Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.

The general features of a group of cysts of the neck (commonly designated “branchial”) are, described. They are found over a relatively wide area and are related more closly with lymph nodes and lymphoid tissues than with other structures. The various congenital hypotheses are discussed and rejected, partly because embryological investigations have indicated their inadequacy and because the cysts do not show any constant features which might support these speculations. The relationship of the cysts to lymph nodes and lymphoid tissue suggests an alternative hypothesis. The term “Branchial Cyst” is misleading and should be discarded. Since it emphasises the one constant feature of the cysts and is purely descriptive, the term “Lateral Lympho‐epithelial Cyst” is suggested for the group.

Topical corticosteroids remain the most common treatment for eczema; however, it is uncertain whether long-term use of these agents has any adverse effect on bone mass. Cyclosporin is very useful in patients with severe atopic dermatitis who have failed conventional therapy. It has been shown to induce bone loss. We compared 43 children with severe eczema who were using topical corticosteroids with 73 healthy children. Of the 43 patients, six were also taking cyclosporin. Bone mineral density was measured in the lumbar spine and in the femoral neck using dual-energy X-ray absorptiometry. In multivariate analysis, subjects with eczema had lower lumbar spine bone mineral density (-0.03 g/cm(2); p = 0.015) and bone mineral apparent density (-0.01 g/cm(3); p = 0.008) but higher FN BMAD (+0.02 g/cm(3); p = 0.029) compared with controls. Patients with eczema on topical corticosteroids who had used cyclosporin had lower lumbar spine bone mineral apparent density (-0.01; p = 0.006) compared with those only on topical corticosteroids in both adjusted and unadjusted analysis. In conclusion, children with severe eczema have decreased lumbar spine bone mass, which is primarily mediated by cyclosporin use rather than by topical corticosteroid use. This effect is likely to lead to a modest increase in the risk of wrist and forearm fractures in children using this agent.

Benzalkonium chloride is a quaternary ammonium cationic detergent present in a number of household products, which can act as a major skin irritant. We present the case of six children who developed granular parakeratosis after exposure to benzalkonium chloride in laundry rinse aids, presenting as a brightly erythematous, tender but minimally pruritic, intertriginous eruption followed by superficial desquamation. The eruptions resolved over 3-4 weeks after cessation of exposure.

Probiotic supplementation may decrease the risk of allergic disease; however, there are differences between studies, such as the type of probiotic, the route or the duration of supplementation. Therefore, determining the most effective probiotic strain/s,

Summary The general features of the various stages of the pilonidal sinus are described. The “congenital hypothesis is reviewed. An alternative hypothesis is presented and the evidence for this is set out. The significance of this view in treatment is bi*iefly discussed.

Summary In review, at the early stage of varicosis there is in an area, a dilatation, sometimes of sudden onset, without valvnlar in competence, with centripetal pulsation and without involvement of the proximal part of the veins. At this stage the veins are capable of contraction, that is, the muscle is not degenerate nor intrinsically weak; yet dilatation does occur. These phenomena are explained by the action of some chemical factor, possibly a hormone or hormones of the oestrogen group, which have been shown to produce relaxation of smooth muscle in other tubes. Once the condition has developed, then, just as with other structures such as bones, mechanical factors come into play and produce the various secondary changes which are clearly the effect of hydrostatic stresses. These give rise to the structures which are “ill‐faced”, worse bodied, shapeless everywhere. The distinction between the two stages is of paramount importance in distinguishing between primary aetiological factors and those responsible for the more obvious and, in some respects, the more important secondary changes.

THE easily accessible position of ganglia allows of comparatively complete clinical investigation, but despite the observations of centuries, the nature and cause of the condition elude both practical and philo-FIGURE I. Photomicrograph of a section taken from the synovial membrane of a tendon sheath in an example of early ganglion. showing areas in which the spindle cells are becoming spheroidal and are undergoing a mucoid change. X indicates the foci o€ cellular change. x 90.sophical probing into the question. At the same time, 8 large amount of information has been collected, and from this certain deductions may be made.