Roger Clayton

Pityriasis lichenoides—an immune complex disease

Circulating immune complexes have been detected in patients with pityriasis lichenoides during disease activity when IgM and C3 have been observed in dermal vessels on direct immunofluorescence of fresh lesions. This implies that pityriasis lichenoides is an immune complex disorder and that deposited complexes play a part in the pathogenesis of the condition. There is a characteristic pattern of immunofluorescence which may be a diagnostic aid.

Immunofluorescence study of pityriasis lichenoides

In a study of 27 patients with pityriasis lichenoides IgM and C3 have been observed on direct immunofluorescence of fresh lesions. Other immunoglobulins and complement components were not observed. Immunofluorescence was seen in 31 (72%) of 43 fresh lesions. It occurred in the walls of superficial dermal vessels and along the dermal-epidermal junction. This pattern of immunofluorescence appears to be characteristic of the disease. Uninvolved skin showed the immunofluorescence less frequently and old scaly lesions none. The concept that pityriasis lichenoides is an immune complex disorder is discussed.

30) Benign hyperglobulinaemic purpura of Waldenstrom

There is no previous history of skin disease, no acne vulgaris. His mother and sister have been similarly affected. Examination. There are folliculo-papular lesions on his right cheek in a circular pattern occurring around a diffuse centrally scarred area (Fig. i). Biopsy. There are prominent piloscbaceous follicles with keratin plugging, and a chronic inflammatory reaction in the corium with a whorled fibroblastic proliferation in one area. No pustular, granulomatous or giant cell foci are seen, but some plasma cells and Russell bodies are present among the inflammatory cells. Treatment. July 1973, Tabs, Dcteclo 1 twice daily produced some improvement after 3 months, Dec. 1975. After a recurrence of his facial rash, erythromycin by mouth was prescribed with slight improvement. Feb. 1976. Prednisone 10 mg on alternate days was started and the erythromycin continued. Comment. The clinical appearance and histological changes arc compatible with a diagnosis of lupoid sycosis.

The effect of PUVA treatment on circulating lymphocytes.

8-Methoxypsoralen (8-MOP) followed by UVA irradiation (PUVA) is now an accepted mode of treatment in dermatology. About 40% of incident UVA passes through the epidermis to the dermis (Everett, Yeargers & Sayre, 1966) and concern has been expressed about the effects of PUVA on circulating lymphocytes. Repeated damage to lymphocyte DNA might impair their function and predispose to neoplastic changes. This is of particular importance in the otherwise healthy psoriasis patient who may have PUVA treatment for many years. Swanbeck et al (1975) have detected a significantly increased incidence of chromosomal aberrations in lymphocytes irradiated in vitro with UVA from patients who had ingested 8-MOP. Carter, WolfF & Schnedl (1976) showed that in vitro 8-MOP and UVA increases the incidence of sister chromatid exchanges (SCE) in cultural lymphocytes, and Mourelatos et al (1977) detected a significantly increased incidence of SCE using in vitro UVA irradiated lymphocytes from psoralen treated patients. But Swanbeck and Mourelatos were unable to detect these chromosomal changes in the in vivo situation. Scherer, Kern & Braun-Falco (1977), also using lymphocytes irradiated in vitro from psoralen treated patients, showed significant inhibition of phytohaemagglutinin (PHA) induced lymphocyte proliferation. We therefore thought it would be of interest to assess this lymphocyte function in psoriasis patients undergoing PUVA treatment. Three patients, who had had PUVA treatment for at least 6 months, were studied. Blood was taken 2 h after 8-MOP ingestion (circa o-8 mg/kg), before UVA irradiation (8-12 J/cm^), immediately afterwards and 24 h later. Lymphocyte PHA reactivity was assessed by a microtechnique using 5 p\ of whole blood diluted to 200 ^1 in RPMI medium containing 10% autologous serum and three diflferent concentrations of PHA. Normal ranges for adults have been established for this technique which has proved very sensitive for detecting impairment of T-lymphocyte function (Valdimarsson & Boler, 1979). The results for optimal concentration of PHA are shown in the table.

DNA synthesis and mitosis in uninvolved epidermis of persistent palmoplantar pustulosis.

Mitotic and DNA synthesizing cell counts have been performed in uninvolved epidermis of twenty‐one patients with persistent palmoplantar pustulosis (PPP). There was no difference in mitotic counts and DNA synthesis in PPP compared with normal epidermis, but both were significantly lower than those found in the clinically uninvolved epidermis of patients with psoriasis.

Betamethasone Valerate Ointment Compared With Fluocinonide FAPG: Use in the Treatment of Psoriasis and Eczema

• Betamethasone 0.1% as valerate in an ointment base and fluocinonide 0.05% in a fatty alcohol propylene glycol (FAPG) base have been compared in a double-blind trial of 76 patients with either eczema or psoriasis. The results show betamethasone valerate ointment to be significantly (P (Arch Dermatol113:599-601, 1977)