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Rowell's syndrome is the name given to a distinct group of patients with lupus erythematosus who develop erythema multiforme-like lesions and have a characteristic serological picture. We report a case of a 29-year-old woman of Afro-Caribbean origin who presented with an erythema multiforme-like eruption on the hands. Subsequently she developed painful erythematous swellings on the feet and scaly plaques on the forearm and thigh consistent with subacute cutaneous lupus. She developed a positive antinuclear factor and had positive anti-Ro and anti-La antibodies and a positive rheumatoid factor. All of these features are consistent with Rowell's syndrome which we believe is a rare but distinct variant of cutaneous lupus erythematosus. [ABSTRACT FROM AUTHOR]

A new method for recovery of exudate from human skin using a suction bulla technique is described. Undiluted exudate was obtained with minimal trauma and analysed for histamine, kinin and prostaglandin (PG)-like activity, by superfusion cascade bioassay. The PG-like activity was further characterized by gel partition, gas-liquid and thin-layer chromatography. PGE[SUB2] and PGF[SUB2α] were further characterized by gas chromatography-mass spectrometry (GC-MS) and PGF[SUB2α] by radioimmunoassay. Histamine was detected as was kinin-like activity. Prostaglandins E[SUB2]and F[SUB2α] with their metabolites, were also detected. The cell content of the bulla fluid was low compared to blood and the protein content was approximately 24 g/l. Histological and electron microscopic studies showed the bullae to arise from a split in the dermo-epidermal junction between the plasma membrane of the epidermal cells and the basal lamina. [ABSTRACT FROM AUTHOR]

We report a patient who has an immediate wealing response to pressure in the absence of symptomatic dermographism, which we designate 'immediate-pressure urticaria'. Our patient also suffered from cholinergic urticaria and chronic idiopathic urticaria in the past, demonstrating the clustering of urticarias which frequently occurs. [ABSTRACT FROM AUTHOR]

A patient with atypical Nekam's disease is described. Although the histological appearances were lichenoid, the presence of porokeratosis and amyloid deposition, previously reported in this condition, argue against the view that Nekam's disease is a subset of lichen planus. [ABSTRACT FROM AUTHOR]

We report the case of a 30-year-old patient who developed scombrotoxic fish poisoning after eating cooked fresh tuna. Symptoms included a bright red rash, tightness of the chest, palpitations, anxiety, mild headache and dizziness, all of which resolved spontaneously within 2–3 h. Such poisoning results from the consumption of spoiled fish of the families Scomberesocidae or Scombridae — in particular tuna, mackerel, skipjack and bonito — which contain high levels of histidine. Incorrect storage of fish allows bacterial histidine decarboxylase to convert histidine to histamine. The ensuing symptoms are thought to result from the ingestion of histamine. Scombrotoxic fish poisoning is preventable by the correct handling and refrigeration of these fish. [ABSTRACT FROM AUTHOR]

We describe a case of localized Tinea imbricata in a 23-year-old, British nurse. The infection was contractd in Papua New Guinea where it is endemic. Topical antifungals were of temporary benefit, but the infection relapsed on stopping treatment. Cure was achieved after a four week course of griseofulvin I g day[sup-1]. [ABSTRACT FROM AUTHOR]

Urticaria is predominantly due to release of mast cell mediators, mainly histamine. Chronic idiopathic urticaria, in which disease activity continues on most days for more than 6 weeks and there is no evidence of a physical urticaria or urticarial vasculitis, is common. An external cause is rarely identified even if a thorough history and appropriate investigation based on this are undertaken. However, approximately 50% of patients with chronic idiopathic urticaria (CIU) have a serum histamine releasing factor present. In one-third of patients with CIU this is an IgG autoantibody directed against the high affinity IgE receptor (FceRI) or less frequently against IgE. Patients with autoinimune urticaria, are clinically more severe. Urticaria can affect the quality of life markedly, being comparable to that of patients awaiting triple coronary by-pass surgery. The rational management of urticaria takes account of likely causes and mediators involved. However explanation and attention to general measures such as minimizing stress, overheating and alcohol are important. Aspirin, nonsteroidal anti-inflammatory drugs and opiates should be avoided if possible. Exclusion diets such as of food colourings and additives may be of some value to a limited number of patients. Second- and third-generation low sedation H1 antagonists are the treatment of choice and improve many patients. Addition of an H2 antagonist or a mast cell stabilizing drug may provide additional benefit for a few. There are reports that leukotriene receptor antagonists improve some patients. Oral steroids are reserved if possible for severe exacerbation of chronic urticaria, and disabling pressure urticaria. Third-line therapies involving immunosuppressive agents are only appropriate for patients with chronic urticaria refractory to other measures, and usually autoimmune. The encouraging results using short courses of oral cyclosporin, high dose intravenous immunoglobulin and plasmapheresis need to be... [ABSTRACT FROM AUTHOR]