A case is presented of generalized skin hyperpigmentation due to alpha-MSH hypersecretion from the pituitary that was most marked in the light-exposed areas. The patient also had secondary adrenal dysfunction, peripheral lymphadenopathy, streptococcal glomerulonephritis and malabsorption. Analysis of this patient's alpha-MSH using high-pressure liquid chromatography (HPLC) showed a novel acetylation profile compared to normal individuals and to patients with Cushing's disease and Nelson's syndrome. Glucocorticoid replacement therapy resulted in suppression of alpha-MSH hypersecretion and complete resolution of the illness.

SUMMARY Intradermal injection of purified protein derivative produced typical delayed type hypersensitivity reactions in five healthy human subjects. The The results suggest that there is no subset selection in the initial emigration of lymphocytes through vascular endothelium in the delayed hypersensitivity reaction, but that the subsets behave differently during the subsequent migration through the tissues. It remains to be determined whether the extent to which T8 cells migrate more rapidly than T4 cells through the tissues may influence the reaction at the site of entry of organisms or antigens into the body by altering the balance of the immunoregulatory lymphocyte subsets. This may underlie some of the differences in susceptibility to infection between subjects and determine the type of granuloma that develops in a particular patient.

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A quantitative study of 8-methoxypsoralen plasma profiles in patients with psoriasis undergoing photochemotherapy shows that a poor response to the treatment may be explained in terms of abnormal pharmacokinetic behaviour. However, not all 'poor responders' exhibit an abnormal pattern and for these an alternative explanation is required.

SUMMARY We have shown that it is possible to produce a satisfactory clinical response with a low UV‐A dosage regime in approximately one‐third of patients with widespread chronic psoriasis. UV‐B phototherapy is as effective initially, but the improvement is not as well maintained as that resulting from photochemotherapy (PUVA). However, in view of the probability that unwanted side effects of PUVA are related to the amount of UV‐A irradiation administered, it would seem appropriate to restrict the use of the higher dosage regimes to selected patients and to those who have not responded to an initial low dosage regime or to UV‐B phototherapy.

Terfenadine, a potent and non-sedative antihistamine, was shown to be effective in chronic idiopathic urticaria in a double-blind crossover placebo controlled trial. An oral twice daily 60 mg dose of terfenadine was given and itch and wheal parameters were assessed daily. Despite the overall effectiveness of terfenadine, a variable response was noted which was similar to that shown in previous studies with other antihistamines.

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