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We describe two children with bullous mast cell disease. Both had been unresponsive to conventional therapy. Oral disodium cromoglycate in doses ranging from 60 to 200 mg per day produced dramatic improvement of the disease. Over the year of the study, no untoward reactions have been noted.

We report a case of osteomyelitis complicating Mohs' surgery for recurrent basal cell carcinoma of the forehead. The need for immediate versus delayed repair after this type of surgery is discussed. It is evident that open, bone-exposed defects allowed to heal by secondary intention require meticulous wound care and follow-up.

Ten ambulatory patients with unilateral and eight with bilateral ulcers of various etiologies were studied to determine the effects of keeping a wound bed moist under a water vapor and oxygen permeable membrane (VPM). In the bilateral group, VPM healing was compared with a debriding enzyme ointment and 10% benzoyl peroxide in the same patient. The faster healing rate with VPM was compared to the healing rate with control substances by the paired t test, with significance at less than 0.05 level. In the unilateral group two patients with ulcers to bone or joint capsule and one patient who had failed grafting healed without surgery. Two patients failed to heal with the VPM. All healing occurred in the face of gross bacterial contamination. Three patients treated with VPM developed cellulitis. Wound healing under a vapor permeable membrane occurs with an increase of the average healing rate by a factor of 2.6 when compared to control substances in ambulatory patients.

Birthmarks of potential medical significance were identified among 4,641 newborn infants: 1.1% had a nevocellular nevus and 0.3% had a sebaceous nevus; 1.8% of black infants, but no white infants, had three or more café au lait spots. The large nevocellular nevus is considered premalignant, but the significance of the small nevocellular nevus has not been established. The sebaceous nevus fades after birth but undergoes hyperplasia at puberty. Multiple café au lait spots occur less commonly in white than in black infants, and are therefore of greater concern as possibly an early sign of neurofibromatosis.

Becker's melanosis is a distinct clinical entity. We report herein two cases with extensive lesions accompanied by subjacent and distant soft tissue and bony abnormalities. Review of the world's literature reveals several additional cases of structural abnormalities associated with Becker's melanosis. Rather than just a dermatologic curiosity, Becker's melanosis may be a marker for underlying structural anomalies.

Vapor permeable membranes (VPM) are commonly being used to treat cutaneous wounds where partial or full thickness skin is lost. Five years of experience with one particular VPM has taught a great deal concerning its proper use. Correct preparation of the treatment site to allow adhesion followed by application of the VPM with the right amount of tension and border are of paramount importance or aggravation rather than improvement of the cutaneous defect may occur. Initially, the membrane should be changed frequently, once or twice a day in heavily contaminated or necrotic wounds. Side effects are usually related to improper application, with resultant leaking of fluid and irritation of normal skin. Recent success has been achieved by weekly application of VPM in the office, removal at home after several days, and subsequent use of 10% benzoyl peroxide lotion until the next office visit. Extreme caution must be exercised if VPM is used to treat patients who are severely leukopenic or malnourished.

A basic discussion of the chromosome disorders and congenital malformations with specific reference to syndromes of interest to the dermatologist is presented. Although the chromosome disorders are uncommon, an introduction to the most prevalent clinical findings should enable the clinician to increase his/her index of suspicion as to the presence of one of these disorders. The latest chromosome banding technics and their application to clinical diagnosis are discussed. Congenital malformations are also uncommonly seen in the practice of dermatology. However, approximately 7% of all newborns have a cutaneous lesion at birth; some of these are of serious medical significance or the manifestation of a systemic disease. These include café au lait marks, congenital nevocellular nevi, and sebaceous nevi. A basic understanding of the mechanics and theory of prenatal diagnosis is becoming increasingly necessary for the dermatologist. Recently, epidermolytic hyperkeratosis has ben diagnosed antenatally, with the promise of other primary dermatologic disorders also being amenable to detection before birth. As the ability to detect and diagnose genetic disease becomes more refined, patients who are at risk themselves or whose offspring are at risk for these disorders will require more detailed information than ever before. Appropriate advice regarding recurrence risk, full spectrum of disease, availability of prenatal diagnosis, and any potential therapy will have to be proffered via genetic counseling.

In an effort to improve clinical response and reduce systemic toxicity, nine patients with recalcitrant psoriasis were treated with rational combinations of chemotherapeutic agents. Five patients received methotrexate by injection, 7.5 or 10 mg, followed 1 hour later by intravenous 5-fluorouracil, 170 to 562 mg/m2, on a weekly schedule. Four patients received oral triacetyl-azauridine, 2 to 4 gm daily, in combination with intravenous 5-fluorouracil, 225 to 600 mg/m2, administered every week. Three patients experienced greater than 75% clearing of disease, five patients experienced greater than 50% clearing, and only one patient failed to respond. Response rates did not differ between the two treatment groups. Adverse effects of these therapies were mild and infrequent. We conclude that 5-fluorouracil in combination with either methotrexate or triacetyl-azauridine is a relatively safe and effective alternative for the therapy of patients with severe psoriasis.