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Fifteen patients with primary Raynaud's phenomenon received captopril 25 mg or placebo, three times daily for 6 weeks, in a randomized double-blind cross-over study. Compared with placebo, captopril produced a significant improvement in cutaneous blood flow but did not alter the frequency or severity of attacks of Raynaud's phenomenon. [ABSTRACT FROM AUTHOR]

The article examines the role of acidic lipid neutrophil chemo-attractant in the pathogenesis of the inflammatory changes in chronic plaque psoriasis. The evidence obtained to date is presented here in six sections, according to the above criteria. The article informs about the process to recover lipoxygenase products from psoriatic lesions. In order to recover such compounds, a skin chamber sampling technique has been developed. It also states that psoriasisis not a multifactorial disease. LTB4-like material and 12-HETE have been recovered from psoriatic lesions and from calcium ionophore stimulated human epidermal cell suspensions. These two compounds, applied topically, have also been shown to reproduce some features of the psoriatic lesion.

The merits of oral ketoconazole and griseofulvin in dermatophytosis have been compared in a double blind study on 74 patients with 152 infected sites. The initial daily doses were 200 mg and 500 mg respectively, but these were doubled after 3 months if there was an inadequate clinical response. Treatment was continued either until clinical and mycological remission was achieved or a year of therapy had been given. Seventy-five per cent (total 80) and 74% (total 72) of all infected sites treated with ketoconazole and griseofulvin respectively were cleared of infection. However, in toe nail infections the respective cure rates were only 21% and 17%. Ketoconazole appeared to act more rapidly in curing tinea corporis or tinea cruris due to Trichophyton rubrum, whereas griseofulvin was superior in T. interdigitale infections. No serious side-effects were encountered in either treatment group. In view of the slight risk of drug-induced hepatitis, ketoconazole is best reserved as a second-line drug for toe nail infections unless there are specific indications, such as griseofulvin intolerance. In these cases liver function tests should be monitored regularly throughout therapy. [ABSTRACT FROM AUTHOR]

The case history of a patient who presented with erythema annulare centrifugum and white banding of the toe nails is recorded. On investigation for an underlying malignancy the patient was found to have an opacity in the lower lobe of the right lung. Subsequently lobectomy was performed and histology of the operative specimen revealed a malignant carcinoid tumour of the bronchus. [ABSTRACT FROM AUTHOR]

Glomangiomas are rare cutaneous tumours composed of glomus cells, which are modified smooth muscle cells. The aetiology of this condition is thought to involve a mutation in a novel gene acting to regulate angiogenesis. We report a patient from a large family with three generations affected by familial multiple glomangiomas. We hypothesized that the growth factors basic fibroblast growth factor and vascular endothelial growth factor, which stimulate/regulate angiogenesis could be involved in the pathogenesis of these lesions. Therefore, using enzyme-linked immunosorbent assays and immunohistochemistry, respectively, we measured systemic and tissue levels of these growth factors in a patient with familial glomangiomas. In addition, we investigated endothelial mitogenicity of the patient's serum as a functional assay of systemic growth factor activity.

When injected into human skin, endothelin-1 produces intense vasoconstriction localized to the site of the injection, but this area of vasoconstriction is surrounded by vasodilatation which spreads several centimetres from the injection site. The vasodilatation induced by intradermal injection of endothelin-1 (63 pmol) into human skin is prevented by local anaesthetic. Pretreatment of human skin with capsaicin also inhibits this response. Pretreatment of subjects with the selective histamine H1-receptor antagonist cetirizine, 10 mg orally 4 h before intradermal injections, inhibited vasodilatation caused by the intradermal injection of histamine (750 pmol), endothelin-1 (63 pmol), and carbachol (750 pmol). Endothelin-1 (0.3-10 microM) and carbachol (1-30 microM) failed to induce histamine release from rat peritoneal mast cells. We conclude that the vasodilatation caused by intradermal injection of endothelin-1 into human skin is neurogenic and is probably mediated by neuropeptide-containing primary afferent neurones. Because neither carbachol nor endothelin-1 cause histamine release from mast cells, our data suggest that histamine release from mast cells at the effector end of the axon reflex is responsible for the carbachol- and endothelin-induced vasodilatation in human skin.

To determine whether the clinical, immunological and serological features of patients with silica-associated systemic sclerosis are different from patients with the 'idiopathic' form of systemic sclerosis (SS) we studied 22 underground coal miners who were exposed to silica dust (SD), 30 mine workers who later developed silicosis (S) and 17 mine workers exposed to silica dust who subsequently developed a systemic sclerosis-like disease (SA-SS). The patients with SA-SS had features clinically indistinguishable from individual patients with SS. They all had Raynaud's phenomenon, 14 had cutaneous sclerosis identical to that seen in acrosclerosis and three had a generalized cutaneous sclerosis. Sixteen patients had bibasilar pulmonary fibrosis, 10 had necrosis of the fingertip pulps, nine had oesophageal involvement and only one patient had renal involvement. Antinuclear antibodies and circulating immune complexes were detected in three and eight patients with SD, 14 and five patients with S and in 16 and nine patients with SA-SS, respectively. Anti-Scl-70 antibody was detected in eight of the 17 patients with SA-SS. Evidence for in vivo endothelial cell damage, as determined by elevated levels of von Willebrand factor, was found in nine patients with SD, 14 patients with S and in 10 patients with SA-SS. Following incubation of the patient's serum with confluent cultures of human umbilical vein endothelial cells there was only a significant reduction in calcium ionophore-induced release of prostacyclin with the serum from SA-SS patients compared to that with control serum (NC). The mean +/- SEM release of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin expressed as ng/10(4) cells) decreased from 2.90 +/- 0.27 to 2.01 +/- 0.33 (SD), 3.34 +/- 0.42 to 1.76 +/- 0.31 (S), 1.98 +/- 0.12 to 0.64 +/- 0.07 (SA-SS) and 2.28 +/- 0.33 to 1.36 +/- 0.21 (NC) with 1 and 20% serum, respectively. This study demonstrates that immune complex and antinuclear antibody formation and in vivo endothelial cell damage occurs following occupational exposure to silica. The patients who subsequently develop a systemic sclerosis-like disease have clinical, immunological and serological features which are indistinguishable from the idiopathic form of the disease although as a group the SA-SS patients have a higher prevalence of pulmonary involvement and the anti-Scl-70 antibody.

Three patients are described who developed numerous pinhead sized pustules within areas of a widespread toxic erythema. The eruption was precipitated by food poisoning in one patient, a suspected, but blood-culture-negative septicaemia in another and in the third patient, by a cephalosporin. This self-limiting syndrome consists of fever, a pustular and erythematous eruption, a neutrophil leucocytosis, subcorneal and spongiform pustules but without a history of psoriasis. We believe that this entity of toxic pustuloderma represents a severe form of toxic erythema.

The vasodilator prostaglandin E2 has been proposed as a mediator of erythema in a variety of cutaneous inflammatory reactions and prostacyclin levels have been found to be elevated in ultraviolet induced erythema. Human recombinant interleukin 1 alpha and lipopolysaccharide induced a concentration- and time-dependent release of prostaglandin E2, but not prostacyclin, from cultured neonatal and adult human dermal microvascular endothelial cells. Prostaglandin E2 was measurable at 2 h after stimulation with 1 U/ml interleukin 1 alpha, levels increased rapidly up to 6 h and more slowly up to 24 h. Lipopolysaccharide (20 micrograms/ml) induced measurable release of prostaglandin E2 between 2 and 4 h after stimulation and release continued up to 24 h when incubation was terminated. With both agonists, release of prostaglandin E2 was inhibited by indomethacin and significantly reduced by cycloheximide. The sensitivity and magnitude of responses of the cutaneous endothelial cells to these pro-inflammatory stimuli appeared to be dependent on their derivation.

Three patients are reported who developed erythema multiforme during treatment with griseofulvin. To our knowledge there have been no previously documented reports of this drug causing erythema multiforme in either the English or American literature.

Incubation of human recombinant IL-1 alpha (hrIL-1 alpha) with cultured human endothelial cells induced a dose- and time-dependent increase in the release of prostacyclin (PGI2). Above a dose of hrIL-1 alpha 0.05 units/ml and following a variable lag phase of between 2 and 4 h, PGI2 release (measured as the stable hydrolysis product 6-keto-prostaglandin F1 alpha) was detected in the culture supernatant and levels continued to rise throughout a 48-h incubation. The release of PGI2 required the continued presence of hrIL-1 alpha, did not demonstrate tachyphylaxis and was not reduced by pre-incubation with the protein synthesis inhibitors cycloheximide, tunicamycin and actinomycin or by the calmodulin antagonist trifluoroperazine. The relationship of these results to ultraviolet radiation induced erythema is discussed.

Out of 98 female referrals with acne vulgaris it was possible to define ovarian morphology by high resolution ultrasound imaging of the pelvis in 82 (84%). Sixty-eight (83%) were shown to have polycystic ovaries, compared with 19% in a control group without acne. The presence of polycystic ovaries in the acne patients did not correlate with acne severity, infertility, menstrual disturbance, hirsutes, or biochemical endocrinological abnormalities.

The effect of the epicutaneous application of 0.1% and 1.0% hexyl nicotinate lotion on upper limb skin blood flow was investigated in 25 patients with Raynaud's phenomenon (RP) and five healthy volunteers. Assessments were made using laser Doppler velocimetry. The 0.1% lotion induced an increase in cutaneous blood flow in both controls and patients when applied at different sites on the upper limb. Increased cutaneous blood flow occurred more often when the lotion was applied to the forearm than to the fingers. A greater increase in blood flow and an increased percentage of positive responses was elicited with the 1.0% hexyl nicotinate lotion. Hexyl nicotinate lotion may be of value in the topical treatment of RP.

We report fifteen cases showing focal acral hyperkeratosis. They were clinically identical to acrokeratoelastoidosis (AKE) but lacked the elastorrhexis which is a feature of AKE. The name focal acral hyperkeratosis is proposed for this condition which differs histologically from AKE.

We report a patient with a 6-year history of recalcitrant painful ulceration of both lower legs, diagnosed as being due to livedoid vasculitis. The lesions healed rapidly and remained healed on treatment with oral ketanserin.

Ninety female patients with acne were allocated randomly to one of three groups and treated either with Diane, a high dose cyproterone acetate (CPA) regime with ethinyloestradiol, or Minovlar. The same dose of oestrogen was common to all three treatment groups. Patients were assessed every 2 months for 6 months, by grading for severity of the acne, lesion counts and photography, and subjectively using a visual analogue scale. In addition, bacteriological sampling and sebum excretion rate (SER) measurements were performed. The results showed a clinical improvement in all three treatment groups, but a more rapid and complete response was seen in those groups who received CPA. There was also a consistent trend suggesting a more favourable response in those in the high dose CPA group. Although there was a marked reduction in SER in the groups treated with CPA, there was no correlation between reduction in SER and clinical improvement in individuals, nor could a reduction in the surface bacterial population be shown to be a primary event in the success of anti-androgen therapy. We have shown that the addition of CPA to oestrogen adds significantly to the therapeutic effect in acne and that anti-androgen and oestrogen combinations are more effective than standard oestrogen and progestagen contraceptive pills.

Histamine is an important pro-inflammatory molecule mediating leukocyte margination, plasma extravasation and vasodilation, but its precise mode of action on vascular endothelium is unclear. We report that histamine is able to induce prolonged release of prostacyclin (PGI2) from human endothelial cells via occupancy of the H1 receptor, without an absolute requirement for the presence of histamine or synthesis of new enzyme protein to facilitate continued release of PGI2.

We describe a case of histologically proven giant cell arteritis (GCA) in a 62-year-old woman who initially presented with upper limb girdle pain and weakness, and intermittent claudication. Clinical improvement was obtained with oral prednisolone. She subsequently developed a photosensitive rash and was diagnosed as having systemic lupus erythematosus. The features of the two conditions and the possibility of an association are discussed.

Thirteen patients with systemic sclerosis were treated with isotretinoin. Nine patients completed between 6 and 14 months of treatment and all showed an improvement in the cutaneous manifestations of their disease. The drug did not appear to benefit internal organs affected by the disease. Most patients experienced the well-recognized side-effects of retinoids, which in three cases necessitated withdrawal from the study within 3 months. Serum levels of type III procollagen aminopropeptide did not show a consistent decline during treatment, despite a clinical improvement. The mode of action of the reported therapeutic effect of isotretinoin in systemic sclerosis is unclear. There may be a preferential suppression of the synthesis of type I collagen, or the drug may be acting by an unrelated mechanism.

A study of dithranol ointment in the mouse-tail test showed that 0.2% dithranol ointment induced a granular layer and orthokeratosis in mouse-tail epidermis. This provides further evidence of the value of the mouse-tail test in evaluating anti-psoriatic activity of topical preparations.

We describe a patient with Klinefelter's syndrome complicated by recalcitrant leg ulcers, in whom marked platelet hyperaggregability was demonstrated and venous disease excluded. Androgen replacement therapy appeared to bring about healing of the patient's ulcers and was associated with reversal of the platelet abnormality. The possible role of androgen deficiency in the pathogenesis of leg ulceration is discussed.

Phagocytosed immune complexes in polymorphonuclear leukocytes of nineteen patients with Raynaud's phenomenon were detected by scoring the cells for IgG and C3 inclusions. Parallel estimations of circulating immune complexes were made by liquid phase C1q binding and polyethylene glycol (PEG) precipitation methods. The results were compared with the degree of cold stress-induced vasospasm measured by quantified infra-red thermography. Thirteen of nineteen patients with Raynaud's phenomenon compared with only one of seventeen normal controls showed significantly elevated levels of phagocytosed IgG. The correlation of IgG and C3 scores for individual patients was high and the IgG and C3 scores correlated well with the thermographic assessment of the severity of the Raynaud's phenomenon. Two of the patients had elevated levels of circulating immune complexes detectable by raised levels of C1q binding, four patients had raised IgG and three patients raised IgM complexes detectable by PEG precipitation. None of the controls had elevated levels of circulating immune complexes detectable by either method. There was no correlation between the levels of circulating and phagocytosed immune complexes.

A pilot study, a double-blind placebo-controlled randomised study and a long term open trial have indicated that nifedipine is effective in the treatment of perniosis. At a dose of 20 mg to 60 mg daily, nifedipine significantly reduced the time to clearance of existing lesions and prevented the development of new chilblains. Nifedipine also reduced the pain, soreness and irritation of the lesions. A comparison of the pre- and post-treatment skin biopsies showed resolution of the dermal oedema and diminution of the perivascular infiltrate. An increase in cutaneous blood flow following administration of nifedipine suggests that the vasodilator action of this drug may be important in its action.