A. F. Finzi

Family history, smoking habits, alcohol consumption and risk of psoriasis

Summary We have conducted a multicentre case‐control study to assess the epidemiological importance of previously suggested risk factors for psoriasis, including family history of the disease, smoking and alcohol consumption. Newly diagnosed psoriatics, with a history of skin manifestations no longer than 2 years were eligible as cases; as controls we selected subjects with newly diagnosed dermatological conditions other than psoriasis. Interviews were performed by trained medical investigators using a structured questionnaire. Two‐hundred and fifteen cases, aged 16–65 years (median age 38), and 267 controls, aged 15–65 years (median age 36), were interviewed and included in the analysis. Family history was a risk factor for psoriasis; the multiple logistic regression (MLR) adjusted‐odds ratio was 18.8 (95% confidence interval 6.4–54.8) for a history in parents, and 3.2 (95% confidence interval 1.5–6.6) for a history in siblings. The risk of psoriasis was higher for current smokers than for those who had never smoked. The MLR adjusted odds ratio was 2.1 (95% confidence interval 1.1–4.0) for people smoking 15 cigarettes or more per day. The risk of psoriasis was higher for alcohol drinkers: compared with teetotallers the MLR adjusted‐odds ratios were 1.3 (95% confidence interval 0.8–2.3) for subjects drinking one or two drinks/day and 1.6 (95% confidence interval 0.9 to 3.0) for those drinking three or more. However, the trend in risk was not statistically significant. Our study confirms the role of family history in psoriasis and provides some evidence of a dose‐response relationship for an association between smoking habits and psoriasis.

Psychological distress and coping strategies in patients with psoriasis: the PSYCHAE Study.

Objective  Our objectives were to determine the prevalence of psychological distress in a large sample of Italian patients with psoriasis; to establish whether disease severity and psychological distress are associated; to identify the strategies employed to cope with psoriasis; to evaluate the coping strategies employed by dermatologists; and to identify potential predictors of psychological distress.

Effectiveness of cyclosporine treatment in severe psoriasis: A clinical and immunologic study

The effectiveness of low doses of cyclosporine (3 to 5 mg/kg/day) for short-term treatment in 13 patients with severe psoriasis was studied. The psoriasis cleared in 12 of 13 patients within 3 to 4 weeks of treatment, and there was appreciable improvement in the thirteenth patient. No major side effects were observed: two patients showed biochemical evidence of slight transient renal dysfunction and three others had cutaneous infections (two viral and one mycotic). An immunohistologic study showed that the psoriatic plaques contained an infiltrate composed mainly of activated helper T lymphocytes. After 15 days of cyclosporine treatment, CD4+ cells were significantly fewer in the epidermis and dermis, and Langerhans cells were more regularly distributed in the epidermis. Our studies of neutrophil chemotaxis showed that it is not significantly influenced by cyclosporine in vitro but is decreased in vivo.

Pityriasis rubra pilaris and retinol-binding protein

Serum levels of retinol‐binding protein (the specific carrier of vitamin A) were measured in eleven patients with pityriasis rubra pilaris and in some of their close relatives. The level of retinol‐binding protein was markedly reduced in every patient, and in some of the relatives. It is postulated that defective synthesis of retinol‐binding protein is a biochemical marker for pityriasis rubra pilaris, probably transmitted as a Mendelian dominant.

Plasma α-melanocyte-stimulating hormone, β-endorphin, met-enkephalin, and natural killer cell activity in vitiligo

Background: The immune system is important in the pathogenesis of vitiligo, and emotional stress has precipitated vitiligo in some patients. Opioid peptides, β-endorphin, met-enkephalin, and α-melanocyte-stimulating hormone (MSH) act as immunomodulators, and their secretion increases during periods of stress. Objective: To see whether these three neuropeptides might be related to vitiligo itself or to some alterations of the immune system in patients with vitiligo, we compared circadian variations in their plasma concentrations and natural killer cell activity of peripheral blood lymphocytes in 14 patients with vitiligo with those of 12 healthy subjects. Methods: Plasma concentrations of neurohormones were evaluated by radioimmunoassay (immunoradiometric assay for β-endorphin). Natural killer cell activity (NKCA) was assayed against K562 cells by 51 Cr release technique. Data were compared by the Student t test and analyzed by cosinor analysis. Results: The NKCA in vitiligo patients was higher than in controls but had similar circadian rhythm. α-MSH had no circadian rhythm in controls or in patients; plasma α-MSH levels were the same. Daily met-enkephalin and β-endorphin oscillations in patients were no longer circadian. β-Endorphin plasma levels in stable vitiligo were higher than in controls. There were no differences between patients with active vitiligo and normal subjects. Met-enkephalin plasma levels were generally higher in vitiligo patients, especially in the one with active vitiligo, than in controls. Conclusion: In vitiligo there are aberrations in neuropeptide, β-endorphin, and met-enkephalin secretion. The plasma met-enkephalin level is positively correlated with the aggressiveness of the disease.

Immunohistological evaluation of basal cell carcinoma immunoinfiltrate during intralesional treatment with alpha2-interferon

SummaryWe investigated the peritumoral and intratumoral immune infiltrate in 6 basal cell carcinomas (BCCs) treated with recombinant alpha2b-interferon. Each BCC was injected intralesionally three times a week for 3 weeks with 1.5×106 IU of interferon per injection (total dose 13.5×106 IU). The immunohistological study was done before the start of interferon therapy and 15 days afterwards, using a series of monoclonal antibodies and an immunocytochemical technique. Before therapy the infiltrate consisted mainly of CD3+ (T) cells, with prevalence of CD4+ (helper/inducer) T cells. The percentage of T cells expressing interleukin-2 receptor (CD25+ cells) was higher in the tumor nests than in the peritumoral infiltrate (20% and 11% respectively). CD1+ (Langerhans) cells and CD14b+ cells (monocytes/macrophages) were present in the peritumoral infiltrate in all cases (9%±5% and 14%±7% respectively). Very few CD56+ (natural killer), CD15+ (granulocytes) and CD20+ (B) cells were observed in the peritumoral infiltrate and none at all in tumor nests. After 15 days of interferon therapy, we observed an increase in peritumoral and intratumoral CD4+ cells. There was a decrease in the number of CD25+ cells and of CD1+ cells in the peritumoral infiltrate. The number of intratumoral CD25+ increased. No variations were seen in CD14b, CD15, CD20, and CD56 positive cells. Eight weeks after completion of therapy, two BCCs were cleared and the remaining four showed clinical and histological improvement. These results may indicate a direct effect of interferon against BCC; in addition the immunohistological findings suggest that intralesional interferon enhances T cell mediated immune response, especially in tumor nests. Interferon may therefore act against BCC as a cytotoxic agent and as an immunomodulator.

T cell subpopulations in vitiligo: A chronobiologic study

The circadian rhythms of helper (CD4) and suppressor (CD8) T cells from the peripheral blood of 12 vitiligo patients (seven with active disease, five with static) and 12 healthy control subjects were studied. Patients with active vitiligo had a lower percentage of CD4+ cells than did control subjects at 0000 hours and at 0600 and 1200 hours; there were no differences between these values in patients with static vitiligo and those in control subjects. The percentage of CD8+ cells were lower at 1200 and 1800 hours in both active and static vitiligo patients than in control subjects. Cosinor analysis of the CD4+ cells showed a circadian rhythm in static vitiligo, whereas the rhythmicity was lost in active vitiligo. CD8+ cells did not show any circadian rhythm in either active or static vitiligo. Our data show more striking aberrations for T cell subtypes in active vitiligo than in static vitiligo. They suggest that cell-mediated immunity may play a role in the pathogenesis of the disease.

INTRAMUSCULAR LOW DOSE ALPHA‐2B INTERFERON AND ETRETINATE FOR TREATMENT OF MYCOSIS FUNGOIDES

Background. Mycosis fungoides is a lymphoma of cutaneous origin characterized by a proliferation of cells with a T phenotype.

Calcipotriol in psoriasis vulgaris: a controlled trial comparing betamethasone dipropionate + salicylic acid

Patients with psoriasis were treated with calcipotriol ointment, 50 ng/g, or betamethasone dipropionate + salicylic acid, applied twice daily, for 6 weeks. At the end of the trial patients took no treatment for a 1‐month follow‐up period. Extension of the psoriatic lesion, using a seven‐point semiquantitative scale (0, no lesion; 1, lesions involving less than 10% of the body surface; 2, 10%–30%; 3, 30%–50%; 4, 50%–70%; 5, 70%‐90%; 6, 90%–100%), and severity of the erythema, infiltration, and exfoliation, using a four‐point scale (0, no skin involvement; 3, maximal), were assessed at baseline and at the fortnightly check‐ups. The scores were then employed to calculate a PASI score.1 The dermatologist finally expressed his judgment on the efficacy of treatment, using a five‐point scale (−1, worsening; 3, healing). Similarly, patients were asked to express an opinion on the acceptability of treatment, using a five‐point scale (1, nil; 5, excellent). At baseline and at the second and sixth weeks of treatment, routine laboratory tests were carried out.

Effects of isotretinoin on the neutrophil chemotaxis in cystic acne.

The authors show that the use of Isotretinoin (Ro 4–3740) in cystic acne brings a reduction of chemotactic activity of the neutrophil granulocytes, like another retinoid, Etretinate, in pustular and v