Basal cell carcinoma (BCC), the most common human malignancy, accounting for 75% of all non-melanoma skin cancer, is uncommon on unexposed skin such as the perianal and genital regions. We describe a woman with BCC of the vulva treated with local resection. All margins of excision were free of disease. The patient recovered without complication and there have been no recurrences after 2 years of follow-up. Approximately 200 cases of BCC on perianal and genital skin have been reported in the literature. Although the aetiology of vulvar BCC is not known, early diagnosis is important. Because BCC in these sites sometimes seems innocuous, biopsy of all suspect lesions is advisable.

Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists.

Tacrolimus is a macrolide that inhibits T-cell activation. The most extensive experience with topical tacrolimus has been in treating atopic dermatitis but it has been used in various skin diseases, including Hailey-Hailey disease, with encouraging results. We report a case of extensive Darier's disease successfully treated with topical tacrolimus, after suspension of oral isotretrinoin due to major depression.

Influence of environmental temperature on the occurrence of non-necrotizing cellulitis of the leg SIR, Non-necrotizing cellulitis of the leg is a common cutaneous bacterial infection whose risk factors include venous insufficiency, lymphoedema and toe-web intertrigo. The role of environmental temperature remains controversial. 1 To study the relationship between environmental temperature and the frequency of non-necrotizing cellulitis of the leg, we reviewed all patients hospitalized with nonnecrotizing cellulitis of the leg in a university hospital in a temperate region of France during a 4-year period, and correlated findings with the local environmental temperature during the same period.Patients included in this study were consecutive patients referred for non-necrotizing cellulitis of the leg from January 1995 to December 1998 in the Departments of Dermatology, Internal Medicine and Infectious Diseases of the Rouen University Hospital. The diagnosis of cellulitis of the leg was retrospectively identified using the database of the Medical Information System. The mean and maximum temperatures of each the 8 days prior to the date of hospital admission were obtained from the local meteorological unit for each case. Correlations between the mean and maximum daily temperature of each day from day ) 8 to the admission day (lag 0-8 days) and the daily number of patients hospitalized for cellulitis of the leg were studied using a nonparametric Poisson regression model to adjust for time trends and days of the week (generalized additive model). 2 Eight hundred and ninety-eight patients with cellulitis of the leg [342 men (38%) and 556 women (62%)] were

In conclusion bromelain can be considered an effective therapeutic option for PLC; its efficacy could be related to its anti-inflammatory, immunomodulatory and/or anti-viral properties.