Showing papers in "British Journal of Dermatology in 1976"

Pigmented lesions in newborn infants.

Abstract: 1058 newborn infants were examined. Forty-one (3-9%) had clinically discernible pigmented lesions compatible with melanocytic naevi. Biopsy was performed on thirty-four of the forty-one and of these; eleven, representing 1-01% of the infants, proved to be melanocytic naevi. No giant (garment) naevi were seen in this series. Two of the eleven naevi pathologically examined showed histological changes similar to those that have been reported in some giant naevi, but the remaining nine were not only different from criteria usually assigned to giant naevi, but they also differed from the usual adult naevi, in that most were predominantly junctional. None of the melanocytic naevi in this series showed any suggestion of malignant change. In newborn infants it is often impossible clinically to distinguish naevi from other types of pigmented lesions, as only eleven out of the thirty-four pigmented lesions were melanocytic naevi. Seven of the eleven melanocytic naevi were under 1-5 cm in diameter. No pigmented lesions were found on the palms, soles or genitalia.

Nails and fungi

Abstract: Himian nails support a surprisingly varied fungal fiora, including not only dermatophytes and yeasts, but many mould species both common and uncommon. These infections are known by two names, onychomycosis and tinea unguium. Onychomycosis literally means 'fungus infecdon of the nail', while 'tinea' is an ancient word for 'ringworm'. I propose, here, to use 'onychomycosis' to include nail infections attributable to any fungus, and to confine 'dnea unguium' to dermatophyte infections only.

An assessment of methods of treating viral warts by comparative treatment trials based on a standard design

Abstract: SUMMARY A series of eleven comparative wart treatment trials undertaken between 1969 and 1975 and involving 1802 patients is described. A method of coding provided groups of patients matched for age, type, number and duration of warts, within which treatments could be randomized. The variation in response to treatment was shown to be influenced significantly by these factors and the level of cure to depend on the proportions of the various response groups within the population under consideration. These proportions were found to vary geographically and at different periods. In all the trials the results were assessed at 12 weeks. In the treatment of hand warts, the percentage cure of patients treated with liquid nitrogen fell significantly from 75 to 40% when the interval between freezings was increased from 3 to 4 weeks. The average number of freezings required for a cure was 3 I amongst all patients cured by 6 or less freezings at intervals of 2 or 3 weeks. In a two–centre trial there was no significant difference between the percentage cure of patients with hand warts treated with liquid nitrogen (69%) and of those applying a paint containing salicylic and lactic acids (SAL) (67%). Patients receiving both treatments concurrently did better (78%) but the difference was not found to be statistically significant. In the treatment of simple plantar warts the percentage cure for the SAL paint (84%) was found to compare favourably with that for a podophyllin treatment (81%). Only one of the patients cured by the paint in that trial was found to have had a recurrence after 6 months. The paint was found to be satisfactory for use under general practice conditions. Additions to the formula did not alter its effectiveness. In the treatment of mosaic plantar warts the overall percentage cure for the SAL paint in a series of comparative trials (1969–75) was 45%. In these trials it was compared directly with one or more other preparations. No differences were found between its efficacy and that of 10% buffered gluteraldehyde (47%), 40% benzalkonium chloride dibromide (Callusolve 40) (30%) and 5% 5-fluorouracil in dimethyl sulphoxide (53%). Only 25% of thirty-six patients treated with 5% idoxuridine in dimethyl sulphoxide were cured. Throughout the trials approximately 30% of patients with hand warts, 2o% of those with simple plantar warts and 50% of those with mosaic plantar warts were found to be resistant to treatment. The adoption of treatment with SAL paint for hand warts and simple plantar warts by the general practitioners in the Edinburgh area has proved satisfactory. Only resistant cases are now referred to hospital and these can be treated within a few weeks instead of 4-5 months as was the case in 1969.

The lines of Blaschko: a review and reconsideration: Observations of the cause of certain unusual linear conditions of the skin.

Abstract: SUMMARY Blaschko's lines are the pattern assumed by many different naevoid and acquired skin diseases on the human skin and mucosae. They were described and drawn by Blaschko 75 years ago. These lines are to be distinguished from other linear patterns such as Voight's lines, Langer's lines, and the lines of innervation of the spinal nerves. They do not follow any known nervous, vascular or l5rmphatic structures in the skin. The epidermis and its appendageal structures, the melanocytes, the vascular system, and the fatty hypoderm, all, separately or in combination, may be involved in the morpho-logical manifestations which follow Blaschko's lines. Many of the naevoid skin conditions are lifelong (e.g. linear sebaceous naevus, unilateral naevoid telangiectasia); many of the acquired skin diseases (e.g. lichen striatus, linear psoriasis) are of relatively short duration (e.g. 1–2 years). The cause of the distribution pattern is unknown. It is possibly a form of human‘mosaicism’ where certain specific cells or groups of cells react differently from other cells due to chromosomal abnormalities. The embryological explanation of Blaschko's lines is not at all clear. Other markers in addition to the skin findings are needed to determine the time and the nature of the change responsible for these lines. The main purpose of this article is to introduce the concept of Blaschko's lines into the medical, paramedical, and general biological fields of science. In this way, it is hoped that some inter-reaction can occur between those who regularly see Blaschko's lines and those who regularly see and study other chromosomal and embryological abnormalities.

The syndrome of ankyloblepharon, ectodermal defects and cleft lip and palate: an autosomal dominant condition

Abstract: SUMMARY Seven patients from four families are reported who had an inherited condition of which the main features were ankyloblepharon, ectodermal defects and cleft lip and palate. The ectodermal defects were partial or complete hair loss, absent or dystrophic nails, pointed widely spaced teeth and partial anhidrosis. Associated anomalies included lacrimal duct atresia, supernumerary nipples, syndactyly and auricular deformities. The inheritance of this abnormality was consistent with that of an autosomal dominant trait. The relationship between this and similar syndromes is discussed.

Essential fatty acids and the skin

Abstract: The essential fatty acids arc a group of naturally occurring fatty acids of chain-lengtb 18, 20 or 22 carbon atoms and containing between 2 and 6 methylenc-interrupted unsaturatcd bonds, all in the CIS configurationThere are two fundamental essential fatty acids from which all others are derived by metabolic chain elongation and desaturation. These are linoleic acid, giving rise to the a)-6 series, and ::(-liDolenic acid, from which derives the (.'j-3 series (the (u-notation signifies the position of the first methylene-interrupted double bond numbered from the terminal methyl group ofthe acid). As their name implies, they are essential to the diet of man, indeed, of all higher animals, as they cannot be synthesized de novo from small molecular weight metabolites of carbohydrates and amino acids, as are all other lipids. Recent reviews comprehensively cover the chemistry and physiological function of the essential fatty acids in animals (Alfin-Slater & Aftergood, 1968; Holman, 1968, 1970) and man (Soderhjelm, Wicsc & Holman, 1970). Relatively little, however, has been reported for skin specifically. Fig. I illustrates interrelations of various essential fatty acids. All have been identified in the skin of man or laboratory animals (\"except (u-3 Ci8:4 and o-^ 020:4) but some only in trace amounts (Vroman, Nemecek & Hsia, 1969; Jonsson & Anggard, 1972; Wilkinson, 1972; Prottey et al., 1975, 1976). By far the most abundant essential fatty acids in skin are linoleic acid, derived solely from the diet, and arachidonic acid, derived from linoleic acid, or from traces in the diet. The various acyl decarboxylation and elongation enzymes that convert dietary linoleic or linoknic acid to the polyunsaturated fatty acids have been characterized in certain organs, mainly the liver (Alfin-Slater & Aftergood, 1968), but there is no conclusive evidence that the skin can perform these reactions independently. Rather, it must be assumed that although certain essential fatty acids arc very important to the skin (e.g. arachidonic acid, as the precursor of prostaglandins) they originate from the liver via the plasma lipoproteins, and are not synthesized per se in the skin. Wilkinson (1972) has demonstrated labelling of various essential fatty acids in skin cultured in vitro with ['\"^Cl-acetate but this is probably by acetate exchange, not synthesis de novo. Further research is necessary to establish whether the skin can perform any ofthe individual elongation and desaturation steps.

Leukotactic properties of soluble substances inpsoriasis scale

Abstract: In an attempt to elucidate the mechanisms underlying the production of transepidermal migration of leukocytes toward the stratum corneum in psoriatic lesions, the chemotactic properties of soluble substances in psoriasis scales were examined by a modified Boyden's chamber. All crude extracts of horny tissues studied, i.e. callus, scales of exfoliative dermatitis and of psoriasis vulgaris, showed chemotactic activity for human peripheral blood leukocytes. But only the chemotactic activity of the psoriasis scale extract was highly potent. This was greatly reduced after dialysis. Fresh serum was not required to manifest the chemotactic activity. By Sephadex G-200 chromatography, the scale extracts from psoriasis vulgaris and pustular psoriasis had potent activity eluted near the cytochrome C marker. The same fractions of other horny tissue extracts, bacterial filtrate prepared from cultured psoriasis scale fragments, and serum did not show such potent activity. On the basis of analysis by gel filtration and recent findings of immunopathological studies, a postulate was made that a complement derived chemotactic factor, possibly a C5 cleavage product, developed as a result of antigen-antibody reaction in the stratum corneum of psoriatic lesions.

Metastatic Crohn's disease

Abstract: Metastatic Crohn's disease is a term used to describe a granulomatous reaction occurring in flexures, and separated from the affected areas of the gastro-intestinal tract by normal skin. Previous reports refer to such lesions affecting the groins, the male genitalia, a flexure on the anterior abdominal wall of an obese patient, and submammary regions. A further case, in which the retro-auricular areas are involved, is presented.

Erythema multiforme in children. Response to treatment with systemic corticosteroids.

Abstract: SUMMARY It is generally accepted that the correct treatment for patients with severe erythema multiforme is systemic corticosteroids. This paper is a review of thirty-two paediatric patients with severe erythema multiforme (Stevens-Johnson syndrome) who were treated with either large doses of systemic corticosteroids or supportive care only. Those patients treated with steroids did not recover sooner than those treated in other fashions and the steroid treated group had a significant incidence of medical complications. This retrospective study proves nothing but it does suggest that treatment of patients with the Stevens-Johnson syndrome with systemic corticosteroids may be associated with significant side effects and prolonged recovery.

The sunburn cell in mouse skin: preliminary quantitative studies on its production.

Abstract: SUMMARY Quantitative studies on sunburn cell (SBC) production in mouse epidermis are reported. Ultraviolet radiation (UVR), 260–300 nm, produced a dose related effect with respect to SBC formation. Maximal spectral reactivity was at wavelengths shorter than 300 nm. In 8-methoxypsoralen (8-MOP) photo-sensitization, SBCs were also produced and this response is dose related with respect to long wave UVR dose. In fluorescein photosensitization, provoked by 487 nm light, SBCs were not produced. The response in 8-MOP photosensitization and 254 nm UVR (given alone) differed in respect of time course, but it is considered that both may perhaps be initiated by a DNA lesion.

Langerhans cells: involvement in the pathogenesis of mycosis fungoides

Abstract: Function of Langerhans cells Langerhans cells (Lc) were initially described in 1868 (Langerhans, 1868) and since that time there has been much speculation concerning the origin, associations and functions of these clear cells, situated in the higher levels of the epidermis. Although initially considered to be related to melanocytes (Billingham & Medawar, 1953) present evidence favours a mesodermal origin (Breathnach et al., 1965; Wolff, 1972). It is now accepted that these dendritic cells form a relatively constant population admixed with epithelial cells in the stratified epithelia of the epidermis, oesophagus and cervix (Wolff & Winkelmann, 1967; Zelickson & Mottaz, 1968). In such sites, the cells appear to be capable of maintaining their position while the surrounding cells keratinize and are sloughed off. It has been suggested that they may be a form of epidermal scavenger (Hashimoto & Tarnowski, 1968). Unfortunately, the keratinocytes with which they form a close association are considerably more efficient at endocytosis of injected tracers (Wolff & Schreiner, 1970). Thus, if the Langerhans cell is a macrophage, it is of the poorly phagocytic variety. Other suggestions concerning function include control of keratinization (Jarrett & Spearman, 1964) and control of keratinocyte proliferation (Potten & Allen, 1976). These theories either lack experimental corroboration or fail to account for all the known facts concerning the cell type. It was Prunieras (1969) who first made the suggestion that antigens applied to the integument might interact with Langerhans cells. This speculation has recently been elegantly substantiated by Silberberg (1971), at the New York University School of Medicine. Such an observation is of fundamental importance in immunology, since it indicates that Langerhans cells may play an important role in the primary immune response. Shelley & Jublin (1976) have confirmed the findings of the New York group.

Changes in transepidermal water loss and the composition of epidermal lecithin after applications of pure fatty acid triglycerides to the skin of essential fatty acid‐deficient rats

Abstract: The importance of various unsaturated fatty acid triglycerides to the repair of faulty skin barrier function was studied in essential fatty acid-deficient rats. Following cutaneous application of the pure triglycerides for up to 5 days, the hitherto high rate of transepidermal water loss, characteristic of essential fatty acid deficiency in rats, was reduced by the triglycerides of linoleic and gamma-linolenic acids. Incorporation of the applied fatty acids into the lecithin of the epidermis accompanied these changes in water loss, indicating that cutaneously applied triglycerides may be metabolized by the skin and incorporated into complex lipids. Other fatty acid triglycerides, including alpha-linolenic, dihomo-gamma-linolenic, arachidonic and omega-7-heneicosatrienoic acid, did not lower the rate of transepidermal water loss, although all were incorporated into epidermal structural lipids. The non-essential oleic acid also had no effect upon the rate of transepidermal water loss. These data suggest that of the two main essential fatty acids that occur in skin, linoleic acid and arachidonic acid, the former specifically plays an important role in regulating barrier function whereas the later may have a separate function, such as serving as a precursor of prostaglandins.

Phototoxic blisters from high frusemide dosage.

Abstract: Blistering of exposed areas has appeared in patients suffering from chronic renal failure treated with high doses of frusemide. The blistering, which resembles that occurring in nalidixic acid phototoxicity and in porphyria cutanea tarda, is considered phototoxic in nature.

The natural history of trichilemmal cysts

Abstract: The histological features of 149 trichilemmal cysts removed from sixty-five patients are reviewed and related to the clinical findings. These cysts, which may be solitary or multiple, gradually increase in size and number, and may produce daughter cysts by budding. When a breach occurs in the wall, inflammatory cells pour in but do not replace the cyst wall. This event may be followed by healing from the margins of the breach, by marsupialization to the overlying epidermis and thus natural resolution, or by proliferation to produce a pseudo-epitheliomatous change which can be confused with a well differentiated squamous cell carcinoma.

The cell cycle in psoriasis: a reappraisal.

Abstract: The current belief that the clinical manifestations of psoriasis (excessive scaling) are due to a twelve-fold speeding up or shortening of the cell division cycle time of the germinative cells in psoriatic epidermis (from 457 to 37-5 h) is shown to be incorrect. A new concept is introduced--that the germinative layer in human epidermis is composed of not one, but three separate and distinct populations of epidermal cells. First, there are cycling cells which are actively moving through the cell cycle. Then there are two categories of non-cycling cells (blocked in the G1 or the G2 periods of the cell cycle) which are capable of moving into the proliferative pool upon specific stimulation. Thus, increased epidermal cell proliferation in active lesions of psoriasis would be brought about mainly by a recruitment or a relase of the two categories of non-cycling cells. The idea that germinative epidermal cells are primarily non-cycling, leads to the suggestion of focusing attention on non-cycling cells (rather than on cycling cells) for the control and treatment of psoriasis. It might be worthwhile considering treating psoriatic patients during periods of clinical remission--with factors to keep the germinative cells in the non-cycling state--rather than during psoriatic flare up--with cancer chemotherapy drugs.

Airborne contact dermatitis from Compositae oleoresins simulating photodermatitis

Abstract: American ragweed (Ambrosia) dermatitis has an airborne pattern and is caused by lipid soluble oleoresins of pollens. A similar weed dermatitis has been described in India and Australia. The weeds involved were all of the Compositae family and contain sesquiterpene lactones with one common antigenic determinant. This study reports seven Danish patients treated for many years under the diagnosis of photodermatitis, who eventually proved to suffer from Compsoitae oleoresin dermatitis. Probably, Compsitae dermatitis is a world-wide disease, although aften misdiagnosed as has happened in Scandinavia.

Treatment of erythema nodosum and nodular vasculitis with potassium iodide.

Abstract: Twenty-four of twenty-eight patients with erythema nodosum and sixteen of seventeen patients with nodular vasculitis responded to treatment with potassium iodide. Relief of symptoms occurred within 2 days. The average duration of treatment was 3 weeks and the lesions took an average of 2 weeks to resolve. The possible mode of action of potassium iodide is discussed and an immunosuppressive effect mediated by heparin is suggested.

Studies on the effect of salicylic acid on normal skin

Abstract: This investigation was prompted by our ignorance of the way in which salicyclic acid aids desquamation. Salicyclic acid in aqueous cream or white soft paraffin and in concentrations of 2-12% was applied to normal skin of twenty-three subjects while the vehicle alone was applied to the contralateral sites. Biopsies and skin surface biopsies were taken from the test and control sites after 1 week. Histological examination showed that there was less horny layer on the test specimens but that there were no qualitative or quantitative differences in the structure of the viable epidermis. Portions of the biopsies were incubated in the presence of tritiated precursor compounds and subsequent autoradiographic examination showed no difference in the incorporation of thymidine, cytidine or histidine between test and control preparations. Scanning electron microscopy of skin surface biopsies showed some changes in all specimens--presumably due to hydration--but also showed striking differences between test and control sites and were especially marked with higher concentrations of salicylic acid. It is suggested that salicylic acid causes desquamation by dissolution of intercellular cement material.

Glaucoma following the application of corticosteroid to the skin of the eyelids

Abstract: A case is reported of intractable glaucoma presumed to be associated with the long-term use of a corticosteroid-containing dermatological preparation on the skin of the eyelids for the control of eczema.

Co-operative double-blind trial of an antibiotic/ corticoid combination in impetiginized atopic dermatitis

Abstract: This double-blind study of an antibiotic coritcosteroid combination, the antibiotic alone and the corticosteroid alone, compared their clinical and microbiological effect in infected atopic dermatitis. Combination therapy reduced the mean scores for infection, inflammation and overall severity to a greater extent than the antibiotic or corticosteroid alone. The clinical and microbiological date are discussed in terms of relevance to clinical use.

The action of a urea-lactic acid ointment in ichthyosis with particular reference to the thickness of the horny layer.

Abstract: SUMMARY The effect of urea—lactic acid ointment on the scales of ichthyotic skin was assessed using the ‘cell swelling’ technique of Christophers & Kligman. The thickness of the horny layer and of the scales was reduced both by the ointment and by the base. The formation of scales was shown to differ from that in psoriasis where the scale forms at the apex of a rete peg and is symmetrical whereas in ichthyosis the separation of the scale may be at an entirely different depth at one margin. There is an increase in the number of ‘T’ cells in X-linked recessive ichthyosis.

PUVA-induced bullous pemphigoid.

Abstract: The disixibution of lesions in pemphigus erythematosus is ascribed to the adverse effect of sunlight on this type; of pemphigus. It has been shown that a positive Nikolsky-sign could be provoked by exposure to an erythema-producing dose of UV-light (Cram & Winkelmann, 1965). UV-light of wave lengths shorter than 320 nm applied to the normal skin of six patients, four with pemphigus vulgaris and two with bullous pemphigoid, produced fresh histological and immunohistochemical changes in the irradiated sites (Cram & Fukuyama, 1972). This report concerns the provocation of bullous pemphigoid in two psoriatics during oral treatment with 8-raethoxypsoralen (8-MOP) and UVA (PUVA therapy).

Systemic use of a new retinoid with and without local dithranol treatment in generalized psoriasis.

Abstract: giving little trouble undl 3 years ago. It then became more active, new lesions appeared, especially on her scalp, and the older ones enlarged. Topical steroids, combined with the use of Uvistat before light exposure, did not help her at all. She was started on chloroquin sulphate 200 mg twice daily, with initial relief. This had to be stopped after 5 weeks because of nausea, retching, photophobia, and weakness in the legs. After the chloroquine was stopped, she flared severely over the face and neck, and when seen in July she was both unsightly and depressed. She was given beta-carotene 50 mg three times daily, and had complete comfort within 2 weeks. This was maintained and all the lesions have regressed satisfactorily. She has been able to discondnue local steroids, and has had no sideeffects from the beta-carotene, which was stopped after 2 months.

A follow‐up study of patients with recurrent urticaria and hypersensitivity to aspirin, benzoates and azo dyes

Abstract: SUMMARY We have studied seventy-five patients with recurrent urticaria and angio-oedema of more than 4 months duration and with positive provocation tests to aspirin, azo dyes, and/or benzoates. Crossreactions between the test compounds were common. The patients were recommended to be on a diet free from salicylates, benzoates, and azo dyes. They were then followed for 6–24 months. At the follow-up, 24% were free from symptoms, 57% considered themselves much better and 19% stated that they were slightly better or unchanged. All patients had followed the diet for at least 1–3 months. Most of those who became totally free of symptoms did not continue with the diet, while most of the patients who considered themselves much better found that it was necessary to continue on the recommended diet. They usually developed symptoms as soon as they ingested something containing azo dyes or benzoates. To be able to maintain such a diet, it is important that the content of additives in food and drugs be properly declared.

Immunological aspects of psoriasis. I. Immunoglobulins and anti-IgG factors.

Abstract: Sixty patients with psoriasis have been studied for quantitative estimation of serum immunoglobulin A, G and M (60 cases), immunoglobulin E (43 cases), salivary immunoglobulin A (28 cases) and anti-IgG factors in the serum (40 cases). All the data have been statistically compared to a large control group (300 subjects). The results show an increase of the serum IgG and IgA means, an increase of salivary IgA which is correlated with the serum IgA, an increase of IgE levels in some patients and the presence of anti-IgG activity in the serum of 45% of patients with psoriasis. All these findings are statistically significant when compared to controls. These data could be in favour of auto-immune processes in psoriasis.

Reticulate acropigmentation of Kitamura

Abstract: SUMMARY Seven cases of reticulate acropigmentation of Kitamura (RAPK) are described. All the patients were female and the pattern of inheritance suggested an autosomal dominant mode. Histologically, RAPK is characterized by epidermal atrophy, an increased number of basal melanocytes and the absence of pigmentary incontinence in the upper dermis. The present cases, from Asia, Africa and Europe, are the first to be described outside Japan.

Steroid‐induced atrophy in an animal and human model

Abstract: SUMMARY A ratchet-controlled micrometer screw gauge has been used to measure the changes in skin thickness produced by topical corticosteroids. Measurable thinning of the mouse ear followed repeated daily application of corticosteroids. This response in the animal was used to assess the atrophic potential in a variety of standard formulations. The same compounds were applied to human skin and the changes in thickness measured. Patterns of response and the rank order of thinning obtained from the animal model were found to parallel closely the human results.

Infantile eczema: A long-term follow-up study.

Abstract: A 15-17 year follow-up study was conducted on ninety-nine patients who had suffered from infantile eczema. The persistance of the eczema and the occurrence of related conditions were noted. The persistence of eczema was shown to be greater in those patients with a positive family history of eczema and in those who had developed asthma or hay-fever. An attempt was made to see if the persistence of eczema was affected by the position of the child in the family, and some factors provoking relapses were noted. The patients were also questioned with regard to their achievements in academic examinations, and to their social, artistic and sporting activities. The results showed a success rate in examinations not significantly higher than average. It was not possible to show if there is a particular type of atopic personality. There was no constant characteristic in social or artistic patterns. The group as a whole were normal at the milestones of early development, i.e. walking, talking and reading, and also normal with regard to weight and height.

Immunological aspects of psoriasis. II. Dissociated impairment of thymus-dependent lymphocytes.

Abstract: We have investigated lymphocyte subpopulations (six different markers) and T cell functions (mitogen responses and serum thymic factor determination) in twenty patients with psoriasis compared with thirty-five healthy subjects. Normal results were found for B cell markers, but significantly lower numbers of T cells were assessed by E-rosettes and anti HTLA serum. Mitogen responses were significantly higher in psoriasis than in normal subjects of the same age. These findings could be in favour of a T cell subpopulation defect involved in an auto-immune pathogenesis of psoriasis.

Identification of subpopulations of lymphocytes and macrophages in the infiltrate of lichen planus lesions of skin and oral mucosa.

Abstract: SUMMARY The mononuclear cells of the infiltrate in lichen planus lesions of skin and oral mucosa have been identified by detection of their membrane receptors in frozen-tissue sections. By this method, the infiltrate would appear to consist of predominantly T lymphocytes, some macrophages and only a few B cells. The pathogenesis of lichen planus is discussed in the light of these findings.