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SUMMARY A morphological and biochemical analysis was made of cornified envelopes isolated from patients with different congenital disorders. Nomarski contrast microscopy of the envelopes showed that their morphology was not greatly altered in several types of keratoderma and parapsoriasis, but it was grossly modified in ichthyotic disorders. The various types of ichthyoses, keratoderm -lysine isopeptide bonds. In the epidermis two morphologically distinct types of CEs have recently been identified:4 a polygonal rigid type (CEr) and an irregularly shaped type with a fragile appearance (CEf) which, in healthy skin, is only present in the lower part of the stratum corneum. These two types possibly represent two successive steps of CE maturation. The stratum corneum of normal subjects contains mainly CEr, whereas the scales in psoriasis contain a much higher proportion of CEf. Keratinocytes in submerged cultures are only able to form CEf4

We describe a 20-year-old man with naevus anaemicus on the chest where, after dermabrasion of the epidermis, enlarged teleangiectatic dark-red vessels were seen within the previously pale area. They were clearly different from those seen on dermabrasion at this site in normal skin and in patients with vitiligo where the area is lighter red with only small punctual bleedings from arterial capillaries. The naevus anaemicus and a port-wine stain (naevus flammeus) in the same location is a phenomenon of vascular twin spotting, which was revealed when the epidermis was removed. The area was transplanted with thin epidermal grafts and healed within 2 weeks. One year later the naevus looked the same as before grafting. Much thicker grafts than those used by us will be needed, but they are not cosmetically acceptable.

The aim of this study was to test the usefulness of a melanocyte-enriched cell suspension for the treatment of leucoderma. After removal of a superficial (4-30 cm2) skin sample, the cells were mechanically separated in a trypsin-EDTA solution, centrifuged and washed in a melanocyte medium. The melanocyte-enriched epidermal cell suspension devoid of stratum corneum and stratum granulosum was then applied to the dermabraded depigmented skin. The 26 patients treated had piebaldism (three), vitiligo vulgaris (17), segmental vitiligo (three), halo naevi (one), naevus depigmentosus (one) and chemical leucoderma (one). In patients with widespread piebaldism we found that by diluting the cell suspension the recipient area could be increased to up to 10 times the size of the donor area with the same good results as without or with less dilution. In patients with vitiligo areas of between 50 and 90 cm2, the recipient areas were increased three- to fivefold in the donor area. Patients with piebaldism, segmental vitiligo and halo naevi healed completely, as did most patients with vitiligo. In naevus depigmentosus no effect was seen. Our new method for treatment of leucoderma has the advantage that cell culture is not needed and that it is more suitable than epidermal sheet grafts when several small areas are to be treated.

The aim of this 2-year study was to test the hypothesis that folic acid, vitamin B12 and sun exposure could be helpful in treating vitiligo. One hundred patients with vitiligo were treated with oral folic acid and vitamin B12 after being informed that sun exposure might enhance repigmentation. They were requested to keep a record of sun exposure in summer and UVB irradiation in winter. The minimal treatment time suggested was 3-6 months but should be longer if improvement was achieved. Clear repigmentation occurred in 52 patients, including 37 who exposed their skin to summer sun and 6 who used UVB lamps in winter. Repigmentation was most evident on sun-exposed areas, where 38% of the patients had previously noted repigmentation during summer months. Total repigmentation was seen in 6 patients. The spread of vitiligo stopped in 64% of the patients after treatment. Folic acid and vitamin B12 supplementation combined with sun exposure can induce repigmentation better than either the vitamins or sun exposure alone. Treatment should continue as long as the white areas continue to repigment. Further studies are needed to determine ideal minimal dosages of vitamins and UV exposure, as well as treatment time.

Thin epidermal sheets, obtained by a high-speed air-driven dermatome, were used to repigment white areas in 19 patients with vitiligo and one boy with piebaldism. In the depigmented skin to be treated the epidermis was removed by a rotating diamond fraise under topical and/or local anaesthesia injections. The method was used on most parts of the body, including the eyelids and genitalia. The maximum total area treated on each occasion was 190 cm2. Excellent results could be obtained if the vitiligo had been stable and had not increased anywhere during the last 2 years. Lack of immobilization could explain a poor result in some areas. The donor area on the buttocks healed quickly without depigmentation. In the transplanted area milia were observed in the first 6 months. No scarring was seen. The technique has a niche in the treatment of depigmented skin, especially in larger areas.

This is a randomized, double-blind, parallel-group, multicenter study involving 120 patients comparing the safety and tolerability of two midpotency topical preparations, fluticasone propionate cream, 0.05%, and hydrocortisone-17-butyrate cream, 0.1%, in the treatment of moderate-to-severe eczema. Safety of the study medications was determined over a twelve-week period using laboratory tests for selected fasting blood chemical levels, hematologic analysis, urinalysis, and morning plasma cortisol levels, and by analyzing both the nature and frequency of reported adverse events. Efficacy was evaluated during the first four weeks of the study. None of the fluticasone-treated patients experienced any severe drug-related adverse events, but one hydrocortisone-17-butyrate-treated patient's eczema was severely exacerbated by drug therapy. Plasma cortisol monitoring revealed minimal hypothalamic-pituitary-adrenal axis suppression. Overall, the nature of drug-related adverse events in patients as young as 12 years old treated with fluticasone propionate cream, 0.05%, indicates this topical application was safe and well tolerated throughout the twelve-week study. Fluticasone cream was also found to be similar in efficacy to hydrocortisone-17-butyrate cream.

We have developed a technique through which we can multiply melanocytes in culture from a small specimen of normally pigmented buttock skin and reimplant them into depigmented sites of vitiligo. To date, 90 patients have benefited in our hands from such autologous transplantation of pigment cells. Often we have an excess of cells which we would like to store for later use in the event a patient requires further treatment. We report here on 4 cases in which we have cryostored cultured melanocytes for 6-12 months, reimplanted them into vitiliginous sites of the donor after one week of reculture, and obtained optimal repigmentation. We now routinely freeze melanocytes left over after treatment.

Deep-seated lipomas can present with symptoms very different from those of the common subcutaneous variety. Rapid growth and nerve encroachment may cause suspicion of malignancy. The case histories as well as the clinical and radiographic findings of 2 patients with alarming symptoms from deep-seated lipomas of hand and forearm, respectively, are described. By means of CT an accurate preoperative diagnosis could be made, and surgery planned accordingly.

The area of UV erythema produced by a small beam head was found to increase with increasing doses. The aim was to investigate whether measurement of the area could be a more useful indicator of UV-induced damage than classic visual grading. Topical pretreatment with all-trans retinoic acid (tretinoin) and betamethasone valerate was used to test the applicability of the method in pharmacological studies. We used a round outlet head (5 mm2) connected by optical fibre to a monochromatic irradiator, and doses ranging from 0.05 to 0.2 Joule of 300 mm UV light were applied to the skin of 6 healthy subjects. Erythemal area was calculated by the measurement of two diameters, and intensity was graded visually (0-6 scale). The area of the erythema correlated with the increase in intensity up to score 6. Area measurement was less subject to intra-investigators' variability than the intensity score. By multiplying intensity by area, a good indicator of UV-induced reactivity was obtained. Pretreatment with betamethasone valerate decreased the area of erythema, as did tretinoin 12 h after irradiation. Thus, area measurement of erythema is a useful adjunct to visual grading of UV-induced skin reactions.

The inhibition of erythema by drugs applied topically after irradiation with 0.2-0.8 J of 313 nm has been studied in healthy volunteers. Indomethacin and piroxicam markedly inhibited the erythema at 6 to 24 h after irradiation but erythema reappeared at 45 h. The results reported suggest that the UVB response is biphasic with an early phase responsive to nonsteroid anti-inflammatory drugs and a late phase which is not responsive. No effect on the intensity of the erythema was seen with betamethasone chloroquine and cetirizine. Oral intake of aspirin before and/or after irradiation did not influence the UV response.

The effects of one week's daily treatment with dexchlorpheniramine (3 + 3 mg x 2) and loratadine (10 mg x 2) on the cutaneous reactions to putative mediators of urticarial reactions were studied in healthy subjects and in patients with chronic urticaria. Biopsy specimens were taken from skin with delayed reactions and studied immunohistochemically for the presence of eosinophilic cationic protein (ECP). In healthy subjects both antihistamines significantly decreased the weal and flare induced by histamine and the histamine releaser compound 48/80. They also reduced the flare seen after injection of PAF (platelet activating factor) and kallikrein. In patients with chronic urticaria the delayed reactions to PAF and kallikrein were larger than in healthy subjects. The immediate flare seen after injection of histamine, 48/80 and PAF, and the delayed reaction to 48/80, were significantly decreased by treatment with loratadine. No correlation was found between the clinical response and test reactions. In the group of healthy subjects, eosinophils were increased in the skin of all subjects after intradermal injection of 100 micrograms of PAF and in 50% after 1 microgram of PAF, but no eosinophils were seen after injection of 1 ng of PAF. In patients with chronic urticaria the eosinophils were increased at all sites where 1 ng of PAF had been injected and also at a limited number of sites of injection of histamine, 48/80, kallikrein and saline. Treatment with the antihistamines had no effect on the influx of eosinophils in the skin.

The effects of oral cetirizine on spontaneous and provoked urticaria were evaluated in two studies. In a double-blind crossover trial, 30 patients with idiopathic urticaria received 10 or 20 mg of cetirizine or placebo. Cetirizine was significantly more effective than placebo in reducing the incidence of erythema, wheals, and pruritus. No serious side effects were reported. In the second study of ten patients with chronic urticaria, immediate and delayed reactions to injected autologous serum, histamine, kallikrein, and synthetic platelet-activating factor (PAF)-acether were inhibited by 10 mg of cetirizine. These results suggest that the mechanism of action of cetirizine may involve inhibition of PAF-induced influx of eosinophils.

The effects of oral administration of the antihistamine cetirizine on the weal and flare caused by intradermal injection of platelet activating factor (PAF-acether), kallikrein, histamine and the patient's own serum were investigated in 10 patients with chronic urticaria. Cetirizine markedly reduced the weal and flare induced by all these agents as measured 12 min after the injections. The delayed reactions observed after injection of PAF, kallikrein and serum were also inhibited by cetirizine at 6 hours. In addition, reactions which were present 20 h after injection of the agent before administration of cetirizine were found to be inhibited at the same point in time after cetirizine treatment. These effects might explain the good inhibitory clinical effect of cetirizine on the patients' urticaria. No side-effects were noted during the treatment.

Possible connections between carpal tunnel syndrome (CTS) and exposure to vibrating handheld tools, repetitive wrist movements, and heavy manual work were examined in a case-referent study. The cases were 38 men operated on for CTS between 1974 and 1980. For each case, two referents were drawn from among other surgical cases (hospital referents) and two further referents from the population register and telephone directory, respectively (population referents). Thirty four of 38 cases (89%) and 143 of 152 referents (94%) were interviewed by telephone. An increased prevalence of obesity, rheumatoid disease, diabetes, or thyroid disease was observed among the cases but most did not suffer from any of these disorders. CTS was significantly correlated with exposure to vibration from handheld tools and to repetitive wrist movements but showed a weaker correlation with work producing a heavy load on the wrist. A cause-effect relation between CTS and exposures to handheld vibrating tools and to work causing repetitive movements of the wrist seems probable. Some differences between hospital and population referents indicate that a case-referent study of this type could be biased by inappropriate selection of referents.

35 individuals showing reactions to penicillin of anaphylactic shock, angioedema or urticaria were investigated. Their skin sensitivity was analysed using 16 different penicillin derivatives. In addition, the content of circulating reagins against the penicilloyl structure in the patient’s sera were analysed using RAST. 17 of the patients had negative skin reactions and RAST results to all substances tested. The other 18 were skin test-positive to at least one derivative but showed markedly heterogeneous patterns of skin reactivity. 14 had positive reactions against penicilloyl structures accompanied by anti-penicilloyl reagins. Four patients showed doubtful reactions only to penicillin or penicilloate and/or penilloate. These patients also had very low levels of reagins against penicilloyl in their sera. Positive skin test results using monovalent penicillin derivatives such as penicillin, penicilloate, penilloate, penicilloyl amide, penicilloyl-formyl-lysine, penicillamine, which cannot form a multivalent antigen with penicillyol specificity, indicated formation of other derivatives of importance in penicillin allergy, e. g., penicillamine protein conjugates. Three patients showed skin reactions to ampicillin polymer and two to benzyl-penicillin polymer. The skin tests performed with the penicillin derivatives used do not seem to give more information on the sensitivity of the patiens than does the RAST using penicilloyl structures.

SUMMARY Plasma from patients with active psoriasis has been shown to induce the formation of stellate fibrin-fibronectin microclots in vitro around cultured keratinocytes and fibroblasts. Such a stellate radiation of fibronectin and fibrin was also demonstrated around monocytes from patients with psoriasis. The phenomenon was not observed in healthy subjects but has been found in various disorders.

The time-course of cutaneous inflammatory responses to LTB4 and PGE2 both alone and in combination has been studied in 10 healthy volunteers. LTB4 induced a transient wheal and flare response in some subjects, maximal at 15 minutes and succeeded by an erythematous, indurated lesion at 2-4 hours. PGE2 elicited a wheal and erythema response which resolved within 1-2 hours. Combination of LTB4 and PGE2 produced acute wheal and erythema responses which did not differ significantly from the summation of responses to the individual constituents of the mixture or from responses to a two-fold increase in the concentration of either component. Wheal and erythema responses persisted, however, with significant potentiation of responses 4 hours after injection. As both leukotrienes and prostaglandins are generated in acute allergic reactions, the effects of these mediators in combination could contribute to persisting and late-onset responses to allergen, in both the skin and lung. In particular, sustained responses to the combination of LTB4 and PGE2 might be important in the pathogenesis of inflammatory skin diseases such as psoriasis.

Thirty patients with acne vulgaris were treated for 12 weeks with 0.025% vitamin A acid in a gel. The numbers of comedones, papules, and pustules were markedly reduced in 25 of the patients.

A woman with nevoid hyperkeratosis of the nipple and areola appearing during puberty is described. It remained unchanged during two pregnancies and caused no problem when breast feeding her two children. Etretinate (1 mg/kg/day) was ineffective in the treatment of this dermatosis.

Suction blisters were raised in lesions and normal appearing skin of patients with psoriasis. The blister roof which contains the epidermis separated at the dermal-epidermal junction was stained with ATPase, OKT-6 and anti-HLA-DR monoclonal antibodies. The technique permits the counting of the Langerhans' cells per mm2. Their mean number varied between 888-987 cells per mm2 in control subjects with the three staining procedures. In patients with psoriasis, the number of cells before treatment was between 1110-1179 in uninvolved skin and 521-1001 per mm2 in the lesions as measured using both monoclonal antibodies and ATPase. However, the latter technique seemed to be inappropriate for lesional skin. After treatment with PUVA bath or oral PUVA with or without etretinate, fewer Langerhans' cells were seen in both lesions and normal appearing skin with the appearance of giant Langerhans' cells with long dendrites. In patients healed with anthralin + UV-B the Langerhans' cells appeared normal in number and size.

A compact light source has been developed. It consists of a high-pressure mercury lamp, a shutter, and water-cooled filters for selected wavelength regions. A mixing device permits simultaneous irradiation from two lamps of different wavelengths. The spectral distribution of the light for seven filter combinations and the construction of a power meter are also described. The application of the lamps to clinical investigations is illustrated by determination of minimal erythemal and blister doses, as well as pigmentation, for various groups of patients. The light intensities available are high enough to make pain threshold measurements possible in the UV and visible regions.

A patient with solar urticaria induced by wavelengths 290-420 nm is reported. Wheals appeared after a few seconds of exposure to the sun; longer exposure caused general malaise and syncope. Intradermal injection of in vitro irradiated plasma caused a local whealing which was not seen with plasma kept dark. The wheals induced by irradiation could be inhibited by local injection of an antihistamine. Local injection of lidocaine and hydrocortisone was ineffective. Depletion of substance P in the skin by topical application of capsaicin did not change the sensitivity to irradiation with 313 nm and a single PUVA treatment did not change the minimal urticarial dose (MUD). Sunscreens were in practice of limited value with the exception of a protective plastic helmet. Repeated daily irradiation with UVA in increasing doses normalized his response to sunlight.

The efficacy of cetirizine dihydrochloride, a new H1-antagonist with minimal sedative or anticholinergic side effects was evaluated in 30 patients with chronic idiopathic urticaria. In the first part of the study, cetirizine 10 mg and placebo were compared in a double-blind cross-over trial. In the second part, patients who did not respond adequately in the first part were randomized, still double-blind, to receive 10 mg cetirizine either once daily or twice daily. In the first part, treatment was discontinued by 17 patients on placebo and two patients on cetirizine because of lack of efficacy. Cetirizine dihydrochloride was found significantly to reduce occurrence of weals, erythema and pruritus compared with placebo (P less than 0.001). Twenty-six of the patients improved on cetirizine and two on placebo. Mild sedation was noted by two patients on cetirizine and by one on placebo.

Metabolites of histidine were determined by high performance liquid chromatography in suction blister fluids from lesions and normal appearing skin of patients with psoriasis and from healthy subjects. There was a significant decrease in the levels of histidine and urocanic acid in the samples obtained from patients with psoriasis as compared to healthy subjects. Virtually only the E-isomer of urocanic acid was detected.

Treatment with high dose (10-50 x 10(6) IU/m2 three times a week) of alpha-interferon (alpha-IFN) has been shown to induce remissions in about 50% of patients with cutaneous T-cell lymphoma. The optimal alpha-IFN dose, however, is not known. 4 patients with advanced cutaneous T-cell lymphoma were therefore treated with alpha-IFN in low doses of 2-4 x 10(6) IU/m2 three times a wk. 1 complete, 1 partial and 1 minor remission were observed. Skin biopsies before and during treatment were taken from 2 of the patients and showed improvement. Low doses of alpha-IFN can thus induce remission in patients with cutaneous T-cell lymphoma.

Lotions of five different corticosteroids were applied on 3 X 4 cm areas of large infiltrated chronic psoriatic plaque in eight patients, and left occluded with a hydrocolloid dressing (Actiderm) for one week. Area treated with clobetasol, betamethasone and triamcinolone were clinically healed within one week in four patients, but slight residual erythema was observed in the other four. Hydrocortisone-treated areas showed better improvement than the non-steroid-treated control area, where infiltration and erythema remained unchanged. In 44 patients with psoriasis, lichen planus, chronic lichenified eczema, discoid lupus erythematosus and necrobiosis lipoidica, treatment with betamethasone applied 1-3 times under Actiderm once a week healed the lesions. The skin-coloured Actiderm is easy to apply and wear and does not loosen when taking a shower or hot bath.

Iontophoresis of histamine in the skin has been shown to release prostaglandins and arachidonic acid in suction blister fluid. Application of DMSO had a similar effect. No effect was found after using the following erythema and oedema irritants: scraping, vibration and ketocaine. Treatment with vasoconstricting drugs such as noradrenaline betamethasone and lidocaine-prilocaine mixture did not influence the prostaglandin or arachidonic acid levels.

A disabling case of keratodermia palmoplantare papuloverrucoides progressiva is described. Less severe cases have been reported in the American literature as keratodermia punctata. The verrucoid lesions of our patient were spontaneously shed during treatment with the aromatic retinoid etretinate, and a daily maintenance dose of 25 mg was necessary to prevent recurrence.

The serum levels of zinc, vitamin A and retinol binding protein (RBP) were studied in 75 acne patients before and during oral treatment with zinc, vitamin A or placebo. In the zinc-treated patients an increase in the mean serum zinc level was seen after 2 weeks, when also the first clinical improvement occurred. After 4 weeks the zinc level had increased by about 30% and no further significant increase was observed during 3 months of treatment. In 33 healthy subjects there was an increase of 14% after 4 weeks of zinc therapy. Vitamin A and placebo induced no significant changes in the serum zinc status. Prior to therapy the serum levels of vitamin A and RBP were lower in the acne patients than in the controls. Zinc + vitamin A treatment raised the serum RBP value to normal after 4 weeks. In patients given vitamin A alone, a probable increase in RBP was achieved. Zinc and placebo treatment did not change the serum level of RBP.

We have studied 15 patients with photo-onycholysis induced by tetracyclines, psoralens, or fluoroquinolones. Three distinct clinical subtypes of onycholysis were seen. Type I showed a half-moon-shaped separation that was concave distally. Type II had a circular notch opened distally and shaped as if the distal nail plate had acted as a convex lens. In type III the changes were located in the central part of the nail bed with no connection to the margins. Ultraviolet (UV) irradiation of normal fingernails with various wavelengths showed that 3% to 20% of the irradiation could penetrate the nail. The different patterns of photodamage might be caused by the nail acting as a lens. Less protection by lack of melanin and absence of sebum and stratum granulosum may favor penetration of UV irradiation and explain why the skin was not always affected.

A second clinical trial of the compound Ro 6-0787, which is a specific monovalent penicilloyl hapten inhibitor of allergic reactions to penicillin has been conducted by investigators from 9 different European groups in 90 patients allergic to penicillin. The effect of a combined Ro 6-0787-penicillin therapy was considered as clinically successful in the large majority of cases, since treatment with penicillin could be pursued or resumed without allergic manifestation in 42 from 46 cases (91 percent). The effect of Ro 6-0787 alone on acute allergic manifestations after interruption of penicillin therapy was more difficult to evaluate but was nevertheless considered satisfactory in 17 from 26 patients (65 percent). A depression of skin hypersensitivity to PPL and/or penicillin and penicillin derivatives sometimes persisting for weeks and months was obvious in numerous allergic patients submitted to combined Ro 6-0787-penicillin treatment. A depressing effect on antipenicillin antibody titers detected by passive hemaglutination was also manifest in some patients. Failure to suppress allergic manifestations was reported in 11 cases, among which some may have been due to insufficient dosage of inhibiting hapten. The overall tolerance of Ro 6-0787 in allergic patients has been very good. Nevertheless, the major obstacle to a wider general use of Ro 6-0787 at the present time appears to be the occurrence of positive skin reactions to that compound in approximately 5 percent of patients allergic to penicillin. It is not yet ascertained whether the occasional positive skin reactions and urticaria to Ro 6-0787 may have been due to aggregation, or incomplete dissolution of the compound or whether it reflects hypersensitivity to another antigenic determinant. With the reservation that patients with positive skin test to Ro 6-0787 have for the time being to be excluded from combined treatment, this monovalent hapten certainly offers a new possibility to resume and/or pursue penicillin therapy in patients demonstrably allergic to that drug.

Two sporadic cases with congenital anonychia and hypoplastic nails combined with ectrophalangia or hypoplastic phalanges are reported. It is suggested that congenital anonychia and hyponychia may be 'bone territory' dependent disorders.

A 42-year-old man presented with systemic lupus erythematosus, universal alopecia and non-pruritic hyperpigmented papular mucinosis. The latter was most evident on acral areas. In hyperpigmented areas of the face the immunofluorescence showed deposits as in LE and with alcian blue and colloidal iron an abundance of mucin was demonstrated in the dermis. A lesion on the back showed only papular mucinosis. Fifteen cases of LE and papular mucinosis reported in the literature are reviewed. Our patient differs with respect to the marked pigmentation of his lesions, their localization and the association with universal alopecia.

An eutectic mixture of 5% lidocaine and 5% prilocaine applied locally to the skin inhibited epinephrine-induced sweating in healthy subjects. It also inhibited palmar and axillary hyperhidrosis from 1 to 6 hours after application to 15 of 17 patients tested. A placebo lotion was without effect. When used daily for 3--4 weeks, only 25% of the patients were very pleased with the treatment. The reason for the decrease of efficacy is uncertain.

The effects of the cutaneous application of EMLA cream (a eutectic mixture of lignocaine and prilocaine in their base form) were studied in volunteers. When tested by pin-prick, EMLA cream 2.5% and 5% produced analgesia of the area tested, the cream being most effective if left in contact with the skin for 60 min. The pain produced by the insertion of an i.v. cannula was successfully blocked by the application of this formulation, especially if applied to the antecubital area. Temporary blanching of the skin areas was frequently observed on removal of the occlusive tape bandages, but prolonged, or repeated, application of 5% EMLA cream did not produce local skin reactions. Tests for delayed hypersensitivity reactions were negative. Plasma concentrations of lignocaine and prilocaine were low after a standard application.

An anesthetic cream with an eutectic mixture of 5% lidocaine and 5% prilocaine has been tested on the skin of healthy subjects and patients with atopic dermatitis and generalized eczema. In healthy subjects a blanching was seen when the analgesia was complete after 30-60 min. In the dry skin and eczematous lesions of atopic dermatitis an application time of 5-15 min caused a blanching and a good analgesia. When applied for 30-60 min the eczematous skin became increasingly red and in one patient purpura appeared. The white dermographism turned red in treated areas. The abnormal vascular reactions to the cream in diseased skin can be explained by a rapid and increased percutaneous absorption of the anesthetics. A shortened application time is here recommended.

A short term anthralin application schedule was used at home in 42 patients with severe psoriasis. In another group of 21 patients treated at our day care center, UV-B irradiation was added when the surplus of anthralin had been washed off. Good healing results within 3-8 weeks were noted in most patients. To prevent relapses 31 patients continued the anthralin treatment once or twice a week after healing. In 15 cases this was combined with UV irradiation. One patient relapsed after a severe infection, but 16 others were observed for 6-9 months and 14 for 3-5 months without relapses. Irritation of non-affected skin is common especially at the beginning of the treatment and some staining of clothes and linen can occur. With proper information about this, the treatment is well accepted by the patient who generally finds it reasonably simple without the need of special protective dressings.

A patient is described with both polymorphous light eruption (PLE) and aquagenic urticaria appearing at 29 yr of age. Her father had the same symptoms after exposure to solar irradiation or water. Four to 6 h after 5-15 min sun-exposure, both had symptoms of general malaise and swelling of various joints. The skin symptoms in our patient were initially urticarial and later mainly papular and vesicular. They were elicited by irradiation with low doses of 300-360 nm and also appeared after 400 and 500 nm. Window glass offered little protection. PUVA treatment improved both conditions remarkably.

After the addition of E. coli polysaccharide to blood from patients with deep inflammatory acne, microclots formed in all patients, whereas this was rarely seen in mild acne and never in controls. Furthermore, spontaneous microclot formation without addition of endotoxin was seen in 5 of the 10 patients with the most severe acne.

Free anthralin was detected in the stratum corneum and in hair follicles in histological sections of patients with psoriasis undergoing short contact therapy. A solution of sodium borate was used to provoke a yellow fluorescent complex. There was a strong fluorescence especially on the plaques and anthralin could be detected in psoriatic plaques up to 48 hours after treatment. It was difficult to completely eliminate the drug by washing with soap and anthralin could even be detected on non-treated areas.