In this study, superficial fungal infections were reported more commonly in female (n = 207) than in male (n = 182) patients. M. canis was the chief agent of tinea capitis and tinea corporis, whilst T. rubrum was the main causative agent of tinea pedis, tinea manuum, and tinea unguium. Onychomycosis due to Candida species was more common in female than in male patients.

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Vasculitis is an adverse effect of numerous drugs. We report on a man who developed vasculitis and died after taking ofloxacin for a chest infection. Case reportA 75 year old man was treated with bumetanide and spironolactone for cardiac failure. Two weeks later he was given ofloxacin 200 mg twice daily for-five days for apparent bronchitis. Several haemorrhagic bullae and palpable purpuric rash developed on the feet and hands (figure). He After the publication of an article entitled "Dermatologists should not be concerned in routine treatment of warts"' we sent a questionnaire to dermatologists to determine whether this was a generally accepted view. We report our results, which show some of the difficulties in defining standards for hospital referrals. Methods and resultsWe sent a questionnaire to 144 randomly selected consultant dermatologists in England and Wales; 131 replies were received (92%). Once general practitioners were sure about the diagnosis ofwarts 46 dermatologists agreed that they should be able to refer any patient they wanted; 43 that they should be able to refer patients with multiple warts; 33 that they should be able to refer patients with single plantar warts; and 93 that they should be able to refer patients with warts resistant to three months' topical treatment. Fifty six, 52, 59, and 17 respectively, however, disagreed that general practitioners should be able to refer under these conditions. Although several dermatologists did not fill in this part of the questionnaire, only three replied "don't know" to these questions. A similar divergence of views was seen in the response to a general question about the appropriateness of a hospital based service for treating warts (table).Widely ranging views were expressed in additional comments or letters, several of which were very detailed. Some consultants argued that warts were far from trivial and that wart clinics offer a valuable 658 BMJ VOLUME 299 9 SEPTEMBER 1989

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