Rona M. Mackie

Comparison of photodynamic therapy with cryotherapy in the treatment of Bowen's disease.

Summary The efficacy and suitability of photodynamic therapy (PDT) was compared with that of cryotherapy in the treatment of 40 lesions of Bowens disease. Lesions were randomized to receive either cryotherapy with liquid nitrogen, or PDT using a portable desktop lamp incorporating a 300 W xenon short arc discharge source. A porphyrin precursor, 5‐aminolaevulinic acid (5‐ALA), was applied topically 4 h before irradiation in the PDT group. Each lesion received 125J/cm2 at a fluence rate of 70mW/cm2. All patients were reviewed at 2‐monthly intervals and treatments repeated if required. Cryotherapy produced clearance in 10 of 20 lesions after one treatment, the remaining 10 lesions requiring two or three treatment applications. PDT resulted in clearance of 15 of 20 lesions after one treatment and of the remaining five lesions after a second treatment. The probability that a lesion cleared after one treatment was greater with PDT than cryotherapy (P < 0.01). Cryotherapy was associated with ulceration (five of 20), infection (two of 20) and recurrent disease (two of 20): no such complications occured following PDT. PDT using a non‐laser light source and topical 5‐ALA appears to be at least as effective as cryotherapy in the treatment of Bowens disease with fewer adverse effects.

Comparison of red and green light in the treatment of Bowen's disease by photodynamic therapy.

Background A variety of protocols exist for the treatment of Bowen’s disease by photodynamic therapy (PDT) using topical 5‐aminolaevulinic acid (5‐ALA). Objective To determine the optimal wavelength (red or green light) for this treatment. Methods A randomized comparison study of ALA–PDT using red (630 ± 15 nm) or green (540 ± 15 nm) light in the treatment of Bowen’s disease. Results The initial clearance rate for lesions treated by red light was 94% (30 of 32) in comparison with 72% (21 of 29) for those lesions receiving green light (P = 0·002). Over the following 12 months, there were two recurrences in the red light group and seven in the green light group reducing the clearance rates to 88% and 48%, respectively. The frequency and severity of pain experienced were similar between the two treatment groups. No hyperthermia, nor significant difference in lesional temperatures, was observed between the wavelengths studied. Conclusion Green light is less effective than red light, at a theoretically equivalent dose, in the treatment of Bowen’s disease by topical ALA–PDT.

Cutaneous and ocular side‐effects of oral photochemotherapy: results of an 8‐year follow‐up study

To determine the long‐term cutaneous side‐effects of oral photochemotherapy (PUVA), we examined 95 patients, 59 with psoriasis and 36 with mycosis fungoides (MF). These comprised 80% and 69% respectively of the patients with these disorders treated with PUVA in our department from 1977 to 1985. Two psoriatic patients had squamous carcinomas, both of whom had received high cumulative UVA doses and also methotrexate concurrently with PUVA. Six patients with MF had actinic keratoses. The mean age of these patients (69 years) was significantly greater than the mean age of the patients without actinic keratoses (54 years), but there was no significant difference in their cumulative UVA doses. No patients developed basal cell carcinomas or malignant melanoma. ‘PUVA lentigines’ were found in 46% of the patients. They were most frequent in patients currently being treated and in those who had received high cumulative UVA doses, but persisted for up to 7 years after discontinuing therapy.

Cellular fine structure in the invasive nodules of different histogenetic types of malignant melanoma.

Ultrastructural studies were carried out on the invasive nodule of forty malignant melanomas. The findings support the concept that the fine structure of lentigo maligna melanoma is often characteristic, and differs from that of superficial spreading and nodular melanoma. The melanosomes in lentigo maligna melanoma are usually ellipsoidal and resemble those of normal melanocytes, whereas the melanosomes in superficial spreading and nodular melanoma are most often spheroidal and abnormal in appearance. Superficial spreading and nodular melanomas cannot be distinguished reliably by their ultrastructure.

Development of an alternative light source to lasers for photodynamic therapy: 3. clinical evaluation in the treatment of pre-malignant non-melanoma skin cancer

The efficacy of a prototype non-laser light source for photodynamic therapy was assessed in clinical practice in the treatment of Bowens disease and actinic keratoses. The light source, incorporating a 300 W short arc plasma discharge, was adjusted by appropriate filters to produce a bandwidth of 630±15 nm. Topical 5-aminolaevulinic acid was applied 4 h before irradiation to permit production within the lesion of the active photosensitizer, protoporphyrin IX. Individual lesions received 94–156 J cm−2. Twenty lesions of Bowens disease and four actinic keratoses were treated in 12 patients. Patients were reviewed at monthly intervals and treatment repeated if residual disease was present. Clearance was achieved with a single treatment in 15 lesions and in all of the remaining nine lesions after a second treatment. The treatment was well tolerated, with pain absent or mild during treatment in 22 lesions, with only one lesion requiring local anaesthesia. Over the 10 days following treatment, no pain was associated with 21 treated lesions. During a 12 month follow-up period, two Bowens disease lesions recurred. The overall complete response rate was 92%. Scarring was evident following PDT in only three lesions. Photodynamic therapy using this portable non-laser light source appears to be an effective and well-tolerated treatment for Bowens disease and actinic keratoses.

A case of bullous pemphigoid and figurate erythema in association with metastatic spread of carcinoma.

Clinical and laboratory findings in a case of bullous pemphigoid developing during the course of metastatic spread of rectal adenocarcinoma are presented. In addition a transient figurate erythema occurred. The possibility of a causal relationship between bullous pemphigoid and malignant disease is discussed.

Treatment of extensive virus warts with etretinate (Tigason) in a patient with sarcoidosis.

A case of extensive warts complicating sarcoidosis is reported. An excellent clinical response has been achieved by the use of oral etretinate (Tigason).

Juvenile plantar dermatosis: A new entity?

102 children with dermatitis predominantly affecting the weight‐bearing areas of the feet, are described. Despite a clinical appearance suggestive of an allergic contact dermatitis, only thirteen children had positive patch tests to any substance in the European battery, or to constituents of their own footwear. The relationship of this condition to two similar dermatoses in the literature is discussed.

A comparison of the dermal lymphoid infiltrates in discoid lupus erythematosus and Jessner's lymphocytic infiltrate of the skin using the monoclonal antibody Leu 8

Jessners lymphocytic infiltration of the skin (14 cases) and discoid lupus erythematosus (13 cases) were studied and the lymphoid infiltrates in the dermis were compared in the two conditions, using a standard immunoperoxidase technique. Mouse monoclonal antibodies were used to identify T helper lymphocytes, T suppressor lymphocytes and, using the antibody Leu 8, “immunoregulatory lymphocytes”. It was shown that the proportions of Leu 8 positive cells was significantly different in the two conditions. The average percentage of Leu 8 positive lymphocytes in the dermal infiltrate found in the cases of Jessners was 65% (range 40–80%) whereas the average percentage in the cases of discoid LE was 15% (range 2–30%). This observation is further evidence that Jessners lymphocytic infiltration and chronic discoid lupus erythematosus should be regarded as separate entities.

Serum anti-tumour antibodies and auto-antibodies in vitiligo

Anti‐tumour antibody was sought in the sera of three groups of patients; idiopathic vitiligo, malignant melanoma and miscellaneous skin disorders. No precipitating antibody to a series of prepared pigmented tumour antigens was demonstrated. All sera were tested for a number of auto‐antibodies. No significant differences were detected between the groups. The evidence for an immunological factor in the causation of vitiligo remains circumstantial only.