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Scabies is the most common neglected tropical disease with cutaneous manifestations, disproportionately affecting socially disadvantaged populations living in overcrowded settings. Scabies infestation is characterised by a generalised intractable pruritus, and is often complicated by secondary bacterial infection, which can lead to a range of complications. Scabies is a clinical diagnosis and requires an adequate degree of suspicion. The use of dermoscopy may improve diagnostic accuracy. In Australia, the first-line treatment recommended for scabies is topical permethrin 5% cream, applied to the whole body and repeated in one week. Oral ivermectin is subsidised by the Pharmaceutical Benefits Scheme with streamlined authority for patients who have completed and failed treatment with topical therapy, have a contraindication to topical treatment or have crusted scabies. Early identification and prompt initiation of treatment is key to minimise the disease burden of scabies., (© 2024 AMPCo Pty Ltd.)

Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR., Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites., Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%)., Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro / in vivo diagnostic strategies to ascertain drug causality., Trial Registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019., Competing Interests: No relevant conflicts of interest to declare., (© 2024 The Author(s).)

Competing Interests: Conflicts of interest The authors declare they have no conflicts of interest.

Background: Immunosuppressed organ-transplant recipients have an increased incidence of, and mortality from, skin cancer. Nicotinamide (vitamin B 3 ) enhances the repair of ultraviolet (UV) radiation-induced DNA damage, reduces the cutaneous immunosuppressive effects of UV radiation, and reduces the incidence of keratinocyte cancers (including squamous-cell and basal-cell carcinomas) and actinic keratoses among high-risk immunocompetent patients. Whether oral nicotinamide is useful for skin-cancer chemoprevention in organ-transplant recipients is unclear., Methods: In this phase 3 trial, we randomly assigned, in a 1:1 ratio, organ-transplant recipients who had had at least two keratinocyte cancers in the past 5 years to receive 500 mg of nicotinamide or placebo twice daily for 12 months. Participants were examined for skin lesions by dermatologists at 3-month intervals for 12 months. The primary end point was the number of new keratinocyte cancers during the 12-month intervention period. Secondary end points included the numbers of squamous-cell and basal-cell carcinomas during the 12-month intervention period, the number of actinic keratoses until 6 months after randomization, safety, and quality of life., Results: A total of 158 participants were enrolled, with 79 assigned to the nicotinamide group and 79 to the placebo group. The trial was stopped early owing to poor recruitment. At 12 months, there were 207 new keratinocyte cancers in the nicotinamide group and 210 in the placebo group (rate ratio, 1.0; 95% confidence interval, 0.8 to 1.3; P = 0.96). No significant between-group differences in squamous-cell and basal-cell carcinoma counts, actinic keratosis counts, or quality-of-life scores were observed. Adverse events and changes in blood or urine laboratory variables were similar in the two groups., Conclusions: In this 12-month, placebo-controlled trial, oral nicotinamide therapy did not lead to lower numbers of keratinocyte cancers or actinic keratoses in immunosuppressed solid-organ transplant recipients. (Funded by the National Health and Medical Research Council; ONTRANS Australian New Zealand Clinical Trials Registry number, ACTRN12617000599370.)., (Copyright © 2023 Massachusetts Medical Society.)

Background: Solid organ transplant recipients (SOTR) are at high risk of keratinocyte carcinoma (KC). Long-term evidence for acitretin as chemoprophylaxis in this population is lacking., Objective: To determine the benefit of long-term acitretin for KC chemoprevention in SOTR., Methods: A retrospective cohort study of SOTR treated with acitretin at an Australian transplant dermatology clinic was performed. General estimating equations were used to evaluate change in rates of histologically confirmed KC in the 6-12 months prior to acitretin and following a minimum 6 months of treatment. A control group of patients within the same service was included, comprising SOTR who were not treated with acitretin., Results: Twenty-two patients received acitretin treatment for at least 6 months, eighteen for at least 5 years and four for at least 9 years. The median KC rate pretreatment was 3.31 per year (IQR 1.93, 5.40). There was a significant reduction in the rate of KC in the first year of acitretin treatment (IRR 0.41, 95% CI 0.22, 0.76, P = 0.005), and this effect was observed for 5 years (IRR at 5 years 0.34, 95% CI 0.17, 0.67, P = 0.002). The control group had no statistically significant change in KC rate over time in the study., Conclusions: Acitretin appears to be well-tolerated and effective in reducing KC in SOTR for at least 5 years. Study limitations include its retrospective nature, small sample size and lack of blinding., (© 2022 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)

Coronavirus disease 2019 (COVID-19) brought the world to its knees. As each nation grappled with launching an effective response while simultaneously minimizing repercussions on health care systems, economies, and societies, the medical and scientific landscape shifted forever. In particular, COVID-19 has challenged and transformed the field of dermatology and the way we practice. In this article, dermatologists from 11 countries share insights gained from local experience. These global perspectives will help provide a better framework for delivering quality dermatologic care and understanding how the field has evolved during this medical crisis., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Importance: There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs)., Objective: To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs., Evidence Review: Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses., Findings: The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC., Conclusions and Relevance: Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.

Background: There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic., Objective: To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed., Methods: A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period., Results: There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1., Limitations: The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small., Conclusion: Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations. Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune-related disorders, and hepatic and renal disease. Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes. Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis. Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies. Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms. As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual. Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences., (© 2020 AMPCo Pty Ltd.)

Perioral ulcerative plaques have a broad list of differential diagnoses. We describe an unusual presentation of chronic progressive perioral ulceration due to herpes simplex type (HSV)-1 on a background of undiagnosed human immunodeficiency virus infection with acquired immunodeficiency syndrome. Whilst chronic mucocutaneous HSV is an AIDS-defining condition with both HSV-1 and HSV-2 implicated, typical reported cases describe vesicular eruptions rather than perioral ulcerative plaques. This case highlights that common infections may present atypically in immunocompromised individuals and may be a clue to underlying systemic illness., (© 2019 The Australasian College of Dermatologists.)

Background: Tinea is a common fungal infection that can affect the skin, nails and hair. Tinea infection has a variety of clinical manifestations and affects all age groups, ranging from tinea pedis in adults to tinea capitis in pre-pubertal children., Objective: This article provides an updated overview of the common clinical manifestations and practical approaches to the diagnosis and management of tinea infections., Discussion: While tinea may be suspected on the basis of clinical grounds, it is important to be aware of the various conditions considered in the differential diagnosis that may mimic tinea infections. Topical and systemic antifungal modalities are available and are selected on the basis of the subtypes and severity of tinea infection. Untreated, tinea can cause significant morbidity and predispose to complications, including cellulitis and ulcers on the feet and alopecia on the scalp.

The number of solid organ transplants has been increasing annually worldwide. Advances in transplantation surgery and community awareness of organ donation have been key contributors. Combined with increased understanding of immunosuppression, there are a growing number of solid organ transplant recipients in the community as a result of improved long-term outcomes. There remains a high incidence of deaths worldwide post-transplant due to non-melanoma skin cancer (NMSC), which has greater morbidity and mortality in this population than in the general community. Many transplant candidates are not screened prior to organ transplantation and not followed up dermatologically after transplant. After a comprehensive review of the MEDLINE database, we present an update of literature on risk factors for melanoma and non-melanoma skin cancer development in transplant recipients. Medications used by transplant recipients, including immunosuppressants and antibiotics, are discussed along with their respective risks of skin cancer development. We conclude with evidence-based recommendations for models of care, including patient education and dermatological review of transplant recipients.

Background/objectives: Although skin disease and skin cancers cause significant morbidity and mortality in Australia, limited time is dedicated to dermatology teaching in most medical courses. The aim of this study was to define the current state of dermatology teaching in Australian medical schools with a view to developing a national core curriculum for dermatology., Methods: An electronic questionnaire was circulated to the dermatology teaching leads and relevant medical program coordinators of the 18 medical schools in Australia., Results: Replies were received from 17 medical schools. Dermatology was included as part of the core curriculum in 15 schools. Time set aside for dermatology teaching varied, as reflected by the number of lectures delivered (0-21, mean 5, median 3) and minimum clinics attended (0-10, mean 1.2, median 0). Only four medical schools had a compulsory clinical attachment in dermatology. Furthermore, satisfying requirements in dermatology was mentioned in the university examination regulations in only six schools. Certain core learning outcomes were addressed in most schools, including the structure and function of the skin, common conditions such as atopic dermatitis and psoriasis and cutaneous malignancies. However, there were important omissions, ranging from common problems like dermatophyte infections and drug reactions to the recognition of dermatological emergencies., Conclusions: These results are a compelling impetus to improve current standards of dermatology teaching, learning and assessment. The introduction of a national core curriculum would provide guidelines for dermatology teaching in medical schools, enabling the more effective utilisation of available time for key learning outcomes., (© 2016 The Australasian College of Dermatologists.)

We report a case of pseudoepitheliomatous hyperplasia (PEH) in a 55-year-old woman following allergic contact dermatitis (ACD) to Grevillea Robyn Gordon. We believe this to be the first reported case of PEH secondary to ACD, and postulate that this was an exaggerated response to severe ACD as a result of a lack of topical treatment., (© 2015 The Australasian College of Dermatologists.)

We report two cases of Caucasian women who developed folliculocentric pustulosis after exposure to amoxycillin. A literature review found that most amoxycillin-related pustular eruptions were reported as acute generalised exanthematous pustulosis (AGEP) or acute localised exanthematous pustulosis (ALEP). Histopathology from both our cases showed sterile suppurative folliculitis, which resolved on the cessation of amoxycillin., (© 2015 The Australasian College of Dermatologists.)

Background: Rosacea is a chronic and common cutaneous condition characterised by symptoms of facial flushing and a broad spectrum of clinical signs. The clinical presentation for rosacea is varied, and there are four primary subtypes, which may overlap - erythrotelangiectatic, inflammatory, phymatous and ocular. It is important to recognise the different subtypes because of the differences in therapy., Objective: The objective of this article is to provide evidence-based clinical updates to clinicians, specifically general practitioners (GPs), to assist with their everyday practice, and effective assessment and treatment of rosacea., Discussion: Therapeutic modalities are chosen on the basis of the subtypes and clinical features identified; often a combination of these therapies is required.

Background and Objectives: Most dermatology admissions to tertiary hospitals in Australia are initially assessed in the emergency department (ED). This 3-year retrospective study examined the types of dermatological conditions that necessitated admission, the factors that predicted admission and the implications for dermatological resource allocation., Methods: The ED database was searched using the International Statistical Classification of Diseases, 10(th) revision (ICD-10) diagnosis codes and keywords in the presenting complaint and triage notes fields. The two lists were then merged and duplicates removed. All admissions were analysed and the medical records of admissions to the dermatology unit were reviewed to determine their final diagnosis., Results: In total, 4817 patients with dermatological conditions presented over the 3-year period. Of these, 937 (20%) required admission, of whom 108 (12%) were admitted under the dermatology unit. The most common conditions requiring admission were cellulitis (n = 534, 56%), boils, furuncles and pilonidal sinuses (n = 183, 19%), and non-specific skin infections (n = 32, 3%). The most common conditions admitted under dermatology were psoriasis (n = 27, 25%), eczema (n = 25, 23%), and cellulitis (n = 16, 15%). Key predictors of admission were Australasian triage code, referral by a health-care professional or corrections officer and arrival by ambulance., Conclusion: Approximately one-fifth of dermatological presentations required admission, mostly for infective processes that did not require specific dermatological care. The predictors of admission reflect the severity of the condition and patients demonstrating these predictors should be referred to the Dermatology unit for admission., (© 2013 The Australasian College of Dermatologists.)

An 82-year-old woman on long-term prednisolone for chronic obstructive airways disease presented with a 2-month history of nodules on her left forearm. This occurred 10 years after nodules on her right forearm caused by a culture-proven Mycobacterium marinum infection. Histopathological examination, polymerase chain reaction and culture of biopsy specimens were positive for M. chelonae. To our knowledge this is the first case of metachronous nontuberculous mycobacterial skin infection reported, and it highlights the diagnostic and therapeutic challenges of such infections., (© 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.)

Background: Cutaneous carcinogenesis is increased in immunosuppressed organ transplant recipients (OTR). Tumour accrual is a useful measure for the rate of cutaneous carcinogenesis. There are few studies in tumour accrual rates in OTR in Australia., Methods: This was a prospective study of renal transplant recipients in a single tertiary referral centre over 5 years (60 months). Outcome measures included tumour accrual, and numbers of skin cancers according to clinical risk factors (age, sex, anatomical location, skin phototype, duration of immunosuppression, history of graft rejection, acitretin use, occupational sun exposure and family history of skin cancer)., Results: A total of 142 patients were included in the study, with a median follow-up duration of 1.9 years. Of these patients, 53 (37%) developed a total of 341 invasive non-melanoma skin cancers (NMSC) (253 squamous cell carcinoma [SCC] and 88 basal cell carcinoma [BCC]) over the study period. Accrual for SCC and BCC were 0.89 SCC/patient per year and 0.31 BCC/patient per year, respectively. The overall NMSC accrual was 1.20 NMSC/patient per year. SCC accrual increased with the duration of immunosuppression. NMSC accrual increased with a history of graft rejection., Conclusions: The current study provides prospective, histologically verified and quantitative evidence for the increase of cutaneous carcinogenesis in renal transplant recipients in Victoria, Australia., (© 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.)

Background/Objectives. There is minimal data available on the types of dermatological conditions which present to tertiary emergency departments (ED). We analysed demographic and clinical features of dermatological presentations to an Australian adult ED. Methods. The St. Vincent's Hospital Melbourne (SVHM) ED database was searched for dermatological presentations between 1 January 2009 and 31 December 2011 by keywords and ICD-10 diagnosis codes. The lists were merged, and the ICD-10 codes were grouped into 55 categories for analysis. Demographic and clinical data for these presentations were then analysed. Results. 123 345 people presented to SVHM ED during the 3-year period. 4817 (3.9%) presented for a primarily dermatological complaint. The most common conditions by ICD-10 diagnosis code were cellulitis (n = 1741, 36.1%), allergy with skin involvement (n = 939, 19.5%), boils/furuncles/pilonidal sinuses (n = 526, 11.1%), eczema/dermatitis (n = 274, 5.7%), and varicella zoster infection (n = 161, 3.3%). Conclusion. The burden of dermatological disease presenting to ED is small but not insignificant. This information may assist in designing dermatological curricula for hospital clinicians and specialty training organisations as well as informing the allocation of dermatological resources to ED.

Mycophenolate use in dermatology is growing due to its reputation as a steroid-sparing agent with a favourable side-effect profile. However, there are limited data on the efficacy and tolerability of mycophenolate for many dermatological indications. We conducted a retrospective clinical audit in 33 dermatology patients who had received mycophenolate at our institution between April 2010 and January 2012. The top indication was pyoderma gangrenosum (14 patients) followed by atopic dermatitis (seven patients). Overall 70 per cent of patients showed some benefit from mycophenolate treatment, with 12 per cent failing to respond. Side-effects were experienced by 45 per cent of patients, two of whom had serious side-effects. Female sex appears to be a risk factor for adverse effects. We conclude that although mycophenolate is a promising agent across a variety of dermatological conditions, further randomised controlled trials are required., (© 2013 The Authors. Australasian Journal of Dermatology © 2013 The Australasian College of Dermatologists.)

We present two cases of cyclosporine-induced sebaceous hyperplasia in renal transplant recipients, successfully treated with isotretinoin. Both patients tolerated isotretinoin well, with no alteration in graft function. These cases provide support for the safe and effective use of oral isotretinoin in the treatment of cyclosporine-induced sebaceous hyperplasia in the kidney transplant population., (© 2011 The Authors. Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists.)

A 43 year-old immunosuppressed woman presented with a widespread macular scaly rash, clinically and histologically consistent with epidermodysplasia verruciformis. She had no family history of epidermodysplasia verruciformis. Human papillomavirus typing was performed on both biopsied skin from clinical lesions and on plucked body hairs. The lesional skin from the arm and knee showed predominantly human papillomavirus-20 and -47 respectively. Human papillomavirus genotyping from the hair follicles revealed that human papillomavirus-20 had the highest viral load, irrespective of body site.

Background: Intraepidermal carcinoma (IEC), superficial basal cell carcinoma (sBCC), and psoriasis are common entities that may all present as well-defined, brightly erythematous plaques. Currently, there are limited data on the dermatoscopic features that differentiate these diagnoses., Objective: We sought to describe the most significant morphologic findings seen on dermatoscopy of IEC, sBCC, and psoriasis, and formulate a diagnostic model based on these features., Method: We conducted a retrospective observational study using macrophotography and dermatoscopy to evaluate the presence or absence of dermatoscopic features and formulated diagnostic models for each diagnosis. A convenient sample of 300 lesions was collected from 255 patients from two hospital dermatology clinics and 4 private dermatology practices. These comprised 150 cases of sBCC, 100 cases of psoriasis, and 50 cases of IEC., Results: The most significant dermatoscopic features of IEC were a clustered vascular pattern, glomerular vessels, and hyperkeratosis. When all 3 features were observed together, the diagnostic probability for IEC was 98%. sBCCs were characterized by a scattered vascular pattern, arborizing microvessels, telangiectatic or atypical vessels, milky-pink background, and brown dots/globules; the diagnostic probability was 99% if 4 of these 6 features were identified. For psoriasis, the significant features identified were a homogenous vascular pattern, red dots, and light-red background, yielding a diagnostic probability of 99% if all 3 features were present., Limitations: Lack of evaluation of interobserver/intraobserver reproducibility is a limitation., Conclusion: Dermatoscopy is valuable in the diagnosis and differentiation of IEC, sBCC, and psoriasis because of consistent dermatoscopic morphology.

Objective: To investigate a reported increase in tinea capitis in an English-language school to determine if it was an outbreak and whether control measures were warranted., Design: Cross-sectional study., Setting and Population: Primary school children enrolled at an English-language school in an outer suburb of Melbourne were screened for tinea capitis in November 2005 by clinical examination, collection of scalp, skin or nail specimens where clinically indicated, and scalp brushing., Main Outcome Measures: Clinical diagnosis of tinea capitis confirmed by microscopy and culture., Results: Parental consent was obtained for 180 children (98%), of whom 153 (85%) were screened. Dermatophytes were isolated from 21% (32/153) of the children screened, comprising 23 infected children (cases) and 9 carriers. Three dermatophyte species were identified: Trichophyton soudanense, Trichophyton violaceum and Microsporum audouinii. Cases and carriers were significantly different to non-cases by ethnicity (P = 0.010): a higher proportion came from Africa, notably Sudan, and Arabic countries., Conclusions: Although our result may reflect what is expected in these migrant groups, tinea capitis caused by these three dermatophyte species is rare in Australian school children. Tinea capitis may continue to be a problem in these groups on account of continuing migration.

A 36-year-old woman presented with a 2-year history of multiple, raised, brown papules and indurated skin over her lower legs. She had received a renal transplant 11 years earlier, and had a history of recurrent deep vein thromboses despite a negative thrombophilic screen. The patient had no history of exposure to gadolinium. Histology at this time revealed a light perivascular lymphoid infiltrate, activated fibroblasts and prominent capillary vessels. The patient re-presented 1 year later with persistence of these lesions, in the setting of worsening renal function requiring haemodialysis. Repeat skin biopsies demonstrated increased dermal collagen and angiogenesis. The dermatopathological findings, in association with renal insufficiency and multiple deep vein thromboses, led to the diagnosis of nephrogenic systemic fibrosis.

A 62-year-old woman presented with diffuse alopecia areata affecting more than 50% of her scalp hairs with sparing of non-pigmented hairs. She was treated with a 2-month course of oral prednisolone and extensive hair regrowth occurred. The new hairs were completely non-pigmented. As a result, the patient's hair colour is now strikingly and completely white, with a normal hair density. This response has been sustained for 6 months after cessation of treatment.

Population registry data and published studies have demonstrated that melanomas in the transplant population occur 1.6-2.5 times more commonly compared with the general population. Studies examining possible risk factors have suggested that in this patient population, there is an increased number of melanocytic naevi. Whether this phenomenon is aetiologically related to subsequent melanoma development is currently unclear. Only one study examined the prognosis of melanomas in this population. The Israel Penn International Transplant Tumor Registry has collated patient data voluntarily submitted by transplant physicians throughout the USA since 1968. Analysis of melanomas in this study found that approximately half were Breslow thickness >1.51 mm. Overall, there was a high rate of nodal and distant metastases, with poorer 1-, 3- and 5-year survival rates compared with the general population. There is a paucity of good-quality evidence regarding melanoma in organ transplant recipients. Further research involving international collaborative trials, particularly on risk factors and the prognosis of melanomas in this population, could present a more substantial evidence base from which treatment guidelines based on data could be developed.

Introduction: Cutaneous squamous cell carcinoma is a malignant tumour of keratinocytes arising in the epidermis, with histological evidence of dermal invasion. Incidence varies by country and skin colour, and is as high as 1/100 in white residents of tropical Australia. People with fair skin colour who sunburn easily without tanning, people with xeroderma pigmentosum, and people who are immunosuppressed are most susceptible to squamous cell carcinoma., Methods and Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: Does the use of sunscreen help prevent cutaneous squamous cell carcinoma? What is the optimal margin for primary excision of cutaneous squamous cell carcinoma? Does micrographically controlled surgery result in lower rates of local recurrence than standard primary excision? Does radiotherapy after surgery affect local recurrence of cutaneous squamous cell carcinoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA)., Results: We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions., Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: micrographically controlled surgery, primary excision, radiotherapy after surgery, and sunscreens.

A retrospective analysis was performed of patients meeting the clinicopathological diagnosis of Sweet's syndrome identified over a 10-year period, in a metropolitan hospital. Nine patients met the inclusion criteria. Two patients had preceding streptococcal infection, two had associated inflammatory bowel disease, two had idiopathic Sweet's syndrome, and three had an underlying malignancy, one of whom was receiving granulocyte colony-stimulating factor. Although only three patients were found to have an elevated white cell count, erythrocyte sedimentation rate or C-reactive protein was elevated in all patients when measured. There was a wide spectrum of clinical presentations, with variations in lesion distribution and the presence/absence of systemic symptoms such as fever and arthralgia. Fever was observed in two-thirds of cases. Seven patients responded to oral corticosteroids, while one patient cleared spontaneously and one patient was lost to follow up. As erythrocyte sedimentation rate or C-reactive protein was elevated in all cases when measured, it may be a useful diagnostic tool.

Solar keratosis is a common problem encountered by dermatologists, particularly in Australia. Solar keratosis is most commonly found on sun-exposed areas such as the scalp, face and forearms. UV radiation is thought to be the major aetiological factor, with age, immunosuppression and human papillomavirus being important contributing factors. Solar keratosis usually presents as a discrete, variably erythematous and irregular lesion with a scaly surface. Although the exact rate of malignant transformation to squamous cell carcinoma is unknown, the majority of squamous cell carcinomas appear to arise from within solar keratosis. For this reason, solar keratosis is commonly treated and, consequently, an increasing number of therapeutic options is now available. Traditional therapies, such as liquid nitrogen cryotherapy, are still popular, but newer choices, such as photodynamic therapy and imiquimod cream, are now providing further options with similar efficacy and superior adverse effect profiles, albeit at a higher cost.

A 36-year-old man presented with a non-pruritic, erythematous facial rash with peri-oral and peri-orbital sparing. The initial clinicopathological diagnosis was rosacea fulminans, which was treated with 25 mg oral prednisolone and cephalexin. The patient re-presented 1 week later with exacerbation of his rash in addition to constitutional symptoms of fever and malaise. A further skin biopsy was taken and the marked neutrophilic infiltrate in the absence of vasculitis made the diagnosis of Sweet's syndrome (acute febrile neutrophilic dermatosis). High-dose prednisolone (50 mg daily), topical hydrocortisone cream and ichthammol in zinc ointment were commenced with rapid clinical improvement. This case highlights the importance of considering Sweet's syndrome as a differential diagnosis when presented with a facial eruption.

Polyfibromatosis is a rare condition in which several cutaneous fibrotic conditions, such as Dupuytren's contracture, keloid formation, Peyronie's disease and plantar fibromatosis, may coexist. Interstitial granulomatous dermatitis with arthritis is also a rare condition characterized by arthritis and infiltrated rope-like lesions with granulomatous histologic features. We report a case of the simultaneous occurrence of both conditions in the same individual. To our knowledge, this has not been previously described. The clinical course has been slow, progressive, and recalcitrant to treatment.

A retrospective analysis was conducted on 93 adult patients with cutaneous leukocytoclastic vasculitis from St. Vincent's Hospital Melbourne to determine the classification, aetiology, severity and prognosis of this population of patients. We developed a new classification system for the purposes of our study based on modifications to the Chapel Hill Consensus Conference definitions for vasculitic syndromes. The results of our study indicate that an obvious cause was not found in 44.1% of patients. Of the patients with secondary vasculitis, the commonest causes were drugs and infections, accounting for a total of 40.9% of patients. Extracutaneous involvement was found in 39.8% of patients. Patients with symptoms resolving in less than 3 months accounted for 59.1% of the population, whereas 24.8% of patients had either symptoms lasting three or more months or evidence of recurrent symptomatology. There were 6 deaths (6.91%) and the rest were lost to follow up. The majority of patients in this retrospective series were classified as having hypersensitivity vasculitis, which is a relatively benign disorder limited mostly to skin with a low incidence of extracutaneous involvement (15.8%). Nevertheless, evidence of systemic involvement or sepsis need to be excluded as this may have important implications for patient treatment and outcome.