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The aim of this study was to identify factors that have influenced the place of occupational therapy across time, in special education in New Zealand. Semi-structured interviews were used to identify key themes. Further analysis led to the identification of three interrelated areas that could be said to have influenced occupational therapy practice in special education in New Zealand:1) 'Structure' - The effect educational and government policy changes have had on the provision of occupational therapy; 2) 'Impact' - Changes in models of service delivery that have occurred over time; and 3) 'Dynamics' - The relationship between occupational therapy and special education. [ABSTRACT FROM AUTHOR]

Serum levels of minocycline hydrochloride were determined in bioassay in a total of 223 acne patients (123 male, 101 female) receiving either the recommended dose (100 mg/day) or a high dose (200 mg/day) of the standard preparation (101 patients) or a modified release formulation (132 patients). Sera were collected within 6 h of the morning dose 7-10 days after the start of treatment. Mean minocycline serum levels were consistently higher in females than in males, irrespective of dose or formulation. The difference only reached statistical significance (P <0.05, Student's t-test) in the case of the standard preparation at a dose of 50 mg, b.d. Serum levels were increased significantly in both sexes at the higher dosage of each formulation (P<0.01) but there was no significant difference between formulations at either dosage. Variation in serum concentrations was not accounted for by variation in body mass. Serum levels above the modal minimum inhibitory concentration (MIC) of mino-cycline for fully sensitive strains of Propionibacterium acnes I (0.125 μg/mL) were recorded in all patients. In contrast, serum levels equal to or greater than the modal MIC of minocycline for resistant propionibacteria (2 μg/ml) were recorded in only 17.9% of patients on the low dose standard preparation compared with 55.6% on the high dose standard preparation (P<0.001, χ[sup2]). Even in females on the high-dose modified release formulation, 32.2% had serum levels below the modal MIC of minocycline for resistant strains. We conclude that, in terms of achievable serum levels over a short time period, there is no advantage of the modified release formulation over the standard preparation of minocycline. Whichever formulation is used, dose manipulation may be necessary to achieve maximum therapeutic benefit, especially in those individuals who are colonized by propionibacteria with reduced sensitivity to minocycline. [ABSTRACT FROM AUTHOR]

Pruritic folliculitis (PF) is one of the specific dermatoses of pregnancy the aetiology of which remains unknown. Several theories have been proposed, and the most commonly accepted is that it represents a hormonally induced acne, as seen in patients taking progestogenic steroids. This theory led to the proposition that serum androgen levels may be elevated in this condition, and may be causative. We studied a cohort of 125 pregnant women presenting with a variety of pregnancy dermatoses of whom 12 had PF. These women were compared with 138 pregnant control subjects without a pregnancy dermatosis to determine whether serum androgens were elevated. There was no significant elevation of serum androgens in the 12 cases of PF. There was an overall preponderance of male infants among the PF cases and birthweight of the infants was found to be reduced compared with those of controls. However, the outcome of pregnancy in all cases was favourable implying that PF has no adverse effect on foetal wellbeing.

Pemphigus vulgaris is an immunobullous disease affecting the skin and mucous membranes most commonly during the fifth and sixth decades of life. Its occurrence in pregnancy is rare. We now report two severe cases of the disorder presenting during pregnancy and discuss its potential effects on the foetus and its management in pregnancy.

Bazex syndrome, or acrokeratosis paraneoplastica, is a cutaneous paraneoplastic syndrome characterized by psoriasiform lesions associated with, usually, a squamous cell carcinoma of the upper aerodigestive tract. We present a case of Bazex syndrome associated with metastatic cervical squamous cell carcinoma with an unknown primary. The features of the condition are discussed in the light of current knowledge.

We report two unusually florid cases of polymorphic eruption of pregnancy (PEP) or pruritic urticarial papules and plaques of pregnancy, the first occurring in a triplet pregnancy, and the second with some clinical features more suggestive of pemphigoid gestationis (PG). The first case responded to treatment with moderately potent topical steroids while the second case required a short course of systemic steroids. Our first case is the only reported case of PEP occurring during a triplet pregnancy. We discuss the effect of multiple pregnancy on PEP and some distinguishing factors between PEP and PG.

We report two sisters from Ghana who presented with cicatricial alopecia simultaneously. In both cases the aetiology is unclear although both gave a history of previous scalp folliculitis. We classify the causes of cicatricial alopecia and the difficulties that can arise in placing such patients in a clinical category. Racial origin may be relevant in our cases; to our knowledge this is the first report of cicatricial alopecia occurring in two sisters.

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 severe, recurrent or disseminated. Likewise, varicella may be more severe and recurrent. In both patterns of infection atypical 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.

656 skin biopsies with positive direct immunofluorescence from the UK and overseas were studied over a 2-year period. The length of time biopsies had remained in Michel's medium at pH 7.0 in various diseases (pemphigoid, pemphigus, linear IgA disease, epidermolysis bullosa acquisita, lupus erythematosus, vasculitis, amyloid, lichen planus and dermatitis herpetiformis) was analysed. We concluded that direct immunofluorescence remained positive at 6 months and that Michel's medium is a reliable long-term maintenance medium for skin biopsies.