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Notes: The occurrence of EG2-positive (EG2+) eosinophils and IgE in biopsy specimens of duodenal mucosa and skin from 39 psoriasis patients was studied, with emphasis on the relation to serum eosinophil cationic protein (ECP), serum IgE and the presence or absence of serum IgA and IgG antigliadin antibodies. Psoriasis patients had significantly elevated serum levels of ECP even after exclusion of five of 37 sera which were Phadiatop positive. The elevated serum ECP was not associated with the presence of IgA or IgG antibodies to gliadin. After exclusion of Phadiatop positive sera the serum IgE values did not differ from those of a group of healthy blood donors.Patients with psoriasis had a pronounced increase of EG2+ cells in their duodenal stroma. Patients without antibodies to gliadin tended to have even more EG2+ cells than those with such antibodies and those with increased duodenal intraepithelial lymphocytes. IgE+ cells were present in most duodenal specimens, and in some specimens there were 〉100 IgE+ cells/section. The number of EG2+ cells was increased in lesional skin and, in some patients, also in non-involved skin, but there was a more pronounced increase in EG2 reactivity in the duodenal than in the skin specimens. IgE reactivity was increased both in non-involved and involved skin and was significantly related to the number of IgE-positive cells in the duodenal stroma. The results of this study indicate that the gastrointestinal tract and the eosinophil granulocyte might be involved in psoriasis in a hitherto unknown way.

Notes: Summary Background A suggested role for nicotine in the pathogenesis of palmoplantar pustulosis (PPP) has been discussed. The target for the inflammation in PPP is the acrosyringium. Nicotine acts as an agonist on nicotinic acetylcholine receptors (nAChRs) and can influence a variety of cellular functions. Objectives To study the α3- and α7-nAChR expression in palmar skin of patients with PPP in comparison with that in healthy smoking and non-smoking controls. Methods Biopsies from 20 patients with PPP, seven healthy smokers and eight healthy non-smokers were studied by immunohistochemistry with a monoclonal anti-α3 and a polyclonal anti-α7 antibody. Results In healthy controls both nAChR subtypes showed stronger immunoreactivity in the eccrine glands and ducts than in the epidermis. The papillary endothelium was positive for both subtypes. Epidermal α3 staining was stronger and that of the coil and dermal ducts weaker in healthy smokers than in healthy non-smokers. In involved PPP skin, granulocytes displayed strong α3 immunoreactivity. The normal epidermal α7 staining pattern was abolished in PPP skin and was replaced by strong mesh-like surface staining, most markedly adjacent to the acrosyringium, which in controls was intensely α7 positive at this level. Endothelial α7 staining was stronger in PPP skin than in the controls. Conclusions Smoking can influence nAChR expression. The altered nAChR staining pattern in PPP skin may indicate a possible role for nicotine in the pathogenesis of PPP. We hypothesize that there is an abnormal response to nicotine in patients with PPP, resulting in inflammation.

Notes: Hyaluronate concentrations were measured in suction blister fluid from blisters raised on the abdominal skin of 12 healthy control subjects, on unaffected skin of 14 patients with psoriasis, and on lesional skin from 12 of these patients.The concentrations of hyaluronate in blister fluid from the controls and from the uninvolved skin of patients with psoriasis were within the same range (2.9–10.5 and 2.4–7.8 mg/1, respectively). Six of the patients had active, widespread, untreated psoriasis and in these cases the hyaluronate concentration in blister fluid from lesional skin was greatly increased (24–30 mg/1). Patients with stable or regressing psoriasis had no significant increase in hyaluronate levels in the blister fluid from lesional skin compared with the controls (range 4.6–12.4 mg/1). Patients with active psoriasis had significantly higher serum hyaluronate concentrations than the controls and those with inactive psoriasis.

Notes: A radioassay method allowing measurements of low concentrations of circulating hyaluronate was used in a study of serum hyaluronate concentrations in 44 patients with psoriasis. Twenty-three of them had only skin lesions and 21 had both skin lesions and arthropathy. In both of these groups significantly elevated serum levels of hyaluronate were found. The highest values were observed in those with widespred and active skin disease and/or active arthritis. Serum hyaluronate positively correlated with the plasma concentrations of α1-antitrypsin and haptoglobin and also with ESR, which may indicate a relationship between acute inflammation and increased production of hyaluronate. Seven patients with widespread atopic dermatitis included for comparison had normal hyaluronate values. In blister fluid from lesional skin in two patients with acute psoriasis, very high concentrations of hyaluronate were found, in comparison with the concentrations in blister fluid from non-involved skin. The increased concentration of serum hyaluronate in psoriasis indicates involvement of dermal and synovial tissue in psoriasis, in addition to the epidermal changes.

Notes: It was recently observed that in six patients with psoriasis and one with palmoplantar pustulosis. with newly discovered gluten intolerance, a gluten-free diet had a remarkable effect on the skin lesions. This prompted us to undertake a screening investigation to discover whether increased levels of serum antibodies to gliadin are more common in patients with psoriasis than in healthy persons. IgA and IgG antibodies to gliadin (IgA AGA and IgG AGA) were quantified by a micro-ELISA method.Out of 302 patients with psoriasis. 16% (18 females, 31 males) showed serum IgA AGA levels above the 90th percentile value (51 u/ml) of the reference group. This tendency was even more marked when the proportion of patients with values 〉70 u/ml was compared with the corresponding proportion of 99 reference subjects. Thus, 3% of the reference subjects but 7.9% of the patients had values 〉70 u/ml. The corresponding figures for men were 1.6% and 8.9%. respectively. Men with psoriasis had a significantly bigher mean IgA AGA than the male reference group. The means based on logarithmic values of the individual IgA AGA values were significantly higher in the psoriatic groups than in the reference groups. Although the mean level of IgG AGA was not increased in the psoriasis group, there was a correlation between the values for IgA AGA and IgG AGA.The serum concentrations of IgG, IgA and IgM were also measured. In the male patients, the mean IgA value was significantly increased. Women in whom IgA AGA was elevated also showed a significantly increased mean IgA. There was no correlation between the IgA AGA and the IgA values. The IgG levels were significantly elevated in both men and women with psoriasis, whereas the IgM levels did not differ from those in the reference group.Studies on the clinical relevance of the findings in this report, both with regard to the activity of the psoriasis and to the presence of intestinal abnormalities, are in progress.

Notes: Etretinate and isotretinoin were compared with respect to their clinical effects and changes in serum lipoprotein concentrations.Sixteen patients with hyperkeratotic and pustular disorders of hands and feet (mainly palmoplantar pustulosis) underwent a double-blind cross-over study. The daily doses of etretinate and isotretinoin were 50 and 40 mg, respectively. Each drug was given for 2 months with a 2-month intermission.The clinical score was reduced both by isotretinoin (P 〈 0.05) and etretinate (P 〈 0.001). Both drugs affected the lipoprotein concentrations. Isotretinoin increased the cholesterol concentration in low-density lipoprotein (LDL) by 20% and the triglyceride concentration in very low-density lipoprotein (VLDL) by 35%, but decreased the high-density lipoprotein cholesterol by 12%. Etretinate elevated LDL-cholesterol by 10%. These changes had reverted to normal 8 weeks after the end of treatment.The data suggest that in the diseases studied, etretinate is preferable to isotretinoin with regard to both clinical effect and serum lipid side-effects.

Notes: The distribution of choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) in involved skin in patients with palmoplantar pustulosis (PPP) and in normal palmar skin in healthy non-smokers and smokers has been studied by immunohistochemistry, especially in relation to the sweat gland apparatus. The sweat gland and its duct showed ChAT- and AChE-like immunoreactivity (LI) of varying intensity in all three groups and with stronger reactivity than in the epidermis. ChAT-LI was present in the coil and in the duct except in the corneal layer. Smokers and patients with PPP displayed significantly fewer ChAT+ acrosyringia than non-smokers. In the patients with PPP, the granulocytes in the pustules and in the papillary dermis displayed ChAT-LI. Western blot analysis of granulocytes from peripheral blood from healthy donors confirmed the presence of ChAT-like proteins in large amounts in neutrophils and small amounts in eosinophils. AChE-LI of varying intensity was found in all parts of the sweat gland apparatus in all three groups. The strongest AChE-LI in the acrosyringia was seen in the lowest part of the stratum corneum, where the PPP pustules are located. No significant differences in staining pattern or intensity were found between the coils, nerve fibres surrounding the coils or ducts. The number of mast cells in the papillary dermis was about four times larger in the patients with PPP than in the control subjects. AChE-LI was observed in about 25% of the mast cells in non-smoking control subjects and in patients with PPP, but only in 10% of those in the smoking control subjects. Our findings indicate that the (non-neuronal) cholinergic system may be involved in cutaneous inflammatory processes.

Notes: In a screening study concerning IgA and IgG antibodies to gliadin (IgA AGA and IgG AGA, respectively) in psoriasis, raised levels of IgA and AGA were found to be more common than in a reference group. To determine whether elevated AGA levels were associated with an increased number of intraepithelial lymphocytes. 33 patients with IgA AGA (n= 28) or IgG AGA (n= 5) values above 90% of the reference values (〉50 units/ml IgA AGA and 〈12 units/ml IgG AGA) underwent gastroduodenoscopy and duodenal biopsy in a prospective study. For comparison, six patients with low levels of both IgA AGA and IgG AGA were included. Five biopsy specimens were taken in each patient. Paraffin-embedded specimens were examined with regard to the degree of intraepithelial lymphocyte infiltration, and scored from 0 to 3. Biopsy specimens with a score of 0 had one mononuclear cell or less per four epithelial cells. The specimens were also examined with regard to the presence of intraepithelial CD3+ T lymphocytes and γ/δ+ T lymphocytes.In the six patients with low IgA/AGA and low IgG AGA, the biopsy score was 0. Fourteen of the 33 patients with raised AGA had a score of ≥1: of these. 12 had raised IgA AGA and two had slightly raised IgG AGA. Two of the patients with raised IgA AGA had partial villous atrophy, but the majority had normal villous architecture. There was a significant correlation both between the biopsy score and the number of intraepithelial CD3+ cells and between the score and the number of intraepithelial γ/δ+ positive T lymphocytes.The serum IgA AGA levels were significantly correlated with the duodenal biopsy score, the number of intraepithelial γ/δ+ T lymphocytes, and the number of CD3+ intraepithelial T lymphocytes. Most patients had no, or only mild, gastrointestinal symptoms. Of the 14 patients with biopsy scores 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:00070963:BJD896:ges" location="ges.gif"/〉1, seven had severe psoriasis and five moderately severe psoriasis, whereas only two bad mild psoriasis. There was no relationship between the duodenal score and haemoglobin, folate, whole blood selenium or serum zinc levels.Some of these patients improve on a gluten-free diet, but it is still too early to draw any definite conclusions concerning the type of relationship between the skin lesions, the increased number of intraepithelial lymphocytes in the duodenal mucosa and gluten hypersensitivity.

Notes: The presence of eosinophils and eosinophil cationic protein (ECP) in the involved and non-involved skin in patients with psoriasis was studied using a polyclonal antibody specific for ECP and a monoclonal antibody (EG2) specific for activated cosinophils and secreted ECP. ECP immunoreactive eosinophils were found in all the specimens from involved psoriatic skin. In new lesions in patients with rapidly progressive disease, intense ECP immunoreactivity was detected both intra- and extracellularly, particularly in the upper third of the epidermis and usually in association with granulocytes. In stable or slowly progressive lesions, less ECP was observed. The EG2-immunoreactivity was positive in the same areas. ECP was also determined in suction-blister fluid from lesional and non-involved skin in psoriasis patients and in healthy subjects. The ECP concentration was greatly elevated in the fluid from lesions in patients with more acute and progressive disease.