摘要:

SUMMARYA study of thirty‐three patients with a clinical diagnosis of dermatitis herpetiformis (DH) referred to our DH clinic over the last 11 years is reported. Twenty‐six were referred by other consultant dermatologists. The diagnosis had been made by the clinical features and response of the rash to dapsone. Seventeen patients were found to have IgA in the uninvolved skin (IgA positive) and in sixteen no IgA was found (IgA negative). The duration of the rash prior to referral to the DH clinic was 3 months to 19 years (mean 5.0 years) for the IgA negative patients and 2 months to 22 years (mean 5.2 years) for the IgA positive group. The length of follow‐up was 3 months to 11 years (mean 5.0 years) for the IgA negative, and 2–11 years (mean 5.6 years) for the IgA positive group. During follow‐up the rash cleared completely and required no treatment in seven of the sixteen IgA negative patients. Thirteen of these sixteen patients no longer required dapsone, but six patients were receiving alternative treatment. In the three patients still taking dapsone IgA has not been found on subsequent biopsy. Of the seventeen IgA positive patients only three were able to stop dapsone during follow‐up and in these three the IgA was still detected in the skin. Small intestinal mucosa was abnormal in eight of eleven IgA positive patients, but was normal in all thirteen IgA negative patients in whom jejunal biopsies were performed.An alternative diagnosis to DH has subsequently been made in thirteen of the sixteen IgA negative patients. Although the significance of IgA in the skin in DH is not known it appears to be part of the disease process. Patients who have a rash suggestive of DH and which is dapsone responsive, but in whom IgA is not found in the uninvolved skin, usually turn out to have a dermatosis other than dermatitis herpetiformis.Referral to a unit with expertise in immunofluorescence techniques of skin biopsies would appear to

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06549.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYFour patients with the clinical picture of epidermolysis bullosa acquisita were investigated. Biopsies were taken from the involved and uninvolved areas of the skin and the immunohistochemical and microscopic changes were studied. Direct immunofluorescence showed deposition of IgG and C3/4 in a linear or notched pattern along the epidermal basement membrane in both the involved and the uninvolved skin. In addition IgA (3/4), IgM (1/4), C4 (3/4) and properdin (3/4) could be detected.Indirect immunofluorescence revealed the presence of circulating antibodies againstinter aliathe epithelial basement membrane zone in one patient. Routine electron microscopy showed that the blister was situated in the dermis leaving the basal lamina in the roof of the blister. With immunoelectron microscopy using peroxidase‐labelled antibody thein vivodeposition of IgG was observed just beneath the basal lamina in the dermis of both the perilesional and the uninvolved skin. These observations show that epidermolysis bullosa acquisita is a distinct entity, in which autoimmune mechanisms might possibly play a rol

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06550.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYDesquamative gingivitis, a sub‐epithelial vesiculo‐bullous disease involving the gingiva, has been shown to have positive direct immunofluorescent findings similar to those of cicatricial pemphigoid. However, the lack of severe scarring, limitation of lesions to the anterior portion of the mouth and the tendency toward limitation of lesions to the oral mucosa over long periods of time in desquamative gingivitis, suggest that desquamative gingivitis and cicatricial pemphigoid are distinct and separate entit

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06551.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYThe mitotic index of pretreatment plaques of chronic psoriasis was determined before treatment with PUVA. There was a wide variation in mitotic indices in different patients.Treatment was given with UV‐A 2 h after oral ingestion of 8‐methoxypsoralen (8‐MOP) two or three times per week, with increasing doses of UV‐A. Patients were considered cleared if there was 95% clearing of all psoriatic plaques.There was no correlation between the mitotic index and the response to treatment, as measured by either the number of joules administered or the number of treatments until the lesions cleared. This suggests that the action of PUVA in psoriasis is not dependent on the amount of increase in epidermal prolif

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06552.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYSeven hundred and sixty‐four liver biopsies were performed in 328 psoriatics on treatment with methotrexate or being considered for systemic treatment either with methotrexate or with psoralens and long‐wave ultraviolet light. The diagnosis of cirrhosis was established histologically in twenty‐one patients. Two patients had cirrhosis in their premethotrexate biopsy and were not given methotrexate. The remainder all showed no signs of cirrhosis or fibrosis in their premethotrexate biopsy. The difference between the methotrexate treated psoriatics and the premethotrexate group was highly significant. Among thirty‐nine patients treated for more than 5 years, ten developed cirrhosis (25.6%). Almost all patients were on a divided dose intermittent oral dosage schedule. The cumulative dose of methotrexate, when cirrhosis was first found, ranged from 590 to 8105 mg, with an average dosage of 2200 mg. Other factors contributing to cirrhosis in this study seem to be previous treatment with arsenic, a previous intake of alcohol, and lowered renal function.Data on later serial biopsies from fourteen patients, of which eleven continued to receive methotrexate due to very severe psoriasis, seem to indicate that methotrexate induced liver cirrhosis is not of a very aggressive nature. When evaluated blind no progression was found in most of the later biopsies, and a ‘cumulative cirrhosis index’ composed of the combined gradings for fibrosis, assessment of membrana limitans, fibrous destruction and regeneration showed a tendency to decrease. In three patients the latest of the serial biopsies showed no cirrhosis. The observation period on continued methotrexate therapy ranged from 1 to 7 years. None of the patients with cirrhosis differed from the remaining patients on methotrexate in their laboratory results for evaluating liver damage, and apart from transient increases in serum glutamic pyruvic transaminases no abnormalities were found.The data support the necessity of liver biopsies in the control of psoriatics treated with methotrexate. Liver biopsies should be performed at least in all psoriatics in whom a cumulative dosage of methotrexate exceeds 1.5g. The data also indicate that methotrexate can be continued at least for a while in patients where the indication is strong enough, if the dosage is maintained as low as possible and alcohol consumpt

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06553.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYThe straight elastic fibres aligned perpendicularly to the dermo‐epidermal junction have been examined by transmission and scanning electron microscopy. We found that these fibres connect the basal lamina to the underlying dermal elastic tissue, and it seems likely that they are involved in dermoepidermal adhesio

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06554.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYBy screening 1500 sera obtained from patients undergoing a bone marrow graft, five sera have been selected which contained antibodies to the basal cell layer (B. C. L.) of the outer root sheath (O. R. S.) of hair follicles. It was demonstrated that these sera reacted with the B. C. L. of the O. R. S. but not with the B. C. L. of the adjacent epidermis. The change in antigenic properties was situated at the orifice of the sebaceous gland canal; thus basal cells below this orifice express an antigen distinct from those expressed by the epidermal basal cells. This is a novel example of tissue specific differentiation antigens that are linked to the type of keratinocyte differentiation.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06555.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYAn account is given of the occurrence in N. W. London of ringworm due to the dysgonic form ofMicrosporum canisin cats, dogs, and humans. The unusual morphology of the dysgonic strain is described as is the extraordinary lability of the fungus in culture. The distribution of cases in man and animals in the area is mapped. The clinical and epidemiological behaviour of the fungus, as illustrated by four family outbreaks, differs little from that of the typical strain. The origin of the dysgonic strain is unknown.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06556.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYThe incidence and distribution of facial follicular porphyrin fluorescence was studied in a large group of subjects ranging in age from 1 to 90 years. Fluorescence appears first on the nose and chin, increases in incidence through adulthood and declines after the age of 50 possibly reflecting the rate of sebum secretion. We have shown that the intensity of fluorescence is proportional to theP. acnespopulation and confirmed that coproporphyrin III is producedin vivo.

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06557.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY

摘要:

SUMMARYForty patients with papulo‐pustular rosacea were treated for 12 weeks on a random double‐blind basis either with oxytetracycline 250 mg twice daily or with metronidazole 200 mg twice daily. Both drugs produced an improvement which was greater after 12 weeks than after 6 weeks, but there was no significant difference between them. Metronidazole appears to be a safe and effective drug for the treatment of rosa

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1980.tb06558.x

出版商:Blackwell Publishing Ltd    

年代:1980

数据来源: WILEY