Notes: Eccrine syringofibroadenoma (ESFA) is a rare disorder. We report the first case of ESFA of the nail apparatus, which presented as a yellow longitudinal onycholytic band of the left fourth finger over an intermittently painful subungual filamentous tumour. Histological examination showed features of ESFA with a digitate pattern of papillomatosis due to the specialized physiological longitudinal arrangement of the ridges in the nail bed. In addition, we describe a new feature of colloidal iron-positive clear cells. In our case, the presence of two types of cells with a central ductal differentiation and a significant amount of mucopolysaccharides in clear cells could suggest differentiation towards both the ductal and the secretory portion of the eccrine gland.

Notes: Background  A successful phase III pilot study compared the efficacy and safety of a fixed clindamycin 1%/tretinoin 0·025% gel formulation (CTG; Velac® gel) applied once daily and a clindamycin 1% lotion formulation (CLN; Dalacin T® lotion) applied twice daily in the treatment of moderate to severe acne vulgaris. Objectives We aimed to follow up this study.Methods The two treatment regimens were compared in a multicentre, single-blind, randomized 12-week investigation of patients with moderate to severe acne vulgaris. Results At week 12, the mean percentage reduction in non-inflamed lesions (open and closed comedones) was greater in the CTG group compared with the CLN group (P = 0·05). Absolute reductions in open and closed comedones were also greater in the CTG group, consistent with the comedolytic activity of tretinoin. There was a significantly greater absolute reduction in inflamed lesions (pustules, papules and nodules) from baseline to both end-point (last observed efficacy outcome; P = 0·043) and week 12 (P = 0·018) in the CTG group compared with the CLN group. Evaluation of the calculated overall acne severity score, considering all five lesion subtypes, demonstrated a significantly greater mean percentage reduction in the CTG group compared with the CLN group, both at end-point (P = 0·01) and at week 12 (P 〈 0·01). The more subjective assessment of overall acne severity according to the Cook scale also demonstrated a significantly greater mean reduction in the CTG group than the CLN group after 12 weeks of therapy (P = 0·007). CTG had a more rapid effect on the onset of improvement compared with CLN; a 50% reduction in total lesion counts by day 60 was found in 77% of patients on CTG compared with 56% receiving CLN (P = 0·003). This was largely due to the reduction in open comedone counts (P = 0·0006). For all other variables, CTG was at least as effective as CLN. Both treatments were well tolerated. Conclusions A single daily topical application of Velac® gel was superior to Dalacin T® lotion applied twice daily in reducing overall acne scores, and was faster acting. The simpler dosing regimen of Velac® gel and its rapid effect are likely to have a positive effect on both patient compliance and cost.

Notes: Histiocytic cells infiltrating the lesions in eosinophilic granuloma of bone as well as in cutaneous histiocytosis X were studied using a murine monoclonal antibody (MA) produced with proliferating cells from an eosinophilic granuloma of bone. This MA reacts with Langerhans cells (LC) of normal human skin or mucous membranes and with proliferating cells of eosinophilic granuloma of bone and skin lesions of Letterer-Siwe disease, as shown by immunohistochemistry and immunogold labelling.As other murine MA's obtained after immunization with human cortical thymocytes, this MA immunoprecipitates the 49-kDa CD la antigen found on human LC and thymic-cell surfaces but not its breakdown product after treatment with trypsin, as demonstrated by analysis of immunoelectron labelling, cytofluorometry and gel electrophoresis. This first production of a CD la MA from an eosinophilic granuloma supports the concept of Langerhans-cell histiocytosis.

Notes: Summary  Background Calcipotriol and betamethasone dipropionate are both widely used, effective treatments for psoriasis. Vitamin D analogues and topical corticosteroids have different mechanisms of action in the treatment of psoriasis. A new vehicle has been developed in order to contain both calcipotriol (50 µg g−1) and betamethasone dipropionate (0·5 mg g−1) in an ointment form. By using calcipotriol and a corticosteroid together, greater efficacy may be achieved than by using either compound alone. Objectives The present study was conducted in order to compare the clinical efficacy and safety of the combined ointment formulation used once daily with the vehicle ointment used twice daily, calcipotriol ointment used twice daily and the combined formulation used twice daily in psoriasis vulgaris. Methods This was an international, multicentre, prospective, randomized, double-blind, vehicle-controlled, parallel group, 4-week study in patients with psoriasis vulgaris amenable to topical treatment. Patients were randomized to one of four treatment groups: combined formulation once daily, combined formulation twice daily, calcipotriol twice daily or vehicle twice daily. Efficacy and safety were assessed. Results There was no statistically significant difference in the mean percentage change in the Psoriasis Area and Severity Index (PASI) from baseline to end of treatment between the two combined formulation groups, but the difference in PASI reduction was significantly higher in the combined formulation groups (68·6% once daily, 73·8% twice daily) than in both the twice daily calcipotriol group (58·8%) and the vehicle group (26·6%). Safety data showed the frequency of adverse events to be less in the combined formulation groups than in both the calcipotriol group and the vehicle group. The proportion of patients with lesional/perilesional adverse reactions was less in the combined formulation groups and vehicle group than in the calcipotriol group (9·9% combined formulation once daily, 10·6% combined formulation twice daily, 19·8% calcipotriol, 12·5% vehicle). Conclusions No statistically significant nor clinically relevant difference in efficacy was seen between the combined formulation used once daily and twice daily. When compared to vehicle ointment or calcipotriol ointment alone, the combined formulation was shown to be clearly more efficacious.

Notes: In a 32-year-old patient suffering from a mild form of epidermolysis bullosa acquisita, the level of the dermolytic cleavage was determined by immunofluorescent mapping of the antigenic determinants (type IV-collagen and laminin), which were found on the roof of the blister. This labelling pattern was compared with the in vivo deposit of IgG by a double immunofluorescent technique. With regard to electron microscopy, this method represents an easier and more rapid diagnostic procedure.

Notes: Over the past 8 years, we have followed a child born as a harlequin baby, who survived due to treatment with retinoids. His condition evolved clinically towards the erythrodermic form of lamellar ichthyosis (non-bullous congenital ichthyosiform erythroderma, NBCIE). According to ultrastructural and biochemical criteria, our patient originally presented with type II harlequin ichthyosis. Investigations showed an abnormal keratinosome structure and extrusion, a keratin pattern characteristic for epidermal hyperproliferation, and an absence of conversion of profilaggrin to filaggrin. Persisting keratinocyte hyperproliferation, associated with the presence of a dermal infiltrate, is in agreement with the present clinical picture of severe NBCIE. However, abnormal lamellar body production and defective filaggrin processing, which is not one of the diagnostic criteria of NBCIE, persist in the patient's skin. Further studies of the epidermal lipid composition, and of possible mutations of the keratinocyte transglutaminase gene performed on epidermal cell cultures of harlequin ichthyosis, will be necessary before type II harlequin ichthyosis can be accepted as an extremely severe form of NBCIE.

Notes: Keratinocytes from a 1-week-old male infant with junctional epidermolysis bullosa letalis (JEBL) were grown in vitro and then grafted as multi-layered epithelia onto nude mice, to investigate whether the defect in the dermo-epidermal cohesiveness in the disease is of epidermal and not mesodermal origin. In culture, there was a birefringent ring of cells at the edges of the keratinocyte colonies and in places some cells looked as though they had been ejected from the periphery of the colony. At confluence, the multi-layered epithelia were easily detached from the culture flasks using only mechanical agitation. On microscopy the fully-differentiated epithelium on days 21, 30 and 40 after grafting sometimes showed blistering at the dermal-epidermal junction. No labelling was noted using a GB3 monoclonal antibody, that reacts with normal human keratinocytes in culture and with the dermo-epidermal basement membrane zone in normal skin. This indicates that the defect of JEBL may be reproduced in culture and also after grafting the cultured epithelia onto a wound without an epidermis. This suggests a possible role for the junctional structure recognized by GB3 in dermo-epidermal cohesiveness.