanthematous pustulosis (AGEP) following oral terbinafine is reported. A 64‐year‐old woman presented with a rapidly spreading micropustular eruption 3 days after completing a 28‐day course of oral terbinafine. There was a positive family history of psoriasis but no personal history. The clinical presentation and histopathology were consistent with AGEP. There was nearly complete resolution of the pustular eruption within 3.5 weeks following cessation of oral terbinafine and treatment with topical and systemic corticosteroids. The patient has remained free of any recurrence 18 months later. A summary of drugs known to be associated with AGEP is presented. Prompt recognition of AGEP is stressed in order to avoid confusion with acute generalized pustular psoriasis or a systemic infection. The most important aspect of management is the immediate withdrawal of the suspect drug.
Reconstruction of the nasal tip using a nasalis myocutaneous flap
Authors: Hunt Michelle J
Published: March 2003

Reconstruction of nasal tip defects is a technical and aesthetic challenge for dermatological surgeons, due to the limited reservoir of available skin and its thick, inflexible nature. The myocutaneous flap described in this paper, using the vascular pedicle of the transverse nasalis muscle, is an excellent option for repair of defects of the nasal tip. It provides a cosmetically superior result to skin grafting, particularly in noses of ‘sebaceous’ quality, by providing similar local skin. The flap maintains normal nasal tip contour and, being an axial pattern flap, its blood supply is reliable.
Allergy to lichen acids in a fragrance
Authors: Rademaker Marius
Published: March 2003

A 48‐year‐old clerical officer with a recurrent facial eruption had positive patch test reactions to nickel, fragrance mix and lichen acid mix. On testing to individual ingredients of fragrance mix and lichen acid mix, she had 2+ reactions to oak moss, which is thought to be the main allergen in fragrance mix, and to usnic acid, which is one of a number of lichen acids comprising oak moss. Avoidance of fragrance use resulted in clearing of the eruption but, subsequently, an acute vesicular flare on her face and hands occurred after exposure to lichen on garden shrubs.
Lasers in skin resurfacing
Authors: Dover Jeffrey S , Hruza George
Published: March 2003

Laser skin resurfacing has revolutionized the approach to facial skin rejuvenation over the last decade. It has also added an approach to managing both atrophic and hypertrophic scars. This paper will review the basic principles of laser skin resurfacing, the different lasers used, the approach to treatment and potential complications of the procedure, followed by a discussion of future prospects in the field.
Ulceration of the urethral meatus after simultaneous pancreas–kidney transplantation
Authors: Davies Derek , Horton Peter J , Gow Elizabeth , Lowe Trish , Chapman Jeremy C , Allen Richard Dm
Published: March 2003

A 39‐year‐old male developed painful ulceration of the glans penis following simultaneous pancreas and kidney transplantation for end‐stage renal failure complicating insulin‐dependent diabetes mellitus. Infection was excluded. Diversion of the pancreatic secretions away from the urinary bladder into the bowel resulted in healing.
Dermatological presentations of infantile myofibromatosis: A review of 27 cases
Authors: Stanford Duncan , Rogers Maureen
Published: March 2003

Twenty‐seven cases of infantile myofibromatosis presenting with dermatological manifestations were retrospectively reviewed. Approximately 80% were solitary lesions and 50% of these appeared on the head and neck. Around 60% were present at or soon after birth. Most lesions were dermal or subcutaneous, although some were intramuscular and intraosseous. The clinical appearance was non‐specific leading to frequent misdiagnosis. While most patients presented with nodules, atrophic depressed lesions and warty pedunculated lesions were also seen. Although 7% of lesions recurred after excision, spontaneous resolution was also documented.
Bullous systemic lupus erythematosus
Authors: Yung Anthony , Oakley Amanda
Published: March 2003

A 19‐year‐old woman with a 6 month history of systemic lupus erythematosus (SLE) developed a widespread urticated, erythematous eruption associated with tense, fluid‐filled blisters, erosions and crusting. Biopsy showed subepidermal blistering with a prominent neutrophilic infiltrate. Direct immunofluorescence showed markedly positive granular IgG deposition with weak IgM, IgA and C3 at the dermo‐ epidermal junction. No circulating antibodies were detected on indirect immunofluorescence. A diagnosis of bullous systemic erythematosus was made. Treatment with prednisone was ineffective. Subsequent treatment with dapsone led to rapid sustained remission of skin symptoms. Bullous SLE is a rare manifestation of SLE. We review the recent literature and discuss the distinctive features of this condition and contrast them with cutaneous SLE with blisters and the subepidermal blistering disorders.
Multiple piloleiomyomas
Authors: Lun Karyn R , Spelman Lynda J
Published: March 2003

A 21‐year‐old female developed multiple painful flesh‐coloured papules over the anterior chest. Skin biopsy was consistent with a diagnosis of piloleiomyomas.
Porphyria cutanea tarda
Authors: Bleasel Narelle R , Varigos George A
Published: March 2003

Porphyria cutanea tarda (PCT) is a metabolic disorder of haem biosynthesis caused by decreased activity of uroporphyrinogen decarboxylase. Porphyria cutanea tarda is manifest by fragility, erosions, bullae, milia and scars on sun‐exposed skin. Excess porphyrins in the skin interact with light of approximately 400 nm‐wavelength radiant energy, forming reactive oxygen species. Porphyria cutanea tarda is categorized as familial, acquired or toxic. Factors that may induce clinical expression of PCT in susceptible individuals include alcohol, oestrogen, iron, polyhalogenated compounds and viral infections. Porphyria cutanea tarda is associated with an increased incidence of the haemochromatosis gene. Treatments for PCT include withdrawal of aggravating factors, phlebotomy and oral antimalarial medications.
Genetics of alopecia areata
Authors: Green Jack , Sinclair Rodney D
Published: March 2003

Alopecia areata is a common disorder with a genetic predisposition where interaction with environmental factors leads to episodes of terminal hair loss. In this review article, we examine the evidence for a genetic basis to this disorder and discuss the prospects for future research into genetic susceptibility areas and the problems that are likely to be encountered in such research.
Mixed immunobullous disease: Is this linear IgA disease?
Authors: Sheridan Adam T , Kirtschig Gudula , Wojnarowska Fenella
Published: March 2003

We report five patients who demonstrated clinical, histological and direct immunofluorescence (IF) features typical of linear IgA disease (LAD), but who also displayed IgG anti‐basement membrane zone (BMZ) antibodies on indirect IF. The presence of circulating IgG anti‐BMZ antibodies is often said to exclude the diagnosis of LAD. Unable to confidently classify these patients, we reviewed their clinical progress for unifying features. This revealed an almost universal benefit from dapsone therapy. We therefore propose that when strong linear IgA deposition is observed at the BMZ, a first line trial of dapsone is indicated, irrespective of the presence of circulating IgG. The class of antibody fixed in vivo appears to influence the clinical picture more than the class of circulating antibody.
Occupational epoxy resin allergic contact dermatitis
Authors: Rademaker Marius
Published: March 2003

Sixteen cases of occupational contact dermatitis to epoxy resins were seen over a 5‐year period. All were men. Six cases worked in the construction industry, two worked as painters, two as engineers, two as car windscreen repairers, and one each worked in a timber yard, a car yard, on a farm and as a cane‐ furniture salesman. Most presented with rashes on their faces (56%), hands (50%) or arms (37%). Two patients were allergic to the reactive diluent phenyl glycidyl ether, and one was allergic to the epoxy hardener isophorone diamine. The rest were allergic to the epoxy resin itself. Outcome in this series was poor because most continued to be exposed to epoxy resins in their workplace environment.
Adult‐onset atopic dermatitis
Authors: Bannister Michael J , Freeman Susanne
Published: March 2003

Atopic dermatitis beginning in adult life is not mentioned in the medical literature. In a review of 2604 patients attending a contact dermatitis clinic, 243 patients (9%) were diagnosed with atopic dermatitis which began for the first time at 20 years of age or older with no contact factors present. This compares with 213 patients (8%) who had atopic dermatitis and contact dermatitis. Patients with purely atopic dermatitis had negative patch testing to relevant allergens and the diagnosis was based on a personal or family history of atopy as well as elevated IgE levels and multiple positive skin prick tests. A broad range of age of onset was found, as well as a female preponderance. The commonest sites of dermatitis were generalized involvement, dermatitis of the hands or eczema involving the face.
Nail staining from hydroquinone cream
Authors: Ozluer Selim M , Muir James
Published: March 2003

Topical hydroquinone is used in the treatment of a number of skin conditions. A 33‐year‐old male presented with brown discolouration of the fingernails following the application of 4% hydroquinone in sorbolene cream and 0.1% tretinoin cream to the face intermittently for 9 months. The discolouration resolved when the creams were ceased.
Erythema multiforme: A case with unusual histopathological features
Authors: Wells Jennifer M , Weedon David , Muir James B
Published: March 2003

A 14‐year‐old boy presented with widespread cutaneous and mucosal lesions clinically consistent with erythema multiforme. He gave a history of previous episodes of a similar eruption. Histological examination of a representative lesion showed changes consistent with erythema multiforme. It also, however, contained large numbers of eosinophils, forming a dermal interstitial infiltrate and epidermal microabscesses. The full blood examination showed a persistent eosinophilia. The appearances initially confused two experienced dermatopathologists.
Lip cancer: Important management issues
Authors: Veness Michael
Published: March 2003

Lip cancer should be diagnosed and treated at an early stage. It most often presents on the lower lip of middle‐aged to elderly males. The aetiology is similar to non‐melanona skin cancer, that is, chronic sun exposure. Despite treatment, a proportion of patients will experience delayed relapse and one in 10 will die from lip cancer. Clinicians need to be aware of the natural history of this disease. Two cases of squamous cell carcinoma of the lip treated by radiotherapy are presented and discussed to highlight important aspects in the management of lip cancer.
Allergic contact dermatitis due to benzalkonium chloride in plaster of Paris
Authors: Wong Deanna A , Watson Alan B
Published: March 2003

Plaster of Paris (POP) bandages are extensively used for splinting and casting injured or surgically repaired body parts. Allergic contact dermatitis caused by POP has been reported only rarely in the medical literature. An 81‐year‐old woman developed multiple large, tense, haemorrhagic bullae on the palm, and an acute vesicular eczematous eruption on the forearm, after the application of a POP splint. Subsequent patch testing revealed positive reactions to both the POP bandage used and to benzalkonium chloride, a component of the POP formulation. Patch tests to two other POP products without benzalkonium chloride were negative. These results confirm those of previous studies which have implicated the quaternary ammonium compound benzalkonium chloride as the allergen responsible for POP‐induced allergic contact dermatitis.
Generalized eczematous reaction to budesonide in a nasal spray with cross‐reactivity to triamcinolone
Authors: Poon Eric , Fewings John M
Published: March 2003

A 78‐year‐old woman suffered a generalized eczematous hypersensitivity reaction following the use of an intranasal budesonide inhaler. Patch testing demonstrated positive reactions to both budesonide and triamcinolone. Her eczema responded to emollients, betamethasone dipropionate ointment and cessation of her intranasal budesonide inhaler.
Amyloidosis of the tongue with kappa light chain disease
Authors: Basak Pinar Y , Ergin Şeniz , Tugĝrul M , Sari Aliye
Published: March 2003

A 70‐year‐old woman presented with a painful, red tongue with papules associated with xerostomia and systemic symptoms including weight loss, difficulty in swallowing and breathing, haemochezia and leg swelling. Biopsy from the tongue demonstrated amyloid deposits and, on further investigation, kappa chain disease was diagnosed. Primary systemic amyloidosis was diagnosed and the patient died within weeks of presentation.
Pseudomonas aeruginosa infection mimicking erythema annulare centrifugum
Authors: Czechowicz Romuald T , Warren Lachlan J , Moore Lynette , Saxon Ben
Published: March 2003

A 3‐year‐old girl receiving chemotherapy for acute lymphocytic leukaemia developed a rapidly expanding red annular plaque on her thigh, initially without signs of systemic toxicity or local pain. Subsequently she developed Pseudomonas aeruginosa sepsis and purpura at the leading edge of the plaque. Skin biopsy showed an extensive necrotizing vasculitis with numerous Gram‐negative bacilli in the blood vessel walls. In immunocompromised individuals, skin biopsy and culture of cutaneous lesions for bacteria and fungi should be considered even in the absence of signs of systemic toxicity or multiple lesions.
Phenolic ablation of the nail matrix
Authors: De Berker David AR
Published: March 2003

Therapeutic ablation of nail is necessary in a variety of settings. The challenge is to achieve destruction of nail matrix with minimal pain and to ensure that there is no re‐growth of nail. There are many different methods of nail ablation, with excisional surgery and phenolic ablation of matrix representing the most common. The balance of published data favours phenolic ablation as a simple procedure with low morbidity and the least chance of recurrence.
PERSONAL REVIEW Post‐acne scarring: A short review of its pathophysiology
Authors: Goodman Greg J
Published: March 2003

The onset of acne is an expected phenomenon in adolescence. However, its arrival produces long‐term psychological and physical sequelae for the individual. A review of available data illustrates the pathophysiological sequence of the advent of post‐acne scarring from its humble beginnings as a microscopic comedone to its eventual devastating end point of indented or exophytic scars. Acne scarring shows many different forms and is explainable by the depth and severity of the antecedent inflammation and the ability of the individual to heal these lesions. Post‐acne scarring is debilitating and socially disabling for many and is the avoidable outcome of untreated or inadequately treated acne. Treatment will depend on the resultant scar topography.
CASE REPORT Concurrent pilomatrix carcinoma and giant pilomatrixoma
Authors: Khammash Muhammad R , Todd David J , Abalkhail Ali
Published: March 2003

A 52‐year‐old man presented with a large, fungating mass on the inner aspect of his left thigh and a smaller hard mass on the inner aspect of his left knee with normal overlying skin. Both lesions had first been noted by the patient 1 year previously and for the first 6 months had a similar appearance until the thigh mass rapidly increased in size and fungated. Pathology of the large thigh lesion showed pilomatrix carcinoma while that of the smaller knee lesion was typical of pilomatrixoma. The pilomatrix carcinoma was widely excised and there has been no evidence of recurrence or metastasis after 3 years. The clinical course of the thigh lesion suggested that pilomatrix carcinoma may arise from a pre‐existing pilomatrixoma. On review of the literature, pilomatrix carcinoma of the lower limb may be more likely to metastasize than those on other sites.
CASE REPORT Giant congenital melanocytic naevus and symptomatic thoracic arachnoid cyst
Authors: Holmes Gary , Wines Nina , Ryman William
Published: March 2003

A 43‐year‐old female with multiple congenital naevi presented with a 5‐year history of right upper quadrant pain. Magnetic resonance imaging demonstrated a large epidural thoracic arachnoid cyst. This case highlights the need to consider that the management of patients with giant congenital melanocytic naevus is variable depending on the age of the patient, the location of lesions and the presence of complications such as neurocutaneous melanosis. The value of magnetic resonance scanning as a screening device is discussed.
CASE REPORT Focal facial dermal dysplasia or aplasia cutis congenita: A case with a hair collar
Authors: Wells Jennifer M , Weedon David
Published: March 2003

Aplasia cutis congenita describes localized defects of skin that may have many causes. A 6‐month‐old male presented with bilateral atrophic patches on his cheeks distributed along a line from the preauricular area to the angle of the mouth. They had been present since birth. He had no other abnormalities detectable on examination and no family history of similar lesions. A distinct collar of long pale hairs surrounded the lesions, especially the largest one. Histology showed changes consistent with aplasia cutis congenita or focal facial dermal dysplasia. We propose our patient’s lesions may be the result of failure of ectodermal fusion over embryological closure lines. This may be a distinct subgroup of atrophic facial lesions.
VIGNETTE IN CONTACT DERMATOLOGY Allergic contact dermatitis from ciclopirox olamine
Authors: Foti Caterina , Diaferio Annalisa , Bonamonte Domenico
Published: March 2003

A 50‐year‐old man with interdigital tinea pedis developed an allergic dermatitis spreading from the toes to the lower shins. Patch tests were strongly positive to ciclopirox olamine 1% pet. Sensitization to this topical antifungal agent has rarely been reported in the literature.
Effects of low‐dose ultraviolet radiation on in vivo human cutaneous recall responses
Authors: Damian Diona L , Barnetson Ross StC , Halliday Gary M
Published: March 2003

Relatively few studies have examined the effects of low‐dose ultraviolet (UV) radiation on in vivo human cutaneous immunity, or the ability of sunscreens to prevent UV‐induced immunosuppression. We have studied the effects of solar‐simulated UV radiation on nickel contact hypersensitivity (CHS) in nickel‐allergic volunteers, and on delayed type hypersensitivity responses in Mantoux‐positive volunteers. Nickel CHS and Mantoux responses were significantly suppressed by acute, suberythemal UV exposures equivalent to less than 8 min summer sunlight. Both UVA and UVB wavebands were immunosuppressive, but UVA‐induced immunosuppression was transient, whereas UVB had a more sustained effect. Dose–responses for UV immunosuppression were determined using the nickel method, enabling calculation of in vivo sunscreen immune protection factors in a manner analogous with sun protection factor measurement. Sunscreens were found to confer significantly less protection against UV‐induced immunosuppression than against UV‐induced erythema.
Spironolactone‐induced hepatitis
Authors: Thai Keng‐Ee , Sinclair Rodney D
Published: March 2003

There is widespread use of spironolactone in medical practice and the indications for its use well established and side effect profile well known. Herein, we present a case of drug‐induced hepatitis occurring in a 50‐year‐old woman using spironolactone for the treatment of androgenetic alopecia. Six weeks after commencement of spironolactone the patient became unwell, complained of an extensive itch, but no icterus or jaundice. Liver function tests found abnormally elevated bilirubin and enzymes levels. After withdrawal of spironolactone, the patient’s symptoms resolved and liver function improved. To date, there has only been one other report of spironolactone‐induced hepatitis.
Lichen planus‐like eruption following autologous bone marrow transplantation for chronic myeloid leukaemia
Authors: Pagliaro John A , White Stephen , Strutton Geoffrey , Guerin Deirdre
Published: March 2003

A 47‐year‐old female treated with an autologous bone marrow transplant and cytotoxic chemotherapy developed a lichen planus‐like eruption 12 months later. It involved the skin and oral mucosa, with the histological features of a lichenoid graft‐versus‐host reaction, including satellite cell necrosis. This eruption developed de novo. The eruption resolved with topical betamethasone valerate 0.1% cream despite the ongoing use of the immunomodulatory agent interferon‐α2b. Such a reaction in an autologous setting has only been described once previously.
Frictional amyloidosis: A study of 10 cases
Authors: Venkataram Mysore N , Bhushnurmath Shivayogi R , Muirhead David E , Al‐Suwaid Abdul Raouf
Published: March 2003

Ten patients with macular amyloidosis were studied with particular reference to the role of friction. All 10 patients had a history of prolonged rubbing over a period of 2–5 years with various objects, such as bath sponges, brushes, towels, plant sticks and leaves. The presence of amyloid was confirmed by histochemical stains in six cases and by electron microscopy in four cases. The study confirms the role of friction in the causation of macular amyloidosis and hence, the term ‘frictional amyloidosis’ aptly describes the condition. The study also emphasizes the need for electron microscopy in the diagnosis of frictional amyloidosis.
Drug‐induced linear IgA bullous disease following antibiotics
Authors: Wiadrowski Todd P , Reid Catherine M
Published: March 2003

A 69‐year‐old woman presented with pneumonia and subacute bacterial endocarditis. Nine days after intravenous vancomycin and ciprofloxacin were commenced, the patient developed a bullous mucocutaneous eruption. Clinical presentation and histopathology were consistent with drug‐induced linear IgA bullous disease (LABD). The patient’s lesions resolved with cessation of antibiotics. A review of the features of drug‐induced LABD and the drugs that have been implicated are presented.
Allergic contact stomatitis caused by acrylic monomer in a denture
Authors: Koutis Dennis , Freeman Susanne
Published: March 2003

A 71‐year‐old edentulous man developed a severely painful red mouth at sites of contact with a new denture. Patch testing showed allergy to samples of the denture material and to 2‐hydroxyethyl methacrylate. Patch testing to methyl methacrylate was negative. Prolonged boiling of the denture resulted in reversal of his symptoms and samples of this fully cured denture material produced negative patch tests. While allergy to acrylates is a rare cause of stomatitis, this possibility must be considered in patients presenting with oral symptoms. Material safety data sheets are unreliable in providing information regarding the type of acrylate present in the material. Hence, patch testing should be performed with a battery of acrylate allergens as well as with small samples of the denture material.
Antiepiligrin (laminin 5) cicatricial pemphigoid complicated and exacerbated by herpes simplex virus type 2 infection
Authors: Gilmour Tanya K , Meyer Paul AR , Rytina Ed , Todd Pamela M
Published: March 2003

A 50‐year‐old man with antiepiligrin (laminin 5) cicatricial pemphigoid (AeCP) involving the eyes, mouth and skin required a combination of systemic drug therapies to suppress the ocular disease. Herpes simplex virus type 2 infection of the mouth and pharynx precipitated an acute deterioration, with laryngeal involvement and an increase in oral ulceration. This is an unusual complication of long‐term immunosuppression and illustrates some of the difficulties in the management of patients with AeCP. Clinical improvement was obtained with oral antiviral therapy and adjustment of his immunosuppressive regimen.
Collagenous and elastotic marginal plaques of the hands
Authors: Mortimore Rohan J , Conrad Roderick J
Published: March 2003

A 49‐year‐old woman presented with an asymptomatic indurated linear plaque extending from the medial surface of the right thumb along the junction of the dorsal and palmar skin of the hand onto the lateral aspect of the index finger. The left hand showed a similar but less extensive plaque. A skin biopsy showed an acellular zone in the reticular dermis composed of thickened bundles of collagen haphazardly arranged, some perpendicular to the epidermis, admixed with elastic fibres and amorphous basophilic elastotic material. Granular calcium deposits were identified, particularly within degenerate collagen bundles. These clinical and histological features are diagnostic of collagenous and elastotic marginal plaques of the hands, a slowly progressive but largely asymptomatic condition. Actinic degeneration and chronic pressure have been proposed as aetiological agents, but our patient did not exhibit marked actinic degeneration and had no history of chronic occupational pressure.
Dowling–Degos disease——A heat aggravated variant
Authors: Kossard Steven , Krivanek Joseph
Published: March 2003

A 22‐year‐old woman presented with a 5‐year history of a micropapular eruption localized to the flexor aspect of her limbs as well as persistent reticulate pigmentation of her neck and upper chest resembling Darier’s disease. The eruption was associated with pruritus that was precipitated by heat and was worse in summer. The axillae, groins and inframammary areas had multiple papules but lacked reticulate pigmentation. Multiple biopsies showed an epidermis with club‐ and antler‐like rete ridges but no acantholysis or dyskeratosis. This distinct clinical presentation may represent an unusual heat aggravated variant of Dowling–Degos disease that clinically shares features with Darier’s disease and transient acantholytic dermatosis.
Allergic contact dermatitis due to thiuram exposure from a fungicide
Authors: Saunders Helen , Watkins Frances
Published: March 2003

A 49‐year‐old man developed a widespread eczematous eruption following contact with plants sprayed with a fungicide. Patch testing revealed a strong reaction to thiuram mix and several of the individual thiuram mix constituents. The fungicide contained tetramethylthiuram disulphide, a thiuram chemical. Thiurams are widely recognized as a cause of rubber‐glove allergy; however, they are also used extensively in fungicides.
Menopause and the skin
Authors: Wines Nina , Willsteed Elizabeth
Published: March 2003

Women live one‐third of their lives in the post‐menopausal state. Significant hormonal alterations occur at the time of menopause, leading to a range of physiological disorders affecting multiple organ systems in the body. The effects of menopause on the skin have been underresearched. Many skin changes occur at the time of menopause and the cutaneous effects of hormone replacement therapy are significant. Menopausal changes in hormones may alter the biomechanical properties of the skin and certain disorders are more common in menopausal women, such as lichen sclerosus, atrophic vulvovaginitis, flushing and dysaesthetic vulvodynia. Hair and oral changes may also be associated. As the average life expectancy increases, dermatologists need to be familiar with skin diseases affecting women in this age group.
Langerhans cell histiocytosis
Authors: Chu Tony
Published: March 2003

Langerhans cell histiocytosis is a rare condition that can affect any organ of the body. Patients of all ages may present to the dermatologist and it is important to make the diagnosis as quickly as possible, because time from presentation to diagnosis is of prognostic importance in adults with the disease. Langerhans cell histiocytosis is now classified as a class I histiocytosis and research into this disease has been very active over the past 10 years. We now know that the disease represents a clonal expansion of a Langerhans cell, which shows phenotypic evidence of activation. The tissue damage induced by the disease appears to be related to local cytokine release.

In single system disease, Langerhans cell histiocytosis is responsive to local therapy but, in resistant single system disease or in multisystem disease, etoposide is the most effective monochemotherapy. Some patients will need maintenance treatment with azathioprine or 6‐mercaptopurine with or without methotrexate. In such cases, physicians who are used to treating chronic and relapsing diseases and who have experience with these drugs, such as dermatologists, are the most appropriate to manage patients with Langerhans cell histiocytosis.
Inflammatory linear verrucous epidermal naevi: A review of 23 cases
Authors: Lee Simon H , Rogers Maureen
Published: March 2003

Twenty‐three patients diagnosed with inflammatory linear verrucous epidermal naevi (ILVEN) over a 13 year period are reviewed retrospectively. These ILVEN showed a predilection for the buttock and legs and were usually unilateral. Onset of the lesions was usually within the first 6 months of life and extension beyond the original margins occurred in 26% of cases. Sixteen of the 23 patients were male. Ten patients had ILVEN predominantly involving the left side, 12 were on the right side and, in one case, the side involved was not recorded.
Report of 19 cases of photoallergic contact dermatitis to sunscreens seen at the Skin and Cancer Foundation
Authors: Cook Natasha , Freeman Susanne
Published: March 2003

We report on our experience with sunscreen allergy between 1992 and 1999 and also review the international literature on sunscreen allergy. There were a total of 21 allergic reactions to sunscreen chemicals observed in 19 patients over the 8 years. There were nine positive photopatch reactions to oxybenzone, eight to butyl methoxy dibenzoylmethane, three to methoxycinnamate and one to benzophenone. No positive reactions were observed to para aminobenzoic acid. Six patients also had positive patch tests to components of the sunscreen base. In our experience, sunscreen chemicals are the most common cause of photoallergic contact dermatitis.
Artefactual skin disease in children and adolescents
Authors: Rogers Maureen , Fairley Michael , Santhanam Radhika
Published: March 2003

As in adults, artefactual skin disease in children and adolescents has heterogenous presentations with multifactorial aetiology. We report a series of 32 young patients aged 8–16 years. There were 24 females and 8 males. In over half of the cases the lesions were on the head and neck. The types of lesions encountered included physical injury producing grazing, erosions and deep ulcers, chemical and thermal burns, hair cutting and shaving and skin painting. We discuss the approach that we believe should be taken with these patients, emphasizing the role of dermatology– psychiatry liaison in their management. Of great importance is the avoidance of confrontation of the patient but the clear exposition of the nature of the problem to the parents. The major aim should be to have the family accept the need for expert psychiatric assistance.
Bullous lesions in Bazex syndrome and successful treatment with oral psoralen phototherapy
Authors: Gill David , Fergin Peter , Kelly John
Published: March 2003

A 59‐year‐old man presented with a psoriasiform dermatitis with associated bullae and destructive nail dystrophy of the hands and feet. He had lost 10 kg weight over 6 months and a mass in the neck was noted. He was provisionally diagnosed with Bazex syndrome (acrokeratosis paraneoplastica) and subsequent investigations revealed a squamous cell carcinoma in the right piriform fossa. His skin lesions were treated with oral psoralen and ultraviolet A phototherapy and this cleared the cutaneous changes, but the nail changes have persisted at 18 months follow up.
Reactive perforating collagenosis: A condition that may be underdiagnosed
Authors: Satchell Andrew C , Crotty Kerry , Lee Stephen
Published: March 2003

Reactive perforating collagenosis is a perforating disorder developing in adults, usually in association with diabetes mellitus or renal failure. We present three cases diagnosed at the Royal Prince Alfred Hospital in a 5 month period. All three patients had long‐standing diabetes mellitus, hypertension, hypercholesterolaemia and ischaemic heart disease. Each patient presented with generalized pruritus and a papular eruption across the trunk and limbs. More than one biopsy or multiple levels were needed before the diagnostic histological features were seen. The first patient responded to 0.5% phenol with 10% glycerine in sorbolene cream. The second patient did not respond to topical betamethasone diproprionate 0.5 mg/g cream and antihistamines (hydroxyzine 25 mg nocte) and required narrow‐band ultraviolet (UV) B. The third patient, having failed to respond to topical betamethasone diproprionate 0.5 mg/g cream and wet dressings, antihistamines (hydroxyzine 25 mg tds and doxepin 50 mg nocte) and UVB required acitretin 25 mg orally per day. Because reactive perforating collagenosis responds to treatment, we believe this condition should be considered in patients with diabetes mellitus or renal failure presenting with pruritus and that biopsy of intact lesions may need multiple levels to help establish the diagnosis.
Merkel cell carcinoma and multiple cutaneous squamous cell carcinomas in a patient with pityriasis rubra pilaris
Authors: Huynh Nghi T , Hunt Michelle J , Cachia Adrian R , Veness Michael J
Published: March 2003

A 79‐year‐old female was diagnosed with Merkel cell carcinoma (MCC) and multiple cutaneous squamous cell carcinomas (SCC) occurring on a background of pityriasis rubra pilaris. At the time of initial diagnosis and treatment for upper limb MCC, axillary nodal metastases were clinically evident. In the ensuing months, she developed multiple rapidly progressing SCC and eventually a left arm soft tissue deposit of metastatic MCC. Treatment involved multiple courses of fractionated radiotherapy. The salient clinical features and supporting evidence for this case are presented.
Studies in long‐pulsed potassium tritanyl phosphate laser for the treatment of spider naevi and perialar telangiectasia
Authors: Goodman Greg J , Roberts Stefania , Bezborodoff Alex
Published: March 2003

Utilization of a 1–10 msec vascular laser to treat facial vessels to limit purpura has become available in recent years. Its efficacy and morbidity in the treatment of common vascular lesions require exploration. We have assessed the relative outcomes and morbidity from a single treatment session of two patterns of ‘difficult to treat’ facial telangiectasia – perialar vessels and spider naevi – with such a system. Two prospective clinical studies with long pulse 532 nm potassium tritanyl phosphate (KTP) laser were performed with subjective and independent objective assessment at 3 days, 1 week and 4 weeks in both studies. Perialar vessels showed good to excellent improvement subjectively at 4 weeks in 53% (8/15), spider naevi in 83% (20/24). Pain of treatment was substantially greater treating perialar telangiectasia than when treating spider naevi (P < 0.01). Morbidity was low in both groups with no long‐term complications. Despite the clinical end‐point of vessel disappearance at time of treatment and good early improvement in the appearance of perialar vessels, the failure rate was significant at 1 month follow up. It would appear that spider naevi behave more predictably, with vessel disappearance at time of treatment most often forecasting a successful outcome. Although not statistically significant, spider naevi probably respond better than perialar vessels to a single treatment with this laser.
Myeloma‐associated systemic amyloidosis presenting with acquired digital cutis laxa‐like changes
Authors: Dicker Tony J , Morton James , Williamson Richard M , Chick Jeff
Published: March 2003

A 59‐year‐old woman presented with a 6‐year history of lax skin on the distal fingers of both hands, as well as a recent increase in the size of her tongue. Histopathology of skin from her distal finger showed amyloid deposition and bone marrow biopsy revealed an underlying plasma cell dyscrasia. Initial treatment with cyclophosphamide, vincristine, adriamycin and methylprednisolone has produced a significant reduction in the swelling of both her hands and tongue. Acquired digital cutis laxa‐like changes are a rare cutaneous manifestation of systemic amyloidosis.
Clinical and histological spectrum of elastotic changes induced by penicillamine
Authors: Poon Eric , Mason Graham H , Oh Chris
Published: March 2003

A 79‐year‐old‐man with cystinuria requiring long‐term penicillamine therapy presented with a 6‐month history of itchy annular lesions in both axillae. Clinical examination revealed lesions consisting of crusted keratotic papules coalescing in an annular distribution. Associated findings included generalized skin laxity accentuated on the upper trunk and arms, as well as small yellowish papules on the neck. Histological evaluation revealed short, thick, eosinophilic elastic fibres with nodular protrusions. Transepidermal elimination of abnormal elastic fibres was also evident. We discuss the histological and clinical spectrum of penicillamine‐induced elastotic changes and compare these changes to those seen in primary elastotic disorders.
Immediate‐type latex hypersensitivity in a hairdresser
Authors: Sajjachareonpong Praneet , Lee Adriene , Nixon Rosemary
Published: March 2003

Hairdressers commonly develop contact dermatitis caused by either skin irritants or allergens to which they are exposed. Those using latex gloves are also at risk of developing immediate hypersensitivity reactions to latex. We present a hairdresser with hand dermatitis, primarily as a result of immediate‐type hypersensitivity to latex causing contact urticaria, diagnosed with radioallergosorbent testing. Only three previous studies have reported latex allergy in hairdressers. This condition needs to be considered as a differential diagnosis in hairdressers presenting with hand dermatitis and a history of wearing either rubber or disposable latex gloves.
Diseases of the generative nail apparatus. Part II: Nail bed
Authors: Goodman Greg J , Nicolopoulos Jenny , Howard Anne
Published: March 2003

Nail bed insults may affect the resultant nail product in a number of ways. If focal in nature, the severity and duration of the insult will determine the appearance of the nail product. Widespread insults may alter the size, shape or colour of the nail plate. Nail bed insults tend to present with more immediacy than nail matrical insults, as there is no need to wait until the nail grows out until the sign is obvious. We are less interested in the history of the event, than we are with the clinical sign being presented to us. Should treatment be required for focal nail bed insults, treatment is likely to be local and curative. Widespread nail bed insults may be associated with systemic diseases and if a result of local problems these may be difficult to treat.