Thesis (doctoral)--Universität Zürich, 1942. / Title and imprint from cover. "Zürich 1942 - Schweizerische Monatsschrift für Zahnheilkunde. Band 52, Nr. 6"--Inside front cover. Includes bibliographical references (p. 22-24).

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Faculty of Health Sciences, WITS University, as partial fulfillment for the requirements of the degree of Master of Medicine in Dermatology Johannesburg 2017 / Introduction: Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin condition affecting 5-20% of children under 11 years of age, characterised by intense pruritus, redness and discomfort. Research suggests that AD has been shown in quality of life assessments to be rated among the worst in term of its effect on sleep. There is no research on the effects of sleep loss on the natural history and time course of skin disorders either, especially in South Africa. Aims: The objectives of this study were: 1. to describe the various sleep disturbances associated with AD in children up to and including 12 years of age and 2. to compare the characteristics of children with sleep problems to those without sleep problems in AD Patients and Methods: This was a prospective observational / descriptive hospital based study conducted at the paediatric dermatology outpatient department at Chris Hani Baragwanath Academic Hospital (CHBAH). Questionnaire technique was used consisting of the children’s sleep habits questionnaire (CSHQ), a useful parent-reported instrument validated to identify both behaviourally based and medically based sleep problems in 4-12 years old school age children. Results: The prevalence of sleep problems in paediatric patients with AD was found to be 61.3%. There was no significant difference between males and females. Snoring as well as apnoea and snorting were significantly different in the rhinitis versus non-rhinitis group. The overall sleep disturbance rate was significantly different in those with rhinitis versus those without. Conclusions: While Atopic Dermatitis is often regarded by health professionals as a minor problem, in this study, 61.3% of children with AD have disturbed sleep. / MT2017

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I investigated the effect of inhibiting NO production in the psoriatic plaque. A 70% inhibition of NO was attained but overall there was no clinical benefit in 17 patients whereas with topical steroids benefit was very apparent with only 12 subjects. Immunocytochemical examination of these patients revealed a 50% reduction in endothelial cells, following L-NMMA treatment, supporting an important effect of NO in angiogenesis. ICAM-1 was also suppressed and there was an increase in CD8 positive cells and Langerhans' cells following L-NMMA. Surprisingly there was no inhibition of keratinocyte proliferation with L-NMMA. It is possible that some of the immunosuppressive effects of NO were inhibited, thus promoting some aspects of psoriasis at the same time as inhibiting others. Finally the direct effects of NO on normal skin were examined using acidified nitrite as a topically applied NO donor. In keeping with the observations in psoriasis there was a reduction in Langerhans' cells which lost dendricity and migrated from the epidermis. This suggests that NO may have some role in activating Langerhans's cells and thereby in antigen presentation. NO increased the adhesion molecules ICAM-1 and VCAM-1, attracting increased numbers of macrophages, T cells and neutrophils but had no effect on mast cell numbers. There was a tendency for higher doses of NO to produce lower levels of cellular infiltration, suggesting an immunosuppressive effect of higher doses. Nitrosotyrosine staining was not marked, suggesting only minor formation of peroxynitrite and this led to recoverable cytotoxicity manifesting as cloudy swelling of keratinocytes. There was some increase in wild type p53 in basal keratinocytes. Associated with this was an increase in apoptosis which was modest but manifested in the epidermis and dermis and was greater with the duration of exposure to NO. There was a high background level of cell proliferation and these cells were no more numerous in the NO treated skin than in the normal skin. However, there were significantly more proliferating cells in skin exposed to the higher dose of NO than those exposed to low dose suggesting that NO may promote keratinocyte proliferation at certain concentrations.

Proefschrift Universiteit van Amsterdam. / Met bibliogr., lit. opg. - Met samenvatting in het Nederlands.