Fritz Gschnait

5-Methoxypsoralen (Bergapten) in photochemotherapy of psoriasis

5‐Methoxypsoralen (5‐MOP, Bergapten) was evaluated as a potential photosensitizing drug in oral photochemotherapy of psoriasis. Treatment results indicate that (1) 5‐MOP is as effective as, and in high doses more effective than, 8‐methoxypsoralen in clearing psoriatic lesions; (2) therapeutic doses of 5‐MOP do not lead to erythema; the acute side‐effects of 8‐MOP PUVA therapy—erythema, blistering, pruritus—are thus avoided; (3) even high doses of 5‐MOP are not followed by nausea. 5‐MOP PUVA therapy thus represents a real alternative to 8‐MOP PUVA, its advantages over 8‐MOP PUVA being greater safety and patient acceptance.

Induction of UV light tolerance by PUVA in patients with polymorphous light eruption

A tan induced by 8‐methoxypsoralen‐long wave ultraviolet light has proved an effective photo‐ protective sunscreen in 5 patients with long wave ultraviolet light‐induced polymorphic light eruption.

Keratoses and nonmelanoma skin tumors in long-term photochemotherapy (PUVA)

Four hundred eighteen patients were treated with oral photochemotherapy up to 5 years and monitored regularly for the occurrence of precancerous conditions or tumors of the skin. Out of this group, six patients (1.4%) developed actinic keratoses and five (1.2%), epidermal tumors (three squamous cell carcinomas, one basal cell carcinoma, one keratoacanthoma) 12 to 53 months after initiation . of 8-methoxypsoralen-photochemotherapy (PUVA). Ten of these eleven patients belonged to a group of 172 individuals with a history of previous exposure to arsenic, ionizing radiation, and/or methotrexate who were considered a risk group. All of the four carcinoma patients had previously had one or more courses of arsenic therapy. No tumors were observed in the remaining 246 nonrisk patients. The mean age of the keratosis-tumor group (59 ± 9 years) and the total cumulative long-wave ultraviolet light (UVA) dose (1,045 ± 959 J/cm 2 ) were significantly higher (p 2 ) of the 407 patients without such skin changes. The skin type and the time period between initiation of PUVA therapy and the final evaluation of the patients did not exhibit substantial differences in both groups. The observed incidence of epidermal carcinomas in the risk group (2.3%) was considerably higher than the expected age-sex-specific incidence of a randomized population (0.1%), whereas the incidence in the nonrisk group (0%) corresponded to the expected rate. However, data on the tumor incidence in psoriatics not treated with PUVA and matched for previous treatments and risk factors were not available. This study shows that the incidence of nonmelanoma skin tumors in long-term PUVA patients without previous medication of arsenic or treatment with ionizing radiation does not differ from the expected incidence of the general population. However, there is an increased incidence of tumors in PUVA patients if certain risk factors are present. The risk factor in our series is previous medication with arsenic, which is carcinogenic per se.

Long‐term photochemotherapy: histopathological and immunofluorescence observations in 243 patients

Skin biopsies of 243 patients treated with photochemotherapy (PUVA) for 1–4 years were examined histologically. Two hundred and six patients were examined retrospectively after total cumulative UV‐A doses of 579·6 ± 598·0 J/cm2 (mean ± s.d.). An eosinophilic homogenization and a reduction of elastic fibres at the dermo‐epidermal junction, and an increase of dermal macrophages were found as possible abnormalities. However, except for the increase of melanophages there was no statistically significant correlation between the incidence of these changes, the total UV‐A dose applied and the skin type of the patients. Neither were such correlations found in thirty‐seven patients biopsied twice after 394·8 ± 267·6 J/cm2 and 808·5 ± 458·9 J/cm2 (mean±s.d.), respectively. Studies with direct immunofluorescence techniques revealed no immunoglobulin deposits in PUVA treated skin in fifty‐six patients after 469·2 ± 370·2 J/cm2; antinuclear antibodies were observed in 4·6% of 129 patients after 169 J/cm2 (mean); in 11%, of fifty‐three patients reexamined after 381 J/cm2 (mean) and in 13·6% of twenty‐two patients reexamined a second time after 643 J/cm2 (mean).

Non-inflammatory dermal elastolysis.

A 33‐year‐old woman is described who suffers from an idiopathic loss of mid‐dermal elastic tissue which leads to wrinkling of the skin and to discrete perifollicular protrusions. In accordance with Shelley & Wood (1977) we conclude that these findings represent a new entity for which we propose the term ‘non‐inflammatory dermal elastolysis’.

Photoprotective effect of a psoralen-UVA-induced tan

SummaryTo determine whether a tan produced by 8-MOP and UVA protects from subsequent solar light irradiation, volunteers were irradiated with unfiltered Xenon arc light before and 10 days after a 1 weeks course of four 8-MOP-UVA treatments. Evaluation of the minimal erythema doses and of histological changes before and after 8-MOP-UVA treatment revealed that the 8-MOP-UVA induced tan protected against the erythemogenic and cell damaging effects of Xenon arc light. Unscheduled repair DNA synthesis, used as a measure for UVB-induced DNA damage and repair, was also investigated in skin irradiated with the Xenon arc before and after 8-MOP-UVA induced tanning. Both the number of grains per sparse labeled cell and the number of sparse labeled cells per 1000 cells, were found to be significantly lower in tanned skin; taking decreased unscheduled repair DNA synthesis as a measure for decreased DNA-damage, these findings also demonstrate a photoprotective effect of the 8-MOP-UVA induced tan.ZusammenfassungZur Klärung der Frage, ob die durch 8-Methoxypsoralen (8-MOP) und langwelliges Ultraviolett-Licht (UV-A) induzierte Hautbräunung vor Sonnenbestrahlung schützt, wurden Testpersonen mit einer ungefilterten Xenon-Lampe vor und 10 Tage nach einer einwöchigen 8-MOP/UV-A-Behandlung (4 Expositionen) bestrahlt. Die Beurteilung erfolgte klinisch durch die Bestimmung minimaler Erythemdosen, cytomorphologisch durch Beurteilung UV-inducierter Gewebs- und Zellschäden in bioptischem Material und autoradiographisch durch die »unscheduled repair«-DNS-Synthese. Ein Vergleich der cutanen Reaktion auf eine definierte, von der Xenon-UV-Quelle (sonnenähnliches Spektrum) emittierten Energiedosis vor und nach Hautpigmentierung durch 8-MOP-UVA zeigte 1) klinisch eine signifikante Anhebung der minimalen Erythemschwelle, 2) histologisch eine signifikante Abnahme UV-inducierter Zellschäden und 3) autoradiographisch eine deutliche Abnahme von Repair-Aktivität als Maß eingetretener DNS-Schädigung. Sowohl die Zahl der Zellen mit Repair-Aktivität, als auch die Summe von Silberkörnern in markierten Zellen waren signifikant erniedrigt. Da die »unscheduled repair«-DNS-Synthese ein Maß für UVB induzierte DNS-Schäden und Reparaturvorgänge darstellt, wird auch anhand dieses Parameters ein Lichtschutzeffekt durch 8-MOP-UVA-Bräunung dokumentiert.

Bullous pemphigoid after radiation therapy

Electron beam therapy applied to a lymph node metastasis from a squamous cell carcinoma was followed by the development of histologically and immunologically typical bullous pemphigoid, the lesions being initially strictly confined to the irradiation area. This observation suggests that the bullous pemphigoid antigen may be altered or unmasked by electron beam radiotherapy, leading subsequently to the production of autoantibodies. The disease in this case effectively responded to the administration of tetracycline and niacinamide, a therapeutic regimen described recently.

Coincidence of vitiligo, alopecia areata, onychodystrophy, localized scleroderma and lichen planus.

The unique coincidence of five dermatological disorders, which occurred in a 39-year-old patient, is discussed. The clinical and laboratory examination did not reveal a common underlying cause. It is hoped this report will stimulate the recognition of other cases and thus aid in determining whether the coincidence of these disorders is a true association of diseases with a common underlying factor or a rare abnormality.

Serum level profiles of 8-methoxypsoralen after oral administration.

In a previous study serum levels of 8-methoxypsora len (8-MOP) , de te rmined 2 h after oral adminis t ra t ion were shown to be highly variable in different pat ients [5]. The photochemotherapeu t ic ( P U V A ) effect depends in par t icular on the dose of 8 -MOP administered. The present s tudy was per formed in o rder to determine: 1. peak values of 8 M O P after oral adminis trat ion and 2. the durat ion of the t ime interval between ingestion of 8 -MOP and its serum peak level.

Disseminated superficial “actinic” porokeratosis

The dramatic therapeutic response of disseminated superficial actinic porokeratosis (DSAP) to retinoid plus psoralens with ultraviolet A prompted a review of clinical, histologic, and etiologic data of all of the DSAP cases available in the English and German literature. The review showed that many case reports lack adequate documentation to confirm actinic induction. More than one third of the patients have observed no exacerbations during the summer. Histologic damage after long-term ultraviolet (UV) exposure could not be observed in every case. In addition, cases do exist in which lesions are distributed mainly in non-UV-exposed skin. These data cause doubt about the importance of actinic induction of DSAP.