I.A. Magnus

“ACTINIC RETICULOID”: A CHRONIC DKHMATOSIS ASSOCIATED WITH SEVERE PHOTOSENSITIVITY AND THE HISTOLOGICAL RESEMBLANCE TO LYMPHOMA

SUMMARY.— Ten elderly male patients with severe persistent photosensitivity of unknown cause are described. The clinical presentation was that of an intense eczematous eruption affecting exposed sites but spreading elsewhere. Frequent episodes of erythroderma were characteristic and in some cases the marked thickening and ridging of the exposed skin simulated a lymphoma. In contrast to most other photodermatoses the photosensitivity extended through the u.v. to the visible spectrum. A wide range of histological changes were noted, in several instances closely resembling lymphoma because of the intensity and pleomorphism of the infiltrate.

Thalidomide in actinic prurigo

Fourteen patíents sufferíng from actíníc prurígo were treated with thalidomide. Eleven patients showed lasting improvement on the drug and three of these remained symptom‐free after discontinuing therapy. No major side‐effects were observed. Thalidomide is an effective drug in the treatment of actinic prurigo but it must be used with adequate contraception in women of child‐bearing age.

Prophylactic PUVA and UVB therapy in polymorphic light eruption—a controlled trial

A double‐blind controlled trial of low‐dose prophylactic oral psoralen photochemotherapy (PUVA) and ultraviolet‐B (UVB) irradiation therapy was undertaken from April to September 1983 in 42 patients with polymorphic light eruption (PLE). Patients were randomly allocated to three groups, PUVA with oral 8‐methoxypsoralen (8‐MOP), UVB with oral placebo, and control low‐dose UVA with oral placebo. The initial dose given to each active treatment group was a third of the predetermined minimal phototoxic or erythema dose, followed three times weekly for 6 weeks by doses incremented by an eighth on each occasion in the PUVA group and by a seventh in the UVB group. Ultraviolet radiation exposure was monitored throughout with polysulphone film lapel badges. Patients recorded their symptoms on a visual analogue scale. Symptoms of rash and itch in patients treated with PUVA and UVB were significantly less affected by increasing exposure to ultraviolet radiation than were these symptoms in control patients.

Hydroxychloroquine in polymorphic light eruption: a controlled trial with drug and visual sensitivity monitoring

A double‐blind controlled trial of oral hydroxychloroquine (HC) treatment in polymorphic light eruption (PLE) was completed in 13 patients on active treatment and 15 on placebo during June, July and August 1982. HC dose was 400 mg daily for the first month and 200 mg daily thereafter. Exposure to ambient solar ultraviolet radiation (UVR) was monitored throughout the trial by polysulphone film lapel badges. Patients scored their symptoms on a visual analogue scale. Drug concentration was monitored in plasma and hair, and oculotoxicity was assessed by visual contrast sensitivity. Moderate clinical improvement occurreds associated with a statistically significant improvement in skin rash (P < 0.01).

Controlled therapeutic trials in polymorphic light eruption

A series of controlled trials of treatments for polymorphic light eruption (PLE) with oral β‐carotene, ketoprofen and chloroquine, and topical benzimidazole sunscreen cream is described. Clinical features were recorded using diary cards filled out by the patients, and exposure to UVR was measured individually in all patients with film badges.

Low-dose oral chloroquine in the treatment of porphyria cutanea tarda.

Seven patients with porphyria cutanea tarda received a total of ten courses of low‐dose oral chloroquine therapy (125 mg chloroquine phosphate twice weekly). Patients were treated for a mean 14.9 months during which time all went into clinical and biochemical remission. Relapse occurred in four patients on a total of six occasions after a mean 17 months. In four patients there was no relapse after a mean 47·3 months. There were no adverse side‐effects from the treatment. Low‐dose oral chloroquine therapy appears to be a safe, effective and convenient treatment for porphyria cutanea tarda, although relapses may occur requiring further therapy.

A case of urticaria solaris studied with a monochromator.

PATIENTS with, urticaria Solaris were divided by Blum (1954) into two groups, according to whether the wave-lengths which caused wheals were shorter or longer than 370 m/i (Blnin, Jiarksdale and Green, 1946 : Blum, Baer and Sulzborger, 1946). In the first group, in which wheals were caused by the shorter wave-lengths, passive transfer of sensitivity could usually be carried out successfully, but not in the second. Most patients in whom sensitivity to difFereiit wave-lengths has been adequately investigated can be placed in one of these two gronps—those of Beal (1948) and Epstein (1949) in the first, and those of Blum, Allington and West (1935) and of Kesten (1951) in the second. However, in a patient of Wiskemann and Wulf (1950) urticaria was provoked by wavelengths of 310-350, 490-520 and 600-680 m// ; in this patient passive transfer tests were positive. Another case which does not fit into this classification was described by Porter (1954). In his ])atient wheals conld be elicited with monochromatic light from a mercury arc s}3ectrograph. Owing to lack of suitable quartz apparatus tests were not carried out at short ultra-violet wave-lengths of 280-320 m/r. It waa found, however, that the 365 m/i line in the ultra-violet and lines in the violet, blue, green, yellow and orange regions produced wheals. Light from a tungsten source, so filtered that only wave-lengths in the infra-red were transmitted, also led to wliealing. Passive transfer tests were l-ejieatedly negative. Although Wiskemann and Wulf, in describing their case, claimed it as unique, it can be seen that Porters earlier case resembles theirs in the wide range of wave-lengths producing wheals. Neither of these cases fits into Blums classification.

The efficacy of phototherapy in polymorphic light eruption

ROGERS, M.F., MORENS, D.M., STEWART, J.A., KAMINSKI, R.M., SPIRA, T . J., FEORINO, P.M., LARSTEN, S.A., FRANCIS, D.P., WILSON, M . & KAUFMAN, L . (1983) National case-control study of Kaposis sarcoma and pneumocystis carinii pneumonia in homosexual men; Part 2. Laboratory results. Annals of Internal Medicine, 99, 151-15S. ROWLAND PAYNE, C.M.E., FARTHING, C , BYROM, N . & STAUGHTON, R .C .D . (1984) Shingles in seven homosexuals. Lancet, i, 103-104.