Per Thune

Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis.

In a double‐blind, block randomized study we investigated the effect of dietary supplementation with eicosapentaenoic acid in patients with psoriasis. The experimental group received 10 g of fish oil daily containing approximately 1.8 g eicosapentaenoic acid, while the controls were given an isoenergetic amount of olive oil. We found no significant change in the clinical manifestations of psoriasis in either group after 8 weeks of treatment. In the experimental group, the amount of n‐3 fatty acids in serum phospholipids was significantly increased at the end of trial as compared to pre‐treatment values, whereas the level of n‐6 fatty acids was decreased.

Epidermal and dermal distribution of a myelomonocytic antigen (L1) shared by epithelial cells in various inflammatory skin diseases

The L1 antigen is a major cytosol component of human granulocytes that may also be expressed by macrophages and epithelial cells. Its epidermal and dermal occurrence was investigated in formalin-fixed routine biopsy material from eleven different inflammatory skin disorders. Localization was performed with a rabbit antiserum to L1 applied in an unlabeled antibody peroxidase-antiperoxidase method. L1 antigen was not found in normal skin except in epithelial cells of pilosebaceous units. However, epidermal L1 antigen was demonstrated in every biopsy specimen from lupus erythematosus, lichen planus, dermatitis herpetiformis, and atopic dermatitis, whereas granuloma annulare test results were usually negative. The occurrence of dermal L1 antigen depended on the composition of the inflammatory infiltrate; specimens rich in neutrophilic granulocytes (e.g., dermatitis herpetiformis) were particularly strongly stained. Extracellular dermal staining was also seen, especially in areas adjacent to accumulation of positive leukocytes. The varying epidermal occurrence of L1 antigen in skin diseases probably signified different degrees of proliferative activity of the epithelial cells and could apparently not be ascribed to uptake from the dermis.

Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study.

The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double‐blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n‐3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P<0.001) and 24% in the corn oil group (P<0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n‐3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P<0.001), whereas the level of n‐6 fatty acids was decreased (P<0.001). In the corn oil group, arachidonic acid, docosahexaenoic acid, and total n‐6 fatty acids, increased significantly (P<0.05), whereas the other fatty acids were similar after corn oil supplementation, compared with baseline. Clinical improvement was significantly correlated with an increase in the concentration of docosahexaenoic acid (22:6, n‐3) in serum phospholipids for the total group (P<0.05). Our patients with atopic dermatitis had significantly lower levels of both n‐6 (P<0.01) and n‐3 (P<0.001) fatty acids in serum phospholipids prior to the start of the trial compared with patients with psoriasis.

The Scandinavian standard photopatch test procedure

Recognizing the growing need for international standardization of photopatch testing techniques, a standard procedure has been used by Scandinavian dermatological clinics since January 1980. The set‐up includes a standardized patient examination scheme, including phototest evaluation of the patients UVA‐ and UVB‐sensitivity, a standard photopatch tray containing 19 substances, and uniform techniques and criteria for the application and evaluation of the tests. Although modifications may be necessary in the future, preliminary experience with the Scandinavian photopatch set‐up has been encouraging, and several positive reactions to most of the substances used have been recorded in the first 350 patients tested.

Perfume allergy due to oak moss and other lichens

During a period of 2 1/2 years, 7 of 2000 patients routinely tested at our laboratory revealed contact allergy to oak moss in perfumes. All reacted to a mixture of different lichens and to some specific lichen compounds. The sensitivity was probably induced by cosmetics containing lichen substances, The following 3 compounds caused reactions in all patients tested atranorin, evernic and usnie acids, 3 of the patients and complete protection against light, rather than by irradiation alone. The data suggest that the sensitizing capacity of the lichen compounds is primarily of a contact rather than of photocontact nature.

The scandinavian multicenter photopatch study. Preliminary results

The Scandinavian photopatch test procedure has been applied to 745 patients with suspected photodermatoses during the years 1980‐1981. Our experience has been encouraging with the recording of several relevant reactions. A total of 132 positive photocontact reactions and 120 ordinary contact reactions Were seen. Photocontact reactions to musk ambrette (19 cases) and PABA (19 cases) were surprisingly frequent. The next most common photocontact reactions were to promethazine (24). chlorpromazine (22 cases and fentichlor (12). Ordinary contact reactions were observed to balsam of Peru (30). PABA (23), lichen mix (21), wood mix (14) and to perfume mix (10).

Pilot study of folate status in healthy volunteers and in patients with psoriasis before and after UV exposure.

Ultraviolet radiation, UV, is widely used for treatment of psoriasis. UV radiation may destroy blood folates in test tubes, but clinical data are scarce. Folate deficiency may increase the risk of cardiovascular diseases, colorectal carcinoma, megaloblastic anemia, pregnancy and birth complications, depression and dementia. The aim of the present study was to investigate the influence of solar radiation, sunbeds and/or broadband UVB phototherapy on the levels of serum and erythrocyte folate in patients with psoriasis or healthy volunteers. Serum and erythrocyte folate status in patients with psoriasis and healthy volunteers was measured before and after exposure to solar radiation, broadband UVB or use of sunbeds. In some cases plasma homocysteine and serum 25-hydroxyvitamin D (25(OH)D) were also measured. Serum and erythrocyte folate levels in healthy volunteers and in psoriasis patients were not influenced to any statistically significant extent after exposure to solar radiation, to single or to multiple UV treatments. However, a slight decay of blood folates and an increase of plasma homocysteine levels were observed in psoriasis patients after exposure to UV radiation. Exposure to sun or sunbeds does not have any significant effect on the levels of blood folate of healthy humans. High doses of broadband UVB phototherapy may slightly decrease blood folates in psoriasis patients. Further studies, using proper, adequate 5-methyltetrahydrofolate methodology, are needed to clarify the influence of broadband phototherapy on folate degradation and the consequences of these on the health of psoriasis patients.

The inhibiting effect of PABA on photocarcinogenesis

SummaryThe efficacy of a 5% solution of para-aminobenzoic acid (PABA) to protect against photocarcinogenesis was tested in 6 groups, each of which contained 30 light pigmented hairless mice. The light source was a Phillips TL 40 W/12, which mainly emits UVB. PABA significantly retarded the tumor induction time (p<0.05) and reduced both tumor yield and carcinoma yield (p<0.05). The dorsal skin of the mice was removed and weighed. The mean weight of UVR-exposed mice skin protected with PABA did not differ from that of the controls, but in the non-protected UVR-exposed mice the skin samples were significantly heavier (p<0.05).

Contact allergy due to lichens in patients with a history of photosensitivity

Ten patients with a history of photosensitivity and of a rash showed abnormal reactions to long‐wave UVR. The rash occurred particularly in areas exposed to light, though other areas were occasionally involved. The development of the rash could in all patients be related to contact with lichens and although exposure to sunlight usually led to an aggravation of symptoms, some patients, particularly forestry workers, showed exacerbations even during the winter. Positive responses were observed in both irradiated and non‐irradiated patch tests with different species of lichen and in several patients irradiation precipitated a stronger response. These findings suggest that lichens can cause both contact and photocontact dermatitis. The suspected allergens contained in these lichens are atranorin, physodalic and pysodic acids.

Psoralen/UVA treatment and chromosomes

SummaryFive psoriasis patients treated with 8-methoxypsoralen and UVA (PUVA) were studied by lymphocyte cultures at the 1st, 5th, 10th and 20th treatment and at a maintenance treatment 6 months later. Abnormal amounts of chromosome aberrations were not found, and the frequency of sister chromatid exchange (examined at the last treatment) was not increased. In vitro experiments with nanogram doses of psoralen (similar to plasma levels in patients) showed no increase in chromosome aberration or SCE frequency.The results indicate that therapeutic doses of PUVA have no clastogenic effect.ZusammenfassungLymphocytenkulturen von 5 Psoriasispatienten kamen zur Untersuchung, die mit 8-Methoxypsoralen und UVA (PUVA) behandelt worden waren. Die Untersuchungen wurden nach der 1., 5., 10. und 20. Behandlung und nach 6 Monaten zur späteren Wiederbehandlung durchgeführt. Es wurden keine abnormen Mengen von Chromosomenaberrationen gefunden und die Frequenz von Geschwisterchromatidaustausch (GCA) (untersucht nach der letzten Behandlung) war nicht erhöht. „In vitro”-Experimente mit Nanogramm-Dosen von Psoralen (entsprechend den Plasmaspiegeln der Patienten) ergaben keine Zunahme von Chromosomenaberrationen oder der GCA-Frequenz.Die Ergebnisse weisen darauf hin, daß therapeutische Dosen von PUVA keinen clastogenen Effekt besitzen.