Håkan Mobacken

Severe oral lichen planus: treatment with an aromatic retinoid (etretinate).

A double‐blind study of twenty‐eight patients with severe oral lichen planus treated with etretinate (75 mg daily) or a placebo for 2 months, showed that the oral retinoid had a marked beneficial effect. Nine non‐responders who had received only placebo then entered an open cross‐over study and they responded well to etretinate.

Effects of a low-dose desogestrel-ethinylestradiol combination on hirsutism, androgens and sex hormone binding globulin in women with a polycystic ovary syndrome.

Abstract. Twenty women suffering from a polycystic ovary syndrome (PCO) accompanied by hirsutism were given a low‐dose oral contraceptive combination containing 0.150 mg desogestrel plus 0.030 mg ethinylestradiol for 8 months. The pretreatment situation regarding hair and hormone profiles in the PCO group was compared with that in 22 regularly menstruating women. Serum levels of free and total testosterone and androstenedione were significantly elevated in PCO women, as were body weight, blood pressure, hair diameter and depilation frequency. Sex hormone binding globulin (SHBG) binding capacity was lower. Following treatment of the PCO group for 8 months, total and free testosterone levels were depressed, but androstenedione had not changed significantly. SHBG binding capacity was increased five‐fold. Body weight decreased in the obese women. Hair growth was significantly suppressed and the hair itself was less coarse. Depilation intervals were longer. Acne, present before the treatment had now disappeared. Blood pressure did not change. Few and mild side effects were recorded. After treatment, 3 women succeeded in becoming pregnant and in 8 others spontaneous menstruations had recurred.

Gastric Morphology and Function in Dermatitis Herpetiformis and in Coeliac Disease

Gastric acid secretory capacity was evaluated in 116 patients with dermatitis herpetiformis by means of the pentagastrin test. Endoscopic gastric mucosal biopsy specimens were obtained from both the body and the antrum in 90 of them. Forty-eight patients (41%) had a maximal acid output less than 10 mmol/h, and 30 of them (26%) were achlorhydric. The frequency of achlorhydria increased with age, and 27 out of 58 patients (47%) more than 50 years old were achlorhydric. Antrum-sparing chronic atrophic gastritis was present in 92% of the achlorhydric patients, and hypergastrinaemia and serum parietal cell antibodies were found in most of them. The prevalence of chronic gastritis of the body and of the antrum increased with age. There was no correlation between atrophic gastritis or achlorhydria and small-intestinal villous atrophy, the results of the D-xylose test, and blood folate and serum zinc determinations. The transferrin saturation index was lower in patients with achlorhydria. The frequency of achlorhydria was significantly higher in patients with dermatitis herpetiformis than in 69 patients with coeliac disease.

Lipid metabolic studies in women with a polycystic ovary syndrome during treatment with a low-dose desogestrel–ethinylestradiol combination

Abstract. Twenty women with the polycystic ovary syndrome (PCO) were treated with a combination of deso‐gestrel and ethinylestradiol (EE) and the effects on lipids and lipoproteins were compared with those induced in a group of 13 regularly menstruating, healthy women. All women were examined before and after 3 months of treatment. Compared with the regularly menstruating women, the PCO women had significantly higher body weights and blood pressure as well as elevated levels of triglycerides in serum and VLDL. During treatment, 14 out of 20 women affected by PCO lost weight. No significant change in blood pressure was observed. In the PCO group, moderate increments were encountered in serum cholesterol, phospholipids and triglycerides. No significant changes were seen in LDL‐cholesterol or HDL‐cholesterol. The ratio LDL‐chol‐esterol/HDL‐cholesterol did not alter. The level of total cholesterol in VLDL rose during treatment. These changes in serum and lipoprotein lipids in PCO patients were of the same type and magnitude as those found in the control group, apart from an increase in HDL‐cholesterol in the latter. The only remaining difference after treatment was a slightly higher level of VLDL triglycerides in the PCO women. Thus only moderate changes were induced in lipid and lipoprotein patterns by the combination of desogestrel and EE. A “positive” influence on lipids and lipoproteins cannot be considered as a further advantage, added to the list of indications when hormonal treatment is used in PCO‐af‐fected women. The clinical implications of elevated triglycerides remain to be clarified.

Influence of Gluten-Free Diet on the Gastric Condition in Dermatitis Herpetiformis

Achlorhydric atrophic gastritis occurs in approximately 25% of patients with dermatitis herpetiformis (DH). The effect of gluten withdrawal on the gastric condition was studied in 35 patients, with a control group of 20 patients continuing their habitual diet. Gastrointestinal examinations were performed initially and repeated after about 1 3/4 years. Adherence to the diet was confirmed by dietary interviews, improvement of malabsorption test results and intestinal villous structure, and decreased dapsone requirement. Neither the non-restricted diet nor the gluten-free diet had any effect on gastric morphology, the ability to secrete gastric acid, serum gastrin levels, or the frequency or titres of circulating parietal cell antibodies. The findings indicate that gluten is not responsible for the perpetuation of the gastric affection in DH, in contrast to the enteropathy.

Serum Antibodies to Gliadin and Small-Intestinal Morphology in Dermatitis Herpetiformis: A Controlled Clinical Study of the Effect of Treatment with a Gluten-Free Diet

Serum gliadin antibodies of the IgA and IgG classes were determined by the diffusion-in-gel enzyme-linked immunosorbent assay in 41 patients with dermatitis herpetiformis before treatment with a gluten-free diet. Increased gliadin antibody levels were found more frequently in patients with subtotal villous atrophy (9 out of 17 patients, or 53%; p less than 0.05) than in patients with partial villous atrophy (2 out of 13 patients, or 15%) or normal villous appearance (2 out of 10 patients, or 20%). The gliadin antibody levels were negatively correlated with the urinary xylose excretion (r = -0.40, p less than 0.02 for the IgA class and r = -0.64, p less than 0.001 for the IgG class). Intestinal morphology improved and mean gliadin antibody levels of the IgA and IgG classes decreased during treatment with a gluten-free diet for 16-36 months (mean, 20 months) (p less than 0.005, n = 26), whereas no significant changes of the gliadin antibody levels or the small-intestinal morphology were observed in the other 15 patients, who continued on a non-restricted diet for 17-35 months (mean, 20 months). Thus, gliadin antibody levels in sera from patients with dermatitis herpetiformis seem to be correlated with the severity of the intestinal disease. However, all patients with villous atrophy are not detected by determination of serum gliadin antibodies.

Different pathogenesis for psoriatic reaction to lithium and practolol

SIR, Reports in recent years on adverse cutaneous reactions more or less similar to psoriasis and provoked by practolol have received widespread attention. Recently lithium for psychiatric disease has also been associated vî ith exacerbation of psoriasis (Baker, 1977; Bakker & Pepplinkhuizen, 1976 j Carter, 1972J Skott, et aL, 1977). To our knowledge, 22 such cases have already been reported in detail. On the basis of the mounting number of patients with lithium-triggered psoriatic reactions, we believe it is appropriate to compare their clinical features with those in the practolol cases. (1) Clinically, the practolol reactions were mostly psoriasiform but lichenoid and lupus-erythematosuslike rashes and exfoliative dermatitis have also been seen. In most reported cases no previous history of psoriasis is known, although exacerbation of a pre-existing psoriasis has been reported (Sondergaard et al., 1976). As for lithium, our 7, Carters 3 and 3 of Bakker et als 4 patients had aggravation of psoriasis. A few patients with psoriasiform lesions erupting during lithium therapy have also been reported from Holland (Bakker & Pepplinkhuizen, 1976), Denmark (Thormann, 1977) and Sweden (Swedish adverse drug reaction committee, 1977). (2) In the psoriasiform type of practolol rash, the occurrence of hyperkeratosis on the soles and palms is a characteristic and early sign (Felix, Ive & Dahl, 1974). In the lithium cases, the clinical picture was that of an extensive psoriasis with less response to traditional therapeutic modalities; none of our 7 patients had palmoplantar lesions. Contrary to the practolol cases, ocular lesions have not been reported in the lithium patients. (3) The average time before skin lesions appeared was 29 months in 15 patients with cutaneous lesions from practolol (Behan et al., 1976). Felix et al. (1974) reported that 10 of 14 patients with the psoriasiform type of practolol rash had a latent period longer than 8 months (mean 13 months). In 3 patients with previous psoriasis, the mean time before the exacerbation of psoriasis was 17 months, and in 8 patients without previous psoriasis the corresponding figure was 15 months (Sondergaard et al., 1976). As for lithium, the skin lesions worsened within the first weeks to 2-4 months in cases reported by Carter, Bakker & Pepplinhuizen and Skott et al. In a recent Danish series of 8 patients, the latent period was 2-12 months with a mean of 5 months (Thormann, 1977). (4) Immunological abnormalities are common in patients with practolol reactions. Dahl et al. (1975) found circulating anti-nuclear antibodies in 42% ofthe patients and Behan et al. in 53%. Actually 87% were positive for at least one of the auto-antibodies (Behan et al., 1976). The significance of these findings for the development of skin lesions is unknown at present. An incidence of antinuclear factor of 18% in a series of lithium treated psychiatric patients has been reported (Presley, Kahn & Williamson, 1976). We have now examined 5 of our patients for rheumatoid factor, auto-antibodies to cell nuclei, thyroid antigens, gastric parietal cell, smooth muscle, epidermal intercellular material and basement membrane zone (in serum), and serum DNA binding capacity. The results were normal in all tests. The number of patients with psoriasis probably exacerbated by lithium is still small, but the available data indicate that there may be different mechanisms of action responsible for the cutaneous reactions to lithium and to practolol. Besides, it is interesting to notice that all 4 of our patients who were HLA-typed had one HLA-phenotype known to be associated with psoriasis (HLA-B13, -B13, -BW17, -Bw-17). The interrelations of lithium and psoriasis should be studied in a large group of subjects on a prospective basis.

Microvascular response to local application of dequalinium chloride. A vital microscopical study of hamster's cheek pouch and a microangiographic study of rabbit's ear.

Dequalinium chloride is a topical antiseptic, whose use may be attended by skin necrosis. Since microcirculatory changes are an early and distinct manifestation of tissue injury, the tissue damaging effect of dequalinium chloride on the microcirculation was examined.