Hans Hammar

Treatment of keloids with excision and postoperative X-ray irradiation.

During a 9-year period 47 patients with 62 keloids, treated with excision and postoperative superficial X-ray irradiation, were included in a retrospective study. The follow-up time was 6 months to 9 years. 88% experienced a good or excellent result. Single or fractioned dose and time interval between excision and radiation did not influence the result. Hyperpigmentation was noted as a side effect in 16 of 47 patients. More favorable results were obtained in the treatment of small keloids and of keloids located in the head-neck area compared to those on the trunk and the extremities.

Erysipelas and necrotizing fasciitis

The clinical course of necrotizing fasciitis in 8 patients is compared with observations on 22 other patients with erysipelas. In necrotizing fasciitis the early erythematous areas turn into a dusky blue colour with later vesiculation and formation of bullae. An important finding is a non‐pitting oedema extending outside the erythematous patches. The disease often progresses and involves further skin areas proximal to the initial ones. Gangrene tends to follow in multiple sites after the Ist week of illness. Group A streptococci in conjunction with widespread thrombosis and vascular necrosis of the involved skin are two major factors in the pathogenesis of the gangrene. Early debridement and excision of necrotic tissue in combination with large doses of penicillin and cloxacillin are confirmed as mandatory to remove toxaemia and inhibit further necrosis of the skin. In 3 of the 8 patients with necrotizing fasciitis the syndrome of disseminated intravascular coagulation complicated the course of the disease. A promising therapeutic result was seen in 2 further patients exhibiting alarming signs and symptoms of early necrotizing fasciitis; the combination of heparin, given intravenously in therapeutic doses guided by activated partial thromboplastin time studies, and of systemic antibiotics alleviated the symptoms, which vanished within 10 days of the start of treatment.

Psoriasis Treatment: Faster Clearance when UVB-Dithranol Is Combined with Topical Clobetasol Propionate

Fifty patients with plaque psoriasis were treated with dithranol and UVB 5 days per week. Twenty-six of these patients also received 13 treatments (once daily in the 1st week, every other day in the 2nd week, twice in the 3rd week and once in the 4th week) with topical clobetasol propionate. The median time for clearance was 2.5 weeks for those on the clobetasol propionate-dithranol-UVB combination compared with 4 weeks when only dithranol-UVB was used. Scaling and induration of the lesions disappeared during the first 2 weeks of treatment with clobetasol propionate-dithranol-UVB which was a significant improvement compared with dithranol-UVB alone. The time of remission in patients completely cleared was the same in the two groups. Relapses occurred slightly more often in the clobetasol propionate treated than in the control group (during treatment 5 of 26 versus 2 of 24; after 6 months 7 of 18 versus 4 of 15) but the differences were not statistically significant. The study shows that addition of topical clobetasol propionate according to our schedule to the traditional dithranol-UVB regimen of psoriasis results in a more rapid clearance of lesions without undesirable side effects.

Complement C3 proteins in psoriasis

A new polymorphism of the complement factor C3 in human plasma was demonstrated by isotachophoresis in agarose gels followed by immunodetection with rabbit anti‐human C3c and C3d immunoglobulins. Four bands were detected in the immunoprint of freshly drawn EDTA‐plasma, which were C3s1, C3s2, C3f1 and C3f2. At least four additional C3 components in Mg2+‐zymosan activated plasma were present, which were C3b1 to C3b4. The different forms of C3 in frozen and thawed heparin‐plasma from 20 patients with psoriasis and 20 healthy individuals were studied from the immunoprint. The total content of C3 components was 29% greater in the patients with psoriasis than controls. The major difference was in the C3b components which were increased by 46%. In psoriatic patients, the two slow C3 components C3s1 and C3s2 were increased by 24 and 56% respectively, when compared with controls. The two fast C3 components C3f1 and C3f2 were decreased to 29 and 37%. The results suggest a direct involvement of the complement factor C3 in psoriasis.

The rate of corneocyte formation in microscopic lesions in patients with active psoriasis

Microscopic lesions in active psoriasis were identified after careful examination with a magnifying glass in areas free of macroscopic lesions and of hair follicles. Biopsies were excised without anesthesia, immediately frozen and cryostat‐sectioned. Care was taken to preserve the horny layer which was stained to reveal corneocyte membranes and nuclei when present. The interlocking sheets of corneocyte layers made it feasible to outline and trace intercellular spaces parallel to the surface and count the number of corneocyte layers between pairs of these. It was assumed that the location of such a space in the horny layer indicates the period of time from its formation. This information was used to assess the rate of corneocyte layer formation at specified intervals of time. The result shows that adjacent areas of the horny layer could be compared and relative rates of corneocyte layer formation computed.

Studies on the energy metabolism in lichen planus.

Various epidermal enzymes and cofactors were measured in patients with lichen planus and in healthy controls with the aid of Lowrys microtechniques, including enzymatic cycling. The steady‐state levels of the nicotinamide adenine dinucleotides NAD* and NADP were decreased and this was evident even in areas still free from lesions. The oxidized and reduced portions of NAD were altered indicating changed equilibria of NAD dependent dehydrogenases. Reduced NADP was more tightly controlled at the normal level which is regarded as evidence of an unaltered biosynthetic potential in this disease. In conjunction with earlier data the results indicate a preserved glycolytic and pentose shunt activity while the mitochondria display signs of dysfunction.

Stimulated mouse ear epidermis in explant culture- The effect of retinoic acid and hexadecane.

SummaryEar skin of adult mice was used as a source of explant cultures of epidermal cells and the requirements for growth were defined. Two growth phases were observed, the first more rapid than the second. All-trans-retinoic acid or n-hexadecane was applied topically for up to 9 days and the skin was then used for explant cultures. During both treatments the ear became red and swollen. The epidermis became hyperkeratotic or deprived of its horny layer. The thickness of the stratum Malpighii increased to up to nine layers, from the normal of two or three layers. The stratum granulosum became multilayered and keratohyalin granules were abundant. Explants of n-hexadecane-treated skin behaved exactly as their normal controls. All-trans-retinoic acid induced an increase in migratory cell activity during the first growth phase. In the second growth phase the growth rate was similar or lower than that of the controls.ZusammenfassungDie Haut der Ohren von erwachsenen Mäusen war Material für Explantatkulturen von epidermalen Zellen und der Darstellung der Proliferationskinetik. Zwei Phasen des Wachstums wurden beobachtet, die erste ging schneller als die letztere vonstatten. All-trans-Retinoid Säure oder n-Hexadecan wurde am Ohr bis zu 9 Tagen gepinselt, dann wurde die Haut für Kulturen verwandt. Unter dieser Behandlung blieb das Ohr rot und angeschwollen. Die Epidermis wurde hyperkeratotisch und Stratum Corneum wurde abgestoßen. Die Dicke des Stratum Malpighii vermehrte sich bis zu neun Schichten, die Kontrollen um zwei bis drei Schichten. Das Stratum granulosum wurde vielschichtig und das Keratohyalin nahm reichlich zu. Die Explantate der Haut die mit n-Hexadecan behandelt wurden wie die der Kontrollen. Allotrans-Retinoid Säure induzierte eine vermehrte Migration von Zellen innerhalb der ersten Phase des Wachstums. Der Grad des Wachstums in der zweiten Phase war ähnlich oder geringer im Verhältnis zu den Kontrollen.

Epidermal nicotinamide adenine dinucleotides in psoriasis during treatment with dithranol

SummaryEpidermal nicotinamide adenine dinucleotides were measured in subcorneal and basal epidermal layers in patients with psoriasis and in healthy controls during a 2-week period in which they were treated once a day with 0.15% dithranol in white petrolatum. Lowrys microtechniques utilizing enzymatic cycling were used. In the controls the total NAD contents decreased 25% during the treatment period. The total NADP content did not change, nor did the proportions of NADH and NADPH.In the psoriatic patients effects of the treatment were seen only in the epidermis of the lesions. Both the total NAD and NADP displayed an initial increase on the second day, followed by a steady decrease to the levels found in the non-involved skin. During the first week of treatment parakeratosis was still evident in the lesions. In spite of variation in the total NAD contents during this period, a significant reduction of the percentage of NADH was found. Concomitant with the appearance of an orthokeratotic horny layer, both NAD+ and NADH returned to normal. The percentage contribution of NADPH did not change during these events.ZusammenfassungEpidermale Nicotinamid-Adenin-Dinukleotide wurden in den subcornealen und basalen Epidermisabschnitten von Patienten mit Psoriasis und bei gesunden Kontrollpersonen während einer Zeit von 2 Wochen bestimmt, in der diese einmal pro Tag mit 0.15% Dithranol in weißem Vaselin behandelt worden sind. Die Lowry-Mikrotechnik mit enzymatischem Cycling fand Verwendung. Der totale NAD-Gehalt in der Haut der Kontrollpersonen verminderte sich um 25% während der Behandlungsperiode. Der totale NADP-Gehalt war nicht verändert, auch nicht die Proportionen von NADH und NADPH.Bei den psoriatischen Patienten wurde die Wirkung der Behandlung nur in der erkrankten Epidermis gesehen. Der totale Gehalt von NAD und NADP wurde am 2. Tag am höchsten gesteigert. Danach senkte sich der Gehalt von NAD und NADP während der Beobachtungsperiode auf das Niveau, das die nichterkrankte Haut hatte. Während der 1. Woche der Behandlung wurde eine Parakeratosis weiter deutlich in der erkrankten Haut gefunden. Eine signifikante Verminderung des relativen NADH-Gehalts wurde während dieser Periode gefunden, obwohl Veränderungen des totalen NADH-Gehalts beobachtet wurden. Gleich-zeitig mit dem Erscheinen einer orthokeratotischen Hornschicht sinkt sowohl NAD+ als auch NADH auf die Norm zurück. Der relative Anteil von NADH bleibt stationär während dieses Vorganges.

Epidermal nicotinamide adenine dinucleotides in psoriasis and neurodermatitis (Lichen Simplex Hypertrophicus)

SummaryEpidermal nicotinamide adenine dinucleotides were measured in subcorneal and basal epidermal layers in patients with psoriasis and neurodermatitis and in healthy controls. Lowrys microtechniques utilizing enzymatic cycling were used. The total NAD content in these groups was except for the involved psoriatic skin about 1.1 mmoles/kg dry weight. Between 40 to 50% of this content consisted of the reduced form. In the involved psoriatic skin the total NAD content was increased to 1.5 mmoles/kg, this increase being mainly due to a rise in NAD+. There was no difference in NAD content between epidermal layers in the various groups studied.The total NADP content was near 0.15 mmoles/kg in healthy controls and in patients with neurodermatitis. The subcorneal layers contained 10% more of the dinucleotide than the basal layers, but in the two layers the reduced form amounted to about 80% of the total. In both non-involved and involved skin of the psoriatic patients the total NADP content was significantly increased above the control level, by up to 20% in the former and up to 65% in the latter. In the two layers studied the NADP+ content was increased by about 75% in both non-involved and involved areas. In contrast, the NADPH content rose only in the basal layers of the lesion, by 55%.The increased levels of NADP+ and NADPH found in psoriasis might suggest an accelerated or differently conducted NADPH dependent biosynthesis in this disease.ZusammenfassungEpidermale Nicotinamid-Adenin-Dinucleotide wurden in den subcornealen und basalen Epidermisabschnitten von Patienten mit Psoriasis und Neurodermitis sowie bei gesunden Kontrollpersonen bestimmt. Die Lowry-Mikrotechnik mit enzymatischem Cycling fand Verwendung. Der totale NAD-Gehalt in der Haut dieser Personen außer der erkrankten Haut von Psoriatikern war ungefähr 1,1 mmol/kg Trockengewicht. Etwa 40–50% von diesem Gehalt wurde in reduzierter Form gefunden. Der totale Gehalt der erkrankten Haut von Patienten mit Psoriasis war zu 1,5 mmol/kg erhöht. Die Vermehrung beruhte hauptsächlich auf einer Zunahme von NAD+. Es bestand kein Unterschied in dem NAD-Gehalt in den Epidermisabschnitten der verschiedenen untersuchten Gruppen.Der totale NADP-Gehalt war nahe 0,15 mmol/kg in den gesunden Kontrollpersonen und in den Patienten mit Neurodermitis. Die subcornealen Epidermisabschnitte enthalten 10% mehr von dem Dinucleotid als die basalen Abschnitte, aber die reduzierte Form betrug etwa 80% von dem totalen Gehalt in den beiden untersuchten Abschnitten. Der totale NADP-Gehalt in der nichterkrankten wie in der erkrankten Haut von Patienten mit Psoriasis waren signifikant über das Kontrollniveau erhöht. Die Vermehrung betrug bis zu 20% in der ersteren und bis zu 65% in der letzteren. Der NADP+-Gehalt in der nicht erkrankten wie in der erkrankten Haut der Psoriatiker war gleichmäßig etwa 75% in den beiden untersuchten Epidermisabschnitten erhöht. Auf der anderen Seite war der NADPH-Gehalt nur zu 55% in den basalen Epidermisabschnitten erhöht.Der erhöhte Gehalt von NADP+ und NADPH der in der Psoriasis gefunden wurde, ist ein Befund, der eine accelerierte oder anders geleitete NADPH-abhängige Biosynthese bei dieser Krankheit andeutet.

The specificity and cellular origin of phenylethanolamine N‐methyltransferase (PNMT)‐like immunoreactivity in psoriatic skin

Phenylethanolamine N‐methyltransferase (PNMT)‐like immunoreactivity has been found in psoriatic skin and in this study, PNMT‐like immunoreactivity was investigated in the involved and uninvolved skin of six patients with lichen planus and four patients with lichen simplex. No PNMT immunoreactivity was observed in these diseases. Studies were carried out using cultured fibroblasts from two patients with psoriasis from uninvolved and involved areas of skin and from two controls using antibodies to PNMT, as well as antibodies to the chemical messengers somatostatin, substance P, parathyroid hormone and peptide histidine isoleucine amide. No immunoreactivity to these substances was found, and fibroblasts are unlikely to be the cellular origin of the PNMT‐like immunoreactivity as seen in psoriatic skin.