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Four men with long-standing chronic actinic dermatitis were treated with a modified PUVA regime which initially included generalized applications of topical steroids given immediately after PUVA exposure. All patients are now free of rash, no longer need protection from UV radiation, and are being maintained on twice monthly PUVA therapy (IO J/cm2).

A 63-year-old Iraqi businessman was being treated with paracetamol 250 mg thrice daily for pain due to osteoarthritis of the cervical spine and was referred when he developed an acute dermatitis of the neck, upper back, shoulders and dorsa of the hands.The patient had been applying an analgesic ointment to his neck and back for 6 weeks in addition to prescribed therapy. The ointment contained menthol, camphor and 12 % methyl salicylate but no antihistamines or local anaesthetics. Patch testing to the constituents of the ointment (2 % in olive oil as recommended by Fisher (1973)) gave a positive reaction to methyl salicylate at 48 h, still present at 72 h, and negative reactions to the other ingredients.He was advised to avoid all proprietary applications and the rash subsided with topical steroid therapy while he continued to take paracetamol as before.He returned to Germany and Iraq and 3 months later returned to the UK with a reappearance of his eczema at the previous sites, although he denied using any topical applications except a steroid cream for a few days prior to appointment. It transpired that he had subsequently received treatment from physicians in Germany and Iraq because of his neck pain and had ceased paracetamol therapy. It was not possible to identify his Iraqi and German tablets completely but analysis showed that both of them contained aspirin (acetyl salicylic acid).A non-aspirin containing analgesic was sub-stituted and further patch testing carried out with results as follows:Aspirin aqueous 0.3 % Aspirin suspension aqueous 5 % Sodium salicylate 2 % aqueous Methyl salicylate 2 % in arachis oil 48 h -ve -ve ++ve ++ve Negative results to the above were found in three control patients.Five days later with his consent he was given 500 mg of aspirin and noticed pruritus and erythema again in the previously affected areas. Discussion

Our results suggest that in the elderly a dose of 600 mg daily is associated with an unacceptable incidence of gastric side effects. It is not clear why elderly patients with osteoarthritis were more prone to gastric side effects than patients with rheumatoid arthritis. Tyson and Glynne reported that in patients over 60 with osteoarthritis benoxaprofen caused more gastric side effects than did ibuprofen, whereas in patients under 60 the reverse was true.4 Compared with other non-steroidal anti-inflammatory agents benoxaprofen has a unique side-effect profile. It remains to be established whether benoxaprofen has the disease-modifying properties that were claimed at the enthusiastic launch of the drug.' 9 We are grateful to Dr A W McKenzie for helpful comments and permission to publish the histological report. We also thank Mrs P K Bramble for help with analysis of data, and Mrs S Palgrave-Moore for secretarial work. Addendum Since the submission of our paper six cases have been reported with hypertrichosis and accelerated nail growth associated with benoxaprofen," one of whom also had milia.22

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