Lars Halkier-Sørensen

The red man syndrome: Exfoliative dermatitis of unknown etiology: A description and follow-up of 38 patients

Thirty-eight patients with erythroderma of unknown etiology were diagnosed over a 15-year period, and represented 19% of all patients admitted to our department for erythroderma. The male:female ratio was 6.6:1, and the median disease duration was 2 years (range 1 to 23 years). Keratoderma of palms and/or soles was seen in 79%. Laboratory findings were normal, except for an increased IgE level in 69% of the patients studied. Lymph node histology showed dermatopathic lymphadenopathy. Bone marrow investigation results were normal in 48%, or showed eosinophilia (32%) or hyperplasia (20%). Initial skin biopsies showed nonspecific histology in most patients, but later biopsies revealed pleomorphic infiltration. During the observation period four patients progressed to mycosis fungoides and another nine patients were suspected of having mycosis. None developed Sézarys syndrome. Only one third of the patients went into complete remission; half of them died during the observation period. Patients with erythroderma of unknown etiology are predominantly men and seem to belong to a certain subgroup--herein called the red man syndrome.

A retrospective study of bone changes in adults treated with etretinate.

Ninety patients aged 17 to 80 years were treated with etretinate for disorders of keratinization and were studied for bone changes. The treatment lasted from 0.1 to 7.9 years, mean 2.4 years. The average dosage of etretinate was 0.57 mg/kg/day (range 0.21 to 1.32 mg/kg/day), and the total dose was 31 gm (range 1 to 197 gm). Standard radiographs of the axial and peripheral skeleton were evaluated. The films of 44 patients showed skeletal abnormalities such as periosteal thickening, hyperostosis of the vertebral column, disk degeneration, osteoporosis, calcification of the spinal ligaments, and slender long bones. The present data indicate that the risk of skeletal disorders in adults treated with etretinate is significant (44 of 90), but that the severity of changes is minor.

Long-term serological follow-up of patients treated for chronic cutaneous borreliosis or culture-positive erythema migrans

The kinetics of antibodies to Borrelia burgdorferi following successful treatment of early and late cutaneous borreliosis were analysed in consecutive serum samples by an enzyme-linked immunosorbent assay (ELISA) technique. Twenty-three patients with culture positive erythema migrans were followed for 23+/-14 months: 41% stayed seronegative, 35% showed an isolated immunoglobulin M (IgM) response, 8% an isolated IgG response and 16% a combined IgM and IgG responses. In general, antibody levels peaked within the first 3 months of symptom onset, whereafter a gradual decline was observed within 1 year. Twenty-two patients with chronic cutaneous borreliosis were followed for 23+/-11 months and all patients stayed IgG positive. Nearly three-quarters showed a clear decline in IgG levels over the years, while the rest did not. After 9+/-1 years 88% of 16 patients examined were still IgG positive. In conclusion, treatment of erythema migrans should be initiated on clinical appearance as a substantial number of patients stayed seronegative. Treatment success may in part be monitored serologically for both seropositive erythema migrans and chronic cutaneous borreliosis as most patients show declining titres after successful treatment. However, continuously high titres do not necessarily indicate treatment failure.

Equation for conversion of transepidermal water loss (TEWL) to a common reference temperature: what is the slope?

Transepidermal water loss (TEWL) is an indirect measure of skin permeability and barrier function. An essential influence on the rate of TEWL is skin surface temperature (1). To facilitate interand intrasubject comparisons, 2 formulae (date plotted semilogarithmically using common logarithms) have been proposed to convert TEWL at any given skin surface temperature to a common standard reference temperature of 30°C: (a) log TEWL30 =log TEWJ.r+0.084 (30-1) (2); (b) log TEWL30 =log TWELr+0.035 (30-1) (3). However, the calculated slopes of the 2 equations differ significantly, being 0.084 and 0.035, respectively. We have previously described the relation between skin surface temperature and TEWL among workers in the fish processing industry and other occupations (4). A significant linear positive relation was found between the respective temperature-TEWL values (p<O.OOl) in the various groups, and the temperature-TEWL relations in the respective groups were identical on the right and left side, and on the volar and dorsal aspect of the 3rd fmger. Furthermore, we found that the slope was identical (p=0.18) in all groups, indicating a similar temperature-TEWL dependence. We therefore decided, being in possession of several hundred temperature-TEWL values ( 4), where the skin temperature ranged from 15 to 35°C, to recalculate the slope.

Analysis of the human antibody response to outer surface protein C (OspC) of Borrelia burgdorferi sensu stricto, B. garinii, and B. afzelii.

Abstract The aim of this study was to determine by Western blotting (WB) the prevalence of anti-outer surface protein C (OspC) IgM and IgG antibodies in patients with Lyme borreliosis according to each of the three genospecies of Borrelia burgdorferi sensu lato. Strains of B. burgdorferi sensu stricto (MUL), B. garinii (DK 6), and B. afzelii (DK 26) served as antigen, all of which expressed abundant OspC. We examined sera from 117 patients with untreated early and late Lyme borreliosis, as well as from 100 blood donors and 29 patients with syphilis. WB results were compared with the B. burgdorferi flagellum enzyme-linked immunosorbent assay (ELISA) data. OspC from B. burgdorferi sensu stricto showed the lowest diagnostic sensitivity. OspC from B. garinii and B. afzelii performed almost identically in erythema migrans, with an IgM positive rate of 36% versus 34%, whereas OspC from B. garinii performed best in neuroborreliosis (60% versus 44%). The anti-OspC IgG response was less prominent than the IgM response and was infrequent in the late stages of the disease (0 – 20%). The benefit of combining the evaluation of anti-OspC responses with all three species was limited. The overall diagnostic sensitivity of WB anti-B. garinii OspC evaluation was, in the early stages of the disease, comparable to the results obtained using the flagellum ELISA. In erythema migrans and neuroborreliosis, the addition of anti-OspC IgM to the flagellum ELISA increased the sensitivity by 15% and 10%, respectively. It can, therefore, be concluded that OspC from B. garinii is a suitable OspC test antigen, and that supplementary use of OspC from other species adds little to the overall diagnostic sensitivity. An ELISA based on B. garinii OspC and native flagella seems currently the most promising concept for a future antibody test in early Lyme borreliosis.