Freerk Heule

Low‐dose cyclosporin A in severe psoriasis. A double‐blind study

Twenty patients with severe plaque psoriasis were selected to receive either low‐dose cyclosporin A (CyA) or placebo (CyA vehicle) in a double‐blind randomized trial at two centres.

Cyclosporin in atopic dermatitis: a multicentre placebo‐controlled study

Summary The efficacy of cyclosporin (Sandimmun®) given in a daily dose of 5 mg/kg for 6 weeks in severe atopic dermatitis was confirmed in this double‐blind, placebo‐controlled, short‐term study. Of the 46 patients included in the study, 23 were randomized to receive cyclosporin and 23 to receive placebo.

Short-term use of cyclosporin A in severe psoriasis

The effectiveness of cyclosporin A (CyA) in low dosages (mean 5 mg/kg/day) for short‐term treatment of severe psoriasis was studied. Of five patients with severe progressive psoriasis vulgaris (mean PASI score 43.8), an almost complete remission in three patients, and a large reduction in PASI score in the remaining two patients, was obtained within 4 weeks. No important clinical side‐effects were found but there was biochemical evidence of slight renal dysfunction in one patient. The mean percentage reduction in the PASI score was 84%. It was concluded that the results reported justify further study of the use of CyA in the treatment of severe psoriasis.

Treatment of Multifocal Primary Cutaneous B-Cell Lymphoma: A Clinical Follow-Up Study of 29 Patients

PURPOSE Although patients with primary cutaneous B-cell lymphoma (CBCL) and localized skin lesions are generally treated with radiotherapy and have an excellent prognosis, the clinical behavior and optimal treatment of CBCL presenting with multifocal skin lesions are less well defined. In this study, we evaluated the clinical behavior of and results of treatment for multifocal CBCL in 29 patients, and we formulated therapeutic guidelines. PATIENTS AND METHODS The study group included 16 patients with primary cutaneous follicular center-cell lymphoma (PCFCCL), eight with primary cutaneous immunocytoma (PCI), and five with primary cutaneous large B-cell lymphoma presenting on the legs (PCLBCL of the leg). RESULTS Only one of the 24 patients with multifocal PCFCCL or PCI developed extracutaneous disease, and no patient died from lymphoma (median follow-up, 54 months). In patients with PCFCCL, treatment with either multiagent chemotherapy (nine patients) or radiotherapy directed toward all skin lesions (five patients) proved equally effective in terms of complete remission, relapse, and survival. In contrast, all five patients with PCLBCL of the leg developed extracutaneous disease, and four of the five died from systemic lymphoma, 8 to 36 months (median, 21 months) after diagnosis. CONCLUSION The results of these preliminary studies suggest that patients with PCFCCL or PCI presenting with multifocal skin lesions have the same excellent prognosis that patients with localized PCFCCL or PCI have and that radiotherapy directed toward all skin lesions is as effective as multiagent chemotherapy. Patients with PCLBCL of the leg have a more unfavorable prognosis, particularly patients presenting with multifocal skin lesions. This last group should always be treated with multiagent chemotherapy.

USE OF CYCLOSPORIN IN PSORIASIS

In the treatment of severe psoriasis, cyclosporin may achieve improvement or remission at low doses, but relapse usually occurs on withdrawal of treatment. An initial dose of 3 mg/kg per day is recommended. Complete remission should not be the objective, and the role of long-term maintenance cyclosporin therapy is uncertain because of potential side-effects--especially nephrotoxicity, hypertension, and a predisposition to malignancy. Guidelines are proposed for the assessment of such treatment.

Results of photopatch testing in Rotterdam during a 10-year period

Background Photoallergic contact dermatitis is of importance in a proportion of photodermatoses and can be evaluated through photopatch testing.

Delayed‐type hypersensitivity to contact allergens in psoriasis

The possibility for patch testing procedures to detect contact allergy was examined in 85 hospitalized patients with forms of psoriasis. Exclusion criteria were active lesions on the back, the use of strong topical corticosteroids, methotrexate, cyclosporin and UV therapy. After screening, a group of 47 patients with different forms of psoriasis were selected for patch testing. Personal history, including topical treatment, occupation and domestic circumstances, were reasons to extend the standard series of allergens. Tars, nickel sulfate, perfume and balsam of Peru scored high. The overall positive rate was 68%. This is higher than that observed in earlier studies. The unexpected results are discussed in the light of the possible mechanism of action.

Placebo-controlled study of psoriasis patients treated topically with a 10% cyclosporine gel

The efficacy of a gel formulation containing 10% cyclosporine was investigated in nine patients with chronic plaque psoriasis. 10% cyclosporine gel was ineffective in patients with chronic plaque-type psoriasis

Subepidermal bullous autoimmune disease associated with immune nephritis: Immunomorphologic studies

There are only a few reports of the association of immune-complex glomerulonephritis with bullous pemphigoid. The occurrence of immune-complex nephritis with linear IgA bullous disease has not been previously reported. We report two cases, one a case of bullous pemphigoid and the other a case of linear IgA bullous disease, both of which were associated with immune-complex glomerulonephritis. The clinical and immunomorphologic data are briefly discussed.

Clinical and laboratory studySubepidermal bullous autoimmune disease associated with immune nephritis: Immunomorphologic studies

There are only a few reports of the association of immune-complex glomerulonephritis with bullous pemphigoid. The occurrence of immune-complex nephritis with linear IgA bullous disease has not been previously reported. We report two cases, one a case of bullous pemphigoid and the other a case of linear IgA bullous disease, both of which were associated with immune-complex glomerulonephritis. The clinical and immunomorphologic data are briefly discussed.