High plasma levels of 8-methoxypsoralen following bath water delivery in dermatological patients

With respect to the clinical advantages known for bath PUVA therapy, it was of interest to compare the plasma levels of 8-methoxypsoralen (8-MOP) in bath therapy with those after oral administration for a better insight into the pharmacokinetics of 8-MOP following different modes of application. Considerable high plasma levels of 8-MOP were observed after bath therapy with interindividual variability. The half-life of plasma 8-MOP was markedly shorter after bath PUVA than after oral application. The pharmacokinetic profile of 8-MOP differs according to the mode of application.

Toxicity of methotrexate treatment in psoriasis and psoriatic arthritis--short- and long-term toxicity in 104 patients

Methotrexate (MTX) is an effective anti-psoriatic agent but there are major concerns about its long-term toxicity, in particular to the liver. Reported frequencies and recommendations for monitoring patients on MTX vary considerably. The aim of this study was to analyse the frequency and severity of MTX-associated adverse drug reactions (ADR) in patients with psoriasis and psoriatic arthritis. A retrospective analysis was performed of 104 psoriasis and psoriatic arthritis patients (60 male, 44 female) treated with MTX between October 1968 and October 1998. The severity of ADR was classified according to Common Toxicity Criteria (CTC). Acute ADR was defined as adverse effects within the first 90 days of MTX therapy. ADR seen later were classified as chronic. In 83 patients 165 ADR were noted within the beginning of MTX therapy. In five patients treatment was terminated because of ADR. During long-term therapy 23 patients received < or = 2000 mg MTX (group A); 81 received a cumulative dose greater than 2000 mg (group B). The total frequency of ADR in group B and the frequency of ADR CTC grade 3 or 4 in general was not significantly increased in group B (chi2 test; P = 0.468). Group B was characterised as follows: CTC grade 3 or 4 blood count changes led significantly more often to the termination of MTX (Fisher's exact test; P = 0.048), CNS side-effects (P = 0.016) and infections were more frequent (chi test; P<0.001). Liver changes and serum enzyme level increases were not significantly more frequent in group B. ADR are common in psoriasis patients on MTX therapy independent of the cumulative dose. In most cases they are temporary by nature and mild. Liver changes and serum enzyme level increases were not a major problem in our patients.

Acquired nevoid telangiectasia

BACKGROUND

Acquired nevoid telangiectasia (ANT) is a segmental dilatation of papillary plexus vessels.

OBJECTIVE

In the present study, the frequency of ANT and its associations with collagen vascular and spinal disease have been investigated.

METHODS

188 unselected patients, seen at an interdisciplinary dermatorheumatologic outpatient clinic, were clinically examined for the presence of ANT and possible associations to preexisting disease.

RESULTS

ANT was seen in 17% of patients, all females. The mean age of ANT patients was 57.5 +/- 8.2 years. Most common diseases were lupus erythematosus and scleroderma. Twenty-four of them suffered from generalized fibromyalgia, 8 had spondylitis deformans, 1 suffered from thoracal syringomyelia and 1 had a spine trauma. Two types of ANT have been seen: the cervicothoracal transition type and the lumbosacral transition type.

CONCLUSIONS

ANT is not uncommon among patients attending a dermatorheumatologic outpatient clinic. ANT indicates spinal or neuromuscular complaints, but is not related to collagen vascular disease itself.

Radiation therapy for extensive actinic keratosis

Actinic keratosis in the most common premalignant keratotic tumour of sun-exposed skin. A 66-year-old man developed a large actinic keratosis on his scalp, which did not respond to conventional treatment. Fractionated radiotherapy with a cumulative dose of 28 Gy resulted in complete remission without relapse during a 14-month follow-up. In older subjects in whom conventional treatment fails, low-dose fractionated radiation therapy is an effective alternative method.

Lupus erythematosus-associated red lunula

BACKGROUND

Red lunulae have only rarely been described in patients with lupus erythematosus.

OBJECTIVE

We assessed the frequency and classified the type of red lunulae in patients with definite lupus erythematosus seen in an interdisciplinary dermatorheumatologic outpatient clinic.

METHODS

We studied 56 patients with either systemic or cutaneous lupus erythematosus for the presence of red lunulae.

RESULTS

Eleven of 56 patients (19.6%) with lupus erythematosus had red lunulae. All of them showed a complete type of red lunulae, which was seen on all finger nails in 10 patients and on a single finger nail in 1 patient. Seven patients suffered from systemic lupus, the other from subacute cutaneous (n = 2) or chronic discoid cutaneous lupus (n = 2). There was no statistically significant difference in autoantibody expression or treatment regimen between patients with or without red lunulae. However, symptomatic patients had a shorter disease interval, and all but 1 showed either periungual erythema or chilblain lupus. Periungual erythema was not observed in any patient without red lunulae.

CONCLUSION

Red lunulae, although rarely described in the literature, are not an uncommon symptom of patients with lupus erythematosus. They seem to be associated with periungual erythema or chilblain lupus. Red lunulae should be considered in the clinical spectrum of lupus disease.

[Nail changes in rheumatic disease]

Clinically the nail organ ist easy to investigate. When estimating dermato-rheumatological diseases, knowledge of important associated nail symptoms is extremely helpful. In some diseases like osteoarthropathia psoriatica and special variants, Reiter's syndrome and connective tissue disease, typical or even characteristic symptoms can be found. In other disorders like rheumatoid arthritis, goal and systemic vasculitis, associated nail disorders are not uncommon, but of less diagnostic specificity. We review data from the literature and from our dermato-rheumatological outpatient clinic.

Is there a psoriatic osteopathy? -- the activity of bone resorption in psoriatics is related to inflammatory joint process

The aim of this study was to examine former own histomorphological results by using biochemical markers of bone collagen catabolism in patients with psoriasis vulgaris and psoriatic arthritis and to compare these results with those from rheumatoid arthritis. - The diagnosis of PsA was made according to the diagnostic criteria of Moll and Wright modified by Bennet. Urine was collected from 99 patients with PsA, 21 patients suffering from PS without articular manifestations, 154 patients with RA fulfilling the ACR criteria of 1987, and 80 healthy controls. Pyridinoline and deoxypyridinoline in urine were analyzed by HPLC, levels of CrP and ESR were estimated using laboratory assessment. - Both crosslinks show a elevated excretion in PsA (particularly in active PsA / aPsA) as well as in RA. PS and Controls show no significant difference in the elimination of crosslinks. The levels of both crosslinks are higher in females than males in all groups. With the exception of Dpyd levels in urine which only show a tendency to correlate with ESR, there are positive correlations between measured crosslink-levels in urine and markers of inflammation. The Pyd/Dpyd ratio displays a significant correlation with ESR. - An increased breakdown of collagen I and II was found only in active forms of psoriatic arthritis and in rheumatoid arthritis. Our biochemical results do not demonstrate a complete agreement with former scintigraphic or histological investigations of other authors and own histomorphological results.

[Therapy of hyperhidrosis with tap water iontophoresis. Positive effect on healing time and lack of recurrence in hand-foot eczema]

Hyperhidrosis is due to an overfunction of eccrine glands (triggered by the autonomous nervous system) and may be a cofactor for palmoplantar eczema (dermatitis). Tapwater iontophoresis was used in 54 patients with hyperhidrosis manuum et pedum. After 10 applications directed by the dermatologist, 89% of patients noted an improvement in their hyperhidrosis. 20 patients suffering from palmoplantar eczema (dermatitis) who continued the treatment at home for at least 6 months were compared with a historical sex- and age-matched group of 20 eczema-patients without iontophoresis: The factors evaluated were the time needed for clearing and the relapse-free interval. Though iontophoresis-treated patients had a slightly faster clearing, this was statistically not significant (20 vs. 22.3 days; p > 0.05). However, the difference for relapse-free interval between the two groups was statistically highly significant (24.8 weeks vs. 8.35 weeks; p < 0.0001). Tapwater iontophoresis seems to be effective not only to control sweating. According to recently published data, galvanization seems to have a capsaicin-like effect as well. Our hypothesis is therefore, that galvanization with tapwater iontophoresis interrupts the neurogenic inflammation and prolongs the relapse-free interval in hyperhidrotic palmoplantar eczema (dermatitis).

[Hydroxyproline excretion in psoriasis and psoriatic arthritis]

In the morning urine of 24 patients with psoriasis and that of 24 patients with psoriatic arthritis, we determined the excretion of hydroxyproline (mg HP/mumol crea), after preceding diet low in collagen. Surprisingly, psoriatic patients without articular involvement showed a significantly higher excretion of HP than those with psoriatic arthritis. Further differentiation revealed that there were no clear-cut correlations between the amount of HP excretion and the activity of the articular process; we proved, however, that the amount of HP excretion was definitely related to the activity of the skin eruptions in both groups of patients. We discuss whether an osteopathy pathogenetically associated with the skin disease (irrespective of synovitis in psoriatic arthritis) may possibly be responsible for these results.

[A combination of psoriasis vulgaris and nevus cell nevus--clinical, histopathologic and histochemical findings]

In a study on 76 patients suffering from psoriasis, we found melanocytic nevi (MCN) within psoriatic lesions in 7%, and in perilesional areas of about 2 cm in 13% of the patients. Under magnification (operating microscope), we failed to detect any signs of psoriasis in both the epidermis covering the MCN and the adjacent epidermis. Histopathologically, 6 out of 7 MCN examined did not show any psoriatic alterations of the epidermis, and in all the 7 cases, the adjacent epidermis was free of psoriasis. Using unfixed frozen sections in histochemistry, we studied the lectin binding of FITC-labeled ConA and UEA I in 5 MCN. The epidermal reaction was comparable to that of psoriatic lesions. In contrast to psoriatic lesions, there was no staining of the spinous layer with a polyclonal antiserum against calmodulin, but only the staining of basal cells as in non-lesional psoriasis. We discuss possible 'protective' factors against psoriasis.

[Alpha 1-fetoprotein--a marker of potential PUVA side-effects in psoriasis?]

Serum concentrations of alpha 1-fetoprotein (AFP) during PUVA treatment have been analyzed in 12 patients suffering from severe psoriasis or psoriatic arthritis. The results have been compared with AFP levels in psoriatics without PUVA treatment (group II), patients with psoriatic arthritis treated with methotrexate (group III), as well as dermatological patients without psoriasis (group IV). All groups revealed AFP levels below 25 ng/ml. Although a slight raise of AFP could be observed during PUVA therapy (p less than 0.005), we assume that AFP detection cannot be regarded as a marker of potential PUVA side-effects in psoriasis.