H. Baart de la Faille

A new development in UVB phototherapy of psoriasis

We have compared the therapeutic effectiveness of a new UVB fluorescent sunlamp, the Philips TL‐01 lamp, which emits a narrow peak around 311–312 nm, with the currently used Philips TL‐I2 lamp, in 10 patients with psoriasis. We also compared the tumour inducing capacity of the two lamps in hairless mice.

An immunofluorescence study of lichen planus

In the present immunofluorescence study we report the occurrence of fibrin or related substances and of IgM in the upper part of the dermis in all forty lichen planus lesions examined. Different amounts of various complement components and fragments were located in the epidermal basement zone, and in the colloid bodies. IgG, IgM, IgA and fibrin were also found in the colloid bodies, sometimes together with albumin.

Accumulation of iron in erythroblasts of patients with erythropoietic protoporphyria

Abstract. We have studied the iron metabolism in nine patients with erythropoietic protoporphyria (EPP) and three patients with sideroblastic anaemia (SA). All, except one EPP patient were iron deficient. The SA patients had a secondary haemochromatosis.

Light-induced skin lesions in lupus erythematosus: photobiological studies

SummaryTo investigate the light sensitivity to various wavelength regions in lupus erythematosus (LE), phototests were performed in 24 LE patients with clinical photosensitivity (7 had systemic LE, 9 discoid LE, and 8 subacute cutaneous LE). Skin areas (measuring 40–60 cm2) were irradiated daily, maximally six times. With all three light sources used (emitting UVB, UVA, and visible light respectively) abnormal papular or papulosquamous reactions could be induced. In four of the 20 patients reacting abnormally, lesions occurred 10 or more days after cessation of the phototests; this indicates that the problem of photosensitivity in LE may be greater than appreciated so far.

Management of Nonstaphylococcal Toxic Epidermal Necrolysis: Follow-Up Study of 16 Case Histories

In this study the clinical and laboratory data of 14 patients who experienced 16 attacks of nonstaphylococcal toxic epidermal necrolysis (TEN) are presented. All patients were treated in the Department of Dermatology of the University Hospital of Utrecht. Only 1 patient died. Attention is focused on a successful management consisting of reversed barrier nursing, painstakingly executed skin care, timely use of antibiotics and a therapy consisting of high dosages of corticosteroids. Thorough management in centers experienced in the treatment of TEN is essential for good treatment results. Further investigations concerning the use of corticosteroids in treating TEN are needed.

Topical 5‐fluorouracil in the treatment of Darier's disease

Two patients suffering from therapy‐resistant Dariers disease were treated with topical 5‐fluorouracil (5‐FC). The drug was applied in a concentration of 1% in a cream base, once daily, in left‐right comparison with either 7.5% salicylic acid in petrolatum or 0.05% vitamin A acid cream. Both patients were on long‐term treatment with oral retinoids. After 1 week of treatment, a considerable improvement was already apparent on the 5‐FU‐treated side, in comparison with the salicylic acid‐ and vitamin A acid‐treated sides. Subsequent treatment of all skin lesions with 5‐FU for a further 2 weeks resulted in complete clearance of the lesions. Remission periods were of 2‐6 months duration. There were no significant adverse effects of treatment, Haematological parameters remained unchanged during the therapy. Topical 5‐FU is a safe and useful addition to currently available treatments for Dariers disease.

Actinic reticuloid simulating sézary syndrome

SummaryA report is given on two male patients who showed all the main characteristics of Sézary syndrome (SS). When phototested, however, they proved to be extremely photosensitive, which suggested a diagnosis of actinic reticuloid (AR). This was supported by the predominance in blood and skin specimens of lymphoid cells with a suppressor/cytotoxic phenotype, the absence of clonal cell proliferation and a benign clinical course. Differential diagnostic problems of SS and erythrodermic AR are discussed.

Complement components in blood serum and, suction blister fluid in erythropoietic protoporphyria

Complement factors C3c, C4, factor B, C3d and the immunoglobulin IgA were determined in suction blister fluid of patients with erythropoictic protoporphyria and in normal controls. The levels increased when the skin of the patients had been previously irradiated with ‘white light’, but not with Kromayer radiation, and were interpreted as being the result of increased vasopermeability.

Salivary gland swelling following naproxen therapy

Summary We report allergic sialadcnitis as a novel side‐effect of naproxen, a non‐steroidal anti‐inflammatory drug (NSAID). Bilateral swelling of the major salivary glands and a rash occurred a few days after the patient had taken the drug. High‐dose systemic corticosteroid therapy was required to control the disorder. Because the salivary gland swelling was not initially recognized as an adverse drug reaction, further doses of naproxen were given on two occasions, with similar results.

Binding of antibodies to nonhistone nucleoproteins on keratinocytes in suspensions

SummaryAntibody binding on the cell surface of epidermal cells, recently established on cultured neonatal foreskin cells, is supposed to play a role in the pathogenesis of in vivo antinuclear antibodies (ANA) of the skin. To study this phenomenon in suspensions of adult human keratinocytes, a cell system more closely related to the in vivo situation, we investigated the binding capacity of nine sera with various antibody profiles against nuclear components, as well as a murine monoclonal Sm-antibody. It was found that sera containing antibodies against nonhistone nucleoproteins bound to the cell surface of keratinocytes, whereas monospecific anti-dsDNA sera and the murine anti-Sm serum did not. This binding was found in both basal and suprabasal keratinocytes. The percentage of cells showing antibody binding was not significantly enhanced by preirradiation with ultraviolet light, as was found in a previously study. The cell surface binding is probably an antigen-antibody binding and not the result of cross-reactivity. Such cell surface binding may be important for the formation of in vivo ANA in the skin.