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Immunological studies in psoriasis. The quantitative evaluation of cell-mediated immunity in patients with psoriasis by experimental sensitization to 2,4-dinitrochlorobenzene.

Quantitative techniques of sensitization to 2,4-dinitrochlorobenzene (DNCB) was used to determine in psoriasis the intensity and frequency of allergic reactions to DNCB following primary challenge with 2,000 microgram allergen and secondary challenge with decreasing doses of DNCB. 56 patients with psoriasis and 23 healthy volunteers were examined. Frequency of positive reactions to DNCB was similar in both groups, since all normal controls were sensitized, whereas only 8 of 56 psoriasis cases failed to develop delayed hypersensitivity to DNCB. However, the intensity of acquired contact allergy was significantly diminished in psoriasis in comparison with controls. The patients with stationary skin lesions resembled the normal population in the intensity of reaction to DNCB. Decreased intensity of DNCB sensitization seemed to be related to the activity of the disease, but not correlated with the extent of the lesions. A relationship was found between reduced reactivity to DNCB and decrease in E rosette-forming lymphocytes. The data suggest that the impaired function of T lymphocytes in active psoriasis could be responsible for both, defective recognition of contact antigens, such as DNCB, and the alteration of secondary response to DNCB.

Dinitrochlorobenzene

["Superficial spreading melanoma" within a psoriasis focus as a delayed sequela following arsenic therapy for psoriasis].

After a longlasting psoriasis (25-30 years) and after an arsenotherapy of psoriasis per os fifteen years ago an arsenic-caused injury occured with formation of a melanoma within the surrounding psoriasis. In examinating comparable Moselle vine dressers with late arsenic-caused injuries during the years 1972-1975, altogether 1600 examinations, precancerosis, basaliomas, morbus-Bowen, spinaliomas, and transitional epithelium carcinomas have been found and have been histologically confirmed. No melano malignom has been found. Al in eleven other cases of vine dressers with arsenic-caused late injuries showing keratosis, precancerosis, and basaliomas together with a long-lasting psoriasis vulgaris no melano malignom has been found.

Adult

Autoimmunity in psoriasis. Relation of disease activity and forms of psoriasis to immunofluorescence findings.

Immunofluorescence (IF) studies using the test providing information on the reactivity of stratum corneum (SC) antibodies and their in vivo binding have been performed in 193 cases of psoriasis and 89 cases with other dermatoses. It has been shown that: 1. Essentially all fully developed, active psoriatic lesions had IgG deposits in the stratum corneum at the sites of the SC antigen, presumably due to in vivo binding of SC antibodies. 2. In various forms of psoriasis SC antigen sites appeared to be completely or almost completely satured with in vivo deposits of IgG as seen in tests with SC antibodies. 3. In most but not all lesions complement components C3 and/or C4 was found in a comparable pattern in the SC, especially when multiple specimens of single cases were studied. Partial or complete saturation of the SC antigen could be observed by the performance of complement indirect IF tests for SC antibodies in such specimens. 4. In lesions with typical histology of psoriasis the above-mentioned immunologic characteristics appeared to be a constant finding. However, in specimens of recent lesions which had not yet developed typical histology a proportion (2 of 17) were negative both for IgG and complement deposits. In receding lesions weak deposits of IgG were present only in a few specimens and complement deposits were as a rule negative. 5. In a group of 89 control specimens of other dermatoses only occasional cases gave the psoriasiform IF pattern, but about 30% of the specimens gave positive reactions in the SC though these were usually of a different pattern.

Antibody Formation

Intraoral psoriasis associated with widespread dermal psoriasis.

A case believed to represent true intraoral psoriasis has been presented and documented with clinicopathologic material. Intraoral lesions in patients with cutaneous psoriasis should be investigated to determine whether these lesions represent psoriasis or another coexisting entity.

Adult

Induction of generalized pustular psoriasis by topical use of betamethasone-dipropionate ointment in psoriasis.

Three patients with chronic discoid psoriasis are described as having a generalized pustular eruption provoked by the topical use of betamethasone-dipropionate ointment (0.05%) over extensive skin areas for two or three weeks. All the lesions were nearly healed when the rash erupted. It is suggested that the potent topical steroid was absorbed through the damaged psoriatic skin, resulting in a systemic effect and a generalized pustular psoriasis (GPP). It was estimated that the patients absorbed at least 1.5 mg betamethasone per day during the application period.(i.e. 3 tablets of CelestonaR 0.5 mg). Just as steroids systemically are contraindicated in chronic discoid psoriasis by the risk of GPP, potent topical steroids must be avoided over large psoriatic skin areas.

Aged

The age-of-onset of psoriasis and the relationship to parental psoriasis.

In series of 419 consecutive patients with psoriasis the peak age-of-onset was between 5 and 9 years of age in girls and between 15 and 20 years in boys. Subsequently, there was a gradual decline in relation to age. The incidence of psoriasis in a parent of a proband was shown to be significantly higher in those patients where a detailed exmination of the family was undertaken, as compared with the information obtained only from case records.

Adolescent

[Psoriasis: A general disease? Can psoriasis be explained biochemically?].

The biochemical problems of psoriasis are discussed, especially two modern hypothesis about the pathogenesis of this skin disease. 1. DHEA-deficiency leading to an increase of G-6-PDH inaugurated by Holzmann et al. 2. cAMP deficiency in psoriatic lesions as a cause of psoriasis hypothized by Voorhees and Duell. A synopsis of the physiology of the steroid hormone DHEA (synthesis, regulation, conjugation and excretion) is given. There are doubts that this hypothesis is correct. Recent findings have indicated, that there is no decrease of cAMP in the psoriatic lesion--in contrast there is an increase of this cyclic nucleotid. It means that this theory is also doubtfull. Treatment of an hypothetical decrease of cAMP by AMP is not possible, because this AMP will not penetrate in the cell and cannot be metabolized to cAMP.

Adolescent

Deposition of fibrinogen (FR-antigen) in skin diseases. I. Psoriasis vulgaris and Psoriasis arthropathica (with special reference to heparin-precipitable fraction).

Twenty-five in-patients with psoriasis arthropathica (ps.a.) and 18 in-patients with psoriasis vulgaris (ps.v.) were examined for cryofibrinogen as heparin-precipitable fraction (HPF), for total fibrinogen in plasma and by immuno-fluorescence (IF) technique for FR-antigen in tissue sections of affected and unaffected skin. A control group of 14 in-patients with various non-psoriatic dermatoses were examined with if for FR-antigen in unaffected skin. Pathological quantities of HPF were found in 6% in ps.v. and in 48% in ps.a. Total fibrinogen in plasma was normal in ps.v. (365 mg%), and moderately elevated in ps.a. (471 mg%). In psoriatics, FR-antigen was found in unaffected skin ps.v. in 50%, in ps.a. in 72%. In affected skin, the figures were 67% and 84% respectively. No direct relationship could be found between the incidence and the degree of HPF, and depositions of FR-antigen in the tissue sections in the skin at the time of the examination. In the control group, no FR-antigen could be found in unaffected skin, except in one case of acne cystica, with traces of FR-antigen in a few areas of the tissue section.

Adult

[Treatment of psoriasis. New possibility of psoriasis treatment using long-wave UV light and a photosensitizer].

Report about the effect of the therapy of psoriasis with topical application of Meladinine and blacklight as inaugurated by Mortazawi and Oberste-Lehn as well as Tronier. In a high percentage of patients treated a regression of the lesions could be observed. As this therapy is possible for ambulatory patients the number of cases in need of stationary treatment may be reduced.

Female

[The pathogenesis of psoriasis. Autoradiographic in vitro studies on cell proliferation in psoriasis vulgaris and other normal and hyperproliferative states of epidermal and dermal human cells].

In the epidermal cells of patients suffering from psoriasis we found a significant prolongation of DNA-synthesis time (ts) in uninvolved skin, very early lesions, and fully developed plaques. In uninvolved psoriatic skin ts in addition increased significantly within 6 hours after stripping of the horny layer. In normal epidermis and in other states of epidermal inflammation and hyperproliferation (akanthosis by petrolatum, toxic dermatitis, chronic allergic ekzema, neurodermitis, allergic patch test reaction) a comparable prolongation of ts was not ascertainable. This prolongation is most distinct in the early lesions and proceeds the development of hyperproliferation and akanthosis. A dermal infiltrate with increased proliferative activity seems to be a stimulus, in the sense of a Koebner-phenomenon. The abnormal psoriatic epidermis, with disturbed DNA-synthesis, reacts to this infiltrate as well as to other irritants not with a limited hyperproliferation but with the development of psoriatic plaque.

Autoradiography