Feasibility and safety of a new technique of extracorporeal photochemotherapy: experience of 240 procedures.

BACKGROUND AND OBJECTIVE: Extracorporeal photochemotherapy (ECP) is a therapeutic approach based on the biological effects of ultraviolet light (UV) - A and psoralens on mononuclear cells collected by apheresis. Recently, ECP has been under investigation as an alternative treatment for various immune and autoimmune diseases. The aim of this study was to evaluate the safety and feasibility of a new three-step ECP technique, in terms of reproducibility, acceptance, tolerability, and short and long term side effects. DESIGN AND METHODS: Seventeen patients affected by acute or chronic graft-versus-host disease (GvHD), pemphigus vulgaris, or interferon-resistant chronic hepatitis C and one patient being treated for prevention of heart transplant rejection underwent 240 ECP procedures. MNC collection and processing parameters were recorded, biological effects of UV-A/8 methoxy-psoralen (8-MOP) were evaluated, and short and long term side effects were monitored. RESULTS: At a mean follow up of 7 months (range 2-19) 240 ECP had been completed, a mean of 7,136 mL (range 1,998-10,591) of whole blood having beenprocessed per procedure. The mean of total nucleated cells collected per procedure was 6.5x109 (range 0.65-23.8), with a mean MNC percentage of 85% (41. 4-98%) in a mean final volume of 115.5 mL (37-160). No severe side effects were documented and no infectious episodes occurred throughout the course of the treatment. INTERPRETATION AND CONCLUSIONS: The new ECP technique was highly reproducible as regards the collection and each processing step. Short and long term side effects were mild. No increase in infectious episodes was recorded. All patients willingly underwent ECP, demonstrating an excellent tolerability for the procedure even after several courses.

Objective prick test evaluation: non-invasive techniques.

Prick test reactions are evaluated and quantified, comparing visual assessment with two non-invasive techniques: remittance spectroscopy and pulsed ultrasound for erythema and skin thickness measurements. Different information is provided by the two methods. Remittance spectroscopy discriminates well between negative and positive reactions (+ or ++), while failing to differentiate stronger reactions, where edema is a prominent feature. The latter reactions are better evaluated by skin thickness measurements, which, on the contrary, are less sensitive in revealing small skin thickness increases in weak reactions.

Ranking of surfactant skin irritancy in vivo in man using the plastic occlusion stress test (POST).

Irritant effects and disturbance of water-holding capacity induced by surfactants were investigated using the plastic occlusion stress test (POST) technique. 4 surfactants (sodium lauryl sulphate (SLS), sorbitan monolaurate, cocoamidopropyl betaine and benzalkonium chloride) and an amphoteric/nonionic (A/N) mix were investigated. 1 x daily for 3 days, test surfactants were applied to marked sites (open) on the volar forearm. After 24 h occlusion with a plastic chamber on the 4th day, skin surface water loss (SSWL) (g/m2h) was recorded continuously for 25 min with an evaporimeter. The differences between the surfactants were statistically significant (Friedman's test p less than 0.01). SLS and the A/N mix revealed significant differences compared to the other compounds (p less than 0.05), both in decay constants and in values recorded at the beginning and at the end of the decay curve. The study suggests a mechanism for the high irritant potential of sodium lauryl sulphate compared to other surfactants: sorbitan monolaurate and benzalkonium chloride seem to influence (at the concentrations tested) to a lesser extent the water-holding capacity of the stratum corneum. The clinical and biological relevance of these observations requires long-term clinical correlations with final product use tests.

In vivo tretinoin-induced changes in skin mechanical properties.

Topical tretinoin has been reported as having anti-aging effects on photodamaged skin. The purpose of this study was to evaluate tretinoin-induced changes in the mechanical properties of the skin of 18 patients (aged 39 +/- 8 years) after 4 months of treatment with topical 0.05% tretinoin on one forearm and a placebo base cream on the other. The biomechanical skin parameters investigated were elasticity, extensibility and hysteresis and data were normalized for skin thickness. A slight but non-significant increase of skin elasticity was detected in the tretinoin-treated sites using low-stressing forces (1.2 X 10(4) Nm-2) and at higher loads (3.8 X 10(4) Nm-2), the increase in skin elasticity was significant (P less than 0.01). This improved skin elasticity was dependent on the increased collagen resulting from topical tretinoin and the replacement of elastotic material. However, topical tretinoin treatment did not improve the responses mediated by elastic fibres.

[Efficacy of fenticonazole in patients with pityriasis versicolor]. / Studio dell'efficacia del fenticonazolo su pazienti affetti da Pityriasis versicolor.

Thirty patients suffering from Pityriasis versicolor were treated with fenticonazole in cream or lotion form with two applications a day. At microscopy, Malassezia furfur was encountered in 25 cases and Pityrosporum orbiculare in 5. Disappearance of the yeast was obtained on average in 2 weeks of treatment. Measurement of sebum content with a Sebumeter apparatus did not reveal significant difference (p greater than 0.05) between patients suffering from Pityriasis versicolor and controls and in treated patients, in the course of topical therapy.

[Psoriasis-pemphigoid association. Description of a case]. / Associazione psoriasi-pemfigoide. Descrizione di un caso.

The paper describes a case of an 85-year-old woman affected by psoriasis for 30 years who developed bullous pemphigoid after UVB treatment. Immunological and histological findings were typical of bullous pemphigoid cell-poor type. Bullous eruptions cleared following combined therapy with betamethasone and azathioprine. The literature on the subject and pathogenetic hypotheses for this unusual association are discussed.

Changes in the water holding capacity of psoriatic stratum corneum in vivo.

This study investigated the functional capacity of the stratum corneum of psoriatic skin to bind water in vivo during a relatively long period of time (water holding capacity--WHC). An electrical capacitance test was applied to the psoriatic skin on the elbows, perilesional skin and apparently normal skin of 11 patients and the elbows of 10 controls. Measurements of electrical capacitance were performed using a Corneometer Schwarzhaupt for 25 min. The WHC levels were calculated for this period. Our results demonstrate that the WHC of psoriatic stratum corneum does not differ from controls in the first 10 min. Only after the 20th min do the WHCs differ significantly (p less than 0.02). Despite the biochemical keratin changes in psoriatic plaque, the latter is highly hygroscopic, in particular in the first minute after bathing. Perilesional skin binds water like the stratum corneum of controls, though not beyond the 20th minute after bathing.

Skin extensibility time in women. Changes in relation to sex hormones.

The influence of female sex hormones on mechanical properties of the skin has been assessed in an in vivo extensometric study. Twenty young (20 +/- 4 years) and 12 middle-aged healthy women (42 +/- 3 years) entered the study. Measurements were carried out on the volar surface of the left forearm on the 10th and 25th day of the menstrual cycle. A significantly decreased skin extensibility time in the pre-menstrual phase was found (25th day) when compared with the 10th day in the young group, while the older one did not reveal significant changes. The data are compatible with an increased water content of the skin noticeable in the pre-menstrual phase and more relevant in young women. In studies on mechanical properties of the skin, changes relative to sex hormones and menstrual cycle need to be taken into account.

Assessment of the effects of a topical product containing glycosaminoglycans in cutaneous hydration.

The hydrating power of a topically applied mixture of glycosaminoglycans has been evaluated by means of an electrical impedance method. The electrical parameters investigated, namely angle alpha and R infinity, are related to the permeability and the hydration of deeper tissues. The study revealed lowering of alpha levels after the application of the product, thus signifying an accumulation of electrical charges in the epidermis consistent with the penetration of glycosaminoglycans. After 15 days of treatment, significant reduction of R infinity levels was recorded. The relationship between R infinity levels, dermal water content and glycosaminoglycans is discussed.

Topical spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands: an autoradiographic study in subjects with acne vulgaris.

The interaction between spironolactone and dihydrotestosterone (DHT) receptors was evaluated with an autoradiographic technique. The inhibition of DHT receptors by spironolactone was found to be related to the decrease of tritiated DHT granules in the sebaceous glands of the treated site. 6 male patients affected by acne vulgaris entered the study. The acute study was performed by applying to 25 cm2 of the back a cream containing 5% spironolactone under occlusive dressing. The dosage of spironolactone applied was 4 mg/cm2 for 48 h. The long-term study was performed by applying the same amount to the entire back, without occlusion, twice daily for 1 month. Skin biopsies were taken at the end of the treatment, incubated with tritiated DHT and processed for autoradiography. Both the acute and the long-term study revealed a decrease of the autoradiographic granules in the treated site. This effect is related to the binding of spironolactone with dihydrotestosterone receptors in the sebaceous glands. Our study demonstrates that 5% topical spironolactone cream acts as an antiandrogen in human sebaceous glands, competing with DHT receptors and producing a decrease of labelled DHT. At the concentrations used the effect has been only local. No side-effects were recorded during both studies.

Immunological alterations in a case of Papillon-Lefèvre syndrome with recurrent cutaneous infections.

An immunological study was performed in a 16-year-old boy affected with Papillon-Lefèvre syndrome (PLS) and recurrent staphylococcal cutaneous infections. A defect of neutrophil intracellular killing of Staphylococcus aureus and a decreased lymphocyte proliferative response to phytohaemagglutinin were detected. The possible role of these alterations in promoting recurrent infections in PLS is discussed.

Eosinophilic ulcers of the tongue.

A case of eosinophilic ulcer of the tongue is presented. Although the entity is rarely described, the distinctive histopathologic pattern featuring the remarkable presence of eosinophils in the superficial corium and in between muscle bundles, together with the benign clinical course, make a diagnosis possible.