Inpatient management of psoriasis: a multicentre service review to establish national admission standards.

Background: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay.

Objectives: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management.

Natural killer-cell lymphocytosis and strongyloides infection.

We report a case of strongyloides infection in a 72-year-old man presenting with acute angio-oedema and urticaria. He was also found to have natural killer cell (NK) large granular lymphocytosis (LGL). We discuss the possible relationship between the strongyloides infection and the NK-LGL lymphocytosis.

Fish tank granuloma in a 14-month-old girl.

A 14-month-old girl developed a persistent ulcerated nodule on her right lower leg associated with further nodules along the thigh. A clinical diagnosis of fish tank granuloma was suspected because of tropical fish tanks at home. The diagnosis was confirmed when Mycobacterium marinum was isolated from low-temperature culture of skin tissue.

The relevance and effect of amalgam replacement in subjects with oral lichenoid reactions.

In this study we examined the prevalence of mercury hypersensitivity in patients with oral lichenoid reactions (OLR) and the effect of amalgam replacement in subjects with amalgams adjacent to OLR irrespective of their mercury sensitivity status. One hundred and ninety-seven patients with oral problems were examined: 109 with OLR, 22 with oral and generalized lichen planus, and 66 with other oral diagnoses, including aphthous ulcers and orofacial granulomatosis. Nineteen per cent of patients with OLR reacted to mercury on patch testing, significantly more than in those with generalized lichen planus (0%) and in those with other oral diagnoses (3%).

Erythemal and therapeutic response of psoriasis to PUVA using high-dose UVA.

In PUVA treatment of psoriasis, clinical observation suggests that uninvolved skin is more susceptible to PUVA erythema than lesions of psoriasis. If this is the case, then the efficacy of PUVA treatment might be increased by using localized high-dose UVA restricted to lesional skin. We have therefore studied the erythemal and therapeutic response of psoriasis to PUVA using high-dose UVA and, for comparison, the erythemal response to UVB.

Calcipotriol improves the response of psoriasis to PUVA.

Combining PUVA with other therapeutic agents which reduce the UVA dose required for clearance of psoriasis may be of benefit by reducing the long-term risk of cutaneous malignancy and by increasing the efficacy of treatment. We have therefore studied the effect of calcipotriol in 13 patients with plaque-type psoriasis who were about to start twice weekly PUVA. In each patient, from the start of PUVA treatment, two plaques on symmetrical body sites were selected for assessment.

Reticulate purpura, cryoglobulinaemia and livedo reticularis.

Two patients with type I cryoglobulinaemia are described, both of whom presented with purpura in a reticulate distribution on the legs, resembling the pattern of physiological livedo. It appeared that increased cooling due to sluggish blood flow in areas of the skin corresponding to the blue areas of physiological livedo may have caused the localization of cryoprecipitate at these sites. To investigate the pathogenesis of the net-like pattern of purpura, three subjects with physiological livedo reticularis of the thighs were studied with a laser-Doppler velocimeter.

The study of plaques of psoriasis using a scanning laser-Doppler velocimeter.

A scanning laser-Doppler velocimeter, able to measure blood flux over a large area without contact with the skin surface, was used for the objective measurement of the vascular changes in psoriasis. Individual plaques were scanned, and tracings of the visible plaque edge taken on to a cellulose-acetate sheet from which area measurements were made using a digitizing tablet. Mean blood flux within plaques was increased fourfold compared with mean background flux.

Secondary localized cutaneous amyloid in Bowen's disease.

A case of Bowen's disease is described in which striking quantities of amyloid were detected in the papillary dermis visualized easily by routine haematoxylin and eosin staining. The material showed positive labelling with an antikeratin monoclonal antibody consistent with the proposed origin of the amyloid as degenerate keratinocytes. The pathobiology of amyloid associated with dysplastic squamous lesions is discussed.

Effect of H1-receptor blockade on anthralin inflammation.

The effect of terfenadine, an H1-receptor antagonist, on anthralin inflammation was studied in 12 subjects. Subjects were randomised to receive terfenadine 60 mg or placebo b.d.