Showing papers in "European Journal of Dermatology in 1993"

Calcipotriol in combination with PUVA: a randomized double blind placebo study in severe psoriasis

Abstract: L'action de la Vitamine D3 d'abord demontree sur le metabolisme phospho-calcique s'etend en fait a beaucoup de tissus grâce a des recepteurs nucleaires presents egalement sur les keratinocytes. La mise au point d'un analogue de la vitamine D3 (Calcipotriol - Dovonex ® permet de traiter tres efficacement par voie topique les lesions de psoriasis sans retentissement sur le metabolisme phosphocalcique. Un protocole therapeutique combinant ce traitement topique a la puvatherapie a ete evalue dans une etude multicentrique randomisee sur 103 psoriasis. L'utilisation prealable de Calcipotriol a permis d'obtenir une amelioration importante ou totale dans plus de 75% des patients et de ramener la duree de la puvatherapie de 34 a 22 jours en reduisant considerablement les doses d'UVA recues

Treatment of severe, chronic urticaria with cyclosporin A

Abstract: Twelve patients with severe, chronic urticaria who had responded poorly to systemic therapy including antihistamines and steroids have been treated with low dose cyclosporin (2.5-3.5 mg/k/day) for 4 weeks. In 9 patients urticaria resolved or improved during treatment and 7 of those reported a beneficial effect which was sustained for a month or more after stopping therapy. Three patients experienced no improvement. Eleven patients were able to discontinue their antihistamines during the course of treatment with cyclosporin. No persistent side effects of cyclosporin were detected in any patient. The results of this preliminary study suggest that low dose cyclosporin results in improvement of severe, chronic urticaria in some patients

Comparison of classification rates for conventional and dermatoscopic images of malignant and benign melanocytic lesions using computerized colour image analysis

Abstract: In the last decade surface microscopy was described by several authors as a highly valid method for the improvement of preoperative diagnosis of melanocytic lesions. Since previously also digital image analysis of conventional slides was found to be a powerful tool for accurate diagnosis of initial malignant melanoma, we investigated in this study, using objective and reliable image analysis criteria, whether conventional or dermatoscopic images are more appropriate for diagnostic evaluation of melanocytic lesions. Features describing the texture, colour and their distributions as well as asymmetry, size and border of the lesions were computed for 320 melanocytic lesions (126 benign melanocytic nevi (MN) and 194 malignat melanoma (MM)) simultaneously documented with both the conventional photographic technique and under the conditions of dermatoscopy (surface miscroscopy with 10x magnification)

Topical 1α, 24(R)-dihydroxyvitamin D3 for the treatment of psoriasis. Review of the literature

Abstract: The use of 1α, 24 (R)-dihydroxyvitamin D3 (1α, 24R (OH) 2 D 3 ), a structural analogue of naturally occurring, active vitamin D 3 (1α, 25 (OH) D 3 ), in the treatment of psoriasis is reviewed based on the results of basic biological investigations and clinical studies which were previously described in the literature. Compared with topical corticosteroids, topical 1α, 24R (OH) 2 D 3 has been proven to be equally effective. Direct comparative studies on the antipsoriatic effect of 1α, 24R (OH) 2 D 3 with those of 1α, 25 (OH) 2 D 3 and calcipotriol (MC 903), another analogue, have not been done yet. The hypercalcemic activity of 1α, 24R (OH) 2 D 3 is weaker than that of 1α, 25 (OH) 2 D 3 . 1α, 24R (OH) 2 D 3 is applicable to the lesions on the face, where irritant dermatitis may occur by the application of MC 903

Linear IgA disease and chronic bullous disease of childhood

Abstract: Chronic bullous disease of childhood and adult linear IgA disease, although rare have existed for many years but have only been recognised in the past 20 years. They have been described in most parts of the world and are probably part of the same disease differing only in the age of onset. The course of the disease is variable with between 30 and 65% of patients going into remission, with a mean disease duration of 3-4 years. Mucosal involvement is found in the majority of cases and may lead to scarring and even blindness. There is an increased incidence of lymphoproliferative diseases in patients with this condition. Treatment with dapsone, or sulphamethoxypyridazine are most commonly used and most effective, but a variety of other treatments have been used in difficult cases

Relapse rate of severe generalized psoriasis after treatment with acitretin or etretinate. Results of the first randomized double-blind multicenter half-year follow-up study

Abstract: Acitretin (A) was compared to etretinate (E) in severe generalized psoriasis of plaque-like type in a randomized double-blind multicentric study over twelve weeks. The results showed that after 50 mg/d monotherapy both groups had a 60.4% and 60.0% improvement, respectively. PSI-score (x) decreased from 30.0 (A) and 28.5 (E) at baseline to 9 and 11.5 points, respectively. The clinical efficacy was comparable at all time points and at the end of the drug treatment phase. Thirty-two patients after A and 30 after E terminated the drug phase of the study with very good to excellent results and gave their consent to enter the double-blind randomized follow-up part of the study

Dermatitis herpetiformis: a genetic disease

Abstract: Familial incidence of dermatitis herpetiformis (DH) can be as high as 6% in Northern Europe and in Utah in the USA. Reports of monozygotic twins with DH and the 90%-100% association of DH with HLA DQw2 leave no doubt that genetic factors are important in the pathogenesis. First-degree relatives of patients with DH may also frequently contract coeliac disease (CD) as well as DH. A gluten-sensitive enteropathy is a common link between DH and CD and evidence from family and HLA studies confirms the shared genetic basis for the enteropathy. The critical molecule most likely to be involved in the immune response leadind to the mucosal damage is a specific HLA class II heterodimer encoded by DQ A1*0501 and B1*0201 alleles in the short arm of chromosome 6

Dendritic cells in the skin after allogeneic bone marrow transplantation: immunohistochemical and electron microscopic monitoring

Abstract: The possible role of skin dendritic cells (DCs) in acute graft-versus-host disease (aGVHD) is still obscure. As a contribution to clarify this issue, we have investigated the sensitivity of different DC subsets to the conditioning regimen to bone marrow transplantation (BMT) and the kinetics of DCs in the skin during aGVHD. The skin of 29 patients undergoing allogeneic bone marrow transplantation (BMT), including 7 patients who developed aGVHD, has been analyzed by a sequential immunohistochemical and electron microscopic (EM) study. CD1a + /HLA-DR + DCs were virtually eliminated from the skin by the conditioning treatment to BMT

Hereditary insights in psoriasis

Abstract: This paper provides a review of current insight into the genetic aspects of psoriasis. Psoriasis shows a high degree of familial aggregation and diverse patterns of inheritance in families. The mode of inheritance is evidently complex, involving either a polygenic pattern of hereditary susceptibility or genetic heterogeneity. Although no genetically-linked marker for psoriasis is known, psoriasis-associated alleles at the HLA and complement loci have been defined, with the strongest being the HLA-Cw6 allele. Evidence for the homogeneity of type I psoriasis is discussed, with reference to genotypic and phenotypic variation among psoriatics

Adhesion molecule modulation in Sweet's syndrome compared to erythema multiforme

Abstract: Cell-cell and cell-matrix interactions play a crucial role for the enrichment of inflammatory cells at sites of inflammation and may influence the composition of the inflammatory infiltrate found in a specific disease. We investigated 8 cases of Sweet's syndrome (SS) compared to 8 cases of erythema multiforme for their specific adhesion molecule expression pattern by immunohistochemical methods using monoclonal antibodies against integrins, members of the immunoglobulin superfamily and selectins. Both diseases exhibit a characteristic cellular infiltrate and the question of this study was how this is correlated with a corresponding modulation of adhesion molecules. Upregulation of ICAM-1, VCAM-1 and E-selectin on endothelial cells was present for both diseases

Werner's syndrome: a review of the clinical and pathological features and pathogenesis

Abstract: Werner's syndrome is a rare autosomal recessive condition which was first described in 1904. Although the diagnostic criteria have been refined since then it is thought to be underdiagnosed in Western societies. In this review we describe the clinical, pathological and biochemical features of the condition and review the current knowledge of the cause, an understanding of which should provide an insight into the normal ageing process itself

Measurement of collagen metabolism in skin diseases. A review of old and new techniques and their clinical applications

Abstract: Collagen composes about 70-80% of the dry weight of the dermis and is a major fibrillar component of the skin. Collagens are a family of closely related but genetically distinct proteins. In normal human dermis type I and type III-collagens are the predominant forms, type I collagen comprising about 80% of the total collagen and type III collagen about 15%. There are also other collagens such as type IV collagen in the basement membranes of skin and type VII collagen in anchoring fibrils. The quality and quantity of collagen in skin can change in various diseases. For example, the amount of collagen is increased in scleroderma and keloids. Alterations in collagen synthesis can occur during ageing, and after treatment with topical glucocorticoids

Pathophysiology of itch

Abstract: Itch and pain are regarded as separate sensory modalities. Itch receptors are mainly found near the dermal-epidermal junction. The nerve fibers involved in the conduction of itch are C-fibers. Such fibers are thought to contain substance P and calcitonin generelated peptide. Synergism between various tissue-derived mediators may explain why agents which appear to be weak pruritogens experimentally may be important in clinical pruritus

Long term remission successfully achieved in severe types of pemphigus vulgaris and bullous pemphigoid by the use of plasmapheresis

Abstract: Twenty cases of pemphigus vulgaris (PV) and bullous pemphigoid (BP) were treated with plasmapheresis therapy which was administered to each patient by one of three techniques: centrifugation, double filgration plasmapheresis (DFPP) or a combination of the two aforementioned techniques. Each plasmapheresis resulted in a rapid reduction in the autoantibody titer, an improvement in clinical symptoms, allowing a lower dose of steroid to be administered, and achieved long-term remission. These findings suggest that plasmapheresis is a suitable adjunctive therapy in the treatment of severe types of PV and BP. Out of the three plasmapheresis techniques examined, DFPP was found to be the most preferred method by which to conduct plasmapheresis, as it was not necessary to supply plasma components

Treatment of urticaria pigmentosa by corticosteroids applied under a hydrocolloid dressing

Abstract: A woman with extensive urticaria pigmentosa was treated by a variety of means over a twenty year period. Antihistamines were of no value and PUVA produced only a temporary reduction in pruritus. Clobetasol propionate 0.05% applied under polythene occlusion led to considerable lightening in the treated area but a much better result was achieved when this potent steroid was applied once weekly under a hydrocolloid dressing (Granuflex) for a total of six weeks. There was longlasting symptomatic and cosmetic improvement in the treated area. This patient subsequently developed a melanocytic junctional naevus on her left shin which showed severe dysplasia. This is unlikely to be related to her short course of PUVA therapy but there is concern about the long term risks of PUVA and it may be preferable to use potent topical steroids under occlusion as the treatment of choice for these patients

Congenital junctional nevi following Blaschko's lines

Abstract: A congenital pigmentary nevoid disorder following Blaschko's lines in a 5-year-old boy is reported. The lesion is characterized by extended agminated pigmented nevi in a bandlike distribution following the whole length of the left forearm. Histologic findings from a biopsy specimen were consistent with a Benign junctional nevus. Various nevoid skin disorders have been associated with Blaschko's lines, but the occurrence of multiple congenital junctional nevi in this arrangement appears to be very unusual. To our knowledge only one similar case with agminated melanocytic nevi following Blaschko's lines has been described in the literature so far

Eosinophil cationic protein in bullous pemphigoid, dermatitis herpetiformis and other blistering disorders

Abstract: To investigate the importance of eosinophil products in the pathogenesis of blister formation in immunobullous and other disorders, the concentration of eosinophil cationic protein (ECP) in serum and blister fluid from 85 patients was measured using radioimmunoassay. A wide range of values was demonstrated in both fluids in all diseases investigated. Median ECP concentration in serum was 75 μg/l in bullous pemphigoid (BP) compared with 23 μg/l in dermatitis herpetiformis (DH) and 36 μg/l in a group of non-immunobullous disorders (normal range up to 55 μg/l). ECP concentrations in blister fluid were 10-100 fold higher than in serum in most disorders but there was no significant correlation between blister and serum values in 51 patients with paired samples available

Malignant proliferating trichilemmal tumor: report of a case arising in the setting of proliferating trichilemmal tumor

Abstract: Malignant degeneration of proliferating trichilemmal cysts is an extremely rare event. The actual incidence of malignant transformation is unknown due to inconsistencies in classification of trichilemmal cysts and the potential for the misclassification of proliferating trichilemmal tumor and malignant proliferating tumor as squamous cell carcinoma. We report a malignant proliferating trichilemmal tumor from the scalp of a 76-year-old man, arising in the setting of a proliferating trichilemmal tumor, and associated with multiple, high-grade local recurrences, focal sebaceous differentiation, and regional lymph node metastases

Classification of eczemas: an approach using pathogenetic criteria

Abstract: Based on pathogenetic categories, a consistent classification of eczemas is proposed. In order to avoid perpetual confusion, the terms endogenous and exogenous should no longer be used for classification. The need for some neologisms is explained together with the meaning of these new terms. Two main groups are topical eczemas and hematogenous eczemas. Each group comprises three types, resulting in a total of six different type of eczemas. Each group comprises three types, resulting in a total of six different types of eczema. The three topical eczemas are irritant contact eczema, allergic contact eczema, and biotopical eczema that is caused by topical action of living organisms such as bacteria, yeasts, or fungi

Recent advances in electron microscopic immunocytochemistry in dermatology

Abstract: Over 30 years ago immunoelectron microscopy (immuno EM) introduced a method of tremendous power and potential into dermatological research, combining the resolution of electron microscopy with the specificity and sensitivity of immunocytochemistry. Immuno EM has become an indispensable technique in dermatology. For example, although one can raise monoclonal antibodies to any component of the skin, immuno EM is the only means of identifying the precise location of the target epitope. Thus, immuno EM is a necessary methodology for elucidating the ultrastructural localization of various molecules in the skin

Acquired pseudomonilethrix in a family with monilethrix

Abstract: The observation of hairs with images of pseudomonilethrix in a woman and her son provided us the opportunity to revise the initial description and the controversy about this hair dysplasia. The posterior study of a third member of this family with monilethrix allowed us to ascertain that in some cases of hair dysplasias, as monilethrix there exists a «hereditary hair weakness» and that certain types of hair, usually fine and light hair, can also exhibit artifactual thickenings or flattenings in its shafts, depending on the side from which it is observed, as a consequence of compressions or other traumas including cosmetic procedures carried out on the hair. A classification of pseudomonilethrix is proposed

Amyopathic dermatomyositis (dermatomyositi sine myositis) in a male patient and possible induction by UV light

Abstract: Amyopathic dermatomyositis is an inflammatory skin disorder characterized by cutaneous features of dermatomyositis but without any clinical or laboratory evidence of muscle involvement. Although the condition may precede the appearence of myositis by several months or a few years, a small percentage of the patients may not develop any evidence of muscle involvement even after several years of follow-up, thus representing true cases of amyopathic dermatomyositis. Diagnosis depends on the presence of skin lesions characteristic of dermatomyositis, such as periorbital edema, erythematous macular and papular lesions confined to bony prominences, generalized pruritus with photosensitivity and a cutaneous histopathologic picture compatible with skin lesions of dermatomyositis

Silica-induced cytokine release in human monocyte cultures and its possible involvement in the pathophysiology of silica-associated scleroderma

Abstract: Long-term exposure to silica (SiO 2 ) may induce silicosis, but also extrapulmonary diseases such such as scleroderma. Since activated macrophages are involved in the early inflammatory 1 stage of scleroderma, we analyzed the cytokine release which might modulate fibroblast metabolism, B-cell activation and endothelial cell function. We investigated the basal secretion of interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor α (TNF α ) by human monocytes in patients with scleroderma (n=8) and healthy volunteers (n=10) and the effect of silica on monocytes in cell cultures from healthy subjects, using quartz dust (SiO 2 -charge DQ-12) with a particle size of ≤ 5 μm in 9 different concentrations up to ≤ 500 μg DQ-12 ml medium