Clinical and Experimental Dermatology

COLVER, G.B.; DAWBER, R.P.R.

doi: 10.1111/j.1365-2230.1989.tb00873.xpmid: 2680174

FINLAY, A.Y.; BRYDEN, J.S.

doi: 10.1111/j.1365-2230.1989.tb00874.xpmid: 2805393

SummaryThe physical integration of out‐patient clinics, outpatient treatment and in‐patient management areas allows full cohesion and continuity of medical and nursing care of dermatology patients.The conversion of a dermatology ward to an outpatient treatment centre has resulted in major benefits in the daily management of dermatology patients, allowing increased flexibility of care despite a reduction in bed numbers and financial savings. Broad changes in concepts of dermatology management are described and arguments given which may be used in the negotiation for improved facilities.

PIMPINELLI, N.; SANTUCCI, M.; BOSI, A.; MORETTI, S.; VALLECCHI, C.; MESSORI, A.; GIANNOTTI, B.

doi: 10.1111/j.1365-2230.1989.tb00875.xpmid: 2680175

SummaryIn this study the clinico‐pathological and immunohistological features, the methods of treatment and follow‐up data of 11 patients with follicular centre‐cell (B‐cell) lymphoma primarily presenting in the skin are reported. All the patients had nodular, tumorous and/or papulonodular skin lesions on the trunk. In nine patients the disease was confined to a circumscribed area of the back. Small papulonodular or plaque‐like lesions, as well as large nodules or tumours, were biopsied in six of 11 patients. No clear‐cut correlation between the age and clinical morphology of the lesions and their histological growth pattern was found. Interestingly, however, a different immuno‐architectural pattern was observed in large, late lesions compared to small, early lesions. Initial treatment consisted of orthovolt radiotherapy (in two patients associated with surgical excision), resulting in complete remission in all patients. Only one patient developed extracutaneous disease, which was limited to a single drainage lymph node appearing simultaneously with a cutaneous relapse. Five other patients had recurrent disease in the skin close to the initial site. The median disease‐free period was 15·5 months. On relapse, radiotherapy alone or in combination with short courses of chemotherapy was performed. This resulted in a second complete remission. All the patients are still alive and in complete remission, with a median survival of 37 months. These results confirm the favourable prognosis of patients affected with primary cutaneous follicular centre‐cell lymphoma limited to the trunk. Orthovolt radiotherapy proved to be the most suitable treatment for both initial lesions and relapses limited to the skin.

HYUN CHO, KWANG; SHIK SHIN, KI; JASOHN, SOOK; JAE CHOI, SUNG; SHIN LEE, YOO

doi: 10.1111/j.1365-2230.1989.tb00876.xpmid: 2805385

SummaryWe describe six cases of Behcet's disease, which showed Sweet's syndrome‐like features. The clinical findings in our patients closely resemble those of the cases described in previous reports on Sweet's syndrome. However, oral and genital mucosal involvement, non‐tenderness of the lesions and a pustular eruption elsewhere made us consider Behcet's disease. Besides the clinical findings, vasculitis was clearly demonstrated in the skin biopsy specimens.

LOGAN, R.A.; O'BRIEN, T.J.; GREAVES, M.W.

doi: 10.1111/j.1365-2230.1989.tb00877.xpmid: 2680176

SummaryA controlled trial of 4‐weeks oral photochemotherapy (PUVA) on 14 patients with severe symptomatic dermographism produced a clinically useful reduction in itching in five patients. In four of these patients itching had relapsed to pre‐treatment levels within 3 months of finishing the PUVA course. A comparison of the weal and flare responses on exposed and covered (control) skin using a calibrated dermographometer showed no significant change in skin reactivity, even in the patients who experienced symptomatic relief. While PUVA may temporarily reduce itching in some patients with symptomatic dermographism, its use cannot generally be justified for treating this type of physical urticaria.

OGAWA, M.M.; HASHIMOTO, T.; NISHIKAWA, T.; CASTRO, R. M.

doi: 10.1111/j.1365-2230.1989.tb00878.xpmid: 2680177

SummaryHuman IgG possesses four main subclasses, namely IgG1, IgG2, IgG3, and IgG4, of these IgG1–IgG3 fix complement, but IgG4 does not.We have studied the IgG subclasses of intercellular antibodies in the sera from 20 patients with Brazilian pemphigus foliaceus by immunofluorescent staining using mouse monoclonal antibodies against human IgG1–IgG4. At the same time, the complement fixing capability of each antibody was examined by complement immunofluorescence.All of four subclasses were frequently detected in most cases with varying distributions. However, no specific pattern was observed. Complement fixing antibodies were found in four patients. However, the distribution of IgG subclasses was incompatible with their known characteristics in terms of complement activation.This discrepancy increases the controversy over the importance of the complement system in blister formation in pemphigus.

ENGLISH, J.S.C.; BUNKER, C.B.; RUTHVEN, K.; DOWD, P.M.; GREAVES, M.W.

doi: 10.1111/j.1365-2230.1989.tb00879.xpmid: 2680178

SummaryA total of 97 out‐patients with steroid responsive dermatoses (63 eczema, 34 psoriasis) were recruited from two centres. They were randomly allocated in a double‐blind manner to receive cither betamethasone dipropionate cream twice daily or betamethasone dipropionate cream in the morning and base cream in the evening. The treatment period was 3 weeks.Eighty‐five patients completed the study. There were no statistical differences between once daily application and twice daily for all of the parameters studied in both the eczema and psoriasis patients. Analysis of the diary card records, however, showed that symptomatic relief occurred more quickly in eczema patients receiving twice daily application of betamethasone dipropionate cream (P= 0·03). The use of betamethasone dipropionate cream once daily in conjunction with an emollient provides a regime which is as effective as a twice daily application of betamethasone dipropionate.

BIEBER, T.; DANNENBERG, B.; RING, J.; BRAUN‐FALCO, O.

doi: 10.1111/j.1365-2230.1989.tb00880.xpmid: 2478318

SummaryApparently normal, and lesional skin from patients with atopic eczema were investigated immunohistochemically with anti‐HLA‐DR, ‐CD1a and ‐IgE antisera. A CD1a + intercellular pattern was observed in uninvolved skin in the majority of the patients whereas an HLA‐DR +/CD1a+ network, mostly localized in basal and supra‐basal areas, was shown in lesional skin of virtually all of them. Moreover, an HLA‐DR +/CD1a + IgE + intercellular pattern was observed in some of the patients only and was predominantly localized in those areas characterized by lymphocyte exocytosis, spongiosis or vesicle formation. Whether keratinocytes are able to synthesize CD1a antigen and FcɛR or if these molecules are only produced and shed by CD1a +/IgE + epidermal dendritic cells remains unclear.

RUSHTON, D.H.; UNGER, W. P.; COTTERILL, P. C.; KINGSLEY, P.; JAMES, K. C.

doi: 10.1111/j.1365-2230.1989.tb00881.xpmid: 2680179

SummaryForty‐seven men with male pattern baldness were treated in a double‐blind clinical trial with topical 2% minoxidil or placebo. Twelve were randomly selected for quantitative hair measurement using the unit area trichogram and visual counting. There was no significant difference after 6 or 12 months of treatment with a 2% minoxidil solution for total hair density (THD; hair cm−2), meaningful hair density (MHD; hair > 40 μm in diameter > 30 mm in length cm−2), per cent of hair in the anagen growth phase, or the per cent of meaningful hair in the anagen growth phase. Significantly fewer hairs were recorded with the visual hair counting method, compared to values obtained from adjacent sites with the unit area trichogram. In addition, a significantly larger mean total hair count was recorded by an experienced observer, compared to an inexperienced observer. Increased pigmentation was observed within the vellus hair population of treated subjects. Our findings indicate that minoxidil appears unlikely to affect the long‐term course of male‐pattern baldness. However, we found no significant deterioration in total hair density, or meaningful hair density in treated subjects, suggesting minoxidil may have a prophylactic effect. Further long‐term studies employing the unit area trichogram are required to evaluate this finding.

PEEREBOOM‐WYNIA, J.D.R.; KOERTEN, H.K.; JOOST, TH.VAN; STOLZ, E.

doi: 10.1111/j.1365-2230.1989.tb00882.xpmid: 2805386

SummaryA scanning electron microscope was used to compare the distal ends of exclamation mark hairs from alopecia areata patients with the fracture surface of normal hair fibres, mechanically broken by traction. The exclamation mark hairs shows minimal damage to the cuticular cell pattern of the hair shaft. Where the cuticle was absent, cortex and medulla showed low‐density features fanning out into a fringe‐like structure at the distal ends. The fracture surfaces of normal hair fibres, mechanically broken by traction showed a markedly abnormal cuticular scale‐pattern, whereas the features of cortical and medullary tissue were normal.These morphological differences between the fracture surface of exclamation mark hairs and normal hair fibres, mechanically broken by traction, may enhance our understanding of the pathogenesis of alopecia areata.