Gianotti-Crosti syndrome associated with Epstein-Barr virus infection

Gianotti-Crosti syndrome (GCS) is a distinct exanthematic, acrolocated eruption of childhood caused by a variety of infectious agents. Historically hepatitis B antigen positive (HBsAG+) papular acrodermatitis of childhood and HBsAg negative (HBsAg-) papulovesicular acrolocated syndrome have been distinguished. Here we characterize the spectrum of associated infectious agents in seven patients with confirmed GCS seen in our departments in the years 1994-1995. Where available, stored frozen serum samples were reanalyzed for antiviral antibodies. The mean age of the two girls and five boys was 22.5 months with a range of 8 to 53 months. None of the patients was HBsAG+. Four patients showed serologic evidence of an acute infection and one patient of a recent Epstein-Barr virus (EBV) infection. In two additional children vaccination preceded the appearance of GCS. In these two patients serologic investigations revealed no evidence of recent infection with most common viruses. Our results underline the role of viral infections other than hepatitis B in the etiology of GCS. EBV infection was the most commonly associated viral disease in our population. We agree with other authors that we should avoid using the terms papular acrodermatitis of childhood and papulovesicular acrolocated syndrome in describing HBsAg+ and HBsAg- forms of GCS.

Muir-Torre syndrome: clinical features and molecular genetic analysis

We report a 62-year-old man with rectal cancer, two keratoacanthomas and multiple sebaceous adenomas, epitheliomas and sebaceous hyperplasia. His brother and father died from colorectal cancer. A subgroup of patients with the Muir-Torre syndrome (MTS) is allelic to the cancer family syndrome. This genetic disorder is caused by an autosomal dominant inherited germline mutation in one of the DNA mismatch repair genes. It is thought that a somatic mutation of the other allele leads to a genomic instability responsible for tumorigenesis. In the patient presented here the instability was detected in two characteristic skin lesions; sebaceous adenoma and epithelioma. The search for a causal germline mutation revealed a frameshift mutation in the mismatch repair gene hMSH2 leading to a truncated protein. A presymptomatic molecular diagnosis can be offered to the children of the patient.

A local lymph node assay to analyse immunosuppressive effects of topically applied drugs

Topical glucocorticosteroids represent the mainstay of antiinflammatory therapy in the treatment of inflammatory skin diseases. Their clinical use, however, is limited by local and systemic side-effects. Thus, in dermatopharmacology there is a large demand for alternative non-steroidal antiinflammatories. Other than transplantation models, most of the frequently used in vivo test systems for assessment of drug-induced immunosuppression measure changes in inflammatory skin responses by means of skin erythema and edema after challenge of sensitized animals. The aim of this study was to develop an alternative mouse model to detect and analyse immunosuppressive effects of topically applied drugs. On the basis of a modified local lymph node assay, we analysed effects of topical hydrocortisone, dexamethasone, mometasone furoate and FK506 (tacrolimus) during the induction phase of contact hypersensitivity. On 4 consecutive days, NMRI mice were treated on the dorsal surfaces of both ears with increasing concentrations of test compound. During the last 3 days, the mice received in addition the contact sensitizer, oxazolone (1%). On day 5, draining auricular lymph nodes were removed in order to assess lymph node cell counts and perform flow cytometric analysis of lymph node cell subpopulations (CD4+/CD25+, Ia+/CD69+, Ia+/B220+). All test compounds proved to exert significant immunosuppressive effects after topical application, but showed differences in their immunomodulatory potential. In conclusion, the local lymph node assay serves as an appropriate model to characterize immunosuppressive effects of topically applied drugs by measuring immunologically relevant end-points.

Surface roughness measurement by means of polychromatic speckle elongation

A new approach for determining the roughness of engineering surfaces that is applicable to industrial in-process measurements is introduced. Laser speckle patterns, arising from light scattered from rough surfaces that are illuminated by polychromatic laser light, are detected in the far-field region. The incoherent superposition of these light intensities and the angular dispersion cause the effect of speckle elongation. This is characterized by increasing speckle widths and leads to a radial structure of the speckle patterns. With increasing surface roughness, the elongation is replaced more and more by the decorrelation of the monochromatic speckle patterns for the different wavelengths. Such effects were detected with the CCD technique and analyzed by local autocorrelation functions of intensity fluctuations that were calculated for different areas of the speckle patterns. The results of surface-roughness determination by means of the speckle elongation effect are presented.

Photo hen's egg test: a model for phototoxicity

The aim of this investigation was to establish a new model for phototoxicity which is more advanced than the widely used cultures of yeasts, bacteria or cells of various origin, and at the same time to avoid animal testing. We studied the extraembryonal vasculature of the incubated hen's egg. This model was originally introduced by toxicologists as an alternative to the rabbit's eye irritation test (Draize test). In the photo hen's egg test, substances are applied to the embryo's yolk-sac blood vessel system at a non-toxic concentration and are irradiated with 5 J/cm2 ultraviolet A (UVA) (320-400 nm). Promethazine, haematoporphyrin, ciprofloxacin and 8-methoxypsoralen were tested in this system. Death of the embryo, membrane discoloration and haemorrhage are parameters for phototoxic damage, which were recorded during an observation period of 24 h. These well-known phototoxic substances induced pronounced damage of the yolk-sac membrane and blood vessels which was not found in the controls (test substance alone, UVA alone or untreated) using a 2 x 2 factorial test design. The photo hen's egg test serves as a valid screening model for substances supposed to be photosensitizers owing to a phototoxic mechanism.

[Vital long-term preservation of human gingiva in perfusion culture]

Perfusion culture offers the advantage of keeping gingiva alive for a long time as an stable explant according to cell biological parameters. To investigate the suitability of cultured human gingival explants for transplantations the biopsies were put into a newly developed perfusion chamber and cultured for at least 21 days. Gingiva explants were derived from healthy donors undergoing surgical removal of molar teeth. The tissue pieces were cultured without prior proteolytic desintegration or subculture. Immediately after excision a morphological and immunohistochemical analysis of the tissue was carried out and the distribution pattern of cytokeratin and vimentin was examined. Gingival explants cultured for 7, 14 and 21 days in serum-free keratinocyte growth medium in perfusion culture were analyzed in the same way. The morphology of the cultured explant (21 days) was well preserved from stratum basale up to stratum corneum. As proved by immunohistochemical incubation with antibodies to CK 5/6, CK 14 and CK 19, a tissue-specific cytokeratin (CK) expression pattern was maintained during the whole perfusion period. After 7 days of culture vimentin was synthesized in the fibroblast layer and was found in small quantities in each layer of the epithelium. In contrast to conventional cultures, where dissociation of the tissue and a subculture interruption is usually needed for long-term culture, this is not necessary for perfusion cultured tissue. The use of perfusion-cultured gingival explants as autogenous transplants is investigated herein.

Is the mismatch repair deficient type of Muir-Torre syndrome confined to mutations in the hMSH2 gene?

The Muir-Torre syndrome (MTS) is a rare autosomal-dominant condition characterized by the occurrence of sebaceous skin lesions and internal tumours in a patient. It has been demonstrated that at least a subgroup of MTS exhibits clinical and molecular genetic features of hereditary nonpolyposis colorectal cancer, including microsatellite instability in skin and visceral tumours, because of mutations in DNA mismatch repair genes. We have identified germline mutations in the hMSH2 gene in two unrelated MTS patients ascertained because of their skin tumours. Our results, together with published MTS cases, support the hypothesis that MTS with its characteristic skin lesions is confined to mutations in the hMSH2 gene.

The history of photography in dermatology. Milestones from the roots to the 20th century

From the Middle Ages to the 20th century, talented artists have created illustrations of signs of human diseases. Since the birth of photography in 1840, artists and physicians have used photographic techniques to illustrate the diseases of the skin; dermatology especially relies on these visual signs. In dermatology today, photography is still very important because of the need for adequate illustrations in medical textbooks and journals. From the early days of daguerreotypes to modern times, medical photography was developed in different stages and many physicians have taken part in the development of photographic techniques and chemistry. This historical survey describes the milestones in the development of medical photographic illustration from its beginning to the 20th century.

Interferon beta induces interleukin-10 expression: relevance to multiple sclerosis

Interferon-beta decreases the relapse rate, relapse severity, progression of neurological disability, and development of new brain lesions observed with brain magnetic resonance imaging in relapsing-remitting multiple sclerosis patients. The mechanism of action of this effect is presently unknown. This study was based on the hypothesis that immunoregulatory effects of interferon-beta may underlie its demonstrated clinical efficacy. The objective of the study was to determine the effect of interferon-beta-1a on the expression of interleukin-10, a cytokine that strongly inhibits cell-mediated immune responses. Interferon-beta-1a induced accumulation of interleukin-10 messenger RNA and protein secretion by cultured peripheral blood mononuclear cells. The observed in vitro effects were similar for healthy control subjects and multiple sclerosis patients. Intramuscular injections of interferon-beta-1a increased serum levels of interleukin-10 at 12 and 24 hours following the injection. Greater increases were induced with 12 x 10(6)-IU than 6 x 10(6)-IU injections. The effect of interferon-beta-1a was relatively specific for interleukin-10, as treatment with interferon-beta-1a did not result in accumulation of transforming growth factor-beta messenger RNA. Upregulation of interleukin-10 represents a possible mechanism of action of interferon-beta's therapeutic effect in relapsing-remitting multiple sclerosis, and has implications for therapy of other autoimmune diseases.

Topical calcipotriol in the treatment of intertriginous psoriasis

The purpose of this study was to examine the effectiveness and side-effects of the vitamin D analogue calcipotriol, applied topically to psoriatic skin lesions in intertriginous areas, in an open and uncontrolled trial. Twelve patients with psoriasis vulgaris who presented with psoriatic lesions in the axilla, and inguinal and anal folds, were treated with calcipotriol ointment (50 micrograms/g) twice daily for 6 weeks. Examination and photographic documentation were performed before treatment, at 3 weeks of treatment, and at 6 weeks of treatment. The mean improvement in the extent and severity of the psoriatic plaques was determined with a semiquantitative grading system closely related to the psoriasis area and severity index (M-PASI). Two of 12 patients showed insufficient response to therapy. Five of 12 patients showed a quick response within 3 weeks or less, and five of 12 patients showed a slow response which could be seen only after 6 weeks of treatment. Minimal burning was reported in one patient, slight lesional and/or perilesional irritation in five patients, and, in the remaining, no side-effects occurred. Topical calcipotriol is an effective and safe treatment for intertriginous psoriasis.

[Primary cutaneous osteoma in hereditary Albright osteodystrophy]

Cutaneous osteomas occur rarely; they represent the formation of bone in the skin. Primary and secondary forms of ossification can be distinguished. We describe the primary form of ossification in a child with Albright's hereditary osteodystrophy.

Maxsim, software for the analysis of multiple axonal arbors and their simulated activation

In order to analyze the structural organization of complex axonal arbors reconstructed from histological serial sections, and to investigate the functional implications of their geometrical properties, we developed software providing the following facilities: (1) direct importation of data files generated by a commercially available 3-D light-microscopic reconstruction system, including routine procedures for identification and correction of data acquisition errors; (2) real-time 3-D rotations of the arbors in the stack of serial sections; (3) multiple interactive display modes; (4) possibility of modifying diameter and/or connectivity of different branches; (5) simulation of the invasion of the arbor by a single action potential initiated at any chosen point, and visualization of spatio-temporal profiles of activation; (6) extraction of quantitative data converted to standard file formats compatible with available mathematical software. All these tools can be applied to single or multiple axons, individually or simultaneously. The software, called Maxsim, is a highly flexible C-written program running on graphical workstations using the UNIX operating system and X-Window environment.

[Purpura fulminans with extensive skin necroses]

Purpura fulminans must be treated as an emergency in internal medicine and dermatology. Its characteristic features are the sudden development of progressively enlarging haemorrhagic skin necrosis, severe disseminated intravascular coagulation with consumption of anticoagulant factors, and signs of shock. Purpura fulminans can be classified into a neonatal form with inherited protein C deficiency and an acquired type for which multiple causes are known. Clinically it is characterized by massive ecchymosis with haemorrhagic blebs and acral necrosis. Histologically the lesions show widespread extravasation of erythrocytes and thrombosis of small vessels. Thrombocytopenia, decrease of coagulation factors, the presence of fibrinogen split products and fragmented erythrocytes in the blood smear help to confirm the diagnosis. The therapy includes fresh-frozen plasma, heparin, antibiotics and surgical debridement of necrotic areas. It is important to recognize the disease promptly because the mortality rate is about 30-40% and only quick intervention helps to save the life of the patient.

[Photodynamic therapy and breast-plasty of a extensive superficial trunk skin basalioma of the breast. An effective combination therapy with photodynamic diagnosis]

We treated a large superficial basal cell carcinoma (ca. 10 x 6 cm) on the right breast in a 48-year old woman with photodynamic therapy (PDT). Fractionated PDT was performed by topical application of delta-aminolevulinic acid (delta-ALA, 20%) with subsequent red light (570-750 nm; 180 J/ cm2) in three sessions. Nearly total remission of the tumor resulted; however, a few residual neoplastic islands partly infiltrating the nipple-areola complex could be detected by photodynamic diagnosis (PDD). These fluorescent areas were marked, excised, and the defect was closed by a rotation advancement flap. Total excision of the tumor was verified histologically. By combining PDT and surgery, this large tumor was treated with excellent cosmetic results. This case demonstrates the efficiency of topical PDT with adjunctive plastic surgery controlled by PDD even in large tumors.

Classification of turnip mosaic virus isolates according to the 3'-untranslated region

The 3'-untranslated region (3'UTR) of five isolates of turnip mosaic virus (TuMV) from United Kingdom, Canada, Greece, the Czech Republic and from Uzbekistan were sequenced and compared with another nine previously sequenced TuMV isolates. All the isolates had 209 nucleotides long 3'UTR, with the exception of the Uzbekistan isolate, which had one-base deletion at nucleotide (nt) position 162. Phylogenetic analysis identified three clusters of related isolates. The clusters correlated with secondary folding of the 3'UTRs, partially with the source host plant of the isolates but not with their geographical origin.

[Hematogenous contact eczema cause by phytogenic drugs exemplified by kava root extract]

The increasing promotion of herbal drugs may lead to allergic problems. A case of systemic contact-type dermatitis after oral administration of kava extract illustrates this special problem. The kava plant is a member of the black pepper family; an intoxicant beverage prepared from the roots of this plant is used ceremonially by many traditional societies of the Southern Pacific. The beverage induces relaxation, enhances a sense of sociability and promotes sleep. These effects are utilized in herbal drugs containing kava, which are sold for insomnia, nervousness and depression. The ichthyosiform kava dermopathy is a well-known side effect of excessive use of kava; in this case report we describe an acute allergic side-effect of kava extract.

Cellular aspects of callosal connections and their development

Detailed visualization, three-dimensional reconstruction, and quantification of individual callosal axons interconnecting the visual areas 17 and 18 of the cat was undertaken in order to clarify the structural basis for interhemispheric interaction. These studies have generated the notion of macro- vs micro-organization of callosal connections. The first refers to the global distribution of callosal connections in the hemisphere as well as to the pattern of area-to-area connections. The latter refers to the fine radial and tangential distributions of individual callosal axons. A discrete disjunctive, 'columnar' pattern of termination of callosal axons, previously unknown for the visual areas, was found. The consequence of caliber and distribution of callosal axons and their branches on the dynamic properties of interhemispheric interactions were analyzed by computer simulations. These studies suggested that callosal axons could synchronize activity within and between the hemispheres in ways relevant for the 'binding' of perceptual features. These new concepts prompted a reexamination of the normal development of callosal connections. The central issue is whether intrinsic developmental programs, or else cellular interactions open to environmental information specify the morphological substrate of interhemispheric interactions. The answer to this question is still incomplete. In development, transient, widespread arbors of callosal axons, which could provide the basis for plastic changes of callosal connections were found in the white matter and the deep cortical layers. On the other hand, growth into the cortex and synaptogenesis of callosal axons appear to be highly, topographically specific albeit not necessarily independent of visual experience.

[PUVA bath therapy. Indications and practical implementation]

Systemic PUVA photochemotherapy is widely used for a variety of skin diseases. Administration of 8-methoxypsoralen in a dilute bathwater solution may be an effective alternative therapy with no systemic side-effects and requiring smaller amounts of UVA to induce the required phototoxic response. PUVA baths of the palms and soles are an interesting alternative for dermatoses confined to these sites. This article reviews the authors' experience with PUVA bath therapy. Indications for and applications of this technique are discussed.

Computational structure of visual callosal axons

We analysed the activation profiles obtained by simulating invasion of an orthodromic action potential in eleven anterogradely filled and serially reconstructed terminal arbors of callosal axons originating and terminating in areas 17 and 18 of the adult cat. This was done in order to understand how geometry relates to computational properties of axons. In the simulation, conduction from the callosal midline to the first bouton caused activation latencies of 0.9-3.2 ms, compatible with published electrophysiological values. Activation latencies of the total set of terminal boutons varied across arbors between 0.3 and 2.7 ms. Arbors distributed boutons in tangentially segregated terminal columns spanning one or, more often, several layers. Individual columns of one axon were frequently activated synchronously or else with a few hundred microseconds of each other. Synchronous activation of spatially separate columns is achieved by: (i) long primary or secondary branches of similar calibre running nearly parallel to each other for several millimetres; (ii) variations in the calibre of branches serially fed to separate columns by the same primary or secondary branch; (iii) exchange of high-order or preterminal branches across columns. The long, parallel branches blatantly violate principles of axonal economy. Simulated alterations of the axonal arbors indicate that similar spatiotemporal patterns of activity could, in principle, be obtained by less axon-costly architectures. The structure of axonal arbors, therefore, may not be determined solely by the type of spatiotemporal activation profiles it achieves in the cortex but also by other constraints, in particular those imposed by developmental mechanisms.

The immunology of multiple sclerosis: new intricacies and new insights

New epidemiology and genetics data have supported the broad concept that multiple sclerosis represents an acquired autoimmunity, which is determined in part by inheritance. Furthermore, it is now widely believed that the pathogenesis of multiple sclerosis involves autoimmune reactivity that is directed against myelin proteins. Much of our understanding of myelin-directed autoimmunity has come from studies on experimental autoimmune encephalomyelitis, a T-cell-mediated, multiple sclerosis-like disease, which is provoked by immunizing animals with myelin proteins. During the past year, significant progress has been made in delineating immune reactivity to myelin antigens. Models that feature restricted epitope recognition and limited T-cell receptor gene utilization have been challenged (often by their original authors). Unifying new concepts include dynamic temporal diversification of the autoimmune response and clear-cut distinctions between the potential and engaged autoimmune repertoire. An abundance of new information about the biologic determinants of T-cell immunopathogenicity is leading rapidly to innovative therapeutic strategies.

Pattern analysis of photopatch test reactions

In a multicenter study, photopatch test results from more than 1500 patients were evaluated between 1985 and 1990 and from 614 patients between 1990 and 1992. Photopatch testing was conducted according to a standardized procedure. Nearly half of the photoreactions were unclassifiable according to the classic definitions of photoallergic or phototoxic reactions. To facilitate the interpretation of these remaining photopatch test reactions, we developed a computerized substance specific reaction pattern analysis. By sequential readings from immediately after irradiation up to 72 h later and by morphological qualification of the reactions, the time course and morphological changes of each individual reaction were monitored. The summation of each individual photoreaction resulted in an overall reaction pattern of a specific substance. Four main categories could be distinguished. The first category was characterized by a peak immediately after irradiation followed by a descrescendo reaction. The second category comprized reactions combining an immediate with a delayed reaction. The third category exhibited a plateau-like delayed reaction. The fourth category showed delayed reactions in a crescendo pattern. Whereas category 1 represents classic phototoxic and category 4 classic photoallergic reaction patterns, the underlying mechanisms of categories 2 and 3 remain to be investigated. Typical substances of category 1 were many of the tested systemic drugs, such as furosemide, most of which are well-known phototoxic agents. Disinfectants, nonsteroidal anti-inflammatory agents and phenothiazines showed the reaction patterns of categories 2 and 3. A delayed type reaction (category 4) could be demonstrated for well-known photoallergens such as fenticlor, musk ambrette, and ultraviolet adsorbents in sunscreens.(ABSTRACT TRUNCATED AT 250 WORDS)

[Photochemotherapy (PUVA) of acute graft-versus-host disease]

For several years, psoralen and UV-A light (PUVA) therapy has been used in the treatment of chronic graft-versus-host disease (GvHD) following allogeneic bone marrow transplantation (BMT). There is little experience with PUVA treatment of acute GvHD. Allogeneic BMT was performed in 25 patients, 10 of whom developed acute GvHD despite immunosuppressive therapy. Six patients with acute cutaneous GvHD grade II-III (n = 2 grade II, n = 4 grade III) were treated with PUVA. We present the results. All the PUVA-treated patients improved markedly after 5-12 sessions of irradiation. In 5 patients the skin cleared completely with 8-18 treatments. In 4 patients chronic GvHD was prevented by maintenance treatment for up to 10 months. Following clearing of acute cutaneous GvHD, 2 patients developed chronic GvHD after therapy-free intervals of 3 and 12 months, respectively. These results indicate a beneficial effect of PUVA in acute cutaneous GvHD and suggest a protective effect against chronic GvHD.

[Lymphomatoid papulosis in a child]

We report a case of a 3-year-old boy who developed crops of papules and ulcerating nodules on the limbs in April 1992. Periodically, new lesions continue to erupt, while others resolve spontaneously. This course is characteristic for rhythmic paradoxical eruptions. This course and the clinical picture, supported by the histopathological and immunohistochemical findings, led to the diagnosis of lymphomatoid papulosis. Lymphomatoid papulosis is extremely rare in childhood. All published cases of lymphomatoid papulosis in children under 10 years of age are reviewed. The differential diagnosis of lymphomatoid papulosis in childhood includes arthropod assaults, pityriasis lichenoides et varioliformis acuta, primary cutaneous Hodgkin's disease, Ki-1 large cell anaplastic lymphoma and other lymphomas and pseudolymphomas in children.

Narrow-band UVB (311 nm) versus conventional broad-band UVB with and without dithranol in phototherapy for psoriasis

BACKGROUND

A narrow-band UVB lamp (Philips TL 01) emitting a peak of approximately 311 nm was developed to improve the phototherapy for psoriasis. Only a few studies have been performed with promising results.

OBJECTIVE

The therapeutic efficacy of the Philips TL 01 lamp in a new 100 W version was compared with conventional broad-band lamps (Sylvania UV 6) in a controlled trial.

METHODS

Twenty-three patients with psoriasis were treated with half-body exposures from the different UVB sources. The rate of clearing was monitored by estimation of the Psoriasis Area and Severity Index. All patients used emollients; excessive scaling was removed with salicylic acid in yellow petrolatum. In 13 patients dithranol in a modified Ingram regimen was added. In most cases the study was discontinued once a difference between the two sides was evident.

RESULTS

In 20 of 23 cases the TL 01 lamp proved to be significantly more effective than the conventional source. Application of dithranol provided a substantial additional therapeutic effect. With the high-intensity TL 01/100W bulbs, exposure times were comparable to broad-band UVB phototherapy.

CONCLUSION

The therapeutic efficacy of Philips TL 01/100W and its practicability for psoriasis phototherapy have been demonstrated.

Phototesting in lupus erythematosus

Ultraviolet (UV) irradiation is a major factor in the pathogenesis of certain variants of cutaneous lupus erythematosus. Photosensitivity constitutes one of the criteria of the American Rheumatism Association for the diagnosis of systemic lupus erythematosus, which further emphasizes its importance. The pathomechanism of UV-induced lupus erythematosus remains unknown. The characterization of photosensitive subacute cutaneous lupus erythematosus (SCLE) by Gilliam and Sontheimer has led to a new approach. Through the development of standardized test methods it has became possible to reproduce cutaneous lesions in the UV-A and UV-B spectrum. These standardized test methods allow a better definition of photosensitivity than clinical history does. Recent clinical data show that besides SCLE another variant, lupus erythematosus tumidus, also reveals pronounced photosensitivity. In this review article phototest procedures, phototest results, and clinical correlations in different subgroups are discussed.

[The effect of UV-A and UV-B irradiation on the skin barrier. Skin physiologic, electron microscopy and lipid biochemistry studies]

In order to gain insight into the effects of UV-irradiation on the skin barrier, functional (skin reactivity), electron microscopic and lipid-biochemical studies were performed. In three different irritation models, both UV-A-irradiated and UV-B-irradiated areas proved to be more resistant to damage than normal skin, providing evidence for improvement of barrier function after UV irradiation. Electron microscopic evaluation showed that UV-B induced a significant increase in horny cell layers, whereas after UV-A no change was detected. However, both UV-B and UV-A exposure resulted in an increase in the amount of all stratum corneum lipids. This was also observed in all major ceramide subfractions, which are believed to be the essential lipid constituents for the epidermal barrier function. These findings may explain the known beneficial effects of phototherapy in dermatoses with impaired barrier function, i.e., atopic dermatitis.

Photosensitivity induced by quinidine sulfate: experimental reproduction of skin lesions

A case of quinidine sulfate-induced photodermatitis is reported. The photosensitive reaction to quinidine sulfate was reproducible in the photopatch test and after oral intake plus ultraviolet A (UVA) irradiation. Eczematous dermatitis was provoked after intradermal injection of in vitro UVA-irradiated quinidine sulfate only in the presence of patient's serum. The clinical picture and histology suggest an allergic reaction. The photobinding of quinidine sulfate to a potential carrier protein in skin or serum seems to be of crucial importance for this type of photodermatitis. Quinidine sulfate is frequently used as an antiarrhythmic drug. Its potential as a photosensitizer should always be considered.

[Chronic actinic dermatitis. Concept and case examples]

Two women patients with chronic eczematous dermatitis, who also developed extremely severe, persistent photosensitivity during a course of 10 and over 40 years, are presented. Both patients had an atopic history with positive immediate skin reactions. Patch and photopatch tests revealed sensitization to several contact allergens, and in one case also a photocontact allergy. The action spectrum of the photosensitivity was confined to UV-B; it was possible to provoke eczematous skin reactions with doses smaller than 1 mJ/cm2 UV-B. Both patients were successfully treated with PUVA therapy. These case reports demonstrate the difficulty of nosological classification of chronic eczematous photosensitive dermatoses under the traditional terms persistent light reaction, photosensitive eczema, photosensitivity dermatitis, and actinic reticuloid. Chronic actinic dermatitis is defined clinically by chronic dermatitis on skin exposed to sun, histologically by spongiotic dermatitis, and photobiologically by experimental provocation of spongiotic dermatitis with UV-B and often also longer wavelengths in the absence of a photoallergen. Chronic actinic dermatitis should be used as a general term in addition to the more specific terms listed above.

[Erythropoietic protoporphyria: synopsis of 20 patients]

The authors present 20 patients (9 men, 11 women) with erythropoietic protoporphyria (EPP). The diagnosis was made on the basis of photosensitivity and porphyrin analysis. The disease first became apparent in the first years of life. The following acute symptoms were induced after exposure to sunlight: pruritus with or without skin changes, burning, pain and erythema, sometimes with petechiae, vesiculation and, in two cases, systemic symptoms. Chronic skin changes included hyalinosis cutis-like skin lesions, scarring, and also petechiae. Phototesting provoked only subjective symptoms, and none of the skin lesions characteristic of EPP could be induced. Postnatal diagnosis was attempted in three newborns, each of whom had one parent with proven EPP, by measuring the porphyrins in erythrocytes of cord blood. In all three normal porphyrin values were determined, and during an observation period of 3 years none has developed EPP. Therapy with carotenoids has yielded good to very good results in two-thirds of the patients. So far, a diagnosis of EPP has been established in 30 patients in Düsseldorf: one has died of liver cirrhosis and another has liver damage.

Influence of UV irradiation on the composition of human stratum corneum lipids

Irradiation with suberythemal doses of either UV-A or UV-B yielded an increase in the amount of stratum corneum lipids extracted from the lumbar skin area of 20 volunteers. These lipids were quantified after separation by high-performance thin-layer chromatography. Ten subfractions in the ceramide region were separated; two of them (fractions 7a and 7b) were only detectable after UV-A or UV-B irradiation. Improvement of barrier function after UV irradiation of human skin with suberythemal doses may be related to an increase in the stratum corneum ceramides.

Effects of ultraviolet A and B on the skin barrier: a functional, electron microscopic and lipid biochemical study

To investigate the effects of ultraviolet A (UVA) and B (UVB) on the skin barrier, functional, electron microscopic and lipid biochemical studies were performed on normal and UV-irradiated skin of volunteers. Skin reactivity against primary irritants was evaluated using the alkali resistance test, the dimethylsulfoxide test and the sodium lauryl sulfate test. In all 3 irritation models, UVA- and UVB-irradiated areas were more resistant to damage than normal skin, indicating improvement of the barrier function after UV irradiation. In a second series of experiments, biopsies were taken and processed for electron microscopic evaluation of the stratum corneum. UVB significantly increased the horny cell layers; UVA did not alter the thickness of the stratum corneum. Finally, stratum corneum lipids were extracted in vivo and quantified after high-performance thin-layer chromatography. UVB and, to some extent, UVA exposure increased the amount of all stratum corneum lipids. This was also observed in all major ceramide subfractions.

[Quinidine-induced photoallergy. A clinical and experimental study]

Photoallergies are type-IV allergic reactions of a special kind. Photoallergies due to quinidine sulphate were described as early as 1942. We present a case of quinidine sulphate-induced photodermatitis. The photoallergic reaction to quinidine sulphate was reproducible not only after oral intake but also in the photopatch test. In addition, an eczematous dermatitis was provoked after intradermal injection of quinidine sulphate previously exposed to UV-A irradiation in vitro together with serum taken from the patient. No dermatitis was seen with quinidine sulphate irradiated in the absence of serum. The binding of the hapten quinidine sulphate to a potential carrier protein in the serum seems to be of crucial importance in this type of photodermatitis. Quinidine sulphate is frequently used as an antiarrhythmic drug. Its potential photoallergenic action should always be considered.

[Animal experiment model of the effect of ultraviolet irradiation on hexachlorobenzene-induced porphyria]

The Effect of UV-Irradiation on the Hexachlorobenzene-induced Porphyria in an Experimental Animal Model Hexachlorobenzene is able to induce in humans and different animal species a hepatic porphyria, which is comparable to porphyria cutanea tarda. We studied whether hexachlorobenzene feeding could induce this porphyria also in hairless rats (Rowett-Nude), as these are suitable for photobiologic studies. After development of hepatic porphyria the rats were irradiated either with UV-A or UV-B light. Biochemical effects on the porphyrin metabolism and clinical as well as histologic skin changes were examined. In the liver of the porphyric rats, UV-A and UV-B irradiation induced increased aminolevulinic acid synthase activity accompanied with augmentation of hepatic porphyrin content. UV-A or UV-B irradiation also lead to increased total porphyrin contents in the skin of porphyric compared to non-irradiated animals. Clinically and histologically, however, only UV-A irradiation induced lesions, which were comparable to skin manifestations of porphyria cutanea tarda.