Pretibial myxoedema: a manifestation of lymphoedema?

Pretibial myxoedema (PTM) in its most extreme form clinically resembles lymphoedema. Studies with quantitative lymphoscintigraphy and fluorescence microlymphography in two patients with extensive PTM confirmed the presence of both functional and structural changes in the lymphatic system. We suggest that mucin deposition in the dermis causes compression of the dermal lymphatics, which results in dermal oedema and the clinical features of lymphoedema.

Drug acetylation and expression of lupus erythematosus.

Acetylator phenotype was measure in 58 patients presenting to a skin clinic with discoid lupus erythematosus (DLE) and in 51 normal healthy subjects. Twenty seven of the patients with DLE were found to have evidence of systemic lupus erythematosus (D+SLE). Frequency of slow acetylator phenotype was 58% in all DLE patients, 52% in those with D+SLE and was no different from the 57% in controls. The distribution of acetylator phenotypes within the groups with DLE and those with D+SLE was similar to controls. Severity of DLE was assessed as number of skin lesions and median lesion count was 11.5 in slow acetylators and 10 in fast acetylators but in D+SLE median lesion count was 22 in slow acetylators and 12 in fast acetylators, and there was a significant inverse relationship between lesion count and rate of acetylation; scores for systemic involvement showed no relationship. We conclude that there is no difference in the frequency or distribution of slow acetylator phenotype between normal subjects and patients with DLE with or without SLE but that actual rate of acetylation may determine severity of expression of the disease in slow acetylators.

Extragenital granuloma inguinale (Donovanosis) diagnosed in the United Kingdom: a clinical, histological, and electron microscopical study.

An extremely rare case of primary extragenital granuloma inguinale affecting the axillae is reported. Clinical, histological, and electron microscopical features of the disease are described, and the rarity, absence of genital lesions, and consequent difficulty in diagnosis are emphasised.

Measurement of the response of psoriasis to short-term application of anthralin.

Thirty-six patients with psoriasis were treated with short-term application of anthralin in three studies. (I) In thirteen patients 2% anthralin was applied daily to lesions on one arm for 60 min; (2) in ten patients 4% anthralin was applied daily to lesions on one-half of the body for 30 min; (3) in thirteen patients 2% anthralin was applied daily to lesions on one-half of the body for 30 min and the strength was increased to 4% and then 8% at intervals of 3 or more days, according to tolerance. Comparison was made with the response to conventional daily treatment with 0.05% to 1% anthralin. Progress was compared clinically by days to clearing, by measurements of plaque thickness with Harpenden calipers, by the frequency and severity of burning, and by patient preference. There was no significant difference in the times to clinical clearance between short-term and conventional anthralin treatments and the rate of decrease of plaque thickness was likewise similar. There was an excellent correspondence between time to reach half plaque thickness and the time for each plaque to clear clinically. There was increased burning with all the short-term treatments but the patients still preferred it. We conclude that short-term treatment with anthralin is as effective as continuous application, but that the increased burning is likely to limit its usefulness.