Efficacy of etretinate (Tigason) in clearing and prevention of relapse of palmoplantar pustulosis

A total of 40 patients with palmoplantar pustulosis (PPP) were initially treated with oral etretinate (Tigason) in an open trail with a maximum treatment period of 16 weeks. Remission, with only slight residual changes in some cases, was achieved in 26 patients (65%) who were randomized to either a low dose of Tigason or placebo. In the Tigason group, 7 of 11 patients were still in remission afer 6 months while in the placebo group, remission persisted in 4 of the 10 patients who stayed in the study throughout the whole 6 months' period. Alopecia led to stopping the treatment in 6 patients and desquamation of the healthy skin in 2 patients. Other side-effects were only mild. As a conclusion, Tigason shows a beneficial effect in the majority of patients with PPP and is better than placebo in preventing relapse of the disease but intolerable side-effects restrict its use in many patients.     

Solar ultraviolet (UV) radiation and UV doses received by patients during four-week climate therapy periods in the Canary Islands.

The ultraviolet (UV) radiation doses received by 270 psoriasis patients were studied during 4-week climate therapy periods in November, March or April in the Canary Islands. The daily total solar UV radiation (ambient radiation load, ARL) was measured using frequent readings with a Robertson-Berger sunburning ultraviolet (SUV) meter. A daily personal radiation load (PRL) was calculated for each patient, using sun exposure diary data. To measure the cumulative UV exposure of particular skin sites (skin site dose, SSD), 10 patients wore polysulphone UV dosimeters. The daily ambient radiation load (ARL) ranged from 2.9 to 8.9 erythemal units (EU); the cumulative ARL for a 4-week treatment period was 182.6 EU. The mean daily personal radiation load (PRL), calculated separately for each week of the treatment period, was from 2.5 to 5.6 EU; the mean total 4-week PRL was 118.0 EU, being about 65% of the ARL. The 4-week cumulative skin site dose (SSD) varied between 22.2 and 63.3% (mean 41.2%) of the corresponding personal radiation load (PRL).     

A double-blind comparison of acitretin and etretinate in the treatment of severe psoriasis. Results of a Nordic multicentre study

Acitretin, the free acid of etretinate, is less lipophilic and has a much shorter terminal half-life than the parent compound. The present double-blind, randomized study compared the therapeutic effectiveness and the tolerability of acitretin (n = 127) and etretinate (n = 41) in psoriasis. Patients were treated with 40 mg daily for the first 4 weeks and with an individually adjusted dose for the subsequent 8 weeks. The average daily doses of acitretin (0.54 mg/kg/day) and etretinate (0.65 mg/kg/day) were similar. The PASI (Psoriasis Area and Severity Index) scores improved in parallel in the 2 treatment groups. At the completion of the study, the PASI score improvement was 75.8% for acitretin and 70.8% for etretinate. Both acitretin and etretinate resulted in mucocutaneous side effects. Assessments of tolerability by investigators and patients showed a statistically significant difference in favour of etretinate. These results demonstrate that acitretin and etretinate have similar therapeutic effectiveness in psoriasis. Although the tolerance to acitretin was lower than to etretinate, acitretin offers the important advantage of a much shorter period of potential teratogenicity and is, therefore, to be preferred in women of childbearing potential.     

Cleansing of hands with emulsion--a solution to skin problems of hospital staff?

In this study of hand cleansing, nursing staff with skin problems used emulsion followed by rinsing with water, while control groups, with or without skin problems, used liquid soap and water. Clinical evaluation of the without skin problems, used liquid soap and water. Clinical evaluation of the skin by a dermatologist, as well as by self-assessment, suggested that when the staff with skin problems used emulsion their skin was in better condition than that of controls with similar skin problems. This favourable effect on skin was later confirmed in extended use of emulsion for hand cleansing in other hospital wards. Objective evaluation of skin condition with biophysical measurements was unsuccessful. Emulsion cleansing of the hands seems to offer a favourable alternative to washing with soap and water, especially for persons with skin problems.     

Lymphocytes and Langerhans cells in patch tests

The distribution of immunocompetent cells was analysed in allergic (nickel) and irritant (dithranol) patch tests using conventional transmission electron microscopy and labelling with monoclonal antibodies in an avidin-biotin immunoperoxidase study. The biopsies were taken 24 or 48 h after the allergen/irritant application. In allergic and irritant reactions, most inflammatory cells were OKT11 positive (pan T lymphocytes). The majority of these cells were also OKT4 positive (helper/inducer T lymphocytes), while the minority were OKT8 positive (suppressor/cytotoxic T lymphocytes). NK9 positive cells (natural killer cells) were observed in small numbers. The number of dendritic OKT6 and OKIal positive cells (Langerhans cells) in the epidermis was unaffected in allergic reactions. In irritant reactions, a normal number of OKT6 positive Langerhans cells was observed, while the number of OKIal positive cells had increased in the epidermis. Dithranol caused prominent fine structural changes in the mitochondria of the Langerhans cells, while the keratinocytes appeared largely unaffected. The present study indicates that allergic and irritant patch tests cannot be differentiated reliably using current immunohistopathological or electron microscopic techniques, in spite of the small differences observed.     

Ichthyosis hystrix (Curth-Macklin). Light and electron microscopic studies performed before and after etretinate treatment

Clinical and light and electron microscopic observations of a 16-year-old male patient suffering from ichthyosis hystrix (Curth-Macklin) are presented. The patient had no family history for this disease. The diagnosis was based on the distinct electron microscopic finding of continuous perinuclear tonofibril shells in the keratinocytes. About 10% of the keratinocytes were binucleate and one third contained conspicuous vacuoles. The steroid sulphatase activity in a skin biopsy was normal. Etretinate treatment proved beneficial during the first year of therapy. Later the treatment was less effective. The basic genetic defect persisted in the phenotype of the keratinocytes during etretinate therapy, but the exceedingly thick horny layer was considerably thinned.