No abstract

Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups. Although the exact aetiology is uncertain, genetic predisposition, infections and autoimmune factors have been implicated in its pathogenesis. Symptoms include pruritus and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. Histopathology is specific with basal cell degeneration, upper dermal oedema, homogenization of collagen and a chronic inflammatory infiltrate. Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe LS of the penis. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity. A multidisciplinary approach to care and the need for long-term monitoring cannot be overemphasized.

Two cases are described of treatment-resistant vulvodynia that responded well to gabapentin. Gabapentin, an anti-epileptic drug, has been used in the treatment of neuropathic pain such as diabetic neuropathy and post-herpetic neuralgia. However, there has been little experience of its use in the relief of symptoms in vulvodynia and we add our observations to the one report of its use in these circumstances that has been published so far.

Nurse led community based GUM services, such as the one provided at the Merseyside Brook Centre, appeal to young people and our success should encourage others to consider similar ventures.

SummaryThe drugs used in HIV medicine often have toxic side effects; additionally, the risk of drug interactions is high because of the frequent necessity to prescribe multiple drugs. This article covers common or important drug side effects and interactions. 2-8% 5) although the range of reactions is similar. The commonest observed reaction is a generalised maculopapular rash, which may be pruritic, occurring one to two weeks after starting treatment (box 1).A study comparing trimethoprim-sulphamethoxazole with trimethoprim-dapsone found that although both treatments were equally effective in the treatment of mild/moderate first episodes of Pneumocystis carinii pneumonia (PCP), twice as many major events were recorded in those receiving cotrimoxazole.6 The incidence of chemical hepatitis (aspartate transaminase, alanine transaminase and/or alkaline phosphatase increased to five times normal levels) and neutropenia (< 750 neutrophils/mm3) was very much more common in the cotrimoxazole group, although rash and fever occurred with equal frequency in both groups. Other reactions to cotrimoxazole are summarised in box 2.Cotrimoxazole increases the antifolate effects ofmethotrexate, pyrimethamine and phenytoin (plasma concentration is also increased.) The effects of sulphonylureas, nicoumalone and warfarin are also enhanced.