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Neutrophilic urticarial dermatosis (NUD), a particular clinical and histological entity, can provide a strong pointer to underlying systemic disease, most frequently rheumatological diseases. We report the first case of NUD in association with a post-streptococcal rheumatic disease, with symptoms including recurrent sore throat, raised antistreptolysin O titre, persistent transient urticaria, polyarthralgia, rheumatic mitral valve disease and Jaccoud arthropathy. Histologically, NUD is characterized by an intense superficial and deep neutrophilic interstitial and perivascular infiltrate, without significant oedema or blood vessel damage. These neutrophils may have a tendency to concentrate along the basement membrane and extend into the epidermis, hair follicles, sebaceous glands and sweat glands (a feature termed 'neutrophilic epitheliotropism'). Clinicians should remain cognizant of NUD, and in particular its frequent association with an underlying inflammatory disorder.

We describe a 59-year-old woman, with a history of autoimmune disease and disseminated uterine leiomyosarcoma, who developed a photoaggravated, blistering skin eruption. An initial rash, at the outset of treatment with chemo- and radiotherapy, resembled erythema multiforme. Review of the original skin biopsy showed it to be subacute cutaneous lupus erythematosus. There were no systemic symptoms or signs to suggest systemic lupus erythematosus. The much later photoaggravated rash consisted mainly of bullae and eventual epidermal denuding which resembled toxic epidermal necrolysis. We propose that the clinical and histological diagnosis is one of bullous subacute cutaneous lupus erythematosus in a patient with no other features of systemic lupus erythematosus.

Summary The expression of herpes varicella zoster virus in patients Already infected with the human immunodeficiency virus (HIV) provides the perfect illustration of an opportunist microbe at work. There is an increased incidence of herpes zoster which may be more sever, recurrent or disseminated. In both Likewise, varicella may be more severe and recurrent. In both patterns of infection a typical lesions in the form of persistent ulcerative or verrucous lesions have been seen. An HIV-positive patient is described who developed verrucous lesions de novo, 4 months after her child had varicella.

Castleman's lymphoma, a benign localized lymphoid hyperplasia, has been reported in association with POEMS syndrome, a multisystem reactive disorder that includes several skin manifestations. Benign reactive angioendotheliomatosis is a rare skin disorder that is associated with various systemic disorders. A patient with long-standing Castleman's lymphoma and POEMS syndrome also developed benign reactive angioendotheliomatosis.

Localized granuloma annulare is the commonest form of a granulomatous dermatosis characterized by flesh coloured or violaceous papules often arranged in rings. Several rare atypical variants are also reported including disseminated or generalized, subcutaneous and perforating types. There is a predilection for females and a documented association with diabetes mellitus in some cases. Recently it has been suggested that atypical variants of granuloma annulare might be associated with the acquired immunodeficiency syndrome (AIDS). We describe a patient presenting with extensive generalized granuloma annulare in whom an underlying diagnosis of Human Immunodeficiency Virus (HIV) disease was confirmed.

Summary We report the case of a homosexual male with a 5-year history of polyarthropathy and a 20-year history of a psoriasiform rash leading to the diagnosis of Reiter's disease and underlying HIV infection.

Summary Ichthyosis hystrix is a rare genodermatosis characterized by persistent spiny scales which cover a significant part of the skin surface. In many cases it is associated with palmoplantar keratoderma, and occasionally deafness and neurological defects coexist. The case of a man with ichthyosis hystrix is reported who developed skin malignancy and dysplastic keratoses, a complication which has not previously been recorded.

Summary A 23-year-old woman is described with confluent yellowish-white papules and plaques on the face. This was associated with hyperplasia of sebaceous glands. There was no clinical evidence of seborrhoea or anhidrotic ectodermal dysplasia. This is considered to be a separate and distinctive clinical and pathological entity.

Summary Three patients who developed toxic epidermal necrolysis whilst receiving carbamazepine are described. Two patients experienced severe oropharyngeal ulceration and extensive cutaneous necrolysis with subsequent transient alopecia, nail shedding and persistent ulceration of the tongue. Histology of the skin revealed changes resembling those found in not only erythema multiforme and toxic epidermal necrolysis but also homograft rejection and the acute graft-versus-host reaction, suggesting that cutaneous damage was mediated by ‘aggressor lymphocytes’ sensitized to epidermal cells.

Summary Widespread thrombophlebitis was the presenting feature of sarcoidosis in a 29-year-old West African woman. To our knowledge superficial thrombophlebitis has not previously been reported in sarcoidosis. Superficial thrombophlebitis is classically linked with pancreatic adenocarcinoma. It has also been associated with many other neoplasms as well as collagen vascular diseases, Behget's syndrome, lymphoproliferative diseases and several infections, such as typhoid or rickettsiosis (Ryan & Wilkinson, 1979). As far as we are aware, widespread superficial thrombophlebitis has not been previously seen with sarcoidosis and we describe a case in which it was a major feature of the disease.

Summary A total of ninety-nine patients, of whom eighty-six had fungal infections of the skin and thirteen erythrasma, took part in a double blind comparison of the efficacy and acceptability of tioconazole and miconazole creams applied twice daily. The duration of treatment was 4 weeks. Of the patients available for review upon completion of treatment, twenty-three of thirty-four patients (68%) treated with tioconazole and twenty-one of thirty-eight patients (55%) treated with miconazole were cured clinically and mycologically. Of the patients available for follow-up 4 weeks later, nineteen of twenty-one patients (90·5%) treated with tioconazole and twelve of fifteen patients (80%) treated with miconazole remained free from infection. Statistical analysis showed that tioconazole achieved a significantly higher mycological cure rate than miconazole. There was no significant difference between the two creams in clinical or overall cure rates.

Summary A 61–year-old man developed epidermolysis bullosa acquisita (EBA) in association with an IgM paraprotein and chronic lymphatic leukaemia (CLL). Direct immunocyto-chemistry and immunoelectron microscopy confirmed the presence of IgM at the dermoepidermal junction. IgG was not present. This appears to be a unique observation in EBA and is discussed in relationship to the possible pathogenesis of the disorder.

Summary A 74-year-old man with mycosis fungoides and strikingly prominent follicular lesions is described. One year after the onset of his eruption he developed features suggestive of progression towards Sezary syndrome with generalized pruritus and increasing erythema and oedema of the face and neck. He also had a significant number of circulating Sezary cells (92% of a total white cell count of 26,700 cells/mm3). Following the administration of chlorambucil, extension of his erythema abated. With continued treatment there was a marked reduction in the number of circulating Sezary cells and his clinical condition improved considerably.

Summary Two cases are reported in which purpuric skin plaques due to leucocytoclastic vasculitis and angio-oedema were the presenting signs of inflammatory bowel disease. The aetiological implications are discussed. One case was controlled with oral colchicine, the other with oral Salazopyrine.