Therapy of psoriasis: comparison of photochemotherapy and several variants of phototherapyVAN WEELDEN, H.; YOUNG, E.; VAN DER LEUN, J.C.
doi: 10.1111/j.1365-2133.1980.tb15831.xpmid: 7000139
SUMMARYFour treatments involving light were compared in two series of patients with severe psoriasis. The first series consisted of ten patients, who were treated by the method of paired comparisons. The treatments given were: (1) exposure to fluorescent sunlamps (B); (2) the same, supplemented by fluorescent UV‐A lamps (A+B); (3) the same as (2) with the addition of the radiation from germicidal lamps (A+B+C); (4) photochemotherapy with oral 8‐MOP followed by UV‐A (PUVA); (5) one of the fields served as control, receiving no light at all. The second series consisted of thirty patients. They were treated either with PUVA or with a placebo capsule followed by A+B (pUVAB).The phototherapies examined differed from many previous attempts in that the increments in dose were made sufficiently large to overcome the increasing tolerance of the skin to light during the treatment.It is concluded (a) that phototherapy, if conducted in this way, is as effective as PUVA, and (b) that the effectiveness achieved with the phototherapies examined is due to the light from the fluorescent sunlamps (B).
Long‐term photochemotherapy: histopathological and immunofluorescence observations in 243 patientsGSCHNAIT, FRITZ; WOLFF, KLAUS; HÖNIGSMANN, HERBERT; STINGL, GEORG; BRENNER, WILHELM; JASCHKE, ERNA; KONRAD, KLAUS
doi: 10.1111/j.1365-2133.1980.tb15832.xpmid: 7000141
SUMMARYSkin biopsies of 243 patients treated with photochemotherapy (PUVA) for 1–4 years were examined histologically. Two hundred and six patients were examined retrospectively after total cumulative UV‐A doses of 579·6 ± 598·0 J/cm2 (mean ± s.d.). An eosinophilic homogenization and a reduction of elastic fibres at the dermo‐epidermal junction, and an increase of dermal macrophages were found as possible abnormalities. However, except for the increase of melanophages there was no statistically significant correlation between the incidence of these changes, the total UV‐A dose applied and the skin type of the patients. Neither were such correlations found in thirty‐seven patients biopsied twice after 394·8 ± 267·6 J/cm2 and 808·5 ± 458·9 J/cm2 (mean±s.d.), respectively. Studies with direct immunofluorescence techniques revealed no immunoglobulin deposits in PUVA treated skin in fifty‐six patients after 469·2 ± 370·2 J/cm2; antinuclear antibodies were observed in 4·6% of 129 patients after 169 J/cm2 (mean); in 11%, of fifty‐three patients reexamined after 381 J/cm2 (mean) and in 13·6% of twenty‐two patients reexamined a second time after 643 J/cm2 (mean).Thirteen out of a total of 572 patients developed a peculiar mottling of skin in areas previously overdosed by PUVA. Subepidermal homogenization and reduction of elastic fibres were found in 45% of the patients, indicating that these changes indeed are a consequence of PUVA. Nuclear and cellular irregularities were found in 45% of the biopsies and 63% showed a disturbed epidermal architecture, but no carcinomas were observed. PUVA‐induced mottling was reversible in 31%, partially reversible in 15%, but continued to be present in 54%.
Decreased epidermal aryl hydrocarbon hydroxylase and localized pustular psoriasisSHUSTER, SAM; RAWLINS, M.D.; CHAPMAN, P.H.; ROGERS, SARAH
doi: 10.1111/j.1365-2133.1980.tb15833.xpmid: 7426403
SUMMARYMicrosomal aryl hydrocarbon hydroxylase (AHH) activity was measured in suction separated epidermis from forearm skin of thirteen patients with localized palmo‐plantar pustular psoriasis and thirteen normal subjects before and after induction by benzanthracene. AHH activity had a mean value of 2·32 μm 30H‐BP/mg microsomal protein/h ± 0·23 (s.e.) in the patients and 3·41 ± 0·23 in the normal subjects. AHH induction was also decreased with a mean value of 1·15±0·1 (s.e.) compared with 1·98±0·14 for the normal subjects. Since in twelve of the patients the psoriasis had always been localized to the palms and soles, the decreased basal and induced AHH activity appears to be a primary characteristic of psoriatic skin; AHH activity might initiate an increase in epidermal cell turnover through modulation of prostaglandin and adenylate cyclase activity.
Topical spermine and putrescine stimulated DNA synthesis in the hairless mouse epidermisGANGE, RICHARD W.; DEQUOY, PETER R.
doi: 10.1111/j.1365-2133.1980.tb15834.xpmid: 7426404
SUMMARYPolyamines were applied topically to the skin of the hairless mouse. Putrescine stimulated the incorporation of thymidine after a 24‐h application period. The effect of polyamines upon skin pretreated with a potent topical steroid was also examined; in this model thymidine incorporation was stimulated by both spermine and putrescine. Pretreatment was performed in order to reduce endogenous polyamine biosynthesis and increase the sensitivity of the epidermis to exogenous polyamines. Depletion of the activity of ornithine decarboxylase, the rate‐limiting polyamine biosynthetic enzyme, by topical steroids was confirmed in the hairless mouse following induction of the enzyme by UV‐B. The results are consistent with those of in vitro studies suggesting a role for polyamines in the control of DNA synthesis; the effect of corticosteroids upon proliferative skin disorders may be mediated through this mechanism.
Protease inhibitor profiles in urticaria and angio‐oedemaEFTEKHARI, N.; WARD, A.MILFORD; ALLEN, R.; GREAVES, M.W.
doi: 10.1111/j.1365-2133.1980.tb15835.xpmid: 6968579
SUMMARYPlasma levels of six protease inhibitors have been measured in patients with chronic urticaria, chronic urticaria with angio‐oedema, cold and cholinergic urticaria. In chronic urticaria Cr esterase inhibitor activity was increased compared with a reference control population but there was no detectable abnormality of any other protease inhibitor. Patients with chronic urticaria/angio‐oedema showed a reduction in inter‐α trypsin inhibitor. They also manifested a rise in C1 esterase inhibitor. In cold urticaria there was a significant lowering of α1 antichymotrypsin. The reduction in α1 antitrypsin in this group probably reflects a genetic difference compared with the control population. Patients with cholinergic urticaria also showed a reduction of α1 antichymotrypsin. The elevated levels of α2 macroglobulin in the three groups are probably due to differences in the mean age of these groups compared with the reference population.Comparison of levels in subgroups of patients with and without active lesions suggest that a consumptive effect may contribute to the reduced values, although it seems unlikely to account for them entirely. The results suggest that involvement of pharmacologically active products of protein digestion may be involved in the pathogenesis of urticaria and should prompt attempts to identify these agents and encourage trial of medications which lead to inhibition of proteolytic activity in urticaria.
Studies on the blood fibrinolytic enzyme system of patients with cutaneous vasculitisTOKI, NAOTIKA; YAMURA, TAKUSO
doi: 10.1111/j.1365-2133.1980.tb15836.xpmid: 6775670
SUMMARYThe fibrinolytic enzyme system in thirty‐two patients suffering from cutaneous vasculitis was investigated. In five of seven patients with Behçet's disease and in five of thirteen patients with erythema nodosum a significant elongation of euglobulin lysis time was observed. On the other hand, in two patients with allergic vasculitis, a significant shortening of euglobulin lysis time was noticed. In the present study, factors responsible for the change of euglobulin lysis time were sought. It was confirmed that the significant elongation of euglobulin lysis time in patients with erythema nodosum was based on an increase of fibrinogen content in the euglobulin fraction. On the other hand, it was speculated that the significant elongation of euglobulin lysis time in patients with Behçet's disease might be due to an increase of antiactivators in the patients' plasma. In the present study, the authors further investigated the status of this antiactivator which is increased in plasma of patients with Behçet's disease, and proposed the possibility that the increased antiactivator might consist of at least two types of antiactivators, one of which is considered to be α2‐plasmin inhibitor.
Neutrophil chemotaxis in the presence of antibiotics: a re‐evaluation using an agarose techniqueGANGE, RICHARD W.
doi: 10.1111/j.1365-2133.1980.tb15837.xpmid: 7426405
SUMMARYNeutrophil chemotaxis in the presence of tetracycline and clindamycin was evaluated using an agarose technique. No significant inhibition of chemotaxis by these antibiotics could be demonstrated, in contrast to previously reported findings using the Boyden chamber technique for measurement of chemotaxis. Both agents caused a minor increase in movement towards a P. acnes derived chemotactic factor. Some reduction of chemokinesis by high concentrations of tetracycline was noted. No effect of the drugs upon generation of chemotactic activity from whole serum could be demonstrated. Normal cell movement occurred in the absence of extracellular calcium and magnesium, in contrast to reported findings using the Boyden chamber.
Sex‐linked ichthyosis and placental sulphatase C deficiencyDE GROOT, W.P.; JOBSIS, A.C.; MARINKOVIC‐ILSEN, A.; KOPPE, J.G.; DE BRUIJN, H.W.A.
doi: 10.1111/j.1365-2133.1980.tb15840.xpmid: 7426407
SUMMARYIchthyosis was diagnosed in six boys born from pregnancies in which placental steroid sulphatase deficiency was present. In four cases the diagnosis of sex‐linked ichthyosis was certain, in the other two the ichthyosis was probably of the sex‐linked type.No arylsulphatase C activity could be demonstrated histochemically either in the epidermis of these boys, or in the epidermis of adults with sex‐linked ichthyosis, whilst it was present in normal controls. In cultured skin fibroblasts steroid‐sulphatase activity was extremely low. We conclude that deficiency of steroid sulphatase C or arylsulphatase C or a third functionally linked enzyme is an important factor in the pathogenesis of sex‐linked ichthyosis.