Intracutaneous botulinum toxin A versus ablative therapy of Hailey-Hailey disease - a case report

BACKGROUND: Hailey-Hailey disease is an autosomal-dominant blistering disease affecting the intertriginous skin. Dermabrasion and ablative laser treatment are known to be curative. Sweating is a common aggravating factor. Botulinum toxin A (BTXA) has been shown to inhibit sudoriferic nerves. OBJECTIVE: To evaluate whether a treatment with BTXA induces remissions and can compete with ablative therapy. To compare dermabrasion with erbium:YAG laser therapy. METHOD: Case report with side-by-side comparison. We used intracutaneous BTXA on both sides of the submammary region. Four days later a limited area of 25 cm 2 on each side was treated with either dermabrasion or erbium:YAG laser. The follow-up was 12 months. RESULTS: Wound healing was complete within 7 days after erbium:YAG laser and two weeks after dermabrasion. Areas treated with BTXA alone also showed complete remission within two weeks. During a follow-up, no relapse occurred with either treatment. CONCLUSION: BTXA is capable of inducing remissions of Hailey-Hailey disease without abrasion for at least 12 months. Among ablative treatments, erbium: YAG laser therapy leads to a more rapid wound closure than dermabrasion, with both causing complete remissions.     

Pansclerotic porphyria cutanea tarda after chronic exposure to organic solvents

A 63 year old man developed generalized scleroderma with massive sclerotic areas, particularly in the abdominal region, four years after being diagnosed with porphyria cutanea tarda (PCT). He had almost daily exposure to organic solvents (benzene, trichlorethylene) for many years. The cutaneous fibrosis progressed dramatically leading to a pansclerosis, even though the uroporphyrin levels were borderline and the liver enzyme values were normal. Organic solvents are among those substances which can cause a cutaneous fibrosis. The unusually complicated clinical development in our patient was a combination of the two initial factors, the PCT and the long term exposure to organic solvents. The pansclerotic PCT was differentiated from a systemic sclerosis, a disabling pansclerotic morphea and a generalized morphea by means of histological examinations, the absence of a Raynaud phenomenon and the non-involvement of additional organs. Auto-antibodies typical for systemic sclerosis were negative. Using a medium dosage of UVA1 phototherapy and intensive physiotherapy, the progression of the skin disease was stopped and the sclerosis improved.     

Mapping of T-cell epitopes of Phl p 5: evidence for crossreacting and non-crossreacting T-cell epitopes within Phl p 5 isoallergens

BACKGROUND: Group 5 allergens represent major grass pollen allergens because of their high sensitization indices. The identification of T-cell epitopes of these allergens is a prerequisite for the design of immunotherapeutic strategies based on peptide vaccination or modified allergens with conserved T-cell epitopes. OBJECTIVE: This study was undertaken to determine T-cell epitopes on Phl p 5 major pollen allergen of timothy grass (Phleumn pratense). METHODS: T-cell lines (TCLs) and T-cell clones (TCCs), specific to Phl p 5, were established from the peripheral blood of 18 patients allergic to grass pollen. All TCCs were mapped for epitope specificities using 178 overlapping dodecapeptides representing the primary structures of two isoforms of Phl p 5 (Phl p 5a and Phl p 5b). Phenotype and cytokine production profiles of TCCs were tested. Selected TCCs were analysed for HLA class II restriction. RESULTS: A total of 82 TCCs were isolated. All TCCs displayed the helper cell (TH) phenotype. Their reactivity with two recombinant expressed isoforms of Phl p 5a and Phl p 5b was heterogeneous. The epitope specificity of the TCCs was then revealed. Nineteen T-cell epitopes could be identified on Phl p 5. Eighty-one percent of mapped TCCs recognized three T-cell reactive regions on the Phl p 5 allergen. Some TCCs were reactive with isoepitopes presenting on Phl p 5a as well as Phl p 5b. Allergen-specific stimulation induced a TH0-like type of cytokine production in 25 of 50 TCCs. Almost all TCCs secreted high concentrations of interleukin-13. CONCLUSION: Phl p 5, a major grass pollen allergen, contains several T-cell epitopes. Some epitope regions were recognized by several patients. Epitope recognition pattern could not be correlated with special HLA class II haplotypes. T-cell stimulating isoepitopes were found at corresponding regions of Phl p 5a and Phl p 5b isoforms.     

Effects of adjuvant interferon-alpha low-dose therapy in melanoma patients on serum inhibin B

Because the primary aim of adjuvant therapy for melanoma is not curative, all the possible aspects of quality of life have to be considered. One aspect of increasing importance is fertility. The effect of adjuvant interferon alpha-therapy for malignant melanoma on male fertility has not been systematically investigated. In the present study, twelve male patients with primary cutaneous melanoma (pT3, 4; N0; M0) who were taking adjuvant low-dose interferon alpha2b (3 x 3 mio U/week) for one year were included. Inhibin B--an established marker of male fertility-was measured with an immunosorbent assay before and after one year of interferon alpha-therapy to investigate whether this treatment has any influence on fertility. The results were compared with those from normal controls (n=40). The mean serum inhibin B concentration in melanoma patients before interferon therapy was 225.4 +/- 112.5 pg/mL; after treatment the level was 229.6 +/- 82.0 pg/mL. This difference was not statistically significant (p>0.05). The serum inhibin B concentration in controls was 201.5 +/- 17.1 pg/mL, which was not statistically different from either untreated or interferon-treated melanoma patients (p>0.05). We conclude that low-dose interferon alpha does not have a significant (negative) effect on inhibin B or male fertility.     

Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix

Pyoderma gangrenosum sometimes takes a recalcitrant course that is unresponsive to standard immuno-suppression with corticosteroids and/or cyclosporin A. In these cases improvement of painful ulcerations is a therapeutic challenge. We report a 17-year-old boy with severe pyoderma gangrenosum treated successfully with mycophenolate mofetil and autologous keratinocyte transplantation using an esterified hyluronic acid delivery system.     

Sport als Risikofaktor und therapeutisches Prinzip in der Dermatologie

Sporting activities may exert positive and negative health effects. This applies not only to the cardiovascular and musculoskeletal system, but also to skin. During sporting activities a person is exposed to environmental factors such as temperature, irradiation, and allergens. These factors may play a key role in the development of skin diseases. Mechanical trauma is caused by acute injury as well as chronic damage. Infectious skin diseases caused by viruses, bacteria or fungi can be transmitted by body contact or the use of communal showers or locker rooms. Intake of performance-enhancing substances may provoke skin changes such as striae distensae, androgenetic alopecia, hypertrichosis and acne. Preexisting skin diseases such as psoriasis, lichen planus, vitiligo, polymorphous light eruption, lupus erythematosus, porphyria, urticaria, and acne rosacea may be aggravated by sporting activities. On the other hand, physical exercise has a therapeutic potential which has hardly been exploited by dermatologists. Especially in chronic skin diseases positive effects have been observed. Therapeutic use of team sports has been shown to decrease suffering, depression, and emotional disturbances and increase life quality in patients with atopic eczema, psoriasis, and venous leg ulcers.     

High-dose botulinum toxin type A therapy for axillary hyperhidrosis markedly prolongs the relapse-free interval

BACKGROUND: Axillary hyperhidrosis is a common condition that can be personally distressing and can interfere with professional and social life. Intracutaneous injections of botulinum toxin type A (BTXA) have recently been shown to induce an effective but temporary anhidrosis, usually for 4 to 6 months. High-dose BTXA was shown to have a lower relapse rate, but it remained unclear whether it could induce a prolongation of the antihidrotic effect. OBJECTIVE: Our aim was to evaluate the long-term effectiveness of "high-dose" botulinum toxin therapy in axillary hyperhidrosis, the response to repeated treatment, and the possible side effects. METHODS: In an open study in a university medical center, 47 patients with axillary hyperhidrosis unresponsive to previous therapies were treated with intracutaneous injections of botulinum A toxin. A total dose of 200 U of BTXA was used per axilla. Patients were followed up for periods up to 29 months. The main outcome measures were patients' satisfaction with the antihidrotic effect, response to repeated treatment, and safety of treatment. RESULTS: Within 6 days of the injection of BTXA, all patients reported cessation of excessive sweating. The follow-up was 17.0 +/- 8.3 months (range, 3-29 months). The relapse rate within 12 months of treatment was 4 of 34 patients (11.8%). The longest relapse-free interval observed was 29 months. Twenty-two patients showed a relapse-free interval of 19 months or more. The number of patients with at least 12 months of remission was significantly higher with 200 U of botulinum toxin than with lower doses reported in current literature (P <.05). Relapsed patients (a total of 6/47) showed an unchanged excellent response to a second or third treatment. The only side effect was temporary pain and burning during the injections. No muscular weakness, insensitivity, or systemic reactions were observed. CONCLUSION: High-dose BTXA treatment is capable of prolonging the antihidrotic effect of intracutaneous BTXA in most patients for more than 19 months. It reduces the percentage of relapses after 12 months of follow-up to less than 12%. So far, there is no clinical evidence of the induction of neutralizing antibodies. High-dose treatment seems to be as safe as low-dose treatment.     

Remittance spectroscopy mapping of human skin in vivo

Remittance spectroscopy of human skin may be influenced by probe application pressure and body site.

Methods:

We investigated remittance spectroscopy qualities of human skin in vivo in different areas: a) forearm, b) frontal, c) back, d) back of the hand, e) palms and f) cheek. Twenty volunteers of skin type 2–3 free of inflammatory skin diseases, were enrolled into the study. Spectroscopy readings were performed with a fiber optic spectrometer (Ocean Optics, USA). The readings were taken with standardized force (0 and 100 pont) by applying the probe vertically to the skin surface. The remittance in relation to wavelength was registered. White light with wavelengths from 420 to 750 nm were used. Individual remittance values and their standard deviations were obtained from 20 readings each.

Results/Conclusions:

Spectroscopic patterns of skin are influenced by external force and regional factors. Standardization remains critical for the use of this approach in bioengineering of skin.     

Gründung der Deutsch-Bulgarischen Dermatologischen Gesellschaft auf dem 7. Nationalkongress der Bulgarischen Dermatologischen Gesellschaft am 13. Mai 2000 in Sofia

Ohne Zusammenfassung