Truth in clinical research trials involving pharmaceutical sponsorship.

Large clinical trials are expensive to mount. Funding comes mainly from pharmaceutical companies seeking information on drug efficacy and adverse events. Patients should be informed of the financial and publication agreements reached between those conducting the trials. This is unlikely to have a significant effect on trial participation and will provide patients with information relevant to informed consent. A small proportion of monies raised from drug trials could be set aside to fund both a trial register site and further studies on adverse drug reactions.

The use of gloves in Australian dermatological practice.

Dermatologists use gloves as a major tool in universal precautions to prevent transmission of infections particularly human immunodeficiency virus (HIV) and hepatitis. We need to know how much protection is conferred by gloves and what problems are associated with glove use. This paper looks at these issues and reports the results of a survey on glove use by Australian dermatologists. The survey found a lack of awareness regarding gloves as a protective measure, suggesting the need to improve knowledge in this area so that realistic precautions can be adopted. Dermatologists have a high rate of glove use and reactions to gloves were noted by 13% of respondents. The authors recommend the use of non-powdered, low-allergen latex gloves. Handwashing prior to using non-powdered latex gloves needs further investigation. Handwashing after wearing latex gloves may decrease sensitization risk.

Radiation-induced localized scleroderma in breast cancer patients.

Radiation-induced scleroderma in breast cancer patients appears to occur in approximately one out of every 500 patients. We report four cases that developed within 3 months of conservative breast surgery and postoperative radiation treatment. The reaction was contained entirely within the treatment field and demonstrated the typical features of this condition where the breast becomes erythematous, violaceous, indurated, retracted, and progressively pigmented. The breast tends to soften and become more comfortable over 1-4 years; however, significant induration, retraction and pigmentary changes remain. There appears to be no predictive factors. Radiation-induced scleroderma must be differentiated from cellulitis and recurrent breast cancer.

Hidradenitis suppurativa, Dowling Degos disease and perianal squamous cell carcinoma.

A patient with hidradenitis suppurativa (HS) is described in association with Dowling Degos disease and perianal squamous cell carcinomas. As the initial treatment for HS failed to give any satisfactory relief he sought no further medical help for the subsequent 40 years. This patient illustrates the management difficulties in HS and the need for regular surveillance to exclude the development of anogenital squamous cell carcinoma. Previous reports of hidradenitis suppurativa in association with Dowling Degos disease are reviewed and the aetiology is discussed.

A pilot study on the percutaneous absorption of microfine titanium dioxide from sunscreens.

Many Australians are being advised to apply microfine titanium dioxide sunscreen daily from the cradle to the grave. However, there is a surprising lack of data on the percutaneous absorption of microfine titanium dioxide. A prospective pilot study was conducted to analyse the percutaneous absorption of microfine titanium dioxide from sunscreens. Selected patients scheduled to have skin surgery, applied titanium dioxide sunscreen to the skin daily for 2-6 weeks prior to their operation. After excision, the stratum corneum of the sample was stripped and the titanium concentration of the remaining epidermis and dermis was measured by inductively coupled plasma-mass spectrometry. The results from this pilot study showed that levels of titanium in the epidermis and dermis of subjects who applied microfine titanium dioxide to their skin were higher than the levels of titanium found in controls. Studies with larger cohorts are necessary to establish if this absorption is statistically significant.

Disseminated superficial actinic porokeratosis. A histological review of 61 cases with particular reference to lymphocytic inflammation.

The pathology of 61 cases of disseminated superficial actinic porokeratosis was reviewed and the relative frequency of the histological features associated with the cornoid lamella and the pathology within and outside the porokeratotic rim were assessed. Papillary dermal lymphocytic infiltrate (97%), spinous layer vacuolar changes (90%), dyskeratotic cells in the epidermis (77%), and liquefaction degeneration of the basal layer (67%) were frequently seen under the cornoid lamella. Papillary lymphocytic infiltration was seen more frequently inside the porokeratotic ring in comparison to the outer skin. Lymphocyte marker studies in nine cases showed a predominance of activated T lymphocytes with positive LN3 and UCHL-1 staining. Together with the finding of a lichenoid reaction pattern, these results lend support to the hypothesis that actinic porokeratosis represents a migrating clone of abnormal keratinocytes with an associated immunological host response.

Lentinginous dysplastic naevi in the elderly: a potential precursor for malignant melanoma.

Seventy-seven skin biopsies diagnosed histologically as lentiginous junctional naevi from individuals aged over 60 years were reviewed. Seventy-three specimens showed a primarily nested pattern with disordered arthitecture concentrated within the rete ridges conforming to the pathology of a lentiginous dysplastic naevus. In 28 biopsies this was combined with a melanoma in situ. The latter was reflected by a focal loss of the rete ridge system, confluent melanocytic hyperplasia and single cell invasion of the epidermis by atypical malanocytes. Four biopsies showed lentiginous junctional naevi with only isolated naevus cell nests without a disordered architecture or cellular atypia. Thirty-seven of the 57 naevi in men were located on the back in contrast to 5 of the 20 women. In women the lower limb was the most frequent site with 8 of the 20 lesions originating at this site in contrast to 1 of the 57 men. The pathological diagnosis of dysplastic lentiginous naevi in the elderly needs to be recognised as having a high association of melanoma-in-situ changes.

The turtle's revenge: a case of soft tissue Mycobacterium chelonae infection.

A case of cutaneous Mycobacterium chelonae infection with sporotrichoid spread and extensive antibiotic resistance is presented. Control of this problem was only achieved after extensive debridement and grafting of the involved limb. The importance of surgery in management is discussed and the literature is reviewed.

Dermatomyositis associated with multifocal lipoatrophy.

A 10-year-old boy had juvenile dermatomyositis and multiple asymmetric lesions of lipoatrophy. The lipoatrophy had occurred without preceding clinical evidence of inflammation. Biopsy specimens of the skin confirmed a lobular panniculitis. This is the first report of the association of lipoatrophy and juvenile dermatomyositis.

Scanning electron microscopy of disseminated superficial actinic porokeratosis.

A typical skin lesion from a patient with biopsy-confirmed disseminated superficial actinic porokeratosis (DSAP) was examined by scanning electron microscopy. The lesion was rimmed by a prominent but discontinuous cornoid lamella. The cornoid lamella was found to consist of a packed layer of keratinocytes whose orientation varied from parallel to the epidermis at the base of the lesion to perpendicular at the summit of the porokeratotic column. The central core of the cornoid lamella consisted of a tightly packed mass of keratin.

Topical propylene glycol and hyperosmolality.

Topical propylene glycol is known to cause elevated serum osmolality in burns patients. Twelve adults with skin disease had quantities of propylene glycol applied to their skin to a maximum of 6.1 g/kg per 24 h for 5 days. Serum electrolyte, lactate and osmolality results remained unchanged during the study. These results suggest that topical propylene glycol may be used in adult dermatological practice without affecting serum osmolality.

Heterotropic brain tissue presenting as bald cysts with a collar of hypertrophic hair. The 'hair collar' sign.

We report the cases of two children who were each noted at birth to have a single bald compressible nodule on the scalp that was surrounded by a collar of hypertrophic hair. One of the mothers had taken doxylamine succinate during pregnancy. Extensive investigations and, finally, surgery revealed that the lesions were heterotropic brain tissue without connection to the brain. Encephaloceles may also have a "hair collar." The presence of a hair collar around any cutaneous lesion should alert the clinician to the possibility of a neuroectodermal defect. All procedures on these lesions should be delayed until appropriate investigations have excluded any connection with the underlying nervous system.