Experience with psoriasis in a psychosomatic dermatology clinic.

We studied 179 psoriatic patients by semistructured colloquia and psychometric tests and determined their cutaneous psycho-neurophysiological profiles by biofeedback methods. The Paykel scale for stressful events showed that 72% of psoriatics had experienced significant stressful events about one month before the appearance of the psoriasis. The Zung test for anxiety and depression showed a high level of anxiety in the psoriatic patients. 64% of the patients who were treated by BFBtraining had a decrease in their PASI index for severity and the extent of the disease and also fewer recurrences at the one-year follow-up. The results of the World Experience Inventory indicated difficulties related to body image and to relationships with others. Psoriasis influenced the sexuality of the patients. It is always difficult when one is afflicted by ill health to enjoy life and the general scores of SWL (Satisfaction with Life), were significantly lower than those of a control group.

Family history, smoking habits, alcohol consumption and risk of psoriasis.

We have conducted a multicentre case-control study to assess the epidemiological importance of previously suggested risk factors for psoriasis, including family history of the disease, smoking and alcohol consumption. Newly diagnosed psoriatics, with a history of skin manifestations no longer than 2 years were eligible as cases; as controls we selected subjects with newly diagnosed dermatological conditions other than psoriasis. Interviews were performed by trained medical investigators using a structured questionnaire. Two-hundred and fifteen cases, aged 16-65 years (median age 38), and 267 controls, aged 15-65 years (median age 36), were interviewed and included in the analysis. Family history was a risk factor for psoriasis; the multiple logistic regression (MLR) adjusted-odds ratio was 18.8 (95% confidence interval 6.4-54.8) for a history in parents, and 3.2 (95% confidence interval 1.5-6.6) for a history in siblings. The risk of psoriasis was higher for current smokers than for those who had never smoked. The MLR adjusted odds ratio was 2.1 (95% confidence interval 1.1-4.0) for people smoking 15 cigarettes or more per day. The risk of psoriasis was higher for alcohol drinkers: compared with teetotallers the MLR adjusted-odds ratios were 1.3 (95% confidence interval 0.8-2.3) for subjects drinking one or two drinks/day and 1.6 (95% confidence interval 0.9 to 3.0) for those drinking three or more. However, the trend in risk was not statistically significant. Our study confirms the role of family history in psoriasis and provides some evidence of a dose-response relationship for an association between smoking habits and psoriasis.

Dystrophic epidermolysis bullosa inversa: a case report.

The inverse form of recessive dystrophic epidermolysis bullosa is a rare genodermatosis characterized by a smouldering course of integumental blistering with improvement of lesions in adulthood, preferential localizations of lesions in flexural areas, severe oral and esophageal mucosal involvement and nail dystrophy. We describe a 41-year-old patient showing all the typical features of this form of epidermolysis bullosa. Ultrastructural findings in specimens obtained from perilesional and healthy skin were similar to those usually observed in the Hallopeau-Siemens form of epidermolysis bullosa. The patient has been treated with phenytoin for a period of 9 months with considerable improvement of the skin manifestations.

[A thioridazine-dihydroergotoxine combination in the treatment of senile pruritus]. / Associazione tioridazina-diidroergotossina nel trattamento del prurito senile.

Senile itching, a peculiar clinical situation consisting of a cutaneous senile involution associated with a relevant neurogenic component, still keeps being a difficult therapeutic problem. For the purpose, a clinical trial, carried out with a combination of thioridazine and dihydroergotoxine on 19 patients carriers of the affection, could show a relevant decrease in all parameters assessed, ie itching, muscle tension and skin temperature measured by biofeedback. The combination also showed a good tolerance.

[Growth factors in the pathogenesis of progressive systemic sclerosis]. / I fattori di crescita nella patogenesi della sclerosi sistemica progressiva.

Scleroderma is a connective tissue disorder characterized by vascular lesions, fibrosis and inflammation. The pathogenesis of this disease is not clear. A vascular lesion, possibly caused by deposition of immune complexes or by release of cytotoxic factors, seems to be at the origin of the disease. As a consequence, platelet adhesion and activation might occur in sclerodermic patients. The observation that platelet might release, upon aggregation, a potent mitogenic factor, named Platelet Derived Growth Factor (PDGF) has focused interest on platelets as the potential mediators of the fibrotic process, characteristic of systemic scleroderma. We found an increased mitogenic activity in plasma derived serum (PDS) of a group of patients with progressive systemic sclerosis (PSS), as compared to control subjects. The activity was inhibited by incubation with anti-PDGF IgG's, suggesting that abnormal PDGF levels might indeed be present in plasma of PSS patients.

Ketanserin in the treatment of progressive systemic sclerosis.

Now progressive systemic sclerosis (PSS) is considered a disease of small vessels with which many immunologic alterations are associated. The presence in the blood of large amounts of serotonin can be considered a very important aggravating factor able to cause the sclerodermic alterations. The authors have treated 10 PSS patients with ketanserin, a selective antagonist of the S2 serotonin receptors, which are found in small vessels and platelets. Their results show that ketanserin represents an efficacious and very well tolerated therapy for treatment of the initial vascular symptoms of PSS.

[Ectodermal dysplasia with severe odontodysplasia. Study of an affected family]. / Dysplasie ectodermique avec odonto-dysplasie grave. Etude d'une famille atteinte.

We present a very extensive family tree, who includes six generations and 17 women and 9 males affected by ectodermal Dysplasia. The clinical symptomatology is more serious in the males than in the females. In our family the syndrome manifests a segregation that suggests a semi-dominant X-linked heredity.

Occupational dermatitis in bakers: a clue for atopic contact dermatitis.

6 patients are described who developed contact dermatitis after cereal contact on atopic skin for periods of 2 to 20 years. 2 patients were wheat flour patch-test-positive. They had punch biopsies taken for standard histological and immunohistochemical investigation by labeling with monoclonal antibodies, anti-DR and anti-IgE. Sections showed features of contact dermatitis. There were many dendritic cells located perivascularly in the papilla and in the epidermidis, intensely positive for monoclonal anti-IgE antibody. In control atopic subjects, there were a few perivascular IgE positive cells, probably mastocytes. This study shows that there may be a relationship between some allergens and atopic eczema in patients exposed to them in the course of their work. In some cases, there was a true allergic contact dermatitis, seen through the clinical and histological characteristics, and the results of immunohistochemical study.

Arachidonic acid and LTB4 enhance aggregation of psoriatic peripheral blood mononuclear leukocytes in vitro.

The aim of the reported series of experiments was to examine the possible role played by arachidonic acid (Aa) derivatives in monocyte aggregation in psoriasis. Twenty patients with active plaque-type psoriasis covering not less than 20% of body surface area and 20 age-matched controls were investigated. Peripheral blood monocytes were harvested according to the technique recently set up by Colotta et al. These preparations usually contained more than 95% monocytes, as assessed by morphology and esterase staining. Aggregation tracings were plotted using a common platelet aggregation recorder system and expressed in arbitrary units. Aa sodium salt, acetylsalicylic acid (ASA), indomethacin, nordihydroguaiaretic acid (NDGA), and leukotriene B4 (LTB4) were used during testing. Aa induced an enhanced aggregation of mononuclear leukocytes (MNL) in psoriatic patients versus normal controls in a concentration-dependent way. Furthermore, neither ASA nor indomethacin inhibited Aa aggregation, while both markedly increased the aggregation response in psoriasis. LTB4 induced an enhancement aggregation in psoriasis, whereas NDGA strongly inhibited it. Although the pathophysiological significance of MNL aggregation described here remains obscure, assembly of the cells at the site of psoriatic skin might be a crucial event.