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Treatment of Hutchinson's melanotic freckle

SIR, The association of acute leukaemia with acute febrile neutrophilic dennatosis (Sweet's syndrome) appears to be well-recognized (Matta et al., 19735 Klock & Oken, 1976; Pirard & Delannoy, 1977; Goodfellow & Calvert, 1979), and acute leukaemia has also been reported in association with pyoderma gangrenosum (Perry & Winkelmann, 1972J Crow & Bowers, 1974; Burton, 1976). Although the classical features of Sweet's syndrome and pyoderma gangrenosum are fairly distinctive, the two diseases have some features in common, and some cases are difficult to categorize with certainty. A review of the cases associated with acute leukaemia (Pye & Choudury, 1977) has shown that some of them are not typical of either Sweet's syndrome or pyoderma gangrenosum (e.g. because of frank blisters and lesions of the oral mucosa). This diagnostic dilemma suggests either that Sweet's syndrome and pyoderma gangrenosum represent the two ends of a nosological continuum, or that acute leukaemia is associated with a different bullous pyoderma which may on occasion mimic either Sweet's syndrome or pyoderma gangrenosum. All authors who have reported such cases agree that the dermal cellular infiltrate is not composed of immature cells, and in some cases skin lesions appear in the aleukaemic phase, but further study of the infiltrate using immuno-cytological and electron microscopic techniques is required to confirm that the infiltrate is not malignant. Such studies may also yield useful information in typical cases of Sweet's syndrome and pyoderma gangrenosum which are not associated with leukaemia.