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Eighty-nine patients with chronic actinic dermatitis (CAD) were retrospectively studied: 69 (78%) male and 20 (22%) female, with mean ages of 66 and 64 years, respectively; nine (10%) were dark skinned. Eight (9%) were abnormally sensitive to UVB wavelengths alone, 74 (83%) to UVB and UVA, and seven (8%) to UVB, UVA and visible radiation. Eighty-six patients were patch tested to an extended standard European series of contact allergens, including in 80 cases a 0.1% mix of three sesquiterpene lactones, and photopatch tested to a standard photopatch series. Sixty-four of these 86 patients (74%) had positive patch or photopatch tests; 36% (29 of 80) were sensitive to the sesquiterpene lactone mix, 21% (18 of 86) to fragrance compounds, 20% (17 of 86) to colophony, and 14% (12 of 86) to rubber chemicals. Ten (12%) had positive photopatch tests; five (6%) to musk ambrette, six (7%) to sunscreens and one to both. Fourteen of the eighty-nine patients with CAD (16%) had preceding endogenous eczema. In 18 of 86 patients (21%), CAD occurred alone, with neither detectable contact nor photocontact allergy, nor a preceding history of endogenous eczema. This study confirms the association between Compositae (sesquiterpene lactone) dermatitis and CAD.

Background Healthcare workers (clinical, allied/paramedical professions and ancillary workers) may have prolonged contact with natural rubber latex devices, particularly in the form of natural rubber latex gloves. Objectives To examine the changing frequency of type IV thiuram allergy in healthcare workers with hand dermatitis over a 16-year period. Methods During the study period, 450 healthcare workers (352 women and 98 men) with hand dermatitis were investigated, and their patch test results were analysed retrospectively. Results On average, a thiuram-positive patch test was noted in 12% of individuals, with a peak incidence of 27% of the patients patch tested in 1994. Comparison of results between 1983–88 and 1989–93 showed a statistically significant increase in the incidence of thiuram-positive patch tests (odds ratio 2·55, 95% confidence interval 1·25–5·20, P = 0·01). Conclusions We have documented a changing frequency of thiuram-positive patch tests in healthcare workers with hand dermatitis since 1983. This may reflect changes in degree of exposure to thiurams in medical gloves during this period.

Azathioprine and cyclosporin have been used as immunosuppressants for many years, but long-term use has also been associated with neoplasia. We report three cases of rapidly fatal Merkel cell carcinoma in patients who had been treated with azathioprine for many years either for rheumatoid arthritis or following organ transplantation. Two of these patients had also received cyclosporin. We suggest that Merkel cell carcinoma may be seen more commonly in immunosuppressed patients than in the normal population and that the oncogenic potential of azathioprine and cyclosporin should be borne in mind when prescribing these drugs.

We report a patient with the glucagonoma syndrome and octreotide-resistant necrolytic migratory erythema (NME). The NME responded on two occasions to an intravenous infusion of essential fatty acids (EFA) and amino acids (AA). A deficit of serum EFA prior to treatment was corrected following the infusion, whilst plasma AA were low before and after treatment. These findings indicate that NME, in the glucagonoma syndrome, may respond to correction of the EFA deficit, and that NME may be a disease of EFA deficiency.

The staphylococcal scalded skin syndrome (SSSS) is very rare in adults. Renal impairment and immunocompromise are predisposing causes. We report a 38-year-old HIV-1 seropositive intravenous drug abuser who developed SSSS due to staphylococcal pneumonia. An exfoliating toxin-releasing Staphylococcus aureus, phage type II type 3C, was isolated from the sputum and from blood cultures. This is the third case of adult SSSS to be reported in the context of HIV disease.

Summary The successful use of cyclosporin A (CSA) in organ transplantation is now well established.1 In recent years its usefulness has extended to the treatment of cutaneous autoimmune disorders,2 including pyoderma gangrenosum (P.G.).3–7 We report mo further cases of recalcitrant P.G., both associated with rheumatoid arthritis (R.A.) which responded to low dose CSA.

SUMMARY Over the past 10 years, oral cyclosporin A (CyA) has been used to treat a range of inflammatory and immunologically mediated dermatological conditions, but only psoriasis has been shown to be responsive in double-blind, controlled trials. Thirteen patients with severe atopic dermatitis were treated for up to 31 months. Ten patients had a good response, one patient a moderate response and two a slight response. In two of these patients, CyA was withdrawn after more than 2 years of continuous treatment because of increasing plasma creatinine levels. Cyclosporin A appears to be useful in the treatment of severe, therapy-resistant atopic dermatitis, but careful monitoring of side-effects and dose adjustments are required.

Trichorrhexis nodosa is a disorder of the hair shaft in which there is a distinctive response to injury. The hair is fragile and on examination regularly spaced pale 'node-like' swellings may be observed. It may affect normal hair following excessive or repeated trauma, or may occur after minimal trauma if there is an inherent defect in keratin synthesis causing abnormally brittle hair. The diagnosis can be readily made clinically and confirmed microscopically. Treatment is aimed at reducing trauma. We describe a case of localized trichorrhexis nodosa in a patient with otherwise apparently normal hair.