[Disseminated superficial actinic porokeratosis with Bowen's disease]

While there have been several reports about the development of malignant neoplasms in porokeratosis of Mibelli and porokeratosis plantaris, palmaris et disseminata, only one case of squamous cell carcinoma in disseminated superficial actinic porokeratosis (DSAP) has been documented. A review is presented of the variants of porokeratosis that have so far been described in the literature as well as the differential diagnosis, genetic aspects and therapy of DSAP. The first case of DSAP with Bowen's disease is presented.

[Allergic vasculitis caused by food allergy]

In two patients with leukocytoclastic vasculitis allergic reactions to foods were shown to be of clinical relevance. Intracutaneous tests with food allergens produced not only immediate wheal and flare reactions but also distinct inflammatory reactions after 8-24 h, which showed the histological and immunopathological characteristics of leukocytoclastic vasculitis. After controlled oral provocation with specific foods exacerbation of petechial lesions was observed. A striking improvement in the patients' condition was achieved by avoidance of the relevant foods and oral administration of cromoglycate.

[Mali's acroangiodermatitis (pseudo-Kaposi) in paralyzed legs]

The cases are reported of two patients afflicted with acroangiodermatitis (pseudo-kaposi) in paralysed legs. From the pathogenetic point of view, the lack of a muscle pump and, possibly, disturbed innervation of vessels are of importance.

[The CO2 laser in dermatotherapy--use and indications]

Due to the high absorption of infrared light in water the CO2 laser (lambda = 10,600 nm) is suitable for cutting and vaporizing tissue. The ablation of pathological tissue by means of the CO2 laser can be exactly controlled. The treated area is usually dry and clear since blood and lymph vessels up to a diameter of 1 mm are sealed. Postoperative swelling and pain are reduced compared with electrosurgery. Important and frequent indications for CO2 laser application are HPV papillomas (condylomata acuminata, common warts, bowenoid papules) and the removal of tattoos. The CO2 laser is also suitable for the removal of benign and disseminated lesions such as angiofibromas, syringomas, trichoepitheliomas, epidermal nevi etc. Lesions of the oral mucosa (leukoplakias, mucosal warts) can be removed by means of the CO2 laser. Additionally, the treatment of vascular lesions (nevi flammei, lymphangiomas, telangiectasias) has been described, although the CO2 laser does not operate in a vessel-specific manner. As this review article demonstrates, the CO2 laser has a broad range of applications and represents an enrichment of dermatotherapy.

Comparison of different methods for enumeration of Langerhans cells in vertical cryosections of human skin

We have quantified Langerhans cells (LC) in cryosections of normal human skin and lesional skin from patients with atopic eczema and psoriasis vulgaris using six different methods. The results from the different methods varied considerably and were sometimes contradictory, for example when LC numbers in psoriatic skin were compared with those in normal skin. Thus, in addition to the staining technique used and the selection of the dendritic cell type to be counted, the enumeration method used can also influence the quantitation of LC in normal and pathological skin.

[Congenital poikiloderma with verrucous hyperkeratosis. An unusual form of Thomson's syndrome?]

A 50 year old male patient suffered from poikilodermatous skin since his 14th year of life. During the past 5 years hyperkeratotic plaques and squamous cell carcinomas developed, leading to metastases into lymph nodes and the lung and fatal outcome. To our knowledge, up to now 6 cases of congenital poikiloderma (Thomson-syndrome, Rothmund-Thomson-syndrome) in conjunction with verrucous hyperkeratosis and squamous cell carcinoma have been reported in the literature.

[Pathophysiology of fibroses. Progressive systemic scleroderma as a model disease]

Fibrosis is characterized by excessive deposition of connective tissue in the involved organs. Although the prime event in the pathogenesis is still poorly understood, several mechanisms are discussed, which finally result in the activation of fibroblasts. Recent studies have demonstrated that immunocompetent cells play a crucial role during the initial phases of the development of fibrosis. Therefore, several mediators have been characterized, which are secreted by platelets, lymphocytes and macrophages and which can attract fibroblasts, induce proliferation and collagen synthesis in mesenchymal cells. These include PDGF, EGF, TGF--beta and many others. In addition, gamma-interferon has been shown to inhibit chemotaxis of fibroblasts and to reduce collagen mRNA levels. A controlled interaction of all the different mediators is required to guarantee a normal functioning of connective tissue. Alterations in these regulation steps can result in excessive deposition of connective tissue and the development of fibrotic processes.

[Chronic herpes simplex infection (herpes simplex persistens et exulcerans) in chronic lymphatic leukemia]

Report of a patient with chronic ulcerative cutaneous herpes simplex and chronic lymphatic leukemia. Rapid improvement was seen on treatment with acyclovir.

[Treatment of naevi flammei with the argon laser]

We report on 901 patients with port wine stains treated by means of an argon laser. The treatment results have been definitively evaluated in 371 patients. They were significantly influenced by the patients' age and by the colour of the lesions. The worst response to the therapy was seen in pink port wine stains in children and juvenile patients (20% good results), in contrast to red and purple lesions in adult patients (80% excellent and good results). The size of the port wine stains did not significantly influence the treatment results, but in extensive lesions homogeneous lightening could not usually be attained and treatment often extended over some years. Port wine stains in the head and neck area responded best to therapy, and lesions on the legs, worst. Altogether, in 60%-70% of adult patients excellent or good results were obtained, the lesions being completely removed or significantly lightened and reduced in size. The side-effects of laser therapy were scar formation (7.3%) and changes in pigmentation (8.6%).

[Serological and immunological diagnosis of HIV-1 infection. Studies of 198 infected cases]

Since 1985, a total of 4281 patients at the Department of Dermatology, University of Munich, were tested for HIV-1 antibodies. Using the ELISA test, 273 were found to be positive, of whom 198 were examined clinically. At the time of the first serological test, 76 of these 198 patients (38.4%) had no clinical symptoms, 98 (49.5%) had a lymphadenopathy syndrome, and 29 had the full-blown picture of AIDS (12.1%). The following additional tests were performed on the 198 patients: antibodies against virus envelope and core proteins, concentration of serum immunoglobulins G, A and M and beta 2-microglobulin, absolute leukocyte and lymphocyte counts, T4/T8 ratio, and intracutaneous cellular immune reaction. Antibodies against virus envelope proteins were present in all the patients. Antibodies against virus core proteins were present in 82% of patients in the latent stage, 64% of patients with the lymphadenopathy syndrome, but only 45% of those with AIDS. Clearcut deviations within the three groups were also present with respect to serum levels of IgG and beta 2-microglobulins, as well as the T4/T8 ratio and the intracutaneous reaction against recall-antigens.

[Epidermolysis bullosa hereditaria dystrophica (Hallopeau-Siemens). Case report and therapy trial with (+)-cyanidanol-3 in 3 patients]

The diagnosis of hereditary epidermolysis bullosa dystrophica (Hallopeau-Siemens) in three patients was confirmed by clinical and histological means as well as by electron microscopy. The clinical course was followed for many years. Since (+)-cyanidanol-3 has been shown to reduce the susceptibility of collagen to mammalian collagenase under in vitro conditions, (+)-cyanidanol-3 was used to treat the three patients for a period of 27 weeks. A decrease in the amount of blistering was observed in all three patients.

Benign symmetric lipomatosis Launois-Bensaude. Report of ten cases and review of the literature

Benign symmetric lipomatosis Launois-Bensaude is a disease rarely reported in the American literature and not mentioned in the standard English textbooks of dermatology. It seems, however, to be relatively common in Europe. Between 1981 and 1985 we examined twelve patients, and a number of case reports have been published in French and German literature. We describe ten typical cases and review the literature. The disease is characterized by massive symmetric fat deposits predominantly in the neck and shoulder girdle area. Pathogenetically, the increase in fatty tissue is assumed to result from a localized defect in catecholamine-induced lipolysis. The disease is frequently associated with alcoholism, hepatopathy, glucose intolerance, hyperuricemia, and malignant tumors of the upper airways, requiring thorough clinical evaluation of all patients. Dietary treatment and weight loss are of limited value in the management of benign symmetric lipomatosis. Surgical removal of lipomatous tissue is frequently followed by recurrence and should be restricted to decompression in patients with functional impairment.

[Sex behavior and sexually transmissible diseases]

Sexually transmitted diseases (STD) are no longer limited to the classic venereal diseases. A great number of viral and bacterial infections can be transmitted by sexual intercourse. Changes in social structures and advances in medicine in recent decades have resulted in greater liberality among the heterosexual and homosexual populations. The acquired immunodeficiency syndrome (AIDS) has introduced a new dimension to discussions on sexual behavior.

[Latent and manifest acquired syphilis--clinical aspects, diagnosis and therapy]

The annual reported incidence of new syphilis infections in the FRG is decreasing; cases with atypical or oligosymptomatic forms of syphilis, however, show a relative increase. In contrast to the primary or secondary stage, the late stages of syphilis are very rare. Of great diagnostic importance is the serological examination which today can be limited to the VDRL and TPHA tests for screening and the FTA-ABS test for confirmation. In cases with an atypical clinical picture or history, the necessity for treatment can be verified with the 19S-IgM-FTA-ABS test and demonstration of treponemal IgM antibodies. Penicillin is still the drug of choice for the treatment of syphilis. In patients who are allergic to penicillin, the administration of erythromycin, tetracycline and, recently, of cephalosporins can be considered.

[Psoriasis pustulosa generalisata--classification, clinical aspects and therapy. Review and experiences with 18 patients]

On the basis of clinico-morphological criteria we suggest the following classification of various pustular forms of psoriasis into four subtypes: generalized pustular psoriasis (von Zumbusch) and its atypical forms, erythema anulare centrifugum-like psoriasis with and without pustulation (EACP); psoriasis vulgaris with pustulation; palmo-plantar pustular psoriasis (Königsbeck-Barber) and its acral variant; acrodermatitis continua suppurativa (Hallopeau), and transitional forms. This classification takes into consideration both clinical aspects and response to treatment, and allows a prognosis of the various types of pustular psoriasis. Owing to its mild course and good treatment results, EACP represents a special form of psoriasis pustulosa generalisata. In our group of patients, systemic glucocorticosteroid therapy has proved deleterious, whereas oral photochemotherapy and etretinate have been found to be highly effective modes of therapy with only mild side effects and have been able to induce even permanent remission in EACP.

[Adjuvant therapy of melanoma patients with gamma interferon]

In a pilot study, 25 patients with high-risk malignant melanomas (a tumor thickness of more than 3 mm and/or a prognostic index of more than 13) and 15 patients with regional lymph-node metastases from malignant melanoma underwent standard surgical procedures. Afterwards, they were treated with gamma interferon in an adjuvant setting. Gamma interferon (200 micrograms) was given subcutaneously three times a week for 6 months. For three times a week for 6 months. For 25 patients, the follow-up has been 12 months or more; for 15 patients, it has been between 7 and 12 months. Tumor relapse occurred in 9 of 25 patients (36%) with high-risk primary tumors and in 5 of 15 patients (33%) with lymph-node metastases. Since these tumor-progression rates are in the same range as those in comparable patients, who did not undergo adjuvant therapy, one can conclude that the adjuvant gamma interferon regimen used is not effective in patients with high-risk malignant melanomas.

[Alpha 2 -interferon therapy in metastasizing malignant melanoma]

Low doses of recombinant alpha 2-interferon were administered to 20 patients with stage III malignant melanoma. Dosage was 2.5 million IU intramuscularly daily in the first four weeks, then 2.5 million IU twice a week. The treatment was well tolerated, but there was no definitely demonstrable therapeutic effect. Only two patients are still alive (average survival time of the patients who died was 24 +/- 15 weeks). When there were distant organ metastases at the onset of treatment, survival time was 16 +/- 8 weeks, in case of distant skin metastases 37 +/- 16 weeks. Comparison of this group with a previously treated "control" group indicated that patients treated with interferon have a shorter survival time. However, all of them were far advanced cases with already shortened life expectancy, so that any comparison with the control group is limited.

[Allergy diet: procedures in diagnosis and therapy of food allergy and pseudo-allergy]

Apart from patient history, skin tests and in vitro methods, certain in vivo techniques such as elimination or provocation tests are of great importance in the diagnosis of food allergy. A variety of dietary approaches are used: elimination diets allow the evaluation of clinical improvement after the stepwise removal of suspected foods; on the other hand, provocation diets involve introducing suspected allergenic foods under clinical control. In each individual patient, a specific selection of food provocations is desirable. Food additives are tested according to the schedule of the oral provocation test for idiosyncrasy (OPTI) by the administration of increasing doses in gelatine capsules. In order to rule out psychological influences, blind techniques should be used. For longer periods, three variably intense allergy diets are recommended: Allergy diet 1 ("allergen-free" diet) is used in patients with severe clinical symptoms over a period of up to 2 weeks. Allergy diet 2 (allergen-poor diet) consists of a positively defined mixture of few permitted foods empirically rated as being weak allergens; this diet is suitable as a baseline diet over longer periods of time in patients with marked hypersensitivity reactions. Allergy diet 3 (additive-free diet) distinguishes permitted and prohibited foods. This diet is recommended for patients with pseudo-allergic reactions to additives such as colouring, preservatives or other triggers of pseudo-allergic reactions. In all dietary procedures, the problem of compliance has to be considered, not only with respect to the patient but also with regard to the medical personnel.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rush hyposensitization with Hymenoptera venoms. Tolerance and results of therapy]

During 290 courses of rush hyposensitization with bee or wasp venoms performed on an in-patient basis there were systemic anaphylactic side effects in 38% before the maintenance dose of 100 micrograms was reached. These reactions were usually mild, occurred mostly at higher venom doses (threshold doses greater than or equal to 1 microgram in about 75%) and were more frequent (P less than 0.05) in patients with a history of a full shock due to stings than in individuals with milder symptoms. Furthermore, systemic anaphylactic side effects occurred more often (P less than 0.01) in bee venom allergic patients with a greater sensitivity in the prick test (threshold less than 10 micrograms/ml) than in those being less reactive; no such dependence was found in wasp venom allergy. RAST results were not correlated to the occurrence of systemic anaphylactic side effects. Evaluation of the therapeutic effect was performed by 163 sting challenge tests, which caused only local sting reactions in 80%. Compared to prior stings improvement of symptoms was achieved in 95% of 157 patients with a history of systemic reactions. Individuals with more severe challenge reactions were older (P less than 0.05) than those with merely generalized skin symptoms. Furthermore, there was a correlation between the occurrence of systemic challenge reactions and systemic anaphylactic side effects during rush hyposensitization as well as between a history of more severe sting reactions and symptoms exceeding generalized skin symptoms at challenge. Thus, hyposensitization with hymenoptera venoms induces partial or complete protection in a high percentage of patients. The course of rush hyposensitization as well as the therapeutic effect depend to some degree on the original intensity of hypersensitivity.

Early persistent UVA-pigmentation: ultrastructural and morphometric analyses

UV-A-induced skin pigmentation was investigated morphologically in semithin and thin sections from 11 volunteers, using different irradiation modalities (single doses of 10, 50 and 100 J/cm2). Visible skin pigmentation was observed in all but two probands, and erythema in two; pronounced pigmentation was present after repeated irradiation only. Contralateral non-irradiated, UV-B-irradiated and suntanned skin specimens UV-B-irradiated and suntanned skin specimens were used as controls. There was an increase in the number of clear cells in the basal layer (x1.6) and particularly of large clear cells (x1.7) after repeated irradiation. Also, the number of melanosomes in melanocytic dendrites (x2.8) increased after repeated irradiation. The number, size and shape of the melanosome complexes in both basal and suprabasal keratinocytes remained unchanged, even when a distinction was made between central and peripheral location. In contrast, suntanned skin showed an increase in melanosome complexes in basal (x5.8) and suprabasal (x3.7) keratinocytes. It is concluded that UV-A-induced skin pigmentation differs in some ways from UV-B or sun-induced melanogenesis, and that the clinical grade of tanning cannot accurately be determined by ultrastructural methods.

Morphometric and ultrastructural analyses of melanocytes, nevus cells, and melanoma cells

Cytological atypia, revealed in the course of routine light microscopy, is considered a valuable indicator of malignancy in melanocytic lesions. A clear definition of the term cytological atypia, however, is lacking. Therefore, by morphometric analysis of ultrathin sections of 11 malignant melanomas (7 invasive, 3 in situ, and 1 lentigo maligna melanoma) and 10 compound nevi, we evaluated the discriminating power of the various facets of cytological atypia, i.e., nuclear area, area of the nucleolus, area of the total cell, and nuclear irregularity. In each case, at least 50 intraepidermal melanocytic cells were examined. The two-sided U-test showed significant differences between intraepidermal nevus and melanoma cells, with regard to the mean values (mean) and standard deviations (s) of the nuclear area (mean and s, p = 0.00011), area of the nucleolus (mean, p = 0.00043; s, p = 0.00011), and area of the total cell (mean, p = 0.00011; s, p = 0.00093). However, only the mean values and standard deviations of the nuclear area allowed a clear distinction in each individual case. The area of the nucleus can be estimated in the course of routine histology. We therefore think that the size and variation of the nuclear area should be considered in the histological differential diagnosis between malignant melanomas and benign nevi.

[Clinical aspects, diagnosis and therapy of syphilis in pregnancy and in newborn infants]

A clinically manifest primary or secondary syphilis that develops during pregnancy has become an extremely rare occurrence. What is more frequently found in pregnant women, however, is a reactive syphilis serology where there is otherwise an absence of clinical symptoms or where, at least, there are untypical symptoms. What has to be decided in these cases is whether one is dealing with latent seropositive syphilis that can be transmitted to the child and thus needs to be treated, or with a serum scar resulting from an infection which occurred some time before. As a rule, this decision can be reached serologically by demonstrating Treponema-specific IgM antibodies by means of the 19S-IgM-FTA-ABS test or some similar methods. In the case of specific IgM detection, immediate treatment of the mother, and thus of the child, is important. Daily intramuscular injections of 1 million I.U. penicillin over a total of 21 days are recommended. Only in proved cases of penicillin allergy should one resort to erythromycin; although it must be said that there is no guarantee that this will produce a therapeutically sufficient fetal blood level. In rare cases such as these, the child must therefore be retreated with penicillin after birth. Today, the clinical signs of premature or retarded congenital syphilis are hardly ever seen in their classic form. Symptoms are frequently uncharacteristic - especially in the case of premature births - and can only be distinguished from other congenital infections with difficulty.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of the 19S IgM FTA ABS test in the diagnosis and therapy of syphilis. Personal experiences and remarks on the method]

Sera from patients with syphilis in various stages (525 sera specimens from untreated and 496 from treated patients) were tested, as were 17 sera specimens from infants with suspected neonatal syphilis. The tests employed for the detection of treponemal and reaginic antibodies were IgG-FTA-ABS, IgM-FTA-ABS, 19S-IgM-FTA-ABS, TPHA, VDRL and the complement fixation test. The purpose of this study was to see whether in all cases the demonstration of antitreponemal antibodies of the IgM class is a reliable criterion for treatment of seropositive patients. This was shown to be valid in nearly all cases where specific IgM was demonstrated by the 19S-IgM-FTA-ABS test. Possible biological or technical factors leading to erroneous results of this test are discussed.

[Photosensitizing properties of nonsteroidal antirheumatic drugs in the photopatch test]

The non-steroidal anti-inflammatory drugs, aspirin, carprofen, diclofenac, ketoprofen, piroxicam, and tiaprofenic acid, were tested in a standard photopatch test series. The routine irradiation dose was 15 J/cm2 UV-A; in most patients additional test series were exposed to non-erythematogenic doses of UV-B and a combination of UV-B and UV-A. In the photopatch test, there were reactions to tiaprofenic acid in 43 of 175 (24.6%), to carprofen in 21 of 86 (24.4%), to aspirin in 7 of 76 (9.2%), to piroxicam in 7 of 84 (8.3%), to diclofenac in 5 of 75 (6.7%), and to ketoprofen in 2 of 53 (3.8%). In 16 patients positive photopatch test results did not start to develop until after the 3rd test day (between day 7 and day 34). In some cases there were positive reactions within the non-irradiated control series. Most of the positive photopatch test reactions could be elicited by UV-A alone; in some cases, however, combined irradiation with UV-B plus UV-A was necessary to yield positive results; only rarely did positive reactions occur exclusively with UV-B. The high incidence of positive photopatch test reactions to non-steroidal anti-inflammatory drugs is a possible indication of a phototoxic action. However, in some cases a photoallergic pathomechanism seems probable with regard to the development of reactions after the 3rd test day, a high UV-sensitivity in the photopatch threshold test, and the results of the histological evaluation of test reactions in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the maximum coagulation depth in human skin for different types of medical lasers

The values for the maximum coagulation depth (MCD) of various types of lasers which are specified in the literature are not comparable, because often different irradiation times were used. MCD depends not only on the wavelength of laser light, but also on the time of action of the laser beam, because of heat transfer. In excised human skin MCD was determined histologically for irradiation with the argon laser, Nd:YAG laser, and CO2 laser. Extending the irradiation time from 0.2 s to 10 s results in a 4-6-fold increase in MCD. Coagulation experiments performed with a soldering iron have shown results similar to those obtained with the CO2 laser. Enlargement of the laser-beam diameter from 1 to 2 mm leads to a 50% increase in MCD. Additional chilling of the skin with water during laser irradiation protects the skin from evaporation, and the values for MCD increase to 3.5 mm for the argon laser and 5.5 mm for Nd:YAG laser. Detailed knowledge of the MCD is necessary to obtain the desired therapeutic effect, and also to avoid unwanted effects.

[The antinuclear antibody spectrum in circumscribed forms of scleroderma]

Sera from 56 patients with circumscribed scleroderma (CS) were tested for the presence of antinuclear antibodies (ANA) by indirect immunofluorescence on HEp-2-cells. 16 patients (28.6%) had ANA, mostly in low titers of 1: 40 and with uncharacteristic fluorescence patterns. Nucleolar antibodies as in progressive systemic sclerosis were seen in a few cases only. Two female patients demonstrated antibodies with a centromere-like pattern. ANA were most frequently found in patients with atrophodermia idiopathica progressiva (60%) and in linear CS (44%). Rheumatoid factor was present in 62% of patients with linear CS; it was less frequent in other forms of CS. Antibodies against double-stranded DNA were found only in one female patient, but three patients with systemic involvement had antibodies to single-stranded DNA. Antibodies to soluble nuclear Scl-70, Ul-RNP and LA(SSB) antigens or to the cytoplasmatic Ro(SSA)-antigen, respectively, were not detected in the patients with CS. These results demonstrate that humoral autoimmune phenomena may occur in CS, mainly in patients with linear CS. These phenomena, however, are less frequent and specific than in progressive systemic sclerosis or in other collagen vascular diseases.

[Immunologic phenotyping of cutaneous lymphomas]

Monoclonal antibodies against lymphoid cell-associated antigens have contributed substantially to our understanding of cutaneous lymphomas. The distribution and function of the most important T- and B-cell antigens are summarized and their expression on cutaneous lymphomas is discussed. Monoclonal antibodies can provide a valuable diagnostic approach to supplement routine histology, especially in histologically doubtful cases.

Laser therapy of bowenoid papulosis and Bowen's disease

Six patients with bowenoid papulosis and two patients with Bowen's disease of the genital area were treated by means of an argon, Nd:YAG, and CO2 laser. In all of the patients, complete resolution of the lesions was achieved. Due to a superficial coagulating effect, application of the argon laser should be restricted to macular and papular pigmented lesions. In contrast, Nd:YAG and CO2 lasers could be used even for treatment of extensive leukoplakia-like and verrucous lesions. Advantages and disadvantages of these two lasers are discussed.

Reactivity of monoclonal antibody BE 2 in different stages of mycosis fungoides and in benign dermal infiltrates

The cutaneous infiltrate in mycosis fungoides (MF) is predominantly composed of T4-positive T-cells. Attempts to distinguish the early stages of this condition from benign inflammatory infiltrates using anti-T3, T4 and other T-cell-associated antibodies have hitherto been unsuccessful. Recently a monoclonal antibody BE 2 has been described as selectively reacting against leukemic cells in patients with cutaneous T-cell lymphoma. To investigate whether the BE 2 antigen is differentially expressed in different stages of MF and benign dermatoses, thus facilitating diagnosis, especially of early MF, the reactivity of monoclonal antibody BE 2 against cutaneous infiltrates from such conditions was assessed. In the early stages of MF only a small number of reactive cells was present. In benign inflammatory infiltrates, especially in those that clinically and histologically were hardly distinguishable from early MF, BE 2 reactivity was essentially the same as in eczematous-stage MF. Lesions from plaque and tumor stage MF contained large numbers of BE 2-reactive cells. Our results indicate that expression of BE 2 is associated with the stage of a given MF lesion and is essentially identical in early MF and eczematous lesions with a similar histopathological appearance.

[Pigmented actinic keratoses]

Four cases of pigmented solar keratoses are reported. The brownish pigmented lesions on sun-exposed skin are clinically similar to lentigo simplex, lentigo senilis, lentigo maligna and pigmented seborrhoic keratosis. The surface is rather rough. Histologically, in addition to characteristic findings of solar keratoses, melanin can be found within the lower epidermis and within melanophages in the upper dermis (incontinence of pigment).

[Therapy and prognosis of malignant melanoma of the skin]

Since 1967 a total of 2403 patients with malignant melanoma have been treated according to a standardized regimen. The five-year survival rate for all patients in stage I was 79%. It was clearly dependent on tumour thickness or prognostic index, respectively. If tumour thickness was less than 0.75 mm or the prognostic index under 6, more than 90% survived for five years. With a tumour thickness of more than 3 mm or a prognostic index of greater than 13 the survival rate decreased to about 50%. Irrespective of tumour thickness the first signs of progression were local recurrence (20%), lymph-node metastases (50%), or distal metastases (30%). In case of progression symptoms recurred in about 80% within the first three years after tumour removal, in about 90% within five years. However, some 10% of progression signs occurred after more than five years. Prognosis was not significantly improved in stage I by adjuvant treatment with dacarbazine and BCG. In stage II the five-year survival rate was still about 30%. But in stage III only those patients with exclusively cutaneous distal metastases had a somewhat better prognosis. Only a few patients lived more than three years after the occurrence of organ metastases.

[Acyclovir in mycosis fungoides and lymphomatoid papulosis]

A survey is given on 23 patients (10 of our own, 13 reported in personal communications and in the literature) suffering from lymphoproliferative diseases and treated with acyclovir (ACV). In 5 patients (3 of 18 with cutaneous T-cell lymphomas, 2 of 5 with lymphomatoid papulosis) partial remission could be achieved. Since herpes simplex virus, cytomegalovirus and viruses like Epstein-Barr and varicella-zoster do not play an etiologic role and since HTLV-I virus, due to its lack of thymidine kinase, cannot activate ACV, the following mechanisms should be discussed regarding the possible effectiveness of ACV in lymphoproliferative diseases: a direct cytopathic effect; activation of ACV by the thymidine kinase of viruses not yet detected in cutaneous lymphoproliferative disorders; ACV activation by cellular thymidine kinase, which has been found to be elevated in lymphoproliferative disorders. Preliminary clinical observations suggest that ACV may exhibit an antiproliferative effect intravenously in some patients with lymphomatoid papulosis.

[Clinical aspects of progressive systemic scleroderma (PSS). Multicenter studies of 194 patients]

Patients from five German Departments of Dermatology (Düsseldorf, Erlangen, Frankfurt am Main, Hamburg and Munich) affected with progressive systemic scleroderma (PSS) were classified and examined. The results of the clinical investigations are presented. In order to guarantee a uniform classification of all patients, the patients were divided into three groups according to the distribution of the affected skin: type I consisted of those with acrosclerosis distal to the wrist, type II had scleroderma extending along the wrist in a proximal direction, and type III had diffuse scleroderma beginning on the trunk. Altogether, 194 patients with PSS were investigated, and the following distribution was found: type I, 32%; type II, 60%; type III, 7%; 1% of the patients could not be classified. The distribution according to the patients' sex and age was in good agreement with published reference data. The incidence, significance, and localization of the major symptoms were investigated. The Raynaud symptom could be identified as being the main clinical symptom in 90% of the patients. Joint involvements (10%-73% depending in the applied parameters), dysphagia (51%), and rest dyspnea (30%) contributed to the main internal symptoms. The extensive clinical, chemical, and immunological results are summarized. In 80% of the cases, high ANA titers could be detected, but these were not correlated to the type of disease.

[Hereditary bullous epidermolyses. Recent aspects of diagnosis and therapy]

The introduction of antibodies specific for distinct basement membrane zone components is helpful in the diagnosis of hereditary mechanobullous diseases. In addition, these reagents have implications for investigation of the pathogenesis of these disorders, which might help to establish the classification based on molecular defects. Antibodies by means of indirect immune fluorescent microscopy can play a key role in the differential diagnosis of junctional and dystrophic types of epidermolysis bullosa. In epidermolysis bullosa hereditaria dystrophica, a disturbance in the regulation of collagenase activity has already been well documented, and several therapeutic approaches have been carried out based on the inhibition of collagenase activity. Concomitant inhibition of collagenolytic activity and stabilization of collagen fibrils might furthermore be helpful in the treatment of these patients. There are already several reports on the therapeutic effects of collagenase inhibitors, and stabilization of collagen fibrils in vitro has been demonstrated by (+)-cyanidanol-3. The preliminary results on therapeutic application of this drug seem to be promising.

Atypical cells in lymphomatoid papulosis express the Hodgkin cell-associated antigen Ki-1

Lymphomatoid papulosis (LyP) is characterized by the presence of large multinucleated cells resembling Reed-Sternberg (RS) cells. Evidence of antigenic similarity between these two cell types has been sought by immunohistologic labeling of 10 biopsies from cases of LyP with monoclonal antibodies against Ki-1 and other RS and Hodgkin (H) cell-associated antigens. In all cases studied, a proportion of the large atypical cells expressed the Ki-1 antigen. On the contrary, in 20 biopsies of benign skin lesions or cutaneous T-cell lymphomas, Ki-1-positive cells were absent or only occasionally present. Furthermore the large atypical cells of LyP also expressed antigens (e.g., T3, T4, HLA-DR, IL-2 receptors) which we have previously demonstrated on RS cells in the majority of cases of Hodgkin's disease (HD). These findings, in conjunction with the observation that Ki-1 antigen expression can be induced on peripheral blood lymphocytes following exposure to phytohemagglutinin or HTLV I, provide evidence that the Ki-1 positive cells in LyP represent activated T cells as RS cells do in many cases of HD.

[Isotretinoin in local treatment of acne and rosacea and animal experiment studies on isotretinoin and arotinoid]

Fifteen patients with acne and 4 with rosacea were treated topically with 0.2% isotretinoin cream twice a day for 16 weeks. Inflammatory lesions responded better (30 +/- 22 versus 15 +/- 12) than non-inflammatory lesions (23 +/- 44 versus 17 +/- 24). Neither the "causal level" (123 +/- 85 versus 130 +/- 66 micrograms/cm2 nor the "replacement sum" (70 +/- 29 versus 77 +/- 30 micrograms/cm2) were changed (lipometer assay). In 150 adult male Syrian hamsters 1-2 drops of isotretinoin in concentrations varying from 0.3% to 0.001% and arotinoid ranging in concentration from 0.3% to 0.00001% in acetone were applied to the left ventral ear or the left flank organ twice a day (5/7 days) for 21 days. In higher concentrations there was a significant reduction in sebaceous gland size. Arotinoid, however, is extremely toxic. Even in concentrations as low as 0.00001% the animals showed severe side-effects within the 1st week.

[Normal pH value of human skin]

Today, the term "normal skin pH" is understood to be the pH value of the surface of the skin of the lower arm of a healthy adult male Caucasian. Its mean value lies in the range 5.4-5.9. In most cases, it is determined by means of a flat glass electrode. The parameter "skin pH" depends mainly on the area of skin and on age, but it also depends to a lesser extent on sex, race and the time of day when values are determined.

Neodymium-YAG laser therapy for vascular lesions

Three patients with port-wine stains with a nodular surface, one patient with macrocheilia resulting from a port-wine stain, and one patient with a capillary hemangioma were treated with a Nd-YAG laser (mediLas, MBB-AT, Munich). Irradiance was between 800 and 1,600 watts/cm2, with energy fluence between 400 and 1,600 joules/cm2. Treatments were performed with local anesthesia on an outpatient basis. In all patients, marked improvements could be obtained after only a few treatments. Histologically there was necrosis of epidermis and dermis immediately after laser application, and ectatic vessels contained coagulated erythrocytes. Depth of coagulation was up to 3.5 mm. Quick restoration of epidermis was observed. After some days, macrophages, fibroblasts, and capillary blood vessels grew into the agglutination thrombi and ectatic vessels were replaced by granulation tissue and, later, by fibrous tissue. In comparison with the argon laser, the Nd-YAG laser coagulates at a much deeper level, but processes of tissue repair take longer and fibrosis is more pronounced after Nd-YAG laser application. Clinically, therefore, scar formation is more likely. Chilling the skin surface during irradiation and shorter exposure times may be effective in reducing the risk of scar formation in the future.

Effects of argon, dye, and Nd:YAG lasers on epidermis, dermis, and venous vessels

The aim of the present study, which was performed at the dorsal aspects of the ears of guinea pigs, was to compare effects of different lasers on epidermis, dermis, and small venous vessels. Irradiations were performed with argon, dye, and Nd:YAG lasers. In the first series tissue repair processes were studied after argon laser application. Laser defects were excised after 1, 4, 8, and 14 days and were prepared for routine histological examination. The breadth of epidermal defect and extent of dermal coagulation and occlusion of vessels by thrombus formation were examined histologically. In a second series parameters of irradiation (ie, exposure time, laser power) of the three different lasers were changed systematically. Laser-induced morphological tissue changes could be best observed 24 hours after irradiation. Each of the lasers led to occlusion of vessels by thrombus formation and also coagulated epidermis and dermis. The extent of dermal and epidermal coagulation was less pronounced after dye laser application. Using short exposure times it was possible to reduce the extent of epidermal damage caused by argon and Nd:YAG lasers. Only 50-msec dye laser pulses led to intravascular thrombus formation without epidermal and dermal damage.

Pseudopelade of Brocq

41 cases with scarring alopecia seen from 1979 to 1983 were analyzed and differentiated. After exclusion of 7 cases with lichen planopilaris, of 5 cases with discoid lupus erythematosus, of 2 cases with scleroderma, and of 1 case with folliculitis decalvans, there remained 26 cases. The clinical histological and direct immunofluorescence (DIF) findings in these patients suggest that pseudopelade of Brocq might be a distinct disease unrelated to other known types of scarring alopecia. The histopathology is characteristic, and shows the following features: little or only moderate lymphocytic infiltrate, absence of significant follicular plugging, and absence or decrease of sebaceous glands. DIF is negative, occasionally only IgM can be found at the basement membrane. The course of the disease is slowly progressive (in spite of little or no visible erythema), becoming eventually stationary after several years and resulting in a more or less severe permanent hair loss.

Mycosis fungoides and Sézary's syndrome show distinct histomorphological features

A light microscopic investigation of skin biopsy specimens from 10 patients with plaque stage mycosis fungoides (MF) and from 6 with Sézary's syndrome (SS) was carried out according to the defined histologic criteria, for the purpose of detecting some morphological characteristics of these diseases for their histological differentiation. This study revealed that some histomorphological differences regarding the epidermal and dermal changes, epidermotropism and the cellular infiltrate existed between MF and SS, and that these diseases were two distinct entities showing differences not only from a clinical and hematologic but also from the histological viewpoint.

[Clinical diagnosis of early malignant melanomas]

Criteria for the clinical diagnosis of early malignant melanomas were sought. A total of 213 pigmented tumors, clinically suspected of being early malignant melanomas, were measured, described, photographed, and classified histologically: 40 proved to be definitely malignant, 49 possibly malignant ("dysplastic"), and 124 definitely benign (mostly melano-/nevocytic nevi, spindle-cell nevi, and Spitz nevi). Malignant melanomas had a horizontal diameter of greater than 5 mm, the patients were older than 18 years, and 62.5% were females. A combination of criteria allowed a clinical diagnosis to be made with an accuracy of 76.2%. The criteria of a horizontal diameter of greater than 5 mm, irregular configuration, and uneven pigmentation permitted 80% of all melanomas to be identified. Histologically atypical, dysplastic nevi could not be diagnosed clinically. They probably constitute a heterogeneous group and only some of them appear to be very early, histologically not clearly recognizable, malignant melanomas.

Monoclonal antibody patterns in lymphomatoid papulosis

Atypical cells resembling Reed-Sternberg cells are a characteristic histologic feature of lymphomatoid papulosis. Thus far no consistent data are available on the nature of these cells, or a possible antigenic relationship between them and Reed-Sternberg cells. Twenty-four biopsy specimens from 14 patients with lymphomatoid papulosis were immunolabeled with antibodies against Ki-1 and other Reed-Sternberg cell-associated antigens. In all cases a proportion of the large, atypical cells expressed the Ki-1 antigen. In contrast, in 20 biopsy specimens of benign inflammatory skin lesions or mycosis fungoides, Ki-1-positive cells were absent or only occasionally present. Furthermore, the large atypical cells of lymphomatoid papulosis also expressed other antigens (for example, T3, T4, HLA-DR, IL-2 receptors) that have previously been demonstrated on Reed-Sternberg cells. Our findings, together with the observation that the Ki-1 antigen can be induced on peripheral blood lymphocytes after prolonged phytohemagglutinin stimulation, suggest that the Ki-1-positive cells in lymphomatoid papulosis are activated T cells closely related to the Reed-Sternberg cells of Hodgkin's disease.