Instrumental and dermatologist evaluation of the effect of glycerine and urea on dry skin in atopic dermatitis.

BACKGROUND/AIMS: Moisturising creams are useful treatment adjuncts in inflammatory dermatoses and have beneficial effects in the treatment of dry, scaly skin. The effects on dryness and skin permeability of a new moisturising cream with 20% glycerine was compared with its placebo and with a medicinally authorised cream with 4% urea (combined with 4% sodium chloride) in the treatment of dry skin. METHODS: Patients (n=109) with atopic dermatitis were treated for 30 days with a moisturiser in a randomised, parallel and double-blind fashion. Transepidermal water loss (TEWL) and skin capacitance were assessed instrumentally, and changes in the dryness of the skin were assessed by the dermatologist. RESULTS: No difference in TEWL was found between glycerine treatment and its placebo, whereas a lower value was found in the urea-treated area compared to the glycerine-treated area. No difference in skin capacitance was found. The clinical assessment of dryness showed urea to be superior to glycerine in treating the condition. CONCLUSIONS: Moisturising creams are different, not only with respect to composition but also with respect to their influence on skin as a barrier to water in patients with atopic dermatitis.

Dermal IgG deposits and increase of mast cells in patients with fibromyalgia--relevant findings or epiphenomena?

Skin biopsies from 25 patients with fibromyalgia, 5 healthy controls, 8 patients with rheumatoid arthritis, and 9 patients with local chronic pain after whiplash injury, were examined for the occurrence of IgG deposits and collagen types, using direct and indirect immunofluorescence, and for dermal connective tissue mast cells, using semithin Epon sections. Fibromyalgia skin biopsies had significantly higher values of IgG deposits in the dermis and vessel walls and showed a higher reactivity for collagen III. They also had a higher mean number of mast cells. There was a correlation between the percentage of damaged/degranulated mast cells and the individual IgG immunofluorescence scores. These findings support the hypothesis of neurogenic inflammation involvement in fibromyalgia.

Costs of the treatment of leg ulcers: initiating a quality assurance process.

Reports on a study which aimed to initiate a quality assurance process among health care personnel in Sweden. An epidemiological survey concerning treatment of leg ulcers in a defined region in Sweden was conducted and the costs of treating leg ulcers at different levels of care were analysed. The epidemiological survey provided the data necessary to calculate the socio-economic costs for the treatment of leg ulcers. The weekly cost was found to be about 24 times higher for hospital inpatients than it was for patients treated at home. The quality assurance process has continued through an interdisciplinary regional consensus conference and the establishment of a consensus programme in the region, with targets and general suggestions for the care and treatment of leg ulcers. To maintain high quality in leg ulcer treatment in the region, an interdisciplinary reference group has been established with members from different clinics at the hospital and members from the primary health care.

Dust exposure in coeliac disease: a case-referent study.

Case series of coeliac disease show that chronic allergic alveolitis (farmers' lung) and fever reactions due to exposure to organic dust (organic dust toxic syndrome) commonly occur among subjects with coeliac disease and dermatitis herpetiformis, these being related disorders. In this case-referent study 105 cases of coeliac disease and dermatitis herpetiformis were compared with 237 referents from the general population by means of a mail inquiry regarding exposure to various environmental factors. Increased odds ratios were obtained with exposure to various farm animals and more clearly for cotton dust, although numbers were few. Animal husbandry in Sweden invariably means heavy exposure to organic dust. The fact that comparatively few persons reported dust exposure may be of doubtful validity in view of the high frequency of exposure to farm animals reported by the cases.

Nail fold capillaroscopy findings in patients with primary fibromyalgia.

The nail fold capillary morphology and blood flow were examined by capillaroscopy in 10 patients with primary fibromyalgia. Only slight morphological anomalies such as moderate enlargement of capillary loops and variations in calibre were found. No obvious correlation emerged between capillary morphology and the duration of the disease, smoking, or history of Raynaud's phenomenon. Three patients with a history of Raynaud's phenomenon showed sluggish capillary flow correlated with subnormal skin temperature during registration. The findings suggest that marked generalized capillary abnormality such as that often involving the nail fold capillaries in many connective tissue disorders is not a prominent feature of primary fibromyalgia.

Effects of single doses of UVA, UVB, and UVC on skin blood flow, water content, and barrier function measured by laser-Doppler flowmetry, optothermal infrared spectrometry, and evaporimetry.

The effect of single doses of ultraviolet (UV) radiation was studied in 6 healthy men of skin Type III. Test areas on the forearm were irradiated with 150 J/cm2 UVA, 0.5 MED, 1 MED, and 3 MED UVB, and 1 MED UVC. Test areas and control areas were followed up for 1 month by clinical assessment, laser-Doppler flowmetry, evaporimetry, and optothermal infrared spectrometry (OTIS). UVA produced immediate erythema; the reaction appeared later with the other wavelength regions. All responses peaked after 12-24 h. The degree of erythema of UV-induced inflammation assessed visually correlated closely with the increase in skin blood flow registered with the laser-Doppler flowmeter. No increase in transepidermal water loss, indicating damage to the epidermal barrier, could be recorded by evaporimetry except on the area irradiated with 3 MED of UVB, where 4 subjects showed a moderate increase after 2 weeks. Changes in water content in the uppermost part of the epidermis, mainly in the stratum corneum, were detected by OTIS. A decrease took place that was most pronounced in the area irradiated with 3 MED UVB. This decrease in the OTIS signal is probably due to a combination of increased thickness and decreased water content of stratum corneum. We believe that these 3 noninvasive methods, especially in combination, are useful in the evaluation of different aspects of UV reactions.

The importance of the coal tar bath in the Ingram treatment of psoriasis. Evaluation by evaporimetry and laser Doppler flowmetry.

The contribution of the tar component to the efficacy of the Ingram regimen in the treatment of psoriasis was assessed in 11 patients with symmetrical lesions on the upper extremities. One arm was immersed in an oil emulsion bath and the other in a coal tar bath. Whole body ultraviolet irradiation followed, and dithranol paste was applied to all lesions. Healing was assessed clinically at weekly intervals, and was found to parallel the normalization of transepidermal water loss (TEWL) as determined by evaporimetry, and the dermal blood flow as evaluated by laser Doppler flowmetry. Results obtained with coal tar baths were not significantly different from those obtained with oil emulsion. We conclude that coal tar bath additive has no advantage over oil emulsion in the Ingram regimen.

Hydration of human stratum corneum studied in vivo by optothermal infrared spectrometry, electrical capacitance measurement, and evaporimetry.

Optothermal infrared spectrometry (OTIS) is a recently introduced method for specific measurement, in vivo, of water in the skin. In the present study the method proved well suited to register the increase in water content in stratum corneum following application of emollients. The results were compared with those obtained with a commercial instrument, the Corneometer, and the two methods were found to match very closely. Neither method indicated any difference in hydration of normal skin between young and elderly women. Evaporimetry was used to detect any influence on the water barrier function of the skin following application of emollients; even though the water content of the skin was significantly higher after emollient treatment, the transepidermal water loss remained unchanged.

Multiple parameter assessment of skin irritancy.

In a previously developed guinea pig model for the study of skin irritancy, the irritant skin reactions caused by repeated open applications of low concentrations of sodium lauryl sulphate (SLS) have been studied macroscopically and microscopically. 2 new assessment methods, evaporimetry, which reflects the water barrier function of stratum corneum, and laser Doppler flowmetry to measure the cutaneous blood flow, have been added and compared with the existing methods of assessment in the model. In the present study of the irritant reaction caused by 1% SLS in 9 test animals, the 5 assessment parameters all showed values which, compared to control untested skin, increased progressively over the 3 days of application. In the assessment of skin irritancy, both evaporimetry and laser Doppler flowmetry have been shown to be useful non-invasive tools which can be quickly and reproducibly performed.

Effects of some antihypertensive drugs on cutaneous blood flow and inflammatory skin responses following allergen challenge in guinea pigs.

The effects of the antihypertensive drugs clonidine, prazosin, and MK 422 (the active parent diacid of enalapril) were studied on the cutaneous blood flow and allergen evoked inflammatory skin reactions in ovalbumin sensitized guinea pigs. The hypotensive effect of the drugs did not significantly change the basal cutaneous blood flow at the time of allergen challenge. MK 422 (0.02 mg/kg) markedly enhanced the wheal and flare reaction following allergen challenge, whereas clonidine (0.005 and 0.05 mg/kg) inhibited the inflammatory response. Prazosin (0.03 mg/kg) did not significantly influence the wheal and flare reaction. Our results indicate that some antihypertensive drugs (clonidine) could be beneficial to antihypertensive patients with inflammatory diseases, while others (ACE-inhibitors) may enhance their inflammatory disorders.

Inhibitory effects of clonidine on allergic reactions in guinea-pig skin.

An experimental guinea-pig model was used to show that clonidine inhibited dose dependently the wheal and flare reaction to i.d. ovalbumin in sensitized animals. The effect of clonidine was counteracted by an alpha 2-adrenoceptor antagonist, yohimbine, but not by an alpha 1-adrenoceptor antagonist, prazosin. An H1-receptor antagonist, clemastine, initially reduced the wheal and flare reaction but did not influence the effect of clonidine. Cimetidine, an H2-receptor antagonist slightly reduced the effect of clonidine on the wheal and flare reaction. It is suggested that clonidine reduces the wheal and flare reaction by stimulating alpha 2-adrenoceptors, which inhibits the axon reflex of the response.

Long-term twice-daily oral acyclovir therapy suppresses frequently recurrent genital herpes.

The efficacy of oral acyclovir in a twice-daily treatment regime was demonstrated in an open long-term study in 8 patients with frequently relapsing genital herpes type II infections. The treatment was well tolerated and no side effects were noted during the medication period of 6-21 months. No signs of decreased sensitivity for acyclovir appeared.

Long-term oral acyclovir treatment prevents recurrent genital herpes.

Thirty-three patients with frequently recurring genital herpes completed a randomized double-blind, crossover trial with oral acyclovir 200 mg 4 times a day and placebo for periods of 12 weeks. Five patients (15%) had full recurrence during acyclovir treatment and 31 (94%) while receiving placebo. The median time to first recurrence was 20 days for placebo and more than 84 days for acyclovir. It was concluded that acyclovir was well tolerated and an effective treatment to suppress the disease in selected cases of severe and frequently recurring genital herpes. However, the relapses seem to occur with the same rate as before, when the suppressive acyclovir treatment is stopped.

Measurement of skin blood-flow and water evaporation as a means of objectively assessing hot flushes after orchidectomy in patients with prostatic cancer.

Hot flushes can occur after orchidectomy for carcinoma of the prostate and are sometimes greatly distressing for patients. Attacks are difficult to register because of their transient and unpredictable nature and have been the object of very little scientific investigation. In 13 postorchidectomy patients who reported hot flushes we recorded cutaneous blood-flow and sweating by use of a laser-Doppler flowmeter and an evaporimeter. A total of 23 attacks were recorded. The rate of evaporation increased by more than 60 g/m2/h in ten attacks, from 10 to 60 g/m2/h in five attacks, and by less than 10 g/m2/h in seven attacks. The cutaneous blood-flow increased synchronously with the increase in evaporation. The intensity of the attacks as experienced by the patients corresponded closely to recorded measurements.

Measurement of transepidermal water loss using an evaporimeter to follow the restitution of the barrier layer of human epidermis after stripping the stratum corneum.

The rate of evaporation after stripping a test area with adhesive tape was followed in 10 women over a period of 15 days. The much increased transepidermal water loss after stripping diminished rapidly on the first 3 days. It then decreased more slowly, approaching but not fully reaching the normal rate by the end of test period. This can be taken to reflect the repair process of the damaged barrier layer. The instrument used makes possible instantaneous reading of the rate of evaporation, and is highly suited for assessing the function of the barrier layer.

Gluten-free diet for dermatitis herpetiformis: the long-term effect on cutaneous, immunological and jejunal manifestations.

In 32 patients with dermatitis herpetiformis (DH) we studied the effect of gluten-free (22 patients) and gluten-reduced (10 patients) diet for periods ranging between 15 and 43 months. Variables such as cutaneous manifestations, dependence on dapsone, IgA deposits in the skin, small-bowel function, and jejunal mucosal morphology were studied. 59% of the patients on gluten-free diet could stop dapsone medication and remain symptom-free, compared with 10% on gluten-reduced diet. The time needed to achieve this therapeutic response varied from 5 to 31 months. IgA decreased in the skin to a degree which roughly paralleled the morphological normalization of the jejunal mucosa. In no patient, however, did the IgA completely disappear. It is suggested that IgA is not the main factor inducing DH symptoms, but rather a secondary phenomenon. Repeated jejunal biopsies revealed normalization of the mucosal histology in 52% of the patients on gluten-free diet, compared with none in the gluten-reduced diet group.