Atopic dermatitis and Sézary syndrome.

A patient with severe atopic dermatitis had pre-Sézary and Sézary syndromes. Although elevated serum IgE values in mycosis fungoides and Sézary syndrome are not infrequent, the direct sequential occurrence of atopic dermatitis and Sézary syndrome is uncommon. The clinical and laboratory changes we observed imply that the relationship of these disorders may be conditioned by changes in immunoresponsiveness.

Immunology of pustulosis palmoplantaris.

The immunologic events of pustule formation in pustulosis palmoplantaris (and in pustular psoriasis) have been discussed with special reference to demonstrating the presence of immunoglobulins and complement within vessels walls, at the epidermo-dermal junction, in the horny layers and around the pustule, as well as its possible significance for the accumulation of leukocytes.

On therapeutic approaches to some special types of acne.

The aim of the present study was to evaluate different treatment schedules in some different types of acne using a quantitative counting technique. Systemic treatment with erythromycine 0.5 g daily and topical treatment with clindamycin phosphate solution 1% was found to be optimal from the efficacy/side effect ratio. The combined treatment was tried in heat-provoked and cosmetic acne with favourable results. Doubling of erythromycine dosage could not prevent premenstrual exacerbation of acne. Diazepam 4 mg daily for two weeks followed by an antihistamine in addition to erythromycine 0.5 g daily gave relatively good results in female patients with acne excorié. In acne coexisting with pronounced seborrhoic dermatitis of the face the addition of hydrocortisone cream 1% was of benefit, although Roaccutane may here be the drug of choice. In female postpubertal acne, the effect of cyproteronacetate-etynilestradiol (Diane) was not superior to treatment with erythromycine 0.5 g daily. By treating special subtypes differently, one could be able to improve the results of acne therapy.

Grading of the severity of atopic dermatitis.

A simple system for baseline grading the severity of atopic dermatitis in clinical work, is presented. The grading, which may be carried out on the basis of one single consultation, permits distinction between mild, moderate and severe atopic dermatitis by means of a score summation using the following parameters: 1) extent (by "rule of nine"), 2) course (via history) and 3) intensity (disturbance of night's sleep by itching).

On erythema annulare centrifugum-type of psoriasis.

A case of EAC type psoriasis is reported. Routine and immunologic investigations were negative. HLA-B8 was found by typing. Some therapeutic benefit was achieved by combination of retinoid (Ro-10-9359) plus PUVA. According to a review of the literature half of the cases are unconnected to classical psoriasis, whereas the other half is connected and mostly of (periodic) pustular character. The necessity of clinical research in this intermediate type between psoriasis vulgaris and pustulosa is emphasized.

Hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream versus desonide (Apolar) 0.1% ointment in the treatment of patients suffering from atopic dermatitis.

A randomized, double-blind, left-right study to compare the therapeutic efficacy and the cosmetic acceptability of the new hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream application form with desonide (Apolar) 0.1% ointment was performed in thirty patients suffering from moderate to severe atopic dermatitis. The medications were applied to symmetrical, bilateral skin lesions twice daily for 4 weeks. Both treatments effected highly significant reductions of the score values for the severity of all clinical skin parameters assessed. Score reductions were, however, more pronounced on Locoid-treated sides than on Apolar-treated sides both after 2 and 4 weeks of therapy. It appeared further that clinical efficacy of treatment at completion of the study was also in favour of Locoid-treated sides, indicating that Locoid fatty cream is more effective than Apolar ointment. No serious side-effects were reported during the study. The expressed patient preferences with respect to cosmetic acceptability of treatments were significantly in favour of Locoid fatty cream, indicating that patients preferred the use of this new galenic formulation over an ointment formulation. It is concluded that the new application form of Locoid, a fatty cream, is a useful and beneficial addition to topical corticosteroid therapy, which will promote patient compliance in a wide range of corticosteroid-responsive skin diseases.

Pregnancy and porphyria cutanea tarda.

A 31-year-old woman developed typical clinical and laboratory signs of PCT at the end of her second pregnancy coincident with the summer season. She had elevated liver function values without history of alcoholism, hepatitis or chemical liver damage. She had taken oral contraceptive only before her first pregnancy which was normal. Her hormone analytic values including estrogens corresponded to normal values in pregnancy. Venesections had a beneficial affect on her condition.

On cell-mediated immunity in acne conglobata.

In 25 of 35 cases of acne conglobata, a reduction in or lack of delayed reactivity was found by intracutaneous tests with a battery of antigens. On the basis of these findings as well as of normal T-cell function in lymphocyte culture and of negative Kveim-tests (in three cases), the possible immunological mechanisms are discussed.

Atopic dermatitis. Correlation of environmental factors with frequency.

Answers to a questionnaire on atopic dermatitis sent to clinicians in different countries--excluding Europe and North America--were evaluated. The questions included frequency as well as the possible role of special influencing/aggravating factors in atopic dermatitis patients. According to the data from 19 different countries, climatologic/geographic conditions, profession, and psychic stress have a decisive role, whereas food items have a smaller role in the course of atopic dermatitis.

The relationship between the course of psoriasis and transepidermal water loss, photoelectric plethysmography and reflex photometry.

The transepidermal water loss (TWL), photoelectric plethysmography and reflex photometry were parallelly registered on the involved hands and forearms of psoriatics. The TWL values showed a fairly good correlation with the clinical course of the disease: they increased during the active phase and decreased after return to normal. The vascular tests did not show a strict parallelism with the clinical state. On the basis of the findings, the temporal relations between epidermal and vascular factors during the different phases of the psoriatic process are discussed. The TWL can be used to predict a relapse occurring on the area investigated but not on a distant area.

On the significance of the trichophytin reactivity in atopic dermatitis.

Patients with pure atopic dermatitis with and without tinea infection were investigated and compared with patients with long-lasting tinea infections and with controls, for presence of intracutaneous reactivity to trichoptin, Penicillium, Cladosporium and Alternaria antigens. RAST to Penicillium and Cladosporium was also performed. The results showed a lack of delayed reactivity, but an immediate reactivity to trichophytin in 50%/40% of atopic patients with/without tinea infection. Non-atopics infected with tinea showed 66% immediate and 33% delayed response to trichophytin. The reactivities in atopic dermatitis (but not in the non-atopic group) went general parallel with mould reactions tested intracutaneously or by RAST. It is assumed that a positive trichophytin reaction in atopic dermatitis does not necessarily mean sensitisation to dermatophytes, but is primarily the sign of a cross sensitivity to moulds.

Immunofluorescence studies in herpes gestationis.

In 4 cases of H.G., direct junctional immunofluorescence findings showed an intense band of C3 present in the involved skin of the patients even after the active lesions had disappeard (i.e. 2 months later). Weak specific fluorescence for IgG and in one case also for IgA and IgM was seen in the involved skin. A less intense junctional band of C3 was also present in the uninvolved skin. Antibodies against basal membrane have not been detected in the sera of the patients.

Treatment of acanthosis nigricans with etretinate (Tigason) in a patient with Lawrence-Seip syndrome (generalized lipodystrophy).

The major symptoms of Lawrence-Seip syndrome or generalized lipodystrophy consist of muscle hypertrophy, loss of subcutaneous fat, hyperlipaemia, diabetes mellitus and acanthosis nigricans. We have successfully treated acanthosis nigricans in a patient with Lawrence-Seip syndrome.

[Acrodermatitis papulosa eruptiva infantum as a prodrome in hepatitis B infection]. / Acrodermatitis papulosa eruptiva infantum als Prodrom bei Hepatitis-B-Infektion.

We report on a 4-year-old boy suffering from typical infantile papular acrodermatitis with an unusual course. The eruption occurred seven weeks before the signs and symptoms of hepatitis. Only trace concentrations of hepatitis B surface antigen (HBsAg) could be detected after three weeks history of the disease. The lesions which persisted for nine weeks were itching, and there were signs of superinfection. We found only localized lymphadenopathy. The condition developed into a chronic HBsAg carrier state.