Kutane Manifestationen der essentiellen Thrombozythämie Erythromelalgie,ischämische Akrozyanose,Livedo racemosa*

Zusammenfassung Anhand einer Fallbeschreibung werden Hautmanifestationen der essentiellen Thrombozyth?mie (ET) vorgestellt, die aufgrund ihrer mikrozirkulatorischen Genese von dermato-angiologischem Interesse sind. DieKenntnis der charakteristischen Hautver?nderungen erm?glicht eine frühzeitige Diagnosestellung dieser myeloproliferativen Erkrankung. Eine rechtzeitige Behandlung kann drohende h?morrhagische und thrombotische Komplikationen verhüten. Wegen ihres kausalen Bezuges zur ET wird die Erythromelalgie hervorgehoben, deren schmerzhafte Symptome durch Acetylsalicyls?ure (ASS) typischerweise prompt gebessert werden. Eingegangen am 9. Mai 1994 Angenommen am 24. August 1994     

Livedo racemosa mit Ulzerationen Zyklische Therapie mit Iloprost (Ilomedin®)-Infusionen

A 43 year old woman suffered from an intermittent painful livedo racemosa at the back since her childhood. Her clinical course was complicated by ulcerations. In careful clinical investigations no signs of an underlying disease could be found, in particular a Sneddon syndrome could be excluded. By means of both conservative and surgical treatments, initial healing of the ulcerations was achieved but relapses occurred. Cyclic infusions of iloprost achieved long-term clearing of the ulcerations and disappearance of the pain. To the best of our knowledge the effectiveness of this treatment has not been described for this disease in the literature.     

Is macular lymphocytic arteritis limited to the skin? Long-term follow-up of seven patients

BackgroundMacular lymphocytic arteritis most commonly presents as hyperpigmented macules on the lower limbs. The pathogenesis of this disease is still unclear and there is an ongoing debate regarding whether it represents a new form of cutaneous vasculitis or an indolent form of cutaneous polyarteritis nodosa.ObjectiveTo describe clinical, histopathological, and laboratory findings of patients with the diagnosis of macular lymphocytic arteritis.MethodsA retrospective search was conducted by reviewing cases followed at the Vasculitis Clinic of the Dermatology Department, School of Medicine, University of São Paulo, between 2005 and 2017. Seven patients were included.ResultsAll cases were female, aged 9–46 years, and had hyperpigmented macules mainly on the legs. Three patients reported symptoms. Skin biopsies evidencing a predominantly lymphocytic infiltrate affecting arterioles at the dermal subcutaneous junction were found, as well as a typical luminal fibrin ring. None of the patients developed necrotic ulcers, neurological damage, or systemic manifestations. The follow-up ranged from 18 to 151 months, with a mean duration of 79 months.Study limitationsThis study is subject to a number of limitations: small sample of patients, besides having a retrospective and uncontrolled study design.ConclusionsTo the best of the authors’ knowledge, this series presents the longest duration of follow-up reported to date. During this period, none of the patients showed resolution of the lesions despite treatment, nor did any progress to systemic vasculitis. Similarities between clinical and skin biopsy findings support the hypothesis that macular lymphocytic arteritis is a benign, incomplete, and less aggressive form of cutaneous polyarteritis nodosa.     

Alcohol and skin disorders*

Background Little is known about skin changes associated with or caused by alcohol intake. Patients and methods In this open study, 65 patients affected with rosacea, rubeosis faciei, pruritus, eczema, non-healing ulcers and psoriasis were examined for signs of high alcohol intake. Thirty-two had elevated aspartate aminotransferase (ASAT) and/or gamma glutamyl transferase (GGT) levels. These patients were interviewed about their drinking habits. As ASAT and/or GGT had been found elevated, it was suggested that they abstain from alcohol. Of the 32 patients with a confirmed regular alcohol intake eight dropped out. The remaining 24 accepted the suggestion and came back for monthly clinical and laboratory controls. Their laboratory values normalized in 2-3 months parallel with healing or improvement of skin symptoms. The 32 patients with dermatoses associated with high alcohol intake were found in a series of 900 consecutive new patients, i.e., over 3%. Conclusions Dermatological patients with increase of ASAT and/or GGT of unknown origin should be suspected to have a high alcohol intake. These patients should be persuaded to try total abstinence for at least 2 months before initiating any dermatological treatment.     

Kontaktekzeme bei Hausfrauen Update nach 1986 unter Berücksichtigung der Epikutantestergebnisse von 2633 Patienten*

Zusammenfassung Die Entwicklung von Handekzemen bei Hausfrauen ist eine relativ h?ufig beobachtete Dermatose. Nach einer ersten Zusammenstellung fakultativer Kontaktquellen in den einzelnen Arbeitsbereichen der Hausfrau von 1986 wird nun ein aktuelles Update vorgestellt, in dem die verschiedenen Noxenquellen einer Hausfrau analysiert und im Vergleich zu den Daten von 1986 bewertet werden. Insbesondere stützt sich diese Arbeit auf die Auswertung der Epikutantestergebnisse eines gro?en Kollektives von 2633 Patienten mit dem Beruf „Hausfrau” und der Diagnose „Handekzem”, welche in den angeschlossenen Kliniken des Informationsverbundes Dermatologischer Kliniken (IVDK) von 1990 bis 1994 gewonnen wurden. Eingegangen am 6. Juni 1997 Angenommen am 29. Oktober 1997     

Low N-acetylating capacity in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis*

Abstract Low constitutive N-acetylating capacity has been implicated as a predisposing factor for the development of adverse reactions to certain drugs. This prompted us to investigate whether the N-acetylating capacity of patients with serious cutaneous adverse reactions, i.e., Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) differed from that of healthy control subjects. N-acctylating activity was measured in hair root cells by preparing a homogenate from freshly extracted hair roots and assessing acetyl-CoA-dependent N-acetylation by RP-HPLC using 2-aminofluorene as a substrate. Samples were obtained from hospitalized patients suffering from acute SJS and TEN or from healthy controls. All patients with SJS and TEN were found to have a low N-acetylating capacity (0.85 nmol/mg/min compared to 2.21 nmol/mg/min in controls, p<0.05). Based on these findings, a low constitutive N-acetylating capacity may be one of the predisposing factors for the development of serious cutaneous adverse reactions to drugs that require N-acetylation in these patients.     

Contact dermatitis caused by cetrimide in antiseptics *

Cetrimide and chlorhexidine are widely used antiseptics. Irritant contact dermatitis from cetrimide has been reported, but only rarely and without pathologic study. We report the clinical and pathologic findings from a series of 18 cases of contact dermatitis caused by antiseptic solutions containing 3% cetrimide and 0.3% chlorhexidine. The patients consisted of 10 males and 8 females, aged from 2 to 62 years. Most patients developed pruritic, burning or painful rashes over the flexors and genitalia after 1 to 4 weeks of daily use of undiluted antiseptics for an underlying pruritic dermatosis. The lesions varied from slight scaling with minimal erythema to fiery or dusky red patches with a glazed surface. The rashes resolved in 2 to 4 weeks after discontinuing the antiseptics. Concentric annular lesions were noted in some patients. Patch testing revealed negative reaction to chlorhexidine 0.5% aq. but irritant reaction to cetrimide 0.5. 1 or 2% aq. and Savlon at 1:3 or 1:6 dilution Light microscopy showed compact orthokeratosis and confluent parakeratosis without spongiosis. Our study suggests that the dermatitis was an irritant reaction to cetrimide after improper self-application of the antiseptic liquids for underlying pruritic rashes or personal hygiene. Recognition of the characteristic xerosis- or chemical-burn-like features primarily involving the flexors or genital area is essential to the diagnosis.     

Biomechanische Stimulationstherapie (BMS) zur physikalischen Behandlung des arthrogenen Stauungssyndroms*

Zusammenfassung Vorgestellt wird anhand einer Kasuistik ein neuartiges physikalisches Therapieverfahren, das bei Patienten mit arthrogenem Stauungssyndrom infolge einer chronischen Venenerkrankung zum Einsatz kommen kann. Die biomechanische Stimulationstherapie (BMS) stellt dabei eine technische Erweiterung physiotherapeutischer M?glichkeiten durch den Einsatz kontrollierter mechanischer Schwingungen dar und führt zu raschen und klinisch günstigen Therapieerfolgen. Vom BMS-Ger?t werden im Rahmen der Behandlung definierte longitudinale Schwingungen im Frequenzbereich zwischen 18 und 36 Hz auf Fu? und Unterschenkel übertragen und damit eine Relaxation der beteiligten Muskulatur sowie eine verbesserte Dehnbarkeit des Kapselbandapparates erm?glicht. Bei der vorgestellten 76j?hrigen Patientin mit langj?hrig vorbestehenden Bewegungseinschr?nkungen im oberen Sprunggelenk, Ulcera cruris venosa bei postthrombotischem Syndrom, konnte der Bewegungsumfang im Sprunggelenk durch eine 10t?gige Behandlungsphase mit der biomechanischen Stimulationstherapie (BMS) im Sprunggelenk um je 16 Grad bzw. 19 Grad an beiden Beinen verbessert und der Erfolg dermatochirurgischer Ma?nahmen bei der Ulcussanierung gesichert werden. Das BMS-Verfahren stammt aus der ehemaligen Sowjetunion. Hier wurde es im Leistungssportbereich zur Muskelrelaxation und Dehnung eingesetzt. Beim arthrogenen Stauungssyndrom wurde es von uns erstmals klinisch erfolgreich zum Einsatz gebracht. Aufgrund vorliegender Ergebnisse bei bislang 6 Patienten mit arthrogenem Stauungssyndrom bewerten wir das BMS-Verfahren als wichtige neuartige physikalische Therapieform des arthrogenen Stauungssyndroms. Eingegangen am 20. August 1996 Angenommen am 2. Oktober 1996     

Exudative discoid and lichenoid chronic dermatosis (Sulzberger-Garbe): presentation with a puzzling penile plaque*

Objective Report of two cases of exudative discoid and lichenoid dermatosis (Sulzberger-Garbe), with typical penile lesions. Differential diagnosis of persistent penile plaques. Background Following remission of the generalized eruption of exudative discoid and lichenoid dermatosis (Sulzberger-Garbe), it is not unusual to see a single remaining lesion localized on the penis. Since Sulzberger et al. (Sulzberger MB, Witten VH, Hunt JA. Puzzling persistent penile plaques. Arch Dermatol 1956:73:101-109) reviewed dermatoses presenting with puzzling persistent penile plaques in 1955, further dermatoses have evolved as important differential diagnoses. Much controversy has arisen as to the justification of exudative discoid and lichenoid dermatosis (Sulzberger-Garbe) as a disease entity. Conclusions Diagnosis of most cases of persistent plaques of dermatitis on the penis is possible with a careful examination of the entire skin, and a thorough history to discover past lesions. The possibility of malignancy makes a biopsy mandatory. Exudative discoid and lichenoid chronic dermatosis (Sulzberger-Garbe) typically responds well to systemic steroids. Intrale-sional triamcinolone acetonide has been demonstrated to be effective in the treatment of a persistent penile plaque in exudative discoid and lichenoid dermatosis (Sulzberger-Garbe), and may be helpful in discontinuing or reducing systemic therapy to a level compatible with long-term treatment.     

Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis*

Please cite this paper as: Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis. Experimental Dermatology 2010; 19: 533–537. Abstract: Hidradenitis suppurativa (acne inversa) is a chronic suppurative and scarring inflammatory disease with predilection in the apocrine gland‐bearing areas. Histological investigations in the 1990s showed keratotic occlusion of the terminal follicle structure to be the initial cause. Our investigations describe and reproduce the morphology and try to figure out very early lesions of HS. A total of 262 operative specimens from 60 patients were investigated by routine histology and 11 operative specimens by immunohistochemistry: HS is dominated by a heterogeneous histological image. 82% of the surgical specimens showed mild or pronounced follicular hyperkeratosis, whereas an isotopic hyperplasia of follicular epithelium was evident in 77%. Pronounced perifolliculitis was seen in 68% and rupture of the follicle structure in 28%. Features which had not so far been described in detail were: epidermal psoriasiform hyperplasia (43%) and subepidermal interfollicular inflammatory infiltrate (78%). In all 11 specimens, immunohistochemical investigations showed a perifollicular and subepidermal inflammation of CD‐3‐, CD‐4‐, CD‐68‐, CD‐79‐ and CD‐8‐cells, the latter with a striking selective epitheliotropism. To conclude, we could show follicular hyperkeratosis and lymphocytic perifollicular inflammation as early patterns in pathogenesis, whereas rupture of the follicle structure takes place later. Finally, it seems that there are two hot spots of inflammatory events (perifollicular and subepidermal) composed of a comparable inflammatory cell mixture. The CD‐8 cell epitheliotropism (follicular and epidermal) described here and its influence in follicular hyperkeratosis, in hyperplasia of follicular epithelium and in epidermal psoriasiform hyperplasia will be of further interest, for instance, concerning early pharmacological intervention.     

重型颅脑损伤后早期血清IL-17、IL-23、乳酸水平变化及对继发性大面积脑梗死的预测价值

目的 探讨重型颅脑损伤后早期血清白细胞介素-17(IL-17)、白细胞介素-23(IL-23)、乳酸(Lac)水平变化及对继发性大面积脑梗死的预测价值.方法 选取2017年9月—2020年9月新华医院崇明分院收治的158例重型颅脑损伤患者为研究组,另选同期来院体检的146例健康体检者,为对照组.比较两组血清IL-17、...     

香菊流浸膏对水痘─带状疱疹病毒抑制作用的实验研究

采用细胞培养技术，通过五种不同的给药途径，观察香菊流浸膏对分离的水痘－带状疱疹病毒的实验室抑制作用。结果证实香菊流浸膏对水痘－带状疱疹病毒复制的每一环节均有不同程度的抑制作用。     

NADPH oxidase inhibition rescues keratinocytes from elevated oxidative stress in a 2D atopic dermatitis and psoriasis model

Emerging evidence suggests oxidative stress plays a role in the pathophysiology of both atopic dermatitis (AD) and psoriasis (PSO). We established in vitro models of AD and PSO skin, and characterized these models in regard to their oxidative stress state. Both AD and PSO model keratinocytes exhibited elevated reactive oxygen species (ROS) levels and accumulated more DNA damage than control cells after oxidative stress induced by 250 µmol/L H₂O₂. Elevated ROS levels and DNA damage accumulation could be inhibited by the NADPH oxidase (NOX) inhibitor diphenyleneiodonium (DPI). Further, immunofluorescence analysis revealed the presence of both NOX1 and NOX4 in keratinocytes. By inhibiting NOX1, stress-related signalling cascades and elevated ROS levels could be abrogated, and survival of AD and PSO cells improved. Taken together, this study reveals that inhibition of NOX inhibition could abrogate elevated oxidative stress in a 2D model of AD and PSO.     

延胡索酸酯治疗银屑病研究进展

延胡索酸酯治疗中重度银屑病患者,安全有效。延胡索酸酯通过影响T细胞、树突状细胞、中性粒细胞、角质形成细胞和内皮细胞等参与机体的免疫过程。本文综述了延胡索酸酯治疗银屑病的相关机制及其在临床中的应用。     

Alpha‐Glucosylrutin: ein hochwirksames Flavonoid zum Schutz vor oxidativem Streß

The flavonoid alpha‐glucosylrutin (AGR) is a potent antioxidant with a high epidermal bioavailability. This makes this substance particularly suitable for various dermato‐cosmetic applications. Flavonoids are phytamines with a common chemical structure and a broad range of activities, the most prominent being their radical scavenging ability. Reactive oxygen species (ROS) damage cells by different mechanisms. Direct cytotoxic effects include destruction of the cell membrane by causing radical chain reactions or induction of mutagenic changes in the nuclear and mitochondrial DNA. Indirect changes involve modification of intracellular signal transduction pathways that regulate inflammatory or proliferative activities. The excellent antioxidant efficacy of AGR has been shown in various experimental studies, both in vitro and in vivo. Subsequent clinical studies have demonstrated that AGR is also effective in the prevention of dermatologic diseases in which oxidative stress is of pathogenetic relevance, e.g. in polymorphous light eruption (PLE). Other promising dermato‐cosmetic areas for AGR application are aging of the skin, especially photoaging. All in vivo evaluations indicate that AGR in the applied concentrations is a very well‐tolerated ingredient for medical skin care preparations.     

HIV and access to fertility treatment in the European and Swedish contexts

Across Europe many people living with HIV face discrimination in accessing fertility treatment. This short communication presents an updated mapping of regulations across Europe, along with a consideration of the Swedish context. Overall, the accessibility and availability of MAR for people living with HIV in Europe is complicated and, in some countries, inconsistent. We encourage sharing best practice from countries with less restricted access. We also call for an end to discrimination based on outdated medical knowledge, and for more clearly defined and readily available guidelines surrounding fertility treatment entitlements for people living with HIV.