Harvey Baker

GENERALIZED PUSTULAR PSORIASIS

SUMMARY.— A series of 104 cases of generalized pustular psoriasis has been studied. The syndrome occurs predominantly in the second half of life, affecting both sexes. Two quite distinct sub‐groups were discernible. In the first the pre‐pustular phase of psoriasis began early in life, was typical through‐out and was prolonged. At least one third of these cases were apparently precipitated by the withdrawal of systemic corticosteroid therapy. Others were provoked by pregnancy or infection. It is likely that this type is usually extraneously provoked. In the second, the psoriasis was of late onset and atypical, acral or flexural patterns predominating in the pre‐pustular phase. In these progress to generalized pustular disease was rapid and apparently spontaneous.

Cell replacement in the human stratum corneum in old age.

SUMMARY. Staining of the human stratum corneum in vivo with fluorescent tetrachlorsalicylanilide has been used to measure the transit time of horny cells in the normal forearm skin of aged people. Stratum corneum thickness was estimated by counting the horny cell layers in biopsy specimens of epidermis, visualized by hydration in alkali. From the two parameters thus obtained, stratum corneum replacement rates were: calculated.

SYSTEMIC CONRTICOSTEROIDS AND FOLIC ACID ANATONISTS IN THE TREATMENT OF GENRALIZED PUSTULAR PSOBLASIS EVALUATION AND PROGNOSIS BASED ON THE STUDY OF 104 CASES

SUMMARY.— Treatment with systemically administered corticosteroids and folio acid antagonists was evaluated in 104 patients with generalized pustular psoriasis.

A prospective study of the effects of weekly oral methotrexate on liver biopsy

he results are reported of a prospective study of liver histological findings in twenty‐five patients with severe psoriasis subjected to liver biopsy before and at intervals after the onset of treatment with methotrexate by anintermittent dosage schedule. The pre‐methotrexate liver biopsy findings in forty‐one other severe psoriatics are also summarized.

INTERMITTENT HIGH DOSE ORAL METHOTREXATE THERAPY IN PSORIASIS

SUMMARY.— Eighteen patients with intractable or severe psoriasis have been treated for up to 28 months with intermittent large oral doses of methotrexate. The disease was completely controlled in 9 and partially controlled in 5 patients. Severe clinical side‐effects were seen in 5 patients, in 4 of whom therapy had to he abandoned. These effects were severe abdominal pain and vomiting in 2; reactivation of colitis, serious ataxia, and epidermal necrolysis in 1 patient each. Concurrent administration of aspirin probably contributed to toxicity by potentiating the action of methotrexate in 2 of these cases.

STRUCTURAL AND FUNCTIONAL ABNORMALITIES OF THE LIVER IN PSORIASIS BEFORE AND DURING METHOTREXATE THERAPY

Summary.— The treatment of psoriasis with methotrexate carries a low but definite risk of producing histological abnormalities in the liver. Forty‐two patients treated for 3 to 80 months were found to have more histological abnormalities than 25 untreated patients with equally severe psoriasis. Of the treated patients, 3 had cirrhosis, all of whom were heavy drinkers, and 12 had fibrosis. None of the untreated patients had cirrhosis, but 4 had fibrosis. Only the cirrhotic patients showed clinical evidence of hepatic inpairment.

PUVA therapy for psoriasis.

Photochemotherapy combines a natural or artificial light to achi effect not produced by the ch separately. Its use in psoriasis w in this journal over 4 years ago Warin 1979). Extracts of Ammi X used topically and orally since bil Nile Valley to induce inflammati( conjunction with sunlight to tr4 The isolation of 8-methoxypsc from the plant allowed clinical s (Lerner et al. 1953) and experime demonstrated the inhibition of D various tissues exposed to 8-MOI ultraviolet light (UVA) (Epsteii 1970, Baden et al. 1972). Vario confirmed the ability of topical p by UVA to induce resolution of I (Tronnier & Schule 1973, Walter the successful use of oral 8-MO followed (Parrish et al. 1974), the development of a high-poten PUVA had arrived. Many studies have since confir of oral PUVA therapy in psoi cooperative multicentre trials in E et al. 1981) and the USA (Me] Roenigk et al. 1979) have achi similar results. About 60% of completely cleared and another 31 improved. Less than 10% fail to i adversely. Treatment consists of the ora of 0.6 mg/kg of 8-MOP. Two h4 psoralen concentrations in the sk the whole body is irradiated with of UVA, starting with 1.0 J cm2 protected. The treatment is give times weekly and the UVA dose s to 7.0 J cm2 or more. In about the European study, a mean of 24 needed over 5 or 6 weeks to a to J. Rather higher doses and more 10 to 12 weeks were given in the study, probably because 3 rath( ments per week were favoured maintenance therapy, once optin been achieved, is controversial every 2 to 4 weeks may succe

Analbuminaemia with cutaneous angiomata.

Miss I Y, aged 65, a retired hospital personnel officer, developed severe ankle oedema at the age of 14. Following a diagnosis of Milroys disease, her legs were unsuccessfully operated upon. From the age of35, cutaneous angiomata began to appear and have recently increased in both size and number. Twelve years ago, analbuminaemia was diagnosed by Dr Tristram Freeman and regular treatment with albumin infusions was begun. Studies of the patients albumin metabolism at that time showed serum albumin 0.38 g/l (1.6% of normal mean) and fractional albumin catabolism 1.4%per day (16 %of normal). Her parents were first cousins. On examination, there was some ankle oedema. Profuse cherry angiomata which varied in size from minute dust-like particles to 1 cm diameter were present over chest, trunk and limbs (Figure I). Histopathology (Dr E Molland): Mildly dilated vessels in papillary dermis; epidermis normal. Some mild chronic inflammation, but no abnormal lipids in vessels walls. Other investigations: Serum albumin 34 g/l (normal 36-47), serum calcium 2.33 mmol/l (normal 2.12-2.62), serum cholesterol 10.2 mmol/l (normal 3.6-7.8).

4) Porphyria cutanea tarda

EBERHARTINGER, CHR. & NIEBAUER, G. (1961) Zur Prognose und Therapie des Pemphigus Vulgaris und ahnlicher Erkrankungen. Hautarzt, 12, 503. FOLDVARi, F. (1958) Pemphigus ou pemphigoide. Dermato logica, 117, 296. LEVER, W.F. (1953) Pemphigus. Medicine, 32, i. LEVER, W.F. (1965) In: Pemphigus and Pemphigoid, pp. 82-83. Charles C.Thomas. Springfield, Illinois. SNEDDON, I.B. & CHURCH, R. C1955) Diagnosis and treatment of pemphigoid—report on 22 cases. British Medica Journal, ii, 1360. STEWART, W.M., LAURET, PH, LECROQ, CL, & THOMINE, E . (1971) Pemphigoide bulleuse et alopecie cicatricielle, pemphigoide bulieuse et recidive in situ. Bulletin de la Societe franfaise de Dermatologie et de Syphiligraphie, 78, 412.

Serial liver biopsy findings in methotrexate-treated psoriasis

remaining cases. In vitro studies showed that one fraction only was responsible and this was confirmed by obtaining positive photopatch tests in human subjects. This fraction was also found to be present in only minimal amounts in the bergamot oil specimen B. These results highlight the importance of using a bergamot sample which contains adequate amoimts of the photo-active fraction; and of appreciating that a phototoxic response would be obtained in any individual, provided an open test technique is used with sufficient concentration. Therefore, in the study of the relevance of bergamot oil photosensitivity, in cases of melanoderma and photodermatoses, the significance of positive photopatch test results can only be determined by comparison with the results obtained using the same concentrations, vehicles, and test techniques, in normal control subjects.