Herbert Hönigsmann

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.

Epidermolytic hereditary palmoplantar keratoderma. Report of a family and treatment with an oral aromatic retinoid.

This study describes a family of 30 people in which 14 members have hereditary epidermolytic palmoplantar keratoderma. Four patients were treated with an oral aromatic retinoid for up to 5 months. They responded in a uniform and dramatic way: 10‐14 days after the onset of therapy, the hyperkeratotic horny layer was sequestered in large sheets resulting in normal appearing skin and restoration of normal surface sensitivity. Biopsies revealed that the underlying disorder of keratinization had remained unchanged. Treatment with the retinoid had to be discontinued as the sensitivity and vulnerability restricted normal function of hands and feet.

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).

Photochemotherapy for pustular psoriasis (von Zumbusch).

Photochemotherapy (PUVA) with oral methoxsalen and UV‐A was instituted in 8 patients with generalized pustular psoriasis (von Zumbusch). Complete clearing of skin lesions and of systemic symptoms was achieved in all patients. Patients who had been on systemic treatment prior to PUVA had to be treated with considerably more UV‐A energy than patients who had received topical therapy alone. Seven patients were kept in complete remission by maintenance therapy for an observation period of up to 1½ years. Side effects of systemic pre‐PUVA treatment resolved during several months of maintenance therapy.

Unscheduled DNA synthesis in normal human skin after single and combined doses of V‐A, UV‐B and UV‐A with methoxsalen (PUVA)

The aim of this study was to measure unscheduled DNA synthesis (UDS) by autoradiography in normal htiman skin (1) after high dose UV‐A, (2) after low dose UV‐A applied before or after erythemogenic doses of UV‐B, (3) after high dose PUVA and (4) after therapeutic doses of PUVA applied before and after erythemogenic doses of UV‐B.

Diffuse melanosis in metastatic melanoma: Further evidence for disseminated single cell metastases in the skin

Electron microscopy (EM) and electron microscopic cytochemistry have shown that diffuse melanosis in advanced metastatic melanoma is the result of an unlimited spread of single melanoma cells throughout the dermis; these cells retain their melanogenic capacity and continue to produce melanized melanosomes which eventually are deposited within dermal macrophages and thus impart to the skin a diffuse slate-blue color. These findings are in accordance with previous observations in a similar patient and thus support the concept that single cell metastasis represents a common pathogenic event in these patients.

Photochemotherapy with Furocoumarins (Psoralens)

Photochemotherapy is the combined use of a photosensitizing chemical compound with non-ionizing electromagnetic radiation to bring about a therapeutically beneficial result not produced by the drug or radiation alone. The drug may be applied topically or administered systemically to reach the skin via the circulation and is subsequently activated by irradiation with appropriate wavelengths.