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The article analyzes electron microscopic observations of mitotic Langerhans' cells (LC) as the possible sign of retinoid-induced stimulation. Three patients with epidermodysplasia verruciformis were treated with retinoid for up to 3 months. Punch biopsies were taken before and during the treatment at 2-4 week intervals under local anesthesia. Mitotic LCs were not observed in biopsies taken before retinoid treatment. A mitotic LC was found in one patient after four weeks of treatment and in another patient after 10 weeks of treatment.

Langerhans cell-mononuclear cell contacts in the epidermis were analysed in minimum positive allergic and toxic patch tests after 6, 12, 24, 48, and 72 hours. No differences between allergic and toxic patch tests were observed in the appearance of Langerhans cells or in the number of Langerhans cell-mononuclear cell contacts. Thus, Langerhans cell-mononuclear cell contacts are not specific for contact allergic reactions, as has previously been suggested. [ABSTRACT FROM AUTHOR]

The light and electron microscopic structure of pityriasis rubra pilaris (PRP) is described in five patients. Hyperkeratosis, hypergranulosis, keratotic plugs in the follicular openings, aeanthosis and focal parakeratosis were observed. A moderate perivascular infiltrate was seen in the upper dermis. Electron microscopy revealed moderately activated keratinocytes, a decreased number of tonofilaments and desmosomes, enlarged intercellular spaces, parakeratosis with lipid-like vacuoles and a large number of keratinosomes. Lymphoid cells were present in the epidermis in moderate numbers. At the dermo-epidermal junction, the basal lamina was focally split, containing gaps. Etretinate therapy produced moderate to marked clinical improvement. The histological picture improved but the typical signs of PRP, including follicular plugging, persisted. Ultrastructurally the cellular activity and the amount of hyperkeratosis and parakeratosis decreased, while increases in keratinosomes, intercellular substance, microvilli and desmosomes were observed during treatment. [ABSTRACT FROM AUTHOR]

Topical application of difluoromethyl ornithine, an irreversible inhibitor of ornithine decarboxylase, on UV-irradiated mouse skin, reduced epidermal putrescine and spermidine contents and greatly enhanced the epidermal uptake of subsequently applied methylglyoxal bis(guanylhydrazone). High epidermal concentrations of methylglyoxal bis(guanylhydrazone) could effectively be lowered by a single application of an ointment containing spermidine. The present results indicate that difluoromethylornithine and methylglyoxal bis(guanylhydrazone) penetrate mammalian skin from topical ointments, and that, in case of a too high (toxic) methylglyoxal bis(guanylhydrazone) concentration, spermidine can be used as a ‘rescuing’ agent. [ABSTRACT FROM AUTHOR]

Eighty ambulatory adult patients with severe psoriasis were included in our 14-week study to compare the clinical effects of treatment with an aromatic retinoid (Tigason), combination treatment with aromatic retinoid plus PUVA (RePUVA), and PUVA alone. RePUVA was given by two different modifications: either 4 weeks of pretreatment with retinoid followed by 6 weeks of PUVA treatment, or 10 weeks of retinoid treatment with concomitant PUVA treatment during the last 6 weeks. The latter modification of RePUVA proved to be significantly more effective than the other treatments (P < 0.01) as regards complete remission. With respect to the number of patients with good or excellent improvement (75–100% improvement) there was no marked difference between RePUVA and PUVA treatments. Retinoid alone proved to be the least effective, showing, however, a good to excellent result in 65% of patients. Besides the increase in efficacy, another advantage achieved by RePUVA was a highly significant (P < 0.001) reduction of total UVA doses to about one third as compared to PUVA therapy. [ABSTRACT FROM AUTHOR]

Thirty-four patients with extensive psoriasis were treated in a double-blind parallel fashion with either acitretin plus bath PUVA (trimethylpsoralen bath + UVA) or etretinate plus bath PUVA. Each group consisted of 17 patients. The dose of retinoid was 40 mg/day during the 2- week monotherapy phase and subsequently 20 mg/day during the combination treatment. Bath PUVA was given three times a week starting with a UVA dose of 0·06 J/cm2. Remission (> 90% improvement) was achieved in all patients in 6–10 weeks. There were no significant differences in clinical response between the two groups; the mean ± SD PASI score (psoriasis area and severity index) before treatment was 22·6 ± 7·1 in the acitretin-PUVA group and 19·4 ± 7·8 in the etretinate-PUVA group. The corresponding figures after treatment were 0·6 ± 0·6 and 1·0 ± 0·5, respectively. Side-effects related to retinoid treatment were frequent in both groups but they were usually mild and well-tolerated. There was only one case of diffuse alopecia after 8 weeks in the etretinate-PUVA group. Scaling of the palms and soles was seen in six patients in the acitretin-group but only in two patients in the etretinate-group. Triglycerides were elevated in about half of the patients in both groups. The present study shows that acitretin is as effective as etretinate in the combination with bath PUVA. [ABSTRACT FROM AUTHOR]

Eighty-four patients with persistent palmoplantar pustulosis (PPP) of long duration were treated with either etretinate or one of three PUVA regimens. PUVA was given either with oral methoxsalen (thirteen cases), with a 1% methoxsalen cream (thirty-three cases) or with trioxsalen baths (eighteen cases). Twenty patients were treated with etretinate. Patients were assessed every fourth week. A mean score for each group was calculated at each visit based on erythema, desquamation, induration and pustulation. In addition, the number of pustules was calculated at each visit. After 12 weeks four of twenty-eight patients treated with local methoxsalen and fourteen of seventeen patients treated with etretinate had completely cleared. At this stage no patient treated with local trioxsalen or oral methoxsalen showed complete clearance. [ABSTRACT FROM AUTHOR]

Three patients with epidermodysplasia verruciformis (EV) were treated with etretinate for 9-13 months. The patients had lesions characteristic of EV, including flat warts, common genital warts, pityriasis-versicolor-like lesions and malignant changes such as actinic keratosis and Bowenoid cancer in situ. During etretinate treatment, some flattening of the warts was observed in all three patients, and the lesions on the chest and back became less red and scaling. However, none of the lesions disappeared completely, and when the treatment was discontinued, the lesions relapsed. No malignant changes were detected during the period of therapy. Electron microscopy revealed the presence of typical large, clear cells containing viral particles in the upper epidermis. Etretinate therapy induced the same type of fine-structural changes as those seen in keratinization disorders and genodermatoses. The clear cells and virus particles persisted throughout the treatment period. More long-term, controlled studies are necessary to make possible an estimate of the curative and cancer-inhibitory effect of etretinate treatment in patients with EV. [ABSTRACT FROM AUTHOR]