A finger-tip unit (FTU) is the amount of ointment expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger. Thirty adult-patients treated various anatomical regions using FTU's of ointment. The number of FTU's required was: face and neck 2.5 (s.d. +/- 0.8); front of trunk 6.7 (s.d. +/- 1.7); back of trunk 6.8 (s.d. +/- 1.2); arm and forearm 3.3 (s.d. +/- 1.0); hand 1.2 (s.d. +/- 0.4); leg and thigh 5.8 (s.d. +/- 1.7); foot 1.8 (s.d. +/- 0.6). One FTU covers 286 cm2 (s.d. +/- 80, n = 30). In males one FTU covers 312 cm2 (s.d. +/- 90, n = 16) and in females 257 cm2 (s.d. +/- 55, n = 14). The use of the FTU in dermatological prescribing provides a readily understandable measure for both patients and doctor.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) is reported to be a marker for underlying malignancy. Much of the evidence for this is based on case reports, small series of cases and reviews of the literature. In order to clarify the association with malignancy and determine the common clinical features of Sweet's syndrome, we reviewed the case notes of patients presenting to six dermatology units in the U.K. Eighty-seven cases of histologically proven Sweet's syndrome were reviewed. Fourteen patients (16%) developed associated malignancy, predominantly haematological, two patients (2%) had a history of previous malignancy and four patients (5%) had premalignant conditions (monoclonal gammopathy, two: myelodysplasia, two). Malignancy developed up to a year after presentation with Sweet's syndrome. Patients with associated malignancy were more likely to be anaemic (P < 0.01) at presentation, had a lower mean platelet count (207 x 10(9)/L vs. 332 x 10(9)/L; P < 0.003) and were, on average, older (59 years vs. 49 years; P = 0.002). Contrary to previous reports, a greater percentage of females developed malignancy than males.

In order to assess the impact of eczema on the lives of affected individuals a postal questionnaire was sent to all members of the National Eczema Society (NES). The survey also sought to ascertain their expectations of their initial consultation with general practitioners and hospital doctors; to assess their satisfaction with these consultations; to obtain their views on the treatment prescribed, and their reasons for joining the NES. Information on 1972 adults (614 male, 1358 female) and from 1944 parents of affected children was received, representing an overall response rate of 29%. The work of 1061 (54%) adults, and the choice of career of 391 (20%) had been affected. Eczema affected the ability to perform domestic duties in 1128 (83%) women compared with 439 (71%) men. Social and leisure activities were affected in 1269 (64%) of adults. The development of personal relationships had been impaired in 273 (14%), and the sex lives of 373 (19%) had been affected. In children sleep (60%) was the most commonly affected activity. The expectations of the initial consultation with their general practitioner of 659 (17%) had not at all been met, of 2528 (65%) partly met, and of only 483 (12%) completely met; 2638 patients had seen a hospital specialist. The expectations of 478 (18%) had not at all been met, of 1164 (62%) partly met, and of only 512 (19%) completely met. Forty-four per cent (1713) were either 'extremely satisfied' or 'satisfied' with the treatments they had been given, 1529 (40%) were 'neutral', 480 (12%) were dissatisfied, and 103 (2.6%) were extremely dissatisfied.(ABSTRACT TRUNCATED AT 250 WORDS)

The parents of children with skin disease are often unsure how much topical therapy, particularly of corticosteroids, they should apply. The aims of this study were to devise simple guidelines on topical therapy for children, parents, doctors and nurses, and to check the accuracy of these guidelines in practice. The guidelines are based upon four principles: the adult fingertip unit (FTU); the 'rule of 9s'; standard height and weight charts for children; and standard nomograms for calculating body surface area. Twenty-four children (11 boys and 13 girls) aged 6 months to 9 years 4 months with atopic eczema were recruited and the number of FTUs required to treat different anatomical areas calculated in accordance with the proposed guidelines. Ointment was applied and the number of FTUs needed for each area was recorded. The amount used was then compared with that predicted. No child required a greater number of FTUs than that predicted, and the number of FTUs predicted for each anatomical region was accurate to within 1 FTU. The guidelines provide a useful indication of how much topical therapy is required for children, and advice sheets have been prepared for children of different ages.

In January 1990, multiple glossy, slightly erythematous, infiltrated plaques developed; these plaques had violaceous borders on the ab¬ domen, the back, and both legs ( Figure). The patient was still being treated with prednisone (10 mg/d) and chloroquine (100 mg/d). His¬ tologie examination of a skin lesion showed a thickened dermis with a homogeneous stratum papillare; some dilated capillaries; and coarse, bundled collagen. These findings confirmed our clinical diag¬ nosis of morphea.Thus, 1 year after EF was diagnosed in our patient, the multiple plaques of morphea developed.Comment.-Some authors identify EF as a separate disease entity,3 while others consider it to be a variant of scleroderma.4While EF clearly differs from scleroderma in clinical pic¬ ture and laboratory findings, the histologie similarities be¬ tween the two are conspicuous. The dermal change in sclero¬ derma is that of thickening caused by broad, elongated, swollen collagen bundles, which are oriented parallel to the surface epithelium. In EF, the dermal collagen can be mildly sclerotic. In EF, inflammation and fibrosis is seen in the subcutis and underlying fascia.2 In scleroderma, the earliest his¬ tologie findings are inflammation of subcutaneous tissue and fibrosis.5 Since fascial thickening is not seen in scleroderma, a full-thickness biopsy specimen helps to distinguish the two processes.The coincidence of scleroderma and EF also suggests a re¬ lationship between the two disorders, as has been illustrated in a review of 52 patients with EF, 15 (29%) of whom had lo¬ calized morphea.1 In addition, several patients have been de¬ scribed in whom progressive systemic sclerosis and EF de¬ veloped concomitantly and in whom multiple plaques of morphea and EF coexisted.