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Propylene glycol is a commonly used vehicle for topical preparations. Although it is well suited for this purpose, it is capable of producing both primary irritant skin reactions and allergic sensitization. The literature on propylene glycol is reviewed, with particular attention to the nature of these adverse cutaneous effects. Guidelines for patients sensitive to propylene glycol are discussed.

This double-blind controlled study investigated the effectiveness of 4% topical erythromycin liquid with 1.2% zinc acetate and 4% topical erythromycin gel with 1.2% zinc octoate applied twice daily in comparison with 250 mg of oral tetracycline twice daily and placebo. One hundred forty-nine patients began and one hundred forty-one completed the study. Three judges recorded acne measurements of severity grade, papule counts, pustule counts, comedo grades, and comedo counts without mutual consultation on visits at 0, 2, 4, 6, 8, and 10 weeks. Analysis of the reduction in the acne severity grade and papule count showed that the erythromycin/zinc liquid and gel were statistically significantly better than placebo and as effective as the oral tetracycline. Analysis of comedo grades showed that at weeks 8 and 10 the 4% topical erythromycin/zinc liquid showed a reduction statistically better than placebo.

A serologic survey for markers of hepatitis B virus (HBV) infection was conducted in 593 dermatologists. Serologic evidence for previous infection was found in 15.4%, indicating that dermatologists are an at-risk population comparable to many other specialties of medicine. Dermatologists with a history of blood transfusion, tattoo, and homosexuality had an increased prevalence of serologic markers for HBV. The type of practice, extent of surgery, and glove-wearing practices did not correlate with HBV serologic markers.

Unilateral dermatomal superficial telangiectasia (UDST) may be congenital or acquired. Acquired UDST may occur coincident with physiologic states of estrogen increase, including puberty and pregnancy in women and adrenarche in men. Acquired UDST may also occur in estrogenized pathologic states such as chronic hepatic disease in alcoholism. The occurrence during estrogenized states, the dermatomes of distribution, and the presence of anemic halos suggest kinship with arterial spiders. UDST and some cases of benign, generalized telangiectasia may be local and universal forms, respectively, of the same pathologic process in the cutaneous microvasculature. Further, this is compatible with both the concept that UDST results from a somatic mutation and the usual nonfamilial presentation of UDST.

Acrodermatitis continua of Hallopeau is considered by many to be a variant of pustular psoriasis because of similar histologic features. Its clinical picture is unique and helps to distinguish acrodermatitis from pustular psoriasis. We present a patient with acrodermatitis continua of Hallopeau resistant to conventional therapy. We describe the beneficial effect of etretinate in this patient.

One hundred sixty-five subjects completed a 10-week, double-blind controlled study comparing the following: (1) a combination of 3% erythromycin and 5% benzoyl peroxide in a gel, (2) 5% benzoyl peroxide gel, (3) 3% erythromycin gel, and (4) the gel vehicle. The benzoyl peroxide gel and the erythromycin gel were superior to the control gel; however, the combination product was more effective than any of the others. This was true for both pustular and papular lesions, but the most dramatic effect was on combined inflammatory lesions, i.e., papules and pustules.

An 18-year-old white woman admitted for an incomplete septic abortion was found to have thrombocytopenia, anemia, and increased activated partial thromboplastin time (PTT). Additionally, results of nontreponemal serologic tests for syphilis were positive, and the fluorescent antinuclear antibody was weakly positive. A mixture of the patient's plasma with normal control plasma showed that the elevation in activated PTT was the result of a circulating anticoagulant, not an inherent clotting defect. Sclerodermoid features were present and consisted of bound-down, hairless skin and scattered subcutaneous indurated plaques. A faint pattern consistent with livedo reticularis was recognized on all extremities. Biopsy specimens of sclerodermoid lesions showed increased and thickened dermal collagen consistent with morphea. We believe that this patient's condition represents an unusual connective tissue disease syndrome consisting of abortion, livedo reticularis, thrombocytopenia, circulating "anticoagulant," negative or slightly positive antinuclear antibodies, and false positive results on nontreponemal serologic tests for syphilis. Sclerodermoid lesions were also a unique feature in our patient.

Development of new antifungal agents has increased significantly over the past two decades, with recent advances reflecting interest in synthetic agents as opposed to antibiotics. We review the various antifungal medications in use or under development, beginning with a discussion of over-the-counter agents, antibiotics, and older azole compounds and ending with an evaluation of newer azoles and the new class of antifungals, the allylamines.

Interferons, glycoproteins originally investigated as antiviral agents, are now known to be active as anticancer agents, immune system modulators, and growth control regulators. For these reasons, interferons have definite and documented relevance to dermatologists. In regard to viral diseases, therapeutic trials in humans have shown promising results in herpes simplex infections, vaccinia, laryngeal papillomas, and condyloma acuminatum, as well as in rabies and hepatitis B. Pilot studies with interferon treatment of melanoma have been so promising that the American Cancer Society has selected this area to receive additional research support. Also, the antiproliferative effects of interferons have potential application to proliferative diseases such as psoriasis.

Two hundred eight patients completed a 12-week, multicenter, double-blind, controlled study comparing a 2% erythromycin ointment to its vehicle. Patients were evaluated by inflammatory lesion counts and Cook acne severity grade at the initial visit and at weeks 2, 4, 8, 10, and 12. The 2% erythromycin ointment proved to be statistically more effective than the vehicle in reducing lesion counts and acne severity grade at weeks 4, 8, 10, and 12. The ointment caused few side effects and was well tolerated by most patients.

Despite evidence that rubber or latex surgeon's gloves appear to prevent or reduce the transmission of hepatitis B virus, physicians continue to perform surgical procedures without wearing gloves. Surveys regarding glove usage among members of the American Academy of Dermatology revealed that a majority of those responding do not regularly wear gloves while performing basic dermatologic procedures, such as shave and punch biopsies and curettage and desiccation. Others are still not wearing gloves regularly while performing excisional surgery, hair transplants, and dermabrasion procedures.

A case of Flegel's disease, or hyperkeratosis lenticularis perstans, is reported. This rare chronic disorder is characterized by asymptomatic hyperkeratotic papules, usually located on the lower extremities. Most reported cases have been from Europe. We report a case of hyperkeratosis lenticularis perstans from our institution that was treated successfully with topical 5-fluorouracil.

Multiple hamartoma syndrome is a genodermatosis with autosomal-dominant inheritance. Characteristic findings include mucocutaneous verrucoid papules, "cobblestoning" of the tongue, and hamartomas of multiple organ systems. Also reported are frequent malignancies, especially of the breast. Herein we report a case of a 42-year-old black woman with typical findings of multiple hamartoma syndrome, including an occult malignancy of the uterine cervix, an as yet unreported site of carcinoma in this syndrome. Additionally, we detail a previously unreported finding of bilateral angioid streaks of the optic fundi. Photographs displaying many of the typical features of multiple hamartoma syndrome and associated histopathology are included, along with a brief review of the literature.

Two hundred sixty-eight patients with mild to moderate acne vulgaris completed a multicenter, double-blind, controlled study comparing isotretinoin 0.05% gel with its vehicle. Patients were treated twice daily for up to 14 weeks. Efficacy was measured by counting facial inflammatory and noninflammatory lesions and by grading acne severity initially and at 2- to 3-week intervals throughout the study. The isotretinoin 0.05% gel proved to be statistically more effective than vehicle in reducing inflammatory lesions after 5 weeks and in reducing noninflammatory lesions and acne severity grade after 8 weeks. Except for two patients who dropped out because of irritation, isotretinoin 0.05% gel was well tolerated.