Nonbacterial pus-forming diseases of the skin

The formation of pus as a result of an inflammatory response to a bacterial infection is well known. Not so well appreciated, however, is the fact that many other nonbacterial agents such as certain fungi, viruses and parasites may provoke pus formation in the skin. Also heat, topical applications, systemically administered drugs and some injected materials can do likewise. Numerous skin diseases of unknown etiology such as pustular acne vulgaris, pustular psoriasis and pustular dermatitis herpetiformis can have bacteriologically sterile pustules. The importance of considering nonbacterial causes of pus-forming conditions of the skin is obvious from a diagnostic and therapeutic point of view.     

Ethanol perturbs lipid organization in models of stratum corneum membranes: An investigation combining differential scanning calorimetry,infrared and 2H NMR spectroscopy

Ethanol is used in a variety of topical products. It is known to enhance the permeability of the skin by altering the ability of the stratum corneum (SC) intercellular membranes to form an effective barrier. In addition, ethanol and other alcohols are key components of antiseptic gels currently used for hand wash. Using infrared and deuterium NMR spectroscopy as well as calorimetry, we have investigated the effect of ethanol on a model membrane composed of lipids representing the three classes of SC lipids, an equimolar mixture of N-palmitoylsphingosine (ceramide), palmitic acid and cholesterol. Ethanol is found to influence the membrane in a dose dependent manner, disrupting packing and increasing lipid motion at low concentrations and selectively extracting lipids at moderate concentrations.     

Ethanol perturbs lipid organization in models of stratum corneum membranes: An investigation combining differential scanning calorimetry, infrared and (2)H NMR spectroscopy

Ethanol is used in a variety of topical products. It is known to enhance the permeability of the skin by altering the ability of the stratum corneum (SC) intercellular membranes to form an effective barrier. In addition, ethanol and other alcohols are key components of antiseptic gels currently used for hand wash. Using infrared and deuterium NMR spectroscopy as well as calorimetry, we have investigated the effect of ethanol on a model membrane composed of lipids representing the three classes of SC lipids, an equimolar mixture of N-palmitoylsphingosine (ceramide), palmitic acid and cholesterol. Ethanol is found to influence the membrane in a dose dependent manner, disrupting packing and increasing lipid motion at low concentrations and selectively extracting lipids at moderate concentrations.     

Clinical Studies with Topical Fluocinolone Acetonide in the Treatment of Various Dermatoses

Fluocinolone acetonide cream is a new, potent topical corticosteroid. When used in conjunction with an occlusive plastic film dressing, herein described, it is highly effective in the treatment of psoriasis of the glabrous skin, pustular and paronychial psoriasis, neurodermatitis, and lichen planus. Psoriasis of the intertriginous areas responds to the local use of the fluocinolone cream alone. Relapses on cessation of treatment respond as a rule to retreatment.Indications, limitations, reactions and contraindications to this form of treatment are discussed.     

Short term effects of a low-carbohydrate diet in overweight and obese subjects with low HDL-C levels

Background

The aim of this study was to evaluate short-term effects of a low-carbohydrate diet in overweight and obese subjects with low HDL-C levels.

Methods

Overweight (BMI between 25-30 kg/m²) or obese (BMI over 30 kg/m²) subjects with low HDL-C levels (men with HDL-C <1.03, women <1.29 mmol/l) were invited to the study. A 1400 kcal 75-gram carbohydrate (CHO) diet was given to women and an 1800 kcal 100-gram CHO diet was given to men for four weeks. The distribution of daily energy of the prescribed diet was 21-22% from CHO, 26-29% from protein and 49-53% from fat. Subjects completed a three-day dietary intake record before each visit. Anthropometric indices, body fat ratio, blood lipids, glucose and insulin were measured. Baseline and week-four results were compared with a Wilcoxon signed ranks test.

Results

Twenty-five women and 18 men participated. Basal median LDL-C level of men was 3.11 and basal median LDL-C level of women was 3.00 mmol/l. After four weeks of a low-carbohydrate diet, the median energy intake decreased from 1901 to 1307 kcal/day, daily energy from carbohydrate from 55% to 33%, body weight from 87.7 to 83.0 kg and HDL-C increased from 0.83 to 0.96 mmol/l in men (p < 0.002, for all). After four weeks of a low-carbohydrate diet, the median energy intake tended to decrease (from 1463 to 1243 kcal, p = 0.052), daily energy from carbohydrate decreased from 53% to 30% (p < 0.001) and body weight decreased from 73.2 to 70.8 kg (p < 0.001) in women, but HDL-C did not significantly change (from 1.03 to 1.01 mmol/l, p = 0.165). There were significant decreases in body mass index, waist circumference, body fat ratio, systolic blood pressure, total cholesterol, triglyceride and insulin levels in all subjects.

Conclusions

HDL-C levels increased significantly with energy restriction, carbohydrate restriction and weight loss in men. HDL-C levels didn't change in women in whom there was no significant energy restriction but a significant carbohydrate restriction and a relatively small but significant weight loss. Our results suggest that both energy and carbohydrate restriction should be considered in overweight and obese subjects with low HDL-C levels, especially when LDL-C levels are not elevated.     

Effects of dietary monounsaturated fatty acids on plasma lipids in humans

In order to test whether monounsaturated fatty acids (MUFA, M) would lower plasma cholesterol and/or triglycerides (TG), 14 young men were studied in a metabolism ward. They were given two experimental diets with the same P/S ratio (P: polyunsaturated; S:saturated fatty acids) but different P + M/S ratios in composition of dietary fatty acids. Six men were in experiment I. In two groups of three, each group was given either the high or the low P + M/S ratio diet for 6 weeks. In experiment II, two groups of four men were subjected to a 3-week cross-over feeding trial (total of 6 weeks). We found in the crossover study that when the dietary P/S ratio was fixed at 1.0, those subjects given a diet with the higher P + M/S ratio of 4.5 showed significantly higher plasma total TG, very low density lipoprotein (VLDL)-TG, low density lipoprotein (LDL)-TG, and LDL-cholesterol than when given a diet with a lower P + M/S ratio of 1.5. Plasma total cholesterol, apoprotein A-I, and apoprotein B-100 were not significantly different between the two dietary periods. Plasma fatty acid patterns showed a significantly higher plasma MUFA level during the period of a higher P + M/S diet. In contrast to some recent reports, our studies indicate that a large amount of dietary MUFA may raise some fractions of plasma lipids in humans.     

A preliminary report on the feeding of cynomolgus monkeys (Macaca fascicularis) with a high-sugar high-fat diet for 33 weeks

Background The metabolic syndrome is common in populations exposed to a typical Western diet. There is a lack of an animal model that mimics this condition. Methods We fed 15 cynomolgus monkeys ad libitum a high‐sugar high‐fat (HSHF) diet for 33 weeks. Body weight, body composition, serum lipids, and insulin were measured at baseline and at 33 weeks. Results The animals tolerated the HSHF diet very well. In the intervention group, total serum cholesterol and low‐density lipoprotein cholesterol were 3‐ and 5‐fold higher, respectively, at 33 weeks as compared with their baseline levels. Serum high‐density lipoprotein cholesterol and triglycerides were not significantly affected. Dual‐energy X‐ray absorptiometry (DXA) analysis of the intervention group indicated that the trunk fat mass increased by 187% during this period. Conclusions Cynomolgus monkeys should be a useful model for investigating the interactions of diet and other factors such as genetics in the development of the metabolic syndrome.     

Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis

ObjectivesTo evaluate the comparative efficacy and tolerability of topical calcipotriol in the treatment of mild to moderate chronic plaque psoriasis.DesignQuantitative systematic review of randomised controlled trials.Subjects6038 patients with plaque psoriasis reported in 37 trials.ResultsCalcipotriol was at least as effective as potent topical corticosteroids, calcitriol, short contact dithranol, tacalcitol, coal tar, and combined coal tar 5%, allantoin 2%, and hydrocortisone 0.5%. Calcipotriol caused significantly more skin irritation than potent topical corticosteroids (number needed to treat to harm for irritation 10, 95% confidence interval 6 to 34). Calcipotriol monotherapy also caused more irritation than calcipotriol combined with a potent topical corticosteroid (6, 4 to 8). However, the number needed to treat for dithranol to produce lesional or perilesional irritation was 4 (3 to 5). On average, treating 23 patients with short contact dithranol led to one more patient dropping out of treatment owing to adverse effects than if they were treated with calcipotriol.ConclusionsCalcipotriol is an effective treatment for mild to moderate chronic plaque psoriasis, more so than calcitriol, tacalcitol, coal tar, and short contact dithranol. Only potent topical corticosteroids seem to have comparable efficacy at eight weeks. Although calcipotriol caused more skin irritation than topical corticosteroids this has to be balanced against the potential long term effects of corticosteroids. Skin irritation rarely led to withdrawal of calcipotriol treatment. Longer term comparative trials of calcipotriol versus dithranol and topical corticosteroids are needed to see whether these short term benefits are mirrored by long term outcomes such as duration of remission and improvement in quality of life.     

A residential study comparing the effects of diets rich in stearic acid, oleic acid, and linoleic acid on fasting blood lipids, hemostatic variables and platelets in young healthy men

Dietary fat is known to influence the variables of blood coagulation and fibrinolysis associated with vascular disease. However, the role of fat content and/or fat composition of the diet in this regard is still not well understood. In the present study, we investigated the effects of three isoenergic diets of differing fat composition in nine healthy young men in a strictly controlled residential study. Subjects consumed the three experimental diets for periods of 2 weeks each, separated by a washout period of at least 5 weeks in a randomized crossover design. The diets provided 38% of total energy intake as fat, 45% as carbohydrate, and 17% as protein, and differed only with respect to the fatty acid composition (stearic acid-rich diet: 34.1% stearic acid, 36.6% oleic acid; oleic acid-rich diet: 65.8% oleic acid; linoleic acid-rich diet: 36.5% linoleic acid, 38% oleic acid). Blood samples were collected at the beginning and at the end of each dietary period from fasted subjects for determination of factor VII coagulant activity (FVIIc), activated factor VII (FVIIa), factor VII antigen (FVIIag), tissue plasminogen activator (tPA) activity, plasminogen activator inhibitor type 1 (PAI-1) activity, fibrinogen, prothrombin fragment 1+2 (F(1+2)), and plasma lipids. There were no significant differences between diets in fasting plasma concentrations of FVIIc, FVIIa, FVIIag, fibrinogen, F(1+2), PAI-1 activity, and tPA activity. Plasma concentrations of lipids (high density lipoproteins, low density lipoproteins, triacylglycerols, and total cholesterol) were also unaffected. Although there were no changes in platelet aggregation response and membrane fluidity observed in any of the diets, increased anti-aggregatory prostaglandin E(1) binding to platelet membranes was observed only in the case of linoleic acid-rich diet. In conclusion, diets with very different fatty acid compositions, at 38% of energy as fat intake, did not significantly influence blood coagulation, fibrinolysis, or blood lipids in the fasting state in young healthy men.     

Effect of dietary cholesterol on plasma cholesterol concentration in subjects following reduced fat,high fibre diet.

One hundred and sixty eight subjects participated in a randomised crossover study to determine whether halving or doubling the present dietary cholesterol intake from eggs had any influence on blood cholesterol concentration in people following current dietary recommendations. During the first eight weeks all participants were advised to follow a reduced fat diet (26% total energy for hyperlipidaemic patients, 35% total energy for normolipidaemic volunteers) with an increased ratio of polyunsaturated to saturated fatty acids. This background diet was continued throughout the 16 week experimental period, during which participants ate either two or seven eggs a week. A small but significant increase in total cholesterol was seen after four weeks in the group eating seven eggs a week compared with that in the group eating two eggs a week, but this was no longer apparent after eight weeks. Previous studies suggesting that dietary cholesterol has a greater effect on the serum cholesterol concentration either have been carried out against a background of a higher fat intake or have contrasted extreme cholesterol intakes. A further reduction in dietary cholesterol seems to be unnecessary in those people who have already reduced their intake of saturated fat and increased the ratio of polyunsaturated to saturated fatty acids and fibre rich carbohydrate.     

The importance of patient selection for photochemotherapy in psoriasis.

Twenty-four patients with psoriasis were treated with orally administered 8-methoxypsoralen followed by exposure to high-intensity long-wavelength ultraviolet radiation (PUVA) at a psoriasis day care centre. Among the 20 with plaque type psoriasis the condition cleared in 13 (65%), after a mean of 20.7 treatment sessions, and improved but failed to clear in 4 (20%); the treatment failed in the other 3 (15%). The other four patients had erythrodermic, pustular or inflammatory psoriasis, and all failed to respond to PUVA therapy. Factors to be considered in patient selection for this form of therapy are the type of psoriasis, the patient''s skin type and th proportion of the body surface area involved.     

Oligaemia,Renal Failure,and Jaundice Associated with Acute Pustular Psoriasis

An episode of acute pustular psoriasis in a middle-aged man was associated with cholestatic jaundice and followed by acute tubular necrosis. It is suggested that renal failure was due to oligaemia after the loss of albumin into and from the skin. Fluid balance, central venous pressure, and arterial blood pressure should be monitored in patients with acute pustular psoriasis.     

Effects of excess dietary phenylalanine on composition of cerebral lipids

Abstract— Concentrations in whole rat brains of lipids (total lipids, phospholipids, galactolipids, cholesterol, plasmalogens) and of proteolipid protein were not altered after feeding for 2 and 6 weeks of diets containing 5 per cent excess l -phenylalanine. After 2 weeks of diet with 7 per cent excess l -phenylalanine there was a slight reduction (5–10 per cent) in the concentrations in whole brain of cholesterol and galactolipids. No significant effects were noted in cerebral hemispheres after 3 weeks of diets with 7 per cent excess l -phenylalanine. In the 5 and 7 per cent supplemented groups of animals, the total amounts of the various lipids were initially reduced to levels which were within 10 per cent of those in diet-matched controls. The results for rats indicate that after 3 weeks of age only very moderate effects on accumulation of cerebral lipids can be produced by excess dietary l -phenylalanine fed at the most toxic levels of supplementation, while lower levels of dietary supplementation are without effect. The results suggest further that the more mature brain is resistant to alteration of deposition of myelin lipids by high levels of phenylalanine.     

T cell-regulated neutrophilic inflammation in autoinflammatory diseases

Previous studies of acute generalized exanthematous pustulosis, a peculiar drug hypersensitivity reaction, suggested that CXCL8-producing T cells regulate sterile, polymorphonuclear neutrophil-rich skin inflammations. In this study, we test the hypothesis of whether CXCL8-producing T cells are present in autoinflammatory diseases like pustular psoriasis and Beh?et's disease. Immunohistochemistry of normal skin revealed few CD4+ and CD8+ T cells, few CXCL8+ cells, and no neutrophilic infiltration, whereas in acute exacerbations of atopic dermatitis, numerous CD4+ T cells but few CD8+ T cells, neutrophils, or CXCL8+ cells were detected. In contrast, a pronounced infiltration of neutrophils and of predominantly CD4+ T cells was observed in skin biopsies from pustular psoriasis, Beh?et's disease, and acute generalized exanthematous pustulosis, with infiltrating T cells strongly positive for CXCL8 and the chemokine receptor CCR6. Skin-derived T cell clones from pustular skin reactions were positive for CCR6 but negative for CCR8 and secreted high amounts of CXCL8 and GM-CSF, often together with IFN-gamma and TNF-alpha after in vitro stimulation. Moreover, some skin-derived T cell clones from Beh?et's disease and from pustular psoriasis predominantly produced CXCL8 and GM-CSF, but failed to secrete IL-5 and IFN-gamma. These cells might represent a particular subset as they differ from both Th1 as well as Th2 T cells and are associated with a unique, neutrophil-rich sterile inflammation. Our findings suggest that CXCL8/GM-CSF-producing T cells may orchestrate neutrophil-rich pathologies of chronic autoinflammatory diseases like pustular psoriasis and Beh?et's disease.     

High-cholesterol diets induce changes in lipid composition of rat erythrocyte membrane including decrease in cholesterol,increase in alpha-tocopherol and changes in fatty acids of phospholipids

Effects of high dietary cholesterol on erythrocyte membrane lipids were studied. Feeding rats with a diet containing 0.5% cholesterol and 0.15% sodium cholate for two weeks induced changes in erythrocyte membrane lipids including a decrease in cholesterol, an increase in alpha-tocopherol (alpha-Toc) and changes in the fatty acid composition of phospholipids. Oleic acid and linoleic acid increased, while arachidonic acid decreased in phosphatidylcholine. Saturated fatty acids decreased and unsaturated fatty acids increased in phosphatidylethanolamine. Almost the same changes in membrane lipids were also noted after six weeks of feeding rats with the diet. A diet containing 0.5% cholesterol but without sodium cholate caused a decrease in erythrocyte cholesterol and an increase in erythrocyte alpha-Toc after two weeks of feeding, as compared to the basal diet, indicating that high dietary cholesterol, but not sodium cholate, was responsible for these changes in the erythrocyte membrane.     

High-cholesterol Diets Induce Changes in Lipid Composition of Rat Erythrocyte Membrane Including Decrease in Cholesterol,Increase in α-Tocopherol and Changes in Fatty Acids of Phospholipids

Effects of high dietary cholesterol on erythrocyte membrane lipids were studied. Feeding rats with a diet containing 0.5% cholesterol and 0.15% sodium cholate for two weeks induced changes in erythrocyte membrane lipids including a decrease in cholesterol, an increase in α-tocopherol (α-Toc) and changes in the fatty acid composition of phospholipids. Oleic acid and linoleic acid increased, while arachidonic acid decreased in phosphatidylcholine. Saturated fatty acids decreased and unsaturated fatty acids increased in phosphatidylethanolamine. Almost the same changes in membrane lipids were also noted after six weeks of feeding rats with the diet. A diet containing 0.5% cholesterol but without sodium cholate caused a decrease in erythrocyte cholesterol and an increase in erythrocyte α-Toc after two weeks of feeding, as compared to the basal diet, indicating that high dietary cholesterol, but not sodium cholate, was responsible for these changes in the erythrocyte membrane.     

Plasma lipoprotein lipid and Lp[a] changes with substitution of elaidic acid for oleic acid in the diet.

The effect of additional dietary trans fatty acids (7% energy) on plasma lipids was assessed in a double-blind comparison of four separate diets: 1, enriched with butter fat (lauric-myristic-palmitic); 2, oleic acid-rich; 3, elaidic acid-rich; 4, palmitic acid-rich. The total dietary period was 11 weeks and comprised normal foods plus specific fat supplements. In 27 mildly hypercholesterolemic men, total and LDL cholesterol were significantly lower during the 3-week oleic acid-rich diet, and were similar during the other three diets. For the four diets LDL cholesterol levels were in mg/dl: 1, 163; 2, 151; 3, 165; 4, 161. HDL cholesterol was significantly higher with the palmitic acid-rich diet, 42 mg/dl, compared with elaidic acid, 38 mg/dl, which in turn was not lower than with oleic acid, 38 mg/dl. Plasma elaidic acid concentration rose seven-fold with the trans fatty acid diet but did not increase the vulnerability of LDL to oxidative change. The elaidic acid-rich diet led to significant elevations in the level of Lp[a] compared to all the other test diets. The Lp[a] level increased to 296 +/- 220 U/l in the elaidic acid-rich period from 235 +/- 182 (mean +/- SD) in the first ("butter") period (P less than 0.001) compared with 249 +/- 204 in the palmitic acid period (P less than 0.001) and 236 +/- 201 in the oleic acid period (NS).(ABSTRACT TRUNCATED AT 250 WORDS)     

Variations in Body Composition and Plasma Lipids in Response to a High‐Carbohydrate Diet

Objective: To examine the extent to which variations in body composition modulate changes in the lipid profile in response to the ad libitum consumption of a diet rich in carbohydrates (CHOs) (high‐CHO diet: 58% of energy as CHOs) or high in fat and in monounsaturated fatty acids (MUFAs) (high‐MUFA diet: 40% of energy as fat, 23% as MUFAs). Research Methods and Procedures: Sixty‐three men were randomly assigned to one of the two diets that they consumed for 6 to 7 weeks. Body composition and fasting plasma lipid levels were measured at the beginning and the end of the dietary intervention. Results: The high‐CHO and high‐MUFA diets induced significant and comparable reductions in body weight and waist circumference. These changes were accompanied by significant and comparable (p < 0.01) reductions in total plasma cholesterol and low‐density lipoprotein cholesterol levels. However, the high‐MUFA diet had more beneficial effects on plasma triglyceride concentrations (p < 0.01) and on plasma high‐density lipoprotein cholesterol levels (p = 0.02) compared with the high‐CHO diet. Diet‐induced changes in waist circumference were significantly associated with changes in low‐density lipoprotein cholesterol levels in the high‐CHO group (r = 0.39, p = 0.03) but not in the high‐MUFA group (r = 0.16, p = 0.38). Discussion: Improvements in plasma lipids induced by the ad libitum consumption of a high‐CHO diet seem to be partly mediated by changes in body weight, whereas lipid changes induced by the high‐MUFA diet seem to be independent of changes in body weight.     

The effect of a lipid-lowering diet on plasma lipids and lipoproteins in mildly hypercholesterolaemic subjects: a potential role for occasional treats

The aim of the study was to compare the effect of a lipid-lowering diet containing chocolate confectionery with an equivalent diet that is chocolate-free. In a parallel design trial, 42 free-living subjects (19 men and 23 women), aged 46.9 yr, mildly hypercholesterolemic (6.9 mmol/L) were allocated to an American Heart Association/National Cholesterol Education Program Step 1 diet that included chocolate confectionery or an identical regimen containing no chocolate. Blood samples for the analysis of plasma lipids were obtained initially, then at 6 and 12 weeks after dietary therapy. Both groups of subjects showed a trend toward a reduction in saturated fat, with those allowed chocolate reaching borderline significance (P < 0.057). Plasma cholesterol and low density lipoprotein cholesterol concentrations were significantly lower (P < 0.03) whereas plasma triacylglycerol was significantly higher (P < 0.02) in the control group compared with the chocolate group. High density lipoprotein cholesterol was reduced in both groups. Subgroup analysis on patients with the apo E3/E3 phenotype showed that the response was identical between the control and chocolate groups. The inclusion of a modest amount of chocolate confectionery did not detract from the response of a lipid-lowering diet.     

Human erythrocyte membrane fluidity and insulin binding are independent of dietary trans fatty acids

Substitution of selected saturated fatty acids of the diet of 29 men and 29 women with cis or trans monounsaturated fatty acids did not affect erythrocyte membrane fluidity, insulin binding, and the membrane cholesterol and phospholipid concentrations. Subjects were fed four different controlled diets with a total fatty acid content of 39 to 40 energy percent for four 6-week periods in a Latin square design. The diets were: (1) high oleic acid (16.7 energy percent oleic); (2) moderate trans (3.8 energy percent trans fatty acids); (3) high trans (6.6 energy percent trans fatty acids); and saturated (16.2 energy percent lauric + myristic + palmitic acids). There were no significant diet effects on red cell ghost fluidity determined by fluorescence polarization of the hydrocarbon probe 1,6-diphenyl-1,3,5-hexatriene (DPH) and the polar analog trimethylammonium-DPH (TMA-DPH). There were limited diet effects on fluidity of membranes as determined with DPH-propionic acid (DPH-PA) for the men. Insulin binding was more closely associated with anisotropy of fluorescence of the surface probe, DPH-PA, than with that of the other probes, which is compatible with the localization of the insulin receptor in a domain at the cell membrane surface.