Biomedical subjects
Publications and source records attributed to E Tegner.
In two persons a papular dermatitis was provoked by UVA on an area of the back which was subjected to high pressure and therefore did not tan. The inflammation observed had the appearance of a polymorphous light eruption, but neither of the individuals had a history of any pathological light reaction.
Two patients with metastasizing melanoma and diffuse melanosis have previously been reported to excrete large quantities of trichochromes in the urine. The present study describes 2 further melanoma patients with diffuse melanosis and trichochromuria. The hair of one of the patients which had been red in childhood and turned brown in adult age returned to red with the appearance of melanosis. Normal excretion of a methylated melanocytic metabolite, 6-hydroxy-5-methoxyindole-2-carboxylic acid, was observed in this patient, possibly indicating exhaustion of the methylating system. The other patients excreted large quantities of 6-hydroxy-5-methoxyindole-2-carboxylic acid. Both patients showed highly increased excretion of 5-S-cysteinyldopa. Both patients with melanosis exhibited fine electrone-dense granules in lysosomes of dermal histiocytes. The findings support the concept that trichochromes or similar pigments in dermal histiocytes are responsible for diffuse melanosis in melanoma patients.
A characteristic dermatitis with skin-coloured or erythematous papules localized to the helices and lobes of the ears and to the skin behind the ears was observed in 25 subjects who had been using new, unwashed sheets and pillow-cases containing permanent-pressing resin.
Thirty-eight patients were treated with PUVA for chronic eczematous dermatitis of the palms. Twenty (53%) were completely free from lesions when treatment was stopped, and 11 (29%) were improved. Patients who showed healing remained in remission for an average of greater than or equal to 11 months (range 3 weeks to greater than or equal to 36 months). When the rash recurred it was often milder than before PUVA. Sixteen of the 38 patients also had chronic plantar dermatitis; PUVA treatment resulted in complete clearing in 7 (41%), and remission persisted for an average of greater than or equal to 16 months.
Forty patients suffering from pustulosis palmoplantaris were treated with PUVA therapy. Thirty-six patients had palmar lesions which cleared in 31 cases; in 18 cases after an initial course of 3 sessions of treatment per week during an average period of 10 weeks, and in another 13 only after additional, less frequent continuation of the PUVA therapy. The average total UVA dose at clearing of the palmar lesions was 191 and the final UVA dose 7.3 J/cm2. After 2 years, 9 out of the 31 cases of palmar lesions were still completely healed, and the average duration of remission was greater than or equal to 15 months. For plantar lesions the results of PUVA therapy, using essentially the same procedure, were less satisfactory: healing being obtained in only 5 out of 34 cases. However, for palmar and plantar lesions alike, most patients have reported long-standing improvement from PUVA therapy. A surprisingly high frequency of nausea was noted as a side-effect.
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An extract of bovine retina and choroid with tyrosine hydroxylating and dopa-oxidizing capacity also showed marked formation of 6-OH-dopa on incubation with tyrosine and ascorbic acid. The extract contained appreciable amounts of methaemoglobin as determined spectrophotometrically, and boiled extracts also showed catalytic activity. The effect of methaemoglobin on the oxidation of tyrosine and dopa was therefore investigated. Methaemoglobin catalysed the formation of dopa and 6-OH-dopa in the presence of tyrosine and ascorbic acid. Hydrogen peroxide plays an important role in this reaction: the rates of formation of both dopa and 6-OH-dopa were increased by addition of hydrogen peroxide but diminished by addition of catalase. Methaemoglobin also catalysed the formation of cysteinyldopa from dopa and cysteine.
5-S-Cysteinyldopa concentrations in serum were studied in healthy individuals exposed to daily high-intensity UVA radiation. A marked increase in 5-S-cysteinyldopa was found after 3 days, and in some individuals concentrations were still higher after 7 to 10 days. The immediate pigment darkening (IPD) and delayed tanning (DT) were weak or absent at pressure sites, i.e. in skin with a low concentration of oxygen.
Two brothers, born in 1944 and 1950, had been brought up in separate homes since 1951. In 1978 they were both afflicted with Behçet's syndrome. This condition is uncommon in Scandinavia, and there are no other known reports of familial cases from the Scandinavian countries. The etiology of the disease is obscure and controversial. In our two cases a hereditary disposition seems more probable than an infectious origin.
Seborrhoeic dermatitis of the face was observed in 28 of 347 patients treated with PUVA for psoriasis. The facial lesions appeared after discontinuation of PUVA, and had not been present at the start of PUVA treatment. They were prevented by masking the face during irradiation.
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During PUVA treatment a 66-year-old woman with mycosis fungoides in stage III suddenly developed widespread papulonodular lesions of alarming clinical and histological appearance. There was rapid spontaneous and complete regression of the eruptions, which was probably an expression of transient lymphomatoid papulosis in connection with MF.
5-S-Cysteinyldopa and dopa concentrations in serum were studied by high-performance liquid chromatography (HPLC) in patients with psoriasis treated by 8-methoxypsoralen and UVA light. A marked increase in 5-S-Cysteinyldopa was found after 3 days' treatment, although no increase in pigmentation could yet be observed. The highest concentrations of 5-S-Cysteinyldopa in serum were noted after 1 or 2 weeks' treatment. In one patient who showed no increase in serum 5-S-Cysteinyldopa treatment was unsuccessful. During PUVA treatment of 3 patients with psoriasis confined to the palms and/or soles a delayed increase in serum 5-S-Cysteinyldopa was noted after 5 weeks. This delayed response after treatment of a small area of the body is remarkable, and may indicate the formation of a systemic melanocyte stimulation factor. There was no increase in the serum dopa concentrations during PUVA treatment, and dopa analysis was of no value in assessing the activity of the melanocytes. Some unexpectedly high dopa values recorded before and during PUVA treatment may be explained by the fact that dopa originates in the nervous system or the adrenals.
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Two cases of contact allergy to lidocaine are reported. They also reacted to chemically related anesthetics of the amide type: one to bupivacaine, mepivacaine and prilocaine and the other to mepivacaine only. The patients also reacted to the chemically nonrelated cincaine, an anesthetic of the ester type. The lidocaine metabolites o-toluidine and mxylidine gave negative reactions.
Four patients with similar cutaneous lesions clinically simulating Bowen's disease or basal cell carcinoma revealed histopathological changes of lichen planus. Examination by direct immunofluorescence was performed in two of the patients, showing ovoid bodies containing IgM, IgA and fibrinogen in one patient and IgM and fibrinogen in the other patient.