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A patient with persistent urticaria related to the premenstrual phase of the menstrual cycle is presented. Although systemic administration of progesterone provoked the eruption, we were unable to confirm that there was an immunological reaction to endogenous progesterone or oestrogen. Mechanisms whereby progesterone can augment subclinical types I and IV hypersensitivity reactions are discussed.

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Pyogenic granuloma, also known as lobular capillary haemangioma, is a solitary, benign vascular skin tumour. Although a single pyogenic granuloma is common, multiple eruptive pyogenic granulomas are extremely rare. We report the occurrence of multiple, eruptive pyogenic granulomas in a previously healthy 17-year-old girl. Over 200 lesions appeared spontaneously over an 8-month period. Lesions were initially treated with cryotherapy, and then with the pulsed dye laser, resulting in their complete clearance.

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A 61-year-old black man suffering from actinic reticuloid with contact allergy to four substances, extreme sensitivity to both ultraviolet A and ultraviolet B, normal visible light sensitivity, and negative results on photopatch tests was placed on a regimen of azathioprine, 50 mg twice a day. At 3 months, clinical appearance was unchanged, as was his strong contact allergy; however, tolerance to natural sunlight was markedly improved. At 6 months the clinical appearance and ultraviolet responses were normal; however, strong contact allergy persisted. To our knowledge, this is the first report of actinic reticuloid in a black person. Azathioprine, after giving an excellent clinical response without leukopenia, was discontinued. A further 9-month follow-up showed continued remission. The persistence of contact allergy, despite profound improvement in photosensitivity and the skin's appearance, suggests that the role of contact allergy in the cause of actinic reticuloid is unclear, and the existence and identity of the hypothesized photosensitizer(s) in actinic reticuloid remain unproved.

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A pilot study of five patients was conducted using an aqueous anthralin cream (Drithocreme) and demonstrated that between twenty and forty minutes was an effective contact time to produce an improvement in induration of psoriatic plaques. In a further, bilateral controlled study, the anthralin cream was used to treat twenty patients with symmetrical chronic plaque psoriasis. The cream was applied to one side of the body overnight and then to the other side in the morning. Thirty minutes later it was washed off both sides in a bath or shower. The results indicated that both overnight and short-contact treatment were equally effective, and the short-contact treatment reduced staining and irritation.

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We have investigated the clinical responses of 21 patients with severe psoriasis to therapy with etretin, a metabolite of etretinate. In a preliminary double-blind dose-finding study, the optimum dose of etretin was determined to be 50 mg/d (mean, 0.66 mg/kg/d). In an open study, patients receiving etretin therapy were followed up for a minimum of six months. An excellent or good response (greater than 50% clearance) was obtained in 18 of 21 patients. The incidence of mucocutaneous side effects from etretin therapy was similar to that previously reported with etretinate therapy. As a group, patients who received etretin therapy for six or more months showed no significant aberrations from normal levels of serum lipids or serum liver enzymes. However, five patients had mild elevation of liver enzymes or blood lipids, which were corrected by dose reduction. Etretin showed equivalent efficacy to that previously reported with etretinate in severe recalcitrant plaque psoriasis vulgaris. Taken with the reportedly more rapid clearance of etretin from the body, there may be clinical advantages of the use of etretin over the use of etretinate.

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The clinical response to isotretinoin (13-cis-retinoic acid) in 11 patients with generalized pustular psoriasis was evaluated. Control of pustulation and systemic symptoms was achieved in ten cases, but additional therapy was required to produce complete clearing of all psoriatic lesions. Also, the efficacy of isotretinoin and etretinate in the treatment of chronic plaque psoriasis was compared in 29 patients. Isotretinoin was found to be less effective than etretinate in the treatment of chronic plaque psoriasis.

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