SKIN

PSORIASIS PATIENTS WITH ANTIBODIES TO GLIADIN CAN BE IMPROVED BY A GLUTEN-FREE DIET

In previous studies patients with severe and/or refractory psoriasis showed a long-standing improvement or total remission of their psoriasis when coeliac disease was revealed and treated with a gluten-free diet (GFD). It has also been observed that a few psoriasis patients with IgA antibodies to gliadin (AGA) and normal duodenal histopathology displayed a marked improvement of their psoriasis when they adhered to a GFD. Therefore, a study was carried out to evaluate the effect of a GFD in 33 AGA-positive and 6 AGA-negative psoriasis patients.

Of the 33 AGA-positive patients, two had IgA antibodies to endomysium (EmA) and 15 an increased number of lymphocytes in the duodenal epithelium. A 3-month period on a GFD was followed by 3 months on the patient’s ordinary diet. The severity of psoriasis was evaluated with the psoriasis area and severity index PASI). Of the 33 patients with AGA, 30 completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA-positive patients with normal routine histology in duodenal biopsy specimens. The AGA-negative patients showed no improvement. There was a highly significant decrease in serum eosinophil cationic protein in patients with elevated AGA. When the normal diet was resumed, the psoriasis deteriorated in 18 of the 30 patients with AGA who had completed the GFD period.

Thus, psoriasis patients with raised AGA might improve on a GFD even if they have no EmA or if the increase in duodenal intraepithelial lymphocytes is slight or seemingly absent.
Michaelsson, G. et al
BRIT.J.DERMATOL. 2000, 142 (1) 44-51

ASSOCIATION OF EARLY-STAGE PSORIASIS WITH SMOKING AND MALE ALCOHOL CONSUMPTION

The interaction between genetic and environmental factors seems to play a role in the causes of psoriasis. Therefore, a study was carried out to determine the association of psoriasis with smoking habits and alcohol consumption. The study group consisted of patients with a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no longer than 2 years after the reported disease onset. It was found that the risk for psoriasis was higher in ex-smokers and in current smokers than in patients who had never smoked. The relation with smoking was stronger and more consistent among women than men. Smoking was strongly associated with pustular lesions with an adjusted odds ratio of 10.5 for those smoking more than 15 cigarettes per day. No significant overall association with alcohol consumption was found after controlling for smoking habits. However, the risk seemed to vary according to sex, with a moderate association being found in men.
Naldi, L. et al
ARCH. DERMATOL. 1999, 135 (12) 1479-84

DISTINGUISHING BETWEEN CELLULITIS AND VARICOSE ECZEMA OF THE LEG

An article states the importance of recognising the difference between these two conditions, and documents two case histories.

Cellulitis is infection and inflammation of the skin and subcutaneous layers that is commonly caused by S. aureus and S. pyogenes. What causes confusion is the erythematous inflammation that is found in both conditions. However, other clinical features differentiate them. Crusting or scaling is the most important sign in eczema and this is not seen in cellulitis, where the skin is smooth and shiny. Small blisters (vesicles) are common in eczema. These break down and the serous fluid released dries to form crusts which coalesce. Although blister formation is uncommon in cellulitis, if blisters do develop they are large and herald the onset of skin necrosis.

Intravenous antibiotics are recommended for cellulitis, as it is a potentially serious problem.
C.M. Quartley-Papafio
BMJ no 7199 19th June 1999

EFFECTS OF THE MENSTRUAL CYCLE ON MEDICAL DISORDERS

It is well recognised that certain medical conditions are exacerbated at specific phases of the menstrual cycle. Abrupt changes in the concentrations of circulating ovarian steroids at ovulation and premenstrually may account for menstrual-cycle related changes in these chronic conditions. Accurate documentation of symptoms on a menstrual calendar allows identification of women with cyclic alterations in disease activity.

The evidence supporting a relationship between oestrogen withdrawal and migraine headache is compelling. The frequency of migraine headaches in women increases considerably after menarche and 60% of women with migraine link attacks to menstruation. Seventy to ninety percent of women with menstrual migraine experience improvement during pregnancy but may experience migraine attacks in the postpartum period.

Menstrual exacerbations occur with all types of seizures. Catamenial epilepsy is believed to result from cyclic alterations in both ovarian hormone levels and drug metabolism.

In many women with asthma there is an increased frequency and severity of attacks premenstrually or at menstruation and may be related to changing levels of progesterone or prostaglandins.

Symptoms of rheumatoid arthritis often improve in the luteal phase when gonadal steroid production is maximal. A subjective increase in morning stiffness and arthritic pain during menstruation and the early follicular phase has been shown.

In women with irritable bowel syndrome symptoms tend to recur and become cyclic, with exacerbation during the postovulatory and premenstrual phases of the menstrual cycle, suggesting a hormonal influence.

Menstrual cycle-related alterations in glycemic control during the luteal and premenstrual phases have been reported in some women with diabetes.

Other disorders exacerbated by the postovulatory and premenstrual phases of the menstrual cycle include acne, endocrine allergy and anaphylaxis, erythema multiforme, urticaria, apthous ulcers, glaucoma and multiple sclerosis.
Case, A.M. and Reid, R.L.
ARCH.INT.MED. 1998, 158 (13) 1405-12

SUMMARY OF ANALYSIS OF ASTHMA AND ECZEMA PILOT STUDY

The Natural Medicines Society initiated a pilot study to ascertain whether naural medicines were helpful to people suffering with either asthma or eczema, or both. Eighty people completed the section relating to asthma and 98 people completed the section on eczema. Some completed both. The Nuffield Institute for Health was asked to analyse the responses and their summary is as follows.

Between two-thirds and three-quarters of the questionnaires were completed by women. In both the asthma and eczema surveys:

• The under twentys were the largest group.
• Around 50% have used natural medicines for over 2 years.
• Between 56-60% of all products used had been prescribed by practitioners.
• Between 88-95% of respondents experienced no side-effects.
• Only 9% of patients felt that they had not benefited from using natural medicines.
• In both conditions 42% of respondents were still taking natural medicines to control their symptoms.
• Almost 70% of the asthma respondents and only 37% of the eczema respondents were taking orthodox medicine as well as natural medicine.
• If respondents had experienced any problem with their natural medicine, they reported back to the practitioner.
• The majority of respondents had turned to natural medicine due to worries about side effects and a lack of confidence in the efficacy of the orthodox treatment.

Homeopathy was used by 17.8% of respondents and the rest were split between a variety of therapies, mainly nutrition, yoga, diet, acupuncture, etc. It was concluded that natural medicines may be useful in the treatment of asthma and especially of eczema. The small sample may not be representative. Further research should be carried out, but funding is so far unobtainable.
NMS NEWS No. 42, Spring 1998

UFOs OF THE INTESTINES

Interstinal parasites are much closer to home than we think. Antony Haynes reviews evidence which highlights the prevalence of previously unidentified faecal organisms (UFOs) and their significance to health. Parasitic infestations are now so widespread thay they affect about 150 million people in the US and at least 40% of the world’s population. Dr. Hermann Bueno, one of the world’s most experienced parasitologists, believes that parasites are the missing diagnosis in the genesis of many chronic health problems. Signs of parasitic infection in adults include:

• abdominal pain
• abdominal bloating
• aches and pains
• anaemia
• arthritis
• autoimmune disease
• chronic fatigue
• colitis
• constipation
• diarrhoea
• fever
• flatulence
• food allergy
• gastritis
• headaches
• inflammatory bowel disease
• immune system problems
• irritable bowel syndrome
• malabsorption
• skin conditions and itching
• sleep disturbances
• rectal bleeding
• vomiting

While over 130 different parasites have been found in Americans, the following are the most common:

Blastocystis hominis, which can be asymptomatic, but can cause irritable bowel, chronic fatigue, arthritis and rheumatism.

Dientamoeba fragilis, which can also be asymptomatic, or cause diarrhoea, tenderness and melaena.

Entamoeba coli, often asymptomatic, but can cause systemic illness and auto-immune reactions.

Giardia lamblia, which adhere to the upper part of the small intestine, preventing digestion and assimilation and causing a range of symptoms.

Endolimax nana, the smallest of the intestinal amoebas, and suspected of being the cause of rheumatoid arthritis and collagen-related diseases.

Most NHS laboratories do not use techniques which could help to identify parasites, and some organisms are thought to be harmless. It can take an average of 16 investigations to diagnose the presence of Giardia.

The major sources of infection are tap water, badly cooked or stored food, human and pet faeces, and holidays abroad.

The best laboratories for detecting UFOs are:
Parascope Laboratory, Tel: 01133 292 4657.
Diagnos-Techs Labs., Tel: 0121 458 3407.
Health Interlink (agents for Great Smokies Diagnostic Lab.), Tel: 01582 794 094.
OPTIMUM NUTRITION 1998, 11; 1; 22-7

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