Biomedical subjects
R H Champion
Publications and source records attributed to R H Champion.
Long-term follow-up of lichen planus.
Several large series of patients with lichen planus were reported some 30 years ago but no recent large surveys have been published. In this study, detailed enquiry was made into the natural history of the disease in 214 patients followed up 8 to 12 years after presentation to the Dermatology Department. The key findings from this study showed that the mean age of onset of lichen planus in males was significantly lower than in females (40.3 years in males compared with 46.4 years in females, p less than 0.05). The main eruption of lichen planus cleared within one year in 68% of the patients but we found a higher recurrence rate than in previous series at 49%. Many patients suffered from persistent brown staining many years after the rash had cleared.
A practical approach to the urticarial syndromes--a dermatologist's view.
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Urticaria: then and now.
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Elephantine sarcoidosis presenting as ulcerating lymphoedema.
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Lichen striatus occurring as an annular eruption: an acquired "locus minoris resistentiae".
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Specific hyposensitization in atopic dermatitis.
Specific hyposensitization is rarely advocated for the treatment of atopic dermatitis. Good results have been obtained in fifteen mainly adolescent and adult patients selected from over 3,000 patients with atopic dermatitis. Criteria included a history of exacerbations of the dermatitis after exposure to the antigen, an airborne antigen which could not be avoided, a rather distinctive clinical picture and symptoms bad enough to warrant the considerable difficulties involved.
Erythema chronicum migrans in Britain.
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Hypersensitivity to bacteria in eczema. III. Arthus-like responses to bacterial antigens without specific antibody.
Seven patients with a macroscopic response resembling an Arthus reaction, and occurring 2-4 h after intracutaneous injections of staphylococcal particulate antigens or total staphylococcal extract, were examined for the appropriate specific antibodies that activate complement, and by immunofluorescence for antigen, immunoglobulin and complement in the reaction site. Four of the patients had serum antibody, and skin reactions with the typical features of early Arthus reactions and containing immunoglobulin, complement and antigen. Three patients had apparently 'non-allergic' responses. They lacked appropriate antibody in serum and immunoglobulin deposits in the lesions, though all except one had complement deposits in reaction sites. One of the three nevertheless had histological changes typical of an Arthus response. Lymphocytes teased from the reaction site skin of one patient with a 'non-allergic' 4 h response comprised 35 B cells bearing IgG out of 200 counted. The nature of the 'non-allergic' response reaching a maximum size at about 4 h macroscopically and in some instances microscopically resembling an Arthus response, is still to be determined but it illustrates the caution necessary in interpretation of skin tests with bacterial antigens.
Hypersensitivity to bacteria in eczema. IV. Cytotoxic effect of antibacterial antibody on skin cells acquiring bacterial antigens.
The sera of persons with generalized eczema (Whitfield-type) or with disseminated nummular eczema were examined for complement-activating antibacterial antibodies to test the hypothesis that some eczematous change results from an antibody-mediated cytotoxic reaction. Bacteria dying in the stratum corneum release soluble antigens, some of which diffuse into the stratum Malpighii and become firmly adsorbed to the epidermal cells. Antibacterial antibody and complement diffusing into the epidermis react with the antigens acquired by the cells and may induce vacuolation or lysis. Phenol-extracted and freeze-press-extracted antigens (both containing teichoic acids) from Staphylococcus aureus and a micrococcus (Baird-Parker types SI and MI respectively) are adsorbed by monolayers of human skin, embryo or amnion. Cells acquiring the antigen(s) are severely damaged when treated with sera containing the appropriate antibacterial antibodies and complement. IgM complement-fixing antibody appears to be much more cytotoxic in this test than IgG. The cytotoxic activity of a serum is specific for the acquired bacterial antigen and appears to depend on a sufficient concentration of the effective antibody, and not on the presence of antibodies with special properties. Explants of full thickness skin treated with bacterial antigen extracts were unharmed by the antibodies that were cytotoxic for monolayers of skin cells treated with the same antigens. The in vitro cytotoxic test should represent a potential in vivo cytotoxic phenomenon, because skin cell monolayers from two patients adsorbed bacterial antigen prepared from cultures obtained from the same patients, and were damaged by autologous serum containing anti-staphylococcal antibody and complement. It seems probable that this may be an aggravating but not necessarily an initiating factor in many cases of eczema.
Hypersensitivity to bacteria in eczema. I. Bacterial culture, skin tests and immunofluorescent detection of immunoglobulins and bacterial antigens.
A study was made of the cytotoxic effect of antibacterial antibody and complement reacting with bacterial antigens firmly adsorbed to epidermal cells. It is believed that this phenomenon enhances the severity of the lesions and their spread in some cases of disseminated eczema. In this first part of the study it is confirmed that Staphylococcus aureus and micrococci are frequently present on lesions and 'unaffected' skin of patients with disseminated eczema. Intradermal skin tests with antigens of staphylococci and micrococci on 122 eczematous patients elicited immediate, or combined immediate and 4 h (Arthus-like) responses, in a large proportion, but few showed uncombined 4 h responses or delayed hypersensitivity, in contrast to findings reported by others. Immunofluorescence tests on skin of thirty patients showed that IgG and IgM diffused into the epidermis, sometimes to the skin surface, of lesional skin, and more immunoglobulin was found in skin of 'unaffected' areas than in skin of normal healthy persons, indicating that clinically unaffected skin in patients with disseminated eczema is abnormal. IgD was present in three of eight samples of unfixed, and six of eight samples of fixed eczematous skin. Staphylococcal and micrococcal antigen was shown on the skin surface and also diffusely in the cytoplasm of cells in the dermis beneath the surface deposits, indicating percutaneous absorption. Further small amounts of antigen were adsorbed to some epidermal cells. These results show that the predisposing conditions for a cytotoxic reaction mediated by hypersensitivity to bacteria do occur. Increased growth of staphylococci and micrococci on eczematous skin would result in increased deposits of antigen. Bacterial antigens are absorbed into the skin and bind with epidermal cells, and immunoglobulins diffuse into the epidermis. Furthermore, skin tests showed that many eczematous patients were hypersensitive to bacteria. Studies on the nature of the antibacterial antibody will be published in the succeeding reports.
Hypersensitivity to bacteria in eczema. II. Titre and immunoglobulin class of antibodies to staphylococci and micrococci.
The amounts of agglutinating antibody to staphylococcal and micrococcal phenol-extracted (probably teichoic acids) and protein antigens, prepared from Baird Parker types S1, SIV and M1, were no greater in eczematous than in control persons. Most antibody to phenol-extracted to phenol-extracted antigens was IgM which frequently activated complement to lyse red cells which had adsorbed the bacterial antigen. IgG antibody against phenol-extracted staphylococcal antigen (Staph. aureus, Baird Parker Type S1) was shown to be specific antibody combining by the F(ab)2 portion of the molecule. The phenol-extracts did not contain staphylococcal Protein A that binds to the Fc portion of IgG. Furthermore, the presence of Protein A in the protein or total antigen extracts did not appear to modify the results of the tanned cell agglutination test. The occurrence of immediate or of 4 h, Arthus-like skin test responses to staphylococcal or micrococcal antigens was unrelated to the agglutinin or complement-lysis titre of the relevant antibody.
Scrotal surprises in children.
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Diseases of the skin. Drug therapy of urticaria.
Most patients with urticaria can be assessed by taking a relatively simple history with few or no investigations and controlled by a suitable antihistamine given at appropriate times until spontaneous resolution occurs without a complete diagnosis ever being made. Those that do not respond in this way require sometimes quite elaborate investigations, the institution of which would be an imposition in a mild case. Even after full investigation and ringing the changes of all available drugs, too many cases persist to the frustration of all concerned.
Generalized pustular psoriasis treated with dapsone.
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Functional urethral construction in female epispadias.
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