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The aetiology of pityriasis lichenoides (PL) is unknown. One major pathogenic theory suggests that PL is a lymphoproliferative disease or inflammatory reaction triggered by an antigenic stimulus, such as a virus or other infectious agent. We report the second case of PL et varioliformis acuta (PLEVA) occurring after measles vaccination and the first following the combined measles, mumps, rubella vaccination.

We describe a case of previously unreported autoimmune hepatitis and lupus-like syndrome induced by infliximab treatment for chronic plaque psoriasis. The condition resolved after withdrawal of infliximab, with the liver injury having been reversed and minimal periportal fibrosis. In a two-part discussion we review the current literature on the pharmacology of infliximab and provide recommendations for management of infliximab side effects.

Oral lichen planus (OLP) is a chronic inflammatory disorder with significant morbidity, associated with symptoms of pain and local discomfort. The concept of contact allergy aggravating or inducing OLP is recognised, and reported allergens include amalgam, metals used in dental restoration and flavourings. To date there has been only one case report of a contact allergy to spearmint oil in a patient with a 3-year history of OLP. We retrospectively reviewed our positive spearmint oil patch test data at the Skin and Cancer Foundation Victoria over a period of 11 years. In total 73 patients of the 1467 tested for allergy to spearmint oil had positive patch tests. The total number of patches tested during this time was 6134. Of the 73 positive reactions, 19 (26%) were classified as relevant, in that the patients had a history of using spearmint oil-containing products. Coexisting OLP and a spearmint allergy were found in 14 of these 19 patients. All patients had erosive OLP and were female. Patients, especially women, with OLP recalcitrant to treatment should be patch tested to flavourings, especially spearmint oil. We believe that spearmint allergy should be considered a cause of OLP, or at least, of oral lichenoid reactions.

Effective treatment of folliculitis decalvans with cyclosporin:A case series Folliculitis decalvans is a neutrophilic cicatricial alopecia that preferentially affects the scalp vertex and occiput. Therapy aims to arrest inflammation and prevent hair loss.Response to antibiotic and anti-inflammatory treatments is unpredictable, resulting in a sometimes chronic, recalcitrant course. 1 We report three patients with refractory folliculitis decalvans responding to cyclosporin. In the absence of a validated outcome measure for folliculitis decalvans, we considered photographic and symptomatic improvement; maintenance of the same therapeutic dose; and ability to taper therapy in assessing treatment response. CASE 1A 60-year-old Caucasian male had a 5-year history of treatment-resistant folliculitis decalvans affecting the vertex (Table 1). Cyclosporin 25 mg twice daily (0.81 mg/kg) was added to finasteride, oral minoxidil, minocycline and topical clindamycin. After 2 months, symptoms started improving; at 9 months, good disease control was achieved without adverse effects. Cyclosporin was slowly withdrawn after a total of 19 months of therapy, with relapse noted 5 months after discontinuation.