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We report the results of a study on 100 patients (aged 12-68) with vitiligo, who were treated by transplantation of cultured autologous melanocytes to the depigmented areas, after removal of the epidermis at the recipient site by dermabrasion. The melanocytes were cultured from a 2 x 3 cm2 superficial shave biopsy taken from pigmented buttock skin. After 2-3 weeks in culture, 700-1000 cells per mm2 were applied on 60-500 cm2 dermabraded areas, and occluded for 1 week. The repigmented portion of the total treated area amounted to 95-100% in 40 patients, 65-94% in 32, 20-64% in 22, and 0-19% in six. It was more difficult to achieve complete pigmentation on the fingers, elbows and knees. In the first few months following the procedure, the treated areas were often hypo- or hyperpigmented, but after 6-8 months they had acquired the same colour as the surrounding skin. No scarring or other side-effects occurred. The donor site had repigmented after 3-6 months in all but two patients, who also showed poor pigmentation in the transplanted areas. At follow-up after 1 and 2 years in 50 and 10 patients, respectively, the repigmented areas remained unchanged. The method is time-consuming, but the results obtained indicate that the procedure can be valuable in motivated patients, when the extent of vitiligo does not exceed 30% of the total body area, and when the areas to be treated are not actively extending.

A 71-year-old woman with chronic urticaria and vitiligo is reported who lacked eosinophil and basophil leukocytes in her blood, bone-marrow and skin. No IgE was detectable in serum. She had a low level of serum eosinophil cationic protein (ECP) which could indicate that some eosinophils had been formed but rapidly destroyed. There was, however, no ECP release when the patient's serum was mixed with heterologous eosinophils. Staining for eosinophilic proteins in white blood cells by monoclonal antibodies revealed no storage or secreted forms of ECP. The source of ECP in our patient therefore remains unknown.

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.

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

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.

Because of the abundance of hyaluronan in skin, interest was early focused on variation in the content of the polysaccharide in various pathological conditions of this tissue. A large amount of early work utilized histological techniques of insufficient specificity but recent developments of specific analytical and staining methods for hyaluronan have supplied new data on its presence and possible role in skin disorders.

Juhlin L. A comparison of the pharmacodynamics of H1-receptor antagonists as assessed by the induced wheal-and-flare model.

In atopic subjects, intradermal injection of platelet-activating factor (PAF), 40 and 400 ng, resulted in an immediate edema reaction markedly blocked by cetirizine, 10 mg twice a day. PAF challenge also induced a significant eosinophil accumulation evidenced by a skin window technique at 2, 4, 8 and 24 h. This inflammatory phenomenon was significantly inhibited by cetirizine. In patients with chronic urticaria, PAF, 100 μg intradermally, induced immediate and late cutaneous reactions (LCR) also blocked by cetirizine, 10 mg twice a day. These LCR were accompanied by an infiltration of the deep dermis by degranulated eosinophils. The pathophysiological mechanism of the PAF-induced skin reactions is discussed as well as the mechanism of action of cetirizine.

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.

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.

The hyperaemia produced by topical application of ketocaine-containing formulations was studied in human skin. The temperature in the hyperaemic area was unchanged or decreased which indicates that the hyperaemia was of a passive type, caused by a reduced flow in the venous side of the capillary bed.

The papers included in this workshop have been chosen to encompass as much as can usefully be included on the structure and function of the nail apparatus in health and disease. In our travels around the world lecturing in this field, we are constantly reminded that many clinicians who treat nail abnormalities have relatively poor insight into the functional anatomy; such knowledge is very important in the diagnosis and management of melanoma, genetic anomalies and in surgical treatments. We will therefore spend a significant part of the session describing pathology in relation to normal structure.

SUMMARY We describe eight patients with grafted leg ulcers, in whom subepidermal bullous lesions appeared after 4–8 weeks either at the donor or the grafted site. The blisters were seen in the centre as well as just outside the graft. They remained for some days and then disappeared. Histology revealed a normal epidermis and a dermis with a moderate lymphocytic infiltration around the capillaries. No clinical signs of pemphigoid were found and friction does not seem to have been a contributing factor. We have at present no explanation for the appearance of the blisters.

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.

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.

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 term chronic urticaria is used where physical urticaria has been excluded and the hives continue to appear for more than 2–3 months. The number of patients with chronic urticaria on a given day can be calculated to be about 6600 among 10 million people [11]. When a patient first visits the clinic the prognosis is partly dependent on the length of time for which the patient has had attacks of urticaria. The prognosis is best for those patients who have had it for only a short time. If the urticaria has lasted for 4 months, Champion et al. [3], found that 23 percent were free of symptoms after 12 months. In patients who have had urticaria for years, the chance of improving without treatment was much less. It is important to remember this when judging the effect of the treatment which I would now like to discuss. My own experience is based on 330 patients with chronic urticaria seen during the period 1972–1978.

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 variety of different, experimentally induced human skin inflammatory stimuli including UV-A (Barr et al., 1982a; Gilchrest et al., 1982), UV-B (Black et al., 1978, 1980; Hensby et al., 1980; Black, Hensby & Greaves, 1982), UV-C (Camp et al., 1978), infra-red (Hensby et al., 1982), trafuril (Plummer et al., 1977) and anthralin (Barr et al., 1982b) cause marked and prolonged elevations of the recoverable levels of arachidonic acid and its cyclo-oxygenase products. The known pharmacology of many prostanoids (products of the prostaglandin cyclo-oxy-genase system) including vasodilatation and synergism with other inflammatory mediators (Hensby, Kingston & Greaves, 1976; Camp, 1982) would suggest a role for prostanoids in various human skin diseases, particularly those associated with an inflammatory component. We now report the preliminary results that we have obtained for the recoverable levels of four prostanoids, namely PGE2, PGD2, PGF2x, and 6-oxo-PGF1x in four human skin disorders, viz. psoriasis, tuberculin delayed hypersensitivity, vitiligo and scleroderma.

This review is based on information in the literature and on allergic reactions reported to the Swedish National Board of Health and Welfare from 1965 to 1979. All doctors in Sweden are supposed to report all severe side effects and side effects which are not well known, especially adverse reactions to new drugs. The effects are then judged as certain, probable, or possible. Only certain and probable allergic reactions will be considered here.

522 patients attending the Venereal Disease Clinic of the University Hospital in Uppsala Sweden between September 1967 and February 1968 were studied to determine the influence of the use of contraceptive gestogen pills on human sexual behavior and on the possible spread of gonorrhea. The patients were diagnosed for presence of gonorrhea and surveyed orally by a special interviewer. Mong the 250 women seen 28.4% were university students and 70.4% of these used oral contraceptives (OCs); 50.1% of the nonstudents used OCs. There was noted a considerable increase in OC use over the previous year when OC use was 48% and 18% respectively. Condom use remained constant at 30% for both periods. The number of sexual partners and frequency of intercourse was significantly higher among women taking pills (p less than .05) and highest in the 20-25 year age group (p less than .01). Sexual intercourse increased 25% among all women using OCs. This increased sexual activity probably increases the risk of gonococcal infection. 67% of the women were diagnosed with the disease and a diagnosis was made with equal frequency among pill users as nonpill users. Evidence indicating increased susceptibility of the mucosa to gonococcal infection with OC use was absent.(AUTHORS MODIFIED)

Some sexual hormones and related compounds have been tested for their ability to increase the phagocytic activity of the reticulo-endothelial system (R. E. S.). Mice were given subcutaneous injections of the compounds daily for 14 days. The phagocytic activity of the R. E. S. was then determined by measuring the amount of fluorescent plastic particles present in the blood and in the liver 15 minutes after these had been injected intravenously. The seminal vesicles, testicles, liver and spleen of these mice were then weighed. The oestrogenic activity of the compounds were determined in the Allen-Doisy test. For both strong and weak oestrogens, the dose which gave a positive response in this test roughly corresponded to the daily dose necessary to induce an increase on the activity of the R. E. S. However, neither the oestrogenic, androgenic, anabolic, progestional nor pituitary inhibitory actions of the compounds tested seems to be responsible for the effect on the R. E. S. Testosterone was found to be inactive under these conditions whereas a nortestosterone derivative increased the phagocytic activity of the R. E. S. Castration 4 days previously did not change the phagocytic activity. In such mice, just as in non-castrated mice, it could be increased both with the nortestosterone derivate and an oestrogenic compound tested.

Osteoid osteoma is infrequently localized to the hand. Initially the lesion causes unspecific symptoms, and the radiographic changes are discrete. Three cases were seen during a period of 5 years. Bone scintigraphy was a useful diagnostic tool, and CT facilitated the identification of the nidus. One of the lesions was a double nidus osteoid osteoma of the scaphoid bone. Only 12 instances of multifocal osteoid osteomas have been reported, none of which was localized to the carpal bones.

Patients with cold urticaria can after exposure to cold air or infusions react with hypotension and cardiovascular collapse. We here report on a patient having a severe cold urticaria who because of angina required myocardial revascularization: She was successfully operated in normothermic cardiopulmonary bypass with cardioplegia.

We have studied 15 patients with photo-onycholysis induced by tetracycline derivatives, trioxsalen and fiuoroquinolones.1 Histological examination was performed in five cases. Three distinct clinical sub-types of onycholysis were seen, a classification justified by their different appearence. In Type I (nine cases) several fingers showed the separating part of the nail plate to be half-moon shaped, concave distally with varying pigmentation proximally. Type II (three cases) demonstrated on just one finger a well-defined, circular notch, widest distally and with a brownish hue proximally; the shape was as if the distal nail plate had acted as a convex lens focusing the light on the hyponychium and the distal nail bed. Type III (three cases) showed on several fingers such changes in the central part of the pink nail bed with no connection to the distal or lateral nail margins. This type shows the link between photo-onycholysis and subungual photo-haemorrhage. The latter represents an aspect or a sequel of photo-onycholysis and depends on the timing. UV-irradiation of normal fingernails with various wavelengths (313, 340, 360 and 400 nm) showed that 3–20% of the radiation could penetrate. The different patterns of photo-damage are due to the fact that the nail acts as a lens. Less protection through lack of melanin, and absence of sebum and a stratum granulosum favour penetration of UV-radiation and explain why the skin is not always affected. Discrete subungual hyperkeratosis resulting in keratin dust also explains some changes, such as nail dyschromia, so far attributed to haemorrhages or melanin deposition.

To the Editor.— Eighteen light-tolerant patients with widespread psoriasis were treated with 15 minutes of a 37 C warm bath with 50 mg of trioxsalen in 100 liters of water. The trioxsalen added was dissolved in 100 ml of 70% alcohol. Immediately after the bath, the skin was irradiated with a set of lamps for ten to 300 seconds at a distance of 60 cm. 1 The lamp gives 0.8M W/sq cm of ultraviolet (UV)-B and 13M W/sq cm of UV-A. The treatment was given five days per week. One arm was left for treatment with coal tar bath, UV light, and stiff dithranol paste. 2 After two to five weeks, the psoriasis had almost or completely healed on the trioxsalentreated skin. The arm treated with the Ingram regimen 2 healed slower in nine patients, faster in one, and at the same rate in the others. It is possible that