[Isolated pemphigus vulgaris of the mouth mucosa--pemphigus test: diagnostic confirmation using direct immunofluorescence study of normal skin]

The diagnosis of oral pemphigus vulgaris (PV) without concomitant cutaneous manifestations is often complicated by difficulties in obtaining a biopsy specimen allowing histological examination and direct immunofluorescence (IF) microscopy. In this clinical study five of our patients with oral PV were investigated: biopsies were taken both from lesional oral mucous membranes and from unaffected gluteal skin for IF analysis. Identical IF results, with intercellular epidermal deposition of IgG in all and of C3 in two of the five cases, were obtained in lesional and nonlesional biopsies. Therefore, it is concluded that with current IF techniques examination of the normal skin is sufficient for the diagnosis of oral PV; thus, the often painful and difficult removal of biopsy specimens from within the affected oral cavity can be avoided. Further studies are needed to confirm the sensitivity of this method.

Prognostic significance of DNA cytometry in cutaneous malignant lymphomas

The current classification of cutaneous malignant lymphomas (ML) into low-grade and high-grade lymphomas was found to be of limited reproducibility and permitted only a rough prediction about outcome. With this in mind, the relationship between nuclear DNA content and both prognosis and histologic grading according to the Kiel classification was evaluated on Feulgen-stained imprint specimens. In all, 49 cases of malignant non-Hodgkin's lymphoma, primary of the skin or with an involvement of the skin as one of the first symptoms, were studied using a computerized high-resolution image analysis system. The 2c deviation index (2cDI), which reflects the variation of the nuclear DNA values around the normal diploid peak, was found to be the best prognostically relevant criterion. Using the 2cDI, a significant discrimination (P less than 0.001 in the U test) between low-grade and high-grade ML was achieved. The prognostic benefit of the 2cDI was well documented by a significant inverse correlation between the 2cDI and the period of time until the patients progressed at least into one higher stage or died of lymphoma (r equals -0.63, P less than 0.05). In addition, the 2cDI enabled prognosis of the course of disease. In the group with low 2cDI values (2cDI, less than 0.5), no progression of the disease was observed after 1 year. In the groups presenting with a 2cDI between 0.5 and 1.0 and higher than 1.0, a progression was found in 57% and 64% of the cases studied, respectively. In conclusion, these measurements indicate that the determination of DNA distribution patterns in imprint specimens allows a precise and objective prognostic evaluation of cutaneous ML.

[Malignant melanoma in childhood and adolescence]

In this review, the epidemiology and prognosis of malignant melanoma in childhood and adolescence (CMM) are discussed with reference to 627 patients reported in the literature. CMM accounts for only 1-2% of all melanomas, but there is the same increasing incidence as in adult melanoma. A distinction is made between congenital CMM (n = 27), CMM on giant congenital pigmented naevi (n = 69) and CMM in small pigmented lesions or de novo. The latter are identical in biological behaviour to melanomas in adults, while the CMM on giant naevi nearly always have an unfavourable outcome. Chemotherapy seems to be more effective in CMM than in adult melanomas, but prophylaxis is also the best therapy in children: early removal of congenital giant pigmented naevi and frequent monitoring, if not excision, of all congenital melanocytic lesions must be considered.

Annular erythema associated with Sjögren's syndrome: a variant of systemic lupus erythematosus

We present a Burmese patient with widespread annular erythema associated with Sjögren's syndrome. Unlike previously described cases, the disease occurred in the setting of systemic lupus erythematosus. Photoprovocation testing revealed light sensitivity in the UVA range with elicitation of subacute cutaneous lupus erythematosus-like lesions. The presence of an erythema annulare centrifugum-like eruption should initiate the search for Sjögren's syndrome and systemic lupus erythematosus.

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p less than 0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p less than 0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.

[Pseudo-Kaposi sarcoma in Prader-Labhart-Willi syndrome]

A 25-year-old male patient presenting with Prader-Labhart-Willi syndrome is reported. He had sought medical help because of lichenoid skin eruptions on his lower legs. Histologically the lesions turned out to be pseudo-Kaposi's sarcoma. The possible aetiopathologic relationship between the two primarily unassociated conditions is discussed.

[Are allergies really increasing?]

A presumed rise in the prevalence of atopic diseases in industrialized countries is currently subject to extensive discussion. Due to a lack of epidemiological longitudinal studies, the controversy among the experts was based mainly on speculation. Only recently have data from various European countries confirmed an increase in atopic diseases. Studies from Sweden, Switzerland and Denmark showed a definite increase in atopic diseases. Studies from Sweden, Switzerland and Denmark showed a definite increase in the prevalence of hay fever, bronchial asthma and atopic eczema, respectively. Japanese investigators have concerned themselves with the putative role of air pollutants in this development. They were able to show a relationship between exposure to particulate air pollutants (diesel exhaust) and the prevalence of mountain cedar pollinosis. To date a lack of baseline data has hampered the evaluation of epidemiologic trends in Germany. We performed a pilot survey study involving more than 1000 pre-school children that yielded initial evidence of an unexpectedly high prevalence of allergic conditions in Bavaria. A comparison with current epidemiologic data from other European countries suggests an increase in allergies in Germany similar to that observed elsewhere.

Lymphomatoid papulosis followed by large-cell lymphoma: immunophenotypical and genotypical analysis

The immunophenotype and genotype of atypical cells in skin and lymph node infiltrates were investigated in a patient with lymphomatoid papulosis (LyP) complicated by anaplastic large-cell lymphoma of the lymph nodes. The large atypical cells in both skin and lymph nodes displayed an almost identical immunophenotype, i.e. CD30+ and CD25+. Southern blot analysis for T-cell receptor beta-chain gene rearrangement revealed an identical gene configuration in DNA extracted from skin and lymph node. Our results strongly support the hypothesis that clonal populations of T cells arising in cutaneous LyP lesions may undergo malignant transformation, spread into regional lymph nodes, and give rise to secondary malignant lymphomas, such as anaplastic large-cell lymphoma.

Absence of extracellular enzyme activity and cytotoxicity in cell-free culture filtrates of Haemophilus ducreyi

Ten isolates of Haemophilus ducreyi, including seven clinical isolates and three laboratory reference strains, were assessed for their ability to produce extracellular enzymes which might contribute to their pathogenicity. Protease, elastase, lecithinase, lipase or collagenase enzyme activity were not detected in culture filtrates from any of the isolates tested using either plate or spectrophotometrical assays. Furthermore, cell-free culture filtrates did not exhibit cytotoxic activity in vitro when tested using either an established tissue culture cell line (Vero) or a primary cell culture of human keratinocytes. These results suggest that extracellular products do not play a role in host invasion or production of tissue damage by H. ducreyi.

[Benign symmetric Launois-Bensaude type III lipomatosis and Bureau-Barrière syndrome]

We report on a patient with an unusual distribution of benign symmetric Launois-Bensaude lipomatosis. In addition, the patient presented with Bureau-Barrière syndrome. With regard to our own observations and those reported in the literature, we propose a new classification of the disease referred to the distribution of the fatty tissue.

[Eosinophilia-myalgia syndrome and L-tryptophan intake]

We present the case of a 52-year-old woman who developed diffuse induration of the skin and severe edema of the subcutaneous tissue involving the extremities and the trunk, sparing hands, feet and face after 10 years of almost constant oral tryptophan medication. The skin manifestations were similar to those of eosinophilic fasciitis (Shulman syndrome). The patient complained of severe muscle pain and weakness. Laboratory studies revealed an elevated Westergren erythrocyte sedimentation rate and eosinophilia. There were no signs of internal organ involvement and no immunological parameters of progressive systemic scleroderma. Eosinophilia and myalgia resolved in response to intermittent systemic therapy with glucocorticosteroids, whereas the progressive scleroderma and the edema showed only slight improvement after the discontinuation of L-tryptophan.

[Solitary and multiple granular cell tumors. Case reports and review of the literature]

Two patients with multiple granular cell tumours (GZTs) of the skin and one patient with GZT of the tongue are reported. The tumours had been becoming larger for several years without subjective symptoms. Only the GZT of the tongue was diagnosed correctly before surgery; the cutaneous GZTs were identified only at histological examination. Benign GZTs reveal similar histomorphological features. In contrast, immunohistochemical studies yield conflicting results. Thus, cellular differentiation of GZT is still controversial. On current evidence, GZTs represent a distinct entity with a common histogeneis. The most widely accepted theory is that they originate from a cell in the peripheral nerve system, which has not yet been more precisely characterized.

[Improving clinical diagnosis of pigmented skin changes in childhood with the dermatoscope]

Prompted by the development of the lightweight, inexpensive and simple to use dermatoscopy, skin surface microscopy can now be applied in daily practice. The case reports presented here document the diagnostic improvement achieved with dermatoscopy in pigment skin lesions of children.

Extracellular binding sites of IgA anti-jejunal antibodies on normal small bowel detected by indirect immunoelectronmicroscopy

Patients with dermatitis herpetiformis (DH) have IgA deposition in the papillary dermis and in the lamina propria of the small bowel. In addition, most of DH patients' sera contain IgA class anti-reticulin antibodies, anti-endomysium antibodies (EMA), and anti-jejunal antibodies (JAB) during times of gluten intake. In previous studies, JAB and EMA seemed to be identical and related to the group of anti-reticulin antibodies. In the present study, pre-embedding en bloc immunoelectronmicroscopic methods were applied for analysis of the ultrastructural binding sites of JAB on monkey and rabbit small bowels. These substrates were incubated with sera from DH patients strongly positive for JAB. Simultaneous investigations with the PAP technique and with 5 nm gold-labeled protein A or second antibodies visualized the bound IgA identically: it was associated with collagen fibrils underlying the epithelial and cryptal basement membranes and with collagen fibrils around capillaries. Staining was also detected along the endomysial collagen fibrils of smooth muscle layers, around elastica and smooth muscle cells of blood vessel walls, and along collagen fibrils near smooth muscle cells in the lamina propria. Neither the peroxidase product nor gold deposition was detected directly on the fibers, but was associated with amorphous material surrounding collagen fibers of different diameters. The distribution of JAB-stained structures corresponded to the localization of reticulin network of the small bowel. Our data indicate that JAB recognize an antigen or antigens associated with an amorphous component of the reticulin-collagen structure of jejunum and may have identical binding sites, as anti-reticulin antibodies and EMA.

[Pyostomatitis vegetans. A specific marker of Crohn disease and ulcerative colitis]

Pyostomatitis vegetans is a rare disease of the oral cavity with characteristic clinical and histopathological findings. Its importance lies in its high correlation with inflammatory diseases of the intestinal tract. The present case report and a review of the literature are taken as a basis to discuss the disease as an entity. Pyostomatitis vegetans is a specific marker for ulcerative colitis and Crohn's disease.

Detection of HTLV-I proviral sequences in CD30-positive large cell cutaneous T-cell lymphomas

To investigate the possibility that cutaneous T-cell lymphomas of large cell type may be associated with human T-cell leukemia/lymphoma virus type I infection in nonendemic regions, tissue samples from six cases of large cell cutaneous T-cell lymphoma and four cases of small cell cutaneous T-cell lymphoma were screened for the presence of integrated proviral human T-cell leukemia/lymphoma virus type I DNA. Combined use of Southern blot hybridization and enzymatic DNA amplification revealed human T-cell leukemia/lymphoma virus type I-specific sequences in all cases of large cell cutaneous T-cell lymphoma and in none of the cases of small cell cutaneous T-cell lymphoma. These results suggest that in nonendemic areas, a significant proportion of large cell cutaneous T-cell lymphoma cases are associated with human T-cell leukemia/lymphoma virus type I.

Binding to human jejunum of serum IgA antibody from children with coeliac disease

Jejunal histology and the presence of serum IgA antibodies (JAB) binding to human jejunum in vitro were studied in 139 children with severe malabsorptive symptoms. Among 33 children with confirmed coeliac disease (ESPGAN criteria), 13 (93%) of 14 sampled before starting on a gluten-free diet had JAB, none of 21 sampled had JAB while on a gluten-free diet of long duration, and 90% of 30 sampled during gluten challenge had JAB. 53 children had severe jejunal villous atrophy (probable coeliac disease): 71% of those younger than 2 years and 94% of those aged 2-18 years had JAB during gluten intake. JAB could not be detected in 53 disease control patients (normal jejunal histology) and in 3 coeliac disease patients with selective IgA deficiency. Simultaneous determination of antigliadin (AGA) and antiendomysium (EMA) levels, and gliadin and tissue absorption studies, showed that JAB and AGA are different, whereas JAB and EMA are probably identical. IgA JAB could be the target-organ-related autoantibodies in coeliac disease.

[Multiple eccrine spiradenomas in a linear nevoid pattern]

A 16-year-old boy presenting with multiple slightly painful, bluish red papules and plaques on the left thorax is reported. The skin lesions were arranged in a linear and arched pattern following the lines of Blaschko. Clinical examination led to the suspicion of multiple leiomyomas, syringomas or glomus tumours. Histological examination revealed that the lesions were typical benign eccrine spiradenomas.

Dermatitis herpetiformis bodies. Ultrastructural study on the skin of patients using direct preembedding immunogold labeling

Skin samples from three adult patients with dermatitis herpetiformis (DH) and granular IgA deposits in the papillary tips were studied using ultrastructural immunogold technique. IgA positive, so-called DH bodies were identified as amorphous clumps--most probably immunocomplex aggregates--scattered throughout the upper papillary dermis. Dermatitis herpetiformis bodies were seen underneath the basement membrane, sometimes along microfibrillar bundles, as well as adjacent to the papillary collagen fibers and within the surface (microfibrillar) region of elastic tissue. Some DH bodies, however, were not related to any fibrillar components. The collagen and elastic fibers, microfibrillar bundles, anchoring fibrils, and elastic microfibrils themselves were unlabeled. Dermatitis herpetiformis bodies were not found in normal human skin. The results of our ultrastructural study indicate that DH bodies either are bound to a nonfibrillar component of dermal connective tissue or represent deposits of immune complexes trapped in DH skin.

Liposome encapsulation improves efficacy of betamethasone dipropionate in atopic eczema but not in psoriasis vulgaris

The effect of a liposomal preparation of beta-methasone dipropionate (0.039%, BDP) has been compared to that of a commercial propylene glycol-gel containing 0.064% BDP in a double-blind, randomized, paired trial lasting 14 d in 10 patients with atopic eczema and 10 patients with psoriasis vulgaris. In eczema, the liposome preparation tended to reduce erythema and scaling more than the conventional gel, the difference in the latter parameter being significant on Day 7. There was greater improvement of psoriasis on the side treated with the reference gel. Hence, liposome encapsulation of BDP may increase the antiinflammatory action but not the antiproliferative effect. Since inhibition of mitotic activity is linked to the atrophogenicity of topical corticosteroids, the results suggest that liposome encapsulation may improve the benefit-risk ratio in eczema.

[Postoperative adjuvant therapy with interferon alfa-2B following laser surgery of condylomata acuminata]

Sexually transmitted diseases caused by human papilloma viruses, such as condylomata acuminata, are increasing in incidence and are often difficult to treat because of their tendency to recur. Many reports in the literature document the usefulness of interferons topically or systemically in these diseases. A randomized study was conducted to evaluate interferon Alfa-2b (Intron A) as adjuvant therapy following CO2 laser surgery of condylomata acuminata. A low-dose regimen was administered (two courses with 1 million I.U. s.c. daily for 6 days with a 2-week interval between the courses) and had hardly any side-effects. The recurrence rate in the therapy group was significantly reduced (42% vs 81%), so routine prophylaxis of recurrence with interferons in condylomata acuminata should be discussed.

Invasive migration of epidemic Kaposi's sarcoma cells in vitro

Kaposi's sarcoma (KS) is a low grade malignant neoplasm which shows invasive growth and often occurs in immunosuppressed patients with the Acquired Immune Deficiency Syndrome (AIDS; epidemic KS). It is also found in elderly men where it is usually limited to the skin (classic KS). The present study investigated the chemotaxis and invasive migration of epidemic KS cells in vitro and compared them to cells grown from classic KS lesions and to fibroblasts. Epidemic KS cells demonstrated invasive migration through reconstituted basement membrane (Matrigel) as well as through interstitial connective tissue (collagen I) in early passages, whereas fibroblasts did not invade either barrier. Epidemic KS cells in late passages did not show any invasive migration. Following pretreatment with tumour necrosis factor alpha (TNF-alpha) there was no enhanced migration through the Matrigel and collagen I for epidemic KS cells, whereas classic KS cells showed an increased migration through the type I collagen barrier.

Congenital multiple plaquelike glomus tumors

We encountered two patients with congenital multiple plaquelike glomus tumors. These lesions were present at birth and enlarged with body growth, attaining a diameter of up to 13 cm. The diagnosis was confirmed by histologic and electron-microscopic examination, which revealed the typical changes of glomus tumors. Immunocytochemistry findings demonstrated the tumor cells to be vimentin- and alpha-smooth muscle-actin-positive and desmin-negative. On ultrastructural examination, typical dense bodies and attachment plaques were easily found within the tumor cells. Glomus cells were coated by a thick basal lamina.

[Colloid milium]

The differential diagnosis and classification of colloid milium, a relatively rare disorder, may be difficult. In this paper, a case report of a 52-year-old male patient with characteristic clinical and histological signs of colloid milium is therefore presented. Recently gained insights into the aetiopathogenesis of colloid milium are discussed.

[Unusual primary cutaneous localized amyloidosis]

The case of a 41-year-old female patient with an unusual type of primary localized cutaneous amyloidosis is reported. Clinical examination revealed lesions typical for macular cutaneous amyloidosis, while histology and histochemistry, in contrast, revealed the presence of nodular amyloidosis of the skin with deposition of lambda light chain amyloid.

Hodgkin's disease followed by lymphomatoid papulosis. Immunophenotypic evidence for a close relationship between lymphomatoid papulosis and Hodgkin's disease

The clinical association of lymphomatoid papulosis and Hodgkin's disease and the striking morphologic similarity of atypical cells in lymphomatoid papulosis to Reed-Sternberg cells in Hodgkin's disease suggest that lymphomatoid papulosis and Hodgkin's disease are related. To test this possibility we studied the antigenic profile of Reed-Sternberg cells in the lymph nodes and of atypical cells in cutaneous lesions of lymphomatoid papulosis in two patients with Hodgkin's disease and lymphomatoid papulosis. In paraffin sections both cell types expressed CD30, CD45 T cell-restricted antigens, and occasionally CD15 antigens. They were negative for CD45 B cell-restricted antigens and for lysozyme. In cutaneous lymphomatoid papulosis lesions a similar immunologic profile of the atypical cells was found; that is, they were positive for CD30, CD2, CD3, and CD25 but negative for B cell and macrophage antigens. The similarity of the immunophenotype of Reed-Sternberg cells in lymph nodes affected by Hodgkin's disease and the immunophenotype of atypical cells of lymphomatoid papulosis lesions in the same patients suggests that the malignant cells in both conditions are derived from activated T cells and that they are closely related if not identical.

[Acne conglobata-like exacerbation of acne vulgaris following administration of anabolic steroids and vitamin B complex-containing preparations]

This article reports the aggravation of preexisting acne vulgaris in a 21-year-old male patient due to the abuse of anabolic drugs during body-building training. After cessation of anabolic drugs the acne healed, leaving hypertrophic scars. This case report shows that the acute aggravation of an acne vulgaris should cast suspicion on the use of hormone preparations.

Tumor necrosis factor alpha induces invasiveness of human skin fibroblasts in vitro

The chemotactic response of fibroblasts plays an important role during wound healing and fibrosis. Several substances have been found to mediate fibroblast migration in vitro. In the tissue, however, fibroblasts have also the potential to pass through connective tissue barriers following a chemotactic stimulus. Since tumor necrosis factor alpha (TNF alpha) is a cytokine released by mononuclear cells during wound healing, we have been interested in studying its effect on the regulation of fibroblast chemotaxis and invasive migration. TNF alpha did not attract skin fibroblasts nor did it alter their chemotactic response towards other chemoattractants like fibroblast conditioned medium or fibronectin. However, whereas normal skin fibroblasts did not invade a collagen I gel, preincubation of the cells with TNF alpha markedly induced their invasive migration into the gel. This seems to be associated with a specific degradation of type I collagen, because TNF alpha did not promote the invasion of skin fibroblasts through a reconstituted basement membrane (Matrigel).

Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis

Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid acitretin represents an important advance due to its rapid elimination kinetics. Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables--psoriasis severity index and total UV-B dose--were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm2 vs 6.9 J/cm2. Side effects showed a similar pattern in both groups. Our data show that the acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation. We conclude that the acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis.

Effect of iron limitation on protein composition and ultrastructure of Haemophilus ducreyi

Protein profiles of whole cells of Haemophilus ducreyi grown in the presence or absence of the iron chelator desferal, were compared by polyacrylamide gel electrophoresis. Each of four strains produced novel proteins in the range 43-160 kDa when cultured under conditions of reduced iron availability. At some sub-inhibitory concentrations, desferal produced enhanced growth, possibly due to it functioning as an exogenous siderophore. Organisms grown under conditions of reduced iron availability ultrastructurally showed also large periplasmic spaces between cytoplasm and outer membrane.

[The dermatoscope. A simplification of epiluminescent microscopy of pigmented skin changes]

The poor prognosis of thick malignant melanomas emphasizes the importance of their early detection. Skin microscopy using a stereomicroscope has been shown to increase the accuracy of clinical diagnosis significantly in pigmented skin lesions. Owing to the development of the Heine Delta 10 dermatoscope, skin microscopy has become less difficult and more rapid. Therefore, this technique can now be applied routinely in daily office practice.

Differentiation between lymphomas and pseudolymphomas of the skin by computerized DNA-image cytometry

The histologic and immunohistologic differential diagnosis between pseudolymphomas (PL) and malignant lymphomas (ML) of the skin can be difficult. Since DNA cytometry has been found to be of both diagnostic and prognostic value in various neoplasms, its ability to discriminate between ML and PL in Feulgen-stained imprints of 17 PL and 49 ML skin biopsies was examined by high-resolution image analysis. The reliability of the following algorithms of DNA distribution was evaluated: 1) 2cDI (2c-deviation index), which reflects the variation of the nuclear DNA values around the diploid DNA peak; 2) percentage of cells having a DNA value greater than or equal to 5c (5cER; 5c-exceeding rate); 3) percentage of cells presenting with a DNA value greater than or equal to 4c (4cER). A 2cDI of 0.1 was found to be the most reliable marker for the differentiation between PL and ML. On the basis of this feature, 16 of 17 cases of PL and 46 of 49 cases of ML were correctly classified. The sensitivity, specificity, and efficiency of this feature were 94%. A 5cER greater than or equal to 1% had a specificity of 100%, but the sensitivity was only 43%. For the 4cER, a sensitivity of 61% and a specificity of 94% were found. In conclusion, the calculation of the 2cDI and the 5cER based on high-resolution image analysis provided additional helpful diagnostic features, and therefore should be included as a diagnostic tool. If the 5cER is at least 1%, the diagnosis of a ML can be confirmed with a specificity of 100%.

[Malignant melanoma of the penis]

In this paper the authors report on four of their own patients suffering from malignant melanoma of the penis, and the recent literature is reviewed. Growth of pigmented lesions and bleeding are the most important clinical symptoms. Malignant melanomas of the penis are often acrolentiginous melanomas; they occur predominantly in older patients and progress more rapidly than malignant melanomas of the common integument.

Dithranol: a review of the mechanism of action in the treatment of psoriasis vulgaris

Dithranol is highly effective in the treatment of psoriasis. The drug inhibits keratinocyte hyperproliferation, granulocyte function and, in addition, may exert an immunosuppressive effect. Free radicals, histamine, eicosanoids and platelet-activating factor have been shown to be involved in dithranol-induced dermatitis, and the oxidation products of the drug are responsible for the staining. Our experimental data suggest that extracellularly generated oxygen free radicals are responsible for both the antipsoriatic and irritative effect of the drug. Furthermore, we could recently provide evidence that extracellularly generated superoxide anion radical also induces an active adaptation mechanism resulting in increased tolerance to dithranol upon repeated application. This adaptive process may explain the requirement for increasing dithranol concentrations to maintain the antipsoriatic efficacy, and also the beneficial effect of other antipsoriatic modalities such as UV-B on dithranol-induced dermatitis. The recognition of this adaptive mechanism may open future prospects to overcome some limitations concerning the practical use of dithranol.

[The atypical fibroxanthoma]

A 84-year-old female patient suffering from atypical fibroxanthoma is presented. A diagnosis of malignant melanoma or a cutaneous metastasis from an unknown primary tumor was suspected. The final diagnosis was established by immunohistological studies showing a strongly positive reaction to vimentin and a negative reaction to S-100 protein and cytokeratin.

Dubowitz syndrome: atopic dermatitis, low birth weight dwarfism and facial dysmorphism

The association of low birth weight dwarfism, distinct facial dysmorphism and eczematous skin lesions has been described repeatedly since the first description by Dubowitz in 1965. The way of inheritance seems to be in some cases autosomal recessive. Because of the rarity of this entity, another case is reported showing an additional preauricular fistula.

[Pancreatogenic panniculitis. 2 case reports with a literature review]

We present 2 cases of subcutaneous fat necrosis associated with pancreatic disease. In 1 of these cases the correct diagnosis led to the detection of a clinically asymptomatic chronic pancreatitis. The pathogenesis of this disease, not yet fully explained, and the differential diagnosis of other forms of panniculitis are reviewed.

Liposome preparations: a step forward in topical drug therapy for skin disease? A review

The production of liposomes, which was described in 1961, soon was claimed to be a useful technology for drug encapsulation. The first preparation (containing a topical antifungal agent), however, was registered only recently. Additional preparations, including some for topical therapy of skin disease, are under clinical investigation. Moreover, a variety of cosmetic products that contain liposomes is available today. In this article we review the literature on liposomes as it pertains to dermatology, including the basic principles of liposome structures and preparations, pharmacokinetics of liposomes and liposome-encapsulated drugs, and the influence on drug activity. Moreover, future applications of liposome preparations are discussed.

[Treatment of stage I malignant melanoma. Open questions and recommendations]

The excision of malignant melanomas is accepted worldwide as a therapy of choice but there are controversies concerning resection margins, prophylactic lymph node dissection, isolated hyperthermic perfusion of extremities and adjuvant therapy in high-risk patients. The relevant literature is analyzed with regard to these aspects, and based on this analysis and our own experiences in more than 3,600 melanoma patients, recommendations for therapy of primary malignant melanomas and follow-up are given.

[Keratoacanthoma centrifugum marginatum]

Keratoacanthoma centrifugum marginatum (KCM) is a rare distinct variant of keratoacanthoma. Based on three personal observations and a review of the literature, the authors describe the clinical and histological features of this neoplasm. Clinically KCM is characterized by the lack of a tendency for spontaneous remission and by continuous centrifugal spread. Histologically there is a subclinical, iceberg-like growth pattern. Like keratoacanthoma, KCM is a highly differentiated, biologically benign, non-metastasizing tumour. The treatment of choice is early excision of the tumour.