Truth in clinical research trials involving pharmaceutical sponsorship

Large clinical trials are expensive to mount. Funding comes mainly from pharmaceutical companies seeking information on drug efficacy and adverse events. Patients should be informed of the financial and publication agreements reached between those conducting the trials. This is unlikely to have a significant effect on trial participation and will provide patients with information relevant to informed consent. A small proportion of monies raised from drug trials could be set aside to fund both a trial register site and further studies on adverse drug reactions.

The use of gloves in Australian dermatological practice

Dermatologists use gloves as a major tool in universal precautions to prevent transmission of infections particularly human immunodeficiency virus (HIV) and hepatitis. We need to know how much protection is conferred by gloves and what problems are associated with glove use. This paper looks at these issues and reports the results of a survey on glove use by Australian dermatologists. The survey found a lack of awareness regarding gloves as a protective measure, suggesting the need to improve knowledge in this area so that realistic precautions can be adopted. Dermatologists have a high rate of glove use and reactions to gloves were noted by 13% of respondents. The authors recommend the use of non-powdered, low-allergen latex gloves. Handwashing prior to using non-powdered latex gloves needs further investigation. Handwashing after wearing latex gloves may decrease sensitization risk.

Hidradenitis suppurativa, Dowling Degos disease and perianal squamous cell carcinoma

A patient with hidradenitis suppurativa (HS) is described in association with Dowling Degos disease and perianal squamous cell carcinomas. As the initial treatment for HS failed to give any satisfactory relief he sought no further medical help for the subsequent 40 years. This patient illustrates the management difficulties in HS and the need for regular surveillance to exclude the development of anogenital squamous cell carcinoma. Previous reports of hidradenitis suppurativa in association with Dowling Degos disease are reviewed and the aetiology is discussed.

A pilot study on the percutaneous absorption of microfine titanium dioxide from sunscreens

Many Australians are being advised to apply microfine titanium dioxide sunscreen daily from the cradle to the grave. However, there is a surprising lack of data on the percutaneous absorption of microfine titanium dioxide. A prospective pilot study was conducted to analyse the percutaneous absorption of microfine titanium dioxide from sunscreens. Selected patients scheduled to have skin surgery, applied titanium dioxide sunscreen to the skin daily for 2-6 weeks prior to their operation. After excision, the stratum corneum of the sample was stripped and the titanium concentration of the remaining epidermis and dermis was measured by inductively coupled plasma-mass spectrometry. The results from this pilot study showed that levels of titanium in the epidermis and dermis of subjects who applied microfine titanium dioxide to their skin were higher than the levels of titanium found in controls. Studies with larger cohorts are necessary to establish if this absorption is statistically significant.

The turtle's revenge: a case of soft tissue Mycobacterium chelonae infection

A case of cutaneous Mycobacterium chelonae infection with sporotrichoid spread and extensive antibiotic resistance is presented. Control of this problem was only achieved after extensive debridement and grafting of the involved limb. The importance of surgery in management is discussed and the literature is reviewed.

Topical propylene glycol and hyperosmolality

Topical propylene glycol is known to cause elevated serum osmolality in burns patients. Twelve adults with skin disease had quantities of propylene glycol applied to their skin to a maximum of 6.1 g/kg per 24 h for 5 days. Serum electrolyte, lactate and osmolality results remained unchanged during the study. These results suggest that topical propylene glycol may be used in adult dermatological practice without affecting serum osmolality.

Squamous cell carcinoma in porokeratosis in two patients

Malignancy arising in porokeratoses is a well recognised but infrequently reported complication. Histological studies suggest that malignancy arises from the abnormal clone of keratinocytes which produce the cornoid lamella. We report two cases of squamous cell carcinoma arising in porokeratoses and postulate genetic, environmental and host factors as important in the evolution of their malignancy.

Disseminated superficial actinic porokeratosis: a clinical study

Disseminated superficial actinic porokeratosis is an autosomal dominant condition that requires sun exposure for full expression. It affects only sun-exposed areas, with relative sparing of the face. In sun-damaged skin of Australians disseminated superficial actinic porokeratosis is commonly mistaken for solar keratosis. Twenty-nine subjects with disseminated superficial actinic porokeratosis were involved in an extensive questionnaire and clinical study. The distribution of lesions was charted on all subjects, with a mean count of 268 lesions per subject. We found no evidence that skin cancer had arisen in disseminated superficial actinic porokeratosis lesions. A review of the etiologic and clinical features of disseminated superficial actinic porokeratosis also is presented.

Twenty nail dystrophy in identical twins

Twelve-year-old identical female twins have had lifelong twenty nail dystrophy. There is no evidence of other skin disorders. The condition has remained unchanged and has been unresponsive to a wide range of therapies. The benign clinical course of their nail disorder suggests twenty nail dystrophy may not be related to lichen planus or other cutaneous diseases. One of the causes of twenty nail dystrophy of childhood may be a localized tissue malformation, analogous to inflammatory linear verrucous epidermal naevus.

Linear porokeratosis in two families with disseminated superficial actinic porokeratosis

Two case reports of linear porokeratosis occurring in individuals or families with disseminated, superficial, actinic porokeratosis (DSAP) are presented. Linear porokeratosis and DSAP may be different expressions of one dominantly inherited condition. We reviewed the clinical features of linear porokeratosis and its association with other forms of porokeratosis. The linear form has a potential for carcinomatous change.

Tests to establish the diagnosis in cholinergic urticaria

Methods for establishing the diagnosis in cholinergic urticaria are reviewed and compared. Provocation by exercise or hot bath is more effective than local provocation by intradermal tests. Of the intradermal tests, responses to nicotine acid tartrate and acetyl beta methylcholine chloride are positive only in patients with the more severe, readily induced eruptions. Furthermore, intradermal testing is not always reproducible in the same patient. In our patients, exercise proved the simplest, most effective diagnostic test.