North-east Scotland appears to have a relatively high incidence of BP when compared with incidence rates in continental Europe. The mortality rate in patients with BP is considerable, especially within the first 2 years of diagnosis.

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.

The thickness of, and number of cell layers in, the stratum corneum and the living epidermis were determined on frozen sections of washed and unwashed skin from normal and atopic individuals of both sexes. The stratum corneum of atopic patients was thinner and had fewer layers of dead cells and intercellular lipid than normal, although the living epidermis was thicker. Regular washing with soap and water had no appreciable effect on the dimensions of the living epidermis of either group but caused a reduction in the number of cell layers and the amount of sudanophilic material in the stratum corneum of both. In atopic patients little surface lipid remained, suggesting that washing with soap and water may be detrimental to the barrier function of the stratum corneum in such patients.

The molecular epidemiology of molluscum contagiosum virus (MCV) infections was investigated by restriction endonuclease analysis of the genomes of 222 separate isolates collected from 147 patients living in Germany (33 patients), Hong Kong (6 patients), and Scotland (108 patients). MCV type 1 (MCV-1) caused 96.6% of the infections, and MCV type 2 (MCV-2) caused 3.4%. However, isolates from four of the 142 MCV-1-infected patients and two of the five MCV-2-infected patients showed minor differences in their DNA restriction patterns because of the loss of a single or very few recognition sites for the enzymes used. No genome variations were detected amongst isolates collected from different sites or on several occasions from individual patients or from closely related patients. Southern blot hybridization revealed a high level of relatedness between MCV-1 and 2. No differences were seen in the appearance or anatomical localization of lesions caused by either virus type. In particular, there was no preferred genital localization for MCV-2 infections.

Summary The high carriage rate of Staphylacoccus aureus and the dense colonization of the skin of patients with atopic dermatitis has been confirmed in British patients; clinical infection is apparent at lower densities of staphylococci than recorded elsewhere. Staphylococcal folliculitis was seen in 16 of 45 patients admitted to hospital for treatment. Phage typing revealed that all phage groups may occur on lesions. Comparison between the phage types and antibiograms of the staphylococci in the carrier sites with those on the lesions of dermatitis and in the pustules suggests that, in general, the bacteria are the same although infection with other strains of staphylococci occurs. During therapy directed at the atopic dermatitis, the staphylococci are greatly reduced in number.

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