Mystery syndromes.
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Dermatitis, Irritant↗
Biomedical subjects
M F Corbett
Publications and source records attributed to M F Corbett.
Flow cytometric analysis of basophil numbers in chronic urticaria: basopenia is related to serum histamine releasing activity.
BACKGROUND: Peripheral blood basophils are reduced in some chronic urticaria patients when counted with granule stains. Approximately 30% of patients with severe chronic urticaria have functional autoantibodies which release histamine from healthy donor basophils in vitro but the relationship between basophil numbers in vivo and serum histamine releasing activity has not been studied. OBJECTIVE: To determine the relationship between basophil numbers and serum basophil histamine releasing activity and to assess whether basophils are present, but undetectable, in peripheral blood with granule stains by using a new flow cytometric method based on surface immunophenotype. METHODS: Basophils were counted manually by a chamber method using a granule stain and by flow cytometry using dual staining with anti-IgE and anti-Fc epsilonRI in 25 chronic idiopathic urticaria patients and 25 healthy controls. Serum histamine releasing activity was assessed on healthy donor basophils in vitro and by the weal response to autologous serum skin testing in vivo (patients only). RESULTS: Basophils were significantly reduced in chronic urticaria by manual counting and flow cytometry. A subgroup of seven patients with in vitro histamine releasing activity showed a marked reduction or absence of basophils by both methods. There were no obvious distinguishing clinical characteristics between these patients and the others; six of them showed positive autologous serum skin-test responses. On comparing the two methods, the manual basophil counts were generally lower than flow cytometric counts. Agreement over the full range of values was not strong and therefore counts obtained by the two methods are not directly interchangeable. CONCLUSION: Basopenia in chronic idiopathic urticaria is associated with serum basophil histamine releasing activity in a subgroup of patients. The lack of granule and surface immunophenotype staining suggests a reduction in numbers rather than an inability to detect circulating degranulated cells by conventional counting methods.
Adolescent↗
Low-dose ultraviolet-B irradiation depletes human epidermal Langerhans cells.
We have examined the effects of low-dose monochromatic UVB irradiation (295 +/- 5 nm), biologically equivalent to that generally incident on the skin during a 12-session sun-bed course, on the expression of the CD1a epidermal Langerhans cell surface marker in human skin in vivo. In five subjects, 1.5 minimal erythema doses (MEDs) at 295 nm depleted its expression by 50%. In five further subjects, a single 1.5 MED dose, 1.5 MEDs in 10 equal fractions on alternate days, and a single 1.5 MED dose at one-tenth the previously used irradiance, delivered to separate sites, also led to variable but significant depletion of CD1a expression of around 30-50%. Thus, low-dose UVB irradiation, whether received rapidly or slowly, appears significantly and approximately equally to deplete human epidermal Langerhans cell numbers as measured by CD1a expression.
Antigens, CD↗
Cross-over designs for clinical trials.
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Clinical Trials as Topic↗
Treatment of atopic eczema with evening primrose oil.
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Anti-Inflammatory Agents, Non-Steroidal↗
Personal solar UVR exposure: a method of increasing the reliability of measurements made with film badge dosimeters.
Polysulphone film, mounted in single aperture badges, has been used extensively to monitor personal solar UVB (280-315 nm) exposure. The reliability of individual badge measurements after exposure to solar simulated radiation was calculated using a 2-way analysis of variance. A new badge mount has been designed with 4 circular apertures. This badge had a 30% greater reliability of measurement than the older badge. The new badges are equally acceptable to clinical trial participants and are more robust in structure. It is suggested that the 4-aperture badge might be a useful successor to the single aperture badge in future studies of this nature.
Film Dosimetry↗
Controlled therapeutic trials in polymorphic light eruption.
A series of controlled trials of treatments for polymorphic light eruption (PLE) with oral beta-carotene, ketoprofen and chloroquine, and topical benzimidazole sunscreen cream is described. Clinical features were recorded using diary cards filled out by the patients, and exposure to UVR was measured individually in all patients with film badges. Symptoms were found to be dependent on exposure. None of the treatments proved very effective, but beta-carotene seemed to give significant slight protection against irritation and erythema, though this was not confirmed in a repeat study using a higher dose. Chloroquine seemed to protect slightly against irritation. As the degree of improvement with chloroquine and beta carotene is quite small, equivalent to a protection factor of 2, it is arguable whether these treatments as used here are worthwhile and in the case of chloroquine, with its risk of adverse side effects, whether it is justifiable. Other treatment and dose regimes are possible and further trials seem worthwhile. Our studies have helped to define the special difficulties in collecting objective data in PLE and should improve the methods for assessing treatment in the photodermatoses.
Adult↗
Bullous pemphigoid: the frequency of mucosal involvement and concurrent malignancy related to indirect immunofluorescence findings.
A review of 124 cases of bullous pemphigoid was made and the clinical findings correlated with the results of indirect immunofluorescence. A circulating IgG basement membrane zone (BMZ) antibody was detected in the serum of eighty-nine (72%) of the patients. Antibody titres in these patients did not correlate with the extent of the disease or with the presence of mucous membrane lesions. Indeed, oral lesions were more common in the thirty-five sero-negative patients with 17% of such patients being affected compared to only 10% of those with positive indirect immunofluorescence findings. This difference, however, was not statistically significant. Concurrent malignant disease (i.e. malignancy occurring within 6 months of pemphigoid being diagnosed) occurred in eight of the seronegative group (23%) and in only four of the eighty-nine seropositive cases (4%); this difference was significant. The association of bullous pemphigoid and malignant disease still remains controversial, but those who believe that the relationship is coincidental must now explain why concurrent malignant disease is more common in patients who have bullous pemphigoid and negative indirect immunofluorescence findings.
Adult↗
The role of clinical trials in dermatology.
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Clinical Trials as Topic↗
Carcinoma cuniculatum: a cast metastasizing to skin and lymph nodes.
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Aged↗
A controlled trial of photochemotherapy for persistent palmoplantar pustulosis.
Twenty-two patients with bilaterally symmetrical persistent palmoplantar pustulosis were treated on one randomly selected side with oral psoralen and long-wave ultraviolet light. The treated side cleared completely in twelve patients, almost cleared in five patients and improved in four. One patient improved on both sides. Fifteen of the twenty-two patients were then treated with topical psoralen and long-wave ultraviolet light on the side that had previously been used as a control. Similar results were obtained. Seven patients cleared completely, six patients were much improved and two were improved. These results are significantly different from those liable to occur by chance (P < 0.001).
Administration, Oral↗
Assessing the treatment of solar urticaria. The dose-response as a quantifying approach.
The weal and flare produced by monochromatic irradiation in solar urticaria may be treated as a classical dose-response. This has been used to investigate therapy with H1 and H2 antihistamines. The conventional H1 drug proved superior. But from the practical viewpoint, solar urticaria is difficult to suppress even with a relatively efficient H1 Antihistamine, chlorpheniramine; the mean protective factor in 5 patients was only 2, insufficient for satisfactory clinical management.
Adult↗
Personnel radiation dosimetry in drug photosensitivity: field study of patients on phenothiazine therapy.
A lapel badge dosimeter sensitive to short wave UVR has been used in a preliminary trial to survey photosensitivity in psychiatric patients on phenothiazine therapy. The badge was found easy to use and the results suggest that chlorpromazine is more photosensitizing than other phenothiazines.
Adult↗
Description and application of a personal ultraviolet dosimeter: a review of preliminary studies.
Preliminary work on a dosimeter suitable for measuring UVR exposure on individual persons is described. It is based on the use of polysulfone film which, on exposure, shows a change in absorbance that is determined spectrophotometrically. The results of studies of groups of persons with vastly different degrees of solar exposure, e.g., outdoor and indoor workers and geriatric patients, and psychiatric patients with photosensitivity from phenothiazine drugs are presented. We consider the dosimeter may also be suitable for epidemiologic studies in sunlight-induced skin cancer.
Antipsychotic Agents↗
The long term treatment with beta-carotene in erythropoietic protoporphyria: a controlled trial.
The efficacy of oral beta-carotene for the prevention of photosensitivity symptoms in erythropoietic protoporphyria was studied in a controlled cross-over trial in which it was compared with a placebo. No significant difference was found between the 2 preparations. Patients' symptoms showed statistically significant association with sunlight hour records.
Adult↗
The response of psoriasis to betamethasone valerate and clobetasol propionate. A 6-month controlled study.
Twelve patients with symmetrical psoriasis were studied for a period of 6 months. Clobetasol propionate 0-05% ointment was applied to the lesions on one side and betamethasone valerate 0-1% ointment to those on the other side as a double-blind controlled trial of these two treatments. All the patients showed a relative improvement on the side treated with clobetasol propionate. Clobetasol propionate-treated lesions tended to clear for longer than the corresponding betamethasone valerate treated lesions. The condition of five of the patients was better at the end of the study period than at the beginning.
Adult↗
A double-blind trial of clomocycline in the treatment of persistent palmoplantar pustulosis.
Sixty patients with persistent palmoplantar pustulosis (PPP) were treated with clomocycline (Megaclor) in a double-blind, cross-over trial in an attempt to establish whether the condition responds to tetracycline. Each patient received 3 months each of clomocycline and placebo in random order. Forty patients completed the trial. Twenty-two failed to respond to either treatment, fifteen improved on clomocycline, two improved on placebo and one placebo and one improbed on both treatments. These results are highly significant (P = 0-003) and suggest that clomocycline may suppress pustulation in some patients. The twenty-two 'non-responders' were compared with the eighteen 'responders' for sex, age, length of history and associated psoriasis but no significant differences were found. Difficulties in assessment and the possiblity of improvement deing due to spontaneous remission are discussed. Further follow-up of both groups suggested that clomocycline used over long periods favourably influenced the course of the disease in the 'responder' group.
Adult↗