European multicenter study of the TRUE Test

A new, standardized, ready-to-apply patch test, the TRUE Test, has been evaluated on 698 consecutive patients with suspected contact dermatitis. The patients were tested with 12 different allergens. Simultaneously, the same 12 allergens in pet. (Trolab) were applied symmetrically to the opposite side of the upper back using the conventional Finn Chamber technique. There were positive test reactions to all 12 allergens tested in the patient group. The concordance of positive reactions between the TRUE Test and the Finn Chamber test was 67%; 13% of all positive reactions were recorded only for the TRUE Test and 20% only for the Finn Chamber method. The frequency of questionable and irritant reactions was of the same low order of magnitude for both test methods; such reactions were recorded in around 2% of all test patches.

Serum alpha fetoprotein in 714 mentally retarded carriers of hepatitis B surface antigen

Sera from 714 mentally retarded carriers of hepatitis B surface antigen were screened for alpha fetoprotein (AFP) by monoclonal radioimmunoassay. Serum AFP levels were less than 20 mcg/L in 708 (99.2%) carriers. One 29-year-old carrier with normal liver function had serum AFP level of 1500 mcg/L, which increased to 12,500 mcg/L after 72 days. She died of multifocal hepatocellular carcinoma (HCC) with cirrhosis. Five other carriers with serum AFP levels between 20 and 165 mcg/L are alive without clinical HCC. No correlation was found between serum AFP level and race, age, sex, Down's syndrome, serum alanine aminotransferase level, and hepatitis B e antigen positivity. Single cross-sectional serum AFP screening by itself is not sufficient for early diagnosis of HCC.

Granular cell tumors: evidence for heterogeneous tumor cell differentiation. An immunocytochemical study

Eighteen granular cell tumors from various sites were examined with antisera directed against protein S-100, neuron specific enolase (NSE), alpha-1-antichymotrypsin, and alpha-1-antitrypsin, glial fibrillary acidic protein (GFAP), lysozyme, factor VIII-related antigen, myoglobin and vimentin, as well as with a monoclonal antibody (lu-5) directed against a panepithelial marker. The immunocytochemical reaction pattern of the tumors was heterogeneous. The brain and pituitary tumors and one thyroid tumor reacted for alpha-1-antichymotrypsin and alpha-1-antitrypsin, but not for S-100 protein and NSE. However, tumors from other sites showed immunoreactions for S-100 protein and NSE and some also for vimentin. Reactions for alpha-1-antichymotrypsin and alpha-1-antitrypsin were not observed. All other reactions were similarly negative. We conclude that the morphologically homogeneous group of granular cell tumors is biologically heterogeneous.

Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries

The minicondylar plate fixation system is a new method for stable internal metaphyseal bone fixation about the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints. Indications for its use are rigid stabilization of fracture, osteotomy, and the bony components of composite tissue transfer. The device should be used in deference to other techniques when early active range of motion is pursued. Its best use is in the face of combined injury or osteotomy with tenolyses/capsulotomy. This implant permits stabilization of small epiphyseal fragments with minimal interference of joint function and perhaps a reduction of irritation of the extensor aponeurosis. Disadvantages include the need for careful preoperative planning because of this implant's small size and unforgiving tolerances of application. The data is included for the first 65 consecutive cases of its use. Despite the institution of range of motion therapy within five days in 77% of the cases, there were no nonunions. Two cases of delayed union were successfully treated by addition of cancellous bone grafts without revision of the fixation devices. Problems included malignments (three cases), infections (two cases), and soft tissue coverage (four cases). Aseptic necrosis of bone is associated with metacarpal head fractures and is seen with the use of this implant in treating such intraarticular fractures.

Systemic responses to tourniquet release in children

The hemodynamic and metabolic effects of deflation of pneumatic tourniquets were assessed in 15 children, seven of whom had bilateral tourniquets applied. Systemic acidosis from release of lactate and PaCO2 after tourniquet deflation did not cause adverse effects in these healthy children. Larger increases in lactate were seen with longer tourniquet inflation times (greater than 75 min) or with bilateral tourniquets. The greatest decrease in pH was seen with simultaneous deflation of bilateral tourniquets. Heart rate did not change with tourniquet deflation, whereas systolic blood pressure decreased 8-10 mm Hg with deflation. Blood pressure returned to control values within 5-10 min; no arrhythmias were seen. Recommendations to minimize the systemic metabolic effects after release of tourniquets in children under general anesthesia include the following: 1) attempt to limit tourniquet inflation times to less than 75 min; 2) use controlled ventilation prior to and after tourniquet deflation to remove the respiratory component of acidosis; 3) check blood gas tensions within 5 min of tourniquet deflation in children with long tourniquet inflation times (greater than 75 min), and where bilateral tourniquets are deflated simultaneously or within 30 min of each other.

Products of two common alleles at the locus for human placental alkaline phosphatase differ by seven amino acids

Amino-terminal amino acid sequences (42 residues) were determined for the products of the three common alleles at the human placental alkaline phosphatase [orthophosphoric-monoester phosphohydrolase (alkaline optimum), EC 3.1.3.1] gene locus. The sequences differ at position 3, which is proline in types 1 and 2 but is leucine in type 3. cDNA libraries were constructed in phage lambda gt11 and used to isolate clones covering the coding regions of types 1 and 3 cDNAs. Comparison of the deduced amino acid sequences of the types 1 and 3 proteins showed 7 differences out of 513 amino acids, each due to a single base substitution. cDNA sequence comparisons showed three silent substitutions in the coding regions and three base differences in the greater than 1 kilobase pairs of 3' untranslated sequences.

Phenotypic difference between allergic and irritant patch test reactions in man

Cellular responses in allergic and irritant contact dermatitis were analysed in situ using an immunohistochemical double staining technique with the aim of uncovering phenotypical differences of diagnostic importance. Allergic and irritant patch test reactions were elicited in 9 individuals using the Finn chamber technique. Thirty-nine skin biopsies from these reactions and from petrolatum controls were obtained 4 to 20 days after the test applications. Cell infiltrates were present throughout the observation period in both allergic and irritant reactions, but were usually greater in the former. In both types of reaction, anti-Leu 3a reactive cells predominated over anti-Leu 2a reactive cells. HLA-DR expression on keratinocytes was found in 9 of 14 allergic reactions, but not in irritant reactions or control areas. HLA-DQ antigens were not detected on keratinocytes. The presence of HLA-DR antigens on keratinocytes may reflect an immunological response of the allergic reactions, and thus be of diagnostic relevance.

Antigen preparation for the patch test

At this time patch testing is the most important tool in the evaluation of patients with dermatoses. From 70 to 80% of all cases of contact allergy are estimated to be discovered by using the standard trays with just 20 to 30 different substances and mixes.

Prevention of irritant dermatitis

Irritant contact dermatitis is the most frequent cause of occupational hand eczema and results from undue environmental demands on the skin. Preventive measures to reduce the irritant stress to the skin is the best method of tackling this problem.

Aluminium in Finn chambers reacts with cobalt and nickel salts in patch test materials

Aluminium has a greater affinity for electrons than cobalt and nickel. Therefore, cobalt and nickel ions would be expected to exchange with metallic aluminium in Finn chambers. This theory has been proven to be valid, as shown in 2 series of experiments: first, cobalt and nickel salt solutions (0.25 M) etch a metallic aluminium surface; secondly, aluminium Finn chambers kept in 10(-3) M nickel salt solutions significantly reduce the concentration of dissolved nickel. Dichromate solutions do not etch an aluminium metal surface significantly. Petrolatum, which is routinely used as vehicle in standard patch tests, probably protects the aluminium of Finn chambers from the interaction of cobalt and nickel salts. The interaction may have significance in tests with solutions.

False-positive, follicular and irritant patch test reactions to metal salts

853 hard metal workers were patch tested with nickel sulphate 5%, potassium dichromate 0.5% and cobalt chloride 1%, each in petrolatum. Non-allergic reactions appeared in 6.5% of the nickel tests, 13% of the chromium tests and 18.3% of the cobalt tests. Most of the individuals with positive, poral or pustular reactions were retested with serial dilutions of metal salts in pet. and in water. The accuracy of a positive initial nickel reaction was 83%, a chromium reaction 40% and a cobalt reaction 62%. The nonallergic reactions were partly reproducible and correlated with both the type of patch test material and with individual factors. Weak and moderately strong positive patch test reactions to metal salts may be irritant and should be checked with serial dilution tests or at least be retested. A reduction of the cobalt chloride concentration from 1% to 0.5% in the standard test material is discussed.

The Finn chamber methylene blue ring

Metallic aluminium and methylene blue applied to human skin interact and give a strong resistant coloration, obtained neither with methylene blue itself nor with other dyes. The reaction proves that aluminium is not an inert material and that the aluminium in Finn chambers can be expected to interact with other patch test substances.

Hand eczema among hard-metal workers

Seven hundred seventy-six of 800 workers in a hard-metal factory were investigated. The prevalence of hand eczema and irritant reactions of the hands was 10% and 15% respectively. Of 1,006 workers who had left the industry during the previous ten years, 87 had had hand eczema. The cumulative incidence of hand eczema for these ten years was estimated to be 17%. Fifty-two percent of the hand eczemas and 67% of the irritant reactions started during the first year of work. The majority of both the hand eczemas and the irritant reactions first appeared in grinding activities. Wet grinding and oil grinding entailed the highest risks of hand eczema. Hand eczema was significantly more common in individuals with an atopic background. Eighteen percent of the individuals with present or previous hand eczema had positive patch-test reactions. Positive patch tests were equally common among individuals with irritant reactions and those with normal skin.

Conversion factors for ultraviolet radiation dosage with different types of ultraviolet therapy

Erythema thresholds were determined using 4 different UV units before and after photosensitization with psoralens or coal tar in healthy volunteers. Conversion factors for equivalent erythema-producing UV doses with the different types of treatment were calculated on the basis of the erythema thresholds. A simple mode of transfer of patients between the different treatments with good precision of UV dosage is thus offered.

Amount of nickel applied with a standard patch test

The concentration of nickel sulphate was determined in 9-16 mg test samples from commercially available patch test antigens. With two different manufacturers of 2.5% nickel sulphate in pet, the concentration range of 25 samples was 0.7 and 1.1% (+/- 2 SD) respectively, and with one manufacturer of 5.0% nickel sulphate in pet, the range was +/- 0.5%. In a normal patch test, the volume of patch test material applied with the Finn chamber technique should be 12-18 microliter (9-16 mg), but has been found to range between 9 and 50 microliter. Thus the amount of nickel applied in standard patch tests varies within at least 6-fold limits.

Patch test allergens in petrolatum: a reappraisal

Patch test materials in petrolatum, from 3 different manufacturers and 14 different types were evaluated by gross and microscopic examination. The allergens were noted to be suspended as particles or droplets in the vehicle. Obvious variations in both size and structure of the included allergen were found with the same chemicals but of different manufacture. Several materials do not meet the pharmaceutical standards which should be requested regarding stability, particle size and packing. A more detailed declaration is proposed.

Finn chamber patch test technique

Proper technique aids reliable patch test results. The Finn chamber volume was determined to be 25 microliters. These studies suggest the optimal volume semi-solid test substance to be 12-15 microliters. More than 18-21 microliters caused significant extrusion of test substance and improper adhesive adherence. Finn chamber paper discs used with solutions absorb a maximum of 17.5 microliters test solutions and keep 15 microliters within the chamber. The evaporation rate of aqueous test solutions from Finn chambers was 1 mg/3 min; thus, the chambers should be applied quickly to avoid drying.

UV treatment of uraemic pruritus reduces the vitamin A content of the skin

The effect of phototherapy on uraemic pruritus and vitamin A content in serum and epidermis was investigated in ten patients with chronic renal failure. The patients and five healthy controls were given repeated whole-body irradiation of UV-A + UV-B (total dose 7.9 + 1.3 J cm-2). Serum and skin samples were obtained before and after the treatment. Serum samples were analysed for retinol, retinol-binding protein and carotene and epidermis samples for retinol, 3-dehydroretinol and carotene. Before treatment, the retinol concentrations in serum and epidermis were higher in patients than in controls. The treatment, which relieved seven patients of pruritus, reduced the epidermal retinol from 11.6 +/- 4.5 to 7.0 +/- 3.8 nmol g-1 protein (P less than 0.02). A similar reduction occurred in the controls (4.5 +/- 1.0 v. 1.7 +/- 1.0, P less than 0.01). No changes of epidermal 3-dehydroretinol, carotene or the serum parameters occurred in either patients or controls. The putative relationship between uraemic pruritus and hypervitaminosis A and the response of this condition to UV therapy is discussed.

[10 years' integrated medical and occupational rehabilitation in 2d phase facilities--confirmed model or end of a trial?]

Founding of a working group of the rehabilitation facilities of the II. phase has occasioned the present study of developments in this area, as seen in particular from the vocational angle. The main emphasis is the role played by the call for integration in rehabilitation, i.e. inclusion of the disease- or disability-generated occupational problems as a vital social aspect to be considered in the treatment and rehabilitation process. For patients in residential programmes, examples are given from the sector of "occupational therapy and job family-related vocational assessment": preparatory vocational programmes, occupational analysis, vocational assessment, and individualized conditioning. Beyond medical care, the centres of the II. phase had been intended to provide "vocational adjustment services"; critical appraisal however reveals the degree of legal imprecision of this term, as well as its lacking in factual delimitation from other forms of rehabilitative measures stipulated in rehabilitation legislation. Also, the vocational functions assigned to the II. and III. phase respectively, tend to overlap more and more, at least at the conceptual level. What is therefore needed to further development of the vocational tasks and functions to be integrated in the II. phase into a direction where a need does exist and where the specific potential of these centres can be used in a meaningful and economical way: the care of most severely disabled persons for whom vocational services require a special educational emphasis.

Long-term safety of trioxsalen bath PUVA treatment: an 8-year follow-up of 149 psoriasis patients

A thorough clinical follow-up study with regard to the occurrence of degenerative skin changes and cutaneous carcinomas was undertaken in 1982 in 149 patients with moderate to severe psoriasis treated with PUVA baths (trioxsalen + UVA). The PUVA treatment had been commenced between 1974 and 1978. With trioxsalen baths a high sensitivity to UVA is obtained. The initial UVA dosage is therefore as low as 0.04-0.08 J/cm2 and in the majority of the patients the maximum daily dose was about 1.0 J/cm2. The accumulated UVA dosage was low. Thus 89% of the patients had received less than 50 J/cm2 in 5-8 years of bath PUVA treatment. No degenerative skin changes were found on PUVA-exposed skin that were not also seen on the facial skin not exposed to PUVA. Two patients showed mild mottling of exposed skin. Otherwise no PUVA-related degenerative changes were observed. No carcinomas were found on bath PUVA-treated skin.

Contact sensitivity to nickel in white gold

Nickel release from white gold discs stored at room temperature for 1 week in synthetic sweat was analyzed. The nickel content of the discs was 2-15%. The nickel release from the discs was 0.09-0.82 microgram. Rhodium plating reduced the nickel release to 0.04-0.54 microgram. 18 nickel-sensitive women were patch tested with the white gold discs and all showed at least 1 positive patch test reaction. All the white gold discs gave a negative dimethylglyoxime test.

Nickel release from ear piercing kits and earrings

Ear piercing with nickel-alloyed studs/clasps involves considerable risk of nickel sensitisation. Stainless steel studs/clasps for ear piercing and different types of earring were stored in synthetic sweat for 1 week. The nickel release was determined. One "hypoallergenic" stud/clasp released 0.005 microgram Ni; 21 unused studs/clasps and earrings released 0.05-3 microgram Ni, and 11 unused studs/clasps and earrings released 6-25 micrograms Ni. 6 earrings which caused dermatitis released 14-442 micrograms Ni. Thus, all studs/clasps and earrings released nickel. Neither gold nor silver plating prevented the nickel release. Nickel-sensitive women were asked to wear studs/clasps releasing various amounts of nickel. The most sensitive of them showed eczematous reactions to studs/clasps releasing nickel down to 0.05 micrograms. The dimethylglyoxime test was positive only when more than 10 micrograms Ni was released.

Phenotypic characterization in situ of inflammatory cells in allergic and irritant contact dermatitis in man

The cellular response in allergic and irritant contact dermatitis was analysed in situ with an immunohistochemical double staining technique. Allergic patch test reactions were elicited in 10 patients and irritant reactions in eight cases, using the Finn chamber technique. Skin biopsies were obtained 6-72 h after test applications. Frozen sections of 43 biopsies were investigated by simultaneous staining with rabbit anti-HLA-DR antibodies and various mouse monoclonal antibodies. The cell infiltrates were usually larger in the allergic than in the irritant reactions. However, the kinetics of the cell responses, the phenotypes of the inflammatory cells, their distribution and spatial relationships were similar. It thus appears that the applications of allergens or irritants to the skin generates a cell pattern that to a large extent reflects an immunological readiness for further immune reactions.

[Concentrations of pollutants in the smoke blowing area of smokers]

The concentrations of particles and nitrogen oxide have been measured in the "blowing cloud" of a smoker. At a distance of 1 m from the smoker, the peak values range from 41 to 750 ppb NO and 3,330 to 99,680 micrograms/m3 particles. These high concentrations decrease very rapidly (half-life period between 2 and 20 s). At a distance of 3 m, there is no more real "blowing cloud". In addition to the sidestream smoke, the relatively high concentrations of particles in the "blowing cloud" of the smoker could also be responsible for the acute irritating effects of the passive smoker.

Relationship between nickel and cobalt sensitization in hard metal workers

853 hard metal workers were examined and patch tested with 20 substances from their environment, including nickel and cobalt. Nickel sensitivity was found in 2 men and 38 women. 88% of the nickel-sensitive individuals had developed a jewelry dermatitis prior to employment in the hard metal industry or before the appearance of hand eczema. 29% of the hard metal workers gave a history of slight irritant dermatitis. In the nickel sensitized group, 40% had had severe hand eczema which generally appeared 6-12 months after starting employment. In 25% of the cases, nickel sensitive individuals developed cobalt allergy, compared with 5% in the total population investigated. Most facts indicate that nickel sensitivity and irritant hand eczema precede cobalt sensitization. Hard metal workers with simultaneous nickel and cobalt sensitivity had a more severe hand eczema than those with isolated cobalt or nickel sensitivity or only irritant dermatitis. 64% of the female population had pierced ear lobes. Among the nickel allergic women, 95% had pierced ear lobes. The use of earrings containing nickel after piercing is strongly suspected of being the major cause of nickel sensitivity. Piercing at an early age seems to increase the risk of incurring nickel sensitivity.

Identification of amino acid and nucleotide sequence of the foot-and-mouth disease virus RNA polymerase

Foot-and-mouth disease virus (FMDV) RNA polymerase was purified from the polyethylene glycol (PEG)-treated supernatant of infected cell media by a combination of ion-exchange chromatography, membrane molecular filtration, and affinity chromatography. The purified RNA polymerase which migrated as a single band of 56,000 molecular weight on a polyacrylamide gel was subjected to automated Edman degradation and the sequence of the first 30 amino acid residues established. On the basis of previous evidence, which indicated that the RNA polymerase was the most 3'-translated polypeptide, plasmids containing cDNA mapping at the 3' end of the genome were characterized by restriction enzyme analysis and nucleotide sequencing. These investigations definitively established the derived amino acid sequence by confirmation of 28 of the amino terminal residues determined by amino acid sequence analysis; the location of the FMDV RNA polymerase coding region at the extreme 3' end of the genome, 96 nucleotides from the poly(A) tail; and the N-terminal cleavage point of the RNA polymerase from its precursor P100 was found to be a glutamic acid-glycine bond.

Skin protection against ionized cobalt and sodium lauryl sulphate with barrier creams

853 individuals who are still working or had previously worked in hard metal manufacture were examined and selected for patch tests with materials from their working environment including metal allergens. The majority of the individuals with positive test reactions to cobalt chloride were retested with serial dilutions of cobalt chloride and with the same serial dilutions after preparation of the skin with a layer of barrier or emollient cream used for hand care in this factory. The irritant effect of sodium lauryl sulphate (SLS) was similarly investigated. The barrier and emollient creams did not give any protection against cobalt chloride or sodium lauryl sulphate. In fact they seemed to enhance the penetration of cobalt ions. Their use in protection against metal allergens and cutting fluids is questionable.

Cobalt allergy in hard metal workers

Hard metal contains about 10% cobalt. 853 hard metal workers were examined and patch tested with substances from their environment. Initial patch tests with 1% cobalt chloride showed 62 positive reactions. By means of secondary serial dilution tests, allergic reactions to cobalt were reproduced in 9 men and 30 women. Weak reactions could not normally be reproduced. A history of hand eczema was found in 36 of the 39 individuals with reproducible positive test reactions to cobalt, while 21 of 23 with a positive initial patch test but negative serial dilution test had never had any skin problems. Hand etching and hand grinding, mainly female activities and traumatic to the hands, were found to involve the greatest risk of cobalt sensitization. 24 individuals had an isolated cobalt allergy. They had probably been sensitized by hard metal work, while the individuals, all women, who had simultaneous nickel allergy had probably been sensitized to nickel before their employment and then became sensitized to cobalt by hard metal work. A traumatic occupation, which causes irritant contact dermatitis and/or a previous contact allergy or atopy is probably a prerequisite for the development of cobalt allergy.

Patch testing with sodium tungstate

Hard metal contains about 90% tungsten carbide. In an investigation of the skin of 853 individuals who are still working or had previously worker in hard metal manufacture, sodium tungstate was included in a patch test with a panel of substances from the environment of the employees. No allergic reactions to tungstate were found. However, irritant pustular reactions appeared in 2.0% of the patch tests. The pustular reactions were often reproducible.

Specific Pseudomonas immunoglobulin E antibodies in sera of patients with cystic fibrosis

Immunoglobulin E antibodies to Psuedomonas aeruginosa were demonstrated in patients with cystic fibrosis colonized with the bacterium.

Passive smoking at work

Air pollution due to tobacco smoke and its effects on employees were investigated in 44 workrooms. For this purpose, the concentrations of CO, NO, NO2, nicotine, and particulate matter were determined, and 472 employees were interviewed about annoyance and irritations. The mean values of the concentrations of the components due to tobacco smoke are: CO = 1.1 ppm, NO = 32 ppb, NO2 = 24 ppb, nicotine = 0.9 micrograms/m3, particulate matter = 133 micrograms/m3. One third of the measured CO values exceeds a critical threshold of 2 ppm CO due to tobacco smoke. One quarter of the persons reports eye irritations at work. One third of the employees qualifies the air with regard to smoke at the workplace as bad. Forty percent of the interviewed persons are disturbed by smoke. The majority of the employees is in favor of a separation into smoking and non-smoking rooms. This seems to be the most appropriate preventive measure for the protection of nonsmokers at work.

[Passive smoking in the work place]

The air pollution due to tobacco smoke and its effects on employees were investigated in 44 work-rooms. For that purpose the concentration of CO, NO, Nicotine and the Particulate Matter were determined and 472 employees were interviewed about annoyance and irritations. The mean values of the concentrations of the components due to tobacco smoke are: CO = 1.1 ppm, NO = 32 ppb, Nicotine = 0.9 micrograms/m3, Particulate Matter = 133 micrograms/m3. The use of an indicator is discussed. One third of the employees qualifies the air wit regard to smoke at work place as bad. 40% of the interviewed persons are disturbed by smoke. One quarter of th persons indicates eye irritations. The majority of the employees support a separation of the rooms in smoking and non-smoking areas. This seems to be the most appropriate preventive measure for the protection of the nonsmokers at work.

Protective effects of various types of clothes against UV radiation

The UV protection factors of twenty commonly used textiles were determined. Protection factors varied between 1.3 and 1700, which shows the importance of giving careful advice to light-sensitive and psoralensensitized patients, regarding suitable clothes.

Plasma concentrations after bath treatment and oral administration of trioxsalen

An analytical method comprising homogenous extraction and determination by gas chromatography mass spectrometry has been developed for the quantitation of trioxsalen in plasma. The limit of sensitivity of the method has been 2 ng/ml of trioxsalen. The method was used to monitor concentrations of trioxsalen in plasma after a 40 mg oral dose or after trioxsalen bath treatment. The concentrations in plasma after oral administration did not exceed 3 ng/ml, while in 2 patients after bath treatment trioxsalen could be determined (2-3 ng/ml). The low plasma concentrations found throw light on the poor UV-sensitizing properties found after oral trioxsalen therapy.

Aspects of the treatment of mycosis fungoides. A report from the Scandinavian Mycosis Fungoides Study Group

The Scandinavian Mycosis Fungoides Study Group includes dermatologic clinics in Denmark, Norway, and Sweden. The results of the first three years of activity are presented herein. In plaque stage, topical nitrogen mustard was highly effective. Preceding intravenous tolerance induction seems to be of no value. PUVA induced equally high remission rates. Both modalities were also highly effective in cutaneous tumor stage. In advanced tumor stage and in case of extracutaneous involvement systemic chemotherapy was given. Topical treatment alone was more effective on the cutaneous lesions including tumors than systemic chemotherapy alone. Therefore a combination of topical and systemic treatment is recommended in advanced stages of mycosis fungoides.