Biomedical subjects
Publications and source records attributed to F Brandrup.
52 (5.4%) of 1063 eczema patients showed a positive reaction to chlorhexidine gluconate 1% aq. and/or 1% pet. on patch testing. At retesting, 21/29 (72%) were still positive and the results of use-test, anamnesis and supplementary testing indicated allergic sensitization in about 50% of these patients. Patients with leg eczema/leg ulcer seem to be particularly at risk.
A girl with widespread vesicular pustular lesions present at birth is reported. The differential diagnosis is discussed, with an extreme eruption of erythema toxicum neonatorum and the newly described entity transient neonatal pustular melanosis (TNPM) under consideration. This benign, self-limited, pustular eruption, with lesions present at birth, requires no specific therapy, but must be distinguished from the neonatal skin manifestations of viral, bacterial and fungal diseases. The condition should not be confused with others involving sepsis.
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2 cases of malignant melanoma in 2 male patients, 68 and 63 years old, associated with mycosis fungoides and parapsoriasis en plaques, respectively, are reported. The parapsoriasis later on developed into mycosis fungoides. A pathogenetic linkage based on decreased cellular immunity in mycosis fungoides is suggested.
In order to investigate the efficacy of anthralin ( Anthraderm ) in the treatment of warts a randomized controlled trial was carried out in 72 patients. During a two-month period of treatment 56% were cured in the group treated with anthralin 2% ( Anthraderm ), evaluated at follow-up 2-9 months after finishing treatment, compared with 26% in the group treated with the comparative drug ( Verucid ). Anthralin 2% ( Anthraderm ) was found to have a significantly better effect, especially in the group of patients with warts solely on the hands.
Analysis of the presence of psoriasis in all first-degree relatives of psoriatic twin probands, 38 monozygotic (MZ) and 24 dizygotic (DZ), has been performed in order to clarify if genetic heterogeneity might be present (the twin-family method). The probands were derived from a population based sample of like-sexed twin pairs. An almost identical frequency of psoriasis in parents, siblings and children, with no sex difference, was found. By comparisons of empirical risk figures for psoriasis in first-degree relatives of concordant as compared with discordant MZ probands and HLA-B 13 and/or HLA-B 17 positive MZ probands compared with MZ probands lacking these antigens, no clue to the presence of genetic heterogeneity was found. An almost identical risk in co-twins and ordinary siblings of DZ-probands was found. The data were incompatible with autosomal recessive or X-linked inheritance, but not incompatible with autosomal dominant inheritance with reduced penetrance or with multifactorial inheritance.
A 63-year-old man had acrokeratosis paraneoplastica (Bazex' syndrome) characterized by violaceous erythema and scaling of the fingers, toes, nose, and aural helices. Severe nail dystrophy was present. Extensive examination of the patient for malignant neoplasms a few months after the initial appearance of the skin changes disclosed no abnormalities, but one year after onset, an epidermoid carcinoma of the lung was found.
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The lymphoid component of skin infiltrates from 6 cases of mycosis fungoides and 2 cases of T cell chronic lymphatic leukaemia consisted almost exclusively of T lymphocytes with abnormally high E receptor expression. Such T cells were also found to dominate the skin infiltrates from 10 patients with severe atopic dermatitis. Blood T lymphocyte counts from all types of patients were within the normal range, but even the blood T lymphocytes of the patients had a strong E receptor expression. The bone marrow in atopic dermatitis and in mycosis fungoides showed normal T cell counts with normal E receptor expression. Supported by basic lymphocyte-kinetic considerations it is likely that the skin in T lymphoproliferative diseases is characterized by an abnormal ability to home and/or to trap T lymphocytes with strong E receptor expression.
Skin biopsies from a patient suffering from lichen nitidus were studied by electron microscopy and immunofluorescence studies. Complete disintegration of the stratum basale in the central area of the lesion and signs of acantholysis in the border area were found. In the central part of the lesion the dermo-epidermal junction was severely damaged in most places. In the dermal infiltrate, macrophages and lymphocytes were found with a considerable representation of Sézary cells, not previously reported in lichen nitidus. The ultrastructural changes are identical with those found in lichen planus. No in vivo bound immunoglobulins, fibrinogen, or complement C3 were found.
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The variation in expression of psoriasis, in individuals with identical genetic constitutions, i.e. monozygotic twins, has been studied in a population-based sample of monozygotic twins in the Danish Twin Register. All verified and probable cases of psoriasis in twins, born between 1891 and 1930 inclusive, were ascertained. Results are presented of an examination of all members of index pairs in which both partners were alive. The zygosity determination was based in 94% of the pairs on very extensive serological examinations. Thirty-two monozygotic pairs were found to include at least one partner with unquestionable psoriasis (18 concordant, 14 discordant). The analyses give firm evidence of the contribution of genetic factors to the manifestation, age at onset, clinical type, course, and severity of psoriasis. A close association between psoriasis and HLA-B 13 an B 17 was found in both discordant and concordant pairs. No difference was found between partners from discordant MZ-pairs with regard to infections or marked 'stress' conditions.
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The skin and oral mucosa were studied in an unselected series of carriers of x-linked chronic granulomatous disease, a hereditary condition in which phagocytic cells display a pronounced functional defect. Three carriers had discoid lupus erythematosus (DLE)-like skin lesions which histopathologically were consistent with DLE of the hypertrophic and profundus type. Four patients had experienced photosensitivity in childhood. Seven patients had recurrent aphthous-like stomatitis which should be distinguished from the recurrent aphthous stomatitis seen in otherwise healthy individuals. The remarkably high incidence of DLE-like symptoms in heterozygous carriers might be related to the presence of mixed populations of defective and normal phagocytes. The variable expression of skin symptoms may be related to uneven distribution of abnormal and normal phagocytes. Female patients with these clinical symptoms, especially the combination of DLE-like skin lesions and aphthous-like stomatitis, should be suspected of being carriers of chronic granulomatous disease and studies of phagocyte function in vitro should be performed, since the diagnosis of the carrier state is of utmost importance for genetic counselling before pregnancy.