Pustular psoriasis in childhood

The activity of tumor necrosis factor (TNF) in serum and in peripheral blood monocytes (PBMC) was determined in 8 patients with fulminating viral hepatitis (FVH), 10 patients with chronic active hepatitis (CAH) and 10 health controls. The activity was monitored in FVH patients before and after treatment with hepatocyte growth factor (HGF). It was found that TNF level was significantly higher in CAH patients than in controls (t = 3.56, P < 0.01) and also significantly higher in FVH than in CAH patients (t = 3.07, P < 0.01). The activity of TNF decreased gradually in FVH patients after HGF treatment and there was a positive correlation (r = 0.09, P < 0.01) between the activity of serum and PBMC TNF. It was found that in animal models of hepatic necrosis there was transient elevation of TNF activity with its peak occurring after 6 hours; the peak could be lowered with HGF treatment (t = 3.65, P < 0.05). The authors are of the opinion that TNF is an important mediator causing hepatic necrosis. The relationship between HGF and TNF was also discussed.     

IgA deficiency and psoriasis: relevance of IgA in the pathogenesis of psoriasis

A psoriatic patient with absolute deficiency of IgA is reported. The manifestations of psoriasis appeared at the age of 6 months and proved to be resistant to various treatments. The present case report and the data available in the literature on IgA and psoriasis all converge on the hypothesis that IgA is a systemic factor which belongs to the 'off switches' of the psoriatic process.     

Dominant inheritance of optic pits

We report a patient with concurrent chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and alopecia universalis. A dramatic improvement in strength accompanied the administration of prednisone, although no regrowth of hair was noted. CIDP and alopecia universalis are two relatively rare autoimmune disorders. The simultaneous occurrence of these disorders suggests a common pathogenetic mechanism, including the possibility of shared antigens between peripheral nerve myelin and the hair follicle.     

Therapy of psoriasis

The possible methods of treating psoriasis and results obtained are reviewed and the superior effectiveness of an approach reported in recent literature, an association of methoxalene per os and broad ultraviolet rays, is pointed out. In almost all cases submitted to such "photochemotherapeutic" treatment, regression of diffused lesions was rapid and complete with no systemic toxic effects or secondary skin alterations. On the basis of recent personal experience, it is stated that similar results may be obtained by the photochemotherapy of psoriasis with appropriate doses of Trisoralen per os and sunlight.     

Mitochondrial distribution and inheritance

Mechanisms mediating the inheritance of mitochondria are poorly understood, but recent studies with the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe have begun to identify components that facilitate this essential process. These components have been identified through the analysis of conditional yeast mutants that display aberrant mitochondrial distribution at restrictive conditions. The analysis of these mutants has uncovered several novel proteins that are localized either to cytoskeletal structures or to the mitochondria themselves. Many mitochondrial inheritance mutants also show altered mitochondrial morphology and defects in maintenance of the mitochondrial genome. Although some inheritance components and mechanisms appear to function specifically in certain types of cells, other conserved proteins are likely to mediate mitochondrial behavior in all eukaryotic cells.     

Infantile psoriasis

We report 14 infants younger than 2 years of age with psoriasis vulgaris in order to call attention to the existence of infantile psoriasis. Three of the patients were noted to have psoriasis in the neonatal period; the onset may have been prenatal in one. In 13 of the 14 patients the site of onset was determined by the isomorphic effect (K?bners phenomenon). Although nail pitting is usually said to be infrequent in childhood psoriasis, 11 (79%) of our patients had typical psoriatic nail changes. Psoriasis must be considered in the differential diagnosis of papulosquamous disorders in infants.     

Pathogenesis of Woronoff ring in psoriasis

As a result of ultraviolet light and coal tar therapy, a white ring (Woronoff) may develop in the normal skin adjacent to psoriatic plaques. Injection of prostaglandin E2 (PGE2) 1 cm outside of Woronoff ring produced redness in the ring, demonstrating that vessels within the ring were not unresponsive to PGE2. Whole skin homogenates from Woronoff ring contained an inhibitor of prostaglandin synthesis that was not found in uninvolved skin that was obtained from either psoriatics or normal controls. Prostaglandin E2 levels in the ring were one third of those in uninvolved skin from either psoriatics or normal controls. These findings suggest that the white ring that surrounds ultraviolet-light-treated psoriatic plaques is produced by a local inability to synthesize PGE2 in response to an ultraviolet light stimulus, resulting from the presence of an inhibitor of prostaglandin synthesis.     

Disturbance of DNA-Synthesis in early psoriasis

In earlier studies we have shown that there is a significant prolongation of DNA-synthesis time (ts) in the epidermal cells of fully developed psoriatic lesions. The present study shows that this prolongation is to be observed even in very early plaques. The prolongation of ts precedes the development of acanthosis. A dermal infiltrate with increased proliferative activity seems to be a stimulus, in the sense of a Koebner-phenomenon. There is no pronounced prolongation of ts in other acute or chronic inflammatory processes of the skin. The behaviour of the infiltrate in psoriasis is similar to that in allergic patch test reaction. However, the abnormal psoriatic epidermis, with disturbed DNA-synthesis, does not react to the above mentioned infiltrate with a limited hyperproliferation but with the development of a psoriatic plaque. There is obviously congenital disturbances of metabolism within the epidermal cells in psoriasis.     

Hyperthermia in the treatment of psoriasis

The effectiveness of commercially available, chemically generated, topical exothermic pads that elevate skin surface temperature from 42 to 43 degrees C was stressed in 22 patients with psoriasis. Control sites were treated with conventional modalities such as Goeckerman's regimen, as well as with occlusion with nonexothermic pads. Skin lesions in 19 patients disappeared after the use of hyperthermia. The average time required for complete regression in the treated areas was 27 days with hyperthermia, compared with 44 days with Goeckerman's regimen. There were no hyperthermic side effects. Seventeen patients whose skin lesions disappeared with the use of both hyperthermia and Goeckerman's regimen were subsequently reexamined. The hyperthermia produced an equal or longer duration of remission than did Goeckerman's regimen.     

Treatment of psoriasis in general practice

Psoriasis is a chronic skin disease which affects about 2% of the population. Several new treatment modalities have been introduced in recent years. This article focuses on topical treatment of mild and moderate psoriasis that can be successfully treated at home. It is important that general practitioners who treat most of these patients are familiar with the best treatment procedures. Phototherapy and systemic therapy, mainly by dermatologists, are described in brief.     

Clinical significance of hyperuricemia in psoriasis

After analysis of 1146 psoriasis patients, high incidence of asymptomatic hyperuricemia (18.8%) and elevated average levels of uric acid in these patients' blood were confirmed (346.8 +/- 2.4 mumol/l). More severe forms of uric acid disbolism lead to aggravated skin affections (psoriatic erythrodermia, exudative psoriasis), arthritis, occur in familial predisposition to psoriasis. Advanced psoriasis patients are at risk to develop apparent gout.