An 18-year-old patient requiring steroid treatment for severe bronchial asthma and with atopic dermatitis acquired a cowpox-like virus infection clinically similar to smallpox from a domestic cat as carrier. In spite of intensive care, with controlled pressure breathing and the last available vaccinia hyperimmunoglobulin, the patient died of pulmonary embolism although viral spread had ceased some days before.

An 18-year-old patient requiring steroid treatment for severe bronchial asthma and with atopic dermatitis acquired a cowpox-like virus infection clinically similar to smallpox from a domestic cat as carrier. In spite of intensive care, with controlled pressure breathing and the last available vaccinia hyperimmunoglobulin, the patient died of pulmonary embolism although viral spread had ceased some days before.

The initial stimulation of DNA-synthesis after application of dithranol as single agent is completely inhibited by addition of tar. The autoradiographic analyse indicates that the good clinical effect of the new antipsoriatic therapy with TCSV may be due to suppression of dithranol-caused irritation by tar. But, restored cytokinetic values do not correspond to clinical remission of psoriasis.

16 patients with polymorphous light eruption were prophylactically treated with selective ultraviolet phototherapy (SUP). Ten patients showed no or only minimal signs of their disease in a following holiday with high sun exposition; 4 patients had the same skin manifestations as in the years before. Indirect evaluation of the therapeutic success had to be performed in two patients, who did not have holidays in this year. Thus SUP may represent a new prophylactic treatment of polymorphous light eruption.

With a new tracer for immunohistology, peroxidase-labeled Protein A, tissue-bound IgG can be demonstrated by direct techniques, and specific antibodies of the IgG-type against tissue or cellular antigens or autoantibodies of IgM- or IgA-type, respectively complement, by indirect techniques [1].

In 16 patients with generalized psoriasis treated with oral retinoid (Ro 10-9359; 1 mg/kg body weight/(day) autoradiographic studies were performed before, and 24 h, 48 h, 1 week and 3 weeks after beginning of treatment on involved and non involved epidermis. During the first week no significant changes of all cellular parameters were found. However, after 3 weeks of continuing medication the increased 3H-thymidine labelling index was markedly lowered and the prolonged DNA synthesis time was shortened; whereas, the cell cycle time remained unaffected. The findings revealed that oral retinoid has a distinct influence on epidermal cell proliferation towards normalization in both involved and non involved epidermis in psoriasis. The time needed for this effect indicates that the drug does not directly interfere with the cell cycle. It seems reasonable, therefore, to combine oral retinoids as a basic adjuvant drug with other antipsoriatic techniques, such as retinoid + anthralin, retinoid + PUVA, retinoid + UVB.

The combined application of an oral retinoid (Ro 10-9359) and phototherapy with predominantly UVB radiation (Selective Ultraviolet Phototherapy=SUP) is a new, highly effective method of treating psoriasis. It has few side effects and can be performed on an out-patient basis. With the aid of this combined treatment we achieved good or very good improvement in 19 out of 23 patients with generalized psoriasis (=82.6%). The average number of radiation sessions required to achieve this was 22.9, and the mean total therapeutic dose (TTD) was 73 J/cm2. In a control group of 40 psoriasis patients, who received only radiation therapy, we achieved good or very good results in only 60% with an average of 26 radiation sessions and 94 J/cm2 TTD. The effect of the oral retinoid and UVB radiation therapy is apparently additive, since the retinoid does not increase the sensitivity of the skin to light.

27 patients with generalized psoriasis were treated with oral administration of Ro 10-9359 (50--75 mg/d) and daily radiations with a source emitting UVA and UVB light at 292.5--335 nm (so called selective UV-phototherapy, SUP). In 24 patients full remission was seen, partly with few remaining lesions at the predilection sites. The average number of sessions necessary for clearing was 21.6 in 5.3 weeks. The total energy required was 68 J/cm2. Only slight side effects, such as cheilitis and hair loss (4 cases) were seen. The clinical efficacy of this combined retinoid-UV-treatment is comparable to the therapeutic effect of systemic PUVA; however, its practicability seems to be higher, and its application on an out-patient basis better.

Vitamin A, Vitamin A acid (retinoic acid) and their synthetic derivatives were variously applied in the management of psoriasis with different therapeutic results. Obviously, they influence the proliferation rate and the differentiation of human keratinizing epithelia and have beneficial effects on skin diseases with disturbances of keratinization, including psoriasis. Systemic application of Vitamin A has been yet largely abandonned since high dosages leading to clearing develop evident systemic toxicity. The anti-psoriatic effect of Vitamin A acid is either moderate or restricted, because of side effects. Only its combined local application with topical corticosteroids may be considered. Oral application of newly synthesized retinoids, however, was beneficial in psoriasis, particularly in erythrodermic or pustular types. With this group of retinoids new pathways were opened in dermatotherapy which may help to replace cytostatic drugs in these cases. Additionally, oral retinoid treatment may be introduced as an adjuvans in the management of widespread psoriasis, in order to enhance the effect of anthralin, PUVA or UVB treatments.

Bei 16 Psoriatikern mit generalisierter Psoriasis, die unter oralet Retinoid-Therapie standen (1 mg/kg Körpergewicht täglich), wurden 24h, 48h, 1 Woche und 3 Wochen nach Therapiebeginn autoradiographische Untersuchungen an der befallenen und nicht befallenen Epidermis durchgeführt. Während der ersten Behandlungswoche fanden sich keine signifikanten Veränderungen der zellkinetischen Parameter, doch nach 3wöchiger Therapie kam es zu einer Minderung des gesteigerten 3H-Markierungsindex und zu einer Verkürzung der verlängerten DNS-Synthesezeit; die mittlere Generationszeit blieb weiterhin unbeeinflußt.

15 patients with superficial basaliomas or premalignant epithelial neoplastic disorders (actinic keratosis, leukoplakia, Bowen's disease) were treated locally over three weeks with retinoic acid (RA) alone or in combination with 5-fluorouracil (5-FU). In 11 cases the lesions disappeared clinically, however, only 5 patients proved to be cured by histological examination. 4 of them were treated with RA combined with 5-FU. There was a decrease of the 3H-index after the first week and an increase after the third week of treatment. These findings suggest, that RA inhibits the proliferation of neoplastic keratinocytes and stimulates the proliferation of normal epidermal cells. Retinoic acid, therefore, has an inhibitory effect on epithelial neoplasias, particularly in combination with 5-FU. Since local therapy with RA and 5-FU is not sufficient for routine clinical purposes in all cases, their use should be restricted to selected patients.