Treatment of viral warts with cimetidine: an open-label study.

The immunomodulatory actions of cimetidine, an H2-receptor antagonist, and its use in the treatment of viral warts has been described previously but its effectiveness is still debated. We report the results in 47 patients with multiple, nongenital viral warts who were treated with oral cimetidine in a 3-month open-label study. The drug was generally well tolerated and 87% of children and 68% of adults improved with treatment. Follow-up data in 65% of the patients showed that there had been no recurrence in the majority of those whose warts had cleared completely during treatment, whereas warts tended to persist or recur in those who had stopped treatment before all the warts had resolved. Our data suggests that cimetidine may be helpful in the treatment of viral warts in both adults and children and supports the need for a randomized controlled trial.

Childhood Jessner's lymphocytic infiltrate of the skin.

We report a case of Jessner's lymphocytic infiltrate of the skin in an 11-year-old boy. This benign lymphocytic infiltrate was originally described in 1953, and classically occurs in middle-aged men. Its occurrence in children appears to be very rare, and there are only two other case reports in the literature.

Vesicular Langerhans cell histiocytosis--an uncommon variant.

A case of the congenital self-healing reticulohistiocytosis variant of Langerhans cell histiocytosis is described. The child was born with a widespread blistering eruption, which rapidly resolved leaving papules and erosions. These ultimately healed leaving anetoderma. Congenital self-healing reticulohistiocytosis should be considered in the differential diagnosis of blistering eruptions present at birth.

Erosive, flexural lichen planus--an uncommon variant.

An unusual pattern and type of lichen planus is described in a 57-year-old female in which the flexures were exclusively involved. The affected areas were chronically eroded and ulcerated and resistant to topical treatment. Erosive lichen planus is known to occur on mucosal surfaces and cases of ulcerative lichen planus have been described involving the feet and lower limbs. Lichen planus involving flexures alone is uncommon and for erosion and ulceration to occur at these sites seems rare. We report a case of erosive, flexural lichen planus of long standing in a middle-aged female.

Natural history, management and complications of herpes labialis.

Infection with herpes simplex virus (HSV) is a common worldwide problem. Primary infection with HSV-1 rarely causes significant problems although widespread involvement in atopic eczema can be life-threatening as may associated encephalitis. Keratoconjunctivitis, pharyngitis and hepatitis can also complicate primary infection. Twenty to 40% of the population at some stage have recurrent orolabial infections with HSV although in only 1% of these cases is this recurrence severe. Recurrent erythema multiforme appears to be associated with HSV-65% of patients are thought to have preceding herpes labialis. Many primary and recurrent infections with HSV-1 require little more than topical antiseptic therapy to control secondary infection. Systemic acyclovir, however, is indicated in various situations including complicated primary infection, infection in neonates, eczema herpeticum, HSV infections in the immunocompromised, and recurrent erythema multiforme. In the latter, prophylactic treatment with 6 months acyclovir appears to be effective.