Showing papers in "Dermatology in 1997"

Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis.

Abstract: Background: We have previously reported how the SCORAD index was designed. This cumulative index combines objective (extent and intensity of lesions) and subjective (daytime pruritu

Roaccutane treatment guidelines: results of an international survey.

Abstract: Background: Oral isotretinoin (Roaccutane®) revolutionized the treatment of acne when it was introduced in 1982. Methods: Twelve dermatologists from several count

Inactivation of Human Viruses by Povidone-Iodine in Comparison with Other Antiseptics

Abstract: Inactivation of a range of viruses, such as adeno-, mumps, rota-, polio- (types 1 and 3), coxsackie-, rhino-, herpes simplex, rubella, measles, influenza and human immunodeficiency viruses, by povidon

Human herpesvirus 7 in patients with pityriasis rosea : Electron microscopy investigations and polymerase chain reaction in mononuclear cells, plasma and skin

Abstract: Background: Clinical evidence suggests a viral etiology for pityriasis rosea (PR). Objective: To evaluate human herpesvirus (HHV)-6 and HHV-7 as candidates for th

Phototherapy of Acne Vulgaris with Visible Light

Abstract: Background: Sun exposure has a beneficial effect on acne vulgaris, but it is not clear which wavelengths contribute to the favourable effect. Objective: The aim of the study was to investigate the effect of visible light on acne vulgaris and define the most effective wavelengths. Methods: Thirty patients (15 men and 15 women) with mild to moderate acne vulgaris, involving the face and/or the back and/or the chest, were treated with three different light sources. They were treated 3 times a week, for a total of 7 weeks, each field for 20 min per session. Results: All the light sources using ‘full spectrum’, green and violet improved the acne, leading to 14% (p > 0.10), 22% (p Conclusion: Visible light is a moderately effective alternative for treatment of acne vulgaris.

Effects of soap and detergents on skin surface pH, stratum corneum hydration and fat content in infants

Abstract: Background: In adults the influence of cleansing preparations on the pH, fat content and hydration of the skin is well documented. Studies in newborn and small infants have not been

Serum S100 – A Marker for Disease Monitoring in Metastatic Melanoma

Abstract: Background : S100 proteins are low-molecular-weight calcium-binding proteins and appear to play an important role in various cellular processes such as cell division and differentiat

Povidone-iodine in antisepsis--state of the art.

Abstract: The natural element iodine has been used for more than 150 years to prevent infection and treat wounds. Yet only due to the development of iodophors has it become possible to use this highly efficient microbicide in a wide range of medical applications. The antimicrobial spectrum is universal. Its efficiency against clinically and epidemiologically significant new pathogens, such as methicillin-resistant Staphylococcus aureus and Enterococcus sp. has also been validated. No development of resistance has been determined. New data are also available on the excellent local tolerability of Betaisodona (povidone-iodine) preparations. On these grounds, a number of clinical fields exist in prophylaxis and therapy, for either once only or repeated applications: the disinfection of hands and skin, mucosa antisepsis, intra- and postoperative wound treatment, therapy of skin infections, burns and chronic wounds.

Scarred for life

Abstract: Acne vulgaris is a common inflammatory dermatosis capable of producing significant psychological and physical scarring. The following work describes the benefit of using a questionnaire as a clinical

Epidemiology and ecology of onychomycosis.

Abstract: The epidemiology and ecology of onychomycosis are complex and little understood. Most is known about tinea unguium, dermatophytic nail infection, and its causative agents. This is often categorised according to the precise locus on the nail of the infection. The principal infectious propagules are thought to be the arthroconidia or chlamydospores which form within the solid substratum of invaded nail tissue. The process of infecting new hosts appears to be facilitated by abrasion, moistening and scratching. The role of the non-dermatophyte yeast Candida as an agent of onychomycosis per se may have been overestimated. The range of interactions between dermatophytes and non-dermatophytes in nails is complex and poorly understood. There may be at least six distinct ecological categories of non-dermatophyte isolations from nails. It would be of clinical interest to know which species found in mixed infections were never able to advance beyond 'secondary colonisation', as they would not require specific treatment.

Molecular effects of povidone-iodine on relevant microorganisms: an electron-microscopic and biochemical study.

Abstract: The aim of this study was to elucidate the effects of povidone-iodine (PVP-I) on cell ultrastructure by electron microscopy and to monitor changes in enzyme activity and nucleotide efflux. St

Prevalence of Hepatitis C Virus Antibodies and Evaluation of Hepatitis C Virus Genotypes in Patients with Lichen planus

Abstract: Background: Several cases of lichen planus (LP) associated with hepatitis C virus (HCV) infection have been described. The reported prevalence rates of anti-HCV in patients with LP show wide geographical variations. An association of HCV-associated disorders with certain HCV geno/subtypes has not been investigated so far. Objective: The aim of the present study was to define the prevalence rate of anti-HCV in German patients with LP and to determine the distribution of HCV geno/subtypes. Methods: All patients with LP of the present study (n = 84) were tested for anti-HCV antibodies by an enzyme-immunoassay (second generation). HCV RNA was detected by reverse-transcription polymerase chain reaction (RT-PCR) and HCV geno/subtyping was performed by the reverse hybridization assay. Serum samples of 87 patients with various cutaneous diseases excluding LP served as control group. Results: Anti-HCV antibodies were detected in 13/84 patients with LP (16%), and 12/13 anti-HCV-positive patients were viraemic as assessed by the presence of HCV RNA. Most patients were infected with subtype HCV-1b (10/12 patients), while the 2 remaining patients were infected with HCV-2b and HCV-3a, respectively. In the control group, anti-HCV antibodies were only observed in 1/87 patients (1.1%), infected with subtype HCV-1b. Conclusion: The statistically significant (p

Investigation on the Efficacy of Povidone-Iodine against Antiseptic-Resistant Species

Abstract: The bactericidal activity of commonly used antiseptics against clinical isolates was determined. It is noteworthy that povidone-iodine (PVP-I) solution showed high bactericidal activity against all of the test strains after 30 s of exposure. However, in the case of chlorhexidine gluconate (CHG), residual bacteria were observed in most species. Next, acquisition of resistance to antiseptics was examined, and it was found that remarkable increases in MICs were seen for CHG and alkyldiaminoethylglycine hydrochloride. The strains which acquired resistance against one antiseptic showed cross-resistance to all antiseptics except for PVP-I. As for bactericidal activity against biofilm, no viable cells were seen after a 10-min exposure to PVP-I solution. No decrease in viable cell count was seen even after a 60-min exposure to any of the other antiseptics. PVP-I showed high activities in all the tests conducted in this study. Thus, PVP-I was confirmed to be a clinically useful antiseptic.

Cytotoxicity and Sensitization of Povidone-lodine and Other Frequently Used Anti-Infective Agents

Abstract: Povidone-iodine is an antiseptic widely used in dermatology. In vitro experiments showed a certain cytotoxicity, yet it is not easy to transfer these toxicological data to in vivo circumstances. In vivo investigations in animals and in humans could exclude cytotoxic effects of povidone-iodine, measured by the wound healing process. Only when administered in combination with detergents was an obvious cytotoxicity seen in wounds but not on the intact skin. In comparison to the frequently used antibiotic neomycin, the sensitization rate of povidone-iodine is very low.

Dermabrasion of congenital nevocellular nevi: Experience in 215 patients

Abstract: Background : The indication for surgical treatment of congenital nevocellular nevi results from aesthetic-cosmetic consideration as well as from the increased risk of melanomatous tr

Short- and Long-Term Effectiveness of Oral and Bath PUVA Therapy in Urticaria pigmentosa and Systemic Mastocytosis

Abstract: Background: Previous studies have shown that oral PUVA is effective in urticaria pigmentosa. Long-term results, however, are unknown. Objective: We studied the long-term effectiveness of oral PUVA treatment in urticaria pigmentosa as well as in systemic mastocytosis. In addition, the success of bath PUVA was examined in these diseases. Methods: Twenty patients with urticaria pigmentosa and systemic mastocytosis treated by oral PUVA were examined retrospectively for a time period of up to 18 years. We studied the duration of improvement and correlated these results with the total PUVA dose, the skin type and the age of onset. Four patients were treated by bath PUVA therapy. Results: In oral PUVA therapy an improvement was seen in 14 out of 20 patients (70%). There was no difference in the response rate between urticaria pigmentosa and systemic mastocytosis and there was no correlation with the total PUVA dosage. The duration of the treatment’s success ranged from a few weeks to more than 10 years. 25% of the patients showed an improvement for more than 5 years. Patients with onset during childhood and early adolescence and patients with skin types I and II responded favourably to the treatment. Bath PUVA therapy was without effect in our 4 patients. Conclusion: Oral PUVA is very effective for the long-term treatment of urticaria pigmentosa as well as systemic mastocytosis.

Venous insufficiency in male workers with a standing profession. Part 1: Epidemiology

Abstract: Background: Chronic venous insufficiency (CVI) in the occupational population is often poorly recognized. The dimensions of this problem have never been thoroughly investigated in t

Quality-switched Ruby Laser Treatment of Solar Lentigines and Becker's Nevus: A Histopathological and Immunohistochemical Study

Abstract: Objective: A histopathological and immunohistochemical study was initiated to assess changes in benign human pigmented skin lesions after quality switched ruby laser (QSRL) irradiation. Method: A total of 196 solar lentigines on 8 patients’ forearms were irradiated in vivo, 13 biopsies were taken. Hematoxylin-eosin staining and immunohistochemical techniques using anti-S-100 and Fontana-Masson stainings, as well as cryosections stained with nitroblue tetra-zolium chloride (NBTC), were employed for the evaluation of the specimens. Results: Immediately after QSRL impact selective photothermal damage (vacuolization) of all pigmented epidermal and basal melanocytes, keratinocytes, superficial dermal melanocytes and melanophages could be observed in solar lentigines. Cryosections stained with NBTC featured minimal thermal damage of the surrounding tissue. One Becker’s nevus was also exposed to the QSRL, biopsies were taken before and immediately after QSRL exposure. In this lesion, superficially located pigments were selectively damaged, but a fair amount of pigmented cells in adnexal structures persisted throughout this single course of QSRL treatment. Recurrence of lentigines was not observed. In Becker’s nevus, following initial fading of the lesion, clinically reactive hyperpigmentation occurred 4 weeks later. Conclusion: We found that pigmented lesions featuring a moderate amount of pigment exclusively in and around the basal cell layer, like solar (actinic) lentigo, can be successfully removed by a single QSRL exposure selectively damaging epidermal and basal pigmented structures. Further investigations concerning QSRL treatment of dermally pigmented skin lesions have to be initiated.

Suppression of UV-lnduced Erythema by Topical Treatment with Melatonin (N-Acetyl-5-Methoxytryptamine)

Abstract: Background: In a previous study, we reported a significant and dose-dependent suppression of UV-induced erythema in human skin by a topically applied melatonin preparation.

Povidone-iodine to prevent mucositis in patients during antineoplastic radiochemotherapy

Abstract: In an open study, the efficacy of povidone-iodine in the prophylaxis of mucositis during antineoplastic radiochemotherapy was determined. 40 patients were randomly assigned to a treatment or control group (each 20 patients). All patients received standard prophylaxis of mucositis with nystatin, dexpanthenol, rutoside and immunoglobulin. In addition, the patients of the treatment group performed 4 times daily rinsing with povidone-iodine, the control patients with sterile water. Clinical examination of the oral mucosa was performed weekly during the radiation period and up to 6 weeks after the end of therapy. Oral mucositis was observed in 14 patients of the treatment group (mean grading: 1.0) and in all 20 patients of the control group (mean grading: 3.0). The mean onset of mucositis was after 2.25 weeks in treatment patients and 1.5 weeks in control patients. The mean total duration of mucositis was 2.75 weeks in treatment patients and 9.25 weeks in control patients. The mean AUC values were 2.5 in treatment patients and 15.75 in control patients. All findings were statistically significantly different between the two groups. It is concluded that rinsing with povidone-iodine reduces the incidence, severity and duration of oral mucositis during antineoplastic radiochemotherapy.

Nondevelopment of resistance by bacteria during hospital use of povidone-iodine.

Abstract: Since the bacterial ability to develop resistance against various factors of their surroundings is a well-known phenomenon, resistance against iodine and specifically against povidone-iodine (PVP-I) has been widely investigated. Yet there is little known about bacterial resistance in long-term daily use of disinfectants in continuous ambulatory peritoneal dialysis (CAPD) patients. The aim of our study was to investigate whether on daily use of PVP-I over a period of at least 6 months coagulase-negative staphylococci (CNS)--the predominant infective organisms of peritonitis--developed resistance against PVP-I. At the catheter exit site of 40 CAPD patients we isolated 36 CNS. 23 CNS (CNS + PVP) orginate from patients using PVP-I, 13 CNS (CNS + CI) from patients using sodium hypochlorite (NaOCl) as disinfectant. The strains were biotyped, antibiotic resistance patterns were determined and resistance against PVP-I or NaOCl was calculated as reduction factor using the quantitative suspension test combined with a turbidimetric standardization. Resistance against PVP-I 0.01% and against NaOCl 0.005% was determined at two contact times (30 and 300 s) for each patient group. In addition, we investigated the effects of plasmid loss on sensitivity to PVP-I. Out of 5 multiple-antibiotic-resistant CNS, 3 strains showed no difference in reduction factor against PVP-I before and after curing. There was no significant difference in reduction factor against NaOCl. CNS + PVP were even significantly more sensitive to PVP-I than CNS + Cl. Taken together, our results demonstrate that long-term use of PVP-I does not cause any bacterial resistance in CNS of CAPD patients.

Collision of primary malignant neoplasms on the skin : The connection between malignant melanoma and basal cell carcinoma

Abstract: Several studies have reported the association of cutaneous malignant melanomas (MM) with carcinomas. Collision malignancies cases from our files were retrieved. Among a series of 78,000 primary cutaneous cancers, 11 were collision tumors of MM with basal cell carcinoma and 106 were basosquamous carcinomas while no association was found between MM and squamous cell carcinomas. It is concluded that coexisting and confluent malignancies of the skin might not always be a random event.

Tinea capitis in Adults: Misdiagnosis or Reappearance?

Abstract: Background: According to the literature, tinea capitis in adults is supposed to be rare; we have recently observed a significant increase in cases. Methods: Epidemiological, clinical and mycological features were studied in all adult tinea capitis diagnosed over 1 year in our department. Results: Eight cases were observed: 75% of them were women, 50% never traveled and 62.5% had an underlying immunosuppressive disease. Scalp scaling and alopecia were the most frequent clinical features. A zoophilic dermatophyte was recovered in 50% of cases. Conclusion: These cases represent 11% of all tinea capitis observed in the same period of time (higher than the 3–5% observed in the literature). Secretion of sebum and colonization by Pityrosporon orbiculare are supported to protect the scalp against dermatophytic invasion after puberty, but an immune defect may also facilitate hair invasion. The erroneous notion of the disease being uncommon and the frequent atypical clinical presentation require a high degree of clinical suspicion.

Clinical Review of 247 Case Records of Spitz Nevus (Epithelioid Cell and/or Spindle Cell Nevus)

Abstract: Background: Spitz nevus has clinically been described as a dome-shaped usually nonpigmented papular or nodular lesion variable in color from pink to red. Objectives: To give an exhaustive description of the clinical features of the Spitz nevus from a large series of 247 patients. Methods: A retrospective analysis of the clinical features of 247 Spitz nevi excised from 1974 to 1993 has been performed. We evaluated the following features: age, sex, anatomical location, clinical and histopathologic features; descriptive statistics were calculated and relationships among the above variables were assessed. Results: Most lesions were pigmented (71.7%), located on the lower extremities (43.3%), more frequent in the first decade (55.8%) and in females (57.9%). The nonpigmented type was more frequent in the head or neck region, whereas the pigmented types were more frequent on the lower extremities. Besides, these types showed different histopathologic features: the spindle cells usually predominated in the flat pigmented type, whereas dome-shaped types were usually composed of both spindle and epithelioid cells. Conclusions: In our patients, the pigmented Spitz nevi were more common than the nonpigmented ones; furthermore pigmented and nonpigmented Spitz nevi showed different anatomical locations and different histopathologic features.

Povidone-Iodine Liposomes – An Overview

Abstract: In recent years, liposomes have been increasingly explored as novel drug delivery systems, and several liposome-based drug products have been approved in Europe, the USA and Japan. Depending on size, composition and surface characteristics, liposomes interact sepcifically with biological structures. Liposomal drug products provide a topical activity at the desired locus of action and are deemed more effective and less toxic than conventional drug formulations. The combination of povidone-iodine (PVP-I) and liposomes unites the exceptional microbicidal activity of the antiseptic substance with the excellent tolerability and lack of immunogenicity of liposomes; in addition, liposomes provide a moist molecular film for the wound environment. The multilamellar vesicles act as microreservoirs hence prolonging the release of the active ingredient. Although no commercial product for repeated application on the eye is currently available, PVP-I has been used in ophthalmology not only for pre- and postoperative antisepsis, but also for the treatment of bacterial and viral conjunctivitis and for prophylaxis against ophthalmia neonatorum. For these indications, liposomal formulations with 2.5 and 5.0% PVP-I were developed. These eye drops are isotonic with tear fluid at pH 6. First in vitro tests demonstrated an excellent antimicrobial efficacy, and a placebo-controlled clinical study on volunteers showed a very good local tolerability. A study on rabbits demonstrated positive results of the PVP-I liposome eye drops compared to placebo and the broad-spectrum antibiotic Polyspectran in a standardized model of Staphylococcus aureus deep eye infection. The other aim is a well-tolerated liposomal PVP-I hydrogel for improved antiseptic wound treatment with moisturizer. It has been reported that liposomes are enriched at the wound bottom for direct action against infection and support of wound healing. An animal study on the efficacy and tolerability of different formulations of a hydrogel with PVP-I liposomes in deep dermal burn wounds has indicated an outstanding quality of wound healing with smooth granulation tissue, less inflammation, less wound contraction and no hyperkeratotic reactivity, especially with the 3% PVP-I liposome formulation.

Demodicidosis in immunocompetent young children : Report of eight cases

Abstract: Demodex folliculorum and Demodex brevis are obligate parasites of the human pilosebaceous unit. They are the most common permanent ectoparasites in adults, but their incidence on children's skin is rare. Only few cases of demodicidosis have been reported in children aged below 5 years and most of them were suffering from leukemia or HIV infection. The aim of this study is to describe demodicidosis in young immunocompetent children. The clinical details of 8 healthy children are given. There were 4 males and 4 females aged between 10 months and 5 years referred to us for evaluation of a facial eruption characterized by erythema, papulopustules and variable edema. In 7 of these patients, skin scrapings were performed and in 1 a 4-mm punch biopsy. Numerous D. folliculorum were found in skin scrapings of 7 cases and at a histologic examination of skin biopsy in 1 case. We employed topical metronidazole gel 1% in all patients and we obtained a 100% recovery without relapses after a 1- to 3-year follow-up. In 2 of our cases Demodex infestation had a mild form resembling pityriasis folliculorum and the other cases presented a rosacea-like form. The reason why these young immunocompetent children developed demodicidosis is still under evaluation and investigation.

Lamotrigine-induced Stevens-Johnson syndrome: demonstration of specific lymphocyte reactivity in vitro.

Abstract: The novel antiepileptic drug lamotrigine (LTG) is effective as an adjunctive medication in partial seizures. The main adverse effects of LTG are skin eruptions, occurring in 3–10% of the treated patie

Cancer proneness of linear porokeratosis may be explained by allelic loss

Abstract: Background: It is well known that porokeratosis, a genetically heterogeneous disorder characterized by the histopathological feature of the cornoid lamella, shows an increased proneness to develop carcinoma. On the other hand, a significant mechanism in the origin of many forms of cancer is loss of heterozygosity or allelic loss. Objective: Because it has recently been proposed that linear porokeratosis may result from allelic loss, one might expect that linear porokeratosis is especially prone to malignant degeneration. In order to test this hypothesis, a review of case reports was performed. Method: Cases of cancer-associated porokeratosis were collected from the European language literature and assigned to one of 5 different types [plaque type of Mibelli (PM); disseminated actinic superficial porokeratosis (DSAP); porokeratosis palmaris, plantaris et disseminata (PPPD); porokeratosis punctata palmaris et plantaris (PPPP); linear porokeratosis (LP)]. Results: Malignant or premalignant lesions were reported in 9 cases of PM, 15 cases of DSAP, 3 cases of PPPD, 1 case of PPPP and 21 cases of LP Conclusion: This analysis supports the view that among the various forms of porokeratosis, the linear type is particularly susceptible to malignant degeneration. Arguments are presented in favor of the assumption that the genetic mechanism of allelic loss giving rise to LP may represent an initial step in the development of cancer.

Sequential combined therapy with thalidomide and narrow-band (TL01) UVB in the treatment of prurigo nodularis.

Abstract: Background: Prurigo nodularis (PN) is a chronic disease of which treatment choices are limited. Among them, thaiidomide and phototherapy have been used with satisfactory results. Un