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Presents letters to the editor regarding articles published in the previous issues of the "British Journal of Dermatology." "Lichen sclerosus et atrophicus in non-identical female twins," which discusses the development of perineal lichen sclerosus et atrophicus in female twins; "Influence of containers on the quantities of topical preparations used," which was about the dispensing of topical agents; "Laser, dermal fibroblasts and psoriasis," which was about psoriasis.

Extensive lesions on 36 patients with psoriasis were treated by Tigason, 1 mg kg/day plus PUVA until skin clearance. A clinical score was calculated for each body area, and erythema, scaling, thickness and pruritus of the lesions were scored from 0 to 3. Skin clearing was defined as a clinical score < 10% of the initial score. Double-blind maintenance treatment was then started. This was Tigason at half of the maximal dose tolerated during the clearing phase of the treatment v. placebo. Relapse of the disease was defined as the occurrence of a clinical score > 50% of the initial score. Among the 36 patients randomized, 20 received placebo and 16 received Tigason. Relapses increased quickly in the patients on placebo, but occurred in few patients treated by Tigason with 60% remaining clear after i year (P < 0.05). Surprisingly, the kinetics of disappearance of the most frequent side effect, cheilitis, was the same in the Tigason group and in the placebo group. This double-blind randomized clinical trial shows that Tigason at low doses is an efficient and well-tolerated maintenance treatment of psoriasis. [ABSTRACT FROM AUTHOR]

The initiating event of several immune effector functions in the skin is the presentation of antigens to lymphoid immunocornpetent cells. Two kinds of antigen-presenting cells have been identified in normal human epidermis: Langerhans cells (LC) and indeterminate cells (Rowden, Phillips & Lewis, 1979). They display a dendritic morphology, bear class II HLA-DR molecules, and are necessary for T-cell activation and proliferation. The role of these epidermal dendritic cells in epidermal cell-lymphocyte interactions and their antigen-presenting proper- tics have been studied in vitro in the mixed epidermal cell-lymphocyte reaction (MECLR). [ABSTRACT FROM AUTHOR]

Until recently, changes in cell physiology following application of pharmacological agents have been studied in vivo or in vitro using monolayered cells. Although both approaches have unique advantages, both have shortcomings. Now the development of a skin-equivalent model has provided a system for studying cell responses at the tissue and organ levels in vitro (Bell, Ivarsson & Merrill, 1979; Bell et at, 1981a, b). The in vitro tissue model can he made simple or complex with respect to cell type heterogeneity and matrix constitution; ideally, however, it should resemble skin as closely as possible. It has the special advantage, unlike skin, of being able to survive for long periods in vitro. In this paper we compare the model morphologically with skin arid review some aspects of the biosynthetic output of cells in the tissue equivalent with that of monolavered cells. Finally we illustrate in a pharmacological study that the model can be used to provide new information that in vivo studies or monolayer cell studies cannot yield. [ABSTRACT FROM AUTHOR]

The possible role of epidermal serine proteases in the genesis of psoriatic lesions was investigated by sequential biopsies of the epidermal damage induced by topical cantharidin. In the skin of normal subjects, epidermal damage was followed by the transient appearance of proteolytic activity in the upper epidermis accompanied by temporary hyperacanthosis and perivascular inflammatory cells in the superficial dermis. In the uninvolved skin of five patients with psoriasis this proteolysis persisted longer, for more than 7 days. Thereafter, in three of the patients, the proteolysis abated, and this was followed by disappearance of the hyperacanthosis and the dermal infiltrate; in the other two psoriatics the proteolysis and hyperacanthosis increased, and a typical Koebner phenomenon ensued. Migration of neutrophils into the epidermis occurred as a later event. Thus the abnormal persistence of proteolytic activity in the upper epidermis after cantharidin application distinguishes the normal from the psoriatic skin injury response and might initiate the psoriatic lesion. [ABSTRACT FROM AUTHOR]

A new diagnostic technique is describe, in which 0·7 mm thick slices of skin are freshly cut, thoroughly washed, slightly fixed and directly incubated in peroxidase-labelled antibodies. This easy technique allows routine immuno-electron microscopic diagnosis of subepidermal auto-immune bullous diseases, with excellent morphological results. [ABSTRACT FROM AUTHOR]

By using a very sensitive and reproducible skin chamber technique we have shown that the aromatic retinoid etretinate (Ro 10–9359) and its main metabolite (Ro 10–1670) significantly inhibit the migration of neutrophils from the blood to tissues when applied into skin chambers (0·1 mg/ml) or when given orally (1 mg/kg/day for 8 days) to normal volunteers. This pharmacological property could be closely linked to the antipsoriatic properties of these drugs. [ABSTRACT FROM AUTHOR]

Incubation of unfixed and unfrozen slices of skin in diaminobenzidine allows visualization of peroxidatic activity in the perinuclear envelope and endoplasmic redculum of normal human Langerhans cells. A similar peroxidatic activity is observed in supra-basal keratinocytes undergoing orthokeratotic differentiation. Basal keratinocytes and melanocytes are always negative. This enzyme is absent in mucous and parakeratotic (psoriatic) differentiation. A peroxidatic activity was also found in the endoplasmic reticulum of normal resident skin macrophages. Mitochondria are also strongly stained by this technique and it was shown that the number of epidermal mitochondria is greatly increased in psoriatic lesions. [ABSTRACT FROM AUTHOR]

Incubation of unfixed slices of skin for t h at 37°C in Hanks' medium allowed the expression of proteolytic activity in the upper keratinocyte layers in psoriatic lesions and, in some cases, in uninvolved skin of psoriatics, but never in normal skin. This proteolysis was inhibited by DFP and TLCK, known inhibitors of the neutral proteinase previously described as increased in psoriatic lesions. The topographical analysis of this proteolytic activity suggests that a disturbance of the protease-antiprotease equilibrium in human epidermis may be implicated in the appearance of psoriatic lesions. [ABSTRACT FROM AUTHOR]

Cellular events occurring in eight patients with bullous pemphigoid were studied by light and electron microscopy. Sections (0.5 μm) of large surface area, overlapping blisters and surrounding skin, were examined and correlated ultrastructural studies were performed on selected areas. The peroxidase contained in granules of neutrophils, eosinophils and young macrophages was visualized by incubation with diaminobenzidine and hydrogen peroxide. This cytochemical reaction was used as a marker to study the release of granule enzymes from these inflammatory cells. The release of such enzymes from eosinophils and occasionally from macrophages on the epidermal basement membrane (more precisely in the lamina lucida) was demonstrated in the skin surrounding the blisters in four patients. The release of these enzymes was also observed in the floor of the blisters in all eight patients. It is well known that these granules contain several proteolytic enzymes. These observations are therefore consistent with the proposal that proteolytic enzymes of eosinophils play a pathogenic role during the initial stages of blister formation in bullous pemphigoid. [ABSTRACT FROM AUTHOR]

The visualization of peroxidase positive lysosomes by diaminobenzidine plus H2O2 allowed easy identification of neutrophils, eosinophils, monocytes and young tissue macrophages in 0.2 μm to 0.5 μm skin plastic sections of large surface area. Evaluation of the lysosomal functions of these phagocytic cells was greatly improved by the possibility of correlating observations on the same cell at light and electron microscopic levels. [ABSTRACT FROM AUTHOR]

A method is described which allows the embedding of 6 mm cutaneous punch biopsies for subsequent light and electron microscopic examination. Sections of 20 mm2 cut at 0.5–1 μm are stained for light microscopy. The subtle tinctorial affinities, which approach those achieved on haematological smears, and the preservation of cellular detail frequently make subsequent ultrastructural examination unnecessary. However, when required, a special technique for trimming and resectioning the tissue blocks allows a good correlation between light and electron microscopic observations. [ABSTRACT FROM AUTHOR]

The carcinogenic risk of photochemotherapy (PUVA) with bi-functional furocoumarins such as 8-methoxypsoralen (8-MOP) which form cross-links in cellular DNA has initiated a search for active but less hazardous psoralens. A new compound, 3-carbethoxypsoralen (3-CPs), studied in the yeast Saccharomyces cerevisiae (eukaryote), has been shown to be very photoactive on DNA and to form only mono-additions to DNA. These Lesions appear to be more easily repaired than the cross-links induced by 8-MOP. 3-CP5 produces less nuclear genetic events such as nuclear mutations and mitotic crossovers, but more cytoplasmic `petite' mutations (damage to mitochondrial DNA) than 8-MOP. In mice it was demonstrated that after local or intra-peritoneal administration, in contrast to 8-MOP, 3-CPs is non-toxic, non-erythematogenic, and non-carcinogenic. A study of ten psoriatic patients has shown that local applications of 3-CP5 plus UV-A exhibit about the same therapeutic activity for the clearing of psoriatic lesions as local treatment with 8-MOP plus UV-A, but without any localized hyperpigmentation. [ABSTRACT FROM AUTHOR]

Serum, red cell and squame folate content have been measured in fifty cases of psoriasis with extensive lesions. Reduced serum and red cell folate have been found in 44% of the patients. Folic aid absorption, studied in twenty-six patients, was impaired in four and significantly increased in all the others. Squame folate content has been found too low to explain the folate deficiency. Malabsorption is a possible hypothesis but it occurs too rarely (four cases). The most likely explanation of folate deficiency seems to be an increased utilization of folate by the skin epidermal cells as a result of the rapid turnover rate. The increased absorption found in most cases investigated could be a compensatory mechanism to equilibrate folate balance. [ABSTRACT FROM AUTHOR]

Wound healing is a very complex phenomenon involving blood, dermal and epidermal factors. These factors are tightly associated since, for example, dermo-epidermal injuries do cicatrize at a lower rate than same sized pure epidermal wounds (Pollack, 1979). On the other hand, in vivo studies of skin cicatrization are of critical interest since numerous pathological, pharmacological or physical conditions, such as occlusion by polyethylene film (Eaglstein & Mertz, 1978), do modify wound healing. In order to undertake in vivo studies in man for normal or pathological skin cicatrization with or without therapeutic agents, one has to use experimental procedures which fit at least three often conflicting conditions. Firstly, these procedures have to be related to the entire complex phenomenon. Secondly, the methods should give quantitative and reproducible data and, if possible, a kinetic evaluation. Thirdly, experimental procedures have to be as non-invasive as possible in order to be acceptable by human volunteers. Histological procedures have been already performed after dermo-epidermal injuries (Winter, 1972). They gave important qualitative results with regard to the entire phenomenon. However, they are invasive and therefore have been essentially performed on animals. Moreover, as far as histological procedures are concerned, quantitative evaluation is difficult. Therefore more analytical and quantitative experimental procedures are of interest. Using suction blisters, which create pure and reproducible epidermal wounds and leave the basal lamina intact (Ortonne, 1980; Dubertret, Lebreton & Touraine, 1982a, b), one may look more selectively at the epidermal events of skin cicatrization. Such experiments may be qualitative if histological procedures are used and quantitative if planimetric evaluations are performed after dermo-epidermal separation (Eaglstein & Mertz, 1978; Fourtanier et al.-, 1984). However, both procedures are invasive. The aim of our work was to develop a reproducible and non-invasive method allowing quantitative analysis of human epidermal healing. The method we propose is based on the repair of the epidermal barrier function after purely epidermal woimds (Saiag et al., in preparation). [ABSTRACT FROM AUTHOR]

Describes a method to improve the cytological and functional analysis of inflammatory skin diseases. Release of lysosomal enzymes from the inflammatory cells; Details on the morphological analysis of inflammatory skin disease; Measurement of the rate of macromolecular synthesis.

The monoclonal antibody OKT 6 reacts specifically with Langerhans' cells, but not with macrophages, in human skin. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor related to a case of macular amyloidosis cutis.

This article focuses on a case report related to graft versus host reaction (GVHR) and lichen planus. In April 1973 researchers observed a patient undergoing a severe GVHR, 22 days after being treated for post-hepatitis aplastic anaemia by a histocompatible bone marrow transplantation from his sister. Buccal and nail lesions were of the erosive variety. Histological examination of a palmar lesion confirmed lichen planus. The liver and small bowel remained unaffected. The skin complications are now life threatening in spite of a very good haematological result and of the absence of liver or bowel disease.