Argyria is a rare cause of cutaneous discolouration caused by silver deposition. We report a case of dramatic and diffuse argyria secondary to ingestion of colloidal silver protein over a 1-year period. Stained electron microscopy with spectral analysis was used to confirm the clinical diagnosis. Silver-protein complexes are deposited in the skin and reduced to inert silver salts by sunlight in a process similar to that harnessed in photography. Our patient had obtained the silver for consumption via mail order. It had been advertised as a cure for a variety of diseases. Colloidal silver protein is commercially available as a 'food supplement', hence circumventing the strict controls placed on medicines.

Cutting fluid technology has rapidly developed, presenting dermatologists and occupational physicians with a changing pattern of skin disease. The use of soluble oils has increased, and has been followed by an increase in the incidence of eczematous dermatitis. This is usually an endemic, chronic, irritant contact dermatitis, but thorough patch testing can also reveal allergic contact dermatitis. In conditions of heavy exposure, the prevalence of dermatitis can be as high as 30 per cent. Individual susceptibility is very variable. Research into resistance factors in those who do not develop dermatitis, and susceptibility factors in those who do, may elucidate basic mechanisms of irritancy. Efforts must continue to be directed at prevention because, once established, soluble oil dermatitis can be slow to resolve, even after specialist treatment and change of job. Prevention can be directed at the machine operative, the soluble oil, and the machine.

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We report the rare instance of four family members with numerous cutaneous lesions of Leishmania major contracted while on holiday in Algeria. Treatment was successful with oral itraconazole for the children and intralesional sodium stibogluconate for the mother. Cutaneous leishmaniasis should be considered in those with apparently sterile plaques returning from endemic areas. These results suggest that itraconazole, which is ideally suited for use in children, is an effective monotherapy for L. major.

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