[Psoriasis treatment at the Dead Sea]. / Psoriasiskur ved Det døde Hav.

During the years 1975 to 1993 a total of 192 patients from Copenhagen with psoriasis, were sent to the Dead Sea, Israel, for a four week treatment of sun exposure and bathing. Total or almost total remission was obtained in 73% and significant improvement in 20% of the 163 patients at the post-treatment hospital control. A patient questionnaire filled in by 233 patients at the treatment centres in 1989-1991 showed that 88% of the patients were very satisfied with their stay. The length of remission was one to three months for 55% of the patients. Climate therapy is a valuable alternative treatment with an efficacy comparable to topical treatments for psoriasis.

[Malignant lentigo]. / Lentigo maligna.

Lentigo maligna (LM) is a premalignant skin alteration, which may progress to lentigo maligna melanoma (LMM). LM usually appears as a small dark brown spot in the head and neck region. Over some years it may gradually enlarge to palm size and the colour become more motley. Histologically many atypical melanocytes are seen in the basal layer of the epidermis and along the adnexal structures, as well as there being dermal elastosis and a lymphohistiocytic inflammatory infiltrate in the superficial dermis. Excision should be performed as soon as the diagnosis is made to avoid more extensive excision, transplantation and development into LMM later on. If transformation of LM into LMM occurs, often after many years, fast growth, increased pigmentation and sometimes a nodular formation are observed. Histologically, the atypical melanocytes have invaded the dermis.

[Malignant lentigo melanoma]. / Lentigo maligna melanom.

Malignant melanoma (MM) arises either from a pre-existing, pigmented nevus, from clinically normal skin, or in rare cases from the non-nevoid lesion named lentigo maligna (LM). We present two cases of LM, one in a 75-year old woman and one in an 89-year old woman, which progressed to MM over ten and two years respectively.

The influence of food on 8-methoxypsoralen serum concentration and minimal phototoxic dose.

Ten adult volunteers were given three oral doses of 0.46-0.56 mg/kg body weight of 8-methoxypsoralen (8-MOP) in a liquid formulation under fasting conditions, and after ingestion of a low-fat or fat-rich breakfast. 8-MOP serum levels and photosensitivity were measured 0.5-4 h after drug ingestion. The 1-h 8-MOP serum levels and photosensitivity were significantly higher in fasting conditions than after ingestion of a low-fat or fat-rich meal (intra-individual median difference in photosensitivity 7.5 J/cm2). On 12 of 20 occasions when the drug was taken after food ingestion, the 1-h 8-MOP serum concentration was below 30 ng/ml. A survey of 43 out-patients undergoing regular PUVA treatment showed that the frequency of erythemal reactions was significantly higher when 8-MOP was ingested with a > 50% smaller quantity of food than usual (P < 0.005). This study demonstrated food-induced variations in 8-MOP photosensitivity both in an experimental situation and in an out-patient survey. In order to optimize the therapeutic effect of PUVA, the quantity of food taken before 8-MOP should remain constant, and the timing of UVA irradiation should be adjusted according to the preceding food intake.

Experimental dermatophyte infection. The extent of the fungal invasion.

A spore suspension from a granular strain of Trichophyton mentagrophytes under occlusion for 4 days was used to produce two fungal lesions on the upper arm of the Trichophytin-negative author. The material for culture was obtained by stripping across the visible lesions and several centimetres into the surrounding skin. Already when the occlusion was removed, the whole stratum corneum was heavily invaded up to 20 mm into the surrounding, normal-looking skin. When the intensity and the size of the visible lesions topped after about 2 weeks, the culture positivity reached 45 mm into the perilesional skin. One week later the spontaneous involution had eliminated nearly all fungal organisms through the entire horny layer of both the visible lesions and their surroundings. After 42 days the lesions were culture-negative. It was concluded that the growth pattern of an experimental infection could be as observed in natural infections.

Isolation of dermatophytes from footwear with adhesive tape strips.

In a study of 34 patients with clinically active tinea pedis it was possible to isolate the responsible dermatophyte from the patients footwear with adhesive tape strips in 41% of the cases. Overgrowth of contaminants was found in most of the rest of the cases. Trichophyton rubrum was the predominant species isolated.

The Candida phototoxicity test. The sensitivity of different strains and species of Candida, standardization attempts and analysis of the dose-response curves for 5- and 8-methoxypsoralen.

The purpose of this study was to answer the question as to whether PUVA-sensitivity of different Candida strains and species varies, to investigate the possibilities for standardization of the test and to produce calibration curves suitable for an approximate quantification of psoralens in plants. In the test, paper discs with different concentrations of 5- or 8-MOP in ethanol 60% were placed on yeast-seeded Sabouraud-agar dishes that were irradiated with UVA. The results were based on the diameter of growth inhibition zones. Small but significant differences in sensitivity were found between the 12 Candida strains tested, somewhat greater between the 15 species. Standardization of the method implies the use of the same test organism, depth of agar, time of pre-diffusion, medium, solvent and method for application of psoralen-extract and UVA dose. Dose-response curves for 5-MOP and 8-MOP obtained under standardized conditions demonstrated a linear relationship between the diameter of growth inhibition zones and the logarithm of the psoralen concentration in the range from 1 to 400 micrograms/ml. They were suitable for estimating the content of ethanolsoluble phototoxic substances in terms of 5- or 8-MOP equivalences.

Seasonal variations in the content of phototoxic compounds in giant hogweed.

The Candida inhibition method of Daniels was used for monthly determinations of the relative amounts of phototoxic substances in giant hogweed from April to September. Significant seasonal variations were found in the highest content of active constituents in April and May, with a decrease in the following months. Except in May (where it was highest for the root), the highest content of phototoxic substances was found in the leaves. It was lower in the root and lowest in the stem and stalk.

The survival of dermatophytes from tape strippings of skin.

The isolation of dermatophytes from skin strippings on vinyl tape decreased with lenght of storage. In addition, the time taken for growth to appear increased with storage. The survival of dermatophytes on skin strippings was at least as good as in conventional skin scrapings.

Combination chemotherapy in the tumour stage of mycosis fungoides with cyclophosphamide, vincristine, vp-16, adriamycin and prednisolone (cop, chop, cavop): a report from the Scandinavian mycosis fungoides study group.

Combination chemotherapy with cyclophosphamide, vincristine, VP-16, adriamycin and prednisolone was given in 9 cases of mycosis fungoides in the tumor stage; 3 of these patients received COP, one received CHOP, and 5 CAVOP. Complete remission was obtained in one case and partial remission in 5, the response rate thus being 6/9. It was impossible, however, to maintain remission. The treatment was reduced or withdrawn owing to toxic effects in 4 cases. These forms of combination chemotherapy are beneficial in non-Hodgkin lymphomas but do not seem to be of value in the tumour stage of mycosis fungoides.

Persistent local cutaneous atrophy following corticosteroid injection for tendinitis.

A 21-year-old female, treated with triamcinolone for tendinitis in the oblique muscles of both forearms, developed a skin atrophy, localized around the injection points. The patient was followed over a period of more than five years during which a partial remission of the skin changes was observed. A synopsis covering local use of steroids for various diseases is given.

The areal extent of dermatophyte infection.

After stripping with vinyl tape, dermatophytes may be cultured throughout the depth of the stratum corneum. In the present study skin strippings were used to investigate the horizontal spread of the dermatophyte infection. In five cases of tinea cruris and in twenty-two cases of tinea corporis, fungi could be cultured not only from the visible lesion, but in the majority of cases also from the normal-looking skin up to 6 cm from the margin of the lesion. No relationship could be found between the size and age of the lesion and the invasion of surrounding, normal-looking skin.