Linear IgA disease (LAD) is an acquired autoimmune subepidermal bullous disease characterized by the linear deposition of IgA at the basement membrane zone. A minority of cases are induced by drugs, of which the most frequently implicated is vancomycin. The target antigens in idiopathic LAD are heterogeneous, but have not previously been reported in vancomycin-induced LAD. We report three cases, and in two of these we investigated the target antigens. In both we identified IgA antibodies to LAD285 and IgA and IgG antibodies (dual response) to BP180.

SUMMARY We present two cases of prurigo pigmentosa, a little‐known dermatosis characterized by itchy red papules which coalesce to give a reticular pattern evolving into a reticulate hyperpigmented mottling. The histological features are non‐specific and some patients with this disorder respond dramatically to dapsone.

Keratosis lichenoides chronica is characterized by violaceous, papular and nodular lesions typically arranged in a linear and reticulate pattern, most marked on the hands and feet, and accompanied by a seborrhoeic dermatitis-like eruption of the face. This rare condition is very refractory to treatment but we report a patient whose eruption responded top photochemotherapy.

The effect of short duration occlusion on skin penetration and stratum corneum water content was studied in vivo in eight human subjects. Percutaneous absorption of hexyl nicotinate was monitored non-invasively by laser Doppler velocimetry (LDV) following each of three randomly assigned pre-treatments: untreated control, 30 min occlusion with a polypropylene chamber and 30 min occlusion followed by exposure to ambient conditions for 1 h. Stratum corneum water content after the same pre-treatments was measured with the dielectric probe technique. The local vasodilatory effect of the nicotinic acid ester was quantified using LDV by the onset of increased blood flow, the time of maximal increase in response, the magnitude of the peak response and the area under the response-time curve. Each of these parameters was significantly different, immediately following occlusion, from the untreated control values. However, if the occluded site was exposed for 1 h prior to hexyl nicotinate application these parameters did not differ significantly from the controls. Stratum corneum water content (expressed as a percentage of a maximal value) showed the same behaviour: the pre-treatment control value was 31.8 +/- 4.8%; after 30 min occlusion, this had risen to 46.9 +/- 6.2%; 1 h later, the reading had returned to 32.1 +/- 6.2%. There was a significant correlation between stratum corneum water content and area under the LDV response-time curve. It appears, therefore, that this method may be useful for quantifying the relationship between increased stratum corneum hydration and enhanced percutaneous absorption in vivo in man.

A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension. (Postgrad Med J 2000;76:576-577) Keywords: portal hypertension; lingual; tongue; varicose vein Case reportAn 82 year old women with known portal hypertension secondary to cirrhosis of the liver was referred to the otolaryngology outpatient department with a two month history of daily haemoptysis and bloodstained pharyngeal secretions; this occurred mostly on early morning coughing. There was no history of weight loss, dysphagia, dysphonia, or throat pain. She had already been investigated for a pulmonary cause of the haemoptysis and none was found. In keeping with her history, liver function tests and the prothrombin time were abnormal. She also had a history of well controlled essential hypertension. Chest radiography showed cardiomegaly, but the jugular venous pressure was not raised and there was no other clinical manifestation of heart failure.Indirect laryngoscopy revealed varicose vessels in the tongue base, mainly on the left side (see fig 1). These appeared friable and one area revealed a propensity to bleed on examination. The rest of the ear, nose, and throat examination was normal.After perioperative cover with fresh frozen plasma, vitamin K, and tranexamic acid she underwent ablation of the varicosities using a 15 watt continuous carbon dioxide laser under general anaesthesia (see fig 2). She had an uneventful recovery and has remained symptom free. AnatomyThe dorsal lingual veins drain the tongue base through two or more tributaries. These course inferiorly, join together and form the lingual vein, which accompanies the lingual artery. These vessels pass between genioglossus and hyoglossus and the vein empties into the internal jugular vein just above the level of the greater cornu of the hyoid bone. (2) Periumbilical veins-veins contained in the falciform ligament anastomose with superior and inferior epigastric veins of the anterior abdominal wall. Excessive dilatation of these veins are evident as caput medusa.(3) Haemorrhoids-the superior rectal vein anastomoses with the middle rectal vein which drains into the internal iliac vein. In addition the middle rectal veins anastomose with the inferior rectal veins which drain into the internal pudendal vein. Increased shunting results in internal and external haemorrhoids. Thus, there is no recognised anastomosis between lingual venous drainage and the portal circulation. DiscussionA varicosity is a condition indicating an enlarged and tortuous vein. Previously described lingual varices referred to sublingual varices on the ventral surface of the tongue or floor of mouth. These were ascribed to the use of dentures, and vitamin C deficiency in an elderly population. 3Burket associated the occurrence of lingual varices with cardiorespiratory disease,...