Many promising treatments for epidermolysis bullosa have turned out to be disappointing. In Chacago, Illinois, USA (Archives of Dermatology1999;135:997−8 [letter];Ibid: 981−2 [editorial]) a man with epidermolysis bullosa simplex noticed that his lesions improved when he was given tetracycline for concurrent acne. The response was dose dependent with an optimal dose of 500 mg three times daily. His father had the same disease and responded similarly to tetracycline. A randomised, controlled trial seems indicated.

As people with Down's syndrome live longer they are more likely to need treatment for “adult” diseases. Avascular necrosis and acetabular dysplasia, alone or combined, may cause severe and early hip disease. Surgeons in Oregon, USA (Journal of Bone and Joint Surgery (British edition) 1999;81-B:436–9) have reported nine hip replacement operations (three bilateral) on six patients with Down's syndrome aged 22–47. All did well with relief of pain and full hip function.

Mortality in severely malnourished children with diarrhoea at a centre in Dhaka, Bangladesh was running at around 15%. After the …