SUMMARY. —Beclomethasone dipropionate is a new topical steroid with marked vasoconstrictor and anti‐inflammatory activity. At a concentration of 0·025% in a simple, oil‐in‐water emulsion “cream” base beclomethasone dipropionate is significantly more effective clinically than is fluocinolone acetonide 0·025%) in an apparently similar base. The effectiveness of beclomethasone dipropionate 0·025% in an ointment base is significantly increased by dissolving the steroid in propylene glycol before incorporating it into the ointment. Beclomethasone dipropionate 0·025% in a propylene glycol/ointment base is clinically indistinguishable from fluocinolone acetonide 0·025% ointment. Further investigation of the influence of cream and ointment bases on the clinical effectiveness of topical steroids might prove interesting.
A case of hydroa vacciniforme occurring in association with Hartnup disease is described.The literature on hydroa vacciniforme is reviewed and it is concluded that it constitutes a distinct entity.The occurrence of aminoaciduria in photodermatoses is discussed.IN recent 3^ears au increasing amount of research has been izndertaken into the photodermatoses, and underlying metabolic abnormalities have been recognized as aetiological factors in some cases. A case of hydroa vacciniforme occurring in association with Hartnup disease was recently observed by the author, and is presented in view of both the rarity ofthis combination and the possible aetiological implications. CASE REPORTS.R., male, born 12.9.1900, was first seen in April 1965 with a rash of 5 days'duration involving exposed sites. The onset was several hours after direct exposure to strong sunlight, and there Avas a history of a similar eruption on 2 occasions during the preceding Slimmer. There was no other skin disease in the patient, nor any skin disease in either the parents, who were um*elated, or the only sibling, a younger sister.In 1964 lie had been referred to a paediatrician for investigation of recurrent attacks of vomiting and coma commencing at the age of 18 months. A persistent, gross, generalized aminoaciduria was revealed by two-dimensional paper chromatograpliy. The pattern of aniinoackl distribution "vvas considered t^'pical of Hartnup disease, and this dia|C!;nosis Avas coniirmed by the tr}^>tophan loading tests.On examination he was an alert and intelligent child, the only clinical abnormality being a rasli involving the face, the dorsa of the hands and the extensor aspects of the legs from mid-thigh to anlvle. On the nose, cheeks and ears M' ere approximately 40 lesions in differing stages of development (Fig. 1). An initial erythema was stated to precede the formation of a small papule which soon became surmounted by a vesicle. Rapid peripheral extension resulted in a large, umbilioated bulla with, a central crust and erytliematous halo, the size of the whole lesion l^eing betAA^een 0-5 and 1 cm. in diameter. Tlie majority of lesions were in this last phase, and confluence of adjacent bullae had occurred on some sites. The affected areas were tender but slio\vcd little oedema excepting on the ears, and there was no visible scarring. Slow resolution of the eruption took place over a period of 3 to 4 weeks, and as the active lesions regressed their sites were marked by pitted scars (Fig. 2).Further outbreaks occurred throughout the summer of 1965 and in each succeedino" year between April and September, there being complete freedom for the rest of the year. On all occasions the rash followed direct exposure to sunlight; the period of
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