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Ultraviolet radiation, UV, is widely used for treatment of psoriasis. UV radiation may destroy blood folates in test tubes, but clinical data are scarce. Folate deficiency may increase the risk of cardiovascular diseases, colorectal carcinoma, megaloblastic anemia, pregnancy and birth complications, depression and dementia. The aim of the present study was to investigate the influence of solar radiation, sunbeds and/or broadband UVB phototherapy on the levels of serum and erythrocyte folate in patients with psoriasis or healthy volunteers. Serum and erythrocyte folate status in patients with psoriasis and healthy volunteers was measured before and after exposure to solar radiation, broadband UVB or use of sunbeds. In some cases plasma homocysteine and serum 25-hydroxyvitamin D (25(OH)D) were also measured. Serum and erythrocyte folate levels in healthy volunteers and in psoriasis patients were not influenced to any statistically significant extent after exposure to solar radiation, to single or to multiple UV treatments. However, a slight decay of blood folates and an increase of plasma homocysteine levels were observed in psoriasis patients after exposure to UV radiation. Exposure to sun or sunbeds does not have any significant effect on the levels of blood folate of healthy humans. High doses of broadband UVB phototherapy may slightly decrease blood folates in psoriasis patients. Further studies, using proper, adequate 5-methyltetrahydrofolate methodology, are needed to clarify the influence of broadband phototherapy on folate degradation and the consequences of these on the health of psoriasis patients.

The Norwegian Melanoma Project was conducted during 1989-1993 as a co-operative study by the dermatological, surgical, oncological and pathological departments of the five university hospitals in Norway. We present the results from the patients diagnosed and treated in our dermatological department at Ullevaal Hospital. During the study period 4582 patients received a clinical evaluation of pigmented lesions and 1347 patients were included in follow-up analyses, which consisted of a complete anamnestical evaluation and a clinical and pathological investigation of excised pigmented lesions. In all, 66 cutaneous malignant melanomas, 50 superficial spreading melanomas, seven lentigo maligna melanomas, eight nodular melanomas and one acral lentiginous melanoma were diagnosed. Correlation of the clinical and anamnestical information demonstrated an increased risk of developing malignant melanoma in persons with red hair and skin type I/II. When the histological thickness of superficial spreading melanomas diagnosed before the start of the project was compared with that of those treated during the project, there was a significant decrease in thickness in the project period.

A number of sulphonamide-derived oral antidiabetics (chlorpropamide, glibenclamide, glipizide, gliquidone, glymidine, tolazamide and tolbutamide) and diuretics (bemetizide, bendroflumethiazide, benzylhydrochlorothiazide, bumetanide, butizide, chloratalidone, furosemide, hydrochlorothiazide, hydroflumethiazide, indapamide, piretanide, polythiazide, trichlormethiazide and xipamide) were investigated for phototoxicity in a cell culture model. Cell death dependent on ultraviolet A fluence and test substance concentration was observed in the presence of the oral antidiabetics glibenclamide and gliquidone, as well as the diuretics bemetizide, bendroflumethiazide, benzyl-hydrochlorothiazide, bumetanide, butizide, hydrochlorothiazide, hydroflumethiazide, piretanide, polythiazide and trichlormethiazide. Bendroflumethiazide was phototoxic at 5x10(-5) M and higher concentrations, bemetizide, benzylhydrochlorothiazide, bumetanide and hydroflumethiazide were phototoxic at 2.5x10(-4) M and higher concentrations, and the oral antidiabetics glibenclamide and gliquidone as well as the diuretics butizide, hydrochlorothiazide, piretanide, polythiazide and trichlormethiazide were phototoxic at 5(-4) M and higher concentrations. Electron microscopic investigations showed swelling of mitochondria and endoplasmic reticulum as well as aggregation of euchromatin when the cells were irradiated in the presence of photosensitizers.

In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients.In a four-month double-blind, multicenter trial, we randomly assigned 145 patients with moderate-to-severe psoriasis to receive in their diet either highly purified ethyl esters of n-3 fatty acids ("fish oil"; 6 g of oil per day, containing 5 g of eicosapentaenoic and docosahexaenoic acid) or an isoenergetic amount of corn oil containing mainly n-6 fatty acids. All the patients were advised to reduce their intake of saturated fatty acids. A 48-hour dietary recall was performed, and the fatty-acid pattern in the serum phospholipids was monitored in a subgroup of patients.In the fish-oil group, n-3 fatty acids were increased in serum phospholipids (P0.001), the ratio of arachidonic acid to eicosapentaenoic acid decreased (P0.001), and the level of n-6 fatty acids decreased (P0.001). In the corn-oil group, only docosahexaenoic acid increased significantly (P0.05). The ratio of polyunsaturated to saturated fatty acids increased in both groups. Plasma concentrations of triacylglycerol decreased from base line in the fish-oil group (P0.05). The score on the Psoriasis Area and Severity Index, as evaluated by the physicians, did not change significantly during the trial in either group. This was also true of a total subjective score reported by the patients, but a selected area of skin in the corn-oil group showed a significant reduction in the clinical signs (P0.05). Scaling was reduced from base line in both groups (P0.01). The fish-oil group had less cellular infiltration (P0.01), and the corn-oil group had improvement in desquamation and redness (P0.05). There was no significant difference in clinical manifestations between the groups. Among the patients in the fish-oil group, an increase in the concentration of n-3 fatty acids in serum phospholipids was not accompanied by clinical improvement, whereas in the corn-oil group there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids.Dietary supplementation with very-long-chain n-3 fatty acids was no better than corn-oil supplementation in treating psoriasis. Clinical improvement was not correlated with an increase in the concentration of n-3 fatty acids in serum phospholipids among the patients in the fish-oil group, whereas there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids in the corn-oil group.

The efficacy of a 5% solution of para-aminobenzoic acid (PABA) to protect against photocarcinogenesis was tested in 6 groups, each of which contained 30 light pigmented hairless mice. The light source was a Phillips TL 40 W/12, which mainly emits UVB. PABA significantly retarded the tumor induction time (p less than 0.05) and reduced both tumor yield and carcinoma yield (p less than 0.05). The dorsal skin of the mice was removed and weighed. The mean weight of UVR-exposed mice skin protected with PABA did not differ from that of the controls, but in the non-protected UVR-exposed mice the skin samples were significantly heavier (p less than 0.05).

Summary Eight children with chronic acquired bullous disease were studied by direct immunofluorescence. Multiple jejunal biopsies were examined as well as tissue antigens (HLA-andthcDRw3 B cell allo-antigen). Juvenile dermatitis herpetiformis (JDH) was diagnosed in seven patients and chronic bullous disease of childhood (CBDC) in one. The use of these different laboratory techniques may make it possible to differentiate more clearly between the different chronic acquired bullous diseases seen in childhood.

Quantitative measurements of eccrine sweat secretion following stimulation with adrenaline and terbutaline sulphate, a beta-stimulator, have been performed in patients with atopic dermatitis and psoriasis by means of the electrolytic water analyzer, "Meeco". Seasonal variations were demonstrated, the values being lower in the late autumn. The response to adrenaline could be blocked by phentolamine, an alpha-inhibitor, while propranolol, a beta inhibitor, had no effect.--The response to terbutaline was blocked by atropine and partly by practolol, a beta-inhibitor. Terbutaline induced a larger sweat response than isoprenaline, another beta-stimulator. A beta-receptor mechanism, in some way related to cholinergic receptors, is suggested.

In a double-blind, cross-over trial with Tigason® and placebo, the parameters of palmoplantar pustulosis underwent significant changes during the retinoid therapy. A hang-over effect was clearly indicated during the placebo period and several patients experienced long-lasting remissions.

Chronic or relapsing irritant eczema of the hands was the main complaint in 34 veterinary surgeons. 9 had contact allergic eczema of occupational character. In 8 cases, the allergies were probably due to antibiotics contaminating the skin during the administration of treatment. Contact allergy to penicillin was observed in 5 cases, to neomycin in 2 and to streptomycin in 1 case. Sensitivities to other work-related substances such as rubber chemicals, antiseptics and local anaesthetics were found in 6 cases. Multiple contact allergies, in particular to different penicillins, were seen frequently. Obvious work-related immediate reactions of probable allergic type were present in 10 cases, but were confirmed with positive RAST or prick test in only 2 cases.

The urinary excretion of porphyrins in two cases of porphyria cutanea tarda (PCT) has been followed during a period in which various treatments have been tried. In one patient pyridoxal-5-phosphate (P-5-P) injections lead to a dramatic increase in porphyrin excretion. In another P-5-P treatment was followed by a significant decrease in porphyrin excretion. p-Aminobenzoic acid (PABA) apparently had no effect on porphyrin excretion, while repeated phlebotomies had the expected effect. In both patients all variations in the total amount of porphyrins excreted were almost exclusively due to the variations in the amounts of heptacarboxylic porphyrin type III and uroporphyrin I. A secondary finding was an increase in hexa- and penta-carboxylic porphyrins type III without a concomitant increase in coproporphyrin III.

The allergenic potential of the aromatic lichen substance atranorin has been investigated by means of the guinea pig maximization test of Magnusson & Kligman. Sensitivity was induced in 30% of the animals, which corresponds to a moderate allergenic capacity (grade III). This is in agreement with the clinically-observed frequency of 1.5% among our patients. A modified photoallergy test on the same animals was performed, but irradiation did not increase the number of positive reactions. 4 patients with proven contact sensitivity to atranorin, evernic, usnic or physodic acid, were examined with different dilutions from 0.001 to 0.1%. Irradiation of the test series did not provoke any clear-cut photoallergic reaction.

Ten patients with a history of photosensitivity and of a rash showed abnormal reactions to long-wave UVR. The rash occurred particularly in areas exposed to light, though other areas were occasionally involved. The development of the rash could in all patients be related to contact with lichens and although exposure to sunlight usually led to an aggravation of symptoms, some patients, particularly forestry workers, showed exacerbations even during the winter. Positive responses were observed in both irradiated and non-irradiated patch tests with different species of lichen and in several patients irradiation precipitated a stronger response. These findings suggest that lichens can cause both contact and photocontact dermatitis. The suspected allergens contained in these lichens are atranorin, physodalic and pysodic acids.

Low density lipoprotein (LDL) receptor activity, measured as 125I-LDL association and degradation at 37 °C, was determined in cultured fibroblasts from involved as well as uninvolved skin obtained from 20 psoriasis patients. The same analyses were conducted in fibroblasts from two reference groups consisting of 19 heterozygotes for familial hypercholesterolemia and 16 normal subjects, respectively. Psoriasis patients had significantly lower LDL receptor activity than normals, and it was comparable to that of the heterozygotes for familial hypercholesterolemia. The reduced LDL receptor activity was not accompanied by an increase in total serum cholesterol. The psoriasis patients had a significant reduction in apo-B concentration, but did not differ from the normals in the other serum lipid or lipoprotein parameters. There was no difference in LDL receptor activity between involved and uninvolved skin from psoriasis patients. These results suggest that there is an abnormal cell membrane in dermal fibroblasts from psoriasis patients. Since their total serum cholesterol is normal, their low LDL receptor activity may be confined to dermal cells, leaving the hepatic lipid metabolism normal. The pathogenetic significance of this finding is unknown.

In 4 patients with pustular psoriasis plasma zinc determinations were performed during exacerbations and remissions. Very low values were detected with a normalizing tendency during periods of remission.

Recognizing the growing need for international standardization of photopatch testing techniques, a standard procedure has been used by Scandinavian dermatological clinics since January 1980. The set-up includes a standardized patient examination scheme, including phototest evaluation of the patient's UVA- and UVB-sensitivity, a standard photopatch tray containing 19 substances, and uniform techniques and criteria for the application and evaluation of the tests. Although modifications may be necessary in the future, preliminary experience with the Scandinavian photopatch set-up has been encouraging, and several positive reactions to most of the substances used have been recorded in the first 350 patients tested.

The Scandinavian photopatch test procedure has been applied to 745 patients with suspected photodermatoses during the years 1980-1981. Our experience has been encouraging with the recording of several relevant reactions. A total of 132 positive photocontact reactions and 120 ordinary contact reactions were seen. Photocontact reactions to musk ambrette (19 cases) and PABA (19 cases) were surprisingly frequent. The next most common photocontact reactions were to promethazine (24), chlorpromazine (22 cases) and fentichlor (12). Ordinary contact reactions were observed to balsam of Peru (30), PABA (23), lichen mix (21), wood mix (14) and to perfume mix (10).

In 18 ambulant patients with palmoplantar pustulosis low plasma zinc concentrations were observed. During treatment with an all-trans aromatic retinoid (RO-10-9359) the values increased while at the same time the skin condition improved in particular with regard to the pustule formation. The observed low plasma zinc values may in some way be related to pustulosis but not as causal factor.

This report describes an acute bullous disease in a child, which was characterized, on immunofluorescent microscopy, by homogeneous linear IgA depositions along the basement membrane zone (BMZ). The clinical picture and the course of illness differed somewhat from chronic bullous disease of childhood (CBDC) and other cases of this type reported to date. 1-3 Report of a Case A 5-year-old boy was seen in our outpatient clinic for an extensive vesiculobullous eruption of three weeks' duration. A few weeks before the eruption started, he had had varicella, which was confirmed diagnostically by a substantial rise in the titer of antibody varicella antigen. The present rash had begun with severe itching. He had otherwise been quite healthy, and he had no history of atopy or gluten-sensitive enteropathy. He had been treated with phenoxymethyl penicillin and dexchlorpheniramine in the last week before admission to the hospital. Physical examination showed an afebrile boy