[Periods and milestones in the history of dermatology]. / Episoder och milstolpar i dermatologins historia.

The history of dermatology may be divided in five periods. The first period, dominated by the humoral doctrine (humoral pathology), extends through the Antiquity, the Middle Ages, the 1600th, 1700th and the major part of the 1800th century. The second period (1775-1840) is characterized by the development of the "dermatological systems" and the third period (1840-1890) by the advances in pathology and microbiology. During the fourth period (1890-1940) dermatology develops into a discipline of medical science. A fifth period started in the middle of the 1940th when the chemotherapeutic and antibiotic drugs and later the glukocorticoids revolutionized dermatological therapy. From this time the advances in especially immunology, genetics, ultrastructural research and molecular biology have also given us a quite new understanding of the pathogenesis of skin diseases.

[Dermato-venereology as a special subject in medical education in Sweden. A historical review]. / Dermato-venereologi som undervisningsämne i svensk läkarutbildning. En historik.

In 1861 a professorship in syphilology was founded at the Karolinska Institute in Stockholm. However, unlike the conditions in Denmark, Finland and Norway, a combined chair in dermatology and syphilology was not established until in 1927. The main reason for this delay was that, according to the laws applicable to the hospitals of Sweden, patients with venereal diseases could be treated solely in special hospitals ("kurhus"). Only in 1901, when these laws were changed, it was possible to establish departments for both skin and venereal diseases. The article is a survey of the development of dermato-venereology as a subject in medical education in Sweden until our time.

[Anton Nyström: the first practitioner in dermatology in Sweden and the controversy about his book on skin disorders]. / Anton Nyström: Sveriges förste praktiserande dermatolog och striden om hans bok "Hudåkommorna".

Anton Nyström (1842-1931), practitioner and author, was at the end of the nineteenth and the beginning of the twentieth century a well-known but also controversial personage in Swedish cultural and intellectual life. The posterity remembers him mainly for having introduced the philosophical system of Auguste Comte and founded a Society for Positivism in Sweden as well as having founded an institution ("Arbetarinstitutet") in Stockholm with the purpose to give an all-round education to the working classes through lectures by leading personalities in the world of culture and science. In numerous publications he treated besides medical topics also religious, cultural, social, political and historical themes. Immediately after his medical graduation in May 1868, he went abroad to study dermatology and stayed for this purpose for nearly one and a half years in Vienna, Paris and London. Back in Sweden in the autumn of 1869, he began writing a book with the title "Theoretical and practical essays on skin disorders." This book is for us today interesting because it illustrates the different views of that time on skin diseases held by Hebra in Vienna, Bazin and Hardy in Paris and Wilson and Tilbury Fox in London. In Paris Nyström had been fascinated by Bazin's and Hardy's theories on constitutional diseases and diathetic states and had, as he says, "embraced the doctrines of Bazin". In Vienna, however, he had disapproved of Hebra's way to reject speculations on internal etiology for skin diseases and to look upon them as having mainly an external cause and of his method to treat skin diseases preferably with local remedies. In London he was on very friendly terms with Tilbury Fox, who to his satisfaction also sympathized with the opinions held by Bazin. ...

[The remarkable debate during the beginning of the nineteenth century concerning the aetiology of scabies]. / Den märkliga striden om etiologin till scabies i Paris under början av 1800-talet.

The scabies mite (acarus or sarcoptes scabiei) was known already to Aristoteles, to the Arabic medicine during the early and to European physicians as well as laymen during the later Middle Ages, depicted in 1687 by Bonomo in Italy and by Schwiebe in Germany during the beginning of the eighteenth century. Later in the middle of the century three pupils to Linnaeus in their doctor's theses stated that the scabies mite (Acarus humanus subcutaneus) was the cause of scabies. The best pictures of the scabies-mite as well as of the flour- and cheese-mite was given by the Swedish entomologist Charles de Geer in 1778. In spite of all these facts the real aetiology of scabies seemed to be unknown in France and in most parts of Europe. This was probably due to the fact that no one had learned the rather simple method to extract the mite from the skin with a needle and thereby verify its existence. In the beginning of the twentieth century scabies was a real problem for the health authorities. In Paris l'Académie de Médecine even offered a reward to the person who could solve the enigma of the itch. Jean Chrysanthe Galés was the pharmacist at l'Hôpital St. Louis, the famous skin hospital in Paris, where at this time about 65 percent of the beds were occupied by patients suffering from scabies. Galés also studied medicine and wanted to write a doctor's thesis. As the theme of a dissertation he was given the cause of the itch. In 1812 he published his thesis ("Essai sur la Gale") including a plate with sketches of mites that he claimed to have extracted from vesicules on the skin of his scabies patients. His findings could not be verified by other investigators. Galés however refused to take part in any control experiments and left the hospital. The debate concerning the supposed cause of the itch continued for two decades both inside and outside the hospital. F.C. Raspail, a famous natural scientist, was interested. After having studied the literature and especially the drawings by de Geer he was convinced that the mites depicted by Galés were similar to de Geers' flour-and cheese mite and that they had no resemblence to his picture of scabies-mite. In a control experiment Raspail could show how Galés had cheated by contaminating his slide with cheese-mites. However, a Corsican student at l'Hôpital St. Louis named S.F. Renucci knew the answer to the riddle. He had long ago been taught by peasant women of his home island how to extract the mite and he could now show the method to the doctors at l'Hôpital St. Louis. this was on August 13 in 1834, which usually in the literature is looked upon as the day when the discovery of the aethiology of scabies was made. Maybe we have a different view in Sweden.

Localization of eosinophil granule major basic protein in incontinentia pigmenti.

We report a case of incontinentia pigmenti and demonstrate the deposition and localization of eosinophil major basic protein (MBP) in the vesicular stage of this neurocutaneous syndrome. The initial stage of incontinentia pigmenti is histologically characterized by intraepidermal vesicles associated with eosinophilic spongiotic dermatitis. Pathologic examination of a lesional tissue specimen from our patient demonstrated epidermal necrosis, spongiosis, and vesicle formation. Indirect immunofluorescence with affinity-chromatography purified antibody to human eosinophil granule MBP demonstrated many intact eosinophils within vesicles and scattered throughout the epidermis and dermis, and extracellular deposition of granular MBP in the tissue. The characteristic finding of extensive tissue eosinophilia in incontinentia pigmenti, as well as the new finding of extracellular deposition of an eosinophil granule protein in lesional tissue, suggests the involvement of eosinophils in the pathogenesis of the disease.

Amino acid sequences in amyloid proteins of kappa III immunoglobulin light-chain origin.

The main amyloid fibril (AL) proteins extracted from the spleen of Patient So 124 with systemic amyloidosis and from a skin nodule of Patient KSA with localized amyloidosis were studied by partial amino acid sequence analysis and proved to be of kappa III immunoglobulin light-chain origin. The sequences were similar to that of Bence Jones protein V and, which has been reported to have a unique kappa III subset sequence. Thus, except for position 9 in protein AL(KSA), the amino acid sequences were identical to position 25 in AL(So 124) and in AL(KSA). The question is being raised whether this kappa III subset might contain amyloidogenic sequences.

T lymphocyte subpopulations in alopecia areata and psoriasis: identification with monoclonal antibodies and Fc receptors.

A comparison of T lymphocyte subpopulations as defined by Fc receptors and monoclonal antibodies was investigated in 9 patients with alopecia areata and alopecia universalis (AA and AU) and in 6 patients with psoriasis. It was shown that there was higher proportion of T lymphocytes with Fc receptors for IgG (Tg cells) in patients with alopecia (AA and AU) and psoriasis. The proportions of total T lymphocytes (Tt), T lymphocytes with Fc receptors for IgM, T suppressor/cytotoxic cells (Leu2A), T helper/inducer (Leu3A) as defined by monoclonal antibodies were within normal range as compared to the normal donors. The possible reason of the dissociation between Tg and T suppressor (Leu2A) cells could be that these cells belong to different subpopulations.

Activities of the International Committee of Dermatology.

The International Committee of Dermatology (ICD) is the Executive Committee of the International League of Dermatological Societies (ILDS). It is composed of twelve regular and six ex officio members, of whom no fewer than ten are going to be replaced at the next Congress in Tokyo. Since the last Congress in Mexico City in 1977, the Committee has met every year but 1981. Most of the activities of the ICD have been concentrated on the preparations of the scientific program for the XVI International Congress in Tokyo in 1982. In order to strengthen the collaboration among the member societies, a "Manual" of the ILDS as well as two "Bulletins" of the ICD have been published. For the purpose of encouraging the advancement of dermatology, special committee for extracongressional matters has been appointed. During the years, important material concerning the activities of the ILDS and the ICD have been accumulated. An archive for this material is planned to be organized in Stockholm. For many reasons, a thorough revision of the present rules and regulations of the ILDS has seemed essential. A proposal for new bylaws will be presented at the Assembly Meeting at the Tokyo Congress.

T cell subpopulations and their functions in vitro. A study in patients with alopecia areata and alopecia universalis.

T lymphocyte subpopulations and their in vitro activities were determined in patients with alopecia areata (AA) and alopecia universalis (AU). The frequencies of T cells with receptors for IgG and T cells with receptors for IgM were determined in 16 cases. The IgG and IgM production of B lymphocytes cocultured with autologous and allogeneic T lymphocytes in the presence of PWM was determined in 12 and 9 cases, respectively, and the antibody-dependent cell-mediated cytotoxicity (ADCC) of unfractionated lymphocytes was examined in 6 cases. Patients with AA and AU had a higher proportion of Tg cells and more pronounced ADCC of unfractionated peripheral lymphocytes than normal persons. Furthermore, PWM-induced Ig production of B lymphocytes in the presence of autologous T lymphocytes seemed to be lower than that of controls.

T lymphocyte subpopulations and pokeweed mitogen-induced immunoglobulin synthesis in vitro by mononuclear cells from psoriasis patients.

T-lymphocyte subpopulations and pokeweed mitogen(PWM)-induced immunoglobulin (Ig) synthesis of mononuclear cells in vitro were studied in patients with psoriasis as well as in age- and sex-matched normal blood donors. The frequences of T cells with receptors for IgG (Tg) and T cells with receptors for IgM (Tm) were examined. The IgG and IgM synthesis in mononuclear cell suspensions in the presence of different amounts of PWM was determined. The percentage of total T cells (rosetting with neuroaminidase-treated sheep red blood cells), including high and low affinity T lymphocytes showed no difference between the patient group and controls. The patients with psoriasis had a significantly higher mean proportion of Tg cells than the normal donors whereas there was no significant difference in the proportions of Tm cells between these two groups. The PWM-induced Ig synthesis in the mononuclear cell suspension seemed lower in patients with psoriasis than in controls, the difference being statistically significant when the results were expressed as ratios of Ig amounts present in the supernatants of PWM-stimulated and non-stimulated cultures (index of stimulation).

Blood lymphocyte subpopulations in Mycosis fungoides and their functions in vitro.

T-lymphocyte subpopulations, PWM stimulated in vitro Ig production by mononuclear cells, and spontaneous cell-mediated cytotoxicity (SCMC) were determined in patients with Mycosis fungoides (MF) as well as in sex- and age-matched normal controls. We were able to confirm our earlier findings of a significantly higher frequency of T-lymphocytes with Fc-receptors for IgG (Tg cells) and a proportion of T lymphocytes with Fe receptors for IgM (Tm cells) not significantly differing from normal controls. As defined by monoclonal antibodies, the proportion of T-helper cells (Leu3A) was significantly lower, whereas the T-suppressors cells (Leu2A) were in the range of normal controls. The PWM stimulated and spontaneous Ig synthesis in vitro was lower in MF patients whereas there was no difference in the SCMC activity, in comparison with normal controls. The lower frequency of T-helper cells in the peripheral blood may be explained by their migration to the skin.

Spontaneous cell-mediated cytotoxicity (SCMC) in patients with alopecia universalis.

The spontaneous cell-mediated cytotoxicity (SCMC) of unfractionated lymphocytes was determined in 5 patients with alopecia universalis (AU). The target cells used were K562 and Chang cell lines. All patients had an increased SCMC as compared with age- and sex-matched donors. The results indicate that SCMC against K562 cells is more pronounced than that against Chang cells.

Blood lymphocyte subpopulations and antibody dependent, cell-mediated cytotoxicity (ADCC) in alopecia areata and universalis.

T-lymphocyte subpopulations and antibody-dependent, cell-mediated cytotoxicity (ADCC) were studied in patients with alopecia areata and universalis. The proportions of T-cells with the receptors for IgG (Tg) and T-cells with receptor for IgM (Tm) were determined in 16 cases. The ADCC of unfractionated lymphocytes was examined in 5 cases. A higher proportion of Tg-cells (T-cell with low affinity for sheep red cells) and a more pronounced ADCC of the peripheral lymphocytes were found in patients with alopecia areata and universalis than in age- and sex-matched normal donors.

Prostaglandin E1 treatment of leg ulcers caused by venous or arterial incompetence.

An open and a double-blind study were undertaken on patients with leg ulcers caused mainly by venous (VI) or arterial incompetence (AI). They were treated with intravenous infusions or injections of prostaglandin E1 (PGE1). Eight of 10 patients in the open study experienced relief of pain and a complete or almost complete healing of their ulcers. In the double-blind study (20 patients) 4 out of 5 patients with a history of leg ulcers due to VI for more than 5 year responded to the PGE1 treatment, compared with one of 5 treated with saline. In the saline group 3 more patients with VI of shorter duration improved. In 3 of 5 patients of PGE1 with ulcers due to AI the original ulcer area was reduced by 78--65% after 70 days, while in the 2 remaining cases healing occurred later on. No effect was noted in the 2 patients with ulcers due to AI who received saline infusions. The results indicate the beneficial effect of PGE1 on pain and healing in leg ulcers caused by peripheral vascular disease.