M. M. Polenghi

Family history, smoking habits, alcohol consumption and risk of psoriasis

Summary We have conducted a multicentre case‐control study to assess the epidemiological importance of previously suggested risk factors for psoriasis, including family history of the disease, smoking and alcohol consumption. Newly diagnosed psoriatics, with a history of skin manifestations no longer than 2 years were eligible as cases; as controls we selected subjects with newly diagnosed dermatological conditions other than psoriasis. Interviews were performed by trained medical investigators using a structured questionnaire. Two‐hundred and fifteen cases, aged 16–65 years (median age 38), and 267 controls, aged 15–65 years (median age 36), were interviewed and included in the analysis. Family history was a risk factor for psoriasis; the multiple logistic regression (MLR) adjusted‐odds ratio was 18.8 (95% confidence interval 6.4–54.8) for a history in parents, and 3.2 (95% confidence interval 1.5–6.6) for a history in siblings. The risk of psoriasis was higher for current smokers than for those who had never smoked. The MLR adjusted odds ratio was 2.1 (95% confidence interval 1.1–4.0) for people smoking 15 cigarettes or more per day. The risk of psoriasis was higher for alcohol drinkers: compared with teetotallers the MLR adjusted‐odds ratios were 1.3 (95% confidence interval 0.8–2.3) for subjects drinking one or two drinks/day and 1.6 (95% confidence interval 0.9 to 3.0) for those drinking three or more. However, the trend in risk was not statistically significant. Our study confirms the role of family history in psoriasis and provides some evidence of a dose‐response relationship for an association between smoking habits and psoriasis.

Occupational dermatitis in bakers: a clue for atopic contact dermatitis

6 patients are described who developed contact dermatitis after cereal contact on atopic skin for periods of 2 to 20 years. 2 patients were wheat flour patch‐test‐positive. They had punch biopsies taken for standard histological and immunohistochemical investigation by labeling with monoclonal antibodies. anti‐DR and anti‐IgE. Sections showed features of contact dermatitis. There were many dendritic cells located perivascularly in the papilla and in the epidermidis, intensely positive for monoclonal anti‐IgE antibody. In control atopic subjects, there were a few perivascular IgE positive cells, probably mastocytes. This study shows that there may be a relationship between some allergens and atopic eczema in patients exposed to them in the course of their work. In some cases, there was a true allergic contact dermatitis, seen through the clinical and histological characteristics, and the results of immunohistochemical study.

Isotretinoin versus Minocycline in Cystic Acne: A Study of Lipid Metabolism

We have recently reported that patients with severe nodular cystic acne have much lower levels of HDL-cholesterol, apolipoprotein A and hepatic lipoprotein lipase than healthy controls or subjects with acne vulgaris. Since isotretinoin is very effective in the treatment of the nodular cystic acne but has been shown to increase blood lipid levels, we decided to compare its clinical effectiveness and its effects on lipid metabolism with those of minocycline in patients with nodular cystic acne. After 20 weeks, the number and mean diameter of the cysts were definitely decreased in both groups, but the improvement was more striking in the isotretinoin-treated group. At the end of the treatment, the HDL-C and hepatic lipoprotein lipase levels in this group were increased toward normal, but not in the minocycline-treated group. Our study showed a significant remission in the acne of patients treated with isotretinoin but not in that of the minocycline-treated patients. Furthermore isotretinoin can also correct the altered lipid metabolism in these patients.

Complement cleavage products in the phototoxic reaction of porphyria cutanea tarda

We have measured C3, C4, CH50 and complement cleavage products C3a and C5a in sera and plasma from PCT patients and normal controls 10 min and I, 4 and 24 h after UVA irradiation.

Dystrophic Epidermolysis bullosa inversa: A Case Report

The inverse form of recessive dystrophic epidermolysis bullosa is a rare genodermatosis characterized by a smouldering course of integumental blistering with improvement of lesions in adulthood, preferential localizations of lesions in flexural areas, severe oral and esophageal mucosal involvement and nail dystrophy. We describe a 41-year-old patient showing all the typical features of this form of epidermolysis bullosa. Ultrastructural findings in specimens obtained from perilesional and healthy skin were similar to those usually observed in the Hallopeau-Siemens form of epidermolysis bullosa. The patient has been treated with phenytoin for a period of 9 months with considerable improvement of the skin manifestations.

IgE on skin dendritic cells: a clue for work-related atopic dermatitis.

P.D.Pigatto, E. Berti, G.F. Altomare, M.M. Polenghi, Second Department of Dermatology, University of Milan, Via Pace, 9, I– 20122 Milan (Italy) We have read the paper of Bruynzeel-Koomen [2] dealing with the experimental evidence for IgE on the surface of Langerhans cells in atopic dermatitis. In our laboratory we have been studying this topic for a long time and in March we submitted an abstract for the 8th International Symposium on Contact Dermatitis held in Cambridge [3], the gist of which is that we have recently seen 5 bakers with the clinical characteristics of atopic dermatitis on the skin, where they come into contact with flour. They also had higher IgE levels and RAST positivity for cereals. We compared this group with 10 control subjects with atopic eczema but without reactions to cereals or grasses. The subjects undergoing the investigation were patch-tested with 3 cereals and as a control with allergens like mite and Al-ternaria, both at a concentration of 100 times the concentrations used for the ordinary prick test. Only 2 of the 5 patients with workrelated dermatitis had a positive reaction for cereals. None of the control reacted to these substances. To better understand the mechanism of skin sensitization, usage tests were run by having the patient apply wheat flour twice daily for no longer than 2 weeks. Positive results were detected for all 5 bakers but we were not able to determine the absolute separation of allergic from irritant dermatitis. Two of the subjects had punch biopsies for immuno-histochemical investigation of tissues with APAAP and the monoclonal antibodies anti DR, RFBD7, and IgE. The immunohistochemical study showed many cells to be positive for the anti-IgE antibody. In the skin of the control atopic subjects there were a few perivascular IgE-positive cells, probably mastocytes. This study showed that there may indeed be a relationship between some allergens and atopic eczema in patients exposed to them in the course of work. We are thus able to confirm the data of Bruynzeel-Koomen [2] and Bruynzeel-Koomen et al. [1]. We feel also that the mechanism might be involved not only for inhalant allergens but for some allergens introduced by mouth and some topical allergens. In our opinion this phenomenon is widespread and important and it may provide clues for understanding some specific forms of eczema. This may be a new type of immunoreaction in atopies. Letters to the Editor

Ketanserin in the treatment of progressive systemic sclerosis

Now progressive systemic sclerosis (PSS) is considered a disease of small vessels with which many immunologic alterations are associated. The presence in the blood of large amounts of serotonin can be considered a very important aggravating factor able to cause the sclerodermic alterations. The authors have treated 10 PSS patients with ketanserin, a selective antagonist of the S2 serotonin receptors, which are found in small vessels and platelets. Their results show that ketanserin represents an efficacious and very well tolerated therapy for treatment of the initial vascular symptoms of PSS.

Medicament dermatitis around leg ulcers due to lack of protein C.

The spermicidallubncant of Durex Top Safe IS tecto! and has a constituents: a spermicidal agent (texafor FNI1 = 2, 4, 6 tn-1sopropyl polyethoxy-phenol), polyethylene glycol and 2 coded perfumes. The nonspermicidal lubncant of Durex Fetherlite IS sens1tol and consists of a silicone flmd (poly-tnmethyl siloxane). Sensitization to phenoxypolyethoxy ethanol (0.5% pet.) has been described by Fisher (2). It appeared that after handling the contraceptive (Durex Top Safe) and durmg mtercourse, the partner of the patient usually placed his hands on the patients body on areas corresponding with the sites of dermatitis (Fig. 1). To which exact constituent of Tecto! (texafor FN11 or perfumes) the patient was sensitized could not be established, because she refused further testing.