Abnormal epidermal cell proliferation on the elbow in psoriatic and normal skin.
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Biomedical subjects
Publications and source records attributed to H Pullmann.
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Activity of acid non-specific esterase (ANAE) in infiltrating lymphocytes in nine patients with mycosis fungoides and four patients with parapsoriasis en plaques was examined in frozen tissue sections. Within the dermal infiltrate 81.7 +/- 6.1% of all lymphocytes contain this enzyme in mycosis fungoides, 74.7 +/- 3.3% in parapsoriasis en plaques. These results correlate well with the percentage of T lymphocytes determined by immunological techniques. Mycosis fungoides may be regarded as an ANAE-positive cutaneous T-cell lymphoma. Because of its simplicity this technique may be of value in further investigations of mycosis fungoides.
Protein A from Staphylococcus aureus, characterized by high affinity binding properties for IgG-type antibodies, was labeled with peroxidase to form a stable immuno-histological tracer molecule of comparatively low molecular weight. It has been used for demonstration of antibodies against tissue antigens, in direct and indirect techniques, and the findings were consistent with those in routine immunofluorescence and in staining with peroxidase-coupled anti-IgG. In comparison, the lowest unspecific tissue adsorption and staining was obtained with Protein A-peroxidase in buffer containing glucose and mannose. The immunohistological preparations were mounted and stored for documentation without apparent loss of staining.
20 patients with generalized psoriasis were treated with an apparatus containing UV-A-and UV-B-fluorescence tubes to be switched separately. The therapy was started with an UV-A-dose of 12 J
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In 16 patients with generalized psoriasis treated with oral retinoid (Ro 10-9359; 1 mg/kg body weight/(day) autoradiographic studies were performed before, and 24 h, 48 h, 1 week and 3 weeks after beginning of treatment on involved and non involved epidermis. During the first week no significant changes of all cellular parameters were found. However, after 3 weeks of continuing medication the increased 3H-thymidine labelling index was markedly lowered and the prolonged DNA synthesis time was shortened; whereas, the cell cycle time remained unaffected. The findings revealed that oral retinoid has a distinct influence on epidermal cell proliferation towards normalization in both involved and non involved epidermis in psoriasis. The time needed for this effect indicates that the drug does not directly interfere with the cell cycle. It seems reasonable, therefore, to combine oral retinoids as a basic adjuvant drug with other antipsoriatic techniques, such as retinoid + anthralin, retinoid + PUVA, retinoid + UVB.
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27 patients with generalized psoriasis were treated with oral administration of Ro 10-9359 (50--75 mg/d) and daily radiations with a source emitting UVA and UVB light at 292.5--335 nm (so called selective UV-phototherapy, SUP). In 24 patients full remission was seen, partly with few remaining lesions at the predilection sites. The average number of sessions necessary for clearing was 21.6 in 5.3 weeks. The total energy required was 68 J/cm2. Only slight side effects, such as cheilitis and hair loss (4 cases) were seen. The clinical efficacy of this combined retinoid-UV-treatment is comparable to the therapeutic effect of systemic PUVA; however, its practicability seems to be higher, and its application on an out-patient basis better.
In nine typical cases of dermatofibroma autoradiographic methods were used to examine the proliferative activity in the tumor and in the overlying epidermis. The number of DNA-synthesizing cells in the dermal nodular lesions was extremely low (0 -- 0.1%). In seven of nine skin lesions acanthosis was to be seen in the overlying epidermis. The quantity of DNA-synthesizing cells in the epidermis overlying the dermatofibroma was not related to the thickness of the epidermis and remained independent, whether the predominant element in the tumor is fibrillar or cellular. In this study we were able to demonstrate the existence of a direct relation between the degree of epidermal proliferation and the distance between the tumor and the epidermis. The duration of DNA-synthesis was constant.
In psoriasis the DNA synthesis time (ts) of keratinocytes in characteristically lengthened in unaffected skin, and in very early and also fully developed lesions. The prolongation of ts in unaffected psoriatic skin can be increased significantly by removal of the horny layer with adhesive tape. After the same procedure, ts remains unchanged in healthy skin and becomes shortened in the skin of patients suffering from atopic dermatitis. These variations of ts after a standardized irritation indicate that this phenomenon may be used in diagnosis of latent psoriasis.
Vitamin A, Vitamin A acid (retinoic acid) and their synthetic derivatives were variously applied in the management of psoriasis with different therapeutic results. Obviously, they influence the proliferation rate and the differentiation of human keratinizing epithelia and have beneficial effects on skin diseases with disturbances of keratinization, including psoriasis. Systemic application of Vitamin A has been yet largely abandonned since high dosages leading to clearing develop evident systemic toxicity. The anti-psoriatic effect of Vitamin A acid is either moderate or restricted, because of side effects. Only its combined local application with topical corticosteroids may be considered. Oral application of newly synthesized retinoids, however, was beneficial in psoriasis, particularly in erythrodermic or pustular types. With this group of retinoids new pathways were opened in dermatotherapy which may help to replace cytostatic drugs in these cases. Additionally, oral retinoid treatment may be introduced as an adjuvans in the management of widespread psoriasis, in order to enhance the effect of anthralin, PUVA or UVB treatments.
The combined application of an oral retinoid (Ro 10-9359) and phototherapy with predominantly UVB radiation (Selective Ultraviolet Phototherapy=SUP) is a new, highly effective method of treating psoriasis. It has few side effects and can be performed on an out-patient basis. With the aid of this combined treatment we achieved good or very good improvement in 19 out of 23 patients with generalized psoriasis (=82.6%). The average number of radiation sessions required to achieve this was 22.9, and the mean total therapeutic dose (TTD) was 73 J/cm2. In a control group of 40 psoriasis patients, who received only radiation therapy, we achieved good or very good results in only 60% with an average of 26 radiation sessions and 94 J/cm2 TTD. The effect of the oral retinoid and UVB radiation therapy is apparently additive, since the retinoid does not increase the sensitivity of the skin to light.
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Using sections from 10 early and five fully developed psoriatic lesions, we counted the mast cells in the papillary body. The results were evaluated statistically and compared with the findings of other researchers. The number of mast cells in the papillary body beneath the basal membrane shows a significant difference between early psoriatic lesions, fully developed psoriasis, and normal skin. Even in the very early lesion, the number of mast cells per mm3 is increased compared with the normal skin, though it is less than in fully developed lesions.
The capillary pattern of the papillary body in early psoriatic lesions was compared with that in normal skin and in full developed psoriatic lesions. In contrast to the normal skin, dilated and occasionally tortuous capillaries were already to be seen in early lesions. Furthermore, the density of the capillary network showed a significant increase, which may have been due to neovascularisation. Our histological examination of fully developed psoriatic lesions revealed the characteristic capillary pattern. The increased capillary density is most probably caused by coiling of the capillaries; it is also possible, however, that the difference between early and advanced psoriatic lesions is due to further vascular proliferation.