Current Problems in Dermatology Vol. 4

Current Problems in Dermatology Vol. 4

Current Problems in Dermatology Vii. 4 Edited by J. W. Η. MALI, Nijmegen With 62 figures and 16 tables S. Karger Basel München Paris London. New York Sydney. 1972

Current Problems in Dermatology Vol. 1: Anniversary number for WILHELM Lurz in honour of his 70th Birthday. Edited by R. SCHUPPLI, Basel. X + 522 p., 95 fig., 1959 Vol. 2: Antibiotic Treatment of Venerial Diseases. Edited by A. LUGER, Vienna. XII + 187 p., 22 fig., 42 tab., 1968 Vol. 3: VI + 193 p., 87 fig., 7 tab., 1970 S. Karger Basel München Paris London New York Sydney Arnold-Böcklin-Strasse 25, CH-4000 Basel 11 (Switzerland) All rights, including that of translation into other languages reserved. Photomechanic reproduction (photocopy, microcopy) of this book or part of it without special permission of the publishers is prohibited. Copyright 1972 by S. Karger AG, Verlag für Medizin und Naturwissenschaften, Basel Printed in Switzerland by Buchdruckerei Gasser & Eggerling AG, Chur Blocks: Steiner & Co., Basel

Table of Contents Introduction X Exfoliative Dermatitis (Erythroderma) By J. E. ADAM, Montreal Etiology 2 Clinical Features 4 Duration 7 Investigations 7 Pathology 8 Skin 8 Lymph Node 9 Pathophysiology 9 Thermoregulation 9 Hemodynamics 10 Anemia 11 Endocrine and Metabolic 11 Renal 12 Gastrointestinal 12 Proteins and Liver 13 Immunology 13 Course and Prognosis 15 Deaths 15 Diagnosis 16 Treatment 17 Exfoliative Dermatitis in Infants and Children 19 References 21

Table of Contents VI Cutaneous Manifestations of Toxoplasmosis Bi J. Jusτυs, Dresden The Parasite 25 Systematics of the Parasite 26 Demonstration of the Parasite 27 Epidemiology and Pathogenesis of Human Toxoplasmosis 28 Manifestations of the Toxoplasmosis 29 Congenital Toxoplasmosis 29 The Toxoplasmosis of Adults 30 Clinical Symptoms and Serologic Diagnosis 30 Therapy of Toxoplasmosis 31 Skin Lesions in Toxoplasmosis 32 Discussion 40 Summary 43 References 44 The Acid Mucopolysaccharides of Skin By P. D. MIER, Nijmegen 1. Chemistry of the Acid Mucopolysaccharides 49 Nomenclature 49 Structure and Properties 50 Protein Linkage 51 Isolation, Fractionation, and Measurement 52 Histochemical Techniques 53 2. Biological Aspects of the AMPS 53 Synthetic Pathways 54 Degradation of AMPS 55 Function of the AMPS 56 3. The AMPS of Skin 57 Distribution within the Skin 58 Species Variation 59 Regicnal Variations 59 Changes with Age 60 4. Experimental Pathology of Cutaneous AMPS 62 Environmental `Stress' 63 Effect of Corticosteroids 64 Effect of Oestrogens and Androgens 65 Experimental Inflammation 65 Effect of Vitamin A 66 Vitamin C Deficiency 66 5. Cutaneous AMPS in Skin Disorders 67 The Mucopolysaccharidoses 68 Genetic Disorders of the Skin 69 `Metabolic' Disorders of the Skin 70 Connective Tissue Diseases 71

Table of Contents VII Hyper- and Neoplastic Skin Conditions 72 Psoriasis 72 Summary 73 References 73 The Langerhans Cell By K. WOLFF, Vienna I. Introduction 80 II. The Langerhans Cell in Retrospect 81 III. Methods for the Demonstration and Identification of Langerhans Cells 82 1. Light Microscopy 82 a) Gold Chloride Methods 82 b) Osmium Iodide and Osmium-Zinc-Iodide 82 c) Enzyme Histochemical Methods 83 d) Supravital Techniques with Quinone-Imine Dyes 83 2. Electron Microscopy 83 IV. The Cell 84 A. Morphology 84 1. Light Microscopy 84 2. Electron Microscopy 85 a) General Features 85 b) Lysosomes 88 c) The Langerhans Cell Granule 91 d) The Origin and Ultimate Fate of the Langerhans Cell Granule 100 B. Histochemistry 103 1. Enzyme Reactions in Different Species 103 a) Alkaline Phosphatase 103 b) Nucleosidephosphatases 104 c) Aminopeptidase 105 d) Cholinesterase 105 e) Nonspecific Esterase 105 f) Acid Phosphatase 105 2. The Significance of the Langerhans Cell Enzymes 105 C. `Indeterminate Cell' 106 D. The Localization and Distribution of Langerhans Cells 107 1. Epidermis, Skin Appendages and Mucous Membranes 107 2. Extraepidermal Localization 107 E. The Cells of Histiocytosis X 108 i. Morphology and Distribution of the Cells 108 2. The Granules 113 V. The Langerhans Cell Population 114 A. Quantitative Behavior of the Langerhans Cell Population 114 B. Studies on the Origin of the Langerhans Cell Population 118 1. Studies on Skin Deprived of its Neural Crest Components.. 118 2. Studies on Embryonic and Adult Skin 119

Table of Contents VII[ C. Kinetics of the Langerhans Cell Population 120 1. Uptake of Tritiated Thymidine 120 2. Mitosis 121 3. Induced Shedding of Langerhans Cells 121 4. Wound Healing 124 5. Comment 124 D. The Response of the Langerhans Cell Population to Various Experimental Stimuli 124 1. Irradiation 124 2. Depigmenting Agents 126 3. Induction of Phagocytoses 127 E. Langerhans Cells in Skin Disease 127 1. Vitiligo and Other States of Depigmentation 128 2. Other Conditions 129 VI. The Nature of the Langerhans Cells 130 A. The Older Concepts 130 B. The Langerhans Cell as a Mesenchymal Cell 131 1. Discussion of Evidence 131 2. Implications 134 VII. The Function of the Langerhans Cells 134 VIII. Conclusions 136 References 137 Tolerance and Desensitization in Experimental Eczema By L. POLAK and J. R. FREY, Basel I. Introduction 146 II. Aquired Tolerance to Low Molecular Chemicals 150 A. Induction of Tolerance to Low Molecular Chemicals in Adult Animals 150 B. Induction of Tolerance during the Primary Response 157 C. Induction of Tolerance during Embryonal Life or Early After Birth 159 III. Natural Tolerance 160 IV. Desensitization 161 V. Theoretical Consideration on Immunological Tolerance 170 References 172 The Role of the Basophilic Leucocyte in Hypersensitivity By P. WOLF-JÜRGENSEN, Copenhagen Introduction 178 History and Occurrence of the Basophilic Leucocyte 179 Cytochemistry 181 Basophil Count in the Blood 182 Extravascular Basophilic Leucocytes 185

Table of Contents 1X Relation to Eosinophilic Leucocytes and Mast Cells 188 Basophilic Leucocytes in Immune Reactions 189 Discussion and Conclusion 192 References 195 Dermabrasion By E. ErsrEuv, Oakland, Calif. History 205 Procedure and Equipment 205 Complications 210 Dermabrasion as a Cosmetic Procedure 213 Dermabrasion as a Therapeutic Procedure 217 Results of Second Survey 224 Long-Term Evaluation of Dermabrasion in Precancerous Skin 226 Areas that Can be Planed 227 Technique of Planing Precancerous Skin 228 Comparison of Dermabrasion and 5-Fluorouracíl for Actinic Keratoses 229 Conclusions 230 References 230

Introduction The fourth volume of Current Problems in Dermatology tries to establish the trend started with the apparition of the third volume. It is our purpose to inform the practising dermatologist about the new developments in his field. Experts in their domain give an exposition of the trend of their investigations and enlarge thus the background on which the practising dermatologist has to act in his every day work. As we work in the clinical situation many times outside of the territory of knowledge it is important to be sure of its border. It is only by applying the new concepts of general medicine and biology that dermatology can hope to remain a speciality of its own. The present development of molecular biology gives an unique opportunity to connect dermatology with the main stream of advancing biological science. The first two contributions in this volume are reviews of clinical conditions. ADAM treats the exfoliative erythrodermia's which constitute always a challenge to the dermatologist. Significantly Jusrus, the writer of the review on toxoplasmosis is a pathologist. It is to be expected that as awareness of this disease increases, the diagnosis may be more often and earlier made. MIER and WOLFF give reviews on subjects which have been for a long time so obscured by technical difficulties that it was impossible for the practical dermatologist to obtain an insight into them. Now new technical developments have made it possible for both contributors to give a balanced opinion about their subjects. WOLF-JüRGΕΝSΕΝΝ brings new information about the elusive basophil leucocyte and forms the transition to the contribution of POLAK and FREY about tolerance and desensitization in experimental eczema. Absorption of their ideas will give the clinician the opportunity to rearrange his clinical observations. It seems not unlikely that at this point cross-fertilization of experiment and clinic might bring real progress in the prevention of skin disease. Finally, EPSTEIN gives a personal opinion about a very practical subject, one of the few parts of dermatology in which the dermatologist can satisfy his urge as an artisan: dermabrasion. J. W. H. MALI, Nijmegen