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The rate of success in treating onychomycosis with 40% urea ointment containing 1% bifonazole, with and without oral griseofulvin, was evaluated. Most patients had onychomycosis of the toes. 11 patients (group A: 5 men and 6 women, average age 48.5) were treated locally under occlusion with the ointment until dissolution of most of the nail, and then with 1% bifonazole cream for a total of 6 months. 11 others (group B: 3 men and 8 women, average age 42.5) received, in addition, griseofulvin 500 mg/day orally during that period. Treatment with the ointment alone did not give higher cure rates than the average of reported cure rates for griseofulvin alone. However, the results of treatment with 40% urea and 1% bifonazole ointment concomitantly with oral griseofulvin seemed superior to those of either of these agents alone, with full cure, partial cure and failure in group A of 22.2, 33.3 and 44.5%, respectively, and in group B, 45.4, 27.3 and 27.3%. This therapeutic experiment should be repeated in larger series of patients.

The diagnosis of bite by the brown recluse spider, Loxosceles reclusus, is rarely based on absolute identification of the insect because the victims are usually bitten while sleeping or dressing. More often, the history, clinical findings and course of the bite lead to the diagnosis. For early confirmation up to 24 hours after the bite, the passive hemagglutination test can be used. For older lesions, the in-vitro lymphocyte transformation test is useful, but is available in only a few medical centers. Treatment of the bite of the brown recluse spider varies from conservative to more active approaches. Resting, local cooling, systemic antibiotics to prevent infection and mild anti-inflammatory drugs may be given. In the more active approach oral corticosteroids are added in the first 72 hours to the antibiotics, especially in massive bites with necrotic centers greater than 2 cm in diameter, or when there is systemic loxoscelism. Recently, good results have been reported with Avlosulfon (dapsone), which is claimed to cure necrotic cutaneous ulcerations, presumably by reducing the activity of polymorphonuclear leukocytes. Other treatments include specific antivenin, (of limited use because it must be administered shortly after the bite), and surgery to prevent spreading of the venom. We describe 3 cases of brown spider bite with typical clinical presentations in adults aged 20-40 years. 2 were treated with corticosteroids and antibiotics and 1 with Avlosulfon and prednisone, all within 72 hours of the bite. 2 recovered completely within a few days, but the third treated with prednisone and antibiotics, developed an ulcer which healed only after several months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic plasmapheresis was successfully used in a 29-year-old man with corticosteroid-resistant pemphigus vulgaris who had severe side-effects from the medication. 4 plasmaphereses were performed over a period of 3 weeks with removal of a total of 7900 ml of plasma. Concurrently he received large doses of adrenal steroids and Imuran. There was clinical improvement soon after the first plasmapheresis and 8 weeks after the treatment was started he was free of lesions. IC-Ab titers markedly decreased during the course of treatment and continued to decrease after it was completed. Side-effects were few and relatively mild. Plasmapheresis may be a useful adjunct in the treatment of pemphigus vulgaris resistant to conventional therapy. It may be used initially together with corticosteroids, giving more rapid improvement, as well as a corticosteroid-sparing effect.

Erythema ab igne (EAI) has not been common since coal stoves have no longer been in general use for heating. Nevertheless, each winter several patients with macular-reticular skin lesions considered to be EAI are seen in our clinic. Correct diagnosis depends on awareness of the condition. 3 women, aged 17, 34 and 50, respectively, in whom EAI was induced by prolonged sitting close to an electrical heating device are presented. When this was discontinued the skin lesions disappeared. In the majority of reported cases of EAI the course was benign, similar to that in our patients in whom there were no additional related lesions. However, isolated cases of squamous cell carcinoma developing in patients with EAI have been described. In other cases the local heating which caused the EAI was applied for relief of pain and the appearance of EAI was the first clue to an underlying internal disease.