Acta dermato-venereologica. Supplementum最新文献

The coexistence of psoriasis with LE or other photosensitive disorders is rare in our patient population, occurring in 0.69% of patients with psoriasis and 1.1% of those with LE. PMLE was the most common cause of photosensitivity in psoriatic patients without LE, occurring in 32%. Less common causes included drug-related photosensitivity (thiazides and thiazide derivatives in four of the five cases), PUVA reactions, and photocontact reactions. The Goeckerman regimen or UVB applied in a cautious, well-controlled atmosphere was generally well tolerated in this group, including patients with PMLE. Photosensitivity occurred in 50% of our patients with psoriasis and LE, and it was secondary to LE in 70% of cases. Most patients were female and had SLE. Psoriasis developed first in 55% of the cases. Studies that were useful for distinguishing photosensitive from nonphotosensitive patients with SLE included determination of antibodies to extractable nuclear antigens (67% versus 14%), double-stranded DNA (64% versus 9%), and skin biopsy for direct immunofluorescence (58% versus 27%). Occasional patients have features suggestive of photosensitivity with or without signs or symptoms of LE. These patients may have atypical psoriatic plaques occasionally yielding routine histology diagnostic of psoriasis with direct immuno-fluorescence results suggestive of lupus. Frequently, connective tissue serology findings are positive, and affected patients require close follow-up for the development of LE. In patients with psoriasis and suspected photosensitivity, we recommend a careful history and examination, skin biopsy for routine histology and direct immunofluorescence, blood tests including determination of antibodies to antinuclear antibodies (Hep-2 substrate if negative on routine substrate), extractable nuclear antigens, and double-stranded DNA, and phototesting when indicated. Large-scale prospective studies are required before the most appropriate therapy for patients with psoriasis and LE can be recommended.

The concept 'sexually transmitted diseases' (STD) was introduced in the nineteen sixties and comprises many diseases of varying importance from scabies to HIV infection. The STD family has grown wider and new members will probably join. The starting point of these studies was that patients with HPV infection, attending the STD clinic, appeared to increase in number in the late eighties. HPV was analysed with the Southern blot technique from portio cervix in a female population attending the STD clinic. In this population 8% were HPV-positive. If vulvar/vaginal HPV manifestations were present the figure increased to 34%. Abnormal cytology was found in 13% and if the woman harboured high-risk types of HPV there was also a greater risk of abnormal cytology (Paper I). Different clinical manifestations of HPV infection were examined in men with respect to different types of HPV. Macular lesions seemed mainly to be related to high-risk types to accuminate lesions. Histological dysplasia was correlated to high-risk HPV types (Paper II). The resemblance of acetowhite lesions of the vulva to oral hairy leukoplakia suggested the possibility of EBV as an etiological factor. EBV was demonstrated with PCR in 48% and HPV in 17%. In the group with no acetowhite reactions the correspondings figures were 11% and 42% (Paper III). As these results were unexpected, another group of women with the same clinical manifestations, as well as a control group, were examined. The tendency to find more EBV in the acetowhite lesions was confirmed. HPV was detected equally in both groups (Paper IV). The inclusion criterion was presence of acetowhite, koilocytotic lesions in routine histological examination. When all biopsies were reevaluated, only 8 of 20 demonstrated an evident koilocytosis (Paper IV). A male group with acetowhite penile lesions and a group with no acetowhite reactions were investigated with respect to EBV and HPV. HPV positivity was strongly correlated to acetowhite lesions but not EBV. All lesions demonstrated an evident koilocytosis (Paper IV). The oral mucosa of men with acetowhite, penile lesions more often harboured both EBV and HPV compared to the controls (Paper IV). The portio cervix was examined to detect EBV and HPV, irrespective of clinical manifestations. EBV and HPV was found in 38% and 33%, respectively (Paper V). In patients with acetowhite, koilocytotic and/or dysplastic lesions on the portio cervix EBV was found in 30% and HPV in 51%. EBV was not associated with either acetowhiteness or dysplasia (Paper VI). A group of HPV infected men was investigated concerning psychological complications in connection with their viral, genital infection. Half of the group were anxious about the risk of giving their partner an oncogenic virus, and a fifth of the group had feelings of "dirtiness" and reported a decrease in their sexual desire (paper VII). In view of this, it is concluded that acetowhite, koilocytotic lesions of the penis and the cervi

This thesis describes the methodology and validation of cutaneous microdialysis for the study of skin penetration of various topically applied substances in experimental dermatological research. Microdialysis is a sampling technique which makes it possible to measure substances in the extracellular water space in human and animal skin in vivo. A microdialysis probe, i.e. a tubular semipermeable membrane connected to afferent and efferent tubings, is placed in the dermis and perfused. Substances from extracellular space may diffuse through the pores of the membrane and be collected in the dialysate for further analysis. Glucose, sodium fusidate, betamethasone 17,21-dipropionate and calcipotriol were chosen as model substances and were investigated by in vitro microdialysis. The perfusion rate, the length of the membrane, stirring rate and temperature influenced recovery of the substances. Lipophilic compounds tend to have low recoveries and differ in recovery and loss. Insertion of the microdialysis probe causes a trauma in the skin. Rat and human skin were studied in vivo. Increase in skin blood flow, erythema and skin thickness were demonstrated by laser Doppler perfusion imaging, Dermaspectrometer colorimetry, Minolta Chromameter colorimetry and ultrasound imaging of cross-sectional skin structure. In addition histamine was released in rat skin due to the needle insertion. An equilibration period of minimum 90 min in human skin and 30 min in rat skin after the insertion is necessary to allow the effects of trauma to diminish. To obtain measurable concentrations in the dialysate in rats treated topically with the lipophilic drug betamethasone 17-valerate, unrealistic high doses and penetration enhancement were required. The highly protein-bound drug fusidic acid was not measurable in the dialysate after topical application, probably due to very low concentrations of free diffusible drug. Measurable concentrations were only observed after high doses of oral administrations of fusidic acid. Calcipotriol could not be detected in the dialysate. The microdialysis technique is probably primarily useful for the study of hydrophilic substances and substances with low protein binding and low molecular weight. However, application of cutaneous microdialysis for the study of lipophilic substances need further methodologically development.

Efficacy of chemical and/or surgical treatment for penile and anal condylomata acuminata was investigated in two retrospective studies of hetero- and homosexual men. Variation in clinical features and symptomatology as well as the reliability of diagnostic criteria by different methods for acetowhite penile lesions was also studied. Furthermore, the antibody response in the course of penile wart disease as well as in asymptomatic genitoanal papillomavirus infection (GPVI) was analysed. In the first retrospective study, as much as 23% of patients still had condylomas after one year of chemical and/or surgical treatment. On the other hand, 38% were cured after a single treatment session. In the group mainly with anal warts, concurrent penile warts were significantly more common among heterosexual men compared to homosexual men (p < 0.001), while intra-anal wart growth was more common among the homosexual males (p < 0.001). When comparing diagnostic methods for subclinical penile HPV infection, conventional histopathology appeared to be the most valuable diagnostic aid to penoscopy, while the additional use of Southern blot, in situ hybridisation and PCR assays for HPV DNA detection did not increase the predictive value of GPVI. We also describe a new distinct clinical entity, HPV-associated balanoposthitis, comprising a wide range of often long-lasting symptoms, such as itching, burning and dyspareunia. A significant increase in the IgG antibody response against defined epitopes in the L1 and L2 capsid proteins of HPV 6, was found among men with previous condylomata. By following a cohort of STD clinic patients with multiple brush samples from the genitoanal region as well as serum samples taken at several consecutive clinical visits, we identified 16 patients who had seroconverted to HPV seropositivity during follow-up. Antibody responses to several HPV-derived peptide and protein antigens were induced at the same time. Seroconversions were usually seen concomitantly with HPV acquisition or at the visit after HPV DNA was first detected. The HPV antibody response was frequently transient and declined or disappeared after clearance of infection. The antibody responses were induced by several different HPV types, indicating limited type-specificity. The most type-restricted response was against HPV 16 capsids, where seroconversions to continuous seropositivity were induced by infection with HPV 16.