A short course of mild steroid ointment is an effective treatment for PA.

Molluscum contagiosum is a common viral infection of the skin that frequently affects children. Lesions take between 6 and 18 months to resolve spontaneously and are a source of great embarrassment to both caretakers and children, often affecting attendance at school and limiting social activity. Treatment options to date have been poorly tolerated by children but recent studies have suggested that potassium hydroxide may be beneficial. This double-blind, randomized, placebo-controlled study compared 10% potassium hydroxide with placebo (normal saline). Twenty patients, aged 2 to 12 years, were recruited. Parents applied a solution twice daily to lesional skin until signs of inflammation appeared. Children were examined by the same observer on days 0, 15, 30, 60, and 90. Seventy percent of children receiving topical potassium hydroxide cleared, compared with 20% in the placebo group. Further dosing studies are required to identify whether weaker concentrations of potassium hydroxide are as efficacious, with less irritancy.

We report a case of vulval squamous cell carcinoma (SCC) arising in chronic hidradenitis suppurativa (HS). The patient had a complex medical history including a 25-year-history of Crohn's disease. In addition she had recently received immunosuppressive therapy for nephrotic syndrome secondary to membranous glomerulonephritis. A painful nodule was noted on the vulva that was clinically very suspicious of SCC. An excision biopsy confirmed the diagnosis. There are few publications in the English literature citing association between HS and the development of SCC. The first report in the English literature of vulval SCC arising in chronic HS was published in 1999. We wish to draw attention to the possibility that patients with HS may develop SCC in lesional skin. A painful lump or ulcer could easily be mistaken for an inflammatory lesion and a low threshold for biopsy is warranted. We suggest constant vigilance with regard to malignant change in ano-genital HS as the diagnosis can be difficult.

Fixed drug eruption is characterized by recurrent well-defined lesions appearing in the same location each time the drug responsible is taken. A number of agents have been implicated. Metronidazole, a nitroimidazole agent widely used for its antibacterial and antiprotozoal activity, has been reported only rarely as the causative agent. We describe a patient with FDE due to metronidazole in whom we were able to induce the clinical and histological features of FDE by topical provocation testing. In agreement with the published literature we commend the use of topical provocation testing as a possible first-line investigation in the diagnosis of FDE. This may avoid the need for subsequent oral provocation testing and therefore the prevention of possible adverse sequelae.

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