No abstract

Overall, the study showed that 4 weeks of treatment with oral terbinafine has similar efficacy to 8 weeks of treatment with griseofulvin for the management of tinea capitis in children.

susceptibility is uncertain. Although many of the children were prescribed doses of metoclopramide above those recommended by manufacturers, relative overdosage, as discussed earlier, does not account for the differences in age and sex. Therapeutic overdosage in the 12-19 year age group may contribute to the high reporting rate, but exclusion of those patients who were prescribed a relative overdose from the analysis means that the sex difference in reporting becomes more pronounced in this age group (table V). As we do not have details of prescribing dosages to the community as a whole assessment of the dose response relation in terms of adverse reactions is impossible. Plasma concentrations and clearances of metoclopramide, however, were similar in children suffering from acute extrapyramidal reactions to those not suffering.'0 Furthermore, prescribing a relative overdose does not account for the age related pattern of reports in the age groups over 20 years, and we therefore favour a pharmacodynamic explanation. This would be supported by the observation that the prolactin response to intravenous metoclopramide, which is due to the dopamine antagonist action of the drug, was substantially greater in 17-20 year old women than men." Moreover, an age related decline in density of D2 receptors has been shown to occur in the striatum of the rat"2 and in the caudate nucleus, putamen, and frontal cerebral cortex of man.'3Only a fairly small proportion of patients were apparently receiving other drugs (table III) Egg and cows' milk hypersensitivity in exclusively breast fed infants with eczema, and detection of egg protein in breast milk ANDREW CANT, R A MARSDEN, P J KILSHAW Abstract Forty nine eczematous infants who were still solely and exclusively breast fed and who had never received anything but breast milk were studied for evidence of sensitisation to foods. Thirty four similar infants without eczema formed a control group. The eczematous infants were divided into three groups according to clinical crite-

Acquired autoimmune bullous diseases of childhood are rare, and can be difficult to distinguish clinically. We have studied 12 children, with an initial diagnosis of bullous pemphigoid (BP) in eight patients, cicatricial pemphigoid (CP) in one, chronic bullous disease of childhood (CBDC) in one, and epidermolysis bullosa acquisita (EBA) in two. All patients had positive indirect immunofluorescence (IIF) of the BMZ with IgG. Using 1 M NaCl split skin, six patients showed epidermal binding of IgG, with additional IgA in three cases, and in five patients IgG antibodies bound a dermal protein. Immunoblotting studies revealed an antibody to type VII collagen (EBA antigen) in three patients who had a dermal pattern on IIF. Six sera reacted with an epidermal protein of 180 and/or 220 kDa, characteristic of BP and CP. One of the three IgA-positive sera detected 220- and 180-kDa epidermal proteins using anti-IgA antibody. Following these studies the diagnosis was changed in three of the children. The diagnosis of CBDC was changed to either BP or EBA because of the presence of circulating IgG autoantibodies. In two children with an initial diagnosis of BP the diagnosis was changed to EBA. We conclude that the clinical picture in bullous disorders of childhood shows considerable overlap, and is often misleading. Additional circulating IgA autoantibodies seem to be more common in BP than has been recognized previously. Indirect immunofluorescence investigation on 1 M NaCl split skin may be helpful in differentiating between BP and EBA, but does not replace immunoblotting studies. EBA is apparently more common in children than in adults. No difference was found between the children with BP and EBA with regard to the duration of disease. The long-term outlook is good, although the course may be protracted.

Summary Eighteen patients with benign chronic bullous dermatosis of childhood were studied and the findings compared with those of dermatitis herpetiformis (twenty‐two cases) and bullous pemphigoid (five cases) beginning in childhood. The patients with benign chronic bullous dermatosis of childhood had a moderately pruritic bullous eruption with maximal involvement of the pelvic and perioral regions which tended to occur at an earlier age than either dermatitis herpetiformis or bullous pemphigoid. In contrast to dermatitis herpetiformis one‐third of the cases with benign chronic bullous dermaiosis of childhood went into remission. Evidence of coeliac disease was only found in the dermatitis herpetiformis group. Surprisingly both diseases shared HLA‐B8. A linear BMZ band of IgA was detected on direct immunofluorescence in all but one of the cases with benign chronic bullous dermatosis of childhood and circulating antibodies were detectable in two‐thirds. Routine histopathology was of little value in distinguishing between benign chronic bullous dermaiosis of childhood and dermatitis herpetiformis or bullous pemphigoid. Several paradoxes have yet to be explained before it can be determined whether benign chronic bullous dermatosis of childhood is a variant of dermatitis herpetiformis or linear IgA disease.

A 9-year-old boy is described with keratotic pits on the left palm, present since birth, which clinically resembled those seen in comedo naevus. Histology and scanning electron microscopy of skin surface replicas showed the lesions to be large, abnormal sweat ducts. It is suggested that comedo naevi are not necessarily pilosebaceous in origin and that in our case the term sweat duct naevus may be more appropriate.

Acne agminata is a papulo-pustular eruption typically affecting the face of young adults and characterized histologically by the presence of caseating granulomata in the dermis. We now describe two adults who developed the condition in the axillae.

Thirty seven breast fed infants with eczema were studied to see whether changes in their mothers' diets affected their skin condition. Nineteen mothers and babies took part in a double blind crossover trial of exclusion of egg and cows' milk, and 18 took part in open exclusion of 11 foods followed by double blind challenge to those mothers whose infants seemed to respond. Babies were examined at the beginning and end of each dietary period, and the extent and severity of the rash were given a numerical score. The eczema improved in six infants when their mothers avoided egg and cows' milk and worsened again when these were reintroduced. Two infants suffered gastrointestinal reactions after maternal ingestion of egg and cows' milk, one developing colitis.Maternal dietary exclusion seems to benefit some breast fed babies with eczema.