Showing papers in "British Journal of Dermatology in 1983"

Human skin battery potentials and their possible role in wound healing

Abstract: Measurements of transcutaneous voltage have been made on seventeen normal volunteers. The results show the presence of 'skin battery' voltages comparable in size to those previously reported for amphibian and mammalian skin. No correlation was found between battery voltage and age or sex in the group studied, but consistent anatomical variations were observed. The possible role of these voltages in the natural wound healing process is discussed.

Thalidomide in the treatment of sixty cases of chronic discoid lupus erythematosus.

Abstract: The therapeutic effect of thalidomide in chronic discoid lupus erythematosus (CDLE) was studied in sixty patients who were followed up for 2 years. In fifty-four patients (90%) a complete or marked regression of the disease was observed, but when the thalidomide was stopped, thirty out of forty-one (71%) patients relapsed. Patients undergoing a second course of thalidomide treatment again responded well. Nine of the patients in whom the disease recurred after successful treatment with thalidomide and who had been unresponsive to intermittent treatment with antimalarials, showed a good response to a second or third course with thalidomide. Mild side-effects were common and 25% of patients complained of slight to moderate polyneuritic symptoms. Since electroneurological examinations had not been performed before the thalidomide therapy, the frequency of neurological side-effects cannot be accurately calculated but we recommend neurological examinations before and periodically during thalidomide treatment. Thalidomide is a very effective drug in CDLE, but in most cases it exerts its effect only whilst treatment is continued. Its use should be restricted to patients resistant to topical steroids and systemic antimalarials.

Cutaneous factors related to the risk of malignant melanoma.

Abstract: In a case-control study, 287 women with malignant melanoma were compared with 574 age-matched controls. Red hair colour at age 5 years was associated with a tripling of risk [relative risk (RR) = 3.0], blonde hair with a 60% increase (RR = 1.6) and fair skin with a doubling (RR = 2.1). Women with melanoma also reported that they tended to burn (RR = 1.4) and to freckle (RR = 1.9) after exposure to sunlight. Since fair skin, red hair, and the tendency to burn or freckle after exposure to sunlight all cluster in the same individuals, the extent to which each of these factors had an independent influence on susceptibility to melanoma was investigated. Hair colour, especially red hair, proved to be the major determinant, followed by skin colour. The reporting of above average numbers of naevi on the body was as strong a predictor of melanoma as was red hair colour (RR = 3.4). A history of psoriasis was also more common in cases than controls (RR = 3.0) as was a history of vitiligo (RR = 1.8). A history of acne appeared to be protective (RR = 0.4) as did a history suggestive of chloasma (RR = 0.6) and premature greying of the hair (RR = 0.6). These relationships were irrespective of hair and skin colour.

Separation of the epidermal sheet by dispase.

Abstract: Dispase is a bacterial neutral protease which is obtained from the culture filtrate of Bacillus polymyxa. After 24-h treatment of the human skin with 500 and 1000 U/ml dispase, the epidermal sheet was easily peeled from the dermis, and its undersurface retained rete ridges. Electron microscopic observation showed that the basal surface was composed of cells with numerous slender villi and cytoplasmic projections. Although the intercellular spaces of the spinous as well as the basal layers were wide, all desmosomes were intact with their accompanying tonofilaments. An epidermal cell suspension was obtained by incubating the dispase-separated epidermal sheet in trypsin solution for 15 min and the viability of the cells was more than 95% as measured by the trypan blue dye exclusion test. A culture of keratinocytes was established by seeding the dissociated cells in the usual way.

The Michelson Lecture. Delusions of parasitosis.

Abstract: Dr Michelson (Fig. i) impressed his personality on, and was responsible for developing, the dermatological life of the University of Minnesota, while at the same time becoming a national and international figure. He did this not by self-advertisement, but quietly, as a disciplined man of few words but many thoughts, winnowed by a discerning mind; friendly to meet, but always commanding respect; not a man to cross lightly. Dr Lynch felt Dr Michelson was regarded highly because of his integrity and self-restraint (Lynch, 1972). Dr Grant Pcterkin admired his conversation and erudition (personal communication). Dr Milton Orkin said he was a superb clinician and teacher (personal communication). Above all his partner, Dr Sheldon Mandel, held him in high esteem and affection (Mandel, 1976). He came of German stock, and his life blended to a marvellous degree the virtues of the New and Old Worlds. Contrary to the usual practice at that time he trained in the United States, and visited Europe secondarily, so that the formative influences of his early dermatological education were exclusively American. One of his many interests was psychosomatic disease (Michelson, t945). He is not an easy man for me to live up to: nor is this an easy subject. In fact Delusions of Parasitosis presents the most difficult problem of management in dermatology. It is also rare; so I decided I needed help, and wrote to 374 people, mostly members of the British Association of Dermatologists^ asking for their experiences. May I say how grateful I am for their help, and that I hope my desire to record them faithfully has been successful. My letter took the form of a general cry for help, asking specifically about the use of pimozide, the age and sex incidence, whether the delusion was really an isolated phenomenon, and did it ever resolve spontaneously? I also asked about outbreaks of imagined parasites in factories or institutions. I had considered sending a computer-type form with, as one correspondent punningly put it, little boxes to put ticks in, but rejected this because I felt too ignorant of the subject in general, and wished to stimulate the memory and imagination of my correspondents rather than to batter them with my preconceived ideas. Two hundred and sixteen replied; twenty-three said they had never seen the problem. Most of these were young, but one, experienced and retired, stated he had always regarded it as 'no more than a minor derangement of rather impressionable people.' This remark was the first indication that such patients are not distributed equally among dermatologists. The information obtained about 282 patients forms the basis of this retrospective study.

A dose-response study of I3-cis-retinoic acid in acne vulgaris.

Abstract: 13-cis-retinoic acid has been used as a single agent in the treatment of seventy-six patients with previously unresponsive cystonodular acne. The study was carried out in a double-blind fashion using three doses of the drug. Ninety per cent of the patients responded with a 70% improvement in the acne severity. Sixty-six per cent of the patients experienced no further problems with their acne during follow-up. Side-effects were frequent. The 0.5 mg/kg b.w. dose is recommended for the initial course of treatment.

Immunofluorescence identification of eosinophil granule major basic protein in the flame figures of Wells' syndrome

Abstract: SUMMARY An indirect immunofluorescence assay using formalin-fixed paraffin-embedded skin was performed on six biopsies from four patients with eosinophilic cellulitis (Wells' syndrome) to determine the extracellular localization of eosinophil granule major basic protein (MBP). Serial sections from each biopsy were treated with either affinity chromatography-purified antihuman- MBP or staphylococcal protein A purified rabbit IgG (control material). There was striking extracellular fluorescence localized to flame figures, and intracellular staining of eosinophils in all sections treated with anti-MBP as compared with controls. The pattern of MBP extracellular staining corresponded to the configuration of each flame figure (as verified by counterstain of the same section with haematoxylin and eosin). These findings show that MBP can be used as a marker for determining eosinophil degranulation and, because MBP is localized to flame figures, they suggest that MBP may play a pathogenic role in Wells' syndrome.

The vascular lesions associated with skin necrosis in renal disease.

Abstract: SUMMARY Three renal allograft recipients and one uraemic patient presented with skin necrosis. In all cases, the subcutaneous arteries and arterioles were narrowed or occluded by mural calcification with or without intimal fibrosis. A review of the literature shows that uraemic patients or allograft recipients with skin necrosis involving the trunk or thighs have a poor prognosis while recovery is common in patients with more peripheral lesions. The aetiology of the arterial lesions is unknown. Their relationship to renal disorders and/or hyperparathyroidism is uncertain and therapy remains unsatisfactory.

A randomized trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers

Abstract: Ninety-three patients with treatment-resistant venous ulcers were included in a multicentre randomized trial to compare cadexomer iodine and the standard treatment used in each centre combined with compression bandages, in healing venous ulcers. The mean duration of ulcers before the trial was more than 2 years. With standard treatment the mean ulcer size increased slightly during the 6-week trial whereas with cadexomer iodine the ulcer size was significantly reduced. Cadexomer iodine was more effective than standard treatment for reduction of pain, removal of pus and debris, removal of exudate, stimulation of granulation and reduction of surrounding erythema. Bacterial infection of ulcers increased or did not change during treatment with the standard therapy whereas cadexomer iodine significantly reduced infection with Staphylococcus aureus, Pseudomonas aeruginosa and other pathogenic organisms. A correlation was seen between the time taken to reduce or eliminate infection with Staphylococcus aureus and rate of ulcer healing. Four patients complained of transient pain in the ulcer after application of the cadexomer iodine. It is concluded that cadexomer iodine increased the rate of healing of infected chronic venous ulcers.

Enhanced comedo formation in rabbit ear skin by squalene and oleic acid peroxides

Abstract: SUMMARY The comedogenicity of UVA-irradiated and non-irradiated substances (squalene, oleic acid, tetradecane, isopropyl myristate, squalane and liquid paraffin) was evaluated by surface microscopy and histological examination after treating the ventral skin of rabbit ears with these substances. The lipid peroxide levels of these substances were also measured. Squalene itself was scarcely comedogenic but squalene peroxides were highly comedogenic. Both oleic acid and its peroxides were able to induce fairly large comedones and there was a good correlation between the lipid peroxide levels and the size of the comedones. The specimens biopsied from these comedones showed marked hyperplasia and hyperkeratosis of the epithelium in the follicular infundibulum and marked proliferation of the sebaceous glands. Although free fatty acids might play a role in the pathogenesis of acne, it is proposed that squalene and free fatty acids in sebum may be less comedogenic than their peroxides.

Anatomical mapping of epidermal Langerhans cell densities in adults

Abstract: The densities of T6 antigen-bearing Langerhans cells in 112 biopsies of human skin from sixteen surgical out-patients and four cadavers were determined for eight anatomical regions. The regional mean densities (+/- s.e.m.) of epidermal Langerhans cells per mm2 were: head and neck, 489 +/- 27; chest, 466 +/- 22; back, 466 +/- 11; upper extremities, 458 +/- 25; lower extremities, 431 +/- 30; buttocks, 411 +/- 11; genitalia, 298 +/- 45; soles, 58 +/- 12. No statistically significant differences were found between any of these Langerhans cell densities except for that of the soles which was lower than those of all other regions (P less than 0.002). No significant differences were detected between the mean densities of patients and cadavers, Caucasians and Hispanics or males and females.

Clues to the aetiology and pathogenesis of herpes gestationis.

Abstract: In a study of twenty-five patients with herpes gestationis we found that 80% possessed the HLA antigen DR3, which confers increased immune responsiveness and a predisposition to 'auto-immune disease'. In five patients the development of herpes gestationis coincided with a change in sexual partner, suggesting that the development of herpes gestationis may depend on exposure to an antigen derived from the father. This might share determinants with a component of the basement membrane zone of skin. Although anti-basement membrane zone antibodies are present in HG it is not clear whether they play a pathogenic role. The infrequency of neonatal involvement and the lack of correlation between immunofluorescence findings and clinical activity in our patients suggested that the antibodies might be a result of tissue damage rather than its cause. Two patients in our study were exceptional in that episodes of herpes gestationis were followed by normal pregnancies. In these patients the relationship of their DR antigens to those of the fetus may have been important in determining whether or not the pregnancy would be affected by herpes gestationis.

A comparison of the phototumorigenic potential of 8-MOP and 5-MOP in hairless albino mice exposed to solar simulated radiation.

Abstract: SUMMARY Hairless albino mice have been treated with topically applied 8-methoxypsoralen and 5-methoxypsoralen at two concentrations and exposed to solar simulated radiation. Both these compounds significantly increased the incidence of cutaneous tumours when compared with controls irradiated after treatment with vehicle. This effect was related to psoralen concentration and at the two concentrations investigated there was no significant difference between the compounds.

Altered polymorphonuclear leukocyte responses in psoriasis: chemotaxis and degranulation.

Abstract: SUMMARY Chemotactic activities of circulating polymorphonuclear leukocytes (PMN) were determined in twenty patients with psoriasis and twenty healthy control persons. After serial dilution of the complement split product C5a and the formylated tripeptide f-met-Ieu-phe (FMLP), chemotaxis profiles showed that PMN migration toward both chemotaxins was significantly increased in psoriasis. In addition, PMN from psoriatic patients responded to chemotaxins at much lower concentrations compared with controls. The liberation of (lysosomal) β-glucuronidase was also determined in cytochalasin B-treated cells confronted with increased concentrations of the chemotaxins. Secretion of this marker enzyme started at lower concentrations in PMN derived from psoriatic patients. Our observations demonstrate migratory and secretory hyper-responsiveness of PMN from psoriatic patients. This may play a role in perpetuating the psoriatic tissue reaction.

Retinoid concentrations in skin, serum and adipose tissue of patients treated with etretinate.

Abstract: Synthetic and natural retinoids were analysed in epidermis, dermis, subcutis and serum of twenty-seven patients treated with etretinate (0.6-1.0 mg/kg/day) for 1-36 months. The concentrations of etretinate (including its major metabolite) in serum and normal-appearing epidermis were 150-600 ng/ml and 50-350 ng/g, respectively. The serum and epidermal values were significantly correlated (P less than 0.05). The drug progressively accumulated in the subcutis attaining a maximum value of 15,500 ng/g. After the treatment, etretinate disappeared from the epidermis within 1 week. By contrast, the drug remained in the subcutis for several months after cessation of treatment. The epidermal composition of endogenous retinoids changed during etretinate therapy as reflected in an increased ratio of 3-dehydroretinol to all-trans retinol.

Interferon in suction blister fluid from psoriatic lesions.

Abstract: Interferon (IFN) (at least 16 units/ml) was demonstrated in suction blister fluid obtained from lesional skin in nine of thirteen patients with psoriasis vulgaris and in two patients with allergic contact dermatitis, but not in blister fluid from unaffected skin. IFN was detected in only three of the sera from the patients with psoriasis. The difference in results between the blister fluid and the sera from these patients was statistically significant (P less than 0.025). Evidence was obtained which indicated that the activity was probably IFN-gamma (immune IFN), but the additional presence of IFN-alpha in some of the fluids could not be excluded. The data indicate that IFN is produced locally in the psoriatic lesions, most likely by activated T lymphocytes.

Juvenile hyaline fibromatosis.

Abstract: SUMMARY A 4-year-old boy with juvenile hyaline fibromatosis (systemic hyalinosis) is described. The clinical features, pathology and prognosis of this condition are discussed.

Thalidomide in actinic prurigo.

Abstract: Fourteen patients suffering from actinic prurigo were treated with thalidomide. Eleven patients showed lasting improvement on the drug and three of these remained symptom-free after discontinuing therapy. No major side-effects were observed. Thalidomide is an effective drug in the treatment of actinic prurigo but it must be used with adequate contraception in women of child-bearing age.

The association of lichen sclerosus et atrophicus and autoimmune-related disease in males.

Abstract: We have investigated the presence of autoimmune-related diseases and autoantibodies in twenty-five men with lichen sclerosus et atrophicus (LSA). These patients had a significantly higher incidence of autoimmune-related disorders than a control population and a higher incidence of autoantibodies than would be expected in the normal male population.

A double‐blind study of 1% metronidazole cream versus systemic oxytetracycline therapy for rosacea

Abstract: SUMMARY In a randomized double-blind trial fifty-one patients with rosacea were treated for 2 months with either 1% metronidazole cream and placebo tablets or with 250 mg oxytetracycline tablets taken twice daily, and placebo cream (the cream base). The patients were assessed before and at the end of the trial, using the following criteria: (1) overall clinical assessment, (2) lesion counts, (3) degree of erythema, (4) independent photographic evaluation, (5) patients' opinion. An improvement was shown in 90% of the patients of both groups, and there was no significant difference between the two treatments. One per cent metronidazole cream has been shown to be significantly better than a placebo cream in the treatment of rosacea (Gamborg Nielsen, 1983a), It was therefore considered important to compare the cream with conventional therapy, and for this reason a double-blind study of 1% metronidazole cream versus a daily dose of 500 mg oxytetracycline was performed.

Human epidermal Langerhans cells are more potent than blood monocytes in inducing some antigen-specific T-cell responses.

Abstract: SUMMARY The abilities of human epidermal Langerhans cells and peripheral blood macrophages to induce specific T-lymphocyte responses to purified protein derivative (PPD), herpes simplex virus and nickel sulphate were compared. On a cell to cell basis the Langerhans cells were found to be about as potent as adherent cells in inducing T-cell responses to PPD, more potent in inducing responses to herpes simplex virus, and several times more potent in inducing responses to nickel. These data indicate that human epidermal Langerhans cells are highly specialized in antigen presentation, particularly for nickel sulphate. They may play an important role in inducing contact sensitivity dermatitis.

Evidence for anti-inflammatory activities of oral synthetic retinoids: experimental findings and clinical experience.

Abstract: Oral retinoids obviously influence dermal components such as cutaneous capillaries and dermal inflammatory cells in addition to their well-known action on keratinizing epithelia. On this basis, they act as an anti-inflammatory drug. In particular, they reduce the elevated skin temperature, inhibit the motility of neutrophils and eosinophils and their migration into the epidermis, decrease DNA synthesis of human lymphocytes by blocking their response to lectins and stimulate Langerhans cells, monocytes and macrophages in various in vitro and in vivo models. These data indicate that oral retinoids may not only normalize disorders of keratinization but also exert distinct therapeutic effects on various skin diseases with dermal inflammatory involvement regardless of their particular aetiology. In some respects, retinoids resemble corticosteroids, acting as a modified hormone. Preliminary clinical experiences with oral retinoid treatment in skin diseases such as cutaneous disseminated LE, bullous pemphigoid, Duhring's disease, pemphigus, Behcet's disease and necrotizing vasculitis with eosinophilia support these data. Monotherapy or combined administration of oral retinoids with corticosteroids in low doses seems therapeutically beneficial in these disorders.

Treatment of rosacea with 1% metronidazole cream. A double-blind study

Abstract: SUMMARY Eighty-one patients with rosacea were treated with either i % metronidazole cream or the cream base as a placebo for two months. The trial was performed double-blind, and the patients were assessed once each month. The variates studied were: (i) overall clinical assessment, (2) lesion counts, (3) degree of erythema, (4) independent photographic evaluation, and (5) patient's opinion. Four patients dropped out of the trial (one treated with metronidazole, three with placebo). In all the variates, 1% metronidazole cream proved to be significantly more effective than placebo.

The unit area trichogram in the assessment of androgen‐dependent alopecia

Abstract: The unit area trichogram was defined in the frontal and occipital areas of ten normal men and ten normal women and the results compared with the findings in ten male and fifteen female patients with androgenic alopecia. The epilation technique provided accurate data of normal hair density (higher than previously reported) and the phases of hair growth. The measurement of hair diameter showed that of 7603 hairs, 1241 were less than 40 microns in diameter, of which only 21 were more than 80 mm in length. Variation in the diameter of individual hair fibres was recorded. The number of hairs less than 40 microns diameter per cm2 of scalp was increased in both men and women with androgenic alopecia. It was concluded that the number of hairs greater than 40 microns in diameter per cm2 (meaningful density) reflected most closely the amount of hair usefully contributing to an individual's clinical appearance.

In situ identification of T6-positive cells in normal human dermis by immunoelectron microscopy

Abstract: Monoclonal anti-T6 antibody, which reacts with the majority of cortical thymocytes but not peripheral T cells, also reacts with human epidermal Langerhans cells, as shown by a four-step immunoperoxidase method and immunoelectron microscopy. To define whether T6-positive cells are also present in normal human dermis, we used these techniques to demonstrate two immunologically distinct populations of histiocyte-like cells in normal human dermis. The first population contains cells devoid of phagolysosomes or Birbeck granules. These cells react with anti-T6 antibody, but not with monoclonal anti-T3 antibody which defines peripheral T cells, and are found predominantly in and around dermal lymphatic vessels. The second is composed of phagolysosome-containing cells which do not react with anti-T6 antibody or anti-T3 antibody. Because to date, Langerhans cells are the only cells in normal human epidermis that react with anti-T6 antibody, these data provide immunological evidence for a specific link between Langerhans cells and a T6-positive dermal mononuclear cell, possibly the so-called indeterminate cell. In addition, application of these techniques should, for the first time, permit the immunological distinction of these T6-positive mononuclear cells from other cells bearing Ia antigens, such as dermal histiocytes and certain lymphocytes, in normal and diseased skin.

Urticaria and vasculitis: a continuum of histological and immunopathological changes.

Abstract: Histopathological criteria were used to classify twenty-four patients with chronic urticaria into three groups, which were then studied to establish whether circulating immune complexes (CICs), complement activation and deposition of immunoreactants are confined to patients with urticarial vasculitis. Group I (three patients) had classical urticarial vasculitis, and two of these patients showed hypocomplementaemia with evidence of C3 conversion and deposition of immunoreactants in lesional and uninvolved skin. Ten patients (group 2) with a dense perivascular mixed-cellular infiltrate had normal or raised complement levels and infrequent evidence of C3 conversion. Immunoreactants were detected only in their lesional skin. Eleven patients (group 3) had only a sparse perivascular infiltrate. In this group, complement was normal and immunofluorescence was essentially negative. Cryoglobulins were detected in group I patients only. Monoclonal rheumatoid factor and C1q binding were positive in all group I patients, half the group 2 patients and none of the group 3 patients. This study suggests that urticaria and urticarial vasculitis form a disease continuum, and identifies a group of patients with features intermediate between urticarial vasculitis and ordinary urticaria.

Subcorneal pustular dermatosis with vesiculo-bullous eruption. Demonstration of subcorneal IgA deposits and a leukocyte chemotactic factor.

Abstract: SUMMARY We report an unusual case of subcorneal pustular dermatosis with widespread vesiculobullous lesions. Reduction of the oral prednisone dosage provoked a severe exacerbation, with erythroderma associated with massive pustule formation. This was effectively controlled by topical PUVA. Subsequent recurrence of skin lesions responded well to oral etretinate. Investigation revealed intercellular IgA deposits at the upper epidermis of the paralesional skin, but no circulating antibodies were detected. Characterization of the chemotactic activity of the soluble components of the scales revealed the presence of a 12,000 molecular weight leukotactic factor resembling that found in psoriasis. Furthermore, the vesicle fluid showed only this chemotactic factor, indicating that it may be a major factor in the pathogenesis of subcorneal pustules.

Mast cell numbers in incisional wounds in rat skin as a function of distance, time and treatment.

Abstract: The dynamic changes in skin mast cell (MC) numbers around incised wounds were studied, using experimental designs amenable to multiple analyses of variance. Sixty-four Wistar albino rats were shaved in the interscapular region, wounded or not wounded, and then killed 2 or 10 days later. During this period, the rats were exposed continually to a cold (2 degrees C) or control (20 degrees C) climate and treated daily over the shaved region with either tap water or a weak sulphuric acid (pH 3.5) solution. The MCs within five adjacent fields of the wound or the control reference and within the superficial and deep halves of the skin were counted (at x 400). The greatest decrease in MC numbers occurred within about 700 microns of the wound. Whereas the paucity of MCs within the wound region was evident at 2 days, near-normal levels were achieved by day 10. Cold exposure produced little effect, but MCs responded differently to the water and acid treatments as a function of distance and skin depth.

Photochemotherapy (PUVA) in the treatment of urticaria pigmentosa

Abstract: SUMMARY Eight patients received PUVA for mastocytosis. Five women had typical adult-onset urticaria pigmentosa, without evidence of systemic disease. Another woman had suspected hepatic involvement while the remaining female had early-onset familial urticaria pigmentosa with morphologically atypical mast cells. The only male patient had cirrhosis with hepatic deposits of mast cells in addition to polycythaemia rubra vera. In all patients, except the man with systemic disease, there was reduced pruritus and wealing and partial to almost complete fading of the macules. The manifestations of urticaria pigmentosa recurred after treatment was discontinued. In both lesional and uninvolved skin there was no significant change in either the mean mast cell counts or mast cell ultrastructure after an average of twenty-seven PUVA exposures. In addition, PUVA did not cause a significant alteration in the histamine content of the skin. The beneficial effect of PUVA in urticaria pigmentosa therefore does not appear to be directly related to a change in mast cell numbers or morphology, or to the histamine concentration in the skin. Urticaria pigmentosa usually presents as a generalized maculo-papular rash which urticates on rubbing (Darier's sign). Many patients are troubled only by the unsightliness of the rash while some complain of pruritus, wealing or flushing. These symptoms are attributed to the release of histamine by mast cells which characteristically occur in increased numbers in the dermis. Symptomatic treatment is often unrewarding, but favourable results have been claimed for cimetidine with or without Hi blockers (Hirschowitz & Groarke, 1979; O'Laughlin & Bredfeldt, 1980) and for oral disodium cromoglycate (Soter, Austen & Wasserman, 1979; Czarnetski & Behrendt, 1981). In 1978, Christophers and colleagues reported that photochemotherapy (PUVA) produced symptomatic relief in all of ten adult patients with typical urticaria pigmentosa. Similarly encouraging results were subsequently reported from other centres (Ortonne et al., 1980; Allevato, Donatti & Cordero, 1980; Granerus, Roupe & Swanbeck, 1981; Vaatainen, Hannuksela & Karvonen, 1981). In this study we examined the effects of PUVA in eight adult patients with urticaria pigmentosa. Although PUVA produced a moderately good clinical response in seven out of these eight patients (reduced pruritus, reduced wealing and faded macules) quantitative studies failed to reveal a consistent effect of PUVA on either the mast cell population density or the histamine concentration in both lesional and clinically uninvolved skin. The findings arc discussed in relation to existing information concerning the effect of ultraviolet radiation (U VR) on mast cells and other constituents of the skin.

Trigeminal trophic syndrome: a successful treatment with transcutaneous electrical stimulation.

Abstract: SUMMARY A patient with chronic ulceration of the face due to trigeminal nerve transection was successfully treated with transcutaneous electrical stimulation (TES). This treatment leads to enhancement of local blood supply with consequent improved wound healing.