The cellular infiltrate was large and active with a greater nonspecific response (few memory T cells) in early lesions of NS patients, which subsided in resolution. In contrast, a predominantly specific immune response was present in S patients, which was initially smaller and ineffective, but was increased and activated in resolving lesions. Such excessive inflammation in healing tissue is conducive to scarring and suggests that the use of topical anti-inflammatory treatments would be appropriate for these patients.

Acne vulgaris is a common inflammatory dermatosis capable of producing significant psychological and physical scarring. The following work describes the benefit of using a questionnaire as a clinical tool to identify acne patients who have developed psychological sequelae as a result of the disease process. In addition, the benefit of isotretinoin on psychological impact has also been highlighted by this work. A prospective clinical study examines the early use of isotretinoin in acne and demonstrates the beneficial effect of early therapy in minimising acne scarring. In summary, oral isotretinoin (Roaccutane®/Accutane®) provides a very effective therapy to prevent acne patients being ‘scarred for life’!

Renal transplant recipients have an increased risk of developing non-melanoma skin cancer. Ultraviolet radiation is one of the major cofactors in the development of skin cancer in the immunosuppressed. In view of this, we undertook this study to determine the advice given to renal transplant recipients and their compliance with that advice. Two hundred and two renal transplant recipients were interviewed using a questionnaire. Their knowledge about the risk of non-melanoma skin cancer and preventive measures was not good, despite advice and literature given to newly transplanted patients at the time of discharge from hospital. Only 54% remembered receiving advice. Renal physicians and nurses gave advice to the majority, with dermatologists providing advice only in 17% of cases. The use of sun-protective measures such as sun avoidance and protective clothing was poor and the use of sun barrier creams was inappropriate. Only 30% of patients knew why extra precautions against sunlight were necessary. Health professionals and dermatologists in particular need to take a more active role in raising the awareness of renal transplant recipients to their increased risk of non-melanoma skin cancer.

PDT is an effective treatment for low-risk BCC, with excellent cosmesis and safety. Imiquimod has higher efficacy than single-cycle PDT but more adverse effects. Highest efficacy is with excisional surgery. Fractionated and combination PDT options warrant further study.

No abstract

The pulsed tunable dye laser (PTDL) is generally considered to have a very low incidence of adverse effects, allowing it to become the treatment of choice for the majority of port wine stains (PWS). The low incidence of adverse effects has led to difficulties in determining the true incidence and type of adverse effect seen with this laser. We therefore undertook a retrospective study of 701 patients with PWS, who received 3877 full treatments to determine the incidence and type of adverse effects seen following treatment with the PTDL. Blistering and crusting were seen in 5.9% an 0.7% of patients, respectively, but were transient events which usually healed without permanent sequelae. Hyper-pigmentation was the most frequently observed adverse effect seen in 9.1% of patients but generally showed gradual resolution over 6-12 months. Hypopigmentation was infrequent, seen in 1.4% of patients. The most significant adverse effects were atrophic and hypertrophic scarring seen in 4.3% and 0.7% of patients, respectively. Our observations show that there is a small but definite risk of atrophic scarring with a predisposition for younger patients. Hypertrophic scarring can occur albeit rarely and there may be predisposition towards the neck. In most cases test areas were not predictive of scarring. This underlines the need for a full discussion of scarring risk in patients with PWS undergoing treatment with the PTDL.

The treatment of acne fulminans has been difficult. It is difficult to perform a controlled treatment trial due to the rarity of the complication. However, it is possible to compare four different therapeutic regimens which have evolved with time in the management of 25 patients over a period of 25 years. Oral antibiotics produced a slow response in the resolution of acne and systemic symptoms. The addition of a systemic steroid produced a quick resolution of systemic features, but the time until resolution of the acne was longer than when it was used in combination with oral isotretinoin. The protocols which used a combination of prednisolone and isotretinoin led to faster control of systemic features as well as clearance of acne when compared with other protocols. This was particularly so if the oral steroid was used sooner rather than later. We conclude that the preferred treatment of acne fulminans is oral prednisolone 0.5-1 mg/kg daily for 4-6 weeks (thereafter slowly reduced to zero) with oral isotretinoin being added to the regimen at the fourth week, initially at 0.5 mg/kg daily and gradually increased to achieve complete clearance.

There is a very small number of patients who suffer from acne even in the sixth and seventh decades of life. These patients have suffered from acne for most of their lives, 30-60 years, and have often received multiple courses of antibiotics over many years. We saw 10 such patients over 4 years. One received oral isotretinoin 1 mg/kg per day, but was unable to tolerate the adverse effects of cheilitis and developed hyperlipidaemia. We subsequently treated nine others with oral isotretinoin, 0.25 mg/kg per day, for 6 months; in six the acne had virtually cleared by 3-4 months while the other three cleared by 6 months. Up to 36 months after therapy these patients have remained clear of acne except for one who relapsed after 11 months. Therefore, as these patients respond well with few side-effects both in the long- and short-term to low-dose isotretinoin, they should be treated with isotretinoin, although at the lower starting dose of 0.25 mg/kg per day compared with younger patients who are treated with 0.5-1 mg/kg per day, and the treatment maintained for 6 months.