Biomedical subjects
Publications and source records attributed to M J LeVine.
Firm, red, subcutaneous plaques developed on the cheeks of a 19-month-old girl during a one-month period of rapid steroid withdrawal. The clinical features were most consistent with poststeroid panniculitis. This rare complication of steroid therapy should be differentiated from other causes of red cheeks in children.
In vitro exposure of peripheral blood lymphocytes (PBLs) to doses of ultraviolet radiation (UVR) achievable during recreational sun exposure produces profound inhibition of lymphocyte blastogenesis. This study demonstrates that this inhibition is mediated by a direct dose-dependent effect on populations enriched for T-lymphocytes and is reversible after incubation of responder cells with phytohemagglutinin (PHA). In contrast, monocyte accessory function for both antigen- and mitogen-induced proliferation is relatively unaffected by in vitro exposure to UVR at doses up to 30 mJ/cm2. Exposure of PBL to UVR also results in the induction of a suppressor mechanism that inhibits the proliferation of unirradiated PBLs. In vitro exposure of human blood cells to UVR may provide a valuable tool for examining the cellular basis for the immunosuppressive effects of UVR.
Natural killer (NK) activity of human mononuclear cells is sensitive to inhibition by radiation, under the control of polymorphic X linked genes. In order to define the mechanism of this inhibition, we have evaluated the ability of treatments known to damage DNA to inhibit NK activity. The alkylating agents streptozotocin (SZ) and N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) were potent inhibitors of NK activity. Further, a specific competitive inhibitor of adenosine diphosphoribosyl polymerase (ADPRP), 3-aminobenzamide, was able to prevent inhibition by gamma-radiation, UV radiation, and the two alkylating drugs, SZ and MNNG, suggesting the ADPRP, known to be activated by DNA strand breakage, mediates the inhibition by these treatments. NK activity of radioresistant subjects was somewhat more resistant to inhibition by SZ or UVR when compared to radiosensitive NK activity but neither of these treatments gave the clear phenotypic distinction of gamma-radiation, suggesting that chemical strand breakage does not precisely model gamma-radiation and also that the mechanism of UVR inhibition may differ from that of gamma-radiation. These results indicate a role for activation of ADPRP in the inhibitory effect of UV and gamma-radiation on human NK activity and suggest that the biochemical basis for polymorphism in the sensitivity of NK activity to gamma-radiation will be found in the sensitivity to ADPRP activation or the level of activation of this enzyme, known to be the key to DNA repair.
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A 61-year-old man was seen for a long-standing, recurrent eczematous dermatitis that appeared only in the summer. A patch test with ammoniated mercury was positive. Photopatch reactions to caine mix and paraphenylenediamine were positive, and phototesting disclosed an idiopathic photosensitivity to UV-A. Avoidance of sunlight exposure and the use of chemical sunscreening agents prevented further recurrence of the dermatitis.
A case is reported of occupational exposure to diaminodiphenylmethane leading to acute photosensitivity. Avoidance of sun exposure with cloth has allowed continued employment while preventing further recurrences.
Exposure to ultraviolet radiation (UVR) has been implicated in the predisposition to certain neoplasms and leads to viral reactivation. Natural killer (NK) activity may play a role in immunosurveillance and response to certain viral infections. We have evaluated the sensitivity to UVR of human NK activity, a nonproliferative function, and the proliferative response to the mitogen phytohemagglutinin (PHA). In vitro exposure to UVR resulted in a dose-dependent inhibition of NK activity and response to PHA. The wavelength dependence for UVR inhibition of NK activity and of the PHA response of lymphocytes were virtually superimposable at wavelengths at or above 300 nm, but NK activity was less sensitive to UVR at 260 and 280 nm. Maximal sensitivity for both functions was found at 260 nm, consistent with a nucleic acid chromophore mediating UVR inhibition of both activities. The DNA-directed drugs mitomycin C, acridine orange, and adriamycin at concentrations that inhibit proliferation are poor inhibitors of NK activity. These results suggest that UVR inhibition of NK activity as well as proliferation may be mediated by a nucleic acid chromophore. NK activity, however, is less sensitive to direct damage of DNA by alkylation, distortion, or oxidation. At 300 nm, the amount of radiation required to inhibit NK activity and proliferation is within the range penetrating to the dermis and capillaries during environmental exposure to sunlight.
Eleven patients with chronic pityriasis lichenoides chronica were treated with topically applied bland emollient cream and minimally erthemogenic doses of UV radiation from fluorescent sunlamps. The conditions of all patients cleared completely in an average of 29 treatments, requiring an average UV dose of 388 millijoules/sq cm at clearance. Phototherapy provides a convenient effective outpatient therapy for pityriasis lichenoides chronica.
The effect of fluocinonide ointment and 5% crude coal tar on clearance of plaque-type psoriasis vulgaris by phototherapy was studied in 25 hospitalized patients using the bilateral comparison technique. All treated areas received ultraviolet radiation from Westinghouse fluorescent FS-40 bulbs (290-400 nm) in doses calculated to produce a minimal delayed erythema. The topically applied compounds (fluocinonide ointment, 5% Crude coal tar, white petrolatum) were applied individually or in combination. In nearly all comparisons clearance of psoriatic plaques was obtained after the same number of ultraviolet exposures, although many (8 or 14) of the areas treated with fluocinonide ointment had an accelerated early response. It thus appears that although the use of topical corticosteroids may enhance the early therapeutic response of psoriatic plaques it does not hasten the clearance of these plaques.
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A tender diffuse erythema developed in a 47-year-old man who had psoriasis when he was treated with either suberythemogenic oral methoxsalen photochemotherapy or ultraviolet (UV)-B phototherapy and intramuscular methotrexate (MTX). Phototests with middle- and long-wavelength UV fluorescent lamps indicated that the sequence and timing of each therapeutic exposure were important to the development of the erythema. Histologic examination of the erythematous area demonstrated an increased number of pyknotic keratinocytes (sunburn cells) in the upper epidermis. It is possible that MTX prevented the repair of DNA damage caused by UV exposure, leading to the appearance of the sunburn cells and erythema. Care must be exercised when using UV radiation and MTX in combination.
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The sodium lauryl (dodecyl) sulfate polyacrylamide gel electrophoresis (SLS PAGE) patterns of keratin polypeptides were followed in 29 patients with psoriasis who were treated with middle wavelength ultraviolet (UV) radiation (UV B), oral methoxsalen, and long wavelength UV radiation (PUVA), or systemic antipsoriatic therapy. The keratin patterns from the Malpighian layer reverted to normal in several weeks, while those of the stratum corneum keratin reverted more slowly, often after clinical clearance of the lesions. These data may indicate that therapy should not be discontinued until there is production of normal stratum corneum polypeptides.
Twenty-six outpatients with chronic plaque-type psoriasis vulgaris were treated five times weekly with topically applied white petrolatum and subsequent exposure to erythemogenic doses of ultraviolet radiation from fluorescent bulbs with a wavelength of 280 to 400 nm. All patients were cleared of psoriasis in ultraviolet-exposed sites in an average of 27 treatments. The combination of topically applied white petrolatum and ultraviolet radiation provides a convenient, cosmetically acceptable outpatient therapy for psoriasis.
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