The effect of local application of 8-methoxypsoralen (8-MOP) and subsequent UVA irradiation on palmoplantar pustulosis (PPP) was studied in 10 patients. In 8 patients 8-MOP baths were used, and in 5 patients an 8-MOP ointment was applied, 3 patients receiving both forms of treatment. The number of treatment sessions varied from 15 to 128, with maximal UVA doses of 1.2 to 12 J/cm2, and total cumulative doses of 8 to 348 J/cm2. Two patients experienced a brisk phototoxic erythema and one patient developed a bullous reaction. Only 3 patients responded favourably to the treatment, 2 with moderate and 1 with good clearing of the lesions. In the remaining 7 patients either no effect (5 patients) or an exacerbation of the disease (2 patients) was seen.
The minimal phototoxic dose values for UVA radiation of psoralen-treated skin and of oral mucous membrane were studied in 16 healthy volunteers. A commercial 0.01% trioxalen ointment was used as the topical photosensitizer. In all 16 persons the radiation dose needed to induce erythema was greater for the buccal mucosa than for the skin, and the average buccal minimal phototoxic dose was 2.3-fold that of the cutaneous minimal phototoxic dose.
Serum antichlamydial antibodies were determined with an immunofluorescence method in 40 patients affected by palmoplantar pustulosis (PPP). Antibody titre greater than or equal to 16 was found in 53% of the cases, the titre being greater than or equal to 64 in 38% of the patients. By comparison, a titre of greater than or equal to 64 was found in 13% out of 55 psoriatics, in 12% out of 41 eczema and urticaria patients, and in 3% out of 37 healthy controls. The difference between the results from the PPP patients and that of the healthy controls was statistically significant (p < 0.01). In only 8 of the 40 PPP patients was any additional evidence found of a previous venereal infection. The possibility that PPP may represent an abnormal reaction to infectious agents, e.g. Chlamydia, is discussed.
The relationship of epidermal urocanic acid concentration and photoisomerization reactivity to human skin cancer was studied. Twelve cutaneous malignant melanoma patients, 10 basal cell carcinoma patients and 22 healthy matched controls were enrolled in the study. A solar simulating ultraviolet irradiator was used for phototesting the minimal erythema dose. Using the Finn Chamber technique, urocanic acid was sampled from the healthy skin of the upper back, prior to and after exposure to suberythemal UV doses. The mean values of total and trans-urocanic acid were higher in basal cell carcinoma patients than in controls, but this difference was not statistically significant. No corresponding phenomenon was evident in the case of cutaneous malignant melanoma patients and their controls. Photoisomerization induced by irradiation with 1 mJ/cm2 CIE (Commission Internationale de l'Eclairage) was statistically significantly lower in cutaneous malignant melanoma patients than in controls (p=0.04). A similar trend was seen in basal cell carcinoma patients vs. their controls, but the difference was not significant.
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