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.

Acid hydrolases in blister fluid. 5. Influence of ultraviolet radiation in patients with polymorphic light eruption.

The minimal erythema dose for chronic polymorphic light eruption (CPLE) patients was significantly reduced for UV-B rays. However, following doses which produced comparable erythema, no significant differences were found in the release of acid hydrolases between CPLE patients and controls. An increased release of acid hydrolases was found to accompany the formation of papular lesions. Increased enzyme activity was first observed some hours after the appearance of the erythema.

Acid hydrolases in blister fluid. 6. Photocontact and contact allergic skin reactions.

Increased acid hydrolase activity has been demonstrated in the fluid from experimental suction blisters raised on the sites of contact or photocontact allergic skin reactions. The magnitude of the increases correlated well with the intensity of the reactions. The enzymes appeared after latent periods of 10 h for vesicular reactions, 15 h for papular reactions and 24 h for erythematous responses. The present observations are very similar to those reported following UV-B; thus our previous conclusions regarding the role of lysosomal hydrolases in UVR erythema may be generalized to include other forms of cutaneous inflammation.

Photosensitivity and allergy to aromatic lichen acids, Compositae oleoresins and other plant substances.

Sixteen patients with verified light sensitivity to both UVB and UVA wavebands showed allergic reactions to various lichen plants (Parmelia spp., Hypogymnia spp., Pseudovernia spp., Cladonia spp., Platismatia spp., Physcia spp., Umbilicaria spp. and Cetraria spp.). Among the aromatic lichen compounds, atranorin was observed to be the most frequently involved allergen, but also several other isolated lichen acids were immunologically active: d-usnic, evernic, stictic, fumarprotocetraric, lobaric, salazinic, diffractaic and physodic/physodalic acid. Several patients showed allergy to other plant substances from other sources such as seven different species from the Compositae family, alantolactone, balsam of Peru, colophony and wood tars. Sensitivity to known photosensitizers was observed in four patients. Aromatic lichen acids are UV-absorbing substances and several are evidently able to photosensitize human skin.

Photosensitivity and allergy to aromatic lichen acids, Compositae oleoresins and other plant substances.

Sixteen patients with verified light sensitivity to both UVB and UVA wavebands showed allergic reactions to various lichen plants (Parmelia spp., Hypogymnia spp., Pseuodovernia spp., Cladonia spp., Platismatia spp., Physcia spp., Umbilicaria spp. and Cetraria spp.). Among the aromatic lichen compounds, atranorin was observed to be the most frequently involved allergen but also several other isolated lichen acids were immunologically active: d-usnic, evernic, stictic, fumarprotocetraric, lobaric, salazinic, diffractaic and physodic/physodalic acid. Several patients showed allergy to other plant substances from other sources such as seven different species from the Compositae family, alantolactone, balsam of Peru, colophony and wood tars. Sensitivity to known photosensitizers was observed in four patients. Aromatic lichen acids are UV-absorbing substances and several are evidently able to photosensitive human skin.

Light sensitivity in mycosis fungoides.

Because of suspected photosensitivity, twelve patients suffering from mycosis fungoides have been phototested with various wavebands. Four patients experienced a burning sensation and erythema following sun-exposure, after the disease had progressed to stage II. On phototesting, abnormal reactions were observed in 7 patients. The offending wavebands were situated mostly in the UVA range, but also in the UVB range and in visible light.

Urinary excretion of porphyrins in two cases of porphyria cutanea tarda during a period of various treatments.

The urinary excretion of porphyrins in two cases of porphyria cutanea tarda (PCT) has been followed during a period in which various treatments have been tried. In one patient pyridoxal-5-phosphate (P-5-P) injections lead to a dramatic increase in porphyrin excretion. In another P-5-P treatment was followed by a significant decrease in porphyrin excretion. p-Aminobenzoic acid (PABA) apparently had no effect on porphyrin excretion, while repeated phlebotomies had the expected effect. In both patients all variations in the total amount of porphyrins excreted were almost exclusively due to the variations in the amounts of heptacarboxylic porphyrin type III and uroporphyrin I. A secondary finding was an increase in hexa- and penta-carboxylic porphyrins type III without a concomitant increase in coproporphyrin III.

[New aspects of the treatment of psoriasis]. / Nye aspekter ved behandling av psoriasis.

Psoriasis is an inflammatory condition of the skin which affects about 2% of the population. Several new treatment modalities have been introduced in recent years. This review considers the mode of action of various forms of treatment, side effects and therapeutic results that have been observed. Etretinate is a synthetic vitamin A analogue. It works alone, or even better in combination with psoralen plus ultraviolet light A (PUVA) or ultraviolet light B (UVB). Cyclosporin is still on trial, but seems to be effective in small doses and can be considered as an alternative in cases of psoriasis that are resistant to other therapies. The interest in dietary measures for psoriasis has been revived after some studies have suggested that dietary supplements of fish oil, a low-fat diet, can improve the condition. Now that n-3-fatty acids are available in capsule form it should be possible to prescribe a diet that is rich enough in fish oils.

Skin and respiratory tract symptoms in veterinary surgeons.

Chronic or relapsing irritant eczema of the hands was the main complaint in 34 veterinary surgeons. 9 had contact allergic eczema of occupational character. In 8 cases, the allergies were probably due to antibiotics contaminating the skin during the administration of treatment. Contact allergy to penicillin was observed in 5 cases, to neomycin in 2 and to streptomycin in 1 case. Sensitivities to other work-related substances such as rubber chemicals, antiseptics and local anaesthetics were found in 6 cases. Multiple contact allergies, in particular to different penicillins, were seen frequently. Obvious work-related immediate reactions of probable allergic type were present in 10 cases, but were confirmed with positive RAST or prick test in only 2 cases.

The effect of local UVB skin irradiation on the rate of formazan deposition in the epidermis of hairless mice studied by means of a tetrazolium-reduction method.

One-hundred-and-twenty hairless mice were irradiated with UVB (310 nm, exposure 60 mJ/cm2) on a limited area of the dorsal skin. At different time intervals after irradiation, the rate of endogenous dehydrogenase activity per mg dry epidermis was measured by the tetrazolium reduction method. The amount of formazan deposited remained normal for 18 h, and then increased, reaching a peak significantly higher than normal at 24 h, and thereafter returned to normal. At day 8 there was a new, probably significant peak. The reaction was followed for 14 days. It was concluded that UVB irradiation provokes a period of increased formazan deposition in the epidermis, similar to what has been observed after ionizing radiation and chemical carcinogens. The validity of the tetrazolium test for skin carcinogenic irritaments was thus also confirmed.

Immunoglobulins in jejunal mucosa and serum from patients with dermatitis herpetiformis.

The quantitative distribution of immunoglobulin-(Ig)-producing cells of the major classes was determined by paired immunohistochemistry in the proximal jejunal mucosa of 29 patients with dermatitis herpetiformis (DH). The specimens were categorized stereomicroscopically in three groups. Compared with controls, the total number of Ig-producing cells in a defined "mucosal tissue unit" was for group I (normal or minor abnormality) found to be raised by a factor of 1.4, but the class ratios remained normal. In group II (major abnormality) the total immunocyte number was raised 2.6 times; IgA, IgM, and IgG cells showed a 2.4-, 3.5-, and 5.1-fold increase, respectively. Group II (intermediate abnormality) fell between the two other groups with regard to changes in the immunocyte population. Altogether the local immunocyte pattern was very similar to that previously found in coeliac disease (CD) specimens of comparable mucosal abnormalities. IgD cells were few, and showed no increase compared with controls. Also IgE cells were few, but were encountered more frequently than in controls. As in CD, staining for extracellular Ig in the lamina propria tended to be more intense than in controls. Normal or increased staining for SC, IgA and IgM in the crypt epithelium indicated a normal external transfer of these components. DH differed from DC in showing no significant rise in the level of serum IgA. Serum IgM was reduced in group III, and IgG was increased in group I.

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis.

In a double-blind, block randomized study we investigated the effect of dietary supplementation with eicosapentaenoic acid in patients with psoriasis. The experimental group received 10 g of fish oil daily containing approximately 1.8 g eicosapentaenoic acid, while the controls were given an isoenergetic amount of olive oil. We found no significant change in the clinical manifestations of psoriasis in either group after 8 weeks of treatment. In the experimental group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of trial as compared to pre-treatment values, whereas the level of n-6 fatty acids was decreased.

Epidermal and dermal distribution of a myelomonocytic antigen (L1) shared by epithelial cells in various inflammatory skin diseases.

The L1 antigen is a major cytosol component of human granulocytes that may also be expressed by macrophages and epithelial cells. Its epidermal and dermal occurrence was investigated in formalin-fixed routine biopsy material from eleven different inflammatory skin disorders. Localization was performed with a rabbit antiserum to L1 applied in an unlabeled antibody peroxidase-antiperoxidase method. L1 antigen was not found in normal skin except in epithelial cells of pilosebaceous units. However, epidermal L1 antigen was demonstrated in every biopsy specimen from lupus erythematosus, lichen planus, dermatitis herpetiformis, and atopic dermatitis, whereas granuloma annulare test results were usually negative. The occurrence of dermal L1 antigen depended on the composition of the inflammatory infiltrate; specimens rich in neutrophilic granulocytes (e.g., dermatitis herpetiformis) were particularly strongly stained. Extracellular dermal staining was also seen, especially in areas adjacent to accumulation of positive leukocytes. The varying epidermal occurrence of L1 antigen in skin diseases probably signified different degrees of proliferative activity of the epithelial cells and could apparently not be ascribed to uptake from the dermis.