Toxic streptococcal syndrome.

The reappearance of more virulent strains of exotoxin-producing streptococci over the past decade has led to the re-emergence of invasive Group A streptococcal infections and the recognition of a new syndrome resembling staphylococcal toxic shock syndrome. Toxic streptococcal syndrome is characterized by fever, shock, multiorgan system failure and a desquamating scarlatiniform rash. It usually occurs in otherwise healthy young adults, often in association with a severe soft tissue infection and has a 30% mortality rate. The case of a 37-year-old obese man, who rapidly developed features of this syndrome after an antecedent pharyngitis and cellulitis, is presented. There was serological evidence of a recent Group A streptococcal infection. Intensive organ supportive measures and intravenous antibiotic therapy led to his gradual recovery.

Sun protective clothing in Australia and the Australian/New Zealand standard: an overview.

Clothing has been part of the sun protection strategy for many years. However, it is only recently that studies have been undertaken to investigate the protectiveness of fabrics and to place clinical advice on a sound scientific basis. Fabrics can now be rated and an ultraviolet protection factor assigned. Several factors influence photoprotection such as construction, stretch, hydration, colour, fibre type and various manufacturing processes. In 1996 the Australian/New Zealand Standard for sun protective clothing was published. This is the first of its kind in the world.

Skin phototyping in Asian Australians.

Skin phototype was assessed in 257 Asian Australians by self-reporting questionnaire. Minimal erythema dose, minimal melanogenic dose and minimal immediate pigment darkening dose were measured in a subgroup of 50 subjects. About 15% of Asian Australians in this study report that they have skin type I or II. Phototesting confirms that there is a UV-sensitive group and a wide spectrum of UV-sensitivity in this population. Whether Fitzpatrick's skin typing system adequately identifies this UV-sensitive group needs assessment by a larger study. The relationship between burning tendency and tanning capacity in Asians may differ from Caucasians.

Dermal melanocytosis: a clinical spectrum.

While most dermal melanocytoses are congenital or have an onset in early childhood, there is a group which is clearly acquired, with an onset in adult life. While the Mongolian spot typically disappears in childhood, other dermal melanocytoses persist for life. A brief review of the clinical spectrum of the dermal melanocytoses is undertaken and three illustrative cases are described: a case of congenital naevus of Ota, a case of acquired bilateral naevus of Ota-like macules, and an unusual case of a congenital dermal melanocytotic lesion on the left had which began to spread in adulthood. The possibilities regarding the pathogenesis of this intriguing group of disorders are considered.

Raimer's bands: case report with a review of solar elastosis.

Raimer's solar elastotic bands of the forearm are a rarely described clinical variant of severe solar elastosis. We report a case of Raimer's bands on the forearm of a 43-year-old woman. Light microscopy demonstrated solar elastosis and electron microscopy revealed activated fibroblasts appearing to secrete the elastotic material. The clinical variants of solar elastosis are outlined and the possible pathogenesis of the elastotic material is discussed.

Ehlers-Danlos syndrome type II: importance of recognition.

We report a case of Ehlers-Danlos syndrome Type II presenting with subtle clinical features and discuss the importance of early recognition of this disorder. A 16 year old Caucasian schoolgirl presented with soft tissue swellings on her fingers. There was a history of poor wound healing and prematurity and a family history of miscarriages. Clinical examination revealed hypermobile joints, hyperelastic skin and a 'cigarette paper' scar at the site of a previous minor surgical excision. Management consisted of genetic counselling and advice concerning career choice, recreational activities, as well as future pregnancy and surgery. This subtype of Ehlers-Danlos syndrome is probably fairly common in the community. While it may present with subtle clinical features, recognition is important so that counselling can be offered at a young age in order to avoid the major consequences that may arise during pregnancy and surgery.

Sun protection by a summer-weight garment: the effect of washing and wearing.

OBJECTIVE: To assess the effect of use (washing and wearing) on the photoprotection provided by a cotton fabric. METHODS: Twenty jersey-knit pure cotton T-shirts were worn for 4-8 hours per week and washed weekly for 10 weeks. Fabric samples taken before and after use were compared. MAIN OUTCOME MEASURES: Fabric ultraviolet protection factor (UPF) was calculated from spectrophotometric ultraviolet radiation transmission data. Changes in fabric structure and hole size were determined for samples from one T-shirt by light microscopy and image analysis. RESULTS: UPF increased consistently and significantly after use, from a mean of 19.0 to 40.6. A corresponding reduction in fabric hole area was seen under the light microscope and confirmed on image analysis (from 8.0% to 3.9% of total image area). CONCLUSION: UPF of pure cotton garments may improve after use, at least in the short term. The increase is mostly accounted for by reduction in fabric hole area due to shrinkage.

Ocular melanoma in childhood.

A case of primary ocular melanoma of the iris in a 10 year old girl is reported. Primary melanoma of the eye is exceedingly rare in childhood. The incidence and risk factors for ocular melanoma are discussed and possible reasons why this tumour is so uncommon in younger age groups are considered.