Cato Mørk

Influence of narrowband UVB phototherapy on vitamin D and folate status

Please cite this paper as: Influence of narrowband UVB phototherapy on vitamin D and folate status. Experimental Dermatology 2010; 19: e67–e72.

Periodontitis in psoriasis patients. A blinded, case-controlled study

Abstract Objective. Destructive periodontitis is one of the most frequent and widespread bacterial infections in humans. Psoriasis is a common condition in the general population. Since both psoriasis and periodontal diseases are characterized by an exaggerated response of the immune system to the epithelial surface microbiota, there may possibly be an association between these two conditions. The aim of the present pilot study was to investigate the prevalence of periodontal disease in psoriasis patients compared to healthy controls. Material and methods. Dental bite-wing X-rays were obtained from 155 psoriasis patients aged 45–60 years, as well as from 155 age- and gender-matched controls. All X-rays were examined by the same investigator for accumulated destructive periodontitis using bone level and loss of teeth as endpoints. Results. A significantly lower radiographic bone level (p <u20090.001) and a significantly higher number of missing teeth (p <u20090.001) were observed in the psoriasis cases compared to the controls. Conclusion. Our study indicates that psoriasis patients experience more bone loss than age- and gender-matched controls.

Pain in primary erythromelalgia--a neuropathic component?

&NA; Erythromelalgia is a condition characterized by attacks of red, hot, painful extremities with relief of symptoms by cooling and aggravation by warmth. Although the main emphasis has been on pathophysiological mechanisms related to circulatory changes, recent reports have focused on an involvement of efferent small nerve fibers indicating a neuropathic component. Since the symptoms resemble those described in neuropathic pain, we wanted to investigate the possible affection of afferent nerve fibers. Twenty‐five patients with primary erythromelalgia were examined by neurological testing, neurography and quantitative sensory testing. Thresholds for heat, cold, heat‐pain and cold‐pain detection were compared with those of a group of 29 healthy controls. The patients had significantly higher median heat (39.5 (36.1–40.8) and cold (29.3 (27.1–30.8)‐detection thresholds at the dorsal aspects of their feet compared to the controls (37.0 (35.4–37.7) and 31.2 (30.3–31.5) respectively). These findings show an impaired small fiber function inside or close to the symptomatic area in this group of erythromelalgia patients. Seven patients had brush‐evoked allodynia and fourteen had punctate hyperalgesia inside or close to the symptomatic areas in their feet. When comparing the individual results, there is a tendency to clustering of patients in two separate groups; reduced small fiber input/no hyperalgesia and normal thermal thresholds/hyperalgesia. Our results showing an affection of afferent small nerve fibers together with the nature of the symptoms, suggest that the pain experienced by erythromelalgia patients could have a neuropathic component.

Specific changes in conduction velocity recovery cycles of single nociceptors in a patient with erythromelalgia with the I848T gain-of-function mutation of Nav1.7.

Abstract Seven patients diagnosed with erythromelalgia (EM) were investigated by microneurography to record from unmyelinated nerve fibers in the peroneal nerve. Two patients had characterized variants of sodium channel Nav1.7 (I848T, I228M), whereas no mutations of coding regions of Navs were found in 5 patients with EM. Irrespective of Nav1.7 mutations, more than 50% of the silent nociceptors in the patients with EM showed spontaneous activity. In the patient with mutation I848T, all nociceptors, but not sympathetic efferents, displayed enhanced early subnormal conduction in the velocity recovery cycles and the expected late subnormality was reversed to supranormal conduction. The larger hyperpolarizing shift of activation might explain the difference to the I228M mutation. Sympathetic fibers that lack Nav1.8 did not show supranormal conduction in the patient carrying the I848T mutation, confirming in human subjects that the presence of Nav1.8 crucially modulates conduction in cells expressing EM mutant channels. The characteristic pattern of changes in conduction velocity observed in the patient with the I848T gain-of function mutation in Nav1.7 could be explained by axonal depolarization and concomitant inactivation of Nav1.7. If this were true, activity-dependent hyperpolarization would reverse inactivation of Nav1.7 and account for the supranormal CV. This mechanism might explain normal pain thresholds under resting conditions.

Prostacyclin reduces symptoms and sympathetic dysfunction in erythromelalgia in a double-blind randomized pilot study

Sympathetic dysfunction and skin microvascular arteriovenous shunting with insufficient nutritive perfusion and tissue hypoxia have been reported in patients with erythromelalgia. The objective of this study was to determine whether iloprost, a synthetic prostacyclin analogue--primarily a vasodilator and inhibitor of platelet activation--improves symptoms and sympathetic function in patients with erythromelalgia. Erythromelalgia is a rare condition, but we managed to collect 12 primary cases for a double-blind, randomized, parallel-group pilot trial evaluating the effect of iloprost (n = 8) and placebo (n = 4). The treatment effect was determined by the need for cooling of affected skin and by vasoconstrictor tests following Valsalvas manoeuvre and contralateral cooling. The results show a significant reduction in symptoms (p < 0.05) and sympathetic dysfunction (p < 0.05) in the iloprost group. Further studies with oral prostacyclins or analogues are suggested.

Erythromelalgia as a paraneoplastic syndrome in a patient with abdominal cancer.

the breast and pectoralis major muscle. Pediatr Dermatol 1995; 3: 34 ± 37. 4. Chapel TA, Tavafoghi V, Mehregan AH, Gagliardi C. Beckers melanosis: an organoid hamartoma. Cutis 1981; 27: 405 ± 406. 5. Uitto J, Santa Cruz DJ, Eisen AZ. Connective tissue nevi of the skin. J Am Acad Dermatol 1980; 3: 441. 6. Fenske NA, Donelan PA. Beckers nevus coexistent with connective-tissue nevus. Arch Dermatol 1984; 120: 1347 ± 1350. Accepted January 9, 1999.

Erythromelalgia in a patient with AIDS.

Erythromelalgia is a clinical syndrome characterized by burning pain in the extremities together with erythema and increased skin temperature. Typically, the patients experience relief from cold, and aggravation from warmth. Symptoms are hypothesized to be caused by arteriovenous shunting and reduced nutritive skin capillary perfusion with corresponding tissue hypoxia. Erythromelalgia is most often primary, but may be secondary to a wide variety of diseases. We report erythromelalgia in a patient with acquired immune deficiency syndrome (AIDS). At peak pain intensity he actively cooled hands and feet for more than 12 h/day. Many doctors handling human immunodeficiency virus/AIDS patients are unfamiliar with erythromelalgia, and the condition can easily be overlooked, especially the more common milder cases.