Controlled double-blind trial of fibrinolysin-desoxyribonuclease (Elase) solution in patients with chronic leg ulcers who are treated before autologous skin grafting.

A controlled, randomized, double-blind trial was performed in 34 hospitalized patients with chronic leg ulcers: 37 ulcerous legs were treated with Elase solution or with saline (placebo) solution. Elase was statistically significantly better in effect on debridement (p less than 0.05) and on enhancing of granulation (p less than 0.05) than saline in patients with chronic venous stasis ulcers. In patients with complex ulcers no statistically significant difference between the two treatments was seen.

In vitro dissolution rates of six 8-methoxypsoralen formulations.

Dissolution rates in water of six oral 8-methoxypsoralen formulations were determined with both the rotating basket method and a column type flow-through method. Comparable and reproducible results were obtained with both methods. In view of the necessity in psoralen-UVA (PUVA) therapy that effective tissue concentrations of the drug be present in the skin during the irradiation period, we propose a requirement for a dissolution rate of 8-MOP tablets or capsules of at least 80% within 25 min. None of the three preparations registered in The Netherlands met this requirement. However, two preparations from abroad and a new capsule formulated in our pharmacy department with solid 8-MOP dispersed in polyethylene glycol 6000 showed satisfactory dissolution profiles.

Psoriasis specific chromosomal proteins, antibodies against them and disease activity.

It has been demonstrated recently that the lymphoid cells of patients with psoriasis have antibodies directed against the psoriasis specific non-histone proteins. A conceptual hypothesis for the role of these antibodies in the pathogenesis of psoriasis presented in this communication, is as follows. Perhaps the psoriasis specific non-histone proteins following phosphorylation bind to histone which keeps psoriasis gene(s) repressed. This may result in the displacement of histone from the DNA. Antibodies against psoriasis specific non-histone proteins may facilitate the displacement of histone. DNA set free, possibly containing psoriasis gene(s), can then be transcribed into RNA causing a shift of the resting pool of keratinocytes in the symptom-free skin of psoriasis patients to the proliferating pool of keratinocytes in the psoriasis lesions.

Clinical and microbiological evaluation of 46 episodes of genital ulceration.

In 44 consecutive patients 46 episodes of genital ulceration were studied. The presumptive clinical diagnosis was evaluated by extensive microbiological investigations. In 15 (33%) episodes the clinical diagnosis did not accord with the microbiological one. Chancroidal lesions were most commonly found to have other microbiological aetiology. Secondary invasion of treponemal or viral lesions by other bacterial species (mostly anaerobes or pyogenic cocci) or genital pyodermia were the cause of confusion in six of nine cases of chancroid. In the other three a ducreyilike bacterium was found. Direct Gram staining of ulcer material did not help the diagnosis of chancroid. The implications of the results of this study for clinical practice are discussed.

Oral phenylalanine loading and sunlight as source of UVA irradiation in vitiligo on the Caribbean island of Curacao NA.

Recently, favourable results have been reported from oral L-phenylalanine (Phe) combined with UVA/sunlight irradiation (Phe-UVA) in the treatment of vitiligo. In the present pilot study vitiligo patients were treated on a thrice weekly scheme of 50 mg Phe.kg-1 body weight and exposed to sunlight as a source of UVA. An observed 81% response on the skin disorder correlates with earlier figures; 43% responded within 3 months. The self-controlled treatment includes the risk of over-irradiation, as possibly happened with one patient. The repigmentation was predominantly of follicular pattern. The assumption that Phe plays a central biochemical regulatory role in melanin, catecholamine and antibody synthesis forms an attractive challenge for the explanation of repigmentation and requires further investigation.

Langerhans' cell population studies with OKT6 and HLA-DR monoclonal antibodies in vitiligo patients treated with oral phenylalanine loading and UVA irradiation.

In vitiligo patients, treated with oral phenylalanine loading combined with UVA irradiation (Phe-UVA), Langerhans' cells (LC) were counted in pigmented and depigmented skin. The LC, which were labelled with OKT6 and HLA-DR monoclonal antibodies, were expressed per linear mm epidermis. Before treatment the number of OKT6(+) cells was significantly increased in vitiliginous skin especially in the basal layer. Under treatment the number went down and was comparable to normal skin. When using HLA-DR labelling the number of LC increased in vitiliginous skin which had been treated with Phe-UVA. The influence of Phe-UVA on the shift of LC subpopulations is discussed.

Hereditary deficiency of C2 in association with linear scleroderma 'en coup de sabre'.

A 32-year-old man suffering from linear frontoparietal scleroderma was found to have low (less than 10% normal) serum classical pathway activity although C1q, C3, C4, C5, and total alternative pathway activity was normal. Addition of purified C2 led to complete restoration of the total hemolytic activity of the classical pathway. The C2 hemolytic assays showed that the patient was not totally deficient in C2. He had about 30% of the normal C2 level. Studies on his available nucleus family members in the Netherlands also showed that the deficiency was inherited; one of the patient's brothers and one of his daughters had half of the normal C2 levels. The C2 deficiency could not be corrected by a three-week regimen of danazol. To the best of our knowledge, this is the first documented case concerning an association of linear frontoparietal scleroderma with C2 deficiency.

[Group treatment of psoriasis with the duo formula]. / Gruppenbehandlung der Psoriasis nach der Duo-Formel.

Group treatment for and by psoriasis patients was the subject of a trial. For 12 sessions over a period of 3 months, a fellow sufferer as co-helper cooperated with a professional specialist as co-worker according to the so-called duo formula. When the results were compared with those in a control group, the patients showed a change in the dimensions examined, as well as in their illness behaviour and insight into the value of problem-solving in groups. Therefore, it is recommended that dermatologist/co-helper teams be instructed for group treatment of chronic skin diseases, because this method stimulates self-activity in patients.

Comparison of bioavailability and phototoxicity of two oral preparations of 5-methoxypsoralen.

5-Methoxypsoralen (5-MOP) (Psoraderm 5) tablets obtained from France and 5-MOP micronized in capsules (manufactured in our pharmacy department) were administered to seven psoriasis patients in a 1.2 mg/kg body weight dose schedule. Bioavailability and phototoxicity were compared. It was found that the maximum serum concentration and the area under the concentration curve were significantly higher (P less than 0.01) after administration of the capsules, indicating higher bioavailability. No erythema developed in any of the patients after administration of the tablets, whereas with the capsules four of the patients developed erythema at the test site. The absence of erythema following the use of the tablets is probably due to the poor bioavailability of this preparation.

Group therapy of psoriasis. Duo formula group treatment (DFGT) as an example.

Between 1978 and 1982 an experiment on group treatment for and by psoriasis sufferers was conducted, based on a pyramid of previous investigations since 1968. Each group was facilitated by a duo consisting of a fellow sufferer and a physician, both having trained together. The subjects practiced the procedure described, directed toward self-care and mutual aid facilitated and supported by the duo, in a series of ten 2-hour weekly sessions. A pretest/posttest control group design was used. Comparing the results of the quantitative analysis of the experimental groups with those of the control groups, the experimental groups showed significant change. The results of the qualitative analysis showed that decrease of anxiety correlated with mastering of the skills involved. The key element affecting outcome was the balance in cooperation within the duo, the expertise of the patient lying in his personal experience of the condition, and the expertise of the physician in his knowledge and skills. One of the method's main characteristics was the intrinsic complementarity of the duo partners.

Phenylalanine and UVA light for the treatment of vitiligo.

The administration of phenylalanine (Phe) combined with UVA exposure was found to be effective in vitiligo. Phe is an amino acid which constitutes part of the daily dietary protein, and when orally administered in a dose of 50 mg/kg body weight, it results in an elevated plasma level. Since peak concentrations of Phe in the blood are reached between 30 and 45 min after ingestion, UVA exposure was administered at this time. After 4 months (32 treatments) reasonable repigmentation preferentially occurred in the skin area of subcutaneous fat (adipose tissue). Apart from the repigmentation of hypo-pigmented macules, vitiligo patients can tolerate more sun than usual, especially at the vitiliginous lesion, and they experience no sunburn as a result of Phe-UVA therapy. Normal skin also tans very well.