[The dermatologic department, Rikshospitalet, is 150 years old].
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Biomedical subjects
Publications and source records attributed to G Rajka.
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Incidence of malignant melanoma of the skin has risen rapidly during the last decades. Mortality rates are also rising, although not so much as incidence rates. There is strong evidence that exposure to sunlight is a major factor in the etiology of melanomas. There appears to be no direct cumulative dose-response relationship, except in the case of lentigo maligna melanoma. Episodes of sunburn among children and young individuals seem to be more important as an etiologic factor for melanoma than chronic exposure to the sun. Very high risk of melanoma exists in persons with dysplastic nevus syndrome. Persons with giant congenital nevi are also at increased risk. However, many melanomas arise de novo. It is our intention to reduce mortality by screening families at risk, by early detection and treatment of melanomas, and by education.
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The major symptoms of Lawrence-Seip syndrome or generalized lipodystrophy consist of muscle hypertrophy, loss of subcutaneous fat, hyperlipaemia, diabetes mellitus and acanthosis nigricans. We have successfully treated acanthosis nigricans in a patient with Lawrence-Seip syndrome.
A case of EAC type psoriasis is reported. Routine and immunologic investigations were negative. HLA-B8 was found by typing. Some therapeutic benefit was achieved by combination of retinoid (Ro-10-9359) plus PUVA. According to a review of the literature half of the cases are unconnected to classical psoriasis, whereas the other half is connected and mostly of (periodic) pustular character. The necessity of clinical research in this intermediate type between psoriasis vulgaris and pustulosa is emphasized.
The immunologic events of pustule formation in pustulosis palmoplantaris (and in pustular psoriasis) have been discussed with special reference to demonstrating the presence of immunoglobulins and complement within vessels walls, at the epidermo-dermal junction, in the horny layers and around the pustule, as well as its possible significance for the accumulation of leukocytes.
Patients with pure atopic dermatitis with and without tinea infection were investigated and compared with patients with long-lasting tinea infections and with controls, for presence of intracutaneous reactivity to trichoptin, Penicillium, Cladosporium and Alternaria antigens. RAST to Penicillium and Cladosporium was also performed. The results showed a lack of delayed reactivity, but an immediate reactivity to trichophytin in 50%/40% of atopic patients with/without tinea infection. Non-atopics infected with tinea showed 66% immediate and 33% delayed response to trichophytin. The reactivities in atopic dermatitis (but not in the non-atopic group) went general parallel with mould reactions tested intracutaneously or by RAST. It is assumed that a positive trichophytin reaction in atopic dermatitis does not necessarily mean sensitisation to dermatophytes, but is primarily the sign of a cross sensitivity to moulds.
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The percentages of lymphocytes carrying different classes of membrane-bound Ig, and lymphocytes forming rosettes with sheep erythrocytes (E-RFC), as well as lymphocytes with receptor for the Fc-part of IgG (EA-RFC) were determined in 19 patients with atopic dermatitis. Lymphocyte suspensions were also stained with a specific rabbit anti-human T-lymphocyte antiserum. Furthermore, the serum concentration of IgG, IgA, IgM and IgE and the complement factors C3 and C4 were measured. A small but significant increase in lymphocytes with membrane-bound IgE and an increase in the serum concentration of IgE and complement factor C4 were observed. A decrease in the percentages of lymphocytes with receptors for sheep erythrocytes (E-RFC) was also found. The percentages of lymphocytes that stained with the anti-T antiserum correlated well with the percentages of lymphocytes forming rosettes with sheep erythrocytes. In one patient we found increased IgE positive lymphocytes, increased IgE serum concentration and a decreased T-cell number.
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In 25 of 35 cases of acne conglobata, a reduction in or lack of delayed reactivity was found by intracutaneous tests with a battery of antigens. On the basis of these findings as well as of normal T-cell function in lymphocyte culture and of negative Kveim-tests (in three cases), the possible immunological mechanisms are discussed.
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The transepidermal water loss (TWL), photoelectric plethysmography and reflex photometry were parallelly registered on the involved hands and forearms of psoriatics. The TWL values showed a fairly good correlation with the clinical course of the disease: they increased during the active phase and decreased after return to normal. The vascular tests did not show a strict parallelism with the clinical state. On the basis of the findings, the temporal relations between epidermal and vascular factors during the different phases of the psoriatic process are discussed. The TWL can be used to predict a relapse occurring on the area investigated but not on a distant area.
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