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To Lucina a comedone was just a comedone. Now she learns (British Journal of Dermatology 2000;142:1084–91) that there are many types including micro-, macro-, ordinary, missed, sandpaper, submarine, drug induced, chlorine induced, naevoid, and conglobate comedones. Unless you are able to recognise the various types you may prescribe the wrong treatment for acne. For instance, macrocomedones may flare up on treatment with isotretinoin and are probably best treated with cautery under local anaesthesia.
Oesophagitis may not always be due to acid reflux. In Melbourne, Australia (Journal of Pediatrics2000;136:641–7), nineteen infants had persisting distress and vomiting unresponsive to a change of formula milk (mostly to hydrolysed formula). Only two of 14 infants tested had a fractional reflux time of over 10% on oesophageal pH monitoring but nine had biopsy proved oesophagitis. All lost their symptoms within two weeks of changing to a hypoallergenic amino acid based formula and after three months, on double blind placebo controlled challenge with the previously best tolerated formula milk, 12 relapsed.
Parents and general practitioners (GPs) may think differently about hyperactivity in children (British Journal of General Practice 2000;50:199–202). A study of 10 inner London GPs and 29 parents of hyperactive children showed that the parents (many of whom had attended a tertiary psychiatric referral centre with their …