Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris.

Androgenic stimulation of sebaceous glands is an important factor in the development of acne. We examined 36 females (aged 14-34 years), selected because none had received oral contraceptives, anti-androgen therapy, or systemic antibiotics during the previous year, or isotretinoin therapy, prior to their participation in the study. Subjects were divided into groups on the basis of acne severity, as follows: physiological, mild and moderate. Only two patients had polycystic ovaries on ultrasound examination. Seven patients had irregular menses; none had evidence of hirsutism. We found that the severity of acne, based on the acne grade, was highly correlated with the inflammatory lesion count, and less correlated with the sebum excretion rate. Either acne grade or inflammatory lesion count could be related to some of the five androgenic hormone determinants; free testosterone (TESTOS), delta 4 androstenedione (DELTA 4), sex hormone binding globulin (SHBG), dehydroepiandrostenedione sulphate (DHEAS) and dihydrotestosterone (DHT). Multiple linear regression analysis determined the best model for predicting ACNE scores as involving DELTA 4 and DHEAS (positive effects), and SHBG (negative effect), P < 0.005, R2 = 0.36). In none of the patients were the levels of DHEAS or SHBG outside the normal range. The findings in the two patients with polycystic ovaries did not differ significantly from those in the remainder of the patients.

The emerging epidemic of skin cancer.

A study of the incidence of skin cancer over a 14-year period in the North Humberside area of the U.K. indicates a steady rise in the numbers of the four most common types of skin cancer. A steep increase in the incidence of squamous cell carcinoma of the skin compared with that of internal squamous cell carcinoma was also detected. Our findings emphasize the need for continuing public education about both the dangers of UV radiation and measures to reduce exposure.

Extensive and fatal basal cell carcinoma: a report of three cases.

Three cases of basal cell carcinoma (BCC) with extensive invasion are described. The first two patients had meningeal and cerebral involvement with exposure of their dural meninges following full thickness skull erosion. The third patient had bilateral orbital and optic nerve involvement resulting in complete blindness. All three patients subsequently died from their disease.

Thromboangiitis obliterans (Bürger's disease) in a woman--a case report and review of the literature.

We report the case of a 43-year-old woman, a longstanding heavy cigarette smoker, who developed Bürger's disease, leading to mid-thigh amputation of her left leg. After she gave up smoking her disease was arrested but Raynaud's phenomenon continues to affect her hands and right foot. In reviewing the literature, we found only 25 previous well-documented cases of Bürger's disease occurring in females that would satisfy clinical, angiographic and histological criteria to make this diagnosis probable.

Chronic granulomatous disease--a case showing long-term survival.

The diagnosis of chronic granulomatous disease of childhood was made in a 10-year-old boy following episodes of recurrent cervical abscesses and ulcerative stomatitis since the age of 4 years. Nineteen years on, on antibiotic prophylaxis, he is now married and remains active although he has been hospitalized with serious complications on many occasions.

Behçet's syndrome with gastro-intestinal tract involvement mimicking carcinoma of the caecum--a case report.

A 43-year-old patient with a 2-year history of orogenital ulceration and hypochromic anaemia developed rapid loss of weight over a period of a few months and presented with a mass in the right iliac fossa, suggestive, clinically and radiologically, of a carcinoma of the caecum. The mass was removed by standard right hemicolectomy. Examination of the resected specimen revealed a large, irregular, ulcerated area of the caecum measuring 7 cm in diameter extending through all the layers of the intestinal wall. Histology showed a non-specific inflammatory infiltrate. One large artery in the pericolic tissue was occluded by organizing thrombus. Five years after the operation, he developed epileptiform seizures. CT scan showed a small infarct in the left insular area of the brain. Six months later he was admitted to another hospital with profuse diarrhoea and died within 24 h from cardiac arrest.

Cutaneous and ocular side-effects of PUVA photochemotherapy--a 10-year follow-up study.

To record the potentially serious side-effects of melanoma and non-melanoma skin cancers and ocular damage following long-term PUVA chemotherapy, we re-examined 198 of 242 patients. These comprised: 90 with psoriasis, 27 with parapsoriasis, 19 with cutaneous T-cell lymphoma, 23 with vitiligo, eight with cutaneous mastocytosis, 16 with atopic dermatitis, three with prurigo nodularis, two with polymorphous light eruption and 10 with pruritus of chronic renal failure on dialysis, treated between 1977 and 1987 in our department. During the 10-year period, 11 patients died of unrelated disease. None of the patients reviewed had previous skin cancer or had been treated with arsenic, methotrexate or ionizing irradiation before PUVA treatment. None of the patients were children under 16 years of age. The mean age was 54.5 years, the sex ratio 102:96 (M:F). The mean cumulative dose of UVA for the whole group was 169.5 J/cm2. One patient with psoriasis, psoriatic arhropathy, ankylosing spondylitis and Crohn's disease, who was on azathioprine for 6 years, developed squamous-cell carcinoma on the left lower leg. Another patient with pustular psoriasis, who received PUVA treatment to her palms and soles only, developed malignant lentigo of Hutchinson on the right lower leg. PUVA lentigines were found in about 20% of patients. All patients had a yearly ophthalmological examination. None of them developed cataracts, lens opacities or had impairment of their visual acuity.

Colchicine therapy in Behçet's syndrome--a report of five cases.

Five patients with Behçet's syndrome of varying duration were treated with colchicine (500 micrograms b.i.d.). All improved clinically and one has remained clear for 1 year after cessation of therapy, although in one patient who had neurological symptoms, paraesthesiae have persisted throughout treatment.

Skin necrosis in giant cell (temporal) arteritis: report of three cases.

Three elderly, female patients presented with scalp ulceration. One developed sudden blindness before the ulceration of the scalp. Biopsy from the ulcerated area in this patient did not show evidence of giant cell arteritis, but the two other patients had histological evidence of giant cell arteritis and one of these also became blind.

Necrotizing fasciitis. A report of five patients.

Five patients with necrotizing fasciitis are reported. Streptococci were isolated in all but one patient, in whom Staphylococcus albus was responsible. Other organisms were also isolated in culture. Surgical debridement and skin grafting were needed in all our patients, in addition to systemic antibiotics and topical treatment, comprising Eusol paraffin soaks. One patient developed this condition after a skin biopsy; another had chronic venous leg ulcer. There was no predisposing cause in the remaining three patients.

Age and sex incidence of allergic contact dermatitis.

A retrospective study of patients patch tested between 1968 and 1970 was undertaken and case records of 200 patients with unequivocal positive patch tests were studied for age and sex distribution. There was an overall female preponderance (61%), with 2 peaks of incidence in the 10-20 and 40-50 year age groups in females, but only 1 peak of incidence in the 40-50 year age group in males. There was a steady decline in all sensitivities after the 6th decade of life in both sexes. Nickel sensitivity was more common in females (92%), whereas dichromate sensitivity predominated in males (64%). Of the 200 patients, only 5(2.5%) were atopics, all of whom were females.