C.R. Lovell

Type I and III collagen content and fibre distribution in normal human skin during ageing

The content of type I and III collagen in normal human skin from subjects of different ages was studied by means of a new high performance liquid chromatography method and by SDS‐polyacrylamide gel electrophoresis and scanning electron microscopy. The ratio of types I and III collagen in covered skin remained constant throughout childhood and young adult life and the proportion of type III was shown to be the same as previously reported. However, in the elderly, the proportion of type III collagen in the dermis increased to a variable degree. Scanning electron microscopic examination showed a decrease in the number of collagen fibre bundles with age. Average bundle width varied significantly with age. These results may reflect an impaired synthesis of type I collagen in aged skin.

Elastic fibres in normal and sun-damaged skin: an immunohistochemical study

Sun‐exposed and sun‐protected skin obtained at post mortem from the nape of the neck in 14 subjects was immunostained using antisera to elastic, lysozyme, amyloid P component, and the plasma protease inhibitors alpha‐I antitrypsin, alpha‐I amichymotrypsin and alpha‐2 macro‐globulin. Both the normal clastic fibres in sun‐protected skin, and clastosis in sun‐exposed skin were positively immunostained for elastin, lysozyme and amyloid P component. Collagen fibres were unstained. No immunostaining of normal elastic fibres or elastosis in the skin was obtained with antisera to alpha‐I antitrypsin, alpha‐I antichymotrypsin or alpha‐2 macroglobulin. It was concluded that the clastosis in sun‐exposed skin does contain elastic fibres. The absence of immunostaining for plasma protease inhibitors probably indicates that the elastic material is mature, and not newly‐formed.

Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)

Background  Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown.

Antineutrophil cytoplasmic antibodies and HLA class II alleles in minocycline-induced lupus-like syndrome.

We report 14 patients with minocycline‐induced lupus‐like syndrome (four men, 10 women; mean age 27·8 years) who developed a lupus‐like illness after chronic use of minocycline for acne (1–10 years, median 3·8). Clinical features resolved completely on drug withdrawal (mean follow‐up 11 months) and reappeared in two patients who were rechallenged. Sera from all 14 patients contained antineutrophil cytoplasmic antibodies (ANCA) giving a perinuclear pattern on indirect immunofluorescence on ethanol‐fixed human neutrophils (p‐ANCA), whereas 14 control asymptomatic individuals taking minocycline for acne were ANCA‐negative. Eleven of the 14 patients had elevated antimyeloperoxidase antibodies and 10 had antielastase antibodies on enzyme‐linked immunosorbent assay, which diminished on extended follow‐up, as did other serological abnormalities. Major histocompatibility complex class II typing demonstrated that all of the 13 patients tested were either HLA‐DR4 (nine of 13) or HLA‐DR2 (four of 13) positive, and all had an HLA‐DQB1 allele encoding for tyrosine at position 30 of the first domain. Our findings suggest a model whereby the presence of p‐ANCA may be a marker for the development of lupus‐like symptoms in genetically susceptible individuals taking minocycline for acne.

Clinical and Pharmacogenetic Influences on Response to Hydroxychloroquine in Discoid Lupus Erythematosus: A Retrospective Cohort Study

The recommended systemic therapy of choice for discoid lupus erythematosus (DLE) is the 4-aminoquinolone antimalarial hydroxychloroquine. There is limited published information on the likelihood of clinical response and, in particular, what factors influence outcome. We conducted a multicenter observational and pharmacogenetic study of 200 patients with DLE treated with hydroxychloroquine. The primary outcome was clinical response to hydroxychloroquine. We investigated the effects of disease attributes and metabolizing cytochrome P450 (CYP) polymorphisms on clinical outcome. Although the majority of patients responded to hydroxychloroquine, a significant proportion (39%) either failed to respond or was intolerant of the drug. Cigarette smoking and CYP genotype did not have any significant influence on response to hydroxychloroquine. Moreover, multivariate analysis indicated that disseminated disease (odds ratio (OR): 0.21; 95% confidence interval (CI): 0.08-0.52; P<0.001) and concomitant systemic lupus erythematosus (SLE; OR: 0.06; 95% CI: 0.01-0.49; P = 0.009) were significantly associated with lack of response to hydroxychloroquine. These findings suggest that baseline lupus severity and SLE are predictors of response to hydroxychloroquine. A prospective study is now required to further investigate the relationship between disease activity and response to hydroxychloroquine. This will have the potential to further inform the clinical management of this disfiguring photosensitive disease.

Allergy to oxidized limonene and linalool is frequent in the U.K.

The oxidized forms of the fragrance terpenes limonene and linalool are known to cause allergic contact dermatitis. Significant rates of contact allergy to these fragrances have been reported in European studies and in a recent worldwide study. Patch testing to oxidized terpenes is not routinely carried out either in the U.K. or in other centres internationally.

VCAM‐1 expression on endothelium in lesions from cutaneous lupus erythematosus is increased compared with systemic and localized scleroderma

Summary The cutaneous lesions in systemic sclerosis (SSc) and lupus erythematosus (LE) are pathologically distinct and may display separate cell adhesion receptors. We have scored lesional skin for the presence of cell adhesion molecules that may influence inflammatory and fibrotic processes in five patients with LE, six patients with diffuse scleroderma and four patients with morphoea. The immunohistological distribution, and the number and intensity of cells staining, were recorded for VCAM‐1, ICAM‐1, E‐selectin, α2 to α6 and β2 integrins and HLA‐DR, VCAM‐1 staining intensity was increased on endothelium from lesions in LE compared with SSc (P=0.05). Low‐level VCAM‐1 and E‐selectin expression was present on endothelium from uninvolved skin including that from patients with morphoea. HLA‐DR expression was increased on infiltrating mononuclear cells (P < 0.05) and keratinocytes in LE (P < 0.05) and the number of fibroblasts staining for ICAM‐1 was increased in lesions from patients with SSc, although this did not reach statistical significance. Overall, with respect to endothelial adhesion events, our findings support an important role for VCAM‐1 in sustaining chronic inflammation in cutaneous LE.

How does psoriasis affect quality of life? Assessing an Ingram‐regimen outpatient programme and validating the WHOQOL‐100

Background, objectives and methods  This paper reports a longitudinal study of the quality of life (QOL) of outpatients receiving treatment for psoriasis in secondary care that was designed to validate a new QOL measure for use in psoriasis: the WHOQOL‐100. Additional aims were to monitor the changes to the QOL of psoriasis patients (n = 83) following a course of topical treatment—a modified Ingram regimen—and to compare their QOL with healthy people (n = 105).

Development and testing of new candidate psoriatic arthritis screening questionnaires combining optimal questions from existing tools

Several questionnaires have been developed to screen for psoriatic arthritis (PsA), but head‐to‐head studies have found limitations. This study aimed to develop new questionnaires encompassing the most discriminative questions from existing instruments.

Contact dermatitis due to hardy primula species and their cultivars

For more than 100 years, it has been widely held that of all the Primula species to cause allergic contact dermatitis, P.obconica is the most likely culprit, particularly in Northern Europe. The main sensitizer is primin, but other sensitizers are reported. Other species are rarely implicated, but we suspect from our discussions with Primula growers that this is probably a consequence of under‐reporting. Moreover, cutaneous reactions to other hardy Primula species and cultivars would appear to be milder and may sometimes be associated with a state of tolerance after repeated handling. With the co‐operation of members of the Midland and West Section of the National Auricula and Primula Society of the UK, 462 questionnaires were sent out to members and 316 replies were returned (response rate 68.4%) with data on 320 growers. 84 out of a total of 320 (26.25%) attributed a cutaneous reaction to Primula species, whereas 236 (73.75%) reported no reaction. Of the 84 who reported reactions, 48 suspected P.auricula, 34 P.obconica, 10 P.vulgaris, 5 P.allionii, 3 P.marginata and 2 P.forrestii. 19 believed that they had reacted to 2 or more species of Primula. Our study suggests that Primula species other than P.obconica may elicit dermatitis more frequently than previously recorded.