In a consecutive series of thirty-six male and female patients referred with severe acne, the effect of 3 months' treatment with placebo or spironolactone (50-200 mg daily) on sebum excretion and clinical and endocrine status was evaluated double-blind. Twenty-six patients completed the study. Abnormal free androgen indices were found in 27% of the original nineteen female subjects. Spironolactone reduced sebum excretion in all female subjects, but there was no correlation between sebum response and androgen status. The clinical response was dose-dependent, with maximum subjective and objective benefit when spironolactone doses of 150-200 mg were used.

The effect of oral spironolactone (200 mg daily) on acne vulgaris has been studied in 21 women in a randomized, placebo-controlled, double-blind crossover study using 3 month treatment periods. Compared with placebo, spironolactone produced significant improvement as assessed by subjective benefit (P less than 0. 001), number of inflamed lesions (P less than 0 . 001) and by an independently evaluated photographic method (P less than 0 .02). There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone. Initial plasma androgen levels were no higher in responders than in non-responders, nor did oral contraceptive use appear to affect clinical response. Spironolactone is a useful alternative therapy for women with acne vulgaris.

The timing and changes of appearance in immune complex deposits in the Arthus reaction in the guinea-pig have been studied by immunofluorescence. At first vessels are outlined, then surrounded by chunky deposits which by 8 hr. have dispersed into the tissues. Complexes have disappeared completely at 18 hr. The relevance of these observations to the study of cutaneous vasculitis in man is discussed.Acceptod for publication Soptomber 17th, 1970.

The endonuclease digest patterns of viral DNA from 48 genital and 45 non-genital molluscum contagiosum virus (MCV) lesions were examined. The overall ratio of MCVI to MCVII was 3.23:1. There was no predominance of either MCV type in genital lesions. No obvious morphological differences were seen between MCVI and MCVII lesions. MCVII was not found in any patient under 15 years old.

SUMMARYRestriction endonuclease analysis of molluscum contagiosum virus DNA revealed two subtypes. In a study of 46 isolates from 41 patients, some with no other disorder and some with atopic dermatitis, the ratio of MCV I isolates to MCV II was 34:12. Multiple clustered lesions removed at the same time from an individual patient yielded only one type of MCV. Lesions induced by MCV I or MCV II were indistinguishable on the basis of size and form. Neither subtype was associated exclusively with lesions at certain sites or with other clinical features. Heterogeneity of DNA restriction endonuclease cleavage patterns amongst isolates of the same subtype was observed, this being greatest for MCV II.Molluscum contagiosum, a benign skin tumour of man resulting from a common poxvirus infection, has not previously been investigated intensively because of the inability to culture the virus in vitro and the fact that ordinarily the papules resolve spontaneously. Transmission of the virus is mechanical, and lesions may be found anywhere on the skin but are usually clustered. A common site of infection in adults is the genital area and, in such cases, sexual transmission of the virus is likely. Numerous, widespread, persistent and disfiguring lesions may develop in the immunosuppressed (for example in Hodgkin's disease or AIDS) and in atopic dermatitis, where immune defects have been suggested as a possible explanation for the increased incidence of molluscum contagiosum and other cutaneous infections (Postlethwaite, 1970;Brown, Nalley & Kraus, 1981). Restriction endonuclease analysis of MCV DNA has revealed two viral subtypes (Darai et al. 1986). We have reported the further characterization and physical mapping of their genomes, which are essentially collinear, and shown that MCV DNA is similar to Orthopoxvirus DNA with respect to size, terminal cross-linking and the presence of inverted terminal repetitions (Porter & Archard, 1987).In the study described here we have characterized viral DNA from 46 independent isolates from 41 individuals presenting to the skin or genito-urinary clinics to see whether there is any correlation between MCV type and clinical features or the distribution of the lesions. When several lesions were clustered at the same site and might reasonably be assumed to have arisen from the same infection, lesions were pooled. Patients with or at risk of human immunodeficiency