Clinical and Experimental Dermatology

FRIEDMANN, P.S.

doi: 10.1111/j.1365-2230.1991.tb00313.xpmid: 2032380

MALI‐GERRITS, M.G.H.; GAASBEEK, D.; BOEZEMAN, J.; VAN DE KERKHOF, P.C.M.

doi: 10.1111/j.1365-2230.1991.tb00314.xpmid: 2032381

SummaryPhotochemotherapy (PUVA) and methotrexate (MTX) are treatments frequently prescribed in patients with severe psoriasis. However, both treatments have carcinogenic potential. A group of 227 patients, who had been treated with PUVA, MTX or the combination, was investigated for the presence of cancer of the skin. As a control, the partners of these patients were investigated at the same visit.Cancers of the skin were observed in 15 out of 227 psoriatics, compared to one out of 95 control subjects. In the psoriatic patients a previous history of skin cancer, arsenic intake and X–ray treatment were observed more frequently.The increased frequency of skin cancers in psoriatics treated with PUVA, MTX and the combination of both, justifies regular surveillance on skin cancer in these patients.

BIRKIN, J. A.; LOWE, J. S.; FRY, J. R.; MILLARD, L. G.

doi: 10.1111/j.1365-2230.1991.tb00315.xpmid: 2032382

SummaryProtein and N—linked glycoprotein biosynthesis was studied in histologically verified normal epidermis, actinic keratoses, keratoacanthoma, intra‐epidermal carcinoma and squamous‐cell carcinoma using polyacrylamide gel electrophoresis (PAGE). The PAGE profiles of 3[H]—leucine‐labelled proteins and 3[H]‐mannose‐labelled glycoprotein from all disease states studied differed from each other and from normal epidermis. A large 3[H]‐mannose‐labelled glycoprotein region (band A) with a peak at 97–92 kDa appeared to indicate the presence of a relatively large proportion of basaloid cells in the tissue. An associated peak in the region of 78–74 kDa also appeared in normal epidermis and what appeared to be non‐invasive lesions. The main region of change in all lesions corresponded to the 66–34‐kDa region (bands B and C). The absence of a group of glycoproteins and proteins in the 62‐58‐kDa region appeared to be specific for invasive squamous‐cell carcinoma. All tumours showed a peak at 38–34 kDa which was not present in normal epidermis. Actinic keratosis had a pattern similar to normal epidermis except that the peaks of band B tended towards the higher‐molecular‐weight end of the band than those in normal epidermis and peaks at 28–22 kDa were seen. The latter seemed to correspond to the presence of a high proportion of spinous cells in the tissue sample.

BIRKIN, J.A.; FRY, J.R.; MILLARD, L.G.

doi: 10.1111/j.1365-2230.1991.tb00316.xpmid: 2032383

SummaryProtein and N‐linked glycoprotein biosynthesis was studied in the uninvolved epidermis of patients with psoriasis by the incorporation of radiolabelled leucine and mannose prior to and during PUVA treatment. Analysis of the polyacrylamide gel electrophoresis (PAGE) patterns of the 3[H]‐labelled proteins and glycoproteins showed that the major changes in untreated uninvolved psoriatic epidermis compared to normal epidermis were: (a) a shift towards the synthesis of low‐molecular‐weight glycoproteins; (b) the absence of a 48‐kDa peak labelled with mannose; (c) the appearance of 3[H]‐mannose‐labelled peaks at 40–36 kDa. PUVA treatment gradually changed the PAGE profile back more towards that expected for normal epidermis, with the reintroduction of a 52–48‐kDa glycoprotein and reduction of the peaks in the 40–34‐kDa region. This effect was dependent on uninterrupted treatment. The PUVA‐treated PAGE profiles were compared to those expected in skin tumours (i.e. increased 3[H]‐mannose‐labelled peaks at 95 and 40–34 kDa with an absence of 62‐kDa peaks). It appeared that these criteria were not seen generally as a result of PUVA treatment. However, the results indicate that tumour development may be possible if a patient responds to PUVA treatment by showing an increased peak at 95 and 40–34 kDa in association with a loss of an 3[H]‐mannose‐labelled peak at 62 kDa.

RAMESH, V.; MISRA, R.S.; SAXENA, U.; MUKHERJEE, A.

doi: 10.1111/j.1365-2230.1991.tb00317.xpmid: 1709600

SummaryThree antituberculous drug regimens have been employed to study the therapeutic response in 90 patients with any one of the commonly encountered paucibacillary forms of skin tuberculosis, namely lupus vulgaris, tuberculosis verrucosa cutis and scrofuloderma. The first two regimens contained rifampicin, isoniazid and either pyrazinamide or thiacetazone, and the third regimen had rifampicin and isoniazid only. The disease was clinically defined as localized when confined to one area and widespread when the lesions were disseminated. The observations revealed that the response of lupus vulgaris and tuberculosis verrucosa cutis was alike in all the three regimens, with the localized lesions subsiding completely after 4 months of therapy and the more extensive forms taking 5 months. Patients with scrofuloderma responded similarly to both the triple drug regimens. The discharge, sinuses and ulcers cleared in 6 months but the lymph nodes took longer to regress, up to 7 months in localized and 9 months in more widespread scrofuloderma. To obtain the same results with rifampicin and isoniazid, all patients with widespread scrofuloderma and one‐third of those with localized forms had to be treated for 10 and 9 months, respectively. No serious drug side‐effects, apart from giddiness with rifampicin and acneiform eruptions with thiacetazone, were encountered. No instances of relapse were noted in the 50% of patients who were followed‐up for 31/2 years after therapy. Single‐drug therapy with isoniazid for lupus vulgaris, as given in the past, is to be discouraged as it may promote the emergence of drug‐resistant bacilli in those with an undetected focus of infection. An additional object of defining effective mutliple drug regimens is to improve patient compliance by reducing the duration of therapy and to avoid confusion by adhering uniformly to the recommended regimen in places where tuberculosis is prevalent.

HYUN CHO, KWANG; HOON KIM, SEON; CHAN PARK, KYOUNG; YOUNG LEE, AI; YONG SONG, KYE; CHI, JE GEUN; SHIN LEE, YOO; JUNG KIM, KYE

doi: 10.1111/j.1365-2230.1991.tb00318.xpmid: 2032370

SummaryFour children affected by intradermal vascular proliferations are presented. The clinicopathological findings closely resemble those of cases described as angioblastoma, a familiar entity in the Japanese literature. Some people suggest that angioblastoma is the same as the tufted angioma described by Wilson‐Jones. We found localized hyperhidrosis in two of our patients. Proliferation of eccrine glands near the tumour lobule was a consistent finding in the biopsy specimens from these four patients. In one patient, some of the vascular tufts were replaced by mucinous material. These findings have not been mentioned in previous reports of tufted angioma.

PRICE, M.L.; MOTTAHEDIN, I.; MAYO, P.R.

doi: 10.1111/j.1365-2230.1991.tb00319.xpmid: 2032371

SummaryTwo groups of people with psoriasis attended a short series of meetings conducted by a clinical psychologist. During these sessions the patients were given the opportunity to discuss between themselves problems created by their skin complaint and they were taught specific relaxation techniques for use whenever they felt under stress.Psychological tests showed that the participants were a noticeably anxious group compared to the general population. However, their levels of anxiety were significantly reduced by the end of the study. There was also a modest trend towards physical improvement. No such changes were seen in a matched control group.

VERBOV, J.L.; MONK, C.J.E.

doi: 10.1111/j.1365-2230.1991.tb00320.xpmid: 2032372

SummaryAn ankle callosity overlying the talus is defined and described in three patients and the lesion is considered common but often unrecognized. The aetiology is discussed.

CURLEY, R.K.; HUDSON, P.M.; MARSDEN, R.A.

doi: 10.1111/j.1365-2230.1991.tb00321.xpmid: 2032373

SummaryWe report four patients with pachydermodactyly, a rare and poorly recognized form of digital fibromatosis characterized by asymptomatic soft‐tissue swelling around one or more proximal interphalangeal joint in young men.

O'DRISCOLL, J.B.; CHALMERS, R.J.G.; WARNES, T.W.

doi: 10.1111/j.1365-2230.1991.tb00322.xpmid: 2032374

SummaryA 47‐year‐old man with primary intestinal lymphangiectasia developed chylous reflux into the skin of the right flank. The clinical appearance resembled lymphangioma circumscriptum with multiple dome‐shaped vesicles filled with milky‐white fluid which discharged on to surrounding skin. Backflow of chyle into the skin of the lower limb, perineum or external genitalia has been described as a rare finding in patients with primary lymphoedema but we believe this to be the first case involving the abdomen and the first case describing chylous reflux into the skin in a patient with intestinal lymphangiectasia.