We report the successful treatment of five children with facial pyogenic granuloma using topical imiquimod 5% cream. In all cases, resolution of the lesions was achieved within 2-4 weeks. Local erythema and scaling, consistent with a typical imiquimod response, was the most commonly observed side effect. No systemic complications were observed in any of the patients. There has been no recurrence of any of the lesions to date. Small mildly erythematous or hypopigmented macules remain at this stage of follow up.

Since it was first approved for use in 1982, isotretinoin has revolutionized the management of acne vulgaris. Despite almost four decades of widespread use, uncertainty still exists regarding the manner in which it is best prescribed. In this review, we provide an update on the pharmacokinetics, mechanism of action, contraindications, interactions, and appropriate dosing schedule of isotretinoin in the treatment of acne. We also discuss the safety of performing concurrent dermatological procedures in patients taking isotretinoin.

We report four cases of cryptococcosis presenting as upper limb cellulitis or ulceration, or both. Three of the four patients were on long-term prednisolone therapy at the time of presentation. In each case, the diagnosis of cryptococcosis was established by a biopsy of the skin. Only one of the four patients had conclusive evidence of disseminated disease. Our cases highlight the importance of skin biopsy in immunosuppressed individuals presenting with cellulitis, particularly when the cellulitis occurs in an atypical location and when the clinical condition fails to respond to standard antibacterial therapy.

Locally advanced skin cancer of the nose is problematic, especially when all nasal skin needs treatment as in the case of skin field cancerisation (SFC). Surgery is considered the gold standard but involves tissue loss which may impact function and cosmesis. In patients who are not good surgical candidates, definitive radiotherapy (RT) can be used.Traditional RT modalities for the nose, such as brachytherapy, superficial x-ray treatment or electrons, have quality assurance issues and can be difficult to conform to the target volume. Volumetric modulated arc therapy (VMAT) is an advanced form of intensity modulated radiotherapy (IMRT). IMRT confines the high dose of radiation to the tumour and is used to avoid irradiating a dose-sensitive structure in the concavity of a volume that requires a therapeutic dose for tumour control. Within the nose, the nasal septum is a dose-limiting structure in the concavity of the skin covering the nose.We present here a case report using a VMAT technique to treat SFC of the nose. To our knowledge, this is the first description in the literature of VMAT for SFC of the nose. We also believe it to be the first time that VMAT simultaneous integrated boost (SIB) to biopsy proven macroscopic disease has been used when treating SFC.

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A 56-year-old man presented with a 4-month history of a painful and pruritic eruption consisting of crusted plaques and blisters on his face, scalp and chest. The patient suffered from headaches and malaise but was afebrile. Two skin biopsies revealed an epidermis which was eroded and covered by locules of serum and neutrophils. In the underlying dermis, there was a marked mixed inflammatory reaction including lymphocytes, neutrophils and numerous eosinophils. There was exocytosis of eosinophils into several follicles with areas of follicular mucinosis. A diagnosis of necrotizing eosinophilic folliculitis was made based upon the clinical and histopathological findings. The diagnosis was supported by the rapid response to a combination of indomethacin and cephalexin. The patient has taken continuous indomethacin (with rabeprazole and misoprostol cover) and cephalexin for 2 years. If treatment is withdrawn he experiences a flare of his disease within 2 weeks. This case highlights the potentially chronic nature of this disease.