bluuebunny/crossref_metadata_2025 huggingface dataset:
OCCUPATIONAL CONTACT DERMATITIS IN NEW SOUTH WALES
Authors: Rosen Robert H. , Freeman Susanne
Published: June 2007

Summary

Five hundred and seventy patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. Data derived from these patients demonstrated that hairdressing, food, construction and the medical industries were the most at risk of OCD. The hairdressing and food industries had a high percentage of apprentices suffering OCD whilst the 35 to 44 year age bracket was most at risk in the construction industry. Allergic contact dermatitis was responsible for 38.2% of cases. The main allergens were chromate, thiuram, epoxy resin, nickel and cobalt. A third (33.9%) of patients were atopic. The average time lost from work was 16 days each year and the calculated yearly cost of OCD in New South Wales was approximately $12 million.
HORMONALLY EXACERBATED HEREDITARY ANGIOEDEMA
Authors: Yip Jennifer , Cunliffe William J.
Published: June 2007

Summary

Hereditary angioedema is a rare disorder which is associated with an inherited deficiency of the inhibitor of the activated first component of complement. Genetic transmission occurs in an autosomal dominant manner. Affected patients are heterozygotes, and their deficiency is incomplete, many of them having up to 20% of the normal amount of the inhibitor.1

We describe two cases of C1 esterase inhibitor deficiency occurring in a mother and daughter in whom the symptoms appeared to be related to the menstrual cycle or the taking of the oral contraceptive pill. Although both features have been mentioned in the literature, to the best of our knowledge premenstrual exacerbations have not been documented previously. We examined the likely basis of hormonally exacerbated hereditary angioedema.
MODERN TREATMENT OF LYMPHOEDEMA I. COMPLEX PHYSICAL THERAPY: THE FIRST 200 AUSTRALIAN LIMBS
Authors: Casley‐Smith Judith R. , Casley‐Smith John R.
Published: June 2007

Summary

Complex Physical Therapy (CPT) is discussed and its principles outlined. CPT involves: 1. skin care, 2. a special lymphatic massage, 3. compression bandaging and (later) garments, 4. special exercises which supplement the massage.

CPT was used on 78 patients with postmastectomy lymphoedema (17 with Grade 1 and 61 with Grade 2). There were significant differences between the Grades. In the first four‐week course the mean Grade 1 was reduced from 121% of normal to 107% (the mean change in the oedema was 103% of its initial value), and Grade 2 from 153% to 123% (with a mean change in oedema of 60%). All these were very highly significant. Over the next year there was a small, but very significant, decrease in the percentage of oedema. A further four‐week course resulted in significant, and similar, reductions in the residual oedema.

CPT was used to treat 128 lymphoedematous legs; 22 were Grade 1 lymphoedema, 84 were Grade 2 and 19 were elephantitic (Grade 3). After the first course of CPT the mean losses were: 1.1, 1.3 and 3.7 litres, respectively (all very significant). Over the next 11 months there were significant further reductions for all legs and in the amount of oedema of the unilateral legs. Some patients had a second course of CPT with similar reductions in the remaining oedema to that after the first course.
TREATMENT OF BASAL CELL CARCINOMA WITH INTRALESIONAL INTERFERON ALPHA: A CASE REPORT AND LITERATURE REVIEW
Authors: Mcdonald Robert R.A. , Georgouras Katherine
Published: June 2007

Summary

We report the case of a 76 year old man with three ulcerated basal cell carcinomas on his lower limbs. He was considered unsuitable for surgical therapy and was treated by intralesional interferon alpha‐2b (Intron A) injections. Twenty months post therapy two of the three treatment sites remain clinically cured. Recurrence occurred at the site which received the smallest total dose of interferon. A review of the therapeutic trials of interferon alpha for basal cell carcinoma is presented. We conclude that interferon alpha‐2b is a useful agent for treatment of basal cell carcinoma in selected patients.
SKIN DISEASE IN GENERAL PRACTICE
Authors: Morgan Vanessa A.
Published: June 2007

Summary

Out of 336 consultations in general practice 52 (15%) concerned a dermatological problem. Sun related problems, eczema/dermatitis and infection were encountered most frequently.
SCYTALIDIUM HYALINUM ISOLATED FROM THE TOE NAIL OF AN AUSTRALIAN PATIENT
Authors: Maslen Mary M. , Hogg Geoffrey G.
Published: June 2007

Summary

The isolation of Scytalidium hyalinum from the toe nail of a patient from Melbourne is reported. This is the first record of the isolation of this fungus from a clinical site in Australia. A brief history is given of the occurrence of Scytalidium hyalinum and the related fungus, Hendersonula toruloidea, in tinea pedis and tinea unguium in immigrants to the United Kingdom from tropical countries. Attention is drawn to the possible presence of these dermatophyte‐like infections in patients in Australia.
OCULAR COMPLICATIONS OF PUVA THERAPY
Authors: See Jo‐Ann , Weller Paul
Published: June 2007

Summary

PUVA, the combination of psoralen and long wave ultraviolet radiation is widely used in the management of psoriasis, vitiligo and several other dermatological disorders. The potential for long term treatment to cause ocular damage remains to be determined and despite the large numbers of patients who have received PUVA treatment, development of cataract is exceedingly rare. This paper discusses cataract formation, reviews the literature concerning the ocular complications of PUVA therapy and proposes guidelines for ocular protection during photochemotherapy.
LICHEN PLANUS MIMICKING AND COEXISTING WITH PSORIASIS IN A BLACK PATIENT
Authors: Delaney Thomas A. , Smith Neil P.
Published: June 2007

Summary

We report a case of lichen planus coexisting with psoriasis in a black patient. As the lesions of lichen planus appeared similar in appearance to the psoriatic plaques its diagnosis was missed by several dermatologists. This may be due to the dark skin of this patient making the characteristic clinical differences between the two conditions less obvious. The coexistance of these two relatively common conditions is probably under reported in the literature. However, differentiation is important as treatment and prognosis of the two disorders differ.
A comparative study of isolutrol versus benzoyl peroxide in the treatment of acne
Authors: Dunlop Katharine J , Barnetson Ross StC
Published: June 2007

Isolutrol is the active principle isolated from aqueous tissue extracts of deep sea shark liver and gall‐bladder. A previous study has demonstrated the ability of isolutrol to reduce hyperseborrhoea, which provides a rationale for its use in the treatment of acne. We have performed a double‐blind clinical trial on 70 patients to evaluate the efficacy and skin tolerance of isolutrol 0.15 g/100 mL (Ketsugo) in the treatment of mild to moderate acne when compared with 5% benzoyl peroxide lotion. The results from this study showed that both isolutrol and benzoyl peroxide significantly improved patients' acne by reducing the number of inflamed lesions. Isolutrol did not significantly reduce the numbers of non‐inflamed lesions whereas benzoyl peroxide did. Fewer side effects were experienced by patients treated with isolutrol when compared with benzoyl peroxide. These results indicate that isolutrol may be a useful adjunct in the treatment of acne, particularly in patients with inflamed lesions.
Pyoderma gangrenosum, erythema elevatum diutinum and IgA monoclonal gammopathy
Authors: Wayte Jeffrey A , Rogers S , Powell FC
Published: June 2007

A patient with erythema elevatum diutinum (EED) developed pyoderma gangrenosum (PG). Investigation revealed an IgA kappa monoclonal gammopathy. Previous reports of PG in association with EED are reviewed and the spectrum of the neutrophilic dermatoses discussed.
Necrotizing fasciitis: The role of Staphylococcus epidermidis, immune status and intravascular coagulation
Authors: Leibowitz Michael R , Ramakrishnan Kalyanakrishnan K
Published: June 2007

An 83 year old Caucasian woman with necrotizing fasciitis (NF) of the right hand is described. Staphylococcus epidermidis was the only organism cultured. Serology failed to demonstrate Streptococcus pyogenes, the common pathogen of NF. Despite antibiotic therapy, gangrene supervened, necessitating digital amputation. Staphylococcus epidermidis is usually non‐pathogenic, but review of the literature indicates that it is relatively commonly found with other pathogens in NF. Accordingly, studies of immune status were undertaken. Apart from reduced myeloperoxidase production (30–50% of normal levels), all humoral, cell‐mediated and neutrophil function tests were normal. This is the first report of Staphylococcus epidermidis as the sole isolate in NF and also the only study of immune status of NF patients. It is concluded that a non‐virulent organism (e.g. Staphylococcus epidermidis) may be pathogenic in the face of advanced age alone. Elevated fibrin degradation productions were also demonstrated in the patient, consistent with lysis of localized intravascular thrombus. The role of anticoagulation in NF is discussed.
Cutaneous malignancies in renal transplant recipients from Nova Scotia, Canada
Authors: Dyall‐Smith Delwyn , Ross J Barrie
Published: June 2007

Four hundred and seventy‐four Nova Scotian renal transplant recipients were screened, using the records of the Nova Scotia Cancer Registry and the Victoria General Hospital, in a retrospective study, for the development of cutaneous malignancies. Sixteen patients developed a total of 60 squamous cell carcinomas (SCC) and 14 developed 28 basal cell carcinomas (BCC). The survival curve shows that within 10 years of transplant, less than 10% will develop SCC. This is a 16‐fold increase above the rate of SCC in the general population of Nova Scotia, Canada. Age at time of transplantation appears to be a significant determinant of subsequent skin cancer risk. None of the previously reported HLA associations was found to hold in this small study. The role of ultraviolet radiation, due to both geographic and lifestyle exposure, is discussed when comparing to other transplant studies.
Bullous pemphigoid in an infant
Authors: Cowen Peter
Published: June 2007

An acral blistering eruption in a 10 week old baby was found on histology and direct immunofluorescence to be bullous pemphigoid. Circulating auto‐antibodies were not detected. He responded quickly to oral prednisolone and there have been no sequelae.
Photoallergic dermatitis to a pig feed additive
Authors: Fewings John , Horton Jeremy
Published: June 2007

A pig farm employee developed a photosensitive dermatitis secondary to Olaquindox contact.
Mechanisms of drug eruptions: Part I
Authors: Breathnach SM
Published: June 2007

The pathogenetic mechanisms underlying common, and less common but severe, adverse cutaneous drug reactions are reviewed. Pharmacogenetic variability may account for a susceptibility to serious drug reactions to sulphonamides and anticonvulsants, as well as to lupus erythematosus (LE)‐like syndrome. Exanthematous drug reactions may have an immunological basis. Cell mediated cutaneous drug reactions, including lichenoid reactions, LE‐like syndrome, fixed drug eruption, erythema multiforme, Stevens‐Johnson syndrome and toxic epidermal necrolysis, will inevitably involve elements of the skin immune system. Graft‐versus‐host disease provides a useful model for aspects of these drug‐induced disorders. Urticaria, angioedema, anaphlyaxis and anaphylactoid reactions may involve Type I immunoglobulin (Ig)‐mediated or Type III hypersensitivity, or may be caused by pharmacological, non‐allergic means. Drug‐induced vasculitis, serum sickness and the Arthus phenomenon are manifestations of the immune complex disease. Drug‐induced pemphigus may involve immune dysregulation, but several thiol‐containing drugs are able to cause antibody‐independent acantholysis directly.
Cryosurgery of malignant and premalignant diseases of the skin: A simple approach
Authors: Sinclair Rodney D , Dawber Rodney PR
Published: June 2007

Cryosurgical treatment of skin cancer and premalignant conditions of the skin has been in widespread use for 20 years. Data accumulated over this period suggest that if attention is paid to the treatment technique and to lesion selection, then cure rates equivalent to radiotherapy, simple surgical excision, and curettage and cautery can be achieved reliably. Moh's micrographic surgery offers a higher cure rate for skin cancer, but is not suitable for the vast majority of lesions seen in clinical practice. The decision to use cryosurgery to treat any particular lesion will therefore be influenced by a number of other considerations. Cryosurgery competes well on morbidity and cosmetic outcome and is the quickest, easiest, cheapest and most readily available of the treatment options. As such it has earned its place among the recognized treatment modalities for skin cancers as well as premalignant conditions of the skin. Cryosurgery is commonly delivered empirically without record of the dose delivered and without audit of the outcome. The aim of this review is to describe in detail one standard technique of therapy that is easily reproduced and has been audited; the timed spot freeze technique. This technique can be used, even by those inexperienced in cryosurgery, to achieve predictable success rates. Many other techniques do exist, but either have not been audited or are unnecessarily cumbersome.
Transient zinc deficiency in a breast‐fed premature infant
Authors: Stapleton Karen M , O'Loughlin Edward , Relic John P
Published: June 2007

Symptomatic zinc deficiency developed in a breast‐fed premature male infant of 31 weeks gestation. At 13 weeks of age he presented with diarrhoea, irritability and an eruption identical to acrodermatitis enteropathica. Breast milk zinc concentrations were low. His course was complicated by milk protein intolerance. After 7 weeks, zinc supplementation was ceased without recurrence of disease.
Hair shaft abnormalities: Part I
Authors: Rogers Maureen
Published: June 2007

The light microscopic and electron microscopic appearances of the normal hair are briefly described. The major hair shaft abnormalities are reviewed in two parts, discussing clinical characteristics, light and electron microscopy and, where information is available, the pathogenesis of these rare conditions. Part I describes monilethrix, pili torti and trichorrhexis nodosa.
Dermal cylindroma and eccrine spiradenoma
Authors: Lee Michael W , Kelly John W
Published: June 2007

Multiple dermal cylindromas on the scalp and back and eccrine spiradenoma on the face of a 59 year old woman are described. A case for a common origin is discussed.
Office radiotherapy in dermatology: A contemporary perspective
Authors: de Launey John W , MacKenzie‐Wood Andrew R
Published: June 2007

Ionizing radiation was recognized very early after its discovery as a useful weapon against both neoplasia and inflammation. Following an initial period of enthusiastic use, recognition of its drawbacks and the development of safe and effective alternative treatments for many applications have resulted in a marked reduction in the use of radiotherapy in most dermatological offices. Nonetheless, this modality remains an important component of our modern therapeutic armamentarium. It is a treatment of choice in some situations, and a useful alternative in many more. A thorough understanding of the principles and practice of safe radiotherapy remains vital to the full practice of dermatology in 1996. The present review summarizes the current practice of radiotherapy and offers some guidelines for safe and effective use of this important tool. Detailed discussions of radiobiology, deep radiotherapy (DXRT) and electron beam (EB) therapy are beyond the scope of this clinical review.
Photodynamic therapy for psoriasis?
Authors: Fergin Peter
Published: June 2007

Photodynamic therapy (PDT), the activation of a photosensitive compound by high intensity red light, is useful for Bowens' disease, thin basal carcinomata and as an adjunctive therapy for various internal malignancies. Its use in the treatment of psoriasis has been attempted only quite recently and some modest success achieved. These clinical experiences are reviewed and the rationale for using PDT for psoriasis is discussed.
Juvenile dermatomyositis
Authors: Halbert Anne R
Published: June 2007

Juvenile dermatomyositis (JDMS) is a chronic inflammatory condition characterized by muscle weakness and a distinctive rash caused by underlying vasculopathy. Long‐term complications include subcutaneous and muscular calcification, contractures and in some cases the gradual development of a second connective tissue disease. Early aggressive treatment with systemic immunosuppressants and other agents such as intravenous immunoglobulin (IVIG) reduces mortality and morbidity.
A review of ultraviolet treatment for psoriasis at Waikato Hospital
Authors: Oakley Amanda MM , Wyllie Kim
Published: June 2007

Details of 79 courses of UVB and 40 courses of PUVA for patients with chronic plaque psoriasis at Waikato Hospital were prospectively collected when a new Phototherapy Unit opened. Efficacy was assessed by clearance rates (73% for UVB, 87.5% for PUVA). There was significant improvement in Psoriasis Disability Index, which was derived from a questionnaire assessing functional disability and completed by the patients before and after treatment. It took a median number of 24 treatments for psoriasis in the patients receiving UVB to clear, and for the PUVA patients the median was 19 treatments. The efficacy could not be correlated with skin type. Fifty per cent of UVB patients and 25% of PUVA patients received symptomatic burns, all localized and minor in nature. Lifetime PUVA dose was calculated, 90% of patients having received less than 400 J/cm2.
Scleredema of Buschke: A report of seven cases
Authors: Tate Bruce J , Kelly John W , Rotstein Harvey
Published: June 2007

Scleredema of Buschke is an uncommon dermatosis characterized by thickened, indurated skin, sometimes with erythema. Histopathology shows thickened dermal collagen with a mild infiltrate of mucin in the deeper dermis. Seven adults with scleredema are presented, four females and three males, and their mean age at diagnosis was 54 years. All had diabetes mellitus for an average of 13 years prior to the onset of scleredema. Complications of diabetes, especially retinopathy (n= 5), neuropathy (n= 4) and peripheral vascular disease (n= 3), were present in five patients. One patient died (cause not established), and another has life‐threatening cardiomyopathy. We have no evidence that the scleredema was a significant aetiologic factor in either case, despite published reports of fatalities related to scleredema. Three patients were followed up for more than 1 year and, irrespective of therapy, the scleredema did not resolve in any patient.
Post‐bullous milia
Authors: Hisa T , Goto Y , Taniguchi S , Nakanishi T , Kakudo K , Takigawa M
Published: June 2007

A 68‐year‐old woman with bullous pemphigoid responded rapidly to treatment with systemic and topical corticosteroids, but subsequently developed multiple milia where the bullae had been.
The descriptive epidemiology of tinea pedis in the community
Authors: Rogers Donna , Kilkenny Monique , Marks Robin
Published: June 2007

Tinea pedis is a common inflammatory skin condition due to infection by dermatophyte fungi. A number of epidemiological studies have been completed on the frequency of tinea pedis in the community, particularly sporting and occupational groups and schools. Most studies have focused on small, high‐risk populations. These include occupational groups involving manual labour, sporting groups such as swimmers, and those working or living in confined conditions with shared washing facilities, which favour the opportunity for crossinfection.

Most studies show that the frequency of tinea pedis is higher in males than females. Tinea pedis infections appear to be least common among children, but do occur, and are commonly misdiagnosed.

The difference between clinical disease and confirmed diagnosis by culture is not always clear when statistics of disease frequency have been presented. Clear diagnostic criteria indicating the level of mycologically confirmed diagnosis should be reported in future studies that include statistics on disease frequency. Future epidemiological studies should also aim to be population‐based in order to obtain a more complete picture of disease frequency.
Skin phototyping in Asian Australians
Authors: Stanford Duncan G , Georgouras Katherine E , Sullivan Elizabeth A , Greenoak Gavin E.
Published: June 2007

Skin phototype was assessed in 257 Asian Australians by self‐reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 30 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV‐sensitive group and a wide spectrum of UV‐sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV‐sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.
Psoriasis: Mechanisms and entry points for possible therapeutic interventions
Authors: Christophers Enno
Published: June 2007

Psoriasis is a heterogeneous disorder not only in regard to its variability in clinical expression and age at onset, but also in the degree to which genetic and immunological factors such as T cells and cytokines contribute. A ‘Psoriasis Treatment Index’ is proposed according to clinical severity and hence suggested treatment regimens. Recent and new treatments include FK 506, cyclosporin, a fusion protein of human interleukin 2 with fragments of diphtheria toxin, topical tumour necrosis factor inhibitors, topical retinoids, T cell receptor peptide vaccines and intercellular adhesion molecule 1 (ICAM‐1) antisense oligonucleotides.
Atopic eczema of adult type in Japan
Authors: Nishioka Kiyoshi
Published: June 2007

Atopic eczema of adult type presents with the classical features of eczema in combination with a red face subject to oozing attacks, rippling hyperpigmentation of the neck and an exudative erythema of the trunk and limbs. The red face and hyperpigmentation appear to follow topical corticosteroid use while the exudative erythema is postulated to be due to late phase reaction of IgE. Treatment involves the avoidance of exacerbating factors together with topical emollients. Topical corticosteroids are ineffective and appear to exacerbate the red face, which causes a significant social problem, affecting the patient's quality of life. New therapies promoted through the media have caused confusion.
Treatment of lentigo maligna
Authors: Gaspar Zoran S , Dawber Rodney PR
Published: June 2007

Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma (LMM) and, if left untreated, 30‐50% of cases will progress to LMM, which is now thought to behave as aggressively as any other melanoma. Literature on the of treatment of LM including conventional surgery, micrographic Mohs surgery, cryosurgery, radiotherapy, electrodesiccation and curettage, 5‐fluorouracil (5‐FU), azelaic acid, retinoic acid and lasers are reviewed. It is concluded that micro‐graphic Mohs surgery has the lowest recurrence rates and that conventional surgery, cryosurgery and radiotherapy all have recurrence rates in the order of 7‐10%. Therefore, on the basis of the current literature available, all three of these methods could be recommended as primary treatment of LM. It is extremely important when choosing one of the above treatments that the physician is adequately trained in the appropriate technique and understands the limitation of the method used and the need for close follow up of the patient
Spitz naevi misdiagnosed histologically as melanoma: Prevalence and clinical profile
Authors: Orchard David C , Dowling John P , Kelly John W
Published: June 2007

A Spitz naevus is a benign melanocytic tumour that may histologically resemble a malignant melanoma. Data was retrospectively gathered from patients who attended the Victorian Melanoma Service to determine the prevalence of Spitz naevi pathologically misdiagnosed as melanoma. Assessment of the clinical characteristics of these patients was also performed and compared to those with correctly diagnosed melanoma. It was found that 6.5% of all melanomas referred were in fact Spitz naevi and that Spitz naevi represented the majority of pathologically misdiagnosed melanomas. The Spitz naevi were more likely to be on the lower extremities and were on average, considerably smaller than the melanomas. Patients with Spitz naevi were more likely to be younger, female, have fewer dysplastic naevi and have brown eyes. One hundred per cent of the Spitz naevi were brought to the attention of the initial doctor by the patient compared to 72% of the melanomas. This study concludes that Spitz naevi that are pathologically misdiagnosed as melanomas retain the clinical characteristics of other Spitz naevi and mat greater clinicopathological communication may reduce the frequency of diagnostic error.
Melasma of the forearms
Authors: O'Brien Timothy J , Dyall‐Smith Delwyn , Hall Anthony P
Published: June 2007

Melasma of the forearms seems to be a relatively common sign which is, to our knowledge, not reported in the literature.1,2 It seems that it may be more common in older patients and especially in postmenopausal women on supplementary oestrogen. The pigmentary change is macular and may be confluent or speckled. Like facial chloasma there is a sharp line of demarcation at the margins. In some, there seems to be an element of erythema.
Naevus lipomatosus cutaneous superficialis
Authors: Armstrong Dermot KB , Walsh Maureen Y , Bingham Ann , McMillan Clifford
Published: June 2007

A young male presenting with cutaneous papules and plaques in a segmental distribution in the pelvic girdle area is reported. The clinical features were suggestive of naevus lipomatosus cutaneous superficialis, but diagnostic biopsy is essential to demonstrate the typical histopathological features and exclude important differential diagnoses such as segmental neurofibromatosis.
Nodular amyloidosis of the lip mimicking an infiltrating neoplasm
Authors: Yu Lawrence L , Heenan Peter J , Randell Peter
Published: June 2007

A case of primary cutaneous nodular amyloidosis of the lip is presented with the unusual clinical appearance of an infiltrating neoplasm.
Non‐infective mucocutaneous presentations of human immunodeficiency virus infection
Authors: Hamann Ian D , Barnetson Ross StC
Published: June 2007

Infection with human immunodeficiency virus (HIV) commonly manifests as one of many skin signs. Early diagnosis is essential. The present review discusses the likely non‐infective presentations of HIV infection from the perspective of the dermatologist While most diseases discussed also occur outside the setting of HIV infection, those clinical and pathological features which are distinctive will be highlighted.
Toxic streptococcal syndrome
Authors: Stanford Duncan G , Georgouras Katherine E , Konya Joseph , Pang Bryan
Published: June 2007

The reappearance of more virulent strains of exotoxin‐producing streptococci over the past decade has led to the re‐emergence of invasive Group A streptococcal infections and the recognition of a new syndrome resembling staphylococcal toxic shock syndrome. Toxic streptococcal syndrome is characterized by fever, shock, multiorgan system failure and a desquamating scarlatiniform rash. It usually occurs in otherwise healthy young adults, often in association with a severe soft tissue infection and has a 30% mortality rate.

The case of a 37‐year‐old obese man, who rapidly developed features of this syndrome after an antecedent pharyngitis and cellulitis, is presented. There was serological evidence of a recent Group A streptococcal infection. Intensive organ supportive measures and intravenous antibiotic therapy led to his gradual recovery.
Retention dressings: A new option for donor site dressings
Authors: Giele Henk
Published: June 2007

Split skin graft donor site dressings should be cheap, easy to apply and remove, reduce pain, provide a moist wound healing environment, be easy to care for and cause minimal interference in the patient's daily activities. Adhesive retention dressings seem to provide these features and are a new option for donor site dressings.
Systemic treatment of severe psoriasis
Authors: Georgouras Katherine E , Zagarella Samuel S , Cains Geoffrey D , Brown Pamela J
Published: June 2007

Severe psoriasis presents a difficult therapeutic challenge. Some modalities such as synthetic retinoids, phototherapy and methotrexate have been available for many years and need reappraisal, cyclosporin has only recently become available and requires careful administration. In this article we focus on the therapeutic modalities available to the dermatologist in Australia.
Isotretinoin: Which dosage?
Authors: Cooper Alan J
Published: June 2007

Long‐term clinical experience with isotretinoin has confirmed both therapeutic effectiveness and the ability to induce prolonged remission. Numerous authors have demonstrated the importance of cumulative dose in achieving stable remission.
Effect of an ointment containing boric acid, zinc oxide, starch and petrolatum on psoriasis
Authors: Limaye Shobha , Weightman Warren
Published: June 2007

A randomized double‐blind controlled trial was undertaken to study the efficacy of a cow udder ointment versus petrolatum alone. A total of 30 patients participated in the study. Sixteen patients completed the trial with 8 of 9 patients improving in the active group and 6 of 7 patients improving in the placebo group. This difference was not statistically significant. The use of a cow udder ointment for psoriasis cannot be supported, particularly with the potential for side effects.
CD30 (Ki‐l)‐positive primary cutaneous T‐cell lymphoma: Report of spontaneous resolution
Authors: Artemi Phillip , Wong Deanna A , Mann Stephen , Regan William
Published: June 2007

A 28‐year‐old man in whom CD30 (Ki‐1)‐positive cutaneous large cell lymphoma manifested as multiple widespread ulcerated nodules, which developed over a 2‐week period, is reported. The lymphoma was composed of large anaplastic cells in large clusters, with scattered eosinophils, neutrophils and small lymphocytes. Extensive staging investigations revealed no extra‐cutaneous disease. No treatment was given because, within weeks of presentation, the nodules began to regress spontaneously and the patient remains disease‐free 20 months later.
The ear‐lobe sign: A helpful sign in facial contact dermatitis
Authors: Rotstein E , Rotstein H
Published: June 2007

The ear‐lobe sign is seen in those who develop contact dermatitis to a substance applied with one hand to the skin of the face and neck. On the ipsilateral side of the face the ear‐lobe is spared whereas on the contralateral side the ear‐lobe is involved. The sign manifests because of the unique combination of the anatomy of the hand and the sweeping movement the hand makes during application.
The use of Terson lens capsule forceps when performing punch biopsy of the skin
Authors: Rotstein AH , Rotstein H
Published: June 2007

When performing skin biopsy using the skin biopsy punch, it is recommended that Terson lens capsule forceps be used as an aid to avoid crush artifact. This is because secure yet gentle purchase of the specimen is allowed by a row of small inwardly directed tines that arise from the 2.5 mm horizontally placed grasping blades, which are inserted into the incision created by a 3mm biopsy punch. The instrument also has the extra advantages of being in the correct working position when held with the hand in the resting position between prone and supine, of allowing an uninterrupted line of vision to the wound during use and is of a shape that minimizes unintentional contact with tissue.
Lichen planus
Authors: Marshman Gillian
Published: June 2007

Lichen planus is a relatively common inflammatory dermatosis of unknown origin. The present review summarizes the histological and clinical features of lichen planus and variants, including lichenoid drug reactions, are described. Possible mechanisms of pathogenesis of lichen planus are reviewed. The development of malignancy in association with lichen planus and the association with hepatitis are discussed. Treatment options for the more difficult manifestations of lichen planus are proposed.
Mast cells in clinical dermatology
Authors: Miyachi Yoshiki , Kurosawa Motohiro
Published: June 2007

Recent advances in cutaneous mast cell biology are briefly reviewed with special reference to our own studies on cultured human mast cells. Of note are the heterogeneity of mastocytosis, the important participation of mast cells in allergic inflammation by releasing cytokines and the inhibitory effect of histamine release from mast cells by phototherapy. It is also stressed that mast cells play a major role in tissue remodelling. These novel findings suggest that mast cells can no longer be regarded simply as cells that initiate immediate allergic reactions, but that they are responsible for various chronic inflammatory or immunological events through cytokine‐dependent leucocyte recruitment. The regulation of mast cell activation should be a critical issue and, thus, a promising therapeutic approach in clinical dermatology.
Melanoma: Accuracy of clinical diagnosis
Authors: MacKenzie‐Wood Andrew R , Milton Gerry W , de Launey John W
Published: June 2007

Clinical diagnosis of melanoma can be difficult. A review of the accuracy of clinical diagnosis of melanoma, over a 12 month period, was undertaken at the Skin and Cancer Foundation Australia. The overall accuracy rate was 65.6% with seborrhoeic keratosis, melanocytic naevi and basal cell carcinoma the most common clinical misdiagnoses given to melanoma. Specialist doctors with more than 10 years experience had a higher rate of correct diagnosis than trainee doctors with 0–5 years experience.
Tips for a better local anaesthetic
Authors: Elliott Timothy G
Published: June 2007

The expert use of local anaesthetics is simple and will greatly enhance patients' acceptance of office‐based procedures. Correct equipment and techniques will enable all dermatologists to practise local anaesthesia as effectively and painlessly as possible. Suggested equipment varies according to the situation, but in general Luer‐Lock syringes of the smallest volume and needles of the narrowest gauge and shortest length appropriate for the procedure are recommended. Making the anaesthetic agent less acidic will minimize the pain. Techniques to minimize pain involve careful explanation to the patient, slow injection of the anaesthetic and making use of the special anatomy of the region to be anaesthetized. The number of needle pricks should be kept to a minimum. Timing of the surgical procedure should take into account the delay in onset of anaesthesia for subcutaneously injected solution and the time for injected adrenaline to produce full vasoconstriction. Planned surgical incision lines drawn out precisely prior to the injection will avoid the problem of distortion caused by tissue expansion. Gloves and appropriate eye protection should be standard and needles and syringes must be disposed of correctly.
Sunscreens and vitamin E provide some protection to the skin immune system from solar‐simulated UV radiation
Authors: Halliday Gary M , Yuen Kylie S , Bestak Rosa , Barnetson Ross St C
Published: June 2007

Previous studies have indicated that sunscreens designed to protect from erythema do not adequately prevent immunosuppression. Mice were irradiated with suberythemal doses of solar‐simulated ultraviolet radiation (ssUVR) to assess the immunoprotective ability of sunscreens. Whereas C3H/HeJ and BALB/c mice had similar sensitivities to ssUVR‐induced inflammation, C3H/HeJ mice were more sensitive to ssUVR‐induced immunosuppression. Octyl dimethyl‐p‐aminobenzoic acid did not protect from immunosuppression and, thus, had an immune protection factor (IPF) of 1. 2‐Ethylhexyl‐p‐methoxycinnamate and microfine titanium dioxide provided limited protection, both having IPF values of 1.127. Immune protection by the sunscreens appeared to be dependent upon absorption of UVA as well as UVB, and was much less than predicted from the sun protection factor. Vitamin E, and inhibitor of lipid peroxidation, also protected the immune system, with an IPF of 1.2, indicating that oxidation of lipids is involved in UVR‐induced immunosuppression, and that it should be possible to develop sunscreens which protect the immune system.
Cytokeratins in primary cutaneous amyloidosis
Authors: Huilgol Shyamala C , Ramnarain Navin , Carrington Peter , Leigh Irene M , Black Martin M
Published: June 2007

The expression of keratins was investigated immunohistochemically on formalin‐fixed and snap‐frozen primary cutaneous amyloidosis tissue with a panel of monospecific and polyspecific antikeratin antibodies which recognized keratins K1, K5, K6, K7, K8, K10, K14, K16, K17, K18, and K19. Amyloid deposits in frozen section of seven cases of macular amyloidosis and lichen amyloidosus always reacted with antibodies LP34 (labeling K5, K6 and K18) MNF (labeling K5, K6, K8, K10, K17 and K18) and RCK 102 (labeling K5 and K8); frozen section in one case each of the seven cases also reacted with antibodies LL001 (labeling K14), Lp1K (labeling K7 and K17), and LP2K (labeling K19), LP1K (labelling K7 and K17), and LP2K (labelling K19), In formalin fixed section of 13 cases of macular amyloidosis and lichen amyloidosus amyloid deposits were labeled with LP34 in three section LL020 ()labelling keratins K5 and K6) in one section and LP2K in two section. In nodular primary cutaneous amyloidosis amyloid deposits were not labeled with any antikeratin antibodies. These data confirm that amyloid in macular amyloidosis and lichen amyloidosus contains keratin epitopes, and suggests derivation of the fibrillar component from keratin intermediate filaments Several different keratins appear to undergo conversion to amyloid, LP34, MNF 116 and RCK 102 antibodies, which have in common the labelling of keratin K5, may be useful in the diagnosis of macular and popular amyloidosis with frozen tissue section.
Subungual squamous cell carcinoma presenting with minimal nail changes: A factor in delayed diagnosis?
Authors: Hale Lloyd R , Dawber Rodney PR
Published: June 2007

Squamous cell carcinoma of the nail bed is a relatively uncommon tumour that may be diagnosed only after considerable delay. The first case presented is a 79‐year‐old man with a history of discomfort and discoloration affecting the right thumbnail of 3 years duration. The second case is a 70‐year‐old man who presented with a recurrent, offensive discharge from beneath the left thumbnail of 40 years duration. Clinical examination of the affected digits revealed minor nail abnormalities. The presence of tumour was fully apparent only after removal of the nail plate and inspection and biopsy of the nail bed. The cases demonstrate that subungual squamous cell carcinoma may present with prolonged symptoms and a deceptively benign appearance. The importance of consideration of the possibility of malignancy, removal of the nail plate for inspection of the nail bed and appropriate biopsy is emphasized.
Occupational contact dermatitis among New Zealand farmers
Authors: Rademaker M
Published: June 2007

Forty‐six farmers were patch tested to determine whether their dermatitis was secondary to an occupational allergen. Twenty‐eight had a positive patch test, of which 23 were thought relevant (definite or probable). In 20 of these cases, the allergen(s) was considered to be work related (definite or probable). The common allergens were pesticides (N‐(1,1,2,2‐tetrachloroethylthio)‐4‐cyclohexene‐1,2‐dicarboximide (captafol), ethylenebis(dithiocarbamato) manganese (maneb) and copper sulfate), rubber compounds (N‐isopropyl‐N‐phenyl‐4‐phenylenediamine (IPPD) and 4‐phenylene diamine base) and sunscreen chemicals.
Erythropoietic protoporphyria treated with narrow‐band (TL‐01) UVB phototherapy
Authors: Warren Lachlan J , George Sheru
Published: June 2007

Erythropoietic protoporphyria is a rare photodermatosis for which treatment options are limited. The present report describes the clinical features of a patient with erythropoietic protoporphyria and liver function test abnormalities associated with treatment with β‐carotene. Subsequent treatment with narrow‐band UVB phototherapy resulted in marked subjective improvement in photosensitivity, which was confirmed by abolition of demonstrated abnormalities on monochromator phototesting. The therapeutic options for photosensitivity in erythropoietic protoporphyria are reviewed and discussed.
Innervated musculocutaneous lip flap (Karapandzic technique)
Authors: Hills Russell J
Published: June 2007

The Karapandzic technique is easy in perform and provides excellent results for full thickness defects larger than one‐third of the tower lip. The flap Ls slid and rotated into position while an intact neurovascular pedicle is maintained. Accordingly, sensation and circulalion of the lip is preserved and function of the orbicularis oris muscle is maintained.
Maryborough skin health survey: Prevalence and sources of advice for skin conditions
Authors: Kilkenny Monique , Stathakis Voula , Jolley Damien , Marks Robin
Published: June 2007

A computer‐assisted telephone interview survey was carried out in the City of Maryborough to determine the prevalence and sources of advice for self‐reported skin conditions. Of the 443 adults contacted, 416 (94%) agreed to participate in the study. One hundred and fourteen people (27%) reported having one or more skin conditions over the past 2 weeks, which included eczema/dermatitis 25.5% (range, 18.1‐32.8%; 95% CI), warts 16.1% (9.8‐22.4%), acne 16.2% (9.6‐22.7%), cold sores 15.1% (7.3‐18.9%) and tinea 11.2% (5.9‐16.5%). Medical practitioners were the most common source of advice for 49% of skin conditions, followed by family and friends or self‐prescribed (25%). Advice from a pharmacist was sought for 19% of skin conditions. Logistic regression analysis showed that those people who reported a moderate to severe inflammatory skin condition, such as dermatitis, urticaria or psoriasis, were most likely to seek advice from their medical practitioner. The type and severity of skin condition were factors which determined where a person sought advice on diagnosis and management.
Benign hypergammaglobulinemia purpura of Waldenström associated with lymphoid interstitial pneumonitis
Authors: Miller Robert M , Weedon David , Robertson Ivan M
Published: June 2007

A 31‐year‐old female is described who developed benign hypergammaglobulinaemic purpura and lymphoid interstitial pneumonitis concomitantly. High titre anti‐nuclear antibodies were also noted. Several years previously, the patient had developed myasthenia gravis and multiple sclerosis. The present case is an example of multiple medical disorders characterized by immune dysregulation and represents the first reported association of hypergammaglobulinaemic purpura with lymphoid interstitial pneumonitis.
Low energy fluence CO2 laser treatment of lymphangiectasia
Authors: Novak Csilla , Spelman Lynda
Published: June 2007

Lymphangiectasia is an uncommonly reported complication of lymphatic insufficiency. These dilatations of lymphatic vessels may be symptomatic, necessitating treatment While CO2 laser ablation has been used with success in the treatment of lymphangiectasia, it is infrequently reported and previous laser protocols have relied on high irradiances. The successful use of low fluence CO* laser in the treatment of multiple lymphangiectases on the lower limb of a middle‐aged Caucasian woman with unilateral chronic lymphoedema is described.
Spectroscopic techniques in the study of protein binding. A fluorescence technique for the evaluation of the albumin binding and displacement of warfarin and warfarin‐alcohol
Authors: Sudlow Gillian , Birkett Donald J. , Wade Denis N.
Published: June 2007

1. The binding of racemic mixtures of warfarin and warfarin‐alcohol to human serum albumin (HSA) is accompanied by an increase in the fluorescence quantum yield of these compounds. This property has been used to measure the characteristics of the binding of warfarin and warfarin‐alcohol to HSA at 22°C and 37°C. Within the limits of the technique, no significant differences between the number of binding sites and strength of binding at the tight site at either temperature were observed.

2. The fluorescence of warfarin and warfarin‐alcohol was used to label their binding site on HSA and to study the effects of other drugs on their binding. The results indicate that these two molecules are bound to the same site on HSA.

3. The validity of using changes in the fluorescence of warfarin as a measure of its displacement from HSA was investigated. Good correlations were observed between drug‐induced decreases in the fluorescence of bound warfarin and displacement as measured by equilibrium dialysis. The displacement of warfarin, as detected by fluorescence, correlates well with the increase in free warfarin resulting from addition of therapeutic drug concentrations to undiluted human serum.

4. The most potent displacing agents, by all the methods used, were iophenoxic acid, phenylbutazone and oxyphenylbutazone. The first of these is no longer used clinically, but the latter two are and have been reported to cause hypoprothromin‐aemia by displacing warfarin from HSA. The present study indicates that changes in the fluorescence of warfarin bound to HSA can be used to measure displacement of bound warfarin and to screen drugs that may cause clinically significant interactions by this mechanism.
Potassium‐sparing effect of amiloride in a diuretic factorial study in man
Authors: Schapel Graham J. , David K. , Edwards G. , Robinson John
Published: June 2007

1. The effects of amiloride (M, 20 mg/day), chlorothiazide (C, 1000 mg/day), ethacrynic acid (E, 100 mg/day) and frusemide (F, furosemide 80 mg/day), given alone and in combination, were investigated in eight patients in a 24 factorial study. Effects between blocks of four treatments in each sixteen‐treatment replicate were confounded with higher interactions to allow for differences between early and late diuresis.

2. All patients exhibited marked diuresis, with significant mean increases in daily urinary sodium excretion (P < 0·05) and urinary volume (P < 0·01) induced by chlorothiazide, frusemide and ethacrynic acid (68, 69 and 38%; and 35, 40 and 34%, respectively). Amiloride appeared to be half to one‐third as potent as the other diuretics.

3. Amiloride produced a significant potassium‐sparing effect (P < 0·01), reducing urinary potassium excretion by 30%, compared to significant urinary potassium wasting with frusemide (increase of 33%, P < 0·01) and chlorothiazide (increase of 31%, P < 0·05).

4. No adverse reactions occurred, but serum potassium levels twice rose to 6 mmol/l and subsided without additional therapy, and on one occasion fell to 2·5 mmol/l, requiring a potassium supplement for 4 days.

5. It was concluded from these factorial studies that amiloride is a mild diuretic and potent potassium‐sparing agent acting independently and additively in combination with chlorothiazide, ethacrynic acid or frusemide. For the three latter diuretics, all two‐drug interactions were simply additive also, without evidence of synergism or antagonism between drugs.