29 Section ofDernmatology 1279 little cedema. The changes are not those of then appeared. Similar transient remissions were multiforme.' produced by methysergide 8 mg daily and cyproheptadine 16 mg per day. Comment This patient shows yet another new manifestation Clinical features: The lesions are easily palpable, caused by cold and based on a vasculitis. The firm, tender, deep-seated nodules on the legs or clinical and histological picture is completely arms. The overlying epidermis shows slight separate from those seen in and in redness over early lesions. Sites of previous delayed type of sensitivity from cold (Sarkany & nodules show no scarring or any other residual Turk 1965, Sarkany 1967). change. REFERENCES Sarkany I Investigations: Detailed investigations including (1967) Proc. roy. Soc. Med. 60, 496 blood count, sedimentation rate, plasma proteins Sarkany I & Turk J L (1965) Proc. roy. Soc. Med. 58, 622 and Wassermann reaction were normal. LE cells and antinuclear factor were not detected.

Dr T J Ryan: The permeability of the vessels of nor- mal skin is influenced by cold and this may be more obvious in pathological states when other factors influencing permeability are introduced. A patient shown here in 1963 (Ryan, 1964, Proc. roy. Soc. Med. 57, 45), and later at a meeting of the British Associa- tion of Dermatology in 1966, was very much disabled by purpura which was predominantly influenced by cold. Each lesion was initially urticarial and became purpuric only after several hours. The only significant finding was an abnormal degree of painful wealing following the intracutaneous inoculation of her own platelets. This did not occur after intracutaneous inoculation of whole blood or red cell stroma. Vasculitis as exhibited by today's patient is pre- sumably caused by some immunological or pharma- cological imbalance. Cold may be encouraging the increase in permeability of the blood vessels. It is not Fig I High power ofpanniculitis showing necessarily the primary cause of the condition. acute inflammatory i,ifiltrate. x 75 Dr Macmillan: Inoculation of the patient's own blood did not reproduce the lesions. Histology: There is an acute (Fig 1). Subcutaneous fat is infiltrated with acute in- flammatory cells. No vasculitis is seen and both the dermis and epidermis appear normal. Comment Recurrent Non-scarring Pressure Panniculitis We have been unable to find a previous descrip- I Sarkany FRCP and A L Macmillan MB MRCP tion of an exactly similar clinical picture asso- (Royal Free Hospital, London) ciated with the histology of panniculitis. The name of recurrent non-scarring pressure panni- Woman aged 37. Housewife culitis is proposed for this entity. History: For five years she has had crops of tender nodules on the legs and arms. The palms and soles are spared. These nodules are asym- metrical and appear spontaneously or 2-12 hours Dr P J Ashurst: I note that this patient has had an enlarged thyroid for approximately the same period after local pressure or a knock. There is no as her skin disease. Would it not be worth while systemic disturbance. The nodules persist for up investigating the possibility of an abnormality in to eight days and resolve completely. Treatment thyroid metabolism? with antihistamines was ineffective. Prednisone in a daily dose of 15 mg suppressed the appear- Dr Macmillan: I interpreted the lump in her neck as an ance of fresh nodules for 48 hours but, in spite of enlarged lymph gland as it did not move on swallow- continued administration of the drug, new lesions ing and was not connected to the thyroid gland. 1280 Proc. roy. Soc. Med. Volume 62 December 1969 30

Dr Harvey Baker: Have you entirely excluded auto- Alopecia Mucinosa erythrocytic purpura? Another possibility might be Dr A J Miller (for Dr K V Sanderson) DNA autosensitivity (Chandler & Nalbandian, 1966, Amer. J. med. Sci. 251, 145). Scleroderma ?Morphea Dr Macmillan: The patient does not show purpura Dr J P Ellis (for Dr S C Gold) and inoculation of her own blood does not reproduce her lesions. Reticulum Cell Sarcoma Dr B J Leppard Dr Harvey Baker: The reaction produced by injection (for Dr K V Sanderson) of blood may depend on the depth of the injection. Pemphigoid in Mother and Newborn Baby The President: We have a patient with pressure Dr K V Sanderson urticaria in whom polycythxmia has been found. I note that your patient has no blood disorder. Giant Pigmented Nevus of Arm Dr Macmillan: The patient has never shown urticaria. Dr Brian Russell The lesions are a panniculitis. There are further differences in the clinical picture. In contrast to Angioendothelioma (Lymphatic Type) pressure urticaria this patient does not develop lesions Dr S C Gold on the palms after clapping, on the soles after walking, or after carrying heavy weights, and the nodules which Basal Cell Naevus Syndrome she develops persist for much longer than the lesions Dr A J Miller (for Dr S C Gold) of pressure urticaria. Congenital Ectodermal Defect with Nail Dystrophy and Resorption of Terminal Phalanges The following cases were also shown: Dr E Swart (for Dr H T Calvert) (1) Striate Eruption (2) Comedo Naevus Systemic Sclerosis: Polymyositis: (3) Pustular Psoriasis Calcinosis Cutis: Carpal Tunnel Syndrome (4) Epidermolysis Bullosa Dr J Almeyda and Dr C Barnes Dr M I Keir (for Dr F R Bettley) (for Dr Brian Russell)

Meeting June 191969 The following cases were shown: Vitiligo with a Raised Edge Dr J Kalivas (for Dr R H Marten) Pyoderma Gangrenosum Dr M I Keir (for Dr R H Meara) Case for Diagnosis - ?Sweet's Syndrome (Recurrent Neutrophilic Dermatosis) (1) Peyronie's Disease. Dupuytren's Contracture Dr C M Ridley (2) Lichen Nitidus Dr D I Porter (for Dr P D Samman) Congenital Anomaly: Cutaneous Pigmentation and Atrophy with Partial Webbing of Digits Lichen Nitidus Dr P D Samman Dr J A Savin (for Dr P D Samman) (1) Collins - von Hippel - Lindau Haemangiomatosis Multiple Pigmented Macules (2) Punctate Keratoderma Dr D C Macmillan (for Dr H R Vickers) Dr P W M Copeman Lichen Sclerosus with Irritation Epidermodysplasia Verruciformis Dr C J Guerrier (for Dr H R Vickers) Dr E Swart (for Dr H T Calvert)