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Visual assessment remains one of the "gold standard" methods of assessing skin color and a number of tools are currently available to reduce the interobserver variability. Ultraviolet light examination remains a mainstay of the assessment of pigmentary disorders, while polarized light photography is useful for the appraisal of dermal changes, in particular those related to vascularity. With the introduction of modern instruments, reflectance spectroscopy using tristimulus colorimeters or narrowband spectrophotometers provides a convenient, objective, and reproducible methodology for the evaluation of pigmentation and skin color. In vivo confocal scanning laser microscopy is a powerful technique for the examination of pigmented lesions, which shows promise in the detection and diagnosis of early melanoma. Dermoscopy is also useful for the differential diagnosis of benign melanocytic lesions and melanoma, and its use has been shown to significantly improve diagnostic accuracy.

1. Lewis EL. Tuberculosis of the penis: a report of 5 new eases, and a complete review of the literature. J Urol 1946;56:73745. 2. Lal MM, Sekhon GS, Dhall JC. Tuberculosis of penis. J Indian Med Assoc 1971;56:316-8. 3. Narayana AS, Kelly DG, Duff FA. Tuberculosis of the penN. Br J Urol 1976;48:274. 4. Agarwalla B, Mohanty GP, Sahu LK, et al. Tuberculosis of the penis: report of 2 eases. J Urol 1980;124:927. 5. Venkataramaiah NR, van Raalte JA, Dutta SN. Tuberculous ulcer of the penis. Postgrad Med J I982;58:59-60. 6. Houston W, Burke GJ. Tuberculosis of the penis. Br J Urol 1983;55:242-3. 7. Sofras F, Kostakopoulos A, Delakas D, et al. Tuberculosis of the penis. Acta Urol Belg 1988;56:475-6. 8. Baskin LS, Mee S. Tuberculosis of the penis presenting as a subcutaneous nodule. J Urol 1989;141:1430-1. 9. Lever WF, Schaumburg-Lever G. Histopathology of the skin. 7th ed. Philadelphia: JB Lippincott, 1990:326-8.

All patients seen in the Contact Dermatitis Clinic of the National Skin Centre, Singapore (and the former Middle Road Hospital) between January 1986 and December 1990 were analysed retrospectively. 5557 patients comprising 2634 (47.4%) males and 2923 (52.6%) females were patch tested. 3154 (56.8%) patients had 1 or more positive reactions. The majority of the patients were Chinese (78.0%), followed by Malays (11.5%), Indians (8.1%) and other minority races (2.4%). The majority of positive reactions belonged to the 21-40 age group. The incidence of positivity decreased after 60 years. The commonest allergens responsible were nickel (17.7%), fragrance (13.3%), neomycin (6.9%), colophony (6.6%) and proflavine (6.5%). Both neomycin and proflavine were commonly used as over-the-counter medicaments. Compared to an earlier report in 1988, there were differences in the incidence of contact sensitivity to some allergens. Potassium dichromate, which used to be a common allergen, was less common. Some allergens (carba-mix, naphthyl-mix, caine-mix and PCMX) have been removed from our standard series as they were uncommon causes of contact allergy. Thimerosal and Amerchol L-101 were added in their place.

Onychomycosis is caused by dermatophytes, moulds and yeasts. It is important to identify the non-dermatophyte moulds as they are resistant to the usual anti-fungals. A prospective study was undertaken in the National Skin Centre, Singapore to study the pattern of dermatophyte and non-dermatophyte onychomycosis. 53 male and 47 female patients seen between June 1990 and June 1991 were entered into the study. Direct microscopy was done and the nail clippings were cultured. Toe and finger nails were equally infected. Dermatophytes were isolated from 21 patients namely, T. rubrum (12/21), T. interdigitale (5/21), T. mentagrophytes (3/21) and T. violaceum (1/21). Candida onychomycosis occurred in 39 patients and was caused by C. albicans (38/39) and C. parapsilosis (1/39). 37/39 patients had associated paronychia. 5 types of moulds were isolated from 12 patients, namely Fusarium species (6/12), Aspergillus species (3/12), S. brevicaulis (1/12), Aureobasilium species (1/12) and Penicillium species (1/12). Although the clinical pattern and microscopy may predict the type of organisms, in practice this is difficult. Only cultures were confirmatory. 28% (28/100) had negative cultures despite a positive microscopy, and moulds (12/100) grown might be contaminants rather than pathogens.

This is a retrospective study of the cure rates of forty patients with subungual and periungual viral warts treated with carbon dioxide laser vapourisation (total of 69 lesions). 70.6% (48/68) lesions had failed treatment with cryotherapy and/or electrocautery treatment previously. 20/68 were treated with CO2 laser vapourisation as a first line treatment. The overall cure rate over 10 months follow-up period was 57.4% (39/68). Most recurrences (24/25) occurred within the first 3 months of vapourisation. The carbon dioxide laser vapourisation cure rate for warts in which previous cryotherapy and/or electrocautery had failed was 47.9% whereas those treated with carbon dioxide laser vapourisation as a first line treatment had a cure rate of 80% (p = 0.043). Subungual warts responded slightly better with a cure rate of 64.7% compared with periungual warts (54.9%) (n.s.). The carbon dioxide laser vapourisation cure rate for recurrent subungual and periungual warts (which failed previous carbon dioxide laser vapourisation) was 73.3% (11/15). Our findings appeared to indicate that periungual and subungual warts can be eradicated by CO2 laser vapourisation. Recurrent warts can be effectively eradicated by further vapourisation. Recalcitrant periungual and subungual warts which have previously failed to respond to cryotherapy and/or electrocautery can be effectively eradicated with CO2 laser vapourisation.