Treatment of poikiloderma of Civatte with the pulsed dye laser: a series of seven cases

Seven patients with poikiloderma of Civatte were treated successfully with the pulsed dye laser. One patient's treatment was complicated by scarring, which appeared 4 months after the treatment.

Cutaneous lesions in hereditary haemorrhagic telangiectasia: successful treatment with the tunable dye laser

BACKGROUND

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant inherited condition that has cutaneous telangiectasia as a component of its manifestations. It has been found that the tunable dye laser is effective in the clearance of these lesions.

METHODS

Twelve patients with HHT between 1991 and 1999 were treated with the tunable dye laser. Treatment was carried out at 3-month intervals.

RESULTS

Of the 12 patients treated with the tunable dye laser, 10 were evaluated after treatment. In all cases, the cutaneous component had resolved.

CONCLUSION

The diagnosis of HHT should be considered in all cases of telangiectatic skin lesions. The tunable dye laser appears to be an effective means of resolving any cosmetic problems.

Pulsed dye laser treatment of necrobiosis lipoidica: report of a case

A 23-year-old woman with long-standing insulin dependent diabetes presented with necrobiosis lipoidica. She was particularly troubled by the telangiectatic element of the lesion and therefore underwent test treatment with the pulsed dye laser. At low fluences minimal therapeutic effect was achieved, and at higher fluences skin breakdown occurred. This resolved with conservative management. It would appear that caution is required when attempting to treat necrobiosis lipoidica with laser.

Sir Ernest Graham-Little, MP, MD FRCP (1867-1950): dermatologist and politician

Sir Ernest Graham-Little was not only one of the foremost British dermatologists of the first half of the 20th century but he also served from 1924 to 1950 as an Independent Member of Parliament. As a dermatologist he played a leading role in medical education, wrote a vast number of clinical papers, was the President of both the British Association of Dermatology (as it then was) and the Section of Dermatology of the Royal Society of Medicine, and he described a form of scarring alopecia that has become known as Graham-Little syndrome. He was the first to describe the syndrome later named after Waterhouse and Friedrichsen. In Parliament he expressed his opinions on a vast array of subjects, often advancing views well ahead of his time. Perhaps most remarkably, for much of his time in Parliament he was still an active dermatologist. Notwithstanding the formidable achievements in his twin careers, his name is not well known.

Can the response of port-wine stains to laser treatment be reliably assessed using subjective methods?

Assessing the results of laser treatment of port-wine stains (PWS) is very subjective. Most publications use scoring systems that physically describe the change in PWS after treatment. For results derived from such an analysis to be meaningful, the observers must be able to produce results that not only have a small interobserver variability but are also reproducible. Previous studies have addressed the former but not the latter. The present study was undertaken to investigate this area of concern. Six professionals, experienced in laser work, blindly assessed the response to laser treatment of 20 PWS, on two occasions, 1 month apart. Twenty pairs of comparable clinical photographs (one pretreatment and one post-treatment) were assessed using three different scoring systems commonly used in previous publications. Intrarater concordance between the two sessions was then assessed. Our results demonstrated that the judges could only consistently score results at the extremes of outcome. There was little agreement in the assessment of results lying between these. The judges were, however, consistently able to place a similar proportion of patients in each outcome category. We conclude that, as yet, there is no satisfactory method of monitoring the progress of an individual's PWS following laser treatment. However, the scoring systems examined would seem to be reasonable for presenting the data from patient series.

The treatment of early cutaneous capillary haemangiomata (strawberry naevi) with the tunable dye laser

We have treated 39 early cutaneous capillary haemangiomata, in 24 infants, with the tunable dye laser at a wavelength of 585 nm (SPTL 1b, Candela Corporation, Wayland, MA, USA). The average age at first treatment was 13 weeks. The first signs of involution were seen at 19 weeks of age. Complete resolution of the lesions was seen in 61. 5% of haemangiomata at an average age of 39 weeks. Two haemangiomata did not respond to laser treatment and were treated successfully with intralesional steroid injection. There were no complications of laser treatment. The natural history of the treated haemangiomata was significantly shorter than historical evidence suggests for untreated lesions. Haemangiomata may be treated safely and effectively with the tunable dye laser in the early weeks of life leading to accelerated involution and resolution.

Welding and non-melanoma skin cancer

This paper reports on five cases of nonmelanoma skin cancer (NMSC) occurring in welders, an occupation in which there is potential for intense exposure to nonsolar ultraviolet irradiation. The status of ultraviolet light as the major aetiological factor in NMSC is well established, and in the great majority of cases solar irradiation is the source. The possible role of nonsolar sources of ultraviolet irradiation should not be overlooked.

Patch testing in a British district general hospital

The results of patch testing in 753 patients attending a dermatology clinic in a British district general hospital over the period 1993-96 are presented. The frequency of positive reactions, and of the relative frequency of common allergens is broadly comparable to series published from specialist contact clinics. This study suggests that nonspecialist dermatology clinics can carry out routine patch testing adequately, although there are likely to be a number of cases which will require review in a specialist clinic or specialist advice.

Lymphoedema and Crohn's disease

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Treatment of traumatic tattoos with the Nd YAG laser: a series of nine cases

Inadequate primary skin cleansing for dirt-ingrained skin abrasions can result in disfiguring traumatic tattoos. We present nine cases of traumatic tattoos treated with the Nd YAG laser. In six cases the pigmentation was completely cleared and in three cases minimal pigmentation remained. The Nd YAG laser offers effective late treatment of traumatic tattoos with many advantages over conventional destructive treatment modalities. The best treatment is still immediate debridement and cleaning.

Giant bladder diverticulum in Ehlers-Danlos syndrome type I causing outflow obstruction

We describe a 16-year-old patient with Ehlers-Danlos syndrome (EDS) type I and recurrent urinary retention caused by giant bladder diverticulum and review the literature on this association.

Telangiectasia macularis eruptiva perstans: a case report and review of the literature

We report a 20-year-old female patient with telangiectasia macularis eruptiva perstans characterised by telangiectatic macular lesions and episodic flushing, two lesions of which were successfully treated by laser. Two clinically different forms of cutaneous mastocytosis have both been previously described as telangiectasia macularis eruptiva perstans, and we now propose that this term be restricted to cutaneous mastocytosis characterised by the typical telangiectatic macules.

Multiple lentigines confined to psoriatic plaques

The development of naevus spilus-like hyperpigmentation at sites of resolving plaques of psoriasis has been reported previously. Although the mechanism is not understood, PUVA therapy has been implicated in most cases. We report an additional case in which lentigines, confined to sites of resolving psoriasis, occurred following oral PUVA. We also describe similar clinical features in two patients who had not received PUVA, which strengthens the observation that this treatment is not a prerequisite for development of this unusual pattern of pigmentation.

Delusions of parasitosis with fatal outcome

The case of a 40-year-old man with delusions of parasitosis as the presentation of a monodelusional psychosis is reported. In spite of treatment with pimozide and depot neuroleptics the patient committed suicide. Since the introduction of pimozide, this drug has come to be regarded as the specific treatment for this disorder; this case is presented to emphasize the fact that not all cases respond, and that the disorder can have a fatal outcome.

Transcutaneous electronic nerve stimulation in the treatment of generalized pruritus

Generalized pruritus is a notoriously troublesome condition for both patient and dermatologist. This paper describes the favourable therapeutic effect of transcutaneous electrical nerve stimulation (TENS) in two elderly patients with severe chronic generalized pruritus unresponsive to other treatment. The therapeutic application of TENS to the treatment of generalized pruritus has not previously been described.

Schöpf-Schulz-Passarge syndrome

Three siblings, the children of a marriage between first cousins, are reported with the characteristic ophthalmological and cutaneous changes of the Schöpf-Schulz-Passarge syndrome. There have been only eight reported cases of this disorder, and it has not previously been described in Great Britain.

Familial malignant melanoma

A case is reported of a 28-year-old man with three separate primary cutaneous malignant melanomas. The patient denied any family history of melanoma, but screening of the first degree relatives resulted in the early diagnosis of two malignant melanomas in his brother and the recognition of a strong family history of melanoma.

Contact urticaria to locusts

We describe a case of allergic contact urticaria provoked by locusts in a laboratory research worker. One of her colleagues also had locust-induced contact urticaria, and another had asthma provoked by locust exposure. Contact urticaria to locusts is an occupational hazard apparently well known to professional entomologists, but one which has not previously been described in the dermatological literature, to my knowledge.

Anthralin-corticosteroid combination therapy in the treatment of chronic plaque psoriasis

A prospective randomized trial of anthralin in Lassar's paste compared with anthralin in 0.0125% clobetasol propionate in the treatment of chronic plaque psoriasis was undertaken. The psoriatic skin of patients treated with the corticosteroid-anthralin combination cleared significantly more quickly than those treated with anthralin alone, with a mean time to clearance of 14.9 days compared with 18.5 days, and with lower concentrations of anthralin. No significant difference was found in the rate of relapse of the two treatment groups, with relapse occurring in over 80% of patients within one year. Anthralin in 0.0125% clobetasol propionate was found to be an effective agent in the treatment of chronic plaque psoriasis, and one that was cosmetically acceptable to patients and nursing staff. An important disadvantage, however, was the development of a staphylococcal folliculitis in four of the 35 patients in which it was used. Because of this, anthralin in Lassar's paste remains our standard inpatient therapy, although the ease of use and cosmetic acceptability of anthralin in clobetasol propionate make it a useful remedy for outpatient use.

Remission of psoriasis with etidronate treatment of underlying Paget's disease of bone

The case is reported of a 64-year-old man in whom psoriasis developed in relation to Paget's disease of the underlying bone. Treatment of Paget's disease was associated with remission of psoriasis. We suggest that local hyperaemia is the common link in this association and that this lends support to the theory that vascular factors are important in the pathogenesis of psoriasis.

Missed malignant melanomas

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Alcohol consumption and psoriasis

A study has been undertaken of the relationship between the severity of psoriasis and alcohol consumption in 100 patients with chronic plaque psoriasis. In male patients, heavy drinking, at a level liable to be detrimental to health, was found significantly more commonly in those with severe psoriasis, and alcohol-related medical or social problems were frequent. By contrast alcohol excess and alcohol-related problems were significantly less common in women irrespective of the severity of their psoriasis.

Angiolymphoid hyperplasia with eosinophilia

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Malignant melanoma: prolonged survival after cerebral metastasis

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Histiocytosis X of the scalp and face responding to topical nitrogen mustard

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Erythromelalgia following pergolide administration

Two patients are described in whom treatment of Parkinson's disease with the ergot derivative pergolide was associated with the development of erythromelalgia. The possible mechanism of pergolide-induced erythromelalgia is briefly discussed.

Histiocytosis X of the scalp and face

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Sarcoid dactylitis

Dactylitis is a rare rheumatological complication of sarcoidosis. It may be accompanied by underlying bone changes, and management is often difficult. We report these 4 cases of dactylitis in which there have been significant bone changes and associated management problems. One case is further complicated by biopsy-proved sarcoid synovitis, uncommon in a British resident, and 2 cases show destructive bone changes, which have rarely been reported in sarcoidosis.