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Thirty cases of X-linked ichthyosis (XLI) and 32 cases of ichthyosis vulgaris (IV) were diagnosed by measuring the steroid sulphatase activity of peripheral blood lymphocytes or the electrophoretic mobility of serum LDL or both. The clinical features of the two conditions were then compared. In both diseases 60-66% of patients had a family history of the condition. Ichthyosis was noted at birth or immediately afterwards in 59% of the patients with XLI while it appeared in infancy in 68% of those with IV. Scales were mostly large and brown or dark brown in patients with XLI, while the majority of patients with IV had small brown or light brown scales. The distribution of the ichthyotic lesions differed in the two types of ichthyosis. On the trunk, the abdomen was more severely involved than the back in 63% of the cases with the XLI, whereas the back was more scaly than the abdomen in 44% of those with IV. On the extremities, the extensor surface was more severely affected than the flexor surface in both types. X-linked ichthyosis was characterized by the presence of lesions in the pre-auricular area, which were found in 93% of the cases with XLI, while only 17% of the IV patients had ichthyotic lesions at this site. Involvement of the preauricular area could be an important clinical feature for distinguishing XLI from IV.

Virological studies were performed on 12 patients with epidermodysplasia verruciformis (EV). Three types of lesions were observed: red plaques, pityriasis versicolor (PV)-like macules and plane warts. Human papillomavirus (HPV) 14, 20 and 21 were isolated from the plaques, HPV 3, 14 and 38 from flat warts and HPV 5, 12, 17, 20 and 38 from PV-like lesions. No clear relationship could be established between the different lesions and the types of HPV. Types 17 and 20 have been isolated most frequently from Japanese EV patients and HPV 5, frequently detected in other countries, is less common, whereas HPV 8 has not been isolated. Skin cancers occurred in six of the cases (50%) and all had benign lesions that were PV-like. At least one type of HPV 5, 17 or 20 could be isolated from these benign lesions and HPV 17 or 20 detected in the cancers. These three types of HPV in EV patients appear to be involved in the malignant transformation.

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A putative new herpesvirus, designated Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus-8 (HHV-8) was recently identified in AIDS-related Kaposi's sarcoma. The DNA sequence of the virus is homologous to the gamma-herpesviruses such as herpesvirus Saimiri or Epstein-Barr virus, both of which are tumorigenic, suggesting that this new virus may also be oncogenic. Thus, we determined whether the virus is present in other skin lesions. DNA samples from 118 skin specimens were tested for the HHV-8 sequence by polymerase chain reaction (PCR) and Southern hybridization. The sequences were detected in 13 of 21 samples from Bowen's disease, three of 11 squamous cell carcinomas, three of 11 actinic keratoses, three of seven leucoplakia, one of six from Paget's disease, one of 12 malignant melanoma, one of seven neurofibromas, two of seven chronic dermatites and one of 14 normal skin samples. On sequencing the PCR products, new mutation points were detected. These results suggest that the virus is associated with lesions other than Kaposi's sarcoma and may be more widespread than expected (with a latent level too low to be detected), like the other herpesviruses. Some lesions. e.g. in Bowen's disease or squamous cell carcinoma, may be locally immunosuppressed, allowing the virus to replicate until the copy number is sufficient for detection.

A patient on long-term minocycline therapy developed blue-black discoloration on the legs. Skin biopsy specimens from the pigmented areas were examined by light and electron microscopy and energy-dispersive X-ray microanalysis. Pigmented granules were present at all levels of the dermis and subcutaneous fat tissues. Ultrastructural examination showed electron-dense granular material within the cytoplasm of dermal macrophages and energy-dispersive X-ray microanalysis indicated that the granules contained iron. Thyroid tissue obtained by aspiration biopsy showed the presence of fine brown granules within the cytoplasm of the follicular epithelial cells. An extract of skin from the pigmented areas was subjected to high performance liquid chromatography and minocycline was detected.

A 29-year-old man being treated for itchy lesions on the amputation stump of the thigh became allergic to betamethasone valerate and gentamicin sulfate cream (Rinderon VG). Closed patch tests with all the ingredients of the cream revealed positive reactions to cetyl alcohol 30% to 5% pet. Gas chromatographic analysis of the cetyl alcohol in the cream base detected stearyl alcohol (C18), myristyl alcohol (C14) and lauryl alcohol (C12) in addition to the main component of cetyl alcohol (C16). Patch testing with 99% pure analytical reagent grade saturated alcohols (C10, C11, C12, C13, C14, C15, C16, C17, C18, C19, C20) showed negative reactions. Thus, it is concluded that some minor impurities in cetyl alcohol not detected by gas chromatography might be the cause of this dermatitis.