Interleukin-1 and interleukin-6 in psoriasis

We report on the levels of expression of IL-1 and IL-6 in skin from psoriasis patients. Different approaches were pursued. Initially, the levels of IL-1 beta and IL-6 were measured in suction blister fluid from lesional and uninvolved skin from psoriasis patients, using a sensitive enzyme-linked immunoabsorbent assay (ELISA) and bio-assay. Skin sections were also examined for the presence of IL-1 and IL-6 using IL-1 beta- and IL-6-specific antibodies. Finally, the expression of IL-1 and IL-6 mRNA was determined in cultured keratinocytes (KC) and fibroblasts from psoriasis skin. Suction blister fluid from lesional and uninvolved psoriasis skin and from skin of healthy individuals did not contain detectable levels (greater than 100 pg/ml) of IL-1 beta. Blister fluid from psoriasis lesions contained low but significant levels of IL-6, whereas the serum levels of IL-6 in these patients was undetectable. Using cryostat skin sections and an IL-1 beta-specific monoclonal antibody (MoAb) in an indirect immunoperoxidase technique, a diffuse staining in the entire epidermis was observed in sections of uninvolved skin from psoriasis patients. In cryostat sections of psoriasis lesions, a faint diffuse staining of the epidermis and a pronounced "dot-like" intracellular staining pattern was observed. On the other hand, the same IL-1 beta-specific MoAb showed, in a indirect immunofluorescence technique using unfixed epidermal cells, bright membrane staining in epidermal cell suspensions from psoriasis lesions. Slightly elevated levels of IL-1 beta and IL-1 alpha mRNA were observed in cultured KC from psoriasis lesions as compared to those in normal KC and in the HEp-2 cell line. Very low levels of IL-6 mRNA were expressed in KC from psoriasis lesions and healthy individuals. Fibroblasts from psoriasis lesions expressed extremely low levels of IL-1 alpha and IL-1 beta, but high levels of IL-6 mRNA. The results point to a paradoxical situation in psoriatic skin: blister fluid from psoriasis lesions contains no IL-1 beta, whereas IL-1 beta is overexpressed on the plasma membrane and in the intracellular compartment of epidermal cells. This finding may help in explaining the observed absence of IL-1 in aqueous extracts of psoriatic scales. Because cultured KC from psoriasis lesions express minimal levels of IL-6 mRNA. dermal fibroblasts, probably together with the inflammatory infiltrate, may represent a major source of IL-6 in psoriasis lesions in vivo.

[Contact allergy for Alstrumeria (inca lily)]

We report 6 patients with occupational contact allergy to Alstroemeria cultivars. Four of them presented with the clinical picture of 'tulip fingers'. They all reacted to parts of fresh plants and to tuliposide A. The literature on Alstroemeria allergy is reviewed.

Contact allergy to spices

A group of 103 patients suspected of contact allergy was tested with the European standard series, wood tars and spices: paprika, cinnamon, laurel, celery seed, nutmeg, curry, black pepper, cloves, white pepper, coriander, cacao and garlic. 32 patients (Group I) were selected on the basis of positive tests to one or more of possible indicators for allergy to spices: colophony, balsam of Peru, fragrance-mix and/or wood tars. 71 patients (Group II) showed no response to these indicators. In Group I (n = 32) a statistically significantly higher % of patients (47%) showed positive reactions to 1 or more spices, compared with 15% in Group II (N = 71). Among the spices, the highest numbers of reactions were found to nutmeg (28%), paprika (19%) and cloves (12%) in the indicator-positive Group I. Fragrance-mix turned out to be a particularly important indicator allergen, especially for paprika, nutmeg and cloves. The contact allergy in 11 out of 32 (Group I) and 7 out of 25 patch-tested patients (recruited from Group II) appeared to be directed mainly against the ether-extractable volatile fractions of the spices.

Sensitization to fragrance materials in Indonesian cosmetics

2 different groups of patients were patch tested with 2 test series (A and B) containing extracts of fragrance raw materials, traditionally used in Indonesian cosmetics. Series A consisted of diluted extracts of commercially available Indonesian fragrances. Series B consisted of extracts prepared in our department from corresponding indigenous flowers and fruits. Group 1 consisted of 32 patients positive to fragrance-mix, of whom 8 (25%) had positive tests to 1 or more of the different extracts of fragrance raw materials. Reactions were observed to extracts of: Rosa hybrida Hort (7); Canangium odoratum Baill (5); Citrus aurantifolia Swingle (4); Jasminum sambac Ait (2). 6 of the 8 patients had reactions to 1 or more of the components of fragrance-mix: oakmoss (3); cinnamic alcohol (2), isoeugenol (1); cinnamic aldehyde (1) and geraniol (1). Group 2 consisted of 159 patients patch tested on suspicion of contact dermatitis, who were fragrance-mix negative. Only 2 (1.2%) had a positive patch test to the extracts of fragrance raw materials. Specimens taken (as is) from the flowers and citrus fruits (being the basis sources of the fragrance raw materials) were less antigenic. The use of additional test series in Indonesia to detect allergy to traditional cosmetics and perfumes merits further investigation.

Purpuric contact dermatitis to benzoyl peroxide

Patch test reactions in a patient with purpuric contact dermatitis to 5% benzoyl peroxide are described. Alterations of the capillary endothelium included obliteration of the lumina with perivascular mononuclear cell infiltrates. There were no epidermal alterations. These observations are discussed with reference to the data in the literature on vascular damage in "dermal" contact dermatitis.

Use of cyclosporin in psoriasis

In the treatment of severe psoriasis, cyclosporin may achieve improvement or remission at low doses, but relapse usually occurs on withdrawal of treatment. An initial dose of 3 mg/kg per day is recommended. Complete remission should not be the objective, and the role of long-term maintenance cyclosporin therapy is uncertain because of potential side-effects--especially nephrotoxicity, hypertension, and a predisposition to malignancy. Guidelines are proposed for the assessment of such treatment.

Pemphigoid in children

Pemphigoid is an autoimmune blistering disease that is rare in childhood. A review of the English, German, and French literature published prior to 1989 revealed 31 cases of juvenile bullous pemphigoid and 12 of other forms (10 cases of juvenile cicatricial and 2 of juvenile localized bullous pemphigoid). Childhood pemphigoid, although less frequent, seems no different than its adult counterpart. While oral lesions are more common in the juvenile bullous form, there is no association with malignancy, which is a controversial and presumably incorrectly assumed association in the adult disease. The prognosis for children is good in most cases, and the disease is self-limiting. The mainstay of therapy has been oral corticosteroids, but dapsone also often produces a good response. A relatively new approach is to give a combination of erythromycin and niacinamide with dapsone for a steroid-sparing effect. In some patients the response to erythromycin plus niacinamide alone has been satisfactory; however, controlled therapeutic trials are lacking. It has been stated that high doses of steroids and immunosuppressive drugs are indicated for the cicatricial, as opposed to juvenile, bullous pemphigoid. From this review of the few cases of childhood cicatricial disease, it seems that the therapeutic approach might be the same for both forms.

Idiopathic erythermalgia: a congenital disorder

Idiopathic erythermalgia during early childhood and adolescence is characterized by red, congested, burning pain of the lower extremities provoked by exercise or exposure to warmth. The clinical symptoms of idiopathic erythermalgia in a young woman and her mother are described. Histopathologic and immunofluorescence findings in biopsy specimens of affected areas of skin were consistent with a nonspecific inflammatory process. The condition was completely refractory to any treatment. Even the long-lasting relief of pain with one low dose of aspirin, which is a prerequisite for the diagnosis of thrombocytemic erythromelalgia, was lacking. Idiopathic erythermalgia appears to be a separate clinical entity and congenital disorder.

Clinical aspects of para-tertiary-butylphenolformaldehyde resin (PTBP-FR) allergy

Sensitization by para-tertiary-butylphenolformaldehyde resin (PTBP-FR), which is particularly useful as a leather glue, has been known for 30 years. We retrospectively studied the clinical aspects of those patients with a PTBP-FR allergy among 1966 patients in whom contact dermatitis was confirmed by patch testing. A positive patch test to PTBP-FR was present in 30 patients (1.5%), 24 of whom were women. Exposure to PTBP-FR as a cause of the dermatitis was "certain" in 7, "very likely" in 6 and "unclear" in 17. 67.7% of the patients had a multiple allergy. In 43.3% of the patients, a history of atopy was found. No clear association of PTBP-FR sensitization with allergies to phenolformaldehyde resin (P-FR) or free para-tertiary-butylphenol (PTBP) emerged in this group of 30 patients. This study supports the hypothesis that PTBP-FR and P-FR do not contain the same sensitizers. Follow-up of 26 of the 30 patients showed a favourable course, dependent on identification of the source of exposure, avoidance of further contact and absence of sensitization to multiple allergens.

Intralesional treatment of basal cell carcinoma with low-dose recombinant interferon gamma

In this pilot clinical trail the efficacy of intralesional low-dose human recombinant interferon-gamma was investigated in seven outpatients with nodular basal cell carcinoma. There was no antitumor response in any case. Toxic side effects were minimal. All tumors were excised surgically 8 weeks after completion of therapy.

[Parapemphigus and variants; clinical and immunological aspects]

The clinical, histopathological and immunological findings and therapeutic data of 29 patients with different variants of pemphigoid seen by us in the period 1981-1988 are summarized. All 29 patients: disseminated or bullous pemphigoid (20 cases), localized pemphigoid (3 cases), cicatricial pemphigoid (2 cases), juvenile pemphigoid (2 cases), papular pemphigoid (1 case) and pemphigus vegetans (1 case) showed as common denominators subepidermal blister formation and linear deposition of Ig (IgG) and complement in the basement membrane zone. In nearly all the cases with disseminated pemphigoid treatment with immunosuppressive drugs orally was indicated. With particular reference to the age of patients in this subgroup (mean age greater than 70 years) aspects inherent to the treatment are briefly discussed. In contrast to the (relatively) benign course of the disease in localized pemphigoid and in juvenile pemphigoid, cicatricial pemphigoid with mucosal localization appears to be a variant within the spectrum of pemphigoid with severe complications due to tissue retraction and loss of local function.

[Epoxy resin as a cause of contact allergic eczema]

Epoxy resin-containing products of the plastic industry are increasingly employed. We retrospectively studied the incidence and course of epoxy resin contact dermatitis in 2265 patients in whom contact dermatitis was confirmed by patch testing. A positive patch test for epoxy resin was present in 31 patients (1.4%). Exposure to epoxy resin as the cause of contact dermatitis was 'certain' in 10, 'very likely' in 9, 'possible' in 4 and 'unclear' in 8 patients. Exposure to epoxy resin was related to occupational (55%) and leisure time activities (13%). In 48% patch tests were positive for multiple test allergens. Hands (56%), arms (38%) and face (38%) were mainly affected. Re-examination of 26 of 31 patients showed that a favourable course depended on identification of the cause of the exposure to epoxy resin, avoidance of further contact and absence of sensitization to multiple allergens.