The characteristics of three primary bullous diseases, pemphigus, pemphigoid, and dermatitis herpetiformis, seen in this country, probably reflecting this region, are discussed and compared to those reported in the literature in the West. One hundred and forty-eight patients with bullous diseases were seen over a period of 15 years. The criteria for confirmation of clinical diagnosis were the findings of the direct immunofluorescent test. Pemphigus vulgaris was the commonest bullous disease. The incidence of bullous pemphigoid was highest in the Indians of Malaysian origin, and they are also more likely to develop pemphigus vulgaris than any other ethnic group. Linear IgA type formed the entire group of dermatitis herpetiformis. The granular type was not seen at all. The patients were treated with prednisolone alone or together with methotrexate or azathioprine. Dapsone alone controlled the dermatitis herpetiformis. The known association between pemphigus and other diseases with immunologic disturbances was not found in this study. The natural history of the bullous disease as seen in the follow-up patients is described. Deaths in pemphigus and pemphigoid were more due to either complications of steroid therapy or unassociated diseases than the primary disease itself. Introduction of immunofluorescence as a diagnostic tool in pemphigus and extension of this facility to other bullous diseases has led to detailed characterization of these diseases as seen in the West; however, publications in English dealing with epidemiologic aspects of bullous diseases in this region are rare.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied the response to treatment in 25 patients with erythema multiforme minor, 13 of whom were given corticosteroid while 12 were not. Apart from a shorter duration of fever, the steroid-treated group did not respond better than the non-steroid treated group.

In this paper we report fifty-nine patients with erythema multiforme. Thirty-four of the patients were classified as erythema multiforme major (EM major) or StevensJohnson syndrome and the other twenty-five erythema multiforme minor (EM minor). The overall features of this group of fifty-nine patients are discussed and the significant differences between the two sub-groups (EM major and EM minor) highlighted.

Skin with busulfan hyperpigmentation was studied using light and electron microscopy. There were both toxic effects on the melanocytes and stimulatory effects on the production of melanin. The mitochondria appeared damaged, and reduced in number. Cytoplasmic vacuoles, myelin figures and conglomerate masses of melanosomes were present. The melanosomes were normal in size but appeared increased. 'Ghost melanocytes' were found in the dermis. The basal lamina was damaged with evidence of duplication. Incontinence of melanin was seen. This hyperpigmentation may be similar to that in fixed drug eruption.

Stevens-Johnson syndrome is relatively rare. The authors report a retrospective study of 34 patients seen at the University Hospital in Malaysia over 16 years and discuss the epidemiology, clinical features, complications, investigations, etiologic association, mortality, sequelae, course of the disease, and the use of steroid.