Pigmentary anomaly caused by mosaic 3q22.2q29 duplication.

A 39-year-old woman sought advice regarding potential risks to her offspring due to previous possible diagnosis of incontinentia pigmenti. She had linear hyperpigmentation along the lines of Blaschko affecting the upper and lower limbs, and skin-coloured papules on the left palm. Ophthalmoscopy revealed hypopigmented spots in the macular region of the retina in each eye due to focal areas of depigmentation of the retinal pigment epithelium.

Acantholytic dyskeratosis of the vulva presenting with clinical features of vulval lichen sclerosus-A possible rare collision entity.

We present a challenging case of chronic, erosive, scarring dermatosis of the vulva with clinical features of long standing lichen sclerosus (LS), namely pallor and loss of vulval architecture, but with histopathology consistently showing features of an acantholytic process. The history and clinical features of this case do not resemble other acantholytic conditions such as pemphigus vulgaris, Hailey-Hailey disease, Darier disease, or the entities described as acantholytic dermatoses affecting the vulva. As far as we are aware, the combination of the clinical features and histopathologic findings in our case do not fit with any previously described condition and we propose that this is a rare entity of a collision of LS and an erosive acantholytic process occurring together.

Successful treatment of high-grade vulval intra-epithelial neoplasia with imiquimod 5% in a renal transplant recipient.

Organ transplant recipients are at a higher risk of pre-malignant human papillomavirus-associated lesions due to immunosuppression. The efficacy of immunomodulants such as imiquimod 5% is not yet fully evaluated in this population. We describe a case of vulval intra-epithelial neoplasia in a renal transplant recipient which was successfully treated with topical imiquimod.

Time in motion--testing efficiency in the dermatology procedure setting.

Background: Time-in-motion studies are validated means of determining efficiency and identifying sources of delay in a complex working environment. This analysis technique was applied to the dermatological surgical services provided by a university hospital department of dermatology.

Objective: To identify any sources of low efficiency in dermatological surgical service provision and to make recommendations for increasing efficiency.

Dicaprylyl maleate--an emerging cosmetic allergen.

Dicaprylyl maleate (DCM) has been reported rarely as a cause of allergic contact dermatitis. The objectives of this study were to identify patients from multiple centres with allergy to DCM in cosmetic products confirmed by patch testing and, in addition, to investigate the effect of testing with aged DCM. This is an international multicentre study of 22 patients with 26 reactions to products containing DCM.

Vulvodynia.

Context: Vulvodynia is a term used to describe chronic burning and/or pain in the vulva without objective physical findings to explain the symptoms. The terminology and classification of vulvodynia continue to evolve, and much remains to be understood about the prevalence, pathogenesis, natural history, and management of this distressing condition.

Starting Point: James Aikens and colleagues showed that chronic vulval pain (vulvodynia or vulvar dysaesthesia) is associated with worse depressive symptoms (Am J Obstet Gynecol 2003; 189: 462-66).

Erosive lichen planus of the vulva and vagina.

Background: Erosive lichen planus causes erosion of the vulva and vagina and characteristic oral lesions. Dyspareunia is usual, and vaginal stenosis may occur. This report highlights the clinical features and the response to medical therapy.

Ulcerative vulvitis in atypical Reiter's syndrome.

We report a case of atypical Reiter's syndrome occurring in a female patient who had severe, ulcerative vulvar disease develop in association with conjunctivitis, low back pain, stomatitis, and psoriasiform skin lesions. Vulvar lesions have rarely been described in Reiter's syndrome and are not well characterized.

A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective.

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral--126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation.

A comparison of real-time and store-and-forward teledermatology: a cost-benefit study.

Background: Increasing use of teledermatology should be based on demonstration of favourable accuracy and cost-benefit analysis for the different methods of use of this technique. Objectives To evaluate the clinical efficacy and cost-effectiveness of real-time and store-and-forward teledermatology.

Methods: Patients attended their own health centre and in the company of a general practitioner (GP) were seen by a hospital dermatologist over the videolink (real-time).

Multicentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis.

Objectives: Comparison of real time teledermatology with outpatient dermatology in terms of clinical outcomes, cost-benefits, and patient reattendance.

Design: Randomised controlled trial with a minimum follow up of three months.

Setting: Four health centres (two urban, two rural) and two regional hospitals.

A randomized controlled trial to assess the clinical effectiveness of both realtime and store-and-forward teledermatology compared with conventional care.

The clinical effectiveness of realtime teledermatology, store-and-forward teledermatology and conventional outpatient dermatological care were evaluated in a randomized control trial. A total of 204 patients took part--102 patients were randomized to the realtime teledermatology consultation, 96 of whose cases were also referred using a store-and-forward technique, and 102 to the conventional outpatient consultation. There were no differences in the reported clinical outcomes of realtime teledermatology and conventional dermatology.

Subcorneal pustular dermatosis involving the face.

We report an interesting case of subcorneal pustular dermatosis in a young woman with prominent involvement of the face. Facial involvement in this condition has not previously been reported.