Phototests in patients with various forms of lupus erythematosus

Responses to ultraviolet B (UVB; 290-320 nm) were tested in 227 patients with main forms of lupus erythematosus (LE): discoid LE (DLE), discoid disseminated LE (DDLE), systemic LE (SLE), and subacute cutaneous LE (SCLE). Four parameters were evaluated: minimal erythema dose (MED), its distribution, persistence of erythema, and photoreproduction of lesions. Patients with LE differed considerably from controls in their UVB reactivity. In addition, there were significant differences between various LE forms, even after a single UV exposure. Lowered MED in comparison to controls was observed most frequently in SLE patients (64.4%) and least frequently in DLE patients (32.1%). Prolonged persistence of erythema induced by 1-2 MED was a constant finding in SCLE. In SLE and DDLE, it was observed in more than 80% of patients, and in DLE in 56.7% of examined cases. Photoreproduction of lesions after single UVB exposure was observed most frequently in SCLE (62.5%) and only in 10% of DLE patients.

Mast cells in the initial stages of psoriasis

Mast cells were counted in 122 patients with psoriasis and 80 healthy volunteers, at different times after scratch from 30 min up to 14 days. Koebner's phenomenon was induced in 74% of patients with active disease (63/85) and in 37.5% with stationary psoriasis (6/16). Mast cells were enumerated also in the skin of ten healthy controls, and their number on the inner aspect of the arm was found to range from 16 to 21 (mean, 17.6 +/- 1.65). Scarification increased the number of skin mast cells both in psoriatics and normal controls. The significant difference was noticed from the 4th day on after scratch, reaching a peak at days 14, simultaneously with the appearance of Koebner's phenomenon. In mature psoriatic lesions the number of mast cells was significantly lower than in newly formed psoriatic lesions, and it decreased progressively with effective anthralin treatment. It is concluded that mast cells play a role in skin response to trauma. In contrast to normal wound healing, their number is steadily increasing at the time of formation of the earliest psoriatic lesions.

T cell defect in patients with epidermodysplasia verruciformis due to human papillomavirus type 3 and 5

Most of the patients with epidermodysplasia verruciformis (EV) were anergic to sensitization to dinitrochlorobenzene (DNCB) and were shown to have a decreased number of T lymphocytes and reduced lymphocyte PHA responsiveness. Preserved cell-mediated immunity (CMI) was found only in the abortive cases of EV infected with human papillomavirus type 3 (HPV-3). CMI was impaired to the same extent in patients with EV induced by HPV-3 and HPV-5, and in EV cases with combined infection with both viruses. In contrast to this, malignant transformation, i.e. of Bowen's carcinoma type, was observed only in the 7 patients infected with HPV-5. This could indicate that malignancy in EV is related rather to the oncogenic potential of HPV-5 type than to the extent of T cell defect that was similar in both EV varieties due to HPV-3 and HPV-5.

Earliest clinical and histological changes in psoriasis

Studies were performed in 89 patients with active psoriasis and in 10 normal volunteers. Areas of uninvolved skin of 10 x 10 cm in size were demarcated and closely observed for 14 days. In 54 patients with psoriasis, there developed very fine, erythematous papules almost skin level (with no scaling of the surface), which changed in the course of observation into typical pinpoint papules. Histological and histochemical studies of these finest changes, referred to as prepinpoint papules, revealed fairly abundant infiltrates composed in a large part of polymorphonuclears. The cells penetrated into the epidermis forming focally small accumulations in the stratum corneum. The granular layer became atrophied or blurred, the stratum corneum was orthokeratotic and there was no epidermal proliferation, i.e. no psoriatic features. Immunofluorescence studies showed in about 50% of prepinpoint papules in vivo fixed immunoglobulins, and in 20% of them also complement. The studies point to the role of polymorphonuclears in the earliest stages of the development of psoriatic lesions.

Atrophoderma Pasini-Pierini is a primary atrophic abortive morphea

BACKGROUND

There are divergent opinions whether atrophoderma Pasini-Pierini (APP) is a nosologic entity or a primary atrophic morphea.

OBJECTIVE

Since usually single cases are reported without a long-term follow-up the present study was performed in order to elucidate the natural history of the disorder.

METHODS

We followed a large series of 139 patients, 91 adults and 48 children, for 4-30 years (mean over 10 years).

RESULTS

APP was found to be 6 times more frequent in females and not uncommon in children (10% of our series of localized scleroderma). At some time during the follow-up period, indurations appeared in the central parts of the lesions in 17% of the patients, and in 22% they coexisted with morphea plaques outside the atrophies. The histological pattern was similar to morphea at the stage of atrophy. No case developed full-blown morphea.

CONCLUSION

APP appears to be an abortive morphea, in which the indurations failed to develop. The differentiation from morphea is of practical importance because of different management and prognosis.

Neutral proteinases and other neutrophil enzymes in psoriasis, and their relation to disease activity

The activities of elastase, cathepsin G, lysozyme and myeloperoxidase of polymorphonuclear leukocytes were determined by spectrophotometry in thirty-six patients with psoriatic lesions, twelve symptom-free patients with psoriasis and fifteen normal controls. The mean activities of cathepsin G, elastase and lysozyme were found to be increased by 55 to 70% in patients with actively spreading plaque lesions compared with healthy controls (P less than 0.01). Most patients with guttate lesions had total enzyme activities within the normal range. Those with stationary plaque psoriasis had activities of both neutral proteinases (cathepsin G and elastase) which were about 40% lower than normal controls (P less than 0.05). In the lesion-free psoriatics, the activities of neutral proteinases were about 70% of control values. Our findings emphasize the importance of assessment of disease activity in this sort of investigation. The present data may help to resolve much of the confusion regarding PMN function in psoriasis.

Childhood scleromyositis: an overlap syndrome associated with PM-Scl antibody

Fourteen patients with childhood scleromyositis followed from 1 to more than 10 years experienced concomitant sclerodermoid and dermatomyositis features, variably expressed at one time or another during the course of the disease. The most characteristic features were myalgia-myositis, arthralgia-arthritis, puffy, atrophic, sclerotic fingers, and Raynaud's phenomenon. This overlap syndrome was the most frequent sclerodermoid condition in children, differing from both systemic scleroderma and dermatomyositis. The course of the disease was protracted and rather benign, and PM-Scl antibody was an important diagnostic and prognostic marker. We present criteria for diagnosis of scleromyositis and its differentiation from systemic scleroderma, dermatomyositis, and Sharp overlap syndrome.

Twenty-one years of follow-up studies of familial epidermodysplasia verruciformis

21 years of follow-up study of a family with epidermodysplasia verruciformis (e.v.) have shown that members of one family can be infected with different human papillomaviruses (HPVs), either HPV 3 or HPV 4, and sometimes with both. The clinical picture resembled disseminated flat warts in cases induced by HPV 3, whereas in those caused by HPV 4 there were flat red or red-brownish plaques and depigmented pityriasis versicolor-like lesions. Malignancies developed only in family members infected with HPV 4, whereas the cases due to HPV 3 ran a more benign and slowly progressive or stationary course. There were also abortive and regressive cases, and the 3 children in whom the wart-like lesions did not recur after removal had an unimpaired cell-mediated immunity (CMI). In all cases of e.v., irrespective of the inducing virus, CMI was low, which seems to be an important factor in the pathogenesis of the disease. Humoral antibodies directed specifically against HPV 3 were present in the majority of the cases, mainly those infected with HPV 3.

The ultrastructural localization of IgA in skin of a patient with mixed form of dermatitis herpetiformis and bullous pemphigoid

A case with mixed features of dermatitis herpetiformis and bullous pemphigoid was investigated by immuno-electron microscopy. There were clinical, histological, and ultrastructural characteristics of both diseases, the response to sulfapyridine was dramatic at the beginning, but intestinal lesions were absent. Direct immunofluorescence tests were made 6 times in the 4 year period and demonstrated in all biopsies exclusively linear IgA deposits. The IgA deposits were shown to occupy the entire lamina lucida and to adhere to the basal cell membranes and lamina densa, very much like IgG deposits in bullous pemphigoid. Antibodies against the basement membrane zone could not be demonstrated in the serum.

Autoantibodies to nucleolar antigens in systemic scleroderma: clinical correlations

Indirect immunofluorescence(IIF) and double immunodiffusion (DID) were performed on the sera of 64 patients who had a nucleolar immunofluorescence pattern on HEp-2 cells. Forty-nine of the sera were from 296 patients with systemic scleroderma (SSc) and 15 sera were from 214 patients with systemic lupus erythematosus (SLE). A homogeneous nucleolar staining pattern was found in 45 of the 64 sera (70.3%), a clumpy fluorescence associated with fibrillarin antibody in 14 (21.8%) and a speckled pattern was found in five of the sera (7.8%). There was a clear correlation between the sera which showed a homogeneous nucleolar staining pattern with symptoms of the polymyositis/scleroderma overlap syndrome that differed from SSc with concomitant myositis. The clumpy pattern was mainly associated with diffuse scleroderma and the speckled pattern with limited scleroderma (previously called acrosclerosis).

Unusual acantholytic bullous dermatosis associated with neoplasia and IgG and IgA antibodies against bovine desmocollins I and II

There are unusual cases of pemphigus that have antibodies nonreactive with either pemphigus vulgaris or pemphigus foliaceus antigens. We describe a patient with an acantholytic bullous dermatosis and lung cancer with intercellular IgG and IgA antibodies that differed in specificity from those of pemphigus vulgaris and pemphigus foliaceus and reacted with bovine desmocollins I and II and recombinant desmocollin protein.

Immunoelectron microscopic studies in IgA linear dermatosis

The authors investigated three cases of IgA linear dermatosis by immunoelectron microscopy. In two of the cases there were additionally some IgG deposits in the basement membrane zone. The arrangement of the IgA deposits was found to vary. In two cases it was of the dermal and the lamina lucida type at the same time, and in one case it was so close to basal cell membranes as to leave an electronlucent space on the side facing the basal lamina. In the third case, the arrangement (only IgG and complement were studied) was exclusively of the dermal type. In one of the cases the deposits had first, i.e., 1 1/2 years earlier, been confined to the lamina lucida, whereas now they were also seen below the basal lamina, although the clinical condition of the patient had remained unchanged. It would seem that the localization of IgA deposits in the basement membrane zone may vary, depending on the evolution of the disease.

Comparative studies on cell-mediated immunity in patients with different warts

The distribution of peripheral blood T and B lymphocytes, the in vitro lymphocyte response to PHA, and in vivo experimental DNCB sensitization were studied in patients with different clinical forms of warts (common, 84; flat, 88; plantar, 22; genital, 14) and in 15 cases of epidermodysplasia verruciformis (EV). The percentage of T lymphocytes forming E rosettes was significantly decreased in patients with common (54.8%), flat (47.5%) and plantar (58.3%) warts, and those with EV (47.6%) in comparison with normal controls (68.4%). The DNCB sensitivity developed less frequently and it was less intensive in patients with common and flat warts than in the normal population. 60% of EV cases were anergic to challenging doses of DNCB. The lymphocyte response to PHA was reduced in all groups of patients studied as compared to normals. T cell function was found to be most defective in patients with EV and those with flat warts. Only a slight but statistically significant defect was demonstrated in the common wart group. CMI in patients with both plantar and genital warts was shown to be almost normal; except minor alterations of PHA-induced lymphocyte transformation and E rosetting T lymphocyte counts. These data have shown the divergency of CMI defect in the patients with different clinical forms of warts caused by various HPV types. This could indicate that distinct HPV types varied in their infectiveness and host cell-mediated resistance is a fundamental factor preventing viral infection.

Tumorous variant of scleromyxedema. Successful therapy with intravenous immunoglobulins

We present an unusual tumorous variety of scleromyxedema mimicking facies leonina in lymphoma. In spite of pronounced and widespread cutaneous changes, hypergammaglobulinaemia and paraproteinaemia, the general condition of the patient was satisfactory, there was no internal involvement and no symptoms of any malignancy. Initially, melphalan and corticosteroids were applied but were not effective. High-dose intravenous immunoglobulin (IVIG) therapy had dramatic effect, and after five 5-day monthly courses the tumours almost regressed and the skin became less hard. After a further five courses in the following year there was complete clearance, which was sustained without any therapy for 1 year (until now). IVIG appears to be the therapy of choice for scleromyxedema. We stress, however, that at the start of therapy, IVIG applications should be supplemented with small doses of melphalan and/or corticosteroids.

Is chemotactic activity of polymorphonuclear leukocytes increased in psoriasis?

Chemotactic activity of PMNs of 44 patients with common psoriasis and 20 healthy individuals was studied by modified Boyden chamber assay and casein as a chemoattractant. The patients were classified according to the activity of the disease, extent of skin lesions, and duration of the disease and of the last relapse. There was a high statistically significant increase in chemotactic response of the PMNs of psoriatics as compared with controls. The increase in chemotactic activity correlated positively with the activity of the disease but not with the extent of skin lesions. Very low values in some patients with longlasting and/or extensive lesions could depend upon the presence of inhibitory factors in plasma. The possible explanation for divergent results obtained by other authors could be due to the fact that various clinical parameters were not taken into account.

Primary atrophic profound linear scleroderma. Report of three cases

We present 3 unusual cases of deep linear, primary atrophic scleroderma, not preceded by inflammatory reaction and sclerosis, involving the subcutis and deeper tissues. These cases differ in the course and prognosis from typical profound scleroderma since they do not lead to disfiguration and crippling deformities. In contrast to the atrophies left after regression of morphea or linear scleroderma, they do not involve the dermis, which does not show discoloration or changes in texture. Infiltrates in the endomysium, involvement of deeper tissues and the progressive character of the disease argue for atypical primary atrophic profound scleroderma. The coexistence in one case of primary facial hemiatrophy appears to indicate also its relationship with primary linear atrophies of the limbs.

Recombinant interferon beta gel as an adjuvant in the treatment of recurrent genital warts: results of a placebo-controlled double-blind study in 120 patients

BACKGROUND

Pilot studies of adjuvant therapy with topically applied interferons (IFN) have shown promising results in reducing the recurrence of condylomata acuminata (CA).

OBJECTIVE

The aim of this multicenter placebo-controlled, double-blind study was to confirm the efficacy and safety of topically applied IFN in a large sample of patients.

METHODS

After removal of CA by CO2 laser surgery, electrocautery or cryosurgery, 120 patients applied either recombinant IFN-beta (0.15 or 1.0 x 10(6) IU/g) or placebo gel to the affected areas 5 times daily for 4 weeks. The patients were followed for a total of 24 weeks or until recurrence of CA was observed, respectively.

RESULTS

In the 105 patients evaluated for efficacy after 24 weeks, recurrence rates were 75% (27/36 patients) in the placebo group, 62% (21/34) in the 1.0 x 10(6) IU/g group (n.s.) and 54% (19/35) in the 0.15 x 10(6) IU/g group (p = 0.034). Only few mild adverse events were noted, which were almost limited to the application site.

CONCLUSION

Topical application of gel containing 0.15 x 10(6) IU/g recombinant IFN-beta is safe and appears to reduce the recurrence of CA after surgical treatment.